Huston, John

BackgroundCarotid plaque imaging with MRI is becoming more commonplace, but practical challenges exist in performing plaque imaging with surface coils.PurposeTo compare the diagnostic performance of a carotid plaque MRI protocol using a standard neurovascular coil (Neurovascular Coil Protocol) to a higher‐resolution carotid plaque MRI using carotid surface coils (Surface Coil Protocol) in characterizing carotid plaque.Study TypeProspective study comparing two MR techniques in plaque characterization.PopulationThirty‐eight consecutive carotid artery disease patients.Field Strength/SequencePatients underwent 3T MRI using 1) a Neurovascular Coil Protocol including the following sequences: 3D‐FSE T1 pre/postcontrast and precontrast 3D IR‐FSPGR, and 2) a Surface Coil Protocol using standard multicontrast MRI sequences.AssessmentPlaque characteristics analyzed by two independent neuroradiologists included intraplaque hemorrhage (IPH), lipid‐rich necrotic‐core (LRNC), and thin/ruptured fibrous cap (TRFC).Statistical TestsDiagnostic performance of the Neurovascular Coil Protocol was compared to the Surface Coil Protocol reference standard using receiver‐operating curves.ResultsFor IPH, sensitivity, specificity, and area under the curve (AUC) of the Neurovascular Coil Protocol were 91.1% (95% confidence interval [CI] = 78.8–97.5%), 87.0% (95% CI = 66.4–97.2%), and 0.92, respectively. For LRNC without IPH sensitivity, specificity, and AUC were 73.3% (95% CI = 44.9–92.2%), 85.7% (95% CI = 67.3–96.0%), and 0.84, respectively. For TRFC, sensitivity, specificity, and AUC were 35.3% (95% CI = 14.2–61.7%), 97.6% (95% CI = 87.4–99.9%), and 0.66 respectively. Interobserver agreement for IPH, LRNC, and TRFC using the Neurovascular Coil Protocol were k = 0.87 (95% CI = 0.75–0.99), k = 0.54 (95% CI = 0.29–0.80), and k = 0.41 (95% CI = 0.08–0.74), respectively.Data ConclusionOur Neurovascular Coil Protocol has high sensitivity, specificity, and accuracy in identifying IPH and LRNC but is limited in assessment of TRFC.Level of Evidence: 1Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2018;47:1264–1272.

PurposeTo investigate the feasibility of using artificial neural networks to estimate stiffness from MR elastography (MRE) data.MethodsArtificial neural networks were fit using model‐based training patterns to estimate stiffness from images of displacement using a patch size of ∼1 cm in each dimension. These neural network inversions (NNIs) were then evaluated in a set of simulation experiments designed to investigate the effects of wave interference and noise on NNI accuracy. NNI was also tested in vivo, comparing NNI results against currently used methods.ResultsIn 4 simulation experiments, NNI performed as well or better than direct inversion (DI) for predicting the known stiffness of the data. Summary NNI results were also shown to be significantly correlated with DI results in the liver (R2 = 0.974) and in the brain (R2 = 0.915), and also correlated with established biological effects including fibrosis stage in the liver and age in the brain. Finally, repeatability error was lower in the brain using NNI compared to DI, and voxel‐wise modeling using NNI stiffness maps detected larger effects than using DI maps with similar levels of smoothing.ConclusionArtificial neural networks represent a new approach to inversion of MRE data. Summary results from NNI and DI are highly correlated and both are capable of detecting biologically relevant signals. Preliminary evidence suggests that NNI stiffness estimates may be more resistant to noise than an algebraic DI approach. Taken together, these results merit future investigation into NNIs to improve the estimation of stiffness in small regions. Magn Reson Med 80:351–360, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

