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Real-time MRI (rt-MRI) in children is a new imaging technique that combines the advantages of US — at frame rates of up to 50 images per second — with the quality and features of MRI. Although still subject of research, it has become a standard tool in the diagnostic portfolio of two pediatric radiology departments in Germany. Based on ultrashort acquisition times, any detrimental effects of macroscopic movements of the child and the physiological movements of the organs are negligible. Especially in pediatric brain imaging, rt-MRI has already proven its value. With suitable indications, rt-MRI can reduce anesthesia and sedation examinations in children below 6 years of age by 40% due to its very short examination time and its robustness to motion. There is a high level of acceptance among parents and referrers when diagnostic possibilities and limitations are communicated correctly. Conclusion: Completely new diagnostic possibilities arise in the imaging of the moving lung, the beating heart, joint movements, and speaking and swallowing, as demonstrated in this video-backed review. What is known: • MRI in moving children has been burdened with severe artifacts. • Gross motion usually has to be handled by sedation and periodic motion of the heart and lungs has to be compensated with time-consuming techniques until now. What is new: • Real-time MRI allows image acquisition with up to 50 frames per second similar to ultrasound frame rate. • Real-time MRI proofs to be very promising for imaging children, reducing examination time and sedation rate drastically. [ABSTRACT FROM AUTHOR]

The recent development of highly undersampled radial gradient echo sequences in combination with nonlinear inverse image reconstruction now allows for MRI examinations in real time. Image acquisition times as short as 20 ms yield MRI videos with rates of up to 50 frames per second with spin density, T1- and T2-type contrast. The addition of an initial 180° inversion pulse achieves accurate T1 mapping within only 4 s. These technical advances promise specific advantages for studies of infants and young children by eliminating the need for sedation or anesthesia. Our preliminary data demonstrate new diagnostic opportunities ranging from dynamic studies of speech and swallowing processes and body movements to a rapid volumetric assessment of brain cerebrospinal fluid spaces in only few seconds. Real-time MRI of the heart and blood flow can be performed without electrocardiogram gating and under free breathing. The present findings support the idea that real-time MRI will complement existing methods by providing long-awaited diagnostic options for patients in early childhood. Major advantages are the avoidance of sedation or anesthesia and the yet unexplored potential to gain insights into arbitrary body functions. [ABSTRACT FROM AUTHOR]

Background: Quantitative mapping of MRI relaxation times is expected to uncover pathological processes in the brain more subtly than standard MRI techniques with weighted contrasts. So far, however, most mapping techniques suffer from a long measuring time, low spatial resolution or even sensitivity to magnetic field inhomogeneity. Objective: To obtain T1 relaxation times of the normal brain from early infancy to adulthood using a novel technique for fast and accurate T1 mapping at high spatial resolution. Materials and methods: We performed whole-brain T1 mapping within less than 3 min in 100 patients between 2 months and 18 years of age with normal brain at a field strength of 3 T. We analyzed T1 relaxation times in several gray-matter nuclei and white matter. Subsequently, we derived regression equations for mean value and confidence interval. Results: T1 relaxation times of the pediatric brain rapidly decrease in all regions within the first 3 years of age, followed by a significantly weaker decrease until adulthood. These characteristics are more pronounced in white matter than in deep gray matter. Conclusion: Regardless of age, quantitative T1 mapping of the pediatric brain is feasible in clinical practice. Normal age-dependent values should contribute to improved discrimination of subtle intracerebral alterations. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • T1-shortening of water protons in nerve cells by a macrocyclic contrast agent. • Injection of macrocyclic gadolinium-based agent into the lateral ventricle of mice. • In vivo MRI visibility of noradrenergic neuron groups and the nucleus ambiguus. • Saturation of extracellular and lipid-associated intracellular water protons. • Preservation of intracellular paramagnetic-ion-associated water proton signals. Abstract Three-dimensional T 1 -weighted MRI of mouse brain in vivo (9.4 T, 80 μm isotropic resolution) identified assemblies of nerve cell bodies in the habenula, hippocampal formation, locus coeruleus, dorsal motor nucleus of vagus, and nucleus ambiguus as high signal intensities, while suppressing the signals of white matter by magnetization transfer and of extracellular water protons by saturation. These observations indicate the presence of intracellular water protons with T 1 values shortened by paramagnetic ions as the source of the bright signal. One day after an intraventricular injection of gadobutrol, a macrocyclic gadolinium-based contrast agent, T 1 -weighted MRI signal intensities of the nerve cell assemblies in the habenula, hippocampal formation, and locus coeruleus increased significantly. With simultaneous saturation of long-T 1 protons of extracellular water, this finding indicates a T 1 -shortening of the intracellular water protons as a result of their interaction with gadolinium ions. [ABSTRACT FROM AUTHOR]

Using proton MRS and MRI of mouse brain at 9.4 T, this work provides the first in vivo evidence of pH-dependent concurrent changes of three amide signals and related metabolic responses to hypercapnia and hypothermia. During hypercapnia, amide proton MRS signals of glutamine at 6.8–6.9 ppm and 7.6 ppm as well as of unspecific compounds at 8.1–8.3 ppm increase by at least 50% both at 37 °C and 22 °C. These changes reflect a reduced proton exchange with water. They are strongly correlated with intracellular pH which ranges from 6.75 ± 0.10 to 7.13 ± 0.06 as determined from a shift in creatine phosphokinase equilibrium. In MRI, saturation transfer from aliphatic as well as aromatic and/or amide protons alters slightly during hypercapnia and significantly during hypothermia. The asymmetry in magnetization transfer ratios decreased slightly during hypercapnia and hypothermia. Regardless of pH or temperature, saturation transfer from aliphatic protons between − 2 and − 4 ppm frequency offset to water protons is significantly greater than that from aromatic/amide protons at corresponding offsets between + 2 and + 4 ppm. Irradiation of aliphatic compounds at − 3.5 ppm frequency offset from water predominantly saturates lipids and water associated with myelin. Taken together, the results indicate that, for the B 1 power used in this study, dipolar coupling between aliphatic and water protons rather than proton exchange is the dominant factor in Z-spectra and magnetization transfer ratio asymmetry of the brain in vivo . [ABSTRACT FROM AUTHOR]

Individual intra-digit somatotopy of all phalanges of the middle and little finger of the right and left hand was studied by functional magnetic resonance imaging in 12 healthy subjects. Phalanges were tactilely stimulated and activation in BA 3b of the human primary somatosensory cortex could be observed for each individual phalanx. Activation peaks were further analysed using the Direction/Order (DiOr) method, which identifies somatotopy, if a significantly high number of subjects exhibit ordered distal-to-proximal phalanx representions along a similar direction. Based on DiOr, ordered and similar-direction-aligned intra-digit maps across subjects were found at the left hand for the little and middle finger and at the right hand for the little finger. In these digits the proximal phalanges were represented more medially along the course of the central sulcus than the distal phalanges. This is contrasted by the intra-digit maps for the middle finger of the right hand, which showed larger inter-subject variations of phalanx alignments without a similar within-digit representation across subjects. As all subjects were right-handed and as the middle finger of the dominant hand probably plays a more individual role in everyday tactile performance than the little finger of the right hand and all left-hand digits, the observed variation might reflect a functional somatotopy based on individual use of that particular digit at the dominant hand. [ABSTRACT FROM AUTHOR]

