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Advanced MR Neuroimaging
Series in Medical Physics and Biomedical Engineering
Series Editors: John G. Webster, E. Russell Ritenour, Slavik Tabakov, and Kwan-Hoong Ng
Recent books in the series:
Advanced MR Neuroimaging: From Theory to Clinical Practice
Ioannis Tsougos
Quantitative MRI of the Brain: Principles of Physical Measurement, Second edition
Mara Cercignani, Nicholas G. Dowell, and Paul S. Tofts (Eds)
A Brief Survey of Quantitative EEG
Kaushik Majumdar
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Paolo Russo (Ed)
Graphics Processing Unit-Based High Performance Computing in Radiation Therapy
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Targeted Muscle Reinnervation: A Neural Interface for Artificial Limbs
Todd A. Kuiken, Aimee E. Schultz Feuser, and Ann K. Barlow (Eds)
Emerging Technologies in Brachytherapy
William Y. Song, Kari Tanderup, and Bradley Pieters (Eds)
Environmental Radioactivity and Emergency Preparedness
Mats Isaksson and Christopher L. Rääf
The Practice of Internal Dosimetry in Nuclear Medicine
Michael G. Stabin
Radiation Protection in Medical Imaging and Radiation Oncology
Richard J. Vetter and Magdalena S. Stoeva (Eds)
Statistical Computing in Nuclear Imaging
Arkadiusz Sitek
The Physiological Measurement Handbook
John G. Webster (Ed)
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Shirley Lehnert
Diagnostic Endoscopy
Haishan Zeng (Ed)
Medical Equipment Management
Keith Willson, Keith Ison, and Slavik Tabakov
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Advanced MR Neuroimaging
from Theory to Clinical Practice
Ioannis Tsougos
Assistant Professor of Medical Physics
Faculty of Medicine, School of Health Sciences,
University of Thessaly
Biopolis, Larissa, Greece
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Library of Congress Cataloging in Publication Data
Names: Tsougos, Ioannis, author.
Title: Advanced MR neuroimaging : from theory to clinical practice / Ioannis Tsougos. Other titles: Series in medical physics and biomedical engineering.
Description: Boca Raton, FL : CRC Press, Taylor & Francis Group, [2018] |
Series: Series in medical physics and biomedical engineering | Includes bibliographical references and index. Identifiers: LCCN 2017037811| ISBN 9781498755238 (hardback ; alk. paper) |
ISBN 1498755232 (hardback ; alk. paper) | ISBN 9781498755252 (e-book) | ISBN 1498755259 (e-book)
Subjects: LCSH: Brain–Magnetic resonance imaging. | Magnetic resonance imaging. Classification: LCC RC386.6.M34 T73 2018 | DDC 616.8/04754–dc23
LC record available at https://lccn.loc.gov/2017037811
Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com
and the CRC Press Web site at http://www.crcpress.com
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Contents
Series Preface |
............................................................................................................. |
|
xi |
|
Preface |
.................................................................................................................... |
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|
xiii |
About the Author..................................................................................................... |
|
xv |
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1 Diffusion MR Imaging |
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|
||
1.1 |
Introduction ......................................................................................................................................... |
|
1 |
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1.1.1 |
Diffusion |
|
1 |
................................................................... |
1.1.2 |
Diffusion in Magnetic Resonance Imaging |
2 |
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1.2 ...............................................................................................Diffusion Imaging: Basic Principles |
|
3 |
||
........................................................................................... |
1.2.1 |
Diffusion - Weighted Imaging |
|
3 |
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1.2.2 |
The b - Value |
|
5 |
........................................................................................ |
1.2.3 |
Apparent Diffusion Coefficient |
8 |
|
............................................................................... |
1.2.4 |
Isotropic or Anisotropic Diffusion? |
10 |
|
........................................................................................................ |
1.2.5 |
Echo Planar Imaging |
|
12 |
................................................................................................ |
1.2.6 |
Main Limitations of DWI |
|
13 |
1.3 ............................................................................................................... |
Diffusion Tensor Imaging |
|
14 |
1.3.1“Rotationally Invariant” Parameters (Mean Diffusivity and Fractional
|
|
Anisotropy) |
|
17 |
|
1.3.2 |
Fiber Tractography |
|
19 |
1.4 |
Conclusions and Future Perspectives.......................................................................................... |
