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PET / MRI: Technology, Work Flow and Clinical ApplicationsMRI clinical applications -
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HOME e-MRI Ultra-high field MRI Clinical applications. Clinical applications of ultra high field MRI The applications of ultra high field MRI in clinical practice are dominated by brain exploration, featuring functional MRI, magnetic resonance spectroscopy, perfusion MRI and time of flight angiography.
chapter summary Ultra-high field MRI 3 teslas and more 4 Ultra-high field MRI 3 teslas and more Physical parameters and ultra high field Adapting equipment and sequences for ultra high fields Clinical applications of ultra high field MRI. Cookie preferences Continue without accepting.
Wave-CAIPI SWI Siemens-Healthineers unique Wave-CAIPI SWI exploits coil sensitivity variations in all three dimensions. Compressed Sensing Cardiac Cine Beyond speed. Beyond breath-holds. Whole-Body Dot Engine Reliably perform whole-body MRI in 25 minutes.
Compressed Sensing SEMAC Highly accelerated musculoskeletal imaging in patients with whole joint replacements based on SEMAC with Compressed Sensing.
Compressed Sensing Time-of-Flight Highly accelerated MR angiography based on the BEAT pulse sequence with a combination of Time-of-Flight ToF MR angiography and Compressed Sensing.
Compressed Sensing SPACE Compressed Sensing CS speeds up data acquisition with sparse data subsampling. ZOOMit PRO Zoomed diffusion weighted imaging for increased lesion conspicuity.
Prostate Dot Engine Improved image quality and consistency of prostate MRI exams. The ASL MR perfusion is based on an endogenous contrast agent using magnetically labeled arterial blood water as a diffusible flow tracer. Therefore, the proton-density-weighted sequence is used to obtain signal changes with and without the use of magnetically labeled blood by either continuous or pulsed RF pulses.
CBF value can be quantified. A general kinetic model for the evaluation of the difference of the longitudinal magnetization in the tissue owing to the labeled blood can be expressed to quantify the blood flow as follows [ 80 ],. The pseudo-continuous ASL pCASL technique was introduced to improve the ASL signals [ 81 ], and is currently used in clinical practice.
Perfusion MRI is a promising tool used to assess stroke, tumors, and neurodegenerative diseases. DSC perfusion MRI is the standard technique used to evaluate brain diseases, such as stroke [ 82 ] and tumors [ 83 ].
A combination of perfusion and DWI is used to evaluate a mismatch between the size of a perfusion defect and the diffusion abnormality that is referred to as the ischemic penumbra [ 84 ]. Tumor grade, recurrence, postoperative changes, or radiation effects can be established with DSC perfusion imaging [ 85 ].
DCE perfusion MRI is often applied in brain diseases [ 86 ] and in patients with breast, prostate, pelvic, and muscle diseases, and can be useful in differentiating between tumor recurrence and radiation necrosis.
The DCE parameters reflect a more extensive BBB disruption and a higher tumor grade [ 87 ], evaluate the treatment prediction [ 88 ], and differentiate pseudo-progression from true progressive disease in GBM patients [ 89 ].
ASL perfusion MRI is mainly applied in brain diseases, such as neurodegenerative [ 90 , 91 ], renal, and cardiovascular diseases. ASL perfusion MRI has been used to evaluate pseudo-progression in brain tumor [ 92 ]. This method is particularly useful for patients with poor intravenous access, infants and children, and pregnant women [ 93 ].
MR spectroscopy MRS is used to determine the molecular structure of compounds, or to detect their presence. MRS is thus sensitive to certain aspects of tissue metabolism. MRS can detect other nuclei in compounds of biological interest, such as phosphorus found in PCr or carbon found in glycogen.
However, proton MRS is more routinely performed in clinical practice compared with 31P or 13C MRS. Therefore, in this review, we only discuss proton MRS. Chemical exchange saturation transfer CEST is a novel MR technique that enables molecular imaging to obtain certain compounds at concentrations that are too low to impact the contrast of standard MRI and too low to be directly detected in MRS at typical water imaging resolutions.
A single voxel spectroscopy SVS study is performed with short or long TE values. The SVS pulse sequences are the following: point resolved spectroscopy PRESS [ 94 ], stimulated echo acquisition mode STEAM [ 95 ], image selected in vivo spectroscopy ISIS [ 96 ], and depth-resolved spectroscopy DRESS [ 97 ].
Longer TE results in the signal decrease as a result of the transverse relaxation T2 that leads to the alteration of the phase of multiplet signals because of J-coupling [ 98 ]. TE values in the range of — ms are typically used, as this leads to the production of a spectrum in which the doublet signal of Lac with a J-coupling constant of nearly 7 Hz is entirely reversed owing to the short TE and long TR [ 99 ].
A spectroscopic imaging is an area of interest. Chemical shift imaging CSI is used for multiple-voxel spectroscopic acquisitions. In spectroscopic imaging, phase encoding gradients can be applied in all three dimensions to sample k-space to select a volume that resembles methods used in MRI [ ].
The most common suppression method is based on the use of a chemical shift selected CHESS pulse sequence [ ]. The typical postprocessing techniques used include Fourier Transform FT , baseline correction, zero filling, and phasing.
Quantification of the MRS signal amplitude can provide a means for estimating the tissue concentration of the signal generating molecules. While MRS signals are usually acquired in the time domain as free induction decays or echoes, they are usually viewed and analyzed in the frequency domain.
