Balanced SSFP imaging of the musculoskeletal system

Optimization of flip angle and radiofrequency pulse phase to maximize steady-state magnetization in three-dimensional missing pulse steady-state free precession

Missing pulse (MP) steady-state free precession (SSFP) is a magnetic resonance imaging (MRI) pulse sequence that is highly tolerant to the magnetic field inhomogeneity. In this study, optimal flip angle and radiofrequency (RF) phase scheduling in three-dimensional (3D) MP-SSFP is introduced to maximize the steady-state magnetization while keeping broadband excitation to cover widely distributed frequencies generated by inhomogeneous magnetic fields. Numerical optimization based on extended phase graph (EPG) simulation was performed to maximize the MP-SSFP steady-state magnetization. To limit the specific absorption rate (SAR) associated with the broadband excitation in 3D MP-SSFP, SAR constraint was introduced in the numerical optimization. Optimized flip angle and RF phase settings were experimentally tested by introducing a linear inhomogeneous magnetic field in a range of 10-20 mT/m and using a phantom with known T1/T2 relaxation and diffusion parameters at 3 T. The experimental results were validated through comparisons with EPG simulation. Image contrasts and molecular diffusion effects were investigated in in vivo human brain imaging with 3D MP-SSFP with the optimal flip angle and RF phase settings. In the phantom measurements, the optimal flip angle and RF phase settings improved the MP-SSFP steady-state magnetization/signal-to-noise ratio by up to 41% under the fixed SAR conditions, which matched well with EPG simulation results. In vivo brain imaging with the optimal RF pulse settings provided T2-like image contrasts. Diffusion effects were relatively minor with the linear inhomogeneous field of 10-20 mT/m for white and gray matter, but cerebrospinal fluid showed conspicuous signal intensity attenuation as the linear inhomogeneous field increased. Numerical optimization achieved significant improvement in the steady-state magnetization in MP-SSFP compared with the RF pulse settings used in previous studies. The proposed flip angle and RF phase optimization is promising to improve 3D MP-SSFP image quality for MRI in inhomogeneous magnetic fields.

Feasibility of simultaneous high-resolution anatomical and quantitative magnetic resonance imaging of sciatic nerves in patients with Charcot-Marie-Tooth type 1A (CMT1A) at 7T

INTRODUCTION/AIMS

Magnetic resonance imaging (MRI) of peripheral nerves can provide image-based anatomical information and quantitative measurement. The aim of this pilot study was to investigate the feasibility of high-resolution anatomical and quantitative MRI assessment of sciatic nerve fascicles in patients with Charcot-Marie-Tooth (CMT) 1A using 7T field strength.

METHODS

Six patients with CMT1A underwent imaging on a high-gradient 7T MRI scanner using a 28-channel knee coil. Two high-resolution axial images were simultaneously acquired using a quantitative double-echo in steady-state (DESS) sequence. By comparing the two DESS echoes, T2 and apparent diffusion coefficient (ADC) maps were calculated. The cross-sectional areas and mean T2 and ADC were measured in individual fascicles of the tibial and fibular (peroneal) portions of the sciatic nerve at its bifurcation and 10 mm distally. Disease severity was measured using Charcot-Marie-Tooth Examination Score (CMTES) version 2 and compared to imaging findings.

RESULTS

We demonstrated the feasibility of 7T MRI of the proximal sciatic nerve in patients with CMT1A. Using the higher field, it was possible to measure individual bundles in the tibial and fibular divisions of the sciatic nerve. There was no apparent correlation between diffusion measures and disease severity in this small cohort.

DISCUSSION

This pilot study indicated that high-resolution MRI that allows for combined anatomical and quantitative imaging in one scan is feasible at 7T field strengths and can be used to investigate the microstructure of individual nerve fascicles.

Merging images with different central frequencies reduces banding artifacts in balanced steady-state free precession magnetic resonance cisternography

Purpose

The aim of this study was to evaluate the utility of merged balanced steady‐state free precession (bSSFP) magnetic resonance cisternography images.

