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Background: Paired cerebral blood flow (CBF) measurement is usually acquired before and after vasoactive stimulus to estimate cerebrovascular reserve (CVR). However, CVR may be confounded because of variations in time-to-maximum CBF response (t_max) following acetazolamide injection. With a mathematical model, CVR can be calculated insensitive to variations in t_max, and a model offers the possibility to calculate additional model-derived parameters. A model that describes the temporal CBF response following a vasodilating acetazolamide injection is proposed and evaluated.

Methods: A bi-exponential model was adopted and fitted to four CBF measurements acquired using arterial spin labelling before and initialised at 5, 15 and 25 min after acetazolamide injection in a total of fifteen patients with Moyamoya disease. Curve fitting was performed using a non-linear least squares method with a priori constraints based on simulations.

Results: Goodness of fit (mean absolute error) varied between 0.30 and 0.62 ml·100 g^-1·min^-1. Model-derived CVR was significantly higher compared to static CVR measures. Maximum CBF increase occurred earlier in healthy- compared to diseased vascular regions.

Conclusions: The proposed mathematical model offers the possibility to calculate CVR insensitive to variations in time to maximum CBF response which gives a more detailed characterisation of CVR compared to static CVR measures. Although the mathematical model adapts generally well to this dataset of patients with MMD it should be considered as experimental; hence, further studies in healthy populations and other patient cohorts are warranted.

Background

Phase-contrast magnetic resonance imaging (PC-MRI) quantifies blood flow and velocity noninvasively. Challenges arise in neurovascular disorders due to small vessels. We evaluated the impact of voxel size, number of signal averages (NSA), and velocity encoding (VENC) on PC-MRI measurement accuracy and precision in a small-lumen vessel phantom.

Methods

We constructed an in vitro model with a constant flow rate using a 2.2-mm inner diameter plastic tube. A reservoir with a weight scale and timer was used as standard reference. Gradient-echo T1 weighted PC-MRI sequence was performed on a 3-T scanner with varying voxel size (2.5, 5.0, 7.5 mm³), NSA (1, 2, 3), and VENC (200, 300, 400 cm/s). We repeated measurements nine times per setting, calculating mean flow rate, maximum velocity, and least detectable difference (LDD).

Results

PC-MRI flow measurements were higher than standard reference values (mean ranging from 7.3 to 9.5 mL/s compared with 6.6 mL/s). Decreased voxel size improved accuracy, reducing flow rate measurements from 9.5 to 7.3 mL/s. The LDD for flow rate and velocity varied between 1 and 5%. The LDD for flow rate decreased with increased voxel size and NSA (p = 0.033 and 0.042). The LDD for velocity decreased with increased voxel size (p < 10^-16). No change was observed when VENC varied.

Conclusions

PC-MRI overestimated flow. However, it has high precision in a small-vessel phantom with constant flow rate. Improved accuracy was obtained with increasing spatial resolution (smaller voxels). Improved precision was obtained with increasing signal-to-noise ratio (larger voxels and/or higher NSA).

Relevance statement

Phase-contrast MRI is clinically used in large vessels. To further investigate the possibility of using phase-contrast MRI for smaller intracranial vessels in neurovascular disorders, we need to understand how acquisition parameters affect phase-contrast MRI-measured flow rate and velocity in small vessels.

Key points

• PC-MRI measures flow and velocity in a small lumen phantom with high precision but overestimates flow rate.

• The precision of PC-MRI measurements matches the precision of standard reference for flow rate measurements.

• Optimizing PC-MRI settings can enhance accuracy and precision in flow rate and velocity measurements.

Purpose

To develop and evaluate a phase unwrapping method for cine phase contrast MRI based on graph cuts.

Methods

A proposed Iterative Graph Cuts method was evaluated in 10 cardiac patients with two-dimensional flow quantification which was repeated at low venc settings to provoke wrapping. The images were also unwrapped by a path-following method (ROMEO), and a Laplacian-based method (LP). Net flow was quantified using semi-automatic vessel segmentation. High venc images were also wrapped retrospectively to asses the residual amount of wrapped voxels.

Results

The absolute net flow error after unwrapping at venc = 100 cm/s was 1.8 mL, which was 0.83 mL smaller than for LP. The repeatability error at high venc without unwrapping was 2.5 mL. The error at venc = 50 cm/s was 7.5 mL, which was 8.2 mL smaller than for ROMEO and 5.7 mL smaller than for LP. For retrospectively wrapped images with synthetic venc of 100/50/25 cm/s, the residual amount of wrapped voxels was 0.00/0.12/0.79%, which was 0.09/0.26/8.0 percentage points smaller than for LP. With synthetic venc of 25 cm/s, omitting magnitude information resulted in 3.2 percentage points more wrapped voxels, and only spatial/temporal unwrapping resulted in 4.6/21 percentage points more wrapped voxels compared to spatiotemporal unwrapping.