The frequency domain representation is derived from the acquired time domain data by the FT. Signal averaging is used in virtually all MRS studies to increase the SNR by averaging the signals obtained in repeated measurements. To quantify the proton spectrum in most of the clinical studies, the internal reference signal is typically used that is either the Cr signal at 3.
One weak aspect related to the use of the Cr signal as a reference is attributed to the fact that the Cr signal is not as uniform throughout the normal brain [ ].
Another weak aspect pertains to the fact that the assumption of the Cr levels do not change with disease and other physiological characteristics may be erroneous. If the water signal is used as a reference signal, its amplitude must be measured by performing a separate measurement in the same brain region without using water suppression.
A linear least-squares optimization procedure has been established and used in spectral fitting techniques. The most popular spectral fitting software is currently the LCModel [ , ].
Furthermore, spectrum fitting software is available either in the time [ ] or frequency domains [ , ]. CEST can be used to apply molecular imaging [ ]. This technique is more appropriate compared with CSI or MR spectroscopy imaging because it provides relatively high resolution.
The principle of CEST is based on the use of the magnetization transfer effects from other molecules to water molecules. Therefore, the requirement of CEST is that the chemical species must have in their structures a 1H proton that is exchangeable with those of water.
Known endogenous diamagnetic CEST agents are involved with exchangeable groups of amide proton -NH , amine proton -NH2 , and hydroxyl proton -OH , whose chemical shifts are ~3. Amide CEST is usually referred to as amide proton transfer APT.
CEST techniques have been applied to map glutamate amine proton , creatine amine proton , glycosaminoglycan Gag hydroxyl proton , myoinositol MI hydroxyl proton , and glucose hydroxyl proton.
The detailed principle of CEST technique has been described in numerous previous papers [ - ]. The goal of clinical spectroscopy is to provide physicians with biochemical information that will assist in the differential diagnosis when standard clinical and radiologic tests fail or are too invasive.
Proton spectroscopy has attained clinical value in that it can monitor the evolution of diseases and associated therapies. Disease can sometimes lead to large changes in metabolite levels. Lactate signal levels are elevated in ischemic brain tissue.
Choline signal levels are elevated in some neoplastic or inflamed tissues. The main applications for amide CEST or APT are the detection of cancer and ischemic stroke.
In tumor regions, the concentration of proteins are elevated compared with surrounding tissues, and thus lead to increased APT levels [ ]. This method was applied to classify tumor progression from radiation necrosis [ ].
The CEST technique is applied in stroke because reduced pH in the ischemic region leads to lowered APT exchange rate, and results in decreased CEST values [ ]. CEST was applied in other-than-brain pathologies, such as breast [ ], prostate [ ], and knee [ ].
PET—MRI is an imaging system that incorporates MRI and PET to gain from the benefits of soft tissue morphological imaging MRI and metabolic imaging PET. This hybrid system is mainly used in the fields of oncology and neurology for clinical and preclinical studies. Some systems operate in totally separate rooms, but other systems do operate in the same room with separate machines.
In these cases, a bed is shared to transfer the subjects from MRI to PET or to fully integrated systems. The first whole-body PET—MRI systems were produced by Philips Amsterdam, The Netherlands and were installed in the US Mount Sinai Medical Center, New York, NY and in Switzerland Geneva University Hospital, Geneva in The system featured a PET and MRI scanner separated by a revolving bed.
The simultaneous PET—MR acquisition system Siemens was installed in The fully integrated whole-body systems were provided in by Siemens and in by GE.
In Korea, the first PET—MRI system was installed at the Gachon University Hospital Inchen, Korea [ 7 , 8 ]. In this part, we only discussed the issues of the fully integrated PET—MRI system. Placing PET detectors in the MR magnet can alter the local magnetic field strength causing the protons to spin at wrong frequencies, thus leading to the formation of severe image distortions and artifacts, such as susceptibility artifacts.
The presence of PET hardware within the gradient coil significantly alters the MR eddy current characteristics of the system possibly leading to degraded spatial linearity. The gradient imperfection would impact imaging spatial resolution and image homogeneity.
The lutetium-based scintillation crystals have acceptable magnetic properties [ ]. The avalanche photodiode for PET can be used in a 7 T MRI system without inducing major effects to magnetic fields [ ]. Attenuation correction describes a method to account for the self-absorption of the emitted annihilation photons, and is a prerequisite for accurate quantification of the PET data [ ].
It is not possible to directly derive the attenuation properties of tissues from MRI measurements. MRI-based attenuation correction methods have been introduced [ ]: segmentation-based [ ] that are usually used in T1-weighted images [ ] or Dixon-sequence-based images [ ], atlas-based [ ], and reconstruction-based [ ] methods.
Attenuation correction of bone is calculated by using ultrashort echo time images [ ]. The simultaneous acquisition of MRI and PET data in the fully integrated PET—MRI systems has major advantages compared with sequential acquisitions.
Two-dimensional or three-dimensional 3D navigator MRI is used to correct respiratory motion in PET images [ ]. A high resolution MRI has been used for the correction of the partial volume effect in PET images [ ]. Finally, MR anatomical images have been used for aligning functional information obtained from PET [ ].
While PET provides a the high sensitivity required to detect minute amounts of radiotracers and b the ability to quantify radiotracer activity throughout the body in absolute terms, MRI provides excellent soft-tissue contrast according to multiple contrast mechanisms at high-spatial resolution.
