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Balaji S, Wiley N, Poorman ME, Kolind SH. Low-field MRI for use in neurological diseases. Curr Opin Neurol 2024:00019052-990000000-00168. [PMID: 38813835 DOI: 10.1097/wco.0000000000001282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE OF REVIEW To review recent clinical uses of low-field magnetic resonance imaging (MRI) to guide incorporation into neurological practice. RECENT FINDINGS Use of low-field MRI has been demonstrated in applications including tumours, vascular pathologies, multiple sclerosis, brain injury, and paediatrics. Safety, workflow, and image quality have also been evaluated. SUMMARY Low-field MRI has the potential to increase access to critical brain imaging for patients who otherwise may not obtain imaging in a timely manner. This includes areas such as the intensive care unit and emergency room, where patients could be imaged at the point of care rather than be transported to the MRI scanner. Such systems are often more affordable than conventional systems, allowing them to be more easily deployed in resource constrained settings. A variety of systems are available on the market or in a research setting and are currently being used to determine clinical uses for these devices. The utility of such devices must be fully evaluated in clinical scenarios before adoption into standard practice can be achieved. This review summarizes recent clinical uses of low-field MR as well as safety, workflows, and image quality to aid practitioners in assessing this new technology.
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Affiliation(s)
- Sharada Balaji
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neale Wiley
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Shannon H Kolind
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine (Neurology)
- Department of Radiology
- International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre, University of British Columbia, Vancouver, British Columbia, Canada
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2
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Munhall CC, Roberts DR, Labadie RF. The Use of Portable, Very Low-field (0.064T) MRI to Image Cochlear Implants: Metallic Image Artifact in Comparison to Traditional, Stationary 3T MRI. OTOLOGY & NEUROTOLOGY OPEN 2024; 4:e049. [PMID: 38533347 PMCID: PMC10962874 DOI: 10.1097/ono.0000000000000049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 01/08/2024] [Indexed: 03/28/2024]
Abstract
Objective To assess image artifact when imaging a cochlear implant (CI) with a conventional 3T MRI machine compared with a very low-field (0.064T) MRI. Patients None. Intervention Diagnostic study. Main Outcome Measure Image artifact size associated with the CI affixed to an MRI phantom at very low-field 0.064T MRI versus 3T MRI. Results The longest diameter of the image artifact was 125 mm for the 3T MRI and 86 mm for the 0.064T MRI, representing 45% longer image artifact generated in the 3T MRI. The actual volume of the imaging phantom was 1371 cm3. The volume of the image artifact was measured as 379 cm3 in the 3T MRI, representing a loss of 27.6% of the actual volume of the imaging phantom. The volume of image artifact was measured as 170 cm3 in the 0.064T MRI, representing a loss of 12.4% of the phantom volume. Conclusions 3T MRI had better image quality. This result was not surprising given that larger magnetic field strength is known to provide higher resolution. There was 15% less image artifact generated in the very low-field MRI machine compared with a conventional 3T device. And there was also subjectively increased distortion of the imaging phantom at 3T MRI compared with the 0.064T MRI. With minimized safety concerns and a much lower cost than conventional 3T machines, very low-field scanners may find expanded clinical uses. This preclinical study explores the potential utility of very low-field MRI in scanning CI recipients.
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Affiliation(s)
- Christopher C. Munhall
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Donna R. Roberts
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Robert F. Labadie
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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3
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Tabet M, Custer C, Khan IR, Sanford E, Sharma J, Choe R, Singh S, Sirsi D, Olson DM, Morriss MC, Raman L, Busch DR. Neuromonitoring of Pediatric and Adult Extracorporeal Membrane Oxygenation Patients: The Importance of Continuous Bedside Tools in Driving Neuroprotective Clinical Care. ASAIO J 2024; 70:167-176. [PMID: 38051987 DOI: 10.1097/mat.0000000000002107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a form of temporary cardiopulmonary bypass for patients with acute respiratory or cardiac failure refractory to conventional therapy. Its usage has become increasingly widespread and while reported survival after ECMO has increased in the past 25 years, the incidence of neurological injury has not declined, leading to the pressing question of how to improve time-to-detection and diagnosis of neurological injury. The neurological status of patients on ECMO is clinically difficult to evaluate due to multiple factors including illness, sedation, and pharmacological paralysis. Thus, increasing attention has been focused on developing tools and techniques to measure and monitor the brain of ECMO patients to identify dynamic risk factors and monitor patients' neurophysiological state as a function in time. Such tools may guide neuroprotective interventions and thus prevent or mitigate brain injury. Current means to continuously monitor and prevent neurological injury in ECMO patients are rather limited; most techniques provide indirect or postinsult recognition of irreversible brain injury. This review will explore the indications, advantages, and disadvantages of standard-of-care, emerging, and investigational technologies for neurological monitoring on ECMO, focusing on bedside techniques that provide continuous assessment of neurological health.
