Comparison of 5 Rectal Preparation Strategies for Prostate MRI and Impact on Image Quality

Purpose: To compare 5 different rectal preparation strategies for prostate MRI. Methods: This 5-arm quality-assurance study evaluated 56 patients per arm (280 patients) including: no preparation, clear-fluids diet (CFD) beginning at 00:00 hours on the day of MRI, Fleet®-enema, enema + CFD, enema + CFD + IV-antispasmodic agent. The study was powered to 0.80 with alpha-error of 0.05. Three blinded radiologists independently evaluated T2-Weighted (T2W) and Diffusion Weighed Imaging (DWI) for: rectal diameter (maximal AP diameter), rectal content (stool, fluid, gas), rectal motion, T2W/DWI image quality, T2W image sharpness and DWI susceptibility artifact using 5-point Likert scales. Overall comparisons were performed using analysis of variance (ANOVA) and Kruskal-Wallis, with pair-wise comparisons using paired t-tests and Wilcoxon sign-rank tests. Results: Rectal diameter and amount of gas were lower in enema compared to non-enema groups (p < 0.001), with smallest diameter and least gas in the enema + CFD + IV-antispasmodic group (p = 0.022-<0.001). T2W image quality and sharpness were highest in the enema + CFD groups (p < 0.001) with no difference comparing enema + CFD with/without IV-antispasmodic (p = 0.064, 0.084). Motion artifact was least in enema + CFD + IV-antispasmodic group compared to all other groups (p < 0.001), followed by the enema + CFD group (p = 0.008-<0.001). DWI image quality was highest (p < 0.001) and DWI susceptibility artifact lowest (p < 0.001) in the enema + CFD groups (p < 0.001) and did not differ comparing enema + CFD with/without anti-spasmodic (p = 0.058-0.202). Conclusions: Use of enema + clear-fluids diet before prostate MRI yields the highest T2W and DWI image quality with the least DWI artifact. IV-antispasmodic use reduces motion on T2W but does not improve image quality on T2W or DWI, or lessen DWI artifact compared to enema + clear-fluids diet.

Quantitative Assessment of the Impact of Geometric Distortions and Their Correction on fMRI Data Analyses

Functional magnetic resonance imaging (fMRI) data is typically collected with gradient-echo echo-planar imaging (GE-EPI) sequences, which are particularly prone to the susceptibility artifact as a result of B0 field inhomogeneity. The component derived from in-plane spin dephasing induces pixel intensity variations and, more critically, geometric distortions. Despite the physical mechanisms underlying the susceptibility artifact being well established, a systematic investigation on the impact of the associated geometric distortions, and the direct comparison of different approaches to tackle them, on fMRI data analyses is missing. Here, we compared two different distortion correction approaches, by acquiring additional: (1) EPI data with reversed phase encoding direction (TOPUP), and (2) standard (and undistorted) GE data at two different echo times (GRE). We first characterized the geometric distortions and the correction approaches based on the estimated ΔB0 field offset and voxel shift maps, and then conducted three types of analyses on the distorted and corrected fMRI data: (1) registration into structural data, (2) identification of resting-state networks (RSNs), and (3) mapping of task-related brain regions of interest. GRE estimated the largest voxel shifts and more positively impacted the quality of the analyses, in terms of the (significantly lower) cost function of the registration, the (higher) spatial overlap between the RSNs and appropriate templates, and the (significantly higher) sensitivity of the task-related mapping based on the Z-score values of the associated activation maps, although also evident when considering TOPUP. fMRI data should thus be corrected for geometric distortions, with the choice of the approach having a modest, albeit positive, impact on the fMRI analyses.

Intraoperative acquisition of DTI in cranial neurosurgery: readout-segmented DTI versus standard single-shot DTI

