An extended phase graph-based framework for DANTE-SPACE simulations including physiological, temporal, and spatial variations

PURPOSE

The delay alternating with nutation for tailored excitation (DANTE)-sampling perfection with application-optimized contrasts (SPACE) sequence facilitates 3D intracranial vessel wall imaging with simultaneous suppression of blood and CSF. However, the achieved image contrast depends closely on the selected sequence parameters, and the clinical use of the sequence is limited in vivo by observed signal variations in the vessel wall, CSF, and blood. This paper introduces a comprehensive DANTE-SPACE simulation framework, with the aim of providing a better understanding of the underlying contrast mechanisms and facilitating improved parameter selection and contrast optimization.

METHODS

An extended phase graph formalism was developed for efficient spin ensemble simulation of the DANTE-SPACE sequence. Physiological processes such as pulsatile flow velocity variation, varying flow directions, intravoxel velocity variation, diffusion, andB 1 + $$ {\mathrm{B}}_1^{+} $$ effects were included in the framework to represent the mechanisms behind the achieved signal levels accurately.

RESULTS

Intravoxel velocity variation improved temporal stability and robustness against small velocity changes. Time-varying pulsatile velocity variation affected CSF simulations, introducing periods of near-zero velocity and partial rephasing. Inclusion of diffusion effects was found to substantially reduce the CSF signal. Blood flow trajectory variations had minor effects, butB 1 + $$ {\mathrm{B}}_1^{+} $$ differences along the trajectory reduced DANTE efficiency in low-B 1 + $$ {\mathrm{B}}_1^{+} $$ areas. Introducing low-velocity pulsatility of both CSF and vessel wall helped explain the in vivo observed signal heterogeneity in both tissue types.

CONCLUSION

The presented simulation framework facilitates a more comprehensive optimization of DANTE-SPACE sequence parameters. Furthermore, the simulation framework helps to explain observed contrasts in acquired data.

Head-and-neck multichannel B1+ mapping and RF shimming of the carotid arteries using a 7T parallel-transmit head coil

PURPOSE

Neurovascular MRI suffers from a rapid drop in B1 + into the neck when using transmit head coils at 7 T. One solution to improving B1 + magnitude in the major feeding arteries in the neck is to use custom RF shims on parallel-transmit head coils. However, calculating such shims requires robust multichannel B1 + maps in both the head and the neck, which is challenging due to low RF penetration into the neck, limited dynamic range of multichannel B1 + mapping techniques, and B0 sensitivity. We therefore sought a robust, large-dynamic-range, parallel-transmit field mapping protocol and tested whether RF shimming can improve carotid artery B1 + magnitude in practice.

METHODS

A pipeline is presented that combines B1 + mapping data acquired using circularly polarized (CP) and CP2-mode RF shims at multiple voltages. The pipeline was evaluated by comparing the predicted and measured B1 + for multiple random transmit shims, and by assessing the ability of RF shimming to increase B1 + in the carotid arteries.

RESULTS

The proposed method achieved good agreement between predicted and measured B1 + in both the head and the neck. The B1 + magnitude in the carotid arteries can be increased by 43% using tailored RF shims or by 37% using universal RF shims, while also improving the RF homogeneity compared with CP mode.

CONCLUSION

B1 + in the neck can be increased using RF shims calculated from multichannel B1 + maps in both the head and the neck. This can be achieved using universal phase-only RF shims, facilitating easy implementation in existing sequences.

Reduced Left Atrial Rotational Flow Is Independently Associated With Embolic Brain Infarcts

BACKGROUND

Up to 25% of embolic strokes occur in individuals without atrial fibrillation (AF) or other identifiable mechanisms.

OBJECTIVES

This study aims to assess whether left atrial (LA) blood flow characteristics are associated with embolic brain infarcts, independently of AF.

METHODS

The authors recruited 134 patients: 44 with a history of ischemic stroke and 90 with no history of stroke but CHA2DS2VASc score ≥1. Cardiac magnetic resonance (CMR) evaluated cardiac function and LA 4-dimensional flow parameters, including velocity and vorticity (a measure of rotational flow), and brain magnetic resonance imaging (MRI) was performed to detect large noncortical or cortical infarcts (LNCCIs) (likely embolic), or nonembolic lacunar infarcts.

RESULTS

Patients (41% female; age 70 ± 9 years) had moderate stroke risk (median CHA2DS2VASc = 3, Q1-Q3: 2-4). Sixty-eight (51%) had diagnosed AF, of whom 58 (43%) were in AF during CMR. Thirty-nine (29%) had ≥1 LNCCI, 20 (15%) had ≥1 lacunar infarct without LNCCI, and 75 (56%) had no infarct. Lower LA vorticity was significantly associated with prevalent LNCCIs after adjustment for AF during CMR, history of AF, CHA2DS2VASc score, LA emptying fraction, LA indexed maximum volume, left ventricular ejection fraction, and indexed left ventricular mass (OR: 2.06 [95% CI: 1.08-3.92 per SD]; P = 0.027). By contrast, LA flow peak velocity was not significantly associated with LNCCIs (P = 0.21). No LA parameter was associated with lacunar infarcts (all P > 0.05).

CONCLUSIONS

Reduced LA flow vorticity is significantly and independently associated with embolic brain infarcts. Imaging LA flow characteristics may aid identification of individuals who would benefit from anticoagulation for embolic stroke prevention, regardless of heart rhythm.

Rapid 3D absolute B1 + mapping using a sandwiched train presaturated TurboFLASH sequence at 7 T for the brain and heart

PURPOSE

To shorten the acquisition time of magnetization-prepared absolute transmit field (B₁ ⁺ ) mapping known as presaturation TurboFLASH, or satTFL, to enable single breath-hold whole-heart 3D B₁ ⁺ mapping.

METHODS

SatTFL is modified to remove the delay between the reference and prepared images (typically 5 T₁ ), with matching transmit configurations for excitation and preparation RF pulses. The new method, called Sandwich, is evaluated as a 3D sequence, measuring whole-brain and gated whole-heart B₁ ⁺ maps in a single breath-hold. We evaluate the sensitivity to B₁ ⁺ and T₁ using numerical Bloch, extended phase graph, and Monte Carlo simulations. Phantom and in vivo images were acquired in both the brain and heart using an 8-channel transmit 7 Tesla MRI system to support the simulations. A segmented satTFL with a short readout train was used as a reference.

RESULTS

The method significantly reduces acquisition times of 3D measurements from 360 s to 20 s, in the brain, while simultaneously reducing bias in the measured B₁ ⁺ due to T₁ and magnetization history. The mean coefficient of variation was reduced by 81% for T₁ s of 0.5-3 s compared to conventional satTFL. In vivo, the reproducibility coefficient for flip angles in the range 0-130° was 4.5° for satTFL and 4.7° for our scheme, significantly smaller than for a short TR satTFL sequence, which was 12°. The 3D sequence measured B₁ ⁺ maps of the whole thorax in 26 heartbeats.

CONCLUSION

Our adaptations enable faster B₁ ⁺ mapping, with minimal T₁ sensitivity and lower sensitivity to magnetization history, enabling single breath-hold whole-heart absolute B₁ ⁺ mapping.

