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Acute allograft injury was observed in a 37-year-old woman within a few weeks after kidney transplantation. Neither renal ultrasound nor computerized tomography (CT) and magnetic resonance (MR) angiography revealed any anomaly. An MR protocol was then performed including arterial spin labeling and intravoxel incoherent motion diffusion weighted imaging. Both arterial spin labeling and the perfusion fraction in the diffusion weighted imaging showed decreased perfusion compared to reference values. The patient subsequently underwent angiography, where an arteriovenous fistula in the upper calix of the transplant kidney was detected and immediate embolization was performed. A second functional MR, performed one week later, demonstrated a 40% increase in organ perfusion. We conclude that functional MR with arterial spin labeling and intravoxel incoherent motion have the potential to provide complementary information of clinical value to conventional imaging for monitoring renal allografts.

Background Arterial spin labeling (ASL) MRI can be used to assess organ perfusion but has yet to be implemented for perfusion evaluation of the lung. Purpose To evaluate pseudo-continuous ASL (PCASL) MRI for the detection of acute pulmonary embolism (PE) and its potential as an alternative to CT pulmonary angiography (CTPA). Materials and Methods Between November 2020 and November 2021, 97 patients (median age, 61 years; 48 women) with suspected PE were enrolled in this prospective study. PCASL MRI was performed within a 72-hour period following CTPA under free-breathing conditions and included three orthogonal planes. The pulmonary trunk was labeled during systole, and the image was acquired during diastole of the subsequent cardiac cycle. Additionally, multisection, coronal, balanced, steady-state free-precession imaging was carried out. Two radiologists blindly assessed overall image quality, artifacts, and diagnostic confidence (five-point Likert scale, 5 = best). Patients were categorized as positive or negative for PE, and a lobe-wise assessment in PCASL MRI and CTPA was conducted. Sensitivity and specificity were calculated on a patient level with the final clinical diagnosis serving as the reference standard. Interchangeability between MRI and CTPA was also tested with use of an individual equivalence index (IEI). Results PCASL MRI was performed successfully in all patients with high scores for image quality, artifact, and diagnostic confidence (κ ≥ .74). Of the 97 patients, 38 were positive for PE. PCASL MRI depicted PE correctly in 35 of 38 patients with three false-positive and three false-negative findings, resulting in a sensitivity of 35 of 38 patients (92% [95% CI: 79, 98]) and a specificity of 56 of 59 patients (95% [95% CI: 86, 99]). Interchangeability analysis revealed an IEI of 2.6% (95% CI: 1.2, 3.8). Conclusion Free-breathing pseudo-continuous arterial spin labeling MRI depicted abnormal lung perfusion caused by acute pulmonary embolism and may be useful as a contrast material-free alternative to CT pulmonary angiography for selected patients. German Clinical Trials Register no. DRKS00023599

Objective To provide a basis for the selection of suitable emulsifiers in oil-in-water emulsions used as tissue analogs for MRI experiments. Three different emulsifiers were investigated with regard to their ability to stabilize tissue-like oil-in-water emulsions. Furthermore, MR signal properties of the emulsifiers themselves and influences on relaxation times and ADC values of the aqueous phase were investigated. Materials and methods Polysorbate 60, sodium dodecyl sulfate (SDS) and soy lecithin were used as emulsifiers. MR characteristics of emulsifiers were assessed in aqueous solutions and their function as a stabilizer was examined in oil-in-water emulsions of varying fat content (10, 20, 30, 40, 50%). Stability and homogeneity of the oil-in-water emulsions were evaluated with a delay of 3 h and 9 h after preparation using T1 mapping and visual control. Signal properties of the emulsifiers were investigated by 1H-MRS in aqueous emulsifier solutions. Relaxometry and diffusion weighted MRI (DWI) were performed to investigate the effect of various emulsifier concentrations on relaxation times (T1 and T2) and ADC values of aqueous solutions. Results Emulsions stabilized by polysorbate 60 or soy lecithin were stable and homogeneous across all tested fat fractions. In contrast, emulsions with SDS showed a significantly lower stability and homogeneity. Recorded T1 maps revealed marked creaming of oil droplets in almost all of the emulsions with SDS. The spectral analysis showed several additional signals for polysorbate and SDS. However, lecithin remained invisible in 1H-MRS. Relaxometry and DWI revealed different influences of the emulsifiers on water: Polysorbate and SDS showed only minor effects on relaxation times and ADC values of aqueous solutions, whereas lecithin showed a strong decrease in both relaxation times (r1,lecithin = 0.11 wt.%−1 s−1, r2,lecithin = 0.57 wt.%−1 s−1) and ADC value (Δ(ADC)lecithin = − 0.18 × 10–3 mm2/s⋅wt.%) with increasing concentration. Conclusion Lecithin is suggested as the preferred emulsifier of oil-in-water emulsions in MRI as it shows a high stabilizing ability and remains invisible in MRI experiments. In addition, lecithin is suitable as an alternative means of adjusting relaxation times and ADC values of water.

Objectives: To systematically compare two modified Look-Locker inversion recovery (MOLLI) T1 mapping sequences and their impact on (1) myocardial T1 values native, (2) post-contrast and (3) extracellular volume (ECV). Methods: 200 patients were prospectively included for 1.5 T CMR for work-up of ischemic or non-ischemic cardiomyopathies. To determine native and post-contrast T1 for ECV calculation, two different T1 mapping MOLLI acquisition schemes, 5(3)3 (designed for native scans with long T1) and 4(1)3(1)2 (designed for post-contrast scans with short T1), were acquired in identical mid-ventricular short-axis slices. Both schemes were acquired in native and post-contrast scans. Results: Datasets from 163 patients were evaluated (age 55 ± 17 years; 38% female). Myocardial T1 native for 5(3)3 was 1017 ± 42 ms vs. 956 ± 40 ms for 4(1)3(1)2, with mean intraindividual difference −61 ms (p < 0.0001). Post-contrast myocardial T1 in patients was similar for both acquisition schemes, with 494 ± 48 ms for 5(3)3 and 490 ± 45 ms for 4(1)3(1)2 and mean intraindividual difference −4 ms. Myocardial ECV for 5(3)3 was 27.6 ± 4% vs. 27 ± 4% for 4(1)3(1)2, with mean difference −0.6 percentage points (p < 0.0001). Conclusions: The T1 MOLLI 5(3)3 acquisition scheme provides a reliable estimation of myocardial T1 for the clinically relevant range of long and short T1 values native and post-contrast. In contrast, the T1 MOLLI 4(1)3(1)2 acquisition scheme may only be used for post-contrast scans according to its designed purpose.

