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This work is a proof-of-concept realization of a novel technique for rapid volumetric acquisition, reconstruction, and visualization of three-directional (3dir) flow velocities. The technique combines real-time 3dir phase-contrast (PC) flow magnetic resonance imaging (MRI) with real-time cross-sectional volume coverage. It offers a rapid examination without dependence on electrocardiography (ECG) or respiratory gating during a continuous image acquisition at up to 16 fps. Real-time flow MRI utilizes pronounced radial undersampling and a model-based nonlinear inverse reconstruction. Volume coverage is achieved by automatically advancing the slice position of each PC acquisition by a small percentage of the slice thickness. Post-processing involves the calculation of maximum intensity projections along the slice dimension resulting in six direction-selective velocity maps and a maximum speed map. Preliminary applications to healthy subjects at 3 T comprise mapping of the carotid arteries and cranial vessels at 1.0 mm in-plane resolution within 30 s as well as of the aortic arch at 1.6 mm resolution within 20 s. In conclusion, the proposed method for rapid mapping of 3dir flow velocities offers a quick assessment of the vasculature either to provide a first clinical survey or to plan for more detailed studies.

Purpose Diffusion-weighted imaging (DWI) is important for differentiating residual tumor and subacute infarctions in early postoperative magnetic resonance imaging (MRI) of central nervous system (CNS) tumors. In cases of pneumocephalus and especially in the presence of intraventricular trapped air, conventional echo-planar imaging (EPI) DWI is distorted by susceptibility artifacts. The performance and robustness of a newly developed DWI sequence using the stimulated echo acquisition mode (STEAM) was evaluated in patients after neurosurgical operations with early postoperative MRI. Methods We compared EPI and STEAM DWI of 43 patients who received 3‑Tesla MRI within 72 h after a neurosurgical operation between 1 October 2019 and 30 September 2021. We analyzed susceptibility artifacts originating from air and blood and whether these artifacts compromised the detection of ischemic changes after surgery. The DWI sequences were (i) visually rated and (ii) volumetrically analyzed. Results In 28 of 43 patients, we found severe and diagnostically relevant artifacts in EPI DWI, but none in STEAM DWI. In these cases, in which artifacts were caused by intracranial air, they led to a worse detection of ischemic lesions and thus to a possible failed diagnosis or lack of judgment using EPI DWI. Additionally, volumetric analysis demonstrated a 14% smaller infarct volume detected with EPI DWI. No significant differences in visual rating and volumetric analysis were detected among the patients without severe artifacts. Conclusion The newly developed version of STEAM DWI with highly undersampled radial encodings is superior to EPI DWI in patients with postoperative pneumocephalus.

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

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

This work describes a dynamic magnetic resonance imaging (MRI) technique for local scanning of the human body with use of a handheld receive coil or coil array. Real-time MRI is based on highly undersampled radial gradient-echo sequences with joint reconstructions of serial images and coil sensitivity maps by regularized nonlinear inversion (NLINV). For this proof-of-concept study, a fixed slice position and field-of-view (FOV) were predefined from the operating console, while a local receive coil (array) is moved across the body—for the sake of simplicity by the subject itself. Experimental realizations with a conventional 3 T magnet comprise dynamic anatomic imaging of the head, thorax and abdomen of healthy volunteers. Typically, the image resolution was 0.75 to 1.5 mm with 3 to 6 mm section thickness and acquisition times of 33 to 100 ms per frame. However, spatiotemporal resolutions and contrasts are highly variable and may be adjusted to clinical needs. In summary, the proposed FLASHlight MRI method provides a robust acquisition and reconstruction basis for future diagnostic strategies that mimic the usage of ultrasound. Necessary extensions for this vision require remote control of all sequence parameters by a person at the scanner as well as the design of more flexible gradients and magnets.