External Hardware and Sensors, for Improved MRI

Complex engineered systems are often equipped with suites of sensors and ancillary devices that monitor their performance and maintenance needs. MRI scanners are no different in this regard. Some of the ancillary devices available to support MRI equipment, the ones of particular interest here, have the distinction of actually participating in the image acquisition process itself. Most commonly, such devices are used to monitor physiological motion or variations in the scanner's imaging fields, allowing the imaging and/or reconstruction process to adapt as imaging conditions change. "Classic" examples include electrocardiography (ECG) leads and respiratory bellows to monitor cardiac and respiratory motion, which have been standard equipment in scan rooms since the early days of MRI. Since then, many additional sensors and devices have been proposed to support MRI acquisitions. The main physical properties that they measure may be primarily "mechanical" (eg acceleration, speed, and torque), "acoustic" (sound and ultrasound), "optical" (light and infrared), or "electromagnetic" in nature. A review of these ancillary devices, as currently available in clinical and research settings, is presented here. In our opinion, these devices are not in competition with each other: as long as they provide useful and unique information, do not interfere with each other and are not prohibitively cumbersome to use, they might find their proper place in future suites of sensors. In time, MRI acquisitions will likely include a plurality of complementary signals. A little like the microbiome that provides genetic diversity to organisms, these devices can provide signal diversity to MRI acquisitions and enrich measurements. Machine-learning (ML) algorithms are well suited at combining diverse input signals toward coherent outputs, and they could make use of all such information toward improved MRI capabilities. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 1.

Optimization of undersampling parameters for 3D intracranial compressed sensing MR angiography at 7 T

Purpose

3D time‐of‐flight MRA can accurately visualize the intracranial vasculature but is limited by long acquisition times. Compressed sensing reconstruction can be used to substantially accelerate acquisitions. The quality of those reconstructions depends on the undersampling patterns used. In this work, we optimize sets of undersampling parameters for various acceleration factors of Cartesian 3D time‐of‐flight MRA.

Methods

Fully sampled datasets, acquired at 7 Tesla, were retrospectively undersampled using variable‐density Poisson disk sampling with various autocalibration region sizes, polynomial orders, and acceleration factors. The accuracy of reconstructions from the different undersampled datasets was assessed using the vessel‐masked structural similarity index. Identified optimal undersampling parameters were then evaluated in additional prospectively undersampled datasets. Compressed sensing reconstruction parameters were chosen based on a preliminary reconstruction parameter optimization.

Results

For all acceleration factors, using a fully sampled calibration area of 12 × 12 k‐space lines and a polynomial order of 2 resulted in the highest image quality. The importance of parameter optimization of the sampling was found to increase for higher acceleration factors. The results were consistent across resolutions and regions of interest with vessels of varying sizes and tortuosity. The number of visible small vessels increased by 7.0% and 14.2% when compared to standard parameters for acceleration factors of 7.2 and 15, respectively.

Conclusion

The image quality of compressed sensing time‐of‐flight MRA can be improved by appropriate choice of undersampling parameters. The optimized sets of parameters are independent of the acceleration factor and enable a larger number of vessels to be visualized.

The impact of atrial fibrillation and stroke risk factors on left atrial blood flow characteristics

AIMS

Altered left atrial (LA) blood flow characteristics account for an increase in cardioembolic stroke risk in atrial fibrillation (AF). Here, we aimed to assess whether exposure to stroke risk factors is sufficient to alter LA blood flow even in the presence of sinus rhythm (SR).

METHODS AND RESULTS

We investigated 95 individuals: 37 patients with persistent AF, who were studied before and after cardioversion [Group 1; median CHA2DS2-VASc = 2.0 (1.5-3.5)]; 35 individuals with no history of AF but similar stroke risk to Group 1 [Group 2; median CHA2DS2-VASc = 3.0 (2.0-4.0)]; and 23 low-risk individuals in SR [Group 3; median CHA2DS2-VASc = 0.0 (0.0-0.0)]. Cardiac function and LA flow characteristics were evaluated using cardiac magnetic resonance. Before cardioversion, Group 1 displayed impaired left ventricular (LV) and LA function, reduced LA flow velocities and vorticity, and a higher normalized vortex volume (all P < 0.001 vs. Groups 2 and 3). After restoration of SR at ≥4-week post-cardioversion, LV systolic function and LA flow parameters improved significantly (all P < 0.001 vs. pre-cardioversion) and were no longer different from those in Group 2. However, in the presence of SR, LA flow peak and mean velocity, and vorticity were lower in Groups 1 and 2 vs. Group 3 (all P < 0.01), and were associated with impaired LA emptying fraction (LAEF) and LV diastolic dysfunction.

CONCLUSION

Patients at moderate-to-high stroke risk display altered LA flow characteristics in SR in association with an LA myopathic phenotype and LV diastolic dysfunction, regardless of a history of AF.

Accelerated calibrationless parallel transmit mapping using joint transmit and receive low-rank tensor completion

Purpose

To evaluate an algorithm for calibrationless parallel imaging to reconstruct undersampled parallel transmit field maps for the body and brain.

Methods

Using a combination of synthetic data and in vivo measurements from brain and body, 3 different approaches to a joint transmit and receive low-rank tensor completion algorithm are evaluated. These methods included: 1) virtual coils using the product of receive and transmit sensitivities, 2) joint-receiver coils that enforces a low rank structure across receive coils of all transmit modes, and 3) transmit low rank that uses a low rank structure for both receive and transmit modes simultaneously. The performance of each is investigated for different noise levels and different acceleration rates on an 8-channel parallel transmit 7 Tesla system.

Results

The virtual coils method broke down with increasing noise levels or acceleration rates greater than 2, producing normalized RMS error greater than 0.1. The joint receiver coils method worked well up to acceleration factors of 4, beyond which the normalized RMS error exceeded 0.1. Transmit low rank enabled an eightfold acceleration, with most normalized RMS errors remaining below 0.1.

Conclusion

This work demonstrates that undersampling factors of up to eightfold are feasible for transmit array mapping and can be reconstructed using calibrationless parallel imaging methods.

Motion correction methods for MRS: experts' consensus recommendations

Long acquisition times due to intrinsically low signal-to-noise ratio and the need for highly homogeneous B₀ field make MRS particularly susceptible to motion or scanner instability compared with MRI. Motion-induced changes in both localization and shimming (ie B₀ homogeneity) degrade MRS data quality. To mitigate the effects of motion three approaches can be employed: (1) subject immobilization, (2) retrospective correction, and (3) prospective real-time correction using internal and/or external tracking methods. Prospective real-time correction methods can simultaneously update localization and the B₀ field to improve MRS data quality. While localization errors can be corrected with both internal (navigators) and external (optical camera, NMR probes) tracking methods, the B₀ field correction requires internal navigator methods to measure the B₀ field inside the imaged volume and the possibility to update the scanner shim hardware in real time. Internal and external tracking can rapidly update the MRS localization with submillimeter and subdegree precision, while scanner frequency and first-order shims of scanner hardware can be updated by internal methods every sequence repetition. These approaches are most well developed for neuroimaging, for which rigid transformation is primarily applicable. Real-time correction greatly improves the stability of MRS acquisition and quantification, as shown in clinical studies on subjects prone to motion, including children and patients with movement disorders, enabling robust measurement of metabolite signals including those with low concentrations, such as gamma-aminobutyric acid and glutathione. Thus, motion correction is recommended for MRS users and calls for tighter integration and wider availability of such methods by MR scanner manufacturers.

Left atrial 4D flow cardiovascular magnetic resonance: a reproducibility study in sinus rhythm and atrial fibrillation

BACKGROUND

Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) allows sophisticated quantification of left atrial (LA) blood flow, and could yield novel biomarkers of propensity for intra-cardiac thrombus formation and embolic stroke. As reproducibility is critically important to diagnostic performance, we systematically investigated technical and temporal variation of LA 4D flow in atrial fibrillation (AF) and sinus rhythm (SR).

