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New implanted medical devices continue to be made available for treatment of medical conditions. Many recipients can benefit from the diagnostic power of MR imaging. Provisions must be made to determine if these patients can be safely scanned. Metal-containing devices can be considered either MR unsafe or conditional. It is essential that all components of an implanted system are completely and accurately identified, with the most restrictive MR safety condition dictating the scanning approach. MR safety considerations for major classes of implanted devices are discussed, recognizing that there have been reports of serious device-related MR safety incidents.

Purpose Diffusion-weighted imaging allows investigators to identify structural, microstructural, and connectivity-based differences between subjects, but variability due to session and scanner biases is a challenge. Methods To investigate DWI variability, we present MASiVar, a multisite data set consisting of 319 diffusion scans acquired at 3 T from b = 1000 to 3000 s/mm2 across 14 healthy adults, 83 healthy children (5 to 8 years), three sites, and four scanners as a publicly available, preprocessed, and de-identified data set. With the adult data, we demonstrate the capacity of MASiVar to simultaneously quantify the intrasession, intersession, interscanner, and intersubject variability of four common DWI processing approaches: (1) a tensor signal representation, (2) a multi-compartment neurite orientation dispersion and density model, (3) white-matter bundle segmentation, and (4) structural connectomics. Respectively, we evaluate region-wise fractional anisotropy, mean diffusivity, and principal eigenvector; region-wise CSF volume fraction, intracellular volume fraction, and orientation dispersion index; bundle-wise shape, volume, fractional anisotropy, and length; and whole connectome correlation and maximized modularity, global efficiency, and characteristic path length. Results We plot the variability in these measures at each level and find that it consistently increases with intrasession to intersession to interscanner to intersubject effects across all processing approaches and that sometimes interscanner variability can approach intersubject variability. Conclusions This study demonstrates the potential of MASiVar to more globally investigate DWI variability across multiple levels and processing approaches simultaneously and suggests harmonization between scanners for multisite analyses should be considered before inference of group differences on subjects.

The purpose of this study is to report the patient safety and image quality of 1.5-T multiparametric MRI of the prostate in patients with cardiac implantable electronic devices (CIEDs).In this retrospective study, a database was searched to identify prostate multiparametric 1.5-T MRI examinations performed with endorectal coils for patients with CIEDs from 2012 to 2016 (study group) and matched patients without CIEDs (control group). Clinical safety in the study group was reviewed. The specific absorption rate (SAR) and signal-to-noise ratio (SNR) were measured in both groups. Imaging quality and artifact on T2-weighted images, DW images, and dynamic contrast-enhanced images were rated on a 5-point scale by two independent readers.The study group consisted of total 28 multiparametric MRI examinations in 25 patients. There were no serious device-related adverse effects observed (0/28; 0%), and the estimated whole-body SAR in the study group was never greater than 1.5 W/kg. The SNR values tended to be lower in the study group than in the control group. However, overall perceived image preferences and influences of artifacts on image quality for the study group were not significantly different from those for the control group (p0.05), which were rated above average (rating 3) by both readers 1 and 2.Multiparametric 1.5-T MRI examination of the prostate can be safely performed in selected patients with CIEDs under controlled conditions with applicable image quality while maintaining a SAR less than 1.5 W/kg.

PurposeDiffusion weighted imaging (DWI) allows investigators to identify structural, microstructural, and connectivitybased differences between subjects, but variability due to session and scanner biases is a challenge.MethodsTo investigate DWI variability, we present MASiVar, a multisite dataset consisting of 319 diffusion scans acquired at 3T from b = 1000 to 3000 s/mm2 across 14 healthy adults, 83 healthy children (5 to 8 years), three sites, and four scanners as a publicly available, preprocessed, and de-identified dataset. With the adult data, we demonstrate the capacity of MASiVar to simultaneously quantify the intrasession, intersession, interscanner, and intersubject variability of four common DWI processing approaches: (1) a tensor signal representation, (2) a multi-compartment neurite orientation dispersion and density model, (3) white matter bundle segmentation, and (4) structural connectomics. Respectively, we evaluate region-wise fractional anisotropy (FA), mean diffusivity, and principal eigenvector; region-wise cerebral spinal fluid volume fraction, intracellular volume fraction, and orientation dispersion index; bundle-wise shape, volume, FA, and length; and whole connectome correlation and maximized modularity, global efficiency, and characteristic path length.ResultsWe plot the variability in these measures at each level and find that it consistently increases with intrasession to intersession to interscanner to intersubject effects across all processing approaches and that sometimes interscanner variability can approach intersubject variability.ConclusionsThis study demonstrates the potential of MASiVar to more globally investigate DWI variability across multiple levels and processing approaches simultaneously and suggests harmonization between scanners for multisite analyses should be considered prior to inference of group differences on subjects.

