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Purpose A prototype wireless guidance device using single sideband amplitude modulation (SSB) is presented for a 1.5T magnetic resonance imaging system. Methods The device contained three fiducial markers each mounted to an independent receiver coil equipped with wireless SSB technology. Acquiring orthogonal projections of these markers determined the position and orientation of the device, which was used to define the scan plane for a subsequent image acquisition. Device localization and scan plane update required approximately 30 ms, so it could be interleaved with high temporal resolution imaging. Since the wireless device is used for localization and does not require full imaging capability, the design of the SSB wireless system was simplified by allowing an asynchronous clock between the transmitter and receiver. Results When coupled to a high readout bandwidth, the error caused by the lack of a shared frequency reference was quantified to be less than one pixel (0.78 mm) in the projection acquisitions. Image guidance with the prototype was demonstrated with a phantom where a needle was successfully guided to a target and contrast was delivered. Conclusion The feasibility of active tracking with a wireless detector array is demonstrated. Wireless arrays could be incorporated into devices to assist in image-guided procedures. Magn Reson Med 71:2243–2249, 2014. © 2013 Wiley Periodicals, Inc.

Magnetic resonance is an exceptionally powerful and versatile measurement technique. The basic structure of a magnetic resonance experiment has remained largely unchanged for almost 50 years, being mainly restricted to the qualitative probing of only a limited set of the properties that can in principle be accessed by this technique. Here we introduce an approach to data acquisition, post-processing and visualization—which we term ‘magnetic resonance fingerprinting’ (MRF)—that permits the simultaneous non-invasive quantification of multiple important properties of a material or tissue. MRF thus provides an alternative way to quantitatively detect and analyse complex changes that can represent physical alterations of a substance or early indicators of disease. MRF can also be used to identify the presence of a specific target material or tissue, which will increase the sensitivity, specificity and speed of a magnetic resonance study, and potentially lead to new diagnostic testing methodologies. When paired with an appropriate pattern-recognition algorithm, MRF inherently suppresses measurement errors and can thus improve measurement accuracy. A new approach to magnetic resonance, ‘magnetic resonance fingerprinting', is reported, which combines a data acquisition scheme with a pattern-recognition algorithm that looks for the ‘fingerprints’ of interest within the data. Although nuclear magnetic resonance is a powerful analytical tool for many scientific and medical disciplines, usually only a fraction of its potential power is harnessed. Most implementations are qualitative, and restricted in the range of properties that are probed. Dan Ma and colleagues introduce a new approach — termed magnetic resonance fingerprinting — aimed at greatly enhancing the amount of quantitative information that can be obtained in one measurement. Their approach combines a data-acquisition scheme that is indiscriminate in the material properties that it probes with pattern-recognition algorithms that look for the 'fingerprints' of interest within the data. Magnetic resonance fingerprinting has the potential to detect and analyse early indicators of disease or complex changes in materials, as well as increasing the sensitivity, specificity and speed of magnetic resonance studies.

Systems, methods, and other embodiments associated with RE-TOSSI are described. One system embodiment includes an MRI apparatus configured to produce a RE-TOSSI pulse sequence and to acquire T2-weighted images in response to the RE-TOSSI pulse sequence. An example RE-TOSSI pulse sequence includes a TOSSI portion and a non-inverting, non-TOSSI portion.

Previous work has shown that the use of radial GRAPPA for the reconstruction of undersampled real-time free-breathing cardiac data allows for frame rates of up to 30 images / s. It is well known that the spiral trajectory offers a higher scan efficiency compared to radial trajectories. For this reason, we have developed a novel through-time spiral GRAPPA method and demonstrate its application to real-time cardiac imaging. By moving from the radial trajectory to the spiral trajectory, the temporal resolution can be further improved at lower acceleration factors compared to radial GRAPPA. In addition, the image quality is improved compared to those generated using the radial trajectory due to the lower acceleration factor. Here we show that 2D frame rates of up to 56 images / s can be achieved using this parallel imaging method with the spiral trajectory.

Multislice parallel imaging involves the simultaneous sampling of multiple parallel slices which are subsequently separated using parallel imaging reconstruction. The CAIPIRINHA technique improves this reconstruction by manipulating the phase of the RF excitation pulses to shift the aliasing pattern such that there is less aliasing energy to be reconstructed. In this work, it is shown that combining the phase manipulation used in CAIPIRINHA with a non-Cartesian (radial) sampling scheme further decreases the aliasing energy for the parallel imaging algorithm to reconstruct, thereby further increasing the degree to which a multi-channel receiver array can be utilized for parallel imaging acceleration. In radial CAIPIRINHA, individual bands (slices) in a multislice excitation are modulated with view-dependent phase, causing a destructive interference of entire slices. This destructive interference leads to a reduction in aliasing compared to the coherent shifts one observes when using this same technique with a Cartesian trajectory. Recovery of each individual slice is possible because the applied phase pattern is known, and a conjugate-gradient reconstruction algorithm minimizes the contributions from other slices. Results are presented with a standard 12-channel head coil with acceleration factors up to 14, where radial CAIPIRINHA produces an improved reconstruction when compared with Cartesian CAIPIRINHA.

PURPOSE To describe a new method for performing dark blood (DB) magnetization preparation in TrueFISP (bSSFP) and apply the technique to high-resolution carotid artery imaging. MATERIALS AND METHODS The developed method (HEFEWEIZEN) provides directional flow suppression, while preserving bSSFP contrast, by periodically applying spatial saturation in short repetition time (TR) TrueFISP. Steady-state free precession (SSFP) conditions are maintained throughout the acquisition for the imaging slice magnetization. HEFEWEIZEN was implemented on a 1.5 T scanner with standard receiver coils. Studies were performed in phantoms, eight asymptomatic volunteers, and two patients with low- and high-grade carotid artery stenosis. RESULTS Average flow suppression was 88% +/- 4% (arterial) and 85% +/- 3% (venous) in a multislice study. Stationary signal, contrast, and fine details were maintained with only slight signal suppression (11% +/- 11%). Comparison to diffusion-prepared SSFP in the common carotid artery demonstrated significant improvement in wall-lumen contrast-to-noise ratio efficiency (P = 0.024). DB contrast was achieved with only 13% increased acquisition time (14.3 sec). Further acceleration was possible by confining the DB preparation to the central 60% of k-space. CONCLUSION A fast, short TR, DB TrueFISP pulse sequence was developed and tested in the carotid arteries of asymptomatic volunteers and patients.

Rationale and Objectives The aim of this study was to investigate whether a respiratory biofeedback system could increase navigator efficiency and maintain image quality compared to conventional respiratory-gated magnetic resonance coronary angiography (MRCA). Materials and Methods Eighteen healthy volunteers underwent MRCA using three different respiratory-gating protocols. A conventional expiratory free-breathing (FB) sequence was compared to two approaches using navigator echo biofeedback (NEB), a midinspiratory approach (NEBin) and an expiratory approach (NEBex). Navigator data reflecting the position of the diaphragm relative to a 3-mm gating window were made available to the subject using a video projector in combination with a Plexiglas screen and mirror goggles. Image quality was graded by two radiologists in consensus using a visual score ranging from 1 (not visible) to 4 (excellent vessel depiction). Results The NEB approaches improved navigator efficiency (71.1% with NEBex and 68.0% with NEBin vs 42.2% with FB), thus reducing total imaging time. This difference was statistically significant (PNEBin = .007; PNEBex = .001). Image quality in the NEBex group was comparable to that in the FB group (median score, 2.44 vs 2.52), but it proved to be significantly lower (median score, 1.94 vs 2.52) for the right coronary artery and the left anterior descending coronary artery in the NEBin group. Conclusion NEB maintains image quality and significantly increases navigator efficiency, thereby decreasing total imaging time by about 40% compared to a conventional FB acquisition strategy.