|
22 |
|
References ...................... |
23 |
2 Artifacts and Pitfalls in Diffusion MRI
2.1 |
Introduction..................................................................................................................................... |
29 |
|
2.2 |
Artifacts and Pitfalls Categorization........................................................................................... |
30 |
|
2.3 |
Artifacts from the Gradient System............................................................................................. |
30 |
|
|
2.3.1 |
Eddy Current Artifacts................................................................................................... |
30 |
|
2.3.2 |
Eddy Currents—Mitigating Strategies......................................................................... |
32 |
2.4 |
Motion Artifacts.............................................................................................................................. |
33 |
|
|
2.4.1 |
Motion Artifacts—Mitigating Strategies..................................................................... |
35 |
|
2.4.2 |
EPI Specific Artifacts....................................................................................................... |
35 |
|
2.4.3 |
Distortions Originating from B0 Inhomogeneities.................................................... |
36 |
|
2.4.4 |
Misregistration Artifacts from Eddy Currents and Subject Motion....................... |
36 |
|
2.4.5 |
Mitigating Strategies—EPI Specific.............................................................................. |
37 |
2.5 |
Artifacts Due to Properties of the Subject Being Imaged and “Physiological” Noise.......... |
38 |
|
|
2.5.1 |
Susceptibility-Induced Distortions............................................................................... |
38 |
|
2.5.2 |
Physiological Noise.......................................................................................................... |
38 |
vi |
|
|
Contents |
2.5.3 |
Susceptibility Effects and Physiological Noise—Mitigating Strategies |
................... 39 |
|
2.6 Processing and Interpretation Pitfalls |
......................................................................................... |
40 |
|
2.6.1 |
Preprocessing of Data...................................................................................................... |
|
40 |
2.6.2 |
Quantitation of Parameters............................................................................................ |
|
42 |
2.6.3 |
Dependence of Estimated Mean Diffusivity on b-Factor.......................................... |
45 |
|
2.6.4 |
Effect on ROI Positioning and Bias on Parametric Maps.......................................... |
45 |
|
2.6.5 |
CSF Contamination in Tract Specific Measurements................................................ |
47 |
|
2.6.6 |
Intrasubject and Intersubject Comparisons................................................................ |
47 |
|
2.7 Mitigating Strategies—Available Methods and Software for Diffusion Data Correction... 48 |
|||
2.7.1 |
RESTORE Algorithm...................................................................................................... |
|
48 |
2.7.2 |
ExploreDTI |
|
49 |
2.7.3 |
FSL-FDT |
|
49 |
2.7.4 |
FreeSurfer—TRACULA.................................................................................................. |
|
49 |
2.7.5 |
TORTOISE |
|
50 |
2.8Conclusion........................................................................................................................................ 50
References |
...................... 50 |
||||
3 Perfusion MR Imaging |
|
|
|||
3.1 |
Introduction..................................................................................................................................... |
|
|
55 |
|
3.2 |
DSC MRI.......................................................................................................................................... |
|
|
56 |
|
|
3.2.1 |
DSC Imaging Explained................................................................................................. |
|
58 |
|
|
3.2.2 |
DSC Perfusion Parameters: CBV, CBF, MTT.............................................................. |
58 |
||
|
|
3.2.2.1 |
CBV |
|
58 |
|
|
3.2.2.2 |
CBF |
|
60 |
|
|
3.2.2.3 |
MTT |
|
.61 |
3.3 |
DCE-MRI......................................................................................................................................... |
|
|
.61 |
|
|
3.3.1 |
DCE Imaging Explained................................................................................................. |
|
62 |
|
3.4 |
ASL ...................... |
66 |
|||
|
3.4.1 |
ASL Imaging Explained.................................................................................................. |
|
66 |
|
|
3.4.2 |
Different ASL Techniques............................................................................................... |
|
66 |
|
|
|
3.4.2.1 |
CASL and pCASL........................................................................................... |
|
67 |
|
|
3.4.2.2 |
PASL |
|
68 |
|
|
3.4.2.3 |
VSASL |
|
68 |
|
3.4.3 |
