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

Prediction of motion induced magnetic fields for human brain MRI at 3T

Objective Maps of B0 field inhomogeneities are often used to improve MRI image quality, even in a retrospective fashion. These field inhomogeneities depend on the exact head position within the static field but acquiring field maps (FM) at every position is time consuming. Here we explore different ways to obtain B0 predictions at different head positions. Methods FM were predicted from iterative simulations with four field factors: 1) sample induced B0 field, 2) system's spherical harmonic shim field, 3) perturbing field originating outside the field of view, 4) sequence phase errors. The simulation was improved by including local susceptibility sources estimated from UTE scans and position-specific masks. The estimation performance of the simulated FMs and a transformed FM, obtained from the measured reference FM, were compared with the actual FM at different head positions. Results The transformed FM provided inconsistent results for large head movements (>5 degree rotation), while the simulation strategy had a superior prediction accuracy for all positions. The simulated FM was used to optimize B0 shims with up to 22.2% improvement with respect to the transformed FM approach. Conclusion The proposed simulation strategy is able to predict movement induced B0 field inhomogeneities yielding more precise estimates of the ground truth field homogeneity than the transformed FM

Analysis of myocardial contractility with magnetic resonance

Heart failure has considerable morbidity and poor prognosis. An understanding of the underlying mechanics governing myocardial contraction is a prerequisite for interpreting and predicting changes induced by heart disease. Gross changes in contractile behaviour of the myocardium are readily detected with existing techniques. For more subtle changes during early stages of cardiac dysfunction, however, it requires a sensitive method for measuring, as well as a precise criterion for quantifying, normal and impaired myocardial function. Cardiovascular Magnetic Resonance (CMR) imaging is emerging as an important clinical tool because of its safety, versatility, and the high quality images it produces that allow accurate and reproducible quantification of cardiac structure and function. Traditional CMR approaches for measuring contractility rely on tagging of the myocardium with fiducial markers and require a lengthy and often subjective dependant post-processing procedure. The aim of this research is to develop a new technique, which uses velocity as a marker for the visualisation and assessment of myocardial contractility. Two parallel approaches have been investigated for the assessment of myocardial velocity. The first of these is haimonic phase (HARP) imaging. HARP imaging allows direct derivation of myocardial velocity and strain without the need of further user interaction. We investigated the effect of respiration on the accuracy of the derived contractility, and assessed the clinical applicability and potential pitfalls of the technique by analysing results from a group of patients with hypertrophic cardiomyopathy. The second technique we have investigated is the direct measurement of myocardial velocity with phase contrast myocardial velocity mapping. The imaging sequence used employs effective blood saturation for reducing flow induced phase errors within the myocardium. View sharing was used to improve the temporal resolution, which permitted acquisition of 3D velocity information throughout the cardiac cycle in a single breath-hold, enabling a comprehensive assessment of strain rate of the left ventricle. One key factor that affects the derivation of myocardial contractility based on myocardial velocity is the practical inconsistency of the velocity data. A novel iterative optimisation scheme by incorporating the incompressibility constraint was developed for the restoration of myocardial velocity data. The method allowed accurate assessment of both in-plane and through-plan strain rates, as demonstrated with both synthetic and in vivo data acquired from normal subjects and ischaemic patients. To further enhance the clinical potential of the technique and facilitate the visual assessment of contractile abnormality with myocardial velocity mapping, a complementary analysis framework, named Virtual Tagging, has been developed. The method used velocity data in all directions combined with a finite element mesh incorporating geometrical and physical constraints. The Virtual Tagging framewoik allowed velocity measurements to be used for calculating strain distribution within the 3D volume. It also permitted easy visualisation of the displacement of the tissue, akin to traditional CMR tagging. Detailed validation of the technique is provided, which involves both numerical simulation and in vitro phantom experiments. The main contribution of this thesis is in the improvement of the effectiveness and quality of quantitative myocardial contractility analysis from both sequence design and medical image computing perspectives. It is aimed at providing a sensitive means of detecting subtle as well as gross changes in contractile behaviour of the myocardium. The study is expected to provide a clinically viable platform for functional correlation with other functional measures such as myocardial perfusion and diffusion, and to serve as an aid for further understanding of the links between intrinsicOpen acces

Characterization and correction of eddy-current artifacts in unipolar and bipolar diffusion sequences using magnetic field monitoring