The use of MRI for intervention and real-time imaging has seen many changes since its inception in the late 1980s. Initial interventional MRI researchers made great strides in building this new specialty, creating devices, sequences, and applications to push the field forward. More recently, researchers have gained more access to the systems themselves, and have taken advantage of this situation to create truly interactive interventional systems. Techniques such as fully interactive scan adjustments and device tracking can be accomplished in real time due to increased transparency between vendors and researchers. Additionally, pulse sequences have undergone an evolution as well, with the constant emergence of novel acquisition schemes to generate image contrast quickly, increase temporal resolution and cover k-space with nonrectilinear trajectories. We will look at both emerging system interface concepts and novel pulse sequences that we believe will continue to push innovation in the field of interventional MRI.

Purpose In radial imaging, projections may become “miscentered” due to gradient errors such as delays and eddy currents. These errors may result in image artifacts and can disrupt the reliability of direct current (DC) navigation. The proposed parallel imaging–based technique retrospectively estimates trajectory error from miscentered radial data without extra acquisitions, hardware, or sequence modification. Theory and Methods After phase correction, self-calibrated GRAPPA operator gridding (GROG) weights are iteratively applied to shift-miscentered projections toward the center of k-space. A search algorithm identifies the shift that aligns the peak k-space signals by maximizing the sum-of-squares DC signal estimate of each projection. The algorithm returns a trajectory estimate and a corrected radial k-space signal. Results Data from a spherical phantom, the head, and the heart demonstrate that image reconstruction with the estimated trajectory restores image quality and reduces artifacts such as streaks and signal voids. The DC signal level is increased and variability is reduced. Conclusion Retrospective phase correction and iterative application of GROG can be used to successfully estimate the trajectory error in two-dimensional radial acquisitions for improved image reconstruction without requiring extra data acquisition or sequence modification. Magn Reson Med, 2015. © 2015 Wiley Periodicals, Inc.

The objective of our study was to evaluate intraoperative low-field MRI for the frequency and duration of imaging sessions needed during surgery, the direct additional procedure time attributable to imaging, and the proportion of cases in which information provided by intraoperative MRI led to a change in the procedure or otherwise was deemed valuable by operating surgeons.One hundred twenty-two patients (65 males, 57 females; age range, 6-77 years; mean age, 43.8 years) underwent 130 neurosurgical and ENT procedures (106 craniotomies, 17 transsphenoidal pituitary resections, three biopsies, three intracranial cyst aspirations or injections, and one skull base resection) in a specially designed surgical MRI suite equipped with a 0.2-T imager and a prototype rotating, tiltable surgical table. The intraoperative MR sequences included free induction with steady-state precession (fast imaging with steady-state precession [FISP]), steady-state free precession T2-weighted, reverse fast imaging with steady-state free precession (PSIF), FLASH, spin-echo T1-weighted, turbo spin-echo (TSE) T2-weighted, and TSE FLAIR. Each case was analyzed for the number of imaging sessions, duration of each session, total imaging time during surgery, and impact of imaging information on procedure.Each patient underwent between one and five intraor postoperative imaging sessions. Imaging times were 1.7 seconds-8 minutes 31 seconds per sequence. The mean total imaging time was 35 minutes 17 seconds per surgical procedure. Imaging was continuous during biopsy and cyst aspiration procedures and averaged 200.67 and 54.66 minutes, respectively. Additional surgical resection based on intraoperative imaging findings was performed in 72.8% of the cases.Intraoperative low-field MRI provides valuable information for surgical decision making that is predominantly related to detection of residual tumor and the exclusion of complications. The benefits of this technology surpass the time cost associated with its implementation when using proper imaging strategies.

Purpose: We used inflammatory breast cancer (IBC) as a model disease to investigate biological changes associated with an antiangiogenesis agent, SU5416, combined with doxorubicin. Experimental Design: Patients with stage IIIB or IV IBC were treated neoadjuvantly with the combination of SU5416 and doxorubicin for induction therapy. The dose of SU5416 (administered on days 1 and 4, every 3 weeks) and doxorubicin (administered on day 1 every 3 weeks) were escalated in cohorts of three patients starting at 110 and 60 mg/m2, respectively, for a total of five cycles leading up to mastectomy. Patients underwent serial assessment (pharmacokinetic sampling, biopsy of breast, tumor blood flow dynamic contrast-enhanced magnetic resonance imaging, plasma angiogenesis, and endothelial cell damage markers) prior to treatment, at the end of cycles no. 2 and no. 5, and after mastectomy. Results: Eighteen patients were enrolled; neutropenia was dose-limiting, and overall median survival was not reached (50 months of study follow-up). Four patients (22%) experienced congestive heart failure, which resolved and were likely attributable to a smaller volume of distribution and higher Cmax of doxorubicin in combination with SU5416. We did observe a significant decline in tumor blood flow using Kep calculated by Brix (pretreatment versus post-cycle no. 5; P = 0.033), trend for a decline in tumor microvessel density after treatment, and low baseline levels of soluble intracellular adhesion molecule were associated with improved event-free survival. Conclusions: This study showed evidence of an unfavorable cardiac interaction between SU5416 and doxorubicin, which prohibits further investigation of this combination. However, this study supports the importance of using IBC as a model for investigating angiogenesis inhibitors.

Purpose To monitor and predict tissue temperature distributions and lesion boundaries during thermal ablation by combining MRI and thermal modeling methods. Materials and Methods Radiofrequency (RF) ablation was conducted in the paraspinal muscles of rabbits with MRI monitoring. A gradient-recalled echo (GRE) sequence via a 1.5T MRI system provided tissue temperature distribution from the phase images and lesion progression from changes in magnitude images. Post-ablation GRE estimates of lesion size were compared with post-ablation T2-weighted turbo-spin-echo (TSE) images and hematoxylin and eosin (H&E)-stained histological slices. A three-dimensional (3D) thermal model was used to simulate and predict tissue temperature and lesion size dynamics. Results The lesion area estimated from repeated GRE images remained constant during the post-heating period when the temperature of the lesion boundary was less than a critical temperature. The final lesion areas estimated from multi-slice (M/S) GRE, TSE, and histological slices were not statistically different. The model-simulated tissue temperature distribution and lesion area closely corresponded to the GRE-based MR measurements throughout the imaging experiment. Conclusion For normal tissue in vivo, the dynamics of tissue temperature distribution and lesion size during RF thermal ablation can be 1) monitored with GRE phase and magnitude images, and 2) simulated for prediction with a thermal model. J. Magn. Reson. Imaging 2007;26:123–132. © 2007 Wiley-Liss, Inc.

Purpose To investigate and evaluate a new rapid dark-blood vessel-wall imaging method using random bipolar gradients with a radial steady-state free precession (SSFP) acquisition in carotid applications. Materials and Methods The carotid artery bifurcations of four asymptomatic volunteers (28–37 years old, mean age = 31 years) were included in this study. Dark-blood contrast was achieved through the use of random bipolar gradients applied prior to the signal acquisition of each radial projection in a balanced SSFP acquisition. The resulting phase variation for moving spins established significant destructive interference in the low-frequency region of k-space. This phase variation resulted in a net nulling of the signal from flowing spins, while the bipolar gradients had a minimal effect on the static spins. The net effect was that the regular SSFP signal amplitude (SA) in stationary tissues was preserved while dark-blood contrast was achieved for moving spins. In this implementation, application of the random bipolar gradient pulses along all three spatial directions nulled the signal from both in-plane and through-plane flow in phantom and in vivo studies. Results In vivo imaging trials confirmed that dark-blood contrast can be achieved with the radial random bipolar SSFP method, thereby substantially reversing the vessel-to-lumen contrast-to-noise ratio (CNR) of a conventional rectilinear SSFP “bright-blood” acquisition from bright blood to dark blood with only a modest increase in TR (∼4 msec) to accommodate the additional bipolar gradients. Conclusion Overall, this sequence offers a simple and effective dark-blood contrast mechanism for high-SNR SSFP acquisitions in vessel wall imaging within a short acquisition time. J. Magn. Reson. Imaging 2007;25:1299–1304. © 2007 Wiley-Liss, Inc.

