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Rafiee F, Mehan WA, Rincon S, Rohatgi S, Rapalino O, Buch K. Diagnostic Utility of 3D Gradient-Echo MR Imaging Sequences through the Filum Compared with Spin-Echo T1 in Children with Concern for Tethered Cord. AJNR Am J Neuroradiol 2023; 44:323-327. [PMID: 36797030 PMCID: PMC10187807 DOI: 10.3174/ajnr.a7791] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/09/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND PURPOSE Fatty intrathecal lesions are a cause of tethered cord, and detection of these on spinal MR imaging is paramount. Conventional T1 FSE sequences are the mainstay of detecting fatty elements; however, 3D gradient-echo MR images, volumetric interpolated breath-hold examination/liver acquisition with volume acceleration (VIBE/LAVA), are popular, given the increased motion resistance. We sought to evaluate the diagnostic accuracy of VIBE/LAVA compared with T1 FSE for detection of fatty intrathecal lesions. MATERIALS AND METHODS In this retrospective, institutional review board-approved study, 479 consecutive pediatric spine MRIs obtained to evaluate cord tethering between January 2016 and April 2022 were reviewed. Inclusion criteria were patients who were 20 years of age or younger who underwent spine MRIs containing both axial T1 FSE and VIBE/LAVA sequences of the lumbar spine. The presence or absence of fatty intrathecal lesions was recorded for each sequence. If fatty intrathecal lesions were present, anterior-posterior and transverse dimensions were recorded. VIBE/LAVA and T1 FSE sequences were evaluated on 2 separate occasions (VIBE/LAVAs first followed by T1 FSE several weeks later) to minimize bias. Basic descriptive statistics compared fatty intrathecal lesion sizes on T1 FSEs and VIBE/LAVAs. Receiver operating characteristic curves were used to determine minimal fatty intrathecal lesion size detectable by VIBE/LAVA. RESULTS Sixty-six patients were included, with 22 having fatty intrathecal lesions (mean age, 7.2 years). T1 FSE sequences revealed fatty intrathecal lesions in 21/22 cases (95%); however, fatty intrathecal lesions on VIBE/LAVA were detected in 12/22 patients (55%). Mean anterior-posterior and transverse dimensions of fatty intrathecal lesions measured larger on T1 FSE compared with VIBE/LAVA sequences (5.4 × 5.0 mm versus 1.5 × 1.6 mm, respectively; P values = .039 anterior-posterior; .027 transverse). CONCLUSIONS While T1 3D gradient-echo MR images may have decreased the acquisition time and are more motion-resistant than conventional T1 FSE sequences, they are less sensitive and may miss small fatty intrathecal lesions.
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Affiliation(s)
- F Rafiee
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - W A Mehan
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S Rincon
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S Rohatgi
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - O Rapalino
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - K Buch
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Sartoretti E, Sartoretti-Schefer S, van Smoorenburg L, Eichenberger B, Schwenk Á, Czell D, Alfieri A, Binkert C, Wyss M, Sartoretti T. Spiral gradient echo versus cartesian turbo spin echo imaging for sagittal contrast-enhanced fat-suppressed T1 weighted spine MRI: an inter-individual comparison study. Br J Radiol 2022; 95:20210354. [PMID: 34762522 PMCID: PMC10996313 DOI: 10.1259/bjr.20210354] [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: 03/17/2021] [Revised: 07/22/2021] [Accepted: 10/19/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare a novel 3D spiral gradient echo (GRE) sequence with a conventional 2D cartesian turbo spin echo (TSE) sequence for sagittal contrast-enhanced (CE) fat-suppressed (FS) T1 weighted (T1W) spine MRI. METHODS In this inter-individual comparison study, 128 patients prospectively underwent sagittal CE FS T1W spine MRI with either a 2D cartesian TSE ("TSE", 285 s, 64 patients) or a 3D spiral GRE sequence ("Spiral", 93 s, 64 patients). Between both groups, patients were matched in terms of anatomical region (cervical/thoracic/lumbar spine and sacrum). Three readers used 4-point Likert scales to assess images qualitatively in terms of overall image quality, presence of artifacts, spinal cord visualization, lesion conspicuity and quality of fat suppression. RESULTS Spiral achieved a 67.4% scan time reduction compared to TSE. Interreader agreement was high (alpha=0.868-1). Overall image quality (4;[3,4] vs 3;[3,4], p<0.001 - p=0.002 for all readers), presence of artifacts (4;[3,4] vs 3;[3,4] p=0.027 - p=0.046 for all readers), spinal cord visualization (4;[4,4] vs 4;[3,4], p<0.001 for all readers), lesion conspicuity (4;[4,4] vs 4;[4,4], p=0.016 for all readers) and quality of fat suppression (4;[4,4] vs 4;[4,4], p=0.027 - p=0.033 for all readers), were all deemed significantly improved by all three readers on Spiral images as compared to TSE images. CONCLUSION We demonstrate the feasibility of a novel 3D spiral GRE sequence for improved and rapid sagittal CE FS T1W spine MRI. ADVANCES IN KNOWLEDGE A 3D spiral GRE sequence allows for improved sagittal CE FS T1W spine MRI at very short scan times.
