Shreyas Vasanawala, MD/PhD

All Publications

• Accelerating cardiac cine MRI using a deep learning-based ESPIRiT reconstruction. Magnetic resonance in medicine Sandino, C. M., Lai, P., Vasanawala, S. S., Cheng, J. Y. 2020

  Abstract

  PURPOSE: To propose a novel combined parallel imaging and deep learning-based reconstruction framework for robust reconstruction of highly accelerated 2D cardiac cine MRI data.METHODS: We propose DL-ESPIRiT, an unrolled neural network architecture that utilizes an extended coil sensitivity model to address SENSE-related field-of-view (FOV) limitations in previously proposed deep learning-based reconstruction frameworks. Additionally, we propose a novel neural network design based on (2+1)D spatiotemporal convolutions to produce more accurate dynamic MRI reconstructions than conventional 3D convolutions. The network is trained on fully sampled 2D cardiac cine datasets collected from 11 healthy volunteers with IRB approval. DL-ESPIRiT is compared against a state-of-the-art parallel imaging and compressed sensing method known as l 1 -ESPIRiT. The reconstruction accuracy of both methods is evaluated on retrospectively undersampled datasets (R=12) with respect to standard image quality metrics as well as automatic deep learning-based segmentations of left ventricular volumes. Feasibility of DL-ESPIRiT is demonstrated on two prospectively undersampled datasets acquired in a single heartbeat per slice.RESULTS: The (2+1)D DL-ESPIRiT method produces higher fidelity image reconstructions when compared to l 1 -ESPIRiT reconstructions with respect to standard image quality metrics (P < .001). As a result of improved image quality, segmentations made from (2+1)D DL-ESPIRiT images are also more accurate than segmentations from l 1 -ESPIRiT images.CONCLUSIONS: DL-ESPIRiT synergistically combines a robust parallel imaging model and deep learning-based priors to produce high-fidelity reconstructions of retrospectively undersampled 2D cardiac cine data acquired with reduced FOV. Although a proof-of-concept is shown, further experiments are necessary to determine the efficacy of DL-ESPIRiT in prospectively undersampled data.

  View details for DOI 10.1002/mrm.28420

  View details for PubMedID 32697891

• Rosette Trajectories Enable Ungated, Motion-Robust, Simultaneous Cardiac and Liver T2 * Iron Assessment. Journal of magnetic resonance imaging : JMRI Bush, A. M., Sandino, C. M., Ramachandran, S., Ong, F., Dwork, N., Zucker, E. J., Syed, A. B., Pauly, J. M., Alley, M. T., Vasanawala, S. S. 2020: e27196

  Abstract

  BACKGROUND: Quantitative T2 * MRI is the standard of care for the assessment of iron overload. However, patient motion corrupts T2 * estimates.PURPOSE: To develop and evaluate a motion-robust, simultaneous cardiac and liver T2 * imaging approach using non-Cartesian, rosette sampling and a model-based reconstruction as compared to clinical-standard Cartesian MRI.STUDY TYPE: Prospective.PHANTOM/POPULATION: Six ferumoxytol-containing phantoms (26-288mug/mL). Eight healthy subjects and 18 patients referred for clinically indicated iron overload assessment.FIELD STRENGTH/SEQUENCE: 1.5T, 2D Cartesian and rosette gradient echo (GRE) ASSESSMENT: GRE T2 * values were validated in ferumoxytol phantoms. In healthy subjects, test-retest and spatial coefficient of variation (CoV) analysis was performed during three breathing conditions. Cartesian and rosette T2 * were compared using correlation and Bland-Altman analysis. Images were rated by three experienced radiologists on a 5-point scale.STATISTICAL TESTS: Linear regression, analysis of variance (ANOVA), and paired Student's t-testing were used to compare reproducibility and variability metrics in Cartesian and rosette scans. The Wilcoxon rank test was used to assess reader score comparisons and reader reliability was measured using intraclass correlation analysis.RESULTS: Rosette R2* (1/T2 *) was linearly correlated with ferumoxytol concentration (r2 = 1.00) and not significantly different than Cartesian values (P = 0.16). During breath-holding, ungated rosette liver and heart T2 * had lower spatial CoV (liver: 18.4±9.3% Cartesian, 8.8%±3.4% rosette, P = 0.02, heart: 37.7%±14.3% Cartesian, 13.4%±1.7% rosette, P = 0.001) and higher-quality scores (liver: 3.3 [3.0-3.6] Cartesian, 4.7 [4.1-4.9] rosette, P = 0.005, heart: 3.0 [2.3-3] Cartesian, 4.5 [3.8-5.0] rosette, P = 0.005) compared to Cartesian values. During free-breathing and failed breath-holding, Cartesian images had very poor to average image quality with significant artifacts, whereas rosette remained very good, with minimal artifacts (P = 0.001).DATA CONCLUSION: Rosette k-sampling with a model-based reconstruction offers a clinically useful motion-robust T2 * mapping approach for iron quantification.

  View details for DOI 10.1002/jmri.27196

  View details for PubMedID 32452088

• Direct measurement of atrioventricular valve regurgitant jets using 4D flow cardiovascular magnetic resonance is accurate and reliable for children with congenital heart disease: a retrospective cohort study. Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance Jacobs, K., Rigdon, J., Chan, F., Cheng, J. Y., Alley, M. T., Vasanawala, S., Maskatia, S. A. 2020; 22 (1): 33

  Abstract

  BACKGROUND: 3D-time resolved flow (4DF) cardiovascular magnetic resonance (CMR) with retrospective analysis of atrioventricular valve regurgitation (AVVR) allows for internal validation by multiple direct and indirect methods. Limited data exist on direct measurement of AVVR by 4DF CMR in pediatric congenital heart disease (CHD). We aimed to validate direct measurement of the AVVR jet as accurate and reliable compared to the volumetric method (clinical standard by 2D CMR) and as a superior method of internal validation than the annular inflow method.METHODS: We identified 44 consecutive patients with diverse CHD referred for evaluation of AVVR by CMR. 1.5T or 3T scanners, intravenous contrast, and a combination of parallel imaging and compressed sensing were used. Four methods of measuring AVVR volume (RVol) were used: volumetric method (VOL; the clinical standard)=stroke volume by 2D balanced steady-state free precession - semilunar valve forward flow (SLFF); annular inflow method (AIM)=atrioventricular valve forward flow [AVFF] - semilunar valve net flow (SLNF); and direct measurement (JET). AVFF was measured using static and retrospective valve tracking planes. SLFF, SLNF, AVFF, and JET were measured by 4DF phase contrast. Regurgitant fraction was calculated as [RVol/(RVol+SLNF)]*100. Statistical methods included Spearman, Wilcoxon rank sum test/Student paired t-test, Bland Altman analysis, and intra-class coefficient (ICC), where appropriate.RESULTS: Regurgitant fraction by JET strongly correlated with the indirect methods (VOL and AIM) (rho=0.73-0.80, p<0.001) and was similar to VOL with a median difference (interquartile range) of -1.5% (-8.3-7.2%; p=0.624). VOL had weaker correlations with AIM and JET (rho=0.69-0.73, p<0.001). AIM underestimated RF by 3.6-6.9% compared to VOL and JET, p<0.03. Intra- and inter- observer reliability were excellent for all methods (ICC 0.94-0.99). The mean (±standard deviation) inter-observer difference for VOL was 2.4% (±5.1%), p<0.05.CONCLUSIONS: In a diverse cohort of pediatric CHD, measurement of AVVR using JET is accurate and reliable to VOL and is a superior method of internal validation compared to AIM. This study supports use of 4DF CMR for measurement of AVVR, obviating need for expert prospective prescription during image acquisition by 2D CMR.

  View details for DOI 10.1186/s12968-020-00612-4

  View details for PubMedID 32404159

• Extreme MRI: Large-scale volumetric dynamic imaging from continuous non-gated acquisitions. Magnetic resonance in medicine Ong, F., Zhu, X., Cheng, J. Y., Johnson, K. M., Larson, P. E., Vasanawala, S. S., Lustig, M. 2020

  Abstract

  PURPOSE: To develop a framework to reconstruct large-scale volumetric dynamic MRI from rapid continuous and non-gated acquisitions, with applications to pulmonary and dynamic contrast-enhanced (DCE) imaging.THEORY AND METHODS: The problem considered here requires recovering 100 gigabytes of dynamic volumetric image data from a few gigabytes of k-space data, acquired continuously over several minutes. This reconstruction is vastly under-determined, heavily stressing computing resources as well as memory management and storage. To overcome these challenges, we leverage intrinsic three-dimensional (3D) trajectories, such as 3D radial and 3D cones, with ordering that incoherently cover time and k-space over the entire acquisition. We then propose two innovations: (a) A compressed representation using multiscale low-rank matrix factorization that constrains the reconstruction problem, and reduces its memory footprint. (b) Stochastic optimization to reduce computation, improve memory locality, and minimize communications between threads and processors. We demonstrate the feasibility of the proposed method on DCE imaging acquired with a golden-angle ordered 3D cones trajectory and pulmonary imaging acquired with a bit-reversed ordered 3D radial trajectory. We compare it with "soft-gated" dynamic reconstruction for DCE and respiratory-resolved reconstruction for pulmonary imaging.RESULTS: The proposed technique shows transient dynamics that are not seen in gating-based methods. When applied to datasets with irregular, or non-repetitive motions, the proposed method displays sharper image features.CONCLUSIONS: We demonstrated a method that can reconstruct massive 3D dynamic image series in the extreme undersampling and extreme computation setting.

  View details for DOI 10.1002/mrm.28235

  View details for PubMedID 32270547

• Invited Commentary: Reducing Sedation and Anesthesia in Pediatric Patients at MRI RADIOGRAPHICS Greer, M. C., Vasanawala, S. S. 2020; 40 (2): 503–4

  View details for DOI 10.1148/rq.2020190211

  View details for Web of Science ID 000518466300018

• Invited Commentary: Reducing Sedation and Anesthesia in Pediatric Patients at MRI. Radiographics : a review publication of the Radiological Society of North America, Inc Greer, M. C., Vasanawala, S. S. 2020: 190211

  View details for DOI 10.1148/rg.2020190211

  View details for PubMedID 32039652

• 4D flow vs. 2D cardiac MRI for the evaluation of pulmonary regurgitation and ventricular volume in repaired tetralogy of Fallot: a retrospective case control study. The international journal of cardiovascular imaging Jacobs, K. G., Chan, F. P., Cheng, J. Y., Vasanawala, S. S., Maskatia, S. A. 2020

  Abstract

  Lengthy exams and breath-holding limit the use of pediatric cardiac MRI (CMR). 3D time-resolved flow MRI (4DF) is a free-breathing, single-sequence exam that obtains magnitude (anatomic) and phase contrast (PC) data. We compare the accuracy of gadobenate dimeglumine-enhanced 4DF on a 1.5T magnet to 2D CMR in children with repaired tetralogy of Fallot (rTOF) to measure pulmonary net flow (PNF) as a reflection of pulmonary regurgitation, forward flow (FF) and ventricular volumetry. Thirty-four consecutive cases were included. 2D PCs were obtained at the valve level. Using 4DF, we measured PNF at the valve and at the main and branch pulmonary arteries. PNF measured at the valve by 4DF demonstrated the strongest correlation (r=0.87, p<0.001) and lowest mean difference (3.5±9.4mL/beat) to aortic net flow (ANF). Semilunar FF and stroke volume of the respective ventricle demonstrated moderate-strong correlation by 4DF (r=0.66-0.81, p<0.001) and strong correlation by 2D (r=0.81-0.84, p<0.001) with similar correlations and mean differences between techniques (p>0.05). Ventricular volumes correlated strongly between 2D and 4DF (r=0.75-0.96, p<0.001), though 4DF overestimated right ventricle volumes by 11.8-19.2mL/beat. Inter-rater reliability was excellent for 2D and 4DF volumetry (ICC=0.91-0.99). Ejection fraction moderately correlated (r=0.60-0.75, p<0.001) with better reliability by 4DF (ICC: 0.80-0.85) than 2D (ICC: 0.69-0.89). 4DF exams were shorter than 2D (9 vs. 71min, p<0.001). 4DF provides highly reproducible and accurate measurements of flow with slight overestimation of RV volumes compared to 2D in pediatric rTOF. 4DF offers important advantages in this population with long-term monitoring needs.

  View details for DOI 10.1007/s10554-019-01751-1

  View details for PubMedID 31894524

• Prospective Deployment of Deep Learning in MRI: A Framework for Important Considerations, Challenges, and Recommendations for Best Practices. Journal of magnetic resonance imaging : JMRI Chaudhari, A. S., Sandino, C. M., Cole, E. K., Larson, D. B., Gold, G. E., Vasanawala, S. S., Lungren, M. P., Hargreaves, B. A., Langlotz, C. P. 2020

  Abstract

  Artificial intelligence algorithms based on principles of deep learning (DL) have made a large impact on the acquisition, reconstruction, and interpretation of MRI data. Despite the large number of retrospective studies using DL, there are fewer applications of DL in the clinic on a routine basis. To address this large translational gap, we review the recent publications to determine three major use cases that DL can have in MRI, namely, that of model-free image synthesis, model-based image reconstruction, and image or pixel-level classification. For each of these three areas, we provide a framework for important considerations that consist of appropriate model training paradigms, evaluation of model robustness, downstream clinical utility, opportunities for future advances, as well recommendations for best current practices. We draw inspiration for this framework from advances in computer vision in natural imaging as well as additional healthcare fields. We further emphasize the need for reproducibility of research studies through the sharing of datasets and software. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 2.

  View details for DOI 10.1002/jmri.27331

  View details for PubMedID 32830874

• Near-Silent and Distortion-Free Diffusion MRI in Pediatric Musculoskeletal Disorders: Comparison With Echo Planar Imaging Diffusion. Journal of magnetic resonance imaging : JMRI Sandberg, J. K., Young, V. A., Syed, A. B., Yuan, J., Hu, Y., Sandino, C., Menini, A., Hargreaves, B., Vasanawala, S. 2020

  Abstract

  Diffusion-weighted imaging (DWI) is common for evaluating pediatric musculoskeletal lesions, but suffers from geometric distortion and intense acoustic noise.To investigate the performance of a near-silent and distortion-free DWI sequence (DW-SD) relative to standard echo-planar DWI (DW-EPI) in pediatric extremity MRI.Prospective validation study.Thirty-nine children referred for extremity MRI.DW-EPI and DW-SD, based on a rotating ultrafast sequence modified with sinusoidal diffusion preparation gradients, at 3T.DW-SD image quality (Sanat ) was assessed from 0 (nondiagnostic) to 5 (outstanding) and comparative image quality (Scomp ) (from -2 = DW-EPI more delineated to +2 = DW-SD more delineated, 0 = same). ADC measured by DW-SD and DW-EPI were compared in bone marrow, muscle, and lesions.Wilcoxon rank-sum test and confidence interval of proportions (CIOP) were calculated for Scomp , Student's t-test, coefficient of variation (COV), and Bland-Altman analysis for ADC values, and intraclass correlation coefficient (ICC) for interreader agreement.DW-SD and DW-EPI ADC values for bone marrow, muscle, and lesions were not significantly different (P = 0.3, P = 0.2, and P = 0.27, respectively) and had an overall ADC COV of 14.8% (95% confidence interval: 12.3%, 16.9%) and no significant proportional bias on Bland-Altman analysis. Sanat CIOP was rated diagnostic or better (score of 3, 4, or 5) in 72-98% of cases for bone marrow, muscle, and soft tissues. DW-SD was equivalent to or preferred over DW-EPI in muscles and soft tissues, with CIOP 86-93% and 93%, respectively. Lesions were equally visualized on DW-SD and DW-EPI in 40-51%, with DW-SD preferred in 44-56% of cases. DW-SD was rated significantly better than DW-EPI across all comparative variables that included bone marrow, muscle, soft tissue, cartilage, and lesions (P < 0.05). Readers had moderate to near-perfect (ICC range = 0.45-0.85).DW-SD of the extremities provided similar ADC values and improved image quality compared with conventional DW-EPI.2 TECHNICAL EFFICACY STAGE: 2.

  View details for DOI 10.1002/jmri.27330

  View details for PubMedID 32815203

• Compressed Sensing: From Research to Clinical Practice With Deep Neural Networks: Shortening Scan Times for Magnetic Resonance Imaging IEEE SIGNAL PROCESSING MAGAZINE Sandino, C. M., Cheng, J. Y., Chen, F., Mardani, M., Pauly, J. M., Vasanawala, S. S. 2020; 37 (1): 117–27

  View details for DOI 10.1109/MSP.2019.2950433

  View details for Web of Science ID 000510210500015

• Compressed Sensing: From Research to Clinical Practice with Deep Neural Networks. IEEE signal processing magazine Sandino, C. M., Cheng, J. Y., Chen, F., Mardani, M., Pauly, J. M., Vasanawala, S. S. 2020; 37 (1): 111–27

  Abstract

  Compressed sensing (CS) reconstruction methods leverage sparse structure in underlying signals to recover high-resolution images from highly undersampled measurements. When applied to magnetic resonance imaging (MRI), CS has the potential to dramatically shorten MRI scan times, increase diagnostic value, and improve overall patient experience. However, CS has several shortcomings which limit its clinical translation such as: 1) artifacts arising from inaccurate sparse modelling assumptions, 2) extensive parameter tuning required for each clinical application, and 3) clinically infeasible reconstruction times. Recently, CS has been extended to incorporate deep neural networks as a way of learning complex image priors from historical exam data. Commonly referred to as unrolled neural networks, these techniques have proven to be a compelling and practical approach to address the challenges of sparse CS. In this tutorial, we will review the classical compressed sensing formulation and outline steps needed to transform this formulation into a deep learning-based reconstruction framework. Supplementary open source code in Python will be used to demonstrate this approach with open databases. Further, we will discuss considerations in applying unrolled neural networks in the clinical setting.

  View details for DOI 10.1109/MSP.2019.2950433

  View details for PubMedID 33192036

  View details for PubMedCentralID PMC7664163

• DIAGNOSTIC IMAGE QUALITY ASSESSMENT AND CLASSIFICATION IN MEDICAL IMAGING: OPPORTUNITIES AND CHALLENGES Ma, J. J., Nakarmi, U., Kin, C., Sandino, C. M., Cheng, J. Y., Syed, A. B., Wei, P., Pauly, J. M., Vasanawala, S. S., IEEE IEEE. 2020: 337–40

  View details for Web of Science ID 000578080300058

• Multi-scale Unrolled Deep Learning Framework for Accelerated Magnetic Resonance Imaging Nakarmi, U., Cheng, J. Y., Rios, E. P., Mardani, M., Pauly, J. M., Ying, L., Vasanawala, S. S., IEEE IEEE. 2020: 1052–55

  View details for Web of Science ID 000578080300214

• Reversal of epigenetic aging and immunosenescent trends in humans. Aging cell Fahy, G. M., Brooke, R. T., Watson, J. P., Good, Z., Vasanawala, S. S., Maecker, H., Leipold, M. D., Lin, D. T., Kobor, M. S., Horvath, S. 2019: e13028

  Abstract

  Epigenetic "clocks" can now surpass chronological age in accuracy for estimating biological age. Here, we use four such age estimators to show that epigenetic aging can be reversed in humans. Using a protocol intended to regenerate the thymus, we observed protective immunological changes, improved risk indices for many age-related diseases, and a mean epigenetic age approximately 1.5years less than baseline after 1year of treatment (-2.5-year change compared to no treatment at the end of the study). The rate of epigenetic aging reversal relative to chronological age accelerated from -1.6year/year from 0-9month to -6.5year/year from 9-12month. The GrimAge predictor of human morbidity and mortality showed a 2-year decrease in epigenetic vs. chronological age that persisted six months after discontinuing treatment. This is to our knowledge the first report of an increase, based on an epigenetic age estimator, in predicted human lifespan by means of a currently accessible aging intervention.

  View details for DOI 10.1111/acel.13028

  View details for PubMedID 31496122

• F-18-FDG PET/MR Refines Evaluation in Newly Diagnosed Metastatic Urethral Adenocarcinoma NUCLEAR MEDICINE AND MOLECULAR IMAGING Laudicella, R., Davidzon, G., Vasanawala, S., Baldari, S., Iagaru, A. 2019; 53 (4): 296–99

  View details for DOI 10.1007/s13139-019-00597-8

  View details for Web of Science ID 000480821000009

• Simultaneous PET/MRI in the Evaluation of Breast and Prostate Cancer Using Combined Na[18F] F and [18F]FDG: a Focus on Skeletal Lesions. Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging Sonni, I., Minamimoto, R., Baratto, L., Gambhir, S. S., Loening, A. M., Vasanawala, S. S., Iagaru, A. 2019

  Abstract

  PURPOSE: The purpose of this study is to prospectively evaluate the performance of sodium 18F]fluoride (Na[18F]F)/2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) simultaneous time-of-flight enabled positron emission tomography (PET)/magnetic resonance imaging (MRI) for the detection of skeletal metastases in selected patients with advanced breast and prostate cancers.PROCEDURE: The institutional review board approved this HIPAA-compliant protocol. Written informed consent was obtained from each patient. A total of 74 patients (23 women and 51 men with breast and prostate cancer, respectively) referred for standard-of-care whole-body bone scintigraphy (WBBS) were enrolled in this prospective study. All patients underwent a [99mTc]methyldiphosphonate ([99mTc]MDP) WBBS followed by Na[18F]F/[18F]FDG PET/MRI. Lesions detected by each imaging modality were tabulated and a lesion-based and patient-based analysis was conducted.RESULTS: On a patient-based analysis, [99mTc]MDP WBBS identified skeletal lesions in 37 patients and PET/MRI in 45 patients. On a lesion-based analysis, WBBS identified a total of 81 skeletal lesions, whereas PET/MRI identified 140 lesions. Additionally, PET/MRI showed extra-skeletal lesions in 19 patients, including lymph nodes (16), prostate (4) lung (3), and liver (2) lesions.CONCLUSIONS: The ability of Na[18F]F/[18F]FDG PET/MRI to identify more skeletal lesions than 99mTc-MDP WBBS and to additionally identify extra-skeletal disease may be beneficial for patient care and represent an alternative to the single modalities performed separately. Na[18F]F/[18F]FDG PET/MRI is a promising approach for evaluation of skeletal and extra-skeletal lesions in a selected population of breast and prostate cancer patients.

  View details for DOI 10.1007/s11307-019-01392-9

  View details for PubMedID 31236756

• Evaluation of the routine use of pelvic MRI in women presenting with symptomatic uterine fibroids: When is pelvic MRI useful? JOURNAL OF MAGNETIC RESONANCE IMAGING Kim-Nhien Vu, Fast, A. M., Shaffer, R. K., Rosenberg, J., Dababou, S., Marrocchio, C., Vasanawala, S. S., Lum, D. A., Chen, B., Hovsepian, D. M., Ghanouni, P. 2019; 49 (7): E271–E281

  View details for DOI 10.1002/jmri.26620

  View details for Web of Science ID 000474612300028

• Targeted rapid knee MRI exam using T-2 shuffling JOURNAL OF MAGNETIC RESONANCE IMAGING Tamir, J. I., Taviani, V., Alley, M. T., Perkins, B. C., Hart, L., O'Brien, K., Wishah, F., Sandberg, J. K., Anderson, M. J., Turek, J. S., Willke, T. L., Lustig, M., Vasanawala, S. S. 2019; 49 (7): E195–E204

  View details for DOI 10.1002/jmri.26600

  View details for Web of Science ID 000474612300019

• How Often is the Dynamic Contrast Enhanced Score Needed in PI-RADS Version 2? Current problems in diagnostic radiology Roh, A. T., Fan, R. E., Sonn, G. A., Vasanawala, S. S., Ghanouni, P., Loening, A. M. 2019

  Abstract

  BACKGROUND: Prostate imaging reporting and data system version 2 (PI-RADS v2) relegates dynamic contrast enhanced (DCE) imaging to a minor role. We sought to determine how often DCE is used in PI-RADS v2 scoring.MATERIALS AND METHODS: We retrospectively reviewed data from 388 patients who underwent prostate magnetic resonance imaging and subsequent biopsy from January 2016 through December 2017. In accordance with PI-RADS v2, DCE was deemed necessary if a peripheral-zone lesion had a diffusion-weighted imaging score of 3, or if a transition-zone lesion had a T2 score of 3 and diffusion-weighted imaging experienced technical failure. Receiver operating characteristic curve analysis assessed the accuracy of prostate-specific antigen density (PSAD) at different threshold values for differentiating lesions that would be equivocal with noncontrast technique. Accuracy of PSAD was compared to DCE using McNemar's test.RESULTS: Sixty-nine lesions in 62 patients (16%) required DCE for PI-RADS scoring. Biopsy of 10 (14%) of these lesions showed clinically significant cancer (Gleason score ≥7). In the subgroup of patients with equivocal lesions, those with clinically significant cancer had significantly higher PSADs than those with clinically insignificant lesions (means of 0.18 and 0.13 ng/mL/mL, respectively; P= 0.038). In this subgroup, there was no statistical difference in accuracy in determining clinically significant cancer between a PSAD threshold value of 0.13 and DCE (P= 0.25).CONCLUSIONS: Only 16% of our patients needed DCE to generate the PI-RADS version 2 score, raising the possibility of limiting the initial screening prostate MRI to a noncontrast exam. PSAD may also be used to further decrease the need for or to replace DCE altogether.

  View details for DOI 10.1067/j.cpradiol.2019.05.008

  View details for PubMedID 31126664

• An MRI Compatible RF MEMs Controlled Wireless Power Transfer System IEEE TRANSACTIONS ON MICROWAVE THEORY AND TECHNIQUES Byron, K., Winkler, S. A., Robb, F., Vasanawala, S., Pauly, J., Scott, G. 2019; 67 (5): 1717–26

  View details for DOI 10.1109/TMTT.2019.2902554

  View details for Web of Science ID 000467528800007

• Evaluation of a Flexible 12-Channel Screen-printed Pediatric MRI Coil RADIOLOGY Winkler, S., Corea, J., Lechene, B., O'Brien, K., Bonanni, J., Chauelhari, A., Alley, M., Taviani, V., Grafendorfer, T., Robb, F., Seem, G., Pauly, J., Lustig, M., Arias, A., Vasanawala, S. 2019; 291 (1): 179–84

  View details for DOI 10.1148/radiol.2019181883

  View details for Web of Science ID 000465222600036

• Evaluation of a Flexible 12-Channel Screen-printed Pediatric MRI Coil. Radiology Winkler, S. A., Corea, J., Lechene, B., O'Brien, K., Bonanni, J. R., Chaudhari, A., Alley, M., Taviani, V., Grafendorfer, T., Robb, F., Scott, G., Pauly, J., Lustig, M., Arias, A. C., Vasanawala, S. 2019: 181883

  Abstract

  Background Screen-printed MRI coil technology may reduce the need for bulky and heavy housing of coil electronics and may provide a better fit to patient anatomy to improve coil performance. Purpose To assess the performance and caregiver and clinician acceptance of a pediatric-sized screen-printed flexible MRI coil array as compared with conventional coil technology. Materials and Methods A pediatric-sized 12-channel coil array was designed by using a screen-printing process. Element coupling and phantom signal-to-noise ratio (SNR) were assessed. Subjects were scanned by using the pediatric printed array between September and November 2017; results were compared with three age- and sex-matched historical control subjects by using a commercial 32-channel cardiac array at 3 T. Caregiver acceptance was assessed by asking nurses, technologists, anesthesiologists, and subjects or parents to rate their coil preference. Diagnostic quality of the images was evaluated by using a Likert scale (5 = high image quality, 1 = nondiagnostic). Image SNR was evaluated and compared. Results Twenty study participants were evaluated with the screen-printed coil (age range, 2 days to 12 years; 11 male and nine female subjects). Loaded pediatric phantom testing yielded similar noise covariance matrices and only slightly degraded SNR for the printed coil as compared with the commercial coil. The caregiver acceptance survey yielded a mean score of 4.1 ± 0.6 (scale: 1, preferred the commercial coil; 5, preferred the printed coil). Diagnostic quality score was 4.5 ± 0.6. Mean image SNR was 54 ± 49 (paraspinal muscle), 78 ± 51 (abdominal wall muscle), and 59 ± 35 (psoas) for the printed coil, as compared with 64 ± 55, 65 ± 48, and 57 ± 43, respectively, for the commercial coil; these SNR differences were not statistically significant (P = .26). Conclusion A flexible screen-printed pediatric MRI receive coil yields adequate signal-to-noise ratio in phantoms and pediatric study participants, with similar image quality but higher preference by subjects and their caregivers when compared with a conventional MRI coil. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Lamb in this issue.

  View details for PubMedID 30806599

• Motion-robust reconstruction of multishot diffusion-weighted images without phase estimation through locally low-rank regularization MAGNETIC RESONANCE IN MEDICINE Hu, Y., Levine, E. G., Tian, Q., Moran, C. J., Wang, X., Taviani, V., Vasanawala, S. S., Mcnab, J. A., Daniel, B. L., Hargreaves, B. A. 2019; 81 (2): 1181–90

  View details for DOI 10.1002/mrm.27488

  View details for Web of Science ID 000462086300038

• Targeted rapid knee MRI exam using T2 shuffling. Journal of magnetic resonance imaging : JMRI Tamir, J. I., Taviani, V., Alley, M. T., Perkins, B. C., Hart, L., O'Brien, K., Wishah, F., Sandberg, J. K., Anderson, M. J., Turek, J. S., Willke, T. L., Lustig, M., Vasanawala, S. S. 2019

  Abstract

  BACKGROUND: MRI is commonly used to evaluate pediatric musculoskeletal pathologies, but same-day/near-term scheduling and short exams remain challenges.PURPOSE: To investigate the feasibility of a targeted rapid pediatric knee MRI exam, with the goal of reducing cost and enabling same-day MRI access.STUDY TYPE: A cost effectiveness study done prospectively.SUBJECTS: Forty-seven pediatric patients.FIELD STRENGTH/SEQUENCE: 3T. The 10-minute protocol was based on T2 Shuffling, a four-dimensional acquisition and reconstruction of images with variable T2 contrast, and a T1 2D fast spin-echo (FSE) sequence. A distributed, compressed sensing-based reconstruction was implemented on a four-node high-performance compute cluster and integrated into the clinical workflow.ASSESSMENT: In an Institutional Review Board-approved study with informed consent/assent, we implemented a targeted pediatric knee MRI exam for assessing pediatric knee pain. Pediatric patients were subselected for the exam based on insurance plan and clinical indication. Over a 2-year period, 47 subjects were recruited for the study and 49 MRIs were ordered. Date and time information was recorded for MRI referral, registration, and completion. Image quality was assessed from 0 (nondiagnostic) to 5 (outstanding) by two readers, and consensus was subsequently reached.STATISTICAL TESTS: A Wilcoxon rank-sum test assessed the null hypothesis that the targeted exam times compared with conventional knee exam times were unchanged.RESULTS: Of the 49 cases, 20 were completed on the same day as exam referral. Median time from registration to exam completion was 18.7 minutes. Median reconstruction time for T2 Shuffling was reduced from 18.9 minutes to 95 seconds using the distributed implementation. Technical fees charged for the targeted exam were one-third that of the routine clinical knee exam. No subject had to return for additional imaging.DATA CONCLUSION: The targeted knee MRI exam is feasible and reduces the imaging time, cost, and barrier to same-day MRI access for pediatric patients.LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2019.

  View details for PubMedID 30637847

• Evaluation of the routine use of pelvic MRI in women presenting with symptomatic uterine fibroids: When is pelvic MRI useful? Journal of magnetic resonance imaging : JMRI Vu, K., Fast, A. M., Shaffer, R. K., Rosenberg, J., Dababou, S., Marrocchio, C., Vasanawala, S. S., Lum, D. A., Chen, B., Hovsepian, D. M., Ghanouni, P. 2019

  Abstract

  BACKGROUND: Pelvic ultrasound (US) diagnosis of uterine fibroids may overlook coexisting gynecological conditions that contribute to women's symptoms.PURPOSE: To determine the added value of pelvic MRI for women diagnosed with symptomatic fibroids by US, and to identify clinical factors associated with additional MRI findings.STUDY TYPE: Retrospective observational study.POPULATION: In all, 367 consecutive women with fibroids diagnosed by US and referred to our multidisciplinary fibroid center between 2013-2017.FIELD STRENGTH/SEQUENCE: All patients had both pelvic US and MRI prior to their consultations. MRIs were performed at 1.5 T or 3 T and included multiplanar T2 -weighted sequences, and precontrast and postcontrast T1 -weighted imaging.ASSESSMENT: Demographics, symptoms, uterine fibroid symptom severity scores, and health-related quality of life scores, as well as imaging findings were evaluated.STATISTICAL TESTS: Patients were separated into two subgroups according to whether MRI provided additional findings to the initial US. Univariate and multivariate regression analyses were performed.RESULTS: Pelvic MRI provided additional information in 162 patients (44%; 95% confidence interval [CI] 39-49%). The most common significant findings were adenomyosis (22%), endometriosis (17%), and partially endocavitary fibroids (15%). Women with pelvic pain, health-related quality of life scores less than 30 out of 100, or multiple fibroids visualized on US had greater odds of additional MRI findings (odds ratio [OR] 1.68, 2.26, 1.63; P = 0.02, 0.004, 0.03, respectively), while nulliparous women had reduced odds (OR 0.55, P = 0.01). Patients with additional MRI findings were treated less often with uterine fibroid embolization (14% vs. 36%, P < 0.001) or MR-guided focused US (1% vs. 5%, P = 0.04), and more often with medical management (17% vs. 8%, P = 0.01).DATA CONCLUSION: Pelvic MRI revealed additional findings in more than 40% of women presenting with symptoms initially ascribed to fibroids by US. Further evaluation using MRI is particularly useful for parous women with pelvic pain, poor quality of life scores, and/or multiple fibroids.LEVEL OF EVIDENCE: 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019.