METHODS

Eighty-six subjects (SR, n = 64; AF, n = 22) with wide-ranging stroke risk (CHA2DS2VASc 0-6) underwent LA 4D flow assessment of peak and mean velocity, vorticity, vortex volume, and stasis. Eighty-five (99%) underwent a second acquisition within the same session, and 74 (86%) also returned at 30 (27-35) days for an interval scan. We assessed variability attributable to manual contouring (intra- and inter-observer), and subject repositioning and reacquisition of data, both within the same session (same-day scan-rescan), and over time (interval scan). Within-subject coefficients of variation (CV) and bootstrapped 95% CIs were calculated and compared.

RESULTS

Same-day scan-rescan CVs were 6% for peak velocity, 5% for mean velocity, 7% for vorticity, 9% for vortex volume, and 10% for stasis, and were similar between SR and AF subjects (all p > 0.05). Interval-scan variability was similar to same-day scan-rescan variability for peak velocity, vorticity, and vortex volume (all p > 0.05), and higher for stasis and mean velocity (interval scan CVs of 14% and 8%, respectively, both p < 0.05). Longitudinal changes in heart rate and blood pressure at the interval scan in the same subjects were associated with significantly higher variability for LA stasis (p = 0.024), but not for the remaining flow parameters (all p > 0.05). SR subjects showed significantly greater interval-scan variability than AF patients for mean velocity, vortex volume, and stasis (all p < 0.05), but not peak velocity or vorticity (both p > 0.05).

CONCLUSIONS

LA peak velocity and vorticity are the most reproducible and temporally stable novel LA 4D flow biomarkers, and are robust to changes in heart rate, blood pressure, and differences in heart rhythm.

Assessment of radio-frequency heating of a parallel transmit coil in a phantom using multi-echo proton resonance frequency shift thermometry

We propose a workflow for validating parallel transmission (pTx) radio-frequency (RF) magnetic field heating patterns using Proton-Resonance Frequency shift (PRF)-based MR thermometry. Electromagnetic (EM) and thermal simulations of a 7 T 8-channel dipole coil were done using commercially available software (Sim4Life) to assess RF heating. The fabrication method for a phantom with electrical properties matched to human tissue is also described, along with methods for its electrical and thermal characterisation. Energy was deposited to specific transmit channels, whilst acquiring 3D PRF data using a pair of interleaved RF shim transmit modes. A multi-echo readout and pre-scan stabilisation protocol were used for increased sensitivity and to correct for measurement-to-measurement instabilities. The electrical properties of the phantom were found to be within 10% of the intended values. Adoption of a 14-min stabilisation scan gave sufficient suppression of any evolving background spatial variation in the B₀ field to achieve <0.001 °C/mm thermometry drift over 10 min of subsequent scanning. Using two RF shim transmit modes enabled full phantom coverage and combining multiple echo times enabled a 13-54% improvement in the RMSE sensitivity to temperature changes. Combining multiple echoes reduced the peak RMSE by 45% and visually reduced measurement-to-measurement instabilities. A reference fibre optic probe showed temperature deviations from the PRF-estimated temperature to be smaller than 0.5 °C. Given the importance of RF safety in pTx applications, this workflow enables accurate validation of RF heating simulations with minimal additional hardware requirements.

An investigation into the minimum number of tissue groups required for 7T in-silico parallel transmit electromagnetic safety simulations in the human head

PURPOSE

Safety limits for the permitted specific absorption rate (SAR) place restrictions on pulse sequence design, especially at ultrahigh fields (≥ 7 tesla). Due to intersubject variability, the SAR is usually conservatively estimated based on standard human models that include an applied safety margin to ensure safe operation. One approach to reducing the restrictions is to create more accurate subject-specific models from their segmented MR images. This study uses electromagnetic simulations to investigate the minimum number of tissue groups required to accurately determine SAR in the human head.

METHODS

Tissue types from a fully characterized electromagnetic human model with 47 tissue types in the head and neck region were grouped into different tissue clusters based on the conductivities, permittivities, and mass densities of the tissues. Electromagnetic simulations of the head model inside a parallel transmit head coil at 7 tesla were used to determine the minimum number of required tissue clusters to accurately determine the subject-specific SAR. The identified tissue clusters were then evaluated using 2 additional well-characterized electromagnetic human models.

RESULTS

A minimum of 4-clusters-plus-air was found to be required for accurate SAR estimation. These tissue clusters are centered around gray matter, fat, cortical bone, and cerebrospinal fluid. For all 3 simulated models, the parallel transmit maximum 10g SAR was consistently determined to within an error of <12% relative to the full 47-tissue model.

CONCLUSION

A minimum of 4-clusters-plus-air are required to produce accurate personalized SAR simulations of the human head when using parallel transmit at 7 tesla.

Navigator-based reacquisition and estimation of motion-corrupted data: Application to multi-echo spin echo for carotid wall MRI

PURPOSE

To assess whether artifacts in multi-slice multi-echo spin echo neck imaging, thought to be caused by brief motion events such as swallowing, can be corrected by reacquiring corrupted central k-space data and estimating the remainder with parallel imaging.

METHODS

A single phase-encode line (ky = 0, phase-encode direction anteroposterior) navigator echo was used to identify motion-corrupted data and guide the online reacquisition. If motion corruption was detected in the 7 central k-space lines, they were replaced with reacquired data. Subsequently, GRAPPA reconstruction was trained on the updated central portion of k-space and then used to estimate the remaining motion-corrupted k-space data from surrounding uncorrupted data. Similar compressed sensing-based approaches have been used previously to compensate for respiration in cardiac imaging. The g-factor noise amplification was calculated for the parallel imaging reconstruction of data acquired with a 10-channel neck coil. The method was assessed in scans with 9 volunteers and 12 patients.

RESULTS

The g-factor analysis showed that GRAPPA reconstruction of 2 adjacent motion-corrupted lines causes high noise amplification; therefore, the number of 2-line estimations should be limited. In volunteer scans, median ghosting reduction of 24% was achieved with 2 adjacent motion-corrupted lines correction, and image quality was improved in 2 patient scans that had motion corruption close to the center of k-space.

CONCLUSION

Motion-corrupted echo-trains can be identified with a navigator echo. Combined reacquisition and parallel imaging estimation reduced motion artifacts in multi-slice MESE when there were brief motion events, especially when motion corruption was close to the center of k-space.

Left Ventricular Flow Analysis

BACKGROUND

Cardiac remodeling, after a myocardial insult, often causes progression to heart failure. The relationship between alterations in left ventricular blood flow, including kinetic energy (KE), and remodeling is uncertain. We hypothesized that increasing derangements in left ventricular blood flow would relate to (1) conventional cardiac remodeling markers, (2) increased levels of biochemical remodeling markers, (3) altered cardiac energetics, and (4) worsening patient symptoms and functional capacity. Methods Thirty-four dilated cardiomyopathy patients, 30 ischemic cardiomyopathy patients, and 36 controls underwent magnetic resonance including 4-dimensional flow, BNP (brain-type natriuretic peptide) measurement, functional capacity assessment (6-minute walk test), and symptom quantification. A subgroup of dilated cardiomyopathy and control subjects underwent cardiac energetic assessment. Left ventricular flow was separated into 4 components: direct flow, retained inflow, delayed ejection flow, and residual volume. Average KE throughout the cardiac cycle was calculated.

