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Mossa-Basha M, Andre JB, Yuh E, Hunt D, LaPiana N, Howlett B, Krakauer C, Crane P, Nelson J, DeZelar M, Meyers K, Larson E, Ralston J, Mac Donald CL. Comparison of brain imaging and physical health between research and clinical neuroimaging cohorts of ageing. Br J Radiol 2024; 97:614-621. [PMID: 38303547 PMCID: PMC11027291 DOI: 10.1093/bjr/tqae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/28/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES To compare brain MRI measures between Adult Changes in Thought (ACT) participants who underwent research, clinical, or both MRI scans, and clinical health measures across the groups and non-MRI subjects. METHODS Retrospective cohort study leveraging MRI, clinical, demographic, and medication data from ACT. Three neuroradiologists reviewed MRI scans using NIH Neuroimaging Common Data Elements (CDEs). Total brain and white matter hyperintensity (WMH) volumes, clinical characteristics, and outcome measures of brain and overall health were compared between groups. 1166 MRIs were included (77 research, 1043 clinical, and 46 both) and an additional 3146 participants with no MRI were compared. RESULTS Compared to the group with research MRI only, the clinical MRI group had higher prevalence of the following: acute infarcts, chronic haematoma, subarachnoid haemorrhage, subdural haemorrhage, haemorrhagic transformation, and hydrocephalus (each P < .001). Quantitative WMH burden was significantly lower (P < .001) and total brain volume significantly higher (P < .001) in research MRI participants compared to other MRI groups. Prevalence of hypertension, self-reported cerebrovascular disease, congestive heart failure, dementia, and recent hospitalization (all P < .001) and diabetes (P = .002) differed significantly across groups, with smaller proportions in the research MRI group. CONCLUSION In ageing populations, significant differences were observed in MRI metrics between research MRI and clinical MRI groups, and clinical health metric differences between research MRI, clinical MRI, and no-MRI groups. ADVANCES IN KNOWLEDGE This questions whether research cohorts can adequately represent the greater ageing population undergoing imaging. These findings may also be useful to radiologists when interpreting neuroimaging of ageing.
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Affiliation(s)
- Mahmud Mossa-Basha
- Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, Washington, 98105 United States
| | - Jalal B Andre
- Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, Washington, 98105 United States
| | - Esther Yuh
- Department of Radiology, University of California San Francisco, 1001 Potrero Avenue, Building 5, San Francisco, California, 94110 United States
| | - David Hunt
- Department of Neurological Surgery, University of Washington, 325 9th Avenue, Seattle, Washington, 98104 United States
| | - Nina LaPiana
- Department of Neurological Surgery, University of Washington, 325 9th Avenue, Seattle, Washington, 98104 United States
| | - Bradley Howlett
- Department of Neurological Surgery, University of Washington, 325 9th Avenue, Seattle, Washington, 98104 United States
| | - Chloe Krakauer
- Health Research Institute, Kaiser Permanente Washington, 1730 Minor Ave, Seattle, Washington, 98101 United States
| | - Paul Crane
- Department of Internal Medicine, University of Washington, 325 9th Avenue, Seattle, Washington, 98104 United States
| | - Jennifer Nelson
- Health Research Institute, Kaiser Permanente Washington, 1730 Minor Ave, Seattle, Washington, 98101 United States
| | - Margaret DeZelar
- Health Research Institute, Kaiser Permanente Washington, 1730 Minor Ave, Seattle, Washington, 98101 United States
| | - Kelly Meyers
- Health Research Institute, Kaiser Permanente Washington, 1730 Minor Ave, Seattle, Washington, 98101 United States
| | - Eric Larson
- Health Research Institute, Kaiser Permanente Washington, 1730 Minor Ave, Seattle, Washington, 98101 United States
| | - James Ralston
- Health Research Institute, Kaiser Permanente Washington, 1730 Minor Ave, Seattle, Washington, 98101 United States
| | - Christine L Mac Donald
- Department of Neurological Surgery, University of Washington, 325 9th Avenue, Seattle, Washington, 98104 United States
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Andre JB, Oztek MA, Anzai Y, Wilson GJ, Mossa-Basha M, Hippe DS, Hoff MN, Cross DJ, Minoshima S. Evaluation of 3-dimensional stereotactic surface projection rendering of arterial spin labeling data in a clinical cohort. J Neuroimaging 2023; 33:933-940. [PMID: 37695098 DOI: 10.1111/jon.13153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND AND PURPOSE To assess the feasibility of 3-dimensional stereotactic surface projection (3D-SSP) as applied to arterial spin labeling (ASL) in a clinical pilot study. METHODS A retrospective sample of 10 consecutive patients who underwent ASL as part of a clinically indicated MR examination was collected during this pilot study. Five additional subjects with normal cerebral perfusion served as a control group. Following voxel-wise M0-correction, cerebral blood flow (CBF) quantification, and stereotactic anatomic standardization, voxel-wise CBF from an individual's ASL dataset was extracted to a set of predefined surface pixels (3D-SSP). A normal database was created from averaging the extracted CBF datasets of the control group. Patients' datasets were compared individually with the normal database by calculating a Z-score on a pixel-by-pixel basis and were displayed in 3D-SSP views for visual inspection. Independent, two-expert reader assessment, using a 3-point scale, compared standard quantitative CBF images to the 3D-SSP maps. RESULTS Patterns and severities of regionally reduced CBF were identified, by both independent readers, in the 3D-SSP maps. Reader assessment demonstrated preference for 3D-SSP over traditionally displayed standard quantitative CBF images in three of four evaluated imaging metrics (p = .026, .031, and .013, respectively); 3D-SSP maps were never found to be inferior to the standard quantitative CBF images. CONCLUSIONS Three-dimensional SSP maps are feasible in a clinical population and enable quantitative data extraction and localization of perfusion abnormalities by means of stereotactic coordinates in a condensed display. The proposed method is a promising approach for interpreting cerebrovascular pathophysiology.
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Affiliation(s)
- Jalal B Andre
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Murat Alp Oztek
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Yoshimi Anzai
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Gregory J Wilson
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Michael N Hoff
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Donna J Cross
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Satoshi Minoshima
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
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Chatterjee AR, Malhotra A, Curl P, Andre JB, Perez-Carrillo GJG, Smith EB. Traumatic Cervical Cerebrovascular Injury and the Role of CTA: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023. [PMID: 37791730 DOI: 10.2214/ajr.23.29783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Traumatic cerebrovascular injury (CVI) involving the cervical carotid and vertebral arteries is rare but can lead to stroke, hemodynamic compromise, and mortality in the absence of early diagnosis and treatment. The diagnosis of both blunt CVI (BCVI) and penetrating CVI is based on cerebrovascular imaging. The most commonly used screening criteria for BCVI include the expanded Denver criteria and the Memphis criteria, each providing varying thresholds for subsequent imaging. Neck CTA has supplanted catheter-based digital subtraction angiography as the preferred screening modality for CVI in patients with trauma. This AJR Expert Panel Narrative Review describes the current state of CTA-based cervical imaging in trauma. We review the most common screening criteria for BCVI, discuss BCVI grading scales that are based on neck CTA, describe the diagnostic performance of CTA in the context of other imaging modalities and evolving treatment strategies, and provide a practical guide for neck CTA implementation.
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Affiliation(s)
- Arindam Rano Chatterjee
- Associate Professor of Radiology, Neurosurgery, and Neurology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis
| | - Ajay Malhotra
- Professor, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Patti Curl
- Assistant Professor, Department of Radiology, Neuroradiology Section, University of Washington School of Medicine, Seattle WA
| | - Jalal B Andre
- Associate Professor, Department of Radiology, Neuroradiology Section, University of Washington School of Medicine, 1959 NE Pacific St., NW011, Seattle, WA 98195
| | - Gloria J Guzman Perez-Carrillo
- Associate Professor of Radiology, Neuroradiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis
| | - Elana B Smith
- Associate Professor, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201
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Hoff MN, Xiang QS, Cross NM, Hippe D, Andre JB. Motion resilience of the balanced steady-state free precession geometric solution. Magn Reson Med 2022; 89:192-204. [PMID: 36093906 DOI: 10.1002/mrm.29438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/26/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Many MRI sequences are sensitive to motion and its associated artifacts. The linearized geometric solution (LGS), a balanced steady-state free precession (bSSFP) off-resonance signal demodulation technique, is evaluated with respect to motion artifact resilience. THEORY AND METHODS The mechanism and extent of LGS motion artifact resilience is examined in simulated, flow phantom, and in vivo clinical imaging. Motion artifact correction capabilities are decoupled from susceptibility artifact correction when feasible to permit controlled analysis of motion artifact correction when comparing the LGS with standard and phase-cycle-averaged (complex sum) bSSFP imaging. RESULTS Simulations reveal that the LGS demonstrates motion artifact reduction capabilities similar to standard clinical bSSFP imaging techniques, with slightly greater resilience in high SNR regions and for shorter-duration motion. Flow phantom experiments assert that the LGS reduces shorter-duration motion artifact error by ∼24%-65% relative to the complex sum, whereas reconstructions exhibit similar error reduction for constant motion. In vivo analysis demonstrates that in the internal auditory canal/orbits, the LGS was deemed to have less artifact in 24%/49% and similar artifact in 76%/51% of radiological assessments relative to the complex sum, and the LGS had less artifact in 97%/81% and similar artifact in 3%/16% of assessments relative to standard bSSFP. Only 2 of 63 assessments deemed the LGS inferior to either complex sum or standard bSSFP in terms of artifact reduction. CONCLUSION The LGS provides sufficient bSSFP motion artifact resilience to permit robust elimination of susceptibility artifacts, inspiring its use in a wide variety of applications.
