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Perfusion dynamics play a vital role in delivering essential nutrients and oxygen to tissues while removing metabolic waste products. Imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) use contrast agents to visualize perfusion and clearance patterns; however, each technique has specific limitations. Hybrid PET/MRI combines the quantitative power and sensitivity of PET with the high functional and anatomical detail of MRI and holds great promise for precision in molecular imaging. However, the development of dual PET/MRI probes has been hampered by challenging synthesis and radiolabeling. Here, we present a novel PET/MRI probe, [ 18 F][Gd(FL 1 )], which exhibits excellent stability comparable to macrocyclic MRI contrast agents used in clinical practice. The unique molecular design of [ 18 F][Gd(FL 1 )] allows selective and expeditious radiolabeling of the gadolinium chelate in the final synthetic step. Leveraging the strengths of MRI and PET signals, the probe enables quantitative in vivo mapping of perfusion and excretion dynamics through an innovative voxel-based analysis. The diagnostic capabilities of [ 18 F][Gd(FL 1 )] were demonstrated in a pilot study on healthy mice, successfully detecting early cases of unilateral renal dysfunction, a condition that is typically challenging to diagnose. This study introduces a new approach for PET/MRI and emphasizes a streamlined probe design for practical synthesis and improved diagnostic accuracy., (© 2024 The Authors. Angewandte Chemie International Edition published by Wiley-VCH GmbH.)

Artificial intelligence (AI) models often face performance drops after deployment to external datasets. This study evaluated the potential of a novel data augmentation framework based on generative adversarial networks (GANs) that creates synthetic patient image data for model training to improve model generalizability. Model development and external testing were performed for a given classification task, namely the detection of new fluid-attenuated inversion recovery lesions at MRI during longitudinal follow-up of patients with multiple sclerosis (MS). An internal dataset of 669 patients with MS ( n = 3083 examinations) was used to develop an attention-based network, trained both with and without the inclusion of the GAN-based synthetic data augmentation framework. External testing was performed on 134 patients with MS from a different institution, with MR images acquired using different scanners and protocols than images used during training. Models trained using synthetic data augmentation showed a significant performance improvement when applied on external data (area under the receiver operating characteristic curve [AUC], 83.6% without synthetic data vs 93.3% with synthetic data augmentation; P = .03), achieving comparable results to the internal test set (AUC, 95.0%; P = .53), whereas models without synthetic data augmentation demonstrated a performance drop upon external testing (AUC, 93.8% on internal dataset vs 83.6% on external data; P = .03). Data augmentation with synthetic patient data substantially improved performance of AI models on unseen MRI data and may be extended to other clinical conditions or tasks to mitigate domain shift, limit class imbalance, and enhance the robustness of AI applications in medical imaging. Keywords: Brain, Brain Stem, Multiple Sclerosis, Synthetic Data Augmentation, Generative Adversarial Network Supplemental material is available for this article. © RSNA, 2024.

Objective. Magnetic resonance (MR) images free of artefacts are of pivotal importance for MR-guided ion radiotherapy. This study investigates MR image quality for simultaneous irradiation in an experimental setup using phantom imaging as well as in-vivo imaging. Observed artefacts are described within the study and their cause is investigated with the goal to find conclusions and solutions for potential future hybrid devices. Approach. An open MR scanner with a field strength of 0.25 T has been installed in front of an ion beamline. Simultaneous magnetic resonance imaging and irradiation using raster scanning were performed to analyze image quality in dedicated phantoms. Magnetic field measurements were performed to assist the explanation of observed artifacts. In addition, in-vivo images were acquired by operating the magnets for beam scanning without transporting a beam. Main Results. The additional frequency component within the isocenter caused by the fringe field of the horizontal beam scanning magnet correlates with the amplitude and frequency of the scanning magnet steering and can cause ghosting artifacts in the images. These are amplified with high currents and fast operating of the scanning magnet. Applying a real-time capable pulse sequence in-vivo revealed no ghosting artifacts despite a continuously changing current pattern and a clinical treatment plan activation scheme, suggesting that the use of fast imaging is beneficial for the aim of creating high quality in-beam MR images. This result suggests, that the influence of the scanning magnets on the MR acquisition might be of negligible importance and does not need further measures like extensive magnetic shielding of the scanning magnets. Significance. Our study delimited artefacts observed in MR images acquired during simultaneous raster scanning ion beam irradiation. The application of a fast pulse sequence showed no image artefacts and holds the potential that online MR imaging in future hybrid devices might be feasible., (Creative Commons Attribution license.)

Background: This study aims at clarifying the impact of persistent residual lesions following first-line treatment for pediatric medulloblastoma., Methods: Data on 84 pediatric patients with medulloblastoma and persistent residual lesions on centrally reviewed magnetic resonance imaging (MRI) at the end of first-line therapy were analyzed., Results: Twenty patients (23.8%) had residual lesions in the tumor bed (R+/M0), 51 (60.7%) had distant lesions (R0/M+) and 13 (15.5%) had both (R+/M+). Overall response to first-line therapy was minor or partial (≥ 25% reduction, minor response [MR]/PR) for 64 (76.2%) and stable disease (SD) for 20 patients (23.8%). Five-year post-primary-treatment progression-free (pptPFS) and overall survival (pptOS) were superior after MR/PR (pptPFS: 62.5 ± 7.0%[MR/PR] vs. 35.9 ± 12.8%[SD], P = .03; pptOS: 79.7 ± 5.9[MR/PR] vs. 55.5 ± 13.9[SD], P = .04). Furthermore, R+/M + was associated with a higher risk for progression (5-year pptPFS: 22.9 ± 17.9%[R+, M+] vs. 72.4 ± 12.0%[R+, M0]; P = .03). Watch-and-wait was pursued in 58 patients, while n = 26 received additional treatments (chemotherapy only, n = 19; surgery only, n = 2; combined, n = 3; valproic acid, n = 2), and their outcomes were not superior to watch-and-wait (5-year pptPFS: 58.5 ± 7.7% vs. 51.6 ± 10.7% P = .71; 5-year pptOS: 76.3 ± 6.9% vs. 69.8 ± 9.7%, P = .74). For the whole cohort, 5-year pptPFS by molecular subgroup (58 cases) were WNT: 100%, SHH: 50.0 ± 35.4%, group-4, 52.5 ± 10.5, group-3 54.2 ± 13.8%; (P = .08)., Conclusions: Overall response and extent of lesions can function as surrogate parameters to predict outcomes in pediatric MB patients with persistent lesions after first-line therapy. Especially in the case of solitary persistent medulloblastoma MRI lesions, additional therapy was not beneficial. Therefore, treatment response, extent/kind of residual lesions and further diagnostic information need consideration for indication of additional treatments for persisting lesions., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

This narrative review explores recent advancements and applications of modern low-field (≤ 1 Tesla) magnetic resonance imaging (MRI) in musculoskeletal radiology. Historically, high-field MRI systems (1.5 T and 3 T) have been the standard in clinical practice due to superior image resolution and signal-to-noise ratio. However, recent technological advancements in low-field MRI offer promising avenues for musculoskeletal imaging. General principles of low-field MRI systems are being introduced, highlighting their strengths and limitations compared to high-field counterparts. Emphasis is placed on advancements in hardware design, including novel magnet configurations, gradient systems, and radiofrequency coils, which have improved image quality and reduced susceptibility artifacts particularly in musculoskeletal imaging. Different clinical applications of modern low-field MRI in musculoskeletal radiology are being discussed. The diagnostic performance of low-field MRI in diagnosing various musculoskeletal pathologies, such as ligament and tendon injuries, osteoarthritis, and cartilage lesions, is being presented. Moreover, the discussion encompasses the cost-effectiveness and accessibility of low-field MRI systems, making them viable options for imaging centers with limited resources or specific patient populations. From a scientific standpoint, the amount of available data regarding musculoskeletal imaging at low-field strengths is limited and often several decades old. This review will give an insight to the existing literature and summarize our own experiences with a modern low-field MRI system over the last 3 years. In conclusion, the narrative review highlights the potential clinical utility, challenges, and future directions of modern low-field MRI, offering valuable insights for radiologists and healthcare professionals seeking to leverage these advancements in their practice., (© 2024. The Author(s).)