The PET—MRI system has been used for the study of patients with hepatobiliary cancer [ ], neuroendocrine tumors [ ], pancreatic adenocarcinoma [ ], prostate cancer [ ], primary brain tumors [ ], dementia [ ], epilepsy [ ], musculoskeletal tumor [ ], and coronary artery disease [ ].
High-intensity focused ultrasound HIFU is a noninvasive therapeutic technique that uses nonionizing ultrasonic waves to heat tissue [ ].
HIFU has been combined with MRI to enable guidance of the treatment and monitoring. It is referred to as MR-guided focused ultrasound surgery MRgFUS. It is a 3D imaging technique that features high-soft-tissue contrast and provides information about temperature, thus allowing the monitoring of ablation.
In , reports were published that described MRgFUS on ex vivo muscle tissue [ ], and the following year on in vivo tissue [ ]. MRgFUS developed by Hynynen [ ] was later transferred to InsighTec in Haifa, Israel in The InsighTec ExAblate was the first MRgFUS system used to obtain Food and Drug Administration market approval in the US in In MRgFUS, MR is used for both target localization and in vivo real time monitoring of temperature based on a technique referred to as MR thermometry [ ], and for verifying tissue destruction using a postprocessing tool.
The thermometric technique of temperature-dependent phase changes in gradient-recalled echo pulse sequences are commonly used to determine the temperature change [ ].
The change in temperature is represented as. where Δϕ is the phase change, γ is the gyromagnetic ratio, c is the proton-resonance frequency shift constant —0. For the bone tumors, the calcification issues can be resolved be using susceptibility-weighted MRI to identify calcifications rather than computer tomography.
An ultrashort TE sequence can be used to improve thermometry in bone. Clinical applications of MRgFUS are still limited. MRI-guided linear accelerator MRI—LINAC is a recently developed and advanced radiation treatment system.
As indicating the name, the MRI—LINAC is fully integrated with the MRI for imaging soft-tissue tumors together with LINAC for the radiotherapy to treat cancers throughout the body. The advantage of MRI-based imaging on a linear accelerator has superior high-definition image quality, especially for some soft-tissue cancers compared with CT-based imaging in the traditional linear accelerators to visualize the target area and adjacent anatomy for treatment setup and delivery.
The first technical prototype MR—Linac was developed and installed in the University Medical Center Utrecht in Utrecht, The Netherlands.
Similar types of measurements have been performed on a hybrid MRI Cobalt device [ ]. The first clinically active MRI-guided radiation therapy machine ViewRay was installed at the Alvin J.
Siteman Cancer Center at Barnes-Jewish Hospital at the Washington University School of Medicine St. Louis, MO, USA. The treatment of the first patients was announced in February LINAC is affected by MRI.
Two main configurations of MRI—LINAC that are being pursued with the radiotherapy beam are either parallel or perpendicular to the main magnetic field.
This configuration is affected by the interference between the delivery of the radiation beam of LINAC and MRI. The operation of the multileaf collimator in the strong magnetic field can be a problem in the shaping of the X-ray beam [ ].
Both configurations have this problem, and vendors lowered magnetic field to minimize this issue. Another issue in the MRI—LINAC is that the accelerated electrons used to produce the X-ray beam can be deviated or defocused, thus causing a loss of the beam current. Previous studies showed that the perpendicular configuration is dominant to the total beam loss compared with the parallel one [ , ].
Skin dose can be increased by secondary electrons owing to the influence of the magnetic field [ ]. In this case, the perpendicular configuration should be advantageous, although the electron return effect can still appear [ ].
Receiver coils can cause attenuation of the primary beam and can increase the skin dose. Detailed explanation can be found in another paper [ ]. MRI quality is also affected by the LINAC.
Any RF noise generated by the LINAC can cause artifacts or noise in images. In addition, LINAC components, such as the accelerator or multileaf collimators cause inhomogeneity of the main magnetic field, thus worsening the imaging quality [ ]. Finally, the radiation beam can affect conductors or electronics in the coil, causing imaging artifacts [ , ].
The MRI-LINAC can adapt the radiation treatment plan based on movement of the organs or tumor, and also track the motion of the tumor. This system reduces complications after radiation treatments. The MRI—LINAC can be used to improve the personalization of the radiation therapy using existing contrast imaging mechanisms, such as diffusion, perfusion, functional, and metabolic, to evaluate treatment effects.
The hybrid system has been focused on daily plan changes based on geometric changes in the organs-at-risk [ , ]. Furthermore, MRI has been used to evaluate radiation treatment effects [ ].
Currently, this hybrid system is used to treat patients with prostate cancer [ ], pelvic lymph nodes [ ], and the esophagus [ ]. The research was supported by the National Research Foundation of Korea grant funded by Ministry of Science and ICT No.
The authors confirm that the data supporting the findings of this study are available within the article. Conceptualization: Geon-Ho Jahng. Data curation: Geon-Ho Jahng, Soonchan Park, Chang-Woo Ryu, and Zang-Hee Cho. Writing—original drafting: Geon-Ho Jahng.
Keywords : Magnetic resonance imaging, History, Technical development, Clinical application, Review. Current Issue Archives. Chang Hyun Yoo 1 , Junghwan Goh 1 , Geon-Ho Jahng 2.
Yona Choi 1,2 , Kook Jin Chun 2 , Eun San Kim 2 , Young Jae Jang 1,2 , Ji-Ae Park 3 , Kum Bae Kim 1 , Geun Hee Kim 4 , Sang Hyoun Choi 1.
