Comparison of quantitative dynamic susceptibility-contrast MRI perfusion estimates obtained using different contrast-agent administration schemes at 3T

Transfer function analysis assesses resting cerebral perfusion metrics using hypoxia-induced deoxyhemoglobin as a contrast agent

Introduction: Use of contrast in determining hemodynamic measures requires the deconvolution of an arterial input function (AIF) selected over a voxel in the middle cerebral artery to calculate voxel wise perfusion metrics. Transfer function analysis (TFA) offers an alternative analytic approach that does not require identifying an AIF. We hypothesised that TFA metrics Gain, Lag, and their ratio, Gain/Lag, correspond to conventional AIF resting perfusion metrics relative cerebral blood volume (rCBV), mean transit time (MTT) and relative cerebral blood flow (rCBF), respectively. Methods: 24 healthy participants (17 M) and 1 patient with steno-occlusive disease were recruited. We used non-invasive transient hypoxia-induced deoxyhemoglobin as an MRI contrast. TFA and conventional AIF analyses were used to calculate averages of whole brain and smaller regions of interest. Results: Maps of these average metrics had colour scales adjusted to enhance contrast and identify areas of high congruence. Regional gray matter/white matter (GM/WM) ratios for MTT and Lag, rCBF and Gain/Lag, and rCBV and Gain were compared. The GM/WM ratios were greater for TFA metrics compared to those from AIF analysis indicating an improved regional discrimination. Discussion: Resting perfusion measures generated by The BOLD analysis resulting from a transient hypoxia induced variations in deoxyhemoglobin analyzed by TFA are congruent with those analyzed by conventional AIF analysis.

DSC MRI in the human brain using deoxyhemoglobin and gadolinium-Simulations and validations at 3T

INTRODUCTION

Dynamic susceptibility contrast (DSC) MRI allows clinicians to determine perfusion parameters in the brain, such as cerebral blood flow, cerebral blood volume, and mean transit time. To enable quantification, susceptibility changes can be induced using gadolinium (Gd) or deoxyhemoglobin (dOHb), the latter just recently introduced as a contrast agent in DSC. Previous investigations found that experimental parameters and analysis choices, such as the susceptibility amplitude and partial volume, affect perfusion quantification. However, the accuracy and precision of DSC MRI has not been systematically investigated, particularly in the lower susceptibility range.

METHODS

In this study, we compared perfusion values determined using Gd with values determined using a contrast agent with a lower susceptibility-dOHb-under different physiological conditions, such as varying the baseline blood oxygenation and/or magnitude of hypoxic bolus, by utilizing numerical simulations and conducting experiments on healthy subjects at 3T. The simulation framework we developed for DSC incorporates MRI signal contributions from intravascular and extravascular proton spins in arterial, venous, and cerebral tissue voxels. This framework allowed us to model the MRI signal in response to both Gd and dOHb.

RESULTS AND DISCUSSION

We found, both in the experimental results and simulations, that a reduced intravascular volume of the selected arterial voxel, reduced baseline oxygen saturation, greater susceptibility of applied contrast agent (Gd vs. dOHb), and/or larger magnitude of applied hypoxic bolus reduces the overestimation and increases precision of cerebral blood volume and flow. As well, we found that normalizing tissue to venous rather than arterial signal increases the accuracy of perfusion quantification across experimental paradigms. Furthermore, we found that shortening the bolus duration increases the accuracy and reduces the calculated values of mean transit time. In summary, we experimentally uncovered an array of perfusion quantification dependencies, which agreed with the simulation framework predictions, using a wider range of susceptibility values than previously investigated. We argue for caution when comparing absolute and relative perfusion values within and across subjects obtained from a standard DSC MRI analysis, particularly when employing different experimental paradigms and contrast agents.