Purpose To test the hypothesis that cardiac and coronary catheterization can be successfully performed under real-time MR guidance using a conventional x-ray angiographic catheter. Materials and Methods Cardiac and coronary catheterization was conducted on eight farm pigs using a real-time True FISP sequence. A pigtail catheter was used for both left- and right-heart catheterizations performed on all eight animals, while an Amplatz or Judkins catheter was used for the right coronary catheterization that was attempted on five animals. The intravascular devices were visualized by means of their native susceptibility artifacts. For right coronary artery catheterizations, 25% diluted gadolinium (Gd) contrast material was injected to confirm engagement of the right coronary artery. Results Cardiac catheterization of both the right- and left-heart chambers was successfully performed in all eight pigs. In addition, right coronary catheterization was successfully completed in four of the five pigs in which it was attempted. The procedure time for cardiac catheterization was one minute, while the time range required for coronary catheterization was 32–91 minutes. Conclusion This work demonstrates that MRI-guided cardiac catheterization using conventional X-ray angiographic catheters is feasible; however, coronary catheterization with this passive-tracking technique is limited. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc.

Purpose To demonstrate the ability of a unique interventional MR system to be used safely and effectively as the only imaging modality for all phases of MR-guided stent-supported angioplasty. Materials and Methods An experimental disease model of renal stenosis was created in six pigs. An interventional MR system, which employed previously reported tools for real-time catheter tracking with automated scan-plane positioning, adaptive image parameters, and radial true–FISP imaging with steady-state precession (True-FISP) imaging coupled with a high-speed reconstruction technique, was then used to guide all phases of the intervention, including: guidewire and catheter insertion, stent deployment, and confirmation of therapeutic success. Pre- and postprocedural X-ray imaging was used as a gold standard to validate the experimental results. Results All of the stent-supported angioplasty interventions were a technical success and were performed without complications. The average postoperative residual stenosis was 14.9%. The image guidance enabled the stents to be deployed with an accuracy of 0.98 ± 0.69 mm. Additionally, using this interventional MRI system to guide renal artery stenting significantly reduces the procedure time, as compared to using X-ray fluoroscopy. Conclusion This study has clearly demonstrated the first successful treatment of renal artery stenting in an experimental animal model solely under MRI guidance and monitoring. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc.

We are investigating imaging techniques to study the tumor response to photodynamic therapy (PDT). Positron emission tomography (PET) can provide physiological and functional information. High-resolution magnetic resonance imaging (MRI) can provide anatomical and morphological changes. Image registration can combine MRI and PET images for improved tumor monitoring. In this study, we acquired high-resolution MRI and microPET 18F-fluorodeoxyglucose (FDG) images from C3H mice with RIF-1 tumors that were treated with Pc 4-based PDT. We developed two registration methods for this application. For registration of the whole mouse body, we used an automatic three-dimensional, normalized mutual information algorithm. For tumor registration, we developed a finite element model (FEM)-based deformable registration scheme. To assess the quality of whole body registration, we performed slice-by-slice review of both image volumes; manually segmented feature organs, such as the left and right kidneys and the bladder, in each slice; and computed the distance between corresponding centroids. Over 40 volume registration experiments were performed with MRI and microPET images. The distance between corresponding centroids of organs was 1.5 +/- 0.4 mm which is about 2 pixels of microPET images. The mean volume overlap ratios for tumors were 94.7% and 86.3% for the deformable and rigid registration methods, respectively. Registration of high-resolution MRI and microPET images combines anatomical and functional information of the tumors and provides a useful tool for evaluating photodynamic therapy.

To evaluate an augmented reality (AR) system in combination with a 1.5-T closed-bore magnetic resonance (MR) imager as a navigation tool for needle biopsies.The experimental protocol had institutional animal care and use committee approval. Seventy biopsies were performed in phantoms by using 20 tube targets, each with a diameter of 6 mm, and 50 virtual targets. The position of the needle tip in AR and MR space was compared in multiple imaging planes, and virtual and real needle tip localization errors were calculated. Ten AR-guided biopsies were performed in three pigs, and the duration of each procedure was determined. After successful puncture, the distance to the target was measured on MR images. The confidence limits for the achieved in-plane hit rate and for lateral deviation were calculated. A repeated measures analysis of variance was used to determine whether the placement error in a particular dimension (x, y, or z) differed from the others.For the 50 virtual targets, a mean error of 1.1 mm +/- 0.5 (standard deviation) was calculated. A repeated measures analysis of variance indicated no statistically significant difference (P.99) in the errors in any particular orientation. For the real targets, all punctures were inside the 6-mm-diameter tube in the transverse plane. The needle depth was within the target plane in 11 biopsy procedures; the mean distance to the center of the target was 2.55 mm (95% confidence interval: 1.77 mm, 3.34 mm). For nine biopsy procedures, the needle tip was outside the target plane, with a mean distance to the edge of the target plane of 1.5 mm (range, 0.07-3.46 mm). In the animal experiments, the puncture was successful in all 10 cases, with a mean target-needle distance of 9.6 mm +/- 4.85. The average procedure time was 18 minutes per puncture.Biopsy procedures performed with a combination of a closed-bore MR system and an AR system are feasible and accurate.

The goal of this study was to evaluate the use of super paramagnetic particles of iron oxide (SPIO) as a dark blood contrast agent, in combination with a bright blood steady-state free precession sequence for magnetic resonance angiography (MRA), in an animal model. The original concentration of the SPIO of 500 mmol Fe/l and dilutions to 250, 125, 60, 30, 10 and 5 mmol Fe/l were intra-arterially injected into the aorta of a pig. Then the dilution of 10 mmol Fe/l was chosen for repeated intra-arterial injections into two pigs. During these intra-arterial SPIO injections MR images were acquired with a 1.5 T scanner. Signal intensity measurements were performed in the aorta. The signal-to-noise ratio during SPIO bolus passage was significantly less than during baseline conditions (Fisher's F-ratio 159.8, p

Rationale and Objectives The purpose of this study is to compare the feasibility and precision of renal artery angioplasty and stent placement using two different MR scanners. Materials and Methods MR imaging-guided angioplasty and stent placements were performed on seven pigs using 0.2 and 1.5 T scanners (Magnetom Open and Magnetom Sonata, Siemens Medical Solutions, Erlangen, Germany). For guidance of catheters, guide wires and stents susceptibility artifact-based tracking was used. The end point of each intervention was to position a stent in the renal artery with its proximal end at the level of the aortic wall. Procedure time and stent position were evaluated. Results Catheterization, angioplasty, and stent placement were feasible using MRI guidance at both 0.2 and 1,5 Tesla. At 1.5 T all catheter manipulations and interventions were performed in less than 30 minutes. At 0.2 T the interventions took up to 90 minutes. No significant difference in the stent deviation was noted between the two scanners. Conclusion The use of a high-performance 1.5 T scanner helped to reduce the procedure time to half of that of a low-field system. Since no difference in stent placement precision was noted, a dedicated MR-stent might be mandatory for more precise stent placement.

