Respiratory organ motion in interventional MRI : tracking, guiding and modeling

Respiratory organ motion is one of the major challenges in interventional MRI, particularly in interventions with therapeutic ultrasound in the abdominal region. High-intensity focused ultrasound found an application in interventional MRI for noninvasive treatments of different abnormalities. In order to guide surgical and treatment interventions, organ motion imaging and modeling is commonly required before a treatment start. Accurate tracking of organ motion during various interventional MRI procedures is prerequisite for a successful outcome and safe therapy. In this thesis, an attempt has been made to develop approaches using focused ultrasound which could be used in future clinically for the treatment of abdominal organs, such as the liver and the kidney. Two distinct methods have been presented with its ex vivo and in vivo treatment results. In the first method, an MR-based pencil-beam navigator has been used to track organ motion and provide the motion information for acoustic focal point steering, while in the second approach a hybrid imaging using both ultrasound and magnetic resonance imaging was combined for advanced guiding capabilities. Organ motion modeling and four-dimensional imaging of organ motion is increasingly required before the surgical interventions. However, due to the current safety limitations and hardware restrictions, the MR acquisition of a time-resolved sequence of volumetric images is not possible with high temporal and spatial resolution. A novel multislice acquisition scheme that is based on a two-dimensional navigator, instead of a commonly used pencil-beam navigator, was devised to acquire the data slices and the corresponding navigator simultaneously using a CAIPIRINHA parallel imaging method. The acquisition duration for four-dimensional dataset sampling is reduced compared to the existing approaches, while the image contrast and quality are improved as well. Tracking respiratory organ motion is required in interventional procedures and during MR imaging of moving organs. An MR-based navigator is commonly used, however, it is usually associated with image artifacts, such as signal voids. Spectrally selective navigators can come in handy in cases where the imaging organ is surrounding with an adipose tissue, because it can provide an indirect measure of organ motion. A novel spectrally selective navigator based on a crossed-pair navigator has been developed. Experiments show the advantages of the application of this novel navigator for the volumetric imaging of the liver in vivo, where this navigator was used to gate the gradient-recalled echo sequence

How to Acquire Cardiac Volumes for Sonographic Examination of the Fetal Heart

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135409/1/jum20163551043.pd

Fetal whole-heart 4D imaging using motion-corrected multi-planar real-time MRI

Purpose: To develop a MRI acquisition and reconstruction framework for volumetric cine visualisation of the fetal heart and great vessels in the presence of maternal and fetal motion. Methods: Four-dimensional depiction was achieved using a highly-accelerated multi-planar real-time balanced steady state free precession acquisition combined with retrospective image-domain techniques for motion correction, cardiac synchronisation and outlier rejection. The framework was evaluated and optimised using a numerical phantom, and evaluated in a study of 20 mid- to late-gestational age human fetal subjects. Reconstructed cine volumes were evaluated by experienced cardiologists and compared with matched ultrasound. A preliminary assessment of flow-sensitive reconstruction using the velocity information encoded in the phase of dynamic images is included. Results: Reconstructed cine volumes could be visualised in any 2D plane without the need for highly-specific scan plane prescription prior to acquisition or for maternal breath hold to minimise motion. Reconstruction was fully automated aside from user-specified masks of the fetal heart and chest. The framework proved robust when applied to fetal data and simulations confirmed that spatial and temporal features could be reliably recovered. Expert evaluation suggested the reconstructed volumes can be used for comprehensive assessment of the fetal heart, either as an adjunct to ultrasound or in combination with other MRI techniques. Conclusion: The proposed methods show promise as a framework for motion-compensated 4D assessment of the fetal heart and great vessels

Quantitative validation of optical flow based myocardial strain measures using sonomicrometry

