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Dehghani S, Shirani S, Jazayeri Gharebagh E. Enhanced Myocardial Tissue Visualization: A Comparative Cardiovascular Magnetic Resonance Study of Gradient-Spin Echo-STIR and Conventional STIR Imaging. Int J Biomed Imaging 2024; 2024:8456669. [PMID: 38590625 PMCID: PMC11001468 DOI: 10.1155/2024/8456669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose This study is aimed at evaluating the efficacy of the gradient-spin echo- (GraSE-) based short tau inversion recovery (STIR) sequence (GraSE-STIR) in cardiovascular magnetic resonance (CMR) imaging compared to the conventional turbo spin echo- (TSE-) based STIR sequence, specifically focusing on image quality, specific absorption rate (SAR), and image acquisition time. Methods In a prospective study, we examined forty-four normal volunteers and seventeen patients referred for CMR imaging using conventional STIR and GraSE-STIR techniques. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), image quality, T2 signal intensity (SI) ratio, SAR, and image acquisition time were compared between both sequences. Results GraSE-STIR showed significant improvements in image quality (4.15 ± 0.8 vs. 3.34 ± 0.9, p = 0.024) and cardiac motion artifact reduction (7 vs. 18 out of 53, p = 0.038) compared to conventional STIR. Furthermore, the acquisition time (27.17 ± 3.53 vs. 36.9 ± 4.08 seconds, p = 0.041) and the local torso SAR (<13% vs. <17%, p = 0.047) were significantly lower for GraSE-STIR compared to conventional STIR in short-axis plan. However, no significant differences were shown in T2 SI ratio (p = 0.141), SNR (p = 0.093), CNR (p = 0.068), and SAR (p = 0.071) between these two sequences. Conclusions GraSE-STIR offers notable advantages over conventional STIR sequence, with improved image quality, reduced motion artifacts, and shorter acquisition times. These findings highlight the potential of GraSE-STIR as a valuable technique for routine clinical CMR imaging.
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Affiliation(s)
- Sadegh Dehghani
- Radiation Sciences Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Shapoor Shirani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Jazayeri Gharebagh
- Radiation Sciences Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Bagnato F, Hametner S, Pennell D, Dortch R, Dula AN, Pawate S, Smith SA, Lassmann H, Gore JC, Welch EB. 7T MRI-Histologic Correlation Study of Low Specific Absorption Rate T2-Weighted GRASE Sequences in the Detection of White Matter Involvement in Multiple Sclerosis. J Neuroimaging 2015; 25:370-8. [PMID: 25898858 DOI: 10.1111/jon.12238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 02/12/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The high value of the specific absorption rate (SAR) of radio-frequency (RF) energy arising from the series of RF refocusing pulses in T2-weighted (T2-w) turbo spin echo (TSE) MRI hampers its clinical application at 7.0 Tesla (7T). T2-w gradient and spin echo (GRASE) uses the speed from gradient refocusing in combination with the chemical-shift/static magnetic field (B0) inhomogeneity insensitivity from spin-echo refocusing to acquire T2-w images with a limited number of refocusing RF pulses, thus reducing SAR. OBJECTIVES To investigate whether low SAR T2-w GRASE could replace T2-w TSE in detecting white matter (WM) disease in MS patients imaged at 7T. METHODS The .7 mm3 isotropic T2-w TSE and T2-w GRASE images with variable echo times (TEs) and echo planar imaging (EPI) factors were obtained on a 7T scanner from postmortem samples of MS brains. These samples were derived from brains of 3 female MS patients. WM lesions (WM-Ls) and normal-appearing WM (NAWM) signal intensity, WM-Ls/NAWM contrast-to-noise ratio (CNR) and MRI/myelin staining sections comparisons were obtained. RESULTS GRASE sequences with EPI factor/TE = 3/50 and 3/75 ms were comparable to the SE technique for measures of CNR in WM-Ls and NAWM and for detection of WM-Ls. In all sequences, however, identification of areas with remyelination, Wallerian degeneration, and gray matter demyelination, as depicted by myelin staining, was not possible. CONCLUSIONS T2-w GRASE images may replace T2-w TSE for clinical use. However, even at 7T, both sequences fail in detecting and characterizing MS disease beyond visible WM-Ls.