ASL beyond CBF Estimation.......................................................................................... |
|
69 |
|
3.5 |
Conclusions and Future Perspectives.......................................................................................... |
|
69 |
||
References ...................... |
70 |
||||
4 Artifacts and Pitfalls of Perfusion MRI |
|
||||
4.1 |
Introduction..................................................................................................................................... |
|
|
75 |
|
4.2 |
Dynamic Susceptibility Contrast (DSC) Imaging Limitations............................................... |
76 |
|||
|
4.2.1 |
Subject Motion |
|
76 |
|
|
4.2.2 |
Relationship between MR Signal and Contrast Concentration............................... |
76 |
||
|
4.2.3 |
Bolus Delay and Dispersion............................................................................................ |
|
77 |
|
|
4.2.4 |
BBB Disruption and Leakage Correction.................................................................... |
77 |
||
|
4.2.5 |
Absolute versus Relative Quantification...................................................................... |
78 |
||
4.3 |
Dynamic Contrast Enhancement (DCE) Imaging Limitations............................................... |
79 |
|||
|
4.3.1 |
Suitability of Tumor Lesions.......................................................................................... |
|
79 |
|
|
4.3.2 |
Subject Motion |
|
79 |
|
|
4.3.3 |
Estimation of Arterial Input Function (AIF).............................................................. |
79 |
||
|
4.3.4 |
Temporal and Spatial Resolutions................................................................................. |
|
80 |
|
|
4.3.5 |
Variability of Results According to the Models Used................................................ |
80 |
Contents |
|
|
vii |
4.3.6 |
Quality Assurance |
|
80 |
4.4 Arterial Spin Labeling (ASL) Imaging Limitations................................................................... |
.81 |
||
4.4.1 |
Subject Motion |
|
.81 |
4.4.2 |
Physiological Signal Variations...................................................................................... |
|
82 |
4.4.3 |
Magnetic Susceptibility Artifacts.................................................................................. |
|
83 |
4.4.4 |
Coil Sensitivity Variations.............................................................................................. |
|
84 |
4.4.5 |
Labeling Efficiency........................................................................................................... |
|
84 |
4.4.6 |
Transit Time Effects......................................................................................................... |
|
84 |
4.4.7 |
Errors from Quantification Models.............................................................................. |
85 |
|
4.5 Conclusions and Future Perspectives.......................................................................................... |
|
85 |
|
References ...................... |
86 |
5
6
Magnetic Resonance Spectroscopy
5.1 |
Introduction..................................................................................................................................... |
|
.91 |
|
5.2 |
MRS Basic Principles Explained................................................................................................... |
|
93 |
|
|
5.2.1 |
Technical Issues |
|
95 |
|
5.2.2 |
Data Acquisition |
|
95 |
|
5.2.3 |
Field Strength (B0) |
|
98 |
|
5.2.4 |
Voxel Size Dependency.................................................................................................. |
|
100 |
|
5.2.5 |
Shimming |
|
101 |
|
5.2.6 |
Water and Lipid Suppression Techniques................................................................... |
102 |
|
5.3 |
MRS Metabolites and Their Biological and Clinical Significance.......................................... |
104 |
||
|
5.3.1 |
Myo-Inositol |
|
104 |
|
5.3.2 |
Choline-Containing Compounds................................................................................ |
106 |
|
|
5.3.3 |
Creatine and Phosphocreatine...................................................................................... |
107 |
|
|
5.3.4 |
Glutamate and Glutamine............................................................................................. |
|
107 |
|
5.3.5 |
N-Acetyl Aspartate |
|
107 |
|
5.3.6 |
Lactate and Lipids |
|
108 |
|
5.3.7 |
Less Commonly Detected Metabolites........................................................................ |
108 |
|
5.4 |
MRS Quantification and Data Analysis..................................................................................... |
110 |
||
|
5.4.1 |
Quantification |
|
110 |
|
5.4.2 |
Post Processing Techniques........................................................................................... |
|
.111 |
5.5 |
Quality Assurance in MRS........................................................................................................... |
|
113 |
5.6Conclusion....................................................................................................................................... 113