Using T-weighted MRI at two different magnetic field strengths, the enhanced longitudinal relaxivity due to paramagnetic manganese ions in mouse brain in vivo is shown to reflect reduced intracellular mobility. One day after systemic administration of manganese chloride, increases of the longitudinal relaxation rate ∆ R in several brain regions are significantly higher at 2.35 T than at 9.4 T. The corresponding relaxivity ratios r/ r = ∆ R/∆ R range from 2.4 (striatum) to 4.4 (cerebellar cortex). In contrast, the ∆ R values after intraventricular administration of gadolinium-DTPA (Gd-DTPA) are not significantly different between both field strengths yielding r/ r ratios from 1.0 to 1.1. The same observation holds true for manganese and Gd-DTPA relaxivities in aqueous solution. The pronounced field strength dependence of manganese relaxivities indicates a reduced mobility of manganese ions in vivo by confinement to a viscous fluid compartment and/or due to macromolecular binding. Moreover, preferential enhancement of nerve cell assemblies by manganese ions and the observation of additional contrast enhancement by magnetization transfer suggest an intracellular localization of manganese. This is further supported by a slow release of manganese from nerve cells postmortem, which occurs despite a high permeability of damaged cellular membranes as demonstrated by a rapid uptake of extracellular Gd-DTPA. [ABSTRACT FROM AUTHOR]

Abstract: This work compares magnetization transfer (MT) MRI of living mice with contrast-enhanced MT MRI using intraventricular administration of gadopentetate dimeglumine (Gd-DTPA), systemic administration of MnCl2, and both. In MT MRI at 9.4T, the contrast-to-noise ratio (CNR) between white matter (WM) and gray matter (GM) increased by 85% after Gd-DTPA injection into the lateral ventricle. When applied in conjunction with manganese-enhanced MT MRI (117μm isotropic resolution, 6min measuring time), Gd-DTPA boosted the CNR increase from +56% to +117%. Additional T1 measurements at 2.35T revealed that intraventricular Gd-DTPA shortens the T1 of GM much more than that of WM, which corresponds to estimated extracellular spaces of 26% in GM and only 15% in WM. These results explain the additional MT contrast enhancement by Gd-DTPA and demonstrate that the T1 shortening by intracellular Mn2+ is well complemented by extracellular Gd-DTPA. The data suggest a high myelin and low water content to hinder access of hydrophilic paramagnetic agents, so that the resulting differential accumulation effectively reduces the MT saturation in water-rich tissues and thereby facilitates the mapping of myelin-rich tissues. Finally, a 156% CNR increase between GM and WM for contrast-enhanced MT MRI at 9.4T using both Gd-DTPA and manganese allowed for 60μm isotropic resolution (102min measuring time), which delineated myelinated fibers and layers even within GM areas such as the thalamus and cerebellar cortex. Improved MT contrasts were also seen in the cervical spinal cord. [Copyright &y& Elsevier]

Abstract: This work demonstrates manganese-enhanced magnetization transfer (MT) MRI to improve the contrast of myelinated structures in mouse brain in vivo. Systemic administration of manganese chloride led to a reduction of the MT ratio by 23% in white matter and 35% in gray matter. The effect increased their contrast-to-noise ratio by 48% and facilitated a mapping of myelin-rich white matter tissues. Relaxation time measurements revealed the manganese-induced shortening of T1 to be smaller in the corpus callosum (−42%) than in the cortex (−52%) or hippocampus (−60%). These findings are in line with the assumption that a high myelin and correspondingly low water content hinder the free diffusion and uptake of manganese ions. The resulting preferential accumulation of manganese in gray matter structures causes a stronger reduction of the MT saturation in gray matter than in white matter. Extending MRI assessments with conventional MT contrast, manganese-enhanced MT MRI at 76×80×160 μm3 resolution and 2.35 T field strength allowed for a delineation of small myelinated structures such as the fornix, mammillothalamic tract, and fasciculus retroflexus in the living mouse brain. [Copyright &y& Elsevier]

Abstract: Functional magnetic resonance imaging (fMRI) based on blood oxygenation level dependent (BOLD) contrast is the most widely used technique for imaging human brain function. However, the dynamic interplay of altered cerebral blood flow (CBF), cerebral blood volume (CBV), and oxidative metabolism (CMRO2) is not yet fully understood. One of the characteristics of the BOLD response is the post-stimulation undershoot, that is increased deoxyhemoglobin, which has been suggested to originate from a delayed recovery of elevated CBV or CMRO2 to baseline. To investigate the CBV contribution to the post-stimulation BOLD undershoot, we performed bolus-tracking experiments using a paramagnetic contrast agent in eight healthy subjects at 3 T. In an initial BOLD experiment without contrast agent, we determined the individual hemodynamic responsiveness. In two separate experiments, we then evaluated the relative CBV (rCBV) during visual stimulation and the post-stimulation undershoot, respectively. The results confirm a pronounced rCBV increase during stimulation (31.4±8.6%), but reveal no change in rCBV relative to baseline in the post-stimulation phase (0.7±7.2%). This finding renders a CBV contribution to the BOLD MRI undershoot unlikely and – in conjunction with a rapid post-stimulation return of CBF to baseline – supports the idea of a prolonged elevation of oxidative metabolism. [Copyright &y& Elsevier]

Abstract: Several tracing studies have established a topographical distribution of fiber connections to the cortex in midsagittal cross-sections of the corpus callosum (CC). The most prominent example is Witelson''s scheme, which defines five vertical partitions mainly based on primate data. Conventional MRI of the human CC does not reveal morphologically discernable structures, although microscopy techniques identified myelinated axons with a relatively small diameter in the anterior and posterior third of the CC as opposed to thick fibers in the midbody and posterior splenium. Here, we applied diffusion tensor imaging (DTI) in conjunction with a tract-tracing algorithm to gain cortical connectivity information of the CC in individual subjects. With DTI-based tractography, we distinguished five vertical segments of the CC, containing fibers projecting into prefrontal, premotor (and supplementary motor), primary motor, and primary sensory areas as well as into parietal, temporal, and occipital cortical areas. Striking differences to Witelson''s classification were recognized in the midbody and anterior third of the CC. In particular, callosal motor fiber bundles were found to cross the CC in a much more posterior location than previously indicated. Differences in water mobility were found to be in qualitative agreement with differences in the microstructure of transcallosal fibers yielding the highest anisotropy in posterior regions of the CC. The lowest anisotropy was observed in compartments assigned to motor and sensory cortical areas. In conclusion, DTI-based fiber tractography of healthy human subjects suggests a modification of the widely accepted Witelson scheme and a new classification of vertical CC partitions. [Copyright &y& Elsevier]