PurposeTo investigate the feasibility of substantially reducing acoustic noise while performing diffusion tensor imaging (DTI) on a compact 3T (C3T) MRI scanner equipped with a 42‐cm inner‐diameter asymmetric gradient.MethodsA‐weighted acoustic measurements were made using 10 mT/m‐amplitude sinusoidal waveforms, corresponding to echo‐planar imaging (EPI) echo spacing of 0.25 to 5.0 ms, on a conventional, whole‐body 3T MRI and on the C3T. Acoustic measurements of DTI with trapezoidal EPI waveforms were then made at peak gradient performance on the C3T (80 mT/m amplitude, 700 T/m/s slew rate) and at derated performance (33 mT/m, 10 to 50 T/m/s) for acoustic noise reduction. DTI was acquired in two different phantoms and in seven human subjects, with and without gradient‐derating corresponding to multi‐ and single‐shot acquisitions, respectively.ResultsSinusoidal waveforms on the C3T were quieter by 8.5 to 15.6 A‐weighted decibels (dBA) on average as compared to the whole‐body MRI. The derated multishot DTI acquisition noise level was only 8.7 dBA (at 13 T/m/s slew rate) above ambient, and was quieter than non‐derated, single‐shot DTI by 22.3 dBA; however, the scan time was almost quadrupled. Although derating resulted in negligible diffusivity differences in the phantoms, small biases in diffusivity measurements were observed in human subjects (apparent diffusion coefficient = +9.3 ± 8.8%, fractional anisotropy = +3.2 ± 11.2%, radial diffusivity = +9.4 ± 16.8%, parallel diffusivity = +10.3 ± 8.4%).ConclusionThe feasibility of achieving reduced acoustic noise levels with whole‐brain DTI on the C3T MRI was demonstrated. Magn Reson Med 79:2902–2911, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

PurposeTo develop a fully automated trajectory and gradient waveform design for the non‐Cartesian shells acquisition, and to develop a magnetization‐prepared (MP) shells acquisition to achieve an efficient three‐dimensional acquisition with improved gray‐to‐white brain matter contrast.MethodsAfter reviewing the shells k‐space trajectory, a novel, fully automated trajectory design is developed that allows for gradient waveforms to be automatically generated for specified acquisition parameters. Designs for two types of shells are introduced, including fully sampled and undersampled/accelerated shells. Using those designs, an MP‐Shells acquisition is developed by adjusting the acquisition order of shells interleaves to synchronize the center of k‐space sampling with the peak of desired gray‐to‐white matter contrast. The feasibility of the proposed design and MP‐Shells is demonstrated using simulation, phantom, and volunteer subject experiments, and the performance of MP‐Shells is compared with a clinical Cartesian magnetization‐prepared rapid gradient echo acquisition.ResultsInitial experiments show that MP‐Shells produces excellent image quality with higher data acquisition efficiency and improved gray‐to‐white matter contrast‐to‐noise ratio (by 36%) compared with the conventional Cartesian magnetization‐prepared rapid gradient echo acquisition.ConclusionWe demonstrated the feasibility of a three‐dimensional MP‐Shells acquisition and an automated trajectory design to achieve an efficient acquisition with improved gray‐to‐white matter contrast. Magn Reson Med 79:2024–2035, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

PurposeTo investigate the effect of the asymmetric gradient concomitant fields (CF) with zeroth and first‐order spatial dependence on fast/turbo spin‐echo acquisitions, and to demonstrate the effectiveness of their real‐time compensation.MethodsAfter briefly reviewing the CF produced by asymmetric gradients, the effects of the additional zeroth and first‐order CFs on these systems are investigated using extended‐phase graph simulations. Phantom and in vivo experiments are performed to corroborate the simulation. Experiments are performed before and after the real‐time compensations using frequency tracking and gradient pre‐emphasis to demonstrate their effectiveness in correcting the additional CFs. The interaction between the CFs and prescan‐based correction to compensate for eddy currents is also investigated.ResultsIt is demonstrated that, unlike the second‐order CFs on conventional gradients, the additional zeroth/first‐order CFs on asymmetric gradients cause substantial signal loss and dark banding in fast spin‐echo acquisitions within a typical brain‐scan field of view. They can confound the prescan correction for eddy currents and degrade image quality. Performing real‐time compensation successfully eliminates the artifacts.ConclusionsWe demonstrate that the zeroth/first‐order CFs specific to asymmetric gradients can cause substantial artifacts, including signal loss and dark bands for brain imaging. These effects can be corrected using real‐time compensation. Magn Reson Med 79:1354–1364, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Objective To determine the prevalence and outcomes of intracranial aneurysm (IA) in patients with bicuspid aortic valve (BAV). Methods Retrospective review of patients with BAV who underwent brain MR angiography at the Mayo Clinic from 1994 to 2013. Results There were 678 patients included in this study—mean age 57±13 years, men 480 (71%), mean follow-up 10±3 years (5913 patient-years). Coarctation of aorta (COA) was present in 154 (23%) patients. There were 59 IAs identified in 52 of 678 patients (7.7%). IA was present in 20/154 patients (12.9%) with COA and 32/524 patients (5.7%) without COA (p<0.001). For the patients without COA, female gender and right–left cusp fusion were risks factors for IA in women after adjustment for all potential variables (HR 1.76, CI 1.31 to 2.68, p=0.03). There was no significant trend in the risk for IA across age tertiles: age ≤40 years versus 41–60 years (HR 1.19, p=0.34), and age 41–60 years versus 61–80 years (HR 1.06, p=0.56). Among the 52 patients with IA, enlargement occurred in three patients (6%), rupture in two patients (4%) and four patients (8%) underwent coil embolisation. For the 626 patients without IA at baseline, no patient developed IA over 7±2 years of imaging follow-up. Conclusions BAV is associated with a higher prevalence of IA compared to the general population, and this risk is higher in patients with COA, right–left cusp fusion and female gender.