References ..................... |
114 |
Artifacts and Pitfalls of MRS
6.1 |
Introduction.................................................................................................................................... |
|
|
123 |
|
6.2 |
Artifacts and Pitfalls...................................................................................................................... |
|
124 |
||
|
6.2.1 |
Effects of Patient Movement.......................................................................................... |
|
124 |
|
|
6.2.2 |
Field Homogeneity and Linewidth............................................................................... |
|
124 |
|
|
6.2.3 |
Frequency Shifts and Temperature Variations........................................................... |
125 |
||
|
6.2.4 |
Voxel Positioning |
|
126 |
|
|
6.2.5 |
Use of Contrast and Positioning in MRS.................................................................... |
128 |
||
|
6.2.6 |
Chemical Shift Displacement........................................................................................ |
|
129 |
|
|
6.2.7 |
Spectral Contamination or Voxel Bleeding................................................................ |
130 |
||
|
6.2.8 |
To Quantify or Not to Quantify?.................................................................................. |
|
131 |
|
|
|
6.2.8.1 |
Relative Quantification................................................................................ |
|
131 |
|
|
6.2.8.2 |
Absolute Quantification............................................................................... |
|
132 |
|
6.2.9 |
Available Software Packages for Quantification and Analysis of MRS Data........ |
134 |
||
|
|
6.2.9.1 |
LCModel |
|
134 |
viii |
|
|
Contents |
6.2.9.2 |
jMRUI |
|
135 |
6.2.9.3 |
TARQUIN |
|
135 |
6.2.9.4 |
SIVIC |
|
136 |
6.2.9.5AQSES 137
6.3Conclusion.......................................................................................................................................138
References ..................... |
138 |
||||
7 Functional Magnetic Resonance Imaging (fMRI) |
|
||||
7.1 |
Introduction.................................................................................................................................... |
|
|
141 |
|
|
7.1.1 |
What Is Functional Magnetic Resonance Imaging (fMRI) of the Brain?.............. |
141 |
||
|
7.1.2 |
Blood Oxygenation Level Dependent (BOLD) fMRI................................................ |
142 |
||
|
7.1.3 |
fMRI Paradigm Design and Implementation............................................................ |
144 |
||
|
|
7.1.3.1 |
Blocked versus Event-Related Paradigms.................................................. |
145 |
|
|
|
7.1.3.2 |
Mixed Paradigm Designs............................................................................ |
146 |
|
7.2 |
fMRI Acquisitions—MR Scanning Sequences.......................................................................... |
148 |
|||
|
7.2.1 |
Spatial Resolution |
|
148 |
|
|
7.2.2 |
Temporal Resolution...................................................................................................... |
|
148 |
|
|
7.2.3 |
Pulse Sequences Used in fMRI..................................................................................... |
|
149 |
|
7.3 |
Analysis and Processing of fMRI Experiments........................................................................ |
151 |
|||
|
7.3.1 |
fMRI Datasets |
|
151 |
|
|
7.3.2 |
Data Preprocessing |
|
152 |
|
|
|
7.3.2.1 |
Slice-Scan Timing Correction.................................................................... |
152 |
|
|
|
7.3.2.2 |
Head Motion Correction............................................................................. |
152 |
|
|
|
7.3.2.3 |
Distortion Correction.................................................................................. |
|
153 |
|
|
7.3.2.4 |
Spatial and Temporal Smoothing............................................................... |
153 |
|
|
7.3.3 |
Statistical Analysis |
|
153 |
|
7.4 |
Pre-Surgical Planning with fMRI............................................................................................... |
|
154 |
||
7.5 |
Resting State fMRI......................................................................................................................... |
|
154 |
||
|
7.5.1 |
Resting State fMRI Procedure...................................................................................... |
|
155 |
|
7.6 |
Conclusion and the Future of fMRI............................................................................................ |
|
156 |
||
References ..................... |
157 |
||||
8 Artifacts and Pitfalls of fMRI |
|
|
|||
8.1 |
Introduction to Quantitative fMRI Limitations....................................................................... |
161 |
|||
8.2 |
Image Acquisition Limitations.................................................................................................... |
|
162 |
||
|
8.2.1 |
Spatial and Temporal Resolution.................................................................................. |
