Model‐based reconstruction framework for correction of signal pile‐up and geometric distortions in prostate diffusion MRI

PURPOSE: Prostate diffusion‐weighted MRI scans can suffer from geometric distortions, signal pileup, and signal dropout attributed to differences in tissue susceptibility values at the interface between the prostate and rectal air. The aim of this work is to present and validate a novel model based reconstruction method that can correct for these distortions. METHODS: In regions of severe signal pileup, standard techniques for distortion correction have difficulty recovering the underlying true signal. Furthermore, because of drifts and inaccuracies in the determination of center frequency, echo planar imaging (EPI) scans can be shifted in the phase‐encoding direction. In this work, using a B0 field map and a set of EPI data acquired with blip‐up and blip‐down phase encoding gradients, we model the distortion correction problem linking the distortion‐free image to the acquired raw corrupted k‐space data and solve it in a manner analogous to the sensitivity encoding method. Both a quantitative and qualitative assessment of the proposed method is performed in vivo in 10 patients. RESULTS: Without distortion correction, mean Dice similarity scores between a reference T2W and the uncorrected EPI images were 0.64 and 0.60 for b‐values of 0 and 500 s/mm2, respectively. Compared to the Topup (distortion correction method commonly used for neuro imaging), the proposed method achieved Dice scores (0.87 and 0.85 versus 0.82 and 0.80) and better qualitative results in patients where signal pileup was present because of high rectal gas residue. CONCLUSION: Model‐based reconstruction can be used for distortion correction in prostate diffusion MRI

ST2 and IL-33 in Pregnancy and Pre-Eclampsia

Normal pregnancy is associated with a mild systemic inflammatory response and an immune bias towards type 2 cytokine production, whereas pre-eclampsia is characterized by a more intense inflammatory response, associated with endothelial dysfunction and a type 1 cytokine dominance. Interleukin (IL)-33 is a newly described member of the IL-1 family, which binds its receptor ST2L to induce type 2 cytokines. A soluble variant of ST2 (sST2) acts as a decoy receptor to regulate the activity of IL-33. In this study circulating IL-33 and sST2 were measured in each trimester of normal pregnancy and in women with pre-eclampsia. While IL-33 did not change throughout normal pregnancy, or between non-pregnant, normal pregnant or pre-eclamptic women, sST2 was significantly altered. sST2 was increased in the third trimester of normal pregnancy (p<0.001) and was further increased in pre-eclampsia (p<0.001). This increase was seen prior to the onset of disease (p<0.01). Pre-eclampsia is a disease caused by placental derived factors, and we show that IL-33 and ST2 can be detected in lysates from both normal and pre-eclampsia placentas. ST2, but not IL-33, was identified on the syncytiotrophoblast layer, whereas IL-33 was expressed on perivascular tissue. In an in vitro placental perfusion model, sST2 was secreted by the placenta into the ‘maternal’ eluate, and placental explants treated with pro-inflammatory cytokines or subjected to hypoxia/reperfusion injury release more sST2, suggesting the origin of at least some of the increased amounts of circulating sST2 in pre-eclamptic women is the placenta. These results suggest that sST2 may play a significant role in pregnancies complicated by pre-eclampsia and increased sST2 could contribute to the type 1 bias seen in this disorder

Rationale, Design and Baseline Characteristics of Participants in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) Trial

BACKGROUND: Long-term aspirin prevents vascular events but is only modestly effective. Rivaroxaban alone or in combination with aspirin might be more effective than aspirin alone for vascular prevention in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD). Rivaroxaban as well as aspirin increase upper gastrointestinal (GI) bleeding and this might be prevented by proton pump inhibitor therapy. METHODS: Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) is a double-blind superiority trial comparing rivaroxaban 2.5 mg twice daily combined with aspirin 100 mg once daily or rivaroxaban 5 mg twice daily vs aspirin 100 mg once daily for prevention of myocardial infarction, stroke, or cardiovascular death in patients with stable CAD or PAD. Patients not taking a proton pump inhibitor were also randomized, using a partial factorial design, to pantoprazole 40 mg once daily or placebo. The trial was designed to have at least 90% power to detect a 20% reduction in each of the rivaroxaban treatment arms compared with aspirin and to detect a 50% reduction in upper GI complications with pantoprazole compared with placebo. RESULTS: Between February 2013 and May 2016, we recruited 27,395 participants from 602 centres in 33 countries; 17,598 participants were included in the pantoprazole vs placebo comparison. At baseline, the mean age was 68.2 years, 22.0% were female, 90.6% had CAD, and 27.3% had PAD. CONCLUSIONS: COMPASS will provide information on the efficacy and safety of rivaroxaban, alone or in combination with aspirin, in the long-term management of patients with stable CAD or PAD, and on the efficacy and safety of pantoprazole in preventing upper GI complications in patients receiving antithrombotic therapy

Characterization of B₀-field fluctuations in prostate MRI

Multi-parametric MRI is increasingly used for prostate cancer detection. Improving information from current sequences, such as T2-weighted and diffusion-weighted (DW) imaging, and additional sequences, such as magnetic resonance spectroscopy (MRS) and chemical exchange saturation transfer (CEST), may enhance the performance of multi-parametric MRI. The majority of these techniques are sensitive to B0-field variations and may result in image distortions including signal pile-up and stretching (echo planar imaging (EPI) based DW-MRI) or unwanted shifts in the frequency spectrum (CEST and MRS). Our aim is to temporally and spatially characterize B0-field changes in the prostate. Ten male patients are imaged using dual-echo gradient echo sequences with varying repetitions on a 3T scanner to evaluate the temporal B0-field changes within the prostate. A phantom is also imaged to consider no physiological motion. The spatial B0-field variations in the prostate are reported as B0-field values (Hz), their spatial gradients (Hz/mm) and the resultant distortions in EPI based DW-MRI images (b-value = 0 s/mm2and two oppositely phase encoded directions). Over a period of minutes, temporal changes in B0-field values were ≤19 Hz for minimal bowel motion and ≥30 Hz for large motion. Spatially across the prostate, the B0-field values had an interquartile range of ≤18 Hz (minimal motion) and ≤44 Hz (large motion). The B$_0$-field gradients were between -2 and 5 Hz/mm (minimal motion) and 2 to 12 Hz/mm (large motion). Overall, B0-field variations can affect DW, MRS and CEST imaging of the prostate

Sensitivity of OGSE activeax to microstructural dimensions on a clinical scanner

Axon diameter can play a key role in the function and performance of nerve pathways of the central and peripheral nervous system. Previously, a number of techniques to measure axon diameter using diffusion MR I have been proposed, majority of which uses single diffusion encoding (SDE) spin-echo sequence. However, recent theoretical research suggests that low-frequency oscillating gradient spin echo (OGSE) offers benefits over SDE for imaging diameters when fibres are of unknown orientation. Furthermore, it suggests that resolution limit for clinical scanners (gradient strength of 60–80 mT/m) is ~ 6 µm. Here we investigate the sensitivity of OGSE to fibre diameters experimentally on a clinical scanner, using microcapillaries of unknown orientation. We use the orientationally invariant OGSE ActiveAx method to image microcapillaries with diameters of 5, 10 or 20 µm. As predicted by theory, we find that 5 µm diameters are undistinguishable from zero. Furthermore, we find accurate and precise estimates for 10 and 20 µm. Finally, we find that low frequency oscillating gradient waveforms are optimal for accurate diameter estimation