PURPOSE: To test soy lecithin as a substance added to water for the construction of MRI phantoms with tissue-like diffusion coefficients. The performance of soy lecithin was assessed for the useable range of adjustable ADC values, the degree of non-Gaussian diffusion, simultaneous effects on relaxation times, and spectral signal properties. METHODS: Aqueous soy lecithin solutions of different concentrations (0%, 0.5%, 1%, 2%, 3% …, 10%) and soy lecithin-agar gels were prepared and examined on a 3Tesla clinical scanner at 18.5° ± 0.5°C. Echoplanar sequences (b values: 0-1000/3000 s/mm2 ) were applied for ADC measurements. Quantitative relaxometry and MRS were performed for assessment of T1 , T2 , and detectable spectral components. RESULTS: The presence of soy lecithin significantly restricts the diffusion of water molecules and mimics the nearly Gaussian nature of diffusion observed in tissue (for b values

Acute pulmonary embolism (PE) can be a life-threatening event that requires immediate care to maintain cardiovascular circulation. In addition to systemic thrombolytic therapy, mechanical thrombectomy may be indicated in cases with a high or intermediate risk of mortality, to directly remove obstructive emboli for rapid patient improvement [1]. Several devices for catheter-directed thrombolysis and mechanical thrombectomy are available, and data regarding the efficacy of these procedures are inconsistent. Non-invasive imaging of pulmonary blood flow might help evaluate treatment success and support the acceptance of revascularization procedures. Arterial spin labeling (ASL)-MRI is a well-established technique in brain imaging to measure organ perfusion without the need for contrast agents, using blood as an endogenous tracer. Perfusion imaging with ASL has already been implemented in routine clinical diagnosis of cerebrovascular pathologies, including arterio-occlusive disease, vascular shunts, and neuro-degenerative diseases [2]. In the lung, the complex vessel anatomy, highly pulsatile nature of blood flow, respiratory movements, and low proton density are challenging conditions for ASL-MRI, hindering its translation to routine clinical use. We recently presented electrocardiogram-triggered pseudo-continuous ASL (PCASL) imaging with balanced steady-state free precession readout at 1.5T as a promising approach to enable the imaging of pulmonary blood flow even under free-breathing conditions [3]. We aimed to demonstrate the first use of PCASL-MRI in patients to monitor the treatment success of catheter-directed mechanical thrombectomy. A 79-year-old female patient was brought to our emergency unit with clinical signs of PE. A contrast-enhanced CT-scan was performed showing a massive occlusion of the right and left pulmonary arteries with signs of right ventricular dysfunction (Fig. 1A-C). Right ventricular strain was diagnosed on echocardiography and electrocardiogram (Fig. 1D). In accordance with the European Society of Cardiology (ESC) guidelines and after interdisciplinary discussion, the patient was brought to the angiography suite in our radiology department for mechanical thrombectomy.

Background: Alteration in kidney perfusion is an early marker of renal damage. The purpose of this study was to evaluate if changes in renal blood flow (RBF) could be detected using MRI with arterial spin labeling (ASL) technique. Methods: RBF as assessed by cortical (CRBF), medullary, and total renal blood flow (TRBF) were measured by MRI with arterial spin labeling (ASL-MRI) using flow-sensitive alternating inversion recovery true fast imaging with steady-state precession sequence. In 11 normotensive healthy individuals (NT) and 11 hypertensive patients (HT), RBF was measured at baseline and after both feet were covered with cold ice packs (cold pressor test) that activates the sympathetic nervous system. In another experiment, RBF was measured in 10 patients with CKD before and after a pharmacological intervention. We compared RBF measurements between the 3 study populations. Results: A significant reduction in CRBF (p = 0.042) and a trend in TRBF (p = 0.053) were observed in response to the activation of the sympathetic nervous system. A trend toward reduction of CRBF (p = 0.051) and TRBF (p = 0.059) has been detected after pharmacological intervention. TRBF was significantly lower in patients with HT and CKD patients compared to NT individuals (NT vs. HT, p = 0.014; NT vs. CKD, p = 0.004). TRBF was lower in patients with CKD compared to HT (p = 0.047). Conclusion: Our data indicate that both acute and short-term changes in RBF could be detected using ASL-MRI. We were able to detect differences in RBF between healthy and diseased individuals by needing only small sample size per group. Thus, ASL-MRI offers an advantage in conducting clinical trials compared to other technologies.

