4D ultra-short TE (UTE) phase-contrast MRI for assessing stenotic flow and hemodynamics.

Phase-contrast (PC) MRI is a non-invasive technique to assess cardiovascular blood flow. However, this technique is not accurate in the case of atherosclerotic disease and vascular and valvular stenosis due to intravoxel dephasing secondary to disturbed blood flow, flow recirculation, and turbulence distal to the narrowing, resulting in flow-related artifacts. Previous studies have shown that reducing the echo time (TE) decreases the errors associated with phase incoherence due to random motions as observed in unsteady and turbulent flows. As part of this dissertation, a novel 3-D cine Ultra-Short (UTE)-PC imaging method has been developed, and implemented to measure the blood velocity using a UTE center-out radial k-space trajectory with short TE time compared to standard PC MRI sequences. 3D UTE characterizes flow in one direction in a 3D volume, resulting in a single component of the flow velocities. In order to obtain a comprehensive flow assessment in three directions, the 3D UTE sequence needs to be repeated three times, which can be inefficient and time consuming. 4-D flow MRI has been recently used for quantitative flow assessment and visualization of complex flow patterns resulting in more anatomical information and comprehensive assessment of blood flow. With 4D flow MRI method, all the flow information in three direction in a 3D volume though the time can be achieved as part of a single scan. In this dissertation, a novel 4D UTE flow MRI technique has also been designed and implemented which is capable of deriving the three orthogonal components of the velocity field in the flow in a single scan, while achieving very short echo times. In flow phantom studies, comprehensive investigation of several different flow rates revealed significant improvement in flow quantification and reduction of flow artifacts when compared to conventional 4D flow. Furthermore, a reduced TE 4D Spiral flow MRI method has also been implemented which reduces scan times when compared to conventional 4D flow MRI (as well as 4D UTE flow). Despite reduction of scan time as well as TE relative to conventional 4D flow, the achieved TE with the 4D spiral technique is indeed longer than 4D UTE flow. In order to assess clinical feasibility and in order to perform further validation of 4D UTE flow, in an IRB-approved study, twelve aortic stenosis (AS) patients underwent Doppler Ultrasound, conventional 4D flow, and 4D UTE flow scans for a 3 way comparison. 4D UTE flow displayed good correlation with Doppler Ultrasound in patients with moderately severe aortic stenosis, though with the added benefit of not having confounding factors encountered in Doppler Ultrasound (e.g., angle dependence, 2D measurement, and difficulty in locating a proper acoustic window). The proposed 4D UTE flow permits 4D visualization of flow and true 3D measurement of all flow quantities, not possible with Doppler. Further investigations will be required to test the technique in patients with severe or critical aortic stenosis wherein conventional 4D flow will be less accurate due to intravoxel dephasing and spin incoherence

Technical Note: Characterization and correction of gradient nonlinearity induced distortion on a 1.0 T open bore MRâ SIM

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135020/1/mp0245.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135020/2/mp0245_am.pd

Magnetic Resonance-Based Automatic Air Segmentation for Generation of Synthetic Computed Tomography Scans in the Head Region

PURPOSE: To incorporate a novel imaging sequence for robust air and tissue segmentation using ultrashort echo time (UTE) phase images and to implement an innovative synthetic CT (synCT) solution as a first step toward MR-only radiation therapy treatment planning for brain cancer. METHODS AND MATERIALS: Ten brain cancer patients were scanned with a UTE/Dixon sequence and other clinical sequences on a 1.0 T open magnet with simulation capabilities. Bone-enhanced images were generated from a weighted combination of water/fat maps derived from Dixon images and inverted UTE images. Automated air segmentation was performed using unwrapped UTE phase maps. Segmentation accuracy was assessed by calculating segmentation errors (true-positive rate, false-positive rate, and Dice similarity indices using CT simulation (CT-SIM) as ground truth. The synCTs were generated using a voxel-based, weighted summation method incorporating T2, fluid attenuated inversion recovery (FLAIR), UTE1, and bone-enhanced images. Mean absolute error (MAE) characterized Hounsfield unit (HU) differences between synCT and CT-SIM. A dosimetry study was conducted, and differences were quantified using γ-analysis and dose-volume histogram analysis. RESULTS: On average, true-positive rate and false-positive rate for the CT and MR-derived air masks were 80.8% ± 5.5% and 25.7% ± 6.9%, respectively. Dice similarity indices values were 0.78 ± 0.04 (range, 0.70-0.83). Full field of view MAE between synCT and CT-SIM was 147.5 ± 8.3 HU (range, 138.3-166.2 HU), with the largest errors occurring at bone-air interfaces (MAE 422.5 ± 33.4 HU for bone and 294.53 ± 90.56 HU for air). Gamma analysis revealed pass rates of 99.4% ± 0.04%, with acceptable treatment plan quality for the cohort. CONCLUSIONS: A hybrid MRI phase/magnitude UTE image processing technique was introduced that significantly improved bone and air contrast in MRI. Segmented air masks and bone-enhanced images were integrated into our synCT pipeline for brain, and results agreed well with clinical CTs, thereby supporting MR-only radiation therapy treatment planning in the brain