Effects of bolus injection duration on perfusion estimates in dynamic CT and dynamic susceptibility contrast MRI

Estimates of cerebral blood flow (CBF) and tissue mean transit time (MTT) have been shown to differ between dynamic CT perfusion (CTP) and dynamic susceptibility contrast MRI (DSC-MRI). This study investigates whether these discrepancies regarding CBF and MTT between CTP and DSC-MRI can be attributed to the different injection durations of these techniques. Five subjects were scanned using CTP and DSC-MRI. Region-wise estimates of CBF, MTT, and cerebral blood volume (CBV) were derived based on oscillatory index regularized singular value decomposition. A parametric model that reproduced the shape of measured time curves and characteristics of resulting perfusion parameter estimates was developed and used to simulate data with injection durations typical for CTP and DSC-MRI for a clinically relevant set of perfusion scenarios and noise levels. In simulations, estimates of CBF/MTT showed larger negative/positive bias and increasing variability for CTP when compared to DSC-MRI, especially for high CBF levels. While noise also affected estimates, at clinically relevant levels, the injection duration effect was larger. There are several methodological differences between CTP and DSC-MRI. The results of this study suggest that the injection duration is among those that can explain differences in estimates of CBF and MTT between these bolus tracking techniques.

Iron Sucrose as MRI Contrast Agent in Ischemic Stroke Model

BACKGROUND

Despite the growing concern about the safety of gadolinium-based contrast agents (GBCAs), they are still the most commonly used. Ferumoxytol, as an off-label alternative MRI contrast agent, cannot be administered by a rapid bolus for dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI).

PURPOSE

To assess the feasibility of iron sucrose (IS) as a contrast agent for MR angiography (MRA) and DSC-PWI.

STUDY TYPE

Prospective animal model.

ANIMAL MODEL

Thirty-six normal rats (16 for MRA, 20 for biocompability tests) and 36 occlusion of the middle cerebral artery (MCAO) model rats.

FIELD STRENGTH/SEQUENCE

3.0T; head and neck angiography, using a fast spoiled gradient-recalled-echo (FSPGR) sequence and DSC-MRI using echo planar imaging(EPI) sequence.

ASSESSMENT

MRA was performed on normal rats to examine the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of different doses of IS. DSC-PWI was performed on MCAO rats at 0, 24, 48, and 72 hours postreperfusion to investigate the lesion detectability of IS. Arterial spin labeling (ASL) and DSC-PWI enhanced by GBCAs were conducted on MCAO rats as controls.

STATISTICAL TESTS

Kruskal-Wallis test was used to compare qualitative assessment. One-way analysis of variance (ANOVA) was used to compare the parametric data. Pearson's r values were evaluated between relative cerebral blood flow(rCBF)-ASL, rCBF-DSC_IS , and rCBF obtained from DSC-PWI enhanced by GBCA.

RESULTS

The mean SNR and CNR of the common carotid artery at doses of 10 mg Fe/kg of IS were comparable with the standard dose of GBCAs (SNR: 68.04 ± 12.55 vs. 67.72 ± 14.66; CNR: 23.78 ± 7.21vs. 21.63 ± 6.83). In MCAO rat models, rCBF and relative cerebral blood volume (rCBV) of ipsilateral striatum declined (0.72 ± 0.14, 0.86 ± 0.11) with prolonged relative mean transit time (rMTT) and relative time-to-peak (rTTP) (1.27 ± 0.24, 1.07 ± 0.03) following occlusion. Hyperperfusion was observed in all rats at 48 and 72 hours postreperfusion, in 4/6 rats at 24 hours postreperfusion for IS-mediated DSC-PWI.

DATA CONCLUSION

IS may be an effective contrast agent for both MRA and DSC-PWI in ischemic stroke models.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY STAGE: 1 J. Magn. Reson. Imaging 2020;52:836-849.