Until today, assessment of renal function has remained a challenge for modern medicine. In many cases, kidney diseases accompanied by a decrease in renal function remain undetected and unsolved, since neither laboratory tests nor imaging diagnostics provide adequate information on kidney status. In recent years, developments in the field of functional magnetic resonance imaging with application to abdominal organs have opened new possibilities combining anatomic imaging with multiparametric functional information. The multiparametric approach enables the measurement of perfusion, diffusion, oxygenation, and tissue characterization in one examination, thus providing more comprehensive insight into pathophysiological processes of diseases as well as effects of therapeutic interventions. However, application of multiparametric fMRI in the kidneys is still restricted mainly to research areas and transfer to the clinical routine is still outstanding. One of the major challenges is the lack of a standardized protocol for acquisition and postprocessing including efficient strategies for data analysis. This article provides an overview of the most common fMRI techniques with application to the kidney together with new approaches regarding data analysis with deep learning.This article implies a selective literature review using the literature database PubMed in May 2021 supplemented by our own experiences in this field.Functional multiparametric MRI is a promising technique for assessing renal function in a more comprehensive approach by combining multiple parameters such as perfusion, diffusion, and BOLD imaging. New approaches with the application of deep learning techniques could substantially contribute to overcoming the challenge of handling the quantity of data and developing more efficient data postprocessing and analysis protocols. Thus, it can be hoped that multiparametric fMRI protocols can be sufficiently optimized to be used for routine renal examination and to assist clinicians in the diagnostics, monitoring, and treatment of kidney diseases in the future.· Multiparametric fMRI is a technique performed without the use of radiation, contrast media, and invasive methods.. · Multiparametric fMRI provides more comprehensive insight into pathophysiological processes of kidney diseases by combining functional and structural parameters.. · For broader acceptance of fMRI biomarkers, there is a need for standardization of acquisition, postprocessing, and analysis protocols as well as more prospective studies.. · Deep learning techniques could significantly contribute to an optimization of data acquisition and the postprocessing and interpretation of larger quantities of data..· Zhang C, Schwartz M, Küstner T et al. Multiparametric Functional MRI of the Kidney: Current State and Future Trends with Deep Learning Approaches. Fortschr Röntgenstr 2022; 194: 983 - 992.Bis heute stellt die Erfassung der Nierenfunktion eine Herausforderung für die moderne Medizin dar. Oftmals bleiben funktionelle Einschränkungen der Niere unentdeckt und die Ursachen ungeklärt, da weder die Labordiagnostik noch zur Verfügung stehende Bildgebungsmethoden ausreichend Information über den Funktionsstatus der Nieren liefern. In den letzten Jahren haben Entwicklungen auf dem Gebiet der multiparametrischen funktionellen Magnetresonanztomografie (fMRT) mit Anwendung an abdominellen Organen neue Möglichkeiten zur kombinierten Erfassung anatomischer Strukturen und funktioneller Informationen eröffnet. Dieser multiparametrische Ansatz erlaubt die Messung verschiedener Parameter wie der Perfusion, Diffusion, Oxygenierung und Charakterisierung von Gewebeparametern in einem Untersuchungsvorgang, wodurch umfassendere Einblicke in die pathophysiologischen Prozesse verschiedener Nierenerkrankungen und die Wirkung therapeutischer Ansätze ermöglicht werden. Allerdings ist die Anwendung an der Niere noch auf die Forschung beschränkt und der Schritt in die klinische Routinediagnostik ausstehend. Eine der größten Herausforderungen stellt das Fehlen standardisierter Protokolle für die Akquisition und die Datenverarbeitung sowie effizienter Methoden zur Datenanalyse dar. Dieses Review bietet eine Übersicht über die weitverbreitetsten fMRT-Techniken mit Anwendung an der Niere und zeigt neue Ansätze zur Datenverarbeitung und Analyse mittels Deep Learning auf.Für diesen Artikel wurde eine selektive Literaturrecherche unter Verwendung der Literaturdatenbank PubMed im Mai 2021 durchgeführt und durch eigene Erfahrungen auf diesem Gebiet ergänzt.Die multiparametrische funktionelle MRT ist eine vielversprechende Technik zur Erfassung der Nierenfunktion in einem umfassenderen Ansatz durch kombinierte Untersuchung verschiedener Funktionsparameter wie der Perfusion, Diffusion und Oxygenierung in einem Untersuchungsablauf. Neue Entwicklungen auf dem Gebiet des Deep Learning könnten wesentlich bei der Bewältigung der Datenmengen und der Entwicklung effizienterer Methoden zur Datenverarbeitung und Analyse beitragen. Diese Fortschritte lassen hoffen, dass multiparametrische fMRT-Protokolle bald ausreichend optimiert sind, um über die Forschung hinaus auch im klinischen Alltag in der Diagnostik, dem Monitoring und der Behandlung von Nierenerkrankungen eingesetzt zu werden.· Die multiparametrische fMRT umfasst strahlenfreie, nicht invasive und kontrastmittelfreie Techniken.. · Durch die kombinierte Aufnahme verschiedener funktioneller und struktureller Gewebeparameter können tiefere Einblicke in pathophysiologische Prozesse von Nierenerkrankungen gewonnen werden.. · Für eine breitere Akzeptanz von MR-Biomarkern in der Zukunft sind die Etablierung von Standards in der Datenakquisition, -verarbeitung und Analyse sowie prospektive Studien notwendig.. · Deep-Learning-Ansätze könnten einen entscheidenden Beitrag sowohl in der Datenakquisition als auch in der Verarbeitung und Interpretation großer Datenmengen leisten..

To compare true positive and false negative results of myocardial edema mapping in two methods. Myocardial edema may be difficult to detect on cardiac MRI. 76 patients (age 59 ± 11 years, 15 female) with acute myocardial infarction (MI) and 10 healthy volunteers were prospectively included in this single-center study. 1.5 T cardiac MRI was performed in patients 2.5 days after revascularization (median) for edema mapping: Steady State Free Precession (SSFP) mapping sequence with T 311 myocardial segments in patients were acutely infarcted with mean T Both edema mapping methods indicate high-grade edema with high sensitivity. Nevertheless, edema in acute infarction may be focally underestimated in both mapping methods. · Sensitivity for edema detection is high for both methods.. · Edema may be focally underestimated by T2prep SSFP edema mapping and dcFSE mapping..· Krumm P, Martirosian P, Rath D et al. Performance of two Methods for Cardiac MRI Edema Mapping: Dual-Contrast Fast Spin-Echo and T2 Prepared Balanced Steady State Free Precession. Fortschr Röntgenstr 2020; 192: 669 - 677.ZIEL: Vergleich von richtig positiven und falsch negativen Werten bei myokardialem Ödem-Mapping zweier Methoden. Der Ödemnachweis mittels MRT kann schwierig sein. 76 Patienten (Alter 59 ± 11 Jahre, 15 weiblich) mit akutem Myokardinfarkt (MI) und 10 gesunde Probanden wurden prospektiv in diese am Einzelzentrum durchgeführte Studie eingeschlossen. Im Median 2,5 Tage nach Revaskularisation wurde eine Herz-MRT bei 1,5 T zum Ödem-Mapping durchgeführt: Eine Steady-State-Free-Precession (SSFP)-Mapping-Sequenz mit T 311 Myokardsegmente in Patienten waren akut infarziert, mit einem mittleren T Beide Methoden zum Ödem-Mapping erfassen ein höhergradiges Ödem mit hoher Sensitivität. Dennoch kann ein Ödem mit beiden Mapping-Methoden auch bei akutem Infarkt fokal unterschätzt werden. · Beide Methoden zeigen eine hohe Sensitivität zur Detektion eines Ödems.. · Ödeme können von T2prep-SSFP und dcFSE-Mapping fokal unterschätzt werden..