Objective: Contrast-enhanced ultrasound (CEUS) is useful in mapping lymphatic vessels in upper limb lymphedema; this study was aimed to evaluate its efficiency in lower limb lymphedema and investigate whether magnetic resonance lymphangiography (MRL) enhance the efficiency of CEUS., Methods: This retrospective study enrolled 48 patients with lymphedema undergoing lymphaticovenous anastomosis (LVA) surgery who received MRL and/or CEUS in addition to conventional indocyanine green (ICG) lymphangiography. The number of anastomotic sites and the duration per site (DPS) for LVA surgery were described and compared., Results: Among the 48 patients subjected to analysis, it was observed that 12 (25%), 20 (41.67%), and 16 (33.33%) of them received ICG, ICG+CEUS, and ICG+CEUS+MRL, respectively. The ICG+CEUS group demonstrated a significant increase in the number of LVAs (median, 5; range, 4-7), compared with the ICG group (median, 2; range, 1-4) (P < .001). Moreover, the ICG+CEUS+MRL group exhibited a higher number of LVAs (median, 8; range, 7-8.25) compared with both the ICG+CEUS and ICG groups (P < .001). For lower limb lymphedema, the ICG+CEUS+MRL group displayed an elevated number of LVAs (median, 8; interquartile range, 7-9) (P = .003), in contrast to the ICG group (median, 3; interquartile range, 1.75-4.25). Furthermore, the DPS in the ICG+CEUS+MRL group (median, 50.56; interquartile range, 48.13-59.29) (P = .005) exhibited a remarkable decrease when compared with the ICG group (median, 131.25; interquartile range, 86.75-198.13])., Conclusions: MRL-CEUS fusion demonstrates superior performance in the identification of lymphatic vessels for lymphedema., Competing Interests: Disclosures None., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: Impaired perivascular clearance has been suggested as a contributing factor to the pathogenesis of Alzheimer disease (AD). However, it remains unresolved when the anatomy of the perivascular space (PVS) is altered during AD progression. Therefore, this study investigates the association between PVS volume and AD progression in cognitively unimpaired (CU) individuals, both with and without subjective cognitive decline (SCD), and in those clinically diagnosed with mild cognitive impairment (MCI) or mild AD., Materials and Methods: A convolutional neural network was trained using manually corrected, filter-based segmentations (n = 1000) to automatically segment the PVS in the centrum semiovale from interpolated, coronal T2-weighted magnetic resonance imaging scans (n = 894). These scans were sourced from the national German Center for Neurodegenerative Diseases Longitudinal Cognitive Impairment and Dementia Study. Convolutional neural network-based segmentations and those performed by a human rater were compared in terms of segmentation volume, identified PVS clusters, as well as Dice score. The comparison revealed good segmentation quality (Pearson correlation coefficient r = 0.70 with P < 0.0001 for PVS volume, detection rate in cluster analysis = 84.3%, and Dice score = 59.0%). Subsequent multivariate linear regression analysis, adjusted for participants' age, was performed to correlate PVS volume with clinical diagnoses, disease progression, cerebrospinal fluid biomarkers, lifestyle factors, and cognitive function. Cognitive function was assessed using the Mini-Mental State Examination, the Comprehensive Neuropsychological Test Battery, and the Cognitive Subscale of the 13-Item Alzheimer's Disease Assessment Scale., Results: Multivariate analysis, adjusted for age, revealed that participants with AD and MCI, but not those with SCD, had significantly higher PVS volumes compared with CU participants without SCD ( P = 0.001 for each group). Furthermore, CU participants who developed incident MCI within 4.5 years after the baseline assessment showed significantly higher PVS volumes at baseline compared with those who did not progress to MCI ( P = 0.03). Cognitive function was negatively correlated with PVS volume across all participant groups ( P ≤ 0.005 for each). No significant correlation was found between PVS volume and any of the following parameters: cerebrospinal fluid biomarkers, sleep quality, body mass index, nicotine consumption, or alcohol abuse., Conclusions: The very early changes of PVS volume may suggest that alterations in PVS function are involved in the pathophysiology of AD. Overall, the volumetric assessment of centrum semiovale PVS represents a very early imaging biomarker for AD., Competing Interests: Conflicts of interest and sources of funding: The authors have declared that no conflict of interest exists. This work was supported by the Deutsche Forschungsgemeinschaft (DFG German Research Foundation) through projects EXC-2047/1-390685813 and EXC2151-390873048 and by the EU–Joint Programme for Neurodegenerative Disease Research through project 01ED2208., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: This study proposes faster virtual observation point (VOP) compression as well as post-processing algorithms for specific absorption rate (SAR) matrix compression. Furthermore, it shows the relation between the number of channels and the computational burden for VOP-based SAR calculation., Methods: The proposed new algorithms combine the respective benefits of two different criteria for determining upper boundedness of SAR matrices by the VOPs. Comparisons of the old and new algorithms are performed for head coil arrays with various channel counts. The new post-processing algorithm is used to post-process the VOP sets of nine arrays, and the number of VOPs for a fixed median relative overestimation is compared., Results: The new algorithms are faster than the old algorithms by a factor of two to more than 10. The compression efficiency (number of VOPs relative to initial number of SAR matrices) is identical. For a fixed median relative overestimation, the number of VOPs increases logarithmically with the number of RF coil channels when post-processing is applied., Conclusion: The new algorithms are much faster than previous algorithms. Post-processing is very beneficial for online SAR supervision of MRI systems with high channel counts, since for a given number of VOPs the relative SAR overestimation can be lowered., (© 2024 The Author(s). Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Objectives: Risk calculators (RCs) improve patient selection for prostate biopsy with clinical/demographic information, recently with prostate MRI using the prostate imaging reporting and data system (PI-RADS). Fully-automated deep learning (DL) analyzes MRI data independently, and has been shown to be on par with clinical radiologists, but has yet to be incorporated into RCs. The goal of this study is to re-assess the diagnostic quality of RCs, the impact of replacing PI-RADS with DL predictions, and potential performance gains by adding DL besides PI-RADS., Material and Methods: One thousand six hundred twenty-seven consecutive examinations from 2014 to 2021 were included in this retrospective single-center study, including 517 exams withheld for RC testing. Board-certified radiologists assessed PI-RADS during clinical routine, then systematic and MRI/Ultrasound-fusion biopsies provided histopathological ground truth for significant prostate cancer (sPC). nnUNet-based DL ensembles were trained on biparametric MRI predicting the presence of sPC lesions (UNet-probability) and a PI-RADS-analogous five-point scale (UNet-Likert). Previously published RCs were validated as is; with PI-RADS substituted by UNet-Likert (UNet-Likert-substituted RC); and with both UNet-probability and PI-RADS (UNet-probability-extended RC). Together with a newly fitted RC using clinical data, PI-RADS and UNet-probability, existing RCs were compared by receiver-operating characteristics, calibration, and decision-curve analysis., Results: Diagnostic performance remained stable for UNet-Likert-substituted RCs. DL contained complementary diagnostic information to PI-RADS. The newly-fitted RC spared 49% [252/517] of biopsies while maintaining the negative predictive value (94%), compared to PI-RADS ≥ 4 cut-off which spared 37% [190/517] (p < 0.001)., Conclusions: Incorporating DL as an independent diagnostic marker for RCs can improve patient stratification before biopsy, as there is complementary information in DL features and clinical PI-RADS assessment., Clinical Relevance Statement: For patients with positive prostate screening results, a comprehensive diagnostic workup, including prostate MRI, DL analysis, and individual classification using nomograms can identify patients with minimal prostate cancer risk, as they benefit less from the more invasive biopsy procedure., Key Points: The current MRI-based nomograms result in many negative prostate biopsies. The addition of DL to nomograms with clinical data and PI-RADS improves patient stratification before biopsy. Fully automatic DL can be substituted for PI-RADS without sacrificing the quality of nomogram predictions. Prostate nomograms show cancer detection ability comparable to previous validation studies while being suitable for the addition of DL analysis., Competing Interests: Compliance with ethical standards Guarantor The scientific guarantor of this publication is David Bonekamp. Conflict of interest Albrecht Stenzinger reports speakers honoraria for Aignostics, Amgen, Astra Zeneca, AGCT, Bayer, Bristol-Myers Squibb, Eli Lilly, Illumina, Incyte, Janssen, MSD, Novartis, Qlucore, Pfizer, Roche, Seagen, Seattle Genetics, Takeda, Thermo Fisher and grants from Bayer, Bristol-Myers Squibb, Chugai, and Incyte. Heinz-Peter Schlemmer declares consulting fees or honoraria from Bayer, Bracco; travel support from Siemens, Bayer, Bracco; consultancy for Bayer; grants/grants pending from EU, BMBF, Deutsche Krebshilfe; payment for lectures from Bayer, Bracco. Heinz-Peter Schlemmer is member of the Advisory Editorial Board of European Radiology. He has not taken part in the review or selection process of this article. David Bonekamp received lecture payments from Bayer Vital. Heinz-Peter Schlemmer is a member of the European Radiology Editorial Board. He has not taken part in the review or selection process of this article. The remaining authors declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry Thomas Hielscher, a co-author of this study, is a biostatistician at the German Cancer Research Center (DKFZ), Heidelberg, Germany, and contributed to the statistical analysis for this paper. Informed consent Written informed consent was waived by the Institutional Review Board (S-164/2019) in Heidelberg. Ethical approval Institutional Review Board approval was obtained with ethics review in Heidelberg (S-164/2019). Study subjects or cohorts overlap One thousand six hundred ten out of the 1627 MRI examinations included in this study have been previously reported. The previous publications focused on DL and radiomics [19, 20, 39], however, data have not been used for systematic clinical RC assessment or development. Regarding the PI-RADS/PSAD biopsy strategy, the test set of a previous study overlaps with 101 exams from biopsy-naïve patients with PI-RADS 3 lesions in the current study [33]. Methodology RetrospectiveDiagnostic and prognostic studyPerformed at one institution, (© 2024. The Author(s).)

Background: Magnetic resonance neurography (MRN) is increasingly used as a diagnostic tool for peripheral neuropathies. Quantitative measures enhance MRN interpretation but require nerve segmentation which is time-consuming and error-prone and has not become clinical routine. In this study, we applied neural networks for the automated segmentation of peripheral nerves., Methods: A neural segmentation network was trained to segment the sciatic nerve and its proximal branches on the MRN scans of the right and left upper leg of 35 healthy individuals, resulting in 70 training examples, via 5-fold cross-validation (CV). The model performance was evaluated on an independent test set of one-sided MRN scans of 60 healthy individuals., Results: Mean Dice similarity coefficient (DSC) in CV was 0.892 (95% confidence interval [CI]: 0.888-0.897) with a mean Jaccard index (JI) of 0.806 (95% CI: 0.799-0.814) and mean Hausdorff distance (HD) of 2.146 (95% CI: 2.184-2.208). For the independent test set, DSC and JI were lower while HD was higher, with a mean DSC of 0.789 (95% CI: 0.760-0.815), mean JI of 0.672 (95% CI: 0.642-0.699), and mean HD of 2.118 (95% CI: 2.047-2.190)., Conclusion: The deep learning-based segmentation model showed a good performance for the task of nerve segmentation. Future work will focus on extending training data and including individuals with peripheral neuropathies in training to enable advanced peripheral nerve disease characterization., Relevance Statement: The results will serve as a baseline to build upon while developing an automated quantitative MRN feature analysis framework for application in routine reading of MRN examinations., Key Points: Quantitative measures enhance MRN interpretation, requiring complex and challenging nerve segmentation. We present a deep learning-based segmentation model with good performance. Our results may serve as a baseline for clinical automated quantitative MRN segmentation., (© 2024. The Author(s).)

Objectives: The purpose of this study was to assess morphological and quantitative changes of the anterior cruciate ligament (ACL) and cartilage after ACL repair., Methods: 7T MRI of the knee was acquired in 31 patients 1.5 years after ACL repair and in 13 controls. Proton density-weighted images with fat saturation (PD-fs) were acquired to assess ACL width, signal intensity, elongation, and fraying. T2/T2* mapping was performed for assessment of ACL and cartilage. Segmentation of the ACL, femoral, and tibial cartilage was carried out at 12 ROIs. The outcome evaluation consisted of the Lysholm Knee Score and International Knee Documentation Committee (IKDC) subjective score and clinical examination., Results: ACL showed a normal signal intensity in 96.8% and an increased width in 76.5% after repair. Fraying occurred in 22.6% without having an impact on the clinical outcome (Lysholm score: 90.39 ± 9.75, p = 0.76 compared to controls). T2 analysis of the ACL revealed no difference between patients and controls (p = 0.74). Compared to controls, assessment of the femoral and tibial cartilage showed a significant increase of T2* times in all ROIs, except at the posterolateral femur. Patients presented a good outcome in clinical examination with a Lysholm score of 87.19 ± 14.89 and IKDC of 80.23 ± 16.84., Conclusion: T2 mapping results suggest that the tissue composition of the ACL after repair is similar to that of a native ACL after surgery, whereas the ACL exhibits an increased width. Fraying of the ACL can occur without having any impact on functional outcomes. T2* analysis revealed early degradation at the cartilage., Clinical Relevance Statement: MRI represents a noninvasive diagnostic tool for the morphological and compositional assessment of the anterior cruciate ligament after repair, whereas knowledge about post-surgical alterations is crucial for adequate imaging interpretation., Key Points: • There has been renewed interest in repairing the anterior cruciate ligament with a proximally torn ligament. • T2 times of the anterior cruciate ligament do not differ between anterior cruciate ligament repair patients and controls. • T2 mapping may serve as a surrogate for the evaluation of the anterior cruciate ligament after repair., (© 2024. The Author(s).)