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Affiliation(s)
- Elisabeth Sartoretti
- Institute of Radiology, Kantonsspital Winterthur,
Winterthur, Switzerland
- University of Zürich,
Zürich, Switzerland
| | | | | | | | - Árpád Schwenk
- Institute of Radiology, Kantonsspital Winterthur,
Winterthur, Switzerland
| | | | - Alex Alfieri
- Department of Neurosurgery, Kantonsspital
Winterthur, Winterthur,
Switzerland
| | - Christoph Binkert
- Institute of Radiology, Kantonsspital Winterthur,
Winterthur, Switzerland
| | | | - Thomas Sartoretti
- Institute of Radiology, Kantonsspital Winterthur,
Winterthur, Switzerland
- University of Zürich,
Zürich, Switzerland
- Department of Radiology and Nuclear Medicine, Maastricht
University Medical Center, Maastricht University,
Maastricht, The Netherlands
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Harreld JH, Khan A, Angel J, Han Y, Li Y, Gajjar A, Patay Z. MRI sequences and interslice gap influence leptomeningeal metastasis detection in children with brain tumors. Neuroradiology 2022; 64:1447-1456. [PMID: 35344053 DOI: 10.1007/s00234-022-02928-7] [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: 08/03/2021] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Accurate detection of leptomeningeal metastasis (LM) is critical for risk stratification and treatment of pediatric brain tumors. Poor-quality staging MRI has been associated with decreased survival in this population, but technical factors differentiating good from poor quality screening MRIs remain undefined. To test the hypothesis that key technical factors are associated with accurate MRI diagnosis of leptomeningeal metastasis in children with leptomeningeal seeding brain tumors. METHODS MRIs acquired at outside facilities and repeated in our institution within 35 days for 75 children with leptomeningeal seeding tumors were assessed for slice thickness and gap; use of T2 FLAIR + Contrast, acquisition plane of 3DT1WI + Contrast (brain); axial T1 + Contrast sequence, and use of pre-contrast T1 images (spine). Reported findings were recorded as positive, negative, or equivocal for LM and classified as true positive (TP; unequivocal metastasis), false negative (FN; not reported), false positive (FP; resolved without treatment), or true negative. Wilcoxon signed-rank and Fisher's exact test were used to assess technical differences between TP and FN MRIs. RESULTS Rate of LM detection was greater with smaller interslice gap in brain (P = 0.003) and spine (P = 0.002); use of T2 FLAIR + Contrast (P = 0.005) and sagittal plane for 3DT1WI + Contrast (P = 0.028) in brain; and use of alternatives to axial TSE/FSE in spine (P = 0.048). Slice thickness was not significant. Pre-contrast T1WI did not contribute to LM diagnosis in spine. CONCLUSION Using post-contrast T2 FLAIR and sagittal 3DT1 in brain, small/no interslice gap, and avoiding TSE/FSE axials in spine may facilitate leptomeningeal metastasis detection in children with brain tumors.
