Sven Zuehlsdorff

Assessment of Chronic Hepatitis and Fibrosis: Comparison of MR Elastography and Diffusion-Weighted Imaging

OBJECTIVE The purpose of our study was to compare the utility of MR elastography (MRE) and diffusion-weighted imaging (DWI) in characterizing fibrosis and chronic hepatitis in patients with chronic liver diseases. SUBJECTS AND METHODS Seventy-six patients with chronic liver disease underwent abdominal MRI, MRE, and DWI. Severities of liver fibrosis and chronic hepatitis were graded by histopathologic analysis according to standard disease-specific classifications. The overall predictive ability of MRE and DWI in assessment of fibrosis was compared by constructing a receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC) on the basis of histopathologic analysis. RESULTS Using ROC analysis, MRE showed greater capability than DWI in discriminating stage 2 or greater (≥ F2), stage 3 or greater (≥ F3), and cirrhosis (≥ F4), shown as significant differences in AUC (p = 0.003, p = 0.001, and p = 0.001, respectively). Higher sensitivity and specificity were shown by MRE in predicting fibrosis scores ≥ F2 (91% and 97%), scores ≥ F3 (92% and 95%), and scores F4 (95% and 87%) compared with DWI (84% and 82%, 88% and 76%, and 85% and 68%, respectively). Although MRE had higher ability in identification of liver with fibrosis scores ≥ F1 than DWI, a significant difference was not seen (p = 0.398). Stiffness values on MRE increased in relation to increasing severity of fibrosis confirmed by histopathology scores; however, a consistent relationship between apparent diffusion coefficient (ADC) values and stage of fibrosis was not shown. In addition, liver tissue with chronic hepatitis preceding fibrosis may account for mild elevation of liver stiffness. CONCLUSION MRE had greater predictive ability in distinguishing the stages of liver fibrosis than DWI.

Motion correction for myocardial T1 mapping using image registration with synthetic image estimation

Quantification of myocardial T1 relaxation has potential value in the diagnosis of both ischemic and nonischemic cardiomyopathies. Image acquisition using the modified Look‐Locker inversion recovery technique is clinically feasible for T1 mapping. However, respiratory motion limits its applicability and degrades the accuracy of T1 estimation. The robust registration of acquired inversion recovery images is particularly challenging due to the large changes in image contrast, especially for those images acquired near the signal null point of the inversion recovery and other inversion times for which there is little tissue contrast. In this article, we propose a novel motion correction algorithm. This approach is based on estimating synthetic images presenting contrast changes similar to the acquired images. The estimation of synthetic images is formulated as a variational energy minimization problem. Validation on a consecutive patient data cohort shows that this strategy can perform robust nonrigid registration to align inversion recovery images experiencing significant motion and lead to suppression of motion induced artifacts in the T1 map. Magn Reson Med, 2011.

Bright-Blood T2-Weighted MRI Has Higher Diagnostic Accuracy Than Dark-Blood Short Tau Inversion Recovery MRI for Detection of Acute Myocardial Infarction and for Assessment of the Ischemic Area at Risk and Myocardial Salvage

Background— T2-Weighted MRI reveals myocardial edema and enables estimation of the ischemic area at risk and myocardial salvage in patients with acute myocardial infarction (MI). We compared the diagnostic accuracy of a new bright-blood T2-weighted with a standard black blood T2-weighted MRI in patients with acute MI. Methods and Results— A breath-hold, bright-blood T2-weighted, Acquisition for Cardiac Unified T2 Edema pulse sequence with normalization for coil sensitivity and a breath-hold T2 dark-blood short tau inversion recovery sequence were used to depict the area at risk in 54 consecutive acute MI patients. Infarct size was measured on gadolinium late contrast enhancement images. Compared with dark-blood T2-weighted MRI, consensus agreements between independent observers for identification of myocardial edema were higher with bright-blood T2-weighted MRI when evaluated per patient (P<0.001) and per segment of left ventricle (P<0.001). Compared with bright-blood T2-weighted MRI, dark-blood T2-weighted MRI underestimated the area at risk compared with infarct size (P<0.001). The 95% limits of agreement for interobserver agreements for the ischemic area at risk and myocardial salvage were wider with dark-blood T2-weighted MRI than with bright-blood T2-weighted MRI. Bright blood enabled more accurate identification of the culprit coronary artery with correct identification in 94% of cases compared with 61% for dark blood (P<0.001). Conclusions— Bright-blood T2-weighted MRI has higher diagnostic accuracy than dark-blood T2-weighted MRI. Additionally, dark-blood T2-weighted MRI may underestimate area at risk and myocardial salvage.