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Affiliation(s)
- Michael N Hoff
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Qing-San Xiang
- Department of Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan M Cross
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Daniel Hippe
- Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jalal B Andre
- Department of Radiology, University of Washington, Seattle, Washington, USA
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5
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Andre JB, Amthor T, Hall CS, Gunn ML, Hoff MN, Cohen W, Beauchamp NJ. Correlating the Radiological Assessment of Patient Motion with the Incidence of Repeat Sequences Documented by Log Files. Curr Probl Diagn Radiol 2022; 51:534-539. [DOI: 10.1067/j.cpradiol.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022]
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Abecassis IJ, Cordy B, Durfy S, Andre JB, Levitt MR, Ellenbogen RG, Silbergeld DL, Ko AL. Evaluating angioarchitectural characteristics of glial and metastatic brain tumors with conventional magnetic resonance imaging. J Clin Neurosci 2020; 76:46-52. [PMID: 32312627 PMCID: PMC10947781 DOI: 10.1016/j.jocn.2020.04.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023]
Abstract
Primary and metastatic brain tumors can overlap in traditional imaging features detected on preoperative conventional magnetic resonance imaging (MRI). The research objective was to determine whether morphological vascular characteristics present in routine preoperative imaging using traditional MRI sequences are predictive of primary versus metastatic brain tumors; secondarily to determine association of conventional and vascular-related imaging parameters with intraoperative blood loss, pathological invasion, and World Health Organization (WHO) tumor grade. A retrospective review analyzed 100 consecutive intracranial tumor surgeries, 50 WHO grade II-IV gliomas and 50 intracranial metastases. Two blinded expert readers independently evaluated preoperative MRIs, obtained via standard morphological imaging sequences, for adjacent or intra-tumoral arterial aneurysm, peritumoral venous ectasia, prominence, or engorgement ("aberrant peritumoral vessels"), and prominent intra-tumoral flow voids. Multivariate analysis was performed to develop models predictive of glioma and glioblastoma (GBM). Aberrant peritumoral vessels and prominent intra-tumoral flow voids were statistically significant predictors of glioma in univariate analyses (p = 0.048, p = 0.001, respectively) and when combined in multivariate analysis (OR = 5.23, p = 0.001), particularly for GBM (OR = 9.08, p < 0.001). Multivariate modeling identified prominent intra-tumoral flow voids and FLAIR invasion as the strongest combined predictors of gliomas and GBM. Aberrant peritumoral vessels and larger tumor volume predicted higher intraoperative blood loss in all analyses. No vascular-related parameters predicted pathological invasion on multivariate analysis. Aberrant peritumoral vessels and prominent intra-tumoral flow voids were predictive of gliomas, specifically GBM. These vascular characteristics, evaluated on routine clinical preoperative MRI imaging, may aid in distinguishinggliomafrom brainmetastases andmay predict intraoperative blood loss.
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Affiliation(s)
| | - Benjamin Cordy
- Departments of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Sharon Durfy
- Departments of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Jalal B Andre
- Radiology, University of Washington, Seattle, WA, USA
| | - Michael R Levitt
- Departments of Neurological Surgery, University of Washington, Seattle, WA, USA; Radiology, University of Washington, Seattle, WA, USA; Mechanical Engineering, University of Washington, Seattle, WA, USA; Stroke and Applied Neuroscience Center, University of Washington, Seattle, WA, USA
| | - Richard G Ellenbogen
- Departments of Neurological Surgery, University of Washington, Seattle, WA, USA; Stroke and Applied Neuroscience Center, University of Washington, Seattle, WA, USA
| | - Daniel L Silbergeld
- Departments of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Andrew L Ko
- Departments of Neurological Surgery, University of Washington, Seattle, WA, USA.
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Nguyen XV, Tahir S, Bresnahan BW, Andre JB, Lang EV, Mossa-Basha M, Mayr NA, Bourekas EC. Prevalence and Financial Impact of Claustrophobia, Anxiety, Patient Motion, and Other Patient Events in Magnetic Resonance Imaging. Top Magn Reson Imaging 2020; 29:125-130. [PMID: 32568974 DOI: 10.1097/rmr.0000000000000243] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Claustrophobia, other anxiety reactions, excessive motion, and other unanticipated patient events in magnetic resonance imaging (MRI) not only delay or preclude diagnostic-quality imaging but can also negatively affect the patient experience. In addition, by impeding MRI workflow, they may affect the finances of an imaging practice. This review article offers an overview of the various types of patient-related unanticipated events that occur in MRI, along with estimates of their frequency of occurrence as documented in the available literature. In addition, the financial implications of these events are discussed from a microeconomic perspective, primarily from the point of view of a radiology practice or hospital, although associated limitations and other economic viewpoints are also included. Efforts to minimize these unanticipated patient events can potentially improve not only patient satisfaction and comfort but also an imaging practice's operational efficiency and diagnostic capabilities.
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Affiliation(s)
- Xuan V Nguyen
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Brian W Bresnahan
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Jalal B Andre
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | | | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Nina A Mayr
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA
| | - Eric C Bourekas
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
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8
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Sommer K, Saalbach A, Brosch T, Hall C, Cross NM, Andre JB. Correction of Motion Artifacts Using a Multiscale Fully Convolutional Neural Network. AJNR Am J Neuroradiol 2020; 41:416-423. [PMID: 32054615 DOI: 10.3174/ajnr.a6436] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/07/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Motion artifacts are a frequent source of image degradation in the clinical application of MR imaging (MRI). Here we implement and validate an MRI motion-artifact correction method using a multiscale fully convolutional neural network. MATERIALS AND METHODS The network was trained to identify motion artifacts in axial T2-weighted spin-echo images of the brain. Using an extensive data augmentation scheme and a motion artifact simulation pipeline, we created a synthetic training dataset of 93,600 images based on only 16 artifact-free clinical MRI cases. A blinded reader study using a unique test dataset of 28 additional clinical MRI cases with real patient motion was conducted to evaluate the performance of the network. RESULTS Application of the network resulted in notably improved image quality without the loss of morphologic information. For synthetic test data, the average reduction in mean squared error was 41.84%. The blinded reader study on the real-world test data resulted in significant reduction in mean artifact scores across all cases (P < .03). CONCLUSIONS Retrospective correction of motion artifacts using a multiscale fully convolutional network is promising and may mitigate the substantial motion-related problems in the clinical MRI workflow.