Purpose Purpose of this study is to evaluate the diagnostic accuracy of quantitative T2/ADC values in differentiating between PCa and lesions showing non-specific inflammatory infiltrates and atrophy, features of chronic prostatitis, as the most common histologically proven differential diagnosis. Methods In this retrospective, single-center cohort study, we analyzed 55 patients suspected of PCa, who underwent mpMRI (3T) including quantitative T2 maps before robot-assisted mpMRI-TRUS fusion prostate biopsy. All prostate lesions were scored according to PI-RADS v2.1. Regions of interest (ROIs) were annotated in focal lesions and normal prostate tissue. Quantitative mpMRI values from T2 mapping and ADC were compared using two-tailed t tests. Receiver operating characteristic curves (ROCs) and cutoff were calculated to differentiate between PCa and chronic prostatitis. Results Focal lesions showed significantly lower ADC and T2 mapping values than normal prostate tissue (p p r = 0.70; p Conclusion T2 mapping showed high diagnostic accuracy for differentiating between PCa and chronic prostatitis, comparable to the performance of ADC values.

Magnetic resonance cholangiopancreatography (MRCP) is an established technique in routine magnetic resonance examination. By applying the compressed sensing (CS) acceleration technique to conventional MRCP sequences, scan time can be markedly reduced. With promising results at 3 T, there is a necessity to evaluate the performance at 1.5 T due to wide scanner availabilities. Aim of this study is to test the feasibility of accelerated 3-dimensional (3D) MRCP with extended sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) using CS in navigator triggering and in a single breath-hold in a clinical setting at 1.5 T and 3 T and compare it with a conventional navigator-triggered 3D SPACE-MRCP.Phantom measurements were performed to adapt sequence parameters. Conventional 3D SPACE-MRCP in navigator triggering (STD_MRCP) as well as CS-accelerated 3D SPACE-MRCP acquired in navigator triggering and in a single breath-hold (CS_MRCP and CS_BH_MRCP) was performed in 66 patients undergoing clinically induced MRI of the pancreatobiliary system at 1.5 T and 3 T. Image quality evaluation was performed by 2 independent radiologists. Dedicated statistics were performed (P0.05 considered significant).In patient imaging, CS_MRCP was superior to STD_MRCP and CS_BH_MRCP in aspects of overall image quality at 1.5 T (P = 0.01; P0.001) and 3 T (P = 0.002; P = 0.013). Overall image quality in CS_BH_MRCP was inferior compared with STD_MRCP and CS_MRCP at 1.5 T. At 3 T, overall image quality in CS_BH_MRCP was superior to STD_MRCP (P = 0.001). Scan time was reduced by 25% to 46% covering 5% of k-space (CS_MRCP at 1.5 and 3 T) and 97% covering 3.6% of k-space (CS_BH_MRCP at 1.5 and 3 T).Compressed sensing-accelerated MRCP is feasible in clinical routine at 1.5 and 3 T offering major reduction of acquisition time. When applying a single breath-hold CS imaging, field strengths of 3 T are recommended.

Background: Kidney perfusion and oxygenation are two important determinants of kidney graft function. In kidney transplantation, repeated graft hypoperfusion may occur during hip flexion, for example in the sitting position, due to the progressive development of fibrotic tissue around iliac arteries. The aim of this study was to assess the changes in oxygenation and perfusion of kidney grafts during hip flexion and extension using a new functional magnetic resonance imaging (fMRI) protocol.Methods: Nineteen kidney graft recipients prospectively underwent MRI on a 3T scanner including diffusion-weighted, blood oxygenation level dependent (BOLD), and arterial spin labeling sequences in hip positions 0° and >90° before and after intravenous administration of 20 mg furosemide.Results: Unexpectedly, graft perfusion values were significantly higher in flexed compared to neutral hip position. Main diffusion-derived parameters were not affected by hip position. BOLD-derived cortico-medullary R2* ratio was significantly modified during hip flexion suggesting an intrarenal redistribution of the oxygenation in favor of the medulla and to the detriment of the cortex. Furthermore, the increase in medullary oxygenation induced by furosemide was significantly blunted during hip flexion (p < 0.001).Conclusion: Hip flexion has an acute impact on perfusion and tissue oxygenation in kidney grafts. Whether these position-dependent changes affect the long-term function and outcome of kidney transplants needs further investigation.

BACKGROUND Quantitative assessment of pulmonary blood flow and visualization of its temporal and spatial distribution without contrast media is of clinical significance. PURPOSE To assess the potential of electrocardiogram (ECG)-triggered pseudocontinuous arterial spin labeling (PCASL) imaging with balanced steady-state free-precession (bSSFP) readout to measure lung perfusion under free-breathing (FB) conditions and to study temporal and spatial characteristics of pulmonary blood flow. STUDY TYPE Prospective, observational. SUBJECTS Fourteen volunteers; three patients with pulmonary embolism. FIELD STRENGTH/SEQUENCES 1.5T, PCASL-bSSFP. ASSESSMENT The pulmonary trunk was labeled during systole. The following examinations were performed: 1) FB and timed breath-hold (TBH) examinations with a postlabeling delay (PLD) of 1000 msec, and 2) TBH examinations with multiple PLDs (100-1500 msec). Scan-rescan measurements were performed in four volunteers and one patient. Images were registered and the perfusion was evaluated in large vessels, small vessels, and parenchyma. Mean structural similarity indices (MSSIM) was computed and time-to-peak (TTP) of parenchymal perfusion in multiple PLDs was evaluated. Image quality reading was performed with three independent blinded readers. STATISTICAL TESTS Wilcoxon test to compare MSSIM, perfusion, and Likert scores. Spearman's correlation to correlate TTP and cardiac cycle duration. The repeatability coefficient (RC) and within-subject coefficient of variation (wCV) for scan-rescan measurements. Intraclass correlation coefficient (ICC) for interreader agreement. RESULTS Image registration resulted in a significant (P