Bright Blood T2 Weighted MRI Has Higher Diagnostic Accuracy Than Dark Blood STIR MRI for Detection of Acute Myocardial Infarction and for Assessment of the Ischemic Area-at-Risk and Myocardial Salvage

Background— T2-Weighted MRI reveals myocardial edema and enables estimation of the ischemic area at risk and myocardial salvage in patients with acute myocardial infarction (MI). We compared the diagnostic accuracy of a new bright-blood T2-weighted with a standard black blood T2-weighted MRI in patients with acute MI. Methods and Results— A breath-hold, bright-blood T2-weighted, Acquisition for Cardiac Unified T2 Edema pulse sequence with normalization for coil sensitivity and a breath-hold T2 dark-blood short tau inversion recovery sequence were used to depict the area at risk in 54 consecutive acute MI patients. Infarct size was measured on gadolinium late contrast enhancement images. Compared with dark-blood T2-weighted MRI, consensus agreements between independent observers for identification of myocardial edema were higher with bright-blood T2-weighted MRI when evaluated per patient (P<0.001) and per segment of left ventricle (P<0.001). Compared with bright-blood T2-weighted MRI, dark-blood T2-weighted MRI underestimated the area at risk compared with infarct size (P<0.001). The 95% limits of agreement for interobserver agreements for the ischemic area at risk and myocardial salvage were wider with dark-blood T2-weighted MRI than with bright-blood T2-weighted MRI. Bright blood enabled more accurate identification of the culprit coronary artery with correct identification in 94% of cases compared with 61% for dark blood (P<0.001). Conclusions— Bright-blood T2-weighted MRI has higher diagnostic accuracy than dark-blood T2-weighted MRI. Additionally, dark-blood T2-weighted MRI may underestimate area at risk and myocardial salvage.

Multiecho dixon fat and water separation method for detecting fibrofatty infiltration in the myocardium

Conventional approaches for fat and water discrimination based on chemical‐shift fat suppression have reduced ability to characterize fatty infiltration due to poor contrast of microscopic fat. The multiecho Dixon approach to water and fat separation has advantages over chemical‐shift fat suppression: 1) water and fat images can be acquired in a single breathhold, avoiding misregistration; 2) fat has positive contrast; 3) the method is compatible with precontrast and late‐enhancement imaging, 4) less susceptible to partial‐volume effects, and 5) robust in the presence of background field variation; and 6) for the bandwidth implemented, chemical‐shift artifact is decreased. The proposed technique was applied successfully in all 28 patients studied. This included 10 studies with indication of coronary artery disease (CAD), of which four cases with chronic myocardial infarction (MI) exhibited fatty infiltration; 13 studies to rule out arrhythmogenic right ventricular cardiomyopathy (ARVC), of which there were three cases with fibrofatty infiltration and two confirmed with ARVC; and five cases of cardiac masses (two lipomas). The precontrast contrast‐to‐noise ratio (CNR) of intramyocardial fat was greatly improved, by 240% relative to conventional fat suppression. For the parameters implemented, the signal‐to‐noise ratio (SNR) was decreased by 30% relative to conventional late enhancement. The multiecho Dixon method for fat and water separation provides a sensitive means of detecting intramyocardial fat with positive signal contrast. Magn Reson Med 61:215–221, 2009.

Carotid arterial wall MRI at 3T using 3D variable-flip-angle turbo spin-echo (TSE) with flow-sensitive dephasing (FSD)

To evaluate the effectiveness of flow‐sensitive dephasing (FSD) magnetization preparation in improving blood signal suppression of three‐dimensional (3D) turbo spin‐echo (TSE) sequence (SPACE) for isotropic high‐spatial‐resolution carotid arterial wall imaging at 3T.

3D Radial Sampling and 3D Affine Transform-based Respiratory Motion Correction Technique for Free-breathing Whole-Heart Coronary MRA with 100% Imaging Efficiency

The navigator gating and slice tracking approach currently used for respiratory motion compensation during free‐breathing coronary magnetic resonance angiography (MRA) has low imaging efficiency (typically 30–50%), resulting in long imaging times. In this work, a novel respiratory motion correction technique with 100% scan efficiency was developed for free‐breathing whole‐heart coronary MRA. The navigator signal was used as a reference respiratory signal to segment the data into six bins. 3D projection reconstruction k‐space sampling was used for data acquisition and enabled reconstruction of low resolution images within each respiratory bin. The motion between bins was estimated by image registration with a 3D affine transform. The data from the different respiratory bins was retrospectively combined after motion correction to produce the final image. The proposed method was compared with a traditional navigator gating approach in nine healthy subjects. The proposed technique acquired whole‐heart coronary MRA with 1.0 mm3 isotropic spatial resolution in a scan time of 6.8 ± 0.9 min, compared with 16.2 ± 2.8 min for the navigator gating approach. The image quality scores, and length, diameter and sharpness of the right coronary artery (RCA), left anterior descending coronary artery (LAD), and left circumflex coronary artery (LCX) were similar for both approaches (P > 0.05 for all), but the proposed technique reduced scan time by a factor of 2.5. Magn Reson Med, 2011.

