Interventional MR Elastography for MRI-Guided Percutaneous Procedures

International audiencePURPOSE : MRI-guided thermal ablations require reliable monitoring methods to ensure complete destruction of the diseased tissue while avoiding damage to the surrounding healthy tissue. Based on the fact that thermal ablations result in substantial changes in biomechanical properties, interventional MR elastography (MRE) dedicated to the monitoring of MR-guided thermal therapies is proposed here. METHODS : Interventional MRE consists of a needle MRE driver, a fast and interactive gradient echo pulse sequence with motion encoding, and an inverse problem solver in real-time. This complete protocol was tested in vivo on swine and the ability to monitor elasticity changes in real-time was assessed in phantom. RESULTS : Thanks to a short repetition time, a reduction of the number of phase-offsets and the use of a sliding window, one refreshed elastogram was provided every 2.56 s for an excitation frequency of 100 Hz. In vivo elastograms of swine liver were successfully provided in real-time during one breath-hold. Changes of elasticity were successfully monitored in a phantom during its gelation with the same elastogram frame rate. CONCLUSION : This study demonstrates the ability of detecting elasticity changes in real-time and providing elastograms in vivo with interventional MRE that could be used for the monitoring of thermal ablations

K-space data processing for Magnetic Resonance Elastography (MRE)

International audienceObject: Magnetic Resonance Elastography (MRE) requires substantial data processing based on phase image reconstruction, wave enhancement and inverse problem solving. The objective of this study is to propose a new, fast MRE method based on MR raw data processing, particularly adapted to applications requiring fast MRE measurement or high elastogram update rate.Material and Methods: The proposed method allows measuring tissue elasticity directly from raw data without prior phase image reconstruction and without phase unwrapping. Experimental feasibility is assessed both in a gelatin phantom and in the liver of a porcine model in vivo. Elastograms are reconstructed with the raw MRE method and compared to those obtained using conventional MRE. In a third experiment, changes in elasticity are monitored in real-time in a gelatin phantom during its solidification by using both conventional MRE and raw MRE.Results: The raw MRE method shows promising results by providing similar elasticity values to the ones obtained with conventional MRE methods while decreasing the number of processing steps and circumventing the delicate step of phase unwrapping. Limitations of the proposed method are the influence of the magnitude on the elastogram and the requirement for a minimum number of phase offsets.Conclusion: This study demonstrates the feasibility of directly reconstructing elastograms from raw data

K-space data processing for magnetic resonance elastography (MRE)

OBJECTIVE: Magnetic resonance elastography (MRE) requires substantial data processing based on phase image reconstruction, wave enhancement, and inverse problem solving. The objective of this study is to propose a new, fast MRE method based on MR raw data processing, particularly adapted to applications requiring fast MRE measurement or high elastogram update rate. MATERIALS AND METHODS: The proposed method allows measuring tissue elasticity directly from raw data without prior phase image reconstruction and without phase unwrapping. Experimental feasibility is assessed both in a gelatin phantom and in the liver of a porcine model in vivo. Elastograms are reconstructed with the raw MRE method and compared to those obtained using conventional MRE. In a third experiment, changes in elasticity are monitored in real-time in a gelatin phantom during its solidification by using both conventional MRE and raw MRE. RESULTS: The raw MRE method shows promising results by providing similar elasticity values to the ones obtained with conventional MRE methods while decreasing the number of processing steps and circumventing the delicate step of phase unwrapping. Limitations of the proposed method are the influence of the magnitude on the elastogram and the requirement for a minimum number of phase offsets. CONCLUSION: This study demonstrates the feasibility of directly reconstructing elastograms from raw data

Magnetic resonance elastography (MRE) of the human brain: technique, findings and clinical applications

Neurological disorders are one of the most important public health concerns in developed countries. Established brain imaging techniques such as magnetic resonance imaging (MRI) and x-ray computerised tomography (CT) have been essential in the identification and diagnosis of a wide range of disorders, although usually are insufficient in sensitivity for detecting subtle pathological alterations to the brain prior to the onset of clinical symptoms—at a time when prognosis for treatment is more favourable. The mechanical properties of biological tissue provide information related to the strength and integrity of the cellular microstructure. In recent years, mechanical properties of the brain have been visualised and measured non-invasively with magnetic resonance elastography (MRE), a particularly sensitive medical imaging technique that may increase the potential for early diagnosis. This review begins with an introduction to the various methods used for the acquisition and analysis of MRE data. A systematic literature search is then conducted to identify studies that have specifically utilised MRE to investigate the human brain. Through the conversion of MRE-derived measurements to shear stiffness (kPa) and, where possible, the loss tangent (rad), a summary of results for global brain tissue and grey and white matter across studies is provided for healthy participants, as potential baseline values to be used in future clinical investigations. In addition, the extent to which MRE has revealed significant alterations to the brain in patients with neurological disorders is assessed and discussed in terms of known pathophysiology. The review concludes by predicting the trends for future MRE research and applications in neuroscience