Conclusion

Iterative Graph Cuts enables unwrapping of cine phase contrast MRI with very small errors, except for at extreme blood velocities, with equal or better performance compared to ROMEO and LP. The use of magnitude information and spatiotemporal unwrapping is recommended.

PURPOSE: To synchronize and pass information between a wireless motion-tracking device and a pulse sequence and show how this can be used to implement customizable navigator interleaving schemes that are part of the pulse sequence design.

METHODS: The device tracks motion by sampling the voltages induced in 3 orthogonal pickup coils by the changing gradient fields. These coils were modified to also detect RF-transmit events using a 3D RF-detection circuit. The device could then detect and decode a set RF signatures while ignoring excitations in the parent pulse sequence. A set of unique RF signatures were then paired with a collection of navigators and used to trigger readouts on the wireless device synchronous to the pulse sequence execution. Navigator interleaving schemes were then demonstrated in 3D RF-spoiled gradient echo, T₁ -FLAIR (fluid-attenuated inversion recovery) PROPELLER (periodically rotated overlapping parallel lines with enhanced reconstruction), and T₂ -FLAIR PROPELLER pulse sequences.

RESULTS: Excitations in the parent pulse sequences were successfully rejected and the RF signatures successfully decoded. For the 3D gradient echo sequence, distortions were removed by interleaving flipped polarity navigators and taking the difference between consecutive readouts. The impact on scan duration was reduced by 54% by breaking up the navigators into smaller parts. Successful motion correction was performed using the PROPELLER pulse sequences in 3 Tesla and 1.5 Tesla MRI scanners without modifications to the device hardware or software.

CONCLUSION: The proposed RF signature-based triggering scheme enables complex interactions between the pulse sequence and a wireless device. Thus, enabling prospective motion correction that is repeatable, versatile, and minimally invasive with respect to hardware setup.

PURPOSE: Implement a fast, motion-robust pulse sequence that acquires T₁ -weighted, T₂ -weighted, T₂ ^* -weighted, T₂ fluid-attenuated inversion recovery, and DWI data in one run with only one prescription and one prescan.

METHODS: A software framework was developed that configures and runs several sequences in one main sequence. Based on that framework, the NeuroMix sequence was implemented, containing motion robust single-shot sequences using EPI and fast spin echo (FSE) readouts (without EPI distortions). Optional multi-shot sequences that provide better contrast, higher resolution, or isotropic resolution could also be run within the NeuroMix sequence. An optimized acquisition order was implemented that minimizes times where no data is acquired.

RESULTS: NeuroMix is customizable and takes between 1:20 and 4 min for a full brain scan. A comparison with the predecessor EPIMix revealed significant improvements for T₂ -weighted and T₂ fluid-attenuated inversion recovery, while taking only 8 s longer for a similar configuration. The optional contrasts were less motion robust but offered a significant increase in quality, detail, and contrast. Initial clinical scans on 1 pediatric and 1 adult patient showed encouraging image quality.

CONCLUSION: The single-shot FSE readouts for T₂ -weighted and T₂ fluid-attenuated inversion recovery and the optional multishot FSE and 3D-EPI contrasts significantly increased diagnostic value compared with EPIMix, allowing NeuroMix to be considered as a standalone brain MRI application.

PURPOSE: To describe a new method for encoding chemical shift using asymmetric readout waveforms that enables more SNR-efficient fat/water imaging.

METHODS: Chemical shift was encoded using asymmetric readout waveforms, rather than conventional shifted trapezoid readouts. Two asymmetric waveforms are described: a triangle and a spline. The concept was applied to a fat/water separated RARE sequence to increase sampling efficiency. The benefits were investigated through comparisons to shifted trapezoid readouts. Using asymmetric readout waveforms, the scan time was either shortened or maintained to increase SNR. A matched in-phase waveform is also described that aims to improve the SNR transfer function of the fat and water estimates. The sequence was demonstrated for cervical spine, musculoskeletal (MSK), and optic nerve applications at 3T and compared with conventional shifted readouts.

RESULTS: blurring. Maintaining the scan times and using asymmetric readout waveforms achieved an SNR improvement in agreement with the prolonged sampling duration.

CONCLUSIONS: Asymmetric readout waveforms offer an additional degree of freedom in pulse sequence designs where chemical shift encoding is desired. This can be used to significantly shorten scan times or to increase SNR with maintained scan time.

PURPOSE: To enable SWI that is robust to severe head movement.

METHODS: Prospective motion correction using a markerless optical tracker was applied to all pulse sequences. Three-dimensional gradient-echo and 3D EPI were used as reference sequences, but were expected to be sensitive to motion-induced B₀ changes, as the long TE required for SWI allows phase discrepancies to accumulate between shots. Therefore, 2D interleaved snapshot EPI was investigated for motion-robust SWI and compared with conventional 2D EPI. Repeated signal averages were retrospectively corrected for motion. The sequences were evaluated at 3 T through controlled motion experiments involving two cooperative volunteers and SWI of a tumor patient.