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Affiliation(s)
- Julie H Harreld
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN, 38015, USA.,Departmentof Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Ayaz Khan
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN, 38015, USA.
| | - Jacqueline Angel
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN, 38015, USA
| | - Yuanyuan Han
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yimei Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Amar Gajjar
- Department of Neuro-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zoltan Patay
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN, 38015, USA
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Abstract
Three-dimensional (3D) magnetic resonance imaging of the spine is now clinically feasible due to technological advancements. Its advantages over two-dimensional imaging include higher in-plane spatial resolution and the ability for reformation in any plane that enables time savings in image acquisition and aids more accurate interpretation. Multispectral 3D techniques for imaging around metal are sometimes useful for evaluating anatomy adjacent to spinal fixation hardware. 3D gradient-recalled echo sequences, including ultrashort or zero time to echo sequences, can provide osseous detail similar to conventional computed tomography.
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Affiliation(s)
- Meghan Sahr
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
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Chong LR, Lee K, Sim FY. 3D MRI with CT-like bone contrast - An overview of current approaches and practical clinical implementation. Eur J Radiol 2021; 143:109915. [PMID: 34461599 DOI: 10.1016/j.ejrad.2021.109915] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 12/24/2022]
Abstract
CT is the imaging modality of choice for assessment of 3D bony morphology but incurs the penalty of ionizing radiation. Improving the ability of 3D MRI to provide high-resolution images of cortical bone with CT-like bone contrast has been a focus of recent research. The ability of 3D MRI to deliver cortical bone information with similar diagnostic performance to CT would complement assessment of soft tissues and medullary bone from a single MRI examination, simplifying evaluation and obviating radiation exposure from additional CT. This article presents an overview of current 3D MRI approaches for imaging cortical bone with CT-like bone contrast including ultrashort echo time, zero echo time, T1-weighted gradient recalled echo, susceptibility-weighted imaging and deep learning techniques. We also discuss clinical implementation of an optimized stack-of-stars 3D gradient recalled echo pulse sequence (3D-Bone) on commercially available MRI scanners for rendering 3D MRI with CT-like bone contrast in our institutional practice.
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Affiliation(s)
- Le Roy Chong
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
| | - Kathy Lee
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
| | - Fang Yang Sim
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
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Sartoretti E, Sartoretti T, van Smoorenburg L, Sartoretti-Schefer S, Wyss M, Binkert CA. Qualitative and Quantitative Analysis of a Spiral Gradient Echo Sequence for Contrast-Enhanced Fat-Suppressed T1-Weighted Spine Magnetic Resonance Imaging. Invest Radiol 2021; 56:517-524. [PMID: 33653993 DOI: 10.1097/rli.0000000000000770] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pulse sequences with non-Cartesian k-space sampling enable improved imaging in anatomical areas with high degrees of motion artifacts. We analyzed a novel spiral 3-dimensional (3D) gradient echo (GRE) magnetic resonance imaging (MRI) sequence ("spiral," 114.7 ± 11 seconds) and compared it with a radial 3D GRE ("vane," 216.7 ± 2 seconds) and a conventional Cartesian 2D turbo spin echo (TSE) sequence ("TSE," 266.7 ± 82 seconds) for contrast-enhanced fat-suppressed T1-weighted spine imaging. MATERIALS AND METHODS Forty consecutive patients referred for contrast-enhanced MRI were prospectively scanned with all 3 sequences. A qualitative analysis was performed by 3 readers using 4- or 5-point Likert scales to independently grade images in terms of overall image quality, occurrence of artifacts, lesion conspicuity, and conspicuity of nerve roots. The numbers of visible nerve roots per sequence and patient were counted in consensus. Coefficient of variation measurements were performed for the paravertebral musculature (CVPM) and the spinal cord (CVSC). RESULTS Spiral (median [interquartile range], 5 [4-5]) exhibited improved overall image quality in comparison to TSE (3 [3-4]) and vane (4 [4-5]; both P < 0.001). Vane surpassed TSE in terms of overall image quality (P < 0.001). Spiral (4 [3.75-4]) and vane (3.5 [3-4]) presented with less artifacts than TSE (3 [2.75-3.25]; both P < 0.001). Spiral (4 [4-5]) outperformed vane (4 [3-5]; P = 0.01) and TSE (4 [3-4]; P = 0.04) in terms of lesion conspicuity. Conspicuity of nerve roots was superior on spiral (3 [3-4]) and vane (4 [3-4]) when compared with TSE (1.5 [1-2]; both P < 0.001). Readers discerned significantly more nerve roots on spiral (4 [2.75-8]) and vane (4 [3.75-7.25]) images when compared with TSE (2 [0-4]; both P < 0.001). Interreader agreement ranged from moderate (α = 0.639) to almost perfect (α = 0.967). CVPM and CVSC were significantly lower on spiral as compared with vane and TSE (P < 0.001, P = 0.04). Vane exhibited lower CVPM and CVSC than TSE (P < 0.001, P = 0.01). CONCLUSIONS A novel spiral 3D GRE sequence improves contrast-enhanced fat-suppressed T1-weighted spinal imaging qualitatively and quantitatively in comparison with a conventional Cartesian 2D TSE sequence and to a lesser extent with a radial 3D GRE sequence at shorter scan times.
