3 T: the good, the bad and the ugly

It is around 20 years since the first commercial 3 T MRI systems became available. The theoretical promise of twice the signal-to-noise ratio of a 1.5 T system together with a greater sensitivity to magnetic susceptibility-related contrast mechanisms, such as the blood oxygen level dependent (BOLD) effect that is the basis for functional MRI (fMRI), drove the initial market in neuroradiology. However, the limitations of the increased field strength soon became apparent, including the increased radiofrequency (RF) power deposition, tissue dependent changes in relaxation times, increased artifacts, and greater safety concerns. Many of these issues are dependent upon MR physics and work arounds have had to be developed to try and mitigate their effects. This article reviews the underlying principles of the good, the bad and the ugly aspects of 3 T, discusses some of the methods used to improve image quality and explains the remaining challenges and concerns.

Basic MR physics

In magnetic resonance, the properties of protons in tissue giving rise to so-called magnetic moments are exploited. The sum of many magnetic moments yields what is referred to as net magnetization, which can be seen as similar to the magnetization a bar magnet produces. The relation and interaction between magnetic moments, net magnetization, the static magnetic field, and radiofrequency fields are discussed. It is shown that radiofrequency excitation can be used to manipulate the net magnetization, such that it can be detected using radiofrequency antennae or coils. Upon excitation, the net magnetization will recover back to its equilibrium orientation with tissue-specific time constants for the transverse and longitudinal components, which, in turn, are important sources of image contrast in cardiac imaging. The discussion concludes with a foray into susceptibility and chemical shift effects resulting from different molecular environments in which protons can reside and which provide additional image contrast mechanisms.

Presurgical language fMRI: Current technical practices in epilepsy surgical planning

Little is known about how language functional MRI (fMRI) is executed in clinical practice in spite of its widespread use. Here we comprehensively documented its execution in surgical planning in epilepsy. A questionnaire focusing on cognitive design, imaging acquisition, analysis and interpretation and practical considerations was developed. Individuals responsible for collecting, analyzing, and interpreting clinical language fMRI data at 63 epilepsy surgical programs responded. The central finding was of marked heterogeneity in all aspects of fMRI. Most programs use multiple tasks, with a fifth routinely using 2, 3, 4 or 5 tasks with a modal run duration of five minutes. Variants of over fifteen protocols are in routine use with forms of noun-verb generation, verbal fluency, and semantic decision-making used most often. Nearly all aspects of data acquisition and analysis vary markedly. Neither of the two best-validated protocols were used by more than 10% of respondents. Preprocessing steps are broadly consistent across sites, language-related blood flow is most often identified using general linear modeling (76% of respondents), and statistical thresholding typically varies by patient (79%). The software SPM is most often used. fMRI programs inconsistently include input from experts with all required skills (imaging, cognitive assessment, MR physics, statistical analysis, brain-behavior relationships). These data highlight marked gaps between the evidence supporting fMRI and its clinical application. Teams performing language fMRI may benefit from evaluating practice with reference to the best-validated protocols to date and ensuring individuals trained in all aspects of fMRI are involved to optimize patient care.