Background: Idiopathic scoliosis is common in adolescence. Due to the rapid growth of the spine, it must be monitored closely with radiographs to ensure timely intervention when therapy is needed. As these radiographs continue into young adulthood, patients are repeatedly exposed to ionizing radiation. Objective: This study aimed to investigate whether real-time magnetic resonance imaging (MRI) is equivalent to conventional radiography in juvenile idiopathic scoliosis for determining curvature, rotation and the Risser stage. Additionally, the time requirement should be quantified. Materials and methods: Children with idiopathic scoliosis who had postero-anterior whole-spine radiography for clinical indications were included in this prospective study. A real-time spine MRI was performed at 3 tesla in the supine position, capturing images in both the coronal and sagittal planes. The scoliosis was assessed using Cobb angle, rotation was evaluated based on Nash and Moe criteria, and the Risser stage was determined for each modality. The correlations between modalities and a correction factor for the Cobb angle between the standing and supine position were calculated. Results: A total of 33 children (aged 5–17 years), who met the inclusion criteria, were recruited. The Cobb angle (R2 = 0.972; P < 0.01) was positively correlated with a correction factor of 1.07 between modalities. Additionally, the degree of rotation (R2 = 0.92; P < 0.01) and the Risser stage (R2 = 0.93; P < 0.01) demonstrated a strong correlation. Conclusion: Real-time MRI is equivalent to conventional radiography in determining baseline parameters. Furthermore, it is radiation-free and less time-consuming. [ABSTRACT FROM AUTHOR]

Purpose: In vivo measurements of CSF and venous flow using real-time phase-contrast (RT-PC) MRI facilitate new insights into the dynamics and physiology of both fluid systems. In clinical practice, however, use of RT-PC MRI is still limited. Because many forms of hydrocephalus manifest in infancy and childhood, it is a prerequisite to investigate normal flow parameters during this period to assess pathologies of CSF circulation. This study aims to establish reference values of CSF and venous flow in healthy subjects using RT-PC MRI and to determine their age dependency. Methods: RT-PC MRI was performed in 44 healthy volunteers (20 females, age 5–40 years). CSF flow was quantified at the aqueduct (Aqd), cervical (C3) and lumbar (L3) spinal levels. Venous flow measurements comprised epidural veins, internal jugular veins and inferior vena cava. Parameters analyzed were peak velocity, net flow, pulsatility, and area of region of interest (ROI). Statistical tests: linear regression, student's t-test and analysis of variance (ANOVA). Results: In adults volunteers, no significant changes in flow parameters were observed. In contrast, pediatric subjects exhibited a significant age-dependent decrease of CSF net flow and pulsatility in Aqd, C3 and L3. Several venous flow parameters decreased significantly over age at C3 and changed more variably at L3. Conclusion: Flow parameters varies depending on anatomical location and age. We established changes of brain and spinal fluid dynamics over an age range from 5–40 years. The application of RT-PC MRI in clinical care may improve our understanding of CSF flow pathology in individual patients. [ABSTRACT FROM AUTHOR]

Velum movement signals generated from real-time magnetic resonance imaging videos of thirty-five German speakers were used to investigate the physiological conditions that might promote sound change involving the development of contrastive vowel nasality. The results suggest that, in comparison to when a nasal consonant precedes a voiced obstruent, the velum gesture associated with a nasal consonant preceding a voiceless obstruent undergoes gestural rescaling and temporal rephasing. This further suggests that the diachronic development of contrastive vowel nasality comprises two stages: the first stage involves gestural shortening and realignment, while the second stage involves a trading relationship between source and effect. [ABSTRACT FROM AUTHOR]

Objective: Clinical-standard MRI is the imaging modality of choice for the wrist, yet limited to static evaluation, thereby potentially missing dynamic instability patterns. We aimed to investigate the clinical benefit of (dynamic) real-time MRI, complemented by automatic analysis, in patients with complete or partial scapholunate ligament (SLL) tears. Material and methods: Both wrists of ten patients with unilateral SLL tears (six partial, four complete tears) as diagnosed by clinical-standard MRI were imaged during continuous active radioulnar motion using a 1.5-T MRI scanner in combination with a custom-made motion device. Following automatic segmentation of the wrist, the scapholunate and lunotriquetral joint widths were analyzed across the entire range of motion (ROM). Mixed-effects model analysis of variance (ANOVA) followed by Tukey's posthoc test and two-way ANOVA were used for statistical analysis. Results: With the increasing extent of SLL tear, the scapholunate joint widths in injured wrists were significantly larger over the entire ROM compared to those of the contralateral healthy wrists (p<0.001). Differences between partial and complete tears were most pronounced at 5°–15° ulnar abduction (p<0.001). Motion patterns and trajectories were altered. Complete SLL deficiency resulted in complex alterations of the lunotriquetral joint widths. Conclusion: Real-time MRI may improve the functional diagnosis of SLL insufficiency and aid therapeutic decision-making by revealing dynamic forms of dissociative instability within the proximal carpus. Static MRI best differentiates SLL-injured wrists at 5°–15° of ulnar abduction. [ABSTRACT FROM AUTHOR]

A novel method is developed that adaptively generates tiny dictionaries for joint T1-T2 mapping in magnetic resonance imaging. This work breaks the bond between dictionary size and representation accuracy (i) by approximating the Bloch-response manifold by piece-wise linear functions and (ii) by adaptively refining the sampling grid depending on the locally-linear approximation error. Data acquisition is accomplished with use of an 2D radially sampled Inversion-Recovery Hybrid-State Free Precession sequence. Adaptive dictionaries are generated with different error tolerances and compared to a heuristically designed dictionary. Based on simulation results, tiny dictionaries were used for T1-T2 mapping in phantom and in vivo studies. Reconstruction and parameter mapping were performed entirely in subspace. All experiments demonstrated excellent agreement between the proposed mapping technique and template matching using heuristic dictionaries. Adaptive dictionaries in combination with manifold projection allow to reduce the necessary dictionary sizes by one to two orders of magnitude. [ABSTRACT FROM AUTHOR]

This study aims to develop a standardized algorithm for gastroesophageal image acquisition and diagnostic assessment using real-time MRI. Patients with GERD symptoms undergoing real-time MRI of the esophagus and esophagogastric junction between 2015 and 2018 were included. A 10 ml bolus of pineapple juice served as an oral contrast agent. Patients performed Valsalva maneuver to provoke reflux and hiatal hernia. Systematic MRI assessment included visual presence of achalasia, fundoplication failure in patients with previous surgical fundoplication, gastroesophageal reflux, and hiatal hernia. A total of 184 patients (n = 92 female [50%], mean age 52.7 ± 15.8 years) completed MRI studies without adverse events at a mean examination time of 15 min. Gastroesophageal reflux was evident in n = 117 (63.6%), hiatal hernia in n = 95 (52.5%), and achalasia in 4 patients (2.2%). Hiatal hernia was observed more frequently in patients with reflux at rest (n = 67 vs. n = 6, p < 0.01) and during Valsalva maneuver (n = 87 vs. n = 8, p < 0.01). Real-time MRI visualized a morphologic correlate for recurring GERD symptoms in 20/22 patients (90%) after fundoplication procedure. In a large-scale single-center cohort of patients with GERD symptoms undergoing real-time MRI, visual correlates for clinical symptoms were evident in most cases. The proposed assessment algorithm could aid in wider-spread utilization of real-time MRI and provides a comprehensive approach to this novel imaging modality. [ABSTRACT FROM AUTHOR]