  View details for PubMedID 30614145

• Data-driven self-calibration and reconstruction for non-cartesian wave-encoded single-shot fast spin echo using deep learning. Journal of magnetic resonance imaging : JMRI Chen, F., Cheng, J. Y., Taviani, V., Sheth, V. R., Brunsing, R. L., Pauly, J. M., Vasanawala, S. S. 2019

  Abstract

  Current self-calibration and reconstruction methods for wave-encoded single-shot fast spin echo imaging (SSFSE) requires long computational time, especially when high accuracy is needed.To develop and investigate the clinical feasibility of data-driven self-calibration and reconstruction of wave-encoded SSFSE imaging for computation time reduction and quality improvement.Prospective controlled clinical trial.With Institutional Review Board approval, the proposed method was assessed on 29 consecutive adult patients (18 males, 11 females, range, 24-77 years).A wave-encoded variable-density SSFSE sequence was developed for clinical 3.0T abdominal scans to enable 3.5× acceleration with full-Fourier acquisitions. Data-driven calibration of wave-encoding point-spread function (PSF) was developed using a trained deep neural network. Data-driven reconstruction was developed with another set of neural networks based on the calibrated wave-encoding PSF. Training of the calibration and reconstruction networks was performed on 15,783 2D wave-encoded SSFSE abdominal images.Image quality of the proposed data-driven approach was compared independently and blindly with a conventional approach using iterative self-calibration and reconstruction with parallel imaging and compressed sensing by three radiologists on a scale from -2 to 2 for noise, contrast, sharpness, artifacts, and confidence. Computation time of these two approaches was also compared.Wilcoxon signed-rank tests were used to compare image quality and two-tailed t-tests were used to compare computation time with P values of under 0.05 considered statistically significant.An average 2.1-fold speedup in computation was achieved using the proposed method. The proposed data-driven self-calibration and reconstruction approach significantly reduced the perceived noise level (mean scores 0.82, P < 0.0001).The proposed data-driven calibration and reconstruction achieved twice faster computation with reduced perceived noise, providing a fast and robust self-calibration and reconstruction for clinical abdominal SSFSE imaging.1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019.

  View details for DOI 10.1002/jmri.26871

  View details for PubMedID 31322799

• 18F-FDG PET/MR Refines Evaluation in Newly Diagnosed Metastatic Urethral Adenocarcinoma. Nuclear medicine and molecular imaging Laudicella, R., Davidzon, G., Vasanawala, S., Baldari, S., Iagaru, A. 2019; 53 (4): 296–99

  Abstract

  We described the clinical impact of 18F-FDG PET/MR in refining the evaluation of a 39-year-old female with newly diagnosed metastatic urethral adenocarcinoma. We detailed the diagnostic imaging workup focusing our attention on the CT, MR, and 18F-FDG PET/MR different findings. In this case, 18F-FDG PET/MR imaging evaluation resulted not only effective but also altered staging and spared additional invasive procedures in the assessment of a metastatic urethral adenocarcinoma. Combining a highly sensitive PET with the increase tissue resolution of MR (PET/MR) may improve abdominal and pelvic lesion detection outperforming PET/CT for this indication.

  View details for DOI 10.1007/s13139-019-00597-8

  View details for PubMedID 31456863

  View details for PubMedCentralID PMC6694445

• An MRI Compatible RF MEMs Controlled Wireless Power Transfer System. IEEE transactions on microwave theory and techniques Byron, K., Winkler, S. A., Robb, F., Vasanawala, S., Pauly, J., Scott, G. 2019; 67 (5): 1717–26

  Abstract

  In magnetic resonance imaging (MRI), wearable wireless receive coil arrays are a key technology goal. An MRI compatible wireless power transfer (WPT) system will be needed to realize this technology. An MRI WPT system must withstand the extreme electromagnetic environment of the scanner and cannot degrade MRI image quality. Here, a WPT system is developed for operation in MRI scanners using new microelectromechanical RF switch (RF MEMs) technology. The WPT system includes a class-E power amplifier, RF MEMs automated impedance matching, a primary coil array employing RF MEMs power steering, and a flexible secondary coil with class E rectification. To adapt WPT technology to MRI, techniques are developed for operation at high magnetic field, and to mitigate the RF interactions between the scanner and WPT system. A major challenge was the identification and suppression of noise and harmonic interference, by gating, filtering, and rectifier topologies. The system can achieve 63% efficiency while exceeding 13 W delivery over a coil distance of 3.5 cm. For continuous WPT beyond 5W, added filters and full-wave class E rectification lowers harmonic generation at some cost to efficiency, while image SNR reaches about 32% of the ideal. RF-gated WPT, which interrupts power transfer in the MRI signal acquisition interval, achieves SNR performance to within 1 dB of the ideal. With further refinement, the inclusion of WPT technology in MRI scanners appears completely feasible.

  View details for DOI 10.1109/TMTT.2019.2902554

  View details for PubMedID 31423023

  View details for PubMedCentralID PMC6696940

• Deep Generative Adversarial Neural Networks for Compressive Sensing MRI IEEE TRANSACTIONS ON MEDICAL IMAGING Mardani, M., Gong, E., Cheng, J. Y., Vasanawala, S. S., Zaharchuk, G., Xing, L., Pauly, J. M. 2019; 38 (1): 167–79

  Abstract

  Undersampled magnetic resonance image (MRI) reconstruction is typically an ill-posed linear inverse task. The time and resource intensive computations require tradeoffs between accuracy and speed. In addition, state-of-the-art compressed sensing (CS) analytics are not cognizant of the image diagnostic quality. To address these challenges, we propose a novel CS framework that uses generative adversarial networks (GAN) to model the (low-dimensional) manifold of high-quality MR images. Leveraging a mixture of least-squares (LS) GANs and pixel-wise l1/l2 cost, a deep residual network with skip connections is trained as the generator that learns to remove the aliasing artifacts by projecting onto the image manifold. The LSGAN learns the texture details, while the l1/l2 cost suppresses high-frequency noise. A discriminator network, which is a multilayer convolutional neural network (CNN), plays the role of a perceptual cost that is then jointly trained based on high-quality MR images to score the quality of retrieved images. In the operational phase, an initial aliased estimate (e.g., simply obtained by zero-filling) is propagated into the trained generator to output the desired reconstruction. This demands a very low computational overhead. Extensive evaluations are performed on a large contrast-enhanced MR dataset of pediatric patients. Images rated by expert radiologists corroborate that GANCS retrieves higher quality images with improved fine texture details compared with conventional Wavelet-based and dictionary-learning-based CS schemes as well as with deep-learning-based schemes using pixel-wise training. In addition, it offers reconstruction times of under a few milliseconds, which are two orders of magnitude faster than the current state-of-the-art CS-MRI schemes.

  View details for DOI 10.1109/TMI.2018.2858752

  View details for Web of Science ID 000455110500017

  View details for PubMedID 30040634

• Deep residual network for off-resonance artifact correction with application to pediatric body MRA with 3D cones. Magnetic resonance in medicine Zeng, D. Y., Shaikh, J., Holmes, S., Brunsing, R. L., Pauly, J. M., Nishimura, D. G., Vasanawala, S. S., Cheng, J. Y. 2019

  Abstract

  To enable rapid imaging with a scan time-efficient 3D cones trajectory with a deep-learning off-resonance artifact correction technique.A residual convolutional neural network to correct off-resonance artifacts (Off-ResNet) was trained with a prospective study of pediatric MRA exams. Each exam acquired a short readout scan (1.18 ms ± 0.38) and a long readout scan (3.35 ms ± 0.74) at 3 T. Short readout scans, with longer scan times but negligible off-resonance blurring, were used as reference images and augmented with additional off-resonance for supervised training examples. Long readout scans, with greater off-resonance artifacts but shorter scan time, were corrected by autofocus and Off-ResNet and compared with short readout scans by normalized RMS error, structural similarity index, and peak SNR. Scans were also compared by scoring on 8 anatomical features by two radiologists, using analysis of variance with post hoc Tukey's test and two one-sided t-tests. Reader agreement was determined with intraclass correlation.The total scan time for long readout scans was on average 59.3% shorter than short readout scans. Images from Off-ResNet had superior normalized RMS error, structural similarity index, and peak SNR compared with uncorrected images across ±1 kHz off-resonance (P < .01). The proposed method had superior normalized RMS error over -677 Hz to +1 kHz and superior structural similarity index and peak SNR over ±1 kHz compared with autofocus (P < .01). Radiologic scoring demonstrated that long readout scans corrected with Off-ResNet were noninferior to short readout scans (P < .05).The proposed method can correct off-resonance artifacts from rapid long-readout 3D cones scans to a noninferior image quality compared with diagnostically standard short readout scans.

  View details for DOI 10.1002/mrm.27825

  View details for PubMedID 31115936

• Near-silent distortionless DWI using magnetization-prepared RUFIS. Magnetic resonance in medicine Yuan, J., Hu, Y., Menini, A., Sandino, C. M., Sandberg, J., Sheth, V., Moran, C. J., Alley, M., Lustig, M., Hargreaves, B., Vasanawala, S. 2019

  Abstract

  To develop a near-silent and distortionless DWI (sd-DWI) sequence using magnetization-prepared rotating ultrafast imaging sequence.A rotating ultrafast imaging sequence was modified with driven-equilibrium diffusion preparation, including eddy-current compensation methods. To compensate for the T1 recovery during readout, a phase-cycling method was used. Both compensation methods were validated in phantoms. The optimized sequence was compared with an EPI diffusion sequence for image distortion, contrast, ADC, and acoustic noise level in phantoms. The sequence was evaluated in 1 brain volunteer, 5 prostate volunteers, and 10 pediatric patients with joint diseases.Combination of several eddy-current compensation methods reduced the artifact to an acceptable level. Phase cycling reduced T1 recovery contamination during readout. In phantom scans, the optimized sequence generated similar image contrast to the EPI diffusion sequence, and ADC maps between the sequences were comparable; sd-DWI had significantly lower acoustic noise (P < .05). In vivo brain scan showed reduced image distortion in sd-DWI compared with the EPI diffusion, although residual motion artifact remains due to brain pulsation. The prostate scans showed that sd-DWI can provide similar ADC compared with EPI diffusion, with no image distortion. Patient scans showed that the sequence can clearly depict joint lesions.An sd-DWI sequence was developed and optimized. Compared with conventional EPI diffusion, sd-DWI provided similar diffusion contrast, accurate ADC measurement, improved image quality, and minimal ambient scanning noise. The sequence showed the ability to obtain in vivo diffusion contrast in relatively motion-free body regions, such as prostate and joint.

  View details for DOI 10.1002/mrm.28106

  View details for PubMedID 31782557

• Unsupervised clustering method to convert high-resolution magnetic resonance volumes to three-dimensional acoustic models for full-wave ultrasound simulations. Journal of medical imaging (Bellingham, Wash.) Looby, K., Herickhoff, C. D., Sandino, C., Zhang, T., Vasanawala, S., Dahl, J. J. 2019; 6 (3): 037001

  Abstract

  Simulations of acoustic wave propagation, including both the forward and the backward propagations of the wave (also known as full-wave simulations), are increasingly utilized in ultrasound imaging due to their ability to more accurately model important acoustic phenomena. Realistic anatomic models, particularly those of the abdominal wall, are needed to take full advantage of the capabilities of these simulation tools. We describe a method for converting fat-water-separated magnetic resonance imaging (MRI) volumes to anatomical models for ultrasound simulations. These acoustic models are used to map acoustic imaging parameters, such as speed of sound and density, to grid points in an ultrasound simulation. The tissues of these models are segmented from the MRI volumes into five primary classes of tissue in the human abdominal wall (skin, fat, muscle, connective tissue, and nontissue). This segmentation is achieved using an unsupervised machine learning algorithm, fuzzy c-means clustering (FCM), on a multiscale feature representation of the MRI volumes. We describe an automated method for utilizing FCM weights to produce a model that achieves ∼ 90 % agreement with manual segmentation. Two-dimensional (2-D) and three-dimensional (3-D) full-wave nonlinear ultrasound simulations are conducted, demonstrating the utility of realistic 3-D abdominal wall models over previously available 2-D abdominal wall models.

  View details for DOI 10.1117/1.JMI.6.3.037001

  View details for PubMedID 31338389

  View details for PubMedCentralID PMC6643101

• View-Sharing Artifact Reduction With Retrospective Compressed Sensing Reconstruction in the Context of Contrast-Enhanced Liver MRI for Hepatocellular Carcinoma (HCC) Screening. Journal of magnetic resonance imaging : JMRI Shaikh, J., Stoddard, P. B., Levine, E. G., Roh, A. T., Saranathan, M., Chang, S. T., Muelly, M. C., Hargreaves, B. A., Vasanawala, S. S., Loening, A. M. 2018

  Abstract

  BACKGROUND: View-sharing (VS) increases spatiotemporal resolution in dynamic contrast-enhanced (DCE) MRI by sharing high-frequency k-space data across temporal phases. This temporal sharing results in respiratory motion within any phase to propagate artifacts across all shared phases. Compressed sensing (CS) eliminates the need for VS by recovering missing k-space data from pseudorandom undersampling, reducing temporal blurring while maintaining spatial resolution.PURPOSE: To evaluate a CS reconstruction algorithm on undersampled DCE-MRI data for image quality and hepatocellular carcinoma (HCC) detection.STUDY TYPE: Retrospective.SUBJECTS: Fifty consecutive patients undergoing MRI for HCC screening (29 males, 21 females, 52-72 years).FIELD STRENGTH/SEQUENCE: 3.0T MRI. Multiphase 3D-SPGR T1 -weighted sequence undersampled in arterial phases with a complementary Poisson disc sampling pattern reconstructed with VS and CS algorithms.ASSESSMENT: VS and CS reconstructions evaluated by blinded assessments of image quality and anatomic delineation on Likert scales (1-4 and 1-5, respectively), and HCC detection by OPTN/UNOS criteria including a diagnostic confidence score (1-5). Blinded side-by-side reconstruction comparisons for lesion depiction and overall series preference (-3-3).STATISTICAL ANALYSIS: Two-tailed Wilcoxon signed rank tests for paired nonparametric analyses with Bonferroni-Holm multiple-comparison corrections. McNemar's test for differences in lesion detection frequency and transplantation eligibility.RESULTS: CS compared with VS demonstrated significantly improved contrast (mean 3.6 vs. 2.9, P<0.0001) and less motion artifact (mean 3.6 vs. 3.2, P=0.006). CS compared with VS demonstrated significantly improved delineations of liver margin (mean 4.5 vs. 3.8, P=0.0002), portal veins (mean 4.5 vs. 3.7, P<0.0001), and hepatic veins (mean 4.6 vs. 3.5, P<0.0001), but significantly decreased delineation of hepatic arteries (mean 3.2 vs. 3.7, P=0.004). No significant differences were seen in the other assessments.DATA CONCLUSION: Applying a CS reconstruction to data acquired for a VS reconstruction significantly reduces motion artifacts in a clinical DCE protocol for HCC screening.LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.

  View details for PubMedID 30390358

• Variable-Density Single-Shot Fast Spin-Echo MRI with Deep Learning Reconstruction by Using Variational Networks RADIOLOGY Chen, F., Taviani, V., Malkiel, I., Cheng, J. Y., Tamir, J. I., Shaikh, J., Chang, S. T., Hardy, C. J., Pauly, J. M., Vasanawala, S. S. 2018; 289 (2): 366–73

  View details for DOI 10.1148/radiol.2018180445

  View details for Web of Science ID 000447652300015

• Motion-robust reconstruction of multishot diffusion-weighted images without phase estimation through locally low-rank regularization. Magnetic resonance in medicine Hu, Y., Levine, E. G., Tian, Q., Moran, C. J., Wang, X., Taviani, V., Vasanawala, S. S., McNab, J. A., Daniel, B. A., Hargreaves, B. L. 2018

  Abstract

  PURPOSE: The goal of this work is to propose a motion robust reconstruction method for diffusion-weighted MRI that resolves shot-to-shot phase mismatches without using phase estimation.METHODS: Assuming that shot-to-shot phase variations are slowly varying, spatial-shot matrices can be formed using a local group of pixels to form columns, in which each column is from a different shot (excitation). A convex model with a locally low-rank constraint on the spatial-shot matrices is proposed. In vivo brain and breast experiments were performed to evaluate the performance of the proposed method.RESULTS: The proposed method shows significant benefits when the motion is severe, such as for breast imaging. Furthermore, the resulting images can be used for reliable phase estimation in the context of phase-estimation-based methods to achieve even higher image quality.CONCLUSION: We introduced the shot-locally low-rank method, a reconstruction technique for multishot diffusion-weighted MRI without explicit phase estimation. In addition, its motion robustness can be beneficial to neuroimaging and body imaging.

  View details for PubMedID 30346058

• 4D Flow MRI Quantification of Mitral and Tricuspid Regurgitation: Reproducibility and Consistency Relative to Conventional MRI JOURNAL OF MAGNETIC RESONANCE IMAGING Feneis, J. F., Kyubwa, E., Atianzar, K., Cheng, J. Y., Alley, M. T., Vasanawala, S. S., Demaria, A. N., Hsiao, A. 2018; 48 (4): 1147–58

  Abstract

  In patients with mitral or tricuspid valve regurgitation, evaluation of regurgitant severity is essential for determining the need for surgery. While transthoracic echocardiography is widely accessible, it has limited reproducibility for grading inlet valve regurgitation. Multiplanar cardiac MRI is the quantitative standard but requires specialized local expertise, and is thus not widely available. Volumetric 4D flow MRI has potential for quantitatively grading the severity of inlet valve regurgitation in adult patients.To evaluate the accuracy and reproducibility of volumetric 4D flow MRI for quantification of inlet valvular regurgitation compared to conventional multiplanar MRI, which may simplify and improve accessibility of cardiac MRI.This retrospective, HIPAA-compliant imaging-based comparison study was conducted at a single institution.Twenty-one patients who underwent concurrent multiplanar and 4D flow cardiac MRI between April 2015 and January 2017.3T; steady-state free-precession (SSFP), 2D phase contrast (2D-PC), and postcontrast 4D flow.We evaluated the intertechnique (4D flow vs. 2D-PC), intermethod (direct vs. indirect measurement), interobserver and intraobserver reproducibility of measurements of regurgitant flow volume (RFV), fraction (RF), and volume (RVol).Statistical analysis included Pearson correlation, Bland-Altman statistics, and intraclass correlation coefficients.There was high concordance between 4D flow and multiplanar MRI, whether using direct or indirect methods of quantifying regurgitation (r = 0.813-0.985). Direct interrogation of the regurgitant jet with 4D flow showed high intraobserver consistency (r = 0.976-0.999) and interobserver consistency (r = 0.861-0.992), and correlated well with traditional indirect measurements obtained as the difference between stroke volume and forward outlet valve flow.4D flow MRI provides highly reproducible measurements of mitral and tricuspid regurgitant volume, and may be used in place of conventional multiplanar MRI.4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1147-1158.

  View details for DOI 10.1002/jmri.26040

  View details for Web of Science ID 000446539100027

  View details for PubMedID 29638024

• Evaluation of atrial septal defects with 4D flow MRI-multilevel and inter-reader reproducibility for quantification of shunt severity. Magma (New York, N.Y.) Chelu, R. G., Horowitz, M., Sucha, D., Kardys, I., Ingremeau, D., Vasanawala, S., Nieman, K., Paul, J., Hsiao, A. 2018

  Abstract

  PURPOSE: With the hypothesis that 4D flow can be used in evaluation of cardiac shunts, we seek to evaluate the multilevel and interreader reproducibility of measurements of the blood flow, shunt fraction and shunt volume in patients with atrial septum defect (ASD) in practice at multiple clinical sites.MATERIALS AND METHODS: Four-dimensional flow MRI examinations were performed at four institutions across Europe and the US. Twenty-nine patients (mean age, 43years; 11 male) were included in the study. Flow measurements were performed at three levels (valve, main artery and periphery) in both the pulmonary and systemic circulation by two independent readers and compared against stroke volumes from 4D flow anatomic data. Further, the shunt ratio (Qp/Qs) was calculated. Additionally, shunt volume was quantified at the atrial level by tracking the atrial septum.RESULTS: Measurements of the pulmonary blood flow at multiple levels correlate well whether measuring at the valve, main pulmonary artery or branch pulmonary arteries (r=0.885-0.886). Measurements of the systemic blood flow show excellent correlation, whether measuring at the valve, ascending aorta or sum of flow from the superior vena cava (SVC) and descending aorta (r=0.974-0.991). Intraclass agreement between the two observers for the flow measurements varies between 0.96 and 0.99. Compared with stroke volume, pulmonic flow is underestimated with 0.26l/min at the main pulmonary artery level, and systemic flow is overestimated with 0.16l/min at the ascending aorta level. Direct measurements of ASD flow are feasible in 20 of 29 (69%) patients.CONCLUSION: Blood flow and shunt quantification measured at multiple levels and performed by different readers are reproducible and consistent with 4D flow MRI.

  View details for DOI 10.1007/s10334-018-0702-z

  View details for PubMedID 30171383

• Volumetric segmentation-free method for rapid visualization of vascular wall shear stress using 4D flow MRI MAGNETIC RESONANCE IN MEDICINE Masutani, E. M., Contijoch, F., Kyubwa, E., Cheng, J., Alley, M. T., Vasanawala, S., Hsiao, A. 2018; 80 (2): 748–55

  Abstract

  To develop a rapid segmentation-free method to visualize and compute wall shear stress (WSS) throughout the aorta using 4D Flow MRI data. WSS is the drag force-per-area the vessel endothelium exerts on luminal blood; abnormal levels of WSS are associated with cardiovascular pathologies. Previous methods for computing WSS are bottlenecked by labor-intensive manual segmentation of vessel boundaries. A rapid automated segmentation-free method for computing WSS is presented.Shear stress is the dot-product of the viscous stress tensor and the inward normal vector. The inward normal vectors are approximated as the gradient of fluid speed at every voxel. Subsequently, a 4D map of shear stress is computed as the partial derivatives of velocity with respect to the inward normal vectors. We highlight the shear stress near the wall by fusing visualization with edge-emphasized anatomical data.As a proof-of-concept, four cases with aortic pathologies are presented. Visualization allows for rapid localization of pathologic WSS. Subsequent analysis of these pathological regions enables quantification of WSS. Average WSS during peak systole measures approximately 50-60 cPa in nonpathological regions of the aorta and is elevated in regions of stenosis, coarctation, and dissection. WSS is reduced in regions of aneurysm.A volumetric technique for calculation and visualization of WSS from 4D Flow MRI data is presented. Traditional labor-intensive methods for WSS rely on explicit manual segmentation of vessel boundaries before visualization. This automated volumetric strategy for visualization and quantification of WSS may facilitate its clinical translation.

  View details for PubMedID 29516632

  View details for PubMedCentralID PMC5910222

• Conical ultrashort echo time (UTE) MRI in the evaluation of pediatric acute appendicitis. Abdominal radiology (New York) Roh, A. T., Xiao, Z., Cheng, J. Y., Vasanawala, S. S., Loening, A. M. 2018

  Abstract

  PURPOSE: Magnetic resonance imaging (MRI) sequences with conical k-space trajectories are able to decrease motion artifacts while achieving ultrashort echo times (UTE). We assessed the performance of free-breathing conical UTE MRI in the evaluation of the pediatric pelvis for suspected appendicitis.METHODS: Our retrospective review of 84 pediatric patients who underwent MRI for suspected appendicitis compared three contrast-enhanced sequences: free-breathing conical UTE, breath-hold three-dimensional (3D) spoiled gradient echo (BH-SPGR), and free-breathing high-resolution 3D SPGR (FB-SPGR). Two radiologists performed blinded and independent evaluations of each sequence for image quality (four point scale), anatomic delineation (four point scale), and diagnostic confidence (five point scale). Subsequently, the three sequences were directly compared for overall image quality (-3 to +3 scale). Scores were compared using Kruskal-Wallis and Wilcoxon signed-rank tests.RESULTS: UTE demonstrated significantly better perceived signal-to-noise ratio (SNR) and fewer artifacts than BH-SPGR and FB-SPGR (means of 3.6 and 3.4, 3.4 and 3.2, 3.1 and 2.7, respectively; p<0.0006). BH-SPGR and FB-SPGR demonstrated significantly better contrast than UTE (means of 3.6, 3.4, and 3.2, respectively; p<0.03). In the remaining categories, UTE performed significantly better than FB-SPGR (p<0.00001), while there was no statistical difference between UTE and BH-SPGR. Direct paired comparisons of overall image quality demonstrated the readers significantly preferred UTE over both BH-SPGR (mean +0.5, p<0.00001) and FB-SPGR (mean +1.2, p<0.00001).CONCLUSIONS: In the evaluation of suspected appendicitis, free-breathing conical UTE MRI performed better in the assessed metrics than FB-SPGR. When compared to BH-SPGR, UTE demonstrated superior perceived SNR and fewer artifacts.

  View details for PubMedID 30066168

• 18F-florbetaben whole-body PET/MRI for evaluation of systemic amyloid deposition. EJNMMI research Baratto, L., Park, S. Y., Hatami, N., Gulaka, P., Vasanawala, S., Yohannan, T. K., Herfkens, R., Witteles, R., Iagaru, A. 2018; 8 (1): 66

  Abstract

  BACKGROUND: Florbetaben, a 18F-labeled stilbene derivative (Neuraceq, formerly known as BAY-949172), is a diagnostic radiopharmaceutical developed to visualize beta-amyloid plaques in the brain. Here, we report a pilot study evaluating patients with suspected cardiac amyloidosis for systemic extent of disease.METHODS: We prospectively enrolled nine patients, 61-86year old (mean±SD 69.4±8.6), referred from the cardiac amyloid clinic. First, dynamic imaging of the heart was acquired immediately after injection of 222-318.2MBq (mean±SD 270.1±33.3) of 18F-florbetaben using the GE SIGNA PET/MRI. This was followed by a whole-body PET/MRI scan 60-146.4min (mean±SD 98±33.4) after injection. Cardiac MRI sequences included ECG-triggered cine SSFP, T2-weighted, and late gadolinium-enhanced imaging. Whole-body MRI sequences included MRAC and axial T1-weighted imaging.RESULTS: High early uptake and delayed high uptake in the left ventricle correlated with amyloid deposition in five patients, while low uptake on early and delayed cardiac imaging was noted in four patients. Cardiac function measurements were successfully obtained in all participants. Areas of increased abnormal 18F-florbetaben accumulation were noted on delayed whole-body imaging in the bone marrow (seven patients), stomach (diffuse in five patients and focal in one patient), brain (five patients), salivary glands (three patients), tongue (three patients), spleen (three patients), skeletal muscles (three patients), ocular muscles (two patients), thyroid (two patients), pleura (two patients), kidneys (two patients), and lungs (two patients).CONCLUSIONS: Whole-body 18F-florbetaben PET/MRI is promising for localization of systemic amyloid deposition. This technique may provide important structural and functional information regarding the organs involved by disease, with potential to guide biopsy and evaluate response to treatment.TRIAL REGISTRATION: Clinicaltrials.gov registration: NCT03119558 .

  View details for PubMedID 30043115

• Variable-Density Single-Shot Fast Spin-Echo MRI with Deep Learning Reconstruction by Using Variational Networks. Radiology Chen, F., Taviani, V., Malkiel, I., Cheng, J. Y., Tamir, J. I., Shaikh, J., Chang, S. T., Hardy, C. J., Pauly, J. M., Vasanawala, S. S. 2018: 180445

  Abstract

  Purpose To develop a deep learning reconstruction approach to improve the reconstruction speed and quality of highly undersampled variable-density single-shot fast spin-echo imaging by using a variational network (VN), and to clinically evaluate the feasibility of this approach. Materials and Methods Imaging was performed with a 3.0-T imager with a coronal variable-density single-shot fast spin-echo sequence at 3.25 times acceleration in 157 patients referred for abdominal imaging (mean age, 11 years; range, 1-34 years; 72 males [mean age, 10 years; range, 1-26 years] and 85 females [mean age, 12 years; range, 1-34 years]) between March 2016 and April 2017. A VN was trained based on the parallel imaging and compressed sensing (PICS) reconstruction of 130 patients. The remaining 27 patients were used for evaluation. Image quality was evaluated in an independent blinded fashion by three radiologists in terms of overall image quality, perceived signal-to-noise ratio, image contrast, sharpness, and residual artifacts with scores ranging from 1 (nondiagnostic) to 5 (excellent). Wilcoxon tests were performed to test the hypothesis that there was no significant difference between VN and PICS. Results VN achieved improved perceived signal-to-noise ratio (P = .01) and improved sharpness (P < .001), with no difference in image contrast (P = .24) and residual artifacts (P = .07). In terms of overall image quality, VN performed better than did PICS (P = .02). Average reconstruction time ± standard deviation was 5.60 seconds ± 1.30 per section for PICS and 0.19 second ± 0.04 per section for VN. Conclusion Compared with the conventional parallel imaging and compressed sensing reconstruction (PICS), the variational network (VN) approach accelerates the reconstruction of variable-density single-shot fast spin-echo sequences and achieves improved overall image quality with higher perceived signal-to-noise ratio and sharpness.

  View details for PubMedID 30040039

• Safety of ferumoxytol in children undergoing cardiac MRI under general anaesthesia. Cardiology in the young Wise-Faberowski, L., Velasquez, N., Chan, F., Vasanawala, S., McElhinney, D. B., Ramamoorthy, C. 2018; 28 (7): 916–21

  Abstract

  BACKGROUND: Ferumoxytol, an "off-label" contrast agent, allows for better cardiac MRI quality as compared with gadolinium-based contrast agents. However, hypotension has been reported with the use of ferumoxytol for indications other than cardiac MRI. The purpose of our investigation was to evaluate the safety of ferumoxytol in children undergoing general anaesthesia for cardiac MRI.METHODS: Medical records of children undergoing general anaesthesia for cardiac MRI were reviewed. Baseline demographic and medical characteristics, as well as imaging and anaesthetic duration and technique, were collected. The incidence of hypotension or other adverse events', need for vasoactive support, or airway intervention throughout the anaesthetic, was recorded.RESULTS: A total of 95 patients were identified, 61 received ferumoxytol and 34 received gadolinium. There were no significant differences between groups with respect to age, weight, or baseline blood pressure. The incidence of low blood pressure - systolic or mean - after contrast administration did not differ between groups, and there was no difference in sustained hypotension or use of vasopressors between groups. One patient who received ferumoxytol had possible anaphylaxis. The image acquisition time (45 versus 68 min, p=0.002) and anaesthesia duration (100 versus 132 min, p=0.02) were shorter in the ferumoxytol group.CONCLUSION: Transient low blood pressure was common in children undergoing cardiac MRI with anaesthesia, but the incidence of hypotension did not differ between ferumoxytol and gadolinium groups. The use of ferumoxytol was associated with significantly shorter scan time and anaesthesia duration, as well as a decreased need for airway intervention.