OBJECTIVEDiffusion tensor imaging (DTI) tractography is commonly used in neurosurgical practice but is largely limited to the preoperative setting. This is due primarily to image degradation caused by susceptibility artifact when conventional single-shot (SS) echo-planar imaging (EPI) DTI (SS-DTI) is acquired for open cranial, surgical position intraoperative DTI (iDTI). Readout-segmented (RS) EPI DTI (RS-DTI) has been reported to reduce such artifact but has not yet been evaluated in the intraoperative MRI (iMRI) environment. The authors evaluated the performance of RS versus SS EPI for DTI of the human brain in the iMRI setting.METHODSPre- and intraoperative 3-T 3D T1-weighted and 2D multislice RS-iDTI (called RESOLVE [readout segmentation of long variable echo-trains] on the Siemens platform) and SS-iDTI images were acquired in 22 adult patients undergoing intraaxial iMRI resections for suspected low-grade glioma (14; 64%), high-grade glioma (7; 32%), or focal cortical dysplasia. Regional susceptibility artifact, anatomical deviation relative to T1-weighted imaging, and tractographic output for surgically relevant tracts were compared between iDTI sequences as well as the intraoperative tract shifts from preoperative DTI.RESULTSRS-iDTI resulted in qualitatively less regional susceptibility artifact (resection cavity, orbitofrontal and anterior temporal cortices) and mean anatomical deviation in regions most prone to susceptibility artifact (RS-iDTI 2.7 ± 0.2 vs SS-iDTI 7.5 ± 0.4 mm) compared to SS-iDTI. Although tract reconstruction success did not significantly differ by DTI method, susceptibility artifact–related tractography failure (of at least 1 surgically relevant tract) occurred for SS-iDTI in 8/22 (36%) patients, and in 5 of these 8 patients RS-iDTI permitted successful reconstruction. Among cases with successful tractography for both sequences, maximal intersequence differences were substantial (mean 9.5 ± 5.7 mm, range −27.1 to 18.7 mm).CONCLUSIONSRS EPI enables higher quality and more accurate DTI for surgically relevant tractography of major white matter tracts in intraoperative, open cranium neurosurgical applications at 3 T.

GP.05 Intraoperative acquisition of diffusion tensor imaging in cranial neurosurgery: readout-segmented DTI versus standard single-shot DTI

Background: Diffusion-tensor imaging (DTI) tractography is commonly used in neurosurgical practice, but is largely limited to the preoperative setting. This is due primarily to image degradation caused by susceptibility artifact when conventional single-shot (SS) echo-planar imaging DTI is acquired for open cranial, surgical position intraoperative DTI (iDTI). A novel, artifact-resistant, readout-segmented (RS) DTI has not yet been evaluated in the intraoperative MRI (iMRI) environment. Our objective was to evaluate the performance of RS-DTI versus SS-DTI for intraoperative white matter imaging. Methods: Pre- and intraoperative 3T, T1-weighted and DTI (RS-iDTI and SS-iDTI) in 22 adults undergoing intraaxial iMRI resections (low-grade glioma: 14, 64%; high-grade glioma: 7, 32%; cortical dysplasia: 1). Regional susceptibility artifact, anatomical deviation relative to T1WI, and tractographic output were compared between iDTI sequences. Results: RS-iDTI resulted in less regional susceptibility artifact and mean anatomic deviation (RS-iDTI: 2.7±0.2 mm versus SS-iDTI 7.5±0.4 mm; p&lt;0.0001). Tractographic failure occurred in 8/22 (36%) patients for SS-iDTI whereas RS-iDTI permitted successful reconstruction in 4 of these 8. Maximal tractographic differences between DTI sequences were substantial (mean 9.7±5.7 mm). Conclusions: Readout-segmented EPI enables higher quality and more accurate DTI for surgically relevant tractography of major white matter tracts in intraoperative, open cranium, neurosurgical applications at 3T.

Pigmented Villonodular Synovitis

Chapter 68 on pigmented villonodular synovitis (PVNS) reviews the clinical features, pathology, and imaging characteristics of PVNS. Epidemiology and treatment are briefly discussed. Diffuse intraarticular PVNS, localized intraarticular PVNS, and localized extraarticular PVNS, also referred to as giant cell tumor of the tendon sheath, are discussed. PVNS is considered to be a benign neoplastic disorder. Joints, tendon sheaths, and bursae may be involved. The knee is the most common location of the intraarticular form. The characteristic MRI finding is low signal intensity synovial proliferation or mass with blooming from susceptibility artifact on gradient echo images, secondary to the presence of hemosiderin.

Ultrasound of the Shoulder

Chapter 120 discusses US of the shoulder, which is most commonly performed to evaluate the tendons of the rotator cuff. In this examination, the long head of the biceps tendon, subacromial-subdeltoid bursa, and acromioclavicular joint are also examined. US demonstrates equal diagnostic accuracy to MRI in the assessment of partial- and full-thickness rotator cuff tears. Dynamic US of the shoulder is useful to evaluate subacromial and subcoracoid impingement as well as long head of the biceps tendon subluxation or dislocation. US is excellent in evaluating the postoperative rotator cuff, as the metallic susceptibility artifact encountered in MRI is not a problem in US.