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Affiliation(s)
| | | | - Luuk van Smoorenburg
- From the Institute of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Sabine Sartoretti-Schefer
- From the Institute of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | | | - Christoph A Binkert
- From the Institute of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
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7
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Kim JR, Yoon HM, Cho YA, Lee JS, Jung AY. Free-breathing contrast-enhanced upper abdominal MRI in children: comparison between Cartesian acquisition and stack-of-stars acquisition with two different fat-suppression techniques. Acta Radiol 2021; 62:541-550. [PMID: 32498544 DOI: 10.1177/0284185120928931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Respiratory artifacts impair image quality of magnetic resonance imaging (MRI) in children who cannot hold breath during MRI examination. PURPOSE To compare the quality of free-breathing contrast-enhanced 3D T1-weighted (T1W) images of the upper abdomen in children using Cartesian acquisition (Cartesian eTHRIVE), stack-of-stars acquisition with spectral fat suppression (3D VANE eTHRIVE), and stack-of-stars acquisition with fat suppression using modified Dixon (3D VANE mDixon). MATERIAL AND METHODS Pediatric patients (aged <19 years) who underwent whole-body MRI with free-breathing contrast-enhanced T1W axial scans of upper abdomen using Cartesian eTHRIVE, 3D VANE eTHRIVE, and 3D VANE mDixon were enrolled. Image quality parameters were assessed including overall image quality, hepatic edge sharpness, hepatic vessel clarity, respiratory artifacts, radial artifacts, lesion conspicuity, and lesion edge sharpness using the Likert scale, where a lower score indicated poorer image quality. The coefficients of variation of signal intensity of liver and spleen were analyzed. RESULTS In 41 patients, 3D VANE eTHRIVE showed the highest scores for all image quality parameters (P ≤ 0.001). 3D VANE eTHRIVE also showed higher scores for respiratory (P ≤ 0.001) and radial artefacts than 3D VANE mDixon (P = 0.001). There were no significant differences in coefficients of variation of signal intensity of the liver and spleen between 3D VANE eTHRIVE and 3D VANE mDixon. Acquisition time was longer for 3D VANE eTHRIVE (81.26 ± 16 s) than for Cartesian eTHRIVE (7.87 ± 0.95 s) and 3D VANE mDixon (76.66 ± 12.4 s, P < 0.001). CONCLUSION The application of stack-of-stars acquisition to 3D T1W abdominal MRI resulted in better image quality than Cartesian acquisition in free-breathing children. In stack-of-stars acquisition, spectral fat suppression resulted in better image quality and fewer artifacts than mDixon.