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Affiliation(s)
- Francesca Bagnato
- Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
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Mehan WA, González RG, Buchbinder BR, Chen JW, Copen WA, Gupta R, Hirsch JA, Hunter GJ, Hunter S, Johnson JM, Kelly HR, Larvie M, Lev MH, Pomerantz SR, Rapalino O, Rincon S, Romero JM, Schaefer PW, Shah V. Optimal brain MRI protocol for new neurological complaint. PLoS One 2014; 9:e110803. [PMID: 25343371 PMCID: PMC4208779 DOI: 10.1371/journal.pone.0110803] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 09/08/2014] [Indexed: 11/18/2022] Open
Abstract
Background/Purpose Patients with neurologic complaints are imaged with MRI protocols that may include many pulse sequences. It has not been documented which sequences are essential. We assessed the diagnostic accuracy of a limited number of sequences in patients with new neurologic complaints. Methods 996 consecutive brain MRI studies from patients with new neurological complaints were divided into 2 groups. In group 1, reviewers used a 3-sequence set that included sagittal T1-weighted, axial T2-weighted fluid-attenuated inversion recovery, and axial diffusion-weighted images. Subsequently, another group of studies were reviewed using axial susceptibility-weighted images in addition to the 3 sequences. The reference standard was the study's official report. Discrepancies between the limited sequence review and the reference standard including Level I findings (that may require immediate change in patient management) were identified. Results There were 84 major findings in 497 studies in group 1 with 21 not identified in the limited sequence evaluations: 12 enhancing lesions and 3 vascular abnormalities identified on MR angiography. The 3-sequence set did not reveal microhemorrhagic foci in 15 of 19 studies. There were 117 major findings in 499 studies in group 2 with 19 not identified on the 4-sequence set: 17 enhancing lesions and 2 vascular lesions identified on angiography. All 87 Level I findings were identified using limited sequence (56 acute infarcts, 16 hemorrhages, and 15 mass lesions). Conclusion A 4-pulse sequence brain MRI study is sufficient to evaluate patients with a new neurological complaint except when contrast or angiography is indicated.
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Affiliation(s)
- William A Mehan
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - R Gilberto González
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bradley R Buchbinder
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - John W Chen
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - William A Copen
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rajiv Gupta
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Joshua A Hirsch
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - George J Hunter
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Scott Hunter
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jason M Johnson
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Hillary R Kelly
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mykol Larvie
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michael H Lev
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stuart R Pomerantz
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Otto Rapalino
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sandra Rincon
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Javier M Romero
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Pamela W Schaefer
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Vinil Shah
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Saleh A, Wenserski F, Cohnen M, Fürst G, Godehardt E, Mödder U. Exclusion of brain lesions: is MR contrast medium required after a negative fluid-attenuated inversion recovery sequence? Br J Radiol 2004; 77:183-8. [PMID: 15020358 DOI: 10.1259/bjr/62546157] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We hypothesized that in patients with negative fluid-attenuated inversion recovery (FLAIR) images T(2) weighted fast spin-echo (FSE) images and T(1) weighted spin-echo (SE) images before and after intravenous administration of gadolinium-based contrast medium display no pathology either. Thus, we assessed the negative predictive value of FLAIR images to rule out MR-detectable brain lesions. 1026 consecutive cranial MR examinations were reviewed. Routine MRI of the brain included T(1) weighted coronal imaging before and after administration of gadopentetate dimeglumine, axial T(2) weighted FSE and fast-FLAIR imaging. The FLAIR images were rated by two radiologists into categories of 0 (without pathologic changes) and 1 (with pathologic changes). Two other radiologists analysed the complete examination. In 284 MR examinations of the brain no abnormalities were found (28%). FLAIR-ratings were false-negative in four cases and false-positive in 30 cases. Sensitivity and specificity of the FLAIR sequence for MR-detectable brain lesions were 99.5% and 89.4%. The unselective application of gadolinium avoided one false-negative MR-reading and improved the sensitivity of the MR-examination from 99.5% to 99.6%. Positive and negative predictive values were 96.1% and 98.4%, respectively. The interobserver reliability was kappa=0.93 for the FLAIR-readers and 0.89 for the readers who rated the complete examination. In conclusion, negative FLAIR images provide a high negative predictive value for MR-detectable brain lesions. Thus, in patients with negative FLAIR images the unselective application of gadolinium seems to be unnecessary.