Received : May 29, ; Revised : August 1, ; Accepted : September 1, International contributions The first nuclear magnetic resonance NMR signals from a living animal were acquired from an anesthetized rat in [ 1 ]. Figure 1. Timeline of MRI developments and summary of the major contributions.
MRI, magnetic resonance imaging; M, magnetic; R, resonance; I, imaging; F, functional; NMR, nuclear magnetic resonance; BOLD, blood oxygen level-dependent; NIH, National Institutes of Health; PET, positron emission tomography; MRI—LINAC, MRI-guided linear accelerators.
Domestic contributions The first MRI system was developed by the Korean Advanced Institute of Science and Technology Daejeon, Korea , and was installed in Shin Hwa Hospital Shin Hwa Nursing Hospital, Seoul, Korea in Development of basic imaging contrast In , spin echoes and free induction decay were detected by Hahn [ 13 , 14 ].
Figure 2. Patient cases to show imaging contrasts acquired from a year-old female, b year-old male, and c year-old male using a 3 T MRI system. Technical developments Several pulse sequences for fast imaging were developed, such as TSE or turbo field echo, half-Fourier, single-shot turbo spin echo HASTE , gradient and spin echo GRASE , balanced steady-state free-precession bSSFP , EPI, and spiral [ 20 ].
Clinical applications Ultrafast imaging is used to eliminate the effects of physiological motion, thus capturing dynamic events in real time or shortening the total scan time. Technical developments Diffusion-weighted imaging DWI was developed to investigate microstructural properties by evaluating the proton diffusion process.
Clinical applications Diffusion MRI techniques, including DWI, DTI, and tractography, are currently extensively used in clinical settings. Technical developments Details of perfusion MRI were summarized in a previous paper [ 77 ].
Clinical applications Perfusion MRI is a promising tool used to assess stroke, tumors, and neurodegenerative diseases. Technical developments of MRS 1 Pulse sequences A single voxel spectroscopy SVS study is performed with short or long TE values. Molecular imaging tools other than MRS CEST can be used to apply molecular imaging [ ].
Clinical applications The goal of clinical spectroscopy is to provide physicians with biochemical information that will assist in the differential diagnosis when standard clinical and radiologic tests fail or are too invasive.
PET—MRI PET—MRI is an imaging system that incorporates MRI and PET to gain from the benefits of soft tissue morphological imaging MRI and metabolic imaging PET. MR-guided focused ultrasound surgery High-intensity focused ultrasound HIFU is a noninvasive therapeutic technique that uses nonionizing ultrasonic waves to heat tissue [ ].
MRI-guided linear accelerator MRI-guided linear accelerator MRI—LINAC is a recently developed and advanced radiation treatment system. Jackson JA, Langham WH.
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Viswanathan AN, Dimopoulos J, Kirisits C, Berger D, Potter R. Computed tomography versus magnetic resonance imaging-based contouring in cervical cancer brachytherapy: results of a prospective trial and preliminary guidelines for standardized contours.
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Biomed Mater Eng. PubMed Google Scholar. Download references. The University of Texas MD Anderson Cancer Center, Houston, TX, USA. You can also search for this author in PubMed Google Scholar.
Department of Medical Physics, Ingham Institute, Sydney, NSW, Australia. Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands.
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Keywords Magnetic resonance imaging Radiotherapy planning Delineation Target volumes Organs at risk. Buying options Chapter EUR eBook EUR Softcover Book EUR Hardcover Book EUR Tax calculation will be finalised at checkout Purchases are for personal use only Learn about institutional subscriptions.
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Article CAS PubMed Google Scholar Horton JK, Blitzblau RC, Yoo S, Geradts J, Chang Z, Baker JA, et al. The first-pass DSC-enhanced MR perfusion is based on the susceptibility effects of gadolinium-based contrast agents on the signal echo.
Cerebral blood volume CBV and flow CBF values as well as time-related parameters, such as the mean transit time MTT and time-to-peak can be mapped in each pixel. Convolution theory is used to evaluate the measured concentrations of the hemodynamic changes of the contrast agent as follows [ 78 ],.
The dynamic contrast-enhanced DCE MR perfusion is based on the relaxivity effects of gadolinium-based contrast agents on the signal echo.
Therefore, a transverse relaxation T1 -weighted imaging sequence usually a three-dimensional sequence , is used to obtain signal increments of time-series images. The area under-the-curve can be mapped. Furthermore, a pharmacokinetic model is used to map permeability-related parameters such as K trans and K ep and the corresponding volume fractions such as v p and v e.
The general equation used to express the hemodynamic event after injecting the contrast agent is expressed with the extended Tofts model as follows [ 79 ],. where C p t is the concentration of contrast agent in blood, K trans is the permeability—surface area constant from the vascular to the extracellular space, and v e is volume fraction in the extravascular and extracellular space.
The ASL MR perfusion is based on an endogenous contrast agent using magnetically labeled arterial blood water as a diffusible flow tracer. Therefore, the proton-density-weighted sequence is used to obtain signal changes with and without the use of magnetically labeled blood by either continuous or pulsed RF pulses.
CBF value can be quantified. A general kinetic model for the evaluation of the difference of the longitudinal magnetization in the tissue owing to the labeled blood can be expressed to quantify the blood flow as follows [ 80 ],.
The pseudo-continuous ASL pCASL technique was introduced to improve the ASL signals [ 81 ], and is currently used in clinical practice.