Technical Note: Characterization and correction of gradient nonlinearity induced distortion on a 10 T open bore MR-SIM

PURPOSE: Distortions in magnetic resonance imaging (MRI) compromise spatial fidelity, potentially impacting delineation and dose calculation. We characterized 2D and 3D large field of view (FOV), sequence-independent distortion at various positions in a 1.0 T high-field open MR simulator (MR-SIM) to implement correction maps for MRI treatment planning. METHODS: A 36 × 43 × 2 cm(3) phantom with 255 known landmarks (∼1 mm(3)) was scanned using 1.0 T high-field open MR-SIM at isocenter in the transverse, sagittal, and coronal axes, and a 465 × 350 × 168 mm(3) 3D phantom was scanned by stepping in the superior-inferior direction in three overlapping positions to achieve a total 465 × 350 × 400 mm(3) sampled FOV yielding \u3e13 800 landmarks (3D Gradient-Echo, TE/TR/α = 5.54 ms/30 ms/28°, voxel size = 1 × 1 × 2 mm(3)). A binary template (reference) was generated from a phantom schematic. An automated program converted MR images to binary via masking, thresholding, and testing for connectivity to identify landmarks. Distortion maps were generated by centroid mapping. Images were corrected via warping with inverse distortion maps, and temporal stability was assessed. RESULTS: Over the sampled FOV, non-negligible residual gradient distortions existed as close as 9.5 cm from isocenter, with a maximum distortion of 7.4 mm as close as 23 cm from isocenter. Over six months, average gradient distortions were -0.07 ± 1.10 mm and 0.10 ± 1.10 mm in the x and y directions for the transverse plane, 0.03 ± 0.64 and -0.09 ± 0.70 mm in the sagittal plane, and 0.4 ± 1.16 and 0.04 ± 0.40 mm in the coronal plane. After implementing 3D correction maps, distortions were reduced to(1 mm) for all voxels up to 25 cm from magnet isocenter. CONCLUSIONS: Inherent distortion due to gradient nonlinearity was found to be non-negligible even with vendor corrections applied, and further corrections are required to obtain 1 mm accuracy for large FOVs. Statistical analysis of temporal stability shows that sequence independent distortion maps are consistent within six months of characterization

Four dimensional magnetic resonance imaging optimization and implementation for magnetic resonance imaging simulation

PURPOSE: Precise radiation therapy for abdominal lesions is complicated by respiratory motion and suboptimal soft tissue contrast from 4-dimensional (4D) computed tomography, whereas 4D magnetic resonance imaging MRI (4DMRI) provides superior tissue discrimination. This work evaluates a novel 4DMRI algorithm for motion management in radiation therapy. METHODS AND MATERIALS: Respiratory-triggered, T2-weighted, single-shot 4DMRI was evaluated for an open 1.0T magnetic resonance simulation platform. An in-house programmable platform was devised that translated objects for a variety of breathing patterns. Coronal 4DMRIs were acquired to evaluate the impact of number of phases on excursion and scan time. The impact of breathing period and regularity on scan time was assessed. A novel clinical 4D prototype phantom was scanned to characterize excursion and absolute volume differences between phase acquisitions. Optimized parameters were applied to abdominal 4DMRIs of 5 volunteers and 2 abdominal cancer patients on an institutional review board-approved protocol. Duty cycle, scan time, and waveform analysis were evaluated. Maximum intensity projection datasets were analyzed. RESULTS: Two- to 5-fold acquisition time increase was measured for 10-phase versus 2-phase phantom experiments. Regular breathing patterns yielded higher duty cycles than irregular (48.5% and 35.9%, respectively, P \u3c .001), whereas faster breathing rates yielded shorter 4DMRI acquisition times. Volumes of a hypodense target were underestimated 4% to 5% for 2 and 4 phases compared with 10 phases. Better agreement was obtained for 6- and 8-phase acquisitions (~3% different from 10 phase). Internal target volume centroids on minimum and maximum images across all phases were \u3c2 mm different across all 10 phases, although slight target excursion variations (up to 4 mm) were observed. In humans, a strong negative association between breathing rate and acquisition time (Pearson\u27s r = -0.68, P \u3c .05) was observed. Eight-phase acquisition times ranged from 7 to 15 minutes, depending on the patient. CONCLUSION: 4DMRI has been optimized and implemented. Irregular breathing patterns and slow breathing rate adversely impacted 4DMRI efficiency; thus, interventions such as biofeedback may be desirable

