Adaptive Total Field Inversion is described for quantitative susceptibility mapping (QSM) reconstruction from total field data through a spatially adaptive suppression of shadow artifacts through ...spatially adaptive regularization. The regularization for shadow suppression consists of penalizing low-frequency components of susceptibility in regions of small susceptibility contrasts as estimated by R2∗ derived signal intensity. Compared with a conventional local field method and two previously proposed regularized total field inversion methods, improvements were demonstrated in phantoms and subjects without and with hemorrhages. This algorithm, named TFIR, demonstrates the lowest error in numerical and gadolinium phantom datasets. In COSMOS data, TFIR performs well in matching ground truth in high-susceptibility regions. For patient data, TFIR comes close to meeting the quality of the reference local field method and outperforms other total field techniques in both clinical scores and shadow reduction.
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•TFIR's adaptive regularization obtains magnetic susceptibility from magnetic field•TFIR has low artifact incidence on both quantitative and clinical scores•The error for TFIR is low on various numerical and ground truth tests•Clinical applications for TFIR include hemorrhages and whole head mapping
Nuclear Magnetic Resonance; Magnetism; Physics Magnetic Resonance Imaging; Algorithms
The objective was to identify changes in quantitative MRI measures in patients with idiopathic normal pressure hydrocephalus (iNPH) occurring in common after oral acetazolamide (ACZ) and external ...lumbar drainage (ELD) interventions.
A total of 25 iNPH patients from two clinical sites underwent serial MRIs and clinical assessments. Eight received ACZ (125-375 mg/day) over 3 months and 12 underwent ELD for up to 72 hours. Five clinically-stable iNPH patients who were scanned serially without interventions served as controls for the MRI component of the study. Subjects were divided into responders and non-responders to the intervention based on gait and cognition assessments made by clinicians blinded to MRI results. The MRI modalities analyzed included T1-weighted images, diffusion tensor Imaging (DTI) and arterial spin labelling (ASL) perfusion studies. Automated threshold techniques were used to define regions of T1 hypo-intensities.
Decreased volume of T1-hypointensities and decreased mean diffusivity (MD) within remaining hypointensities was observed after ACZ and ELD but not in controls. Patients responding positively to these interventions had more extensive decreases in T1-hypointensites than non-responders: ACZ-responders (4,651 ± 2,909 mm(3)), ELD responders (2,338 ± 1,140 mm(3)), ELD non-responders (44 ± 1,188 mm(3)). Changes in DTI MD within T1-hypointensities were greater in ACZ-responders (7.9% ± 2%) and ELD-responders (8.2% ± 3.1%) compared to ELD non-responders (2.1% ± 3%). All the acetazolamide-responders showed increases in whole-brain-average cerebral blood flow (wbCBF) estimated by ASL (18.8% ± 8.7%). The only observed decrease in wbCBF (9.6%) occurred in an acetazolamide-non-responder. A possible association between cerebral atrophy and response was observed, with subjects having the least cortical atrophy (as indicated by a positive z-score on cortical thickness measurements) showing greater clinical improvement after ACZ and ELD.
T1-hypointensity volume and DTI MD measures decreased in the brains of iNPH patients following oral ACZ and ELD. The magnitude of the decrease was greater in treatment responders than non-responders. Despite having different mechanisms of action, both ELD and ACZ may decrease interstitial brain water and increase cerebral blood flow in patients with iNPH. Quantitative MRI measurements appear useful for objectively monitoring response to acetazolamide, ELD and potentially other therapeutic interventions in patients with iNPH.
Current radiologic diagnosis of normal pressure hydrocephalus (NPH) requires a subjective judgment of whether lateral ventricular enlargement is disproportionate to cerebral atrophy based on visual ...inspection of brain images. We investigated whether quantitative measurements of lateral ventricular volume and total cortical thickness (a correlate of cerebral atrophy) could be used to more objectively distinguish NPH from normal controls (NC), Alzheimer's (AD), and Parkinson's disease (PD). Volumetric MRIs were obtained prospectively from patients with NPH (n=5), PD (n=5), and NC (5). Additional NC (n=5) and AD patients (n=10) from the ADNI cohort were examined. Although mean ventricular volume was significantly greater in the NPH group than all others, the range of values overlapped those of the AD group. Individuals with NPH could be better distinguished when ventricular volume and total cortical thickness were considered in combination. This pilot study suggests that volumetric MRI measurements hold promise for improving NPH differential diagnosis.
The objective of this study was to assess the contribution of multi-parametric (mp) magnetic resonance imaging (MRI) quantitative features in the machine learning-based grading of gliomas with a ...multi-region-of-interests approach.