Perfusion MRI is a promising tool used to assess stroke, tumors, and neurodegenerative diseases. DSC perfusion MRI is the standard technique used to evaluate brain diseases, such as stroke [ 82 ] and tumors [ 83 ].
A combination of perfusion and DWI is used to evaluate a mismatch between the size of a perfusion defect and the diffusion abnormality that is referred to as the ischemic penumbra [ 84 ].
Tumor grade, recurrence, postoperative changes, or radiation effects can be established with DSC perfusion imaging [ 85 ]. DCE perfusion MRI is often applied in brain diseases [ 86 ] and in patients with breast, prostate, pelvic, and muscle diseases, and can be useful in differentiating between tumor recurrence and radiation necrosis.
The DCE parameters reflect a more extensive BBB disruption and a higher tumor grade [ 87 ], evaluate the treatment prediction [ 88 ], and differentiate pseudo-progression from true progressive disease in GBM patients [ 89 ].
ASL perfusion MRI is mainly applied in brain diseases, such as neurodegenerative [ 90 , 91 ], renal, and cardiovascular diseases. ASL perfusion MRI has been used to evaluate pseudo-progression in brain tumor [ 92 ].
This method is particularly useful for patients with poor intravenous access, infants and children, and pregnant women [ 93 ]. MR spectroscopy MRS is used to determine the molecular structure of compounds, or to detect their presence.
MRS is thus sensitive to certain aspects of tissue metabolism. MRS can detect other nuclei in compounds of biological interest, such as phosphorus found in PCr or carbon found in glycogen. However, proton MRS is more routinely performed in clinical practice compared with 31P or 13C MRS.
Therefore, in this review, we only discuss proton MRS. Chemical exchange saturation transfer CEST is a novel MR technique that enables molecular imaging to obtain certain compounds at concentrations that are too low to impact the contrast of standard MRI and too low to be directly detected in MRS at typical water imaging resolutions.
A single voxel spectroscopy SVS study is performed with short or long TE values. The SVS pulse sequences are the following: point resolved spectroscopy PRESS [ 94 ], stimulated echo acquisition mode STEAM [ 95 ], image selected in vivo spectroscopy ISIS [ 96 ], and depth-resolved spectroscopy DRESS [ 97 ].
Longer TE results in the signal decrease as a result of the transverse relaxation T2 that leads to the alteration of the phase of multiplet signals because of J-coupling [ 98 ]. TE values in the range of — ms are typically used, as this leads to the production of a spectrum in which the doublet signal of Lac with a J-coupling constant of nearly 7 Hz is entirely reversed owing to the short TE and long TR [ 99 ].
A spectroscopic imaging is an area of interest. Chemical shift imaging CSI is used for multiple-voxel spectroscopic acquisitions. In spectroscopic imaging, phase encoding gradients can be applied in all three dimensions to sample k-space to select a volume that resembles methods used in MRI [ ].
The most common suppression method is based on the use of a chemical shift selected CHESS pulse sequence [ ]. The typical postprocessing techniques used include Fourier Transform FT , baseline correction, zero filling, and phasing.
Quantification of the MRS signal amplitude can provide a means for estimating the tissue concentration of the signal generating molecules. While MRS signals are usually acquired in the time domain as free induction decays or echoes, they are usually viewed and analyzed in the frequency domain.
The frequency domain representation is derived from the acquired time domain data by the FT. Signal averaging is used in virtually all MRS studies to increase the SNR by averaging the signals obtained in repeated measurements. To quantify the proton spectrum in most of the clinical studies, the internal reference signal is typically used that is either the Cr signal at 3.
One weak aspect related to the use of the Cr signal as a reference is attributed to the fact that the Cr signal is not as uniform throughout the normal brain [ ]. Another weak aspect pertains to the fact that the assumption of the Cr levels do not change with disease and other physiological characteristics may be erroneous.
If the water signal is used as a reference signal, its amplitude must be measured by performing a separate measurement in the same brain region without using water suppression.
A linear least-squares optimization procedure has been established and used in spectral fitting techniques. The most popular spectral fitting software is currently the LCModel [ , ]. Furthermore, spectrum fitting software is available either in the time [ ] or frequency domains [ , ].
CEST can be used to apply molecular imaging [ ]. This technique is more appropriate compared with CSI or MR spectroscopy imaging because it provides relatively high resolution. The principle of CEST is based on the use of the magnetization transfer effects from other molecules to water molecules.
Therefore, the requirement of CEST is that the chemical species must have in their structures a 1H proton that is exchangeable with those of water.
Known endogenous diamagnetic CEST agents are involved with exchangeable groups of amide proton -NH , amine proton -NH2 , and hydroxyl proton -OH , whose chemical shifts are ~3. Amide CEST is usually referred to as amide proton transfer APT.
CEST techniques have been applied to map glutamate amine proton , creatine amine proton , glycosaminoglycan Gag hydroxyl proton , myoinositol MI hydroxyl proton , and glucose hydroxyl proton. The detailed principle of CEST technique has been described in numerous previous papers [ - ].
The goal of clinical spectroscopy is to provide physicians with biochemical information that will assist in the differential diagnosis when standard clinical and radiologic tests fail or are too invasive.
Proton spectroscopy has attained clinical value in that it can monitor the evolution of diseases and associated therapies. Disease can sometimes lead to large changes in metabolite levels. Lactate signal levels are elevated in ischemic brain tissue.
Choline signal levels are elevated in some neoplastic or inflamed tissues. The main applications for amide CEST or APT are the detection of cancer and ischemic stroke. In tumor regions, the concentration of proteins are elevated compared with surrounding tissues, and thus lead to increased APT levels [ ].