RESULTS

Patients had reduced direct flow proportion and direct-flow average KE compared with controls ( P<0.0001). The residual volume proportion and residual volume average KE were increased in patients ( P<0.0001). Importantly, in a multiple linear regression model to predict the patient's 6-minute walk test, the independent predictors were age (β=-0.3015; P=0.019) and direct-flow average KE (β=0.280, P=0.035; R² model, 0.466, P=0.002). In contrast, neither ejection fraction nor left ventricular volumes were independently predictive.

CONCLUSIONS

This study demonstrates an independent predictive relationship between the direct-flow average KE and a prognostic measure of functional capacity. Intracardiac 4-dimensional flow parameters are novel biomarkers in heart failure and may provide additive value in monitoring new therapies and predicting prognosis.

2378Blunted stress myocardial oxygenation and not myocardial perfusion reserve is associated with arrhythmic risk in hypertrophic cardiomyopathy

Background

In hypertrophic cardiomyopathy (HCM), myocardial ischaemia is believed to play a role in fatal life-threatening ventricular arrhythmias and caused by microvascular dysfunction manifesting as impaired myocardial perfusion. However, previous studies suggest that myocardial oxygenation during vasodilator stress may also be blunted when perfusion is normal, due to increased metabolic demands conferred by energy-costly sarcomeric mutations, left ventricular hypertrophy and outflow obstruction. Whether or not impaired myocardial perfusion reserve or blunted stress oxygenation on cardiac magnetic resonance (CMR) predict the risk of ventricular arrhythmia in HCM is unknown.

Purpose

We sought to investigate if impaired myocardial perfusion reserve or stress oxygenation is associated with an increased risk of ventricular arrhythmia in HCM.

Methods

103 genotyped HCM patients (mean age 47±15 years) and 32 age- and sex-matched healthy controls underwent adenosine stress blood oxygen level dependent (BOLD) imaging, first pass perfusion and late gadolinium imaging (LGE) on CMR to assess stress oxygenation (BOLD ΔSI), myocardial perfusion reserve index (MPRI), and fibrosis respectively. All HCM patients were monitored for ventricular tachycardia (≥3 beats, ≥120 beats per minute) on a 24-hour Holter.

Results

As expected, MPRI was significantly reduced in HCM (1.5±0.4 vs 2.0±0.3, p<0.0001) compared to controls. Stress oxygenation response was blunted in HCM versus controls (9.1±4.1% vs 17.0±1.6%, p<0.0001, Figure 1B). Twenty-six (25%) patients developed ventricular tachycardia on Holter monitoring. On univariate analysis, only stress oxygenation and not MPRI associated with ventricular tachycardia. The prevalence of ventricular tachycardia in HCM increased with decreasing quartiles of stress oxygenation (Figure 1D). HCM patients in the lowest quartile of oxygenation (BOLD ΔSI <6.5%) were at a three-fold risk of ventricular tachycardia (OR 3.04, 95% confidence interval 1.02–9.05, p=0.04) on multivariable analysis (after adjusting for sudden cardiac death risk factors and LGE mass) compared to other patients. Sarcomeric mutation status was an independent determinant of stress oxygenation on multivariable analysis. Stress oxygenation was impaired in phenotype-negative sarcomeric mutation carriers (Sarc+P-, n=16) despite normal perfusion (Figure 1C, E). Sarcomeric HCM (Sarc+HCM) had more severe impairment in stress oxygenation than genotype negative HCM (G-HCM) and controls (Figure 1E).

Figure 1

Conclusion

In HCM, blunted stress-induced oxygenation is associated with an increased risk of ventricular arrhythmia and may represent a novel biomarker of arrhythmic risk. Sarcomeric mutation status is an important determinant of stress oxygenation response.

Acknowledgement/Funding

National Institute for Health Research Oxford Biomedical Centre and British Heart Foundation.

Scattering matrix imaging pulse design for real-time respiration and cardiac motion monitoring

Purpose

The scattering matrix (S‐matrix) of a parallel transmit (pTx) coil is sensitive to physiological motion but requires additional monitoring RF pulses to be measured. In this work, we present and evaluate pTx RF pulse designs that simultaneously excite for imaging and measure the S‐matrix to generate real‐time motion signals without prolonging the image sequence.

Theory and Methods

Three pTx waveforms for measuring the S‐matrix were identified and superimposed onto the imaging excitation RF pulses: (1) time division multiplexing, (2) frequency division multiplexing, and (3) code division multiplexing. These 3 methods were evaluated in healthy volunteers for scattering sensitivity and image artefacts. The S‐matrix and real‐time motion signals were calculated on the image calculation environment of the MR scanner. Prospective cardiac triggers were identified in early systole as a high rate of change of the cardiac motion signal. Monitoring accuracy was compared against electrocardiogram or the imaged diaphragm position.

Results

All 3 monitoring approaches measure the S‐matrix during image excitation with quality correlated to input power. No image artefacts were observed for frequency multiplexing, and low energy artefacts were observed in the other methods. The accuracy of the achieved prospective cardiac gating was 15 ± 16 ms for breath hold and 24 ± 17 ms during free breathing. The diaphragm position prediction accuracy was 1.3 ± 0.9 mm. In all volunteers, good quality cine images were acquired for breath hold scans and dual gated CINEs were demonstrated.

Conclusion

The S‐matrix can be measured during image excitation to generate real‐time cardiac and respiratory motion signals for prospective gating. No artefacts are introduced when frequency division multiplexing is used.

Cardiac gating using scattering of an 8-channel parallel transmit coil at 7T

PURPOSE

To establish a cardiac signal from scattering matrix or scattering coefficient measurements made on a 7T 8-channel parallel transmit (pTx) system, and to evaluate its use for cardiac gating.

METHODS

Measurements of the scattering matrix and scattering coefficients were acquired using a monitoring pulse sequence and during a standard cine acquisition, respectively. Postprocessing used an independent component analysis and gating feature identification. The effect of the phase of the excitation radiofrequency (RF) field ( B1+ shim) on the cardiac signal was simulated for multiple B1+ shim configurations, and cine images were reconstructed from both the scattering coefficients and electrocardiogram (ECG).

RESULTS

The cardiac motion signal was successfully identified in all subjects with a mean signal-to-noise ratio of 33.1 and 5.7 using the scattering matrix and scattering coefficient measurements, respectively. The dominant gating feature in the cardiac signal was a peak aligned with end-systole that occurred on average at 311 and 391 ms after the ECG trigger, with a mean standard deviation of 13.4 and 18.1 ms relative to ECG when using the scattering matrix and scattering coefficients measurements, respectively. The scattering coefficients showed a dependence on B1+ shim with some shim configurations not showing any cardiac signal. Cine images were successfully reconstructed using the scattering coefficients with minimal differences compared to those using ECG.

CONCLUSION

We have shown that the scattering of a pTx RF coil can be used to estimate a cardiac signal, and that scattering matrix and coefficients can be used to cardiac gate MRI acquisitions with the scattering matrix providing a superior cardiac signal. Magn Reson Med 80:633-640, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Test-retest variability of left ventricular 4D flow cardiovascular magnetic resonance measurements in healthy subjects

BACKGROUND

Quantification and visualisation of left ventricular (LV) blood flow is afforded by three-dimensional, time resolved phase contrast cardiovascular magnetic resonance (CMR 4D flow). However, few data exist upon the repeatability and variability of these parameters in a healthy population. We aimed to assess the repeatability and variability over time of LV 4D CMR flow measurements.