New implanted medical devices continue to be made available for treatment of medical conditions. Many recipients can benefit from the diagnostic power of MR imaging. Provisions must be made to determine if these patients can be safely scanned. Metal-containing devices can be considered either MR unsafe or conditional. It is essential that all components of an implanted system are completely and accurately identified, with the most restrictive MR safety condition dictating the scanning approach. MR safety considerations for major classes of implanted devices are discussed, recognizing that there have been reports of serious device-related MR safety incidents.

Objectives The aim of this study was to evaluate the impact of technology improvements on the outcomes of magnetic resonance-guided focused ultrasound (MRgFUS) treatments of symptomatic uterine leiomyomas (uterine fibroids). The study compared ablation volumes and incidence of adverse events in patient groups treated with two generations of MRgFUS systems from a single vendor. Methods The present study describes the results of a retrospective comparative study of two groups of women with symptomatic uterine leiomyomas who were clinically treated with MRgFUS at a single institution. Group 1 (n = 130) was treated using the first-generation system between March 2005 and December 2009. Group 2 (n = 71) was treated using the second-generation between December 2013 and September 2019. Results The second-generation MRgFUS system resulted in significantly improved nonperfused volume ratios in both dark and bright T2 fibroid categories compared with the first-generation system (dark – 80% versus46 %, p = 0.00002 and bright – 46% versus 32%, p = 0.001). There have been no recorded hospital admissions, no skins burns, and no reported major adverse events since the introduction of this second-generation ExAblate 2100 system with advanced safety and treatment planning features. Conclusion This study has demonstrated that improvements to current MRgFUS technology resulted in significantly increased efficacy and patient safety of clinical treatments of patients with symptomatic uterine leiomyomas.

An understanding of the bias and variance of diffusion weighted magnetic resonance imaging (DW-MRI) acquisitions across scanners, study sites, or over time is essential for the incorporation of multiple data sources into a single clinical study. Studies that combine samples from various sites may be introducing confounding factors due to site-specific artifacts and patterns. Differences in bias and variance across sites may render the scans incomparable, and, without correction, inferences obtained from these data may be misleading. We present an analysis of the bias and variance of scans of the same subjects across different sites and evaluate their impact on statistical analyses. In previous work, we presented a simulation extrapolation (SIMEX) technique for bias estimation as well as a wild bootstrap technique for variance estimation in metrics obtained from a Q-ball imaging (QBI) reconstruction of empirical high angular resolution diffusion imaging (HARDI) data. We now apply those techniques to data acquired from 5 healthy volunteers on 3 independent scanners under closely matched acquisition protocols. The bias and variance of GFA measurements were estimated on a voxel-wise basis for each scan and compared across study sites to identify site-specific differences. Further, we provide model recommendations that can be used to determine the extent of the impact of bias and variance as well as aspects of the analysis to account for these differences. We include a decision tree to help researchers determine if model adjustments are necessary based on the bias and variance results.

Purpose To assess risks of RF-heating of a vagus nerve stimulator (VNS) during 1.5T prostate MRI using body coil transmit and to compare these risks with those associated with MRI head exams using a transmit/receive head coil. Methods Spatial distributions of radio-frequency (RF) B1 fields generated by transmit/receive (T/R) body and head coils were empirically assessed along the long axis of a 1.5 T MRI scanner bore. Measurements were obtained along the center axis of the scanner and laterally offset by 15 cm (body coil) and 7 cm (head coil). RF-field measurements were supplemented with direct measurements of RF-heating of 15 cm long copper wires affixed to and submerged in the “neck” region of the gelled saline-filled (sodium chloride and polyacrylic acid) “head-and-torso” phantom. Temperature elevations at the lead tips were measured using fiber-optic thermometers with the phantom positioned at systematically increased distances from the scanner iso-center. Results B1 field measurements demonstrated greater than 10dB reduction in RF power at distances beyond 28 cm and 24 cm from iso-center for body and head coil, respectively. Moreover, RF power from body coil transmit at distances greater than 32 cm from iso-center was found to be lower than from the RF power from head coil transmit measured at locations adjacent to the coil array at its opening. Correspondingly, maximum temperature elevations at the tips of the copper wires decreased with increasing distance from iso-center— from 7.4°C at 0 cm to no appreciable heating at locations beyond 40 cm. Conclusions For the particular scanner model evaluated in this study, positioning an implanted VNS farther than 32 cm from iso-center (configuration achievable for prostate exams) can reduce risks of RF-heating resulting from the body coil transmit to those associated with using a T/R head coil. This article is protected by copyright. All rights reserved.