Magnetic resonance imaging metal artifact reduction for eye plaque patient with dental braces

Purpose : To determine if metal artifact reduction can minimize magnetic susceptibility artifacts in the orbits for an eye plaque brachytherapy patient with metallic dental braces. Material and methods: A 62-year-old female patient with a choroidal melanoma in the right eye received a 1.5 T magnetic resonance imaging (MRI) simulation for 3D eye plaque brachytherapy planning. The protocol included conventional 3D T 1 -weighted and 2D T 2 -weighted MRIs. A vendor-supplied T 2 -weighted metal artifact reduction sequence was added to the protocol to reduce magnetic susceptibility artifacts from the metallic dental braces. The metal artifact reduction sequence combined turbo spin echo acquisitions, high RF excitation and readout bandwidths, and view angle tilting and slice encoding for metal artifact correction with z-shimming to correct in-plane and through-plane image distortions, respectively. Results : Dental braces caused significant signal loss and image distortion in the orbits on the conventional T 1 -weighted and T 2 -weighted MRIs, and the MRIs were unusable for treatment planning. The metal artifact reduction sequence with 13 z-phase encodes minimized distortion and signal loss in the orbits, allowing the tumor to be clearly delineated. Conclusions : T 2 -weighted MRI with metal artifact reduction was successfully applied to minimize artifacts in the orbits resulting from the dental braces, thus allowing the MRIs to be used in 3D brachytherapy treatment planning

Clinical workflow for MR-only simulation and planning in prostate

Abstract Purpose To describe the details and experience of implementing a MR-only workflow in the clinic for simulation and planning of prostate cancer patients. Methods Forty-eight prostate cancer patients from June 2016 - Dec 2016 receiving external beam radiotherapy were scheduled to undergo MR-only simulation. MR images were acquired for contouring (T2w axial, coronal, sagittal), synthetic-CT generation (3D FFE-based) and fiducial identification (3D bFFE-based). The total acquisition time was 25 min. Syn-CT was generated at the console using commercial software called MRCAT. As part of acceptance testing of the MRCAT package, external laser positioning system QA (< 2 mm) and geometric fidelity QA (< 2 mm within 50 cm LR and 30 cm AP) were performed and baseline values were set. Our current combined CT + MR simulation process was modified to accommodate a MRCAT-based MR-only simulation workflow. An automated step-by-step process using a MIM™ workflow was created for contouring on the MR images. Patient setup for treatment was achieved by matching the MRCAT DRRs with the orthogonal KV radiographs based on either fiducial ROIs or bones. 3-D CBCTs were acquired and compared with the MR/syn-CT to assess the rectum and bladder filling compared to simulation conditions. Results Forty-two patients successfully underwent MR-only simulation and met all of our institutional dosimetric objectives that were developed based on a CT + MR-based workflow. The remaining six patients either had a hip prosthesis or their large body size fell outside of the geometric fidelity QA criteria and thus they were not candidates for MR-only simulation. A total time saving of ~15 min was achieved with MR-based simulation as compared to CT + MR-based simulation. An automated and organized MIM workflow made contouring on MR much easier, quicker and more accurate compared with combined CT + MR images because the temporal variations in normal structure was minimal. 2D and 3D treatment setup localization based on bones/fiducials using a MRCAT reference image was successfully achieved for all cases. Conclusions MR-only simulation and planning with equivalent or superior target delineation, planning and treatment setup localization accuracy is feasible in a clinical setting. Future work will focus on implementing a robust 3D isotropic acquisition for contouring