Characterizing anisotropy in fibrous soft materials by MR elastography of slow and fast shear waves

The general objective of this work was to develop experimental methods based on magnetic resonance elastography (MRE) to characterize fibrous soft materials. Mathematical models of tissue biomechanics capable of predicting injury, such as traumatic brain injury (TBI), are of great interest and potential. However, the accuracy of predictions from such models depends on accuracy of the underlying material parameters. This dissertation describes work toward three aims. First, experimental methods were designed to characterize fibrous materials based on a transversely isotropic material model. Second, these methods are applied to characterize the anisotropic properties of white matter brain tissue ex vivo. Third, a theoretical investigation of the potential application of MRE to probe nonlinear mechanical behavior of soft tissue was performed. These studies provide new methods to characterize anisotropic and nonlinear soft materials as well as contributing significantly to our understanding of the behavior of specific biological soft tissues

AM-FM methods for image and video processing

This dissertation is focused on the development of robust and efficient Amplitude-Modulation Frequency-Modulation (AM-FM) demodulation methods for image and video processing (there is currently a patent pending that covers the AM-FM methods and applications described in this dissertation). The motivation for this research lies in the wide number of image and video processing applications that can significantly benefit from this research. A number of potential applications are developed in the dissertation. First, a new, robust and efficient formulation for the instantaneous frequency (IF) estimation: a variable spacing, local quadratic phase method (VS-LQP) is presented. VS-LQP produces much more accurate results than current AM-FM methods. At significant noise levels (SNR \u3c 30dB), for single component images, the VS-LQP method produces better IF estimation results than methods using a multi-scale filterbank. At low noise levels (SNR \u3e 50dB), VS-LQP performs better when used in combination with a multi-scale filterbank. In all cases, VS-LQP outperforms the Quasi-Eigen Approximation algorithm by significant amounts (up to 20dB). New least squares reconstructions using AM-FM components from the input signal (image or video) are also presented. Three different reconstruction approaches are developed: (i) using AM-FM harmonics, (ii) using AM-FM components extracted from different scales and (iii) using AM-FM harmonics with the output of a low-pass filter. The image reconstruction methods provide perceptually lossless results with image quality index values bigger than 0.7 on average. The video reconstructions produced image quality index values, frame by frame, up to more than 0.7 using AM-FM components extracted from different scales. An application of the AM-FM method to retinal image analysis is also shown. This approach uses the instantaneous frequency magnitude and the instantaneous amplitude (IA) information to provide image features. The new AM-FM approach produced ROC area of 0.984 in classifying Risk 0 versus Risk 1, 0.95 in classifying Risk 0 versus Risk 2, 0.973 in classifying Risk 0 versus Risk 3 and 0.95 in classifying Risk 0 versus all images with any sign of Diabetic Retinopathy. An extension of the 2D AM-FM demodulation methods to three dimensions is also presented. New AM-FM methods for motion estimation are developed. The new motion estimation method provides three motion estimation equations per channel filter (AM, IF motion equations and a continuity equation). Applications of the method in motion tracking, trajectory estimation and for continuous-scale video searching are demonstrated. For each application, we discuss the advantages of the AM-FM methods over current approaches

Novel approaches for quantitative electrogram analysis for rotor identification: Implications for ablation in patients with atrial fibrillation