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Affiliation(s)
- Margherita Tabet
- From the Department of Anesthesiology and Pain Management, The University of Texas Southwestern medical center/Children's Medical Center, Dallas, Texas
| | - Chasity Custer
- Division of Pediatric Critical Care Medicine, UT Southwestern Medical Center/Children's Medical Center, Dallas, Texas
| | - Imad R Khan
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Ethan Sanford
- From the Department of Anesthesiology and Pain Management, The University of Texas Southwestern medical center/Children's Medical Center, Dallas, Texas
- Division of Pediatric Critical Care Medicine, UT Southwestern Medical Center/Children's Medical Center, Dallas, Texas
| | - Jayesh Sharma
- From the Department of Anesthesiology and Pain Management, The University of Texas Southwestern medical center/Children's Medical Center, Dallas, Texas
| | - Regine Choe
- Department of Biomedical Engineering, University of Rochester, Rochester, New York
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York
| | - Sumit Singh
- Department of Radiology, UT Southwestern Medical Center/Children's Medical Center, Dallas, Texas
| | - Deepa Sirsi
- Division of Pediatric Neurology, UT Southwestern Medical Center/Children's Medical Center, Dallas, Texas
| | - DaiWai M Olson
- Department of Neurology, UT Southwestern Medical Center, Dallas, Texas
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Michael Craig Morriss
- Department of Radiology, UT Southwestern Medical Center/Children's Medical Center, Dallas, Texas
| | - Lakshmi Raman
- Department of Pediatrics, The University of Texas Southwestern medical center
| | - David R Busch
- From the Department of Anesthesiology and Pain Management, The University of Texas Southwestern medical center/Children's Medical Center, Dallas, Texas
- Department of Neurology, UT Southwestern Medical Center, Dallas, Texas
- Department of Biomedical Engineering, UT Southwestern Medical Center, Dallas, Texas
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4
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Islam KT, Zhong S, Zakavi P, Chen Z, Kavnoudias H, Farquharson S, Durbridge G, Barth M, McMahon KL, Parizel PM, Dwyer A, Egan GF, Law M, Chen Z. Improving portable low-field MRI image quality through image-to-image translation using paired low- and high-field images. Sci Rep 2023; 13:21183. [PMID: 38040835 PMCID: PMC10692211 DOI: 10.1038/s41598-023-48438-1] [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] [Received: 08/22/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023] Open
Abstract
Low-field portable magnetic resonance imaging (MRI) scanners are more accessible, cost-effective, sustainable with lower carbon emissions than superconducting high-field MRI scanners. However, the images produced have relatively poor image quality, lower signal-to-noise ratio, and limited spatial resolution. This study develops and investigates an image-to-image translation deep learning model, LoHiResGAN, to enhance the quality of low-field (64mT) MRI scans and generate synthetic high-field (3T) MRI scans. We employed a paired dataset comprising T1- and T2-weighted MRI sequences from the 64mT and 3T and compared the performance of the LoHiResGAN model with other state-of-the-art models, including GANs, CycleGAN, U-Net, and cGAN. Our proposed method demonstrates superior performance in terms of image quality metrics, such as normalized root-mean-squared error, structural similarity index measure, peak signal-to-noise ratio, and perception-based image quality evaluator. Additionally, we evaluated the accuracy of brain morphometry measurements for 33 brain regions across the original 3T, 64mT, and synthetic 3T images. The results indicate that the synthetic 3T images created using our proposed LoHiResGAN model significantly improve the image quality of low-field MRI data compared to other methods (GANs, CycleGAN, U-Net, cGAN) and provide more consistent brain morphometry measurements across various brain regions in reference to 3T. Synthetic images generated by our method demonstrated high quality both quantitatively and qualitatively. However, additional research, involving diverse datasets and clinical validation, is necessary to fully understand its applicability for clinical diagnostics, especially in settings where high-field MRI scanners are less accessible.
