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Awan KM, Goncalves Filho ALM, Tabari A, Applewhite BP, Lang M, Lo WC, Sellers R, Kollasch P, Clifford B, Nickel D, Husseni J, Rapalino O, Schaefer P, Cauley S, Huang SY, Conklin J. Diagnostic evaluation of deep learning accelerated lumbar spine MRI. Neuroradiol J 2024; 37:323-331. [PMID: 38195418 PMCID: PMC11138337 DOI: 10.1177/19714009231224428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND AND PURPOSE Deep learning (DL) accelerated MR techniques have emerged as a promising approach to accelerate routine MR exams. While prior studies explored DL acceleration for specific lumbar MRI sequences, a gap remains in comprehending the impact of a fully DL-based MRI protocol on scan time and diagnostic quality for routine lumbar spine MRI. To address this, we assessed the image quality and diagnostic performance of a DL-accelerated lumbar spine MRI protocol in comparison to a conventional protocol. METHODS We prospectively evaluated 36 consecutive outpatients undergoing non-contrast enhanced lumbar spine MRIs. Both protocols included sagittal T1, T2, STIR, and axial T2-weighted images. Two blinded neuroradiologists independently reviewed images for foraminal stenosis, spinal canal stenosis, nerve root compression, and facet arthropathy. Grading comparison employed the Wilcoxon signed rank test. For the head-to-head comparison, a 5-point Likert scale to assess image quality, considering artifacts, signal-to-noise ratio (SNR), anatomical structure visualization, and overall diagnostic quality. We applied a 15% noninferiority margin to determine whether the DL-accelerated protocol was noninferior. RESULTS No significant differences existed between protocols when evaluating foraminal and spinal canal stenosis, nerve compression, or facet arthropathy (all p > .05). The DL-spine protocol was noninferior for overall diagnostic quality and visualization of the cord, CSF, intervertebral disc, and nerve roots. However, it exhibited reduced SNR and increased artifact perception. Interobserver reproducibility ranged from moderate to substantial (κ = 0.50-0.76). CONCLUSION Our study indicates that DL reconstruction in spine imaging effectively reduces acquisition times while maintaining comparable diagnostic quality to conventional MRI.
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Affiliation(s)
- Komal M Awan
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | | | - Azadeh Tabari
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | - Brooks P Applewhite
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | - Min Lang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | | | | | | | | | | | - Jad Husseni
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | - Otto Rapalino
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | - Pamela Schaefer
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | | | - Susie Y Huang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
- Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, USA
| | - John Conklin
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
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Lang M, Clifford B, Lo WC, Applewhite BP, Tabari A, Filho ALMG, Hosseini Z, Longo MGF, Cauley SF, Setsompop K, Bilgic B, Feiweier T, Lev MH, Schaefer PW, Rapalino O, Huang SY, Conklin J. Clinical Evaluation of a 2-Minute Ultrafast Brain MR Protocol for Evaluation of Acute Pathology in the Emergency and Inpatient Settings. AJNR Am J Neuroradiol 2024; 45:379-385. [PMID: 38453413 DOI: 10.3174/ajnr.a8143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/07/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND PURPOSE The use of MR imaging in emergency settings has been limited by availability, long scan times, and sensitivity to motion. This study assessed the diagnostic performance of an ultrafast brain MR imaging protocol for evaluation of acute intracranial pathology in the emergency department and inpatient settings. MATERIALS AND METHODS Sixty-six adult patients who underwent brain MR imaging in the emergency department and inpatient settings were included in the study. All patients underwent both the reference and the ultrafast brain MR protocols. Both brain MR imaging protocols consisted of T1-weighted, T2/T2*-weighted, FLAIR, and DWI sequences. The ultrafast MR images were reconstructed by using a machine-learning assisted framework. All images were reviewed by 2 blinded neuroradiologists. RESULTS The average acquisition time was 2.1 minutes for the ultrafast brain MR protocol and 10 minutes for the reference brain MR protocol. There was 98.5% agreement on the main clinical diagnosis between the 2 protocols. In head-to-head comparison, the reference protocol was preferred in terms of image noise and geometric distortion (P < .05 for both). The ultrafast ms-EPI protocol was preferred over the reference protocol in terms of reduced motion artifacts (P < .01). Overall diagnostic quality was not significantly different between the 2 protocols (P > .05). CONCLUSIONS The ultrafast brain MR imaging protocol provides high accuracy for evaluating acute pathology while only requiring a fraction of the scan time. Although there was greater image noise and geometric distortion on the ultrafast brain MR protocol images, there was significant reduction in motion artifacts with similar overall diagnostic quality between the 2 protocols.
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Affiliation(s)
- Min Lang
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Bryan Clifford
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Wei-Ching Lo
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Brooks P Applewhite
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Azadeh Tabari
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | | | - Zahra Hosseini
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Maria Gabriela Figueiro Longo
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Stephen F Cauley
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Kawin Setsompop
- Departments of Radiology and Electrical Engineering (K.S.), Stanford University, Stanford, California
| | - Berkin Bilgic
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | - Michael H Lev
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Pamela W Schaefer
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Otto Rapalino
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Susie Y Huang
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - John Conklin
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
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Ganesh VKSV, Kamepalli HK, Sharma DP, Thomas B, Kesavadas C. Multi-contrast echo-planar imaging sequence (Echo-planar imaging mix) in clinical situations demanding faster MRI-brain scans. J Neurosci Rural Pract 2024; 15:341-348. [PMID: 38746507 PMCID: PMC11090545 DOI: 10.25259/jnrp_508_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/10/2024] [Indexed: 05/16/2024] Open
Abstract
Objectives The excellent resolution offered by magnetic resonance imaging (MRI) has a trade-off in the form of scan duration. The purpose of the present study was to assess the clinical utility of echo-planar imaging mix (EPIMix), an echo-planar imaging-based MRI sequence for the brain with a short acquisition time. Materials and Methods This was a retrospective observational study of 50 patients, who could benefit from faster MRI brain scans. The T1, T2, fluid attenuated inversion recovery, diffusion-weighted imaging (DWI), and T2*/susceptibility-weighted imaging sequences were acquired, conventionally and with EPIMix. Conventional and EPIMix images were assessed by two radiologists for overall quality, motion, and susceptibility artifacts and scored on a Likert scale. The scores given for conventional and EPIMix images were compared. The diagnostic performance of EPIMix was also assessed by the ability to detect clinically relevant findings. Results The acquisition time for conventional MRI was 11 min and 45 s and for EPIMix 1 min and 15 s. All EPIMix images were sufficient for diagnostic use. On assessment of the diagnostic performance, it was excellent for ischemic and hemorrhagic strokes. Smaller lesions, lesions adjacent to bone, and post-operative tumors were difficult to identify. Moderate to perfect agreement (Kappa values 0.41-1) was seen between radiologists for all categories except skull base, calvarial, and orbital lesions. Image quality, artifact assessment showed excellent interobserver agreement (>90%) for the scores. All EPIMix images showed reduced motion artifacts. The EPIMix-DWI was comparable to conventional-DWI in terms of quality and artifacts. The remaining sequences showed reduced quality and increased susceptibility. Conclusion The EPIMix has a significantly reduced acquisition time than conventional MRI and could be used instead of conventional MRI in situations demanding faster scans such as suspected acute ischemic or hemorrhagic stroke. In other clinical scenarios, it could help tailor the MRI examination for each patient.
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Affiliation(s)
- Viswanadh Kalaparti Sri Venkata Ganesh
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Hari Kishore Kamepalli
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Goo HW, Park SH. Fast Quantitative Magnetic Resonance Imaging Evaluation of Hydrocephalus Using 3-Dimensional Fluid-Attenuated Inversion Recovery: Initial Experience. J Comput Assist Tomogr 2024; 48:292-297. [PMID: 37621082 DOI: 10.1097/rct.0000000000001539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
OBJECTIVE This study aimed to demonstrate the initial experience of using fast quantitative magnetic resonance imaging (MRI) to evaluate hydrocephalus. METHODS A total of 109 brain MRI volumetry examinations (acquisition time, 7 minutes 30 seconds) were performed in 72 patients with hydrocephalus. From the measured ventricular system and brain volumes, ventricle-brain volume percentage was calculated to standardize hydrocephalus severity (processing time, <5 minutes). The obtained values were categorized into no, mild, and severe based on the fronto-occipital horn ratio (FOHR) and the ventricle-brain volume percentages reported in the literature. The measured volumes and percentages were compared between patients with mild hydrocephalus and those with severe hydrocephalus. The diagnostic performance of brain hydrocephalus MRI volumetry was evaluated using receiver operating characteristic curve analysis. RESULTS Ventricular volumes and ventricle-brain volume percentages were significantly higher in in patients with severe hydrocephalus than in those with mild hydrocephalus (FOHR-based severity: 352.6 ± 165.6 cm 3 vs 149.1 ± 78.5 cm 3 , P < 0.001, and 26.8% [20.8%-33.1%] vs 12.1% ± 6.0%, P < 0.001; percentage-based severity: 359.5 ± 143.3 cm 3 vs 137.0 ± 62.9 cm 3 , P < 0.001, and 26.8% [21.8%-33.1%] vs 11.3% ± 4.2%, P < 0.001, respectively), whereas brain volumes were significantly lower in patients with severe hydrocephalus than in those with mild hydrocephalus (FOHR-based severity: 878.1 ± 363.5 cm 3 vs 1130.1 cm 3 [912.1-1244.2 cm 3 ], P = 0.006; percentage-based severity: 896.2 ± 324.6 cm 3 vs 1142.3 cm 3 [944.2-1246.6 cm 3 ], P = 0.005, respectively). The ventricle-brain volume percentage was a good diagnostic parameter for evaluating the degree of hydrocephalus (area under the curve, 0.855; 95% confidence interval, 0.719-0.990; P < 0.001). CONCLUSIONS Brain MRI volumetry can be used to evaluate hydrocephalus severity and may provide guide interpretation because of its rapid acquisition and postprocessing times.
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Affiliation(s)
- Hyun Woo Goo
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Thrall JH, Brink JA, Zalis ME. The Environmental, Social, Governance Movement and Radiology: Opportunities and Strategy. J Am Coll Radiol 2024; 21:265-270. [PMID: 37495034 DOI: 10.1016/j.jacr.2023.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/20/2022] [Accepted: 02/07/2023] [Indexed: 07/28/2023]
Abstract
The environmental, social, governance (ESG) movement has come to health care organizations, in part through the Biden administration's challenge to them to reduce greenhouse gas emissions by 50% by 2030 and achieve net zero emissions by 2050, in support of more robust environmental sustainability. Radiology practices should become knowledgeable about ESG concepts and look for opportunities that are meaningful and achievable to support their host organizations' ESG efforts. Examples of initiatives to support improved environmental sustainability include selecting the least energy intensive imaging method for a given diagnosis, shutting down equipment in standby mode, sourcing energy from renewable sources, and reducing waste through recycling. Optimizing imaging protocols can reduce radiation exposure to patients, energy used per examination, and the use of other resources such as iodinated contrast media, an environmental pollutant. Achieving socially equitable access to services for ethnic and racial minorities remains a challenge in the US health care system. Extending hours of operation for screening services to include nights and weekends can provide options for patients who otherwise must take time away from work with loss of income. With respect to governance, more transparency in leadership selection and greater opportunities for participation by women and racial/ethnic minorities in the leadership of professional organizations should be supported in radiology. To succeed in ESG initiatives, radiology practice leaders should consider appointing a lead person and a multifunctional team that includes broad representation from the radiology workplace. The team should work to identify opportunities that are realistic and achievable within their institutional contexts.