This work describes a new method for diffusion-weighted (DW) magnetic resonance imaging (MRI) without susceptibility artifacts. The technique combines a DW spin-echo module and a single-shot stimulated echo acquisition mode (STEAM) MRI readout with undersampled radial trajectories and covers a volume by a gapless series of cross-sectional slices. In a first step, optimal coil sensitivities for all slices are obtained from a series of non-DW acquisitions by nonlinear inverse reconstruction with regularization to the image and coil sensitivities of a directly neighboring slice. In a second step, these coil sensitivities are used to compute all series of non-DW and DW images by linear inverse reconstruction with spatial regularization to a neighboring image. Proof-of-principle applications to the brain (51 sections) and prostate (31 sections) of healthy subjects were realized for a protocol with two b-values and 6 gradient directions at 3 T. Including averaging the measuring times for studies of the brain at 1.0×1.0×3.0 mm(3) resolution (b =1,000 s mm(−2)) and prostate at 1.4×1.4×3.0 mm(3) resolution (b =600 s mm(-2)) were 2.5 min and 4.5 min, respectively. All reconstructions were accomplished online with use of a multi-GPU computer integrated into the MRI system. The resulting non-DW images, mean DW images averaged across directions and maps of the apparent diffusion coefficient confirm the absence of geometric distortions or false signal alterations and demonstrate diagnostic image quality. The novel method for DW STEAM MRI of a volume without susceptibility artifacts warrants extended clinical trials.

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

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

Background The aim of this study was to evaluate the reproducibility and clinical value of the novel single-shot T1 mapping method for rapid and accurate multi-slice coverage of the whole brain, described by Wang et al. 2015. Methods At a field strength of 3 Tesla, T1 mappings of 139 patients (51 of them without pathologic findings) and two repeats of five volunteers were performed at 0.5 mm in-plane resolution. Mean T1 values were determined in 18 manually segmented regions-of-interest without pathologic findings. Reproducibility of the repeated scans was calculated using mean coefficient of variations. Pathologies were grouped and separately evaluated. Results The mean age of the cohort was 49 (range 1–95 years). T1 relaxation times for ordinary brain and pathologies were in accordance with the literature values. Intra- and inter-subject reproducibility was excellent, and mean coefficient of variations were 2.4% and 3.8%, respectively. Discussion The novel rapid T1 mapping method is a reliable magnetic resonance imaging technique for identifying and quantifying normal brain structures and may thus serve as a basis for assessing pathologies. The fast and parallel online calculation enables a comfortable use in everyday clinical practice. We see a possible clinical value in a large spectrum of diseases, which should be investigated in further studies.

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

Rapid volume coverage sequences based on real-time MRI allow for scanning of the entire brain within a few seconds. Movements of children become almost irrelevant due to the ultra-fast acquisition of 30 ms per slice. The adoption of these sequences in a real-time cranial MRI protocol (RT-cMRI) is expected to reduce the frequency of examinations requiring anesthesia in infants and toddlers. The aim of the study was to quantify the reduction in the number of anesthesia examinations in young children after the implementation of the new RT-cMRI protocol.All cMRI studies of children up to 6 years in the first 12 months after the establishment of the RT-cMRI 2019/2020 were retrospectively compared to a matched group of the same period in 2017/2018. The frequency of examinations under anesthesia vs. non-sedation examinations was analyzed. In addition, the number of follow-up examinations and the effectiveness of RT-cMRI was determined.The launch of RT-cMRI led to a significant decrease in the proportion of cMRI under anesthesia from 92 % to 55 %. Only 2 % of the RT-cMRI failed and required conventional MRI under sedation in the follow-up. The speed and ease of use of RT-cMRI increased the number of follow-up examinations from 1.3 to 1.4 examinations per child.This innovative real-time MRI examination allows a drastic reduction in the number of studies under anesthesia for suitable cranial pathologies in children under 6 years. However, cautious selection of indications as well as adjustments to the workflow in the radiological department are required.· Real-time MRI sequences are almost unaffected by patient movement. · The application of real-time cranial MRI can spare children from sedation. · Low-threshold access results in more frequent follow-up examinations.· Sorge I, Hirsch FW, Voit D et al. Decreased Need for Anesthesia during Ultra-Fast Cranial MRI in Young Children: One-Year Summary. Fortschr Röntgenstr 2022; 194: 192 - 198.ZIEL: Durch schnelle, der Echtzeit-MRT entlehnten Volume-Coverage-Sequenzen kann das gesamte Gehirn innerhalb weniger Sekunden abgebildet werden. Durch die ultraschnelle Akquisition von 30 ms pro Schicht führen selbst Makrobewegungen der Kinder nicht zu bewegungsbedingten Bildartefakten. Es ist erwartbar, dass sich mit der Implementierung dieser Sequenzen in ein Echtzeit-MRT-Protokoll (RT-cMRT) der Sedierungsbedarf bei Kleinkindern und Säuglingen verringert. Das Ziel dieser Studie war, das Ausmaß des Rückgangs an Sedierungsuntersuchungen nach Einführung eines neuen RT-cMRT-Protokolls zu quantifizieren.Es wurden retrospektiv alle cMRT-Untersuchungen eines Jahres bei Kindern unter 6 Jahren nach Einführung der RT-cMRT (2019/2020) mit einer gleichen Zeitspanne vor der Umstellung (2017/2018) verglichen. Es wurde die Häufigkeit von Untersuchungen mit oder ohne Sedierung erfasst und die Zahl an Wiederholungsuntersuchungen sowie die Effektivität der RT-cMRT bestimmt.Die Einführung der RT-cMRT ging mit einem deutlichen Rückgang des Anteils an Sedierungsuntersuchungen von 92 % auf 55 % einher. Nur 2 % der RT-cMRT-Untersuchungen waren insuffizient und benötigten im Anschluss noch eine konventionelle MRT. Durch die leichte Verfügbarkeit der RT-cMRT wurden 1,4 statt bisher nur 1,3 Untersuchungen pro Kind und somit mehr Follow-up-Untersuchungen durchgeführt.Mit innovativer Echtzeit-MRT ist es möglich, bei Säuglingen und Kleinkindern die Zahl an Sedierungen für kraniale MRT – bei geeigneten Erkrankungen – drastisch zu reduzieren. Jedoch sind hierfür neben der Auswahl geeigneter Indikationen auch Anpassungen der Arbeitsabläufe in der radiologischen Abteilung vonnöten.· Echtzeit-MRT-Sequenzen sind kaum anfällig für Patientenbewegungen.. · Der Einsatz von kranialer Echtzeit-MRT kann Kindern Sedierungen ersparen.. · Durch den niedrigschwelligen Zugang kommt es zu häufigeren Follow-up-Untersuchungen..