This method was applied to classify tumor progression from radiation necrosis [ ]. The CEST technique is applied in stroke because reduced pH in the ischemic region leads to lowered APT exchange rate, and results in decreased CEST values [ ].
CEST was applied in other-than-brain pathologies, such as breast [ ], prostate [ ], and knee [ ]. PET—MRI is an imaging system that incorporates MRI and PET to gain from the benefits of soft tissue morphological imaging MRI and metabolic imaging PET.
This hybrid system is mainly used in the fields of oncology and neurology for clinical and preclinical studies. Some systems operate in totally separate rooms, but other systems do operate in the same room with separate machines.
In these cases, a bed is shared to transfer the subjects from MRI to PET or to fully integrated systems. The first whole-body PET—MRI systems were produced by Philips Amsterdam, The Netherlands and were installed in the US Mount Sinai Medical Center, New York, NY and in Switzerland Geneva University Hospital, Geneva in The system featured a PET and MRI scanner separated by a revolving bed.
The simultaneous PET—MR acquisition system Siemens was installed in The fully integrated whole-body systems were provided in by Siemens and in by GE.
In Korea, the first PET—MRI system was installed at the Gachon University Hospital Inchen, Korea [ 7 , 8 ]. In this part, we only discussed the issues of the fully integrated PET—MRI system.
Placing PET detectors in the MR magnet can alter the local magnetic field strength causing the protons to spin at wrong frequencies, thus leading to the formation of severe image distortions and artifacts, such as susceptibility artifacts.
The presence of PET hardware within the gradient coil significantly alters the MR eddy current characteristics of the system possibly leading to degraded spatial linearity. The gradient imperfection would impact imaging spatial resolution and image homogeneity.
The lutetium-based scintillation crystals have acceptable magnetic properties [ ]. The avalanche photodiode for PET can be used in a 7 T MRI system without inducing major effects to magnetic fields [ ].
Attenuation correction describes a method to account for the self-absorption of the emitted annihilation photons, and is a prerequisite for accurate quantification of the PET data [ ]. It is not possible to directly derive the attenuation properties of tissues from MRI measurements.
MRI-based attenuation correction methods have been introduced [ ]: segmentation-based [ ] that are usually used in T1-weighted images [ ] or Dixon-sequence-based images [ ], atlas-based [ ], and reconstruction-based [ ] methods.
Attenuation correction of bone is calculated by using ultrashort echo time images [ ]. The simultaneous acquisition of MRI and PET data in the fully integrated PET—MRI systems has major advantages compared with sequential acquisitions.
Two-dimensional or three-dimensional 3D navigator MRI is used to correct respiratory motion in PET images [ ]. A high resolution MRI has been used for the correction of the partial volume effect in PET images [ ]. Finally, MR anatomical images have been used for aligning functional information obtained from PET [ ].
While PET provides a the high sensitivity required to detect minute amounts of radiotracers and b the ability to quantify radiotracer activity throughout the body in absolute terms, MRI provides excellent soft-tissue contrast according to multiple contrast mechanisms at high-spatial resolution.
The PET—MRI system has been used for the study of patients with hepatobiliary cancer [ ], neuroendocrine tumors [ ], pancreatic adenocarcinoma [ ], prostate cancer [ ], primary brain tumors [ ], dementia [ ], epilepsy [ ], musculoskeletal tumor [ ], and coronary artery disease [ ].
High-intensity focused ultrasound HIFU is a noninvasive therapeutic technique that uses nonionizing ultrasonic waves to heat tissue [ ]. HIFU has been combined with MRI to enable guidance of the treatment and monitoring. It is referred to as MR-guided focused ultrasound surgery MRgFUS.
It is a 3D imaging technique that features high-soft-tissue contrast and provides information about temperature, thus allowing the monitoring of ablation. In , reports were published that described MRgFUS on ex vivo muscle tissue [ ], and the following year on in vivo tissue [ ].
MRgFUS developed by Hynynen [ ] was later transferred to InsighTec in Haifa, Israel in The InsighTec ExAblate was the first MRgFUS system used to obtain Food and Drug Administration market approval in the US in In MRgFUS, MR is used for both target localization and in vivo real time monitoring of temperature based on a technique referred to as MR thermometry [ ], and for verifying tissue destruction using a postprocessing tool.
The thermometric technique of temperature-dependent phase changes in gradient-recalled echo pulse sequences are commonly used to determine the temperature change [ ]. The change in temperature is represented as. where Δϕ is the phase change, γ is the gyromagnetic ratio, c is the proton-resonance frequency shift constant —0.
For the bone tumors, the calcification issues can be resolved be using susceptibility-weighted MRI to identify calcifications rather than computer tomography. An ultrashort TE sequence can be used to improve thermometry in bone.
Clinical applications of MRgFUS are still limited. MRI-guided linear accelerator MRI—LINAC is a recently developed and advanced radiation treatment system. As indicating the name, the MRI—LINAC is fully integrated with the MRI for imaging soft-tissue tumors together with LINAC for the radiotherapy to treat cancers throughout the body.
The advantage of MRI-based imaging on a linear accelerator has superior high-definition image quality, especially for some soft-tissue cancers compared with CT-based imaging in the traditional linear accelerators to visualize the target area and adjacent anatomy for treatment setup and delivery.
The first technical prototype MR—Linac was developed and installed in the University Medical Center Utrecht in Utrecht, The Netherlands.