Purpose: Dose calculation for MR-guided radiotherapy (MRgRT) at the 0.35 T MR-Linac is currently based on deformation of planning CTs (defCT) acquired for each patient. We present a simple and robust bulk density overwrite synthetic CT (sCT) method for abdominal treatments in order to streamline clinical workflows., Method: Fifty-six abdominal patient treatment plans were retrospectively evaluated. All patients had been treated at the MR-Linac using MR datasets for treatment planning and plan adaption and defCT for dose calculation. Bulk density CTs (4M-sCT) were generated from MR images with four material compartments (bone, lung, air, soft tissue). The relative electron densities (RED) for bone and lung were extracted from contoured CT structure average REDs. For soft tissue, a correlation between BMI and RED was evaluated. Dose was recalculated on 4M-sCT and compared to dose distributions on defCTs assessing dose differences in the PTV and organs at risk (OAR)., Results: Mean RED of bone was 1.17 ± 0.02, mean RED of lung 0.17 ± 0.05. The correlation between BMI and RED for soft tissue was statistically significant (p < 0.01). PTV dose differences between 4M-sCT and defCT were D mean : -0.4 ± 1.0%, D 1% : -0.3 ± 1.1% and D 95% : -0.5 ± 1.0%. OARs showed D 2% : -0.3 ± 1.9% and D mean : -0.1 ± 1.4% differences. Local 3D gamma index pass rates (2%/2mm) between dose calculated using 4M-sCT and defCT were 96.8 ± 2.6% (range 89.9-99.6%)., Conclusion: The presented method for sCT generation enables precise dose calculation for MR-only abdominal MRgRT., (Copyright © 2022 The Author(s). Published by Elsevier GmbH.. All rights reserved.)

Background: Mechanical thrombectomy (MT) is the standard of care for patients with a stroke and large vessel occlusion. Clot composition is not routinely assessed in clinical practice as no specific diagnostic value is attributed to it, and MT is performed in a standardized 'non-personalized' approach. Whether different clot compositions are associated with intrinsic likelihoods of recanalization success or treatment outcome is unknown., Methods: We performed a prospective, non-randomized, single-center study and analyzed the clot composition in 60 consecutive patients with ischemic stroke undergoing MT. Clots were assessed by ex vivo multiparametric MRI at 9.4 T (MR microscopy), cone beam CT, and histopathology. Clot imaging was correlated with preinterventional CT and clinical data., Results: MR microscopy showed red blood cell (RBC)-rich (21.7%), platelet-rich (white,38.3%) or mixed clots (40.0%) as distinct morphological entities, and MR microscopy had high accuracy of 95.4% to differentiate clots. Clot composition could be further stratified on preinterventional non-contrast head CT by quantification of the hyperdense artery sign. During MT, white clots required more passes to achieve final recanalization and were not amenable to contact aspiration compared with mixed and RBC-rich clots (maneuvers: 4.7 vs 3.1 and 1.2 passes, P<0.05 and P<0.001, respectively), whereas RBC-rich clots showed higher probability of first pass recanalization (76.9%) compared with white clots (17.4%). White clots were associated with poorer clinical outcome at discharge and 90 days after MT., Conclusion: Our study introduces MR microscopy to show that the hyperdense artery sign or MR relaxometry could guide interventional strategy. This could enable a personalized treatment approach to improve outcome of patients undergoing MT., Competing Interests: Competing interests: KK-J received research support from Novartis Pharma GmbH, unrelated to this work (Nürnberg, Germany). DFB reports consultancy for Medtronic and payed lectures for Cerenovus, and a research grant by MicroVention, unrelated to this work. KS received funding from the Olympia-Morata-Program of the Medical Faculty of Heidelberg University and from the Daimler-Benz-Foundation unrelated to this work. CU received travel funding and/or speaker honoraria from Cerenovus unrelated to this work. CH reports consultancy payments by Brainomix and lecture fees by Stryker. LS reports research support and consultancy fees from Novartis, Roche, Bristol-Myers Squibb, and Merck. MB served on the scientific advisory board of ECASS, TENSION, Springer, Boehringer, BBRaun, and Vascular Dynamics; received speaker honoraria from Guerbet, Bayer, Novartis, Codman, Roche, and Teva; is coeditor of Clinical Neuroradiology; and received research support from Novartis Pharma GmbH (Nürnberg, Germany), Guerbet, Siemens, Bayer Healthcare, Hopp Foundation, European Union, and DFG. MOB received funding from DFG (SFB1389 and Emmy Noether program, BR 6153/1-1) and Novartis Pharma GmbH, unrelated to this work. UN, DS, MF, GB, AK, VS, TH, FSe, FP, NS, JJ, TC, SHa, FSa, SHe, PAR, WW and MAM report no disclosures relevant for this work., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Glioblastoma is the most common and aggressive primary malignant brain tumor with poor prognosis. Novel immunotherapeutic approaches are currently under investigation. Even though magnetic resonance imaging (MRI) is the most important imaging tool for treatment monitoring, response assessment is often hampered by therapy-related tissue changes. As tumor and therapy-associated tissue reactions differ structurally, we hypothesize that biomechanics could be a pertinent imaging proxy for differentiation. Longitudinal MRI and magnetic resonance elastography (MRE) were performed to monitor response to immunotherapy with a toll-like receptor 7/8 agonist in orthotopic syngeneic experimental glioma. Imaging results were correlated to histology and light sheet microscopy data. Here, we identify MRE as a promising non-invasive imaging method for immunotherapy-monitoring by quantifying changes in response-related tumor mechanics. Specifically, we show that a relative softening of treated compared to untreated tumors is linked to the inflammatory processes following therapy-induced re-education of tumor-associated myeloid cells. Mechanistically, combined effects of myeloid influx and inflammation including extracellular matrix degradation following immunotherapy form the basis of treated tumors being softer than untreated glioma. This is a very early indicator of therapy response outperforming established imaging metrics such as tumor volume. The overall anti-tumor inflammatory processes likely have similar effects on human brain tissue biomechanics, making MRE a promising tool for gauging response to immunotherapy in glioma patients early, thereby strongly impacting patient pathway., (© 2024. The Author(s).)

Brain tumor diagnostics have significantly evolved with the use of positron emission tomography (PET) and advanced magnetic resonance imaging (MRI) techniques. In addition to anatomical MRI, these modalities may provide valuable information for several clinical applications such as differential diagnosis, delineation of tumor extent, prognostication, differentiation between tumor relapse and treatment-related changes, and the evaluation of response to anticancer therapy. In particular, joint recommendations of the Response Assessment in Neuro-Oncology (RANO) Group, the European Association of Neuro-oncology, and major European and American Nuclear Medicine societies highlighted that the additional clinical value of radiolabeled amino acids compared to anatomical MRI alone is outstanding and that its widespread clinical use should be supported. For advanced MRI and its steadily increasing use in clinical practice, the Standardization Subcommittee of the Jumpstarting Brain Tumor Drug Development Coalition provided more recently an updated acquisition protocol for the widely used dynamic susceptibility contrast perfusion MRI. Besides amino acid PET and perfusion MRI, other PET tracers and advanced MRI techniques (e.g. MR spectroscopy) are of considerable clinical interest and are increasingly integrated into everyday clinical practice. Nevertheless, these modalities have shortcomings which should be considered in clinical routine. This comprehensive review provides an overview of potential challenges, limitations, and pitfalls associated with PET imaging and advanced MRI techniques in patients with gliomas or brain metastases. Despite these issues, PET imaging and advanced MRI techniques continue to play an indispensable role in brain tumor management. Acknowledging and mitigating these challenges through interdisciplinary collaboration, standardized protocols, and continuous innovation will further enhance the utility of these modalities in guiding optimal patient care., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Purpose: According to the World Health Organization classification for tumors of the central nervous system, mutation status of the isocitrate dehydrogenase (IDH) genes has become a major diagnostic discriminator for gliomas. Therefore, imaging-based prediction of IDH mutation status is of high interest for individual patient management. We compared and evaluated the diagnostic value of radiomics derived from dual positron emission tomography (PET) and magnetic resonance imaging (MRI) data to predict the IDH mutation status non-invasively., Methods: Eighty-seven glioma patients at initial diagnosis who underwent PET targeting the translocator protein (TSPO) using [ 18 F]GE-180, dynamic amino acid PET using [ 18 F]FET, and T1-/T2-weighted MRI scans were examined. In addition to calculating tumor-to-background ratio (TBR) images for all modalities, parametric images quantifying dynamic [ 18 F]FET PET information were generated. Radiomic features were extracted from TBR and parametric images. The area under the receiver operating characteristic curve (AUC) was employed to assess the performance of logistic regression (LR) classifiers. To report robust estimates, nested cross-validation with five folds and 50 repeats was applied., Results: TBR GE-180 features extracted from TSPO-positive volumes had the highest predictive power among TBR images (AUC 0.88, with age as co-factor 0.94). Dynamic [ 18 F]FET PET reached a similarly high performance (0.94, with age 0.96). The highest LR coefficients in multimodal analyses included TBR GE-180 features, parameters from kinetic and early static [ 18 F]FET PET images, age, and the features from TBR T2 images such as the kurtosis (0.97)., Conclusion: The findings suggest that incorporating TBR GE-180 features along with kinetic information from dynamic [ 18 F]FET PET, kurtosis from TBR T2 , and age can yield very high predictability of IDH mutation status, thus potentially improving early patient management., (© 2024. The Author(s).)