Materials and Methods

Twenty ears of 10 healthy volunteers (six men, four women; mean age ± standard deviation, 26.7 ± 1.6 yr) and 10 patients (two men, eight women; mean age, 46.3 ± 10.9 yr) with neoplasm around the sella turcica were included. Two different devices (A and B) were used to confirm the versatility of our method for MR devices with different local magnetic field homogeneity. Images with different central frequencies (±10, ±20, ±30, ±40, and ±50 Hz) were merged with the maximum magnitude of corresponding pixels from the images acquired using both devices. Two neuroradiologists visually graded the image quality of 11 sites in the inner ear and three sites around the sella turcica (scale: 0–2) and compared the quality with that of the corresponding basic image (0 Hz).

Results

The image quality was better in merged images of the vestibule, superior semicircular canal (SCC), posterior SCC, and horizontal SCC (P = 0.005 to 0.020 mainly at ±40 and ±50 Hz on devices A and B), as well as in merged images of the sella turcica and right cavernous sinus (±50 Hz, P = 0.003 and 0.020 on device B, respectively), than it was in the corresponding basic images.

Conclusions

The maximum magnitude merging of images with different central frequencies makes it possible to reduce banding artifacts on bSSFP images without the need for special pulse sequences and image processing programs.

Phase-cycled simultaneous multislice balanced SSFP imaging with CAIPIRINHA for efficient banding reduction

PURPOSE

To present a time-efficient technique for banding reduction in balanced steady-state free precession (bSSFP) imaging using phase-cycled simultaneous multislice (SMS) acquisition with CAIPIRINHA (controlled aliasing in parallel imaging results in higher acceleration).

THEORY

The proposed technique exploits the inherent phase modulation of SMS imaging with CAIPIRINHA to acquire multiple phase-cycled images, which can be combined for efficient banding reduction within the same scan time of a single-band bSSFP scan.

METHODS

Bloch equation simulation, phantom and in vivo brain, abdominal and cardiac imaging experiments were performed on healthy volunteers at 3T using multi-channel head and body array coils with SMS acceleration factors of two to four. The performance of banding reduction was quantitatively evaluated based on the percent ripple of signal distribution and signal-to-noise ratio (SNR) efficiency in both phantom and human studies.

RESULTS

The banding artifact was successfully removed or suppressed using phase-cycled SMS bSSFP imaging across SMS factors of two to four. The performance of banding reduction improved with higher SMS factors along with increased SNR efficiency.

CONCLUSION

Phase-cycled SMS bSSFP with CAIPIRINHA is a promising technique for efficient band reduction in bSSFP without prolonged scan time. Further evaluation of this technique in clinical applications is warranted. Magn Reson Med 76:1764-1774, 2016. © 2015 International Society for Magnetic Resonance in Medicine.

Spectrally selective imaging with wideband balanced steady-state free precession MRI

PURPOSE

Unwanted, bright fat signals in balanced steady-state free precession sequences are commonly suppressed using spectral shaping. Here, a new spectral-shaping method is proposed to significantly improve the uniformity of stopband suppression without compromising the level of passband signals.

METHODS

The proposed method combines binomial-pattern excitation pulses with a wideband balanced steady-state free precession sequence kernel. It thereby increases the frequency separation between the centers of pass and stopbands by π radians, enabling improved water-fat contrast. Simulations were performed to find the optimal flip angles and subpulse spacing for the binomial pulses that maximize contrast and signal efficiency.

RESULTS

Comparisons with a conventional binomial balanced steady-state free precession sequence were performed in simulations as well as phantom and in vivo experiments at 1.5 T and 3 T. Enhanced fat suppression is demonstrated in vivo with an average improvement of 58% in blood-fat and 68% in muscle-fat contrast (P < 0.001, Wilcoxon signed-rank test).

CONCLUSION

The proposed binomial wideband balanced steady-state free precession method is a promising candidate for spectrally selective imaging with enhanced reliability against field inhomogeneities.

A systems view of risk factors for knee osteoarthritis reveals insights into the pathogenesis of the disease

Early detection of osteoarthritis (OA) remains a critical yet unsolved multifaceted problem. To address the multifaceted nature of OA a systems model was developed to consolidate a number of observations on the biological, mechanical and structural components of OA and identify features common to the primary risk factors for OA (aging, obesity and joint trauma) that are present prior to the development of clinical OA. This analysis supports a unified view of the pathogenesis of OA such that the risk for developing OA emerges when one of the components of the disease (e.g., mechanical) becomes abnormal, and it is the interaction with the other components (e.g., biological and/or structural) that influences the ultimate convergence to cartilage breakdown and progression to clinical OA. The model, applied in a stimulus-response format, demonstrated that a mechanical stimulus at baseline can enhance the sensitivity of a biomarker to predict cartilage thinning in a 5 year follow-up in patients with knee OA. The systems approach provides new insight into the pathogenesis of the disease and offers the basis for developing multidisciplinary studies to address early detection and treatment at a stage in the disease where disease modification has the greatest potential for a successful outcome.