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Affiliation(s)
- Kh Tohidul Islam
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia.
| | - Shenjun Zhong
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
- Australian National Imaging Facility, Brisbane, QLD, Australia
| | - Parisa Zakavi
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
| | - Zhifeng Chen
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
- Department of Data Science and AI, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - Helen Kavnoudias
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Radiology, Alfred Hospital, Melbourne, VIC, Australia
| | | | - Gail Durbridge
- Herston Imaging Research Facility, University of Queensland, Brisbane, QLD, Australia
| | - Markus Barth
- School of Information Technology and Electrical Engineering and Centre for Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
| | - Katie L McMahon
- School of Clinical Science, Herston Imaging Research Facility, Queensland University of Technology, Brisbane, QLD, Australia
| | - Paul M Parizel
- David Hartley Chair of Radiology, Department of Radiology, Royal Perth Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Andrew Dwyer
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Gary F Egan
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
| | - Meng Law
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Radiology, Alfred Hospital, Melbourne, VIC, Australia
| | - Zhaolin Chen
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
- Department of Data Science and AI, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
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5
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Cawley P, Padormo F, Cromb D, Almalbis J, Marenzana M, Teixeira R, Uus A, O’Muircheartaigh J, Williams SC, Counsell SJ, Arichi T, Rutherford MA, Hajnal JV, Edwards AD. Development of neonatal-specific sequences for portable ultralow field magnetic resonance brain imaging: a prospective, single-centre, cohort study. EClinicalMedicine 2023; 65:102253. [PMID: 38106560 PMCID: PMC10725077 DOI: 10.1016/j.eclinm.2023.102253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 12/19/2023] Open
Abstract
Background Magnetic Resonance (MR) imaging is key for investigation of suspected newborn brain abnormalities. Access is limited in low-resource settings and challenging in infants needing intensive care. Portable ultralow field (ULF) MRI is showing promise in bedside adult brain imaging. Use in infants and children has been limited as brain-tissue composition differences necessitate sequence modification. The aim of this study was to develop neonatal-specific ULF structural sequences and test these across a range of gestational maturities and pathologies to inform future validation studies. Methods Prospective cohort study within a UK neonatal specialist referral centre. Infants undergoing 3T MRI were recruited for paired ULF (64mT) portable MRI by convenience sampling from the neonatal unit and post-natal ward. Key inclusion criteria: 1) Infants with risk or suspicion of brain abnormality, or 2) preterm and term infants without suspicion of major genetic, chromosomal or neurological abnormality. Exclusions: presence of contra-indication for MR scanning. ULF sequence parameters were optimised for neonatal brain-tissues by iterative and explorative design. Neuroanatomic and pathologic features were compared by unblinded review, informing optimisation of subsequent sequence generations in a step-wise manner. Main outcome: visual identification of healthy and abnormal brain tissues/structures. ULF MR spectroscopy, diffusion, susceptibility weighted imaging, arteriography, and venography require pre-clinical technical development and have not been tested. Findings Between September 23, 2021 and October 25, 2022, 102 paired scans were acquired in 87 infants; 1.17 paired scans per infant. Median age 9 days, median postmenstrual age 40+2 weeks (range: 31+3-53+4). Infants had a range of intensive care requirements. No adverse events observed. Optimised ULF sequences can visualise key neuroanatomy and brain abnormalities. In finalised neonatal sequences: T2w imaging distinguished grey and white matter (7/7 infants), ventricles (7/7), pituitary tissue (5/7), corpus callosum (7/7) and optic nerves (7/7). Signal congruence was seen within the posterior limb of the internal capsule in 10/11 infants on finalised T1w scans. In addition, brain abnormalities visualised on ULF optimised sequences have similar MR signal patterns to 3T imaging, including injury secondary to infarction (6/6 infants on T2w scans), hypoxia-ischaemia (abnormal signal in basal ganglia, thalami and white matter 2/2 infants on T2w scans, cortical highlighting 1/1 infant on T1w scan), and congenital malformations: polymicrogyria 3/3, absent corpus callosum 2/2, and vermian hypoplasia 3/3 infants on T2w scans. Sequences are susceptible to motion corruption, noise, and ULF artefact. Non-identified pathologies were small or subtle. Interpretation On unblinded review, optimised portable MR can provide sufficient contrast, signal, and resolution for neuroanatomical identification and detection of a range of clinically important abnormalities. Blinded validation studies are now warranted. Funding The Bill and Melinda Gates Foundation, the MRC, the Wellcome/EPSRC Centre for Medical Engineering, the MRC Centre for Neurodevelopmental Disorders, and the National Institute for Health Research (NIHR) Biomedical Research Centres based at Guy's and St Thomas' and South London & Maudsley NHS Foundation Trusts and King's College London.