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Affiliation(s)
- K Sommer
- From Philips Research, (K.S., A.S., T.B.) Hamburg, Germany
| | - A Saalbach
- From Philips Research, (K.S., A.S., T.B.) Hamburg, Germany
| | - T Brosch
- From Philips Research, (K.S., A.S., T.B.) Hamburg, Germany
| | - C Hall
- Radiology Solutions (C.H.), Philips, Seattle, Washington
| | - N M Cross
- Department of Radiology (N.M.C., J.B.A.), University of Washington, Seattle, Washington
| | - J B Andre
- Department of Radiology (N.M.C., J.B.A.), University of Washington, Seattle, Washington
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Ooi MB, Li Z, Robison RK, Wang D, Anderson AG, Zwart NR, Bakhru A, Nagaraj S, Mathews T, Hey S, Koonen JJ, Dimitrov IE, Friel HT, Lu Q, Obara M, Saha I, Wang H, Wang Y, Zhao Y, Temkit M, Hu HH, Chenevert TL, Togao O, Tkach JA, Nagaraj UD, Pinho MC, Gupta RK, Small JE, Kunst MM, Karis JP, Andre JB, Miller JH, Pinter NK, Pipe JG. Spiral T1 Spin-Echo for Routine Postcontrast Brain MRI Exams: A Multicenter Multireader Clinical Evaluation. AJNR Am J Neuroradiol 2020; 41:238-245. [PMID: 32029467 DOI: 10.3174/ajnr.a6409] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/10/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Spiral MR imaging has several advantages compared with Cartesian MR imaging that can be leveraged for added clinical value. A multicenter multireader study was designed to compare spiral with standard-of-care Cartesian postcontrast structural brain MR imaging on the basis of relative performance in 10 metrics of image quality, artifact prevalence, and diagnostic benefit. MATERIALS AND METHODS Seven clinical sites acquired 88 total subjects. For each subject, sites acquired 2 postcontrast MR imaging scans: a spiral 2D T1 spin-echo, and 1 of 4 routine Cartesian 2D T1 spin-echo/TSE scans (fully sampled spin-echo at 3T, 1.5T, partial Fourier, TSE). The spiral acquisition matched the Cartesian scan for scan time, geometry, and contrast. Nine neuroradiologists independently reviewed each subject, with the matching pair of spiral and Cartesian scans compared side-by-side, and scored on 10 image-quality metrics (5-point Likert scale) focused on intracranial assessment. The Wilcoxon signed rank test evaluated relative performance of spiral versus Cartesian, while the Kruskal-Wallis test assessed interprotocol differences. RESULTS Spiral was superior to Cartesian in 7 of 10 metrics (flow artifact mitigation, SNR, GM/WM contrast, image sharpness, lesion conspicuity, preference for diagnosing abnormal enhancement, and overall intracranial image quality), comparable in 1 of 10 metrics (motion artifacts), and inferior in 2 of 10 metrics (susceptibility artifacts, overall extracranial image quality) related to magnetic susceptibility (P < .05). Interprotocol comparison confirmed relatively higher SNR and GM/WM contrast for partial Fourier and TSE protocol groups, respectively (P < .05). CONCLUSIONS Spiral 2D T1 spin-echo for routine structural brain MR imaging is feasible in the clinic with conventional scanners and was preferred by neuroradiologists for overall postcontrast intracranial evaluation.
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Affiliation(s)
- M B Ooi
- From Philips Healthcare (M.B.O., I.E.D., H.T.F., Q.L., H.W., Y.W., Y.Z.)
| | - Z Li
- Gainesville, Florida; Barrow Neurological Institute (Z.L., A.G.A., N.R.Z., J.P.K.)
| | - R K Robison
- Rochester, Minnesota; Phoenix Children's Hospital (R.K.R., M.T., H.H.H., J.H.M.)
| | - D Wang
- Phoenix, Arizona; Mayo Clinic (D.W., J.G.P.)
| | - A G Anderson
- Gainesville, Florida; Barrow Neurological Institute (Z.L., A.G.A., N.R.Z., J.P.K.)
| | - N R Zwart
- Gainesville, Florida; Barrow Neurological Institute (Z.L., A.G.A., N.R.Z., J.P.K.)
| | - A Bakhru
- Buffalo, New York; Philips Healthcare (A.B., S.N., T.M.)
| | - S Nagaraj
- Buffalo, New York; Philips Healthcare (A.B., S.N., T.M.)
| | - T Mathews
- Buffalo, New York; Philips Healthcare (A.B., S.N., T.M.)
| | - S Hey
- Bangalore, India; Philips Healthcare, (S.H., J.J.K.), Best, the Netherlands
| | - J J Koonen
- Bangalore, India; Philips Healthcare, (S.H., J.J.K.), Best, the Netherlands
| | - I E Dimitrov
- From Philips Healthcare (M.B.O., I.E.D., H.T.F., Q.L., H.W., Y.W., Y.Z.)
| | - H T Friel
- From Philips Healthcare (M.B.O., I.E.D., H.T.F., Q.L., H.W., Y.W., Y.Z.)
| | - Q Lu
- From Philips Healthcare (M.B.O., I.E.D., H.T.F., Q.L., H.W., Y.W., Y.Z.)
| | - M Obara
- Philips Healthcare (M.O.), Tokyo, Japan
| | - I Saha
- Philips Healthcare (I.S.), Gurgaon, India
| | - H Wang
- From Philips Healthcare (M.B.O., I.E.D., H.T.F., Q.L., H.W., Y.W., Y.Z.)
| | - Y Wang
- From Philips Healthcare (M.B.O., I.E.D., H.T.F., Q.L., H.W., Y.W., Y.Z.)
| | - Y Zhao
- From Philips Healthcare (M.B.O., I.E.D., H.T.F., Q.L., H.W., Y.W., Y.Z.)
| | - M Temkit
- Rochester, Minnesota; Phoenix Children's Hospital (R.K.R., M.T., H.H.H., J.H.M.)
| | - H H Hu
- Rochester, Minnesota; Phoenix Children's Hospital (R.K.R., M.T., H.H.H., J.H.M.)
| | - T L Chenevert
- University of Michigan (T.L.C.), Ann Arbor, Michigan
| | - O Togao
- Kyushu University Hospital (O.T.), Kyushu, Japan
| | - J A Tkach
- Cincinnati Children's Hospital (J.A.T., U.D.N.), Cincinnati, Ohio
| | - U D Nagaraj
- Cincinnati Children's Hospital (J.A.T., U.D.N.), Cincinnati, Ohio
| | - M C Pinho
- University of Texas Southwestern Medical Center (M.C.P.), Dallas, Texas
| | - R K Gupta
- Fortis Memorial Research Institute (R.K.G.), Gurgaon, India
| | - J E Small
- Lahey Hospital and Medical Center (J.E.S., M.M.K.), Burlington, Massachusetts
| | - M M Kunst
- Lahey Hospital and Medical Center (J.E.S., M.M.K.), Burlington, Massachusetts
| | - J P Karis
- Gainesville, Florida; Barrow Neurological Institute (Z.L., A.G.A., N.R.Z., J.P.K.)
| | - J B Andre
- University of Washington (J.B.A.), Seattle, Washington
| | - J H Miller
- Rochester, Minnesota; Phoenix Children's Hospital (R.K.R., M.T., H.H.H., J.H.M.)
| | - N K Pinter
- Phoenix, Arizona; DENT Neurologic Institute (N.K.P.)
| | - J G Pipe
- Phoenix, Arizona; Mayo Clinic (D.W., J.G.P.)
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Amukotuwa SA, Fischbein NJ, Albers GW, Davis S, Donnan GA, Andre JB, Bammer R. Comparison of T2*GRE and DSC-PWI for hemorrhage detection in acute ischemic stroke patients: Pooled analysis of the EPITHET, DEFUSE 2, and SENSE 3 stroke studies. Int J Stroke 2019; 15:216-225. [PMID: 31291850 DOI: 10.1177/1747493019858781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS The objective of this study was to compare the diagnostic performance of the baseline pre-contrast images of dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) with conventional T2*gradient recalled echo (GRE) imaging for detection of hemorrhage in acute ischemic stroke patients. MATERIAL AND METHODS T2*GRE and DSC-PWI from 393 magnetic resonance imaging scans from 221 patients enrolled in three prospective stroke studies were independently evaluated by two readers blinded to clinical and other imaging data. Agreement between T2*GRE and DSC-PWI for the presence of hemorrhage, and acute hemorrhagic transformation, was assessed using the kappa statistic. Inter-reader agreement was also assessed using the kappa statistic. RESULTS Agreement between the baseline images of DSC-PWI and T2*GRE regarding the presence of hemorrhage was almost perfect (kreader 1 : 0.90, 95% confidence interval 0.86-0.95 and kreader 2 : 0.91, 95% confidence interval 0.87-0.96). Agreement between the sequences was still higher for detection of acute hemorrhagic transformation (kreader 1 : 0.94, 95% confidence interval 0.91-0.98 and kreader 2 : 0.95, 95% confidence interval 0.92-0.98). Inter-reader agreement for detection of hemorrhage was also almost perfect for both T2*GRE (k: 0.95, 95% confidence interval 0.91-0.98) and DSC-PWI (k: 0.96, 95% confidence interval 0.93-0.99). Acute hemorrhagic transformation detected on T2*GRE was missed on DSC-PWI by one or both readers in 5/393 (1.3%) scans. CONCLUSION The almost perfect statistical agreement between DSC-PWI and conventional T2*GRE suggests that DSC-PWI is sufficient for hemorrhage screening prior to thrombolysis in stroke patients. T2*GRE can therefore be omitted when DSC-PWI is included, thereby shortening the acute ischemic stroke magnetic resonance imaging protocol and expediting treatment. Trial registration: ClinicalTrials.gov Identifier: NCT02586415.