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Affiliation(s)
- James H Thrall
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Subcommittee Chair, ACR Centennial Committee; Chair, Ethics in Publishing Subcommittee, ACR Publications Committee.
| | - James A Brink
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Chief, Enterprise Imaging, Mass General Brigham Health System; Radiologist-in-Chief, Massachusetts General Hospital
| | - Michael E Zalis
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Lead, Imaging Sustainability Task Force, Mass General Brigham Health System
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Wu W, Miller E, Hurteau-Miller J, Thipse M, Kapoor C, Webster R, McAuley D, Tu A. Validation of a shortened MR imaging protocol for pediatric spinal pathology. Childs Nerv Syst 2023; 39:3163-3168. [PMID: 36997725 DOI: 10.1007/s00381-023-05940-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/23/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE Conventional pediatric spine MRI protocols have multiple sequences resulting in long acquisition times. Sedation is consequently required. This study evaluates the diagnostic capability of a limited MRI spine protocol for selected common pediatric indications. METHODS Spine MRIs at CHEO between 2017 and 2020 were reviewed across pediatric patients younger than four years old. Two blinded neuroradiologists reviewed limited scan sequences, and results were independently compared to previously reported findings from the complete imaging series. T2 sagittal sequences from the craniocervical junction to sacrum and T1 axial sequence of the lumbar spine constitute the short protocol, with the outcomes of interest being cerebellar ectopia, syrinx, level of conus, filum < 2 mm, fatty filum, and spinal dysraphism. RESULTS A total of 105 studies were evaluated in 54 male and 51 female patients (mean age 19.2 months). The average combined scan time of the limited sequences was 15 min compared to 35 min for conventional protocols (delta = 20 min). The average percent agreement between full and limited sequences was > 95% in all but identifying a filum < 2 mm, where the percent agreement was 87%. Using limited MR sequences had high sensitivity (> 0.91) and specificity (> 0.99) for the detection of cerebellar ectopia, syrinx, fatty filum, and spinal dysraphism. CONCLUSION This study demonstrates that selected spinal imaging sequences allow for consistent and accurate diagnosis of specific clinical conditions. A limited spine imaging protocol has potential as a screening test to reduce the need for full-sequence MRI scans. Further work is needed to determine utility of selected imaging for other clinical indications.
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Affiliation(s)
- W Wu
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - E Miller
- Department of Medical Imaging, University of Ottawa, CHEO, 401 Smyth Ave, Ottawa, ON, K1H8L1, Canada
| | - J Hurteau-Miller
- Department of Medical Imaging, University of Ottawa, CHEO, 401 Smyth Ave, Ottawa, ON, K1H8L1, Canada
| | - M Thipse
- CHEO Research Institute, 401 Smyth Ave, Ottawa, ON, K1H8L1, Canada
| | - C Kapoor
- Department of Medical Imaging, University of Ottawa, CHEO, 401 Smyth Ave, Ottawa, ON, K1H8L1, Canada
| | - R Webster
- CHEO Research Institute, 401 Smyth Ave, Ottawa, ON, K1H8L1, Canada
| | - D McAuley
- Division of Pediatric Neurosurgery, Department of Surgery, Rm 3359, CHEO, 401 Smyth Ave, Ottawa, ON, K1H8L1, Canada
| | - A Tu
- Division of Pediatric Neurosurgery, Department of Surgery, Rm 3359, CHEO, 401 Smyth Ave, Ottawa, ON, K1H8L1, Canada.
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Razumov A, Rogov O, Dylov DV. Optimal MRI undersampling patterns for ultimate benefit of medical vision tasks. Magn Reson Imaging 2023; 103:37-47. [PMID: 37423471 DOI: 10.1016/j.mri.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/30/2023] [Accepted: 06/29/2023] [Indexed: 07/11/2023]
Abstract
Compressed sensing is commonly concerned with optimizing the image quality after a partial undersampling of the measurable k-space to accelerate MRI. In this article, we propose to change the focus from the quality of the reconstructed image to the quality of the downstream image analysis outcome. Specifically, we propose to optimize the patterns according to how well a sought-after pathology could be detected or localized in the reconstructed images. We find the optimal undersampling patterns in k-space that maximize target value functions of interest in commonplace medical vision problems (reconstruction, segmentation, and classification) and propose a new iterative gradient sampling routine universally suitable for these tasks. We validate the proposed MRI acceleration paradigm on three classical medical datasets, demonstrating a noticeable improvement of the target metrics at the high acceleration factors (for the segmentation problem at ×16 acceleration, we report up to 12% improvement in Dice score over the other undersampling patterns).
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Affiliation(s)
- Artem Razumov
- Skolkovo Institute of Science and Technology, Moscow, Russia
| | - Oleg Rogov
- Skolkovo Institute of Science and Technology, Moscow, Russia
| | - Dmitry V Dylov
- Skolkovo Institute of Science and Technology, Moscow, Russia.
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Tabari A, Lang M, Awan K, Liu W, Clifford B, Lo WC, Splitthoff DN, Cauley S, Rapalino O, Schaefer P, Huang SY, Conklin J. Optimized flow compensation for contrast-enhanced T1-weighted Wave-CAIPI 3D MPRAGE imaging of the brain. Eur Radiol Exp 2023; 7:34. [PMID: 37394534 DOI: 10.1186/s41747-023-00351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/25/2023] [Indexed: 07/04/2023] Open
Abstract
Flow-related artifacts have been observed in highly accelerated T1-weighted contrast-enhanced wave-controlled aliasing in parallel imaging (CAIPI) magnetization-prepared rapid gradient-echo (MPRAGE) imaging and can lead to diagnostic uncertainty. We developed an optimized flow-mitigated Wave-CAIPI MPRAGE acquisition protocol to reduce these artifacts through testing in a custom-built flow phantom. In the phantom experiment, maximal flow artifact reduction was achieved with the combination of flow compensation gradients and radial reordered k-space acquisition and was included in the optimized sequence. Clinical evaluation of the optimized MPRAGE sequence was performed in 64 adult patients, who all underwent contrast-enhanced Wave-CAIPI MPRAGE imaging without flow-compensation and with optimized flow-compensation parameters. All images were evaluated for the presence of flow-related artifacts, signal-to-noise ratio (SNR), gray-white matter contrast, enhancing lesion contrast, and image sharpness on a 3-point Likert scale. In the 64 cases, the optimized flow mitigation protocol reduced flow-related artifacts in 89% and 94% of the cases for raters 1 and 2, respectively. SNR, gray-white matter contrast, enhancing lesion contrast, and image sharpness were rated as equivalent for standard and flow-mitigated Wave-CAIPI MPRAGE in all subjects. The optimized flow mitigation protocol successfully reduced the presence of flow-related artifacts in the majority of cases.Relevance statementAs accelerated MRI using novel encoding schemes become increasingly adopted in clinical practice, our work highlights the need to recognize and develop strategies to minimize the presence of unexpected artifacts and reduction in image quality as potential compromises to achieving short scan times.Key points• Flow-mitigation technique led to an 89-94% decrease in flow-related artifacts.• Image quality, signal-to-noise ratio, enhancing lesion conspicuity, and image sharpness were preserved with the flow mitigation technique.• Flow mitigation reduced diagnostic uncertainty in cases where flow-related artifacts mimicked enhancing lesions.
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Affiliation(s)
- Azadeh Tabari
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Min Lang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Komal Awan
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Wei Liu
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | | | | | | | - Stephen Cauley
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Otto Rapalino
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Pamela Schaefer
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Susie Y Huang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
- Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - John Conklin
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
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Buch K, Berlyand Y, Prabhakar A, Grimaldi PJ, Shea MD, Gupta R, Paul A. An ultrafast brain MRI technique for evaluating acute neurologic deficits in the emergency department. Emerg Radiol 2023; 30:391-393. [PMID: 37086336 DOI: 10.1007/s10140-023-02133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/03/2023] [Indexed: 04/23/2023]
Abstract
Herein we share our preliminary experience with an ultrafast brain MRI technique for use in the ED consisting of axial T1-weighted (40 s), axial T2-weighted (62 s), axial diffusion-weighted (80 s), axial FLAIR (96 s), axial T2* (6 s), and axial susceptibility-weighted (108 s) imaging for a total scan time of 6 min and 53 s. Utilization of this ultrafast technique yields an efficient assessment of the brain, decreases ED length of stay and inpatient observation admissions, and may obviate the need for vascular imaging with either CTA or MRA in the ED.
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Affiliation(s)
- Karen Buch
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Yosef Berlyand
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Anand Prabhakar
- Department of Radiology, Newton Wellesley Hospital, Newton, MA, 02468, USA
- Division of Emergency Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Philip J Grimaldi
- Department of Radiology, Newton Wellesley Hospital, Newton, MA, 02468, USA
| | - Michael D Shea
- Department of Radiology, Newton Wellesley Hospital, Newton, MA, 02468, USA
| | - Rajiv Gupta
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Aaron Paul
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
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10
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Lang M, Cartmell S, Tabari A, Briggs D, Pianykh O, Kirsch J, Cauley S, Lo WC, Risacher S, Filho AG, Succi MD, Rapalino O, Schaefer P, Conklin J, Huang SY. Evaluation of the Aggregated Time Savings in Adopting Fast Brain MRI Techniques for Outpatient Brain MRI. Acad Radiol 2023; 30:341-348. [PMID: 34635436 PMCID: PMC8989721 DOI: 10.1016/j.acra.2021.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Clinical validation studies have demonstrated the ability of accelerated MRI sequences to decrease acquisition time and motion artifact while preserving image quality. The operational benefits, however, have been less explored. Here, we report our initial clinical experience in implementing fast MRI techniques for outpatient brain imaging during the COVID-19 pandemic. METHODS Aggregate acquisition times were extracted from the medical record on consecutive imaging examinations performed during matched pre-implementation (7/1/2019-12/31/2019) and post-implementation periods (7/1/2020-12/31/2020). Expected acquisition time reduction for each MRI protocol was calculated through manual collection of acquisition times for the conventional and accelerated sequences performed during the pre- and post-implementation periods. Aggregate and expected acquisition times were compared for the five most frequently performed brain MRI protocols: brain without contrast (BR-), brain with and without contrast (BR+), multiple sclerosis (MS), memory loss (MML), and epilepsy (EPL). RESULTS The expected time reductions for BR-, BR+, MS, MML, and EPL protocols were 6.6 min, 11.9 min, 14 min, 10.8 min, and 14.1 min, respectively. The overall median aggregate acquisition time was 31 [25, 36] min for the pre-implementation period and 18 [15, 22] min for the post-implementation period, with a difference of 13 min (42%). The median acquisition time was reduced by 4 min (25%) for BR-, 14.0 min (44%) for BR+, 14 min (38%) for MS, 11 min (52%) for MML, and 16 min (35%) for EPL. CONCLUSION The implementation of fast brain MRI sequences significantly reduced the acquisition times for the most commonly performed outpatient brain MRI protocols.
