Introduction of Ultra-High-Field MR Imaging in Infants: Preparations and Feasibility

High resolution and contrast 7 tesla MR brain imaging of the neonate

Introduction

Ultra-high field MR imaging offers marked gains in signal-to-noise ratio, spatial resolution, and contrast which translate to improved pathological and anatomical sensitivity. These benefits are particularly relevant for the neonatal brain which is rapidly developing and sensitive to injury. However, experience of imaging neonates at 7T has been limited due to regulatory, safety, and practical considerations. We aimed to establish a program for safely acquiring high resolution and contrast brain images from neonates on a 7T system.

Methods

Images were acquired from 35 neonates on 44 occasions (median age 39 + 6 postmenstrual weeks, range 33 + 4 to 52 + 6; median body weight 2.93 kg, range 1.57 to 5.3 kg) over a median time of 49 mins 30 s. Peripheral body temperature and physiological measures were recorded throughout scanning. Acquired sequences included T2 weighted (TSE), Actual Flip angle Imaging (AFI), functional MRI (BOLD EPI), susceptibility weighted imaging (SWI), and MR spectroscopy (STEAM).

Results

There was no significant difference between temperature before and after scanning (p = 0.76) and image quality assessment compared favorably to state-of-the-art 3T acquisitions. Anatomical imaging demonstrated excellent sensitivity to structures which are typically hard to visualize at lower field strengths including the hippocampus, cerebellum, and vasculature. Images were also acquired with contrast mechanisms which are enhanced at ultra-high field including susceptibility weighted imaging, functional MRI, and MR spectroscopy.

Discussion

We demonstrate safety and feasibility of imaging vulnerable neonates at ultra-high field and highlight the untapped potential for providing important new insights into brain development and pathological processes during this critical phase of early life.

Multi-echo Acquisition and Thermal Denoising Advances Infant Precision Functional Imaging

The characterization of individual functional brain organization with Precision Functional Mapping has provided important insights in recent years in adults. However, little is known about the ontogeny of inter-individual differences in brain functional organization during human development, but precise characterization of systems organization during periods of high plasticity might be most influential towards discoveries promoting lifelong health. Collecting and analyzing precision fMRI data during early development has unique challenges and emphasizes the importance of novel methods to improve data acquisition, processing, and analysis strategies in infant samples. Here, we investigate the applicability of two such methods from adult MRI research, multi-echo (ME) data acquisition and thermal noise removal with Noise reduction with distribution corrected principal component analysis (NORDIC), in precision fMRI data from three newborn infants. Compared to an adult example subject, T2* relaxation times calculated from ME data in infants were longer and more variable across the brain, pointing towards ME acquisition being a promising tool for optimizing developmental fMRI. The application of thermal denoising via NORDIC increased tSNR and the overall strength of functional connections as well as the split-half reliability of functional connectivity matrices in infant ME data. While our findings related to NORDIC denoising are coherent with the adult literature and ME data acquisition showed high promise, its application in developmental samples needs further investigation. The present work reveals gaps in our understanding of the best techniques for developmental brain imaging and highlights the need for further developmentally-specific methodological advances and optimizations, towards precision functional imaging in infants.

Introduction of ultra-high-field MR brain imaging in infants: vital parameters, temperature and comfort

Background

Brain MRI in infants at ultra-high-field scanners might improve diagnostic quality, but safety should be evaluated first. In our previous study, we reported simulated specific absorption rates and acoustic noise data at 7 Tesla.

Methods

In this study, we included twenty infants between term-equivalent age and three months of age. The infants were scanned on a 7 Tesla MRI directly after their clinically indicated 3 Tesla brain MRI scan. Vital parameters, temperature, and comfort were monitored throughout the process. Brain temperature was estimated during the MRI scans using proton MR spectroscopy.

Results

We found no significant differences in vital parameters, temperature, and comfort during and after 7 Tesla MRI scans, compared to 3 Tesla MRI scans.

Conclusions

These data confirm our hypothesis that scanning infants at 7 Tesla MRI appears to be safe and we identified no additional risks from scanning at 3 Tesla MRI.