  View details for PubMedID 29848399

• Body diffusion-weighted imaging using magnetization prepared single-shot fast spin echo and extended parallel imaging signal averaging MAGNETIC RESONANCE IN MEDICINE Gibbons, E. K., Vasanawala, S. S., Pauly, J. M., Kerr, A. B. 2018; 79 (6): 3032–44

  Abstract

  This work demonstrates a magnetization prepared diffusion-weighted single-shot fast spin echo (SS-FSE) pulse sequence for the application of body imaging to improve robustness to geometric distortion. This work also proposes a scan averaging technique that is superior to magnitude averaging and is not subject to artifacts due to object phase.This single-shot sequence is robust against violation of the Carr-Purcell-Meiboom-Gill (CPMG) condition. This is achieved by dephasing the signal after diffusion weighting and tipping the MG component of the signal onto the longitudinal axis while the non-MG component is spoiled. The MG signal component is then excited and captured using a traditional SS-FSE sequence, although the echo needs to be recalled prior to each echo. Extended Parallel Imaging (ExtPI) averaging is used where coil sensitivities from the multiple acquisitions are concatenated into one large parallel imaging (PI) problem. The size of the PI problem is reduced by SVD-based coil compression which also provides background noise suppression. This sequence and reconstruction are evaluated in simulation, phantom scans, and in vivo abdominal clinical cases.Simulations show that the sequence generates a stable signal throughout the echo train which leads to good image quality. This sequence is inherently low-SNR, but much of the SNR can be regained through scan averaging and the proposed ExtPI reconstruction. In vivo results show that the proposed method is able to provide diffusion encoded images while mitigating geometric distortion artifacts compared to EPI.This work presents a diffusion-prepared SS-FSE sequence that is robust against the violation of the CPMG condition while providing diffusion contrast in clinical cases. Magn Reson Med 79:3032-3044, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

  View details for PubMedID 29044721

• High-resolution 3D volumetric contrast-enhanced MR angiography with a blood pool agent (ferumoxytol) for diagnostic evaluation of pediatric brain arteriovenous malformations. Journal of neurosurgery. Pediatrics Iv, M., Choudhri, O., Dodd, R. L., Vasanawala, S. S., Alley, M. T., Moseley, M., Holdsworth, S. J., Grant, G., Cheshier, S., Yeom, K. W. 2018: 1–10

  Abstract

  OBJECTIVE Patients with brain arteriovenous malformations (AVMs) often require repeat imaging with MRI or MR angiography (MRA), CT angiography (CTA), and digital subtraction angiography (DSA). The ideal imaging modality provides excellent vascular visualization without incurring added risks, such as radiation exposure. The purpose of this study is to evaluate the performance of ferumoxytol-enhanced MRA using a high-resolution 3D volumetric sequence (fe-SPGR) for visualizing and grading pediatric brain AVMs in comparison with CTA and DSA, which is the current imaging gold standard. METHODS In this retrospective cohort study, 21 patients with AVMs evaluated by fe-SPGR, CTA, and DSA between April 2014 and August 2017 were included. Two experienced raters graded AVMs using Spetzler-Martin criteria on all imaging studies. Lesion conspicuity (LC) and diagnostic confidence (DC) were assessed using a 5-point Likert scale, and interrater agreement was determined. The Kruskal-Wallis test was performed to assess the raters' grades and scores of LC and DC, with subsequent post hoc pairwise comparisons to assess for statistically significant differences between pairs of groups at p < 0.05. RESULTS Assigned Spetzler-Martin grades for AVMs on DSA, fe-SPGR, and CTA were not significantly different (p = 0.991). LC and DC scores were higher with fe-SPGR than with CTA (p < 0.05). A significant difference in LC scores was found between CTA and fe-SPGR (p < 0.001) and CTA and DSA (p < 0.001) but not between fe-SPGR and DSA (p = 0.146). A significant difference in DC scores was found among DSA, fe-SPGR, and CTA (p < 0.001) and between all pairs of the groups (p < 0.05). Interrater agreement was good to very good for all image groups (κ = 0.77-1.0, p < 0.001). CONCLUSIONS Fe-SPGR performed robustly in the diagnostic evaluation of brain AVMs, with improved visual depiction of AVMs compared with CTA and comparable Spetzler-Martin grading relative to CTA and DSA.

  View details for PubMedID 29882734

• A Wireless Power Transfer System for MRI Scanners Byron, K., Robb, F., Vasanawala, S., Pauly, J., Scott, G., IEEE IEEE. 2018

  View details for Web of Science ID 000462702400012

• The impact of computed high b-value images on the diagnostic accuracy of DWI for prostate cancer: A receiver operating characteristics analysis. Scientific reports Ning, P., Shi, D., Sonn, G. A., Vasanawala, S. S., Loening, A. M., Ghanouni, P., Obara, P., Shin, L. K., Fan, R. E., Hargreaves, B. A., Daniel, B. L. 2018; 8 (1): 3409

  Abstract

  To evaluate the performance of computed high b value diffusion-weighted images (DWI) in prostate cancer detection. 97 consecutive patients who had undergone multiparametric MRI of the prostate followed by biopsy were reviewed. Five radiologists independently scored 138 lesions on native high b-value images (b = 1200 s/mm2), apparent diffusion coefficient (ADC) maps, and computed high b-value images (contrast equivalent to b = 2000 s/mm2) to compare their diagnostic accuracy. Receiver operating characteristic (ROC) analysis and McNemar's test were performed to assess the relative performance of computed high b value DWI, native high b-value DWI and ADC maps. No significant difference existed in the area under the curve (AUC) for ROCs comparing B1200 (b = 1200 s/mm2) to computed B2000 (c-B2000) in 5 readers. In 4 of 5 readers c-B2000 had significantly increased sensitivity and/or decreased specificity compared to B1200 (McNemar's p < 0.05), at selected thresholds of interpretation. ADC maps were less accurate than B1200 or c-B2000 for 2 of 5 readers (P < 0.05). This study detected no consistent improvement in overall diagnostic accuracy using c-B2000, compared with B1200 images. Readers detected more cancer with c-B2000 images (increased sensitivity) but also more false positive findings (decreased specificity).

  View details for PubMedID 29467370

• K-Means Clustering for High-Resolution, Realistic Acoustic Maps Looby, K., Sandino, C., Zhang, T., Vasanawala, S., Dahl, J., Duric, N., Byram, B. C. SPIE-INT SOC OPTICAL ENGINEERING. 2018

  View details for DOI 10.1117/12.2293990

  View details for Web of Science ID 000450861900027

• Robust Self-Carlibrating nCPMG Acquisition: Application to Body Diffusion-Weighted Imaging IEEE TRANSACTIONS ON MEDICAL IMAGING Gibbons, E. K., Le Roux, P., Vasanawala, S. S., Pauly, J. M., Kerr, A. B. 2018; 37 (1): 200–209

  Abstract

  This paper demonstrates a robust diffusion-weighted single-shot fast spin echo (SS-FSE) sequence in the presence of significant off-resonance, which includes a variable-density acquisition and a self-calibrated reconstruction as improvements. A non-Carr-Purcell-Meiboom-Gill (nCPMG) SS-FSE acquisition stabilizes both the main and parasitic echo families for each echo. This preserves both the in-phase and quadrature components of the magnetization throughout the echo train. However, nCPMG SS-FSE also promotes aliasing of the quadrature component, which complicates reconstruction. A new acquisition and reconstruction approach is presented here, where the field-of-view is effectively doubled, but a partial k-space and variable density sampling is used to improve scan efficiency. The technique is presented in phantom scans to validate SNR and robustness against rapidly varying object phase. In vivo healthy volunteer examples and the clinical cases are demonstrated in abdominal imaging. This new approach provides comparable SNR to previous nCPMG acquisition techniques as well as providing more uniform apparent diffusion coefficient maps in phantom scans. In vivo scans suggest that this method is more robust against motion than previous approaches. The proposed reconstruction is an improvement to the nCPMG sequence as it is auto-calibrating and is justified to accurately treat the signal model for the nCPMG SS-FSE sequence.

  View details for DOI 10.1109/TMI.2017.2741421

  View details for Web of Science ID 000419346900018

  View details for PubMedID 28829307

  View details for PubMedCentralID PMC5784776

• A Novel High-Resolution Magnetic Resonance Imaging Protocol Detects Aldosterone-Producing Adenomas in Patients with Negative Computed Tomography. American journal of hypertension Raber, I., Isom, R. T., Louie, J. D., Vasanawala, S., Bhalla, V. 2018

  View details for PubMedID 29648568

• Automatic renal segmentation for MR urography using 3D-GrabCut and random forests. Magnetic resonance in medicine Yoruk, U., Hargreaves, B. A., Vasanawala, S. S. 2018; 79 (3): 1696–1707

  Abstract

  To introduce and evaluate a fully automated renal segmentation technique for glomerular filtration rate (GFR) assessment in children.An image segmentation method based on iterative graph cuts (GrabCut) was modified to work on time-resolved 3D dynamic contrast-enhanced MRI data sets. A random forest classifier was trained to further segment the renal tissue into cortex, medulla, and the collecting system. The algorithm was tested on 26 subjects and the segmentation results were compared to the manually drawn segmentation maps using the F1-score metric. A two-compartment model was used to estimate the GFR of each subject using both automatically and manually generated segmentation maps.Segmentation maps generated automatically showed high similarity to the manually drawn maps for the whole-kidney (F1 = 0.93) and renal cortex (F1 = 0.86). GFR estimations using whole-kidney segmentation maps from the automatic method were highly correlated (Spearman's ρ = 0.99) to the GFR values obtained from manual maps. The mean GFR estimation error of the automatic method was 2.98 ± 0.66% with an average segmentation time of 45 s per patient.The automatic segmentation method performs as well as the manual segmentation for GFR estimation and reduces the segmentation time from several hours to 45 s. Magn Reson Med 79:1696-1707, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

  View details for PubMedID 28656614

  View details for PubMedCentralID PMC5745323

• Pelvic Blood Flow Predicts Fibroid Volume and Embolic Required for Uterine Fibroid Embolization: A Pilot Study With 4D Flow MR Angiography AMERICAN JOURNAL OF ROENTGENOLOGY Malone, C. D., Banerjee, A., Alley, M. T., Vasanawala, S. S., Roberts, A. C., Hsiao, A. 2018; 210 (1): 189–200

  Abstract

  We report here an initial experience using 4D flow MRI in pelvic imaging-specifically, in imaging uterine fibroids. We hypothesized that blood flow might correlate with fibroid volume and that quantifying blood flow might help to predict the amount of embolic required to achieve stasis at subsequent uterine fibroid embolization (UFE).Thirty-three patients with uterine fibroids and seven control subjects underwent pelvic MRI with 4D flow imaging. Of the patients with fibroids, 10 underwent 4D flow imaging before UFE and seven after UFE; in the remaining 16 patients with fibroids, UFE had yet to be performed. Four-dimensional flow measurements were performed using Arterys CV Flow. The flow fraction of the internal iliac artery was expressed as the ratio of internal iliac artery flow to external iliac artery flow and was compared between groups. The flow ratios between the internal iliac arteries on each side were calculated. Fibroid volume versus internal iliac flow fraction, embolic volume versus internal iliac flow fraction, and embolic volume ratio between sides versus the ratio of internal iliac artery flows between sides were compared.The mean internal iliac flow fraction was significantly higher in the 26 patients who underwent imaging before UFE (mean ± standard error, 0.78 ± 0.06) than in the seven patients who underwent imaging after UFE (0.48 ± 0.07, p < 0.01) and in the seven control patients without fibroids (0.48 ± 0.08, p < 0.0001). The internal iliac flow fraction correlated well with fibroid volumes before UFE (r = 0.7754, p < 0.0001) and did not correlate with fibroid volumes after UFE (r = -0.3051, p = 0.51). The ratio of embolic required to achieve stasis between sides showed a modest correlation with the ratio of internal iliac flow (r = 0.6776, p = 0.03).Internal iliac flow measured by 4D flow MRI correlates with fibroid volume and is predictive of the ratio of embolic required to achieve stasis on each side at subsequent UFE and may be useful for preprocedural evaluation of patients with uterine fibroids.

  View details for PubMedID 29090998

• Self-Calibrating Wave-Encoded Variable-Density Single-Shot Fast Spin Echo Imaging. Journal of magnetic resonance imaging : JMRI Chen, F., Taviani, V., Tamir, J. I., Cheng, J. Y., Zhang, T., Song, Q., Hargreaves, B. A., Pauly, J. M., Vasanawala, S. S. 2018; 47 (4): 954–66

  Abstract

  It is highly desirable in clinical abdominal MR scans to accelerate single-shot fast spin echo (SSFSE) imaging and reduce blurring due to T2 decay and partial-Fourier acquisition.To develop and investigate the clinical feasibility of wave-encoded variable-density SSFSE imaging for improved image quality and scan time reduction.Prospective controlled clinical trial.With Institutional Review Board approval and informed consent, the proposed method was assessed on 20 consecutive adult patients (10 male, 10 female, range, 24-84 years).A wave-encoded variable-density SSFSE sequence was developed for clinical 3.0T abdominal scans to enable high acceleration (3.5×) with full-Fourier acquisitions by: 1) introducing wave encoding with self-refocusing gradient waveforms to improve acquisition efficiency; 2) developing self-calibrated estimation of wave-encoding point-spread function and coil sensitivity to improve motion robustness; and 3) incorporating a parallel imaging and compressed sensing reconstruction to reconstruct highly accelerated datasets.Image quality was compared pairwise with standard Cartesian acquisition independently and blindly by two radiologists on a scale from -2 to 2 for noise, contrast, confidence, sharpness, and artifacts. The average ratio of scan time between these two approaches was also compared.A Wilcoxon signed-rank tests with a P value under 0.05 considered statistically significant.Wave-encoded variable-density SSFSE significantly reduced the perceived noise level and improved the sharpness of the abdominal wall and the kidneys compared with standard acquisition (mean scores 0.8, 1.2, and 0.8, respectively, P < 0.003). No significant difference was observed in relation to other features (P = 0.11). An average of 21% decrease in scan time was achieved using the proposed method.Wave-encoded variable-density sampling SSFSE achieves improved image quality with clinically relevant echo time and reduced scan time, thus providing a fast and robust approach for clinical SSFSE imaging.1 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2018;47:954-966.

  View details for PubMedID 28906567

• An RF-gated wireless power transfer system for wireless MRI receive arrays CONCEPTS IN MAGNETIC RESONANCE PART B-MAGNETIC RESONANCE ENGINEERING Byron, K., Robb, F., Stang, P., Vasanawala, S., Pauly, J., Scott, G. 2017; 47B (4)

  View details for DOI 10.1002/cmr.b.21360

  View details for Web of Science ID 000435269700001

• Free-breathing pediatric chest MRI: Performance of self-navigated golden-angle ordered conical ultrashort echo time acquisition. Journal of magnetic resonance imaging : JMRI Zucker, E. J., Cheng, J. Y., Haldipur, A., Carl, M., Vasanawala, S. S. 2017

  Abstract

  To assess the feasibility and performance of conical k-space trajectory free-breathing ultrashort echo time (UTE) chest magnetic resonance imaging (MRI) versus four-dimensional (4D) flow and effects of 50% data subsampling and soft-gated motion correction.Thirty-two consecutive children who underwent both 4D flow and UTE ferumoxytol-enhanced chest MR (mean age: 5.4 years, range: 6 days to 15.7 years) in one 3T exam were recruited. From UTE k-space data, three image sets were reconstructed: 1) one with all data, 2) one using the first 50% of data, and 3) a final set with soft-gating motion correction, leveraging the signal magnitude immediately after each excitation. Two radiologists in blinded fashion independently scored image quality of anatomical landmarks on a 5-point scale. Ratings were compared using Wilcoxon rank-sum, Wilcoxon signed-ranks, and Kruskal-Wallis tests. Interobserver agreement was assessed with the intraclass correlation coefficient (ICC).For fully sampled UTE, mean scores for all structures were ≥4 (good-excellent). Full UTE surpassed 4D flow for lungs and airways (P < 0.001), with similar pulmonary artery (PA) quality (P = 0.62). 50% subsampling only slightly degraded all landmarks (P < 0.001), as did motion correction. Subsegmental PA visualization was possible in >93% scans for all techniques (P = 0.27). Interobserver agreement was excellent for combined scores (ICC = 0.83).High-quality free-breathing conical UTE chest MR is feasible, surpassing 4D flow for lungs and airways, with equivalent PA visualization. Data subsampling only mildly degraded images, favoring lesser scan times. Soft-gating motion correction overall did not improve image quality.2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017.

  View details for DOI 10.1002/jmri.25776

  View details for PubMedID 28570032

• Free-breathing pediatric chest MRI: Performance of self-navigated golden-angle ordered conical ultrashort echo time acquisition. Journal of magnetic resonance imaging : JMRI Zucker, E. J., Cheng, J. Y., Haldipur, A., Carl, M., Vasanawala, S. S. 2017

  Abstract

  To assess the feasibility and performance of conical k-space trajectory free-breathing ultrashort echo time (UTE) chest magnetic resonance imaging (MRI) versus four-dimensional (4D) flow and effects of 50% data subsampling and soft-gated motion correction.Thirty-two consecutive children who underwent both 4D flow and UTE ferumoxytol-enhanced chest MR (mean age: 5.4 years, range: 6 days to 15.7 years) in one 3T exam were recruited. From UTE k-space data, three image sets were reconstructed: 1) one with all data, 2) one using the first 50% of data, and 3) a final set with soft-gating motion correction, leveraging the signal magnitude immediately after each excitation. Two radiologists in blinded fashion independently scored image quality of anatomical landmarks on a 5-point scale. Ratings were compared using Wilcoxon rank-sum, Wilcoxon signed-ranks, and Kruskal-Wallis tests. Interobserver agreement was assessed with the intraclass correlation coefficient (ICC).For fully sampled UTE, mean scores for all structures were ≥4 (good-excellent). Full UTE surpassed 4D flow for lungs and airways (P < 0.001), with similar pulmonary artery (PA) quality (P = 0.62). 50% subsampling only slightly degraded all landmarks (P < 0.001), as did motion correction. Subsegmental PA visualization was possible in >93% scans for all techniques (P = 0.27). Interobserver agreement was excellent for combined scores (ICC = 0.83).High-quality free-breathing conical UTE chest MR is feasible, surpassing 4D flow for lungs and airways, with equivalent PA visualization. Data subsampling only mildly degraded images, favoring lesser scan times. Soft-gating motion correction overall did not improve image quality.2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017.

  View details for DOI 10.1002/jmri.25776

  View details for PubMedID 28570032

• Fast Comprehensive Single-Sequence Four-Dimensional Pediatric Knee MRI With T-2 Shuffling JOURNAL OF MAGNETIC RESONANCE IMAGING Bao, S., Tamir, J. I., Young, J. L., Tariq, U., Uecker, M., Lai, P., Chen, W., Lustig, M., Vasanawala, S. S. 2017; 45 (6): 1700-1711

  Abstract

  To develop and clinically evaluate a pediatric knee magnetic resonance imaging (MRI) technique based on volumetric fast spin-echo (3DFSE) and compare its diagnostic performance, image quality, and imaging time to that of a conventional 2D protocol.A 3DFSE sequence was modified and combined with a compressed sensing-based reconstruction resolving multiple image contrasts, a technique termed T2 Shuffling (T2 Sh). With Institutional Review Board (IRB) approval, 28 consecutive children referred for 3T knee MRI prospectively underwent a standard clinical knee protocol followed by T2 Sh. T2 Sh performance was assessed by two readers blinded to diagnostic reports. Interpretive discrepancies were resolved by medical record chart review and consensus between the readers and an orthopedic surgeon. Image quality was evaluated by rating anatomic delineation, with 95% confidence interval. A Wilcoxon rank-sum test assessed the null hypothesis that T2 Sh structure delineation compared to conventional 2D is unchanged. Intraclass correlation coefficients were calculated for interobserver agreement. Imaging time of the conventional protocol and T2 Sh was compared.There was 81% and 87% concordance between T2 Sh reports and diagnostic reports, respectively, for each reader. Upon consensus review, T2 Sh had 93% sensitivity and 100% specificity compared to clinical reports for detection of clinically relevant findings. The 95% confidence interval of diagnostic or better rating was 95-100%, with 34-80% interobserver agreement. There was no significant difference in structure delineation between T2 Sh and 2D, except for the retinaculum (P < 0.05), where 2D was preferred. Typical imaging time for T2 Sh and the conventional exam was 7 and 13 minutes, respectively.A single-sequence pediatric knee exam is feasible with T2 Sh, providing multiplanar, reformattable 4D images. Level of Evidence 2 J. Magn. Reson. Imaging 2016;00:000-000.

  View details for DOI 10.1002/jmri.25508

  View details for Web of Science ID 000401259900015

• Feasibility of Ferumoxytol-Enhanced Neonatal and Young Infant Cardiac MRI Without General Anesthesia JOURNAL OF MAGNETIC RESONANCE IMAGING Lai, L. M., Cheng, J. Y., Alley, M. T., Zhang, T., Lustig, M., Vasanawala, S. S. 2017; 45 (5): 1407-1418

  Abstract

  To assess the feasibility of ferumoxytol-enhanced anesthesia-free cardiac MRI in neonates and young infants for complex congenital heart disease (CHD).With Institutional Review Board approval, 21 consecutive neonates and young infants (1 day to 11 weeks old; median age of 3 days) who underwent a rapid two-sequence (MR angiography [MRA] and four-dimensional [4D] flow) MRI protocol with intravenous ferumoxytol without sedation (n = 17) or light sedation (n = 4) at 3 Tesla (T) (except one case at 1.5T) between June 2014 and February 2016 were retrospectively identified. Medical records were reviewed for indication, any complications, if further diagnostic imaging was performed after MRI, and surgical findings. Two radiologists scored the images in two sessions on a 5-point scale for overall image quality and delineation of various anatomical structures. Confidence interval of proportions for likelihood of requiring additional diagnostic imaging after MRI was determined. For the possibility of reducing the protocol to a single rapid sequence, Wilcoxon-rank sum test was used to assess whether 4D flow and MRA significantly differed in anatomical delineation.One of 21 patients (4.8%, 80% confidence interval 0-11%) required additional imaging, a computed tomography angiography to assess lung parenchyma and peripheral pulmonary arteries. Only 1 of 13 patients (7.7%) with operative confirmation had a minor discrepancy between radiology and operative reports (80% confidence interval 0-17%). 4D flow was significantly superior to MRA (P < 0.05) for the evaluation of systemic arteries, valves, ventricular trabeculae, and overall quality. Using Cohen's kappa coefficient, there was good interobserver agreement for the evaluation of systemic arteries by 4D flow (κ = 0.782), and systemic veins and pulmonary arteries by MRA (κ > 0.6). Overall 4D flow measurements (mean κ = 0.64-0.74) had better internal agreement compared with MRA (mean κ = 0.30-0.64).Ferumoxytol-enhanced cardiac MRI, without anesthesia, is feasible for the evaluation of complex CHD in neonates and young infants, with a low likelihood of need for additional diagnostic studies. The decreased risk by avoiding anesthesia must be balanced against the potential for adverse reactions with ferumoxytol.2 J. Magn. Reson. Imaging 2016.

  View details for Web of Science ID 000399657300015

• Resolving phase ambiguity in dual-echo dixon imaging using a projected power method MAGNETIC RESONANCE IN MEDICINE Zhang, T., Chen, Y., Bao, S., Alley, M. T., Pauly, J. M., Hargreaves, B. A., Vasanawala, S. S. 2017; 77 (5): 2066-2076

  Abstract

  To develop a fast and robust method to resolve phase ambiguity in dual-echo Dixon imaging.A major challenge in dual-echo Dixon imaging is to estimate the phase error resulting from field inhomogeneity. In this work, a binary quadratic optimization program was formulated to resolve the phase ambiguity. A projected power method was developed to efficiently solve the optimization problem. Both the 1-peak fat model and 6-peak fat model were applied to three-dimensional (3D) datasets. Additionally, the proposed method was extended to dynamic magnetic resonance imaging (MRI) applications using the 6-peak fat model. With institutional review board (IRB) approval and patient consent/assent, the proposed method was evaluated and compared with region growing on 29 consecutive 3D high-resolution patient datasets.Fast and robust water/fat separation was achieved by the proposed method in different representative 3D datasets and dynamic 3D datasets. Superior water/fat separation was achieved using the 6-peak fat model compared with the 1-peak fat model. Compared to region growing, the proposed method reduced water/fat swaps from 76 to 7% of the patient cohort.The proposed method can achieve fast and robust phase error estimation in dual-echo Dixon imaging. Magn Reson Med, 2016. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.26287

  View details for Web of Science ID 000399666400034

  View details for PubMedCentralID PMC5123983

• 3D Cartesian MRI with compressed sensing and variable view sharing using complementary poisson-disc sampling MAGNETIC RESONANCE IN MEDICINE Levine, E., Daniel, B., Vasanawala, S., Hargreaves, B., Saranathan, M. 2017; 77 (5): 1774-1785

  Abstract

  To enable robust, high spatio-temporal-resolution three-dimensional Cartesian MRI using a scheme incorporating a novel variable density random k-space sampling trajectory allowing flexible and retrospective selection of the temporal footprint with compressed sensing (CS).A complementary Poisson-disc k-space sampling trajectory was designed to allow view sharing and varying combinations of reduced view sharing with CS from the same prospective acquisition. These schemes were used for two-point Dixon-based dynamic contrast-enhanced MRI (DCE-MRI) of the breast and abdomen. Results were validated in vivo with a novel approach using variable-flip-angle data, which was retrospectively accelerated using the same methods but offered a ground truth.In breast DCE-MRI, the temporal footprint could be reduced 2.3-fold retrospectively without introducing noticeable artifacts, improving depiction of rapidly enhancing lesions. Further, experiments with variable-flip-angle data showed that reducing view sharing improved accuracy in reconstruction and T1 mapping. In abdominal MRI, 2.3-fold and 3.6-fold reductions in temporal footprint allowed reduced motion artifacts.The complementary-Poisson-disc k-space sampling trajectory allowed a retrospective spatiotemporal resolution tradeoff using CS and view sharing, imparting robustness to motion and contrast enhancement. The technique was also validated using a novel approach of fully acquired variable-flip-angle acquisition. Magn Reson Med, 2016. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.26254

  View details for Web of Science ID 000399666400005

  View details for PubMedCentralID PMC5074926

• Current and potential imaging applications of ferumoxytol for magnetic resonance imaging. Kidney international Toth, G. B., Varallyay, C. G., Horvath, A., Bashir, M. R., Choyke, P. L., Daldrup-Link, H. E., Dosa, E., Finn, J. P., Gahramanov, S., Harisinghani, M., Macdougall, I., Neuwelt, A., Vasanawala, S. S., Ambady, P., Barajas, R., Cetas, J. S., Ciporen, J., DeLoughery, T. J., Doolittle, N. D., Fu, R., Grinstead, J., Guimaraes, A. R., Hamilton, B. E., Li, X., McConnell, H. L., Muldoon, L. L., Nesbit, G., Netto, J. P., Petterson, D., Rooney, W. D., Schwartz, D., Szidonya, L., Neuwelt, E. A. 2017

  Abstract

  Contrast-enhanced magnetic resonance imaging is a commonly used diagnostic tool. Compared with standard gadolinium-based contrast agents, ferumoxytol (Feraheme, AMAG Pharmaceuticals, Waltham, MA), used as an alternative contrast medium, is feasible in patients with impaired renal function. Other attractive imaging features of i.v. ferumoxytol include a prolonged blood pool phase and delayed intracellular uptake. With its unique pharmacologic, metabolic, and imaging properties, ferumoxytol may play a crucial role in future magnetic resonance imaging of the central nervous system, various organs outside the central nervous system, and the cardiovascular system. Preclinical and clinical studies have demonstrated the overall safety and effectiveness of this novel contrast agent, with rarely occurring anaphylactoid reactions. The purpose of this review is to describe the general and organ-specific properties of ferumoxytol, as well as the advantages and potential pitfalls associated with its use in magnetic resonance imaging. To more fully demonstrate the applications of ferumoxytol throughout the body, an imaging atlas was created and is available online as supplementary material.

  View details for DOI 10.1016/j.kint.2016.12.037

  View details for PubMedID 28434822

• MRI vs. Ultrasound as the initial imaging modality for pediatric and young adult patients with suspected appendicitis. Academic emergency medicine Imler, D., Keller, C., Sivasankar, S., Wang, N. E., Vasanawala, S., Bruzoni, M., Quinn, J. 2017

  Abstract

  While ultrasound (US), given its lack of ionizing radiation is currently the recommended initial imaging study of choice for the diagnosis of appendicitis in pediatric and young adult patients, it does have significant shortcomings. US is time intensive, operator dependent, and results in frequent inconclusive studies, thus necessitating further imaging, and admission for observation or repeat clinical visits. A rapid focused Magnetic Resonance Imaging (MRI) for appendicitis has been shown to have definitive sensitivity and specificity, similar to Computed tomography (CT) but without radiation and offers a potential alternative to US.In this single-center prospective cohort study, we sought to determine the difference in total length of stay and charges between rapid MRI and US as the initial imaging modality in pediatric and young adult patients presenting to the Emergency Department (ED) with suspected appendicitis. We hypothesized that rapid MRI would be more efficient and cost effective than US as the initial imaging modality in the ED diagnosis of appendicitis.A prospective randomized cohort study of consecutive patients was conducted in patients 2-30 years of age in an academic ED with access to both rapid MRI and US imaging modalities 24/7. Prior to the start of the study, the days of the week were randomized to either rapid MRI or US as the initial imaging modality. Physicians evaluated patients with suspected appendicitis per their usual manner. If the physician decided to obtain radiologic imaging, the pre-determined imaging modality for the day of the week was used. All decisions regarding other diagnostic testing and/or further imaging were left to the physician's discretion. Time intervals (min) between triage, order placement, start of imaging, end of imaging, image result and disposition (discharge vs. admission), as well as total charges (diagnostic testing, imaging and repeat ED visits) were recorded.Over a 100-day period, 82 patients were imaged to evaluate for appendicitis; 45/82 (55%) of patients were in the US first group; and 37/82 (45%) patients were in the rapid MRI first group. There were no differences in patient demographics or clinical characteristics between the groups and no cases of missed appendicitis in either group. 11/45 (24%) of US first patients had inconclusive studies, resulting in follow-up rapid MRI and 5 return ED visits contrasted with no inconclusive studies or return visits (p< 0.05) in the rapid MRI group. The rapid MRI compared to US group was associated with longer ED length of stay (mean difference 100 min; 95% CI 35-169) and increased ED charges (mean difference $4,887; 95% CI $1,821 - $8,513).In the diagnosis of appendicitis, US first imaging is more time efficient and less costly than rapid MRI despite inconclusive studies after US imaging. Unless the process of obtaining a rapid MRI becomes more efficient and less expensive, US should be the first line imaging modality for appendicitis in patients 2-30 years of age. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/acem.13180

  View details for PubMedID 28207968

• Increased Speed and Image Quality for Pelvic Single-Shot Fast Spin-Echo Imaging with Variable Refocusing Flip Angles and Full-Fourier Acquisition. Radiology Loening, A. M., Litwiller, D. V., Saranathan, M., Vasanawala, S. S. 2017; 282 (2): 561-568

  Abstract

  Purpose To assess image quality and speed improvements for single-shot fast spin-echo (SSFSE) with variable refocusing flip angles and full-Fourier acquisition (vrfSSFSE) pelvic imaging via a prospective trial performed in the context of uterine leiomyoma evaluation. Materials and Methods Institutional review board approval and informed consent were obtained. vrfSSFSE and conventional SSFSE sagittal and coronal oblique acquisitions were performed in 54 consecutive female patients referred for 3-T magnetic resonance (MR) evaluation of known or suspected uterine leiomyomas. Two radiologists who were blinded to the image acquisition technique semiquantitatively scored images on a scale from -2 to 2 for noise, image contrast, sharpness, artifacts, and perceived ability to evaluate uterine, ovarian, and musculoskeletal structures. The null hypothesis of no significant difference between pulse sequences was assessed with a Wilcoxon signed rank test by using a Holm-Bonferroni correction for multiple comparisons. Results Because of reductions in specific absorption rate, vrfSSFSE imaging demonstrated significantly increased speed (more than twofold, P < .0001), with mean repetition times compared with conventional SSFSE imaging decreasing from 1358 to 613 msec for sagittal acquisitions and from 1494 to 621 msec for coronal oblique acquisitions. Almost all assessed image quality and perceived diagnostic capability parameters were significantly improved with vrfSSFSE imaging. These improvements included noise, sharpness, and ability to evaluate the junctional zone, myometrium, and musculoskeletal structures for both sagittal acquisitions (mean values of 0.56, 0.63, 0.42, 0.56, and 0.80, respectively; all P values < .0001) and coronal oblique acquisitions (mean values of 0.81, 1.09, 0.65, 0.93, and 1.12, respectively; all P values < .0001). For evaluation of artifacts, there was an insufficient number of cases with differences to allow statistical testing. Conclusion Compared with conventional SSFSE acquisition, vrfSSFSE acquisition increases 3-T imaging speed via reduced specific absorption rate and leads to significant improvements in perceived image quality and perceived diagnostic capability when evaluating pelvic structures. (©) RSNA, 2016 Online supplemental material is available for this article.

