Abdominal T2-Weighted Imaging and T2 Mapping Using a Variable Flip Angle Radial Turbo Spin-Echo Technique. Keerthivasan, M. B., Galons, J., Johnson, K., Umapathy, L., Martin, D. R., Bilgin, A., & Altbach, M. I. Journal of magnetic resonance imaging: JMRI, 55(1):289–300, January, 2022.
doi  abstract   bibtex   
BACKGROUND: T2 mapping is of great interest in abdominal imaging but current methods are limited by low resolution, slice coverage, motion sensitivity, or lengthy acquisitions. PURPOSE: Develop a radial turbo spin-echo technique with refocusing variable flip angles (RADTSE-VFA) for high spatiotemporal T2 mapping and efficient slice coverage within a breath-hold and compare to the constant flip angle counterpart (RADTSE-CFA). STUDY TYPE: Prospective technical efficacy. SUBJECTS: Testing performed on agarose phantoms and 12 patients. Focal liver lesion classification tested on malignant (N = 24) and benign (N = 11) lesions. FIELD STRENGTH/SEQUENCE: 1.5 T/RADTSE-VFA, RADTSE-CFA. ASSESSMENT: A constrained objective function was used to optimize the refocusing flip angles. Phantom and/or in vivo data were used to assess relative contrast, T2 estimation, specific absorption rate (SAR), and focal liver lesion classification. STATISTICAL TESTS: t-Tests or Mann-Whitney Rank Sum tests were used. RESULTS: Phantom data did not show significant differences in mean relative contrast (P = 0.10) and T2 accuracy (P = 0.99) between RADTSE-VFA and RADTSE-CFA. Adding noise caused T2 overestimation predominantly for RADTSE-CFA and low T2 values. In vivo results did not show significant differences in mean spleen-to-liver (P = 0.62) and kidney-to-liver (P = 0.49) relative contrast between RADTSE-VFA and RADTSE-CFA. Mean T2 values were not significantly different between the two techniques for spleen (T2VFA  = 109.2 ± 12.3 msec; T2CFA  = 110.7 ± 11.1 msec; P = 0.78) and kidney-medulla (T2VFA  = 113.0 ± 8.7 msec; T2CFA  = 114.0 ± 8.6 msec; P = 0.79). Liver T2 was significantly higher for RADTSE-CFA (T2VFA  = 52.6 ± 6.6 msec; T2CFA  = 60.4 ± 8.0 msec) consistent with T2 overestimation in the phantom study. Focal liver lesion classification had comparable T2 distributions for RADTSE-VFA and RADTSE-CFA for malignancies (P = 1.0) and benign lesions (P = 0.39). RADTSE-VFA had significantly lower SAR than RADTSE-CFA increasing slice coverage by 1.5. DATA CONCLUSION: RADTSE-VFA provided noise-robust T2 estimation compared to the constant flip angle counterpart while generating T2-weighted images with comparable contrast. The VFA scheme minimized SAR improving slice efficiency for breath-hold imaging. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 1.
@article{keerthivasan_abdominal_2022,
	title = {Abdominal {T2}-{Weighted} {Imaging} and {T2} {Mapping} {Using} a {Variable} {Flip} {Angle} {Radial} {Turbo} {Spin}-{Echo} {Technique}},
	volume = {55},
	issn = {1522-2586},
	doi = {10.1002/jmri.27825},
	abstract = {BACKGROUND: T2 mapping is of great interest in abdominal imaging but current methods are limited by low resolution, slice coverage, motion sensitivity, or lengthy acquisitions.
PURPOSE: Develop a radial turbo spin-echo technique with refocusing variable flip angles (RADTSE-VFA) for high spatiotemporal T2 mapping and efficient slice coverage within a breath-hold and compare to the constant flip angle counterpart (RADTSE-CFA).
STUDY TYPE: Prospective technical efficacy.
SUBJECTS: Testing performed on agarose phantoms and 12 patients. Focal liver lesion classification tested on malignant (N = 24) and benign (N = 11) lesions.
FIELD STRENGTH/SEQUENCE: 1.5 T/RADTSE-VFA, RADTSE-CFA.
ASSESSMENT: A constrained objective function was used to optimize the refocusing flip angles. Phantom and/or in vivo data were used to assess relative contrast, T2 estimation, specific absorption rate (SAR), and focal liver lesion classification. STATISTICAL TESTS: t-Tests or Mann-Whitney Rank Sum tests were used.
RESULTS: Phantom data did not show significant differences in mean relative contrast (P = 0.10) and T2 accuracy (P = 0.99) between RADTSE-VFA and RADTSE-CFA. Adding noise caused T2 overestimation predominantly for RADTSE-CFA and low T2 values. In vivo results did not show significant differences in mean spleen-to-liver (P = 0.62) and kidney-to-liver (P = 0.49) relative contrast between RADTSE-VFA and RADTSE-CFA. Mean T2 values were not significantly different between the two techniques for spleen (T2VFA  = 109.2 ± 12.3 msec; T2CFA  = 110.7 ± 11.1 msec; P = 0.78) and kidney-medulla (T2VFA  = 113.0 ± 8.7 msec; T2CFA  = 114.0 ± 8.6 msec; P = 0.79). Liver T2 was significantly higher for RADTSE-CFA (T2VFA  = 52.6 ± 6.6 msec; T2CFA  = 60.4 ± 8.0 msec) consistent with T2 overestimation in the phantom study. Focal liver lesion classification had comparable T2 distributions for RADTSE-VFA and RADTSE-CFA for malignancies (P = 1.0) and benign lesions (P = 0.39). RADTSE-VFA had significantly lower SAR than RADTSE-CFA increasing slice coverage by 1.5.
DATA CONCLUSION: RADTSE-VFA provided noise-robust T2 estimation compared to the constant flip angle counterpart while generating T2-weighted images with comparable contrast. The VFA scheme minimized SAR improving slice efficiency for breath-hold imaging.
LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 1.},
	language = {eng},
	number = {1},
	journal = {Journal of magnetic resonance imaging: JMRI},
	author = {Keerthivasan, Mahesh B. and Galons, Jean-Philippe and Johnson, Kevin and Umapathy, Lavanya and Martin, Diego R. and Bilgin, Ali and Altbach, Maria I.},
	month = jan,
	year = {2022},
	pmid = {34254382},
	pmcid = {PMC8678192},
	keywords = {Data Collection, Humans, Magnetic Resonance Imaging, Phantoms, Imaging, Prospective Studies, T2 mapping, abdominal imaging, radial MRI, turbo spin-echo, variable flip angle},
	pages = {289--300},
}

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