Actual patient position versus safety models: Specific Absorption Rate implications of initial head position for Ultrahigh Field Magnetic Resonance Imaging

Specific absorption rate (SAR) relates power absorption to tissue heating, and therefore is used as a safety constraint in magnetic resonance imaging (MRI). This study investigates the implications of initial head positioning on local and whole-head SAR. A virtual body model was simulated at 161 positions inside an eight-channel parallel-transmit (pTx) array. On-axis displacements and rotations of up to 20 mm/degrees and off-axis axial/coronal translations were investigated. Single-channel, radiofrequency (RF) shimming (i.e., single-spoke pTx) and multispoke pTx pulses were designed for seven axial, five coronal and five sagittal slices at each position (the slices were consistent across all positions). Whole-head and local SAR were calculated using safety models consisting of a single (centred) body position, multiple representative positions and all simulated body positions. Positional mismatches between safety models and actual positions cause SAR underestimation. For axial imaging, the actual peak local SAR was up to 4.2-fold higher for both single-channel and 5-spoke pTx, 3.5-fold higher for 3-/4-spoke pTx, and 2-fold higher for RF shimming and 2-spoke pTx, compared with that calculated using the centred body position. For sagittal and coronal imaging, the underestimation of peak local SAR was up to 5.2-fold and 3.8-fold, respectively. Using all body positions to estimate SAR prevented SAR underestimation but yielded up to 11-fold SAR overestimation for RF shimming. Local SAR of single-channel and pTx multispoke pulses showed considerable dependence on the initial patient position. RF shimming yielded much lower sensitivity to positional mismatches for axial imaging but not for sagittal and coronal imaging. This was deemed attributable to the higher degrees-of-freedom of control offered by the investigated coil array for axial imaging. Whole-head SAR is less sensitive to positional mismatches compared with local SAR. Nevertheless, whole-head SAR increased by up to 80% for sagittal imaging. Local and whole-head SAR were observed to be more sensitive to positional mismatches in the axial plane, because of larger variations in coil-tissue proximity. Using all possible body positions in the safety model may become substantially over-conservative and limit imaging performance, especially for the RF shimming mode for axial imaging.

In vivo T1 mapping of neonatal brain tissue at 64 mT

PURPOSE

Ultralow-field (ULF) point-of-care MRI systems allow image acquisition without interrupting medical provision, with neonatal clinical care being an important potential application. The ability to measure neonatal brain tissue T1 is a key enabling technology for subsequent structural image contrast optimization, as well as being a potential biomarker for brain development. Here we describe an optimized strategy for neonatal T1 mapping at ULF.

METHODS

Examinations were performed on a 64-mT portable MRI system. A phantom validation experiment was performed, and a total of 33 in vivo exams were acquired from 28 neonates with postmenstrual age ranging from 31+4 to 49+0  weeks. Multiple inversion-recovery turbo spin-echo sequences were acquired with differing inversion and repetition times. An analysis pipeline incorporating inter-sequence motion correction generated proton density and T1 maps. Regions of interest were placed in the cerebral deep gray matter, frontal white matter, and cerebellum. Weighted linear regression was used to predict T1 as a function of postmenstrual age.

RESULTS

Reduction of T1 with postmenstrual age is observed in all measured brain tissue; the change in T1 per week and 95% confidence intervals is given by dT1  = -21 ms/week [-25, -16] (cerebellum), dT1  = -14 ms/week [-18, -10] (deep gray matter), and dT1  = -35 ms/week [-45, -25] (white matter).

CONCLUSION

Neonatal T1 values at ULF are shorter than those previously described at standard clinical field strengths, but longer than those of adults at ULF. T1 reduces with postmenstrual age and is therefore a candidate biomarker for perinatal brain development.

Towards an integrated neonatal brain and cardiac examination capability at 7 T: electromagnetic field simulations and early phantom experiments using an 8-channel dipole array

OBJECTIVE

Neonatal brain and cardiac imaging would benefit from the increased signal-to-noise ratio levels at 7 T compared to lower field. Optimal performance might be achieved using purpose designed RF coil arrays. In this study, we introduce an 8-channel dipole array and investigate, using simulations, its RF performances for neonatal applications at 7 T.

METHODS

The 8-channel dipole array was designed and evaluated for neonatal brain/cardiac configurations in terms of SAR efficiency (ratio between transmit-field and maximum specific-absorption-rate level) using adjusted dielectric properties for neonate. A birdcage coil operating in circularly polarized mode was simulated for comparison. Validation of the simulation model was performed on phantom for the coil array.

RESULTS

The 8-channel dipole array demonstrated up to 46% higher SAR efficiency levels compared to the birdcage coil in neonatal configurations, as the specific-absorption-rate levels were alleviated. An averaged normalized root-mean-square-error of 6.7% was found between measured and simulated transmit field maps on phantom.