Real-time magnetic resonance imaging (MRI) or model-based MRI reconstructions of parametric maps require the solution of an ill-posed nonlinear inverse problem. Respective algorithms, e.g., the iteratively regularized Gauss-Newton method, implicitly combine datasets from multiple receive coils. Because these local coils may exhibit complex sensitivity profiles with rather different phase offsets, the numerical optimization may lead to phase singularities which in turn cause "black holes" in magnitude images. The purpose of this work is to develop a method for inverse reconstructions of multi-coil MRI data which avoids the generation of such spatially selective phase singularities. It is proposed to use volumetric body coil data and start the iterative reconstruction of multi-coil data with a reference image which offers proper phase information. In more detail, inverse reconstructions of multi-coil data are initialized with a complex "seed" image which is obtained by a Fast Fourier Transform (FFT) reconstruction of data from a single body coil element. This is accomplished at no additional cost as only very few body coil scans with identical conditions as the multi-coil acquisitions are needed as part of the regular prep scan period. The method is evaluated for anatomical real-time MRI and model-based phase-contrast flow MRI in real-time at 3 T. The proposed method overcomes phase singularities in all cases for arbitrary sets of receive coils. In conclusion, the automatic use of a single body coil reference image is simple, robust, and further improves the reliability of advanced MRI reconstructions from multi-coil data.

Purpose To develop a rapid and motion-robust technique for volumetric MRI, which is based on cross-sectional real-time MRI acquisitions with automatic advancement of the slice position. Methods Real-time MRI with a frame-by-frame moving cross-section is performed with use of highly undersampled radial gradient-echo sequences offering spin density, T1 , or T2 /T1 contrast. Joint reconstructions of serial images and coil sensitivity maps from spatially overlapping sections are accomplished by nonlinear inversion with regularization to the preceding section-formally identical to dynamic real-time MRI. Shifting each frame by 20% to 25% of the section thickness ensures 75% to 80% overlap of successive sections. Acquisition times of 40 to 67 ms allow for rates of 15 to 25 sections per second, while volumes are defined by the number of cross-sections times the section shift. Results Preliminary realizations at 3T comprise studies of the human brain, carotid arteries, liver, and prostate. Typically, coverage of a 90- to 180-mm volume at 0.8- to 1.2-mm in-plane resolution, 4- to 6-mm section thickness, and 0.8- to 1.5-mm section shift is accomplished within total measuring times of 4 to 6 seconds and a section speed of 15 to 37.5 mm per second. However, spatiotemporal resolution, contrast including options such as fat saturation and total measuring time are highly variable and may be adjusted to clinical needs. Promising volumetric applications range from fetal MRI to dynamic contrast-enhanced MRI. Conclusion The proposed method allows for rapid and motion-robust volume coverage in a variety of imaging scenarios.