To assess 12-month outcomes and safety of clinical magnetic resonance (MR)-guided focused ultrasound (US) treatments of uterine leiomyomas.Between March 2005 and December 2009, 150 women with symptomatic uterine leiomyomas were clinically treated with MR-guided focused US at a single institution; 130 patients completed treatment and agreed to have their data used for research purposes. Patients were followed through retrospective review of medical records and phone interviews conducted at 3-, 6-, and 12-month intervals after treatment to assess additional procedures and symptom relief. Outcome measures and treatment complications were analyzed for possible correlations with the appearance of the tumors on T2-weighted imaging.The cumulative incidence of additional tumor-related treatments 12 months after MR-guided focused US was 7.4% by the Kaplan-Meier method. At 3-, 6-, and 12-month follow-up, 86% (90 of 105), 93% (92 of 99), and 88% (78 of 89) of patients reported relief of symptoms, respectively. No statistically significant correlation between tumor appearance on T2-weighted imaging and 12-month outcome was found. Treatment-related complications were observed in 17 patients (13.1%): 16 patients had minor complications and one had a major complication (deep vein thrombosis). All complications were resolved within the 12-month follow-up period.MR-guided focused US is a noninvasive treatment option that can be used to effectively and safely treat uterine leiomyomas and delivers significant and lasting symptom relief for at least 12 months. The incidence of additional treatment during this time period is comparable with those in previous reports of uterine artery embolization.

Objective: To use diffusion tensor imaging (DTI) to assess gray matter and white matter tract diffusion in behavioral variant frontotemporal dementia (bvFTD), semantic dementia (SMD), and progressive nonfluent aphasia (PNFA). Methods: This was a case-control study where 16 subjects with bvFTD, 7 with PNFA, and 4 with SMD were identified and matched by age and gender to 19 controls. All subjects had 3-T head MRI with a DTI sequence with diffusion encoding in 21 directions. Gray matter mean diffusivity (MD) was assessed using a region-of-interest (ROI) and voxel-level approach, and voxel-based morphometry was used to assess patterns of gray matter loss. White matter tract diffusivity (fractional anisotropy and radial diffusivity) was assessed by placing ROIs on tracts of interest. Results: In bvFTD, increased gray matter MD and gray matter loss were identified bilaterally throughout frontal and temporal lobes, with abnormal diffusivity observed in white matter tracts that connect to these regions. In SMD, gray matter loss and increased MD were identified predominantly in the left temporal lobe, with tract abnormalities observed in the inferior longitudinal fasciculus and uncinate fasciculus. In PNFA, gray matter loss and increased MD were observed in left inferior frontal lobe, insula, and supplemental motor area, with tract abnormalities observed in the superior longitudinal fasciculus. Conclusions: The diffusivity of gray matter is increased in regions that are atrophic in frontotemporal dementia, suggesting disruption of the cytoarchitecture of remaining tissue. Furthermore, damage was identified in white matter tracts that interconnect these regions, supporting the hypothesis that these diseases involve different and specific brain networks.

Christopher P Favazza, Deirdre M King, Heidi A Edmonson, Joel P Felmlee, Phillip J Rossman, Nicholas J Hangiandreou, Robert E Watson, Krzysztof R Gorny Department of Radiology, Mayo Clinic, Rochester, MN, USA Abstract: Radiofrequency (RF) shields have been recently developed for the purpose of shielding portions of the patient's body during magnetic resonance imaging (MRI) examinations. We present an experimental evaluation of a commercially available RF shield in the MRI environment. All tests were performed on 1.5 T and 3.0 T clinical MRI scanners. The tests were repeated with and without the RF shield present in the bore, for comparison. Effects of the shield, placed within the scanner bore, on the RF fields generated by the scanner were measured directly using tuned pick-up coils. Attenuation, by as much as 35 dB, of RF field power was found inside the RF shield. These results were supported by temperature measurements of metallic leads placed inside the shield, in which no measurable RF heating was found. In addition, there was a small, simultaneous detectable increase (~1 dB) of RF power just outside the edges of the shield. For these particular scanners, the autocalibrated RF power levels were reduced for scan locations prescribed just outside the edges of the shield, which corresponded with estimations based on the pick-up coil measurements. Additionally, no significant heating during MRI scanning was observed on the shield surface. The impact of the RF shield on the RF fields inside the magnet bore is likely to be dependent on the particular model of the RF shield or the MRI scanner. These results suggest that the RF shield could be a valuable tool for clinical MRI practices. Keywords: radiofrequency shield, magnetic resonance imaging, radiofrequency attenuation