|
162 |
|
|
8.2.2 |
Spatial and Temporal fMRI Resolution—Mitigating Strategies............................. |
164 |
||
|
8.2.3 |
EPI-Related Image Distortions..................................................................................... |
|
166 |
|
8.3 |
Physiological Noise and Motion Limitations............................................................................. |
167 |
|||
|
8.3.1 |
Physiological Noise—Mitigating Strategies................................................................ |
169 |
||
|
|
8.3.1.1 |
Cardiac Gating.............................................................................................. |
|
169 |
|
|
8.3.1.2 |
Acquisition-Based Image Corrections....................................................... |
170 |
|
|
|
8.3.1.3 |
Calibration |
|
170 |
8.4 |
Interpretation Limitations............................................................................................................ |
|
171 |
||
8.5 |
Quality Assurance in fMRI.......................................................................................................... |
|
173 |
8.6Conclusion.......................................................................................................................................174
References ..................... |
174 |
9 The Role of Multiparametric MR Imaging—Advanced MR Techniques in the Assessment of Cerebral Tumors
9.1 |
Introduction.................................................................................................................................... |
179 |
Contents |
|
|
ix |
9.2 |
Gliomas |
............. 181 |
|
|
9.2.1 |
DWI Contribution in Gliomas...................................................................................... |
183 |
|
9.2.2 |
DTI Contribution in Gliomas....................................................................................... |
186 |
|
9.2.3 |
Perfusion Contribution in Gliomas............................................................................. |
187 |
|
9.2.4 |
MRS Contribution in Gliomas...................................................................................... |
188 |
9.3 |
Cerebral Metastases....................................................................................................................... |
189 |
|
|
9.3.1 |
DWI/DTI Contribution in Metastases........................................................................ |
191 |
|
9.3.2 |
Perfusion Contribution in Metastases......................................................................... |
193 |
|
9.3.3 |
MRS Contribution in Metastases................................................................................. |
193 |
9.4 |
Meningiomas.................................................................................................................................. |
194 |
|
|
9.4.1 |
DWI/DTI Contribution in Meningiomas................................................................... |
194 |
|
9.4.2 |
Perfusion Contribution in Meningiomas.................................................................... |
196 |
|
9.4.3 |
MRS Contribution in Meningiomas............................................................................ |
197 |
9.5 |
Primary Cerebral Lymphoma...................................................................................................... |
198 |
|
|
9.5.1 |
DWI/DTI Contribution in PCLs.................................................................................. |
198 |
|
9.5.2 |
Perfusion Contribution in PCLs................................................................................... |
198 |
|
9.5.3 |
MRS Contribution in PCLs........................................................................................... |
199 |
9.6 |
Intracranial Abscesses.................................................................................................................. |
200 |
|
|
9.6.1 |
DWI DTI Contribution in Abscesses......................................................................... |
200 |
|
9.6.2 |
Perfusion Contribution in Abscesses........................................................................... |
201 |
|
9.6.3 |
MRS Contribution in Abscesses.................................................................................. |
202 |
9.7 |
Summary and Conclusion........................................................................................................... |
202 |
|
References .................... |
203 |
Index 215
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Series Preface
The Series in Medical Physics and Biomedical Engineering describes the applications of physical sciences, engineering, and mathematics in medicine and clinical research.
The series seeks (but is not restricted to) publications in the following topics:
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The Series in Medical Physics and Biomedical Engineering is an international series that meets the need for up-to-date texts in this rapidly developing field. Books in the series range in level from introductory graduate textbooks and practical handbooks to more advanced expositions of current research.