4D radial acquisition contrast-enhanced MR angiography and intracranial arteriovenous malformations: quickly approaching digital subtraction angiography.

Background and Purpose— The current gold standard for imaging intracranial AVMs involves catheter-based techniques, namely cerebral digital subtraction angiography (DSA). However, DSA presents some procedural risks to the patient. Unfortunately, AVM patients usually undergo multiple DSA exams throughout their diagnostic and therapeutic course, significantly increasing their procedural risk exposure. As such, high-quality noninvasive imaging is desired. We hypothesize that 4D radial acquisition contrast-enhanced MRA approximates the vascular architecture and hemodynamics of AVMs compared to conventional angiography. Methods— Thirteen consecutive AVM patients were assessed by 4D radial acquisition contrast-enhanced MRA and DSA. The 4D rCE-MRA images were independently assessed regarding the location, nidal size, Spetzler–Martin grade, and identification of arterial feeders, drainage pattern, and any other vascular anomalies. Results— 4D rCE-MRA correctly depicted the size, venous drainage pattern, and prominent arterial feeders in all cases. Spetzler–Martin grade was correctly determined between reviewers and between the different imaging modalities in all cases except 1. The nidus size was in good correlation between the reviewers, where r=0.99, P<0.000001. There was very good agreement between reviewers regarding the individual scans (&kgr;=0.63 to 1), whereas the agreement between the DSA and 4D rCE-MRA images was also good (&kgr;=0.61 to 0.85). Conclusions— We have developed a 4D radial acquisition contrast-enhanced MRA sequence capable of imaging intracranial AVMs approximating that of DSA. Image analysis demonstrates equivalency in terms of grading AVMs using the Spetzler–Martin grading scale. This 4D rCE-MRA sequence has the potential to avoid some applications of DSA, thus saving patients from potential procedural risks.

Phase-Sensitive Inversion Recovery for Myocardial T1 Mapping with Motion Correction and Parametric Fitting

The assessment of myocardial fibrosis and extracellular volume requires accurate estimation of myocardial T1s. While image acquisition using the modified Look‐Locker inversion recovery technique is clinically feasible for myocardial T1 mapping, respiratory motion can limit its applicability. Moreover, the conventional T1 fitting approach using the magnitude inversion recovery images can lead to less stable T1 estimates and increased computational cost. In this article, we propose a novel T1 mapping scheme that is based on phase‐sensitive image reconstruction and the restoration of polarity of the MR signal after inversion. The motion correction is achieved by registering the reconstructed images after background phase removal. The restored signal polarity of the inversion recovery signal helps the T1 fitting resulting in improved quality of the T1 map and reducing the computational cost. Quantitative validation on a data cohort of 45 patients proves the robustness of the proposed method against varying image contrast. Compared to the magnitude T1 fitting, the proposed phase‐sensitive method leads to less fluctuation in T1 estimates. Magn Reson Med, 2013.

Active catheter tracking using parallel MRI and real-time image reconstruction.

In this work active MR catheter tracking with automatic slice alignment was combined with an autocalibrated parallel imaging technique. Using an optimized generalized autocalibrating partially parallel acquisitions (GRAPPA) algorithm with an acceleration factor of 2, we were able to reduce the acquisition time per image by 34%. To accelerate real‐time GRAPPA image reconstruction, the coil sensitivities were updated only after slice reorientation. For a 2D trueFISP acquisition (160 × 256 matrix, 80% phase matrix, half Fourier acquisition, TR = 3.7 ms, GRAPPA factor = 2) real‐time image reconstruction was achieved with up to six imaging coils. In a single animal experiment the method was used to steer a catheter from the vena cava through the beating heart into the pulmonary vasculature at an image update rate of about five images per second. Under all slice orientations, parallel image reconstruction was accomplished with only minor image artifacts, and the increased temporal resolution provided a sharp delineation of intracardial structures, such as the papillary muscle. Magn Reson Med, 2006.