Background: Congenital heart disease (CHD) is often associated with chronic right ventricular (RV) volume overload. Real-time magnetic resonance imaging (MRI) enables the analysis of cardiac function during free breathing. Objective: To evaluate the influence of respiration in pediatric patients with CHD and chronic RV volume overload. Methods and materials: RV volume overload patients (n=6) and controls (n=6) were recruited for cardiac real-time MRI at 1.5 tesla during free breathing. Breathing curves from regions of interest reflecting the position of the diaphragm served for binning images in four different tidal volume classes, each in inspiration and expiration. Tidal volumes were estimated from these curves by data previously obtained by magnetic resonance-compatible spirometry. Ventricular volumes indexed to body surface area and Frank-Starling relationships referenced to the typical tidal volume indexed to body height (TTVi) were compared. Results: Indexed RV end-diastolic volume (RV-EDVi) and indexed RV stroke volume (RV-SVi) increased during inspiration (RV-EDVi/TTVi: RV load: + 16 ± 4%; controls: + 22 ± 13%; RV-SVi/TTVi: RV load: + 21 ± 6%; controls: + 35 ± 17%; non-significant for comparison). The increase in RV ejection fraction during inspiration was significantly lower in RV load patients (RV load: + 1.1 ± 2.2%; controls: + 6.1 ± 1.5%; P=0.01). The Frank-Starling relationship of the RV provided a significantly reduced slope estimate in RV load patients (inspiration: RV load: 0.75 ± 0.11; controls: 0.92 ± 0.02; P=0.02). Conclusion: In pediatric patients with CHD and chronic RV volume overload, cardiac real-time MRI during free breathing in combination with respiratory-based binning indicates an impaired Frank-Starling relationship of the RV. [ABSTRACT FROM AUTHOR]

Neurofeedback (NFB) allows subjects to learn self-regulation of neuronal brain activation based on information about the ongoing activation. The implementation of real-time functional magnetic resonance imaging (rt-fMRI) for NFB training now facilitates the investigation into underlying processes. Our study involved 16 control and 16 training right-handed subjects, the latter performing an extensive rt-fMRI NFB training using motor imagery. A previous analysis focused on the targeted primary somato-motor cortex (SMC). The present study extends the analysis to the supplementary motor area (SMA), the next higher brain area within the hierarchy of the motor system. We also examined transfer-related functional connectivity using a whole-volume psycho-physiological interaction (PPI) analysis to reveal brain areas associated with learning. The ROI analysis of the pre- and post-training fMRI data for motor imagery without NFB (transfer) resulted in a significant training-specific increase in the SMA. It could also be shown that the contralateral SMA exhibited a larger increase than the ipsilateral SMA in the training and the transfer runs, and that the right-hand training elicited a larger increase in the transfer runs than the left-hand training. The PPI analysis revealed a training-specific increase in transfer-related functional connectivity between the left SMA and frontal areas as well as the anterior midcingulate cortex (aMCC) for right- and left-hand trainings. Moreover, the transfer success was related with training-specific increase in functional connectivity between the left SMA and the target area SMC. Our study demonstrates that NFB training increases functional connectivity with non-targeted brain areas. These are associated with the training strategy (i.e., SMA) as well as with learning the NFB skill (i.e., aMCC and frontal areas). This detailed description of both the system to be trained and the areas involved in learning can provide valuable information for further optimization of NFB trainings. [ABSTRACT FROM AUTHOR]

Purpose. To develop generic optimization strategies for image reconstruction using graphical processing units (GPUs) in magnetic resonance imaging (MRI) and to exemplarily report on our experience with a highly accelerated implementation of the nonlinear inversion (NLINV) algorithm for dynamic MRI with high frame rates. Methods. The NLINV algorithm is optimized and ported to run on a multi-GPU single-node server. The algorithm is mapped to multiple GPUs by decomposing the data domain along the channel dimension. Furthermore, the algorithm is decomposed along the temporal domain by relaxing a temporal regularization constraint, allowing the algorithm to work on multiple frames in parallel. Finally, an autotuning method is presented that is capable of combining different decomposition variants to achieve optimal algorithm performance in different imaging scenarios. Results. The algorithm is successfully ported to a multi-GPU system and allows online image reconstruction with high frame rates. Real-time reconstruction with low latency and frame rates up to 30 frames per second is demonstrated. Conclusion. Novel parallel decomposition methods are presented which are applicable to many iterative algorithms for dynamic MRI. Using these methods to parallelize the NLINV algorithm on multiple GPUs, it is possible to achieve online image reconstruction with high frame rates. [ABSTRACT FROM AUTHOR]

Objectives: Depositions of linear gadolinium-based MRI contrast agents are readily visible in T1-weighted MRIs of certain brain regions in both adults and children. Macrocyclic contrast agents such as gadobutrol have so far escaped detection by qualitative MRI in children. This study aimed to assess whether there is evidence for deposition of gadobutrol in children using quantitative T1 mapping. Methods: This retrospective study included patients, naive to other gadolinium-based contrast agents than gadobutrol, who had received gadobutrol as part of a clinically indicated MRI. For each patient, T1 relaxation times at 3 T were measured using single-shot T1 mapping at two time points. In each of six brain regions, age-adjusted T1 relaxation times were correlated with a number of previous gadobutrol administrations. To combine interindividual, cross-sectional effects with intraindividual, longitudinal effects, both linear mixed model and generalized additive mixed model were applied. Results: One hundred four examinations of 52 children (age median 11.4, IQR 6.3–15, 26 female) with a median of 7 doses of gadobutrol in the history of their neurological or neurooncological disease were included. After correction for age and indeterminate disease-related effects to T1 time, a negative correlation of T1 time with the number of gadobutrol doses administered was observed in both mixed models in the putamen (beta − 1.65, p =.03) and globus pallidus (beta − 1.98, p =.012) Conclusions: The results indicate that in children, gadobutrol is deposited in the globus pallidus and putamen. Key Points: • Previous gadobutrol administration correlates with reduced T1 relaxation times in the globus pallidus and putamen in children. • This decreased T1 might be caused by gadobutrol retention within these gray-matter nuclei. [ABSTRACT FROM AUTHOR]