Generating multiple contrasts using single-shot radial T1 sensitive and insensitive steady-state imaging

PURPOSE

Recently, the (Resolution Enhanced-) T1 insensitive steady-state imaging (TOSSI) approach has been proposed for the fast acquisition of T2 -weighted images. This has been achieved by balanced steady-state free precession (bSSFP) imaging between unequally spaced inversion pulses. The purpose of this work is to present an extension of this technique, considerably increasing both the efficiency and possibilities of TOSSI.

THEORY AND METHODS

A radial trajectory in combination with an appropriate view-sharing reconstruction is used. Because each projection traverses the contrast defining k-space center, several different contrasts can be extracted from a single-shot measurement. These contrasts include various T2 -weightings and T2 /T1 -weighting if an even number of inversion pulses is used, while an odd number allow the generation of several images with predefined tissue types cancelled.

RESULTS

The approach is validated for brain and abdominal imaging at 3.0 Tesla. Results are compared with RE-TOSSI, bSSFP, and turbo spin-echo images and are shown to provide similar contrasts in a fraction of scan time. Furthermore, the potential utility of the approach is illustrated by images obtained from a brain tumor patient.

CONCLUSION

Radial T1 sensitive and insensitive steady-state imaging is able to generate multiple contrasts out of one single-shot measurement in a short scan time.

Dynamically phase-cycled radial balanced SSFP imaging for efficient banding removal

PURPOSE

Balanced steady-state free precession (bSSFP) imaging suffers from banding artifacts due to its inherent sensitivity to inhomogeneities in the main magnetic field. These artifacts can be removed by the acquisition of multiple images at different frequency offsets. However, conventional phase-cycling is hindered by a long scan time. The purpose of this work is to present a novel approach for efficient banding removal in bSSFP imaging.

THEORY AND METHODS

To this end, the phase-cycle during a single-shot radial acquisition of an image was dynamically changed. Thus, each projection is acquired with a different frequency offset. Using conventional radial gridding, an artifact-free image can be reconstructed out of this dataset.

RESULTS

The approach is validated at clinical field strength [3.0 Tesla (T)] as well as at ultrahigh field (9.4T). Robust elimination of banding artifacts was obtained for different imaging regions, including brain imaging at ultrahigh field with an in-plane resolution of 0.25 × 0.25 mm(2). Besides banding artifact-free imaging, the applicability of the proposed technique for fat-water separation is demonstrated.

CONCLUSION

Dynamically phase-cycled radial bSSFP has the potential for banding-free bSSFP imaging in a short scan time, in the presence of severe field inhomogeneities and at high resolution.

Three-dimensional topographical variation of femoral cartilage T2 in healthy volunteer knees

OBJECTIVE

Quantitative knee cartilage T2 assessment on limited two-dimensional midsagittal or midcoronal planes may be insufficient to assess variations in normal cartilage composition. The purpose of this work was to reveal characteristic 3D distribution of T2 values in femoral cartilage in healthy volunteer knees.

MATERIALS AND METHODS

Sixteen volunteers were enrolled in this study. One knee joint in each volunteer was imaged using a 3D fast image employing steady-state acquisition cycled phases (FIESTA-C) sequence for modeling distal femoral morphology, as well as a sagittal T2 mapping of cartilage. 3D distribution of cartilage T2 values was generated for the femoral condyles. At each medial and lateral condyle, four regions of interest (ROI) were manually defined based on the cartilage covered by the 3D surface model of the medial and lateral menisci.

RESULTS

The 3D maps showed a relatively inhomogeneous distribution of cartilage T2 on the medial and lateral condyles. Cartilage T2 values in the internal half of the weight-bearing zone were significantly higher than those in all other zones on both lateral and medial condyles.