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Affiliation(s)
- Jeong Rye Kim
- Department of Radiology, Dankook University Hospital, Chungcheongnam-do, Republic of Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ah Young Jung
- 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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8
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Zhang Y, Kwon W, Lee HY, Ko SM, Kim SH, Lee WY, Yong SJ, Jung SH, Byun CS, Lee J, Yang H, Han J, Ackman JB. Imaging Assessment of Visceral Pleural Surface Invasion by Lung Cancer: Comparison of CT and Contrast-Enhanced Radial T1-Weighted Gradient Echo 3-Tesla MRI. Korean J Radiol 2021; 22:829-839. [PMID: 33686817 PMCID: PMC8076827 DOI: 10.3348/kjr.2020.0955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/10/2020] [Accepted: 11/28/2020] [Indexed: 12/25/2022] Open
Abstract
Objective To compare the diagnostic performance of contrast-enhanced radial T1-weighted gradient-echo 3-tesla (3T) magnetic resonance imaging (MRI) and computed tomography (CT) for the detection of visceral pleural surface invasion (VPSI). Visceral pleural invasion by non-small-cell lung cancer (NSCLC) can be classified into two types: PL1 (without VPSI), invasion of the elastic layer of the visceral pleura without reaching the visceral pleural surface, and PL2 (with VPSI), full invasion of the visceral pleura. Materials and Methods Thirty-three patients with pathologically confirmed VPSI by NSCLC were retrospectively reviewed. Multidetector CT and contrast-enhanced 3T MRI with a free-breathing radial three-dimensional fat-suppressed volumetric interpolated breath-hold examination (VIBE) pulse sequence were compared in terms of the length of contact, angle of mass margin, and arch distance-to-maximum tumor diameter ratio. Supplemental evaluation of the tumor-pleura interface (smooth versus irregular) could only be performed with MRI (not discernible on CT). Results At the tumor-pleura interface, radial VIBE MRI revealed a smooth margin in 20 of 21 patients without VPSI and an irregular margin in 10 of 12 patients with VPSI, yielding an accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F-score for VPSI detection of 91%, 83%, 95%, 91%, 91%, and 87%, respectively. The McNemar test and receiver operating characteristics curve analysis revealed no significant differences between the diagnostic accuracies of CT and MRI for evaluating the contact length, angle of mass margin, or arch distance-to-maximum tumor diameter ratio as predictors of VPSI. Conclusion The diagnostic performance of contrast-enhanced radial T1-weighted gradient-echo 3T MRI and CT were equal in terms of the contact length, angle of mass margin, and arch distance-to-maximum tumor diameter ratio. The advantage of MRI is its clear depiction of the tumor-pleura interface margin, facilitating VPSI detection.
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Affiliation(s)
- Yu Zhang
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Woocheol Kwon
- Department of Diagnostic Radiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Ho Yun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Departement of Health Sciences and Technology, Samsung Advanced Institute of Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Sung Min Ko
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Sang Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Won Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Suk Joong Yong
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Soon Hee Jung
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Chun Sung Byun
- Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - JunHyeok Lee
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Honglei Yang
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Junhee Han
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jeanne B Ackman
- Harvard Medical School, Massachusetts General Hospital, Founders House, Boston, MA, USA
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Dovjak GO, Kanbur I, Prayer F, Brugger PC, Gruber GM, Weber M, Stuhr F, Ulm B, Kasprian GJ, Prayer D. Comparison of the colon with T1 breath-hold vs T1 free-breathing-A retrospective fetal MRI study. Eur J Radiol 2020; 134:109457. [PMID: 33302027 DOI: 10.1016/j.ejrad.2020.109457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Fetal magnetic resonance imaging (MRI) plays an increasingly important role in the prenatal diagnosis of gastrointestinal abnormalities. During gestation, the bowel develops T1-weighted hyperintensity due to meconium formation. Currently used T1-weighted sequences are performed in maternal breath-hold (BH) technique, which may take up to 20 s. The free-breathing (FB) T1-weighted 3D radial VIBE (volumetric interpolated breath-hold examination) sequence requires no breath-hold, improving patient comfort. This study aimed to address how well the FB acquisition technique can visualize large bowel structures compared to the routinely performed breath-hold sequence. METHODS Forty-seven fetal MRI studies between 21 and 36 weeks of gestation without abdominal pathologies on prenatal MRI and ultrasound were included. All fetal scans were performed using a Philips Ingenia 1.5 T MRI. Coronal T1-weighted BH and FB sequences without fat suppression were compared. The following acquisition parameters were used (T1, FB): resolution 1.137 mm, 1.004 mm; matrix size 288 × 288, 448 × 448; FOV 328 mm, 450 mm; TR 81-132 ms, 3.47 ms; TE 4.6 ms, 1.47 ms. Due to the necessity of the breath-hold the duration of the sequence could not exceed 20 s (mean duration of the T1-weighted BH sequence 15.17 s, and mean duration of the FB sequence 26.42 s). In all examined fetuses the following structures were evaluated with respect to their visibility (0-not visible, 1-partially visible, 2-clearly visible): rectum, sigmoid, descending, transverse and ascending colon, cecum. Furthermore, motion artifacts were assessed (0-none, 1-intermediate, 2-severe motion artifacts), and the signal intensity (SI) ratio between maternal fat and fetal rectum SI was calculated. RESULTS No significant differences in the visibility of sigmoid and colon between BH and FB were detected, only the cecum could be seen slightly better (in 29.8 % of cases) using BH technique. Motion artifacts were similar between BH and FB. There was a non-significant SI difference (p = 0.68) in the rectum, with a higher SI in the BH sequence. CONCLUSIONS The FB acquisition technique compared to T1 using BH is equal regarding visibility of bowel structures and artifacts. Due to non-inferiority to the BH technique, the FB sequence is a good alternative in cases where BH cannot be performed. As the FB sequence further allows for thinner slices with a good signal, even small bowel loops may be visualized.