RESULTS: The performed continuous head motion was in the range of 5-8° rotations. The image quality of the 3D sequences and conventional 2D EPI was poor unless the rotational motion axis was parallel to B₀ . Interleaved snapshot EPI had minimal intraslice phase discrepancies due to its small temporal footprint. Phase inconsistency between signal averages was well tolerated due to the high-pass filter effect of the SWI processing. Interleaved snapshot EPI with prospective and retrospective motion correction demonstrated similar image quality, regardless of whether motion was present. Lesion depiction was equal to 3D EPI with matching resolution.

CONCLUSION: Susceptibility-based imaging can be severely corrupted by head movement despite accurate prospective motion correction. Interleaved snapshot EPI is a superior alternative for patients who are prone to move and offers SWI which is insensitive to motion when combined with prospective and retrospective motion correction.

PURPOSE: To enable motion-robust diffusion weighted imaging of the brain using well-established imaging techniques.

METHODS: An optical markerless tracking system was used to estimate and correct for rigid body motion of the head in real time during scanning. The imaging coordinate system was updated before each excitation pulse in a single-shot EPI sequence accelerated by GRAPPA with motion-robust calibration. Full Fourier imaging was used to reduce effects of motion during diffusion encoding. Subjects were imaged while performing prescribed motion patterns, each repeated with prospective motion correction on and off.

RESULTS: Prospective motion correction with dynamic ghost correction enabled high quality DWI in the presence of fast and continuous motion within a 10° range. Images acquired without motion were not degraded by the prospective correction. Calculated diffusion tensors tolerated the motion well, but ADC values were slightly increased.

CONCLUSIONS: Prospective correction by markerless optical tracking minimizes patient interaction and appears to be well suited for EPI-based DWI of patient groups unable to remain still including those who are not compliant with markers.

PURPOSE: The purpose of this work is to describe a T₁ -weighted fluid-attenuated inversion recovery (FLAIR) sequence that is able to produce sharp magnetic resonance images even if the subject is moving their head throughout the acquisition.

METHODS: The robustness to motion artifacts and retrospective motion correction capabilities of the PROPELLER (periodically rotated overlapping parallel lines with enhanced reconstruction) trajectory were combined with prospective motion correction. The prospective correction was done using an intelligent marker attached to the subject. This marker wirelessly synchronizes to the pulse sequence to measure the directionality and magnitude of the magnetic fields present in the MRI machine during a short navigator, thus enabling it to determine its position and orientation in the scanner coordinate frame. Three approaches to incorporating the marker-navigator into the PROPELLER sequence were evaluated. The specific absorption rate, and subsequent scan time, of the T₁ -weighted FLAIR PROPELLER sequence, was reduced using a variable refocusing flip-angle scheme. Evaluations of motion correction performance were done with 4 volunteers and 3 types of head motion.

RESULTS: During minimal out-of-plane movement, retrospective PROPELLER correction performed similarly to the prospective correction. However, the prospective clearly outperformed the retrospective correction when there was out-of-plane motion. Finally, the combination of retrospective and prospective correction produced the sharpest images even during large continuous motion.

CONCLUSION: Prospective motion correction of a PROPELLER sequence makes it possible to handle continuous, large, and high-speed head motions with only minor reductions in image quality.

PURPOSE: To develop reconstruction methods for improved image quality of chemical shift displacement-corrected fat/water imaging combined with partial Fourier acquisition.

THEORY: Fat/water separation in k-space enables correction of chemical shift displacement. Modeling fat and water as real-valued rather than complex improves the conditionality of the inverse problem. This advantage becomes essential for k-space separation. In this work, it was described how to perform regularized fat/water imaging with real estimates in k-space, and how fat/water imaging can be combined with partial Fourier reconstruction using Projection Onto Convex Sets (POCS).

METHODS: The reconstruction methods were demonstrated on chemical shift encoded gradient echo and fast spin echo data from volunteers, acquired at 1.5 T and 3 T. Both fully sampled and partial Fourier acquisitions were made. Data was retrospectively rejected from the fully sampled dataset to evaluate POCS and homodyne reconstruction.

RESULTS: Fat/water separation in k-space eliminated chemical shift displacement, while real-valued estimates considerably reduced the noise amplification compared to complex estimates. POCS reconstruction could recover high spatial frequency information in the fat and water images with lower reconstruction error than homodyne. Partial Fourier in the readout direction enabled more flexible choice of gradient echo imaging parameters, in particular image resolution.

CONCLUSION: Chemical shift displacement-corrected fat/water imaging can be performed with regularization and real-valued estimates to improve image quality by reducing ill-conditioning of the inverse problem in k-space. Fat/water imaging can be combined with POCS, which offers improved image quality over homodyne reconstruction.