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Affiliation(s)
- Shalini A Amukotuwa
- Department of Radiology, University of Melbourne, Melbourne, Victoria, Australia.,Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | | | - Gregory W Albers
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephen Davis
- Department of Neurology, University of Melbourne, Parkville, Victoria, Australia
| | - Geoffrey A Donnan
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jalal B Andre
- Department of Radiology and Imaging Services, University of Washington Medical Center, Seattle, WA, USA
| | - Roland Bammer
- Department of Radiology, Stanford University, Stanford, CA, USA.,Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
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Rane S, Peskind ER, Hendrickson RB, Raskind MA, Andre JB. P3-330: NON-INVASIVE IN VIVO MEASUREMENTS OF PARENCHYMAL GLYMPHATIC FLOW IN OLDER ADULTS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Swati Rane
- University of Washington Medical Center; Seattle WA USA
| | - Elaine R. Peskind
- VA Puget Sound Health Care System; Seattle WA USA
- University of Washington; Seattle WA USA
| | - Rebecca B. Hendrickson
- VA Puget Sound Health Care System; Seattle WA USA
- University of Washington; Seattle WA USA
| | - Murray A. Raskind
- University of Washington; Seattle WA USA
- Veterans Affairs Puget Sound Health Care System; Seattle WA USA
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12
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Gaddikeri S, Mossa-Basha M, Andre JB, Hippe DS, Anzai Y. Optimal Fat Suppression in Head and Neck MRI: Comparison of Multipoint Dixon with 2 Different Fat-Suppression Techniques, Spectral Presaturation and Inversion Recovery, and STIR. AJNR Am J Neuroradiol 2017; 39:362-368. [PMID: 29242364 DOI: 10.3174/ajnr.a5483] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 10/16/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Uniform complete fat suppression is essential for identification and characterization of most head and pathology. Our aim was to compare the multipoint Dixon turbo spin-echo fat-suppression technique with 2 different fat-suppression techniques, including a hybrid spectral presaturation with inversion recovery technique and an inversion recovery STIR technique, in head and neck fat-suppression MR imaging. MATERIALS AND METHODS Head and neck MR imaging datasets of 72 consecutive patients were retrospectively reviewed. All patients were divided into 2 groups based on the type of fat-suppression techniques used (group A: STIR and spectral presaturation with inversion recovery gadolinium-T1WI; group B: multipoint Dixon T2 TSE and multipoint Dixon gadolinium-T1WI TSE). Objective and subjective image quality and scan acquisition times were assessed and compared between multipoint Dixon T2 TSE versus STIR and multipoint Dixon gadolinium-T1WI TSE versus spectral presaturation with inversion recovery gadolinium-T1WI using the Mann-Whitney U test. RESULTS A total of 64 patients were enrolled in the study (group A, n = 33 and group B, n = 31). Signal intensity ratios were significantly higher for multipoint Dixon T2 and gadolinium-T1WI techniques compared with STIR (P < .001) and spectral presaturation with inversion recovery gadolinium-T1WI (P < .001), respectively. Two independent blinded readers revealed that multipoint Dixon T2 and gadolinium-T1WI techniques had significantly higher overall image quality (P = .022 and P < .001) and fat-suppression grades (P < .013 and P < .001 across 3 different regions) than STIR and spectral presaturation with inversion recovery gadolinium-T1WI, respectively. The scan acquisition time was relatively short for the multipoint Dixon technique (2 minutes versus 4 minutes 56 seconds for the T2-weighted sequence and 2 minutes versus 3 minutes for the gadolinium-T1WI sequence). CONCLUSIONS The multipoint Dixon technique offers better image quality and uniform fat suppression at a shorter scan time compared with STIR and spectral presaturation with inversion recovery gadolinium-T1WI techniques.
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Affiliation(s)
- S Gaddikeri
- From the Departments of Neuroradiology (S.G.) .,Radiology (S.G.), Rush University Medical Center, Chicago, Illinois
| | | | - J B Andre
- Department of Neuroradiology (J.B.A.), University of Washington Medical Center, Seattle, Washington
| | - D S Hippe
- Radiology (D.S.H.), University of Washington, Seattle, Washington
| | - Y Anzai
- Department of Radiology (Y.A.), University of Utah Health Center, Salt Lake City, Utah
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13
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de Havenon A, Haynor DR, Tirschwell DL, Majersik JJ, Smith G, Cohen W, Andre JB. Association of Collateral Blood Vessels Detected by Arterial Spin Labeling Magnetic Resonance Imaging With Neurological Outcome After Ischemic Stroke. JAMA Neurol 2017; 74:453-458. [PMID: 28192548 DOI: 10.1001/jamaneurol.2016.4491] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Robust collateral blood vessels have been associated with better neurologic outcome following acute ischemic stroke (AIS). The most commonly used methods for identifying collaterals are contrast-based angiographic imaging techniques, which are not possible in all patients after AIS. Objective To assess the association between the presence of collateral vessels identified using arterial spin labeling (ASL) magnetic resonance imaging, a technique that does not require exogenous administration of contrast, and neurologic outcome in patients after AIS. Design, Setting, and Participants This retrospective cohort study examined 38 patients after AIS admitted to a tertiary academic medical center between 2012 and 2014 who underwent MRI with ASL. Main Outcomes and Measures According to a prespecified hypothesis, ASL images were graded for the presence of collaterals by 2 neuroradiologists. Modified Rankin Scale (mRS) scores at discharge and other composite data were abstracted from the medical record by a neurologist blinded to radiologic data. Results Of the 38 patients, 19 (50.0%) were male, and the mean (SD) age was 61 (20) years. In 25 of 38 patients (65.8%), collaterals were detected using ASL, which were significantly associated with both a good outcome (mRS score of 0-2 at discharge; P = .02) and a 1-point decrease in mRS score at discharge (odds ratio, 6.4; 95% CI, 1.7-23.4; P = .005). In a multivariable ordinal logistic regression model, controlling for admission National Institutes of Health Stroke Scale score, history of atrial fibrillation, premorbid mRS score, and stroke parent artery status, there was a strong association between the presence of ASL collaterals and a 1-point decrease in the mRS score at discharge (odds ratio, 5.1; 95% CI, 1.2-22.1; P = .03). Conclusions and Relevance Following AIS, the presence of ASL collaterals is strongly associated with better neurological outcome at hospital discharge. This novel association between ASL collaterals and improved neurologic outcome may help guide prognosis and management, particularly in patients who are unable to undergo contrast-based radiological studies.
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Affiliation(s)
| | - David R Haynor
- Department of Radiology, University of Washington, Seattle
| | | | | | - Gordon Smith
- Department of Neurology, University of Utah, Salt Lake City
| | - Wendy Cohen
- Department of Radiology, University of Washington, Seattle
| | - Jalal B Andre
- Department of Radiology, University of Washington, Seattle
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14
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Abstract
The imaging of treated gliomas is complicated by a variety of treatment related effects, which can falsely simulate disease improvement or progression. Distinguishing between disease progression and treatment effects is difficult with standard MR imaging pulse sequences and added specificity can be gained by the addition of advanced imaging techniques.
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Affiliation(s)
- Mark F Dalesandro
- Department of Radiology, Harborview Medical Center, University of Washington, Box 357115, 1959 Northeast Pacific Street, NW011, Seattle, WA 98195-7115, USA
| | - Jalal B Andre
- Department of Radiology, Harborview Medical Center, University of Washington, Box 357115, 1959 Northeast Pacific Street, NW011, Seattle, WA 98195-7115, USA.
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15
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Gunn ML, Maki JH, Hall C, Bhargava P, Andre JB, Carnell J, Amthor T, Beauchamp NJ. Improving MRI Scanner Utilization Using Modality Log Files. J Am Coll Radiol 2017; 14:783-786. [PMID: 28126532 DOI: 10.1016/j.jacr.2016.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/16/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Martin L Gunn
- Department of Radiology, University of Washington, Seattle, Washington.
| | - Jeffrey H Maki
- Department of Radiology, University of Washington, Seattle, Washington
| | - Christopher Hall
- Department of Radiology, University of Washington, Seattle, Washington; Philips Radiology Solutions, Seattle, Washington
| | - Puneet Bhargava
- Department of Radiology, University of Washington, Seattle, Washington
| | - Jalal B Andre
- Department of Radiology, University of Washington, Seattle, Washington
| | - Jonathan Carnell
- Department of Radiology, University of Washington, Seattle, Washington
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16
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Hoff MN, Andre JB, Xiang Q. Combined geometric and algebraic solutions for removal of bSSFP banding artifacts with performance comparisons. Magn Reson Med 2016; 77:644-654. [DOI: 10.1002/mrm.26150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 12/22/2015] [Accepted: 01/14/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Michael N. Hoff
- Department of RadiologyUniversity of WashingtonSeattle Washington USA
| | - Jalal B. Andre
- Department of RadiologyUniversity of WashingtonSeattle Washington USA
| | - Qing‐San Xiang
- Department of Physics & AstronomyUniversity of British ColumbiaVancouver BC Canada
- Department of RadiologyUniversity of British ColumbiaVancouver BC Canada
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17
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Abstract
Traumatic brain injury (TBI), including concussion, is a public health concern, as it affects over 1.7 million persons in the United States per year. Yet, the diagnosis of TBI, particularly mild TBI (mTBI), can be controversial, as neuroimaging findings can be sparse on conventional magnetic resonance and computed tomography examinations, and when present, often poorly correlate with clinical signs and symptoms. Furthermore, the discussion of TBI, concussion, and head impact exposure is immediately complicated by the many differing opinions of what constitutes each, their respective severities, and how the underlying biomechanics of the inciting head impact might alter the distribution, severity, and prognosis of the underlying brain injury. Advanced imaging methodologies hold promise in improving the sensitivity and detectability of associated imaging biomarkers that might better correlate with patient outcome and prognostication, allowing for improved triage and therapeutic guidance in the setting of TBI, particularly in mTBI. This work will examine the defining symptom complex associated with mTBI and explore changes in cerebral blood flow measured by arterial spin labeling, as a potential imaging biomarker for TBI, and briefly correlate these observations with findings identified by single photon emission computed tomography and positron emission tomography imaging.