Forty-three patients who were newly diagnosed as having a glioma were included in this study. The patients were scanned prior to any therapy using a standard brain tumor magnetic resonance (MR) imaging protocol that included T1 and T2-weighted, diffusion-weighted, diffusion tensor, MR perfusion and MR spectroscopic imaging. Three different regions-of-interest were drawn for each subject to encompass tumor, immediate tumor periphery, and distant peritumoral edema/normal. The normalized mp-MRI features were used to build machine-learning models for differentiating low-grade gliomas (WHO grades I and II) from high grades (WHO grades III and IV). In order to assess the contribution of regional mp-MRI quantitative features to the classification models, a support vector machine-based recursive feature elimination method was applied prior to classification.
A machine-learning model based on support vector machine algorithm with linear kernel achieved an accuracy of 93.0%, a specificity of 86.7%, and a sensitivity of 96.4% for the grading of gliomas using ten-fold cross validation based on the proposed subset of the mp-MRI features.
In this study, machine-learning based on multiregional and multi-parametric MRI data has proven to be an important tool in grading glial tumors accurately even in this limited patient population. Future studies are needed to investigate the use of machine learning algorithms for brain tumor classification in a larger patient cohort.
•Machine learning-based grading of gliomas with a multi-region-of-interests approach.•An accuracy of 93.0% with a specificity of 86.7% was achieved.•The solid tumor, tumor periphery and peritumoral edema/normal regions were defined.•mp-MRI: rCBV, ADC, Cho/NAA, FA, NAA (tumor); FA, MTT (periphery); Cho/NAA (edema).
Brain retraction systems are frequently required to achieve surgical exposure of deep-seated brain lesions. Spatula-based systems can be associated with injury to the cortex and deep white matter, ...particularly adjacent to the sharp edges, which can result in uneven pressure on the parenchyma over the course of a long operation. The use of tubular retractor systems has been proposed as a method to overcome these limitations. There have been no studies assessing the degree of brain injury associated with the use of tubular retractors. METHODS :Twenty patients were retrospectively identified at Weill Cornell Medical College who underwent resection of deep-seated brain lesions between 2005 and 2014 with the aid of a METRx tubular retractor system. Using the Brainlab software, pre- and postoperative images were analyzed to assess volume, depth, extent of resection, and change in postoperative MR FLAIR hyperintensity and restricted diffusion on diffusion-weighted imaging (DWI).
The mean preoperative tumor volume was 16.25 ± 17.6 cm(3). Gross-total resection was achieved in 75%, near-total resection in 10%, and subtotal resection in 15% of patients. There was a small but not statistically significant increase in average FLAIR hyperintensity volume by 3.25 ± 10.51 cm(3) (p = 0.16). The average postoperative volume of DWI high signal area with restricted diffusion on apparent diffusion coefficient maps was 8.35 ± 3.05 cm(3). Assuming that the volume of restricted diffusion on DWI around tumor was 0 preoperatively, this represented a statistically significant increase on DWI (p < 0.001).
Although tubular retractors do not appear to significantly increase FLAIR signal in the brain, DWI intensity around the retractors can be identified. These data indicate that although tubular retractors may minimize damage to surrounding tissues, they still cause cytotoxic edema and cellular damage. Objective comparison against other retraction methods, as compared by 3D volumetric analysis or similar methods, will be important in determining the true advantage of tubular retractor systems.
Purpose
Typical quantitative susceptibility mapping (QSM) reconstruction steps consist of first estimating the magnetization field from the gradient‐echo images, and then reconstructing the ...susceptibility map from the estimated field. The errors from the field‐estimation steps may propagate into the final QSM map, and the noise in the estimated field map may no longer be zero‐mean Gaussian noise, thus, causing streaking artifacts in the resulting QSM. A multiecho complex total field inversion (mcTFI) method was developed to compute the susceptibility map directly from the multiecho gradient echo images using an improved signal model that retains the Gaussian noise property in the complex domain. It showed improvements in QSM reconstruction over the conventional field‐to‐source inversion.
Methods
The proposed mcTFI method was compared with the nonlinear total field inversion (nTFI) method in a numerical brain with hemorrhage and calcification, the numerical brains provided by the QSM Challenge 2.0, 18 brains with intracerebral hemorrhage scanned at 3T, and 6 healthy brains scanned at 7T.
Results
Compared with nTFI, the proposed mcTFI showed more accurate QSM reconstruction around the lesions in the numerical simulations. The mcTFI reconstructed QSM also showed the best image quality with the least artifacts in the brains with intracerebral hemorrhage scanned at 3T and healthy brains scanned at 7T.
Conclusion
The proposed multiecho complex total field inversion improved QSM reconstruction over traditional field‐to‐source inversion through better signal modeling.
The purpose of this study was to determine the normative apparent diffusion coefficient (ADC) values at 3T using high b-value (3000 s/mm(2)) diffusion-weighted images (DWI) and compare the signal ...characteristics of the high b value with standard b-value (1000 s/mm(2)) DWI.