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Affiliation(s)
- Paul Cawley
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Neonatal Intensive Care Unit, Evelina Children’s Hospital London, St Thomas’ Hospital, 6th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
| | - Francesco Padormo
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Medical Physics, Guy’s & St. Thomas' NHS Foundation Trust, London, UK
- Hyperfine, Inc., 351 New Whitfield St., Guilford, Connecticut 06437, USA
| | - Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Neonatal Intensive Care Unit, Evelina Children’s Hospital London, St Thomas’ Hospital, 6th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
| | - Jennifer Almalbis
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Neonatal Intensive Care Unit, Evelina Children’s Hospital London, St Thomas’ Hospital, 6th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
| | - Massimo Marenzana
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Rui Teixeira
- Hyperfine, Inc., 351 New Whitfield St., Guilford, Connecticut 06437, USA
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Jonathan O’Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Steven C.R. Williams
- Centre for Neuroimaging Sciences, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - Serena J. Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
- Paediatric Neurosciences, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Mary A. Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
| | - Joseph V. Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - A. David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Neonatal Intensive Care Unit, Evelina Children’s Hospital London, St Thomas’ Hospital, 6th Floor North Wing, Westminster Bridge Road, London SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SE1 1UL, UK
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Foody GM. Challenges in the real world use of classification accuracy metrics: From recall and precision to the Matthews correlation coefficient. PLoS One 2023; 18:e0291908. [PMID: 37792898 PMCID: PMC10550141 DOI: 10.1371/journal.pone.0291908] [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: 05/01/2023] [Accepted: 09/07/2023] [Indexed: 10/06/2023] Open
Abstract
The accuracy of a classification is fundamental to its interpretation, use and ultimately decision making. Unfortunately, the apparent accuracy assessed can differ greatly from the true accuracy. Mis-estimation of classification accuracy metrics and associated mis-interpretations are often due to variations in prevalence and the use of an imperfect reference standard. The fundamental issues underlying the problems associated with variations in prevalence and reference standard quality are revisited here for binary classifications with particular attention focused on the use of the Matthews correlation coefficient (MCC). A key attribute claimed of the MCC is that a high value can only be attained when the classification performed well on both classes in a binary classification. However, it is shown here that the apparent magnitude of a set of popular accuracy metrics used in fields such as computer science medicine and environmental science (Recall, Precision, Specificity, Negative Predictive Value, J, F1, likelihood ratios and MCC) and one key attribute (prevalence) were all influenced greatly by variations in prevalence and use of an imperfect reference standard. Simulations using realistic values for data quality in applications such as remote sensing showed each metric varied over the range of possible prevalence and at differing levels of reference standard quality. The direction and magnitude of accuracy metric mis-estimation were a function of prevalence and the size and nature of the imperfections in the reference standard. It was evident that the apparent MCC could be substantially under- or over-estimated. Additionally, a high apparent MCC arose from an unquestionably poor classification. As with some other metrics of accuracy, the utility of the MCC may be overstated and apparent values need to be interpreted with caution. Apparent accuracy and prevalence values can be mis-leading and calls for the issues to be recognised and addressed should be heeded.