Robust selective weighted field mapping using multi-echo gradient echo-based MRI

In 3D gradient echo (GRE) and echo planar imaging (EPI), strong macroscopic field gradients are observed at air/tissue interfaces. The respective field gradients lead to an apparent increase in intravoxel dephasing, and, subsequently, to signal loss or image distortion. We propose an analytical approximation and a consequent method to compute low and high resolution field maps over all field map regimes (small and large echo spacing). A number of approaches which compute field maps from reconstructed phase data rely upon optimized linear least square fit and complex division approaches owing to the simplicity of their implementation. Most of these techniques, however, have historically considered only the phase signal when computing off-resonance maps while ignoring magnitude data. This latter may be of notable interest since the presence of noise is well depicted and interpreted. The presence of noise and phase aliasing that increase with increasing echo time (TE) and echo spacing (ΔTE) may seriously challenge the off-resonance map accuracy. These techniques still remain subject to the trade-off during the choice of GRE sequences, TE and ΔTE. In this work, we explore a novel model that considers any type of TE and ΔTE regime (small or large) and high phase wraps complexity. The field offset is weighted by the magnitude signal decay quality, to make the field mapping procedure as noise independent as possible. The performance of the proposed method was tested using simulated, experimental phantoms and in vivo human studies. The proposed approach markedly outperforms conventional techniques. It provides a correction equivalent to that of the conventional techniques in regions with high SNR ([Formula: see text]20), yielding a mean error of about 0.1 Hz, but appearing more robust in regions with low SNR ([Formula: see text]10), such as near the sinus cavity and at the very edge of the brain (mean error less than 1 Hz), where phase wraps and noise are highly present. The proposed technique shows promise to enhance field map generation over any acquisition regime and in regions of both high and low SNR and it can be easily implemented for rapid computation and used in a clinical setting.

Mixed model phase evolution for correction of magnetic field inhomogeneity effects in 3D quantitative gradient echo-based MRI

PURPOSE

In 3D gradient echo magnetic resonance imaging (MRI), strong field gradients B0_macro are visually observed at air/tissue interfaces. At low spatial resolution in particular, the respective field gradients lead to an apparent increase in intravoxel dephasing, and subsequently, to signal loss or inaccurate R2* estimates. If the strong field gradients are measured, their influence can be removed by postprocessing.

METHODS

Conventional corrections usually assume a linear phase evolution with time. For high macroscopic gradient inhomogeneities near the edge of the brain and at the paranasal sinuses, however, this assumption is often broken. Herein, we explored a novel model that considers both linear and stochastic dependences of the phase evolution with echo time in the presence of weak and strong macroscopic field inhomogeneities. We tested the performance of the model at large field gradients using simulation, phantom, and human in vivo studies.

RESULTS

The performance of the proposed approach was markedly better than the standard correction method, providing a correction equivalent to that of the conventional approach in regions with high signal to noise ratio (SNR > 10), but appearing more robust in regions with low SNR (SNR < 4).

CONCLUSION

The proposed technique shows promise to improve R2* measurements in regions of large susceptibilities. The clinical and research applications still require further investigation.

Bayesian estimation of cerebral perfusion using reduced-contrast-dose dynamic susceptibility contrast perfusion at 3T

BACKGROUND AND PURPOSE

DSC perfusion has been increasingly used in conjunction with other contrast-enhanced MR applications and therefore there is need for contrast-dose reduction when feasible. The purpose of this study was to establish the feasibility of reduced-contrast-dose brain DSC perfusion by using a probabilistic Bayesian method and to compare the results with the commonly used singular value decomposition technique.

MATERIALS AND METHODS

Half-dose (0.05-mmol/kg) and full-dose (0.1-mmol/kg) DSC perfusion studies were prospectively performed in 20 patients (12 men; 34-70 years of age) by using a 3T MR imaging scanner and a gradient-EPI sequence (TR/TE, 1450/22 ms; flip angle, 90°). All DSC scans were processed with block circulant singular value decomposition and Bayesian probabilistic methods. SNR analysis was performed in both half-dose and full-dose groups. The CBF, CBV, and MTT maps from both full-dose and half-dose scans were evaluated qualitatively and quantitatively in both WM and GM on coregistered perfusion maps. Statistical analysis was performed by using a t test, regression, and Bland-Altman analysis.

RESULTS

The SNR was significantly (P < .0001) lower in the half-dose group with 32% and 40% reduction in GM and WM, respectively. In the half-dose group, the image-quality scores were significantly higher in Bayesian-derived CBV (P = .02) and MTT (P = .004) maps in comparison with block circulant singular value decomposition. Quantitative values of CBF, CBV, and MTT in Bayesian-processed data were comparable and without a statistically significant difference between the half-dose and full-dose groups. The block circulant singular value decomposition-derived half-dose perfusion values were significantly different from those of the full-dose group both in GM (CBF, P < .001; CBV, P = .02; MTT, P = .02) and WM (CBF, P < .001; CBV, P = .003; MTT, P = .01).