Institutional review board approval was obtained for this prospective study which included 20 volunteers (10 M, 10 F, mean age: 38.7+/-14.9) without any known clinical disease or radiological findings. All brain examinations were performed with 3T MR by using similar parameters of b1000 and b3000 DWI sequences. DWI and ADC maps were obtained. Signal intensity, noise, signal to noise ratio (SNR), contrast to noise (CNR), contrast ratio (CR), and ADC values of bilateral posterior limb of internal capsule, frontal white matter, parietal gray matter, pons, thalamus, splenium of corpus callosum were measured on b1000 and b3000 DW images.
In all anatomic locations, MR signal intensity, SNR and ADC values of b3000 images were significantly lower than MR signal intensity, SNR and ADC values of b1000 images (p<0.001). The CNR and CR values at the posterior limb of internal capsule and pons were significantly increased on b3000 images (p<0.001) and decreased in the other regions measured.
The ADC values calculated from standard b-value DWI were significantly higher than those calculated from high b-value DWI. These results agree with the previous studies. In the regions where CNR values increase with high b value, b3000 DWI images may provide additional clinical information.
Purpose
To develop a tissue field‐filtering algorithm, called maximum spherical mean value (mSMV), for reducing shadow artifacts in QSM of the brain without requiring brain‐tissue erosion.
Theory and ...Methods
Residual background field is a major source of shadow artifacts in QSM. The mSMV algorithm filters large field‐magnitude values near the border, where the maximum value of the harmonic background field is located. The effectiveness of mSMV for artifact removal was evaluated by comparing existing QSM algorithms in numerical brain simulation as well as using in vivo human data acquired from 11 healthy volunteers and 93 patients.
Results
Numerical simulation showed that mSMV reduces shadow artifacts and improves QSM accuracy. Better shadow reduction, as demonstrated by lower QSM variation in the gray matter and higher QSM image quality score, was also observed in healthy subjects and in patients with hemorrhages, stroke, and multiple sclerosis.
Conclusion
The mSMV algorithm allows QSM maps that are substantially equivalent to those obtained using SMV‐filtered dipole inversion without eroding the volume of interest.
The utility of DWI with high b-value in ischemic stroke is still unsettled. The purpose of this study is to compare high b-value (3000) and standard b-value (1000) diffusion-weighted images in ...patients with ischemic stroke at 3T.
27 patients with acute stroke who were admitted to the hospital during the first 24h after symptom onset were included in this study. All patients had a brain MRI study with stroke protocol including standard (b=1000) DWI and high b-value (b=3000) DWI sequences at 3T MR scanner. Number and localization of the lesions were assessed MR signal intensities (SI), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), contrast ratio (CR) and apparent diffusion coefficient (ADC) values of the lesions and normal parenchyma on DWI with b=1000 and b=3000 sequences were measured.
All patients with acute stroke revealed hyperintense lesions due to restricted diffusion on DWI with both b-values. However, lesions of restricted diffusion were more conspicuous in b=3000 value DWI than b=1000, and additional 4 ischemic lesions were detected on b=3000 DWI. SNR, CNR, SI and also ADC values in both stroke area and normal parenchyma were lower at b=3000 than the value at b=1000. At b=3000, CR was significantly greater than b=1000 images.
Although quantitative analysis shows higher SI, SNR and CNR values with standard b-value (b=1000) diffusion-weighted imaging, using higher b-value may still be beneficial in detecting additional subtle lesions in patients whose clinical findings are not correlated with standard b-value DWI in stroke.
We aimed to demonstrate the feasibility of whole brain oxygen extraction fraction (OEF) mapping for measuring lesion specific and regional OEF abnormalities in multiple sclerosis (MS) patients. In 22 ...MS patients and 11 healthy controls (HC), OEF and neural tissue susceptibility (
χ
n
) maps were computed from MRI multi-echo gradient echo data. In MS patients, 80 chronic active lesions with hyperintense rim on quantitative susceptibility mapping were identified, and the mean OEF and
χ
n
within the rim and core were compared using linear mixed-effect model analysis. The rim showed higher OEF and
χ
n
than the core: relative to their adjacent normal appearing white matter, OEF contrast = −6.6 ± 7.0% vs. −9.8 ± 7.8% (p < 0.001) and
χ
n
contrast = 33.9 ± 20.3 ppb vs. 25.7 ± 20.5 ppb (p = 0.017). Between MS and HC, OEF and
χ
n
were compared using a linear regression model in subject-based regions of interest. In the whole brain, compared to HC, MS had lower OEF, 30.4 ± 3.3% vs. 21.4 ± 4.4% (p < 0.001), and higher
χ
n
, −23.7 ± 7.0 ppb vs. −11.3 ± 7.7 ppb (p = 0.018). Our feasibility study suggests that OEF may serve as a useful quantitative marker of tissue oxygen utilization in MS.
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