Rationale and Objectives The aim of this study was to assess the potential benefit of a high-fat meal for preparation of patients before lymphangiography of the thoracic and abdominal lymphatic vessels by a heavily T2-weighted 3D magnetic resonance sequence at 3T. Materials and Methods A heavily T2-weighted 3D Fast-Spin-Echo sequence was applied twice for lymphangiography in 15 healthy volunteers. One examination was performed following overnight fasting and the second examination was conducted 3 hours after a drinking of 200 ml of cream and a solid meal. The effect of a high-fat meal on the visualization of different segments of the thoracic and abdominal lymphatic vessels was analyzed by scoring of the image quality. Results Evaluation of the summarized score of all four segments of the thoracic duct showed significantly improved general visualization of the lymphatic system in the postprandial examination when compared to the results obtained after overnight fasting (mean ± SD: 4.5 ± 1.7 vs. 5.9 ± 1.8, p = 0.007*). Regarding different segments of the lymphatic system significant differences between pre and post cream lymphangiographies were found in the cervical segment (p = 0.012*), the inferior thoracic segment (p = 0.003*) and the abdominal segment (p = 0.035*). In contrast, the visualization of the superior thoracic segment was not significantly improved by high fat meal preparation of the subjects (p = 0.388). Conclusion A high-fat meal 3 hours prior to T2-weighted MR-lymphangiography improves the visualization of the main lymphatic thoracic and abdominal vessels, particularly the abdominal and cervical part as well as the inferior segment of the thoracic duct.

The aim of this study was to compare the diagnostic performance of simultaneous multislice diffusion-weighted imaging (DWI-SMS) with that of standard DWI (DWI-STD) in whole-body 3-T PET/MRI examination protocols in oncological patients. In a phantom study, we evaluated the apparent diffusion coefficients (ADC) from the two techniques. In ten volunteers, we assessed ADC values in different organs. In 20 oncological patients, we evaluated subjective image quality (Likert scale, 5 indicating excellent) and artefacts in different body regions. We also rated the conspicuity and acquired the ADC values of PET-positive tumorous lesions. The scan time for the whole-body DWI-SMS examinations was 40% shorter than the scan time for the DWI-STD examinations (84 s vs. 140 s per table position). The phantom and volunteer studies showed lower ADC values from DWI-SMS in the liver and muscle (psoas muscle 1.4 vs. 1.3). In patients, DWI-SMS provided poorer subjective image quality in the thoracoabdominal region (3.0 vs. 3.8, p = 0.02) and overall more artefacts (138 vs. 105). No significant differences regarding conspicuity and ADC values of lesions were found. DWI-SMS seems to provide reliable conspicuity and ADC values of tumorous lesions similar to those provided by DWI-STD. Therefore, although providing poorer image quality in certain regions, DWI-SMS can clearly reduce PET/MRI scan times in oncological patients. • DWI-SMS can reduce PET/MRI scan times in oncological patients. • DWI-SMS provides reliable ADC values and good lesion conspicuity similar to those provided by DWI-STD. • DWI-SMS may provide poorer image quality in regions with low signal.

Purpose: To develop a motion correction for Positron-Emission-Tomography (PET) using simultaneously acquired magnetic-resonance (MR) images within 90 s. Methods: A 90 s MR acquisition allows the generation of a cardiac and respiratory motion model of the body trunk. Thereafter, further diagnostic MR sequences can be recorded during the PET examination without any limitation. To provide full PET scan time coverage, a sensor fusion approach maps external motion signals (respiratory belt, ECG-derived respiration signal) to a complete surrogate signal on which the retrospective data binning is performed. A joint Compressed Sensing reconstruction and motion estimation of the subsampled data provides motion-resolved MR images (respiratory + cardiac). A 1-POINT DIXON method is applied to these MR images to derive a motion-resolved attenuation map. The motion model and the attenuation map are fed to the Customizable and Advanced Software for Tomographic Reconstruction (CASToR) PET reconstruction system in which the motion correction is incorporated. All reconstruction steps are performed online on the scanner via Gadgetron to provide a clinically feasible setup for improved general applicability. The method was evaluated on 36 patients with suspected liver or lung metastasis in terms of lesion quantification (SUVmax, SNR, contrast), delineation (FWHM, slope steepness) and diagnostic confidence level (3-point Likert-scale). Results: A motion correction could be conducted for all patients, however, only in 30 patients moving lesions could be observed. For the examined 134 malignant lesions, an average improvement in lesion quantification of 22%, delineation of 64% and diagnostic confidence level of 23% was achieved. Conclusion: The proposed method provides a clinically feasible setup for respiratory and cardiac motion correction of PET data by simultaneous short-term MRI. The acquisition sequence and all reconstruction steps are publicly available to foster multi-center studies and various motion correction scenarios.

The purpose of this study was to evaluate contrast-media-free arterial spin labeling, a technique of functional magnetic resonance imaging (MRI), for assessment of kidney perfusion in a clinical study. We examined renal perfusion by arterial spin labeling in 15 healthy adults using a clinical 1.5-T MRI system, twice under baseline conditions and 60 minutes after a single oral dose of 50 mg captopril. Data evaluation included assessment of interstudy and interrater reproducibility in addition to the pharmacological effect of captopril on kidney perfusion and a sample size calculation for potential application of the technique in pharmacological intervention studies. Interstudy reproducibility of cortical and medullary kidney perfusion was excellent (intraclass correlation coefficients 0.77 and 0.83, respectively). Interrater reproducibility was excellent in the cortex and good in the medulla (intraclass correlation coefficients 0.97 and 0.66, respectively). Ingestion of 50 mg captopril was associated with an 11% drop of systolic blood pressure and a rise in kidney perfusion by 22% in the cortex (369 ± 48 vs 452 ± 56 mL/[min·100 g], P < .001) and 26% in the medulla (157 ± 39 to 198 ± 45 ml/[min·100 g]; P < .01). Statistical power analysis revealed that a small sample size of only 6 participants is needed in a clinical trial to capture an equal change in kidney perfusion to the one induced by 50 mg captopril with a statistical power of 82% and an α error of 0.05. In conclusion, funtional MRI with arterial spin labeling is a reliable method for quantification of kidney perfusion and for fast assessment of pharmacologically induced renal perfusion changes, allowing low case numbers.