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Affiliation(s)
- Jalal B Andre
- Harborview Medical Center, University of Washington, Seattle, WA
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18
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de Havenon A, Sultan-Qurraie A, Tirschwell D, Cohen W, Majersik J, Andre JB. Medial Occipital Lobe Hyperperfusion Identified by Arterial Spin-Labeling: A Poor Prognostic Sign in Patients with Hypoxic-Ischemic Encephalopathy. AJNR Am J Neuroradiol 2015; 36:2292-5. [PMID: 26338917 DOI: 10.3174/ajnr.a4444] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/30/2015] [Indexed: 11/07/2022]
Abstract
Hypoxic-ischemic encephalopathy carries an uncertain prognosis. We sought to retrospectively assess the prognostic value of arterial spin-labeling MR imaging in 22 adult patients diagnosed with hypoxic-ischemic encephalopathy. Quantitative CBF maps were generated from the M0 map, and arterial spin-labeling data on a per-voxel basis were regionally interrogated via visual inspection and ROI placement. Hyperperfusion was defined as regional increases in CBF of >20% (relative to global CBF) and/or >100 mL/100 g/min. Eleven of 22 patients had prominent bilateral medial occipital lobe hyperperfusion, all of whom died before hospital discharge. One patient who had nondistinct arterial spin-labeling hyperperfusion and restricted diffusion survived. Medial occipital lobe hyperperfusion is a distinctive pattern that merits prospective investigation in a cohort of patients with moderate hypoxic-ischemic encephalopathy to determine its predictive ability in patients with a higher likelihood of survival.
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Affiliation(s)
- A de Havenon
- From the Department of Neurology (A.d.H., J.M.), University of Utah, Salt Lake City, Utah
| | | | | | - W Cohen
- Radiology (W.C., J.B.A.), University of Washington, Seattle, Washington
| | - J Majersik
- From the Department of Neurology (A.d.H., J.M.), University of Utah, Salt Lake City, Utah
| | - J B Andre
- Radiology (W.C., J.B.A.), University of Washington, Seattle, Washington.
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19
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Andre JB, Bresnahan BW, Mossa-Basha M, Hoff MN, Smith CP, Anzai Y, Cohen WA. Toward Quantifying the Prevalence, Severity, and Cost Associated With Patient Motion During Clinical MR Examinations. J Am Coll Radiol 2015; 12:689-95. [PMID: 25963225 DOI: 10.1016/j.jacr.2015.03.007] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/04/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the prevalence, severity, and cost estimates associated with motion artifacts identified on clinical MR examinations, with a focus on the neuroaxis. METHODS A retrospective review of 1 randomly selected full calendar week of MR examinations (April 2014) was conducted for the detection of significant motion artifacts in examinations performed at a single institution on 3 different MR scanners. A base-case cost estimate was computed from recently available institutional data, and correlated with sequence time and severity of motion artifacts. RESULTS A total of 192 completed clinical examinations were reviewed. Significant motion artifacts were identified on sequences in 7.5% of outpatient and 29.4% of inpatient and/or emergency department MR examinations. The prevalence of repeat sequences was 19.8% of total MRI examinations. The base-case cost estimate yielded a potential cost to the hospital of $592 per hour in lost revenue due to motion artifacts. Potential institutional average costs borne (revenue forgone) of approximately $115,000 per scanner per year may affect hospitals, owing to motion artifacts (univariate sensitivity analysis suggested a lower bound of $92,600, and an upper bound of $139,000). CONCLUSIONS Motion artifacts represent a frequent cause of MR image degradation, particularly for inpatient and emergency department patients, resulting in substantial costs to the radiology department. Greater attention and resources should be directed toward providing practical solutions to this dilemma.
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Affiliation(s)
- Jalal B Andre
- Department of Radiology, University of Washington, Seattle, Washington.
| | - Brian W Bresnahan
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Michael N Hoff
- Department of Radiology, University of Washington, Seattle, Washington
| | - C Patrick Smith
- Department of Radiology, Harborview Medical Center, Seattle, Washington
| | - Yoshimi Anzai
- Department of Radiology, University of Washington, Seattle, Washington
| | - Wendy A Cohen
- Department of Radiology, University of Washington, Seattle, Washington
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20
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Andre JB, Nagpal S, Hippe DS, Ravanpay AC, Schmiedeskamp H, Bammer R, Palagallo GJ, Recht L, Zaharchuk G. Cerebral Blood Flow Changes in Glioblastoma Patients Undergoing Bevacizumab Treatment Are Seen in Both Tumor and Normal Brain. Neuroradiol J 2015; 28:112-9. [PMID: 25923677 DOI: 10.1177/1971400915576641] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED Bevacizumab (BEV) is increasingly used to treat recurrent glioblastoma (GBM) with some reported improvement in neurocognitive function despite potential neurotoxicities. We examined the effects of BEV on cerebral blood flow (CBF) within recurrent GBM tumor and in the contralateral middle cerebral artery (MCA) territory.Post-chemoradiation patients with histologically confirmed GBM were treated with BEV and underwent routine, serial tumor imaging with additional pseudocontinuous arterial spin labeling (pcASL) following informed consent. Circular regions-of-interest were placed on pcASL images directly over the recurrent tumor and in the contralateral MCA territory. CBF changes before and during BEV treatment were evaluated in tumor and normal tissue. Linear mixed models were used to assess statistical significance.Fifty-three pcASL studies in 18 patients were acquired. Evaluation yielded lower mean tumoral CBF during BEV treatment compared with pre-treatment (45 ± 27 vs. 65 ± 27 ml/100 g/min, p = 0.002), and in the contralateral MCA territory during, compared with pre-BEV treatment (35 ± 8.4 vs. 41 ± 8.4 ml/100 g/min, p = 0.03). The decrease in mean CBF tended to be greater in the tumoral region than in the contralateral MCA, though the difference did not reach statistical significance (31% vs. 13%; p = 0.082). CONCLUSIONS BEV administration results in statistically significant global CBF decrease with a potentially preferential decrease in tumor perfusion compared with normal brain tissue.
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Affiliation(s)
- Jalal B Andre
- Department of Radiology, University of Washington; Seattle, WA, USA Department of Radiology, Stanford University, Stanford, CA, USA
| | - Seema Nagpal
- Department of Neurology and Neurological Sciences, Stanford University; Stanford, CA, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington; Seattle, WA, USA
| | - Ali C Ravanpay
- Department of Neurological Surgery, University of Washington; Seattle, WA, USA
| | | | - Roland Bammer
- Department of Radiology, Stanford University, Stanford, CA, USA
| | | | - Lawrence Recht
- Department of Neurological Surgery, University of Washington; Seattle, WA, USA
| | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, CA, USA
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21
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Gaddikeri S, Andre JB, Benjert J, Hippe DS, Anzai Y. Impact of model-based iterative reconstruction on image quality of contrast-enhanced neck CT. AJNR Am J Neuroradiol 2015; 36:391-6. [PMID: 25300982 DOI: 10.3174/ajnr.a4123] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Improved image quality is clinically desired for contrast-enhanced CT of the neck. We compared 30% adaptive statistical iterative reconstruction and model-based iterative reconstruction algorithms for the assessment of image quality of contrast-enhanced CT of the neck. MATERIALS AND METHODS Neck contrast-enhanced CT data from 64 consecutive patients were reconstructed retrospectively by using 30% adaptive statistical iterative reconstruction and model-based iterative reconstruction. Objective image quality was assessed by comparing SNR, contrast-to-noise ratio, and background noise at levels 1 (mandible) and 2 (superior mediastinum). Two independent blinded readers subjectively graded the image quality on a scale of 1-5, (grade 5 = excellent image quality without artifacts and grade 1 = nondiagnostic image quality with significant artifacts). The percentage of agreement and disagreement between the 2 readers was assessed. RESULTS Compared with 30% adaptive statistical iterative reconstruction, model-based iterative reconstruction significantly improved the SNR and contrast-to-noise ratio at levels 1 and 2. Model-based iterative reconstruction also decreased background noise at level 1 (P = .016), though there was no difference at level 2 (P = .61). Model-based iterative reconstruction was scored higher than 30% adaptive statistical iterative reconstruction by both reviewers at the nasopharynx (P < .001) and oropharynx (P < .001) and for overall image quality (P < .001) and was scored lower at the vocal cords (P < .001) and sternoclavicular junction (P < .001), due to artifacts related to thyroid shielding that were specific for model-based iterative reconstruction. CONCLUSIONS Model-based iterative reconstruction offers improved subjective and objective image quality as evidenced by a higher SNR and contrast-to-noise ratio and lower background noise within the same dataset for contrast-enhanced neck CT. Model-based iterative reconstruction has the potential to reduce the radiation dose while maintaining the image quality, with a minor downside being prominent artifacts related to thyroid shield use on model-based iterative reconstruction.