Similar types of measurements have been performed on a hybrid MRI Cobalt device [ ]. The first clinically active MRI-guided radiation therapy machine ViewRay was installed at the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital at the Washington University School of Medicine St.
Louis, MO, USA. The treatment of the first patients was announced in February LINAC is affected by MRI. Two main configurations of MRI—LINAC that are being pursued with the radiotherapy beam are either parallel or perpendicular to the main magnetic field.
This configuration is affected by the interference between the delivery of the radiation beam of LINAC and MRI. The operation of the multileaf collimator in the strong magnetic field can be a problem in the shaping of the X-ray beam [ ]. Both configurations have this problem, and vendors lowered magnetic field to minimize this issue.
Another issue in the MRI—LINAC is that the accelerated electrons used to produce the X-ray beam can be deviated or defocused, thus causing a loss of the beam current. Previous studies showed that the perpendicular configuration is dominant to the total beam loss compared with the parallel one [ , ].
Skin dose can be increased by secondary electrons owing to the influence of the magnetic field [ ]. In this case, the perpendicular configuration should be advantageous, although the electron return effect can still appear [ ]. Receiver coils can cause attenuation of the primary beam and can increase the skin dose.
Detailed explanation can be found in another paper [ ]. MRI quality is also affected by the LINAC. Any RF noise generated by the LINAC can cause artifacts or noise in images.
In addition, LINAC components, such as the accelerator or multileaf collimators cause inhomogeneity of the main magnetic field, thus worsening the imaging quality [ ]. Finally, the radiation beam can affect conductors or electronics in the coil, causing imaging artifacts [ , ].
The MRI-LINAC can adapt the radiation treatment plan based on movement of the organs or tumor, and also track the motion of the tumor.
This system reduces complications after radiation treatments. The MRI—LINAC can be used to improve the personalization of the radiation therapy using existing contrast imaging mechanisms, such as diffusion, perfusion, functional, and metabolic, to evaluate treatment effects.
The hybrid system has been focused on daily plan changes based on geometric changes in the organs-at-risk [ , ]. Furthermore, MRI has been used to evaluate radiation treatment effects [ ]. Currently, this hybrid system is used to treat patients with prostate cancer [ ], pelvic lymph nodes [ ], and the esophagus [ ].
The research was supported by the National Research Foundation of Korea grant funded by Ministry of Science and ICT No. The authors confirm that the data supporting the findings of this study are available within the article. Conceptualization: Geon-Ho Jahng. Data curation: Geon-Ho Jahng, Soonchan Park, Chang-Woo Ryu, and Zang-Hee Cho.
Writing—original drafting: Geon-Ho Jahng. Keywords : Magnetic resonance imaging, History, Technical development, Clinical application, Review. Current Issue Archives. Chang Hyun Yoo 1 , Junghwan Goh 1 , Geon-Ho Jahng 2. Yona Choi 1,2 , Kook Jin Chun 2 , Eun San Kim 2 , Young Jae Jang 1,2 , Ji-Ae Park 3 , Kum Bae Kim 1 , Geun Hee Kim 4 , Sang Hyoun Choi 1.
Received : May 29, ; Revised : August 1, ; Accepted : September 1, International contributions The first nuclear magnetic resonance NMR signals from a living animal were acquired from an anesthetized rat in [ 1 ]. Figure 1. Timeline of MRI developments and summary of the major contributions.
MRI, magnetic resonance imaging; M, magnetic; R, resonance; I, imaging; F, functional; NMR, nuclear magnetic resonance; BOLD, blood oxygen level-dependent; NIH, National Institutes of Health; PET, positron emission tomography; MRI—LINAC, MRI-guided linear accelerators.
Domestic contributions The first MRI system was developed by the Korean Advanced Institute of Science and Technology Daejeon, Korea , and was installed in Shin Hwa Hospital Shin Hwa Nursing Hospital, Seoul, Korea in Development of basic imaging contrast In , spin echoes and free induction decay were detected by Hahn [ 13 , 14 ].
Figure 2. Patient cases to show imaging contrasts acquired from a year-old female, b year-old male, and c year-old male using a 3 T MRI system. Technical developments Several pulse sequences for fast imaging were developed, such as TSE or turbo field echo, half-Fourier, single-shot turbo spin echo HASTE , gradient and spin echo GRASE , balanced steady-state free-precession bSSFP , EPI, and spiral [ 20 ].
Clinical applications Ultrafast imaging is used to eliminate the effects of physiological motion, thus capturing dynamic events in real time or shortening the total scan time.
Technical developments Diffusion-weighted imaging DWI was developed to investigate microstructural properties by evaluating the proton diffusion process. Clinical applications Diffusion MRI techniques, including DWI, DTI, and tractography, are currently extensively used in clinical settings.
Technical developments Details of perfusion MRI were summarized in a previous paper [ 77 ]. Clinical applications Perfusion MRI is a promising tool used to assess stroke, tumors, and neurodegenerative diseases.
Technical developments of MRS 1 Pulse sequences A single voxel spectroscopy SVS study is performed with short or long TE values.
Molecular imaging tools other than MRS CEST can be used to apply molecular imaging [ ]. Clinical applications The goal of clinical spectroscopy is to provide physicians with biochemical information that will assist in the differential diagnosis when standard clinical and radiologic tests fail or are too invasive.