Background: Accurate detection of lymph node (LN) metastases in prostate cancer (PCa) is a challenging but crucial step for disease staging. Ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) enables distinction between healthy LNs and nodes suspicious for harboring metastases. When combined with MRI at an ultra-high magnetic field, an unprecedented spatial resolution can be exploited to visualize these LNs., Purpose: The aim of this study was to explore USPIO-enhanced MRI at 7 T in comparison to 3 T for the detection of small suspicious LNs in the same cohort of patients with PCa., Materials and Methods: Twenty PCa patients with high-risk primary or recurrent disease were referred to our hospital for an investigational USPIO-enhanced 3 T MRI examination with ferumoxtran-10. With consent, they underwent a 7 T MRI on the same day. Three-dimensional anatomical and T2*-weighted images of both examinations were evaluated blinded, with an interval, by 2 readers who annotated LNs suspicious for metastases. Number, size, and level of suspicion (LoS) of LNs were paired within patients and compared between field strengths., Results: At 7 T, both readers annotated significantly more LNs compared with 3 T (474 and 284 vs 344 and 162), with 116 suspicious LNs on 7 T (range, 1-34 per patient) and 79 suspicious LNs on 3 T (range, 1-14 per patient) in 17 patients. For suspicious LNs, the median short axis diameter was 2.6 mm on 7 T (1.3-9.5 mm) and 2.8 mm for 3 T (1.7-10.4 mm, P = 0.05), with large overlap in short axis of annotated LNs between LoS groups. At 7 T, significantly more suspicious LNs had a short axis <2.5 mm compared with 3 T (44% vs 27%). Magnetic resonance imaging at 7 T provided better image quality and structure delineation and a higher LoS score for suspicious nodes., Conclusions: In the same cohort of patients with PCa, more and more small LNs were detected on 7 T USPIO-enhanced MRI compared with 3 T MRI. Suspicious LNs are generally very small, and increased nodal size was not a good indication of suspicion for the presence of metastases. The high spatial resolution of USPIO-enhanced MRI at 7 T improves structure delineation and the visibility of very small suspicious LNs, potentially expanding the in vivo detection limits of pelvic LN metastases in PCa patients., Competing Interests: Conflicts of interest and sources of funding: Funding of the 7T MRI system at the Erwin L. Hahn Institute for MRI was supported by the German Research Foundation (DFG; project number 432657511)., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: To evaluate whether artifacts on contrast-enhanced (CE) breast MRI maximum intensity projections (MIPs) might already be forecast before gadolinium-based contrast agent (GBCA) administration during an ongoing examination by analyzing the unenhanced T1-weighted images acquired before the GBCA injection., Materials and Methods: This IRB-approved retrospective analysis consisted of n = 2884 breast CE MRI examinations after intravenous administration of GBCA, acquired with n = 4 different MRI devices at different field strengths (1.5 T/3 T) during clinical routine. CE-derived subtraction MIPs were used to conduct a multi-class multi-reader evaluation of the presence and severity of artifacts with three independent readers. An ensemble classifier (EC) of five DenseNet models was used to predict artifacts for the post-contrast subtraction MIPs, giving as the input source only the pre-contrast T1-weighted sequence. Thus, the acquisition directly preceded the GBCA injection. The area under ROC (AuROC) and diagnostics accuracy scores were used to assess the performance of the neural network in an independent holdout test set (n = 285)., Results: After majority voting, potentially significant artifacts were detected in 53.6% (n = 1521) of all breast MRI examinations (age 49.6 ± 12.6 years). In the holdout test set (mean age 49.7 ± 11.8 years), at a specificity level of 89%, the EC could forecast around one-third of artifacts (sensitivity 31%) before GBCA administration, with an AuROC = 0.66., Conclusion: This study demonstrates the capability of a neural network to forecast the occurrence of artifacts on CE subtraction data before the GBCA administration. If confirmed in larger studies, this might enable a workflow-blended approach to prevent breast MRI artifacts by implementing in-scan personalized predictive algorithms., Clinical Relevance Statement: Some artifacts in contrast-enhanced breast MRI maximum intensity projections might be predictable before gadolinium-based contrast agent injection using a neural network., Key Points: • Potentially significant artifacts can be observed in a relevant proportion of breast MRI subtraction sequences after gadolinium-based contrast agent administration (GBCA). • Forecasting the occurrence of such artifacts in subtraction maximum intensity projections before GBCA administration for individual patients was feasible at 89% specificity, which allowed correctly predicting one in three future artifacts. • Further research is necessary to investigate the clinical value of such smart personalized imaging approaches., (© 2023. The Author(s).)

Introduction: Magnetic resonance guided radiotherapy (MRgRT) allows daily adaptation of treatment plans to compensate for positional changes of target volumes and organs at risk (OARs). However, current adaptation times are relatively long and organ movement occurring during the adaptation process might offset the benefit gained by adaptation. The aim of this study was to evaluate the dosimetric impact of these intrafractional changes. Additionally, a method to predict the extent of organ movement before the first treatment was evaluated in order to have the possibility to compensate for them, for example by adding additional margins to OARs., Materials & Methods: Twenty patients receiving adaptive MRgRT for treatment of abdominal lesions were retrospectively analyzed. Magnetic resonance (MR) images acquired at the start of adaptation and immediately before irradiation were used to calculate adapted and pre-irradiation dose in OARs directly next to the planning target volume. The extent of organ movement was determined on MR images acquired during simulation sessions and adaptive treatments, and their agreement was evaluated. Correlation between the magnitude of organ movement during simulation and the duration of simulation session was analyzed in order to assess whether organ movement might be relevant even if the adaptation process could be accelerated in the future., Results: A significant increase in dose constraint violations was observed from adapted (6.9%) to pre-irradiation (30.2%) dose distributions. Overall, OAR dose increased significantly by 4.3% due to intrafractional organ movement. Median changes in organ position of 7.5 mm (range 1.5-10.5 mm) were detected within a median time of 17.1 min (range 1.6-28.7 min). Good agreement was found between the range of organ movement during simulation and adaptation (66.8%), especially if simulation sessions were longer and multiple MR images were acquired. No correlation was determined between duration of simulation sessions and magnitude of organ movement., Conclusion: Intrafractional organ movement can impact dose distributions and lead to violations of OAR tolerance doses, which impairs the benefit of daily on-table plan adaptation. By application of simulation images, the extent of intrafractional organ movement can be predicted, which possibly allows to compensate for them., (© 2024. The Author(s).)

Background: Particle therapy makes a noteworthy contribution in the treatment of tumor diseases. In order to be able to irradiate from different angles, usually expensive, complex and large gantries are used. Instead rotating the beam via a gantry, the patient itself might be rotated. Here we present tolerance and compliance of volunteers for a fully-enclosed patient rotation system in a clinical magnetic resonance (MR)-scanner for potential use in MR-guided radiotherapy, conducted within a prospective evaluation study., Methods: A patient rotation system was used to simulate and perform magnetic resonance imaging (MRI)-examinations with 50 volunteers without an oncological question. For 20 participants, the MR-examination within the bore was simulated by introducing realistic MRI noise, whereas 30 participants received an examination with image acquisition. Initially, body parameters and claustrophobia were assessed. The subjects were then rotated to different angles for simulation (0°, 45°, 90°, 180°) and imaging (0°, 70°, 90°, 110°). At each angle, anxiety and motion sickness were assessed using a 6-item State-Trait-Anxiety-Inventory (STAI-6) and a modified Motion Sickness Assessment Questionnaire (MSAQ). In addition, general areas of discomfort were evaluated., Results: Out of 50 subjects, three (6%) subjects terminated the study prematurely. One subject dropped out during simulation due to nausea while rotating to 45°. During imaging, further two subjects dropped out due to shoulder pain from positioning at 90° and 110°, respectively. The average result for claustrophobia (0 = no claustrophobia to 4 = extreme claustrophobia) was none to light claustrophobia (average score: simulation 0.64 ± 0.33, imaging 0.51 ± 0.39). The mean anxiety scores (0% = no anxiety to 100% = maximal anxiety) were 11.04% (simulation) and 15.82% (imaging). Mean motion sickness scores (0% = no motion sickness to 100% = maximal motion sickness) of 3.5% (simulation) and 6.76% (imaging) were obtained across all participants., Conclusion: Our study proves the feasibility of horizontal rotation in a fully-enclosed rotation system within an MR-scanner. Anxiety scores were low and motion sickness was only a minor influence. Both anxiety and motion sickness showed no angular dependency. Further optimizations with regard to immobilization in the rotation device may increase subject comfort., (© 2024. The Author(s).)

Background: The harm-to-benefit ratio of prostate cancer (PCa) screening remains controversial mainly due to the unfavorable test characteristics of prostate-specific antigen (PSA) as a screening test., Methods: In this nonsystematic review, we present a current overview of the body of evidence on prostate cancer screening with a focus on the role of magnetic resonance imaging (MRI) of the prostate., Results: Evidence generated in large randomized controlled trials showed that PSA-based screening significantly decreases cancer-specific mortality. The main obstacle in developing and implementing PCa screening strategies is the resulting overdiagnosis and as a consequence overtreatment of indolent cancers. Opportunistic screening is characterized by an adverse benefit-to-harm ratio and should, therefore, not be recommended. The German Statutory Early Detection Program for prostate cancer, which consists of a digital rectal examination (DRE) as a stand-alone screening test, is not evidence-based, neither specific nor sensitive enough and results in unnecessary diagnostics. The European Commission recently urged member states to develop population-based and organized risk-adapted PSA-based screening programs, which are currently tested in the ongoing German PROBASE trial. Finetuning of the diagnostic pathway following PSA-testing seems key to improve its positive and negative predictive value and thereby making PCa screening more accurate. Incorporation of prostatic MRI into screening strategies leads to more accurate diagnosis of clinically significant prostate cancer, while diagnosis of indolent cancers is reduced. In the future, molecular liquid-based biomarkers have the potential to complement or even replace PSA in PCa screening and further personalize screening strategies. Active surveillance as an alternative to immediate radical therapy of demographically increasing PCa diagnoses can potentially further improve the benefit-to-harm ratio of organized screening., Conclusion: Early detection of PCa should be organized on a population level into personalized and evidence-based screening strategies. Multiparametric MRI of the prostate may play a key role in this setting., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: The pursuit of adaptive radiotherapy using MR imaging for better precision in patient positioning puts stringent demands on the hardware components of the MR scanner. Particularly in particle therapy, the dose distribution and thus the efficacy of the treatment is susceptible to beam attenuation from interfering materials in the irradiation path. This severely limits the usefulness of conventional imaging coils, which contain highly attenuating parts such as capacitors and preamplifiers in an unknown position, and requires development of a dedicated radiofrequency (RF) coil with close consideration of the materials and components used., Purpose: In MR-guided radiation therapy in the human torso, imaging coils with a large FOV and homogeneous B 1 field distribution are required for reliable tissue classification. In this work, an imaging coil for MR-guided particle therapy was developed with minimal ion attenuation while maintaining flexibility in treatment., Methods: A birdcage coil consisting of nearly radiation-transparent materials was designed and constructed for a closed-bore 1.5 T MR system. Additionally, the coil was mounted on a rotatable patient capsule for flexible positioning of the patient relative to the beam. The ion attenuation of the RF coil was investigated in theory and via measurements of the Bragg peak position. To characterize the imaging quality of the RF coil, transmit and receive field distributions were simulated and measured inside a homogeneous tissue-simulating phantom for various rotation angles of the patient capsule ranging from 0° to 345° in steps of 15°. Furthermore, simulations with a heterogeneous human voxel model were performed to better estimate the effect of real patient loading, and the RF coil was compared to the internal body coil in terms of SNR for a full rotation of the patient capsule., Results: The RF coil (total water equivalent thickness (WET) ≈ 420 µm, WET of conductor ≈ 210 µm) can be considered to be radiation-transparent, and a measured transmit power efficiency (B 1 + / P $\sqrt {\mathrm{P}} $ ) between 0.17 µT/ W $\sqrt {\mathrm{W}} $ and 0.26 µT/ W $\sqrt {\mathrm{W}} $ could be achieved in a volume (Δz = 216 mm, complete x and y range) for the 24 investigated rotation angles of the patient capsule. Furthermore, homogeneous transmit and receive field distributions were measured and simulated in the transverse, coronal and sagittal planes in a homogeneous phantom and a human voxel model. In addition, the SNR of the radiation-transparent RF coil varied between 103 and 150, in the volume (Δz = 216 mm) of a homogeneous phantom and surpasses the SNR of the internal body coil for all rotation angles of the patient capsule., Conclusions: A radiation-transparent RF coil was developed and built that enables flexible patient to beam positioning via full rotation capability of the RF coil and patient relative to the beam, with results providing promising potential for adaptive MR-guided particle therapy., (© 2024 The Authors. Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