CONCLUSIONS

Analysis of 3D distribution of femoral cartilage T2 may be valuable in determining the site-specific normal range of cartilage T2 in the healthy knee joint.

Three-dimensional MRI of the musculoskeletal system

OBJECTIVE

The purposes of this review are to describe commonly available 3D MRI techniques and to discuss the literature to date regarding the utility of such techniques in the assessment of internal derangement of joints.

CONCLUSION

Long acquisition and postprocessing times and limited contrast characteristics have generally prohibited routine use of 3D MRI in clinical practice. However, technical advances, including higher-field-strength MRI systems, high performance gradients, high-resolution multichannel coils, and pulse sequences with shorter acquisition times, have made feasible 3D isotropic MRI with reasonable acquisition times.

Influence of medial meniscectomy on stress distribution of the femoral cartilage in porcine knees: a 3D reconstructed T2 mapping study

OBJECTIVE

Previous studies have shown that meniscectomy results in an increase of local load transmission and may cause degeneration of the knee cartilage. Using 3D reconstructed T2 mapping, we examined the influence on the femoral cartilage under loading after medial meniscectomy.

DESIGN

Ten porcine knees were imaged using a pressure device and a 3.0-T magnetic resonance imaging (MRI) system. Consecutive sagittal T2 maps were obtained in neutral alignment with and without compression, and under compression at 10° varus alignment. After medial meniscectomy, the aforementioned MRI was repeated. Cartilage T2 before and after meniscectomy under each condition were compared at the 12 regions of interest (ROIs) defined on the 3D weight-bearing area of the femoral cartilage.

RESULTS

Before meniscectomy, large decreases in T2 under neutral compression were mainly seen at the anterior and central ROIs of the medial cartilage, which shifted to the posterior ROIs after meniscectomy. There were significant differences in decrease in T2 ratio with loading before and after meniscectomy (9.8%/4.3% at the anterior zone, 4.0%/11.4% at the posterior zone, P < 0.05). By applying varus compression, a more remarkable decrease in the cartilage T2 in posterior ROIs after meniscectomy was achieved. (Before/after meniscectomy: 8.7%/2.5% at the anterior zone, 7.2%/18.7% at the posterior zone, P < 0.05).

CONCLUSIONS

Assuming a decrease in T2 with loading correlated with the applied pressure, a deficiency of the medial meniscus resulted in a shift of the primary area with a maximal decrease of cartilage T2 with loading posteriorly in the porcine knee joint, presumably reflecting the intraarticular environment of load transmission.

Qualitative and quantitative assessment of isotropic ankle magnetic resonance imaging: three-dimensional isotropic intermediate-weighted turbo spin echo versus three-dimensional isotropic fast field echo sequences

Objective

To compare the image quality of volume isotropic turbo spin echo acquisition (VISTA) imaging method with that of the three-dimensional (3D) isotropic fast field echo (FFE) imaging method applied for ankle joint imaging.

Materials and Methods

MR imaging of the ankles of 10 healthy volunteers was performed with VISTA and 3D FFE sequences by using a 3.0 T machine. Two radiologists retrospectively assessed the tissue contrast between fluid and cartilage (F-C), and fluid and the Achilles tendon (F-T) with use of a 4-point scale. For a quantitative analysis, signal-to-noise ratio (SNR) was obtained by imaging phantom, and the contrast ratios (CRs) were calculated between F-T and F-C. Statistical analyses for differences in grades of tissue contrast and CRs were performed.

Results

VISTA had significantly superior grades in tissue contrast of F-T (p = 0.001). Results of 3D FFE had superior grades in tissue contrast of F-C, but these result were not statistically significant (p = 0.157). VISTA had significantly superior CRs in F-T (p = 0.002), and 3D FFE had superior CRs in F-C (p = 0.003). The SNR of VISTA was higher than that of 3D FFE (49.24 vs. 15.94).

Conclusion

VISTA demonstrates superior tissue contrast between fluid and the Achiles tendon in terms of quantitative and qualitative analysis, while 3D FFE shows superior tissue contrast between fluid and cartilage in terms of quantitative analysis.

Cartilage morphology at 3.0T: assessment of three-dimensional magnetic resonance imaging techniques

PURPOSE

To compare six new three-dimensional (3D) magnetic resonance (MR) methods for evaluating knee cartilage at 3.0T.

