Challenges in Acquiring Clinical Simultaneous SPECT-MRI on a PET-MRI Scanner

The INSERT is the world’s first clinical SPECTMRI brain imaging system based on scintillation detectors with a SiPM readout. Here we demonstrate its use within a clinical MRI environment for the first time. Using a standard transmit-receive head coil, and with an appropriate selection of a custom MRI sequence (GRE), we overcome mutual interference. The INSERT and its bulky 50 kg tungsten collimator introduce magnetic field inhomogeneity. Due to the specific MRI-compatible collimator design, inhomogeneity is compensated by shimming, leading to simultaneous acquisition. We process the SPECT data acquired alongside the MRI sequence to evaluate the SPECT system performance and the impact of the MRI. Finally, we present a set of simultaneous SPECT-MRI acquisitions, demonstrating multimodal imaging capabilities, albeit with a limited MRI sequence

2D sodium MRI of the human calf using half-sinc excitation pulses and compressed sensing

PURPOSE: Sodium MRI can be used to quantify tissue sodium concentration (TSC) in vivo; however, UTE sequences are required to capture the rapidly decaying signal. 2D MRI enables high in-plane resolution but typically has long TEs. Half-sinc excitation may enable UTE; however, twice as many readouts are necessary. Scan time can be minimized by reducing the number of signal averages (NSAs), but at a cost to SNR. We propose using compressed sensing (CS) to accelerate 2D half-sinc acquisitions while maintaining SNR and TSC. METHODS: Ex vivo and in vivo TSC were compared between 2D spiral sequences with full-sinc (TE = 0.73 ms, scan time ≈ 5 min) and half-sinc excitation (TE = 0.23 ms, scan time ≈ 10 min), with 150 NSAs. Ex vivo, these were compared to a reference 3D sequence (TE = 0.22 ms, scan time ≈ 24 min). To investigate shortening 2D scan times, half-sinc data was retrospectively reconstructed with fewer NSAs, comparing a nonuniform fast Fourier transform to CS. Resultant TSC and image quality were compared to reference 150 NSAs nonuniform fast Fourier transform images. RESULTS: TSC was significantly higher from half-sinc than from full-sinc acquisitions, ex vivo and in vivo. Ex vivo, half-sinc data more closely matched the reference 3D sequence, indicating improved accuracy. In silico modeling confirmed this was due to shorter TEs minimizing bias caused by relaxation differences between phantoms and tissue. CS was successfully applied to in vivo, half-sinc data, maintaining TSC and image quality (estimated SNR, edge sharpness, and qualitative metrics) with ≥50 NSAs. CONCLUSION: 2D sodium MRI with half-sinc excitation and CS was validated, enabling TSC quantification with 2.25 × 2.25 mm2 resolution and scan times of ≤5 mins

Challenges in Acquiring Clinical Simultaneous SPECT-MRI on a PET-MRI Scanner

The INSERT is the world's first clinical SPECT-MRI brain imaging system based on scintillation detectors with a silicon photomultiplier readout. Here, we demonstrate its use within a clinical MRI environment for the first time. Using a standard transmit-receive head coil, and with an appropriate selection of a custom MRI sequence (GRE), we overcome mutual interference. The INSERT and its bulky 50kg tungsten collimator introduce magnetic field inhomogeneity. Due to the specific MRI-compatible collimator design, inhomogeneity is compensated by shimming, leading to simultaneous acquisition. We process the SPECT data acquired alongside the MRI sequence to evaluate the SPECT system performance and the impact of the MRI. Finally, we present a set of simultaneous SPECT-MRI acquisitions, demonstrating multimodal imaging capabilities, albeit with a limited MRI sequence

First Simultaneous Acquisition of a Clinical SPECT-MRI Brain INSERT

The INSERT (INtegrated SPECT/MRI for Enhanced stratification of brain tumours in Radio-chemoTherapy) is currently the only MRI-compatible SPECT stationary system for clinical application, in particular for brain multimodal imaging with an inner bore of 28 cm and a field of view of 20 cm (transaxial) × 10 cm (axial). The intrinsic spatial resolution is 1 mm and the extrinsic one is 10 mm. This modular scanner fits in an unmodified MRI scanner and is a scale-up of a smaller preclinical version, whose mutual compatibility with MRI was extensively characterized. It is composed of 20 detection modules (with 8-mm thick CsI:Tl scintillators of 5 cm 10 cm area read by an array of SiPM) and a massive multi-mini×slit-slat collimator, realized in tungsten. Here we report the first demonstration of successful simultaneous SPECT/MRI acquisition of phantoms (hot rods) using a commercial transceiver coil in a Siemens Biograph mMR scanner