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

Background This paper describes the use of real-time magnetic resonance imaging to simultaneously obtain magnetic resonance imaging (MRI) videos in both a sagittal and coronal plane during the performance of a musical exercise in five advanced trombone players. Methods Dual-slice recordings were implemented in a frame-interleaved manner with 20 ms acquisitions per frame to achieve two interleaved videos at a rate of 25 frames per second. A customized MATLAB toolkit was used for the extraction of line profiles from MRI videos to quantify tongue movements associated with exercise performance from both perspectives. Results Across all subjects, the analyses revealed precise coupling of vertical movements of the dorsal tongue surface (DTS), viewed from a sagittal perspective, with reduction in the vertical and horizontal dimensions of the air channel formed between the DTS and the hard palate, viewed from a coronal perspective. The cross-correlation between these movements was very strong (mean R=0.967). Conclusions These results demonstrate the unique utility of this dual-slice technology in describing the coordination of complex tongue movements occurring in two planes (i.e., three directions) simultaneously, lending a deeper understanding of lingual motor control during trombone performance.

Objective . Atherosclerosis is a leading cause of mortality and morbidity. Optical endoscopy, ultrasound, and X-ray offer minimally invasive imaging assessments but have limited sensitivity for characterizing disease and therapeutic response. Magnetic resonance imaging (MRI) endoscopy is a newer idea employing tiny catheter-mounted detectors connected to the MRI scanner. It can see through vessel walls and provide soft-tissue sensitivity, but its slow imaging speed limits practical applications. Our goal is high-resolution MRI endoscopy with real-time imaging speeds comparable to existing modalities. Methods . Intravascular (3 mm) transmit-receive MRI endoscopes were fabricated for highly undersampled radial-projection MRI in a clinical 3-tesla MRI scanner. Iterative nonlinear reconstruction was accelerated using graphics processor units connected via a single ethernet cable to achieve true real-time endoscopy visualization at the scanner. MRI endoscopy was performed at 6-10 frames/sec and 200-300 μ m resolution in human arterial specimens and porcine vessels ex vivo and in vivo and compared with fully sampled 0.3 frames/sec and three-dimensional reference scans using mutual information (MI) and structural similarity (3-SSIM) indices. Results . High-speed MRI endoscopy at 6-10 frames/sec was consistent with fully sampled MRI endoscopy and histology, with feasibility demonstrated in vivo in a large animal model. A 20-30-fold speed-up vs. 0.3 frames/sec reference scans came at a cost of ~7% in MI and ~45% in 3-SSIM, with reduced motion sensitivity. Conclusion . High-resolution MRI endoscopy can now be performed at frame rates comparable to those of X-ray and optical endoscopy and could provide an alternative to existing modalities, with MRI’s advantages of soft-tissue sensitivity and lack of ionizing radiation.

Introduction Diffusion-weighted imaging in stimulated echo acquisition mode (STEAM-DWI) is an interesting alternative with less susceptibility artifacts compared to the most commonly used diffusion-weighted echo-planar imaging (EPI-DWI). Sensitivity and specificity of a novel STEAM-DWI, described by Merrem et al. 2017 [1], were assessed in patients with ischemic stroke. Methods EPI- and STEAM-DWIs were performed in patients with suspected subacute stroke between 01 July 2019 and 30 June 2020 using 3-T MRI. Three neuroradiologists independently and separately rated STEAM-DWI images with respect to (i) signs of an acute/subacute stroke, (ii) the number, size and localization of infarctions and, (iii) the presence of artifacts. Results In 55 (23 right, 23 left, 9 both hemispheres) of 85 patients a subacute stroke was confirmed using EPI-DWI. The cerebral vascular territories were affected as follows: anterior cerebral artery 8 %, middle cerebral artery 48 %, posterior cerebral artery 27 %, brainstem 7 %, cerebellum 10 %. In 53 of 55 (96 %) cases the stroke was detected by usage of STEAM-DWI, in 35 of 37 patients microembolic events were noticed (95 %). Results showed a sensitivity and specificity of 100 % (70/70) for major infarcts (>9 mm² in-plane) and a sensitivity of up to 94 % (121/129) for detecting subacute microembolic lesions. No susceptibility artifacts were noticed in STEAM-DWI. Conclusion Compared to standard EPI-DWI, STEAM-DWI offers a more robust alternative for diagnosing subacute strokes in areas affected by susceptibility artifacts.