The motivations for developing MR-guided minimally invasive therapy include its excellent soft tissue contrast, tomographic imaging in any direction (as opposed to projection imaging as in fluoroscopy), the absence of ionizing radiation,the abundance of contrast mechanisms (including bright blood pulse sequences that lead to excellent vessel conspicuity without exogenous contrast agent injection), the ability to obtain physiologic information such as perfusion, and an overall excellent safety profile. The main pulse sequences used today for interventional MR imaging are T1/T2-weighted FISP and TrueFISP, T2-weighted turbo spin-echo, and T1-weighted FLASH. The specific clinical question, the underlying pathophysiology,and the procedure to be performed dictate which sequence is used. Each of these sequences has been written to acquire data in conventional rectilinear trajectories, radial k-space paths, or even spirals. In many ways, the questions being researched in interventional MR imaging have been dictated by the primary issues in greatest need of resolution or that most directly facilitate new clinical development. A decade ago, research focused on exploration of new scan strategies for contrast and temporal resolution. Advancements in the last decade have made it possible to acquire and display greater than 10 images per second in realtime with millimeter resolution in all three directions. This temporal and spatial resolution is considered high enough to guide most interventions. With this capability, other research has focused on instrument tracking. The field has gone from the capability to track a single coil and superimpose it on a previously acquired roadmap to systems that follow, adapt, and provide high-resolution images due to the advent of multichannel receiver systems, improved graphics, higher processor speeds, and increases in speed and quantity of memory. Hence, instruments can be reliably identified and tracked and the information can be used to update pulse sequence parameters in real time, thereby opening new opportunities for interventional MR imaging that extend from biopsy and thermal therapy to image-guided vascular and cardiac procedures. Today, we see such issues as RF heating of wires used for device localization and the noise generated by rapid switching of MR gradients being significant obstacles yet to overcome to allow the full strength of MR-guided interventions to be realized clinically. It is anticipated that these topics will emerge as critical concepts in the next decade of interventional MR imaging research.

Reliable visualization and tracking are essential for guiding endovascular devices within blood vessels. The most commonly used methods are susceptibility artifact-based tracking that relies on the artifact created within the image by the device and microcoil- or antenna-based tracking that uses the high signal generated by small MR endovascular receive coils when the transmit coil emits a nonselective radiofrequency pulse. To date, the use of endovascular MR guidance techniques has primarily been confined to animal experiments. There are only a few reports on MR-guided endovascular applications in patients. Therefore, access to the patient within the scanner, dedicated devices, and safety issues remain major challenges. To face these challenges, attention from all radiologists, especially interventional radiologists, is required to make MR-guided endovascular procedures a clinical reality.

Rationale and Objectives Three-dimensional (3D) nonrigid image registration for potential applications in prostate cancer treatment and interventional magnetic resonance (iMRI) imaging–guided therapies were investigated. Materials and Methods An almost fully automated 3D nonrigid registration algorithm using mutual information and a thin plate spline (TPS) transformation for MR images of the prostate and pelvis were created and evaluated. In the first step, an automatic rigid body registration with special features was used to capture the global transformation. In the second step, local feature points (FPs) were registered using mutual information. An operator entered only five FPs located at the prostate center, left and right hip joints, and left and right distal femurs. The program automatically determined and optimized other FPs at the external pelvic skin surface and along the femurs. More than 600 control points were used to establish a TPS transformation for deformation of the pelvic region and prostate. Ten volume pairs were acquired from three volunteers in the diagnostic (supine) and treatment positions (supine with legs raised). Results Various visualization techniques showed that warping rectified the significant pelvic misalignment by the rigid-body method. Gray-value measures of registration quality, including mutual information, correlation coefficient, and intensity difference, all improved with warping. The distance between prostate 3D centroids was 0.7 ± 0.2 mm after warping compared with 4.9 ± 3.4 mm with rigid-body registration. Conclusion Semiautomatic nonrigid registration works better than rigid-body registration when patient position is changed greatly between acquisitions. It could be a useful tool for many applications in the management of prostate.

Purpose To determine whether consistent regions of activity could be observed in the lumbar spinal cord of single subjects with spin-echo functional MRI (fMRI) if several repeated experiments were performed within a single imaging session. Materials and Methods Repeated fMRI experiments of the human lumbar spinal cord were performed at 1.5 T with a single-shot spin-echo technique (half-Fourier single-shot turbo spin-echo (HASTE)) as used by previous investigators, and a modified method (fluid-attenuated inversion recovery (FLAIR)-HASTE) that nulled the otherwise highly variable signal from the cerebrospinal fluid (CSF). Results FLAIR-HASTE reduced the variability of the signal in the CSF region to background levels, and presumably reduced associated artifacts in the spinal cord. Consistent areas of activation in the spinal cord in response to a thermal stimulus just below the knee were not observed across the fMRI experiments with either method. Conclusion FLAIR-HASTE was useful for removing artifact in the spinal cord signal induced by variability in the CSF signal. However, with the techniques used in this study, we were not able to confirm the presence of a consistent fMRI response in the lumbar spinal cord because of the signal enhancement by extravascular protons (SEEP) effect during thermal stimulation of the hindlimb. J. Magn. Reson. Imaging 2005;21:527–535. © 2005 Wiley-Liss, Inc.

The objective of our study was to assess physiologic lung deformation and compression originating from cardiovascular motion and their subsequent impact on determining the volume of small pulmonary nodules throughout the cardiac cycle on ECG-gated MDCT.Seventy-three small noncalcified pulmonary nodules were identified in 30 patients who underwent ECG-gated MDCT. The volume of each nodule was assessed throughout the cardiac cycle using computer-aided automatic segmentation algorithms, and the assessment was repeated three times. To ensure the validity of the subtle changes in volume that were detected, we determined the volume and signal attenuation in phantom data sets and patient nodules without temporal or spatial differentiation. Subsequently, nodules were assigned to pulmonary segments, and volume changes were correlated to cardiac phases, nodular location, and mean nodular size. Statistical multivariate tests were performed to evaluate significant patterns.The validity of significant measurements was proven in evaluated phantom data sets with a general tendency toward overestimating nodular volume (p = 0.492). Statistical evaluation of nodular signal attenuation confirmed true deformation and compression of nodules rather than partial volume effects as the reason for volume variations (p = 0.874). Differentiating pulmonary nodules in cardiac phases, pulmonary locations, and mean nodular volumes, we found that one single effect did not determine the amount of cardiovascular motion conveyed to pulmonary parenchyma and subsequently led to nodule deformation. Multivariate testing revealed statistically significant measures identifying patterns correlating variation in nodular volume with cardiac phase (p0.001), nodular location (p = 0.007), and mean nodular size (p0.001).Cardiovascular motion was disproportionately conveyed to various pulmonary segments and led to changes in the volume of pulmonary nodules, especially in small pulmonary nodules. A precise volumetric assessment was therefore possible only by identifying the underlying cardiac phase.

To perform a phase II clinical trial to evaluate efficacy and safety of interactive magnetic resonance (MR) imaging-guided radiofrequency (RF) interstitial thermal ablation (ITA) of primary renal tumors.Ten male patients (age range, 25-83 years) with peripheral renal cell carcinoma and contraindications to surgery were treated with percutaneous RF ITA entirely guided and monitored with a 0.2-T MR imaging unit. By using a 200-W RF ablation system and custom-fabricated MR imaging-compatible cool-tip electrodes, pulsed RF current was applied for single or multiple ablation cycle(s) of 12-15 minutes until the entire tumor was replaced by an enlarging zone of low signal intensity on T2-weighted and/or short inversion time inversion-recovery images acquired intermittently during the procedure. Kidney MR images were acquired before, immediately after, and 2 weeks after ablation and then every 3 months for 1 year and every 6 months thereafter. Intra- and postprocedural complications were assessed with clinical evaluation of patients for pain and hemodynamic instability and evaluation of MR images for evidence of hemorrhage or other unexpected findings. Follow-up images were assessed for delayed complications such as renal ischemia, infarct, urinoma, or tumor recurrence.Treated tumors ranged between 0.63 and 16.90 mL in volume and 1.0 and 3.6 cm in maximum diameter. Successful RF electrode insertion and/or repositioning into the renal mass was achieved in all cases with direct MR "fluoroscopic" guidance. Thirty ablation cycles were conducted at 21 electrode positions in the 10 procedures, and complete ablation, as defined with MR imaging, was achieved in all cases by the end of the procedure. Apart from two small self-limited perirenal hematomas, no intra- or postprocedural complications were observed. No delayed complications or tumor recurrence occurred during a mean follow-up period of 25 months +/- 9.4 (standard deviation).Although these results are preliminary, interactive MR imaging-guided RF ITA for treatment of primary renal tumors has a high success rate.