  View details for DOI 10.1148/radiol.2016151574

  View details for PubMedID 27564132

• Body Diffusion Weighted Imaging Using Non-CPMG Fast Spin Echo IEEE TRANSACTIONS ON MEDICAL IMAGING Gibbons, E. K., Le Roux, P., Vasanawala, S. S., Pauly, J. M., Kerr, A. B. 2017; 36 (2): 549-559

  Abstract

  SS-FSE is a fast technique that does not suffer from off-resonance distortions to the degree that EPI does. Unlike EPI, SS-FSE is ill-suited to diffusion weighted imaging (DWI) due to the Carr-Purcell-Meiboom-Geill (CPMG) condition. Non- CPMG phase cycling does accommodate SS-FSE and DWI but places constraints on reconstruction, which are resolved here through parallel imaging. Additionally, improved echo stability can be achieved by using short duration and highly selective DIVERSE radiofrequency pulses. Here, signal-to-noise ratio (SNR) comparisons between EPI and nCPMG SS-FSE acquisitions and reconstruction techniques give similar values. Diffusion imaging with nCPMG SS-FSE gives similar SNR to an EPI acquisition, though apparent diffusion coefficient values are higher than seen with EPI. In vivo images have good image quality with little distortion. This method has the ability to capture distortionfree DWI images near areas of significant off-resonance as well as preserve adequate SNR. Parallel imaging and DIVERSE refocusing RF pulses allow shorter ETL compared to previous implementations and thus reduces phase encode direction blur and SAR accumulation.

  View details for DOI 10.1109/TMI.2016.2622238

  View details for Web of Science ID 000396115800019

• Conspicuity of Malignant Lesions on PET/CT and Simultaneous Time-Of-Flight PET/MRI PLOS ONE Minamimoto, R., Iagaru, A., Jamali, M., Holley, D., Barkhodari, A., Vasanawala, S., Zaharchuk, G. 2017; 12 (1)

  Abstract

  To compare the conspicuity of malignant lesions between FDG PET/CT and a new simultaneous, time-of-flight (TOF) enabled PET/MRI scanner.All patients underwent a single-injection of FDG, followed by a dual imaging protocol consisting of PET/CT followed by TOF PET/MRI. PET/CT and PET/MRI images were evaluated by two readers independently for areas of FDG uptake compatible with malignancy, and then categorized into 5 groups (1: PET/MRI and PET/CT positive; 2: PET/MRI positive, PET/CT positive in retrospect; 3: PET/CT positive, PET/MRI positive in retrospect; 4: PET/MRI positive, PET/CT negative; 5: PET/MRI negative, PET/CT positive) by consensus. Patients with no lesions on either study or greater than 10 lesions based on either modality were excluded from the study.Fifty-two patients (mean±SD age: 58±14 years) underwent the dual imaging protocol; of these, 29 patients with a total of 93 FDG-avid lesions met the inclusion criteria. The majority of lesions (56%) were recorded prospectively in the same location on PET/CT and PET/MRI. About an equal small fraction of lesions were seen on PET/CT but only retrospectively on PET/MRI (9%) and vice versa (12%). More lesions were identified only on PET/MRI but not on PET/CT, even in retrospect (96% vs. 81%, respectively; p = 0.003). Discrepant lesions had lower maximum standardized uptake value (SUVmax) than concordant lesions on both modalities (p<0.001).While most lesions were identified prospectively on both modalities, significantly more lesions were identified with PET/MRI than with PET/CT.

  View details for DOI 10.1371/journal.pone.0167262

  View details for Web of Science ID 000392381100001

  View details for PubMedID 28103230

  View details for PubMedCentralID PMC5245859

• Relative value of three whole-body MR approaches for PET-MR, including gadofosveset-enhanced MR, in comparison to PET-CT. Clinical imaging Obara, P., Loening, A., Taviani, V., Iagaru, A., Hargreaves, B. A., Vasanawala, S. 2017; 48: 62–68

  Abstract

  Evaluate MR protocol for PET-MR including coronal DWI (cDWI), fat-suppressed T2 (T2w), and gadofosveset-enhanced T1 (CE).18 patients underwent same-day PET-CT and PET-MR. Image quality and performance of each sequence, and combination of all three sequences, was evaluated with respect to PET-CT.Lesion conspicuity was best on cDWI, while delineation was best on CE. Considering all three sequences combined, both readers showed good sensitivity and specificity (>80%). Relative sensitivity was highest on CE and lowest on T2w.Whole-body MR performed well in detecting malignant lesions compared to PET-CT. CE showed overall highest performance.

  View details for PubMedID 29031209

• Comprehensive Multi-Dimensional MRI for the Simultaneous Assessment of Cardiopulmonary Anatomy and Physiology. Scientific reports Cheng, J. Y., Zhang, T., Alley, M. T., Uecker, M., Lustig, M., Pauly, J. M., Vasanawala, S. S. 2017; 7 (1): 5330

  Abstract

  Diagnostic testing often assesses the cardiovascular or respiratory systems in isolation, ignoring the major pathophysiologic interactions between the systems in many diseases. When both systems are assessed currently, multiple modalities are utilized in costly fashion with burdensome logistics and decreased accessibility. Thus, we have developed a new acquisition and reconstruction paradigm using the flexibility of MRI to enable a comprehensive exam from a single 5-15 min scan. We constructed a compressive-sensing approach to pseudo-randomly acquire highly subsampled, multi-dimensionally-encoded and time-stamped data from which we reconstruct volumetric cardiac and respiratory motion phases, contrast-agent dynamics, and blood flow velocity fields. The proposed method, named XD flow, is demonstrated for (a) evaluating congenital heart disease, where the impact of bulk motion is reduced in a non-sedated neonatal patient and (b) where the observation of the impact of respiration on flow is necessary for diagnostics; (c) cardiopulmonary imaging, where cardiovascular flow, function, and anatomy information is needed along with pulmonary perfusion quantification; and in (d) renal function imaging, where blood velocities and glomerular filtration rates are simultaneously measured, which highlights the generality of the technique. XD flow has the ability to improve quantification and to provide additional data for patient diagnosis for comprehensive evaluations.

  View details for PubMedID 28706270

• Variable refocusing flip angle single-shot fast spin echo imaging of liver lesions: increased speed and lesion contrast. Abdominal radiology (New York) Hicks, R. M., Loening, A. M., Ohliger, M. A., Vasanawala, S. S., Hope, T. A. 2017

  Abstract

  To evaluate acquisition time and clinical image quality of a variable refocusing flip angle (vrf) single-shot fast spin echo (SSFSE) sequence in comparison with a conventional SSFSE sequence for imaging of liver lesions in patients undergoing whole-body PET/MRI for oncologic staging.A vrfSSFSE sequence was acquired in 43 patients with known pancreatic neuroendocrine tumors undergoing68Ga-DOTA-TOC PET on a simultaneous time-of-flight 3.0T PET/MRI. Liver lesions ≥1.5 cm with radionucleotide uptake were analyzed. Contrast-to-noise ratios (CNRs) were measured, and four blinded radiologists assessed overall image quality. Differences in repetition time and CNR were assessed using a paired Student's t test with p < 0.05 considered statistically significant. Inter-reader variability was assessed with Fleiss' kappa statistic.53 eligible lesions in 27 patients were included for analysis. vrfSSFSE demonstrated higher mean lesion CNR compared to SSFSE (9.9 ± 4.1 vs. 6.7 ± 4.1, p < 0.001). Mean repetition time (TR) was 679 ± 97 ms for the vrfSSFSE sequence compared to 1139 ± 106 ms for SSFSE (p < 0.0001), corresponding to a 1.7-fold decrease in acquisition time. Overall quality of liver lesion and common bile duct images with the vrfSSFSE sequence was graded as superior than or equivalent to the SSFSE sequence for 59% and 67% of patients, respectively.Compared to conventional SSFSE, vrfSSFSE resulted in improved lesion contrast on simultaneous PET/MRI in patients with liver metastases. Due to decreased SAR demands, vrfSSFSE significantly decreased TR, allowing coverage of the entire liver in a single twenty-second breath hold. This may have important clinical implications in the setting of PET/MRI, where scan time is limited by the necessity of whole-body image acquisition in addition to bed specific imaging.

  View details for PubMedID 28689221

• High-resolution diffusion-weighted imaging of the breast with multiband 2D radiofrequency pulses and a generalized parallel imaging reconstruction MAGNETIC RESONANCE IN MEDICINE Taviani, V., Alley, M. T., Banerjee, S., Nishimura, D. G., Daniel, B. L., Vasanawala, S. S., Hargreaves, B. A. 2017; 77 (1): 209-220

  Abstract

  To develop a technique for high-resolution diffusion-weighted imaging (DWI) and to compare it with standard DWI methods.Multiple in-plane bands of magnetization were simultaneously excited by identically phase modulating each subpulse of a two-dimensional (2D) RF pulse. Several excitations with the same multiband pattern progressively shifted in the phase-encode direction were used to cover the prescribed field of view (FOV). The phase-encoded FOV was limited to the width of a single band to reduce off-resonance-induced distortion and blurring. Parallel imaging (PI) techniques were used to resolve aliasing from the other bands and to combine the different excitations. Following validation in phantoms and healthy volunteers, a preliminary study in breast cancer patients (N=14) was performed to compare the proposed method to conventional DWI with PI and to reduced-FOV DWI.The proposed method gave high-resolution diffusion-weighted images with minimal artifacts at the band intersections. Compared to PI alone, higher phase-encoded FOV-reduction factors and reduced noise amplification were obtained, which translated to higher resolution images than conventional (non-multiband) DWI. The same resolution and image quality achievable over targeted regions using existing reduced-FOV methods was obtained, but the proposed method also enables complete bilateral coverage.We developed an in-plane multiband technique for high-resolution DWI and compared its performance with other standard DWI methods. Magn Reson Med 77:209-220, 2017. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.26110

  View details for Web of Science ID 000391038800022

• Prospective Evaluation of 68Ga-RM2 PET/MRI in Patients with Biochemical Recurrence of Prostate Cancer and Negative Conventional Imaging. Journal of nuclear medicine : official publication, Society of Nuclear Medicine Minamimoto, R., Sonni, I., Hancock, S., Vasanawala, S., Loening, A., Gambhir, S. S., Iagaru, A. 2017

  Abstract

  Purpose:68Ga-labeled DOTA-4-amino-1-carboxymethyl-piperidine-D-Phe-Gln-Trp-Ala-Val-Gly-His-Sta-Leu-NH2 (68Ga-RM2) is a synthetic bombesin receptor antagonist that targets gastrin-releasing peptide receptors (GRPr). GRPr proteins are highly overexpressed in several human tumors, including prostate cancer. We present data from the use of 68Ga-RM2 in patients with biochemical recurrence (BCR) of prostate cancer (PC) and negative conventional imaging (CI). Methods: We enrolled 32 men with BCR PC, 59-83 year-old (mean±standard deviation (SD): 68.7±6.4). Imaging started at 40-69 minutes (mean±SD: 50.5±6.8) after injection of 133.2-151.7 MBq (mean±SD: 140.6±7.4) of 68Ga-RM2 using a time-of-flight (TOF)-enabled simultaneous positron emission tomography (PET) / magnetic resonance imaging (MRI) scanner. T1-weighted (T1w), T2-weighted (T2w) and diffusion-weighted images (DWI) were acquired. Results: All patients had rising prostate specific antigen (PSA) (range: 0.3-119.0 ng/mL; mean±SD: 10.1 ± 21.3) and negative CI (CT or MRI, and 99mTc MDP bone scan) prior to enrollment. The observed 68Ga-RM2 PET detection rate was 71.8%. 68Ga-RM2 PET identified recurrent prostate cancer in 23 of the 32 participants, while the simultaneous MRI scan identified findings compatible with recurrent prostate cancer in 11 of the 32 patients. PSA velocity (PSAv) values were 0.32±0.59 ng/ml/year (range: 0.04-1.9) in patients with negative PET scans and 2.51±2.16 ng/ml/year (range: 0.13-8.68) in patients with positive PET scans (P: 0.006). Conclusion:68Ga-RM2 PET can be used for assessment of GRPr expression in patients with BCR PC. High uptake in multiple areas compatible with cancer lesions suggests that 68Ga-RM2 is a promising PET radiopharmaceutical for localization of disease in participants with BCR PC and negative CI.

  View details for PubMedID 29084827

• T-2 shuffling: Sharp, multicontrast, volumetric fast spin-echo imaging MAGNETIC RESONANCE IN MEDICINE Tamir, J. I., Uecker, M., Chen, W., Lai, P., Alley, M. T., Vasanawala, S. S., Lustig, M. 2017; 77 (1): 180-195

  View details for DOI 10.1002/mrm.26102

  View details for Web of Science ID 000391038800020

• An RF-gated wireless power transfer system for wireless MRI receive arrays. Concepts in magnetic resonance. Part B, Magnetic resonance engineering Byron, K., Robb, F., Stang, P., Vasanawala, S., Pauly, J., Scott, G. 2017; 47B (4)

  Abstract

  In MRI systems, cable-free receive arrays would simplify setup while reducing the bulk and weight of coil arrays and improve patient comfort and throughput. Since battery power would limit scan time, wireless power transfer (WPT) is a viable option to continuously supply several watts of power to on-coil electronics. To minimize added noise and decouple the wireless power system from MRI coils, restrictions are placed on the coil geometry of the wireless power system, which are shown to limit its efficiency. Continuous power harvesting can also cause a large increase in the background noise of the image due to diode rectifier up-conversion of noise around the frequency of the transmitted power. However, by RF gating the transmitted power off during the MRI receive time while continuing to supply power from a storage capacitor, WPT is demonstrated to have minimal impact on image quality at received power levels up to 11 W. The integration of WPT with a 1.5T scanner is demonstrated.

  View details for PubMedID 31057343

• Autocalibrating motion-corrected wave-encoding for highly accelerated free-breathing abdominal MRI. Magnetic resonance in medicine Chen, F., Zhang, T., Cheng, J. Y., Shi, X., Pauly, J. M., Vasanawala, S. S. 2016

  Abstract

  To develop a motion-robust wave-encoding technique for highly accelerated free-breathing abdominal MRI.A comprehensive 3D wave-encoding-based method was developed to enable fast free-breathing abdominal imaging: (a) auto-calibration for wave-encoding was designed to avoid extra scan for coil sensitivity measurement; (b) intrinsic butterfly navigators were used to track respiratory motion; (c) variable-density sampling was included to enable compressed sensing; (d) golden-angle radial-Cartesian hybrid view-ordering was incorporated to improve motion robustness; and (e) localized rigid motion correction was combined with parallel imaging compressed sensing reconstruction to reconstruct the highly accelerated wave-encoded datasets. The proposed method was tested on six subjects and image quality was compared with standard accelerated Cartesian acquisition both with and without respiratory triggering. Inverse gradient entropy and normalized gradient squared metrics were calculated, testing whether image quality was improved using paired t-tests.For respiratory-triggered scans, wave-encoding significantly reduced residual aliasing and blurring compared with standard Cartesian acquisition (metrics suggesting P < 0.05). For non-respiratory-triggered scans, the proposed method yielded significantly better motion correction compared with standard motion-corrected Cartesian acquisition (metrics suggesting P < 0.01).The proposed methods can reduce motion artifacts and improve overall image quality of highly accelerated free-breathing abdominal MRI. Magn Reson Med, 2016. © 2016 International Society for Magnetic Resonance in Medicine.

  View details for DOI 10.1002/mrm.26567

  View details for PubMedID 27943402

• Depletion-Mode GaN HEMT Q-Spoil Switches for MRI Coils IEEE TRANSACTIONS ON MEDICAL IMAGING Lu, J. Y., Grafendorfer, T., Zhang, T., Vasanawala, S., Robb, F., Pauly, J. M., Scott, G. C. 2016; 35 (12): 2558-2567

  Abstract

  Q-spoiling is the process of decoupling an MRI receive coil to protect the equipment and patient. Conventionally, Q-spoiling is performed using a PIN diode switch that draws significant current. In this work, a Q-spoiling technique using a depletion-mode Gallium Nitride HEMT device was developed for coil detuning at both 1.5 T and 3 T MRI. The circuits with conventional PIN diode Q-spoiling and the GaN HEMT device were implemented on surface coils. SNR was measured and compared for all surfaces coils. At both 1.5 T and 3 T, comparable SNR was achieved for all coils with the proposed technique and conventional Q-spoiling. The GaN HEMT device has significantly reduced the required power for Q-spoiling. The GaN HEMT device also provides useful safety features by detuning the coil when unpowered.

  View details for DOI 10.1109/TMI.2016.2586053

  View details for Web of Science ID 000391547700005

  View details for PubMedID 27362895

• Body diffusion weighted imaging using non-CPMG fast spin echo. IEEE transactions on medical imaging Gibbons, E., Le Roux, P., Vasanawala, S., Pauly, J., Kerr, A. 2016: -?

  Abstract

  SS-FSE is a fast technique that does not suffer from off-resonance distortions to the degree that EPI does. Unlike EPI, SS-FSE is ill-suited to diffusion weighted imaging (DWI) due to the Carr-Purcell-Meiboom-Geill (CPMG) condition. Non- CPMG phase cycling does accommodate SS-FSE and DWI but places constraints on reconstruction, which are resolved here through parallel imaging. Additionally, improved echo stability can be achieved by using short duration and highly selective DIVERSE radiofrequency pulses. Here, signal-to-noise ratio (SNR) comparisons between EPI and nCPMG SS-FSE acquisitions and reconstruction techniques give similar values. Diffusion imaging with nCPMG SS-FSE gives similar SNR to an EPI acquisition, though apparent diffusion coefficient values are higher than seen with EPI. In vivo images have good image quality with little distortion. This method has the ability to capture distortionfree DWI images near areas of significant off-resonance as well as preserve adequate SNR. Parallel imaging and DIVERSE refocusing RF pulses allow shorter ETL compared to previous implementations and thus reduces phase encode direction blur and SAR accumulation.

  View details for PubMedID 27810802

• Fast comprehensive single-sequence four-dimensional pediatric knee MRI with T2 shuffling. Journal of magnetic resonance imaging : JMRI Bao, S., Tamir, J. I., Young, J. L., Tariq, U., Uecker, M., Lai, P., Chen, W., Lustig, M., Vasanawala, S. S. 2016

  Abstract

  To develop and clinically evaluate a pediatric knee magnetic resonance imaging (MRI) technique based on volumetric fast spin-echo (3DFSE) and compare its diagnostic performance, image quality, and imaging time to that of a conventional 2D protocol.A 3DFSE sequence was modified and combined with a compressed sensing-based reconstruction resolving multiple image contrasts, a technique termed T2 Shuffling (T2 Sh). With Institutional Review Board (IRB) approval, 28 consecutive children referred for 3T knee MRI prospectively underwent a standard clinical knee protocol followed by T2 Sh. T2 Sh performance was assessed by two readers blinded to diagnostic reports. Interpretive discrepancies were resolved by medical record chart review and consensus between the readers and an orthopedic surgeon. Image quality was evaluated by rating anatomic delineation, with 95% confidence interval. A Wilcoxon rank-sum test assessed the null hypothesis that T2 Sh structure delineation compared to conventional 2D is unchanged. Intraclass correlation coefficients were calculated for interobserver agreement. Imaging time of the conventional protocol and T2 Sh was compared.There was 81% and 87% concordance between T2 Sh reports and diagnostic reports, respectively, for each reader. Upon consensus review, T2 Sh had 93% sensitivity and 100% specificity compared to clinical reports for detection of clinically relevant findings. The 95% confidence interval of diagnostic or better rating was 95-100%, with 34-80% interobserver agreement. There was no significant difference in structure delineation between T2 Sh and 2D, except for the retinaculum (P < 0.05), where 2D was preferred. Typical imaging time for T2 Sh and the conventional exam was 7 and 13 minutes, respectively.A single-sequence pediatric knee exam is feasible with T2 Sh, providing multiplanar, reformattable 4D images. Level of Evidence 2 J. Magn. Reson. Imaging 2016;00:000-000.

  View details for DOI 10.1002/jmri.25508

  View details for PubMedID 27726251

• Cloud-processed 4D CMR flow imaging for pulmonary flow quantification. European journal of radiology Chelu, R. G., Wanambiro, K. W., Hsiao, A., Swart, L. E., Voogd, T., van den Hoven, A. T., van Kranenburg, M., Coenen, A., Boccalini, S., Wielopolski, P. A., Vogel, M. W., Krestin, G. P., Vasanawala, S. S., Budde, R. P., Roos-Hesselink, J. W., Nieman, K. 2016; 85 (10): 1849-1856

  Abstract

  In this study, we evaluated a cloud-based platform for cardiac magnetic resonance (CMR) four-dimensional (4D) flow imaging, with fully integrated correction for eddy currents, Maxwell phase effects, and gradient field non-linearity, to quantify forward flow, regurgitation, and peak systolic velocity over the pulmonary artery.We prospectively recruited 52 adult patients during one-year period from July 2014. The 4D flow and planar (2D) phase-contrast (PC) were acquired during same scanning session, but 4D flow was scanned after injection of a gadolinium-based contrast agent. Eddy-currents were semi-automatically corrected using the web-based software. Flow over pulmonary valve was measured and the 4D flow values were compared against the 2D PC ones.The mean forward flow was 92 (±30) ml/cycle measured with 4D flow and 86 (±29) ml/cycle measured with 2D PC, with a correlation of 0.82 and a mean difference of -6ml/cycle (-41-29). For the regurgitant fraction the correlation was 0.85 with a mean difference of -0.95% (-17-15). Mean peak systolic velocity measured with 4D flow was 92 (±49) cm/s and 108 (±56) cm/s with 2D PC, having a correlation of 0.93 and a mean difference of 16cm/s (-24-55).4D flow imaging post-processed with an integrated cloud-based application accurately quantifies pulmonary flow. However, it may underestimate the peak systolic velocity.

  View details for DOI 10.1016/j.ejrad.2016.07.018

  View details for PubMedID 27666627

• Feasibility of ferumoxytol-enhanced neonatal and young infant cardiac MRI without general anesthesia. Journal of magnetic resonance imaging : JMRI Lai, L. M., Cheng, J. Y., Alley, M. T., Zhang, T., Lustig, M., Vasanawala, S. S. 2016

  Abstract

  To assess the feasibility of ferumoxytol-enhanced anesthesia-free cardiac MRI in neonates and young infants for complex congenital heart disease (CHD).With Institutional Review Board approval, 21 consecutive neonates and young infants (1 day to 11 weeks old; median age of 3 days) who underwent a rapid two-sequence (MR angiography [MRA] and four-dimensional [4D] flow) MRI protocol with intravenous ferumoxytol without sedation (n = 17) or light sedation (n = 4) at 3 Tesla (T) (except one case at 1.5T) between June 2014 and February 2016 were retrospectively identified. Medical records were reviewed for indication, any complications, if further diagnostic imaging was performed after MRI, and surgical findings. Two radiologists scored the images in two sessions on a 5-point scale for overall image quality and delineation of various anatomical structures. Confidence interval of proportions for likelihood of requiring additional diagnostic imaging after MRI was determined. For the possibility of reducing the protocol to a single rapid sequence, Wilcoxon-rank sum test was used to assess whether 4D flow and MRA significantly differed in anatomical delineation.One of 21 patients (4.8%, 80% confidence interval 0-11%) required additional imaging, a computed tomography angiography to assess lung parenchyma and peripheral pulmonary arteries. Only 1 of 13 patients (7.7%) with operative confirmation had a minor discrepancy between radiology and operative reports (80% confidence interval 0-17%). 4D flow was significantly superior to MRA (P < 0.05) for the evaluation of systemic arteries, valves, ventricular trabeculae, and overall quality. Using Cohen's kappa coefficient, there was good interobserver agreement for the evaluation of systemic arteries by 4D flow (κ = 0.782), and systemic veins and pulmonary arteries by MRA (κ > 0.6). Overall 4D flow measurements (mean κ = 0.64-0.74) had better internal agreement compared with MRA (mean κ = 0.30-0.64).Ferumoxytol-enhanced cardiac MRI, without anesthesia, is feasible for the evaluation of complex CHD in neonates and young infants, with a low likelihood of need for additional diagnostic studies. The decreased risk by avoiding anesthesia must be balanced against the potential for adverse reactions with ferumoxytol.2 J. Magn. Reson. Imaging 2016.

  View details for DOI 10.1002/jmri.25482

  View details for PubMedID 27678106

• Predictors of Nondiagnostic Ultrasound for Appendicitis. journal of emergency medicine Keller, C., Wang, N. E., Imler, D. L., Vasanawala, S. S., Bruzoni, M., Quinn, J. V. 2016

  Abstract

  Ionizing radiation and cost make ultrasound (US), when available, the first imaging study for the diagnosis of suspected pediatric appendicitis. US is less sensitive and specific than computed tomography (CT) or magnetic resonance imaging (MRI) scans, which are often performed after nondiagnostic US.We sought to determine predictors of nondiagnostic US in order to guide efficient ordering of imaging studies.A prospective cohort study of consecutive patients 4 to 30 years of age with suspected appendicitis took place at an emergency department with access to 24/7 US, MRI, and CT capabilities. Patients with US as their initial study were identified. Clinical (i.e., duration of illness, highest fever, and right lower quadrant pain) and demographic (i.e., age and sex) variables were collected. Body mass index (BMI) was calculated based on Centers for Disease Control and Prevention criteria; BMI >85th percentile was categorized as overweight. Patients were followed until day 7. Univariate and stepwise multivariate logistic regression analysis was performed.Over 3 months, 106 patients had US first for suspected appendicitis; 52 (49%) had nondiagnostic US results. Eighteen patients had appendicitis, and there were no missed cases after discharge. On univariate analysis, male sex, a yearly increase in age, and overweight BMI were associated with nondiagnostic US (p < 0.05). In the multivariate model, only BMI (odds ratio 4.9 [95% CI 2.0-12.2]) and age (odds ratio 1.1 [95% CI 1.02-1.20]) were predictors. Sixty-eight percent of nondiagnostic US results occurred in overweight patients.Overweight and older patients are more likely to have a nondiagnostic US or appendicitis, and it may be more efficient to consider alternatives to US first for these patients. Also, this information about the accuracy of US to diagnose suspected appendicitis may be useful to clinicians who wish to engage in shared decision-making with the parents or guardians of children regarding imaging options for children with acute abdominal pain.

  View details for DOI 10.1016/j.jemermed.2016.07.101

  View details for PubMedID 27692650

• Decompressing vein and bilateral superior venae cavae in a patient with hypoplastic left heart syndrome. Echocardiography (Mount Kisco, N.Y.) Stauffer, K. J., Arunamata, A., Vasanawala, S. S., Behera, S. K., Kipps, A. K., Silverman, N. H. 2016; 33 (9): 1428-1431

  Abstract

  The levoatrial cardinal vein (LACV), first described in 1926, acts as a decompressing vessel for pulmonary venous return in cases of severe left-sided obstruction with an intact or significantly restrictive atrial septum. The LACV and the persistent left superior vena cava (LSVC) are thought to share similar embryologic origins. To challenge this notion, we present a unique case of a neonate with hypoplastic left heart syndrome, cor triatriatum, and a decompressing LACV in the presence of bilateral superior venae cavae.

  View details for DOI 10.1111/echo.13292

  View details for PubMedID 27641733

• A semiflexible 64-channel receive-only phased array for pediatric body MRI at 3T. Magnetic resonance in medicine Zhang, T., Grafendorfer, T., Cheng, J. Y., Ning, P., Rainey, B., Giancola, M., Ortman, S., Robb, F. J., Calderon, P. D., Hargreaves, B. A., Lustig, M., Scott, G. C., Pauly, J. M., Vasanawala, S. S. 2016; 76 (3): 1015-1021

  Abstract

  To design, construct, and validate a semiflexible 64-channel receive-only phased array for pediatric body MRI at 3T.A 64-channel receive-only phased array was developed and constructed. The designed flexible coil can easily conform to different patient sizes with nonoverlapping coil elements in the transverse plane. It can cover a field of view of up to 44 × 28 cm(2) and removes the need for coil repositioning for body MRI patients with multiple clinical concerns. The 64-channel coil was compared with a 32-channel standard coil for signal-to-noise ratio and parallel imaging performances on different phantoms. With IRB approval and informed consent/assent, the designed coil was validated on 21 consecutive pediatric patients.The pediatric coil provided higher signal-to-noise ratio than the standard coil on different phantoms, with the averaged signal-to-noise ratio gain at least 23% over a depth of 7 cm along the cross-section of phantoms. It also achieved better parallel imaging performance under moderate acceleration factors. Good image quality (average score 4.6 out of 5) was achieved using the developed pediatric coil in the clinical studies.A 64-channel semiflexible receive-only phased array has been developed and validated to facilitate high quality pediatric body MRI at 3T. Magn Reson Med 76:1015-1021, 2016. © 2015 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.25999

  View details for PubMedID 26418283

  View details for PubMedCentralID PMC4811745

• Assessment of the precision and reproducibility of ventricular volume, function, and mass measurements with ferumoxytol-enhanced 4D flow MRI JOURNAL OF MAGNETIC RESONANCE IMAGING Hanneman, K., Kino, A., Cheng, J. Y., Alley, M. T., Vasanawala, S. S. 2016; 44 (2): 383-392

  Abstract

  To compare the precision and interobserver agreement of ventricular volume, function, and mass quantification by 3D time-resolved (4D) flow MRI relative to cine steady-state free precession (SSFP).With Institutional Research Board approval, informed consent, and HIPAA compliance, 22 consecutive patients with congenital heart disease (CHD) (10 males, 6.4 ± 4.8 years) referred for 3T ferumoxytol-enhanced cardiac MRI were prospectively recruited. Complete ventricular coverage with standard 2D short-axis cine SSFP and whole chest coverage with axial 4D flow were obtained. Two blinded radiologists independently segmented images for left ventricular (LV) and right ventricular (RV) myocardium at end systole (ES) and end diastole (ED). Statistical analysis included linear regression, analysis of variance (ANOVA), Bland-Altman (BA) analysis, and intraclass correlation (ICC).Significant positive correlations were found between 4D flow and SSFP for ventricular volumes (r = 0.808-0.972, P < 0.001), ejection fraction (EF) (r = 0.900-928, P < 0.001), and mass (r = 0.884-0.934, P < 0.001). BA relative limits of agreement for both ventricles were between -52% to 34% for volumes, -29% to 27% for EF, and -41% to 48% for mass, with wider limits of agreement for the RV compared to the LV. There was no significant difference between techniques with respect to mean square difference of ED-ES mass for either LV (F = 2.05, P = 0.159) or RV (F = 0.625, P = 0.434). Interobserver agreement was moderate to good with both 4D flow (ICC 0.523-0.993) and SSFP (ICC 0.619-0.982), with overlapping confidence intervals.Quantification of ventricular volume, function, and mass can be accomplished with 4D flow MRI with precision and interobserver agreement comparable to that of cine SSFP. J. Magn. Reson. Imaging 2016;44:383-392.

  View details for DOI 10.1002/jmri.25180

  View details for Web of Science ID 000380068100014

  View details for PubMedID 26871420

  View details for PubMedCentralID PMC4947013

• Robust self-navigated body MRI using dense coil arrays. Magnetic resonance in medicine Zhang, T., Cheng, J. Y., Chen, Y., Nishimura, D. G., Pauly, J. M., Vasanawala, S. S. 2016; 76 (1): 197-205

  Abstract

  To develop a robust motion estimation method for free-breathing body MRI using dense coil arrays.Self-navigating pulse sequences can measure subject motion without using external motion monitoring devices. With dense coil arrays, individual coil elements can provide localized motion estimates. An averaged motion estimate over all coils is often used for motion compensation. However, this motion estimate may not accurately represent the dominant motion within the imaging volume. In this work, a coil clustering method is proposed to automatically determine the dominant motion for dense coil arrays. The feasibility of the proposed method is investigated in free-breathing abdominal MRI and cardiac MRI, and compared with manual motion estimate selection for respiratory motion estimation and electrocardiography for cardiac motion estimation.Automated motion estimation achieved similar respiratory motion estimation compared to manual selection (averaged correlation coefficient 0.989 and 0.988 for abdominal MRI and cardiac MRI, respectively), and accurate cardiac triggering compared to electrocardiography (averaged temporal variability 17.5 ms).The proposed method can provide accurate automated motion estimation for body MRI using dense coil arrays. It can enable self-navigated free-breathing abdominal and cardiac MRI without the need for external motion monitoring devices. Magn Reson Med 76:197-205, 2016. © 2015 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.25858

  View details for PubMedID 26220204

  View details for PubMedCentralID PMC4732937

• Comprehensive motion-compensated highly accelerated 4D flow MRI with ferumoxytol enhancement for pediatric congenital heart disease. Journal of magnetic resonance imaging Cheng, J. Y., Hanneman, K., Zhang, T., Alley, M. T., Lai, P., Tamir, J. I., Uecker, M., Pauly, J. M., Lustig, M., Vasanawala, S. S. 2016; 43 (6): 1355-1368

  Abstract

  To develop and evaluate motion-compensation and compressed-sensing techniques in 4D flow MRI for anatomical assessment in a comprehensive ferumoxytol-enhanced congenital heart disease (CHD) exam.A Cartesian 4D flow sequence was developed to enable intrinsic navigation and two variable-density sampling schemes: VDPoisson and VDRad. Four compressed-sensing methods were developed: A) VDPoisson scan reconstructed using spatial wavelets; B) added temporal total variation to A; C) VDRad scan using the same reconstruction as in B; and D) added motion compensation to C. With Institutional Review Board (IRB) approval and Health Insurance Portability and Accountability Act (HIPAA) compliance, 23 consecutive patients (eight females, mean 6.3 years) referred for ferumoxytol-enhanced CHD 3T MRI were recruited. Images were acquired and reconstructed using methods A-D. Two cardiovascular radiologists independently scored the images on a 5-point scale. These readers performed a paired wall motion and functional assessment between method D and 2D balanced steady-state free precession (bSSFP) CINE for 16 cases.Method D had higher diagnostic image quality for most anatomical features (mean 3.8-4.8) compared to A (2.0-3.6), B (2.2-3.7), and C (2.9-3.9) with P < 0.05 with good interobserver agreement (κ ≥ 0.49). Method D had similar or better assessment of myocardial borders and cardiac motion compared to 2D bSSFP (P < 0.05, κ ≥ 0.77). All methods had good internal agreement in comparing aortic with pulmonic flow (BA mean < 0.02%, r > 0.85) and compared to method A (BA mean < 0.13%, r > 0.84) with P < 0.01.Flow, functional, and anatomical assessment in CHD with ferumoxytol-enhanced 4D flow is feasible and can be significantly improved using motion compensation and compressed sensing. J. Magn. Reson. Imaging 2016;43:1355-1368.