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Affiliation(s)
- S Gaddikeri
- From the Department of Neuroradiology (S.G., J.B.A., Y.A.), University of Washington Medical Center, University of Washington, Seattle, Washington
| | - J B Andre
- From the Department of Neuroradiology (S.G., J.B.A., Y.A.), University of Washington Medical Center, University of Washington, Seattle, Washington
| | - J Benjert
- Department of Neuroradiology (J.B.), University of Washington and VA Puget Sound, Seattle, Washington
| | - D S Hippe
- Department of Radiology (D.S.H.), University of Washington, Seattle, Washington
| | - Y Anzai
- From the Department of Neuroradiology (S.G., J.B.A., Y.A.), University of Washington Medical Center, University of Washington, Seattle, Washington
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22
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Holdsworth SJ, Yeom KW, Antonucci MU, Andre JB, Rosenberg J, Aksoy M, Straka M, Fischbein NJ, Bammer R, Moseley ME, Zaharchuk G, Skare S. Diffusion-weighted imaging with dual-echo echo-planar imaging for better sensitivity to acute stroke. AJNR Am J Neuroradiol 2014; 35:1293-302. [PMID: 24763417 DOI: 10.3174/ajnr.a3921] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE Parallel imaging facilitates the acquisition of echo-planar images with a reduced TE, enabling the incorporation of an additional image at a later TE. Here we investigated the use of a parallel imaging-enhanced dual-echo EPI sequence to improve lesion conspicuity in diffusion-weighted imaging. MATERIALS AND METHODS Parallel imaging-enhanced dual-echo DWI data were acquired in 50 consecutive patients suspected of stroke at 1.5T. The dual-echo acquisition included 2 EPI for 1 diffusion-preparation period (echo 1 [TE = 48 ms] and echo 2 [TE = 105 ms]). Three neuroradiologists independently reviewed the 2 echoes by using the routine DWI of our institution as a reference. Images were graded on lesion conspicuity, diagnostic confidence, and image quality. The apparent diffusion coefficient map from echo 1 was used to validate the presence of acute infarction. Relaxivity maps calculated from the 2 echoes were evaluated for potential complementary information. RESULTS Echo 1 and 2 DWIs were rated as better than the reference DWI. While echo 1 had better image quality overall, echo 2 was unanimously favored over both echo 1 and the reference DWI for its high sensitivity in detecting acute infarcts. CONCLUSIONS Parallel imaging-enhanced dual-echo diffusion-weighted EPI is a useful method for evaluating lesions with reduced diffusivity. The long TE of echo 2 produced DWIs that exhibited superior lesion conspicuity compared with images acquired at a shorter TE. Echo 1 provided higher SNR ADC maps for specificity to acute infarction. The relaxivity maps may serve to complement information regarding blood products and mineralization.
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Affiliation(s)
- S J Holdsworth
- From the Department of Radiology (S.J.H., K.W.Y., M.U.A., J.R., M.A., M.S., N.J.F., R.B., M.E.M., G.Z.), Stanford University, Stanford, California
| | - K W Yeom
- From the Department of Radiology (S.J.H., K.W.Y., M.U.A., J.R., M.A., M.S., N.J.F., R.B., M.E.M., G.Z.), Stanford University, Stanford, California
| | - M U Antonucci
- From the Department of Radiology (S.J.H., K.W.Y., M.U.A., J.R., M.A., M.S., N.J.F., R.B., M.E.M., G.Z.), Stanford University, Stanford, California
| | - J B Andre
- Department of Radiology (J.B.A.), University of Washington, Seattle, Washington
| | - J Rosenberg
- From the Department of Radiology (S.J.H., K.W.Y., M.U.A., J.R., M.A., M.S., N.J.F., R.B., M.E.M., G.Z.), Stanford University, Stanford, California
| | - M Aksoy
- From the Department of Radiology (S.J.H., K.W.Y., M.U.A., J.R., M.A., M.S., N.J.F., R.B., M.E.M., G.Z.), Stanford University, Stanford, California
| | - M Straka
- From the Department of Radiology (S.J.H., K.W.Y., M.U.A., J.R., M.A., M.S., N.J.F., R.B., M.E.M., G.Z.), Stanford University, Stanford, California
| | - N J Fischbein
- From the Department of Radiology (S.J.H., K.W.Y., M.U.A., J.R., M.A., M.S., N.J.F., R.B., M.E.M., G.Z.), Stanford University, Stanford, California
| | - R Bammer
- From the Department of Radiology (S.J.H., K.W.Y., M.U.A., J.R., M.A., M.S., N.J.F., R.B., M.E.M., G.Z.), Stanford University, Stanford, California
| | - M E Moseley
- From the Department of Radiology (S.J.H., K.W.Y., M.U.A., J.R., M.A., M.S., N.J.F., R.B., M.E.M., G.Z.), Stanford University, Stanford, California
| | - G Zaharchuk
- From the Department of Radiology (S.J.H., K.W.Y., M.U.A., J.R., M.A., M.S., N.J.F., R.B., M.E.M., G.Z.), Stanford University, Stanford, California
| | - S Skare
- Clinical Neuroscience (S.S.), Karolinska Institute, Stockholm, Sweden
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Soman S, Holdsworth SJ, Skare S, Andre JB, Van AT, Aksoy M, Bammer R, Rosenberg J, Barnes PD, Yeom KW. Effect of Number of Acquisitions in Diffusion Tensor Imaging of the Pediatric Brain: Optimizing Scan Time and Diagnostic Experience. J Neuroimaging 2014; 25:296-302. [DOI: 10.1111/jon.12093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 09/11/2013] [Accepted: 09/15/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Salil Soman
- Department of Radiology; Stanford University; Stanford CA
| | | | - Stefan Skare
- Clinical Neuroscience; Karolinska Institute; Stockholm Sweden
| | | | - Anh T. Van
- Department of Radiology; Lucas Center; Stanford University; Stanford CA
| | - Murat Aksoy
- Department of Radiology; Lucas Center; Stanford University; Stanford CA
| | - Roland Bammer
- Department of Radiology; Lucas Center; Stanford University; Stanford CA
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Soman S, Holdsworth SJ, Barnes PD, Rosenberg J, Andre JB, Bammer R, Yeom KW. Improved T2* imaging without increase in scan time: SWI processing of 2D gradient echo. AJNR Am J Neuroradiol 2013; 34:2092-7. [PMID: 23744690 DOI: 10.3174/ajnr.a3595] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE 2D gradient-echo imaging is sensitive to T2* lesions (hemorrhages, mineralization, and vascular lesions), and susceptibility-weighted imaging is even more sensitive, but at the cost of additional scan time (SWI: 5-10 minutes; 2D gradient-echo: 2 minutes). The long acquisition time of SWI may pose challenges in motion-prone patients. We hypothesized that 2D SWI/phase unwrapped images processed from 2D gradient-echo imaging could improve T2* lesion detection. MATERIALS AND METHODS 2D gradient-echo brain images of 50 consecutive pediatric patients (mean age, 8 years) acquired at 3T were retrospectively processed to generate 2D SWI/phase unwrapped images. The 2D gradient-echo and 2D SWI/phase unwrapped images were compared for various imaging parameters and were scored in a blinded fashion. RESULTS Of 50 patients, 2D gradient-echo imaging detected T2* lesions in 29 patients and had normal findings in 21 patients. 2D SWI was more sensitive than standard 2D gradient-echo imaging in detecting T2* lesions (P < .0001). 2D SWI/phase unwrapped imaging also improved delineation of normal venous structures and nonpathologic calcifications and helped distinguish calcifications from hemorrhage. A few pitfalls of 2D SWI/phase unwrapped imaging were noted, including worsened motion and dental artifacts and challenges in detecting T2* lesions adjacent to calvaria or robust deoxygenated veins. CONCLUSIONS 2D SWI and associated phase unwrapped images processed from standard 2D gradient-echo images were more sensitive in detecting T2* lesions and delineating normal venous structures and nonpathologic mineralization, and they also helped distinguish calcification at no additional scan time. SWI processing of 2D gradient-echo images may be a useful adjunct in cases in which longer scan times of 3D SWI are difficult to implement.
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Affiliation(s)
- S Soman
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
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Schmiedeskamp H, Andre JB, Straka M, Christen T, Nagpal S, Recht L, Thomas RP, Zaharchuk G, Bammer R. Simultaneous perfusion and permeability measurements using combined spin- and gradient-echo MRI. J Cereb Blood Flow Metab 2013; 33:732-43. [PMID: 23462570 PMCID: PMC3652702 DOI: 10.1038/jcbfm.2013.10] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to estimate magnetic resonance imaging-based brain perfusion parameters from combined multiecho spin-echo and gradient-echo acquisitions, to correct them for T₁₋, T₂₋, and T₂₋*-related contrast agent (CA) extravasation effects, and to simultaneously determine vascular permeability. Perfusion data were acquired using a combined multiecho spin- and gradient-echo (SAGE) echo-planar imaging sequence, which was corrected for CA extravasation effects using pharmacokinetic modeling. The presented method was validated in simulations and brain tumor patients, and compared with uncorrected single-echo and multiecho data. In the presence of CA extravasation, uncorrected single-echo data resulted in underestimated CA concentrations, leading to underestimated single-echo cerebral blood volume (CBV) and mean transit time (MTT). In contrast, uncorrected multiecho data resulted in overestimations of CA concentrations, CBV, and MTT. The correction of CA extravasation effects resulted in CBV and MTT estimates that were more consistent with the underlying tissue characteristics. Spin-echo perfusion data showed reduced large-vessel blooming effects, facilitating better distinction between increased CBV due to active tumor progression and elevated CBV due to the presence of cortical vessels in tumor proximity. Furthermore, extracted permeability parameters were in good agreement with elevated T1-weighted postcontrast signal values.
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Affiliation(s)
- Heiko Schmiedeskamp
- Lucas Center, Department of Radiology, Stanford University, Stanford, California 94305-5488, USA
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Andre JB, Zaharchuk G, Fischbein NJ, Augustin M, Skare S, Straka M, Rosenberg J, Lansberg MG, Kemp S, Wijman CAC, Albers GW, Schwartz NE, Bammer R. Clinical assessment of standard and generalized autocalibrating partially parallel acquisition diffusion imaging: effects of reduction factor and spatial resolution. AJNR Am J Neuroradiol 2012; 33:1337-42. [PMID: 22403781 DOI: 10.3174/ajnr.a2980] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE PI improves routine EPI-based DWI by enabling higher spatial resolution and reducing geometric distortion, though it remains unclear which of these is most important. We evaluated the relative contribution of these factors and assessed their ability to increase lesion conspicuity and diagnostic confidence by using a GRAPPA technique. MATERIALS AND METHODS Four separate DWI scans were obtained at 1.5T in 48 patients with independent variation of in-plane spatial resolution (1.88 mm(2) versus 1.25 mm(2)) and/or reduction factor (R = 1 versus R = 3). A neuroradiologist with access to clinical history and additional imaging sequences provided a reference standard diagnosis for each case. Three blinded neuroradiologists assessed scans for abnormalities and also evaluated multiple imaging-quality metrics by using a 5-point ordinal scale. Logistic regression was used to determine the impact of each factor on subjective image quality and confidence. RESULTS Reference standard diagnoses in the patient cohort were acute ischemic stroke (n = 30), ischemic stroke with hemorrhagic conversion (n = 4), intraparenchymal hemorrhage (n = 9), or no acute lesion (n = 5). While readers preferred both a higher reduction factor and a higher spatial resolution, the largest effect was due to an increased reduction factor (odds ratio, 47 ± 16). Small lesions were more confidently discriminated from artifacts on R = 3 images. The diagnosis changed in 5 of 48 scans, always toward the reference standard reading and exclusively for posterior fossa lesions. CONCLUSIONS PI improves DWI primarily by reducing geometric distortion rather than by increasing spatial resolution. This outcome leads to a more accurate and confident diagnosis of small lesions.
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Affiliation(s)
- J B Andre
- Department of Radiology, Stanford University, Stanford, California, USA.
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Andre JB, Zaharchuk G, Saritas E, Komakula S, Shankaranarayan A, Banerjee S, Rosenberg J, Nishimura DG, Fischbein NJ. Clinical evaluation of reduced field-of-view diffusion-weighted imaging of the cervical and thoracic spine and spinal cord. AJNR Am J Neuroradiol 2012; 33:1860-6. [PMID: 22555576 DOI: 10.3174/ajnr.a3134] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE DWI has the potential to improve the detection and evaluation of spine and spinal cord pathologies. This study assessed whether a recently described method (rFOV DWI) adds diagnostic value in clinical patients. MATERIALS AND METHODS Consecutive patients undergoing clinically indicated cervical and/or thoracic spine imaging received standard anatomic sequences supplemented with sagittal rFOV DWI by using a b-value of 500 s/mm(2). Two neuroradiologists blinded to clinical history evaluated the standard anatomic sequences only for pathology and provided their level of confidence in their diagnosis. These readers then rescored the examinations after reviewing the rFOV DWI study and indicated whether this sequence altered findings or confidence levels. RESULTS Two hundred twenty-three patients were included in this study. One hundred eighty patient scans (80.7%) demonstrated at least 1 pathologic finding. Interobserver agreement for identifying pathology (κ = 0.77) and in assessing the added value of the rFOV DWI sequence (κ = 0.77) was high. In pathologic cases, the rFOV DWI sequence added clinical utility in 33% of cases (P < .00001, Fisher exact test). The rFOV DWI sequence was found to be helpful in the evaluation of acute infarction, demyelination, infection, neoplasm, and intradural and epidural collections (P < .001, χ(2) test) and provided a significant increase in clinical confidence in the evaluation of 11 of the 15 pathologic subtypes assessed (P < .05, 1-sided paired Wilcoxon test). CONCLUSIONS rFOV diffusion-weighted imaging of the cervical and thoracic spine is feasible in a clinical population and increases clinical confidence in the diagnosis of numerous common spinal pathologies.
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Affiliation(s)
- J B Andre
- Departments of Radiology, Stanford University, Stanford, California, USA.
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Abstract
Unlike those of the brain, advances in diffusion-weighted imaging (DWI) of the human spinal cord have been challenged by the more complicated and inhomogeneous anatomy of the spine, the differences in magnetic susceptibility between adjacent air and fluid-filled structures and the surrounding soft tissues, and the inherent limitations of the initially used echo-planar imaging techniques used to image the spine. Interval advances in DWI techniques for imaging the human spinal cord, with the specific aims of improving the diagnostic quality of the images, and the simultaneous reduction in unwanted artifacts have resulted in higher-quality images that are now able to more accurately portray the complicated underlying anatomy and depict pathologic abnormality with improved sensitivity and specificity. Diffusion tensor imaging (DTI) has benefited from the advances in DWI techniques, as DWI images form the foundation for all tractography and DTI. This review provides a synopsis of the many recent advances in DWI of the human spinal cord, as well as some of the more common clinical uses for these techniques, including DTI and tractography.
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Affiliation(s)
- Jalal B Andre
- Department of Radiology, Stanford University, Stanford, CA 94305-5105, USA.
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Schmiedeskamp H, Straka M, Newbould RD, Zaharchuk G, Andre JB, Olivot JM, Moseley ME, Albers GW, Bammer R. Combined spin- and gradient-echo perfusion-weighted imaging. Magn Reson Med 2011; 68:30-40. [PMID: 22114040 DOI: 10.1002/mrm.23195] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 07/21/2011] [Accepted: 08/02/2011] [Indexed: 11/09/2022]
Abstract
In this study, a spin- and gradient-echo echo-planar imaging (SAGE EPI) MRI pulse sequence is presented that allows simultaneous measurements of gradient-echo and spin-echo dynamic susceptibility-contrast perfusion-weighted imaging data. Following signal excitation, five readout trains were acquired using spin- and gradient-echo echo-planar imaging, all of them with echo times of less than 100 ms. Contrast agent concentrations in brain tissue were determined based on absolute R2* and R(2) estimates rather than relative changes in the signals of individual echo trains, producing T(1)-independent dynamic susceptibility-contrast perfusion-weighted imaging data. Moreover, this acquisition technique enabled vessel size imaging through the simultaneous quantification of R2* and R(2), without an increase in acquisition time. In this work, the concepts of SAGE EPI pulse sequence and results in stroke and tumor imaging are presented. Overall, SAGE EPI combined the advantages of higher sensitivity to contrast agent passage of gradient-echo perfusion-weighted imaging with better microvascular selectivity of spin-echo perfusion-weighted imaging.