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Affiliation(s)
- Giles M. Foody
- School of Geography, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
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7
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Campbell-Washburn AE, Keenan KE, Hu P, Mugler JP, Nayak KS, Webb AG, Obungoloch J, Sheth KN, Hennig J, Rosen MS, Salameh N, Sodickson DK, Stein JM, Marques JP, Simonetti OP. Low-field MRI: A report on the 2022 ISMRM workshop. Magn Reson Med 2023; 90:1682-1694. [PMID: 37345725 PMCID: PMC10683532 DOI: 10.1002/mrm.29743] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/21/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023]
Abstract
In March 2022, the first ISMRM Workshop on Low-Field MRI was held virtually. The goals of this workshop were to discuss recent low field MRI technology including hardware and software developments, novel methodology, new contrast mechanisms, as well as the clinical translation and dissemination of these systems. The virtual Workshop was attended by 368 registrants from 24 countries, and included 34 invited talks, 100 abstract presentations, 2 panel discussions, and 2 live scanner demonstrations. Here, we report on the scientific content of the Workshop and identify the key themes that emerged. The subject matter of the Workshop reflected the ongoing developments of low-field MRI as an accessible imaging modality that may expand the usage of MRI through cost reduction, portability, and ease of installation. Many talks in this Workshop addressed the use of computational power, efficient acquisitions, and contemporary hardware to overcome the SNR limitations associated with low field strength. Participants discussed the selection of appropriate clinical applications that leverage the unique capabilities of low-field MRI within traditional radiology practices, other point-of-care settings, and the broader community. The notion of "image quality" versus "information content" was also discussed, as images from low-field portable systems that are purpose-built for clinical decision-making may not replicate the current standard of clinical imaging. Speakers also described technical challenges and infrastructure challenges related to portability and widespread dissemination, and speculated about future directions for the field to improve the technology and establish clinical value.
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Affiliation(s)
- Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kathryn E Keenan
- Physical Measurement Laboratory, National Institute of Standards and Technology, Boulder, Colorado, USA
| | - Peng Hu
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - John P Mugler
- Department of Radiology & Medical Imaging, Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Andrew G Webb
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Departments of Neurology and Neurosurgery, and the Yale Center for Brain and Mind Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jürgen Hennig
- Dept.of Radiology, Medical Physics, University Medical Center Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthew S Rosen
- Massachusetts General Hospital, A. A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts, USA
| | - Najat Salameh
- Center for Adaptable MRI Technology (AMT Center), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Daniel K Sodickson
- Department of Radiology, NYU Langone Health, New York, New York, USA
- Center for Advanced Imaging Innovation and Research, NYU Langone Health, New York, New York, USA
| | - Joel M Stein
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - José P Marques
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
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8
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Shoghli A, Chow D, Kuoy E, Yaghmai V. Current role of portable MRI in diagnosis of acute neurological conditions. Front Neurol 2023; 14:1255858. [PMID: 37840918 PMCID: PMC10576557 DOI: 10.3389/fneur.2023.1255858] [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: 07/10/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Neuroimaging is an inevitable component of the assessment of neurological emergencies. Magnetic resonance imaging (MRI) is the preferred imaging modality for detecting neurological pathologies and provides higher sensitivity than other modalities. However, difficulties such as intra-hospital transport, long exam times, and availability in strict access-controlled suites limit its utility in emergency departments and intensive care units (ICUs). The evolution of novel imaging technologies over the past decades has led to the development of portable MRI (pMRI) machines that can be deployed at point-of-care. This article reviews pMRI technologies and their clinical implications in acute neurological conditions. Benefits of pMRI include timely and accurate detection of major acute neurological pathologies such as stroke and intracranial hemorrhage. Additionally, pMRI can be potentially used to monitor the progression of neurological complications by facilitating serial measurements at the bedside.
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Affiliation(s)
| | | | | | - Vahid Yaghmai
- Department of Radiological Sciences, School of Medicine, University of California, Irvine, Irvine, CA, United States
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9
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Kimberly WT, Sorby-Adams AJ, Webb AG, Wu EX, Beekman R, Bowry R, Schiff SJ, de Havenon A, Shen FX, Sze G, Schaefer P, Iglesias JE, Rosen MS, Sheth KN. Brain imaging with portable low-field MRI. NATURE REVIEWS BIOENGINEERING 2023; 1:617-630. [PMID: 37705717 PMCID: PMC10497072 DOI: 10.1038/s44222-023-00086-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 09/15/2023]
Abstract
The advent of portable, low-field MRI (LF-MRI) heralds new opportunities in neuroimaging. Low power requirements and transportability have enabled scanning outside the controlled environment of a conventional MRI suite, enhancing access to neuroimaging for indications that are not well suited to existing technologies. Maximizing the information extracted from the reduced signal-to-noise ratio of LF-MRI is crucial to developing clinically useful diagnostic images. Progress in electromagnetic noise cancellation and machine learning reconstruction algorithms from sparse k-space data as well as new approaches to image enhancement have now enabled these advancements. Coupling technological innovation with bedside imaging creates new prospects in visualizing the healthy brain and detecting acute and chronic pathological changes. Ongoing development of hardware, improvements in pulse sequences and image reconstruction, and validation of clinical utility will continue to accelerate this field. As further innovation occurs, portable LF-MRI will facilitate the democratization of MRI and create new applications not previously feasible with conventional systems.