Objectives: The breathing phase for the determination of thoracic indices in patients with pectus excavatum is not standardized. The aim of this study was to identify the best period for reliable assessments of morphologic indices by dynamic observations of the chest wall using real-time MRI. Methods: In this prospective study, patients with pectus excavatum underwent morphologic evaluation by real-time MRI at 3 T between January 2020 and June 2021. The Haller index (HI), correction index (CI), modified asymmetry index (AI), and modified eccentricity index (EI) were determined during free, quiet, and forced breathing respectively. Breathing-related differences in the thoracic indices were analyzed with the Wilcoxon signed-rank test. Motion of the anterior chest wall was analyzed as well. Results: A total of 56 patients (11 females and 45 males, median age 15.4 years, interquartile range 14.3–16.9) were included. In quiet expiration, the median HI in the cohort equaled 5.7 (4.5–7.2). The median absolute differences (Δ) in the thoracic indices between peak inspiration and peak expiration were ΔHI = 1.1 (0.7–1.6, p <.001), ΔCI = 4.8% (1.3–7.5%, p <.001), ΔAI = 3.0% (1.0–5.0%, p <.001), and ΔEI = 8.0% (3.0–14.0%, p <.05). The indices varied significantly during different inspiratory phases, but not during expiration (p >.05 each). Furthermore, the dynamic evaluation revealed three distinctive movement patterns of the funnel chest. Conclusions: Real-time MRI reveals patterns of chest wall motion and indicate that thoracic indices of pectus excavatum should be assessed in the end-expiratory phase of quiet expiration. Key Points: • The thoracic indices in patients with pectus excavatum depend on the breathing phase. • Quiet expiration represents the best breathing phase for determining thoracic indices. • Real-time MRI can identify different chest wall motion patterns in pectus excavatum. [ABSTRACT FROM AUTHOR]

Abstract Magnetoencephalography of a visual area along the human parieto-occipital sulcus suggested that this region represents the human homologue of the monkey visual area V6 complex (visual area V6/visuomotor area V6A) involved in the integration of visual and somatomotor information. We used functional magnetic resonance imaging at 2.0 T and 2 × 2 × 3 mm3 resolution (16 sections) to characterize visual areas along the parieto-occipital sulcus in five healthy human subjects. Paradigms comprised a full-field checkerboard stimulation, a full-field luminance flicker as well as a foveal and peripheral luminance flicker using both a direct and differential design for comparing functional states. Along the parieto-occipital sulcus, and in contrast to primary visual areas, luminance stimulation evoked much larger activation volumes than checkerboard stimulation. Moreover, based on anatomic landmarks, luminance stimulation identified two functionally distinct regions of parieto-occipital sulcus activations: an inferior part (supposedly visual area V6) and a superior portion (supposedly visuomotor area V6A). With these assignments, foveal vs. peripheral luminance stimulation revealed a weaker foveal overrepresentation in visual area V6/visuomotor area V6A than in early visual areas, and only a mild tendency for a retinotopic organization in visual area V6. Further analyses of the functional coding of the human visual area V6 complex require functional magnetic resonance imaging at even higher spatial resolution. [ABSTRACT FROM AUTHOR]

Background: Real-time magnetic resonance imaging (MRI) based on a fast low-angle shot technique 2.0 (FLASH 2.0) is highly effective against artifacts caused due to the bulk and pulmonary and cardiac motions of the patient. However, to date, there are no reports on the application of this innovative technique to pediatric lung MRI. Objective: This study aimed to identify the limits of resolution and image quality of real-time lung MRI in children and to assess the types and minimal size of lesions with these new sequences. Materials and methods: In this retrospective study, pathological lung findings in 87 children were classified into 6 subgroups, as detected on conventional MRI: metastases and tumors, consolidation, scars, hyperinflation, interstitial pathology and bronchiectasis. Subsequently, the findings were grouped according to size (4–6 mm, 7–9 mm and ≥ 10 mm) and evaluated for visual delineation of the findings (0 = not visible, 1 = hardly visible and 2 = well visualized). Results: Real-time MRI allows for diagnostic, artifact-free thorax images to be obtained, regardless of patient movements. The delineation of findings strongly correlates with the size of the pathology. Metastases, consolidation and scars were visible at 100% when larger than 9 mm. In the 7–9 mm subgroup, the visibility was 83% for metastases, 88% for consolidation and 100% for scars in T2/T1 weighting. Though often visible, smaller pathological lesions of 4–6 mm in size did not regularly meet the expected diagnostic confidence: The visibility of metastases was 18%, consolidation was 64% and scars was 71%. Diffuse interstitial lung changes and hyperinflation, known as "MR-minus pathologies," were not accessible to real-time MRI. Conclusion: The method provides motion robust images of the lung and thorax. However, the lower sensitivity for small lung lesions is a major limitation for routine use of this technique. Currently, the method is adequate for diagnosing inflammatory lung diseases, atelectasis, effusions and lung scarring in children with irregular breathing patterns or bulk motion on sedation-free MRI. A medium-term goal is to improve the diagnostic accuracy of small nodules and interstitial lesions. [ABSTRACT FROM AUTHOR]

Velum position was analysed as a function of vowel height in German tense and lax vowels preceding a nasal or oral consonant. Findings from previous research suggest an interdependence between vowel height and the degree of velum lowering, with a higher velum during high vowels and a more lowered velum during low vowels. In the current study, data were presented from 33 native speakers of Standard German who were measured via non-invasive high quality real-time magnetic resonance imaging. The focus was on exploring the spatiotemporal extent of velum lowering in tense and lax /a, i, o, ø/, which was done by analysing velum movement trajectories over the course of VN and VC sequences in CVNV and CVCV sequences by means of functional principal component analysis. Analyses focused on the impact of the vowel category and vowel tenseness. Data indicated that not only the position of the velum was affected by these factors but also the timing of velum closure. Moreover, it is argued that the effect of vowel height was to be better interpreted in terms of the physiological constriction location of vowels, i.e., the specific tongue position rather than phonetic vowel height. [ABSTRACT FROM AUTHOR]

Background: Cardiac real-time magnetic resonance imaging (RT-MRI) provides high-quality images even during free-breathing. Difficulties in post-processing impede its use in clinical routine.Objective: To demonstrate the feasibility of quantitative analysis of cardiac free-breathing RT-MRI and to compare image quality and volumetry during free-breathing RT-MRI in pediatric patients to standard breath-hold cine MRI.Materials and Methods: Pediatric patients (n = 22) received cardiac RT-MRI volumetry during free breathing (1.5 T; short axis; 30 frames per s) in addition to standard breath-hold cine imaging in end-expiration. Real-time images were binned retrospectively based on electrocardiography and respiratory bellows. Image quality and volumetry were compared using the European Cardiovascular Magnetic Resonance registry score, structure visibility rating, linear regression and Bland-Altman analyses.Results: Additional time for binning of real-time images was 2 min. For both techniques, image quality was rated good to excellent. RT-MRI was significantly more robust against artifacts (P < 0.01). Linear regression revealed good correlations for the ventricular volumes. Bland-Altman plots showed a good limit of agreement (LoA) for end-diastolic volume (left ventricle [LV]: LoA -0.1 ± 2.7 ml/m2, right ventricle [RV]: LoA -1.9 ± 3.4 ml/m2), end-systolic volume (LV: LoA 0.4 ± 1.9 ml/m2, RV: LoA 0.6 ± 2.0 ml/m2), stroke volume (LV: LoA -0.5 ± 2.3 ml/m2, RV: LoA -2.6 ± 3.3 ml/m2) and ejection fraction (LV: LoA -0.5 ± 1.6%, RV: LoA -2.1 ± 2.8%).Conclusion: Compared to standard cine MRI with breath hold, RT-MRI during free breathing with retrospective respiratory binning offers good image quality, reduced image artifacts enabling fast quantitative evaluations of ventricular volumes in clinical practice under physiological conditions. [ABSTRACT FROM AUTHOR]