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

PURPOSE To test the feasibility of cardiac real-time MRI in combination with retrospective gating by MR-compatible spirometry, to improve motion control, and to allow quantification of respiratory-induced changes during free-breathing. METHODS Cross-sectional real-time MRI (1.5T; 30 frames/s) using steady-state free precession contrast during free-breathing was combined with MR-compatible spirometry in healthy adult volunteers (n = 4). Retrospective binning assigned images to classes that were defined by electrocardiogram and spirometry. Left ventricular eccentricity index as an indicator of septal position and ventricular volumes in different respiratory phases were calculated to assess heart-lung interactions. RESULTS Real-time MRI with MR-compatible spirometry is feasible and well tolerated. Spirometry-based binning improved motion control significantly. The end-diastolic epicardial eccentricity index increased significantly during inspiration (1.04 ± 0.04 to 1.19 ± 0.05; P < .05). During inspiration, right ventricular end-diastolic volume (79 ± 17 mL/m2 to 98 ± 18 mL/m2 ), stroke volume (41 ± 8 mL/m2 to 59 ± 11 mL/m2 ) and ejection fraction (53 ± 3% to 60 ± 1%) increased significantly, whereas the end-systolic volume remained almost unchanged. Left ventricular end-diastolic volume, left ventricular stroke volume, and left ventricular ejection fraction decreased during inspiration, whereas the left ventricular end-systolic volume increased. The relationship between stroke volume and end-diastolic volume (Frank-Starling relationship) based on changes induced by respiration allowed for a slope estimate of the Frank-Starling curve to be 0.9 to 1.1. CONCLUSION Real-time MRI during free-breathing combined with MR-compatible spirometry and retrospective binning improves image stabilization, allows quantitative image analysis, and importantly, offers unique opportunities to judge heart-lung interactions.

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

OBJECTIVE: Movements inside the oral cavity during lip trilling in horn-playing are poorly understood and controversial, particularly with respect to pedagogy. Developments in real-time magnetic resonance imaging (RT-MRI) allow representations of oral cavity movement during lip trill performance on a MRI-compatible horn to be recorded and quantified. METHODS: We present RT-MRI data on 11 highly skilled horn players obtained from serial images acquired at acquisition times of 33.3, 18.2, and 10.0 ms (i.e., at 30, 55 and 100 frames/sec) as they performed sixteenth note, whole-step trills between Eb4 and F4 (concert pitch) at two tempos, ~60 bpm and as fast as possible. RESULTS: For fast trilling (mean speed 178.3±24.7 bpm), 7 of 11 subjects exclusively utilized a tongue movement strategy, 3 used both a tongue and jaw strategy, and 1 exclusively used a jaw strategy. For trilling at ~60 bpm, all 11 subjects used a tongue movement strategy. CONCLUSIONS: We suggest using these movement strategies in teaching whole-step trills.

This study uses real-time (cine) MRI to examine how orofacial myofunctional disorders (OMDs) affect muscle function during speech and horn playing. Dynamic MRI images were captured of an OMD subject and control subjects reciting a speech task and sustaining a note on an MRI-compatible horn. A following visual feedback session allowed the OMD subject to view and react to their (cine) MRI next to the image of an elite subject. Profile lines created in MATLAB allowed analysis of muscle function and changes in oral cavitation between the OMD and control subjects. In both the speech and horn films, the OMD subject consistently utilized maladaptive muscle movements, resulting in low and forward tongue position against the front teeth. Both control subjects had tongue placement free of the front teeth, and the horn control subject could elevate the tongue to narrow the air stream and play higher pitches. The MRI films suggest a connection between speech disorders and compromised horn-playing technique. OMDs limit the ability of the tongue to make the changes in oral cavitation used to play different pitches on the horn.