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Affiliation(s)
- A Saleh
- Institute of Diagnostic Radiology, Clinic of Thoracic and Cardiovascular Surgery, University Hospital Düsseldorf, Germany
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Tomura N, Kato K, Takahashi S, Sashi R, Izumi JI, Narita K, Watarai J. Multi-shot echo-planar Flair imaging of brain tumors: comparison of spin-echo T1-weighted, fast spin-echo T2-weighted, and fast spin-echo Flair imaging. Comput Med Imaging Graph 2002; 26:65-72. [PMID: 11818186 DOI: 10.1016/s0895-6111(01)00039-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Multi-shot echo-planar fluid-attenuated inversion-recovery (EPI-Flair) was compared with spin-echo T1-weighted (SE-T1W), fast SE T2-weighted (FSE-T2W), and fast Flair (F-Flair) in imaging brain tumors. In 32 patients with various different brain tumors, three reviewers independently evaluated image quality. Two reviewers evaluated the image quality of precontrast EPI-Flair to be significantly better than that of precontrast SE-T1W. Two reviewers evaluated the image quality of postcontrast EPI-Flair as superior to that of postcontrast SE-T1W. Artifacts on postcontrast EPI-Flair were significantly more prominent than those on postcontrast F-Flair. Multi-shot EPI-Flair appeared to be superior to SE-T1W, and almost equivalent to FSE-T2W in terms of image quality.
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Affiliation(s)
- Noriaki Tomura
- Department of Radiology, Akita University School of Medicine, 1-1-1 Hondo, Akita City, 010-8543, Akita, Japan.
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Rovaris M, Filippi M. The role of magnetic resonance in the assessment of multiple sclerosis. J Neurol Sci 2000; 172 Suppl 1:S3-S12. [PMID: 10606798 DOI: 10.1016/s0022-510x(99)00270-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although the correlations between magnetic resonance imaging (MRI) findings and long-term disease evolution range from poor to moderate, conventional pre- and post-contrast MRI provides sensitive and reliable measures to monitor multiple sclerosis (MS) activity over time. MRI pulse sequences that have been recently introduced have shorter acquisition times and their use in large-scale studies can significantly decrease their costs in terms of both working load and patients' discomfort. The application of non-conventional techniques can increase the pathological specificity of MRI findings and, as a consequence, improve the relationship with the clinical evolution of the disease. These techniques also enable us to quantify the subtle abnormalities occuring in the so-called normal-appearing white matter, thus allowing a more accurate assessment of MS burden to be achieved. Some of these techniques have already shown their value for assessing MS dynamics, whereas other still need to go through a more complete validation process prior to any extensive clinical application in MS.
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Affiliation(s)
- M Rovaris
- Neuroimaging Research Unit, Department of Neuroscience, Scientific Institute Ospedale San Raffaele, University of Milan, via Olgettina 60, 20132, Milan, Italy
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Rovaris M, Rocca MA, Yousry I, Yousry TA, Colombo B, Comi G, Filippi M. Lesion load quantification on fast-FLAIR, rapid acquisition relaxation-enhanced, and gradient spin echo brain MRI scans from multiple sclerosis patients. Magn Reson Imaging 1999; 17:1105-10. [PMID: 10499672 DOI: 10.1016/s0730-725x(99)00068-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Previous studies have addressed the issue of the usefullness of fast fluid-attenuated (fast-FLAIR), rapid acquisition relaxation-enhanced (RARE), and gradient spin echo (GRASE) sequences in small groups of patients with multiple sclerosis (MS). The aim of this study was to assess and compare the lesion volumes and the intra-rater reproducibility of such measurements using fast-FLAIR, dual echo RARE, and dual echo GRASE brain scans from a large sample of MS patients. Using a 1.5 Tesla scanner, fast-FLAIR, dual echo RARE, and dual echo GRASE scans (24 axial, 5-mm thick contiguous interleaved slices) of the brain were obtained from 50 MS patients. Total lesion loads (TLL) were assessed twice using a semi-automated local thresholding segmentation technique by the same rater from the scans obtained with the three techniques. Mean TLL were 20.3 mL for fast-FLAIR, 16.6 mL for RARE, and 17.6 mL for GRASE sequences. Mean TLL detected by the three techniques were significantly heterogeneous (p < 0.001); at post-hoc analysis, the mean lesion volume detected on fast-FLAIR images was significantly higher than that on both RARE and GRASE images (p < 0.001) and the mean TLL on GRASE scans was significantly higher than that on RARE scans (p = 0.001). The mean values of intra-observer coefficient of variation for TLL measurements were similar for the three techniques (2.69% for fast-FLAIR, 2.33% for RARE, and 2.65% for GRASE). Our results confirm that fast-FLAIR sequences detect higher lesion volumes than those detected by other magnetic resonance imaging (MRI) sequences with shorter acquisition times. However, the reproducibility of TLL measurements is comparable among fast-FLAIR, RARE, and GRASE. This suggests that when assessing MS disease burden with MRI, the choice of the pulse sequence to be used should be dictated by the clinical setting.
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Affiliation(s)
- M Rovaris
- Department of Neuroscience, Scientific Institute Ospedale San Raffaele, Milan, Italy
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