Purpose To evaluate the feasibility of a self-gated free-breathing volume-interpolated breath-hold examination (VIBE) sequence using compressed sensing (CS) for contrast-enhanced multiphase liver MRI. Materials and Methods We identified 23 patients who underwent multiphase gadobutrol-enhanced liver magnetic resonance imaging (MRI) using 1) a prototype free-breathing VIBE sequence with respiratory self-gating and CS (VIBECS), and 2) a standard breath-hold VIBE (VIBESTD) on the same 1.5T scanner at two timepoints. VIBECS was continuously acquired for 128 seconds and a time-series of 16 timepoints was jointly reconstructed from the dataset. The unenhanced, arterial, portal-venous, and venous timepoints with the best image quality were selected and compared to the corresponding VIBESTD series serving as reference. Image quality was assessed qualitatively (image quality, sharpness, lesion conspicuity, vessel contrast, noise, motion/other artifacts; two readers independently; 5-point Likert scale; 5 = excellent) and quantitatively (vessel contrast [VC], coefficient-of-variation [CV]) Statistics were performed using Wilcoxon-sign-rank (ordinal) and paired t-test (continuous variables). Results Image quality and lesion conspicuity revealed no significant differences between the sequences (P ≥ 0.3). VIBESTD showed a tendency to higher motion artifacts (P ≥ 0.07). Image sharpness significantly increased in VIBECS as compared to VIBESTD (P ≤ 0.03). Arterial phase vessel contrast appeared significantly lower in VIBECS than in VIBESTD (P = 0.04). VIBECS showed reconstruction artifacts not present in VIBESTD (P = 0.001). Image noise was significantly lower in VIBECS than in VIBESTD (P ≤ 0.004). Arterial phase VC was significantly lower in VIBECS than in VIBESTD (P = 0.01). CV revealed no differences between sequences (P = 0.7). Conclusion VIBECS is feasible for continuous free-breathing contrast-enhanced multiphase liver MRI, providing similar image quality and lesion conspicuity as VIBESTD. Level of Evidence: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:459–467.

Purpose To assess the feasibility of simultaneous multislice (SMS) single-shot echo-planar-imaging (EPI) for accelerated diffusion-weighted imaging (DWI) of the prostate. Materials and Methods For phantom measurements a dedicated DWI phantom with different sucrose concentrations was used. In addition, 10 volunteers and 16 patients with suspected prostate cancer were examined for in vivo measurements. All examinations were performed with a 3T magnetic resonance imaging (MRI) system. A prototype simultaneous multislice EPI sequence (DW-EPISMS; acquisition time 3:14 min) was acquired and compared to a single-shot EPI sequence (DW-EPISS; acquisition time 6:12 min) serving as a standard of reference. Different image quality parameters of EPISMS were assessed qualitatively (overall image quality, anatomic differentiability, lesion conspicuity, image noise, distortion; two independent readers; 5-point Likert-scale [5 = excellent]) and quantitatively (ADC-values by calculating interclass correlation [ICC] and Bland–Altman limits of agreement [LoA] as measures for reproducibility) and compared to DW-EPISS. Results DW-EPISMS allowed for a substantially reduced acquisition time as compared to DW-EPISS (˜50%). Bland–Altman plots revealed robust measurement repeatability for DW-EPISMS in the phantom study. Overall image quality did not significantly differ between DW-EPISMS and DW-EPISS (b1500 images P = 0.5; ADC maps P = 0.7). Only in b1500 DW images was subjective image noise rated significantly higher in DW-EPISS than in DW-EPISMS (P = 0.006). Quantitative analysis of ADC-values revealed not significant differences between DW-EPISMS and DW-EPISS (P = 0.7) and high measures for reproducibility ICC ≥0.96. Conclusion Simultaneous multislice DWI is feasible for accelerated prostate MRI allowing for a substantially reduced examination time with similar image quality and ADC-values as compared to a standard of reference DWI sequence. Level of Evidence: 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1507–1515.

A Cartesian subsampling scheme is proposed incorporating the idea of PF acquisition and variable-density Poisson Disc (vdPD) subsampling by redistributing the sampling space onto a smaller region aiming to increase k-space sampling density for a given acceleration factor. Especially the normally sparse sampled high-frequency components benefit from this sampling redistribution, leading to improved edge delineation. The prospective subsampled and compacted k-space can be reconstructed by a seamless combination of a CS-algorithm with a Hermitian symmetry constraint accounting for the missing part of the k-space. This subsampling and reconstruction scheme is called Compressed Sensing Partial Subsampling (ESPReSSo) and was tested on in-vivo abdominal MRI datasets. Different reconstruction methods and regularizations are investigated and analyzed via global (intensity-based) and local (region-of-interest and line evaluation) image metrics, to conclude a clinical feasible setup. Results substantiate that ESPReSSo can provide improved edge delineation and regional homogeneity for multidimensional and multi-coil MRI datasets and is therefore useful in applications depending on well-defined tissue boundaries, such as image registration and segmentation or detection of small lesions in clinical diagnostics.