Dynamic cardiac metrics, including myocardial strains and displacements, provide a quantitative approach to evaluate cardiac function. However, in current clinical diagnosis, largely 2D strain measures are used despite that cardiac motions are complex 3D volumes over time. Recent advances in 4D ultrasound enable the capability to capture such complex motion in a single image data set. In our previous work, a 4D optical flow based motion tracking algorithm was developed to extract full 4D dynamic cardiac metrics from such 4D ultrasound data. In order to quantitatively evaluate this tracking method, in-vivo coronary artery occlusion experiments at various locations were performed on three canine hearts. Each dog was screened with 4D ultrasound and sonomicrometry data was acquired during each occlusion study. The 4D ultrasound data from these experiments was then analyzed with the tracking method and estimated principal strain measures were directly compared to those recorded by sonomicrometry. Strong agreement was observed independently for the three canine hearts. This is the first validation study of optical flow based strain estimation for 4D ultrasound with a direct comparison with sonomicrometry using in-vivo data

4D reduced TE (RTE) spiral phase contrast NRI for rapid quantification and visualization of blood flow and hemodynamics.

4D flow Phase Contrast MRI is a relatively new technique in MRI which is capable of deriving time-resolved three-dimensional velocity fields in a 3D volume noninvasively. 4D flow imaging is a 3D k-space acquisition where for the third dimension, an additional phase-encoding step is required. The velocity field can then be used to obtain flow waveform, wall shear stress, vascular compliance, blood pressure, and other hemodynamic information. A significant limitation of 4D flow methods has been the requisite long scan times, requiring the patient to remain motionless at times on the order of 10-20 minutes, depending on scan parameters. The scan times may become more prohibitive in case of 4D cardiovascular studies where respiratory gating with navigator echoes is required. In this thesis the feasibility of using a reduced TE stack of spirals k-space acquisition for 4D flow imaging are investigated. Starting with fundamentals of MRI, the basics of Phase contrast and 4D flow MRI are thoroughly discussed in Chapter 1-3 and subsequently experimental phantom results are reported in Chapter 4, pointing to the feasibility of performing highly accurate 4D velocity and flow measurement with the proposed pulse sequence under a variety of flow conditions and with substantial reductions in scan time when compared to conventional 4D flow. In phantom studies, results based on the root mean square error criterion indicate that 4D Reduced TE (RTE) Spiral PC MRI is capable of providing the same level of accuracy as conventional 4D conventional PC MRI but in a much shorter scan time (30% reduction in scan time when imaging an FOV of 100*100*60 mm3 and spatial resolution of 1.5*1.5*3 mm3). Moreover, the proposed method has the added advantage of achieving the shorter echo time of 2 ms versus 3.6 ms for conventional 4D flow at Q=50ml/s and 1.57 ms versus 3.2 ms at the higher flow rate of Q=150 ml/s leading to more accurate assessment of flow distal to narrowings. Statistical results indicate that at low flow rates performance of both methods are similar. At higher flow rates, however, 4D RTE spiral flow achieves better accuracy. Qualitative results in phantom studies also revealed that at higher flow rates, better flow visualization was achieved with4D RTE spiral flow compared with conventional 4D flow. In the second part of Chapter 4, we also report on application of the proposed sequence, in-vivo, to 5 healthy volunteers and 5 subjects with mild to moderate Aortic Stenosis (AS) disease. Results from the proposed method were statistically correlated with velocity profiles derived from conventional 4D flow and Doppler Ultrasound. Results indicate that 4D RTE Spiral is capable of providing the same level of accuracy in flow measurement as Conventional 4D flow MRI for imaging of the aortic valve, but on average resulted in a 30% reduction in scan time and 45% reduction in echo time. 4D RTE Spiral was also able to achieve an echo time of 1.68 ms versus 2.9 ms for that of conventional 4D flow MRI, permitting less signal dephasing in the presence of jet flows distal to occlusions. With Doppler Ultrasound adopted as the reference method, 4D RTE Spiral flow measured peak velocity and maximum pressure gradient with a higher level of accuracy when compared to Conventional 4D flow MRI. Both methods measured left-ventricular out flow tract (LVOT) diameter, Aortic Valve (AV) eject time and time to AV peak with same accuracy. It is concluded that 4D RTE Spiral flow MRI is an excellent technique for flow measurement in cardiac patients who are unable to tolerate longer scan times, currently required by conventional 4D flow methods

REAL-TIME 4D ULTRASOUND RECONSTRUCTION FOR IMAGE-GUIDED INTRACARDIAC INTERVENTIONS

Image-guided therapy addresses the lack of direct vision associated with minimally- invasive interventions performed on the beating heart, but requires effective intraoperative imaging. Gated 4D ultrasound reconstruction using a tracked 2D probe generates a time-series of 3D images representing the beating heart over the cardiac cycle. These images have a relatively high spatial resolution and wide field of view, and ultrasound is easily integrated into the intraoperative environment. This thesis presents a real-time 4D ultrasound reconstruction system incorporated within an augmented reality environment for surgical guidance, whose incremental visualization reduces common acquisition errors. The resulting 4D ultrasound datasets are intended for visualization or registration to preoperative images. A human factors experiment demonstrates the advantages of real-time ultrasound reconstruction, and accuracy assessments performed both with a dynamic phantom and intraoperatively reveal RMS localization errors of 2.5-2.7 mm, and 0.8 mm, respectively. Finally, clinical applicability is demonstrated by both porcine and patient imaging

Improving patient-specific assessments of regional aortic mechanics via quantitative magnetic resonance imaging with early applications in patients at elevated risk for thoracic aortopathy

Unstable aortic aneurysms and dissections are serious cardiovascular conditions associated with high mortality. The current gold standards for assessment of stability, however, rely on simple geometric measurements, like cross-sectional area or increased diameter between follow-up scans, and fail to incorporate information about underlying aortic mechanics. Displacement encoding with stimulated echoes (DENSE) magnetic resonance imaging (MRI) has been used previously to determine heterogeneous circumferential strain patterns in the aortas of healthy volunteers. Here, I introduce technical improvements to DENSE aortic analysis and early pilot application in patients at higher risk for the development of aortopathies. Modifications to the DENSE aortic postprocessing method involving the separate spatial smoothing of the inner and outer layers of the aortic wall allowed for the preservation of radial and shear strains without impacting circumferential strain calculations. The implementation of a semiautomatic segmentation approach utilizing the intrinsic kinematic information provided by DENSE MRI reduced lengthy post-processing times while generating circumferential strain distributions with good agreement to a manually generated benchmark. Finally, a new analysis pipeline for the combined use and spatial correlation of 4D phase-contrast MRI alongside DENSE MRI to quantify both regional fluid and solid mechanics in the descending aorta is explored in a limited pilot study

Temporal Interpolation via Motion Field Prediction

Navigated 2D multi-slice dynamic Magnetic Resonance (MR) imaging enables high contrast 4D MR imaging during free breathing and provides in-vivo observations for treatment planning and guidance. Navigator slices are vital for retrospective stacking of 2D data slices in this method. However, they also prolong the acquisition sessions. Temporal interpolation of navigator slices an be used to reduce the number of navigator acquisitions without degrading specificity in stacking. In this work, we propose a convolutional neural network (CNN) based method for temporal interpolation via motion field prediction. The proposed formulation incorporates the prior knowledge that a motion field underlies changes in the image intensities over time. Previous approaches that interpolate directly in the intensity space are prone to produce blurry images or even remove structures in the images. Our method avoids such problems and faithfully preserves the information in the image. Further, an important advantage of our formulation is that it provides an unsupervised estimation of bi-directional motion fields. We show that these motion fields can be used to halve the number of registrations required during 4D reconstruction, thus substantially reducing the reconstruction time.Comment: Submitted to 1st Conference on Medical Imaging with Deep Learning (MIDL 2018), Amsterdam, The Netherland