Spiral gradient echo versus cartesian turbo spin echo imaging for sagittal contrast-enhanced fat-suppressed T1 weighted spine MRI: an inter-individual comparison study

OBJECTIVES

To compare a novel 3D spiral gradient echo (GRE) sequence with a conventional 2D cartesian turbo spin echo (TSE) sequence for sagittal contrast-enhanced (CE) fat-suppressed (FS) T1 weighted (T1W) spine MRI.

METHODS

In this inter-individual comparison study, 128 patients prospectively underwent sagittal CE FS T1W spine MRI with either a 2D cartesian TSE ("TSE", 285 s, 64 patients) or a 3D spiral GRE sequence ("Spiral", 93 s, 64 patients). Between both groups, patients were matched in terms of anatomical region (cervical/thoracic/lumbar spine and sacrum). Three readers used 4-point Likert scales to assess images qualitatively in terms of overall image quality, presence of artifacts, spinal cord visualization, lesion conspicuity and quality of fat suppression.

RESULTS

Spiral achieved a 67.4% scan time reduction compared to TSE. Interreader agreement was high (alpha=0.868-1). Overall image quality (4;[3,4] vs 3;[3,4], p<0.001 - p=0.002 for all readers), presence of artifacts (4;[3,4] vs 3;[3,4] p=0.027 - p=0.046 for all readers), spinal cord visualization (4;[4,4] vs 4;[3,4], p<0.001 for all readers), lesion conspicuity (4;[4,4] vs 4;[4,4], p=0.016 for all readers) and quality of fat suppression (4;[4,4] vs 4;[4,4], p=0.027 - p=0.033 for all readers), were all deemed significantly improved by all three readers on Spiral images as compared to TSE images.

CONCLUSION

We demonstrate the feasibility of a novel 3D spiral GRE sequence for improved and rapid sagittal CE FS T1W spine MRI.

ADVANCES IN KNOWLEDGE

A 3D spiral GRE sequence allows for improved sagittal CE FS T1W spine MRI at very short scan times.

Impact of Acoustic Noise Reduction on Patient Experience in Routine Clinical Magnetic Resonance Imaging

OBJECTIVES

Acoustic noise emission from MRI scanners is considered a major factor of patient discomfort during routine MRI examinations. We prospectively evaluated the impact of acoustic noise reduction using software implementations in routine clinical MRI on subjective patient experience and image quality.

METHODS

Two-hundred consecutive patients undergoing one of four MRI examinations (brain, lumbar spine, shoulder, and knee) at a single center were prospectively randomized into two groups at a 1 to 1 ratio: standard MRI examination and MRI examination with acoustic noise reduction. After the examination, patients were asked to complete a questionnaire aimed at defining their subjective experience (primary endpoint). Two readers assessed subjective image quality of all patient studies in consensus (secondary endpoint). Nonparametric tests and logistic regression models were used for statistical analysis.

RESULTS

Hundred-seventy-four patients were included in the final study. Patients in the intervention group felt less discomforted by the acoustic noise (p = 0.01) and reported increased audibility of music through the headphones (p = 0.03). No significant difference in subjective image quality was found.

CONCLUSION

Our study indicates that the effects of acoustic noise reduction in routine clinical MRI can be translated into reduced patient discomfort from acoustic noise and improved audibility of music. Acoustic noise reduction thus significantly contributes to increased patient comfort during MRI examinations.

Spiral 3D time-of-flight MR angiography for rapid non-contrast carotid artery imaging: Clinical feasibility and protocol optimization

PURPOSE

To assess the clinical feasibility of spiral 3D Time-Of-Flight (TOF) MR Angiography (MRA) sequence variants for rapid non-contrast carotid artery imaging.

METHODS

Nine different 3D TOF MRA sequences were acquired in nine healthy volunteers on a standard clinical 1.5 T scanner. Three cartesian sequences (fully sampled (10:15 min), accelerated with SENSE (05:08 min), accelerated with Compressed SENSE (03:32 min)) and six different spiral sequences were acquired (spiral acquisition windows ranging from 10 to 5 ms (01:32 min-03:05 min)). Three readers graded the images qualitatively in terms of overall image quality, vessel sharpness, inhomogeneous intraluminal signal, background noise, visualization of large and small vessels and overall impression of the number of visible vessels. Cross-sectional areas of the vessel lumen were measured and vessel sharpness was quantified.