Purpose: Traditional phase-contrast MRI is affected by displacement artifacts caused by non-synchronized spatial- and velocity-encoding time points. The resulting inaccurate velocity maps can affect the accuracy of derived hemodynamic parameters. This study proposes and characterizes a 3D radial phase-contrast UTE (PC-UTE) sequence to reduce displacement artifacts. Furthermore, it investigates the displacement of a standard Cartesian flow sequence by utilizing a displacement-free synchronized-single-point-imaging MR sequence (SYNC-SPI) that requires clinically prohibitively long acquisition times., Methods: 3D flow data was acquired at 3T at three different constant flow rates and varying spatial resolutions in a stenotic aorta phantom using the proposed PC-UTE, a Cartesian flow sequence, and a SYNC-SPI sequence as reference. Expected displacement artifacts were calculated from gradient timing waveforms and compared to displacement values measured in the in vitro flow experiments., Results: The PC-UTE sequence reduces displacement and intravoxel dephasing, leading to decreased geometric distortions and signal cancellations in magnitude images, and more spatially accurate velocity quantification compared to the Cartesian flow acquisitions; errors increase with velocity and higher spatial resolution., Conclusion: PC-UTE MRI can measure velocity vector fields with greater accuracy than Cartesian acquisitions (although pulsatile fields were not studied) and shorter scan times than SYNC-SPI. As such, this approach is superior to traditional Cartesian 3D and 4D flow MRI when spatial misrepresentations cannot be tolerated, for example, when computational fluid dynamics simulations are compared to or combined with in vitro or in vivo measurements, or regional parameters such as wall shear stress are of interest., (© 2024 Physikalisch-Technische Bundesanstalt (PTB) and The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Background and Purpose: MR-guided radiotherapy (MRgRT) online plan adaptation accounts for tumor volume changes, interfraction motion and thus allows daily sparing of relevant organs at risk. Due to the high interfraction variability of bladder and rectum, patients with tumors in the pelvic region may strongly benefit from adaptive MRgRT. Currently, fast automatic annotation of anatomical structures is not available within the online MRgRT workflow. Therefore, the aim of this study was to train and validate a fast, accurate deep learning model for automatic MRI segmentation at the MR-Linac for future implementation in a clinical MRgRT workflow., Materials and Methods: For a total of 47 patients, T2w MRI data were acquired on a 1.5 T MR-Linac (Unity, Elekta) on five different days. Prostate, seminal vesicles, rectum, anal canal, bladder, penile bulb, body and bony structures were manually annotated. These training data consisting of 232 data sets in total was used for the generation of a deep learning based autocontouring model and validated on 20 unseen T2w-MRIs. For quantitative evaluation the validation set was contoured by a radiation oncologist as gold standard contours (GSC) and compared in MATLAB to the automatic contours (AIC). For the evaluation, dice similarity coefficients (DSC), and 95% Hausdorff distances (95% HD), added path length (APL) and surface DSC (sDSC) were calculated in a caudal-cranial window of ± 4 cm with respect to the prostate ends. For qualitative evaluation, five radiation oncologists scored the AIC on the possible usage within an online adaptive workflow as follows: (1) no modifications needed, (2) minor adjustments needed, (3) major adjustments/ multiple minor adjustments needed, (4) not usable., Results: The quantitative evaluation revealed a maximum median 95% HD of 6.9 mm for the rectum and minimum median 95% HD of 2.7 mm for the bladder. Maximal and minimal median DSC were detected for bladder with 0.97 and for penile bulb with 0.73, respectively. Using a tolerance level of 3 mm, the highest and lowest sDSC were determined for rectum (0.94) and anal canal (0.68), respectively. Qualitative evaluation resulted in a mean score of 1.2 for AICs over all organs and patients across all expert ratings. For the different autocontoured structures, the highest mean score of 1.0 was observed for anal canal, sacrum, femur left and right, and pelvis left, whereas for prostate the lowest mean score of 2.0 was detected. In total, 80% of the contours were rated be clinically acceptable, 16% to require minor and 4% major adjustments for online adaptive MRgRT., Conclusion: In this study, an AI-based autocontouring was successfully trained for online adaptive MR-guided radiotherapy on the 1.5 T MR-Linac system. The developed model can automatically generate contours accepted by physicians (80%) or only with the need of minor corrections (16%) for the irradiation of primary prostate on the clinically employed sequences., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [The authors report institutional collaborations with TheraPanacea, Elekta, Philips, Kaiku and PTW Freiburg which provided technical and/or financial support. TheraPanacea developed the proposed model, but were not involved in the analysis and scoring of the testing dataset.], (Copyright © 2023 The Author(s). Published by Elsevier GmbH.. All rights reserved.)

Elevated serum prolactin concentrations occur in inherited disorders of biogenic amine metabolism because dopamine deficiency leads to insufficient inhibition of prolactin secretion. This work from the International Working Group on Neurotransmitter Related Disorders (iNTD) presents the results of the first standardized study on levodopa-refractory hyperprolactinemia (LRHP; >1000 mU/L) and pituitary magnetic resonance imaging (MRI) abnormalities in patients with inherited disorders of biogenic amine metabolism. Twenty-six individuals had LRHP or abnormal pituitary findings on MRI. Tetrahydrobiopterin deficiencies were the most common diagnoses (n = 22). The median age at diagnosis of LRHP was 16 years (range: 2.5-30, 1st-3rd quartiles: 12.25-17 years). Twelve individuals (nine females) had symptoms attributed to hyperprolactinemia: menstruation-related abnormalities (n = 7), pubertal delay or arrest (n = 5), galactorrhea (n = 3), and decreased sexual functions (n = 2). MRI of the pituitary gland was obtained in 21 individuals; six had heterogeneity/hyperplasia of the gland, five had adenoma, and 10 had normal findings. Eleven individuals were treated with the dopamine agonist cabergoline, ameliorating the hyperprolactinemia-related symptoms in all those assessed. Routine monitoring of these symptoms together with prolactin concentrations, especially after the first decade of life, should be taken into consideration during follow-up evaluations. The potential of slow-release levodopa formulations and low-dose dopamine agonists as part of first-line therapy in the prevention and treatment of hyperprolactinemia should be investigated further in animal studies and human trials. This work adds hyperprolactinemia-related findings to the current knowledge of the phenotypic spectrum of inherited disorders of biogenic amine metabolism., (© 2023 The Authors. Journal of Inherited Metabolic Disease published by John Wiley & Sons Ltd on behalf of SSIEM.)

This manuscript describes the ISMRM OSIPI (Open Science Initiative for Perfusion Imaging) lexicon for dynamic contrast-enhanced and dynamic susceptibility-contrast MRI. The lexicon was developed by Taskforce 4.2 of OSIPI to provide standardized definitions of commonly used quantities, models, and analysis processes with the aim of reducing reporting variability. The taskforce was established in February 2020 and consists of medical physicists, engineers, clinicians, data and computer scientists, and DICOM (Digital Imaging and Communications in Medicine) standard experts. Members of the taskforce collaborated via a slack channel and quarterly virtual meetings. Members participated by defining lexicon items and reporting formats that were reviewed by at least two other members of the taskforce. Version 1.0.0 of the lexicon was subject to open review from the wider perfusion imaging community between January and March 2022, and endorsed by the Perfusion Study Group of the ISMRM in the summer of 2022. The initial scope of the lexicon was set by the taskforce and defined such that it contained a basic set of quantities, processes, and models to enable users to report an end-to-end analysis pipeline including kinetic model fitting. We also provide guidance on how to easily incorporate lexicon items and definitions into free-text descriptions (e.g., in manuscripts and other documentation) and introduce an XML-based pipeline encoding format to encode analyses using lexicon definitions in standardized and extensible machine-readable code. The lexicon is designed to be open-source and extendable, enabling ongoing expansion of its content. We hope that widespread adoption of lexicon terminology and reporting formats described herein will increase reproducibility within the field., (© 2023 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Objective: To compensate subject-specific field inhomogeneities and enhance fat pre-saturation with a fast online individual spectral-spatial (SPSP) single-channel pulse design., Methods: The RF shape is calculated online using subject-specific field maps and a predefined excitation k-space trajectory. Calculation acceleration options are explored to increase clinical viability. Four optimization configurations are compared to a standard Gaussian spectral selective pre-saturation pulse and to a Dixon acquisition using phantom and volunteer (N = 5) data at 1.5 T with a turbo spin echo (TSE) sequence. Measurements and simulations are conducted across various body parts and image orientations., Results: Phantom measurements demonstrate up to a 3.5-fold reduction in residual fat signal compared to Gaussian fat saturation. In vivo evaluations show improvements up to sixfold for dorsal subcutaneous fat in sagittal cervical spine acquisitions. The versatility of the tailored trajectory is confirmed through sagittal foot/ankle, coronal, and transversal cervical spine experiments. Additional measurements indicate that excitation field (B1) information can be disregarded at 1.5 T. Acceleration methods reduce computation time to a few seconds., Discussion: An individual pulse design that primarily compensates for main field (B0) inhomogeneities in fat pre-saturation is successfully implemented within an online "push-button" workflow. Both fat saturation homogeneity and the level of suppression are improved., (© 2024. The Author(s).)

Hyperpolarization techniques significantly enhance the sensitivity of magnetic resonance (MR) and thus present fascinating new directions for research and applications with in vivo MR imaging and spectroscopy (MRI/S). Hyperpolarized 13 C MRI/S, in particular, enables real-time non-invasive assessment of metabolic processes and holds great promise for a diverse range of clinical applications spanning fields like oncology, neurology, and cardiology, with a potential for improving early diagnosis of disease, patient stratification, and therapy response assessment. Despite its potential, technical challenges remain for achieving clinical translation. This paper provides an overview of the discussions that took place at the international workshop "New Horizons in Hyperpolarized 13 C MRI," in March 2023 at the Bavarian Academy of Sciences and Humanities, Munich, Germany. The workshop covered new developments, as well as future directions, in topics including polarization techniques (particularly focusing on parahydrogen-based methods), novel probes, considerations related to data acquisition and analysis, and emerging clinical applications in oncology and other fields., (© 2023. The Author(s).)

Objective: First implementation of dynamic oxygen-17 ( 17 O) MRI at 7 Tesla (T) during neuronal stimulation in the human brain., Methods: Five healthy volunteers underwent a three-phase 17 O gas ( 17 O 2 ) inhalation experiment. Combined right-side visual stimulus and right-hand finger tapping were used to achieve neuronal stimulation in the left cerebral hemisphere. Data analysis included the evaluation of the relative partial volume (PV)-corrected time evolution of absolute 17 O water (H 2 17 O) concentration and of the relative signal evolution without PV correction. Statistical analysis was performed using a one-tailed paired t test. Blood oxygen level-dependent (BOLD) experiments were performed to validate the stimulation paradigm., Results: The BOLD maps showed significant activity in the stimulated left visual and sensorimotor cortex compared to the non-stimulated right side. PV correction of 17 O MR data resulted in high signal fluctuations with a noise level of 10% due to small regions of interest (ROI), impeding further quantitative analysis. Statistical evaluation of the relative H 2 17 O signal with PV correction (p = 0.168) and without (p = 0.382) did not show significant difference between the stimulated left and non-stimulated right sensorimotor ROI., Discussion: The change of cerebral oxygen metabolism induced by sensorimotor and visual stimulation is not large enough to be reliably detected with the current setup and methodology of dynamic 17 O MRI at 7 T., (© 2023. The Author(s).)