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A World Congress on Medical Physics and Biomedical Engineering is held every three years in cooperation with International Federation for Medical and Biological Engineering (IFMBE)
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Series Preface |
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The IOMP website (www.iomp.org) contains information on all the activities of the IOMP, policy statements 1 and 2 and the ‘IOMP: Review and Way Forward’ which outlines all the activities of IOMP and plans for the future.
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Preface
Since its early medical application about 40 years ago, magnetic resonance imaging has revolutionized brain neuroimaging, providing non-invasively excellent high-resolution images without the use of ionizing radiation.
Nevertheless, despite the superior quality, conventional MR imaging provides only anatomical, rather than physiological, information and may therefore be sometimes non-specific.
During the last decade, some of the greatest achievements in neuroimaging have been related to remarkable advances in MR techniques, which provided insights into tissue microstructure, microvasculature, metabolism, and brain connectivity. These advanced MR neuroimaging techniques include diffusion, perfusion, magnetic resonance spectroscopy, and functional MRI.
Previously available mostly in research environments, they are now establishing themselves firmly in the everyday clinical practice in a plethora of clinical MR systems. However, despite the growing interest and wider acceptance, the lack of a comprehensive body of knowledge, the intrinsic complexity and physical difficulty of the techniques, as well as an appreciable number of associated artifacts and pitfalls, still confine their routine clinical application.
This book focuses on the basic principles and physics theory of diffusion, perfusion, magnetic resonance spectroscopy, and functional MRI, accompanied by their clinical applications, with particular emphasis on the associated artifacts and pitfalls using a comprehensive and didactic approach. It aims to bridge the gap between theoretical applications and optimized clinical practice of advanced techniques by addressing all of them in a single and concise volume.
The book is organized in nine chapters. Four chapters (Chapters 1, 3, 5, and 7) describe the basic principles of the discussed techniques, providing an overview of the methods with a step-by-step didactic approach, explaining fundamentals as well as clinical implications. These are, followed by respective dedicated chapters on the potential artifacts and pitfalls of each technique, including the proposed mitigating strategies, with special attention in the postprocessing techniques (Chapters 2, 4, 6, and 8).
The final chapter (Chapter 9) covers a multiparametric approach utilizing all the aforementioned advanced MR techniques, evaluating the different underlying patho-physiological characteristics of brain tumors in an attempt to illustrate the potential ability of these techniques to contribute to a more accurate diagnosis.
Each chapter, as well as several important sections within each chapter, begins with a dedicated “Focus Point” box, “sensitizing” the reader’s attention to the key features, by highlighting the most important concepts that follow. An introduction in every chapter further guides the reader into the forthcoming more detailed information. Lastly, summary tables and aggregated classifications are used in an attempt to facilitate memorization, supporting those who wish to delve into and apply these techniques in the clinical routine.
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The book can serve as an educational manual for neuroimaging researchers and basic scientists (radiologists, neurologists, neurosurgeons, medical physicists, engineers, etc.) with an interest in advanced MR techniques, as well as a reference for experienced clinical scientists who wish to optimize their multi-parametric imaging approach.
In conclusion, I sincerely hope this is an easy-to-read yet comprehensive handbook, which can be used as an essential guide to the advanced MR imaging techniques routinely used in clinical practice for the diagnosis and follow-up of patients with brain tumours.
Ioannis Tsougos
Assistant Professor of Medical Physics
Medical School, University of Thessaly
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About the Author
Dr. Ioannis Tsougos holds a BSc in physics, and an MSc and a PhD in medical radiation physics. Currently, he is an assistant professor of Medical Radiation Physics at the medical school of the University of Thessaly, Larissa, Greece and a visiting researcher in the Neuroimaging Division at the Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom. He has authored more than 75 research papers and 10 international book chapters. In addition, he frequently acts as a reviewer for several journals in medical physics/radiology and European research foundations projects. Dr. Tsougos has broad multidisciplinary teaching and clinical experience, specializing in advanced MR techniques, and he is a member of the EFOMP, ESR, and ESMRMB.
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