MATERIALS AND METHODS

We compared: fast-spin-echo cube (FSE-Cube), vastly undersampled isotropic projection reconstruction balanced steady-state free precession (VIPR-bSSFP), iterative decomposition of water and fat with echo asymmetry and least-squares estimation combined with spoiled gradient echo (IDEAL-SPGR) and gradient echo (IDEAL-GRASS), multiecho in steady-state acquisition (MENSA), and coherent oscillatory state acquisition for manipulation of image contrast (COSMIC). Five-minute sequences were performed twice on 10 healthy volunteers and once on five osteoarthritis (OA) patients. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured from the volunteers. Images of the five volunteers and the five OA patients were ranked on tissue contrast, articular surface clarity, reformat quality, and lesion conspicuity. FSE-Cube and VIPR-bSSFP were compared to IDEAL-SPGR for cartilage volume measurements.

RESULTS

FSE-Cube had top rankings for lesion conspicuity, overall SNR, and CNR (P < 0.02). VIPR-bSSFP had top rankings in tissue contrast and articular surface clarity. VIPR and FSE-Cube tied for best in reformatting ability. FSE-Cube and VIPR-bSSFP compared favorably to IDEAL-SPGR in accuracy and precision of cartilage volume measurements.

CONCLUSION

FSE-Cube and VIPR-bSSFP produce high image quality with accurate volume measurement of knee cartilage.

Dual half-echo phase correction for implementation of 3D radial SSFP at 3.0 T

Fat/water separation methods such as fluctuating equilibrium magnetic resonance and linear combination steady-state free precession have not yet been successfully implemented at 3.0 T due to extreme limitations on the time available for spatial encoding with the increase in magnetic field strength. We present a method to utilize a three-dimensional radial sequence combined with linear combination steady-state free precession at 3.0 T to take advantage of the increased signal levels over 1.5 T and demonstrate high spatial resolution compared to Cartesian techniques. We exploit information from the two half-echoes within each pulse repetition time to correct the accumulated phase on a point-by-point basis, thereby fully aligning the phase of both half-echoes. The correction provides reduced sensitivity to static field (B(0)) inhomogeneity and robust fat/water separation. Resultant images in the knee joint demonstrate the necessity of such a correction, as well as the increased isotropic spatial resolution attainable at 3.0 T. Results of a clinical study comparing this sequence to conventional joint imaging sequences are included.

Sensitivity to change of cartilage morphometry using coronal FLASH, sagittal DESS, and coronal MPR DESS protocols--comparative data from the Osteoarthritis Initiative (OAI)

OBJECTIVE

The Osteoarthritis Initiative (OAI) is targeted at identifying sensitive biomarkers and risk factors of symptomatic knee osteoarthritis (OA) onset and progression. Quantitative cartilage imaging in the OAI relies on validated fast low angle shot (FLASH) sequences that suffer from relatively long acquisition times, and on a near-isotropic double echo steady-state (DESS) sequence. We therefore directly compared the sensitivity to cartilage thickness changes and the correlation of these protocols longitudinally.

METHODS

Baseline (BL) and 12 month follow-up data of 80 knees were acquired using 1.5 mm coronal FLASH and 0.7 mm sagittal DESS (sagDESS) sequences. In these and in 1.5 mm coronal multi-planar reconstructions (MPR) of the DESS the medial femorotibial cartilage was segmented with blinding to acquisition order. In the weight-bearing femoral condyle, a 60% (distance between the trochlear notch and the posterior femur) and a 75% region of interest (ROI) were studied.

RESULTS

The standardized response mean (SRM = mean change/standard deviation of change) in central medial femorotibial (cMFTC) cartilage thickness was -0.34 for coronal FLASH, -0.37 for coronal MPR DESS, -0.36 for sagDESS with the 60% ROI, and -0.38 for the 75% ROI. Using every second 0.7 mm sagittal slice (DESS) yielded similar SRMs in cMFTC for the 60% and 75% ROI from odd (-0.35/-0.36) and even slice numbers (-0.36/-0.39), respectively. BL cartilage thickness displayed high correlations (r > or = 0.94) between the three protocols; the correlations of longitudinal changes were > or = 0.79 (Pearson) and > or = 0.45 (Spearman).