METHODS

Forty five controls underwent CMR 4D flow data acquisition. Of these, 10 underwent a second scan within the same visit (scan-rescan), 25 returned for a second visit (interval scan; median interval 52 days, IQR 28-57 days). The LV-end diastolic volume (EDV) was divided into four flow components: 1) Direct flow: inflow that passes directly to ejection; 2) Retained inflow: inflow that enters and resides within the LV; 3) Delayed ejection flow: starts within the LV and is ejected and 4) Residual volume: blood that resides within the LV for > 2 cardiac cycles. Each flow components' volume was related to the EDV (volume-ratio). The kinetic energy at end-diastole (ED) was measured and divided by the components' volume.

RESULTS

The dominant flow component in all 45 controls was the direct flow (volume ratio 38 ± 4%) followed by the residual volume (30 ± 4%), then delayed ejection flow (16 ± 3%) and retained inflow (16 ± 4%). The kinetic energy at ED for each component was direct flow (7.8 ± 3.0 microJ/ml), retained inflow (4.1 ± 2.0 microJ/ml), delayed ejection flow (6.3 ± 2.3 microJ/ml) and the residual volume (1.2 ± 0.5 microJ/ml). The coefficients of variation for the scan-rescan ranged from 2.5%-9.2% for the flow components' volume ratio and between 13.5%-17.7% for the kinetic energy. The interval scan results showed higher coefficients of variation with values from 6.2-16.1% for the flow components' volume ratio and 16.9-29.0% for the kinetic energy of the flow components.

CONCLUSION

LV flow components' volume and their associated kinetic energy values are repeatable and stable within a population over time. However, the variability of these measurements in individuals over time is greater than can be attributed to sources of error in the data acquisition and analysis, suggesting that additional physiological factors may influence LV flow measurements.

Differential flow improvements after valve replacements in bicuspid aortic valve disease: a cardiovascular magnetic resonance assessment

BACKGROUND

Abnormal aortic flow patterns in bicuspid aortic valve disease (BAV) may be partly responsible for the associated aortic dilation. Aortic valve replacement (AVR) may normalize flow patterns and potentially slow the concomitant aortic dilation. We therefore sought to examine differences in flow patterns post AVR.

METHODS

Ninety participants underwent 4D flow cardiovascular magnetic resonance: 30 BAV patients with prior AVR (11 mechanical, 10 bioprosthetic, 9 Ross procedure), 30 BAV patients with a native aortic valve and 30 healthy subjects.

RESULTS

The majority of subjects with mechanical AVR or Ross showed normal flow pattern (73% and 67% respectively) with near normal rotational flow values (7.2 ± 3.9 and 10.6 ± 10.5 mm2/ms respectively vs 3.8 ± 3.1 mm2/s for healthy subjects; both p > 0.05); and reduced in-plane wall shear stress (0.19 ± 0.13 N/m2 for mechanical AVR vs. 0.40 ± 0.28 N/m2 for native BAV, p < 0.05). In contrast, all subjects with a bioprosthetic AVR had abnormal flow patterns (mainly marked right-handed helical flow), with comparable rotational flow values to native BAV (20.7 ± 8.8 mm2/ms and 26.6 ± 16.6 mm2/ms respectively, p > 0.05), and a similar pattern for wall shear stress. Data before and after AVR (n = 16) supported these findings: mechanical AVR showed a significant reduction in rotational flow (30.4 ± 16.3 → 7.3 ± 4.1 mm2/ms; p < 0.05) and in-plane wall shear stress (0.47 ± 0.20 → 0.20 ± 0.13 N/m2; p < 0.05), whereas these parameters remained similar in the bioprosthetic AVR group.

CONCLUSIONS

Abnormal flow patterns in BAV disease tend to normalize after mechanical AVR or Ross procedure, in contrast to the remnant abnormal flow pattern after bioprosthetic AVR. This may in part explain different aortic growth rates post AVR in BAV observed in the literature, but requires confirmation in a prospective study.

Diaphragm position can be accurately estimated from the scattering of a parallel transmit RF coil at 7 T

Purpose

To evaluate the use of radiofrequency scattering of a parallel transmit coil to track diaphragm motion.

Methods

Measurements made during radiofrequency excitation on an 8‐channel parallel transmit coil by the directional couplers of the radiofrequency safety monitor were combined and converted into diaphragm position. A 30‐s subject‐specific calibration with an MRI navigator was used to determine a diaphragm estimate from each directional‐coupler measure. Seven healthy volunteers were scanned at 7 T, in which images of the diaphragm were continuously acquired and directional couplers were monitored during excitation radiofrequency pulses. The ability to detect coughing was evaluated in one subject. The method was implemented on the scanner and evaluated for diaphragm gating of a free‐breathing cardiac cine.

Results

Six of the seven scans were successful. In these subjects, the root mean square difference between MRI and scattering estimation of the superior–inferior diaphragm position was 1.4 ± 0.5 mm. On the scanner, the position was calculated less than 2 ms after every radiofrequency pulse. A prospectively gated (echocardiogram and respiration) high‐resolution free‐breathing cine showed no respiratory artifact and sharp blood‐myocardium definition.

Conclusions

Transmit coil scattering is sensitive to diaphragm motion and provides rapid, quantitative, and accurate monitoring of respiration. Magn Reson Med 79:2164–2169, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Combined fMRI-MRS acquires simultaneous glutamate and BOLD-fMRI signals in the human brain

Combined fMRI-MRS is a novel method to non-invasively investigate functional activation in the human brain using simultaneous acquisition of hemodynamic and neurochemical measures. The aim of the current study was to quantify neural activity using combined fMRI-MRS at 7 T. BOLD-fMRI and semi-LASER localization MRS data were acquired from the visual cortex of 13 participants during short blocks (64 s) of flickering checkerboards. We demonstrate a correlation between glutamate and BOLD-fMRI time courses (R=0.381, p=0.031). In addition, we show increases in BOLD-fMRI (1.43±0.17%) and glutamate concentrations (0.15±0.05 I.U., ~2%) during visual stimulation. In contrast, we observed no change in glutamate concentrations in resting state MRS data during sham stimulation periods. Spectral line width changes generated by the BOLD-response were corrected using line broadening. In summary, our results establish the feasibility of concurrent measurements of BOLD-fMRI and neurochemicals using a novel combined fMRI-MRS sequence. Our findings strengthen the link between glutamate and functional activity in the human brain by demonstrating a significant correlation of BOLD-fMRI and glutamate over time, and by showing ~2% glutamate increases during 64 s of visual stimulation. Our tool may become useful for studies characterizing functional dynamics between neurochemicals and hemodynamics in health and disease.

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Novel MRI sequence measures hemodynamics and neurochemistry in same TR.

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Stimulation block duration relevant for functional experiments (64s).

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BOLD-fMRI and glutamate time courses correlate during functional stimulation.

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Visual stimulation increases glutamate concentrations.

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Useful to study fundamental relationship between hemodynamics and neurochemistry.

Hexagonal gradient scheme with RF spoiling improves spoiling performance for high-flip-angle fast gradient echo imaging

Purpose

To present a framework in which time‐varying gradients are applied with RF spoiling to reduce unwanted signal, particularly at high flip angles.

Methods

A time‐varying gradient spoiler scheme compatible with RF spoiling is defined, in which spoiler gradients cycle through the vertices of a hexagon, which we call hexagonal spoiling. The method is compared with a traditional constant spoiling gradient both in the transition to and in the steady state. Extended phase graph (EPG) simulations, phantom acquisitions, and in vivo images were used to assess the method.

Results

Simulations, phantom and in vivo experiments showed that unwanted signal was markedly reduced by employing hexagonal spoiling, both in the transition to and in the steady state. For adipose tissue at 1.5 Tesla, the unwanted signal in the steady state with a 60 ° flip angle was reduced from 22% with constant spoiling to 2% with hexagonal spoiling.