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Affiliation(s)
- G O Dovjak
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - I Kanbur
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - F Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - P C Brugger
- Center for Anatomy and Cell Biology, Department of Anatomy, Medical University of Vienna, Austria
| | - G M Gruber
- Department of Anatomy and Biomechanics, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - M Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - F Stuhr
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - B Ulm
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Austria
| | - G J Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - D Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria.
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10
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Feasibility of free-breathing T1-weighted 3D radial VIBE for fetal MRI in various anomalies. Magn Reson Imaging 2020; 69:57-64. [PMID: 32171775 DOI: 10.1016/j.mri.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES In magnetic resonance (MR) fetal imaging, the image quality acquired by the traditional Cartesian-sampled breath-hold T1-weighted (T1W) sequence may be degraded by motion artifacts arising from both mother and fetus. The radial VIBE sequence is reported to be a viable alternative to conventional Cartesian acquisition for both pediatric and adult MR, yielding better image quality. This study evaluated the role of radial VIBE in fetal MR imaging and compared its image quality and motion artifacts with those of the Cartesian T1W sequence. MATERIALS AND METHODS We included 246 pregnant women with 50 lesions on 1.5-T MR imaging. Image quality and lesion conspicuity were evaluated by two radiologists, blinded to the acquisition schemes used, using a five-point scale, where a higher score indicated a better trajectory method. Mixed-model analysis of variance and interobserver variability assessment were performed. RESULTS The radial VIBE sequence showed a significantly better performance than conventional T1W imaging in the head and neck, fetal body, and placenta region: 3.92 ± 0.88 vs 3 ± 0.74, p < 0.001, 3.8 ± 0.94 vs 3.15 ± 0.87, p < 0.001, and 4.17 ± 0.63 vs 3.12 ± 0.72, p < 0.001, respectively. Additionally, fewer motion artifacts were observed in all regions with the radial VIBE sequence (p < 0.01). Of 50 lesions, 49 presented better lesion conspicuity on radial VIBE images than on T1W images (4.34 ± 0.91 vs 3.48 ± 1.46, p < 0.001). CONCLUSION For fetal imaging, the radial VIBE sequences yielded better image quality and lesion conspicuity, with fewer motion artifacts, than conventional breath-hold Cartesian-sampled T1W sequences.