PET—MRI PET—MRI is an imaging system that incorporates MRI and PET to gain from the benefits of soft tissue morphological imaging MRI and metabolic imaging PET. MR-guided focused ultrasound surgery High-intensity focused ultrasound HIFU is a noninvasive therapeutic technique that uses nonionizing ultrasonic waves to heat tissue [ ].
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Direct estimation of the fiber orientation density function from diffusion-weighted MRI data using spherical deconvolution. Zhang H, Schneider T, Wheeler-Kingshott CA, Alexander DC. NODDI: practical in vivo neurite orientation dispersion and density imaging of the human brain. Jensen JH, Helpern JA, Ramani A, Lu H, Kaczynski K.
Diffusional kurtosis imaging: the quantification of non-gaussian water diffusion by means of magnetic resonance imaging. Basser PJ, Pajevic S, Pierpaoli C, Duda J, Aldroubi A. In vivo fiber tractography using DT-MRI data.
Mori S, Crain BJ, Chacko VP, van Zijl PC. Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging. Ann Neurol. Jones DK. Tractography gone wild: probabilistic fibre tracking using the wild bootstrap with diffusion tensor MRI.
Bullmore E, Sporns O. Complex brain networks: graph theoretical analysis of structural and functional systems. Nat Rev Neurosci. Sotak CH. The role of diffusion tensor imaging in the evaluation of ischemic brain injury - a review.
NMR Biomed. Alexander AL, Hurley SA, Samsonov AA, Adluru N, Hosseinbor AP, Mossahebi P, et al. Characterization of cerebral white matter properties using quantitative magnetic resonance imaging stains.
Brain Connect. Baliyan V, Das CJ, Sharma R, Gupta AK. Diffusion weighted imaging: technique and applications. World J Radiol. Zhang Y, Schuff N, Jahng GH, Bayne W, Mori S, Schad L, et al. Diffusion tensor imaging of cingulum fibers in mild cognitive impairment and Alzheimer disease.
Zhang Y, Du AT, Hayasaka S, Jahng GH, Hlavin J, Zhan W, et al. Patterns of age-related water diffusion changes in human brain by concordance and discordance analysis.
Neurobiol Aging. Jahng GH, Xu S, Weiner MW, Meyerhoff DJ, Park S, Schuff N. DTI studies in patients with Alzheimer's disease, mild cognitive impairment, or normal cognition with evaluation of the intrinsic background gradients. Jahng GH, Xu S.
Local susceptibility causes diffusion alterations in patients with Alzheimer's disease and mild cognitive impairment. Brain Imaging Behav. Jahng GH, Xu S, Kim MJ. Mapping of distributions of a local b-matrix cross-term strength using diffusion tensor MRI in patients with Alzheimer's disease.
Med Phys. Charles-Edwards EM, deSouza NM. Diffusion-weighted magnetic resonance imaging and its application to cancer. Cancer Imaging. Takahara T, Imai Y, Yamashita T, Yasuda S, Nasu S, Van Cauteren M.
Diffusion weighted whole body imaging with background body signal suppression DWIBS : technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med. Larsen EH. Ugeskr Laeger. Villringer A, Rosen BR, Belliveau JW, Ackerman JL, Lauffer RB, Buxton RB, et al.
Dynamic imaging with lanthanide chelates in normal brain: contrast due to magnetic susceptibility effects. Koretsky AP. Early development of arterial spin labeling to measure regional brain blood flow by MRI. Jahng GH, Li KL, Ostergaard L, Calamante F.
Perfusion magnetic resonance imaging: a comprehensive update on principles and techniques. Korean J Radiol. Ostergaard L, Weisskoff RM, Chesler DA, Gyldensted C, Rosen BR.
High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part I: Mathematical approach and statistical analysis. Tofts PS. Modeling tracer kinetics in dynamic Gd-DTPA MR imaging.
Buxton RB, Frank LR, Wong EC, Siewert B, Warach S, Edelman RR. A general kinetic model for quantitative perfusion imaging with arterial spin labeling.
Dai W, Garcia D, de Bazelaire C, Alsop DC. Continuous flow-driven inversion for arterial spin labeling using pulsed radio frequency and gradient fields. Keir SL, Wardlaw JM. Systematic review of diffusion and perfusion imaging in acute ischemic stroke.
Cha S, Knopp EA, Johnson G, Wetzel SG, Litt AW, Zagzag D. Intracranial mass lesions: dynamic contrast-enhanced susceptibility-weighted echo-planar perfusion MR imaging. Ostergaard L, Sorensen AG, Chesler DA, Weisskoff RM, Koroshetz WJ, Wu O, et al.
Combined diffusion-weighted and perfusion-weighted flow heterogeneity magnetic resonance imaging in acute stroke. Lee SJ, Kim JH, Kim YM, Lee GK, Lee EJ, Park IS, et al.
Perfusion MR imaging in gliomas: comparison with histologic tumor grade. Brix G, Kiessling F, Lucht R, Darai S, Wasser K, Delorme S, et al. Microcirculation and microvasculature in breast tumors: pharmacokinetic analysis of dynamic MR image series.
MRI clinical applications Jahng 1Soonchan Park applocationsChang-Woo Ryu 1Zang-Hee Cho 2. Applicatiojs to: MRI clinical applications Jahng Sweet potato pancakes gmail. com Zpplications Fax: The paper is published to recognize the anniversary. Geon-Ho Jahng invited Professor Z. Cho to join to submit this manuscript because he has been one of the leaders in the field of magnetic resonance imaging MRI during the last 40 years.
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