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Affiliation(s)
- W Taylor Kimberly
- Department of Neurology and the Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Annabel J Sorby-Adams
- Department of Neurology and the Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew G Webb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ed X Wu
- Laboratory of Biomedical Imaging and Signal Processing, Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Rachel Beekman
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale New Haven Hospital and Yale School of Medicine, Yale Center for Brain & Mind Health, New Haven, CT, USA
| | - Ritvij Bowry
- Departments of Neurosurgery and Neurology, McGovern Medical School, University of Texas Health Neurosciences, Houston, TX, USA
| | - Steven J Schiff
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Adam de Havenon
- Division of Vascular Neurology, Department of Neurology, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USA
| | - Francis X Shen
- Harvard Medical School Center for Bioethics, Harvard law School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Gordon Sze
- Department of Radiology, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USA
| | - Pamela Schaefer
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Juan Eugenio Iglesias
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Centre for Medical Image Computing, University College London, London, UK
- Computer Science and AI Laboratory, Massachusetts Institute of Technology, Boston, MA, USA
| | - Matthew S Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale New Haven Hospital and Yale School of Medicine, Yale Center for Brain & Mind Health, New Haven, CT, USA
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10
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Abbas A, Hilal K, Rasool AA, Zahidi UF, Shamim MS, Abbas Q. Low-field magnetic resonance imaging in a boy with intracranial bolt after severe traumatic brain injury: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23225. [PMID: 37392768 PMCID: PMC10555635 DOI: 10.3171/case23225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/24/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Conventional magnetic resonance imaging (cMRI) is sensitive to motion and ferromagnetic material, leading to suboptimal images and image artifacts. In many patients with neurological injuries, an intracranial bolt (ICB) is placed for monitoring intracranial pressure (ICP). Repeated imaging (computed tomography [CT] or cMRI) is frequently required to guide management. A low-field (0.064-T) portable magnetic resonance imaging (pMRI) machine may provide images in situations that were previously considered contraindications for cMRI. OBSERVATIONS A 10-year-old boy with severe traumatic brain injury was admitted to the pediatric intensive care unit, and an ICB was placed. Initial head CT showed a left-sided intraparenchymal hemorrhage with intraventricular dissection and cerebral edema with mass effect. Repeated imaging was required to assess the brain structure because of continually fluctuating ICP. Transferring the patient to the radiology suite was risky because of his critical condition and the presence of an ICB; hence, pMRI was performed at the bedside. Images obtained were of excellent quality without any ICB artifact, guiding the decision to continue to manage the patient conservatively. The child later improved and was discharged from the hospital. LESSONS pMRI can be used to obtain excellent images at the bedside in patients with an ICB, providing useful information for better management of patients with neurological injuries.
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11
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Sabir H, Kipfmueller F, Bagci S, Dresbach T, Grass T, Nitsch-Felsecker P, Pantazis C, Schmitt J, Schroeder L, Mueller A. Feasibility of bedside portable MRI in neonates and children during ECLS. Crit Care 2023; 27:134. [PMID: 37016432 PMCID: PMC10071221 DOI: 10.1186/s13054-023-04416-7] [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: 02/15/2023] [Accepted: 03/27/2023] [Indexed: 04/06/2023] Open
Abstract
Magnetic resonance imaging (MRI) is the preferred neuroimaging technique in pediatric patients. However, in neonates and instable pediatric patients accessibility to MRI is often not feasible due to instability of patients and equipment not being feasible for MRI. Low-field MRI has been shown to be a feasible neuroimaging tool in pediatric patients. We present the first four patients receiving bedside high-quality MRI during ECLS treatment. We show that it is safe and feasible to perform bedside MRI in this patient population. This opens the route to additional treatment decisions and may guide optimized treatment in these patients.