Purpose: Diffusion-weighted imaging (DWI) is an essential element of almost every brain MRI examination. The most widely applied DWI technique, a single-shot echo-planar imaging DWI (EPI-DWI) sequence, suffers from a high sensitivity to magnetic field inhomogeneities. As an alternative, a single-shot stimulated echo acquisition mode diffusion-weighted MRI (STEAM-DWI) has recently been re-introduced after it became significantly faster. The aim of the study was to investigate the applicability of STEAM-DWI as a substitute to EPI-DWI in a daily routine of pediatric radiology. Methods: Retrospectively, brain MRI examinations of 208 children with both EPI-DWI and STEAM-DWI were assessed. Visual resolution and diagnostic confidence were evaluated, the extent of susceptibility artifacts was quantified, and contrast-to-noise ratio was calculated in case of diffusion restriction. Furthermore, the correlation of apparent diffusion coefficient values between STEAM-DWI and EPI-DWI was tested. Results: STEAM-DWI was inferior to EPI-DWI in visual resolution but with higher diagnostic confidence and lower artifact size. The apparent diffusion coefficient values of both sequences demonstrated excellent correlation. The contrast-to-noise ratio of STEAM-DWI was only half of that of EPI-DWI (58% resp. 112%). Conclusion: STEAM-DWI is a robust alternative to EPI-DWI when increased susceptibility artifacts are to be expected. Drawbacks are a lower contrast-to-noise ratio and poorer visual resolution. [ABSTRACT FROM AUTHOR]

• A physiological comparative analysis of coarticulatory vowel nasalization in American and Standard Southern British English. • Greater vowel nasalization and tongue tip lenition in American English. • The velum gesture was stable across both dialects. • A trade-off exists between increased vowel nasalization and tongue tip lenition in both dialects. • The greater nasalization in the vowel is caused by a shift of the VN boundary later in time. • Coda reduction is one of the physiological mechanisms responsible for the onset of diachronic vowel nasalization. The diachronic change by which coarticulatory nasalization increases in VN (vowel-nasal) sequences has been modelled as an earlier alignment of the velum combined with oral gesture weakening of N. The model was tested by comparing American (USE) and Standard Southern British English (BRE) based on the assumption that this diachronic change is more advanced in USE. Real-time MRI data was collected from 16 USE and 27 BRE adult speakers producing monosyllables with coda /Vn, Vnd, Vnz/. For USE, nasalization was greater in V, less in N, and there was greater tongue tip lenition than for BRE. The dialects showed a similar stability of the velum gesture and a trade-off between vowel nasalization and tongue tip lenition. Velum alignment was not earlier in USE. Instead, a closer approximation of the time of the tongue tip peak velocity towards the tongue tip maximum for USE caused a shift in the acoustic boundary within VN towards N, giving the illusion that the velum gesture has an earlier alignment in USE. It is suggested that coda reduction which targets the tongue tip more than the velum is a principal physiological mechanism responsible for the onset of diachronic vowel nasalization. [ABSTRACT FROM AUTHOR]

Venous system pathologies have increasingly been linked to clinically relevant disorders of CSF circulation whereas the exact coupling mechanisms still remain unknown. In this work, flow dynamics of both systems were studied using real-time phase-contrast flow MRI in 16 healthy subjects during normal and forced breathing. Flow evaluations in the aqueduct, at cervical level C3 and lumbar level L3 for both the CSF and venous fluid systems reveal temporal modulations by forced respiration. During normal breathing cardiac-related flow modulations prevailed, while forced breathing shifted the dominant frequency of both CSF and venous flow spectra towards the respiratory component and prompted a correlation between CSF and venous flow in the large vessels. The average of flow magnitude of CSF was increased during forced breathing at all spinal and intracranial positions. Venous flow in the large vessels of the upper body decreased and in the lower body increased during forced breathing. Deep respiration couples interdependent venous and brain fluid flow—most likely mediated by intrathoracic and intraabdominal pressure changes. Further insights into the driving forces of CSF and venous circulation and their correlation will facilitate our understanding how the venous system links to intracranial pressure regulation and of related forms of hydrocephalus. [ABSTRACT FROM AUTHOR]

Abstract: This study explored the question of intra-digit somatotopy of sensory representations in the little and index finger of 10 subjects using tactile stimulation of the fingertip (p1) and base (p4) and functional magnetic resonance imaging (fMRI) at 1.5mm isotropic spatial resolution. The Euclidian distances between p1 and p4 peak representations in Brodmann area 3b resulted in 5.0±0.7mm for the little finger and 6.7±0.5mm for the index finger. These non-collocated representations were found to be consistently ordered across subjects for the little but not the index finger. When using separate distances for medial–lateral, anterior–posterior, and inferior–superior orientations, p4 was 1.9±0.7mm medial to p1 for the little finger in agreement with findings in macaque monkeys, whereas no consistent intra-digit somatotopy across subjects was found for the index finger. This discrepancy could point to differences in the map-forming processes based on sensory input. On the behavioral level it may be attributed to our everyday use of the hand, for which p4 of the index finger plays a much less important role than p4 of the little finger, which is located at the outer border of the hand. [Copyright &y& Elsevier]

In radial fast spin-echo magnetic resonance imaging (MRI), a set of overlapping spokes with an inconsistent T2 weighting is acquired, which results in an averaged image contrast when employing conventional image reconstruction techniques. This work demonstrates that the problem may be overcome with the use of a dedicated reconstruction method that further allows for T2 quantification by extracting the embedded relaxation information. Thus, the proposed reconstruction method directly yields a spin-density and relaxivity map from only a single radial data set. The method is based on an inverse formulation of the problem and involves a modeling of the received MRI signal. Because the solution is found by numerical optimization, the approach exploits all data acquired. Further, it handles multicoil data and optionally allows for the incorporation of additional prior knowledge. Simulations and experimental results for a phantom and human brain in vivo demonstrate that the method yields spin-density and relaxivity maps that are neither affected by the typical artifacts from TE mixing, nor by streaking artifacts from the incomplete k-space coverage at individual echo times. [ABSTRACT FROM AUTHOR]