Inherited salt-losing tubulopathies are associated with immunodeficiency due to impaired IL-17 responses

Salt levels in culture affect the polarisation of Th17 cells, which normally protect the host from fungal and bacterial infections. Here, the authors study patients with salt-losing tubulopathies (SLT) to find that, while Th17 immunity is dampened in SLT patients, their Th17-inducing signaling pathways are intact and can be reinvigorated by exogenous salt

Planning of gamma knife radiosurgery (GKR) for brain arteriovenous malformations using triple magnetic resonance angiography (triple-MRA)

PurposeIntra-arterial Digital Subtraction Angiography (DSA) is the gold standard technique for radiosurgery target delineation in brain Arterio-Venous Malformations (AVMs). This study aims to evaluate whether a combination of three Magnetic Resonance Angiography sequences (triple-MRA) could be used for delineation of brain AVMs for Gamma Knife Radiosurgery (GKR).MethodsFifteen patients undergoing DSA for GKR targeting of brain AVMs also underwent triple-MRA: 4D Arterial Spin Labelling based angiography (ASL-MRA), Contrast-Enhanced Time-Resolved MRA (CE-MRA) and High Definition post-contrast Time-Of-Flight angiography (HD-TOF). The arterial phase of the AVM nidus was delineated on triple-MRA by an interventional neuroradiologist and a consultant neurosurgeon (triple-MRA volume). Triple-MRA volumes were compared to AVM targets delineated by the clinical team for delivery of GKR using the current planning paradigm, i.e., stereotactic DSA and volumetric MRI (DSA volume). Difference in size, degree of inclusion (DI) and concordance index (CcI) between DSA and triple-MRA volumes are reported.ResultsAVM target volumes delineated on triple-MRA were on average 9.8% smaller than DSA volumes (95%CI:5.6-13.9%; SD:7.14%; p = .003). DI of DSA volume in triple-MRA volume was on average 73.5% (95%CI:71.2-76; range: 65-80%). The mean percentage of triple-MRA volume not included on DSA volume was 18% (95%CI:14.7-21.3; range: 7-30%).ConclusionThe technical feasibility of using triple-MRA for visualisation and delineation of brain AVMs for GKR planning has been demonstrated. Tighter and more precise delineation of AVM target volumes could be achieved by using triple-MRA for radiosurgery targeting. However, further research is required to ascertain the impact this may have in obliteration rates and side effects

Challenges in glucoCEST MR body imaging at 3 Tesla

Background: The aim of this study was to translate dynamic glucose enhancement (DGE) body magnetic resonance imaging (MRI) based on the glucose chemical exchange saturation transfer (glucoCEST) signal to a 3 T clinical field strength. / Methods: An infusion protocol for intravenous (i.v.) glucose was optimised using a hyperglycaemic clamp to maximise the chances of detecting exchange-sensitive MRI signal. Numerical simulations were performed to define the optimum parameters for glucoCEST measurements with consideration to physiological conditions. DGE images were acquired for patients with lymphomas and prostate cancer injected i.v. with 20% glucose. / Results: The optimised hyperglycaemic clamp infusion based on the DeFronzo method demonstrated higher efficiency and stability of glucose delivery as compared to manual determination of glucose infusion rates. DGE signal sensitivity was found to be dependent on T2, B1 saturation power and integration range. Our results show that motion correction and B0 field inhomogeneity correction are crucial to avoid mistaking signal changes for a glucose response while field drift is a substantial contributor. However, after B0 field drift correction, no significant glucoCEST signal enhancement was observed in tumour regions of all patients in vivo. / Conclusions: Based on our simulated and experimental results, we conclude that glucose-related signal remains elusive at 3 T in body regions, where physiological movements and strong effects of B1+ and B0 render the originally small glucoCEST signal difficult to detect