  View details for DOI 10.1002/jmri.25106

  View details for PubMedID 26646061

  View details for PubMedCentralID PMC4865413

• Resolving phase ambiguity in dual-echo dixon imaging using a projected power method. Magnetic resonance in medicine Zhang, T., Chen, Y., Bao, S., Alley, M. T., Pauly, J. M., Hargreaves, B. A., Vasanawala, S. S. 2016

  Abstract

  To develop a fast and robust method to resolve phase ambiguity in dual-echo Dixon imaging.A major challenge in dual-echo Dixon imaging is to estimate the phase error resulting from field inhomogeneity. In this work, a binary quadratic optimization program was formulated to resolve the phase ambiguity. A projected power method was developed to efficiently solve the optimization problem. Both the 1-peak fat model and 6-peak fat model were applied to three-dimensional (3D) datasets. Additionally, the proposed method was extended to dynamic magnetic resonance imaging (MRI) applications using the 6-peak fat model. With institutional review board (IRB) approval and patient consent/assent, the proposed method was evaluated and compared with region growing on 29 consecutive 3D high-resolution patient datasets.Fast and robust water/fat separation was achieved by the proposed method in different representative 3D datasets and dynamic 3D datasets. Superior water/fat separation was achieved using the 6-peak fat model compared with the 1-peak fat model. Compared to region growing, the proposed method reduced water/fat swaps from 76 to 7% of the patient cohort.The proposed method can achieve fast and robust phase error estimation in dual-echo Dixon imaging. Magn Reson Med, 2016. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.26287

  View details for PubMedID 27221766

  View details for PubMedCentralID PMC5123983

• Safety and technique of ferumoxytol administration for MRI. Magnetic resonance in medicine Vasanawala, S. S., Nguyen, K., Hope, M. D., Bridges, M. D., Hope, T. A., Reeder, S. B., Bashir, M. R. 2016; 75 (5): 2107-2111

  Abstract

  Ferumoxytol is an ultrasmall superparamagnetic iron oxide agent marketed for the treatment of anemia. There has been increasing interest in its properties as an MRI contrast agent as well as greater awareness of its adverse event profile. This mini-review summarizes the current state of knowledge of the risks of ferumoxytol and methods of administration. Magn Reson Med 75:2107-2111, 2016. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.26151

  View details for PubMedID 26890830

  View details for PubMedCentralID PMC4854636

• 3D Cartesian MRI with compressed sensing and variable view sharing using complementary poisson-disc sampling. Magnetic resonance in medicine Levine, E., Daniel, B., Vasanawala, S., Hargreaves, B., Saranathan, M. 2016: -?

  Abstract

  To enable robust, high spatio-temporal-resolution three-dimensional Cartesian MRI using a scheme incorporating a novel variable density random k-space sampling trajectory allowing flexible and retrospective selection of the temporal footprint with compressed sensing (CS).A complementary Poisson-disc k-space sampling trajectory was designed to allow view sharing and varying combinations of reduced view sharing with CS from the same prospective acquisition. These schemes were used for two-point Dixon-based dynamic contrast-enhanced MRI (DCE-MRI) of the breast and abdomen. Results were validated in vivo with a novel approach using variable-flip-angle data, which was retrospectively accelerated using the same methods but offered a ground truth.In breast DCE-MRI, the temporal footprint could be reduced 2.3-fold retrospectively without introducing noticeable artifacts, improving depiction of rapidly enhancing lesions. Further, experiments with variable-flip-angle data showed that reducing view sharing improved accuracy in reconstruction and T1 mapping. In abdominal MRI, 2.3-fold and 3.6-fold reductions in temporal footprint allowed reduced motion artifacts.The complementary-Poisson-disc k-space sampling trajectory allowed a retrospective spatiotemporal resolution tradeoff using CS and view sharing, imparting robustness to motion and contrast enhancement. The technique was also validated using a novel approach of fully acquired variable-flip-angle acquisition. Magn Reson Med, 2016. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.26254

  View details for PubMedID 27097596

  View details for PubMedCentralID PMC5074926

• Combined parenchymal and vascular imaging: High spatiotemporal resolution arterial evaluation of hepatocellular carcinoma JOURNAL OF MAGNETIC RESONANCE IMAGING Hope, T. A., Petkovska, I., Saranathan, M., Hargreaves, B. A., Vasanawala, S. S. 2016; 43 (4): 859-865

  Abstract

  To assess the ability of high-resolution arterial phase imaging of hepatocellular carcinoma (HCC) to provide combined vascular characterization and parenchymal evaluation.Thirty-eight consecutive studies in cirrhotic patients with HCC scanned with a view-shared 2-point-Dixon-based Differential Subsampling with Cartesian Ordering (DISCO) sequence were analyzed. Lesion contrast relative to precontrast and adjacent parenchyma was evaluated and compared using a Fisher's exact test. Visibility of hepatic arteries and tumor feeding vessels were graded on a 5-point scale. Catheter angiography was used as a reference standard for arterial anatomy.The high spatiotemporal multiphasic acquisition allowed imaging of both the angiographic and late arterial phase in 30 of 38 studies with good image quality. Maximal lesion enhancement compared to precontrast occurred more frequently during the late arterial phase compared to maximal lesion-to-adjacent, which occurred more frequently during the early arterial phase (P < 0.001). Common and proper hepatic arteries were visualized adequately in 100%, right hepatic artery in 94-97%, left hepatic artery in 94%, and segmental vessel in 83% of cases. Arterial variants were detected with sensitivity of 87-100% and specificity of 100%.High spatiotemporal resolution arterial phase imaging provides multiple angiographic and arterial phases in a single breath-hold, enabling accurate depiction of vascular anatomy while maintain optimal arterial phase imaging for characterization of focal lesions. J. Magn. Reson. Imaging 2016;43:859-865.

  View details for DOI 10.1002/jmri.25042

  View details for Web of Science ID 000373000500009

• Pilot Comparison of Ga-68-RM2 PET and Ga-68-PSMA-11 PET in Patients with Biochemically Recurrent Prostate Cancer JOURNAL OF NUCLEAR MEDICINE Minamimoto, R., Hancock, S., Schneider, B., Chin, F. T., Jamali, M., Loening, A., Vasanawala, S., Gambhir, S. S., Iagaru, A. 2016; 57 (4): 557-562

  Abstract

  Glu-NH-CO-NH-Lys-(Ahx)-[(68)Ga(HBED-CC)] ((68)Ga-PSMA-11) is a PET tracer that can detect prostate cancer relapses and metastases by binding to the extracellular domain of PSMA.(68)Ga-labeled DOTA-4-amino-1-carboxymethyl-piperidine-d-Phe-Gln-Trp-Ala-Val-Gly-His-Sta-Leu-NH2 ((68)Ga-RM2) is a synthetic bombesin receptor antagonist that targets gastrin-releasing peptide receptors. We present pilot data on the biodistribution of these PET tracers in a small cohort of patients with biochemically recurrent prostate cancer.Seven men (mean age ± SD, 74.3 ± 5.9 y) with biochemically recurrent prostate cancer underwent both(68)Ga-PSMA-11 PET/CT and(68)Ga-RM2 PET/MRI scans. SUVmaxand SUVmeanwere recorded for normal tissues and areas of uptake outside the expected physiologic biodistribution.All patients had a rising level of prostate-specific antigen (mean ± SD, 13.5 ± 11.5) and noncontributory results on conventional imaging.(68)Ga-PSMA-11 had the highest physiologic uptake in the salivary glands and small bowel, with hepatobiliary and renal clearance noted, whereas(68)Ga-RM2 had the highest physiologic uptake in the pancreas, with renal clearance noted. Uptake outside the expected physiologic biodistribution did not significantly differ between(68)Ga-PSMA-11 and(68)Ga-RM2; however,(68)Ga-PSMA-11 localized in a lymph node and seminal vesicle in a patient with no abnormal(68)Ga-RM2 uptake. Abdominal periaortic lymph nodes were more easily visualized by(68)Ga-RM2 in two patients because of lack of interference by radioactivity in the small intestine.(68)Ga-PSMA-11 and(68)Ga-RM2 had distinct biodistributions in this small cohort of patients with biochemically recurrent prostate cancer. Additional work is needed to understand the expression of PSMA and gastrin-releasing peptide receptors in different types of prostate cancer.

  View details for DOI 10.2967/jnumed.115.168393

  View details for PubMedID 26659347

• Combined parenchymal and vascular imaging: High spatiotemporal resolution arterial evaluation of hepatocellular carcinoma. Journal of magnetic resonance imaging Hope, T. A., Petkovska, I., Saranathan, M., Hargreaves, B. A., Vasanawala, S. S. 2016; 43 (4): 859-865

  Abstract

  To assess the ability of high-resolution arterial phase imaging of hepatocellular carcinoma (HCC) to provide combined vascular characterization and parenchymal evaluation.Thirty-eight consecutive studies in cirrhotic patients with HCC scanned with a view-shared 2-point-Dixon-based Differential Subsampling with Cartesian Ordering (DISCO) sequence were analyzed. Lesion contrast relative to precontrast and adjacent parenchyma was evaluated and compared using a Fisher's exact test. Visibility of hepatic arteries and tumor feeding vessels were graded on a 5-point scale. Catheter angiography was used as a reference standard for arterial anatomy.The high spatiotemporal multiphasic acquisition allowed imaging of both the angiographic and late arterial phase in 30 of 38 studies with good image quality. Maximal lesion enhancement compared to precontrast occurred more frequently during the late arterial phase compared to maximal lesion-to-adjacent, which occurred more frequently during the early arterial phase (P < 0.001). Common and proper hepatic arteries were visualized adequately in 100%, right hepatic artery in 94-97%, left hepatic artery in 94%, and segmental vessel in 83% of cases. Arterial variants were detected with sensitivity of 87-100% and specificity of 100%.High spatiotemporal resolution arterial phase imaging provides multiple angiographic and arterial phases in a single breath-hold, enabling accurate depiction of vascular anatomy while maintain optimal arterial phase imaging for characterization of focal lesions. J. Magn. Reson. Imaging 2016;43:859-865.

  View details for DOI 10.1002/jmri.25042

  View details for PubMedID 26340309

• High temporal resolution dynamic MRI and arterial input function for assessment of GFR in pediatric subjects. Magnetic resonance in medicine Yoruk, U., Saranathan, M., Loening, A. M., Hargreaves, B. A., Vasanawala, S. S. 2016; 75 (3): 1301-1311

  Abstract

  To introduce a respiratory-gated high-spatiotemporal-resolution dynamic-contrast-enhanced MRI technique and a high-temporal-resolution aortic input function (HTR-AIF) estimation method for glomerular filtration rate (GFR) assessment in children.A high-spatiotemporal-resolution DCE-MRI method with view-shared reconstruction was modified to incorporate respiratory gating, and an AIF estimation method that uses a fraction of the k-space data from each respiratory period was developed (HTR-AIF). The method was validated using realistic digital phantom simulations and demonstrated on clinical subjects. The GFR estimates using HTR-AIF were compared with estimates obtained by using an AIF derived directly from the view-shared images.Digital phantom simulations showed that using the HTR-AIF technique gives more accurate AIF estimates (RMSE = 0.0932) compared with the existing estimation method (RMSE = 0.2059) that used view-sharing (VS). For simulated GFR > 27 mL/min, GFR estimation error was between 32% and 17% using view-shared AIF, whereas estimation error was less than 10% using HTR-AIF. In all clinical subjects, the HTR-AIF method resulted in higher GFR estimations than the view-shared method.The HTR-AIF method improves the accuracy of both the AIF and GFR estimates derived from the respiratory-gated acquisitions, and makes GFR estimation feasible in free-breathing pediatric subjects. Magn Reson Med, 2015. © 2015 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.25731

  View details for PubMedID 25946307

• Qualitative grading of aortic regurgitation: a pilot study comparing CMR 4D flow and echocardiography INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING Chelu, R. G., van den Bosch, A. E., van Kranenburg, M., Hsiao, A., van den Hoven, A. T., Ouhlous, M., Budde, R. P., Beniest, K. M., Swart, L. E., Coenen, A., Lubbers, M. M., Wielopolski, P. A., Vasanawala, S. S., Roos-Hesselink, J. W., Nieman, K. 2016; 32 (2): 301-307

  Abstract

  Over the past 10 years there has been intense research in the development of volumetric visualization of intracardiac flow by cardiac magnetic resonance (CMR).This volumetric time resolved technique called CMR 4D flow imaging has several advantages over standard CMR. It offers anatomical, functional and flow information in a single free-breathing, ten-minute acquisition. However, the data obtained is large and its processing requires dedicated software. We evaluated a cloud-based application package that combines volumetric data correction and visualization of CMR 4D flow data, and assessed its accuracy for the detection and grading of aortic valve regurgitation using transthoracic echocardiography as reference. Between June 2014 and January 2015, patients planned for clinical CMR were consecutively approached to undergo the supplementary CMR 4D flow acquisition. Fifty four patients(median age 39 years, 32 males) were included. Detection and grading of the aortic valve regurgitation using CMR4D flow imaging were evaluated against transthoracic echocardiography. The agreement between 4D flow CMR and transthoracic echocardiography for grading of aortic valve regurgitation was good (j = 0.73). To identify relevant,more than mild aortic valve regurgitation, CMR 4D flow imaging had a sensitivity of 100 % and specificity of 98 %. Aortic regurgitation can be well visualized, in a similar manner as transthoracic echocardiography, when using CMR 4D flow imaging.

  View details for DOI 10.1007/s10554-015-0779-7

  View details for Web of Science ID 000369810300011

  View details for PubMedCentralID PMC4737795

• Hemodynamic safety and efficacy of ferumoxytol as an intravenous contrast agents in pediatric patients and young adults MAGNETIC RESONANCE IMAGING Ning, P., Zucker, E. J., Wong, P., Vasanawala, S. S. 2016; 34 (2): 152-158

  Abstract

  To evaluate the safety and feasibility of off-label use of ferumoxytol as an intravenous MRI contrast agents in pediatric patients and young adults.With HIPAA compliance and IRB approval, 86 consecutive patients who had undergone 3 T or 1.5 T MRI with ferumoxytol were retrospectively identified. The blood pressure and heart rate of patients before and after ferumoxytol injection were compared. The overall image quality was evaluated independently by two radiologists with a four-point scale. Interobserver agreement was calculated using weighted kappa statistics.The mean±standard deviation (SD) pre and post-contrast systolic blood pressures (SBP) were 101±18 and 95±20, respectively. There was a statistically significant difference between pre-SBP and post-SBP (P=0.003). The pre-contrast diastolic blood pressure (DBP) and the post-contrast diastolic blood pressure (DBP) were 60±14 and 51±17, respectively. There was a statistically significant difference between pre-DBP and post-DBP (P<0.001). The number of patients with SBP and DBP increase, SBP increase and DBP decrease, SBP decrease and DBP increase, SBP and DBP decrease, SBP increase and DBP unchanged were 14 (16%), 9 (10%), 6 (7%), 56 (65%), 1 (1%), respectively. There was moderate agreement on all individual assessments of image quality (kappa=0.45). Eighty-two of 86 (95.4%) studies were scored 3 or above (at least diagnostic quality) by both readers, with 90% confidence interval of 92-99%.Ferumoxytol is effective as an MR contrast agent. In our sample, there was on average a small but clinically insignificant drop in SBP and DBP post-contrast injection. Large, randomized, controlled trials are needed to establish optimal dosing, imaging procedures, and safety monitoring.

  View details for DOI 10.1016/j.mri.2015.10.019

  View details for Web of Science ID 000368312600012

• T2 shuffling: Sharp, multicontrast, volumetric fast spin-echo imaging. Magnetic resonance in medicine Tamir, J. I., Uecker, M., Chen, W., Lai, P., Alley, M. T., Vasanawala, S. S., Lustig, M. 2016

  Abstract

  A new acquisition and reconstruction method called T2 Shuffling is presented for volumetric fast spin-echo (three-dimensional [3D] FSE) imaging. T2 Shuffling reduces blurring and recovers many images at multiple T2 contrasts from a single acquisition at clinically feasible scan times (6-7 min).The parallel imaging forward model is modified to account for temporal signal relaxation during the echo train. Scan efficiency is improved by acquiring data during the transient signal decay and by increasing echo train lengths without loss in signal-to-noise ratio (SNR). By (1) randomly shuffling the phase encode view ordering, (2) constraining the temporal signal evolution to a low-dimensional subspace, and (3) promoting spatio-temporal correlations through locally low rank regularization, a time series of virtual echo time images is recovered from a single scan. A convex formulation is presented that is robust to partial voluming and radiofrequency field inhomogeneity.Retrospective undersampling and in vivo scans confirm the increase in sharpness afforded by T2 Shuffling. Multiple image contrasts are recovered and used to highlight pathology in pediatric patients. A proof-of-principle method is integrated into a clinical musculoskeletal imaging workflow.The proposed T2 Shuffling method improves the diagnostic utility of 3D FSE by reducing blurring and producing multiple image contrasts from a single scan. Magn Reson Med 77:180-195, 2017. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.26102

  View details for PubMedID 26786745

  View details for PubMedCentralID PMC4990508

• High-resolution diffusion-weighted imaging of the breast with multiband 2D radiofrequency pulses and a generalized parallel imaging reconstruction. Magnetic resonance in medicine Taviani, V., Alley, M. T., Banerjee, S., Nishimura, D. G., Daniel, B. L., Vasanawala, S. S., Hargreaves, B. A. 2016

  Abstract

  To develop a technique for high-resolution diffusion-weighted imaging (DWI) and to compare it with standard DWI methods.Multiple in-plane bands of magnetization were simultaneously excited by identically phase modulating each subpulse of a two-dimensional (2D) RF pulse. Several excitations with the same multiband pattern progressively shifted in the phase-encode direction were used to cover the prescribed field of view (FOV). The phase-encoded FOV was limited to the width of a single band to reduce off-resonance-induced distortion and blurring. Parallel imaging (PI) techniques were used to resolve aliasing from the other bands and to combine the different excitations. Following validation in phantoms and healthy volunteers, a preliminary study in breast cancer patients (N=14) was performed to compare the proposed method to conventional DWI with PI and to reduced-FOV DWI.The proposed method gave high-resolution diffusion-weighted images with minimal artifacts at the band intersections. Compared to PI alone, higher phase-encoded FOV-reduction factors and reduced noise amplification were obtained, which translated to higher resolution images than conventional (non-multiband) DWI. The same resolution and image quality achievable over targeted regions using existing reduced-FOV methods was obtained, but the proposed method also enables complete bilateral coverage.We developed an in-plane multiband technique for high-resolution DWI and compared its performance with other standard DWI methods. Magn Reson Med 77:209-220, 2017. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.26110

  View details for PubMedID 26778549

• Hemodynamic safety and efficacy of ferumoxytol as an intravenous contrast agents in pediatric patients and young adults. Magnetic resonance imaging Ning, P., Zucker, E. J., Wong, P., Vasanawala, S. S. 2016; 34 (2): 152–58

  Abstract

  To evaluate the safety and feasibility of off-label use of ferumoxytol as an intravenous MRI contrast agents in pediatric patients and young adults.With HIPAA compliance and IRB approval, 86 consecutive patients who had undergone 3 T or 1.5 T MRI with ferumoxytol were retrospectively identified. The blood pressure and heart rate of patients before and after ferumoxytol injection were compared. The overall image quality was evaluated independently by two radiologists with a four-point scale. Interobserver agreement was calculated using weighted kappa statistics.The mean±standard deviation (SD) pre and post-contrast systolic blood pressures (SBP) were 101±18 and 95±20, respectively. There was a statistically significant difference between pre-SBP and post-SBP (P=0.003). The pre-contrast diastolic blood pressure (DBP) and the post-contrast diastolic blood pressure (DBP) were 60±14 and 51±17, respectively. There was a statistically significant difference between pre-DBP and post-DBP (P<0.001). The number of patients with SBP and DBP increase, SBP increase and DBP decrease, SBP decrease and DBP increase, SBP and DBP decrease, SBP increase and DBP unchanged were 14 (16%), 9 (10%), 6 (7%), 56 (65%), 1 (1%), respectively. There was moderate agreement on all individual assessments of image quality (kappa=0.45). Eighty-two of 86 (95.4%) studies were scored 3 or above (at least diagnostic quality) by both readers, with 90% confidence interval of 92-99%.Ferumoxytol is effective as an MR contrast agent. In our sample, there was on average a small but clinically insignificant drop in SBP and DBP post-contrast injection. Large, randomized, controlled trials are needed to establish optimal dosing, imaging procedures, and safety monitoring.

  View details for PubMedID 26518061

• Qualitative grading of aortic regurgitation: a pilot study comparing CMR 4D flow and echocardiography. The international journal of cardiovascular imaging Chelu, R. G., van den Bosch, A. E., van Kranenburg, M., Hsiao, A., van den Hoven, A. T., Ouhlous, M., Budde, R. P., Beniest, K. M., Swart, L. E., Coenen, A., Lubbers, M. M., Wielopolski, P. A., Vasanawala, S. S., Roos-Hesselink, J. W., Nieman, K. 2016; 32 (2): 301–7

  Abstract

  Over the past 10 years there has been intense research in the development of volumetric visualization of intracardiac flow by cardiac magnetic resonance (CMR).This volumetric time resolved technique called CMR 4D flow imaging has several advantages over standard CMR. It offers anatomical, functional and flow information in a single free-breathing, ten-minute acquisition. However, the data obtained is large and its processing requires dedicated software. We evaluated a cloud-based application package that combines volumetric data correction and visualization of CMR 4D flow data, and assessed its accuracy for the detection and grading of aortic valve regurgitation using transthoracic echocardiography as reference. Between June 2014 and January 2015, patients planned for clinical CMR were consecutively approached to undergo the supplementary CMR 4D flow acquisition. Fifty four patients(median age 39 years, 32 males) were included. Detection and grading of the aortic valve regurgitation using CMR4D flow imaging were evaluated against transthoracic echocardiography. The agreement between 4D flow CMR and transthoracic echocardiography for grading of aortic valve regurgitation was good (j = 0.73). To identify relevant,more than mild aortic valve regurgitation, CMR 4D flow imaging had a sensitivity of 100 % and specificity of 98 %. Aortic regurgitation can be well visualized, in a similar manner as transthoracic echocardiography, when using CMR 4D flow imaging.

  View details for PubMedID 26498478

• Prospective Comparison of 99mTc-MDP Scintigraphy, Combined 18F-NaF and 18F-FDG PET/CT, and Whole-Body MRI in Patients with Breast and Prostate Cancer. Journal of nuclear medicine Minamimoto, R., Loening, A., Jamali, M., Barkhodari, A., Mosci, C., Jackson, T., Obara, P., Taviani, V., Gambhir, S. S., Vasanawala, S., Iagaru, A. 2015; 56 (12): 1862-1868

  Abstract

  We prospectively evaluated the combined (18)F-NaF/(18)F-FDG PET/CT in patients with breast and prostate cancers, and compared the results to (99m)Tc MDP bone scintigraphy (BS) and whole-body MRI (WBMRI).30 patients (15 women with breast cancer and 15 men with prostate cancer) referred for standard of care BS were prospectively enrolled in this study. (18)F-NaF/(18)F-FDG PET/CT and WBMRI were performed following BS. WBMRI protocol consisted of both non-contrast enhanced and contrast enhanced sequences. Lesions detected with each test were tabulated and the results were compared.For extra skeletal lesions, (18)F-/(18)F-FDG PET/CT and WBMRI had no statistically significant differences in sensitivity (92.9% vs 92.9%, P = 1.00), PPV (81.3% vs 86.7%, P = 0.68) and accuracy (76.5% vs 82.4%, P = 0.56). However, (18)F-/(18)F-FDG PET/CT showed significantly higher sensitivity and accuracy than WBMRI (96.2% vs 81.4%, P<0.001, 89.8% vs 74.7%, P = 0.01) and BS (96.2% vs 64.6%, P<0.001, 89.8% vs 65.9%, P<0.001) for the detection of skeletal lesions. Overall, (18)F-/(18)F-FDG PET/CT showed higher sensitivity and accuracy than WBMRI (95.7% vs 83.3%, P<0.002, 87.6% vs 76.0%, P< 0.02), but not statistically significant when compared to a combination of WBMRI and BS (95.7% vs 91.6%, P = 0.17, 87.6% vs 83.0%, P = 0.53). (18)F-/(18)F-FDG PET/CT showed no significant difference with a combination of (18)F-/(18)F-FDG PET/CT and WBMRI. No statistically significant differences in PPV were noted among the 3 examinations.The (18)F NaF/(18)F FDG PET/CT is superior to WBMRI and (99m)Tc-MDP scintigraphy for evaluation of skeletal disease extent. Further, (18)F NaF/(18)F FDG PET/CT and WBMRI detected extra-skeletal disease that may change the management of these patients. The (18)F NaF/(18)F FDG PET/CT provide similar diagnostic ability with combination of WBMRI and BS in patients with breast and prostate cancers. Larger cohorts are needed in order to confirm these preliminary findings, ideally using the newly introduced simultaneous PET/MRI scanners.

  View details for DOI 10.2967/jnumed.115.162610

  View details for PubMedID 26405167

• Improved Quantification and Mapping of Anomalous Pulmonary Venous Flow With Four-Dimensional Phase-Contrast MRI and Interactive Streamline Rendering JOURNAL OF MAGNETIC RESONANCE IMAGING Hsiao, A., Yousaf, U., Alley, M. T., Lustig, M., Chan, F. P., Newman, B., Vasanawala, S. S. 2015; 42 (6): 1765-1776

  View details for DOI 10.1002/jmri.24928

  View details for Web of Science ID 000368258100034

• Whole-body simultaneous time-of-flight PET-MRI: early experience with clinical studies. EJNMMI physics Minamimoto, R., Iagaru, A., Jamali, M., Barkodhodari, A., Holley, D., Vasanawala, S., Zaharchuk, G. 2015; 2: A64-?

  View details for DOI 10.1186/2197-7364-2-S1-A64

  View details for PubMedID 26956324

  View details for PubMedCentralID PMC4798693

• Increased Speed and Image Quality in Single-Shot Fast Spin Echo Imaging Via Variable Refocusing Flip Angles JOURNAL OF MAGNETIC RESONANCE IMAGING Loening, A. M., Saranathan, M., Ruangwattanapaisarn, N., Litwiller, D. V., Shimakawa, A., Vasanawala, S. S. 2015; 42 (6): 1747-1758

  Abstract

  To develop and validate clinically a single-shot fast spin echo (SSFSE) sequence utilizing variable flip angle refocusing pulses to shorten acquisition times via reductions in specific absorption rate (SAR) and improve image quality.A variable refocusing flip angle SSFSE sequence (vrfSSFSE) was designed and implemented, with simulations and volunteer scans performed to determine suitable flip angle modulation parameters. With Institutional Review Board (IRB) approval/informed consent, patients referred for 3T abdominal magnetic resonance imaging (MRI) were scanned with conventional SSFSE and either half-Fourier (n = 25) or full-Fourier vrfSSFSE (n = 50). Two blinded radiologists semiquantitatively scored images on a scale from -2 to 2 for contrast, noise, sharpness, artifacts, cardiac motion-related signal loss, and the ability to evaluate the pancreas and kidneys.vrfSSFSE demonstrated significantly increased speed (∼2-fold, P < 0.0001). Significant improvements in image quality parameters with full-Fourier vrfSSFSE included increased contrast, sharpness, and visualization of pancreatic and renal structures with higher bandwidth technique (mean scores 0.37, 0.83, 0.62, and 0.31, respectively, P ≤ 0.001), and decreased image noise and improved visualization of renal structures when used with an equal bandwidth technique (mean scores 0.96 and 0.35, respectively, P < 0.001). Increased cardiac motion-related signal loss with full-Fourier vrfSSFSE was seen in the pancreas but not the kidney.vrfSSFSE increases speed at 3T over conventional SSFSE via reduced SAR, and when combined with full-Fourier acquisition can improve image quality, although with some increased sensitivity to cardiac motion-related signal loss. J. Magn. Reson. Imaging 2015.

  View details for DOI 10.1002/jmri.24941

  View details for Web of Science ID 000368258100032

• Imaging patients with breast and prostate cancers using combined 18F NaF/18F FDG and TOF simultaneous PET/ MRI. EJNMMI physics Iagaru, A., Minamimoto, R., Jamali, M., Barkodhodari, A., Gambhir, S. S., Vasanawala, S. 2015; 2: A65-?

  View details for DOI 10.1186/2197-7364-2-S1-A65

  View details for PubMedID 26956325

  View details for PubMedCentralID PMC4798635

• Congenital heart disease assessment with 4D flow MRI. Journal of magnetic resonance imaging Vasanawala, S. S., Hanneman, K., Alley, M. T., Hsiao, A. 2015; 42 (4): 870-886

  Abstract

  With improvements in surgical and medical management, patients with congenital heart disease (CHD) are often living well into adulthood. MRI provides critical data for diagnosis and monitoring of these patients, yielding information on cardiac anatomy, blood flow, and cardiac function. Though historically these exams have been complex and lengthy, four-dimensional (4D) flow is emerging as a single fast technique for comprehensive assessment of CHD. The 4D flow consists of a volumetric time-resolved acquisition that is gated to the cardiac cycle, providing a time-varying vector field of blood flow as well as registered anatomic images. In this article, we provide an overview of MRI evaluation of congenital heart disease by means of example of three relatively common representative conditions: tetralogy of Fallot, aortic coarctation, and anomalous pulmonary venous drainage. Then 4D flow data acquisition, data correction, and postprocessing techniques are reviewed. We conclude with several examples that highlight the comprehensive nature of the evaluation of congenital heart disease with 4D flow. J. Magn. Reson. Imaging 2015;42:870-886.

  View details for DOI 10.1002/jmri.24856

  View details for PubMedID 25708923

• Clinical performance of a free-breathing spatiotemporally accelerated 3-D time-resolved contrast-enhanced pediatric abdominal MR angiography. Pediatric radiology Zhang, T., Yousaf, U., Hsiao, A., Cheng, J. Y., Alley, M. T., Lustig, M., Pauly, J. M., Vasanawala, S. S. 2015; 45 (11): 1635-1643

  Abstract

  Pediatric contrast-enhanced MR angiography is often limited by respiration, other patient motion and compromised spatiotemporal resolution.To determine the reliability of a free-breathing spatiotemporally accelerated 3-D time-resolved contrast-enhanced MR angiography method for depicting abdominal arterial anatomy in young children.With IRB approval and informed consent, we retrospectively identified 27 consecutive children (16 males and 11 females; mean age: 3.8 years, range: 14 days to 8.4 years) referred for contrast-enhanced MR angiography at our institution, who had undergone free-breathing spatiotemporally accelerated time-resolved contrast-enhanced MR angiography studies. A radio-frequency-spoiled gradient echo sequence with Cartesian variable density k-space sampling and radial view ordering, intrinsic motion navigation and intermittent fat suppression was developed. Images were reconstructed with soft-gated parallel imaging locally low-rank method to achieve both motion correction and high spatiotemporal resolution. Quality of delineation of 13 abdominal arteries in the reconstructed images was assessed independently by two radiologists on a five-point scale. Ninety-five percent confidence intervals of the proportion of diagnostically adequate cases were calculated. Interobserver agreements were also analyzed.Eleven out of 13 arteries achieved acceptable image quality (mean score range: 3.9-5.0) for both readers. Fair to substantial interobserver agreement was reached on nine arteries.Free-breathing spatiotemporally accelerated 3-D time-resolved contrast-enhanced MR angiography frequently yields diagnostic image quality for most abdominal arteries in young children.

