Optimization of encoding gradients for MR‐ARFI

MR acoustic radiation force imaging provides a promising method to monitor therapeutic ultrasound treatments. By measuring the displacement induced by the acoustic radiation force, MR acoustic radiation force imaging can locate the focal spot, without a significant temperature rise. In this work, the encoding gradient for MR acoustic radiation force imaging is optimized to achieve an enhanced accuracy and precision of the displacement measurement. By analyzing the sources of artifacts, bulk motion and eddy currents are shown to introduce errors to the measurement, and heavy diffusion‐weighting is shown to result in noisy displacement maps. To eliminate these problems, a new encoding scheme is proposed, which utilizes a pair of bipolar gradients. Improved precision is achieved with robustness against bulk motion and background phase distortion, and improved accuracy is achieved with reduced diffusion‐weighting and optimized encoding pulse width. The experiment result shows that the signal‐to‐noise ratio can be enhanced by more than 2‐fold. These significant improvements are obtained at no cost of scan time or encoding sensitivity, enabling the detection of a displacement less than 0.l μm in a gel phantom with MR acoustic radiation force imaging. Magn Reson Med 63:1050–1058, 2010. © 2010 Wiley‐Liss, Inc.     

3.0‐T MR‐guided focused ultrasound for preoperative localization of nonpalpable breast lesions: An initial experimental ex vivo study

Purpose

To compare the accuracy of magnetic resonance‐guided focused ultrasound (MRgFUS) with MR‐guided needle‐wire placement (MRgNW) for the preoperative localization of nonpalpable breast lesions.

Materials and Methods

In this experimental ex vivo study, 15 turkey breasts were used. In each breast phantom an artificial nonpalpable “tumor” was created by injecting an aqueous gel containing gadolinium. MRgFUS (n = 7) was performed with the ExAblate 2000 system (InSightec). With MRgFUS the ablated tissue changes in color and increases in stiffness. A rim of palpable and visible ablations was created around the tumor to localize the tumor and facilitate excision. MRgNW (n = 8) was performed by MR‐guided placement of an MR‐compatible needle‐wire centrally in the tumor. After surgical excision of the tumor, MR images were used to evaluate tumor‐free margins (negative/positive), minimum tumor‐free margin (mm), and excised tissue volume (cm³).

Results

With MRgFUS localization no positive margins were found after excision (0%). With MRgNW two excision specimens (25%) had positive margins (P = 0.48). Mean minimum tumor‐free margin (±SD) with MRgFUS was significantly larger (5.5 ± 2.4 mm) than with MRgNW (0.9 ± 1.4 mm) (P < 0.001). Mean volume ± SD of excised tissue did not differ between MRgFUS and MRgNW localization, ie, 44.0 ± 9.4 cm³ and 39.5 ± 10.7 cm³ (P = 0.3).

Conclusion

The results of this experimental ex vivo study indicate that MRgFUS can potentially be used to localize nonpalpable breast lesions in vivo. J. Magn. Reson. Imaging 2009;30:884–889. © 2009 Wiley‐Liss, Inc.     

Spectrally selective pencil‐beam navigator for motion compensation of MR‐guided high‐intensity focused ultrasound therapy of abdominal organs

MR‐guided high‐intensity focused ultrasound (MR‐HIFU) is a noninvasive technique for depositing thermal energy in a controlled manner deep within the body. However, the MR‐HIFU treatment of mobile abdominal organs is problematic as motion‐related thermometry artifacts need to be corrected and the focal point position must be updated in order to follow the moving organ to avoid damaging healthy tissue. In this article, a fat‐selective pencil‐beam navigator is proposed for real‐time monitoring and compensation of through‐plane motion. As opposed to the conventional spectrally nonselective navigator, the fat‐selective navigator does not perturb the water–proton magnetization used for proton resonance frequency shift thermometry. This allows the proposed navigator to be placed directly on the target organ for improved motion estimation accuracy. The spectral and spatial selectivity of the proposed navigator pulse is evaluated through simulations and experiments, and the improved slice tracking performance is demonstrated in vivo by tracking experiments on a human kidney and on a human liver. The direct motion estimation provided by the fat‐selective navigator is also shown to enable accurate motion compensated MR‐HIFU therapy of in vivo porcine kidney, including motion compensation of thermometry and beam steering based on the observed three‐dimensional kidney motion. Magn Reson Med, 2011. © 2011 Wiley‐Liss, Inc.     

Rapid freehand MR‐guided percutaneous needle interventions: An image‐based approach to improve workflow and feasibility

Purpose:

To develop and evaluate software‐based methods for improving the workflow of magnetic resonance (MR)‐guided percutaneous interventions.

Materials and Methods:

A set of methods was developed that allows the user to: 1) plan an entire procedure, 2) directly apply this plan to skin entry site localization without further imaging, and 3) place a needle under real‐time MR guidance with automatic alignment of three orthogonal slices along a planned trajectory with preference to the principal patient axes. To validate targeting accuracy and time, phantom experiments (96 targets) and in vivo paraspinal and kidney needle punctures in two pigs (55 targets) were performed. The influence of trajectory obliquity, level of experience, and organ motion on targeting accuracy and time was analyzed.