Background and Purpose: Before quantitative imaging biomarkers (QIBs) acquired with magnetic resonance imaging (MRI) can be used for interventional trials in radiotherapy (RT), technical validation of these QIBs is necessary. The aim of this study was to assess the reproducibility of apparent diffusion coefficient (ADC) values, derived from diffusion-weighted (DW) MRI, in head and neck cancer using a 1.5 T MR-Linac (MRL) by comparison to a 3 T diagnostic scanner (DS)., Material and Methods: DW-MRIs were acquired on MRL and DS for 15 head and neck cancer patients before RT and in week 2 and rigidly registered to the planning computed tomography. Mean ADC values were calculated for submandibular (SG) and parotid (PG) glands as well as target volumes (TV, gross tumor volume and lymph nodes), which were delineated based on computed tomography. Mean absolute ADC differences as well as within-subject coefficient of variation (wCV) and intraclass correlation coefficients (ICCs) were calculated for all volumes of interest., Results: A total of 23 datasets were analyzed. Mean ADC difference (DS-MRL) for SG, PG and TV resulted in 142, 254 and 93·10 -6 mm 2 /s. wCVs/ICCs, comparing MRL and DS, were determined as 13.7 %/0.26, 24.4 %/0.23 and 16.1 %/0.73 for SG, PG and TV, respectively., Conclusion: ADC values, measured on the 1.5 T MRL, showed reasonable reproducibility with an ADC underestimation in contrast to the DS. This ADC shift must be validated in further experiments and considered for future translation of QIB candidates from DS to MRL for response adaptive RT., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: CEST MRI is influenced by fat signal, which can reduce the apparent CEST contrast or lead to pseudo-CEST effects. Our goal was to develop a fat artifact correction based on multi-echo fat-water separation that functions stably for 7 T knee MRI data., Methods: Our proposed algorithm utilizes the full complex data and a phase demodulation with an off-resonance map estimation based on the Z-spectra prior to fat-water separation to achieve stable fat artifact correction. Our method was validated and compared to multi-echo-based methods originally proposed for 3 T by Bloch-McConnell simulations and phantom measurements. Moreover, the method was applied to in vivo 7 T knee MRI examinations and compared to Gaussian fat saturation and a published single-echo Z-spectrum-based fat artifact correction method., Results: Phase demodulation prior to fat-water separation reduced the occurrence of fat-water swaps. Utilizing the complex signal data led to more stable correction results than working with magnitude data, as was proposed for 3 T. Our approach reduced pseudo-nuclear Overhauser effects compared to the other correction methods. Thus, the mean asymmetry contrast at 3.5 ppm in cartilage over five volunteers increased from -9.2% (uncorrected) and -10.6% (Z-spectrum-based) to -1.5%. Results showed higher spatial stability than with the fat saturation pulse., Conclusion: Our work demonstrates the feasibility of multi-echo-based fat-water separation with an adaptive fat model for fat artifact correction for CEST MRI at 7 T. Our approach provided better fat artifact correction throughout the entire spectrum and image than the fat saturation pulse or Z-spectrum-based correction method for both phantom and knee imaging results., (© 2023 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Purpose: To apply multi-shot high-resolution multi inversion spin and gradient echo (MI-SAGE) acquisition for simultaneous liver T 1 , T 2 and T 2 * mapping., Methods: Inversion prepared spin- and gradient-echo EPI was developed with ascending slice order across measurements for efficient acquisition with T 1 , T 2 , and T 2 ⁎ weighting. Multi-shot EPI was also implemented to minimize distortion and blurring while enabling high in-plane resolution. A dictionary-matching approach was used to fit the images to quantitative parameter maps, which were compared to T 1 measured by modified Look-Locker (MOLLI), T 1 measured by variable flip angle (VFA), T 2 measured by multiple echo time-based Half Fourier Single-shot Turbo spin-Echo (HASTE), T 2 measured by radial turbo-spin-echo (rTSE) and T 2 ⁎ measured by multiple gradient echo (MGRE) sequences., Results: The multi-shot variant of the sequence achieved higher in-plane resolution of 1.7 × 1.7 mm 2 with good image quality in 28 s. Derived quantitative maps showed comparable values to conventional mapping methods. As measured in phantom and in vivo, MOLLI, MESE and MGRE give closest values to MISAGE. VFA, HASTE and rTSE show obvious overestimation., Conclusions: The proposed multi-shot inversion prepared spin- and gradient-echo EPI sequence allows for high-resolution quantitative T 1 , T 2 and T 2 liver tissue characterization in a single breath-hold scan., (Copyright © 2023 Elsevier Inc. All rights reserved.)

In magnetic resonance imaging (MRI), the perception of substandard image quality may prompt repetition of the respective image acquisition protocol. Subsequently selecting the preferred high-quality image data from a series of acquisitions can be challenging. An automated workflow may facilitate and improve this selection. We therefore aimed to investigate the applicability of an automated image quality assessment for the prediction of the subjectively preferred image acquisition. Our analysis included data from 11,347 participants with whole-body MRI examinations performed as part of the ongoing prospective multi-center German National Cohort (NAKO) study. Trained radiologic technologists repeated any of the twelve examination protocols due to induced setup errors and/or subjectively unsatisfactory image quality and chose a preferred acquisition from the resultant series. Up to 11 quantitative image quality parameters were automatically derived from all acquisitions. Regularized regression and standard estimates of diagnostic accuracy were calculated. Controlling for setup variations in 2342 series of two or more acquisitions, technologists preferred the repetition over the initial acquisition in 1116 of 1396 series in which the initial setup was retained (79.9%, range across protocols: 73-100%). Image quality parameters then commonly showed statistically significant differences between chosen and discarded acquisitions. In regularized regression across all protocols, 'structured noise maximum' was the strongest predictor for the technologists' choice, followed by 'N/2 ghosting average'. Combinations of the automatically derived parameters provided an area under the ROC curve between 0.51 and 0.74 for the prediction of the technologists' choice. It is concluded that automated image quality assessment can, despite considerable performance differences between protocols and anatomical regions, contribute substantially to identifying the subjective preference in a series of MRI acquisitions and thus provide effective decision support to readers., (© 2023. The Author(s).)

Sodium is an essential ion that plays a central role in many physiological processes including the transmembrane electrochemical gradient and the maintenance of the body's homeostasis. Due to the crucial role of sodium in the human body, the sodium nucleus is a promising candidate for non-invasively assessing (patho-)physiological changes. Almost 10 years ago, Madelin et al. provided a comprehensive review of methods and applications of sodium ( 23 Na) MRI (Madelin et al., 2014) [1]. More recent review articles have focused mainly on specific applications of 23 Na MRI. For example, several articles covered 23 Na MRI applications for diseases such as osteoarthritis (Zbyn et al., 2016, Zaric et al., 2020) [2,3], multiple sclerosis (Petracca et al., 2016, Huhn et al., 2019) [4,5] and brain tumors (Schepkin, 2016) [6], or for imaging certain organs such as the kidneys (Zollner et al., 2016) [7], the brain (Shah et al., 2016, Thulborn et al., 2018) [8,9], and the heart (Bottomley, 2016) [10]. Other articles have reviewed technical developments such as radiofrequency (RF) coils for 23 Na MRI (Wiggins et al., 2016, Bangerter et al., 2016) [11,12], pulse sequences (Konstandin et al., 2014) [13], image reconstruction methods (Chen et al., 2021) [14], and interleaved/simultaneous imaging techniques (Lopez Kolkovsky et al., 2022) [15]. In addition, 23 Na MRI topics have been covered in review articles with broader topics such as multinuclear MRI or ultra-high-field MRI (Niesporek et al., 2019, Hu et al., 2019, Ladd et al., 2018) [16-18]. During the past decade, various research groups have continued working on technical improvements to sodium MRI and have investigated its potential to serve as a diagnostic and prognostic tool. Clinical research applications of 23 Na MRI have covered a broad spectrum of diseases, mainly focusing on the brain, cartilage, and skeletal muscle (see Fig. 1). In this article, we aim to provide a comprehensive summary of methodological and hardware developments, as well as a review of various clinical research applications of sodium ( 23 Na) MRI in the last decade (i.e., published from the beginning of 2013 to the end of 2022)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: According to PI-RADS v2.1, T2-weighted imaging (T2WI) is the dominant sequence for transition zone (TZ) lesions. This study aimed to assess, whether diffusion-weighted imaging (DWI) information influences the assignment of T2WI scores., Method: Out of 283 prostate MRI examinations with correlated biopsy results, fourty-four patients were selected retrospectively: first, 22 patients with a TZ lesion with T2WI and DWI scores ≥ 4, to represent lesions with unequivocal suspicion on T2WI and DWI. Second, 22 additional patients with TZ lesions of similar T2WI appearance but with corresponding DWI score ≤ 3 were added as control. Four residents and one board-certified radiologist each performed two assessments of the included patients: First, only T2WI was available (T2-only read); second, both T2WI and DWI sequences were available (biparametric read). Lesion scores were assessed using Wilcoxon signed-rank test, inter-reader agreement using weighted kappa and Kendall's W statistics, and sensitivity/specificity using McNemar test., Results: The T2WI scores were significantly different between the T2-only and biparametric read for 3 out of 4 residents (p ≤ 0.049) but not for the radiologist. The overall PI-RADS scores derived from the two reading sessions differed considerably for 35/220 cases (all readers pooled). Inter-reader agreement was fair for the T2WI and overall PI-RADS scores (mean kappa 0.27-0.30) and moderate for the DWI scores (mean kappa 0.43)., Conclusions: For inexperienced readers, assessment of T2WI is variable and potentially biased by availability of DWI information, which can lead to changes of overall PI-RADS score and consequently clinical management. Assessment of T2WI should be performed before reviewing DWI to ensure non-biased interpretation of TZ lesions in the dominant sequence., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: KS Zhang, P. Mayer, PA Glemser, AA Tavakoli, M. Keymling, LT Rotkopf, M. Görtz, T. Hielscher and M. Hohenfellner have nothing to declare. C. Meinzer declares: Research funding: Bundesministerium für Wirtschaft und Klimaschutz (BMWK): 01MT21004B. HU Kauczor declares: Consulting fee or honoraria (speakers bureau): Siemens, Philips, Sanofi, Median; grants/research support: Siemens, Philips, Boehringer Ingelheim. A. Stenzinger declares: Research funding: Bayer, Bristol-Myers Squibb, Chugai, and Incyte; speaker’s honoraria: Aignostics, Amgen, Astra Zeneca, AGCT, Bayer, BMS, Eli Lilly, Illumina, Incyte, Janssen, MSD, Novartis, Pfizer, Qlucore, Roche, Seagen, Seattle Genetics, Takeda, and Thermo Fisher. D. Bonekamp declares: Payment for lectures: Bayer Vital. HP Schlemmer declares: Consulting fee or honorarium: Siemens, Curagita, Profound, Bayer; travel support: Siemens, Curagita, Profound, Bayer; board member: Curagita; consultancy: Curagita, Bayer; grants/grants pending: BMBF, Deutsche Krebshilfe, Dietmar-Hopp-Stiftung, Roland-Ernst-Stiftung; payment for lectures: Siemens, Curagita, Profound, Bayer., (Copyright © 2023. Published by Elsevier B.V.)