RESULTS

The SENSE and Compressed SENSE accelerated cartesian sequences and the Spiral 6 ms and 5 ms sequences were deemed comparable to the fully sampled cartesian sequence in most qualitative categories (p > 0.05) based on exact binomial tests. The Spiral 6 ms and 5 ms sequences achieved a scan time reduction of 75.3% and 69.9% respectively compared to the fully sampled cartesian sequence. The spiral sequences (generally) exhibited improved subjective vessel sharpness (p < 0.01-p = 0.13) but increased background noise (p = 0.03-p = 0.25). Cross-sectional area measurements were similar between all sequences (Krippendorff's alpha: 0.955-0.982). Quantitative vessel sharpness was increased for all spiral sequences compared to all cartesian sequences (p = 0.004).

CONCLUSIONS

Spiral 3D TOF MRA sequences with a spiral acquisition window of 5 ms or 6 ms may be used for accurate, rapid, clinical non-contrast carotid artery imaging.

Qualitative and Quantitative Analysis of a Spiral Gradient Echo Sequence for Contrast-Enhanced Fat-Suppressed T1-Weighted Spine Magnetic Resonance Imaging

OBJECTIVES

Pulse sequences with non-Cartesian k-space sampling enable improved imaging in anatomical areas with high degrees of motion artifacts. We analyzed a novel spiral 3-dimensional (3D) gradient echo (GRE) magnetic resonance imaging (MRI) sequence ("spiral," 114.7 ± 11 seconds) and compared it with a radial 3D GRE ("vane," 216.7 ± 2 seconds) and a conventional Cartesian 2D turbo spin echo (TSE) sequence ("TSE," 266.7 ± 82 seconds) for contrast-enhanced fat-suppressed T1-weighted spine imaging.

MATERIALS AND METHODS

Forty consecutive patients referred for contrast-enhanced MRI were prospectively scanned with all 3 sequences. A qualitative analysis was performed by 3 readers using 4- or 5-point Likert scales to independently grade images in terms of overall image quality, occurrence of artifacts, lesion conspicuity, and conspicuity of nerve roots. The numbers of visible nerve roots per sequence and patient were counted in consensus. Coefficient of variation measurements were performed for the paravertebral musculature (CVPM) and the spinal cord (CVSC).

RESULTS

Spiral (median [interquartile range], 5 [4-5]) exhibited improved overall image quality in comparison to TSE (3 [3-4]) and vane (4 [4-5]; both P < 0.001). Vane surpassed TSE in terms of overall image quality (P < 0.001). Spiral (4 [3.75-4]) and vane (3.5 [3-4]) presented with less artifacts than TSE (3 [2.75-3.25]; both P < 0.001). Spiral (4 [4-5]) outperformed vane (4 [3-5]; P = 0.01) and TSE (4 [3-4]; P = 0.04) in terms of lesion conspicuity. Conspicuity of nerve roots was superior on spiral (3 [3-4]) and vane (4 [3-4]) when compared with TSE (1.5 [1-2]; both P < 0.001). Readers discerned significantly more nerve roots on spiral (4 [2.75-8]) and vane (4 [3.75-7.25]) images when compared with TSE (2 [0-4]; both P < 0.001). Interreader agreement ranged from moderate (α = 0.639) to almost perfect (α = 0.967). CVPM and CVSC were significantly lower on spiral as compared with vane and TSE (P < 0.001, P = 0.04). Vane exhibited lower CVPM and CVSC than TSE (P < 0.001, P = 0.01).

CONCLUSIONS

A novel spiral 3D GRE sequence improves contrast-enhanced fat-suppressed T1-weighted spinal imaging qualitatively and quantitatively in comparison with a conventional Cartesian 2D TSE sequence and to a lesser extent with a radial 3D GRE sequence at shorter scan times.

Diffusion-weighted MRI of ischemic stroke at 3T: Value of synthetic b-values

OBJECTIVES

Diffusion-weighted imaging (DWI) plays a crucial role in the diagnosis of ischemic stroke. We assessed the value of computed and acquired high b-value DWI in comparison with conventional b = 1000 s mm^-2 DWI for ischemic stroke at 3T.

METHODS

We included 36 patients with acute ischemic stroke who presented with diffusion abnormalities on DWI performed within 24 h of symptom onset. B-values of 0, 500, 1000 and 2000 s mm^-2 were acquired. Synthetic images with b-values of 1000, 1500, 2000 and 2500 s mm^-2 were computed. Two readers compared synthetic (syn) and acquired (acq) b = 2000 s mm^-2 images with acquired b = 1000 s mm^-2 images in terms of lesion detection rate, image quality, presence of uncertain hyperintensities and lesion conspicuity. Readers also selected their preferred b-value. Contrast ratio (CR) measurements were performed. Non-parametrical statistical tests and weighted Cohens' κ tests were computed.

