Diffusion-weighted imaging with dual-echo echo-planar imaging for better sensitivity to acute stroke

Prognostic Value of Apparent Diffusion Coefficient for Mechanical Thrombectomy in Patients with Acute Posterior Ischemic Stroke

BACKGROUND

This study investigates the prognostic value of the apparent diffusion coefficient (ADC) in magnetic resonance imaging for patients with acute posterior circulation stroke (PCS) undergoing endovascular therapy (EVT).

METHODS

A retrospective analysis was conducted of patients with acute PCS from January 2017 to December 2021, confirmed by diffusion-weighted imaging (DWI)-ADC within 24 hours of onset. Patients were categorized based on their 3-month modified Rankin Scale score after EVT. Data on the National Institutes of Health Stroke Scale at admission, ADC value, and 3-month modified Rankin Scale score were collected. Multivariable logistic regression analyzed the impact of various factors on ADC values. The receiver operating characteristic curve assessed predictive indices.

RESULTS

Among 94 patients, 47 had a good prognosis and 47 had a poor prognosis. Univariate analysis showed that factors significantly associated with a good prognosis included lower National Institutes of Health Stroke Scale at admission, higher ADC values, smaller infarct areas, unilateral infarction, basilar artery occlusion, lower pons-midbrain-thalamus scores, intravenous thrombolysis, intra-arterial thrombolysis, and fewer perioperative complications (P < 0.05). Multivariable logistic regression identified high ADC values (P = 0.002) and unilateral infarction (P = 0.017) as independent predictive factors for prognosis. An ADC value >549 × 10-6 mm2/second was associated with a higher rate of good prognosis. Combining ADC values with unilateral infarction resulted in the highest area under the curve and Youden Index of 0.766, with sensitivity and specificity of 89.36% and 87.23%, respectively (P < 0.05).

CONCLUSIONS

High ADC values and unilateral infarction are independent predictive factors for the prognosis of patients with PCS after EVT. Combining these factors provides the highest predictive accuracy, aiding in clinical decision making for PCS treatment.

The quest for high spatial resolution diffusion-weighted imaging of the human brain in vivo

Diffusion-weighted imaging, a contrast unique to MRI, is used for assessment of tissue microstructure in vivo. However, this exquisite sensitivity to finer scales far above imaging resolution comes at the cost of vulnerability to errors caused by sources of motion other than diffusion motion. Addressing the issue of motion has traditionally limited diffusion-weighted imaging to a few acquisition techniques and, as a consequence, to poorer spatial resolution than other MRI applications. Advances in MRI imaging methodology have allowed diffusion-weighted MRI to push to ever higher spatial resolution. In this review we focus on the pulse sequences and associated techniques under development that have pushed the limits of image quality and spatial resolution in diffusion-weighted MRI.

Robust Self-Calibrating nCPMG Acquisition: Application to Body Diffusion-Weighted Imaging

This paper demonstrates a robust diffusion-weighted single-shot fast spin echo (SS-FSE) sequence in the presence of significant off-resonance, which includes a variable-density acquisition and a self-calibrated reconstruction as improvements. A non-Carr-Purcell-Meiboom-Gill (nCPMG) SS-FSE acquisition stabilizes both the main and parasitic echo families for each echo. This preserves both the in-phase and quadrature components of the magnetization throughout the echo train. However, nCPMG SS-FSE also promotes aliasing of the quadrature component, which complicates reconstruction. A new acquisition and reconstruction approach is presented here, where the field-of-view is effectively doubled, but a partial k-space and variable density sampling is used to improve scan efficiency. The technique is presented in phantom scans to validate SNR and robustness against rapidly varying object phase. In vivo healthy volunteer examples and the clinical cases are demonstrated in abdominal imaging. This new approach provides comparable SNR to previous nCPMG acquisition techniques as well as providing more uniform apparent diffusion coefficient maps in phantom scans. In vivo scans suggest that this method is more robust against motion than previous approaches. The proposed reconstruction is an improvement to the nCPMG sequence as it is auto-calibrating and is justified to accurately treat the signal model for the nCPMG SS-FSE sequence.

The influence of diffusion gradient direction on diffusion-weighted imaging of breast mass-like lesions at 3.0T

Background It has been challenging to achieve ideal breast diffusion-weighted imaging (DWI). The optimization of diffusion gradient direction is of great importance. Purpose To evaluate the effect of diffusion gradient direction on the apparent diffusion coefficient (ADC) values of breast mass-like lesions and the visual grades of image quality, lesion visibility, and sharpness of breast contour at 3.0T. Material and Methods Sixty consecutive patients with mass-like lesions were enrolled in this study. In addition to typical breast magnetic resonance imaging (MRI) protocols, the breasts were scanned with conventional orthogonal DWI (c-DWI), tetrahedral DWI (t-DWI), and 3in1 DWI (3in1-DWI) sequences. The DW images were observed and visually graded by two radiologists independently. For ADC measurement, one radiographer manually selected the region of interest (ROI). Results For both readers, t-DWI had better image quality and sharpness of breast contour than c-DWI. Regarding lesion visibility, no significant differences were observed among three sequences. The mean ADC values were 1.462 × 10^-3, 1.490 × 10^-3, and 1.446 × 10^-3 mm² s^-1 for c-DWI, t-DWI, and 3in1-DWI, respectively. The ADC values extracted from both t-DWI and 3in1-DWI were not statistically different compared with those from c-DWI. In all DWI sequences, the ADC of malignant lesions was significantly reduced compared with benign lesions. Conclusion DWI with tetrahedral or 3in1 diffusion gradients is a more useful technique in clinical breast MRI than c-DWI because the image quality and sharpness of breast contour are improved. ADC is comparable to c-DWI.