The purpose of this study was to assess the feasibility of MRI to guide and monitor radiofrequency ablation of normal pulmonary tissue in a rabbit model.Percutaneous puncture and lung radiofrequency ablation were performed in six New Zealand white rabbits under MRI control using a 0.2-T open MRI scanner. Technical feasibility and complication detection were evaluated. The ablation zone appearance and size were assessed using MRI, CT, and gross pathology. Interclass correlation coefficients (ICCs) of the maximum short-axis diameters of the lesions on gross pathology and the corresponding diameters as measured on each MRI pulse sequence and on CT scans were calculated.MRI guidance of percutaneous puncture and radiofrequency ablation of pulmonary tissue is feasible. A pneumothorax was detected and treated using MRI. In the specimen, the mean coagulation necrosis diameter was 9.8 mm. The T1-weighted spoiled gradient-echo fast low-angle shot images showed the highest ICC (0.81) for the thermal lesion diameter.Our results indicate that MRI guidance is feasible and useful for radiofrequency ablation of normal pulmonary tissue.

Rationale and objectives To compare the appropriate pulse sequences for interventional device guidance during magnetic resonance (MR) imaging at 0.2 T and to evaluate the dependence of sequence selection on the anatomic region of the procedure. Materials and methods Using a C-arm 0.2 T system, four interventional MR sequences were applied in 23 liver cases and during MR-guided neck interventions in 13 patients. The imaging protocol consisted of: multislice turbo spin echo (TSE) T 2 w, sequential-slice fast imaging with steady precession (FISP), a time-reversed version of FISP (PSIF), and FISP with balanced gradients in all spatial directions (True-FISP) sequences. Vessel conspicuity was rated and contrast-to-noise ratio (CNR) was calculated for each sequence and a differential receiver operating characteristic was performed. Results Liver findings were detected in 96% using the TSE sequence. PSIF, FISP, and True-FISP imaging showed lesions in 91%, 61%, and 65%, respectively. The TSE sequence offered the best CNR, followed by PSIF imaging. Differential receiver operating characteristic analysis also rated TSE and PSIF to be the superior sequences. Lesions in the head and neck were detected in all cases by TSE and FISP, in 92% using True-FISP, and in 84% using PSIF. True-FISP offered the best CNR, followed by TSE imaging. Vessels appeared bright on FISP and True-FISP imaging and dark on the other sequences. Conclusion In interventional MR imaging, no single sequence fits all purposes. Image guidance for interventional MR during liver procedures is best achieved by PSIF or TSE, whereas biopsies in the head and neck are best performed using FISP or True-FISP sequences.

PURPOSE To show the feasibility of acquiring homogenous 3-dimensional datasets with high temporal and spatial resolution from computed tomographic angiographic (CTA) scans of the lower extremities and to assess automated vessel-tracking techniques for vascular evaluation. METHODS Eighteen men (mean age 67.0 years, range 43-83) with aneurysmal or occlusive vascular diseases underwent contrast-enhanced CTA of the lower limb arteries utilizing a 16-row CT imager. Curved multiplanar reformations were generated by manual selection of vessel centerlines in the infrarenal aorta and the arterial vasculature in the pelvis, thigh, and calf based on volume-rendering techniques. For each vessel, opacification and depiction were quantitatively evaluated. The manually segmented images were compared to datasets processed with automated vessel-tracking strategies by 5 radiologists, who evaluated diagnostic reliability and image quality. A Differential Receiver Operating Characteristic (DROC) analysis was performed. RESULTS An increase in the temporal and spatial resolution led to acquisition of high quality CTA datasets. Significant homogeneity of the vascular contrast-to-noise ratios was achieved in the pelvic (coefficient of variance 1.5% to 10.1%), thigh (0.1% to 9.4%), and calf (3.3% to 19.2%) vessels. The assessment of vascular delineation revealed full-width-at-half-maximum contrast values of 96.4%, 95.5%, and 111.3% in the pelvis, thigh, and calf, respectively. Observers were not able to distinguish between manual and automated vascular segmentation, as represented by a 0.56 value for the area under the DROC curve. CONCLUSIONS High-resolution CTA lower extremity datasets were acquired successfully, presenting vascular signal intensities of high homogeneity suitable for automated vessel-tracking techniques. Automated 3D visualization tools produced reliable, reproducible, and time-efficient centerline extractions that were comparable to manually defined centerlines.

To compare three k-space sampling schemes in cine True-FISP cardiac magnetic resonance imaging and to evaluate changes in calculated quantitative functional cardiac parameters as a function of underlying k-space sampling techniques.Using a 1.5 T MR imaging system (Magnetom Sonata, Siemens Medical Solutions, Erlangen, Germany), three k-space data-sampling schemes: rectilinear (2.96 ms/1.58 ms/70 degrees /12 s TR/TE/FA/AcquisitionTime), and two radial k-space acquisitions, with filtered back-projection (RADIAL) (2.45 ms/1.25 ms/ 50 degrees /3.3 s TR/TE/FA/AT), and steady-state projection imaging with dynamic echotrain readout (SPIDER) (3.39 ms/1.62 ms/55 degrees /1.8 s TR/TE/FA/AT) of a True-FISP sequence were applied in 10 healthy volunteers. Long- and short-axis breath-hold series were acquired and signal-to-noise ratios (SNR) for blood and myocardium were determined, as was contrast-to-noise ratios (CNR). Quantitative cardiac functional analysis included: determination of end-systolic/end-diastolic volumes, ejection fraction, and left ventricular mass. Functional analysis was performed by two independent readers three times for each volunteer and k-space sampling strategy. Statistical analysis evaluated the accuracy of the measurements obtained from each of the three sampling techniques and the intra- and interobserver reliability.Intraobserver and interobserver reliability measures of functional data were homogeneous without statistically significant differences. Intraobserver correlation coefficients ranged from 0.94-0.99; interobserver correlation coefficients ranged from 0.97-0.99. Direct comparison of SPIDER- and RADIAL-sampled True-FISP sequences showed no statistically significant differences in measured functional parameters with interstudy correlation coefficients from 0.88-0.98. RADIAL and SPIDER images had better temporal resolution and were qualitatively judged to provide superior wall/blood border definition. Statistically significant differences were identified in each volumetric functional parameter when results from the rectilinear sampling acquisitions were compared with either radial or SPIDER sampling techniques. RADIAL and SPIDER results were consistently higher than volumetric measures obtained from the rectilinear data set.Employing faster sampling schemes led to enhanced signal homogeneity while maintaining the necessary CNR for estimation of functional cardiac parameters. Enhanced signal homogeneity and maintained CNR will most likely improve the accuracy of the cardiac functional parameter determination.

The Spiral two-point Dixon (Spiral 2PD) technique has recently been proposed as a method for unambiguous water–fat decomposition in spiral imaging. It also corrects for off-resonance blurring artifacts using only two data sets. In the Spiral 2PD technique, several predetermined off-resonance frequencies are tested to both separate water and fat signals and deblur the decomposed images. Unfortunately, the algorithm is computationally quite intensive since the range of tested frequencies must be set sufficiently large to span the full range of anticipated B0 variation over the scanned objects. The block regional off-resonance correction (BRORC) algorithm corrects for off-resonance blurring artifacts block by block through the reconstructed image and usually provides several times higher computational efficiency than the conventional frequency-segmented off-resonance correction algorithm. This work shows that both water–fat decomposition and blurring artifact correction can be performed block by block using two spiral images with different TEs and that this new technique (BRORC-Spiral2PD technique) significantly improves the computational efficiency of other Spiral 2PD algorithms, opening new opportunities for spiral imaging. Magn Reson Med 52:1342–1350, 2004. © 2004 Wiley-Liss, Inc.