Conclusions

A time‐varying gradient spoiler scheme that works with RF spoiling, called “hexagonal spoiling,” has been presented and found to offer improved spoiling over the traditional constant spoiling gradient. Magn Reson Med 77:1231–1237, 2017. © 2016 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Prospective motion correction and selective reacquisition using volumetric navigators for vessel-encoded arterial spin labeling dynamic angiography

PURPOSE

The aim of this study was to improve robustness to motion in a vessel-encoded angiography sequence used for patient scans. The sequence is particularly sensitive to motion between imaging segments, which causes ghosting and blurring that propagates to the final angiogram.

METHODS

Volumetric echo planar imaging (EPI) navigators acquired in 275 ms were inserted after the imaging readout in a vessel-encoded pseudo-continuous arterial spin labeling (VEPCASL) sequence. The effects of movement between segments on the images were tested with phantom experiments. Deliberate motion experiments with healthy volunteers were performed to compare prospective motion correction (PMC) with reacquisition versus no correction.

RESULTS

In scans without motion, the addition of the EPI navigator to the sequence did not affect the quality of the angiograms in comparison with the original sequence. PMC and reacquisition improved the visibility of vessels in the angiograms compared with the scans without correction. The reacquisition strategy was shown to be important for complete correction of imaging artifacts.

CONCLUSION

We have demonstrated an effective method to correct motion in vessel-encoded angiography. For reacquisition of 15 segments, the technique requires approximately 30 s of additional scanning (∼25%). Magn Reson Med 76:1420-1430, 2016. © 2015 International Society for Magnetic Resonance in Medicine.

Large dynamic range relative B1+ mapping

Purpose

Parallel transmission (PTx) requires knowledge of the B1+ produced by each element. However, B1+ mapping can be challenging when transmit fields exhibit large dynamic range. This study presents a method to produce high quality relative B1+ maps when this is the case.

Theory and Methods

The proposed technique involves the acquisition of spoiled gradient echo (SPGR) images at multiple radiofrequency drive levels for each transmitter. The images are combined using knowledge of the SPGR signal equation using maximum likelihood estimation, yielding an image for each channel whose signal is proportional to the B1+ field strength. Relative B1+ maps are then obtained by taking image ratios. The method was tested using numerical simulations, phantom imaging, and through in vivo experiments.

Results

The numerical simulations demonstrated that the proposed method can reconstruct relative transmit sensitivities over a wide range of B1+ amplitudes and at several SNR levels. The method was validated at 3 Tesla (T) by comparing it with an alternative B1+ mapping method, and demonstrated in vivo at 7T.

Conclusion

Relative B1+ mapping in the presence of large dynamic range has been demonstrated through numerical simulations, phantom imaging at 3T and experimentally at 7T. The method will enable PTx to be applied in challenging imaging scenarios at ultrahigh field. Magn Reson Med 76:490–499, 2016. © 2015 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

3D GABA imaging with real-time motion correction, shim update and reacquisition of adiabatic spiral MRSI

Gamma-aminobutyric acid (GABA) and glutamate (Glu) are the major neurotransmitters in the brain. They are crucial for the functioning of healthy brain and their alteration is a major mechanism in the pathophysiology of many neuro-psychiatric disorders. Magnetic resonance spectroscopy (MRS) is the only way to measure GABA and Glu non-invasively in vivo. GABA detection is particularly challenging and requires special MRS techniques. The most popular is MEscher-GArwood (MEGA) difference editing with single-voxel Point RESolved Spectroscopy (PRESS) localization. This technique has three major limitations: a) MEGA editing is a subtraction technique, hence is very sensitive to scanner instabilities and motion artifacts. b) PRESS is prone to localization errors at high fields (≥3T) that compromise accurate quantification. c) Single-voxel spectroscopy can (similar to a biopsy) only probe steady GABA and Glu levels in a single location at a time. To mitigate these problems, we implemented a 3D MEGA-editing MRS imaging sequence with the following three features: a) Real-time motion correction, dynamic shim updates, and selective reacquisition to eliminate subtraction artifacts due to scanner instabilities and subject motion. b) Localization by Adiabatic SElective Refocusing (LASER) to improve the localization accuracy and signal-to-noise ratio. c) K-space encoding via a weighted stack of spirals provides 3D metabolic mapping with flexible scan times. Simulations, phantom and in vivo experiments prove that our MEGA-LASER sequence enables 3D mapping of GABA+ and Glx (Glutamate+Gluatmine), by providing 1.66 times larger signal for the 3.02ppm multiplet of GABA+ compared to MEGA-PRESS, leading to clinically feasible scan times for 3D brain imaging. Hence, our sequence allows accurate and robust 3D-mapping of brain GABA+ and Glx levels to be performed at clinical 3T MR scanners for use in neuroscience and clinical applications.

Automated tuning of an eight-channel cardiac transceive array at 7 tesla using piezoelectric actuators

Purpose

Ultra-high field (UHF) MR scanning in the body requires novel coil designs due to B₁ field inhomogeneities. In the transverse electromagnetic field (TEM) design, maximum B₁ transmit power can only be achieved if each individual transmit element is tuned and matched for different coil loads, which requires a considerable amount of valuable scanner time.

Methods

An integrated system for autotuning a multichannel parallel transmit (pTx) cardiac TEM array was devised, using piezoelectric actuators, power monitoring equipment and control software. The reproducibility and performance of the system were tested and the power responses of the coil elements were profiled. An automated optimization method was devised and evaluated.

Results

The time required to tune an eight-element pTx cardiac RF array was reduced from a mean of 30 min to less than 10 min with the use of this system.

Conclusion

Piezoelectric actuators are an attractive means of tuning RF coil arrays to yield more efficient B₁ transmission into the subject. An automated mechanism for tuning these elements provides a practical solution for cardiac imaging at UHF, bringing this technology closer to clinical use. Magn Reson Med 73:2390–2397, 2015. © 2014 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine.

Aortic 4D flow: quantification of signal-to-noise ratio as a function of field strength and contrast enhancement for 1.5T, 3T, and 7T

PURPOSE

To investigate for the first time the feasibility of aortic four-dimensional (4D) flow at 7T, both contrast enhanced (CE) and non-CE. To quantify the signal-to-noise ratio (SNR) in aortic 4D flow as a function of field strength and CE with gadobenate dimeglumine (MultiHance).

METHODS

Six healthy male volunteers were scanned at 1.5T, 3T, and 7T with both non-CE and CE acquisitions. Temporal SNR was calculated. Flip angle optimization for CE 4D flow was carried out using Bloch simulations that were validated against in vivo measurements.

RESULTS

The 7T provided 2.2 times the SNR of 3T while 3T provided 1.7 times the SNR of 1.5T in non-CE acquisitions in the descending aorta. The SNR gains achieved by CE were 1.8-fold at 1.5T, 1.7-fold at 3T, and 1.4-fold at 7T, respectively.

CONCLUSION

The 7T provides a new tool to explore aortic 4D flow, yielding higher SNR that can be used to push the boundaries of acceleration and resolution. Field strength and contrast enhancement at all fields provide significant improvements in SNR.