Image quality assessment of single-shot turbo spin echo diffusion-weighted imaging with parallel imaging technique: a phantom study

OBJECTIVE

This study aimed to evaluate the image quality and apparent diffusion coefficient (ADC) values of single-shot turbo spin echo (TSE) diffusion-weighted (DW) images obtained using a parallel imaging (PI) technique.

METHODS

All measurements were performed on a 3.0-T whole-body MRI system and 32-channel phased-array coil. Signal-to-noise ratio (SNR) and ADC values were measured with a DW imaging (DWI) phantom comprising granulated sugar and agar. The SNRs were calculated using a subtraction method and compared among TSE-DW images at acceleration factors (AFs) of 1-4. Image blur was visually assessed on TSE-DW images of a pin phantom at AFs of 1-4. The ADC values were calculated using DW images with b = 0 and 1000 s mm(-2). The ADC values of TSE-DW images and echo-planar imaging EPI-DW images were compared.

RESULTS

The SNRs decreased as AFs increased, despite selecting the shortest echo time. A lower AF caused increased image blur in the phase-encoding direction. The ADC values of TSE-DWI tended to be lower than those of EPI-DWI, and AFs of 3 and 4 yielded variable ADC values on TSE-DW images.

CONCLUSION

TSE-DWI with an AF of 3 or 4 yielded reduced SNRs; in addition, the image noise and artefacts associated with PI technique may have affected ADC measurements, despite improving image blur in the phase-encoding direction.

ADVANCES IN KNOWLEDGE

Optimizing the imaging parameters of TSE-DWI is useful for providing good image quality and accurate ADC measurements.

Intensity-Corrected Dual-Echo Echo-Planar Imaging (DE-EPI) for Improved Pediatric Brain Diffusion Imaging

Here we investigate the utility of a dual-echo Echo-Planar Imaging (DE-EPI) Diffusion Weighted Imaging (DWI) approach to improve lesion conspicuity in pediatric imaging. This method delivers two ‘echo images’ for one diffusion-preparation period. We also demonstrate how the echoes can be utilized to remove transmit/receive coil-induced and static magnetic field intensity modulations on both echo images, which often mimic pathology and thereby pose diagnostic challenges. DE-EPI DWI data were acquired in 18 pediatric patients with abnormal diffusion lesions, and 46 pediatric patient controls at 3T. Echo1 [TE = 45ms] and Echo2 [TE = 86ms] were corrected for signal intensity variation across the images by exploiting the images equivalent coil-sensitivity and susceptibility-induced modulations. Two neuroradiologists independently reviewed Echo1 and Echo2 and their intensity-corrected variants (cEcho1 and cEcho2) on a 7-point Likert scale, with grading on lesion conspicuity diagnostic confidence. The apparent diffusion coefficient (ADC) map from Echo1 was used to validate presence of true pathology. Echo2 was unanimously favored over Echo1 for its sensitivity for detecting acute brain injury, with a mean respective lesion conspicuity of 5.7/4.4 (p < 0.005) and diagnostic confidence of 5.1/4.3 (p = 0.025). cEcho2 was rated higher than cEcho1, with a mean respective lesion conspicuity of 5.5/4.3 (p < 0.005) and diagnostic confidence of 5.4/4.4 (p < 0.005). cEcho2 was favored over all echoes for its diagnostic reliability, particularly in regions close to the head coil. This work concludes that DE-EPI DWI is a useful alternative to conventional single-echo EPI DWI, whereby Echo2 and cEcho2 allows for improved lesion detection and overall higher diagnostic confidence.

Cognitive demands during quiet standing elicit truncal tremor in two frequency bands: differential relations to tissue integrity of corticospinal tracts and cortical targets

The ability to stand quietly is disturbed by degradation of cerebellar systems. Given the complexity of sensorimotor integration invoked to maintain upright posture, the integrity of supratentorial brain structures may also contribute to quiet standing and consequently be vulnerable to interference from cognitive challenges. As cerebellar system disruption is a common concomitant of alcoholism, we examined 46 alcoholics and 43 controls with a force platform to derive physiological indices of quiet standing during cognitive (solving simple, mental arithmetic problems) and visual (eyes closed) challenges. Also tested were relations between tremor velocity and regional gray matter and white matter tissue quality measured with the diffusion tensor imaging (DTI) metric of mean diffusivity (MD), indexing disorganized microstructure. Spectral analysis of sway revealed greater tremor in alcoholic men than alcoholic women or controls. Cognitive dual-tasking elicited excessive tremor in two frequency bands, each related to DTI signs of degradation in separate brain systems: tremor velocity at a low frequency (2–5 Hz/0–2 Hz) correlated with higher MD in the cerebellar hemispheres and superior cingulate bundles, whereas tremor velocity at a higher frequency (5–7 Hz) correlated with higher MD in the motor cortex and internal capsule. These brain sites may represent “tremorgenic networks” that, when disturbed by disease and exacerbated by cognitive dual-tasking, contribute to postural instability, putting affected individuals at heightened risk for falling.