A Parametric Study of Radiative Dipole Body Array Coil for 7 Tesla MRI

In this contribution we present numerical and experimental results of a parametric quantitative study of radiative dipole antennas in a phased array configuration for efficient body magnetic resonance imaging at 7T via parallel transmission. For magnetic resonance imaging (MRI) at ultrahigh fields (7T and higher) dipole antennas are commonly used in phased arrays, particularly for body imaging targets. This study reveals the effects of dipole positioning in the array (elevation of dipoles above the subject and inter-dipole spacing) on their mutual coupling, $B_1^{+}$ per $P_{acc}$ and $B_1^{+}$ per maximum local SAR efficiencies as well as the RF-shimming capability. The numerical and experimental results are obtained and compared for a homogeneous phantom as well as for a real human models confirmed by in-vivo experiments

7 T renal MRI: challenges and promises

The progression to 7 Tesla (7 T) magnetic resonance imaging (MRI) yields promises of substantial increase in signal-to-noise (SNR) ratio. This increase can be traded off to increase image spatial resolution or to decrease acquisition time. However, renal 7 T MRI remains challenging due to inhomogeneity of the radiofrequency field and due to specific absorption rate (SAR) constraints. A number of studies has been published in the field of renal 7 T imaging. While the focus initially was on anatomic imaging and renal MR angiography, later studies have explored renal functional imaging. Although anatomic imaging remains somewhat limited by inhomogeneous excitation and SAR constraints, functional imaging results are promising. The increased SNR at 7 T has been particularly advantageous for blood oxygen level-dependent and arterial spin labelling MRI, as well as sodium MR imaging, thanks to changes in field-strength-dependent magnetic properties. Here, we provide an overview of the currently available literature on renal 7 T MRI. In addition, we provide a brief overview of challenges and opportunities in renal 7 T MR imaging

Simulation-based evaluation of SAR and flip angle homogeneity for five transmit head arrays at 14 T

INTRODUCTION: Various research sites are pursuing 14 T MRI systems. However, both local SAR and RF transmit field inhomogeneity will increase. The aim of this simulation study is to investigate the trade-offs between peak local SAR and flip angle uniformity for five transmit coil array designs at 14 T in comparison to 7 T. METHODS: Investigated coil array designs are: 8 dipole antennas (8D), 16 dipole antennas (16D), 8 loop coils (8D), 16 loop coils (16L), 8 dipoles/8 loop coils (8D8L) and for reference 8 dipoles at 7 T. Both RF shimming and k T-points were investigated by plotting L-curves of peak SAR levels vs flip angle homogeneity. RESULTS: For RF shimming, the 16L array performs best. For k T-points, superior flip angle homogeneity is achieved at the expense of more power deposition, and the dipole arrays outperform the loop coil arrays. DISCUSSION AND CONCLUSION: For most arrays and regular imaging, the constraint on head SAR is reached before constraints on peak local SAR are violated. Furthermore, the different drive vectors in k T-points alleviate strong peaks in local SAR. Flip angle inhomogeneity can be alleviated by k T-points at the expense of larger power deposition. For k T-points, the dipole arrays seem to outperform loop coil arrays

A perturbation approach for ultrafast calculation of RF field enhancements near medical implants in MRI

Patients with medical implants often are deprived of magnetic resonance imaging examination because of safety risks. One specific risk is the enhancement of the radiofrequency fields around the medical implant potentially resulting in significant tissue heating and damage. The assessment of this enhancement is a computationally demanding task, with simulations taking hours or days to converge. Conventionally the source of the radiofrequency fields, patient anatomy, and the medical implant are simulated concurrently. To alleviate the computational burden, we reformulate a fast simulation method that views the medical implant as a small perturbation of the simulation domain without the medical implant and calculates the radiofrequency fields associated with this perturbation. Previously, this method required an extensive offline stage where the result is intractable for large simulation domains. Currently, this offline stage is no longer required and the method is completely online. The proposed method results in comparable radiofrequency fields but is orders of magnitude faster compared to standard simulation technique; the finite-difference time-domain, the finite-sums, and the finite element methods. This acceleration could enable patient-specific and potentially online radiofrequency safety assessment

Deep learning based correction of RF field induced inhomogeneities for T2w prostate imaging at 7 T

At ultrahigh field strengths images of the body are hampered by B 1 -field inhomogeneities. These present themselves as inhomogeneous signal intensity and contrast, which is regarded as a "bias field" to the ideal image. Current bias field correction methods, such as the N4 algorithm, assume a low frequency bias field, which is not sufficiently valid for T2w images at 7 T. In this work we propose a deep learning based bias field correction method to address this issue for T2w prostate images at 7 T. By combining simulated B 1 -field distributions of a multi-transmit setup at 7 T with T2w prostate images at 1.5 T, we generated artificial 7 T images for which the homogeneous counterpart was available. Using these paired data, we trained a neural network to correct the bias field. We predicted either a homogeneous image (t-Image neural network) or the bias field (t-Biasf neural network). In addition, we experimented with the single-channel images of the receive array and the corresponding sum of magnitudes of this array as the input image. Testing was carried out on four datasets: the test split of the synthetic training dataset, volunteer and patient images at 7 T, and patient images at 3 T. For the test split, the performance was evaluated using the structural similarity index measure, Wasserstein distance, and root mean squared error. For all other test data, the features Homogeneity and Energy derived from the gray level co-occurrence matrix (GLCM) were used to quantify the improvement. For each test dataset, the proposed method was compared with the current gold standard: the N4 algorithm. Additionally, a questionnaire was filled out by two clinical experts to assess the homogeneity and contrast preservation of the 7 T datasets. All four proposed neural networks were able to substantially reduce the B 1 -field induced inhomogeneities in T2w 7 T prostate images. By visual inspection, the images clearly look more homogeneous, which is confirmed by the increase in Homogeneity and Energy in the GLCM, and the questionnaire scores from two clinical experts. Occasionally, changes in contrast within the prostate were observed, although much less for the t-Biasf network than for the t-Image network. Further, results on the 3 T dataset demonstrate that the proposed learning based approach is on par with the N4 algorithm. The results demonstrate that the trained networks were capable of reducing the B 1 -field induced inhomogeneities for prostate imaging at 7 T. The quantitative evaluation showed that all proposed learning based correction techniques outperformed the N4 algorithm. Of the investigated methods, the single-channel t-Biasf neural network proves most reliable for bias field correction

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013

Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study. Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort. Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample. Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe