Chronometric TMS-fMRI of personalized left dorsolateral prefrontal target reveals state-dependency of subgenual anterior cingulate cortex effects

Transcranial magnetic stimulation (TMS) applied to a left dorsolateral prefrontal cortex (DLPFC) area with a specific connectivity profile to the subgenual anterior cingulate cortex (sgACC) has emerged as a highly effective non-invasive treatment option for depression. However, antidepressant outcomes demonstrate significant variability among therapy plans and individuals. One overlooked contributing factor is the individual brain state at the time of treatment. In this study we used interleaved TMS-fMRI to investigate the influence of brain state on acute TMS effects, both locally and remotely. TMS was performed during rest and during different phases of cognitive task processing. Twenty healthy participants were included in this study. In the first session, imaging data for TMS targeting were acquired, allowing for identification of individualized targets in the left DLPFC based on highest anti-correlation with the sgACC. The second session involved chronometric interleaved TMS-fMRI measurements, with 10 Hz triplets of TMS administered during rest and at distinct timings during an N-back task. Consistent with prior findings, interleaved TMS-fMRI revealed significant BOLD activation changes in the targeted network. The precise timing of TMS relative to the cognitive states during the task demonstrated distinct BOLD response in clinically relevant brain regions, including the sgACC. Employing a standardized timing approach for TMS using a task revealed more consistent modulation of the sgACC at the group level compared to stimulation during rest. In conclusion, our findings strongly suggest that acute local and remote effects of TMS are influenced by brain state during stimulation. This study establishes a basis for considering brain state as a significant factor in designing treatment protocols, possibly improving TMS treatment outcomes.

Citizen science approach to assessing patient perception of MRI with flexible radiofrequency coils

Magnetic Resonance Imaging (MRI) is a major medical imaging modality, which is non-invasive and provides unique soft tissue contrast without ionizing radiation. The successful completion of MRI exams critically depends on patient compliance, and, thus patient comfort. The design, appearance and usability of local MRI radiofrequency (RF) coils potentially influences the patients' perception of the exam. However, systematic investigations and empirical evidence for these aspects are missing. A questionnaire specifically evaluating the impact of RF coils on patient comfort in MRI would be a valuable addition to clinical studies comparing the performance of novel flexible RF coils with standard rigid coils. This paper describes the development of such a questionnaire in the scope of a citizen science (CS) initiative conducted with a group of students at the upper secondary school level. In this work, the CS initiative is presented in the format of a case report and its impact on scientific projects and the students' education is outlined. The resulting questionnaire is made available in German and English so as to be directly applicable by researchers working on the clinical evaluation of novel RF coils or the comfort evaluation of specific hardware setups in general.

Feasibility of online non-rigid motion correction for high-resolution supine breast MRI

PURPOSE

Conventional breast MRI is performed in the prone position with a dedicated coil. This allows high-resolution images without breast motion, but the patient position is inconsistent with that of other breast imaging modalities or interventions. Supine breast MRI may be an interesting alternative, but respiratory motion becomes an issue. Motion correction methods have typically been performed offline, for instance, the corrected images were not directly accessible from the scanner console. In this work, we seek to show the feasibility of a fast, online, motion-corrected reconstruction integrated into the clinical workflow.

METHODS

Fully sampled T2 -weighted (T2 w) and accelerated T1 -weighted (T1 w) breast supine MR images were acquired during free-breathing and were reconstructed using a non-rigid motion correction technique (generalized reconstruction by inversion of coupled systems). Online reconstruction was implemented using a dedicated system combining the MR raw data and respiratory signals from an external motion sensor. Reconstruction parameters were optimized on a parallel computing platform, and image quality was assessed by objective metrics and by radiologist scoring.

RESULTS

Online reconstruction time was 2 to 2.5 min. The metrics and the scores related to the motion artifacts significantly improved for both T2 w and T1 w sequences. The overall quality of T2 w images was approaching that of the prone images, whereas the quality of T1 w images remained significantly lower.

CONCLUSION

The proposed online algorithm allows a noticeable reduction of motion artifacts and an improvement of the diagnostic quality for supine breast imaging with a clinically acceptable reconstruction time. These findings serve as a starting point for further development aimed at improving the quality of T1 w images.

Panoramic Magnetic Resonance Imaging of the Breast With a Wearable Coil Vest

BACKGROUND

Breast cancer, the most common malignant cancer in women worldwide, is typically diagnosed by x-ray mammography, which is an unpleasant procedure, has low sensitivity in women with dense breasts, and involves ionizing radiation. Breast magnetic resonance imaging (MRI) is the most sensitive imaging modality and works without ionizing radiation, but is currently constrained to the prone imaging position due to suboptimal hardware, therefore hampering the clinical workflow.

OBJECTIVES

The aim of this work is to improve image quality in breast MRI, to simplify the clinical workflow, shorten measurement time, and achieve consistency in breast shape with other procedures such as ultrasound, surgery, and radiation therapy.

MATERIALS AND METHODS

To this end, we propose "panoramic breast MRI"-an approach combining a wearable radiofrequency coil for 3 T breast MRI (the "BraCoil"), acquisition in the supine position, and a panoramic visualization of the images. We demonstrate the potential of panoramic breast MRI in a pilot study on 12 healthy volunteers and 1 patient, and compare it to the state of the art.

RESULTS

With the BraCoil, we demonstrate up to 3-fold signal-to-noise ratio compared with clinical standard coils and acceleration factors up to 6 × 4. Panoramic visualization of supine breast images reduces the number of slices to be viewed by a factor of 2-4.

CONCLUSIONS

Panoramic breast MRI allows for high-quality diagnostic imaging and facilitated correlation to other diagnostic and interventional procedures. The developed wearable radiofrequency coil in combination with dedicated image processing has the potential to improve patient comfort while enabling more time-efficient breast MRI compared with clinical coils.

A modular system of flexible receive-only coil arrays for 3 T Magnetic Resonance Imaging

Flexible form-fitting radiofrequency coils provide high signal-to-noise ratio (SNR) for magnetic resonance imaging (MRI), and in array configuration large anatomical areas of interest can be covered. We propose a modular system - "ModFlex"- of flexible lightweight 4-channel coaxial coil arrays for 3 T MRI. We investigated the performance difference between commercial reference coils and 8- and 16-channel ModFlex receive-only array systems. In vivo, six anatomical targets in four regions of interest - the neck, the ankle, the spine and the hip - were imaged with the novel coil array system. The versatility of ModFlex and the robustness of the coil characteristics for different use cases is demonstrated. We measured an SNR gain for 4 out of 6 and similar SNR for 2 out of 6 anatomical target regions as compared to commercial reference coils. Parallel imaging capabilities are comparable to standard coils in hip and neck imaging, but ModFlex outperforms standard coils in ankle and spine imaging. High SNR combined with high acceleration possibilities enables faster imaging workflows and/or high-resolution MR acquisitions. The coil's versatility is beneficial for use cases with varying subject sizes and could improve patient comfort.

Flexible Multi-Turn Multi-Gap Coaxial RF Coils: Design Concept and Implementation for Magnetic Resonance Imaging at 3 and 7 Tesla

Magnetic resonance has become a backbone of medical imaging but suffers from inherently low sensitivity. This can be alleviated by improved radio frequency (RF) coils. Multi-turn multi-gap coaxial coils (MTMG-CCs) introduced in this work are flexible, form-fitting RF coils extending the concept of the single-turn single-gap CC by introducing multiple cable turns and/or gaps. It is demonstrated that this enables free choice of the coil diameter, and thus, optimizing it for the application to a certain anatomical site, while operating at the self-resonance frequency. An equivalent circuit for MTMG-CCs is modeled to predict their resonance frequency. Possible configurations regarding size, number of turns and gaps, and cable types for different B ₀ field strengths are calculated. Standard copper wire loop coils (SCs) and flexible CCs made from commercial coaxial cable were fabricated as receive-only coils for 3 T and transmit/receive coils at 7 T with diameters between 4 and 15 cm. Electromagnetic simulations are used to investigate the currents on MTMG-CCs, and demonstrate comparable specific absorption rate of 7 T CCs and SCs. Signal-to-noise ratio (SNR), transmit efficiency, and active detuning performance of CCs were compared in bench tests and MR experiments. For the form-fitted receive-only CCs at 3 T no significant SNR degradation was found as compared to flat SCs on a balloon phantom. Form-fitted transmit/receive CCs at 7 T showed higher transmit efficiency and SNR. MTMG-CCs can be sized to optimize sensitivity, are flexible and lightweight, and could therefore enable the fabrication of wearable coils with improved patient comfort.