RESULTS

Syn1000 and syn1500 matched acq1000 images in terms of lesion detection rate, image quality and presence of uncertain hyperintensities but presented with significantly improved lesion conspicuity (p < 0.01) and were frequently selected as preferred b-values. Acq2000 images exhibited a similar lesion detection rate and improved lesion conspicuity (p < 0.01) but worse image quality (p < 0.01) than acq1000 images. Syn2000 and syn2500 images performed significantly worse (p < 0.01) than acq1000 images in most or all categories. CR significantly increased with increasing b-values.

CONCLUSION

Synthetic images at b = 1000 and 1500 s mm^-2 and acquired DWI images at b = 2000 s mm^-2 may be of clinical value due to improved lesion conspicuity.

ADVANCES IN KNOWLEDGE

Synthetic b-values enable improved lesion conspicuity for DWI of ischemic stroke.

Amide proton transfer weighted (APTw) imaging based radiomics allows for the differentiation of gliomas from metastases

We sought to evaluate the utility of radiomics for Amide Proton Transfer weighted (APTw) imaging by assessing its value in differentiating brain metastases from high- and low grade glial brain tumors. We retrospectively identified 48 treatment-naïve patients (10 WHO grade 2, 1 WHO grade 3, 10 WHO grade 4 primary glial brain tumors and 27 metastases) with either primary glial brain tumors or metastases who had undergone APTw MR imaging. After image analysis with radiomics feature extraction and post-processing, machine learning algorithms (multilayer perceptron machine learning algorithm; random forest classifier) with stratified tenfold cross validation were trained on features and were used to differentiate the brain neoplasms. The multilayer perceptron achieved an AUC of 0.836 (receiver operating characteristic curve) in differentiating primary glial brain tumors from metastases. The random forest classifier achieved an AUC of 0.868 in differentiating WHO grade 4 from WHO grade 2/3 primary glial brain tumors. For the differentiation of WHO grade 4 tumors from grade 2/3 tumors and metastases an average AUC of 0.797 was achieved. Our results indicate that the use of radiomics for APTw imaging is feasible and the differentiation of primary glial brain tumors from metastases is achievable with a high degree of accuracy.

Clinical feasibility of ultrafast intracranial vessel imaging with non-Cartesian spiral 3D time-of-flight MR angiography at 1.5T: An intra-individual comparison study

Objectives

Non-Cartesian Spiral readout can be implemented in 3D Time-of-flight (TOF) MR angiography (MRA) with short acquisition times. In this intra-individual comparison study we evaluated the clinical feasibility of Spiral TOF MRA in comparison with compressed sensing accelerated TOF MRA at 1.5T for intracranial vessel imaging as it has yet to be determined.

Materials and methods

Forty-four consecutive patients with suspected intracranial vascular disease were imaged with two Spiral 3D TOFs (Spiral, 0.82x0.82x1.2 mm³, 01:32 min; Spiral 0.8, 0.8x0.8x0.8 mm^3, 02:12 min) and a Compressed SENSE accelerated 3D TOF (CS 3.5, 0.82x0.82x1.2 mm³, 03:06 min) at 1.5T. Two neuroradiologists assessed qualitative (visualization of central and peripheral vessels) and quantitative image quality (Contrast Ratio, CR) and performed lesion and variation assessment for all three TOFs in each patient. After the rating process, the readers were questioned and representative cases were reinspected in a non-blinded fashion. For statistical analysis, the Friedman and Nemenyi post-hoc test, Kendall W tests, repeated measure ANOVA and weighted Cohen's Kappa tests were used.

Results

The Spiral and Spiral 0.8 outperformed the CS 3.5 in terms of peripheral image quality (p<0.001) and performed equally well in terms of central image quality (p>0.05). The readers noted slight differences in the appearance of maximum intensity projection images. A good to high degree of interstudy agreement between the three TOFs was observed for lesion and variation assessment (W = 0.638, p<0.001 –W = 1, p<0.001). CR values did not differ significantly between the three TOFs (p = 0.534). Interreader agreement ranged from good (K = 0.638) to excellent (K = 1).

Conclusions

Compared to the CS 3.5, both the Spiral and Spiral 0.8 exhibited comparable or better image quality and comparable diagnostic performance at much shorter acquisition times.