Diffusion tensor imaging (DTI) of moving organs is gaining increasing attention but robust performance requires sequence modifications and dedicated correction methods to account for system imperfections. In this study, eddy currents in the “unipolar” Stejskal-Tanner and the velocity-compensated “bipolar” spin-echo diffusion sequences were investigated and corrected for using a magnetic field monitoring approach in combination with higher-order image reconstruction. From the field-camera measurements, increased levels of second-order eddy currents were quantified in the unipolar sequence relative to the bipolar diffusion sequence while zeroth and linear orders were found to be similar between both sequences. Second-order image reconstruction based on field-monitoring data resulted in reduced spatial misalignment artifacts and residual displacements of less than 0.43 mm and 0.29 mm (in the unipolar and bipolar sequences, respectively) after second-order eddy-current correction. Results demonstrate the need for second-order correction in unipolar encoding schemes but also show that bipolar sequences benefit from second-order reconstruction to correct for incomplete intrinsic cancellation of eddy-currents

T2-Weighted 4D Magnetic Resonance Imaging for Application in Magnetic Resonance-Guided Radiotherapy Treatment Planning.

Objectives The aim of this study was to develop and verify a method to obtain good temporal resolution T2-weighted 4-dimensional (4D-T2w) magnetic resonance imaging (MRI) by using motion information from T1-weighted 4D (4D-T1w) MRI, to support treatment planning in MR-guided radiotherapy.Materials and methods Ten patients with primary non-small cell lung cancer were scanned at 1.5 T axially with a volumetric T2-weighted turbo spin echo sequence gated to exhalation and a volumetric T1-weighted stack-of-stars spoiled gradient echo sequence with golden angle spacing acquired in free breathing. From the latter, 20 respiratory phases were reconstructed using the recently developed 4D joint MoCo-HDTV algorithm based on the self-gating signal obtained from the k-space center. Motion vector fields describing the respiratory cycle were obtained by deformable image registration between the respiratory phases and projected onto the T2-weighted image volume. The resulting 4D-T2w volumes were verified against the 4D-T1w volumes: an edge-detection method was used to measure the diaphragm positions; the locations of anatomical landmarks delineated by a radiation oncologist were compared and normalized mutual information was calculated to evaluate volumetric image similarity.Results High-resolution 4D-T2w MRI was obtained. Respiratory motion was preserved on calculated 4D-T2w MRI, with median diaphragm positions being consistent with less than 6.6 mm (2 voxels) for all patients and less than 3.3 mm (1 voxel) for 9 of 10 patients. Geometrical positions were coherent between 4D-T1w and 4D-T2w MRI as Euclidean distances between all corresponding anatomical landmarks agreed to within 7.6 mm (Euclidean distance of 2 voxels) and were below 3.8 mm (Euclidean distance of 1 voxel) for 355 of 470 pairs of anatomical landmarks. Volumetric image similarity was commensurate between 4D-T1w and 4D-T2w MRI, as mean percentage differences in normalized mutual information (calculated over all respiratory phases and patients), between corresponding respiratory phases of 4D-T1w and 4D-T2w MRI and the tie-phase of 4D-T1w and 3-dimensional T2w MRI, were consistent to 0.41% ± 0.37%. Four-dimensional T2w MRI displayed tumor extent, structure, and position more clearly than corresponding 4D-T1w MRI, especially when mobile tumor sites were adjacent to organs at risk.Conclusions A methodology to obtain 4D-T2w MRI that retrospectively applies the motion information from 4D-T1w MRI to 3-dimensional T2w MRI was developed and verified. Four-dimensional T2w MRI can assist clinicians in delineating mobile lesions that are difficult to define on 4D-T1w MRI, because of poor tumor-tissue contrast

Processing of structural neuroimaging data in young children:bridging the gap between current practice and state-of-the-art methods

The structure of the brain is subject to very rapid developmental changes during early childhood. Pediatric studies based on Magnetic Resonance Imaging (MRI) over this age range have recently become more frequent, with the advantage of providing in vivo and non-invasive high-resolution images of the developing brain, toward understanding typical and atypical trajectories. However, it has also been demonstrated that application of currently standard MRI processing methods that have been developed with datasets from adults may not be appropriate for use with pediatric datasets. In this review, we examine the approaches currently used in MRI studies involving young children, including an overview of the rationale for new MRI processing methods that have been designed specifically for pediatric investigations. These methods are mainly related to the use of age-specific or 4D brain atlases, improved methods for quantifying and optimizing image quality, and provision for registration of developmental data obtained with longitudinal designs. The overall goal is to raise awareness of the existence of these methods and the possibilities for implementing them in developmental neuroimaging studies