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Affiliation(s)
- Min Lang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
| | - Samuel Cartmell
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Daniel Briggs
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Oleg Pianykh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - John Kirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Stephen Cauley
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Wei-Ching Lo
- Siemens Medical Solutions, Boston, Massachusetts
| | - Seretha Risacher
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Augusto Goncalves Filho
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Marc D Succi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Pamela Schaefer
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Susie Y Huang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts.
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11
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Clinical Feasibility of Automated Brain Tissue and Myelin Volumetry of Normal Brian Using Synthetic Magnetic Resonance Imaging With Fast Imaging Protocol: A Single-Center Pilot Study. J Comput Assist Tomogr 2023; 47:108-114. [PMID: 36668983 PMCID: PMC9869954 DOI: 10.1097/rct.0000000000001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study aimed to investigate the clinical feasibility of synthetic magnetic resonance imaging (MRI) with fast imaging protocol for automated brain tissue and myelin volumetry in healthy volunteers at 3.0-T MRI. METHODS Thirty-four healthy volunteers were scanned using synthetic MRI with 3 sets of scan parameters: groups Fast (FAS; 2 minutes, 29 seconds), Routine (ROU; 4 minutes, 7 seconds), and Research (RES; 7 minutes, 46 seconds). White matter (WM), gray matter (GM), cerebrospinal fluid (CSF), non-WM/GM/CSF (NoN), brain parenchymal volume (BPV), intracranial volume (ICV), and myelin volume (MYV) were compared between 3 groups. Linear correlation analysis was performed for measured volumes of groups FAS and ROU versus group RES. RESULTS Significant differences were found in all the measured brain tissue volumes between groups FAS and ROU (P < 0.001), FAS and RES (P < 0.05), and ROU and RES (P < 0.05), except for NoN between groups ROU and RES (P = 0.0673), ICV between groups FAS and ROU (P = 0.2552), and ICV between groups FAS and RES (P = 0.4898). The intergroup coefficients of variation were 4.36% for WM, 6.39% for GM, 10.14% for CSF, 67.5% for NoN, 1.21% for BPV, 0.08% for ICV, and 5.88% for MYV. Strong linear correlation was demonstrated for WM, GM, CSF, BPV, ICV, and MYV (R = 0.9230-1.131) between FAS versus RES, and ROU versus RES. CONCLUSIONS Using synthetic MRI with fast imaging protocol can change the measured brain tissue volumes of volunteers. It is necessary to use consistent acquisition protocols for comparing or following up cases quantitatively.
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12
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Lang M, Rapalino O, Huang S, Lev MH, Conklin J, Wald LL. Emerging Techniques and Future Directions: Fast and Portable Magnetic Resonance Imaging. Magn Reson Imaging Clin N Am 2022; 30:565-582. [PMID: 35995480 DOI: 10.1016/j.mric.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fast MRI and portable MRI are emerging as promising technologies to improve the speed, efficiency, and availability of MR imaging. Fast MRI methods are increasingly being adopted to create screening protocols for the diagnosis and management of acute pathology in the emergency department. Faster imaging can facilitate timely diagnosis, reduce motion artifacts, and improve departmental MR operations. Point-of-care and portable MRI are emerging technologies that require radiologists to reenvision the role of MRI as a tool with greater accessibility, fewer siting constraints, and the ability to provide valuable diagnostic information at the bedside. Recently introduced commercially available pulse sequences and new MRI scanners are bringing these technologies closer to the patient's clinical setting, and we expect their use to only increase over the coming decade. This article provides an overview of these emerging technologies for emergency radiologists.
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Affiliation(s)
- Min Lang
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Susie Huang
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Athinoula A. Martinos Center for Biomedical Imaging, 149 13th Street, Charleston, MA 02129, USA
| | - Michael H Lev
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Lawrence L Wald
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Athinoula A. Martinos Center for Biomedical Imaging, 149 13th Street, Charleston, MA 02129, USA
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13
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Hwang KP, Fujita S. Synthetic MR: Physical principles, clinical implementation, and new developments. Med Phys 2022; 49:4861-4874. [PMID: 35535442 DOI: 10.1002/mp.15686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 11/07/2022] Open
Abstract
Current clinical MR imaging practices rely on the qualitative assessment of images for diagnosis and treatment planning. While contrast in MR images is dependent on the spin parameters of the imaged tissue, pixel values on MR images are relative and are not scaled to represent any tissue properties. Synthetic MR is a fully featured imaging workflow consisting of efficient multiparameter mapping acquisition, synthetic image generation, and volume quantitation of brain tissues. As the application becomes more widely available on multiple vendors and scanner platforms, it has also gained widespread adoption as clinicians begin to recognize the benefits of rapid quantitation. This review will provide details about the sequence with a focus on the physical principles behind its relaxometry mechanisms. It will present an overview of the products in their current form and some potential issues when implementing it in the clinic. It will conclude by highlighting some recent advances of the technique, including a 3D mapping method and its associated applications. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ken-Pin Hwang
- Department of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030
| | - Shohei Fujita
- Department of Radiology, Graduate School of Medicine, The University of Tokyo.,Department of Radiology, Juntendo University, Tokyo, Japan
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14
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Conklin J, Tabari A, Longo MGF, Cobos CJ, Setsompop K, Cauley SF, Kirsch JE, Huang SY, Rapalino O, Gee MS, Caruso PJ. Evaluation of highly accelerated wave controlled aliasing in parallel imaging (Wave-CAIPI) susceptibility-weighted imaging in the non-sedated pediatric setting: a pilot study. Pediatr Radiol 2022; 52:1115-1124. [PMID: 35119490 DOI: 10.1007/s00247-021-05273-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/28/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Susceptibility-weighted imaging (SWI) is highly sensitive for intracranial hemorrhagic and mineralized lesions but is associated with long scan times. Wave controlled aliasing in parallel imaging (Wave-CAIPI) enables greater acceleration factors and might facilitate broader application of SWI, especially in motion-prone populations. OBJECTIVE To compare highly accelerated Wave-CAIPI SWI to standard SWI in the non-sedated pediatric outpatient setting, with respect to the following variables: estimated scan time, image noise, artifacts, visualization of normal anatomy and visualization of pathology. MATERIALS AND METHODS Twenty-eight children (11 girls, 17 boys; mean age ± standard deviation [SD] = 128.3±62 months) underwent 3-tesla (T) brain MRI, including standard three-dimensional (3-D) SWI sequence followed by a highly accelerated Wave-CAIPI SWI sequence for each subject. We rated all studies using a predefined 5-point scale and used the Wilcoxon signed rank test to assess the difference for each variable between sequences. RESULTS Wave-CAIPI SWI provided a 78% and 67% reduction in estimated scan time using the 32- and 20-channel coils, respectively, corresponding to estimated scan time reductions of 3.5 min and 3 min, respectively. All 28 children were imaged without anesthesia. Inter-reader agreement ranged from fair to substantial (k=0.67 for evaluation of pathology, 0.55 for anatomical contrast, 0.3 for central noise, and 0.71 for artifacts). Image noise was rated higher in the central brain with wave SWI (P<0.01), but not in the peripheral brain. There was no significant difference in the visualization of normal anatomical structures and visualization of pathology between the standard and wave SWI sequences (P=0.77 and P=0.79, respectively). CONCLUSION Highly accelerated Wave-CAIPI SWI of the brain can provide similar image quality to standard SWI, with estimated scan time reduction of 3-3.5 min depending on the radiofrequency coil used, with fewer motion artifacts, at a cost of mild but perceptibly increased noise in the central brain.
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Affiliation(s)
- John Conklin
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Azadeh Tabari
- Harvard Medical School, Boston, MA, USA. .,Division of Pediatric Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
| | - Maria Gabriela Figueiro Longo
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Camilo Jaimes Cobos
- Harvard Medical School, Boston, MA, USA.,Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Kawin Setsompop
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Stephen F Cauley
- Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - John E Kirsch
- Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Susie Yi Huang
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Otto Rapalino
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael S Gee
- Harvard Medical School, Boston, MA, USA.,Division of Pediatric Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Paul J Caruso
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Pediatric Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
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15
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Gómez-Ramírez J, Fernández-Blázquez MA, González-Rosa JJ. Prediction of Chronological Age in Healthy Elderly Subjects with Machine Learning from MRI Brain Segmentation and Cortical Parcellation. Brain Sci 2022; 12:brainsci12050579. [PMID: 35624966 PMCID: PMC9139275 DOI: 10.3390/brainsci12050579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 01/11/2023] Open
Abstract
Normal aging is associated with changes in volumetric indices of brain atrophy. A quantitative understanding of age-related brain changes can shed light on successful aging. To investigate the effect of age on global and regional brain volumes and cortical thickness, 3514 magnetic resonance imaging scans were analyzed using automated brain segmentation and parcellation methods in elderly healthy individuals (69–88 years of age). The machine learning algorithm extreme gradient boosting (XGBoost) achieved a mean absolute error of 2 years in predicting the age of new subjects. Feature importance analysis showed that the brain-to-intracranial-volume ratio is the most important feature in predicting age, followed by the hippocampi volumes. The cortical thickness in temporal and parietal lobes showed a superior predictive value than frontal and occipital lobes. Insights from this approach that integrate model prediction and interpretation may help to shorten the current explanatory gap between chronological age and biological brain age.