Amide Proton Transfer Weighted Imaging Shows Differences in Multiple Sclerosis Lesions and White Matter Hyperintensities of Presumed Vascular Origin

Objectives: To assess the ability of 3D amide proton transfer weighted (APTw) imaging based on magnetization transfer analysis to discriminate between multiple sclerosis lesions (MSL) and white matter hyperintensities of presumed vascular origin (WMH) and to compare APTw signal intensity of healthy white matter (healthy WM) with APTw signal intensity of MSL and WHM. Materials and Methods: A total of 27 patients (16 female, 11 males, mean age 39.6 years) with multiple sclerosis, 35 patients (17 females, 18 males, mean age 66.6 years) with small vessel disease (SVD) and 20 healthy young volunteers (9 females, 11 males, mean age 29 years) were included in the MSL, the WMH, and the healthy WM group. MSL and WMH were segmented on fluid attenuated inversion recovery (FLAIR) images underlaid onto APTw images. Histogram parameters (mean, median, 10th, 25th, 75th, 90th percentile) were calculated. Mean APTw signal intensity values in healthy WM were defined by "Region of interest" (ROI) measurements. Wilcoxon rank sum tests and receiver operating characteristics (ROC) curve analyses of clustered data were applied. Results: All histogram parameters except the 75 and 90th percentile were significantly different between MSL and WMH (p = 0.018-p = 0.034). MSL presented with higher median values in all parameters. The histogram parameters offered only low diagnostic performance in discriminating between MSL and WMH. The 10th percentile yielded the highest diagnostic performance with an AUC of 0.6245 (95% CI: [0.532, 0.717]). Mean APTw signal intensity values of MSL were significantly higher than mean values of healthy WM (p = 0.005). The mean values of WMH did not differ significantly from the values of healthy WM (p = 0.345). Conclusions: We found significant differences in APTw signal intensity, based on straightforward magnetization transfer analysis, between MSL and WMH and between MSL and healthy WM. Low AUC values from ROC analyses, however, suggest that it may be challenging to determine type of lesion with APTw imaging. More advanced analysis of the APT CEST signal may be helpful for further differentiation of MSL and WMH.

Compressed SENSE accelerated 3D T1w black blood turbo spin echo versus 2D T1w turbo spin echo sequence in pituitary magnetic resonance imaging

PURPOSE

To compare image quality between a 2D T1w turbo spin echo (TSE) sequence and a Compressed SENSE accelerated 3D T1w black blood TSE sequence (equipped with a black blood prepulse for blood signal suppression) in pre- and postcontrast imaging of the pituitary and to assess scan time reductions.

METHODS AND MATERIALS

For this retrospective study, 56 patients underwent pituitary MR imaging at 3T. 28 patients were scanned with the 2D- and 28 patients with the accelerated 3D sequence. Two board certified neuroradiologists independently evaluated 13 qualitative image features (12 features on postcontrast- and 1 feature on precontrast images).SNR and CNR measurements were obtained. Interreader agreement was assessed with the intraclass correlation coefficient while differences in scores were assessed with exact Wilcoxon rank sum tests.

RESULTS

The interreader agreement ranged from fair (visibility of the ophthalmic nerve, ICC = 0.57) to excellent (presence and severity of pulsation artefacts, ICC = 0.97). The Compressed SENSE accelerated 3D sequence outperformed the 2D sequence in terms of "overall image quality" (median: 4 versus 3, p = 0.04) and "presence and severity of pulsation artefacts" (median: 0 versus 1, p < 0.001). There were no significant differences in any other qualitative and quantitative (SNR, CNR) image quality features. Scan time was reduced by 03:53 min (33.1%) by replacing the 2D with the 3D sequence.

CONCLUSION

The Compressed SENSE accelerated 3D T1w black blood TSE sequence is a reliable alternative for the standard 2D sequence in pituitary imaging. The black blood prepulse may aid in suppression of pulsation artefacts.

Reduction of procedure times in routine clinical practice with Compressed SENSE magnetic resonance imaging technique

Objectives

Acceleration of MR sequences beyond current parallel imaging techniques is possible with the Compressed SENSE technique that has recently become available for 1.5 and 3 Tesla scanners, for nearly all image contrasts and for 2D and 3D sequences. The impact of this technique on examination timing parameters and MR protocols in a clinical setting was investigated in this retrospective study.

Material and methods

A numerical analysis of the examination timing parameters (scan time, exam time, procedure time, interscan delay time, changeover time, nonscan time) based on the MR protocols of 6 different body regions (brain, knee, lumbar spine, breast, shoulder) using MR log files was performed and the total number of examinations acquired from January to April both in 2017 and 2018 on a 1.5 T MR scanner was registered. Percentages, box plots and unpaired two-sided t tests were obtained for statistical evaluation.

Results

All examination timing parameters of the six anatomical regions analysed were significantly shortened after implementation of Compressed SENSE. On average, scan times were accelerated by 20.2% (p<0.0001) while procedure times were shortened by 16% (p<0.0001). Considering all anatomical regions and all MR protocols, 27% more examinations were performed over the same 4 month period in 2018 compared to 2017.

Conclusion

Compressed SENSE allows for a significant acceleration of MR examinations and a considerable increase in the total number of MR examinations is possible.