  View details for DOI 10.1007/s00247-015-3384-y

  View details for PubMedID 26040509

  View details for PubMedCentralID PMC4580561

• Free-breathing pediatric MRI with nonrigid motion correction and acceleration JOURNAL OF MAGNETIC RESONANCE IMAGING Cheng, J. Y., Zhang, T., Ruangwattanapaisarn, N., Alley, M. T., Uecker, M., Pauly, J. M., Lustig, M., Vasanawala, S. S. 2015; 42 (2): 407-420

  Abstract

  To develop and assess motion correction techniques for high-resolution pediatric abdominal volumetric magnetic resonance images acquired free-breathing with high scan efficiency.First, variable-density sampling and radial-like phase-encode ordering were incorporated into the 3D Cartesian acquisition. Second, intrinsic multichannel butterfly navigators were used to measure respiratory motion. Lastly, these estimates are applied for both motion-weighted data-consistency in a compressed sensing and parallel imaging reconstruction, and for nonrigid motion correction using a localized autofocusing framework. With Institutional Review Board approval and informed consent/assent, studies were performed on 22 consecutive pediatric patients. Two radiologists independently scored the images for overall image quality, degree of motion artifacts, and sharpness of hepatic vessels and the diaphragm. The results were assessed using paired Wilcoxon test and weighted kappa coefficient for interobserver agreements.The complete procedure yielded significantly better overall image quality (mean score of 4.7 out of 5) when compared to using no correction (mean score of 3.4, P < 0.05) and to using motion-weighted accelerated imaging (mean score of 3.9, P < 0.05). With an average scan time of 28 seconds, the proposed method resulted in comparable image quality to conventional prospective respiratory-triggered acquisitions with an average scan time of 91 seconds (mean score of 4.5).With the proposed methods, diagnosable high-resolution abdominal volumetric scans can be obtained from free-breathing data acquisitions. J. Magn. Reson. Imaging 2015;42:407-420.

  View details for DOI 10.1002/jmri.24785

  View details for Web of Science ID 000358258600019

  View details for PubMedCentralID PMC4404177

• Ferumoxytol as an off-label contrast agent in body 3T MR angiography: a pilot study in children PEDIATRIC RADIOLOGY Ruangwattanapaisarn, N., Hsiao, A., Vasanawala, S. S. 2015; 45 (6): 831-839

  Abstract

  Ferumoxytol is an ultrasmall superparamagnetic iron oxide (USPIO) nanoparticle agent used to treat iron deficiency anemia in adults with chronic kidney disease.We aim to determine the feasibility of using ferumoxytol for clinical pediatric cardiac and vascular imaging.We retrospectively identified 23 consecutive children who underwent MRI with ferumoxytol (11 males; mean age: 7.4 years, range: 3 days-18 years), yielding 12 abdominal MR angiography and 15 cardiac MRI studies. Medical records were reviewed for the clinical indication, ferumoxytol dose, injection rate, sedation and any complication. A two-reader consensus scored the images on a five-point scale for overall image quality and delineation of various anatomical structures. Signal-to-background ratios for abdominal aorta and inferior vena cava for abdominal cases and blood pool-myocardium contrast ratios for cardiac cases were calculated. The confidence intervals for obtaining a score of three or above for each image parameter were calculated by using adjusted Wald method.For abdominal MR angiography, average scores for overall image quality, as well as delineation of the hepatic artery, superior mesenteric artery, renal artery and veins were 4.5, 4.3, 4.3, 3.7 and 4.7, respectively. For cardiac exams, the average scores for overall image quality, systemic arteries, pulmonary arteries, pulmonary veins, valves and ventricles were 4.4, 4.6, 4.1, 4.8, 4.1 and 4.7, respectively. For all parameters, the lower bound for the proportion of cases to have a score of 3 or above was 65%. Signal-to-background ratios for aorta and abdominal veins averaged 86 +/- 74 and 86 +/- 77 for full-dose images, and 23 and 18 for half-dose images, respectively. Mean blood pool to myocardium contrast ratio was 3:3.Ferumoxytol can provide excellent image quality for pediatric body MR angiography/MR venography at a dose of 1.5 or 3 mg Fe/kg. Further investigation should be directed toward understanding the lowest dose that can be administered.

  View details for DOI 10.1007/s00247-014-3226-3

  View details for Web of Science ID 000355345800007

  View details for PubMedID 25427433

• Faster pediatric 3-T abdominal magnetic resonance imaging: comparison between conventional and variable refocusing flip-angle single-shot fast spin-echo sequences. Pediatric radiology Ruangwattanapaisarn, N., Loening, A. M., Saranathan, M., Litwiller, D. V., Vasanawala, S. S. 2015; 45 (6): 847-854

  Abstract

  Single-shot fast spin echo (SSFSE) is particularly appealing in pediatric patients because of its motion robustness. However radiofrequency energy deposition at 3 tesla forces long pauses between slices, leading to longer scans, longer breath-holds and more between-slice motion.We sought to learn whether modulation of the SSFSE refocusing flip-angle train could reduce radiofrequency energy deposition without degrading image quality, thereby reducing inter-slice pauses and overall scan times.We modulated the refocusing flip-angle train for SSFSE to minimize energy deposition while minimizing blurring and motion-related signal loss. In a cohort of 50 consecutive patients (25 boys, mean age 5.5 years, range 1 month to 17 years) referred for abdominal MRI we obtained standard SSFSE and variable refocusing flip-angle (vrfSSFSE) images and recorded sequence scan times. Two readers independently scored the images in blinded, randomized order for noise, tissue contrast, sharpness, artifacts and left lobe hepatic signal uniformity on a four-point scale. The null hypothesis of no difference between SSFSE and vrfSSFSE image-quality was assessed with a Mann-Whitney U test, and the null hypothesis of no scan time difference was assessed with the paired t-test.SSFSE and vrfSSFSE mean acquisition times were 54.3 and 26.2 s, respectively (P-value <0.0001). For each reader, SSFSE and vrfSSFSE noise, tissue contrast, sharpness and artifacts were not significantly different (P-values 0.18-0.86). However, SSFSE had better left lobe hepatic signal uniformity (P < 0.01, both readers).vrfSSFSE is twice as fast as SSFSE, with equivalent image quality with the exception of left hepatic lobe signal heterogeneity.

  View details for DOI 10.1007/s00247-014-3227-2

  View details for PubMedID 25433510

  View details for PubMedCentralID PMC4449830

• Isolation of the right subclavian artery in a patient with d-transposition of the great arteries. Annals of pediatric cardiology Arunamata, A., Perry, S. B., Kipps, A. K., Vasanawala, S. S., Axelrod, D. M. 2015; 8 (2): 161-163

  Abstract

  Isolation of the right subclavian artery (RSCA) is rare, and this finding in association with d-transposition of the great arteries (d-TGA) is extremely unusual. We present a case of an isolated RSCA in a newborn with d-TGA in whom the clinical presentation was diagnostic. We discuss the imaging modalities used to confirm the diagnosis, the embryological basis of the finding, and the surgical repair.

  View details for DOI 10.4103/0974-2069.154154

  View details for PubMedID 26085773

• Classification of Hypervascular Liver Lesions Based on Hepatic Artery and Portal Vein Blood Supply Coefficients Calculated from Triphasic CT Scans JOURNAL OF DIGITAL IMAGING Boas, F. E., Kamaya, A., Do, B., Desser, T. S., Beaulieu, C. F., Vasanawala, S. S., Hwang, G. L., Sze, D. Y. 2015; 28 (2): 213-223

  Abstract

  Perfusion CT of the liver typically involves scanning the liver at least 20 times, resulting in a large radiation dose. We developed and validated a simplified model of tumor blood supply that can be applied to standard triphasic scans and evaluated whether this can be used to distinguish benign and malignant liver lesions. Triphasic CTs of 46 malignant and 32 benign liver lesions were analyzed. For each phase, regions of interest were drawn in the arterially enhancing portion of each lesion, as well as the background liver, aorta, and portal vein. Hepatic artery and portal vein blood supply coefficients for each lesion were then calculated by expressing the enhancement curve of the lesion as a linear combination of the enhancement curves of the aorta and portal vein. Hepatocellular carcinoma (HCC) and hypervascular metastases, on average, both had increased hepatic artery coefficients compared to the background liver. Compared to HCC, benign lesions, on average, had either a greater hepatic artery coefficient (hemangioma) or a greater portal vein coefficient (focal nodular hyperplasia or transient hepatic attenuation difference). Hypervascularity with washout is a key diagnostic criterion for HCC, but it had a sensitivity of 72 % and specificity of 81 % for diagnosing malignancy in our diverse set of liver lesions. The sensitivity for malignancy was increased to 89 % by including enhancing lesions that were hypodense on all phases. The specificity for malignancy was increased to 97 % (p = 0.039) by also examining hepatic artery and portal vein blood supply coefficients, while maintaining a sensitivity of 76 %.

  View details for DOI 10.1007/s10278-014-9725-9

  View details for Web of Science ID 000351242500012

  View details for PubMedID 25183580

• Robust 4D Flow Denoising Using Divergence-Free Wavelet Transform MAGNETIC RESONANCE IN MEDICINE Ong, F., Uecker, M., Tariq, U., Hsiao, A., Alley, M. T., Vasanawala, S. S., Lustig, M. 2015; 73 (2): 828-842

  Abstract

  To investigate four-dimensional flow denoising using the divergence-free wavelet (DFW) transform and compare its performance with existing techniques.DFW is a vector-wavelet that provides a sparse representation of flow in a generally divergence-free field and can be used to enforce "soft" divergence-free conditions when discretization and partial voluming result in numerical nondivergence-free components. Efficient denoising is achieved by appropriate shrinkage of divergence-free wavelet and nondivergence-free coefficients. SureShrink and cycle spinning are investigated to further improve denoising performance.DFW denoising was compared with existing methods on simulated and phantom data and was shown to yield better noise reduction overall while being robust to segmentation errors. The processing was applied to in vivo data and was demonstrated to improve visualization while preserving quantifications of flow data.DFW denoising of four-dimensional flow data was shown to reduce noise levels in flow data both quantitatively and visually. Magn Reson Med 73:828-842, 2015. © 2014 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.25176

  View details for Web of Science ID 000348139500043

  View details for PubMedID 24549830

  View details for PubMedCentralID PMC4139475

• Inlet and outlet valve flow and regurgitant volume may be directly and reliably quantified with accelerated, volumetric phase-contrast MRI. Journal of magnetic resonance imaging Hsiao, A., Tariq, U., Alley, M. T., Lustig, M., Vasanawala, S. S. 2015; 41 (2): 376-385

  Abstract

  To determine whether it is feasible to use solely an accelerated 4D phase-contrast magnetic resonance imaging (4D-PC MRI) acquisition to quantify net and regurgitant flow volume through each of the cardiac valves.Accelerated, 4D-PC MRI examinations performed between March 2010 through June 2011 as part of routine MRI examinations for congenital, structural heart disease were retrospectively reviewed and analyzed using valve-tracking visualization and quantification algorithms developed in Java and OpenGL. Excluding patients with transposition or single ventricle physiology, a total of 34 consecutive pediatric patients (19 male, 15 female; mean age 6.9 years; age range 10 months to 15 years) were identified. 4D-PC flow measurements were compared at each valve and against routine measurements from conventional cardiac MRI using Bland-Altman and Pearson correlation analysis.Inlet and outlet valve net flow were highly correlated between all valves (P = 0.940-0.985). The sum of forward flow at the outlet valve and regurgitant flow at the inlet valve were consistent with volumetric displacements in each ventricle (P = 0.939-0.948). These were also highly consistent with conventional planar MRI measurements with net flow (P = 0.923-0.935) and regurgitant fractions (P = 0.917-0.972) at the outlet valve and ventricular volumes (P = 0.925-0.965).It is possible to obtain consistent measurements of net and regurgitant blood flow across the inlet and outlet valves relying solely on accelerated 4D-PC. This may facilitate more efficient clinical quantification of valvular regurgitation. J. Magn. Reson. Imaging 2015;41:376-385.© 2013 Wiley Periodicals, Inc.

  View details for DOI 10.1002/jmri.24578

  View details for PubMedID 24677253

  View details for PubMedCentralID PMC4126899

• Fast pediatric 3D free-breathing abdominal dynamic contrast enhanced MRI with high spatiotemporal resolution. Journal of magnetic resonance imaging Zhang, T., Cheng, J. Y., Potnick, A. G., Barth, R. A., Alley, M. T., Uecker, M., Lustig, M., Pauly, J. M., Vasanawala, S. S. 2015; 41 (2): 460-473

  Abstract

  To develop a method for fast pediatric 3D free-breathing abdominal dynamic contrast enhanced (DCE) magnetic resonance imaging (MRI) and investigate its clinical feasibility.A combined locally low rank parallel imaging method with soft gating is proposed for free-breathing DCE MRI acquisition. With Institutional Review Board (IRB) approval and informed consent/assent, 23 consecutive pediatric patients were recruited for this study. Free-breathing DCE MRI with ∼1 mm(3) spatial resolution and a 6.5-sec frame rate was acquired on a 3T scanner. Undersampled data were reconstructed with a compressed sensing method without motion correction (FB-CS) and the proposed method (FB-LR). A follow-up respiratory-triggered acquisition (RT-CS) was performed as a reference standard. The reconstructed images were evaluated independently by two radiologists. Wilcoxon tests were performed to test the hypothesis that there was no significant difference between different reconstructions. Quantitative evaluation of contrast dynamics was also performed.The mean score of overall image quality of FB-LR was 4.0 on a 5-point scale, significantly better (P < 0.05) than FB-CS reconstruction (mean score 2.9), and similar to RT-CS (mean score 4.1). FB-LR also matched the temporal fidelity of contrast dynamics with a root mean square error less than 5%.Fast 3D free-breathing DCE MRI with high scan efficiency and image quality similar to respiratory-triggered acquisition is feasible in a pediatric clinical setting.J. Magn. Reson. Imaging 2013. © 2013 Wiley Periodicals, Inc.

  View details for DOI 10.1002/jmri.24551

  View details for PubMedID 24375859

• High resolution multi-arterial phase MRI improves lesion contrast in chronic liver disease. Clinical and investigative medicine. Me´decine clinique et experimentale Clarke, S. E., Saranathan, M., Rettmann, D. W., Hargreaves, B. A., Vasanawala, S. S. 2015; 38 (3): E90-9

  Abstract

  To determine the reliability of arterial phase capture and evaluate hypervascular lesion contrast kinetics with a combined view-sharing and parallel imaging dynamic contrast-enhanced acquisition, DIfferential Sub-sampling with Cartesian Ordering (DISCO), in patients with known chronic liver disease.A retrospective review of 3T MR images from 26 patients with known chronic liver disease referred for hepatocellular carcinoma surveillance or post-treatment follow up was performed. After administration of a gadolinium-based contrast agent, a multiphasic acquisition was obtained in a 28 s breath-hold, from which seven sequential post-contrast image volumes were reconstructed.The late arterial phase was successfully captured in all cases (26/26, 95% CI 87-100%). Images obtained 26 s post-injection had the highest frequency of late arterial phase capture (20/26) and lesion detection (23/26) of any individual post-contrast time; however, the multiphasic data resulted in a significantly higher frequency of late arterial phase capture (26/26, p=0.03) and a higher relative contrast (5.37+/-0.97 versus 7.10+/-0.98, p < 0.01).Multiphasic acquisition with combined view-sharing and parallel imaging reliably captures the late arterial phase and provides sufficient temporal resolution to characterize hepatic lesion contrast kinetics in patients with chronic liver disease while maintaining high spatial resolution.

  View details for PubMedID 26026643

• Free-breathing pediatric MRI with nonrigid motion correction and acceleration. Journal of magnetic resonance imaging : JMRI Cheng, J. Y., Zhang, T., Ruangwattanapaisarn, N., Alley, M. T., Uecker, M., Pauly, J. M., Lustig, M., Vasanawala, S. S. 2015; 42 (2): 407–20

  Abstract

  To develop and assess motion correction techniques for high-resolution pediatric abdominal volumetric magnetic resonance images acquired free-breathing with high scan efficiency.First, variable-density sampling and radial-like phase-encode ordering were incorporated into the 3D Cartesian acquisition. Second, intrinsic multichannel butterfly navigators were used to measure respiratory motion. Lastly, these estimates are applied for both motion-weighted data-consistency in a compressed sensing and parallel imaging reconstruction, and for nonrigid motion correction using a localized autofocusing framework. With Institutional Review Board approval and informed consent/assent, studies were performed on 22 consecutive pediatric patients. Two radiologists independently scored the images for overall image quality, degree of motion artifacts, and sharpness of hepatic vessels and the diaphragm. The results were assessed using paired Wilcoxon test and weighted kappa coefficient for interobserver agreements.The complete procedure yielded significantly better overall image quality (mean score of 4.7 out of 5) when compared to using no correction (mean score of 3.4, P < 0.05) and to using motion-weighted accelerated imaging (mean score of 3.9, P < 0.05). With an average scan time of 28 seconds, the proposed method resulted in comparable image quality to conventional prospective respiratory-triggered acquisitions with an average scan time of 91 seconds (mean score of 4.5).With the proposed methods, diagnosable high-resolution abdominal volumetric scans can be obtained from free-breathing data acquisitions. J. Magn. Reson. Imaging 2015;42:407-420.

  View details for PubMedID 25329325

• Increased speed and image quality in single-shot fast spin echo imaging via variable refocusing flip angles. Journal of magnetic resonance imaging : JMRI Loening, A. M., Saranathan, M., Ruangwattanapaisarn, N., Litwiller, D. V., Shimakawa, A., Vasanawala, S. S. 2015

  Abstract

  To develop and validate clinically a single-shot fast spin echo (SSFSE) sequence utilizing variable flip angle refocusing pulses to shorten acquisition times via reductions in specific absorption rate (SAR) and improve image quality.A variable refocusing flip angle SSFSE sequence (vrfSSFSE) was designed and implemented, with simulations and volunteer scans performed to determine suitable flip angle modulation parameters. With Institutional Review Board (IRB) approval/informed consent, patients referred for 3T abdominal magnetic resonance imaging (MRI) were scanned with conventional SSFSE and either half-Fourier (n = 25) or full-Fourier vrfSSFSE (n = 50). Two blinded radiologists semiquantitatively scored images on a scale from -2 to 2 for contrast, noise, sharpness, artifacts, cardiac motion-related signal loss, and the ability to evaluate the pancreas and kidneys.vrfSSFSE demonstrated significantly increased speed (∼2-fold, P < 0.0001). Significant improvements in image quality parameters with full-Fourier vrfSSFSE included increased contrast, sharpness, and visualization of pancreatic and renal structures with higher bandwidth technique (mean scores 0.37, 0.83, 0.62, and 0.31, respectively, P ≤ 0.001), and decreased image noise and improved visualization of renal structures when used with an equal bandwidth technique (mean scores 0.96 and 0.35, respectively, P < 0.001). Increased cardiac motion-related signal loss with full-Fourier vrfSSFSE was seen in the pancreas but not the kidney.vrfSSFSE increases speed at 3T over conventional SSFSE via reduced SAR, and when combined with full-Fourier acquisition can improve image quality, although with some increased sensitivity to cardiac motion-related signal loss. J. Magn. Reson. Imaging 2015.

  View details for PubMedID 26094580

• Simultaneous whole-body time-of-flight 18F-FDG PET/MRI: a pilot study comparing SUVmax with PET/CT and assessment of MR image quality. Clinical nuclear medicine Iagaru, A., Mittra, E., Minamimoto, R., Jamali, M., Levin, C., Quon, A., Gold, G., Herfkens, R., Vasanawala, S., Gambhir, S. S., Zaharchuk, G. 2015; 40 (1): 1-8

  Abstract

  The recent introduction of hybrid PET/MRI scanners in clinical practice has shown promising initial results for several clinical scenarios. However, the first generation of combined PET/MRI lacks time-of-flight (TOF) technology. Here we report the results of the first patients to be scanned on a completely novel fully integrated PET/MRI scanner with TOF.We analyzed data from patients who underwent a clinically indicated F FDG PET/CT, followed by PET/MRI. Maximum standardized uptake values (SUVmax) were measured from F FDG PET/MRI and F FDG PET/CT for lesions, cerebellum, salivary glands, lungs, aortic arch, liver, spleen, skeletal muscle, and fat. Two experienced radiologists independently reviewed the MR data for image quality.Thirty-six patients (19 men, 17 women, mean [±standard deviation] age of 61 ± 14 years [range: 27-86 years]) with a total of 69 discrete lesions met the inclusion criteria. PET/CT images were acquired at a mean (±standard deviation) of 74 ± 14 minutes (range: 49-100 minutes) after injection of 10 ± 1 mCi (range: 8-12 mCi) of F FDG. PET/MRI scans started at 161 ± 29 minutes (range: 117 - 286 minutes) after the F FDG injection. All lesions identified on PET from PET/CT were also seen on PET from PET/MRI. The mean SUVmax values were higher from PET/MRI than PET/CT for all lesions. No degradation of MR image quality was observed.The data obtained so far using this investigational PET/MR system have shown that the TOF PET system is capable of excellent performance during simultaneous PET/MR with routine pulse sequences. MR imaging was not compromised. Comparison of the PET images from PET/CT and PET/MRI show no loss of image quality for the latter. These results support further investigation of this novel fully integrated TOF PET/MRI instrument.

  View details for DOI 10.1097/RLU.0000000000000611

  View details for PubMedID 25489952

• High resolution multi-arterial phase MRI improves lesion contrast in chronic liver disease. Clinical and investigative medicine. Médecine clinique et experimentale Clarke, S. E., Saranathan, M., Rettmann, D. W., Hargreaves, B. A., Vasanawala, S. S. 2015; 38 (3): E90-9

  View details for PubMedID 26026643

• Improved quantification and mapping of anomalous pulmonary venous flow with four-dimensional phase-contrast MRI and interactive streamline rendering. Journal of magnetic resonance imaging : JMRI Hsiao, A., Yousaf, U., Alley, M. T., Lustig, M., Chan, F. P., Newman, B., Vasanawala, S. S. 2015; 42 (6): 1765–76

  Abstract

  Cardiac MRI is routinely performed for quantification of shunt flow in patients with anomalous pulmonary veins, but can be technically-challenging to perform. Four-dimensional phase-contrast (4D-PC) MRI has potential to simplify this exam. We sought to determine whether 4D-PC may be a viable clinical alternative to conventional 2D phase-contrast MR imaging.With institutional review board approval and HIPAA-compliance, we retrospectively identified all patients with anomalous pulmonary veins who underwent cardiac MRI at either 1.5 Tesla (T) or 3T with parallel-imaging compressed-sensing (PI-CS) 4D-PC between April, 2011 and October, 2013. A total of 15 exams were included (10 male, 5 female). Algorithms for interactive streamline visualization were developed and integrated into in-house software. Blood flow was measured at the valves, pulmonary arteries and veins, cavae, and any associated shunts. Pulmonary veins were mapped to their receiving atrial chamber with streamlines. The intraobserver, interobserver, internal consistency of flow measurements, and consistency with conventional MRI were then evaluated with Pearson correlation and Bland-Altman analysis.Triplicate measurements of blood flow from 4D-PC were highly consistent, particularly at the aortic and pulmonary valves (cv 2-3%). Flow measurements were reproducible by a second observer (ρ = 0.986-0.999). Direct measurements of shunt volume from anomalous veins and intracardiac shunts matched indirect estimates from the outflow valves (ρ = 0.966). Measurements of shunt fraction using 4D-PC using any approach were more consistent with ventricular volumetric displacements than conventional 2D-PC (ρ = 0.972-0.991 versus 0.929).Shunt flow may be reliably quantified with 4D-PC MRI, either indirectly or with detailed delineation of flow from multiple shunts. The 4D-PC may be a more accurate alternative to conventional MRI.

  View details for PubMedID 25914149

• Simultaneous Whole-Body Time-of-Flight F-18-FDG PET/MRI A Pilot Study Comparing SUVmax With PET/CT and Assessment of MR Image Quality CLINICAL NUCLEAR MEDICINE Iagaru, A., Mittra, E., Minamimoto, R., Jamali, M., Levin, C., Quon, A., Gold, G., Herfkens, R., Vasanawala, S., Gambhir, S. S., Zaharchuk, G. 2015; 14 (1): 1-8

  Abstract

  The recent introduction of hybrid PET/MRI scanners in clinical practice has shown promising initial results for several clinical scenarios. However, the first generation of combined PET/MRI lacks time-of-flight (TOF) technology. Here we report the results of the first patients to be scanned on a completely novel fully integrated PET/MRI scanner with TOF.We analyzed data from patients who underwent a clinically indicated F FDG PET/CT, followed by PET/MRI. Maximum standardized uptake values (SUVmax) were measured from F FDG PET/MRI and F FDG PET/CT for lesions, cerebellum, salivary glands, lungs, aortic arch, liver, spleen, skeletal muscle, and fat. Two experienced radiologists independently reviewed the MR data for image quality.Thirty-six patients (19 men, 17 women, mean [±standard deviation] age of 61 ± 14 years [range: 27-86 years]) with a total of 69 discrete lesions met the inclusion criteria. PET/CT images were acquired at a mean (±standard deviation) of 74 ± 14 minutes (range: 49-100 minutes) after injection of 10 ± 1 mCi (range: 8-12 mCi) of F FDG. PET/MRI scans started at 161 ± 29 minutes (range: 117 - 286 minutes) after the F FDG injection. All lesions identified on PET from PET/CT were also seen on PET from PET/MRI. The mean SUVmax values were higher from PET/MRI than PET/CT for all lesions. No degradation of MR image quality was observed.The data obtained so far using this investigational PET/MR system have shown that the TOF PET system is capable of excellent performance during simultaneous PET/MR with routine pulse sequences. MR imaging was not compromised. Comparison of the PET images from PET/CT and PET/MRI show no loss of image quality for the latter. These results support further investigation of this novel fully integrated TOF PET/MRI instrument.

  View details for Web of Science ID 000346633400023

• Clinical performance of contrast enhanced abdominal pediatric MRI with fast combined parallel imaging compressed sensing reconstruction. Journal of magnetic resonance imaging : JMRI Zhang, T., Chowdhury, S., Lustig, M., Barth, R. A., Alley, M. T., Grafendorfer, T., Calderon, P. D., Robb, F. J., Pauly, J. M., Vasanawala, S. S. 2014; 40 (1): 13-25

  Abstract

  To deploy clinically, a combined parallel imaging compressed sensing method with coil compression that achieves a rapid image reconstruction, and assess its clinical performance in contrast-enhanced abdominal pediatric MRI.With Institutional Review Board approval and informed patient consent/assent, 29 consecutive pediatric patients were recruited. Dynamic contrast-enhanced MRI was acquired on a 3 Tesla scanner using a dedicated 32-channel pediatric coil and a three-dimensional SPGR sequence, with pseudo-random undersampling at a high acceleration (R = 7.2). Undersampled data were reconstructed with three methods: a traditional parallel imaging method and a combined parallel imaging compressed sensing method with and without coil compression. The three sets of images were evaluated independently and blindly by two radiologists at one siting, for overall image quality and delineation of anatomical structures. Wilcoxon tests were performed to test the hypothesis that there was no significant difference in the evaluations, and interobserver agreement was analyzed.Fast reconstruction with coil compression did not deteriorate image quality. The mean score of structural delineation of the fast reconstruction was 4.1 on a 5-point scale, significantly better (P < 0.05) than traditional parallel imaging (mean score 3.1). Fair to substantial interobserver agreement was reached in structural delineation assessment.A fast combined parallel imaging compressed sensing method is feasible in a pediatric clinical setting. Preliminary results suggest it may improve structural delineation over parallel imaging. J. Magn. Reson. Imaging 2014;40:13-25. © 2013 Wiley Periodicals, Inc.

  View details for DOI 10.1002/jmri.24333

  View details for PubMedID 24127123

  View details for PubMedCentralID PMC3984374

• Enhancement of Respiratory Navigator-Gated Three-Dimensional Spoiled Gradient-Recalled Echo Sequence with Variable Flip Angle Scheme MAGNETIC RESONANCE IN MEDICINE Iwadate, Y., Brau, A. C., Vasanawala, S. S., Kabasawa, H. 2014; 72 (1): 172-177

  Abstract

  To develop and demonstrate the feasibility of a new technique for respiratory-gated, fat-suppressed, three-dimensional spoiled gradient-recalled echo (3D-SPGR) with navigator gating for more accurate and robust motion detection.A navigator-gated 3D-SPGR technique was modified to include a wait period immediately prior to the navigator sequence for magnetization recovery. Furthermore, a variable flip angle scheme was realized by a combination of ramp-up, ramp-down, and attenuation strategies for optimizing point spread functions. Phantom and human experiments were conducted with our technique on 1.5T scanners.Using the method, T1-weighted 3D images with improved signal homogeneity were acquired with a maximum flip angle of 30° in phantom and human tests. Also, compared with the conventional navigator-gated 3D-SPGR, accurate respiratory motion detection of free-breathing subjects was provided, leading to reduced motion artifacts.The combination of wait insertion and the variable flip angle method improved both motion detection accuracy and image homogeneity in a navigator-gated 3D-SPGR study.

  View details for DOI 10.1002/mrm.24902

  View details for Web of Science ID 000337624400020

  View details for PubMedID 23904390

• An open-label study to evaluate sildenafil for the treatment of lymphatic malformations. Journal of the American Academy of Dermatology Danial, C., Tichy, A. L., Tariq, U., Swetman, G. L., Khuu, P., Leung, T. H., Benjamin, L., Teng, J., Vasanawala, S. S., Lane, A. T. 2014; 70 (6): 1050-1057

  Abstract

  Lymphatic malformations can be challenging to treat. Mainstay interventions including surgery and sclerotherapy are invasive and can result in local recurrence and complications.We sought to assess the effect of 20 weeks of oral sildenafil on reducing lymphatic malformation volume and symptoms in children.Seven children (4 boys, 3 girls; ages 13-85 months) with lymphatic malformations were given oral sildenafil for 20 weeks in this open-label study. The volume of the lymphatic malformation was calculated blindly using magnetic resonance imaging performed before and after 20 weeks of sildenafil. Lymphatic malformations were assessed clinically on weeks 4, 12, 20, and 32. Both the physician and parents evaluated the lymphatic malformation in comparison with baseline.Four subjects had a lymphatic malformation volume decrease (1.0%-31.7%). In 2 subjects, despite a lymphatic malformation volume increase (1.1%-3.7%), clinical improvement was noted while on sildenafil. One subject had a 29.6% increase in lymphatic malformation volume and no therapeutic response. Lymphatic malformations of all 6 subjects who experienced a therapeutic response on sildenafil softened and became easily compressible. Adverse events were minimal.A randomized controlled trial will be necessary to verify the effects of sildenafil on lymphatic malformations.Sildenafil can reduce lymphatic malformation volume and symptoms in some children.

  View details for DOI 10.1016/j.jaad.2014.02.005

  View details for PubMedID 24656411

• Perforated appendicitis: an underappreciated mimic of intussusception on ultrasound. Pediatric radiology Newman, B., Schmitz, M., Gawande, R., Vasanawala, S., Barth, R. 2014; 44 (5): 535-541

  Abstract

  We encountered multiple cases in which the US appearance of ruptured appendicitis mimicked intussusception, resulting in diagnostic and therapeutic delay and multiple additional imaging studies.To explore the clinical and imaging discriminatory features between the conditions.Initial US images in six children (age 16 months to 8 years; 4 boys, 2 girls) were reviewed independently and by consensus by three pediatric radiologists. These findings were compared and correlated with the original reports and subsequent US, fluoroscopic, and CT images and reports.All initial US studies demonstrated a multiple-ring-like appearance (target sign, most apparent on transverse views) with diagnostic consensus supportive of intussusception. In three cases, US findings were somewhat discrepant with clinical concerns. Subsequently, four of the six children had contrast enemas; two were thought to have partial or complete intussusception reduction. Three had a repeat US examination, with recognition of the correct diagnosis. None of the US examinations demonstrated definite intralesional lymph nodes or mesenteric fat, but central echogenicity caused by debris/appendicolith was misinterpreted as fat. All showed perilesional hyperechogenicity that, in retrospect, represented inflamed fat "walling off" of the perforated appendix. There were four CTs, all of which demonstrated a double-ring appearance that correlated with the US target appearance, with inner and outer rings representing the dilated appendix and walled-off appendiceal rupture, respectively. All six children had surgical confirmation of perforated appendicitis.Contained perforated appendicitis can produce US findings closely mimicking intussusception. Clinical correlation and careful multiplanar evaluation should allow for sonographic suspicion of perforated appendicitis, which can be confirmed on CT if necessary.