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Affiliation(s)
- Jaime Gómez-Ramírez
- Institute of Biomedical Research Cadiz (INiBICA), Universidad de Cádiz, 11003 Cádiz, Spain;
- Correspondence:
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16
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Jabłoński B, Gójska-Grymajło A, Ossowska D, Szurowska E, Wyszomirski A, Rojek B, Karaszewski B. New Remote Cerebral Microbleeds on T2 *-Weighted Echo Planar MRI After Intravenous Thrombolysis for Acute Ischemic Stroke. Front Neurol 2022; 12:744701. [PMID: 35242092 PMCID: PMC8886895 DOI: 10.3389/fneur.2021.744701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background The main and well-defined complication of intravenous administration of recombinant tissue plasminogen activator (tPA) in patients with acute ischemic stroke (AIS) is symptomatic intracranial hemorrhage (sICH). However, rtPA might also be connected with the formation of cerebral microbleeds (CMBs), located remotely from the ischemic lesions, that may remain clinically silent. This association might be important because the load of CMBs has been associated with cognitive impairment. We investigated whether administration of rtPA in AIS results in the appearance of new CMBs and if the initial load of CMBs is associated with hemorrhagic transformation. Methods A total of fifty-nine consecutive patients with AIS treated with rtPA underwent MRI including T2*-weighted Echo Planar Imaging (T2*-EPI) shortly before and 7–9 days after rtPA administration. We calculated the load of new CMBs located outside the MR diffusion restriction area in the follow-up imaging and assessed hemorrhagic transformation with ECASS-II scoring. Results A total of forty-nine patients were included for the final analysis. On initial T2*-EPI-GRE, 37 baseline microbleeds (CMBs) were observed in 14 patients (28.6%). On follow-up T2*-EPI-GRE amount of CMBs increased to a total number of 103. New CMBs were found in 5 (14.3%) of 35 patients without and in 9 (64.3%) of 14 with any baseline CMBs. Multiple logistic regression analysis indicated that presence of baseline CMBs (risk ratio [RR] 5.95, 95% CI 2.69–13.20, p < 0.001) and lower platelets level (risk ratio [RR] 0.992, 95% CI 0.986–0.998, p = 0.007) were independently associated with new CMBs. The baseline load of CMBs was not associated with the risk of hemorrhagic transformation. Conclusion In this study, new CMBs were found in nearly 30% of patients with AIS on the 7–9 days after rtPA treatment. Baseline CMBs correlated with a higher risk of new CMBs appearing after the rtPA treatment, independently of other factors. At the same time, in our sample, baseline CMBs did not correlate with an increased risk of hemorrhagic transformation. Since the associations between the CMBs load and cognitive impairment have already been proved, further studies are warranted to investigate possible associations between the thrombolytic treatment of patients with AIS, mainly those with baseline CMBs, and the risk of earlier cognitive decline.
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Affiliation(s)
- Bartosz Jabłoński
- Department of Adult Neurology, University Clinical Center, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Gójska-Grymajło
- Department of Adult Neurology, University Clinical Center, Medical University of Gdańsk, Gdańsk, Poland
| | - Daria Ossowska
- Department of Adult Neurology, University Clinical Center, Medical University of Gdańsk, Gdańsk, Poland.,II Department of Radiology, Medical University of Gdańsk, Department of Radiology, University Clinical Centre, Gdańsk, Poland
| | - Edyta Szurowska
- II Department of Radiology, Medical University of Gdańsk, Department of Radiology, University Clinical Centre, Gdańsk, Poland
| | - Adam Wyszomirski
- Department of Adult Neurology, University Clinical Center, Medical University of Gdańsk, Gdańsk, Poland
| | - Bartłomiej Rojek
- Department of Adult Neurology, University Clinical Center, Medical University of Gdańsk, Gdańsk, Poland
| | - Bartosz Karaszewski
- Department of Adult Neurology, University Clinical Center, Medical University of Gdańsk, Gdańsk, Poland
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17
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Af Burén S, Kits A, Lönn L, De Luca F, Sprenger T, Skare S, Falk Delgado A. A 78 Seconds Complete Brain MRI Examination in Ischemic Stroke: A Prospective Cohort Study. J Magn Reson Imaging 2022; 56:884-892. [PMID: 35170134 PMCID: PMC9544312 DOI: 10.1002/jmri.28107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Fast 78-second multicontrast echo-planar MRI (EPIMix) has shown good diagnostic performance for detecting infarctions at a comprehensive stroke center, but its diagnostic performance has not been evaluated in a prospective study at a primary stroke center. PURPOSE To prospectively determine whether EPIMix was noninferior in detecting ischemic lesions compared to routine clinical MRI. STUDY TYPE Prospective cohort study. POPULATION A total of 118 patients with acute MRI and symptoms of ischemic stroke. FIELD STRENGTH AND SEQUENCE A 3 T. EPIMix (echo-planar based: T1-FLAIR, T2-weighted, T2-FLAIR, T2*, DWI) and routine clinical MRI sequences (T1-weighted fast spin echo, T2-weighted PROPELLER, T2-weighted-FLAIR fast spin echo, T2* gradient echo echo-planar, and DWI spin echo echo-planar). ASSESSMENT Three radiologists, blinded for clinical information, assessed signs of ischemic lesions (DWI↑, ADC↓, and T2/T2-FLAIR↑) on EPIMix and routine clinical MRI, with disagreements solved in consensus with a fourth reader to establish the reference standard. STATISTICAL TESTS Diagnostic performance including sensitivity and specificity against the reference standard was evaluated. EPIMix sensitivity was tested for noninferiority compared to the reference standard using Nam's restricted maximum likelihood estimation (RMLE) Score. A P-value < 0.05 was considered statistically significant. RESULTS Of 118 patients (mean age 62 ± 16 years, 58% males), 25% (n = 30) had MRI signs of acute infarcts. EPIMix was noninferior with 97% (95% CI 83-100) sensitivity for reader 1, 100% (95% CI 88-100) sensitivity for reader 2, and 90% (95% CI 88-98) sensitivity for reader 3 vs. 93% (95% CI 78-99) sensitivity for readers 1 and 2 and 90% (95% CI 74-98) for reader 3 on routine clinical MRI. Specificity was 99% (95% CI 94-100) for reader 1, 100% (95% CI 96-100) for reader 2, and 98% (95% CI 92-100) for reader 3 on EPIMix vs. 100% (95% CI 96-100) for all readers on routine clinical MRI. CONCLUSION EPIMix was noninferior to routine clinical MRI for the diagnosis of acute ischemic stroke. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Siri Af Burén
- Department of Radiology, Capio Saint Göran Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Annika Kits
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lucas Lönn
- Department of Radiology, Capio Saint Göran Hospital, Stockholm, Sweden
| | - Francesca De Luca
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tim Sprenger
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.,MR Applied Science Laboratory Europe, GE Healthcare, Stockholm, Sweden
| | - Stefan Skare
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Falk Delgado
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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18
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Ngamsombat C, Gonçalves Filho ALM, Longo MGF, Cauley SF, Setsompop K, Kirsch JE, Tian Q, Fan Q, Polak D, Liu W, Lo WC, Gilberto González R, Schaefer PW, Rapalino O, Conklin J, Huang SY. Evaluation of Ultrafast Wave-Controlled Aliasing in Parallel Imaging 3D-FLAIR in the Visualization and Volumetric Estimation of Cerebral White Matter Lesions. AJNR Am J Neuroradiol 2021; 42:1584-1590. [PMID: 34244127 DOI: 10.3174/ajnr.a7191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/29/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to evaluate an ultrafast 3D-FLAIR sequence using Wave-controlled aliasing in parallel imaging encoding (Wave-FLAIR) compared with standard 3D-FLAIR in the visualization and volumetric estimation of cerebral white matter lesions in a clinical setting. MATERIALS AND METHODS Forty-two consecutive patients underwent 3T brain MR imaging, including standard 3D-FLAIR (acceleration factor = 2, scan time = 7 minutes 50 seconds) and resolution-matched ultrafast Wave-FLAIR sequences (acceleration factor = 6, scan time = 2 minutes 45 seconds for the 20-channel coil; acceleration factor = 9, scan time = 1 minute 50 seconds for the 32-channel coil) as part of clinical evaluation for demyelinating disease. Automated segmentation of cerebral white matter lesions was performed using the Lesion Segmentation Tool in SPM. Student t tests, intraclass correlation coefficients, relative lesion volume difference, and Dice similarity coefficients were used to compare volumetric measurements among sequences. Two blinded neuroradiologists evaluated the visualization of white matter lesions, artifacts, and overall diagnostic quality using a predefined 5-point scale. RESULTS Standard and Wave-FLAIR sequences showed excellent agreement of lesion volumes with an intraclass correlation coefficient of 0.99 and mean Dice similarity coefficient of 0.97 (SD, 0.05) (range, 0.84-0.99). Wave-FLAIR was noninferior to standard FLAIR for visualization of lesions and motion. The diagnostic quality for Wave-FLAIR was slightly greater than for standard FLAIR for infratentorial lesions (P < .001), and there were fewer pulsation artifacts on Wave-FLAIR compared with standard FLAIR (P < .001). CONCLUSIONS Ultrafast Wave-FLAIR provides superior visualization of infratentorial lesions while preserving overall diagnostic quality and yields white matter lesion volumes comparable with those estimated using standard FLAIR. The availability of ultrafast Wave-FLAIR may facilitate the greater use of 3D-FLAIR sequences in the evaluation of patients with suspected demyelinating disease.