Abstract: Fine-scale functional organization of the finger areas in the human primary somatosensory cortex was investigated by high-resolution BOLD MRI at 3 T using a multi-echo FLASH sequence with a voxel size of 2 mm3. In six subjects independent tactile stimulation of the distal phalanx of the fingers of the right hand resulted in small circumscribed and barely overlapping activations precisely located along the posterior wall of the central sulcus. Three out of six subjects showed a complete succession of activation sites for all five fingers. The maps also allowed for the identification of individual variations in finger somatotopy. When registered onto the individual high-resolution MRI anatomy and compared with cytoarchitectonical maps, the finger representations were confirmed to lie within Brodmann area 3b as the main input region of the primary somatosensory cortex. [Copyright &y& Elsevier]

The finite sampling of k-space in MRI causes spurious image artifacts, known as Gibbs ringing, which result from signal truncation at the border of k-space. The effect is especially visible for acquisitions at low resolution and commonly reduced by filtering at the expense of image blurring. The present work demonstrates that the simple assumption of a piecewise-constant object can be exploited to extrapolate the data in k-space beyond the measured part. The method allows for a significant reduction of truncation artifacts without compromising resolution. The assumption translates into a total variation minimization problem, which can be solved with a nonlinear optimization algorithm. In the presence of substantial noise, a modified approach offers edge-preserving denoising by allowing for slight deviations from the measured data in addition to supplementing data. The effectiveness of these methods is demonstrated with simulations as well as experimental data for a phantom and human brain in vivo. [ABSTRACT FROM AUTHOR]

Abstract: Variations of a subject''s vigilance may pose a severe confound during functional brain mapping. Here, we focused on BOLD MRI responses to eyes opening and closing in complete darkness and the associated changes in the EEG''s alpha frequency band (Berger''s effect) as a possible approach to this problem. In awake subjects, BOLD MRI activation patterns were positively correlated to eyes opening and negatively to alpha power. In contrast, activation patterns of subjects with diminished wakefulness as determined by alpha band analysis were negatively correlated to eyes opening. We conclude that a control of the subjects'' state of wakefulness must be of prime concern for functional MRI, especially for paradigms which allow for a free shift of vigilance. [Copyright &y& Elsevier]

Abstract: While the advantages of parallel acquisition techniques for echo-planar imaging (EPI) are well documented for studies affected by magnetic field inhomogeneities, this work focuses on the costs in functional MRI of brain regions without artifacts due to susceptibility effects. For a visual stimulation paradigm and relative to conventional EPI (2.9 T; TR/TE=2000/36 ms), the use of parallel acquisition at a reduction factor of 2 decreased the mean number of activated voxels by 21% at 2×2×2-mm3 resolution (n=6) and by 15% at 3×3×3-mm3 resolution (n=6). The loss of sensitivity reflects both a decreased signal-to-noise ratio of the native images due to a lower number of contributing gradient echoes and a decreased BOLD MRI sensitivity due to the coverage of a smaller range of TEs. [Copyright &y& Elsevier]

Participation of the primary motor cortex (M1) in motor imagery was addressed using functional magnetic resonance imaging at 2.0 T and 2×2×4 mm3 resolution in six right-handed subjects. Paradigms comprised visually cued execution and imagination of a sequential finger-to-thumb opposition task (12 s) contrasted with motor rest and visual imagery (18 s), respectively. Motor execution activated M1 as well as other parts of the motor system including supplementary motor area (SMA) and premotor areas (PM). In contrast, motor imagery did not lead to activations in M1 except for 1/6 subjects but involved SMA and PM bilaterally as well as the anterior intraparietal cortex. Moreover, a region-of-interest analysis revealed a weak initial MRI signal increase in M1 in 4/6 subjects. This novel finding of a transient response reflecting the onset of imagination which does not lead to sustained M1 activation may explain previous contradictory reports. [Copyright &y& Elsevier]

New experimental and clinical findings question the historic view of hydrocephalus and its 100-year-old classification. In particular, real-time magnetic resonance imaging (MRI) evaluation of cerebrospinal fluid (CSF) flow and detailed insights into brain water regulation on the molecular scale indicate the existence of at least three main mechanisms that determine the dynamics of neurofluids: (1) inspiration is a major driving force; (2) adequate filling of brain ventricles by balanced CSF upsurge is sensed by cilia; and (3) the perivascular glial network connects the ependymal surface to the pericapillary Virchow–Robin spaces. Hitherto, these aspects have not been considered a common physiologic framework, improving knowledge and therapy for severe disorders of normal-pressure and posthemorrhagic hydrocephalus, spontaneous intracranial hypotension, and spaceflight disease. [ABSTRACT FROM AUTHOR]

Background: Conventional MRI sequences are often affected in neuropediatric imaging by unavoidable movements. Therefore, children younger than 6 years usually have to be examined under sedation/anesthesia. A new real-time MRI technique with automatic slice advancement allows for motion-robust T2-weighted volume coverage of the whole brain within a few seconds in adults. Objective: To evaluate to which extent the new volume coverage method can be used to visualize cerebrospinal fluid and reduce the need for anesthesia in children. Materials and methods: We assessed 30 children ages 6 years and younger with suspected or proven hydrocephalus, hygroma or macrocephalus using volume coverage sequences with 20 slices per second in three planes. If necessary, a parent was placed in the bore together with the child for calming and gentle immobilization. We compared visualization of cerebrospinal fluid spaces and course of the shunt catheter in volume coverage sequences vs. fast spin-echo sequences. Results: The clinical issue could be sufficiently assessed in all children with use of volume coverage sequences, whereas conventional fast spin-echo sequences performed moderately to poorly. Visualization of the tip of a shunt failed in 16% of volume coverage scans and 27% of turbo spin-echo scans. A subsequent examination under anesthesia was never necessary. None of the examinations had to be stopped prematurely. Conclusion: The motion-robust volume coverage sequences with T2-type contrast can be used to avoid sedation of children in the evaluation of cerebrospinal fluid spaces, even in the presence of vigorous motion. For other indications and contrasts, the technique must still be evaluated. [ABSTRACT FROM AUTHOR]