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Affiliation(s)
- Heiko Schmiedeskamp
- Department of Radiology, Stanford University, Lucas Center, Stanford, California, USA
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Zaharchuk G, Saritas EU, Andre JB, Chin CT, Rosenberg J, Brosnan TJ, Shankaranarayan A, Nishimura DG, Fischbein NJ. Reduced field-of-view diffusion imaging of the human spinal cord: comparison with conventional single-shot echo-planar imaging. AJNR Am J Neuroradiol 2011; 32:813-20. [PMID: 21454408 DOI: 10.3174/ajnr.a2418] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DWI of the spinal cord is challenging because of its small size and artifacts associated with the most commonly used clinical imaging method, SS-EPI. We evaluated the performance of rFOV spinal cord DWI and compared it with the routine fFOV SS-EPI in a clinical population. MATERIALS AND METHODS Thirty-six clinical patients underwent 1.5T MR imaging examination that included rFOV SS-EPI DWI of the cervical spinal cord as well as 2 comparison diffusion sequences: fFOV SS-EPI DWI normalized for either image readout time (low-resolution fFOV) or spatial resolution (high-resolution fFOV). ADC maps were created and compared between the methods by using single-factor analysis of variance. Two neuroradiologists blinded to sequence type rated the 3 DWI methods, based on susceptibility artifacts, perceived spatial resolution, signal intensity-to-noise ratio, anatomic detail, and clinical utility. RESULTS ADC values for the rFOV and both fFOV sequences were not statistically different (rFOV: 1.01 ± 0.18 × 10(-3) mm(2)/s; low-resolution fFOV: 1.12 ± 0.22 × 10(-3) mm(2)/s; high-resolution fFOV: 1.10 ± 0.21 × 10(-3) mm(2)/s; F = 2.747, P > .05). The neuroradiologist reviewers rated the rFOV diffusion images superior in terms of all assessed measures (P < 0.0001). Particular improvements were noted in patients with metal hardware, degenerative disease, or both. CONCLUSIONS rFOV DWI of the spinal cord overcomes many of the problems associated with conventional fFOV SS-EPI and is feasible in a clinical population. From a clinical standpoint, images were deemed superior to those created by using standard fFOV methods.
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Affiliation(s)
- G Zaharchuk
- Department of Radiology, Stanford University, California, USA.
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Andre JB, Lu S, Spearman K, Raval SN. Peritumoral apparent diffusion coefficient as a metric of response in patients with recurrent glioblastoma multiforme treated with bevacizumab and irinotecan. Neuroradiol J 2008; 21:350-61. [PMID: 24256904 DOI: 10.1177/197140090802100309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 04/12/2008] [Indexed: 11/15/2022] Open
Abstract
Bevacizumab and irinotecan have shown promising results in patients with recurrent glioblastoma multiforme (GBM), which traditionally carries a poor prognosis after first-line therapies have been exhausted. Retrospectively documenting the short-term effects of this chemotherapeutic regimen on recurrent GBM, as evidenced by comparative magnetic resonance images obtained two weeks prior to, and one-month following initiation of treatment, we hypothesize that peritumoral apparent diffusion coefficient (ADC) values will decrease on post-treatment scans. Brain MR data were collected from August 2005 to December 2006, in which post-contrast T1-weighted images demonstrated measurable enhancement or GBM tumor mass. Pre- and post-treatment MR images for ten consecutive patients were collected, each having failed temozolomide and radiation therapy. Pre- and post-treatment recurrent GBM bulk tumor and peritumoral T2 signal abnormality were measured in three dimensions. Diffusion of peritumoral T2 signal abnormality was evaluated on pre- and post-treatment ADC. All patients witnessed a significant decrease in tumor bulk ranging from 15.3% to 96.7% with a mean reduction of 48.2%, having received an average of two cycles of chemotherapy. FLAIR images demonstrated a mean volumetric reduction in peritumoral T2 signal abnormality of 44.3%. ADC measurements demonstrated an average reduction in peritumoral ADC of 20.6%, which was statistically significant (p-value < .005). Recurrent GBM tumor bulk demonstrated a 48.2% mean reduction, with corresponding decrease in peritumoral ADC values of 20.6%, suggesting that ADC may represent a valuable metric in the evaluation of the chemotherapeutic response of recurrent GBM, when treated with bevacizumab and irinotecan.
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Affiliation(s)
- J B Andre
- Department of Radiology, Monmouth Medical Center; Long Branch, NJ 07740 (JA, SL, KS) -
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Andre JB, Sebastian VA, Ruchman RM, Saad SA. CT and appendicitis: evaluation of correlation between CT diagnosis and pathological diagnosis. Postgrad Med J 2008; 84:321-4. [DOI: 10.1136/pgmj.2007.066779] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hopper TAJ, Wehrli FW, Saha PK, Andre JB, Wright AC, Sanchez CP, Leonard MB. Quantitative Microcomputed Tomography Assessment of Intratrabecular, Intertrabecular, and Cortical Bone Architecture in a Rat Model of Severe Renal Osteodystrophy. J Comput Assist Tomogr 2007; 31:320-8. [PMID: 17414773 DOI: 10.1097/01.rct.0000238007.19258.3d] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the effects of renal osteodystrophy (ROD) on bone microarchitecture in growing rats. METHODS A total of 24 rats underwent 5/6 nephrectomy (NX) and were fed a high-phosphorus diet to induce ROD; another 6 underwent sham NX. In vitro microcomputed tomography images (GEMS, London, Ontario, Canada) were obtained in the femoral metaphysis and midshaft. RESULTS Trabecular and cortical bone volume/total volume (BV/TV) were significantly lower in NX specimens because of pores within the trabeculae and along the endosteal surface. Topological analysis using component labeling in 3-dimensions verified that trabecular pores connected to the marrow space. After the trabecular pores were filled using a morphological filter, trabecular thickness was significantly increased in NX. In contrast, cortical thickness was significantly decreased in NX compared with controls; however, after filling the endocortical pores, thickness did not differ. CONCLUSIONS The ROD resulted in decreased cortical and trabecular BV/TV, increased porosity, and increased trabecular thickness. Advanced image processing algorithms demonstrated the effects of cortical and trabecular porosity on BV/TV and structure in ROD.
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Affiliation(s)
- Tim A J Hopper
- School of Physical and Chemical Sciences, Queensland University of Technology, Brisbane, Australia
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Zorc JJ, Scarfone RJ, Li Y, Hong T, Harmelin M, Grunstein L, Andre JB. Scheduled follow-up after a pediatric emergency department visit for asthma: a randomized trial. Pediatrics 2003; 111:495-502. [PMID: 12612227 DOI: 10.1542/peds.111.3.495] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Follow-up with a primary care provider (PCP) is recommended after an emergency department (ED) visit for asthma to assess clinical status and develop a management plan to improve future care. However, previous ED-based studies of urban children with asthma have reported low follow-up rates. The objective of this study was to determine whether scheduling an appointment at the time of an ED visit improves PCP follow-up for urban children. A secondary goal was to assess the effect of this intervention on short-term health outcomes and the use of recommended preventive controller medications. METHODS This randomized trial enrolled a convenience sample of children who were 2 to 18 years old and discharged after treatment for acute asthma in an urban children's hospital ED. Both intervention and control subjects were instructed to follow up with their PCP within 3 to 5 days. Study staff assisted intervention subjects to call their PCP from the ED and schedule an appointment. When follow-up could not be scheduled, assistance continued after ED discharge by telephone until an appointment date was confirmed. Study outcomes included PCP visits, asthma-related morbidity, and daily use of preventive medication 4 weeks after the ED visit. Outcomes were assessed by telephone interview and confirmed by PCP record review. RESULTS A total of 278 eligible subjects were enrolled over 8 months; intervention and control groups were similar by demographic variables and PCP type as well as by asthma history, symptoms, and previous medication use. Only 38% of subjects reported using a daily controller medication, although 70% described persistent asthma symptoms for which these are recommended. For the intervention group, follow-up appointments were successfully obtained during the ED visit for 24% of subjects; when unsuccessful, a median of 3 telephone calls (range: 1-14) were needed to confirm that an appointment had been scheduled. During the 4 weeks after the ED visit, intervention subjects were more likely than controls to follow up with their PCP (64% vs 46%; relative probability for follow-up: 1.4; 95% confidence interval: 1.1-1.7). Study groups did not differ in return ED visits, missed school or work, or the percentage reporting daily use of a controller medication (58% vs 54%) 4 weeks after the ED visit. The median time to the next PCP visit was shorter among intervention subjects (13 vs 54 days). CONCLUSIONS Scheduling an appointment after an ED visit increased the likelihood that urban children with asthma would follow up with a PCP. An appointment could not be obtained during the ED visit for most children. Other interventions are needed to improve linkage between ED and primary care for asthma and to improve the use of controller medications.
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Affiliation(s)
- Joseph J Zorc
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pennsylvania School of Medicine and the Children's Hospital of Philadelphia, PA 19104-4399, USA.
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