Objectives To use diffusion tensor imaging to assess white matter tract degeneration in progressive supranuclear palsy (PSP) and to investigate correlates between tract integrity and clinical measures. Design Case-control study. Setting Tertiary care medical center. Patients/Participants Twenty patients with probable PSP and 20 age- and sex-matched healthy controls were enrolled. All patients with PSP underwent standardized clinical testing, including the Frontal Behavioral Inventory and Frontal Assessment Battery to assess behavioral change, the PSP Rating Scale to measure disease severity, the Movement Disorder Society–sponsored revision of the Unified Parkinson's Disease Rating Scale (parts II and III) to measure motor function, and the PSP Saccadic Impairment Scale to measure eye movement abnormalities. Methods Fractional anisotropy and mean diffusivity were measured using region of interest analysis and tract-based spatial statistics. Results Compared with controls, abnormal diffusivity was observed predominantly in the superior cerebellar peduncles, body of the corpus callosum, inferior longitudinal fasciculus, and superior longitudinal fasciculus in patients with PSP. Fractional anisotropy values in the superior cerebellar peduncles correlated with disease severity ( r = −0.59, P = .006), inferior longitudinal fasciculus correlated with motor function ( r = −0.51, P = .02), and superior longitudinal fasciculus correlated with severity of saccadic impairments ( r = −0.45, P = .047). Conclusions The results of this study demonstrate that PSP is associated with degeneration of the brainstem, association, and commissural fibers and that this degeneration likely plays an important role in clinical dysfunction.

To determine the patterns of diffusivity associated with cognitive domain functions in older adults without dementia.We studied older adults without dementia (n = 220) who underwent neuropsychometric testing and a diffusion tensor imaging (DTI) examination at 3 T in a cross-sectional study. Memory, language, attention/executive function, and visual-spatial processing domains were assessed within 4 months of the MRI examination. A fluid-attenuated inversion recovery-based DTI sequence that enabled uncontaminated cortical diffusion measurements was performed. Associations between cortical mean diffusivity (MD) and cognitive function were tested using voxel-based regression analysis. Association between tract diffusivity and cognitive function was tested with regions of interest drawn on color-coded fractional anisotropy (FA) maps.Memory function was associated with the medial temporal lobe cortical MD on voxel-based analysis (p0.001, corrected for multiple comparisons), and inferior longitudinal fasciculus and posterior and anterior cingulum FA on tract-based analysis (p0.001). Language function was associated with the left temporal lobe cortical MD (p0.001, corrected for multiple comparisons), inferior longitudinal fasciculus, fornix, and posterior cingulum FA (p0.05). Attention and executive function was associated with the posterior and anterior cingulum FA, and visual-spatial function was associated with posterior cingulum FA (p0.01).Specific cognitive domain functions are associated with distinct patterns of cortical and white matter diffusivity in elderly with no dementia. Posterior cingulum tract FA was associated with all 4 cognitive domain functions, in agreement with the hypothesis that the posterior cingulate cortex is the main connectivity hub for cognitive brain networks. Microstructural changes identified on DTI may be associated with neurodegenerative pathologies underlying cognitive changes in older adults without dementia.

Purpose: To reduce image artifacts from the unnecessary use of driven‐ equilibrium. Driven‐equilibrium methods known as fast recovery, RESTORE, or DRIVE enable reduction of repetition time (TR) and hence acquisition time in RARE (FSE or TSE)imaging by applying additional RF pulses following each echotrain to accelerate T1 recovery. Fast recovery (FR) techniques are most useful when TR is less than 4*T1. For neuroimaging, the benefit of FR diminishes as TR increases beyond ∼3s. In regions of rapid susceptibility change such as near metallic implants, FR techniques can introduce artifact because the magnetization is not properly rephased when the FR pulses are applied. In our clinical practice we observe that technologists frequently adjust TR over a range of 2–5s on a patient‐ specific basis to minimize scan time. We do not observe, however, that technologists reliably disable FR when TR is long enough, introducing possible artifacts. Methods: An FR‐FSE pulse sequence was modified to automatically disable the FR feature whenever TR exceeded a user‐defined threshold (TR0). Under IRB approval, a healthy volunteer was scanned with the sequence using TRs ranging from 1–5s, and TR0=900ms or 6s. Contrast‐ to‐noise measurements were made between CSF, gray matter and white matter for each dataset. Results: The volunteer study shows decreasing benefit of FR as TRs increase beyond 3s. A patient with bilateral auditory brainstem implants scanned with and without FR demonstrates FR‐induced artifacts. Conclusions: We demonstrate an FR‐FSE pulse sequence that automatically disables fast‐recovery whenever TR exceeds an operator‐ selected threshold. The pulse sequence avoids unnecessary artifacts in regions of rapid susceptibility changes, while retaining the advantages of FR when TR