Purpose: To assess the diagnostic potential of real-time MRI for assessment of hiatal hernias in patients with GERD-like symptoms compared to endoscopy.Material and Methods: One hundred eight patients with GERD-like symptoms were included in this observational cohort study between 2015 and 2017. Real-time MRI was performed at 3.0 Tesla with temporal resolution of 40 ms, dynamically visualizing the esophageal transport of a pineapple juice bolus, its passage through the gastroesophageal junction, and functional responses during Valsalva maneuver. Hernia detection on MRI and endoscopy was calculated using contingency tables with diagnosis of hernia on either modality as reference.Results: Of 108 patients, 107 underwent successful MRI without adverse events; 1 examination was aborted to inability to swallow pineapple juice in supine position. No perforation or acute bleeding occurred during endoscopy. Median examination time was 15 min. Eighty-five patients (79.4%) were diagnosed with hiatal hernia on either real-time MRI or endoscopy. Forty-six hernias were visible on both modalities. Seventeen hernias were evident exclusively on MRI, and 22 exclusively on endoscopy. Sixteen of the 63 MRI-detected hernias (25.4%) were detectable only during Valsalva maneuver, which were smaller compared to hernias at rest (median - 13.5 vs - 33.0 mm, p < 0.001). Diagnostic accuracy for hernia detection was comparable for MRI and endoscopy (sensitivity 74% vs 80%, p = 0.4223; specificity 100% vs 100%, p > 0.99).Conclusion: Real-time MRI is a fast and safe modality for assessment of the gastroesophageal junction, without radiation exposure or administration of gadolinium-based contrast media. Although MRI and endoscopy yield comparable diagnostic accuracy, dynamic MRI sequences are able to visualize hiatal hernias that were occult on static MRI sequences or endoscopy in a relevant number of cases.Key Points: • Real-time MRI is a safe and fast imaging modality for examination of the gastroesophageal junction, combining anatomical and functional information for enhanced detection of hiatal hernias. • Real-time MRI and endoscopy yield comparably high diagnostic accuracy: real-time MRI visualizes hiatal hernias that were occult on endoscopy in a relevant number of patients; however, several hiatal hernias detected on endoscopy were occult on real-time MRI. • There is clinical potential of real-time MR imaging in patients with GERD-like symptoms and equivocal findings on endoscopy or pH-metry, for anatomical visualization in patients planned for surgical intervention, or those with suspected fundoplication failures. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to propose and evaluate a slice‐to‐volume registration (SVR) method integrating an advanced dual‐slice real‐time magnetic resonance image (MRI) and three‐dimensional (3D) MRI volume of the tibiofemoral joint for determining their 3D kinematics. Methods: The real‐time and 3D MRI of the knee were collected from 12 healthy adults at 5 static flexion positions and during dynamic flexion/extension movement. The 3D positions and orientations of the femur and tibia were obtained by registering their volumetric models constructed from the 3D MRI to dual‐slice real‐time MRI using an optimization process. The proposed method was quantitatively evaluated for its performance in terms of the robustness and measurement accuracy, and compared to those of a single‐slice SVR method. Its repeatability in measuring knee kinematics during flexion/extension movement was also determined. Results: In comparison to the single‐slice SVR method, the dual‐slice method was significantly superior, giving a successful registration rate > 95%, a bias less than 0.5 mm in translations and 0.6° in rotations and a precision <0.7 mm in translations and 0.9° in rotations for determining the 3D tibiofemoral poses. For repeatability of the dual‐slice SVR in measuring tibiofemoral kinematics during dynamic flexion/extension, the means of the time‐averaged standard deviations were <0.9° for joint angles and 0.5 mm for joint translations. Conclusion: A dual‐slice SVR method in conjunction with real‐time MRI has been developed and evaluated for its performance in measuring 3D kinematics of the tibiofemoral joint in 12 young adults in terms of the accuracy, robustness, and repeatability. The proposed MRI‐based 3D measurement method provides a noninvasive and ionizing radiation‐free approach for 3D kinematic measurement of the tibiofemoral joint, which will be helpful for future academic and clinical applications. [ABSTRACT FROM AUTHOR]

Purpose: To assess the diagnostic potential of dynamic real-time MRI for fundoplication failure in patients with persistent or recurrent GERD-like (gastroesophageal reflux disease) complaints.Material and Methods: Twenty-two consecutive patients (male n = 11; female n = 11; median age 59 years) with recurrent or persistent GERD-like symptom after fundoplication were enrolled between 2015 and 2017. Median duration of GERD-like symptoms was 21 months. Real-time MRI (3 Tesla) was performed at 40 ms temporal resolution using undersampled radial fast low-angle shot acquisitions with nonlinear inverse image reconstruction. MRI movies dynamically visualized bolus transit of pineapple juice through the gastroesophageal junction, position of the fundoplication wrap and recurring hernia or reflux during Valsalva maneuver. MRI results were compared to endoscopic findings.Results: Real-time MRI was successfully completed in all patients without adverse events (average examination time 15 min). Morphological correlates for GERD-like symptoms were evident in 20 patients (90.1%) with gastric reflux in 19 cases. Nine patients (40.1%) had wrap disruption and recurrent gastric hernia. Wrap migration or telescoping hernia was detected in nine patients (40.1%). One patient presented with continued reflux despite intact fundoplication wrap. Esophageal dysmotility with delayed bolus passage was observed in one case. On endoscopy, gastric hernia or wrap disruption was diagnosed in seven cases, and esophagitis or Barret's metaplasia in nine cases.Conclusion: Real-time MRI is a fast and safe modality for dynamic imaging after fundoplication, without radiation exposure or administration of gadolinium-based contrast media. In a relevant number of cases, real-time MRI reveals correlates for GERD-like symptoms.Key Points: • Real-time MRI reliably visualizes the gastroesophageal junction after fundoplication surgery. • Patients with recurring GERD-like symptoms have a high rate of morphological failure patterns that can be identified by real-time MRI. • Dynamic assessment of gastroesophageal junction by real-time MRI is a perspective diagnostic tool for detection of fundoplication failure. [ABSTRACT FROM AUTHOR]

Noradrenaline is a neurotransmitter involved in general arousal, selective attention, memory, inflammation, and neurodegeneration. The purpose of this work was to delineate noradrenergic neurons in vivo by T1-weighted MRI with magnetization transfer (MT). In the brainstem of human and mice, MRI identified the locus coeruleus, dorsal motor vagus nucleus, and nucleus tractus solitarius. Given (1) the long T1 and low magnetization transfer ratio for the noradrenergic cell groups compared to other gray matter, (2) significant correlation between MT MRI signal intensity and proton density, and (3) no correlation between magnetization transfer ratio (or R1) and iron, copper, or manganese in human brain, the high MRI signal of the noradrenergic neurons must be attributed to abundant water protons interacting with any T1-shortening paramagnetic ions in active cells rather than to specific T1-shortening molecules. The absence of a high MRI signal from the locus coeruleus of Ear2(−/−) mice lacking noradrenergic neurons confirms that cell bodies of noradrenergic neurons are the source of the bright MRI appearance. The observation of this high signal in DBH(−/−) mice, in 3-week-old mice, and in mice under hyperoxia/hypercapnia/hypoxia together with the general absence of neuromelanin (NM) in noradrenergic neurons of young rodents further excludes that it is due to NM, dopamine β-hydroxylase, their binding to paramagnetic ions, blood inflow, or hemoglobin. Instead, these findings indicate a high density of water protons whose T1 is shortened by paramagnetic ions as the relevant source of the high MRI signal. In the brain of APP/PS1/Ear2(−/−) mice, a transgenic model of Alzheimer's disease, MRI detected noradrenergic neuron loss in the locus coeruleus. Proton magnetic resonance spectroscopy revealed that a 60–75% reduction of noradrenaline is responsible for a reduction of N-acetylaspartate and glutamate in the hippocampus as well as for a shortening of the water proton T2 in the frontal cortex. These results suggest that a concurrent shortage of noradrenaline in Alzheimer's disease accelerates pathologic processes such as inflammation and neuron loss. [ABSTRACT FROM AUTHOR]