A comparison of spectral quality in magnetic resonance spectroscopy data acquired with and without a novel EPI-navigated PRESS sequence in school-aged children with fetal alcohol spectrum disorders

Single voxel spectroscopy (SVS) can generate useful information regarding metabolite concentrations provided that the MR signal can be averaged over several minutes during which the subject remains stationary. This requirement can be particularly challenging for children who cannot otherwise be scanned without sedation. To address this problem we developed an EPI volume navigated (vNav) SVS PRESS sequence, which applies real-time head pose (location and orientation), frequency, and first-order B0 shim adjustments. A water-independent preprocessing algorithm removes residual frequency and phase shifts resulting from within-TR movements. We compare results and performance of the standard and vNav PRESS sequences in a sample of 9- to 10-year-olds from a South African cohort of children with fetal alcohol spectrum disorders (FASD) and healthy controls. Magnetic resonance spectroscopy (MRS) data in the deep cerebellar nuclei were initially acquired with the standard PRESS sequence. The children were re-scanned 1 year later with the vNav PRESS sequence. Good quality data were acquired in 73% using the vNav PRESS sequence, compared to only 50% for the standard PRESS sequence. Additionally, tighter linewidths and smaller variances in the measured concentrations were observed. These findings confirm previous reports demonstrating the efficacy of our innovative vNav sequence with healthy volunteers and young children with HIV and expand its application to a school-aged population with FASD-disorders often associated with attention problems and hyperactivity. This study provides the most direct evidence to date regarding degree to which these new methods can improve data quality in research studies employing MRS.

Study protocol: The Whitehall II imaging sub-study

BACKGROUND

The Whitehall II (WHII) study of British civil servants provides a unique source of longitudinal data to investigate key factors hypothesized to affect brain health and cognitive ageing. This paper introduces the multi-modal magnetic resonance imaging (MRI) protocol and cognitive assessment designed to investigate brain health in a random sample of 800 members of the WHII study.

METHODS/DESIGN

A total of 6035 civil servants participated in the WHII Phase 11 clinical examination in 2012-2013. A random sample of these participants was included in a sub-study comprising an MRI brain scan, a detailed clinical and cognitive assessment, and collection of blood and buccal mucosal samples for the characterisation of immune function and associated measures. Data collection for this sub-study started in 2012 and will be completed by 2016. The participants, for whom social and health records have been collected since 1985, were between 60-85 years of age at the time the MRI study started. Here, we describe the pre-specified clinical and cognitive assessment protocols, the state-of-the-art MRI sequences and latest pipelines for analyses of this sub-study.

DISCUSSION

The integration of cutting-edge MRI techniques, clinical and cognitive tests in combination with retrospective data on social, behavioural and biological variables during the preceding 25 years from a well-established longitudinal epidemiological study (WHII cohort) will provide a unique opportunity to examine brain structure and function in relation to age-related diseases and the modifiable and non-modifiable factors affecting resilience against and vulnerability to adverse brain changes.

Optimized saturation pulse train for human first-pass myocardial perfusion imaging at 7T

Purpose

To investigate whether saturation using existing methods developed for 3T imaging is feasible for clinical perfusion imaging at 7T, and to propose a new design of saturation pulse train for first-pass myocardial perfusion imaging at 7T.

Methods

The new design of saturation pulse train consists of four hyperbolic-secant (HS8) radiofrequency pulses, whose peak amplitudes are optimized for a target range of static and transmit field variations and radiofrequency power deposition restrictions measured in the myocardium at 7T. The proposed method and existing methods were compared in simulation, phantom, and in vivo experiments.

Results

In healthy volunteer experiments without contrast agent, average saturation efficiency with the proposed method was 97.8%. This is superior to results from the three previously published methods at 86/95/90.8%. The first series of human first-pass myocardial perfusion images at 7T have been successfully acquired with the proposed method.

Conclusion

Existing saturation methods developed for 3T imaging are not optimal for perfusion imaging at 7T. The proposed new design of saturation pulse train can saturate effectively, and with this method first-pass myocardial perfusion imaging is feasible in humans at 7T. Magn Reson Med 73:1450–1456, 2015. © 2014 The Authors. Magnetic Resonance in Medicine Published by Wiley Periodicals, Inc. on behalf of International Society of Medicine in Resonance.

An in vivo 1H magnetic resonance spectroscopy study of the deep cerebellar nuclei in children with fetal alcohol spectrum disorders

BACKGROUND

Prenatal alcohol exposure has been linked to impairment in cerebellar structure and function, including eyeblink conditioning. The deep cerebellar nuclei, which play a critical role in cerebellar-mediated learning, receive extensive inputs from brain stem and cerebellar cortex and provide the point of origin for most of the output fibers to other regions of the brain. We used in vivo (1) H magnetic resonance spectroscopy (MRS) to examine effects of prenatal alcohol exposure on neurochemistry in this important cerebellar region.

METHODS

MRS data from the deep cerebellar nuclei were acquired from 37 children with heavy prenatal alcohol exposure and 17 non- or minimally exposed controls from the Cape Coloured (mixed ancestry) community in Cape Town, South Africa.

RESULTS

Increased maternal alcohol consumption around time of conception was associated with lower N-Acetylaspartate (NAA) levels in the deep nuclei (r = -0.33, p < 0.05). Higher levels of alcohol consumption during pregnancy were related to lower levels of the choline-containing metabolites (r = -0.37, p < 0.01), glycerophosphocholine plus phosphocholine (Cho). Alcohol consumption levels both at conception (r = 0.35, p < 0.01) and during pregnancy (r = 0.38, p < 0.01) were related to higher levels of glutamate plus glutamine (Glx). All these effects continued to be significant after controlling for potential confounders.

CONCLUSIONS

The lower NAA levels seen in relation to prenatal alcohol exposure may reflect impaired neuronal integrity in the deep cerebellar nuclei. Our finding of lower Cho points to disrupted Cho metabolism of membrane phospholipids, reflecting altered neuropil development with potentially reduced content of dendrites and synapses. The alcohol-related alterations in Glx may suggest a disruption of the glutamate-glutamine cycling involved in glutamatergic excitatory neurotransmission.

Real-time motion- and B0-correction for LASER-localized spiral-accelerated 3D-MRSI of the brain at 3T

The full potential of magnetic resonance spectroscopic imaging (MRSI) is often limited by localization artifacts, motion-related artifacts, scanner instabilities, and long measurement times. Localized adiabatic selective refocusing (LASER) provides accurate B1-insensitive spatial excitation even at high magnetic fields. Spiral encoding accelerates MRSI acquisition, and thus, enables 3D-coverage without compromising spatial resolution. Real-time position- and shim/frequency-tracking using MR navigators correct motion- and scanner instability-related artifacts. Each of these three advanced MRI techniques provides superior MRSI data compared to commonly used methods. In this work, we integrated in a single pulse sequence these three promising approaches. Real-time correction of motion, shim, and frequency-drifts using volumetric dual-contrast echo planar imaging-based navigators were implemented in an MRSI sequence that uses low-power gradient modulated short-echo time LASER localization and time efficient spiral readouts, in order to provide fast and robust 3D-MRSI in the human brain at 3T. The proposed sequence was demonstrated to be insensitive to motion- and scanner drift-related degradations of MRSI data in both phantoms and volunteers. Motion and scanner drift artifacts were eliminated and excellent spectral quality was recovered in the presence of strong movement. Our results confirm the expected benefits of combining a spiral 3D-LASER-MRSI sequence with real-time correction. The new sequence provides accurate, fast, and robust 3D metabolic imaging of the human brain at 3T. This will further facilitate the use of 3D-MRSI for neuroscience and clinical applications.