Abstract BACKGROUND There are conflicting data between natural history studies suggesting a very low risk of rupture for small, unruptured intracranial aneurysms and retrospective studies that have identified a much higher frequency of small, ruptured aneurysms than expected. OBJECTIVE To use the prospective International Study of Unruptured Intracranial Aneurysms cohort to identify morphological characteristics predictive of unruptured intracranial aneurysm rupture. METHODS A case-control design was used to analyze morphological characteristics associated with aneurysm rupture in the International Study of Unruptured Intracranial Aneurysms database. Fifty-seven patients with ruptured aneurysms during follow-up were matched (by size and location) with 198 patients with unruptured intracranial aneurysms without rupture during follow-up. Twelve morphological metrics were measured from cerebral angiograms in a blinded fashion. RESULTS Perpendicular height ( P = .008) and size ratio (ratio of maximum diameter to the parent vessel diameter; P = .01) were predictors of aneurysm rupture on univariate analysis. Aspect ratio, daughter sacs, multiple lobes, aneurysm angle, neck diameter, parent vessel diameter, and calculated aneurysm volume were not statistically significant predictors of rupture. On multivariate analysis, perpendicular height was the only significant predictor of rupture (Chi-square 7.1, P -value .008). CONCLUSION This study underscores the importance of other morphological factors, such as perpendicular height and size ratio, that may influence unruptured intracranial aneurysm rupture risk in addition to greatest diameter and anterior vs posterior location.

PurposeThe homeostasis of intracranial pressure (ICP) is of paramount importance for maintaining normal brain function. A noninvasive technique capable of making direct measurements of ICP currently does not exist. MR elastography (MRE) is capable of noninvasively measuring brain tissue stiffness in vivo, and may act as a surrogate to measure ICP. The objective of this study was to investigate the impact of changing ICP on brain stiffness using MRE in a swine model.MethodsBaseline MRE measurements were obtained, and then catheters were surgically placed into the left and right lateral ventricles of three animals. ICP was systematically increased over the range of 0 to 55 millimeters mercury (mmHg), and stiffness measurements were made using brain MRE at vibration frequencies of 60 hertz (Hz), 90 Hz, 120 Hz, and 150 Hz.ResultsA significant linear correlation between stiffness and ICP in the cross‐subject comparison was observed for all tested vibrational frequencies (P ≤ 0.01). The 120 Hz (0.030 ± 0.004 kilopascal (kPa)/mmHg, P < 0.0001) and 150 Hz (0.031 ± 0.008 kPa/mmHg, P = 0.01) vibrational frequencies had nearly identical slopes, which were approximately two‐ to three‐fold higher than the 90 Hz (0.017 ± 0.002 kPa/mmHg, P < 0.0001) and 60 Hz (0.009 ± 0.002 kPa/mmHg, P = 0.001) slopes, respectively.ConclusionIn this study, MRE demonstrated the potential for noninvasive measurement of changes in ICP. Magn Reson Med 79:1043–1051, 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‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.