PROSPECTIVE HEAD MOVEMENT CORRECTION FOR HIGH-RESOLUTION MRI USING AN IN-BORE OPTICAL TRACKING SYSTEM

In MRI of the human brain, subject motion is a major cause of magnetic resonance image quality degradation. To compensate the effects of head motion during data acquisition, an in-bore optical motion tracking system is proposed. The system comprises one or two MR compatible infrared cameras that are fixed on a holder right above and in front of the head coil. The resulting close proximity of the cameras to the object allows precise tracking of its movement. During image acquisition, the MRI scanner uses this tracking information to prospectively compensate for head motion by adjusting gradient field direction and RF phase and frequency. Experiments performed on subjects demonstrate the system's robustness, exhibiting an accuracy of better than 0.1mm and 0.15˚

Analysis of first pass myocardial perfusion imaging with magnetic resonance

Early diagnosis and localisation of myocardial perfusion defects is an important step in the treatment of coronary artery disease. Thus far, coronary angiography is the conventional standard investigation for patients with known or suspected coronary artery disease and it provides information about the presence and location of coronary stenoses. In recent years, the development of myocardial perfusion CMR has extended the role of MR in the evaluation of ischaemic heart disease beyond the situations where there have already been gross myocardial changes such as acute infarction or scarring. The ability to non-invasively evaluate cardiac perfusion abnormalities before pathologic effects occur, or as follow-up to therapy, is important to the management of patients with coronary artery disease. Whilst limited multi-slice 2D CMR perfusion studies are gaining increased clinical usage for quantifying gross ischaemic burden, research is now directed towards complete 3D coverage of the myocardium for accurate localisation of the extent of possible defects. In 3D myocardial perfusion imaging, a complete volumetric data set has to be acquired for each cardiac cycle in order to study the first pass of the contrast bolus. This normally requires a relatively large acquisition window within each cardiac cycle to ensure a comprehensive coverage of the myocardium and reasonably high resolution of the images. With multi-slice imaging, long axis cardiac motion during this large acquisition window can cause the myocardium imaged in different cross- sections to be mis-registered, i.e., some part of the myocardium may be imaged more than twice whereas other parts may be missed out completely. This type of mis-registration is difficult to correct for by using post-processing techniques. The purpose of this thesis is to investigate techniques for tracking through plane motion during 3D myocardial perfusion imaging, and a novel technique for extracting intrinsic relationships between 3D cardiac deformation due to respiration and multiple ID real-time measurable surface intensity traces is developed. Despite the fact that these surface intensity traces can be strongly coupled with each other but poorly correlated with respiratory induced cardiac deformation, we demonstrate how they can be used to accurately predict cardiac motion through the extraction of latent variables of both the input and output of the model. The proposed method allows cross-modality reconstruction of patient specific models for dense motion field prediction, which after initial modelling can be use in real-time prospective motion tracking or correction. In CMR, new imaging sequences have significantly reduced the acquisition window whilst maintaining the desired spatial resolution. Further improvements in perfusion imaging will require the application of parallel imaging techniques or making full use of the information content of the ¿-space data. With this thesis, we have proposed RR-UNFOLD and RR-RIGR for significantly reducing the amount of data that is required to reconstruct the perfusion image series. The methods use prospective diaphragmatic navigator echoes to ensure UNFOLD and RIGR are carried out on a series of images that are spatially registered. An adaptive real-time re-binning algorithm is developed for the creation of static image sub-series related to different levels of respiratory motion. Issues concerning temporal smoothing of tracer kinetic signals and residual motion artefact are discussed, and we have provided a critical comparison of the relative merit and potential pitfalls of the two techniques. In addition to the technical and theoretical descriptions of the new methods developed, we have also provided in this thesis a detailed literature review of the current state-of-the-art in myocardial perfusion imaging and some of the key technical challenges involved. Issues concerning the basic background of myocardial ischaemia and its functional significance are discussed. Practical solutions to motion tracking during imaging, predictive motion modelling, tracer kinetic modelling, RR-UNFOLD and RR-RIGR are discussed, all with validation using patient and normal subject data to demonstrate both the strength and potential clinical value of the proposed techniques.Open acces