Spiral imaging has recently gained acceptance in MR applications requiring rapid data acquisition. One of the main disadvantages of spiral imaging, however, is blurring artifacts that result from off-resonance effects. Spatial-spectral (SPSP) pulses are commonly used to suppress those spins that are chemically shifted from water and lead to off-resonance artifacts. However, SPSP pulses may produce nonuniform fat signal suppression or unwanted water signal suppression when applied in the presence of B(0) field inhomogeneities. Dixon techniques have been developed as methods for water-fat signal decomposition in rectilinear sampling schemes since they can produce unequivocal water-fat signal decomposition even in the presence of B(0) inhomogeneities. This article demonstrates that three-point and two-point Dixon techniques can be extended to conventional spiral and variable-density spiral data acquisitions for unambiguous water-fat decomposition with off-resonance blurring correction. In the spiral three-point Dixon technique, water-fat signal decomposition and image deblurring are performed based on the frequency maps that are directly derived from the acquired images. In the spiral two-point Dixon technique, several predetermined frequencies are tested to create a frequency map. The newly proposed techniques can achieve more effective and more uniform fat signal suppression when compared to the conventional spiral acquisition method with SPSP pulses.

OBJECTIVE. The purpose of this study was to test the use of CO2 as a black blood contrast agent for MR imaging–guided vascular procedures in an animal model.MATERIALS AND METHODS. Repeated intraarterial CO2 injections were performed through a catheter located in the aorta and the renal arteries of three fully anesthetized pigs. Real-time images were acquired using a steady-state free precession sequence.RESULTS. During the CO2 injections, the bright blood in the aorta and the main renal artery was totally replaced, and this procedure resulted in an immediate, statistically significant signal loss in the vessel lumen. In more peripheral vessels, CO2 improved the vessel conspicuity substantially. Confirmation of vessel patency distal to the catheter tip position was possible.CONCLUSION. The use of carbon dioxide in combination with a bright blood MR imaging sequence improves vessel conspicuity and provides immediate information about blood flow distal to the catheter. This technique may be used to facilitat...

This study sought to evaluate whether surgical clips affect tissue conductivity and thereby alter the induction of radiofrequency ablation lesions and to determine whether therapy is safe after previous placement of clips in the liver.An ex vivo porcine hepatic model was used. Three clips were placed around a radiofrequency electrode at 10, 20, and 30 mm from the point of insertion. Clips were arranged in a plane either perpendicular or parallel to the electrode track. After placement of the liver specimen on a grounding pad, radiofrequency energy was applied in a standardized manner for 5 min. Lesion growth and morphology were documented for each minute.Radiofrequency lesions appeared circular and homogeneous after 5 min. Lesion diameter perpendicular to the radiofrequency electrode averaged 30 mm. However, lesion formation was irregular during the early phase of the radiofrequency ablation. The lesion extended irregularly toward the 1-cm clip after 60 sec of ablation. During the second minute, a distinct lesion was observed around the clip 1 cm from the electrode; the primary lesion had not yet reached the clip. During the final 3 min, the primary lesion reached the 1-cm clip and ultimately incorporated the satellite lesion. No lesions were detected surrounding the more distant clips.Our data suggest that with the parameters applied in our study, radiofrequency ablation can be safely performed in patients with implanted clips. No aberrant conduction is observed around surgical clips that are located 20 mm and further from the radiofrequency electrode.

Rationale and Objectives To aid in surgical and radiation therapy planning for prostate adenocarcinoma, a general-purpose automatic registration method that is based on mutual information was used to align magnetic resonance (MR) images and single photon emission computed tomographic (SPECT) images of the pelvis and prostate. Materials and Methods The authors assessed the effects of various factors on alignment between pairs of MR and SPECT images, including the use of particular pulse sequences in MR imaging, image voxel intensity scaling, the use of different regions on the MR-SPECT histogram, spatial masking of nonoverlapping visual data between images, and multiresolution optimization. A mutual information algorithm was used as the cost function for automatic registration. Automatic registration was deemed acceptable when it resulted in a transformation with less than 2 voxel units (6 mm) difference in translation and less than 2° difference in rotation from that obtained with manual registration performed independently by nuclear medicine radiologists. Results Paired sets of MR and SPECT image volumes from four of five patients were successfully registered. For successful registration, MR images must be optimal and registration must be performed at full spatial resolution and at the full intensity range. Masking, cropping, and the normalization of mutual information, used to register partially overlapping MR-SPECT volumes, were not successful. Multiresolution optimization had little effect on the accuracy and speed of the registration. Conclusion Automatic registration between MR and SPECT images of the pelvis can be achieved when data acquisition and image processing are performed properly. It should prove useful for prostate cancer diagnosis, staging, and treatment planning.

Background: This study assessed the feasibility of high-resolution magnetic resonance imaging of the pancreas by means of an endoscopically inserted endoluminal magnetic resonance receiver coil. Method: A 0.032-inch diameter internal magnetic resonance imaging receiver coil was endoscopically inserted into the pancreatic duct in 4 pigs through the accessory channel of a standard duodenoscope to obtain high-resolution magnetic resonance images by using T1- and T2-weighted sequences. Results: The pig anatomy precluded the usual transoral approach; however, transgastric access allowed endoscopic transpapillary insertion of a receiver coil into the pancreatic duct in all animals without the need for sphincterotomy. The small swine pancreas could then be visualized by magnetic resonance imaging with a 0.3 × 0.3-mm in-plane resolution. Conclusion: High-resolution pancreas magnetic resonance imaging is feasible by using an endoscopically inserted endoluminal receiver coil. The smaller stomach and larger pancreatic duct diameter in humans will facilitate clinical application of the imaging procedure.

Purpose To examine new sequences that restrict acquisition of spins to those excited by both of the RF pulses in missing pulse steady state free precession (MP-SSFP) MRI. Materials and Methods New MP-SSFP sequences were created by replacing one of the slice selective pulses (SSPs) with an orthogonal SSP for inner volume imaging, and with a chemical shift selective (CHESS) pulse for chemical shift imaging. The inner volume sequence was applied to a reduced field of view at the center of a resolution phantom; resulting images were evaluated for differences in the aliased signal. The CHESS sequence was applied to volunteers, as well as to and fat, water, and acetic acid phantoms. Results were evaluated with SNR measurements. Results The inner volume sequence eliminated the aliased signal, while nonselected fat and water levels were suppressed to that of noise by the CHESS sequence. Conclusion Results suggest a novel steady state technique for rapid inner volume or chemical shift imaging. J. Magn. Reson. Imaging 2004;19:124–132. © 2003 Wiley-Liss, Inc.

This study was performed to test the hypothesis that temporary renal ischemia will result in increased thermal lesion size during radiofrequency thermal ablation in the kidney.Twelve kidneys were treated in six pigs that were placed under general anesthesia in the MR suite, using a 0.2-T open C-shaped MR imaging system. A 4-cm-long, 14-mm-diameter balloon catheter was placed into the aorta using a transfemoral approach, and the balloon was positioned proximal to the renal arteries via guidance with MR imaging. A 2-cm exposed-tip MR-compatible 17-gauge radiofrequency electrode was placed into one kidney under MR fluoroscopy using fast imaging with steady-state free precession (FISP) sequences. Thermal ablation was performed with the electrode tip temperature maintained at 90 +/- 2 degrees C for 10 min. This procedure was repeated in the contralateral kidney. The balloon was inflated during one ablation. Postablation images were obtained, the pigs were sacrificed, and both kidneys of each animal were harvested for pathologic correlation.Technical success was achieved in all animals. The lesion measured 14.2 +/- 2.2 mm (mean +/- standard deviation) for the ischemic kidney versus 8.0 +/- 2.6 mm in the normally perfused kidney (p = 0.00002). No significant complications were noted. In all images, thermal lesions displayed low signal intensity with a sharp rim of high signal intensity best visualized using short tau inversion recovery (STIR) sequences with a mean accuracy of 1.3 +/- 1.2 mm when compared with pathologic findings and a mean contrast-to-noise ratio of 4.9 +/- 2.5.We accept the hypothesis that temporary renal ischemia leads to a significantly increased radiofrequency ablation lesion size. We conclude that catheter-based balloon perfusion reduction is feasible, that the procedure does not lead to major complications, and that it can be performed using MR imaging as the sole imaging modality.