CONCLUSION

The 8-channel dipole array design integrated for neonatal brain and cardiac MR was successfully demonstrated, in simulation with coverage of the baby and increased SAR efficiency levels compared to the birdcage. We conclude that the 8Tx-dipole array promises safe operating procedures for MR imaging of neonatal brain and heart at 7 T.

Evaluation of specific absorption rate and heating in children exposed to a 7T MRI head coil

PURPOSE

To evaluate specific absorption rate (SAR) and temperature distributions resulting from pediatric exposure to a 7T head coil.

METHODS

Exposure from a 297-MHz birdcage head transmit coil (CP mode single-channel transmission) was simulated in several child models (ages 3-14, mass 13.9-50.4 kg) and one adult, using time-domain electromagnetic and thermal solvers. Position variability, age-related changes in dielectric properties, and differences in thermoregulation were also considered.

RESULTS

Age-adjusted dielectric properties had little effect in this population. Head average SAR (hdSAR) was the limiting factor for all models centered in the coil. The value of hdSAR (normalized to net power) was found to decrease linearly with increasing mass (R²  = 0.86); no equivalent relationship for peak-spatial 10g averaged SAR (psSAR_10g ) was identified. Relatively small (< 10%) variability was observed in hdSAR for position shifts of ±25 mm in each orthogonal direction when normalized to net power; accounting for B1+$$ {\mathrm{B}}_1^{+} $$ efficiency can lead to much larger variability. Position sensitivity of psSAR_10g was greater, but in most cases hdSAR remained the limiting quantity. For thermal simulations, if blood temperature is fixed (i.e., asserting good thermoregulation), maximum temperatures are compliant with International Electrotechnical Commission limits during 60-min exposure at the SAR limit. Introducing variable blood temperature leads to core temperature changes proportional to whole-body averaged SAR, exceeding guideline limits for all child models.

CONCLUSIONS

Children experienced higher SAR than adults for the 297-MHz head transmit coil examined in this work. Thermal simulations suggest that core temperature changes could occur in smaller subjects, although experimental data are needed for validation.

Brain proton magnetic resonance spectroscopy and neurodevelopment after preterm birth: a systematic review

BACKGROUND

Preterm infants are at risk of neurodevelopmental impairments. At present, proton magnetic resonance spectroscopy (¹H-MRS) is used to evaluate brain metabolites in asphyxiated term infants. The aim of this review is to assess associations between cerebral ¹H-MRS and neurodevelopment after preterm birth.

METHODS

PubMed and Embase were searched to identify studies using ¹H-MRS and preterm birth. Eligible studies for this review included ¹H-MRS of the brain, gestational age ≤32 weeks, and neurodevelopment assessed at a corrected age (CA) of at least 12 months up to the age of 18 years.

RESULTS

Twenty papers evaluated ¹H-MRS in preterm infants at an age between near-term and 18 years and neurodevelopment. ¹H-MRS was performed in both white (WM) and gray matter (GM) in 12 of 20 studies. The main regions were frontal and parietal lobe for WM and basal ganglia for GM. N-acetylaspartate/choline (NAA/Cho) measured in WM and/or GM is the most common metabolite ratio associated with motor, language, and cognitive outcome at 18-24 months CA.

CONCLUSIONS

NAA/Cho in WM assessed at term-equivalent age was associated with motor, cognitive, and language outcome, and NAA/Cho in deep GM was associated with language outcome at 18-24 months CA.

IMPACT

In preterm born infants, brain metabolism assessed using ¹H-MRS at term-equivalent age is associated with motor, cognitive, and language outcomes at 18-24 months. ¹H-MRS at term-equivalent age in preterm born infants may be used as an early indication of brain development. Specific findings relating to NAA were most predictive of outcome.

Dear reviewers: Responses to common reviewer critiques about infant neuroimaging studies

The field of adult neuroimaging relies on well-established principles in research design, imaging sequences, processing pipelines, as well as safety and data collection protocols. The field of infant magnetic resonance imaging, by comparison, is a young field with tremendous scientific potential but continuously evolving standards. The present article aims to initiate a constructive dialog between researchers who grapple with the challenges and inherent limitations of a nascent field and reviewers who evaluate their work. We address 20 questions that researchers commonly receive from research ethics boards, grant, and manuscript reviewers related to infant neuroimaging data collection, safety protocols, study planning, imaging sequences, decisions related to software and hardware, and data processing and sharing, while acknowledging both the accomplishments of the field and areas of much needed future advancements. This article reflects the cumulative knowledge of experts in the FIT’NG community and can act as a resource for both researchers and reviewers alike seeking a deeper understanding of the standards and tradeoffs involved in infant neuroimaging.