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Affiliation(s)
- C Ngamsombat
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Department of Radiology (C.N.), Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand
| | - A L M Gonçalves Filho
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - M G F Longo
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - S F Cauley
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - K Setsompop
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology (K.S., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - J E Kirsch
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - Q Tian
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - Q Fan
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - D Polak
- Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Department of Physics and Astronomy (D.P.), Heidelberg University, Heidelberg, Germany.,Siemens Healthcare GmbH, (D.P., W.-C.L.), Erlangen, Germany
| | - W Liu
- Siemens Shenzhen Magnetic Resonance Ltd (W.L.), Shenzhen, China
| | - W-C Lo
- Siemens Healthcare GmbH, (D.P., W.-C.L.), Erlangen, Germany
| | - R Gilberto González
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - P W Schaefer
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - O Rapalino
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - J Conklin
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - S Y Huang
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.) .,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology (K.S., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
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Duan Y, Xu Z. Editorial for "One-Minute Multi-Contrast Echo Planar Brain MRI in Ischemic Stroke - A Retrospective Observational Study of Diagnostic Performance". J Magn Reson Imaging 2021; 54:1096-1097. [PMID: 33974309 DOI: 10.1002/jmri.27685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Yang Duan
- Center for Neuroimaging, Department of Radiology, the Northern Theater General Hospital, Shenyang, Liaoning Province, 110086, China
| | - Zhihua Xu
- Department of Radiology, TongDe Hospital of Zhejiang Province, Hangzhou, 310012, China
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20
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Kits A, De Luca F, Kolloch J, Müller S, Mazya MV, Skare S, Falk Delgado A. One-Minute Multi-contrast Echo Planar Brain MRI in Ischemic Stroke: A Retrospective Observational Study of Diagnostic Performance. J Magn Reson Imaging 2021; 54:1088-1095. [PMID: 33942426 DOI: 10.1002/jmri.27641] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Fast multi-contrast echo planar MRI (EPIMix) has comparable diagnostic performance to standard MRI for detecting brain pathology but its performance in detecting acute cerebral infarctions has not been determined. PURPOSE To assess the diagnostic performance of EPIMix for the detection of acute cerebral infarctions. STUDY TYPE Retrospective observational cohort. POPULATION One hundred and seventy-two consecutive patients with a clinical suspicion of non-hyperacute ischemic stroke (January 2018 to December 2019). FIELD STRENGTH AND SEQUENCE 1.5 T or 3 T. EPIMix ((echo-planar based: diffusion weighted (DWI), T2*-weighted, T2-weighted, T2- and T1-fluid attenuated inversion recovery (FLAIR) images) vs. standard MRI: echo-planar DWI, echo-planar T2*-weighted or susceptibility weighted, turbo spin-echo T2-weighted, T2- and T1-FLAIR turbo spin-echo sequences. ASSESSMENT Three neuroradiologists rated EPIMix and standard MRI on two separate occasions. Incongruent assessments were resolved in consensus with the fourth reader. The ratings included the diagnostic category (acute infarct, normal, and other pathology). Congruent diagnoses together with consensus diagnoses served as the reference standard. STATISTICAL TESTS The diagnostic performance of EPIMix and standard MRI against the reference standard was calculated by the area under the receiver operating characteristic curve (AUC) and compared by DeLong's test. Sensitivity and specificity were determined. Inter-rater agreements were evaluated by Fleiss's kappa. RESULTS Of 172 patients (61 ± 16 years, 103 men), acute infarcts were present in 80/172 (47%), normal findings in 60/172 (35%), and other pathology in 32/172 (19%). Across readers, the AUCs were .94-.95 for EPIMix and .95-.99 for standard MRI, with overlapping 95% CI (P = .02-.18). Inter-rater agreement for EPIMix was 0.90 and for standard MRI was 0.93. The sensitivity for EPIMix and standard MRI was 88-91% and 91-98%, respectively, while the specificity was 98-100% and 98-99%, both with overlapping 95% CI. CONCLUSION Multi-contrast echo planar MRI showed a high but marginally lower diagnostic performance compared to standard MRI for the detection and characterization of acute brain infarct. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Annika Kits
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Francesca De Luca
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jens Kolloch
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Susanne Müller
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Skare
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Falk Delgado
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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Ultraschnelle MRT für die neurologische Notfalldiagnostik. ROFO-FORTSCHR RONTG 2020. [DOI: 10.1055/a-1192-9695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Ultrafast Brain Magnetic Resonance Imaging in Acute Neurological Emergencies: Diagnostic Accuracy and Impact on Patient Management. Invest Radiol 2020; 55:181-189. [PMID: 31917761 DOI: 10.1097/rli.0000000000000625] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate diagnostic accuracy and impact on patient management of an ultrafast (4:33 minutes/5 sequences) brain magnetic resonance imaging (MRI) protocol for the detection of intracranial pathologies in acute neurological emergencies. MATERIALS AND METHODS Four hundred forty-nine consecutive emergency patients with acute nontraumatic neurological symptoms were evaluated for this institutional review board-approved prospective single-center trial. Sixty patients (30 female, 30 male; mean age, 61 years) with negative head CT were included and underwent emergency brain MRI at 3 T subsequent to CT. MRI included the ultrafast protocol (ultrafast-MRI; sag T1 GRE, ax T2 TSE, ax T2 TSE Flair, ax T2* EPI-GRE, ax DWI SS-EPI; TA, 5 minutes) and an equivalent standard-length protocol (TA, 15 minutes) as reference standard. Two blinded board-certified neuroradiologists independently analyzed the MRI with regard to image quality (1, nondiagnostic; 2, substantial artifacts; 3, satisfactory; 4, minor artifacts; 5, no artifacts) and intracranial pathologies. Sensitivity and specificity for the detection of intracranial pathologies were calculated accordingly. RESULTS Ninety-three additional intracranial lesions (acute ischemia, n = 21; intracranial hemorrhage/microbleeds, n = 27; edema, n = 2; white matter lesion, n = 38; chronic infarction, n = 3; others, n = 2) were detected by ultrafast-MRI, whereas 101 additional intracranial lesions were detected by the standard-length protocol (acute ischemia, n = 24; intracranial hemorrhage/microbleeds, n = 32; edema, n = 2; white matter lesion, n = 38; chronic infarction, n = 3; others, n = 2). Image quality was equivalent to the standard-length protocol. Ultrafast-MRI demonstrated high diagnostic accuracy (sensitivity, 0.939 [0.881-0.972]; specificity, 1.000 [0.895-1.000]) for the detection of intracranial pathologies. MRI led to a change in patient management in 10% compared with the initial CT. CONCLUSIONS Ultrafast-MRI enables time-optimized diagnostic workup in acute neurological emergencies at high sensitivity and specificity compared with a standard-length protocol, with direct impact on patient management. Ultrafast MRI protocols are a powerful tool in the emergency setting and may be implemented on various scanner types based on the optimization of individual acquisition parameters.
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Ahamed SH, Lee KJ, Tang PH. Role of a modified ultrafast MRI brain protocol in clinical paediatric neuroimaging. Clin Radiol 2020; 75:914-920. [PMID: 32782127 DOI: 10.1016/j.crad.2020.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022]
Abstract
AIM To establish a role for modified ultrafast magnetic resonance imaging (MRI) of the brain in clinical paediatric patients based on clinically acceptable image quality and diagnostic accuracy. MATERIALS AND METHODS A prospective study was conducted with institutional review board approval on an ultrafast MRI brain protocol consisting of sagittal T1-weighted, axial T2-weighted, axial fluid-attenuated inversion recovery (FLAIR), axial diffusion-weighted imaging (DWI), and axial T2∗-weighted sequences. Preliminary investigations revealed that the default ultrafast T2-weighted sequence was prone to pulsation artefacts. A modified ultrafast T2-weighted sequence was therefore developed to replace the default ultrafast T2-weighted sequence. Thirty-five patients with clinical indication for neuroimaging underwent ultrafast MRI, modified ultrafast T2-weighted sequence and standard MRI at 3 T. Image quality of ultrafast MRI sequences were graded as clinically "diagnostic" or "non-diagnostic" and compared against the corresponding standard MRI sequences as the reference standard. The modified ultrafast T2-weighted sequence surpassed the default ultrafast T2-weighted sequence in image quality. The ultrafast MRI protocol was therefore replaced with the modified ultrafast T2-weighted sequence creating a modified ultrafast MRI protocol. The clinical reports of modified ultrafast MRI were compared against standard MRI for diagnostic concordance, categorised further as "normal", "clinically significant", or "clinically minor" abnormalities. RESULTS Ultrafast T1-weighted, FLAIR, and DWI sequences had comparable image quality to standard MRI sequences. The ultrafast T2∗-weighted sequence had significantly higher non-diagnostic images (42.9%) compared to the standard MRI sequence (2.9%). The default ultrafast T2-weighted sequence had significantly higher non-diagnostic images compared to the modified ultrafast T2-weighted sequence and standard T2-weighted sequence (82.9%, 5.7%, 8.6%, respectively). There was 100% concordance for normal and clinically significant abnormalities and 23% discordance for clinically minor abnormalities. Modified ultrafast MRI takes 5 minutes 41 seconds compared to standard MRI time of 14 minutes 57 seconds. CONCLUSION The modified ultrafast MRI protocol for brain imaging demonstrates clinically acceptable image quality in four out of five sequences and has high accuracy in diagnosing normal and clinically significant abnormalities when compared against the standard MRI protocol for brain imaging. It could potentially benefit a select group of paediatric patients who require neuroimaging.
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Affiliation(s)
- S H Ahamed
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore.
| | - K J Lee
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A∗STAR), 11 Biopolis Way, #02-02 Helios, 138667, Singapore
| | - P H Tang
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
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Sindhura M, Rangasami R, Chandrasekharan A. Role of Ultrafast MR Imaging in Stroke Patients. J Neurosci Rural Pract 2020; 11:436-441. [PMID: 32753809 PMCID: PMC7394614 DOI: 10.1055/s-0040-1712716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objectives The aim of the study is to assess the role of ultrafast (UF) magnetic resonance (MR) sequences in stroke imaging. Material and Methods We prospectively studied 85 patients having clinical suspicion of stroke referred for MR imaging (MRI) during August 2016 to July 2018. These patients were subjected to both conventional and UF MRI sequences. The patients were divided into six categories based on the pathologies encountered. Further subclassification was done based on the size of the lesions as ≤10 mm and >10 mm as seen separately in both UF and conventional MR sequences. The number and visibility of these lesions on conventional and UF MRI were compared. The image quality of all the subjects was also compared based on a scale categorized into excellent, satisfactory, and poor. The findings on conventional and UF imaging sequences were correlated with the final clinical diagnosis arrived at the time of discharge. Results In our study comprising 85 patients, 57 showed pathologies. The patients showing pathologies were assigned into the six categories as acute infarct (34 cases), acute hemorrhagic infarct (six cases), chronic infarct (17 cases), chronic hemorrhagic infarct (four cases), subacute infarct (three cases), and chronic hemorrhage (one case). The number of lesions seen on conventional and UF sequences were the same although there was a slight decrease in the size of the lesions on UF sequences as compared with conventional counterparts. The image quality using UF sequences was better in motion prone patients while conventional imaging showed better image quality in cooperative patients. Conclusion In motion prone patients, UF sequences are a suitable alternative for conventional sequences as they help in arriving at the diagnosis in lesser time, with reasonably good image quality, and without motion artifacts. In cooperative stroke patients, it is better to use conventional MR sequences as the image quality is better.
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Affiliation(s)
- Manne Sindhura
- Department of Radiology and Imaging Sciences, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai, India
| | - Rajeswaran Rangasami
- Department of Radiology and Imaging Sciences, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai, India
| | - Anupama Chandrasekharan
- Department of Radiology and Imaging Sciences, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai, India
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One-Minute Ultrafast Brain MRI With Full Basic Sequences: Can It Be a Promising Way Forward for Pediatric Neuroimaging? AJR Am J Roentgenol 2020; 215:198-205. [PMID: 32255685 DOI: 10.2214/ajr.19.22378] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE. The long scan time of brain MRI is a major drawback that limits its clinical use for evaluating pediatric patients who are inherently prone to motion and frequently require sedatives. This study investigated the clinical feasibility of a 1-minute ultrafast brain MRI protocol in pediatric patients by assessing its image quality in comparison with that of routine brain MRI. MATERIALS AND METHODS. Twenty-three patients were enrolled who underwent 1-minute ultrafast MRI and routine brain MRI protocols including five essential sequences (T1-weighted imaging, T2-weighted imaging, DWI, FLAIR, and T2*-weighted imaging). Total scan time for the same image contrast levels was 1 minute 11 seconds for ultrafast MRI versus 9 minutes 51 seconds for routine brain MRI. Two readers independently reviewed all images from the two MRI protocols and graded the image quality on a 4-point Likert scale. The Wilcoxon signed rank test was used to compare the readers' ratings; interobserver agreement between the readers was also assessed. RESULTS. Although the mean scores of overall image quality and anatomic delineation in ultrafast brain MR images were significantly lower than those in routine brain MR images, ultrafast brain MRI showed sufficient overall image quality and anatomic delineation with more than 2 points on the 4-point scale. CONCLUSION. The 1-minute ultrafast brain MRI protocol showed at least sufficient image quality compared with routine brain MRI. Therefore, 1-minute ultrafast brain MRI can be a viable first-line neuroimaging study for pediatric patients because of its shorter scan time, absence of radiation hazard, and reduced sedation requirements.