Metabolic magnetic resonance imaging (MRI) using hyperpolarized (HP) pyruvate is becoming a non-invasive technique for diagnosing, staging, and monitoring response to treatment in cancer and other diseases. The clinically established method for producing HP pyruvate, dissolution dynamic nuclear polarization, however, is rather complex and slow. Signal Amplification By Reversible Exchange (SABRE) is an ultra-fast and low-cost method based on fast chemical exchange. Here, for the first time, we demonstrate not only in vivo utility, but also metabolic MRI with SABRE. We present a novel routine to produce aqueous HP [1- 13 C]pyruvate-d 3 for injection in 6 minutes. The injected solution was sterile, non-toxic, pH neutral and contained ≈30 mM [1- 13 C]pyruvate-d 3 polarized to ≈11 % (residual 250 mM methanol and 20 μM catalyst). It was obtained by rapid solvent evaporation and metal filtering, which we detail in this manuscript. This achievement makes HP pyruvate MRI available to a wide biomedical community for fast metabolic imaging of living organisms., (© 2023 The Authors. Angewandte Chemie International Edition published by Wiley-VCH GmbH.)

pH alterations are a hallmark of many pathologies including cancer and kidney disease. Here, we introduce [1,5- 13 C 2 ]Z-OMPD as a hyperpolarized extracellular pH and perfusion sensor for MRI which allows to generate a multiparametric fingerprint of renal disease status and to detect local tumor acidification. Exceptional long T 1 of two minutes at 1 T, high pH sensitivity of up to 1.9 ppm per pH unit and suitability of using the C 1 -label as internal frequency reference enables pH imaging in vivo of three pH compartments in healthy rat kidneys. Spectrally selective targeting of both 13 C-resonances enables simultaneous imaging of perfusion and filtration in 3D and pH in 2D within one minute to quantify renal blood flow, glomerular filtration rates and renal pH in healthy and hydronephrotic kidneys with superior sensitivity compared to clinical routine methods. Imaging multiple biomarkers within a single session renders [1,5- 13 C 2 ]Z-OMPD a promising new hyperpolarized agent for oncology and nephrology., (© 2023. Springer Nature Limited.)

Purpose: This study aimed to assess repeatability after repositioning (inter-scan), intra-rater, inter-rater and inter-sequence variability of mean apparent diffusion coefficient (ADC) measurements in MRI-detected prostate lesions., Method: Forty-three patients with suspicion for prostate cancer were included and received a clinical prostate bi-/multiparametric MRI examination with repeat scans of the T2-weighted and two DWI-weighted sequences (ssEPI and rsEPI). Two raters (R1 and R2) performed single-slice, 2D regions of interest (2D-ROIs) and 3D-segmentation-ROIs (3D-ROIs). Mean bias, corresponding limits of agreement (LoA), mean absolute difference, within-subject coefficient of variation (CoV) and repeatability/reproducibility coefficient (RC/RDC) were calculated. Bradley & Blackwood test was used for variance comparison. Linear mixed models (LMM) were used to account for multiple lesions per patient., Results: Inter-scan repeatability, intra-rater and inter-sequence reproducibility analysis of ADC showed no significant bias. 3D-ROIs demonstrated significantly less variability than 2D-ROIs (p < 0.01). Inter-rater comparison demonstrated small significant systematic bias of 57 × 10 -6 mm 2 /s for 3D-ROIs (p < 0.001). Intra-rater RC, with the lowest variation, was 145 and 189 × 10 -6 mm 2 /s for 3D- and 2D-ROIs, respectively. For 3D-ROIs of ssEPI, RCs and RDCs were 190-198 × 10 -6 mm 2 /s for inter-scan, inter-rater and inter-sequence variation. No significant differences were found for inter-scan, inter-rater and inter-sequence variability., Conclusions: In a single-scanner setting, single-slice ADC measurements showed considerable variation, which may be lowered using 3D-ROIs. For 3D-ROIs, we propose a cut-off of ∼ 200 × 10 -6 mm 2 /s for differences introduced by repositioning, rater or sequence effects. The results suggest that follow-up measurements should be possible by different raters or sequences., Competing Interests: Declaration of Competing Interest KS Zhang, CJO Neelsen, M. Wennmann, PA Glemser, T. Hielscher, V Weru, M. Görtz, V. Schütz, M. Hohenfellner have nothing to declare. Albrecht Stenzinger declares: Consulting fee and payment for lectures: Astra Zeneca, BMS, Novartis, Roche, Illumina, Thermo Fisher. Travel support: Astra Zeneca, BMS, Novartis, Illumina, Thermo Fisher. Board Member: Astra Zeneca, BMS, Novartis, Thermo Fisher. Heinz-Peter Schlemmer declares: Consulting fee or honorarium: Siemens, Curagita, Profound, Bayer. Travel support: Siemens, Curagita, Profound, Bayer. Board Member: Curagita. Consultancy: Curagita, Bayer. Grants/Grants pending: BMBF, Deutsche Krebshilfe, Dietmar-Hopp-Stiftung, Roland-Ernst-Stiftung. Payment for lectures: Siemens, Curagita, Profound, Bayer. David Bonekamp declares: Payment for lectures: Profound Medical Inc., Bayer Vital., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Nanomaterials play an important role in the development and application of hyperpolarized materials for magnetic resonance imaging (MRI). In this context they can not only act as hyperpolarized materials which are directly imaged but also play a role as carriers for hyperpolarized gases and catalysts for para-hydrogen induced polarization (PHIP) to generate hyperpolarized substrates for metabolic imaging. Those three application possibilities are discussed, focusing on carbon-based materials for the directly imaged particles. An overview over recent developments in all three fields is given, including the early developments in each field as well as important steps towards applications in MRI, such as making the initially developed methods more biocompatible and first imaging experiments with spatial resolution in either phantoms or in vivo studies. Focusing on the important features nanomaterials need to display to be applicable in the MRI context, a wide range of different approaches to that extent is covered, giving the reader a general idea of different possibilities as well as recent developments in those different fields of hyperpolarized magnetic resonance. This article is categorized under: Therapeutic Approaches and Drug Discovery > Emerging Technologies Diagnostic Tools > In Vivo Nanodiagnostics and Imaging., (© 2023 The Authors. WIREs Nanomedicine and Nanobiotechnology published by Wiley Periodicals LLC.)

Background: Hybrid MRI linear accelerators (MR-Linac) might enable individualized online adaptation of radiotherapy using quantitative MRI sequences as diffusion-weighted imaging (DWI). The purpose of this study was to investigate the dynamics of lesion apparent diffusion coefficient (ADC) in patients with prostate cancer undergoing MR-guided radiation therapy (MRgRT) on a 1.5T MR-Linac. The ADC values at a diagnostic 3T MRI scanner were used as the reference standard., Patients and and Methods: In this prospective single-center study, patients with biopsy-confirmed prostate cancer who underwent both an MRI exam at a 3T scanner (MRI 3T ) and an exam at a 1.5T MR-Linac (MRL) at baseline and during radiotherapy were included. Lesion ADC values were measured by a radiologist and a radiation oncologist on the slice with the largest lesion. ADC values were compared before vs . during radiotherapy (during the second week) on both systems via paired t-tests. Furthermore, Pearson correlation coefficient and inter-reader agreement were computed., Results: A total of nine male patients aged 67 ± 6 years [range 60 - 67 years] were included. In seven patients, the cancerous lesion was in the peripheral zone, and in two patients the lesion was in the transition zone. Inter-reader reliability regarding lesion ADC measurement was excellent with an intraclass correlation coefficient of (ICC) > 0.90 both at baseline and during radiotherapy. Thus, the results of the first reader will be reported. In both systems, there was a statistically significant elevation of lesion ADC during radiotherapy (mean MRL-ADC at baseline was 0.97 ± 0.18 × 10 -3 mm 2 /s vs . mean MRL-ADC during radiotherapy 1.38 ± 0.3 × 10 -3 mm 2 /s, yielding a mean lesion ADC elevation of 0.41 ± 0.20 × 10 -3 mm 2 /s, p < 0.001). Mean MRI 3T -ADC at baseline was 0.78 ± 0.165 × 10 -3 mm 2 /s vs . mean MRI 3T -ADC during radiotherapy 0.99 ± 0.175 × 10 -3 mm 2 /s, yielding a mean lesion ADC elevation of 0.21 ± 0.96 × 10 -3 mm 2 /s p < 0.001). The absolute ADC values from MRL were consistently significantly higher than those from MRI 3T at baseline and during radiotherapy (p < = 0.001). However, there was a strong positive correlation between MRL-ADC and MRI 3T -ADC at baseline ( r = 0.798, p = 0.01) and during radiotherapy ( r = 0.863, p = 0.003)., Conclusions: Lesion ADC as measured on MRL increased significantly during radiotherapy and ADC measurements of lesions on both systems showed similar dynamics. This indicates that lesion ADC as measured on the MRL may be used as a biomarker for evaluation of treatment response. In contrast, absolute ADC values as calculated by the algorithm of the manufacturer of the MRL showed systematic deviations from values obtained on a diagnostic 3T MRI system. These preliminary findings are promising but need large-scale validation. Once validated, lesion ADC on MRL might be used for real-time assessment of tumor response in patients with prostate cancer undergoing MR-guided radiation therapy., (© 2023 Haidara Almansour et al., published by Sciendo.)

Carbon-13 hyperpolarized pyruvate is about to become the next-generation contrast agent for molecular magnetic resonance imaging of cancer and other diseases. Here, efficient and rapid pyruvate hyperpolarization is achieved via signal amplification by reversible exchange (SABRE) with parahydrogen through synergistic use of substrate deuteration, alternating, and static microtesla magnetic fields. Up to 22 and 6% long-lasting 13 C polarization ( T 1 = 3.7 ± 0.25 and 1.7 ± 0.1 min) is demonstrated for the C1 and C2 nuclear sites, respectively. The remarkable polarization levels become possible as a result of favorable relaxation dynamics at the microtesla fields. The ultralong polarization lifetimes will be conducive to yielding high polarization after purification, quality assurance, and injection of the hyperpolarized molecular imaging probes. These results pave the way to future in vivo translation of carbon-13 hyperpolarized molecular imaging probes prepared by this approach.

Multiple sites within Germany operate human MRI systems with magnetic fields either at 7 Tesla or 9.4 Tesla. In 2013, these sites formed a network to facilitate and harmonize the research being conducted at the different sites and make this technology available to a larger community of researchers and clinicians not only within Germany, but also worldwide. The German Ultrahigh Field Imaging (GUFI) network has defined a strategic goal to establish a 14 Tesla whole-body human MRI system as a national research resource in Germany as the next progression in magnetic field strength. This paper summarizes the history of this initiative, the current status, the motivation for pursuing MR imaging and spectroscopy at such a high magnetic field strength, and the technical and funding challenges involved. It focuses on the scientific and science policy process from the perspective in Germany, and is not intended to be a comprehensive systematic review of the benefits and technical challenges of higher field strengths., (© 2023. The Author(s).)