CONCLUSIONS

Cartilage morphometry with FLASH and DESS displays similar longitudinal sensitivity to change. Analysis of every second slice of the 0.7 mm DESS provides adequate sensitivity to change.

Imaging of the musculoskeletal system in vivo using ultra-high field magnetic resonance at 7 T

Recently, great progress has been made in particularly in the imaging of cartilage and bone structure. Increased interest has focused on high-field (3 Tesla) imaging and more recently on ultra-high field (UHF) magnetic resonance imaging (MRI) at 7 T for in vivo imaging. Because the signal-to-noise ratio (SNR) scales linearly with field strength, a substantial increase in SNR is expected compared with lower field strengths. This gain in SNR can be used to increase spatial resolution or reduce imaging time. The goal of this review was to highlight recent developments and challenges in in vivo musculoskeletal (MSK) imaging using UHF-MRI at 7 T. One focus of this review is on the emerging methodology of quantitative MRI for the assessment of trabecular bone structure at the tibia, wrist, and knee. In particular for this application, susceptibility effects between the bone and bone marrow transitions that scale with field strength have to be considered. Another important MSK application is the characterization of knee cartilage morphology. The higher SNR provided by UHF-MRI is a potential advantage for visualizing, segmenting, and analyzing cartilage. Standard clinical MSK imaging relies heavily on T1, T2, and proton density weighted fast spin echo sequences. However, fast spin echo imaging has proven to be very challenging at higher fields because of very high specific absorption rates, using multiple pulses in a short time frame; thus the imaging protocols have to be adapted and gradient echo sequences may be more beneficial. Imaging of more central body parts such as the spine at 7 T is still in its infancy and dedicated coils have to be developed.

Pilot study of improved lesion characterization in breast MRI using a 3D radial balanced SSFP technique with isotropic resolution and efficient fat-water separation

PURPOSE

To assess a 3D radial balanced steady-state free precession (SSFP) technique that provides submillimeter isotropic resolution and inherently registered fat and water image volumes in comparison to conventional T2-weighted RARE imaging for lesion characterization in breast magnetic resonance imaging (MRI).

MATERIALS AND METHODS

3D projection SSFP (3DPR-SSFP) combines a dual half-echo radial k-space trajectory with a linear combination fat/water separation technique (linear combination SSFP). A pilot study was performed in 20 patients to assess fat suppression and depiction of lesion morphology using 3DPR-SSFP. For all patients fat suppression was measured for the 3DPR-SSFP image volumes and depiction of lesion morphology was compared against corresponding T2-weighted fast spin echo (FSE) datasets for 15 lesions in 11 patients.

RESULTS

The isotropic 0.63 mm resolution of the 3DPR-SSFP sequence demonstrated improved depiction of lesion morphology in comparison to FSE. The 3DPR-SSFP fat and water datasets were available in a 5-minute scan time while average fat suppression with 3DPR-SSFP was 71% across all 20 patients.

CONCLUSION

3DPR-SSFP has the potential to improve the lesion characterization information available in breast MRI, particularly in comparison to conventional FSE. A larger study is warranted to quantify the effect of 3DPR-SSFP on specificity.

Novel contrast mechanisms at 3 Tesla and 7 Tesla

Osteoarthritis (OA) is the most common musculoskeletal degenerative disease, affecting millions of people. Although OA has been considered primarily a cartilage disorder associated with focal cartilage degeneration, it is accompanied by well-known changes in subchondral and trabecular bone, including sclerosis and osteophyte formation. The exact cause of OA initiation and progression remains under debate, but OA typically first affects weightbearing joints such as the knee. Magnetic resonance imaging (MRI) has been recognized as a potential tool for quantitative assessment of cartilage abnormalities due to its excellent soft tissue contrast. Over the last two decades, several new MR biochemical imaging methods have been developed to characterize the disease process and possibly predict the progression of knee OA. These new MR biochemical methods play an important role not only for diagnosis of disease at an early stage, but also for their potential use in monitoring outcome of various drug therapies (success or failure). Recent advances in multicoil radiofrequency technology and high field systems (3 T and above) significantly improve the sensitivity and specificity of imaging studies for the diagnosis of musculoskeletal disorders. The current state-of-the-art MR imaging methods are briefly reviewed for the quantitative biochemical and functional imaging assessment of musculoskeletal systems.