Purpose To develop a model-based reconstruction technique for single-shot T1 mapping with high spatial resolution, accuracy, and precision using an inversion-recovery (IR) fast low-angle shot (FLASH) acquisition with radial encoding. Methods The proposed model-based reconstruction jointly estimates all model parameters, that is, the equilibrium magnetization, steady-state magnetization, 1/ T1*, and all coil sensitivities from the data of a single-shot IR FLASH acquisition with a small golden-angle radial trajectory. Joint sparsity constraints on the parameter maps are exploited to improve the performance of the iteratively regularized Gauss-Newton method chosen for solving the nonlinear inverse problem. Validations include both a numerical and experimental T1 phantom, as well as in vivo studies of the human brain and liver at 3 T. Results In comparison to previous reconstruction methods for single-shot T1 mapping, which are based on real-time MRI with pixel-wise fitting and a model-based approach with a predetermination of coil sensitivities, the proposed method presents with improved robustness against phase errors and numerical precision in both phantom and in vivo studies. Conclusion The comprehensive model-based reconstruction with L1 regularization offers rapid and robust T1 mapping with high accuracy and precision. The method warrants accelerated computing and online implementation for extended clinical trials. Magn Reson Med 79:730–740, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

OBJECTIVE: The functional role of the glottis in brass performance is poorly understood and controversial, particularly with respect to pedagogy. Technological limitations have prevented the non-invasive, systematic study of the glottis in the past, but developments in real-time magnetic resonance imaging (RT-MRI) allow representations of glottal movement during performance on a MRI-compatible horn to be recorded and quantified. METHODS: We present RT-MRI data obtained on 6 advanced-level horn players from serial images acquired at an acquisition time of 33.3 ms as they performed sustained note exercises on three notes (concert Eb2, Eb4, and Bb4) at each of three dynamics (pp, mf, and ff) and a staccato exercise. An advanced-level trumpet player was also studied performing a modification of the staccato exercise designed to minimize vertical movement of the larynx. Glottal movements and positions in the coronal plane were analyzed using a customized MATLAB toolkit. RESULTS: In sustained note playing, there is a significant influence of dynamic on the degree of glottal adduction/abduction. There is greater adduction with softer notes, and greater abduction with louder notes. In slow staccato playing, glottal closure accompanies the cessation of each note and persists until iteration of the next note in the sequence. CONCLUSIONS: We demonstrate that RT-MRI provides a suitable method to identify and quantify glottal movement during horn playing. We further show that there is a direct relationship between dynamic level and glottal adduction/abduction, and that the glottis is involved in performing notes during slow staccato playing.

Recent MRI studies of blood flow in the inferior vena cava (IVC) resulted in findings which are inconsistent with earlier observations by invasive procedures - most likely because ECG-gated MRI techniques are unable to resolve dynamic adjustments due to respiration. The purpose of this work was to apply real-time phase-contrast MRI at 50 ms resolution to re-evaluate IVC flow in response to normal and deep breathing as well as breath holding and Valsalva maneuver (11 young healthy subjects). Real-time flow MRI relied on highly undersampled radial gradient-echo sequences and a model-based nonlinear inverse reconstruction. A frequency analysis of the predominant pulsatility classified IVC flow in individual subjects as "cardiac", "respiratory" or "mixed" type. Peak flow velocities during free breathing ranged from 30 to 58 cm s(-1), while flow rates varied from 15 to 37 ml s(-1). The subject-specific IVC flow pattern persists during deep breathing although the enhanced respiratory influence may shift subjects form "cardiac" to "mixed" or from "mixed" to "respiratory" type. Peak velocities increased relative to normal breathing but led to similar flow rates of 16 to 34 ml s(-1). Inspiration during deep breathing elicited brief periods of flow reversal in all subjects with mean peak velocities of -21 cm s(-1). The observation of only mildly flattened parabolic velocity distributions within the IVC indicated mostly laminar flow. Breath holding reduced blood flow velocities and rates by more than 40% on average, while Valsalva maneuvers completely abolished venous return. In conclusion, IVC blood flow is dominated by the acquired respiratory behavior of individual subjects and its pressure-induced alterations relative to cardiac pulsation. The responses to breath holding and Valsalva maneuver are in full agreement with previous invasive observations of reduced or even ceased flow, respectively.