  View details for DOI 10.1007/s00247-014-2873-8

  View details for PubMedID 24463638

• ESPIRiT-An Eigenvalue Approach to Autocalibrating Parallel MRI: Where SENSE Meets GRAPPA MAGNETIC RESONANCE IN MEDICINE Uecker, M., Lai, P., Murphy, M. J., Virtue, P., Elad, M., Pauly, J. M., Vasanawala, S. S., Lustig, M. 2014; 71 (3): 990-1001

  View details for DOI 10.1002/mrm.24751

  View details for Web of Science ID 000331614600011

• ESPIRiT--an eigenvalue approach to autocalibrating parallel MRI: where SENSE meets GRAPPA. Magnetic resonance in medicine Uecker, M., Lai, P., Murphy, M. J., Virtue, P., Elad, M., Pauly, J. M., Vasanawala, S. S., Lustig, M. 2014; 71 (3): 990-1001

  Abstract

  Parallel imaging allows the reconstruction of images from undersampled multicoil data. The two main approaches are: SENSE, which explicitly uses coil sensitivities, and GRAPPA, which makes use of learned correlations in k-space. The purpose of this work is to clarify their relationship and to develop and evaluate an improved algorithm.A theoretical analysis shows: (1) The correlations in k-space are encoded in the null space of a calibration matrix. (2) Both approaches restrict the solution to a subspace spanned by the sensitivities. (3) The sensitivities appear as the main eigenvector of a reconstruction operator computed from the null space. The basic assumptions and the quality of the sensitivity maps are evaluated in experimental examples. The appearance of additional eigenvectors motivates an extended SENSE reconstruction with multiple maps, which is compared to existing methods.The existence of a null space and the high quality of the extracted sensitivities are confirmed. The extended reconstruction combines all advantages of SENSE with robustness to certain errors similar to GRAPPA.In this article the gap between both approaches is finally bridged. A new autocalibration technique combines the benefits of both.

  View details for DOI 10.1002/mrm.24751

  View details for PubMedID 23649942

• Investigating the feasibility of rapid MRI for image-guided motion management in lung cancer radiotherapy. BioMed research international Sawant, A., Keall, P., Pauly, K. B., Alley, M., Vasanawala, S., Loo, B. W., Hinkle, J., Joshi, S. 2014; 2014: 485067-?

  Abstract

  Cycle-to-cycle variations in respiratory motion can cause significant geometric and dosimetric errors in the administration of lung cancer radiation therapy. A common limitation of the current strategies for motion management is that they assume a constant, reproducible respiratory cycle. In this work, we investigate the feasibility of using rapid MRI for providing long-term imaging of the thorax in order to better capture cycle-to-cycle variations. Two nonsmall-cell lung cancer patients were imaged (free-breathing, no extrinsic contrast, and 1.5 T scanner). A balanced steady-state-free-precession (b-SSFP) sequence was used to acquire cine-2D and cine-3D (4D) images. In the case of Patient 1 (right midlobe lesion, ~40 mm diameter), tumor motion was well correlated with diaphragmatic motion. In the case of Patient 2, (left upper-lobe lesion, ~60 mm diameter), tumor motion was poorly correlated with diaphragmatic motion. Furthermore, the motion of the tumor centroid was poorly correlated with the motion of individual points on the tumor boundary, indicating significant rotation and/or deformation. These studies indicate that image quality and acquisition speed of cine-2D MRI were adequate for motion monitoring. However, significant improvements are required to achieve comparable speeds for truly 4D MRI. Despite several challenges, rapid MRI offers a feasible and attractive tool for noninvasive, long-term motion monitoring.

  View details for DOI 10.1155/2014/485067

  View details for PubMedID 24524077

  View details for PubMedCentralID PMC3913339

• Investigating the Feasibility of Rapid MRI for Image-Guided Motion Management in Lung Cancer Radiotherapy BIOMED RESEARCH INTERNATIONAL Sawant, A., Keall, P., Pauly, K. B., Alley, M., Vasanawala, S., Loo, B. W., Hinkle, J., Joshi, S. 2014

  Abstract

  Cycle-to-cycle variations in respiratory motion can cause significant geometric and dosimetric errors in the administration of lung cancer radiation therapy. A common limitation of the current strategies for motion management is that they assume a constant, reproducible respiratory cycle. In this work, we investigate the feasibility of using rapid MRI for providing long-term imaging of the thorax in order to better capture cycle-to-cycle variations. Two nonsmall-cell lung cancer patients were imaged (free-breathing, no extrinsic contrast, and 1.5 T scanner). A balanced steady-state-free-precession (b-SSFP) sequence was used to acquire cine-2D and cine-3D (4D) images. In the case of Patient 1 (right midlobe lesion, ~40 mm diameter), tumor motion was well correlated with diaphragmatic motion. In the case of Patient 2, (left upper-lobe lesion, ~60 mm diameter), tumor motion was poorly correlated with diaphragmatic motion. Furthermore, the motion of the tumor centroid was poorly correlated with the motion of individual points on the tumor boundary, indicating significant rotation and/or deformation. These studies indicate that image quality and acquisition speed of cine-2D MRI were adequate for motion monitoring. However, significant improvements are required to achieve comparable speeds for truly 4D MRI. Despite several challenges, rapid MRI offers a feasible and attractive tool for noninvasive, long-term motion monitoring.

  View details for DOI 10.1155/2014/485067

  View details for Web of Science ID 000330472600001

  View details for PubMedID 24524077

  View details for PubMedCentralID PMC3913339

• Improvement of gadoxetate arterial phase capture with a high spatio-temporal resolution multiphase three-dimensional SPGR-dixon sequence. Journal of magnetic resonance imaging Hope, T. A., Saranathan, M., Petkovska, I., Hargreaves, B. A., Herfkens, R. J., Vasanawala, S. S. 2013; 38 (4): 938-945

  Abstract

  PURPOSE: To determine whether a multiphase method with high spatiotemporal resolution (STR) by means of a combination of parallel imaging, pseudorandom sampling and temporal view sharing improves the capture and intensity of gadoxetate arterial phase images as well as lesion enhancement. MATERIALS AND METHODS: Thirty-seven patients were imaged with a conventional spoiled gradient echo acquisition and 48 with a high STR multiphase acquisition after the administration of gadoxetate. Arterial phase capture, image quality, and quality of fat suppression were qualitatively graded. Fourteen lesions in the conventional group and 28 in the high STR multiphase group were imaged, including 34 focal nodular hyperplasias. The ratio of lesion to parenchyma enhancement as well as relative hepatic artery enhancement were calculated. Chi-squared, Mann-Whitney U and student t-tests were used to compare differences. RESULTS: The high STR multiphase acquisition included the arterial phase more frequently than conventional acquisitions (P < 0.001), with the arterial phase missed in 17% (95% CI of 4-28%) of patients with conventional acquisition compared with 2% (95% CI of 0-6%) with the high STR multiphase acquisition. There was no loss of image quality or degree of fat saturation. Additionally, there was increased relative intensity of the hepatic arteries (P < 0.001) as well as lesion enhancement (P = 0.01). CONCLUSION: The high STR multiphase acquisition resulted in more reliable gadoxetate arterial phase capture compared with a conventional acquisition while preserving image quality with robust fat saturation J. Magn. Reson. Imaging 2013. © 2013 Wiley Periodicals, Inc.

  View details for DOI 10.1002/jmri.24048

  View details for PubMedID 23371926

• Noncontrast-enhanced renal angiography using multiple inversion recovery and alternating TR balanced steady-state free precession MAGNETIC RESONANCE IN MEDICINE Dong, H. Z., Worters, P. W., Wu, H. H., Ingle, R. R., Vasanawala, S. S., Nishimura, D. G. 2013; 70 (2): 527-536

  Abstract

  Noncontrast-enhanced renal angiography techniques based on balanced steady-state free precession avoid external contrast agents, take advantage of high inherent blood signal from the $T_2/T_1$ contrast mechanism, and have short steady-state free precession acquisition times. However, background suppression is limited; inflow times are inflexible; labeling region is difficult to define when tagging arterial flow; and scan times are long. To overcome these limitations, we propose the use of multiple inversion recovery preparatory pulses combined with alternating pulse repetition time balanced steady-state free precession to produce renal angiograms. Multiple inversion recovery uses selective spatial saturation followed by four nonselective inversion recovery pulses to concurrently null a wide range of background $T_1$ species while allowing for adjustable inflow times; alternating pulse repetition time steady-state free precession maintains vessel contrast and provides added fat suppression. The high level of suppression enables imaging in three-dimensional as well as projective two-dimensional formats, the latter of which has a scan time as short as one heartbeat. In vivo studies at 1.5 T demonstrate the superior vessel contrast of this technique. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.24480

  View details for Web of Science ID 000322128300025

  View details for PubMedID 23172805

• Pediatric Hepatobiliary Magnetic Resonance Imaging RADIOLOGIC CLINICS OF NORTH AMERICA Vy Thao Tran, V. T., Vasanawala, S. 2013; 51 (4): 599-?

  Abstract

  Magnetic resonance (MR) imaging is an effective and noninvasive modality for evaluating hepatobiliary pathologic conditions. This article provides an up-to-date review of anatomy, indications, and imaging goals and protocols, including patient preparation, pulse sequences, and contrast agents used in pediatric MR hepatobiliary imaging. This article also highlights some of the common MR features of pediatric liver pathologic conditions, including tumors, congenital biliary ductal plate malformations, trauma, fibrosis, and infection.

  View details for DOI 10.1016/j.rcl.2013.03.005

  View details for Web of Science ID 000322847100004

  View details for PubMedID 23830788

• Venous and arterial flow quantification are equally accurate and precise with parallel imaging compressed sensing 4D phase contrast MRI. Journal of magnetic resonance imaging Tariq, U., Hsiao, A., Alley, M., Zhang, T., Lustig, M., Vasanawala, S. S. 2013; 37 (6): 1419-1426

  Abstract

  To evaluate the precision and accuracy of parallel-imaging compressed-sensing 4D phase contrast (PICS-4DPC) magnetic resonance imaging (MRI) venous flow quantification in children with patients referred for cardiac MRI at our children's hospital.With Institutional Review Board (IRB) approval and Health Insurance Portability and Accountability Act (HIPAA) compliance, 22 consecutive patients without shunts underwent 4DPC as part of clinical cardiac MRI examinations. Flow measurements were obtained in the superior and inferior vena cava, ascending and descending aorta, and the pulmonary trunk. Conservation of flow to the upper, lower, and whole body was used as an internal physiologic control. The arterial and venous flow rates at each location were compared with paired t-tests and F-tests to assess relative accuracy and precision.Arterial and venous flow measurements were strongly correlated with the upper (ρ = 0.89), lower (ρ = 0.96), and whole body (ρ = 0.97); net aortic and pulmonary trunk flow rates were also tightly correlated (ρ = 0.97). There was no significant difference in the value or precision of arterial and venous flow measurements in upper, lower, or whole body, although there was a trend toward improved precision with lower velocity-encoding settings.With PICS-4DPC MRI, the accuracy and precision of venous flow quantification are comparable to that of arterial flow quantification at velocity-encodings appropriate for arterial vessels. J. Magn. Reson. Imaging 2013;37:1419-1426. © 2012 Wiley Periodicals, Inc.

  View details for DOI 10.1002/jmri.23936

  View details for PubMedID 23172846

  View details for PubMedCentralID PMC3582745

• Abdominal MR Imaging in Children: Motion Compensation, Sequence Optimization, and Protocol Organization RADIOGRAPHICS Chavhan, G. B., Babyn, P. S., Vasanawala, S. S. 2013; 33 (3): 703-719

  Abstract

  Familiarity with basic sequence properties and their trade-offs is necessary for radiologists performing abdominal magnetic resonance (MR) imaging. Acquiring diagnostic-quality MR images in the pediatric abdomen is challenging due to motion, inability to breath hold, varying patient size, and artifacts. Motion-compensation techniques (eg, respiratory gating, signal averaging, suppression of signal from moving tissue, swapping phase- and frequency-encoding directions, use of faster sequences with breath holding, parallel imaging, and radial k-space filling) can improve image quality. Each of these techniques is more suitable for use with certain sequences and acquisition planes and in specific situations and age groups. Different T1- and T2-weighted sequences work better in different age groups and with differing acquisition planes and have specific advantages and disadvantages. Dynamic imaging should be performed differently in younger children than in older children. In younger children, the sequence and the timing of dynamic phases need to be adjusted. Different sequences work better in smaller children and in older children because of differing breath-holding ability, breathing patterns, field of view, and use of sedation. Hence, specific protocols should be maintained for younger children and older children. Combining longer-higher-resolution sequences and faster-lower-resolution sequences helps acquire diagnostic-quality images in a reasonable time.

  View details for DOI 10.1148/rg.333125027

  View details for Web of Science ID 000319111700009

  View details for PubMedID 23674770

• An investigational study to evaluate sildenafil for the treatment of lymphatic malformations International Investigative Dermatology Meeting Danial, C., Tichy, A., Tariq, U., Swetman, G. L., Khuu, P., Leung, T., Teng, J., VASANAWALA, S., Lane, A. NATURE PUBLISHING GROUP. 2013: S175–S175

  View details for Web of Science ID 000317698901320

• Coil compression for accelerated imaging with Cartesian sampling MAGNETIC RESONANCE IN MEDICINE Zhang, T., Pauly, J. M., Vasanawala, S. S., Lustig, M. 2013; 69 (2): 571-582

  Abstract

  MRI using receiver arrays with many coil elements can provide high signal-to-noise ratio and increase parallel imaging acceleration. At the same time, the growing number of elements results in larger datasets and more computation in the reconstruction. This is of particular concern in 3D acquisitions and in iterative reconstructions. Coil compression algorithms are effective in mitigating this problem by compressing data from many channels into fewer virtual coils. In Cartesian sampling there often are fully sampled k-space dimensions. In this work, a new coil compression technique for Cartesian sampling is presented that exploits the spatially varying coil sensitivities in these nonsubsampled dimensions for better compression and computation reduction. Instead of directly compressing in k-space, coil compression is performed separately for each spatial location along the fully sampled directions, followed by an additional alignment process that guarantees the smoothness of the virtual coil sensitivities. This important step provides compatibility with autocalibrating parallel imaging techniques. Its performance is not susceptible to artifacts caused by a tight imaging field-of-view. High quality compression of in vivo 3D data from a 32 channel pediatric coil into six virtual coils is demonstrated.

  View details for DOI 10.1002/mrm.24267

  View details for Web of Science ID 000314059500031

  View details for PubMedID 22488589

  View details for PubMedCentralID PMC3396763

• IMPROVED VISUALIZATION AND QUANTIFICATION OF 4D FLOW MRI DATA USING DIVERGENCE-FREE WAVELET DENOISING IEEE 10th International Symposium on Biomedical Imaging - From Nano to Macro (ISBI) Ong, F., Uecker, M., Tariq, U., Hsiao, A., Alley, M. T., Vasanawala, S. S., Lustig, M. IEEE. 2013: 1186–1189

  View details for Web of Science ID 000326900100297

• Nonrigid motion correction in 3D using autofocusing withlocalized linear translations MAGNETIC RESONANCE IN MEDICINE Cheng, J. Y., Alley, M. T., Cunningham, C. H., Vasanawala, S. S., Pauly, J. M., Lustig, M. 2012; 68 (6): 1785-1797

  Abstract

  MR scans are sensitive to motion effects due to the scan duration. To properly suppress artifacts from nonrigid body motion, complex models with elements such as translation, rotation, shear, and scaling have been incorporated into the reconstruction pipeline. However, these techniques are computationally intensive and difficult to implement for online reconstruction. On a sufficiently small spatial scale, the different types of motion can be well approximated as simple linear translations. This formulation allows for a practical autofocusing algorithm that locally minimizes a given motion metric--more specifically, the proposed localized gradient-entropy metric. To reduce the vast search space for an optimal solution, possible motion paths are limited to the motion measured from multichannel navigator data. The novel navigation strategy is based on the so-called "Butterfly" navigators, which are modifications of the spin-warp sequence that provides intrinsic translational motion information with negligible overhead. With a 32-channel abdominal coil, sufficient number of motion measurements were found to approximate possible linear motion paths for every image voxel. The correction scheme was applied to free-breathing abdominal patient studies. In these scans, a reduction in artifacts from complex, nonrigid motion was observed.

  View details for DOI 10.1002/mrm.24189

  View details for Web of Science ID 000311398600012

  View details for PubMedID 22307933

  View details for PubMedCentralID PMC3376676

• Evaluation of Valvular Insufficiency and Shunts with Parallel-imaging Compressed-sensing 4D Phase-contrast MR Imaging with Stereoscopic 3D Velocity-fusion Volume-rendered Visualization RADIOLOGY Hsiao, A., Lustig, M., Alley, M. T., Murphy, M. J., Vasanawala, S. S. 2012; 265 (1): 87-95

  Abstract

  To assess the potential of compressed-sensing parallel-imaging four-dimensional (4D) phase-contrast magnetic resonance (MR) imaging and specialized imaging software in the evaluation of valvular insufficiency and intracardiac shunts in patients with congenital heart disease.Institutional review board approval was obtained for this HIPAA-compliant study. Thirty-four consecutive retrospectively identified patients in whom a compressed-sensing parallel-imaging 4D phase-contrast sequence was performed as part of routine clinical cardiac MR imaging between March 2010 and August 2011 and who had undergone echocardiography were included. Multiplanar, volume-rendered, and stereoscopic three-dimensional velocity-fusion visualization algorithms were developed and implemented in Java and OpenGL. Two radiologists independently reviewed 4D phase-contrast studies for each of 34 patients (mean age, 6 years; age range, 10 months to 21 years) and tabulated visible shunts and valvular regurgitation. These results were compared with color Doppler echocardiographic and cardiac MR imaging reports, which were generated without 4D phase-contrast visualization. Cohen κ statistics were computed to assess interobserver agreement and agreement with echocardiographic results.The 4D phase-contrast acquisitions were performed, on average, in less than 10 minutes. Among 123 valves seen in 34 4D phase-contrast studies, 29 regurgitant valves were identified, with good agreement between observers (k=0.85). There was also good agreement with the presence of at least mild regurgitation at echocardiography (observer 1, κ=0.76; observer 2, κ=0.77) with high sensitivity (observer 1, 75%; observer 2, 82%) and specificity (observer 1, 97%; observer 2, 95%) relative to the reference standard. Eight intracardiac shunts were identified, four of which were not visible with conventional cardiac MR imaging but were detected with echocardiography. No intracardiac shunts were found with echocardiography alone.With velocity-fusion visualization, the compressed-sensing parallel-imaging 4D phase-contrast sequence can augment conventional cardiac MR imaging by improving sensitivity for and depiction of hemodynamically significant shunts and valvular regurgitation.

  View details for DOI 10.1148/radiol.12120055

  View details for Web of Science ID 000309517600011

  View details for PubMedID 22923717

  View details for PubMedCentralID PMC3447178

• DIfferential subsampling with cartesian ordering (DISCO): A high spatio-temporal resolution dixon imaging sequence for multiphasic contrast enhanced abdominal imaging JOURNAL OF MAGNETIC RESONANCE IMAGING Saranathan, M., Rettmann, D. W., Hargreaves, B. A., Clarke, S. E., Vasanawala, S. S. 2012; 35 (6): 1484-1492

  Abstract

  To develop and evaluate a multiphasic contrast-enhanced MRI method called DIfferential Sub-sampling with Cartesian Ordering (DISCO) for abdominal imaging.A three-dimensional, variable density pseudo-random k-space segmentation scheme was developed and combined with a Dixon-based fat-water separation algorithm to generate high temporal resolution images with robust fat suppression and without compromise in spatial resolution or coverage. With institutional review board approval and informed consent, 11 consecutive patients referred for abdominal MRI at 3 Tesla (T) were imaged with both DISCO and a routine clinical three-dimensional SPGR-Dixon (LAVA FLEX) sequence. All images were graded by two radiologists using quality of fat suppression, severity of artifacts, and overall image quality as scoring criteria. For assessment of arterial phase capture efficiency, the number of temporal phases with angiographic phase and hepatic arterial phase was recorded.There were no significant differences in quality of fat suppression, artifact severity or overall image quality between DISCO and LAVA FLEX images (P > 0.05, Wilcoxon signed rank test). The angiographic and arterial phases were captured in all 11 patients scanned using the DISCO acquisition (mean number of phases were two and three, respectively).DISCO effectively captures the fast dynamics of abdominal pathology such as hyperenhancing hepatic lesions with a high spatio-temporal resolution. Typically, 1.1 × 1.5 × 3 mm spatial resolution over 60 slices was achieved with a temporal resolution of 4-5 s.

  View details for DOI 10.1002/jmri.23602

  View details for Web of Science ID 000304035100028

  View details for PubMedID 22334505

  View details for PubMedCentralID PMC3354015

• Fast l(1)-SPIRiT Compressed Sensing Parallel Imaging MRI: Scalable Parallel Implementation and Clinically Feasible Runtime IEEE TRANSACTIONS ON MEDICAL IMAGING Murphy, M., Alley, M., Demmel, J., Keutzer, K., Vasanawala, S., Lustig, M. 2012; 31 (6): 1250-1262

  Abstract

  We present l₁-SPIRiT, a simple algorithm for auto calibrating parallel imaging (acPI) and compressed sensing (CS) that permits an efficient implementation with clinically-feasible runtimes. We propose a CS objective function that minimizes cross-channel joint sparsity in the wavelet domain. Our reconstruction minimizes this objective via iterative soft-thresholding, and integrates naturally with iterative self-consistent parallel imaging (SPIRiT). Like many iterative magnetic resonance imaging reconstructions, l₁-SPIRiT's image quality comes at a high computational cost. Excessively long runtimes are a barrier to the clinical use of any reconstruction approach, and thus we discuss our approach to efficiently parallelizing l₁-SPIRiT and to achieving clinically-feasible runtimes. We present parallelizations of l₁-SPIRiT for both multi-GPU systems and multi-core CPUs, and discuss the software optimization and parallelization decisions made in our implementation. The performance of these alternatives depends on the processor architecture, the size of the image matrix, and the number of parallel imaging channels. Fundamentally, achieving fast runtime requires the correct trade-off between cache usage and parallelization overheads. We demonstrate image quality via a case from our clinical experimentation, using a custom 3DFT spoiled gradient echo (SPGR) sequence with up to 8× acceleration via Poisson-disc undersampling in the two phase-encoded directions.

  View details for DOI 10.1109/TMI.2012.2188039

  View details for Web of Science ID 000304911300008

  View details for PubMedID 22345529

• Images in clinical medicine. Splenic spirals. New England journal of medicine Patadia, S., Vasanawala, S. S. 2012; 366 (22): 2111-?

  View details for DOI 10.1056/NEJMicm1105154

  View details for PubMedID 22646633

• Inversion-recovery-prepared dixon bSSFP: Initial clinical experience with a novel pulse sequence for renal MRA within a breathhold JOURNAL OF MAGNETIC RESONANCE IMAGING Worters, P. W., Saranathan, M., Xu, A., Vasanawala, S. S. 2012; 35 (4): 875-881

  Abstract

  To evaluate the capability of a new breathhold non-contrast-enhanced MRA method (Non-contrast Outer Radial Inner Square k-space Scheme, NORISKS) to visualize renal arteries by comparing the method with a routine clinical but significantly longer non-contrast-enhanced (non-CE) MRA technique.Eighteen subjects referred for abdominal MRI were examined with NORISKS and a routine non-contrast-enhanced MRA technique. Two versions of NORISKS were evaluated: with and without ECG gating. The images were then scored independently and in blinded manner by two radiologists on 5-point scales for visualization of the proximal and distal renal arteries and quality of fat suppression.No statistically significant difference was detected between NORISKS and routine clinical non-CE MRA in all categories except for visualization of the distal renal arteries where ungated NORISKS performed poorer than the routine non-CE MRA (P < 10(-4) ).We have demonstrated a promising non-CE MRA method for acquiring renal angiograms within a breathhold without any compromise in spatial resolution or coverage. ECG-gated NORISKS is able to acquire renal angiograms that are comparable to a routine clinical non-CE MRA method (Inhance IFIR, GE Healthcare), which requires approximately seven times the scan time of NORISKS.

  View details for DOI 10.1002/jmri.23503

  View details for Web of Science ID 000301712400015

  View details for PubMedID 22095672

  View details for PubMedCentralID PMC3290713

• Rapid Pediatric Cardiac Assessment of Flow and Ventricular Volume With Compressed Sensing Parallel Imaging Volumetric Cine Phase-Contrast MRI AMERICAN JOURNAL OF ROENTGENOLOGY Hsiao, A., Lustig, M., Alley, M. T., Murphy, M., Chan, F. P., Herfkens, R. J., Vasanawala, S. S. 2012; 198 (3): W250-W259

  Abstract

  The quantification of cardiac flow and ventricular volumes is an essential goal of many congenital heart MRI examinations, often requiring acquisition of multiple 2D phase-contrast and bright-blood cine steady-state free precession (SSFP) planes. Scan acquisition, however, is lengthy and highly reliant on an imager who is well-versed in structural heart disease. Although it can also be lengthy, 3D time-resolved (4D) phase-contrast MRI yields global flow patterns and is simpler to perform. We therefore sought to accelerate 4D phase contrast and to determine whether equivalent flow and volume measurements could be extracted.Four-dimensional phase contrast was modified for higher acceleration with compressed sensing. Custom software was developed to process 4D phase-contrast images. We studied 29 patients referred for congenital cardiac MRI who underwent a routine clinical protocol, including cine short-axis stack SSFP and 2D phase contrast, followed by contrast-enhanced 4D phase contrast. To compare quantitative measurements, Bland-Altman analysis, paired Student t tests, and F tests were used.Ventricular end-diastolic, end-systolic, and stroke volumes obtained from 4D phase contrast and SSFP were well correlated (ρ = 0.91-0.95; r(2) = 0.83-0.90), with no statistically significant difference. Ejection fractions were well correlated in a subpopulation that underwent higher-resolution compressed-sensing 4D phase contrast (ρ = 0.88; r(2) = 0.77). Four-dimensional phase contrast and 2D phase contrast flow rates were also well correlated (ρ = 0.90; r(2) = 0.82). Excluding ventricles with valvular insufficiency, cardiac outputs derived from outlet valve flow and stroke volumes were more consistent by 4D phase contrast than by 2D phase contrast and SSFP.Combined parallel imaging and compressed sensing can be applied to 4D phase contrast. With custom software, flow and ventricular volumes may be extracted with comparable accuracy to SSFP and 2D phase contrast. Furthermore, cardiac outputs were more consistent by 4D phase contrast.

  View details for DOI 10.2214/AJR.11.6969

  View details for Web of Science ID 000301069000006

  View details for PubMedID 22358022

  View details for PubMedCentralID PMC3515670

• Rapid MR venography in children using a blood pool contrast agent and multi-station fat-water-separated volumetric imaging PEDIATRIC RADIOLOGY Ghanouni, P., Walters, S. G., Vasanawala, S. S. 2012; 42 (2): 242-248

  Abstract

  A rapid, reliable radiation-free method of pediatric body venography might complement US by evaluating veins in the abdomen and pelvis and by providing a global depiction of venous anatomy. We describe a MR venography technique utilizing gadofosveset, a blood pool contrast agent, in children. The technique allows high-spatial-resolution imaging of the veins from the diaphragm to the knees in less than 15 min of total exam time.

  View details for DOI 10.1007/s00247-011-2254-5

  View details for Web of Science ID 000301664100015

  View details for PubMedID 21989981

  View details for PubMedCentralID PMC3288576

• Sildenafil for Severe Lymphatic Malformations NEW ENGLAND JOURNAL OF MEDICINE Swetman, G. L., Berk, D. R., Vasanawala, S. S., Feinstein, J. A., Lane, A. T., Bruckner, A. L. 2012; 366 (4): 384-386

  View details for Web of Science ID 000299464100029

  View details for PubMedID 22276841

• Estimation of liver T*2 in transfusion-related iron overload in patients with weighted least squares T*2 IDEAL MAGNETIC RESONANCE IN MEDICINE Vasanawala, S. S., Yu, H., Shimakawa, A., Jeng, M., Brittain, J. H. 2012; 67 (1): 183-190

  Abstract

  MRI imaging of hepatic iron overload can be achieved by estimating T(2) values using multiple-echo sequences. The purpose of this work is to develop and clinically evaluate a weighted least squares algorithm based on T(2) Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation (IDEAL) technique for volumetric estimation of hepatic T(2) in the setting of iron overload. The weighted least squares T(2) IDEAL technique improves T(2) estimation by automatically decreasing the impact of later, noise-dominated echoes. The technique was evaluated in 37 patients with iron overload. Each patient underwent (i) a standard 2D multiple-echo gradient echo sequence for T(2) assessment with nonlinear exponential fitting, and (ii) a 3D T(2) IDEAL technique, with and without a weighted least squares fit. Regression and Bland-Altman analysis demonstrated strong correlation between conventional 2D and T(2) IDEAL estimation. In cases of severe iron overload, T(2) IDEAL without weighted least squares reconstruction resulted in a relative overestimation of T(2) compared with weighted least squares.

  View details for DOI 10.1002/mrm.22986

  View details for PubMedID 21574184

• Combined respiratory and cardiac triggering improves blood pool contrast-enhanced pediatric cardiovascular MRI PEDIATRIC RADIOLOGY Vasanawala, S. S., Chan, F. P., Newman, B., Alley, M. T. 2011; 41 (12): 1536-1544

  Abstract

  Contrast-enhanced cardiac MRA suffers from cardiac motion artifacts and often requires a breath-hold.This work develops and evaluates a blood pool contrast-enhanced combined respiratory- and ECG-triggered MRA method.An SPGR sequence was modified to enable combined cardiac and respiratory triggering on a 1.5-T scanner. Twenty-three consecutive children referred for pediatric heart disease receiving gadofosveset were recruited in HIPAA-compliant fashion with IRB approval and informed consent. Children underwent standard non-triggered contrast-enhanced MRA with or without suspended respiration. Additionally, a free-breathing-triggered MRA was acquired. Triggered and non-triggered studies were presented in blinded random order independently to two radiologists twice. Anatomical structure delineation was graded for each triggered and non-triggered acquisition and the visual quality on triggered MRA was compared directly to that on non-triggered MRA.Triggered images received higher scores from each radiologist for all anatomical structures on each of the two reading sessions (Wilcoxon rank sum test, P < 0.05). In direct comparison, triggered images were preferred over non-triggered images for delineating cardiac structures, with most comparisons reaching statistical significance (binomial test, P < 0.05).Combined cardiac and respiratory triggering, enabled by a blood pool contrast agent, improves delineation of most anatomical structures in pediatric cardiovascular MRA.

  View details for DOI 10.1007/s00247-011-2196-y

  View details for Web of Science ID 000297621800005

  View details for PubMedID 21786125

• Functional hepatobiliary MR imaging in children PEDIATRIC RADIOLOGY Tamrazi, A., Vasanawala, S. S. 2011; 41 (10): 1250-1258

  Abstract

  Clinical application efforts for the hepatocyte-specific MRI contrast agent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) have mainly been directed toward detection and characterization of various hepatic masses in the adult population.Here we report our initial experience with Gd-EOB-DTPA for evaluating congenital and acquired hepatobiliary pathologies in the pediatric population.Twenty-one consecutive children receiving Gd-EOB-DTPA for functional hepatobiliary evaluation at our institution were retrospectively identified with IRB approval. The use of Gd-EOB-DTPA was classified in each case as definite, potential, or no clinical utility, focusing on the clinical value gained beyond traditional noncontrast fluid-sensitive MR cholangiopancreatography (FS-MRCP) and other imaging modalities.Definite added value of Gd-EOB-DTPA was found in 12 patients, with potential value in 4 patients, and no value in 5 patients. Benefit was seen in cases of iatrogenic and non-iatrogenic biliary strictures, perihepatic fluid collections for biliary leak, hepatobiliary dysfunction in the absence of hyperbilirubinemia, and in the functional exclusion of cystic duct occlusion that can be seen in acute cholecystitis.This is the first reported series of children with Gd-EOB-DTPA and this early work suggests potential pediatric applications.

  View details for DOI 10.1007/s00247-011-2086-3

  View details for Web of Science ID 000294690500005

  View details for PubMedID 21553038

• Point/counterpoint: dose-related issues in cardiac CT imaging. Pediatric radiology Newman, B., Vasanawala, S. S. 2011; 41: 528-533

  Abstract

  This manuscript reviews some of the more controversial dose-related issues in cardiac CT imaging. Discussion covers the relative merits of cardiac CT versus MR, advantages and concerns regarding gated versus nongated cardiac CT and advantages and concerns regarding the use of breast shields in girls undergoing cardiac CT imaging.

  View details for DOI 10.1007/s00247-011-2153-9

  View details for PubMedID 21847735

• Advances in pediatric body MRI. Pediatric radiology Vasanawala, S. S., Lustig, M. 2011; 41: 549-554

  Abstract

  MRI offers an alternative to CT, and thus is central to an ALARA strategy. However, long exam times, limited magnet availability, and motion artifacts are barriers to expanded use of MRI. This article reviews developments in pediatric body MRI that might reduce these barriers: high field systems, acceleration, navigation and newer contrast agents.