Objective The goal of this work was to systematically evaluate the reproducibility of amide proton transfer chemical exchange saturation transfer (APT-CEST) at 3 T and its signal dependence on pH, protein concentration, and acquisition parameters. An in vitro system based on bovine serum albumin (BSA) was used, and its limitations were tested by comparing it to in vivo measurements. The contribution of small endogenous metabolites on the APT-CEST signal at 3 T was also investigated. In addition, the reliability of different z-spectrum interpolations as well as the use of only a few frequency offset data points instead of a whole z-spectrum were tested. Materials and methods We created both a BSA phantom at different concentrations and pH values and a metabolite phantom with different small molecules. Chemical exchange saturation transfer data were acquired using a 2-dimensional fast spoiled gradient-echo sequence with pulsed CEST preparation at different saturation durations and power levels. Healthy volunteer measurements were taken for comparison. Z-spectra were interpolated using a 24th-order polynomial (Poly), an eighth-order Fourier series (Fourier), and a smoothing Spline (sSpline) algorithm. To evaluate reduced data sets, only 6 to 14 frequency offsets of the z-spectrum were used and interpolated via a cubic Spline. Region of interest (ROI) evaluations were used to investigate the reproducibility of amide magnetization transfer ratio asymmetry [MTRasym(3.5 ppm)] and to analyze the MTRasym and z-spectra. Results Interscan standard deviations of MTRasym(3.5 ppm) were always below 0.3%. MTRasym(3.5 ppm) increased when the BSA concentrations increased and decreased when the pH increased. The amine MTRasym signal of small molecules was very small compared with BSA and was only detectable using short saturation times and higher power levels. The MTRasym(3.5 ppm) between BSA concentration steps and between nearly all pH steps was significantly different for all 3 fitting methods. The Fourier and sSpline methods showed no statistically significant differences; however, the results for the Poly method were significantly higher at some concentrations and pH values. Using only few frequency offsets resulted in less significant differences compared with fitting the complete z-spectrum. In general, MTRasym(3.5 ppm) of gray matter, white matter, and ventricle ROIs from volunteer scans increased with an increase in saturation power and partially decreased with an increase in saturation duration. Intra-ROI covariances of MTRasym(3.5 ppm) revealed the highest variations for Poly, whereas using reduced spectral data resulted in an increased signal variation. Conclusions Amide proton transfer-CEST imaging is a highly reproducible method in which absolute signal differences of approximately 0.5% are detectable in principle. For in vivo applications, Fourier or sSpline interpolations of z-spectra are preferable. Using reduced data sets delivers similar results but with increased variation and therefore decreased (pH/concentration) differentiation capability. Differentiation capability increases with increases in the saturation duration and power level. The results from the in vitro BSA system cannot be directly transferred to the in vivo situation due to different chemical environments resulting in, for example, higher asymmetric macromolecular cMT effects in vivo. Amine signals from small molecules are unlikely to contribute to APT-CEST at 3 T (except for creatine); however, signals can be enhanced by using short saturation times and higher power levels.

Purpose To investigate the capabilities of a modern pseudo-continuous arterial spin labeling (PCASL) technique for non-invasive assessment of the temporal and spatial distribution of the liver perfusion in healthy volunteers on a clinical MR system at 3T. Materials and methods A 2D-PCASL multi-slice echo planar imaging sequence was adapted to the specific conditions in liver: a) labeling by PCASL was optimized to the flow characteristics in the portal vein , b) background suppression was applied for reduction of motion related artifacts , c) post labeling delays (PLDs) were varied over a large range (0.7–3.5 s) in order to get better insight in the temporal and spatial distribution of tagged blood in the liver, and d) a special timed-breathing protocol was used allowing for recording of 16 to 18 label-control image pairs and a reference M0 image for each of 4 to 6 slices within approx. 5 min for one PLD. Results Measurements with multiple PLDs showed dominating perfusion signal in macroscopic blood vessels for PLDs up to 1.5 s, whereas pure liver parenchyma revealed maximum perfusion signal for a PLD of approx. 2 s, and detectable signal up to PLDs of 3.5 s. Data fitting to a perfusion model for liver provided a mean global perfusion of 153 ± 15 ml/100 g/min and a mean transit time of 1938 ± 332 ms in liver parenchyma. Measurements with a single PLD of 2 s demonstrated that portal-venous and arterial perfusion components can be measured separately by two measurements with two different positions of the labeling plane (one for labeling of the global hepatopetal blood flow and one for selective labeling of the portal blood flow only). Relative contribution of blood from the hepatic artery to the global liver perfusion, the hepatic perfusion index (HPI), amounted to approx. 23%. Conclusion Modern and adapted protocols for assessment of liver perfusion by PCASL have the potential to provide perfusion and blood transit time maps in reasonable acquisition time.

PurposeThe aim of this study was to assess the volume of the respective kidney compartments with particular interest in renal sinus fat as an early biomarker and to compare the distribution between individuals with normal glucose levels and individuals with prediabetes and diabetes.Material and MethodsThe sample comprised N = 366 participants who were either normoglycemic (N = 230), had prediabetes (N = 87) or diabetes (N =49), as determined by Oral Glucose Tolerance Test. Other covariates were obtained by standardized measurements and interviews. Whole-body MR measurements were performed on a 3 Tesla scanner. For assessment of the kidneys, a coronal T1w dual-echo Dixon and a coronal T2w single shot fast spin echo sequence were employed. Stepwise semi-automated segmentation of the kidneys on the Dixon-sequences was based on thresholding and geometric assumptions generating volumes for the kidneys and sinus fat. Inter- and intra-reader variability were determined on a subset of 40 subjects. Associations between glycemic status and renal volumes were evaluated by linear regression models, adjusted for other potential confounding variables. Furthermore, the association of renal volumes with visceral adipose tissue was assessed by linear regression models and Pearson’s correlation coefficient.ResultsRenal volume, renal sinus volume and renal sinus fat increased gradually from normoglycemic controls to individuals with prediabetes to individuals with diabetes (renal volume: 280.3±64.7 ml vs 303.7±67.4 ml vs 320.6±77.7ml, respectively, p < 0.001). After adjustment for age and sex, prediabetes and diabetes were significantly associated to increased renal volume, sinus volume (e.g. βprediabetes= 10.1, 95% CI: [6.5, 13.7]; pDiabetes= 11.86, 95% CI: [7.2, 16.5]; pprediabetes= 7.13, 95% CI: [4.5, 9.8]; pDiabetes= 7.34, 95% CI: [4.0, 10.7]; pConclusionRenal volume and particularly renal sinus fat volume already increases significantly in prediabetic subjects. There is a significant association between VAT and renal sinus fat, suggesting that there are metabolic interactions between these perivascular fat compartments.