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The field of infant MRI is young with evolving standards.

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We address 20 questions that researchers commonly receive reviewers.

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These come from research ethics boards, grant, and manuscript reviewers.

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This article reflects the cumulative knowledge of experts in the FIT’NG community.

Specific absorption rate and temperature in neonate models resulting from exposure to a 7T head coil

PURPOSE

To investigate safe limits for neonatal imaging using a 7T head coil, including both specific absorption rate (SAR) and temperature predictions.

METHODS

Head-centered neonate models were simulated using finite-difference time domain-based electromagnetic and thermal solvers. The effects of higher water content of neonatal tissues compared with adults, position shifts, and thermal insulation were also considered. An adult model was simulated for comparison.

RESULTS

Maximum and average SAR are both elevated in the neonate when compared with an adult model. When normalized to B1+ , the SAR experienced by a neonate is greater than an adult by approximately a factor of 2; when normalized to net forward power (forward-reflected), this increases to a factor of 2.5-3.0; and when normalized to absorbed power, approximately a factor of 4. Use of age-adjusted dielectric properties significantly increases the predicted SAR, compared with using adult tissue properties for the neonates. Thermal simulations predict that change in core temperature/maximum temperature remain compliant with International Electrotechnical Commission limits when a thermally insulated neonate is exposed at the SAR limit for up to an hour.

CONCLUSION

This study of two neonate models cannot quantify the variability expected within a larger population. Likewise, the use of age-adjusted dielectric properties have a significant effect, but while their use is well motivated by literature, there is uncertainty in the true dielectric properties of neonatal tissue. Nevertheless, the main finding is that unlike at lower field strengths, operational limits for 7T neonatal MRI using an adult head coil should be more conservative than limits for use on adults.

Fast and High-Resolution Neonatal Brain MRI Through Super-Resolution Reconstruction From Acquisitions With Variable Slice Selection Direction

The brain of neonates is small in comparison to adults. Imaging at typical resolutions such as one cubic mm incurs more partial voluming artifacts in a neonate than in an adult. The interpretation and analysis of MRI of the neonatal brain benefit from a reduction in partial volume averaging that can be achieved with high spatial resolution. Unfortunately, direct acquisition of high spatial resolution MRI is slow, which increases the potential for motion artifact, and suffers from reduced signal-to-noise ratio. The purpose of this study is thus that using super-resolution reconstruction in conjunction with fast imaging protocols to construct neonatal brain MRI images at a suitable signal-to-noise ratio and with higher spatial resolution than can be practically obtained by direct Fourier encoding. We achieved high quality brain MRI at a spatial resolution of isotropic 0.4 mm with 6 min of imaging time, using super-resolution reconstruction from three short duration scans with variable directions of slice selection. Motion compensation was achieved by aligning the three short duration scans together. We applied this technique to 20 newborns and assessed the quality of the images we reconstructed. Experiments show that our approach to super-resolution reconstruction achieved considerable improvement in spatial resolution and signal-to-noise ratio, while, in parallel, substantially reduced scan times, as compared to direct high-resolution acquisitions. The experimental results demonstrate that our approach allowed for fast and high-quality neonatal brain MRI for both scientific research and clinical studies.

MR spectroscopy in pediatric neuroradiology

Magnetic resonance spectroscopy (MRS), being able to identify and measure some brain components (metabolites) in pathologic lesions and in normal-appearing tissue, offers a valuable additional diagnostic tool to assess several pediatric neurological diseases. In this review we will illustrate the basic principles and clinical applications of brain proton (H¹; hydrogen) MRS (H¹MRS), by now the only MRS method widely available in clinical practice. Performing H¹MRS in the brain is inherently less complicated than in other tissues (e.g., liver, muscle), in which spectra are heavily affected by magnetic field inhomogeneities, respiration artifacts, and dominating signals from the surrounding adipose tissues. H¹MRS in pediatric neuroradiology has some advantages over acquisitions in adults (lack of motion due to children sedation and lack of brain iron deposition allow optimal results), but it requires a deep knowledge of pediatric pathologies and familiarity with the developmental changes in spectral patterns, particularly occurring in the first two years of life. Examples from our database, obtained mainly from a 1.5 Tesla clinical scanner in a time span of 15 years, will demonstrate the efficacy of H¹MRS in the diagnosis of a wide range of selected pediatric pathologies, like brain tumors, infections, neonatal hypoxic-ischemic encephalopathy, metabolic and white matter disorders.