  View details for DOI 10.1007/s00247-011-2103-6

  View details for PubMedID 21847737

  View details for PubMedCentralID PMC3505997

• Active gastrointestinal hemorrhage identification by blood pool contrast-enhanced magnetic resonance angiography PEDIATRIC RADIOLOGY Williams, J., Vasanawala, S. S. 2011; 41 (9): 1198-1200

  Abstract

  Localization of the source of gastrointestinal hemorrhage can be challenging. Currently, this is often accomplished with tagged red blood cell scintigraphy, with attendant ionizing radiation and relatively poor spatial resolution. We describe an analogous method of detecting acute gastrointestinal hemorrhage by enhanced MRI with blood pool contrast agent. Briefly, following precontrast fat-suppressed volumetric T1-weighted image acquisition, single-dose gadofosveset trisodium, a blood pool agent, is administered. Then serial post-T1-weighted images are obtained. This technique is a novel method for evaluating gastrointestinal hemorrhage.

  View details for DOI 10.1007/s00247-011-2139-7

  View details for Web of Science ID 000293979800013

  View details for PubMedID 21594539

• Volumetric fat-water separated T2-weighted MRI PEDIATRIC RADIOLOGY Vasanawala, S. S., Madhuranthakam, A. J., Venkatesan, R., Sonik, A., Lai, P., Brau, A. C. 2011; 41 (7): 875-883

  Abstract

  Pediatric body MRI exams often cover multiple body parts, making the development of broadly applicable protocols and obtaining uniform fat suppression a challenge. Volumetric T2 imaging with Dixon-type fat-water separation might address this challenge, but it is a lengthy process.We develop and evaluate a faster two-echo approach to volumetric T2 imaging with fat-water separation.A volumetric spin-echo sequence was modified to include a second shifted echo so two image sets are acquired. A region-growing reconstruction approach was developed to decompose separate water and fat images. Twenty-six children were recruited with IRB approval and informed consent. Fat-suppression quality was graded by two pediatric radiologists and compared against conventional fat-suppressed fast spin-echo T2-W images. Additionally, the value of in- and opposed-phase images was evaluated.Fat suppression on volumetric images had high quality in 96% of cases (95% confidence interval of 80-100%) and were preferred over or considered equivalent to conventional two-dimensional fat-suppressed FSE T2 imaging in 96% of cases (95% confidence interval of 78-100%). In- and opposed-phase images had definite value in 12% of cases.Volumetric fat-water separated T2-weighted MRI is feasible and is likely to yield improved fat suppression over conventional fat-suppressed T2-weighted imaging.

  View details for DOI 10.1007/s00247-010-1963-5

  View details for Web of Science ID 000292167300011

  View details for PubMedID 21243349

• Improved cardiovascular flow quantification with time-resolved volumetric phase-contrast MRI PEDIATRIC RADIOLOGY Hsiao, A., Alley, M. T., Massaband, P., Herfkens, R. J., Chan, F. P., Vasanawala, S. S. 2011; 41 (6): 711-720

  Abstract

  Cardiovascular flow is commonly assessed with two-dimensional, phase-contrast MRI (2-D PC-MRI). However, scan prescription and acquisition over multiple planes is lengthy, often requires direct physician oversight and has inconsistent results. Time-resolved volumetric PC-MRI (4-D flow) may address these limitations.We assess the degree of agreement and internal consistency between 2-D and 4-D flow quantification in our clinical population.Software enabling flow calculation from 4-D flow was developed in Java. With IRB approval and HIPAA compliance, 18 consecutive patients without shunts were identified who underwent both (1) conventional 2-D PC-MRI of the aorta and main pulmonary artery and (2) 4-D flow imaging. Aortic and pulmonary flow rates were assessed with both techniques.Both methods showed general agreement in flow rates (ρ: 0.87-0.90). Systemic and pulmonary arterial flow rates were well-correlated (ρ: 4-D 0.98-0.99, 2-D 0.93), but more closely matched with 4-D (P < 0.05, Brown-Forsythe). Pulmonary flow rates were lower than systemic rates for 2-D (P < 0.05, two-sample t-test). In a sub-analysis of patients without pulmonary or aortic regurgitation, 2-D showed improved correlation of flow rates while 4-D phase-contrast remained tightly correlated (ρ: 4-D 0.99-1.00, 2-D 0.99).4-D PC-MRI demonstrates greater consistency than conventional 2-D PC-MRI for flow quantification.

  View details for DOI 10.1007/s00247-010-1932-z

  View details for Web of Science ID 000290544500005

  View details for PubMedID 21221566

• An Approach to Pediatric Liver MRI AMERICAN JOURNAL OF ROENTGENOLOGY Mitchell, C. L., Vasanawala, S. S. 2011; 196 (5): W519-W526

  Abstract

  This article illustrates an approach to MRI for hepatobiliary imaging in children. The indications, patient preparation, protocols, pulse sequences, and contrast agents will be highlighted.Significant advances in hepatobiliary MRI have allowed reliable, high quality imaging in a pediatric population.

  View details for DOI 10.2214/AJR.10.6076

  View details for Web of Science ID 000289769000004

  View details for PubMedID 21512040

• PRACTICAL PARALLEL IMAGING COMPRESSED SENSING MRI: SUMMARY OF TWO YEARS OF EXPERIENCE IN ACCELERATING BODY MRI OF PEDIATRIC PATIENTS. 8th IEEE International Symposium on Biomedical Imaging (ISBI) - From Nano to Macro Vasanawala, S. S., MURPHY, M. J., Alley, M. T., Lai, P., Keutzer, K., Pauly, J. M., Lustig, M. IEEE. 2011: 1039–1043

  View details for Web of Science ID 000298849400238

• Adrenal and renal corticomedullary junction iron deposition in red cell aplasia PEDIATRIC RADIOLOGY Rakow-Penner, R., Glader, B., Yu, H., Vasanawala, S. 2010; 40 (12): 1955-1957

  Abstract

  Iron deposition can occur in the kidneys as a result of hemolysis or extensive iron overload from transfusions. With T2* MRI, renal iron deposition can be visualized. In this report, renal corticomedullary junction iron deposition is noted using T2* MRI in a boy with red cell aplasia. The renal corticomedullary junction iron deposition is an indication of the severity of his iron overload. This is an unusual finding and brings clinical attention to the boy's renal function for further evaluation.

  View details for DOI 10.1007/s00247-010-1824-2

  View details for PubMedID 20852855

• A method of rapid robust respiratory synchronization for MRI PEDIATRIC RADIOLOGY Vasanawala, S. S., Jackson, E. 2010; 40 (10): 1690-1692

  Abstract

  Respiratory motion degrades MRI exams. Adequate detection of respiratory motion with pneumatic respiratory belts in small children is challenging and time-consuming.

  View details for DOI 10.1007/s00247-010-1755-y

  View details for Web of Science ID 000281907100014

  View details for PubMedID 20567966

  View details for PubMedCentralID PMC3004967

• Respiratory Navigated Free Breathing 3D Spoiled Gradient-Recalled Echo Sequence for Contrast-Enhanced Examination of the Liver: Diagnostic Utility and Comparison With Free Breathing and Breath-Hold Conventional Examinations AMERICAN JOURNAL OF ROENTGENOLOGY Young, P. M., Brau, A. C., Iwadate, Y., Vasanawala, S., Daniel, B. L., Tamrazi, A., Herfkens, R. J. 2010; 195 (3): 687-691

  Abstract

  The purpose of our study was to evaluate image quality in a 3D spoiled gradient-recalled echo (SPGR) sequence that was modified to incorporate respiratory navigation to limit the deleterious effects of respiratory motion and to compare it with conventional scanning during breath-holding and free breathing.Respiratory navigation of 3D SPGR sequences is technically feasible, and image quality is modestly improved over free breathing acquisitions using conventional 3D SPGR sequences. This may represent a promising imaging alternative for patients who cannot hold their breath.

  View details for DOI 10.2214/AJR.09.3892

  View details for Web of Science ID 000281180500022

  View details for PubMedID 20729447

• Improved Pediatric MR Imaging with Compressed Sensing RADIOLOGY Vasanawala, S. S., Alley, M. T., Hargreaves, B. A., Barth, R. A., Pauly, J. M., Lustig, M. 2010; 256 (2): 607-616

  Abstract

  To develop a method that combines parallel imaging and compressed sensing to enable faster and/or higher spatial resolution magnetic resonance (MR) imaging and show its feasibility in a pediatric clinical setting.Institutional review board approval was obtained for this HIPAA-compliant study, and informed consent or assent was given by subjects. A pseudorandom k-space undersampling pattern was incorporated into a three-dimensional (3D) gradient-echo sequence; aliasing then has an incoherent noiselike pattern rather than the usual coherent fold-over wrapping pattern. This k-space-sampling pattern was combined with a compressed sensing nonlinear reconstruction method that exploits the assumption of sparsity of medical images to permit reconstruction from undersampled k-space data and remove the noiselike aliasing. Thirty-four patients (15 female and 19 male patients; mean age, 8.1 years; range, 0-17 years) referred for cardiovascular, abdominal, and knee MR imaging were scanned with this 3D gradient-echo sequence at high acceleration factors. Obtained k-space data were reconstructed with both a traditional parallel imaging algorithm and the nonlinear method. Both sets of images were rated for image quality, radiologist preference, and delineation of specific structures by two radiologists. Wilcoxon and symmetry tests were performed to test the hypothesis that there was no significant difference in ratings for image quality, preference, and delineation of specific structures.Compressed sensing images were preferred more often, had significantly higher image quality ratings, and greater delineation of anatomic structures (P < .001) than did images obtained with the traditional parallel reconstruction method.A combination of parallel imaging and compressed sensing is feasible in a clinical setting and may provide higher resolution and/or faster imaging, addressing the challenge of delineating anatomic structures in pediatric MR imaging.

  View details for DOI 10.1148/radiol.10091218

  View details for Web of Science ID 000280272100032

  View details for PubMedID 20529991

  View details for PubMedCentralID PMC2909438

• T-2 relaxation times of C-13 metabolites in a rat hepatocellular carcinoma model measured in vivo using C-13-MRS of hyperpolarized [1-C-13]pyruvate NMR IN BIOMEDICINE Yen, Y., Le Roux, P., Mayer, D., King, R., Spielman, D., Tropp, J., Pauly, K. B., Pfefferbaum, A., Vasanawala, S., Hurd, R. 2010; 23 (4): 414-423

  Abstract

  A single-voxel Carr-Purcell-Meibloom-Gill sequence was developed to measure localized T(2) relaxation times of (13)C-labeled metabolites in vivo for the first time. Following hyperpolarized [1-(13)C]pyruvate injections, pyruvate and its metabolic products, alanine and lactate, were observed in the liver of five rats with hepatocellular carcinoma and five healthy control rats. The T(2) relaxation times of alanine and lactate were both significantly longer in HCC tumors than in normal livers (p < 0.002). The HCC tumors also showed significantly higher alanine signal relative to the total (13)C signal than normal livers (p < 0.006). The intra- and inter-subject variations of the alanine T(2) relaxation time were 11% and 13%, respectively. The intra- and inter-subject variations of the lactate T(2) relaxation time were 6% and 7%, respectively. The intra-subject variability of alanine to total carbon ratio was 16% and the inter-subject variability 28%. The intra-subject variability of lactate to total carbon ratio was 14% and the inter-subject variability 20%. The study results show that the signal level and relaxivity of [1-(13)C]alanine may be promising biomarkers for HCC tumors. Its diagnostic values in HCC staging and treatment monitoring are yet to be explored.

  View details for DOI 10.1002/nbm.1481

  View details for Web of Science ID 000277525800011

  View details for PubMedID 20175135

  View details for PubMedCentralID PMC2891253

• State-of-the-Art in Pediatric Body and Musculoskeletal Magnetic Resonance Imaging SEMINARS IN ULTRASOUND CT AND MRI MacKenzie, J. D., Vasanawala, S. S. 2010; 31 (2): 86-99

  Abstract

  Pediatric body and musculoskeletal MRI has seen tremendous advances over the past few years. These advances have enabled high-quality imaging in even the smallest children and expanded the range of clinical problems amenable to MRI. In this review, we highlight some advances: transition to 3 Tesla, parallel imaging, motion compensation, and new contrast agents. Given the increasing saliency of concerns regarding ionizing radiation from computed tomography, these advances could not be more welcome.

  View details for DOI 10.1053/j.sult.2010.01.005

  View details for Web of Science ID 000276295500004

  View details for PubMedID 20304318

• MRI of the liver-how to do it PEDIATRIC RADIOLOGY Vasanawala, S. S. 2010; 40 (4): 431-437

  Abstract

  This article details indications, patient preparation, pulse sequences/protocols, and contrast agents for pediatric hepatobiliary MRI. When performed well, MRI provides superior diagnostic information relative to CT for evaluation of hepatic tumors, liver transplants, and biliary disease.

  View details for DOI 10.1007/s00247-009-1522-0

  View details for Web of Science ID 000275555900008

  View details for PubMedID 20225098

• Navigated abdominal T1-W MRI permits free-breathing image acquisition with less motion artifact PEDIATRIC RADIOLOGY Vasanawala, S. S., Iwadate, Y., Church, D. G., Herfkens, R. J., Brau, A. C. 2010; 40 (3): 340-344

  Abstract

  T1-W imaging of the pediatric abdomen is often limited by respiratory motion artifacts. Although navigation has been commonly employed for coronary MRA and T2-W imaging, navigation for T1-W imaging is less developed. Thus, we incorporated a navigator pulse into a fat-suppressed T1-W SPGR sequence such that steady-state contrast was not disrupted. Ten children were scanned after gadolinium administration three times in immediate succession: breath-hold with no navigation, free-breathing with navigation, and free-breathing without navigation. Motion artifacts were scored for each sequence by two radiologists,showing fewer motion artifacts with navigation compared to free-breathing and greater motion artifacts than with breath-holding. This work demonstrates the feasibility and potential utility of navigation for pediatric abdominal T1-W imaging.

  View details for DOI 10.1007/s00247-009-1502-4

  View details for Web of Science ID 000274386700008

  View details for PubMedID 20066407

  View details for PubMedCentralID PMC3004966

• Magnetic resonance imaging for uterine and vaginal anomalies CURRENT OPINION IN OBSTETRICS & GYNECOLOGY Church, D. G., Vancil, J. M., Vasanawala, S. S. 2009; 21 (5): 379-389

  Abstract

  Pediatric pelvic MRI has had dramatic advances in the past few years. This review documents studies demonstrating the accuracy of MRI for the evaluation of uterine and vaginal anomalies and discusses the salient changes to MRI methods that are particularly applicable to evaluating the pediatric patient with these developmental anomalies.MRI has high accuracy for evaluation of uterine and vaginal anomalies. Significant advances, such as volumetric imaging, increased resolution, decreased motion artifacts, and shorter examination time, have increased the access and utility of MRI for pediatric patients.MRI techniques have evolved markedly in the past several years, providing a robust method of evaluating uterine and vaginal anomalies in the pediatric patient.

  View details for DOI 10.1097/GCO.0b013e3283307c3e

  View details for Web of Science ID 000270062100003

  View details for PubMedID 19623067

• Appendiceal hyperemia and/or distention is not always appendicitis: appendicitis mimicry in the pediatric population CLINICAL IMAGING Price, R. O., Jeffrey, R. B., Vasanawala, S. S. 2009; 33 (5): 402-405

  Abstract

  Appendicitis is the most common surgical cause of acute abdominal pain in the pediatric population. Several conditions can mimic the clinical presentation of appendicitis, leaving imaging as an essential modality to uncover the etiology, yet under certain circumstances, it can be misleading. Here, we present three cases where findings on multidetector computerized tomography scans supported the diagnosis of appendicitis, yet an alternate cause was found. These cases highlight a particular pitfall of satisfaction of search.

  View details for DOI 10.1016/j.clinimag.2009.01.010

  View details for Web of Science ID 000269764400014

  View details for PubMedID 19712824

• MR Voiding Cystography for Evaluation of Vesicoureteral Reflux AMERICAN JOURNAL OF ROENTGENOLOGY Vasanawala, S. S., Kennedy, W. A., Ganguly, A., Fahrig, R., Rieke, V., Daniel, B., Barth, R. A. 2009; 192 (5): W206-W211

  Abstract

  The purpose of our study is to present a real-time interactive continuous fluoroscopy MRI technique for vesicoureteral reflux (VUR) diagnosis.MR voiding cystography with a real-time interactive MR fluoroscopic technique on an open MRI magnet is feasible for the evaluation of VUR in children.

  View details for DOI 10.2214/AJR.08.1251

  View details for Web of Science ID 000265387300045

  View details for PubMedID 19380524

• Advances in Pediatric MR Imaging MAGNETIC RESONANCE IMAGING CLINICS OF NORTH AMERICA MacKenzie, J. D., Vasanawala, S. S. 2008; 16 (3): 385-?

  Abstract

  This article describes the considerable technical achievements that have been made in MR imaging in the evaluation of pediatric patients. The latest techniques in improving signal intensity, resolution, and speed are discussed. The multitude of new options for pediatric MR imaging are illustrated, including higher field strength imaging, multi-channel coil technology coupled with parallel imaging, and new pulse sequence designs. Several future directions in the field of pediatric body and musculoskeletal imaging also are highlighted.

  View details for DOI 10.1016/j.mric.2008.04.008

  View details for Web of Science ID 000264835900002

  View details for PubMedID 18585595

• Balanced SSFP imaging of the musculoskeletal system JOURNAL OF MAGNETIC RESONANCE IMAGING Gold, G. E., Hargreaves, B. A., Reeder, S. B., Block, W. F., Kijowski, R., Vasanawala, S. S., Kornaat, P. R., Bammer, R., Newbould, R., Bangerter, N. K., Beaulieu, C. F. 2007; 25 (2): 270-278

  Abstract

  Magnetic resonance imaging (MRI), with its unique ability to image and characterize soft tissue noninvasively, has emerged as one of the most accurate imaging methods available to diagnose bone and joint pathology. Currently, most evaluation of musculoskeletal pathology is done with two-dimensional acquisition techniques such as fast spin echo (FSE) imaging. The development of three-dimensional fast imaging methods based on balanced steady-state free precession (SSFP) shows great promise to improve MRI of the musculoskeletal system. These methods may allow acquisition of fluid sensitive isotropic data that can be reformatted into arbitrary planes for improved detection and visualization of pathology. Sensitivity to fluid and fat suppression are important issues in these techniques to improve delineation of cartilage contours, for detection of marrow edema and derangement of other joint structures.

  View details for DOI 10.1002/jmri.20819

  View details for Web of Science ID 000244133000006

  View details for PubMedID 17260387

• Value of delayed imaging in MDCT of the abdomen and pelvis AMERICAN JOURNAL OF ROENTGENOLOGY Vasanawala, S. S., Desser, T. 2006; 187 (1): 154-163

  Abstract

  Our objective was to illustrate the benefits of obtaining delayed CT images.There are several clinical scenarios in which delayed CT images may improve diagnostic specificity.

  View details for DOI 10.2214/AJR.05.0148

  View details for PubMedID 16794170

• Articular cartilage of the knee: Evaluation with fluctuating equilibrium MR imaging - Initial experience in healthy volunteers RADIOLOGY Gold, G. E., Hargreaves, B. A., Vasanawala, S. S., Webb, J. D., Shimakawa, A. S., Brittain, J. H., Beaulieu, C. F. 2006; 238 (2): 712-718

  Abstract

  Institutional review board approval and informed consent were obtained for this HIPAA-compliant study, whose purpose was to prospectively compare three magnetic resonance (MR) imaging techniques-fluctuating equilibrium, three-dimensional (3D) spoiled gradient-recalled acquisition in the steady state (SPGR), and two-dimensional (2D) fast spin echo (SE)-for evaluating articular cartilage in the knee. The study cohort consisted of 10 healthy volunteers (four men, six women; age range, 26-42 years). Cartilage signal-to-noise ratio (SNR), SNR efficiency, cartilage-fluid contrast-to-noise ratio (CNR), CNR efficiency, image quality, cartilage visibility, and fat suppression were compared. Cartilage volume was compared for the fluctuating equilibrium and 3D SPGR techniques. Compared with 3D SPGR and 2D fast SE, fluctuating equilibrium yielded the highest cartilage SNR efficiency and cartilage-fluid CNR efficiency (P < .01 for both). Image quality was similar with all sequences. Fluctuating equilibrium imaging yielded higher cartilage visibility than did 2D fast SE imaging (P <. 01) but worse fat suppression than did 3D SPGR and 2D fast SE imaging (P < .04). Cartilage volume measurements with fluctuating equilibrium and 3D SPGR were similar. Fluctuating equilibrium MR imaging is a promising method for evaluating articular cartilage in the knee.

  View details for DOI 10.1148/radiol.2381042183

  View details for Web of Science ID 000234859100040

  View details for PubMedID 16436826

• Dual-acquisition phase-sensitive fat-water separation using balanced steady-state free precession MAGNETIC RESONANCE IMAGING Hargreaves, B. A., Bangerter, N. K., Shimakawa, A., Vasanawala, S. S., Brittain, J. H., Nishimura, D. G. 2006; 24 (2): 113-122

  Abstract

  Balanced steady-state free precession (SSFP) sequences use fully re-focussed gradient waveforms to achieve a high signal and useful image contrast in short scan times. Despite these strengths, the clinical feasibility of balanced SSFP is still limited both by bright fat signal and by the signal voids that result from off-resonance effects such as field or susceptibility variations. A new method, dual-acquisition phase-sensitive SSFP, combines the signals from two standard balanced SSFP acquisitions to separate fat and water while simultaneously reducing the signal voids. The acquisitions are added in quadrature and then phase corrected using a simple algorithm before fat and water can be identified simply by the sign of the signal. This method is especially useful for applications at high field, where the RF power deposition, spatial resolution requirements and gradient strength limit the minimum repetition times. Finally, dual-acquisition phase-sensitive SSFP can be combined with other magnetization preparation schemes to produce specific image contrast in addition to separating fat and water signals.

  View details for DOI 10.1016/j.mri.2005.10.013

  View details for Web of Science ID 000235506400002

  View details for PubMedID 16455400

• Controversies in protocol selection in the Imaging of articular cartilage SEMINARS IN MUSCULOSKELETAL RADIOLOGY Gold, G. E., Hargreaves, B. A., Reeder, S. B., Vasanawala, S. S., Beaulieu, C. F. 2005; 9 (2): 161-172

  Abstract

  Magnetic resonance (MR) imaging, with its unique ability to noninvasively image and characterize soft tissue, has shown promise in assessment of cartilage. The development of new, fast imaging methods with high contrast will improve the MR evaluation of cartilage morphology. In addition to morphological MR imaging methods, MR imaging contrast mechanisms under development may reveal detailed information regarding the physiology of cartilage. However, many of these methods remain to be tested in the clinical setting. Protocol selection for cartilage imaging requires understanding of the patient population and the advantages and limitations of these techniques.

  View details for Web of Science ID 000230039200008

  View details for PubMedID 16044384

• Rapid musculoskeletal MRI with phase-sensitive steady-state free precession: Comparison with routine knee MRI AMERICAN JOURNAL OF ROENTGENOLOGY Vasanawala, S. S., Hargreaves, B. A., Pauly, J. M., Nishimura, D. G., Beaulieu, C. F., Gold, G. E. 2005; 184 (5): 1450-1455

  Abstract

  The aim of this work was to show the potential utility of a novel rapid 3D fat-suppressed MRI method for joint imaging.Phase-sensitive steady-state free precession provides rapid 3D joint imaging with robust fat suppression and excellent cartilage delineation.

  View details for Web of Science ID 000228875300013

  View details for PubMedID 15855095

• Accommodation of requests for emergency US and CT: Applications of queueing theory to scheduling of urgent studies RADIOLOGY Vasanawala, S. S., Desser, T. S. 2005; 235 (1): 244-249

  Abstract

  The purpose of this study was to determine whether queueing theory would allow prediction of optimal number of schedule slots to be reserved for urgent computed tomography (CT) and ultrasonography (US). Institutional review board approval was obtained; informed consent was exempted. Emergency studies were modeled as a Poisson process; slots were reserved such that rate of rescheduling of routine studies to accommodate emergencies was predicted to be below a certain level. Model was tested with 3 years of emergency US and CT requests. US and CT requests showed Poisson distribution. US rescheduling was near that predicted. CT rescheduling exceeded that predicted, which reflected increasing CT use. By using more recent CT data for prediction, a more concordant rescheduling rate resulted.

  View details for DOI 10.1148/radiol.2351040289

  View details for PubMedID 15716391

• Analysis of multiple-acquisition SSFP MAGNETIC RESONANCE IN MEDICINE Bangerter, N. K., Hargreaves, B. A., Vasanawala, S. S., Pauly, J. M., Gold, G. E., Nishimura, D. G. 2004; 51 (5): 1038-1047

  Abstract

  Refocused steady-state free precession (SSFP) is limited by its high sensitivity to local field variation, particularly at high field strengths or the long repetition times (TRs) necessary for high resolution. Several methods have been proposed to reduce SSFP banding artifact by combining multiple phase-cycled SSFP acquisitions, each differing in how individual signal magnitudes and phases are combined. These include maximum-intensity SSFP (MI-SSFP) and complex-sum SSFP (CS-SSFP). The reduction in SSFP banding is accompanied by a loss in signal-to-noise ratio (SNR) efficiency. In this work a general framework for analyzing banding artifact reduction, contrast, and SNR of any multiple-acquisition SSFP combination method is presented. A new sum-of-squares method is proposed, and a comparison is performed between each of the combination schemes. The sum-of-squares SSFP technique (SOS-SSFP) delivers both robust banding artifact reduction and higher SNR efficiency than other multiple-acquisition techniques, while preserving SSFP contrast.

  View details for DOI 10.1002/mrm.20052

  View details for Web of Science ID 000221239000022

  View details for PubMedID 15122688

• Knee cartilage volume with fluctuating equilibrium MRI 9th World Congress of the OsteoArthritis-Research-Society-International Gold, G. E., Hargreaves, B. A., Vasanawala, S. S., Webb, J., Shimakawa, A., Brittain, J. H., Pauly, J. M., Beaulieu, C. F. W B SAUNDERS CO LTD. 2004: S1–S1

  View details for Web of Science ID 000225708200003

• Fat-suppressed steady-state free precession imaging using phase detection MAGNETIC RESONANCE IN MEDICINE Hargreaves, B. A., Vasanawala, S. S., Nayak, K. S., Hu, B. S., Nishimura, D. G. 2003; 50 (1): 210-213

  Abstract

  Fully refocused steady-state free precession (SSFP) is a rapid, efficient imaging sequence that can provide diagnostically useful image contrast. In SSFP, the signal is refocused midway between excitation pulses, much like in a spin-echo experiment. However, in SSFP, the phase of the refocused spins alternates for each resonant frequency interval equal to the reciprocal of the sequence repetition time (TR). Appropriate selection of the TR results in a 180 degrees phase difference between lipid and water signals. This phase difference can be used for fat-water separation in SSFP without any increase in scan time. The technique is shown to produce excellent non-contrast-enhanced, flow-independent angiograms of the peripheral vasculature.

  View details for DOI 10.1002/mrm.10488

  View details for Web of Science ID 000183961800028

  View details for PubMedID 12815698

• Comparison of new sequences for high-resolution cartilage imaging MAGNETIC RESONANCE IN MEDICINE Hargreaves, B. A., Gold, G. E., Beaulieu, C. F., Vasanawala, S. S., Nishimura, D. G., Pauly, J. M. 2003; 49 (4): 700-709

  Abstract

  The high prevalence of osteoarthritis continues to demand improved accuracy in detecting cartilage injury and monitoring its response to different treatments. MRI is the most accurate noninvasive method of diagnosing cartilage lesions. However, MR imaging of cartilage is limited by scan time, signal-to-noise ratio (SNR), and image contrast. Recently, there has been renewed interest in SNR-efficient imaging sequences for imaging cartilage, including various forms of steady-state free-precession as well as driven-equilibrium imaging. This work compares several of these sequences with existing methods, both theoretically and in normal volunteers. Results show that the new steady-state methods increase SNR-efficiency by as much as 30% and improve cartilage-synovial fluid contrast by a factor of three. Additionally, these methods markedly decrease minimum scan times, while providing 3D coverage without the characteristic blurring seen in fast spin-echo images.

  View details for DOI 10.1002/mrm.10424

  View details for Web of Science ID 000182007200013

  View details for PubMedID 12652541

• Characterization and reduction of the transient response in steady-state MR imaging MAGNETIC RESONANCE IN MEDICINE Hargreaves, B. A., Vasanawala, S. S., Pauly, J. M., Nishimura, D. G. 2001; 46 (1): 149-158

  Abstract

  Refocused steady-state free precession (SSFP) imaging sequences have recently regained popularity as faster gradient hardware has allowed shorter repetition times, thereby reducing SSFP's sensitivity to off-resonance effects. Although these sequences offer fast scanning with good signal-to-noise efficiency, the "transient response," or time taken to reach a steady-state, can be long compared with the total imaging time, particularly when using 2D sequences. This results in lost imaging time and has made SSFP difficult to use for real-time and cardiac-gated applications. A linear-systems analysis of the steady-state and transient response for general periodic sequences is shown. The analysis is applied to refocused-SSFP sequences to generate a two-stage method of "catalyzing," or speeding up the progression to steady-state by first scaling, then directing the magnetization. This catalyzing method is compared with previous methods in simulations and experimentally. Although the second stage of the method exhibits some sensitivity to B(1) variations, our results show that the transient time can be significantly reduced, allowing imaging in a shorter total scan time. Magn Reson Med 46:149-158, 2001.

  View details for Web of Science ID 000169561000019

  View details for PubMedID 11443721

• Linear combination steady-state free precession MRI MAGNETIC RESONANCE IN MEDICINE Vasanawala, S. S., Pauly, J. M., Nishimura, D. G. 2000; 43 (1): 82-90

  Abstract

  A new, fast, spectrally selective steady-state free precession (SSFP) imaging method is presented. Combining k-space data from SSFP sequences with certain phase schedules of radiofrequency excitation pulses permits manipulation of the spectral selectivity of the image. For example, lipid and water can be resolved. The contrast of each image depends on both T1 and T2, and the relative contribution of the two relaxation mechanisms to image contrast can be controlled by adjusting the flip angle. Several potential applications of the technique, referred to as linear combination steady-state free precession (LCSSFP), are demonstrated: fast musculoskeletal, abdominal, angiographic, and brain imaging.

  View details for Web of Science ID 000084538500010

  View details for PubMedID 10642734

• Fluctuating equilibrium MRI MAGNETIC RESONANCE IN MEDICINE Vasanawala, S. S., Pauly, J. M., Nishimura, D. G. 1999; 42 (5): 876-883

  Abstract

  A new fast, spectrally selective imaging method called fluctuating equilibrium magnetic resonance is presented. With all gradients refocused over a repetition interval, certain phase schedules of radiofrequency excitation pulses produce an equilibrium magnetization that fluctuates from excitation to excitation, thus permitting simultaneous acquisition of several images with different contrast features. For example, lipid and water images can be rapidly acquired. The effective echo time can be adjusted using the flip angle, thus providing control over the T(2) contribution to the contrast. Several applications of the technique are presented, including fast musculoskeletal, abdominal, breast, and brain imaging, in addition to MR angiography. A technique for combining lipid and water images generated with this sequence for angiography is described and other potential applications are suggested. Magn Reson Med 42:876-883, 1999.

  View details for Web of Science ID 000083447900006

  View details for PubMedID 10542345

• Prospective MR signal-based cardiac triggering MAGNETIC RESONANCE IN MEDICINE Vasanawala, S. S., Sachs, T. S., Brittain, J. H., Meyer, C. H., Nishimura, D. G. 1999; 42 (1): 82-86

  Abstract

  A cardiac motion compensation method using magnetic resonance signal-based triggering is presented. The method interlaces a triggering pulse sequence with an imaging sequence. The triggering sequence is designed to measure aortic blood velocity, from which cardiac phase can be inferred. The triggering sequence is executed repeatedly and the acquired data processed after each sequence iteration. When the desired phase of the cardiac cycle is detected, data are acquired using the imaging sequence. A signal-processing unit of a conventional scanner is used to process the triggering data in real time and issue triggering commands. Alternatively, a workstation, with a bus adaptor, can access data as they are acquired, process and display the data, and issue triggering commands. With a graphical user interface, the triggering pulse sequence and data-processing techniques can be modified instantaneously to optimize triggering. The technique is demonstrated with coronary artery imaging using both conventional two-dimensional Fourier transform scans and spiral trajectories.

  View details for Web of Science ID 000081433800012

  View details for PubMedID 10398953