The aim of this study was to test the hypotheses that (a) MR imaging-guided radiofrequency (RF) thermal ablation is safe and feasible in porcine brain using an open C-arm-shaped low-field MR system, and that (b) induced thermal lesion size can be predicted using low-field MR imaging. Magnetic resonance-guided RF ablation was performed in the cerebral frontal lobes of six pigs. An 18-G monopolar RF electrode was inserted into the porcine brain using MR image guidance and RF was then applied for 10 min. After post-procedure imaging (T2-weighted, T1-weighted before and after gadodiamide administration), the pigs were killed and the brains were used for pathologic examination. Successful RF electrode placement was accomplished in all cases without complications; total magnet time ranged from 73 to 189 min. The thermal lesion size varied from 10 to 12 mm perpendicular to the electrode track and was easily visualized on T2-weighted and enhanced T1-weighted images. Enhanced T1-weighted imaging demonstrated the highest brain-to-RF thermal lesion contrast-to-noise ratio with an average of 1.5 +/- 1.6. Enhanced T1-weighted imaging never underestimated pathologic lesion diameter with a mean difference of 2.3 +/- 1.0 mm and a radiologic/pathologic correlation of 0.69. Magnetic resonance imaging-guided RF thermal ablation is feasible and safe in the porcine brain using an open MR low-field system. Induced-thermal lesion size can best be monitored using enhanced T1-weighted images. In the future, RF ablation under low-field MR guidance may offer an alternative treatment option for primary and secondary brain tumors.

Interventional magnetic resonance imaging (IMRI) is a rapidly emerging application for MRI in which diagnostic and therapeutic procedures are performed with MR image guidance. Real-time or near-real-time image acquisition and relative insensitivity to motion are essential for most intraoperative, therapeutic, and diagnostic procedures performed under MR guidance. The purpose of this work was to demonstrate the development and utility of two alternative rapid acquisition strategies during IMRI that are analogous to computed tomography fluoroscopy or keyhole MRI in a radial rather than rectilinear coordinate frame. The two strategies discussed here, interleaved projection reconstruction and continuous projection reconstruction, are compared and the feasibility of their application in experimental interventional applications is studied. J. Magn. Reson. Imaging 2001;13:142-151.

A new way to correct magnetic resonance image artifacts resulting from view-dependent phase variations and view-dependent variations in rigid body object translation is presented by exploiting basic properties of the trajectory of radial k-space acquisitions. Simulations, phantom studies, and in vivo experiments are used to demonstrate the feasibility and the utility of this method. While somewhat analogous to navigator echo correction, in which special gradients are interleaved into the imaging sequence so echoes at the center of k-space can be acquired prior to or after collection of the image data, the current method does not require additional new gradient structures within the pulse sequence or increases in scan time. The new method uses the phase information from all collected radial k-space data points rather than only the navigator echo, which permits correction of multiple sources of view-dependent phase variation in the image data. The resultant effect is improved image quality in radial MRI acquisitions. Magn Reson Med 45:277-288, 2001.

The purpose of this study was to test the hypothesis that decreasing liver perfusion in rabbits results in an increase in thermal lesion size and that these effects can be accurately monitored using magnetic resonance imaging (MRI). We additionally tested the hypothesis that the increase in thermal lesion size would depend on the particular vessel or vessels occluded (hepatic artery, portal vein, or both). Using an Institutional Animal Care and Use Committee approved protocol, 20 New Zealand white rabbits were randomly assigned to four treatment groups (five in each group): control and ligation of portal vein (PV), hepatic artery (HA), or both PV and HA (HAPV). Surgical ligation of the appropriate vessel was performed under general anesthesia. Immediately after ligation, the rabbits were placed in a 0.2-T open MR system, and an 18-G copper radiofrequency (RF) electrode with a 2-cm exposed tip was inserted into the liver. RF was applied for 10 minutes with the tip temperature maintained at 90 degrees +/- 2 degrees C. Before and after ablation, perfusion data were obtained for 90 seconds using 30 3-second sequential single oblique-slice fast imaging with steady-state progression (FISP) acquisitions after injection of gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) via the inferior vena cava. Postablation scanning included axial and oblique turbo spin-echo (TSE) T2-weighted (T2w), STIR, and Gd-enhanced T1w sequences. Lesion size was determined perpendicular to the RF electrode using software calipers on the imager. The rabbits were sacrificed after completion of the post-therapy scans, and their livers were harvested for histologic analysis. The liver showed a mean increase in signal amplitude (SA) of 76% 24 seconds after Gd contrast injection in the control group. After contrast injection, the SA increased to a mean of only 66% in the group with ligated hepatic arteries, with no difference in the time to peak compared with the control group. No significant SA increase over baseline could be found in the groups with ligated PV or ligated PV and HA. T2-weighted images demonstrated the highest lesion-to-liver contrast-to-noise ratios (CNRs; mean -5.5) on postprocedure images, followed by STIR images (mean -2.2) in the control group. The lesions were poorly delineated on the Gd-enhanced images. Average maximum lesion sizes (mean +/- 95% confidence interval) were 22 +/- 4.3 mm after ligation of PV, 22 +/- 2.6 mm after ligation of both PV and HA, 14 +/- 2.0 mm after ligation of HA, and 13 +/- 1.9 mm in the control group. We accept the hypothesis that the diameter of the region of coagulation necrosis achieved by standardized RF ablation in the liver increases with reduced organ perfusion and that this effect can be accurately monitored using MRI. The major factor influencing the size of the coagulation area is the portal venous flow. Occlusion of the hepatic artery alone does not significantly increase lesion size. T2w sequences are best suited for postprocedure imaging due to the high lesion-to-liver CNR in rabbits with normal hepatic perfusion. J. Magn. Reson. Imaging 2001;13:57-63.

The purpose of this study was to compare the contrast between radiofrequency (RF) thermal liver lesions and surrounding tissue in T2-weighted turbo spin-echo sequences (TSE T2), short TI inversion recovery techniques (STIR), and contrast-enhanced (CE) T1-weighted spin-echo images. Nineteen RF thermal ablations were performed on eight patients with metastatic liver tumors. After ablation, contrast-to-noise ratios (CNRs) were calculated between mean signal amplitudes from three regions of interest (ROI) (lesion, surrounding edema, and normal tissue) using TSE T2-weighted, STIR, and contrast-enhanced T1-weighted (CE T1) sequences for each lesion. CNRs between the thermal lesion and normal liver tissue for both TSE T2-weighted (mean 0.9) and STIR (2.0) images were significantly lower than for CE T1-weighted (8.4) images (t-test, alpha = 0.05). However, CNRs between edema rim and the core of the thermal lesion for both TSE T2-weighted (8.1) and STIR images (7.2) were not significantly different (t-test, alpha = 0.05) from CNRs between lesion and normal tissue for CE T1-weighted images (8.4), nor was the CNR between edema rim and normal tissue for both TSE T2-weighted (10.3) and STIR (9.8) images. Although the edema was not visible on CE T1-weighted images, 18 of 19 lesions (94.7%) were surrounded by a hyperintense rim on TSE T2-weighted or STIR images. Both TSE T2-weighted and STIR sequences represent valid techniques for repeatable assessment of RF thermal lesions.

This project incorporated a novel inductive coupling structure of three micro coils into an invasive device tip to determine both its tip position and orientation. Moreover, with the introduction of a new target-navigation technique the MR scan plane was defined automatically by the invasive device orientation and target tissue location. A time domain multiplexing technique was applied for simultaneous MR imaging and device tracking. Using these techniques, the acquired MR images always showed both the invasive device and its target tissue. Thus, roadmap images and their potential misregistration errors were avoided. A graphical user interface (GUI) was also designed to assist interventional physicians in monitoring and guiding the insertion of the interventional device. Ex vivo phantom and in vivo animal experiments were performed to test this new technique. The methods developed in this project provide a new active technique for interventional device guidance using MRI. Magn Reson Med 44:56-65, 2000.