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Jaimes C, Yang E, Connaughton P, Robson CD, Robertson RL. Diagnostic equivalency of fast T2 and FLAIR sequences for pediatric brain MRI: a pilot study. Pediatr Radiol 2020; 50:550-559. [PMID: 31863192 DOI: 10.1007/s00247-019-04584-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/21/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Faster and motion robust magnetic resonance imaging (MRI) sequences are desirable in pediatric brain MRI as they can help reduce the need for monitored anesthesia care, which is a costly and limited resource that carries medical risks. OBJECTIVE To evaluate the diagnostic equivalency of commercially available accelerated motion robust MR sequences relative to standard sequences. MATERIALS AND METHODS This was an institutional review board-approved prospective study. Subjects underwent a clinical brain MRI using conventional multiplanar images at 3 Tesla followed by fast axial T2 and FLAIR (fluid-attenuated inversion recovery) sequences optimized for an approximately 50% reduction in acquisition time. Conventional and fast images from each subject were reviewed by two blinded pediatric neuroradiologists. The readers evaluated the presence of 12 findings. Intra-observer agreement was estimated for fast versus conventional sequences. For each set of sequences, interobserver agreement calculations and chi-square tests were used to evaluate differences between fast and conventional acquisitions. An independent third reader reviewed the intra-observer discrepancies and adjudicated them as being more conspicuous on fast sequence, conventional sequence or the equivalent. The readers also were asked to rate motion artifacts with a previously validated score. RESULTS Images from 77 children (mean age: 11.3 years) were analyzed. Intra-observer agreement (fast versus conventional) ranged between 89.2% and 92.3%. Interobserver agreement ranged between 86.1% and 88.4%. Interobserver agreement was significantly higher for conventional FLAIR relative to fast FLAIR for small (<5 mm) foci of T2 in the white matter. Otherwise, interobserver agreement was not different between the fast and conventional sequences. For awake subjects, fast sequences had significantly fewer artifacts (P<0.05). CONCLUSION Conventional T2 and FLAIR sequences can be optimized to shorten acquisition while maintaining diagnostic equivalency. These faster sequences were also less susceptible to motion artifacts.
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Affiliation(s)
- Camilo Jaimes
- Division of Pediatric Neuroradiology, Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02215, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA.,Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Edward Yang
- Division of Pediatric Neuroradiology, Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02215, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | | | - Caroline D Robson
- Division of Pediatric Neuroradiology, Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02215, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Richard L Robertson
- Division of Pediatric Neuroradiology, Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02215, USA. .,Department of Radiology, Harvard Medical School, Boston, MA, USA.
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Ryu KH, Baek HJ, Skare S, Moon JI, Choi BH, Park SE, Ha JY, Kim TB, Hwang MJ, Sprenger T. Clinical Experience of 1-Minute Brain MRI Using a Multicontrast EPI Sequence in a Different Scan Environment. AJNR Am J Neuroradiol 2020; 41:424-429. [PMID: 32029473 DOI: 10.3174/ajnr.a6427] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The long scan time of MR imaging is a major drawback limiting its clinical use in neuroimaging; therefore, we aimed to investigate the clinical feasibility of a 1-minute full-brain MR imaging using a multicontrast EPI sequence on a different MR imaging scanner than the ones previously reported. MATERIALS AND METHODS We retrospectively reviewed the records of 146 patients who underwent a multicontrast EPI sequence, including T1-FLAIR, T2-FLAIR, T2WI, DWI, and T2*WI sequences. Two attending neuroradiologists assessed the image quality of each sequence to compare the multicontrast EPI sequence with routine MR imaging protocols. We used the Wilcoxon signed rank test and McNemar test to compare the 2 MR imaging protocols. RESULTS The multicontrast EPI sequence generally showed sufficient image quality of >2 points using a 4-point assessment scale. Regarding image quality and susceptibility artifacts, there was no significant difference between the multicontrast EPI sequence DWI and routine DWI (P > .05), attesting to noninferiority of the multicontrast EPI, whereas there were significant differences in the other 4 sequences between the 2 MR imaging protocols. CONCLUSIONS The multicontrast EPI sequence showed sufficient image quality for clinical use with a shorter scan time; however, it was limited by inferior image quality and frequent susceptibility artifacts compared with routine brain MR imaging. Therefore, the multicontrast EPI sequence cannot completely replace the routine MR imaging protocol at present; however, it may be a feasible option in specific clinical situations such as screening, time-critical diseases or for use with patients prone to motion.
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Affiliation(s)
- K H Ryu
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - H J Baek
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea .,Department of Radiology (H.J.B.), Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S Skare
- Department of Clinical Neuroscience (S.S., T.S.), Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology (S.S.), Karolinska University Hospital, Stockholm, Sweden
| | - J I Moon
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - B H Choi
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - S E Park
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - J Y Ha
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - T B Kim
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - M J Hwang
- MR Applications and Workflow, GE Healthcare (M.J.H.), Seoul, Republic of Korea
| | - T Sprenger
- Department of Clinical Neuroscience (S.S., T.S.), Karolinska Institute, Stockholm, Sweden.,MR Applied Science Laboratory Europe (T.S.), GE Healthcare Stockholm, Sweden
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Ma S, Nguyen CT, Han F, Wang N, Deng Z, Binesh N, Moser FG, Christodoulou AG, Li D. Three-dimensional simultaneous brain T 1 , T 2 , and ADC mapping with MR Multitasking. Magn Reson Med 2019; 84:72-88. [PMID: 31765496 DOI: 10.1002/mrm.28092] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/01/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To develop a simultaneous T1 , T2 , and ADC mapping method that provides co-registered, distortion-free images and enables multiparametric quantification of 3D brain coverage in a clinically feasible scan time with the MR Multitasking framework. METHODS The T1 /T2 /diffusion weighting was generated by a series of T2 preparations and diffusion preparations. The underlying multidimensional image containing 3 spatial dimensions, 1 T1 weighting dimension, 1 T2 -preparation duration dimension, 1 b-value dimension, and 1 diffusion direction dimension was modeled as a 5-way low-rank tensor. A separate real-time low-rank model incorporating time-resolved phase correction was also used to compensate for both inter-shot and intra-shot phase inconsistency induced by physiological motion. The proposed method was validated on both phantom and 16 healthy subjects. The quantification of T1 /T2 /ADC was evaluated for each case. Three post-surgery brain tumor patients were scanned for demonstration of clinical feasibility. RESULTS Multitasking T1 /T2 /ADC maps were perfectly co-registered and free from image distortion. Phantom studies showed substantial quantitative agreement ( R 2 = 0.999 ) with reference protocols for T1 /T2 /ADC. In vivo studies showed nonsignificant T1 (P = .248), T2 (P = .97), ADC (P = .328) differences among the frontal, parietal, and occipital regions. Although Multitasking showed significant differences of T1 (P = .03), T2 (P < .001), and ADC (P = .001) biases against the references, the mean bias estimates were small (ΔT1 % < 5%, ΔT2 % < 7%, ΔADC% < 5%), with all intraclass correlation coefficients greater than 0.82 indicating "excellent" agreement. Patient studies showed that Multitasking T1 /T2 /ADC maps were consistent with the clinical qualitative images. CONCLUSION The Multitasking approach simultaneously quantifies T1 /T2 /ADC with substantial agreement with the references and is promising for clinical applications.
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Affiliation(s)
- Sen Ma
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California.,Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Christopher T Nguyen
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts
| | - Fei Han
- Siemens Healthcare, Los Angeles, California
| | - Nan Wang
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California.,Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Zixin Deng
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nader Binesh
- S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Franklin G Moser
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Debiao Li
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California.,Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Polak D, Cauley S, Huang SY, Longo MG, Conklin J, Bilgic B, Ohringer N, Raithel E, Bachert P, Wald LL, Setsompop K. Highly-accelerated volumetric brain examination using optimized wave-CAIPI encoding. J Magn Reson Imaging 2019; 50:961-974. [PMID: 30734388 PMCID: PMC6687581 DOI: 10.1002/jmri.26678] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Rapid volumetric imaging protocols could better utilize limited scanner resources. PURPOSE To develop and validate an optimized 6-minute high-resolution volumetric brain MRI examination using Wave-CAIPI encoding. STUDY TYPE Prospective. POPULATION/SUBJECTS Ten healthy subjects and 20 patients with a variety of intracranial pathologies. FIELD STRENGTH/SEQUENCE At 3 T, MPRAGE, T2 -weighted SPACE, SPACE FLAIR, and SWI were acquired at 9-fold acceleration using Wave-CAIPI and for comparison at 2-4-fold acceleration using conventional GRAPPA. ASSESSMENT Extensive simulations were performed to optimize the Wave-CAIPI protocol and minimize both g-factor noise amplification and potential T1 /T2 blurring artifacts. Moreover, refinements in the autocalibrated reconstruction of Wave-CAIPI were developed to ensure high-quality reconstructions in the presence of gradient imperfections. In a randomized and blinded fashion, three neuroradiologists assessed the diagnostic quality of the optimized 6-minute Wave-CAIPI exam and compared it to the roughly 3× slower GRAPPA accelerated protocol using both an individual and head-to-head analysis. STATISTICAL TEST A noninferiority test was used to test whether the diagnostic quality of Wave-CAIPI was noninferior to the GRAPPA acquisition, with a 15% noninferiority margin. RESULTS Among all sequences, Wave-CAIPI achieved negligible g-factor noise amplification (gavg ≤ 1.04) and burring artifacts from T1 /T2 relaxation. Improvements of our autocalibration approach for gradient imperfections enabled increased robustness to gradient mixing imperfections in tilted-field of view (FOV) prescriptions as well as variations in gradient and analog-to-digital converter (ADC) sampling rates. In the clinical evaluation, Wave-CAIPI achieved similar mean scores when compared with GRAPPA (MPRAGE: ØW = 4.03, ØG = 3.97; T2 w SPACE: ØW = 4.00, ØG = 4.00; SPACE FLAIR: ØW = 3.97, ØG = 3.97; SWI: ØW = 3.93, ØG = 3.83) and was statistically noninferior (N = 30, P < 0.05 for all sequences). DATA CONCLUSION The proposed volumetric brain exam retained comparable image quality when compared with the much longer conventional protocol. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:961-974.