Purpose: In this work, we investigated the ability of neural networks to rapidly and robustly predict Lorentzian parameters of multi-pool CEST MRI spectra at 7 T with corresponding uncertainty maps to make them quickly and easily available for routine clinical use., Methods: We developed a deepCEST 7 T approach that generates CEST contrasts from just 1 scan with robustness against B 1 inhomogeneities. The input data for a neural feed-forward network consisted of 7 T in vivo uncorrected Z-spectra of a single B 1 level, and a B 1 map. The 7 T raw data were acquired using a 3D snapshot gradient echo multiple interleaved mode saturation CEST sequence. These inputs were mapped voxel-wise to target data consisting of Lorentzian amplitudes generated conventionally by 5-pool Lorentzian fitting of normalized, denoised, B 0 - and B 1 -corrected Z-spectra. The deepCEST network was trained with Gaussian negative log-likelihood loss, providing an uncertainty quantification in addition to the Lorentzian amplitudes., Results: The deepCEST 7 T network provides fast and accurate prediction of all Lorentzian parameters also when only a single B 1 level is used. The prediction was highly accurate with respect to the Lorentzian fit amplitudes, and both healthy tissues and hyperintensities in tumor areas are predicted with a low uncertainty. In corrupted cases, high uncertainty indicated wrong predictions reliably., Conclusion: The proposed deepCEST 7 T approach reduces scan time by 50% to now 6:42 min, but still delivers both B 0 - and B 1 -corrected homogeneous CEST contrasts along with an uncertainty map, which can increase diagnostic confidence. Multiple accurate 7 T CEST contrasts are delivered within seconds., (© 2022 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Purpose: This study aims to find a relation between the number of channels and the computational burden for specific absorption rate (SAR) calculation using virtual observation point-based SAR compression., Methods: Eleven different arrays of rectangular loops covering a cylinder of fixed size around the head of an anatomically correct voxel model were simulated. The resulting Q-matrices were compressed with 2 different compression algorithms, with the overestimation fixed to a certain fraction of worst-case SAR, median SAR, or minimum SAR. The latter 2 were calculated from 1e6 normalized random excitation vectors., Results: The number of virtual observation points increased with the number of channels to the power of 2.3-3.7, depending on the compression algorithm when holding the relative error fixed. Together with the increase in the size of the Q-matrices (and therefore the size of the virtual observation points), the total increase in computational burden with the number of channels was to the power of 4.3-5.7., Conclusion: The computational cost emphasizes the need to use the best possible compression algorithms when moving to high channel counts., (© 2022 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Purpose: To evaluate the benefits and challenges of dynamic parallel transmit (pTx) pulses for fat saturation (FS) and water-excitation (WE), in the context of CEST MRI., Methods: "Universal" k T -points (for FS) and spiral non-selective (for WE) trajectories were optimized offline for flip angle (FA) homogeneity. Routines to optimize the pulse shape online, based on the subject's fields maps, were implemented (target FA of 110°/0° for FS, 0°/5° for WE at fat/water frequencies). The pulses were inserted in a CEST sequence with a pTx readout. The different fat suppression schemes and their effects on CEST contrasts were compared in 12 volunteers at 7T., Results: With a 25%-shorter pulse duration, pTx FS largely improved the FA homogeneity (root-mean-square-error (RMSE) = 12.3° vs. 53.4° with circularly-polarized mode, at the fat frequency). However, the spectral selectivity was degraded mainly in the cerebellum and close to the sinuses (RMSE = 5.8° vs. 0.2° at the water frequency). Similarly, pTx WE showed a trade-off between FA homogeneity and spectral selectivity compared to pTx non-selective pulses (RMSE = 0.9° and 1.1° at the fat and water frequencies, vs. 4.6° and 0.5°). In the brain, CEST metrics were reduced by up to 31.9% at -3.3 ppm with pTx FS, suggesting a mitigated lipid-induced bias., Conclusion: This clinically compatible implementation of dynamic pTx pulses improved the fat suppression homogeneity at 7T taking into account the subject-specific B 0 heterogeneities online. This study highlights the lipid-induced biases on the CEST z-spectrum. The results are promising for body applications where B 0 heterogeneities and fat are more substantial., (© 2022 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Despite great successes in oncology, patient outcomes are often still discouraging, and hence the diagnostic imaging paradigm is increasingly shifting toward functional imaging of the pathology to better understand individual disease biology and to personalize therapies. The dissolution Dynamic Nuclear Polarization (d-DNP) hyperpolarization method has enabled unprecedented real-time MRI sensing of metabolism and tissue pH using hyperpolarized [1- 13 C]pyruvate as a biosensor with great potential for diagnosis and monitoring of cancer patients. However, current d-DNP is expensive and suffers from long hyperpolarization times, posing a substantial translational roadblock. Here, we report the development of Re-Dissolution Signal Amplification By Reversible Exchange (Re-D SABRE), which relies on fast and low-cost hyperpolarization of [1- 13 C]pyruvate by chemical exchange with parahydrogen at microtesla magnetic fields. [1- 13 C]pyruvate is precipitated from catalyst-containing methanol using ethyl acetate and rapidly reconstituted in aqueous media. 13 C polarization of 9 ± 1% is demonstrated after redissolution in water with residual iridium mass fraction of 8.5 ± 1.5 ppm; further improvement is anticipated via process automation. Re-D SABRE makes hyperpolarized [1- 13 C]pyruvate biosensor available at a fraction of the cost (<$10,000) and production time (≈1 min) of currently used techniques and makes aqueous hyperpolarized [1- 13 C]pyruvate "ready" for in vivo applications.

Purpose: To improve whole-brain SNR at 7 Tesla, a novel 32-element hybrid human head array coil was developed, constructed, and tested., Methods: Our general design strategy is based on 2 major ideas: Firstly, following suggestions of previous works based on the ultimate intrinsic SNR theory, we combined loops and dipoles for improvement of SNR near the head center. Secondly, we minimized the total number of array elements by using a hybrid combination of transceive (TxRx) and receive (Rx) elements. The new hybrid array consisted of 8 folded-end TxRx-dipole antennas and 3 rows of 24 Rx-loops all placed in a single layer on the surface of a tight-fit helmet., Results: The developed array significantly improved SNR in vivo both near the center (∼20%) and at the periphery (∼20% to 80%) in comparison to a common commercial array coil with 8 transmit (Tx) and 32 Rx-elements. Whereas 24 loops alone delivered central SNR very similar to that of the commercial coil, the addition of complementary dipole structures provided further improvement. The new array also provided ∼15% higher Tx efficiency and better longitudinal coverage than that of the commercial array., Conclusion: The developed array coil demonstrated advantages in combining complementary TxRx and Rx resonant structures, that is, TxRx-dipoles and Rx-loops all placed in a single layer at the same distance to the head. This strategy improved both SNR and Tx-performance, as well as simplified the total head coil design, making it more robust., (© 2022 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Important issues in designing radiofrequency (RF) coils for human head imaging at ultra-high field (UHF; ≥7 T) are the inhomogeneity and longitudinal coverage (along the magnet axis) of the transmit (Tx) RF field. Both the homogeneity and coverage produced by Tx volume coils can be improved by means of three-dimensional (3D) RF shimming, which requires the use of multirow Tx-arrays. In addition, according to recent findings of the ultimate intrinsic signal-to-noise ratio (UISNR) theory, the loop-only receive (Rx) arrays do not provide optimal SNR near the brain center at UHF. The latter can be obtained by combining complementary conductive structures carrying different current patterns (e.g., loops and dipole antennas). In this work, we developed, constructed, and evaluated a novel 32-element hybrid array design for human head imaging at 7 T. The array consists of 16 transceiver loops placed in two rows circumscribing the head and 16 folded-end Rx-only dipoles positioned in the centers of loops. By placing all elements in a single layer, we increased RF power deposition into the tissue and, thus, preserved the Tx-efficiency. Using this hybrid design also simplifies the coil structure by minimizing the total number of array elements. The array demonstrated whole brain coverage, 3D RF shimming capability, and high SNR. It provided ~15% higher SNR near the brain center and, depending on the RF shim mode, from 20% to 40% higher Tx-efficiency than a common commercial head array coil., (© 2022 The Authors. NMR in Biomedicine published by John Wiley & Sons Ltd.)

Purpose: Magnetic resonance imaging (MRI) of the lung can be used for diagnosis and monitoring of interstitial lung disease. Biophysical models of alveolar lung tissue are needed to understand the complex interplay of susceptibility, diffusion, and flow effects, and their influence on magnetic resonance (MR) spin dephasing., Methods: In this work, we present a method for modeling the signal decay of lung tissue by utilizing a two-compartment model, which considers the different spin dephasing mechanisms in the alveolar vasculature and interstitial tissue. This allows calculating the magnetization dynamics and the MR lineshape, which can be measured noninvasively using clinical MR scanners., Results: The accuracy of the method was evaluated using finite element simulations and the experimentally measured lineshapes of a healthy volunteer. In this comparison, the model performs well, indicating that the relevant spin dephasing mechanisms are correctly taken into account., Conclusions: The proposed method can be used to estimate the influence of blood flow and alveolar geometry on the MR lineshape of lung tissue., (© 2022 The Authors. Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

Longitudinally orientated dipoles and microstrip antennas have both demonstrated superior results as RF transmit elements for body imaging at 7 T MRI, and are as of today the most commonly used transmit elements. In this study, the performances of the two antenna concepts were compared for use in local RF antenna arrays by numerical simulations. Antenna elements investigated are the fractionated dipole and the microstrip line with meander structures. Phantom simulations with a single antenna element were performed and evaluated with regard to specific absorption rate (SAR) efficiency in the center of the subject. Simulations of array configurations with 8 and 16 elements were performed with anatomical body models. Both antenna elements were combined with a loop coil to compare hybrid configurations. Singular value decomposition of the B 1 fields, RF shimming, and calculation of the voxel-wise power and SAR efficiencies were performed in regions of interest with varying sizes to evaluate the transmit performance. The signal-to-noise ratio (SNR) was evaluated to estimate the receive performance. Simulated data show similar transmit profiles for the two antenna types in the center of the phantom (penetration depth > 20 mm). For body imaging, no considerable differences were determined for the different antenna configurations with regard to the transmit performance. Results show the advantage of 16 transmit channels compared with today's commonly used 8-channel systems (minimum RF shimming excitation error of 4.7% (4.3%) versus 2.7% (2.8%) for the 8-channel and 16-channel configurations with the microstrip antennas in a (5 cm) + cube in the center of a male (female) body model). Highest SNR is achieved for the 16-channel configuration with fractionated dipoles. The combination of either fractionated dipoles or microstrip antennas with loop coils is more favorable with regard to the transmit performance compared with only increasing the number of elements.3 cube in the center of a male (female) body model). Highest SNR is achieved for the 16-channel configuration with fractionated dipoles. The combination of either fractionated dipoles or microstrip antennas with loop coils is more favorable with regard to the transmit performance compared with only increasing the number of elements., (© 2022 The Authors. NMR in Biomedicine published by John Wiley & Sons Ltd.)