Combination of surface electromyography (EMG) with diffusion-weighted magnetic resonance imaging (DW-MRI) enables improved studies of spontaneous mechanical contractions in resting human musculature (SMAM). Mechanical muscular activities follow characteristic electrical neuromuscular activities after a delay of several tens of milliseconds. A low-cost standalone system for simultaneous surface EMG measurements during DW-MRI with a real-time model-based surface EMG activity detection is demonstrated which controls the MR sequence. Therefore, a multilayer perceptron (MLP) with sequential forward selection (SFS) was investigated. MLP achieved an area under curve (AUC) of 0.933 in the detection of small surface EMG activities based on five time-domain features. Integration on a microcontroller system enabled fast real-time surface EMG activity detection with highly flexible trigger time settings. Small deviations with only 7.2±1.7 ms time delay between decision of MLP activity detection and onset of MR sequence were measured.

In clinical diagnostic, magnetic resonance imaging (MRI) is a valuable and versatile tool. The acquisition process is, however, susceptible to image distortions (artifacts) which may lead to degradation of image quality. Automated and reference-free localization and quantification of artifacts by employing convolutional neural networks (CNNs) is a promising way for early detection of artifacts. Training relies on high amount of expert labeled data which is a time-demanding process. Previous studies were based on global labels, i.e. a whole volume was automatically labeled as artifact-free or artifact-affected. However, artifact appearance is rather localized. We propose a local labeling which is conducted via a graphical user interface (GUI). Moreover, the GUI provides easy handling of data viewing, preprocessing (labeling, patching, data augmentation), network parametrization and training, data and network evaluation as well as deep visualization of the learned network content. The GUI is not limited to these features and will be extended in the future. The developed GUI is made publicly available and features a modular outline to target different applications of machine learning and deep learning, such as artifact detection, classification and segmentation.

Purpose To enable fast and flexible high-resolution four-dimensional (4D) MRI of periodic thoracic/abdominal motion for motion visualization or motion-corrected imaging. Methods We proposed a Cartesian three-dimensional k-space sampling scheme that acquires a random combination of k-space lines in the ky/kz plane. A partial Fourier–like constraint compacts the sampling space to one half of k-space. The central k-space line is periodically acquired to allow an extraction of a self-navigated respiration signal used to populate a k-space of multiple breathing positions. The randomness of the acquisition (induced by periodic breathing pattern) yields a subsampled k-space that is reconstructed using compressed sensing. Local image evaluations (coefficient of variation and slope steepness through organs) reveal information about motion resolvability. Image quality is inspected by a blinded reading. Sequence and reconstruction method are made publicly available. Results The method is able to capture and reconstruct 4D images with high image quality and motion resolution within a short scan time of less than 2 min. These findings are supported by restricted-isometry-property analysis, local image evaluation, and blinded reading. Conclusion The proposed method provides a clinical feasible setup to capture periodic respiratory motion with a fast acquisition protocol and can be extended by further surrogate signals to capture additional periodic motions. Retrospective parametrization allows for flexible tuning toward the targeted applications. Magn Reson Med, 2016. © 2016 International Society for Magnetic Resonance in Medicine

To evaluate feasibility of a 3D-isotropic self-gated radial volumetric interpolated breath-hold examination (VIBE) for late-phase MRI of the liver. 70 patients were included and underwent liver MRI at 1.5 T. Depending on the diagnosis, either Gd-EOB-DTPA (35 patients) or gadobutrol (35 patients) were administered. During late (gadobutrol) or hepatocyte-specific phase (Gd-EOB-DTPA), a radial prototype sequence was acquired and reconstructed using (1) self-gating with 40 % acceptance (rVIBE40); (2) with 100 % acceptance of the data (rVIBE100) and compared to Cartesian VIBE (cVIBE). Images were assessed qualitatively (image quality, lesion conspicuity, artefacts; 5-point Likert-scale: 5 = excellent; two independent readers) and quantitatively (coefficient-of-variation (CV); contrast-ratio) in axial and coronal reformations. In eight cases only rVIBE provided diagnostic image quality. Image quality of rVIBE40 was rated significantly superior (p

Purpose To systematically evaluate image characteristics of simultaneous-multislice (SMS)-accelerated diffusion-weighted imaging (DWI) of the liver using different breathing schemes in comparison to standard sequences. Materials and Methods DWI of the liver was performed in 10 healthy volunteers and 12 patients at 1.5T using an SMS-accelerated echo planar imaging sequence performed with respiratory-triggering and free breathing (SMS-RT, SMS-FB). Standard DWI sequences served as reference (STD-RT, STD-FB). Reduction of scan time by SMS-acceleration was measured. Image characteristics of SMS-DWI and STD-DWI with both breathing schemes were analyzed quantitatively (apparent diffusion coefficient [ADC], signal-to-noise ratio [SNR]) and qualitatively (5-point Likert scale, 5 = excellent). Qualitative and quantitative parameters were compared using Friedman test and Dunn-Bonferroni post-hoc method with P-values < 0.05 considered statistically significant. Results SMS-DWI provided diagnostic image quality in volunteers and patients both with RT and FB with a reduction of scan time of 70% (0:56 vs. 3:20 min in FB). Overall image quality did not significantly differ between FB and RT acquisition in both STD and SMS sequences (median STD-RT 5.0, STD-FB 4.5, SMS-RT: 4.75; SMS-FB: 4.5; P = 0.294). SNR in the right hepatic lobe was comparable between the four tested sequences. ADC values were significantly lower in SMS-DWI compared to STD-DWI irrespective of the breathing scheme (1.2 ± 0.2 × 10-3 mm2/s vs. 1.0 ± 0.2 × 10-3 mm2/s; P < 0.001). Conclusion SMS-acceleration provides considerable scan time reduction for hepatic DWI with equivalent image quality compared to the STD technique both using RT and FB. Discrepancies in ADC between STD-DWI and SMS-DWI need to be considered when transferring the SMS technique to clinical routine reading. J. MAGN. RESON. IMAGING 2016;44:865–879.