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Affiliation(s)
- Daniel Polak
- Department of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Siemens Healthcare, Erlangen, Germany
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Stephen Cauley
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Susie Y Huang
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria Gabriela Longo
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Conklin
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Berkin Bilgic
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ned Ohringer
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | | | - Peter Bachert
- Department of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lawrence L Wald
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Kawin Setsompop
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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30
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Amukotuwa SA, Fischbein NJ, Albers GW, Davis S, Donnan GA, Andre JB, Bammer R. Comparison of T2*GRE and DSC-PWI for hemorrhage detection in acute ischemic stroke patients: Pooled analysis of the EPITHET, DEFUSE 2, and SENSE 3 stroke studies. Int J Stroke 2019; 15:216-225. [PMID: 31291850 DOI: 10.1177/1747493019858781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS The objective of this study was to compare the diagnostic performance of the baseline pre-contrast images of dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) with conventional T2*gradient recalled echo (GRE) imaging for detection of hemorrhage in acute ischemic stroke patients. MATERIAL AND METHODS T2*GRE and DSC-PWI from 393 magnetic resonance imaging scans from 221 patients enrolled in three prospective stroke studies were independently evaluated by two readers blinded to clinical and other imaging data. Agreement between T2*GRE and DSC-PWI for the presence of hemorrhage, and acute hemorrhagic transformation, was assessed using the kappa statistic. Inter-reader agreement was also assessed using the kappa statistic. RESULTS Agreement between the baseline images of DSC-PWI and T2*GRE regarding the presence of hemorrhage was almost perfect (kreader 1 : 0.90, 95% confidence interval 0.86-0.95 and kreader 2 : 0.91, 95% confidence interval 0.87-0.96). Agreement between the sequences was still higher for detection of acute hemorrhagic transformation (kreader 1 : 0.94, 95% confidence interval 0.91-0.98 and kreader 2 : 0.95, 95% confidence interval 0.92-0.98). Inter-reader agreement for detection of hemorrhage was also almost perfect for both T2*GRE (k: 0.95, 95% confidence interval 0.91-0.98) and DSC-PWI (k: 0.96, 95% confidence interval 0.93-0.99). Acute hemorrhagic transformation detected on T2*GRE was missed on DSC-PWI by one or both readers in 5/393 (1.3%) scans. CONCLUSION The almost perfect statistical agreement between DSC-PWI and conventional T2*GRE suggests that DSC-PWI is sufficient for hemorrhage screening prior to thrombolysis in stroke patients. T2*GRE can therefore be omitted when DSC-PWI is included, thereby shortening the acute ischemic stroke magnetic resonance imaging protocol and expediting treatment. Trial registration: ClinicalTrials.gov Identifier: NCT02586415.
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Affiliation(s)
- Shalini A Amukotuwa
- Department of Radiology, University of Melbourne, Melbourne, Victoria, Australia.,Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | | | - Gregory W Albers
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephen Davis
- Department of Neurology, University of Melbourne, Parkville, Victoria, Australia
| | - Geoffrey A Donnan
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jalal B Andre
- Department of Radiology and Imaging Services, University of Washington Medical Center, Seattle, WA, USA
| | - Roland Bammer
- Department of Radiology, Stanford University, Stanford, CA, USA.,Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
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Abstract
OBJECTIVE. The purposes of this article are to describe implementation of an abbreviated brain MRI protocol for use in children with primary headache and to present an experience with the adaptation of the protocol in practice, work flow integration, and effects on sedation use. CONCLUSION. The abbreviated brain MRI protocol reduced the need for sedation for 74% of the study sample. Use of this protocol in this particular patient population continues, but further validation is required before its use is expanded to other pediatric populations.
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Delgado AF, Kits A, Bystam J, Kaijser M, Skorpil M, Sprenger T, Skare S. Diagnostic performance of a new multicontrast one‐minute full brain exam (EPIMix) in neuroradiology: A prospective study. J Magn Reson Imaging 2019; 50:1824-1833. [DOI: 10.1002/jmri.26742] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/21/2019] [Accepted: 03/21/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Anna F. Delgado
- Department of Clinical NeuroscienceKarolinska Institutet Stockholm Sweden
- Department of NeuroradiologyKarolinska University Hospital Stockholm Sweden
| | - Annika Kits
- Department of NeuroradiologyKarolinska University Hospital Stockholm Sweden
| | - Jessica Bystam
- Department of NeuroradiologyKarolinska University Hospital Stockholm Sweden
| | - Magnus Kaijser
- Department of NeuroradiologyKarolinska University Hospital Stockholm Sweden
- Department of Medicine, SolnaKarolinska Institutet Stockholm Sweden
| | - Mikael Skorpil
- Department of NeuroradiologyKarolinska University Hospital Stockholm Sweden
- Department of Molecular Medicine and SurgeryKarolinska Institutet Stockholm Sweden
| | - Tim Sprenger
- Department of Clinical NeuroscienceKarolinska Institutet Stockholm Sweden
- MR Applied Science Laboratory EuropeGE Healthcare Stockholm Sweden
| | - Stefan Skare
- Department of Clinical NeuroscienceKarolinska Institutet Stockholm Sweden
- Department of NeuroradiologyKarolinska University Hospital Stockholm Sweden
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Sarma A, Poussaint TY. Indications and Imaging Modality of Choice in Pediatric Headache. Neuroimaging Clin N Am 2019; 29:271-289. [PMID: 30926117 DOI: 10.1016/j.nic.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pediatric headache is a common problem, with various underlying causes. Appropriate patient selection for neuroimaging is necessary to optimize the clinical evaluation. This review aims to provide a focused discussion of the clinical evaluation of children with headache, including published guidelines pertaining to neuroimaging, technical considerations for neuroimaging, and tailoring of examinations for specific clinical entities known to cause pediatric headache.
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Affiliation(s)
- Asha Sarma
- Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 2200 Children's Way, Suite 1421, Nashville, TN 37232-9700, USA.
| | - Tina Young Poussaint
- Department of Radiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02130, USA
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Avey GD, Belden DS, Zea RD, Yu JPJ. Factors predicting the time-length variability of identically protocoled MRI exams. J Magn Reson Imaging 2019; 49:e265-e270. [PMID: 30637838 DOI: 10.1002/jmri.26591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/15/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Clinical variability in MRI exam durations can impede efficient MRI utilization. There is a paucity of data regarding the degree of variability of identically protocoled MRI studies and when nontechnological factors contribute to time-length variations in MRI exams. PURPOSE To measure the magnitude of variation in MRI exam duration for identically protocoled MRI exams and to identify potential contributors to variations in MRI exam times. STUDY TYPE Retrospective. SUBJECTS 2705 identically protocoled MRI examinations of the cervical spine without contrast, comprehensive stroke exams, and comprehensive brain examinations performed on adult patients from June 30, 2016 through June 30, 2017. ASSESSMENT MRI exam duration was obtained directly from the image data. Potential predictors for exam length variability were evaluated including patient age, patient gender, performing technologist, patient status (inpatient/outpatient/emergency department), MRI field strength, use of sedation, day of week, and the time of day. STATISTICAL TESTS Linear regression analysis was performed for each individual variable after correcting for the MRI exam type. A multivariate mixed model was generated to assess for independent associations between the predictors and exam duration. RESULTS There was substantial variability in the duration of the selected clinical MRI exams, with standard deviations (SDs) ranging between 19% and 29% of the mean exam length for each individual type of exam. The performing technologist was the most significant identified factor contributing to this variation in exam length; SD = 2.645 (P < 0.001). Compared with outpatient exams, inpatient exams required 4.18 minutes longer to complete (P < 0.001), and emergency department studies 1.86 minutes longer (P = 0.005). Male gender was associated with an additional 1.36 minutes of exam time (P < 0.001). DATA CONCLUSION Nontechnical factors are associated with substantial variation in MRI exam times. These variations can be predicted based on relatively simple clinical and demographic factors, with implications for MRI exam scheduling, protocol design, staff training, and workflow design. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2019.
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Affiliation(s)
- Gregory D Avey
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Daryn S Belden
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ryan D Zea
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - John-Paul J Yu
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Ryu KH, Choi DS, Baek HJ, Cho SB, Ha JY, Kim TB, Hwang MJ. Clinical feasibility of 1-min ultrafast brain MRI compared with routine brain MRI using synthetic MRI: a single center pilot study. J Neurol 2018; 266:431-439. [DOI: 10.1007/s00415-018-9149-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 12/24/2022]
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Sum MY, Low K, Tang PH. General anesthesia / sedation requirement influences the way MRI brain scans are ordered in a tertiary pediatric hospital. J Magn Reson Imaging 2018; 49:e250-e255. [PMID: 30390374 DOI: 10.1002/jmri.26551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND MRI guidelines have been created to help clinicians order scans appropriately. Some scans in children are carried out under general anesthesia (GA) / sedation. PURPOSE To evaluate if the requirement for GA/sedation influences the way MRI brain scans are ordered. STUDY TYPE Retrospective. POPULATION Children with MRI brain scans in 2015 to 2017. FIELD STRENGTH 3T, 1.5T. ASSESSMENT Institutional Review Board approval for waiver of consent was obtained. Clinical MRI brain reports for children were classified into whether they conformed to the American College of Radiology (ACR) 2013 guidelines by research assistants under supervision of a pediatric radiologist. Scans were sorted into those with normal brains or abnormality. STATISTICAL TEST The statistical difference between groups was assessed using t-test for continuous variables and chi-square test for categorical variables with IBM SPSS 19. RESULTS Of the total 1893 MRI scans, 431 were performed under GA and six under sedation. Of the 431 cases performed under GA/sedation, 383 (87.6%) were ordered according to guidelines. Of the 1456 cases that did not require GA/sedation, 710 (48.8%) conformed to guidelines. The percentage of scans ordered according to guidelines was 38.8% higher in those who had scans performed under GA/sedation (P < 0.001). MRI scans were normal in 635 (58.0%) out of the 1093 cases ordered according to guidelines and normal in 638 (79.8%) out of the 800 cases that did not follow guidelines. Scans not ordered according to guidelines had higher proportion of normal scans (21.8%) compared with those ordered according to guidelines (P < 0.001). DATA CONCLUSION Higher adherence to imaging guidelines is seen in younger patients who were exposed to the risks of GA/sedation for the MRI. Scans not adhering to guidelines had a higher percentage of having no brain abnormality detected. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2019;49:e250-e255.