Results:

Mean targeting error was 1.8 ± 0.9 mm (in vitro) and 2.9 ± 1.0 mm (in vivo) in all directions. No statistically significant differences in targeting accuracy between single‐ and double‐oblique trajectories, novice and expert users, or paraspinal and kidney punctures were observed. The average time (in vivo) from trajectory planning to verification of accurate needle placement was 6 minutes.

Conclusion:

The developed methods allow for accurate needle placement along complex trajectories and are anticipated to reduce table time for MR‐guided percutaneous needle interventions. J. Magn. Reson. Imaging 2013;37:1202–1212. © 2013 Wiley Periodicals, Inc.     

Diffusion‐weighted imaging of the liver: Comparison of navigator triggered and breathhold acquisitions

Purpose

To compare a free breathing navigator triggered single shot echoplanar imaging (SS EPI) diffusion‐weighted imaging (DWI) sequence with prospective acquisition correction (PACE) with a breathhold (BH) DWI sequence for liver imaging.

Materials and Methods

Thirty‐four patients were evaluated with PACE‐DWI and BH DWI of the liver using b‐values of 0, 50, and 500 s/mm². There were 29 focal liver lesions in 18 patients. Qualitative evaluation was performed on a 3‐point scale ( 1 - 3 ) by two independent observers (maximum score 9). Quantitative evaluation included estimated SNR (signal to noise ratio), lesion‐to‐liver contrast ratio, liver and lesion apparent diffusion coefficients (ADCs), and coefficient of variation (CV) of ADC in liver parenchyma and focal liver lesions (estimate of noise contamination in ADC).

Results

PACE‐DWI showed significantly better image quality, higher SNR and lesion‐to‐liver contrast ratio when compared with BH DWI. ADCs of liver and focal lesions with both sequences were significantly correlated (r = 0.838 for liver parenchyma, and 0.904 for lesions, P < 0.0001), but lower with the BH sequence (P < 0.02). There was higher noise contamination in ADC measurement obtained with BH DWI (with a significantly higher SD and CV of ADC).

Conclusion

The use of a navigator echo to trigger SS EPI DWI improves image quality and liver to lesion contrast, and enables a more precise ADC quantification compared with BH DWI acquisition. J. Magn. Reson. Imaging 2009;30:561–568. © 2009 Wiley‐Liss, Inc.     

Toward MR-guided high intensity focused ultrasound for presurgical localization: focused ultrasound lesions in cadaveric breast tissue

Purpose:

To investigate magnetic resonance image‐guided high intensity focused ultrasound (MR‐HIFU) as a surgical guide for nonpalpable breast tumors by assessing the palpability of MR‐HIFU‐created lesions in ex vivo cadaveric breast tissue.

Materials and Methods:

MR‐HIFU ablations spaced 5 mm apart were made in 18 locations using the ExAblate2000 system. Ablations formed a square perimeter in mixed adipose and fibroglandular tissue. Ablation was monitored using T1‐weighted fast spin echo images. MR‐acoustic radiation force impulse (MR‐ARFI) was used to remotely palpate each ablation location, measuring tissue displacement before and after thermal sonications. Displacement profiles centered at each ablation spot were plotted for comparison. The cadaveric breast was manually palpated to assess stiffness of ablated lesions and dissected for gross examination. This study was repeated on three cadaveric breasts.

Results:

MR‐ARFI showed a collective postablation reduction in peak displacement of 54.8% ([4.41 ± 1.48] μm pre, [1.99 ± 0.82] μm post), and shear wave velocity increase of 65.5% ([10.69 ± 1.60] mm pre, [16.33 ± 3.10] mm post), suggesting tissue became stiffer after the ablation. Manual palpation and dissection of the breast showed increased palpability, a darkening of ablation perimeter, and individual ablations were visible in mixed adipose/fibroglandular tissue.

Conclusion:

The results of this preliminary study show MR‐HIFU has the ability to create palpable lesions in ex vivo cadaveric breast tissue, and may potentially be used to preoperatively localize nonpalpable breast tumors. J. Magn. Reson. Imaging 2012;35:1089‐1097. © 2011 Wiley Periodicals, Inc.     

Adapting MRI acoustic radiation force imaging for in vivo human brain focused ultrasound applications

A variety of magnetic resonance imaging acoustic radiation force imaging (MR‐ARFI) pulse sequences as the means for image guidance of focused ultrasound therapy have been recently developed and tested ex vivo and in animal models. To successfully translate MR‐ARFI guidance into human applications, ensuring that MR‐ARFI provides satisfactory image quality in the presence of patient motion and deposits safe amount of ultrasound energy during image acquisition is necessary. The first aim of this work was to study the effect of motion on in vivo displacement images of the brain obtained with 2D Fourier transform spin echo MR‐ARFI. Repeated bipolar displacement encoding configuration was shown less sensitive to organ motion. The optimal signal‐to‐noise ratio of displacement images was found for the duration of encoding gradients of 12 ms. The second aim was to further optimize the displacement signal‐to‐noise ratio for a particular tissue type by setting the time offset between the ultrasound emission and encoding based on the tissue response to acoustic radiation force. A method for measuring tissue response noninvasively was demonstrated. Finally, a new method for simultaneous monitoring of tissue heating during MR‐ARFI acquisition was presented to enable timely adjustment of the ultrasound energy aimed at ensuring the safety of the MR‐ARFI acquisition. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.