University of Minnesota Ph.D. dissertation. May 2017. Major: Biomedical Engineering. Advisor: Elena Tolkacheva. 1 computer file (PDF); xxviii, 349 pages + 4 audio/video filesAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia that causes stroke affecting more than 2.3 million people in the US. Catheter ablation with pulmonary vein isolation (PVI) to terminate AF is successful for paroxysmal AF but suffers limitations with persistent AF patients as current mapping methods cannot identify AF active substrates outside of PVI region. Recent evidences in the mechanistic understating of AF pathophysiology suggest that ectopic activity, localized re-entrant circuit with fibrillatory propagation and multiple circuit re-entries may all be involved in human AF. Accordingly, the hypothesis that rotor is an underlying AF mechanism is compatible with both the presence of focal discharges and multiple wavelets. Rotors are stable electrical sources which have characteristic spiral waves like appearance with a pivot point surrounded by peripheral region. Targeted ablation at the rotor pivot points in several animal studies have demonstrated efficacy in terminating AF. The objective of this dissertation was to develop robust spatiotemporal mapping techniques that can fully capture the intrinsic dynamics of the non-stationary time series intracardiac electrogram signal to accurately identify the rotor pivot zones that may cause and maintain AF. In this thesis, four time domain approaches namely multiscale entropy (MSE) recurrence period density entropy (RPDE), kurtosis and intrinsic mode function (IMF) complexity index and one frequency domain approach namely multiscale frequency (MSF) was proposed and developed for accurate identification of rotor pivot points. The novel approaches were validated using optical mapping data with induced ventricular arrhythmia in ex-vivo isolated rabbit heart with single, double and meandering rotors (including numerically simulated data). The results demonstrated the efficacy of the novel approaches in accurate identification of rotor pivot point. The chaotic nature of rotor pivot point resulted in higher complexity measured by MSE, RPDE, kurtosis, IMF and MSF compared to the stable rotor periphery that enabled its accurate identification. Additionally, the feasibility of using conventional catheter mapping system to generate patient specific 3D maps for intraprocedural guidance for catheter ablation using these novel approaches was demonstrated with 1055 intracardiac electrograms obtained from both atria’s in a persistent AF patient. Notably, the 3D maps did not provide any clinically significant information on rotor pivot point identification or the presence of rotors themselves. Validation of these novel approaches is required in large datasets with paroxysmal and persistent AF patients to evaluate their clinical utility in rotor identification as potential targets for AF ablation

MAGNETIC RESONANCE ELASTOGRAPHY FOR APPLICATIONS IN RADIATION THERAPY

Magnetic resonance elastography (MRE) is an imaging technique that combines mechanical waves and magnetic resonance imaging (MRI) to determine the elastic properties of tissue. Because MRE is non-invasive, there is great potential and interest for its use in the detection of cancer. The first part of this thesis concentrates on parameter optimization and imaging quality of an MRE system. To do this, we developed a customized quality assurance phantom, and a series of quality control tests to characterize the MRE system. Our results demonstrated that through optimizing scan parameters, such as frequency and amplitude, MRE could provide a good qualitative elastogram for targets with different elasticity values and dimensions. The second part investigated the feasibility of integrating MRE into radiation therapy (RT) workflow. With the aid of a tissue-equivalent prostate phantom (embedded with three dominant intraprostatic lesions (DILs)), an MRE-integrated RT framework was developed. This framework contains a comprehensive scan protocol including Computed Tomography (CT) scan, combined MRI/MRE scans and a Volumetric Modulated Arc Therapy (VMAT) technique for treatment delivery. The results showed that using the comprehensive information could boost the MRE defined DILs to 84 Gy while keeping the remainder of the prostate to 78 Gy. Using a VMAT based technique allowed us to achieve a highly conformal plan (conformity index for the prostate and combined DILs was 0.98 and 0.91). Based on our feasibility study, we concluded that MRE data can be used for targeted radiation dose escalation. In summary, this thesis demonstrates that MRE is feasible for applications in radiation oncology

Magnetic Resonance Elastography of the Brain: from Phantom to Mouse to Man

The overall objective of this study is to develop magnetic resonance elastography: MRE) imaging to better understand brain deformation, brain tissue mechanical properties, and brain-skull interaction in vivo. The findings of this study provide parameters for numerical models of human head biomechanics, as well as data for validation of these models. Numerical simulations offer enormous potential to the study of traumatic brain injury: TBI) and may also contribute to the development of prophylactic devices for high-risk subjects: e.g., military personnel, first-responders, and athletes). Current numerical models have not been adequately parameterized or validated and their predictions remain controversial. This dissertation describes three kinds of MRE experiments, conducted in phantom: physical model), mouse, and man. Phantom studies provide a means to experimentally confirm the accuracy of MRE estimates of viscoelastic parameters in relatively simple materials and geometries. Studies in the mouse provide insight into the dispersive nature of brain tissue mechanical properties at frequencies beyond those that can be measured in humans. Studies in human subjects provide direct measurements of the human brain\u27s response to dynamic extracranial loads, including skull-brain energy transmission and viscoelastic properties