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Affiliation(s)
- Min Yi Sum
- Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, Singapore
| | - Kathy Low
- Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, Singapore
| | - Phua Hwee Tang
- Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, Singapore
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38
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Zacà D, Hasson U, Minati L, Jovicich J. Method for retrospective estimation of natural head movement during structural MRI. J Magn Reson Imaging 2018; 48:927-937. [PMID: 29393987 DOI: 10.1002/jmri.25959] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/16/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Head motion during brain structural MRI scans biases brain morphometry measurements but quantitative retrospective methods estimating head motion from structural MRI have not been evaluated. PURPOSE To verify the hypothesis that two metrics retrospectively computed from MR images: 1) average edge strength (AES, reduced with image blurring) and 2) entropy (ENT, increased with blurring and ringing artifacts) could be sensitive to in-scanner head motion during acquisition of T1 -weighted MR images. STUDY TYPE Retrospective. POPULATION/SUBJECTS/PHANTOM/SPECIMEN/ANIMAL MODEL In all, 83 healthy control (HC) and 120 Parkinson's disease (PD) patients. FIELD STRENGTH/SEQUENCE 3D magnetization-prepared rapid gradient-echo (MPRAGE) images at 3T. ASSESSMENT We 1) compared AES and ENT distribution between HC and PD; 2) evaluated the correlation between tremor score (TS) and AES (or ENT) in PD; and 3) investigated cortical regions showing an association between AES (or ENT) and local and network-level covariance measures of cortical thickness (CT), gray to white matter contrast (GWC) and gray matter density maps (GMx). STATISTICAL TESTS 1) Student's t-test. 2) Spearman's rank correlation. 3) General linear model and partial least square analysis. RESULTS AES, but not ENT, differentiated HC and PD (P = 0.02, HC median AES = 39.8, interquartile range = 9.8, PD median AES = 37.6, interquartile range = 8.1). In PD, AES correlated negatively with TS (ρ = -0.21, P = 0.02) and showed a significant relationship (|Z| >3, P < 0.001) with structural covariance of CT and GWC in 54 out of 68 cortical regions. DATA CONCLUSION In clinical populations prone to head motion, AES can provide a reliable retrospective index of motion during structural scans, identifying brain areas whose morphometric measures covary with motion. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:927-937.
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Affiliation(s)
- Domenico Zacà
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy
| | - Uri Hasson
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy
| | - Ludovico Minati
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy
| | - Jorge Jovicich
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy
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Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, Bragge P, Brazinova A, Büki A, Chesnut RM, Citerio G, Coburn M, Cooper DJ, Crowder AT, Czeiter E, Czosnyka M, Diaz-Arrastia R, Dreier JP, Duhaime AC, Ercole A, van Essen TA, Feigin VL, Gao G, Giacino J, Gonzalez-Lara LE, Gruen RL, Gupta D, Hartings JA, Hill S, Jiang JY, Ketharanathan N, Kompanje EJO, Lanyon L, Laureys S, Lecky F, Levin H, Lingsma HF, Maegele M, Majdan M, Manley G, Marsteller J, Mascia L, McFadyen C, Mondello S, Newcombe V, Palotie A, Parizel PM, Peul W, Piercy J, Polinder S, Puybasset L, Rasmussen TE, Rossaint R, Smielewski P, Söderberg J, Stanworth SJ, Stein MB, von Steinbüchel N, Stewart W, Steyerberg EW, Stocchetti N, Synnot A, Te Ao B, Tenovuo O, Theadom A, Tibboel D, Videtta W, Wang KKW, Williams WH, Wilson L, Yaffe K, Adams H, Agnoletti V, Allanson J, Amrein K, Andaluz N, Anke A, Antoni A, van As AB, Audibert G, Azaševac A, Azouvi P, Azzolini ML, Baciu C, Badenes R, Barlow KM, Bartels R, Bauerfeind U, Beauchamp M, Beer D, Beer R, Belda FJ, Bellander BM, Bellier R, Benali H, Benard T, Beqiri V, Beretta L, Bernard F, Bertolini G, Bilotta F, Blaabjerg M, den Boogert H, Boutis K, Bouzat P, Brooks B, Brorsson C, Bullinger M, Burns E, Calappi E, Cameron P, Carise E, Castaño-León AM, Causin F, Chevallard G, Chieregato A, Christie B, Cnossen M, Coles J, Collett J, Della Corte F, Craig W, Csato G, Csomos A, Curry N, Dahyot-Fizelier C, Dawes H, DeMatteo C, Depreitere B, Dewey D, van Dijck J, Đilvesi Đ, Dippel D, Dizdarevic K, Donoghue E, Duek O, Dulière GL, Dzeko A, Eapen G, Emery CA, English S, Esser P, Ezer E, Fabricius M, Feng J, Fergusson D, Figaji A, Fleming J, Foks K, Francony G, Freedman S, Freo U, Frisvold SK, Gagnon I, Galanaud D, Gantner D, Giraud B, Glocker B, Golubovic J, Gómez López PA, Gordon WA, Gradisek P, Gravel J, Griesdale D, Grossi F, Haagsma JA, Håberg AK, Haitsma I, Van Hecke W, Helbok R, Helseth E, van Heugten C, Hoedemaekers C, Höfer S, Horton L, Hui J, Huijben JA, Hutchinson PJ, Jacobs B, van der Jagt M, Jankowski S, Janssens K, Jelaca B, Jones KM, Kamnitsas K, Kaps R, Karan M, Katila A, Kaukonen KM, De Keyser V, Kivisaari R, Kolias AG, Kolumbán B, Kolundžija K, Kondziella D, Koskinen LO, Kovács N, Kramer A, Kutsogiannis D, Kyprianou T, Lagares A, Lamontagne F, Latini R, Lauzier F, Lazar I, Ledig C, Lefering R, Legrand V, Levi L, Lightfoot R, Lozano A, MacDonald S, Major S, Manara A, Manhes P, Maréchal H, Martino C, Masala A, Masson S, Mattern J, McFadyen B, McMahon C, Meade M, Melegh B, Menovsky T, Moore L, Morgado Correia M, Morganti-Kossmann MC, Muehlan H, Mukherjee P, Murray L, van der Naalt J, Negru A, Nelson D, Nieboer D, Noirhomme Q, Nyirádi J, Oddo M, Okonkwo DO, Oldenbeuving AW, Ortolano F, Osmond M, Payen JF, Perlbarg V, Persona P, Pichon N, Piippo-Karjalainen A, Pili-Floury S, Pirinen M, Ple H, Poca MA, Posti J, Van Praag D, Ptito A, Radoi A, Ragauskas A, Raj R, Real RGL, Reed N, Rhodes J, Robertson C, Rocka S, Røe C, Røise O, Roks G, Rosand J, Rosenfeld JV, Rosenlund C, Rosenthal G, Rossi S, Rueckert D, de Ruiter GCW, Sacchi M, Sahakian BJ, Sahuquillo J, Sakowitz O, Salvato G, Sánchez-Porras R, Sándor J, Sangha G, Schäfer N, Schmidt S, Schneider KJ, Schnyer D, Schöhl H, Schoonman GG, Schou RF, Sir Ö, Skandsen T, Smeets D, Sorinola A, Stamatakis E, Stevanovic A, Stevens RD, Sundström N, Taccone FS, Takala R, Tanskanen P, Taylor MS, Telgmann R, Temkin N, Teodorani G, Thomas M, Tolias CM, Trapani T, Turgeon A, Vajkoczy P, Valadka AB, Valeinis E, Vallance S, Vámos Z, Vargiolu A, Vega E, Verheyden J, Vik A, Vilcinis R, Vleggeert-Lankamp C, Vogt L, Volovici V, Voormolen DC, Vulekovic P, Vande Vyvere T, Van Waesberghe J, Wessels L, Wildschut E, Williams G, Winkler MKL, Wolf S, Wood G, Xirouchaki N, Younsi A, Zaaroor M, Zelinkova V, Zemek R, Zumbo F. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol 2017; 16:987-1048. [DOI: 10.1016/s1474-4422(17)30371-x] [Citation(s) in RCA: 822] [Impact Index Per Article: 117.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/06/2017] [Accepted: 09/27/2017] [Indexed: 12/11/2022]
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Fagundes J, Longo MG, Huang SY, Rosen BR, Witzel T, Heberlein K, Gonzalez RG, Schaefer P, Rapalino O. Diagnostic Performance of a 10-Minute Gadolinium-Enhanced Brain MRI Protocol Compared with the Standard Clinical Protocol for Detection of Intracranial Enhancing Lesions. AJNR Am J Neuroradiol 2017; 38:1689-1694. [PMID: 28705816 DOI: 10.3174/ajnr.a5293] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/12/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The development of new MR imaging scanners with stronger gradients and improvement in coil technology, allied with emerging fast imaging techniques, has allowed a substantial reduction in MR imaging scan times. Our goal was to develop a 10-minute gadolinium-enhanced brain MR imaging protocol with accelerated sequences and to evaluate its diagnostic performance compared with the standard clinical protocol. MATERIALS AND METHODS Fifty-three patients referred for brain MR imaging with contrast were scanned with a 3T scanner. Each MR image consisted of 5 basic fast precontrast sequences plus standard and accelerated versions of the same postcontrast T1WI sequences. Two neuroradiologists assessed the image quality and the final diagnosis for each set of postcontrast sequences and compared their performances. RESULTS The acquisition time of the combined accelerated pre- and postcontrast sequences was 10 minutes and 15 seconds; and of the fast postcontrast sequences, 3 minutes and 36 seconds, 46% of the standard sequences. The 10-minute postcontrast axial T1WI had fewer image artifacts (P < .001) and better overall diagnostic quality (P < .001). Although the 10-minute MPRAGE sequence showed a tendency to have more artifacts than the standard sequence (P = .08), the overall diagnostic quality was similar (P = .66). Moreover, there was no statistically significant difference in the diagnostic performance between the protocols. The sensitivity, specificity, and accuracy values for the 10-minute protocol were 100.0%, 88.9%, and 98.1%. CONCLUSIONS The 10-minute brain MR imaging protocol with contrast is comparable in diagnostic performance with the standard protocol in an inpatient motion-prone population, with the additional benefits of reducing acquisition times and image artifacts.
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Affiliation(s)
- J Fagundes
- From the Clínica de Diagnóstico por Imagem (J.F.), Rio de Janeiro, Brazil
| | - M G Longo
- Department of Radiology (M.G.L., S.Y.H., R.G.G., P.S., O.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - S Y Huang
- Department of Radiology (M.G.L., S.Y.H., R.G.G., P.S., O.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - B R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging (B.R.R., T.W.), Charlestown, Massachusetts
| | - T Witzel
- Athinoula A. Martinos Center for Biomedical Imaging (B.R.R., T.W.), Charlestown, Massachusetts
| | - K Heberlein
- Siemens Medical Solutions (K.H.), Malvern, Pennsylvania
| | - R G Gonzalez
- Department of Radiology (M.G.L., S.Y.H., R.G.G., P.S., O.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - P Schaefer
- Department of Radiology (M.G.L., S.Y.H., R.G.G., P.S., O.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - O Rapalino
- Department of Radiology (M.G.L., S.Y.H., R.G.G., P.S., O.R.), Massachusetts General Hospital, Boston, Massachusetts
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