Quality of 186 child brain spectra using motion and B0 shim navigated single voxel spectroscopy

PURPOSE

To evaluate B0 shim and motion navigated single voxel spectroscopy in children. Assess the repeatability of metabolite concentrations in three regions: medial frontal grey matter, peritrigonal white matter, and basal ganglia. Determine the extent of intra- and interacquisition movement in this population.

METHODS

Linewidth and signal to noise ratio were calculated to assess spectral quality of 186 spectra at 3 Tesla. Repeatability was assessed on 31 repeat scans. Navigator images were used to assess localization errors, while navigator motion and shim logs were used to demonstrate the efficacy of correction needed during the scans.

RESULTS

Average linewidths ± standard deviations of N-acetyl aspartate are 3.8 ± 0.6 Hz, 4.4 ± 0.5 Hz, and 4.7 ± 0.8 Hz in each region, respectively. Scan-to-scan measurement variance in metabolite concentrations closely resembled the expected variance. A total of 73% and 32% of children moved before and during the acquisition, causing a voxel shift of more than 10% of the voxel volume, 1.5 mm. The predominant movement directions were sliding out of the coil and nodding (up-down rotation). First-order B0 corrections were significant (>10 μT/m) in 18 % of acquisitions.

CONCLUSION

Prospective motion and B0 correction provides high quality repeatable spectra. The study found that most children moved between acquisitions and a substantial number moved during acquisitions.

Aortic dilation in bicuspid aortic valve disease: flow pattern is a major contributor and differs with valve fusion type

BACKGROUND

Ascending aortic dilation is important in bicuspid aortic valve (BAV) disease, with increased risk of aortic dissection. We used cardiovascular MR to understand the pathophysiology better by examining the links between 3-dimensional flow abnormalities, aortic function, and aortic dilation.

METHODS AND RESULTS

A total of 142 subjects underwent cardiovascular MR (mean age, 40 years; 95 with BAV, 47 healthy volunteers). Patients with BAV had predominantly abnormal right-handed helical flow in the ascending aorta, larger ascending aortas (18.3±3.3 versus 15.2±2.2 mm/m²; P<0.001), and higher rotational (helical) flow (31.7±15.8 versus 2.9±3.9 mm²/s; P<0.001), systolic flow angle (23.1°±12.5° versus 7.0°±4.6°; P<0.001), and systolic wall shear stress (0.85±0.28 versus 0.59±0.17 N/m²; P<0.001) compared with healthy volunteers. BAV with right-handed flow and right-non coronary cusp fusion (n=31) showed more severe flow abnormalities (rotational flow, 38.5±16.5 versus 27.8±12.4 mm²/s; P<0.001; systolic flow angle, 29.4°±10.9° versus 19.4°±11.4°; P<0.001; in-plane wall shear stress, 0.64±0.23 versus 0.47±0.22 N/m²; P<0.001) and larger aortas (19.5±3.4 versus 17.5±3.1 mm/m²; P<0.05) than right-left cusp fusion (n=55). Patients with BAV with normal flow patterns had similar aortic dimensions and wall shear stress to healthy volunteers and younger patients with BAV showed abnormal flow patterns but no aortic dilation, both further supporting the importance of flow pattern in the pathogenesis of aortic dilation. Aortic function measures (distensibility, aortic strain, and pulse wave velocity) were similar across all groups.

CONCLUSIONS

Flow abnormalities may be a major contributor to aortic dilation in BAV. Fusion type affects the severity of flow abnormalities and may allow better risk prediction and selection of patients for earlier surgical intervention.

Real-time motion and B0 correction for localized adiabatic selective refocusing (LASER) MRSI using echo planar imaging volumetric navigators

A method is presented to correct the effects of motion and motion-related B(0) perturbations on spectroscopic imaging in real time through the use of a volumetric navigator. It is demonstrated that, for an axial slice, lifting the chin significantly disrupts the B(0) homogeneity in the zero-order (frequency), first-order Y (coronal) axis and second-order ZY term. This volumetric navigator is able to measure and correct in real time both head pose and zero- to first-order B(0) inhomogeneities. The volumetric navigator was validated in six volunteers who deliberately lifted and then dropped their chin during the scan. These scans show that motion correction alone is not sufficient to recover the spectral quality. By applying real-time shim adjustments, spectral quality was fully recovered to linewidths below 0.08 ppm and the signal-to-noise ratio to within acceptable limits in five of six subjects. In the sixth subject, 83% of the spectra within the volume of interest were recovered, compared with the worst case nonshim-corrected scan, where none of the voxels fell within these quality bounds. It is shown that the use of a volumetric navigator comes at no additional cost to the scan time or spectral signal-to-noise ratio.

Volumetric navigators for real-time motion correction in diffusion tensor imaging

Prospective motion correction methods using an optical system, diffusion-weighted prospective acquisition correction, or a free induction decay navigator have recently been applied to correct for motion in diffusion tensor imaging. These methods have some limitations and drawbacks. This article describes a novel technique using a three-dimensional-echo planar imaging navigator, of which the contrast is independent of the b-value, to perform prospective motion correction in diffusion weighted images, without having to reacquire volumes during which motion occurred, unless motion exceeded some preset thresholds. Water phantom and human brain data were acquired using the standard and navigated diffusion sequences, and the mean and whole brain histogram of the fractional anisotropy and mean diffusivity were analyzed. Our results show that adding the navigator does not influence the diffusion sequence. With head motion, the whole brain histogram-fractional anisotropy shows a shift toward lower anisotropy with a significant decrease in both the mean fractional anisotropy and the fractional anisotropy histogram peak location (P<0.01), whereas the whole brain histogram-mean diffusivity shows a shift toward higher diffusivity with a significant increase in the mean diffusivity (P<0.01), even after retrospective motion correction. These changes in the mean and the shape of the histograms are recovered substantially in the prospective motion corrected data acquired using the navigated sequence.

Volumetric navigators for prospective motion correction and selective reacquisition in neuroanatomical MRI

We introduce a novel method of prospectively compensating for subject motion in neuroanatomical imaging. Short three-dimensional echo-planar imaging volumetric navigators are embedded in a long three-dimensional sequence, and the resulting image volumes are registered to provide an estimate of the subject's location in the scanner at a cost of less than 500 ms, ~ 1% change in contrast, and ~3% change in intensity. This time fits well into the existing gaps in sequences routinely used for neuroimaging, thus giving a motion-corrected sequence with no extra time required. We also demonstrate motion-driven selective reacquisition of k-space to further compensate for subject motion. We perform multiple validation experiments to evaluate accuracy, navigator impact on tissue intensity/contrast, and the improvement in final output. The complete system operates without adding additional hardware to the scanner and requires no external calibration, making it suitable for high-throughput environments.

Real-time motion and B0 corrected single voxel spectroscopy using volumetric navigators

In population groups where head pose cannot be assumed to be constant during a magnetic resonance spectroscopy examination or in difficult-to-shim regions of the brain, real-time volume of interest, frequency, and shim optimization may be necessary. We investigate the effect of pose change on the B0 homogeneity of a (2 cm)3 volume and observe typical first-order shim changes of 1 μT/m per 1° rotation (chin down to up) in four different volumes of interest in a single volunteer. An echo planar imaging volume navigator was constructed to measure and apply in real-time within each pulse repetition time: volume of interest positioning, frequency adjustment, and first-order shim adjustment. This volume navigator is demonstrated in six healthy volunteers and achieved a mean linewidth of 4.4 Hz, similar to that obtained by manual shim adjustment of 4.9 Hz. Furthermore, this linewidth is maintained by the volume navigator at 4.9 Hz in the presence of pose change. By comparison, a mean linewidth of 7.5 Hz was observed, when no correction was applied.