CONCLUSIONS

Reduced-contrast-dose (0.05-mmol/kg) DSC perfusion of the brain is feasible at 3T by using the Bayesian probabilistic method with quantitative results comparable with those of the full-dose protocol.

Gadolinium contrast agents for CNS imaging: current concepts and clinical evidence

SUMMARY

The aim of this article was to review the properties of the various gadolinium-based contrast agents used for CNS imaging along with the clinical evidence and published data that highlight the impact these different properties can have on diagnostic performance. In addition, approaches to optimizing image acquisition that take into account the different properties of specific gadolinium-based contrast agents and an extensive review of the safety profiles of the various agents are presented.

Nuclear magnetic resonance imaging of tumour growth and neovasculature performance in vivo reveals Grb7 as a novel antiangiogenic target

Development of neovasculature is a necessary requirement for tumour growth and it provides additional opportunities for therapeutic intervention. However, current antiangiogenic therapies have limited efficacy, mostly because of the development of resistance. Hence, characterization of new antiangiogenic molecular targets is of considerable clinical interest. We report that a calmodulin-binding domain (CaM-BD) deletion mutant of the growth factor receptor bound protein 7 (Grb7) (denoted Grb7Δ) impairs tumour growth and associated angiogenesis in vivo. We implanted glioma C6 cells in rat brains transfected with an enhanced yellow fluorescent protein (EYFP) chimera of Grb7∆, its EYFP-Grb7 wild type counterpart, and EYFP alone. We systematically followed intracerebral growth of the tumours, their cellularity and the functional performance of tumour-associated microvasculature using magnetic resonance imaging, including anatomical T1W and T2W images and functional diffusion and perfusion parameters. Tumours grown from implanted C6 cells expressing EYFP-Grb7Δ developed slower, became smaller and presented lower apparent cellularity than those derived from cells expressing EYFP-Grb7 and EYFP. Vascular perfusion measurements within tumours derived from EYFP-Grb7∆-expressing cells showed significantly lower cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) values. These findings were independently validated by histological and immunohistochemical techniques. Taken together, these findings confirm that the CaM-BD of Grb7 plays an important role in tumour growth and associated angiogenesis in vivo, thus identifying this region of the protein as a novel target for antiangiogenic treatment.

The 39 steps: evading error and deciphering the secrets for accurate dynamic susceptibility contrast MRI

Dynamic susceptibility contrast (DSC) MRI is the most commonly used MRI method to assess cerebral perfusion and other related haemodynamic parameters. Although the technique is well established and used routinely in clinical centres, there are still many problems that impede accurate perfusion quantification. In this review article, we present 39 steps which guide the reader through the theoretical principles, practical decisions, potential problems, current limitations and latest advances in DSC-MRI. The 39 steps span the collection, analysis and interpretation of DSC-MRI data, expounding issues and possibilities relating to the contrast agent, the acquisition of DSC-MRI data, data pre-processing, the contrast concentration-time course, the arterial input function, deconvolution, common perfusion parameters, post-processing possibilities, patient studies, absolute versus relative quantification and automated analysis methods.

Automatic selection of arterial input function on dynamic contrast-enhanced MR images

Dynamic susceptibility contrast-magnetic resonance imaging (DSC-MRI) data analysis requires the knowledge of the arterial input function (AIF) to quantify the cerebral blood flow (CBF), volume (CBV) and the mean transit time (MTT). AIF can be obtained either manually or using automatic algorithms. We present a method to derive the AIF on the middle cerebral artery (MCA). The algorithm draws a region of interest (ROI) where the MCA is located. Then, it uses a recursive cluster analysis on the ROI to select the arterial voxels. The algorithm had been compared on simulated data to literature state of art automatic algorithms and on clinical data to the manual procedure. On in silico data, our method allows to reconstruct the true AIF and it is less affected by partial volume effect bias than the other methods. In clinical data, automatic AIF provides CBF and MTT maps with a greater contrast level compared to manual AIF ones. Therefore, AIF obtained with the proposed method improves the estimate reliability and provides a quantitatively reliable physiological picture.