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Lala SV, Strubel N, Nocera N, Bittman ME, Fefferman NR. Visualization of the normal appendix in children: feasibility of a single contrast-enhanced radial gradient recalled echo MRI sequence. Pediatr Radiol 2019; 49:770-776. [PMID: 30783687 DOI: 10.1007/s00247-019-04352-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 01/03/2019] [Accepted: 02/04/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) assessment for appendicitis is limited by exam time and patient cooperation. The radially sampled 3-dimensional (3-D) T1-weighted, gradient recalled echo sequence (radial GRE) is a free-breathing, motion robust sequence that may be useful in evaluating appendicitis in children. OBJECTIVE To compare the rate of detection of the normal appendix with contrast-enhanced radial GRE versus contrast-enhanced 3-D GRE and a multi-sequence study including contrast-enhanced radial GRE. MATERIALS AND METHODS This was a retrospective study of patients ages 7-18 years undergoing abdominal-pelvic contrast-enhanced MRI between Jan. 1, 2012, and April 1, 2016. Visualization of the appendix was assessed by consensus between two pediatric radiologists. The rate of detection of the appendix for each sequence and combination of sequences was compared using a McNemar test. RESULTS The rate of detection of the normal appendix on contrast-enhanced radial GRE was significantly higher than on contrast-enhanced 3-D GRE (76% vs. 57.3%, P=0.003). The rate of detection of the normal appendix with multi-sequence MRI including contrast-enhanced radial GRE was significantly higher than on contrast-enhanced 3-D GRE (81.3% vs. 57%, P<0.001). There was no significant difference between the rate of detection of the normal appendix on contrast-enhanced radial GRE alone and multi-sequence MRI including contrast-enhanced radial GRE (76% vs. 81.3%, P=0.267). CONCLUSION Contrast-enhanced radial GRE allows superior detection of the normal appendix compared to contrast-enhanced 3-D GRE. The rate of detection of the normal appendix on contrast-enhanced radial GRE alone is nearly as good as when the contrast-enhanced radial GRE is interpreted with additional sequences.
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Affiliation(s)
- Shailee V Lala
- Department of Radiology, New York University School of Medicine, 660 First Ave., New York, NY, 10016, USA.
| | - Naomi Strubel
- Department of Radiology, New York University School of Medicine, 660 First Ave., New York, NY, 10016, USA
| | - Nicole Nocera
- Department of Radiology, New York University School of Medicine, 660 First Ave., New York, NY, 10016, USA
| | - Mark E Bittman
- Department of Radiology, New York University School of Medicine, 660 First Ave., New York, NY, 10016, USA
| | - Nancy R Fefferman
- Department of Radiology, New York University School of Medicine, 660 First Ave., New York, NY, 10016, USA
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12
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Hu HH, Benkert T, Jones JY, McAllister AS, Rusin JA, Krishnamurthy R, Block KT. 3D T1-weighted contrast-enhanced brain MRI in children using a fat-suppressed golden angle radial acquisition: an alternative to Cartesian inversion-recovery imaging. Clin Imaging 2019; 55:112-118. [DOI: 10.1016/j.clinimag.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/18/2018] [Accepted: 02/08/2019] [Indexed: 02/07/2023]
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13
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Warren KE, Vezina G, Poussaint TY, Warmuth-Metz M, Chamberlain MC, Packer RJ, Brandes AA, Reiss M, Goldman S, Fisher MJ, Pollack IF, Prados MD, Wen PY, Chang SM, Dufour C, Zurakowski D, Kortmann RD, Kieran MW. Response assessment in medulloblastoma and leptomeningeal seeding tumors: recommendations from the Response Assessment in Pediatric Neuro-Oncology committee. Neuro Oncol 2019; 20:13-23. [PMID: 28449033 DOI: 10.1093/neuonc/nox087] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Lack of standard response criteria in clinical trials for medulloblastoma and other seeding tumors complicates assessment of therapeutic efficacy and comparisons across studies. An international working group was established to develop consensus recommendations for response assessment. The aim is that these recommendations be prospectively evaluated in clinical trials, with the goal of achieving more reliable risk stratification and uniformity across clinical trials. Current practices and literature review were performed to identify major confounding issues and justify subsequently developed recommendations; in areas lacking scientific investigations, recommendations were based on experience of committee members and consensus was reached after discussion. Recommendations apply to both adult and pediatric patients with medulloblastoma and other seeding tumors. Response should be assessed using MR imaging (brain and spine), CSF cytology, and neurologic examination. Clinical imaging standards with minimum mandatory sequence acquisition that optimizes detection of leptomeningeal metastases are defined. We recommend central review prior to inclusion in treatment cohorts to ensure appropriate risk stratification and cohort inclusion. Consensus recommendations and response definitions for patients with medulloblastomas and other seeding tumors have been established; as with other Response Assessment in Neuro-Oncology recommendations, these need to now be prospectively validated in clinical trials.