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Affiliation(s)
- Hemmen Sabir
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Florian Kipfmueller
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Soyhan Bagci
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Till Dresbach
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tamara Grass
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Patrizia Nitsch-Felsecker
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christos Pantazis
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Joachim Schmitt
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Lukas Schroeder
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Andreas Mueller
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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12
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Deoni SCL, Burton P, Beauchemin J, Cano-Lorente R, De Both MD, Johnson M, Ryan L, Huentelman MJ. Neuroimaging and verbal memory assessment in healthy aging adults using a portable low-field MRI scanner and a web-based platform: results from a proof-of-concept population-based cross-section study. Brain Struct Funct 2023; 228:493-509. [PMID: 36352153 PMCID: PMC9646260 DOI: 10.1007/s00429-022-02595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2022]
Abstract
Consumer wearables and health monitors, internet-based health and cognitive assessments, and at-home biosample (e.g., saliva and capillary blood) collection kits are increasingly used by public health researchers for large population-based studies without requiring intensive in-person visits. Alongside reduced participant time burden, remote and virtual data collection allows the participation of individuals who live long distances from hospital or university research centers, or who lack access to transportation. Unfortunately, studies that include magnetic resonance neuroimaging are challenging to perform remotely given the infrastructure requirements of MRI scanners, and, as a result, they often omit socially, economically, and educationally disadvantaged individuals. Lower field strength systems (< 100 mT) offer the potential to perform neuroimaging at a participant's home, enabling more accessible and equitable research. Here we report the first use of a low-field MRI "scan van" with an online assessment of paired-associate learning (PAL) to examine associations between brain morphometry and verbal memory performance. In a sample of 67 individuals, 18-93 years of age, imaged at or near their home, we show expected white and gray matter volume trends with age and find significant (p < 0.05 FWE) associations between PAL performance and hippocampus, amygdala, caudate, and thalamic volumes. High-quality data were acquired in 93% of individuals, and at-home scanning was preferred by all individuals with prior MRI at a hospital or research setting. Results demonstrate the feasibility of remote neuroimaging and cognitive data collection, with important implications for engaging traditionally under-represented communities in neuroimaging research.
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Affiliation(s)
- Sean C L Deoni
- Maternal, Newborn, and Child Health Discovery & Tools, Bill & Melinda Gates Foundation, 500 5th Ave, Seattle, WA, 98109, USA.
| | - Phoebe Burton
- Advanced Baby Imaging Lab, Rhode Island Hospital, Providence, RI, USA
- Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Jennifer Beauchemin
- Advanced Baby Imaging Lab, Rhode Island Hospital, Providence, RI, USA
- Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Rosa Cano-Lorente
- Advanced Baby Imaging Lab, Rhode Island Hospital, Providence, RI, USA
- Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | | | | | - Lee Ryan
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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13
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Muacevic A, Adler JR, Marino MA, Maniakhina L, Li JJ, Ku A, Ko K, Miulli DE. Utilization of Portable Brain Magnetic Resonance Imaging in an Acute Care Setting. Cureus 2022; 14:e33067. [PMID: 36726935 PMCID: PMC9886369 DOI: 10.7759/cureus.33067] [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: 11/10/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is an important noninvasive diagnostic tool used in multiple facets of medicine, especially in the assessment of the neurological system with increasing usage over the past decades. Advancement in technology has led to the creation of portable MRI (pMRI) that was cleared for use recently. Methodology A prospectively collected retrospective study was conducted at a single institution to include patients aged >18 years, admitted to the hospital, and requiring MRI for any brain pathology. pMRI was completed using portable MRI. Traditional MRI was completed with a standard 1.5T MRI, and when possible, the results of the two studies were compared. Results We obtained pMRI on 20 patients, with a total of 22 scans completed. Notably, on the pMRI, we were able to identify midline structures to determine midline shifts, identify the size of ventricles, and see large pathologies, including ischemic and hemorrhagic strokes, edema, and tumors. Patients with implants or electrodes in and around the calvarium sometimes pose challenges to image acquisition. Conclusions Portable brain MRI is a practical and useful technology that can provide immediate information about the head, especially in an acute care setting. Portable brain MRI has a lower resolution and quality of imaging compared to that of transitional MRI, and therefore, it is not a replacement for traditional MRI.
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