Head Motion Correction in Magnetic Resonance Imaging Using NMR Field Probes

Magnetic Resonance Imaging (MRI) is a widely used imaging technology in medicine. Its advantages include good soft tissue contrast and the use of non-ionizing radiation in contrast to for example computed tomography (CT). One drawback are the long acquisition times that are needed. They depend on the diagnostic use case but are usually within the range of minutes. These long scan times make the images prone to patient motion during image acquisition which can lead to blurring or ghosting artifacts. Those artifacts might render the diagnostic value of the images useless which requires the image to be reacquired or the patient to be sedated before the scan to prevent motion artifacts. This is where motion correction comes into play. One can distinguish between retrospective and prospective motion correction (PMC) methods. Retrospective motion correction tries to improve image quality after the image acquisition by post-processing and possibly using additional motion tracking information, if available. Prospective motion correction relies on a motion tracking modality that is used to provide motion information to update imaging parameters during image acquisition. Both motion correction methods can also be used in combination with each other. This thesis, however, will focus on the implementation and validation of a system for prospective head motion correction. The system consisted of four nuclear magnetic resonance (NMR) field probes using. Those feld probes were attached to the head and used to measure the spatiotemporal evolution of magnetic felds. By switching spatially varying magnetic fields, this information can be used to track the field probes' positions and calculate the corresponding head motion in order to perform prospective motion correction.Die Magnetresonanztomographie (MRT) ist ein in der Medizin weitverbreitetes bildgebendes Verfahren. Ihre Vorteile sind unter anderem der gute Gewebekontrast und die Verwendung von nichtionisierender Strahlung im Gegensatz zur Computertomographie (CT). Ein Nachteil ist die Länge der Zeit, die notwendig ist um ein Bild aufzunehmen. Sie hängt natürlich vom jeweiligen diagnostischen Anwendungsfall ab, bewegt sich aber normalerweise im Bereich von Minuten. Diese langen Aufnahmezeiten machen die Bilder anfällig für Patientenbewegungen, welche zu unscharfen Bildern oder sogenannten Ghostingartefakten, bei denen sich Bildteile wiederholen, führen. Diese Artefakte können dazu führen, dass eine Diagnose nicht mehr möglich ist, was entweder eine erneute Aufnahme des Bildes notwendig macht oder eine Sedierung des Patienten, um Bewegung zu vermeiden. Hier kommen Bewegungskorrekturverfahren ins Spiel. Die sogenannte prospektive Bewegungskorrektur benötigt zusätzliche Bewegungsinformationen, die noch während der Bildaufnahme dazu verwendet werden, die Bildgebungsparameter so zu verändern, dass der Bildausschnitt der Bewegung folgt. Diese Arbeit beschäftigt sich mit der Entwicklung und Validierung eines Systems zur prospektiven Bewegungskorrektur. Das entwickelte System bestand aus vier Kernspinresonanz-Magnetfeldsensoren (NMR field probes). Diese Sensoren wurden am Kopf der Probanden befestigt und konnten die räumliche und zeitliche Veränderung des Magnetfeldes messen. Das Ziel war es, dadurch die Sensorpositionen zu bestimmen und die zugehörigen Kopfbewegungen zu berechnen, um mit diesen Informationen die prospektive Bewegungskorrektur zu implementieren. Dabei war der erste Schritt die Entwicklung eines eigenständigen Sende- und Empfangssystems zur Signalgeneration und -akquise der Sensoren. Dieses System bestand aus mikroelektronischen Komponenten und war nötig, um die Messungen der Sensoren unabhängig von der Hardware des Kernspintomographen durchführen zu können. Im zweiten Schritt sollte die Genauigkeit der Positionsbestimmung der Sensoren verbessert werden. Die Position der Sensoren wurde durch lineare Magnetfeldgradienten bestimmt, die nacheinander auf allen räumlichen Achsen geschaltet wurden. Echte Gradienten besitzen allerdings ein charakteristisches nichtlineares Verhalten, das ausgemessen werden musste, um das lineare Modell der Positionsbestimmung zu verbessern. Dazu wurden Messungen mit einem Sensor in verschiedenen bekannten Positionen durchgeführt sowie zusätzlich Messungen mit einer sogenannten Feldkamera, welche aus 16 dieser Sensoren besteht. Im letzten Schritt wurde dann das fertige System zur Bewegungskorrektur für verschiedene Bildgebungssequenzen getestet und schließlich mit einem anderen Bewegungskorrektursystem verglichen, welches auf einer optischen Kamera basiert