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Affiliation(s)
- Katherine E Warren
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Gilbert Vezina
- Department of Radiology, Children's National Medical Center, Washington, DC
| | - Tina Y Poussaint
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Monika Warmuth-Metz
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Marc C Chamberlain
- Department of Neurology, Seattle Cancer Care Alliance, Seattle, Washington
| | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington, DC
| | - Alba A Brandes
- Medical Oncology Department, AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - Moshe Reiss
- Division of Pediatric Neuro-Oncology, New York Medical College, Valhalla, New York
| | - Stewart Goldman
- Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Michael J Fisher
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ian F Pollack
- Department of Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Michael D Prados
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California.,Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Susan M Chang
- Department of Neurosurgery, University of California San Francisco, San Francisco, California
| | - Christelle Dufour
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France
| | - David Zurakowski
- Departments of Anesthesia & Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Rolf D Kortmann
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
| | - Mark W Kieran
- Pediatric Neuro-Oncology, Dana Farber Boston Children's Cancer and Blood Disorder's Center, Boston, Massachusetts
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14
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Post-contrast T1-weighted spine 3T MRI in children using a golden-angle radial acquisition. Neuroradiology 2019; 61:341-349. [DOI: 10.1007/s00234-019-02165-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/09/2019] [Indexed: 11/26/2022]
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15
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Chen Y, Yang X, Wen Z, Lu B, Xiao X, Shen B, Yu S. Fat-suppressed gadolinium-enhanced isotropic high-resolution 3D-GRE-T1WI for predicting small node metastases in patients with rectal cancer. Cancer Imaging 2018; 18:21. [PMID: 29784058 PMCID: PMC5963161 DOI: 10.1186/s40644-018-0153-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/07/2018] [Indexed: 12/21/2022] Open
Abstract
Background To investigate the application value of fat-suppressed gadolinium-enhanced isotropic high-resolution 3D-GRE-T1WI in regional nodes with different short-axis diameter ranges in rectal cancer, especially in nodes ≤5 mm. Methods Patients with rectal adenocarcinoma confirmed by postoperative histopathology were included, and all the patients underwent preoperative 3.0 T rectal magnetic resonance imaging (MRI) and total mesorectal excision (TME) within 2 weeks after an MR scan. The harvested nodes from specimens were matched with nodes in the field of view (FOV) of images for a node-by-node evaluation. The maximum short-axis diameters of all the visible nodes in the FOV of images were measured by a radiologist; the morphological and enhancement characteristics of these nodes were also independently evaluated by two radiologists. The χ2 test was used to evaluate differences in morphological and enhancement characteristics between benign and malignant nodes. The enhancement characteristics were further compared between benign and malignant nodes with different short-axis diameter ranges using the χ2 test. Kappa statistics were used to describe interobserver agreement. Results A total of 441 nodes from 70 enrolled patients were included in the evaluation, of which 111 nodes were metastatic. Approximately 85.5 and 95.6% of benign nodes were found to have obvious enhancement and homogeneous or mild-heterogeneous enhancement, respectively, whereas approximately 89.2 and 85.1% of malignant nodes showed moderate or mild enhancement and obvious-heterogeneous or rim-like enhancement, respectively. The area under the receiver operating characteristic (ROC) curve (AUC) values of the enhancement degree for identifying the overall nodal status, nodes ≤5 mm and nodes > 5 mm and ≤ 10 mm were 0.887, 0.859 and 0.766 for radiologist 1 and 0.892, 0.823 and 0.774 for radiologist 2, respectively. The AUCs of enhancement homogeneity were 0.940, 0.928 and 0.864 for radiologist 1 and 0.944, 0.938 and 0.842 for radiologist 2, respectively. Nodal border and signal homogeneity were also of certain value in distinguishing metastatic nodes. Conclusions Enhancement characteristics based on fat-suppressed gadolinium-enhanced isotropic high-resolution 3D-GRE-T1WI were helpful for diagnosing metastatic nodes in rectal cancer and were a reliable indicator for nodes ≤5 mm.
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Affiliation(s)
- Yan Chen
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Xinyue Yang
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Ziqiang Wen
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Baolan Lu
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Xiaojuan Xiao
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Bingqi Shen
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Shenping Yu
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China.
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Three-Dimensional Radial VIBE Sequence for Contrast-Enhanced Brain Imaging: An Alternative for Reducing Motion Artifacts in Restless Children. AJR Am J Roentgenol 2018; 210:876-882. [DOI: 10.2214/ajr.17.18490] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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