Various kinds of nonrectilinear Cartesian k-space trajectories have been studied, such as spiral, circular, and rosette trajectories. Although the nonrectilinear Cartesian sampling techniques generally have the advantage of fast data acquisition, the gridding process prior to 2D-FFT image reconstruction usually requires a number of additional calculations, thus necessitating an increase in the computation time. Further, the reconstructed image often exhibits artifacts resulting from both the k-space sampling pattern and the gridding procedure. To date, it has been demonstrated in only a few studies that the special geometric sampling patterns of certain specific trajectories facilitate fast image reconstruction. In other words, the inherent link among the trajectory, the sampling scheme, and the associated complexity of the regridding/reconstruction process has been investigated to only a limited extent. In this study, it is demonstrated that a Lissajous trajectory has the special geometric characteristics necessary for rapid reconstruction of nonrectilinear Cartesian k-space trajectories with constant sampling time intervals. Because of the applicability of a uniform resampling (URS) algorithm, a high-quality reconstructed image is obtained in a short reconstruction time when compared to other gridding algorithms.

This article describes a number of concepts that provide insights into the process of MR imaging. The use of shaped, fixed-bandwidth RF pulses and magnetic field gradients is described to provide an understanding of the methods used for slice selection. Variations in the slice-excitation profile are shown as a function of the RF pulse shape used, the truncation method used, and the tip angle. It should be remembered that although the goal is to obtain uniform excitation across the slice, this goal is never achieved in practice, thus necessitating the use of slice gaps in some cases. Excitation, refocusing, and inversion pulses are described. Excitation pulses nutate the spins from the longitudinal axis into the transverse plane, where their magnetization can be detected. Refocusing pulses are used to flip the magnetization through 180 degrees once it is in the transverse plane, so that the influence of magnetic field inhomogeneities is eliminated. Inversion pulses are used to flip the magnetization from the +z to the -z direction in invesrsion-recovery sequences. Radiofrequency pulses can also be used to eliminate either fat or water protons from the images because of the small differences in resonant frequency between these two types of protons. Selective methods based on chemical shift and binomial methods are described. Once the desired magnetization has been tipped into the transverse plane by the slice-selection process, two imaging axes remain to be spatially encoded. One axis is easily encoded by the application of a second magnetic field gradient that establishes a one-to-one mapping between position and frequency during the time that the signal is converted from analog to digital sampling. This frequency-encoding gradient is used in combination with the Fourier transform to determine the location of the precessing magnetization. The second image axis is encoded by a process known as phase encoding. The collected data can be described as the 2D Fourier transform of the object being imaged. Thus, a concept known as k-space is used to describe the image data and its relationship to the imaging gradient waveforms. The article demonstrates how phase encoding selects the row of k-space from which the data will be recorded, and frequency encoding determines the column. The goal of any acquisition strategy is to map k-space completely, and two methods, spiral imaging and echo-planar imaging, are described to demonstrate that the data acquisition path need not be a straight line.

Keyhole acquisition techniques have been used to reduce image acquisition times primarily in contrast agent studies and via simulation in interventional MRI procedures. More recent simulations have suggested that improved definition of an interventional device [e.g., biopsy needles, radio frequency (RF) electrodes] could be achieved by rotating the keyhole pattern in k-space so that the read out direction lies perpendicular to the device orientation in real space. This study seeks to validate the earlier predictions of improved efficacy of a rotated stripes keyhole acquisition in actual in vitro and in vivo interventional MR imaging procedures. A true-FISP sequence was modified to perform central stripes keyhole (as known as conventional keyhole) acquisitions after a full initial reference data set was acquired. The gradients of this sequence were then modified to rotate the k-space definition and the keyhole stripes by 10 degrees, 20 degrees, 30 degrees, 45 degrees, and 60 degrees from their conventional k-space orientation. Acquisitions were performed during insertion of interventional devices in phantom and in vivo RF ablation procedures, using the modified sequence selected which placed the phase encoding axis at parallel and perpendicular orientations to the devices. Resulting images were compared between the two orientations for needle width and tip accuracy. Apparent needle width was thinner and tip position more accurately determined for placement of phase encoding parallel to the needle in all cases. Rotated keyhole imaging provides the required temporal advantage of conventional keyhole imaging along with a near optimal definition of an interventional device when the phase encoding is oriented parallel to the direction of the needle motion. Magn Reson Med 42:554-560, 1999.

Rapid T2 weighted (T2W) images would facilitate physicians being able to distinguish normal tissues, vessels, tumors, and thermal lesions from therapeutic devices throughout interventional MRI procedures commonly performed in open low-field scanners (e.g., 0.2 T). Conventional diagnostic MRI techniques have not been successful at low-field strength for fast T2W imaging during the guidance phase of interventional MRI (I-MRI) procedures. FISP and true-FISP methods yield T1/T2-weighted images and do not always provide sufficient contrast for device guidance or lesion assessment. As such, a variant of PSIF (a gradient reversed form of FISP) which collects the T2-weighted spin echo of the SSFP signal was developed and implemented at 0.2 T for use in I-MRI procedures. The sequence has a balanced readout gradient to reduce motion sensitivity. Asymmetric sampling toward the end of the TR cycle reduces T2* decay of the spin echo component in the SSFP signal. The sequence gives one image in 5–7 s in vivo with adequate SNR and T2 contrast for interventional applications. Patient studies showed that the PSIF sequence variant demarcates many tumors not detectable by either FISP or true-FISP. Results from animal experiments suggested that it has potential to monitor thermal lesions during interstitial thermal ablation procedures. Magn Reson Med 42:335–344, 1999. © 1999 Wiley-Liss, Inc.

Successful radiofrequency (RF) thermal ablation was performed on VX2 tumors implanted in 23 rabbit livers under magnetic resonance (MR) guidance using a C-arm-shaped low-field 0.2 T system. RF application and immediate postprocedure MRI of all animals was performed [T2-weighted, turbo short tau inversion recovery (STIR), T1-weighted before and after gadopentetate dimeglumine administration). Follow-up MRI with a superparamagnetic iron oxide (SPIO) contrast medium was performed in nine rabbits at 2 weeks and in four rabbits at 1 month post RF ablation. All livers were harvested for pathologic examination. T2-weighted and turbo-STIR images demonstrated the highest tumor-to-RF-thermal lesion contrast-to-noise ratios (CNRs; means 4.5 and 3.8, respectively) on postprocedure images; this was redemonstrated at 2- and 4-week follow-up imaging. T2-weighted imaging never overestimated pathologic lesion size by more than 2 mm, and the radiologic-pathologic correlation coefficient was not less than 0.90. In conclusion, MRI-guided RF thermal ablation in implanted liver tumor is feasible using a C-arm-shaped low-field 0.2 T system. The thermal lesion size can be most accurately monitored with T2-weighted and turbo-STIR images. Magn Reson Med 42:141–149, 1999. © 1999 Wiley-Liss, Inc.

Fourteen percutaneous sclerotherapy procedures with magnetic resonance (MR) imaging guidance were performed in three patients with low-flow vascular malformations. All targeted vascular malformation compartments were filled with sclerosing agent without complications in a mean procedural time of 29 minutes. Follow-up imaging demonstrated reduction in size of the treated portions in all patients. In conclusion, sclerotherapy with MR imaging guidance can be performed safely and allows monitoring of injection.

SummaryInterventional procedures using magnetic resonance (MR) image-guidance have recently increased in interest. A variety of methodologies for visualising and automatically tracking instruments, including endoscopes, RF ablation electrodes and catheters, have been developed and introduced to help the interventionist to safely guide the device towards the target tissue. This article describes and compares characteristics of the four most commonly-used localisation and tracking systems for MRI-guided interventional procedures: those based on the susceptibility artifact of the device; those which intentionally created field inhomogeneity along the device; those relying on an optical tracking system; and active tracking systems using micro-receive coils.