Nicholas Schiltz

Comparative and cost-effectiveness approaches can be used to assess the value of MRI, but these studies have not traditionally been explored in the ISMRM community. This session will provide an introduction to comparative and cost-effectiveness research (CER), with particular focus on decision model approaches. Topics covered include: best practices for setting up a decision tree model, key measures and interpretation including incremental-cost effectiveness ratio, and the value of information. At the end of the session, audience members should know  how to create an outline of a model for their own research questions to assess the value of MRI.

Shivani Pahwa

Wei-Ching Lo¹, Kawin Setsompop^2,3,4,5, Congyu Liao², Susie Yi Huang^2,3,4,5, John Conklin^2,3,4, Stephen F. Cauley^2,3,4, Wei Liu⁶, Bryan Clifford¹, Steffen Bollmann¹, Xiaozhi Cao^2,7, Zijing Zhang^2,8, Daniel Polak^2,3,9,10, Daniel Nicolas Splitthoff⁹, Thorsten Feiweier⁹, Qiyuan Tian^2,3,4, Jaejin Cho², John E. Kirsch^2,3,4, Shivraman Giri¹, Otto Rapalino^3,4, Pamela W. Schaefer^3,4, Larry L. Wald², and Berkin Bilgic^2
1Siemens Medical Solutions, Boston, MA, United States, ²Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States, ³Department of Radiology, Massachusetts General Hospital, Boston, MA, United States, ⁴Harvard Medical School, Boston, MA, United States, ⁵Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Boston, MA, United States, ⁶Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China, ⁷Center for Brain Imaging Science and Technology, Biomedical Engineering, Zhejiang University, Hangzhou, Zhejiang, China, ⁸State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering, Zhejiang University, Hangzhou, Zhejiang, China, ⁹Siemens Healtcare GmbH, Erlangen, Germany, ¹⁰Department of Physics and Astronomy, Heidelberg University, Heidelberg, Germany

We utilize Wave-CAIPI and BUDA techniques to develop a rapid 2-minute protocol that produces high in-plane resolution and distortion-free axial images for comprehensive evaluation of the brain. The protocol includes 3D T1-weighted Wave-CAIPI MPRAGE, 3D dark-fluid T2-weighted Wave-CAIPI SPACE-FLAIR, 2D T2*-weighted gradient echo BUDA, 2D T2-weighted and diffusion-weighted spin-echo BUDA. The results of the optimized protocol demonstrate comparable image quality, tissue contrast, and spatial resolution to standard clinical scans while keeping the total scan time to less than 2 minutes. The advanced acquisition and reconstruction framework presented here offers a path toward increasing clinical acceptance of ultrafast brain examinations.

Vera Catharina Keil¹, Marion Smits^2,3, Steffi Thust^3,4, Jan Petr⁵, Laszlo Solymosi¹, and Elia Manfrini^1,6
1Neuroradiology, University Hospital Bonn, Bonn, Germany, ²Department of Radiology and Nuclear Medicine (Ne-515), Erasmus MC, Rotterdam, Netherlands, ³Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery Queen Square, London, United Kingdom, ⁴Department of Brain Rehabilitation and Repair, UCL Institute of Neurology Queen Square, London, United Kingdom, ⁵Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany, ⁶Universita Politecnica delle Marche. Facolta di Medicina e Chirurgia, Ancona, Italy

This pan-European online survey study revealed that clinically working Neuroradiologists appreciate the additional diagnostic accuracy rendered by quantitative MRI techniques. However, the clinical implementation of many techniques is hampered by a lack of knowledge on how to acquire, post-process and interpret results of multiple quantitative MRI techniques including ASL, CEST/APT, IVIM and others. With exception of DSC and DWI  in tumor imaging and stroke, the number of indications is also still limited especially regarding head/neck Radiology and neurodegenerative diseases.

Yogesh kannan Mariappan¹, Jaladhar Neelavalli¹, Nehul Makani^1,2, Narayana Krishna Rolla¹, Karthik Gopalakrishnan¹, Nalini Pagadala^1,2, and Jitendar Saini^3
1Philips Healthcare, Bengaluru, India, ²Indian Institute of Technology, Madras, Chennai, India, ³National Institute for Mental Health and Neuroscience, Bengaluru, India

In Phase contrast Angiography (PCA), the flow is encoded as additional phase onto the background phase typically using a Fast field echo (FFE) based pulse sequence. This flow dependent phase is then extracted and is used in further downstream processing. The background phase is typically discarded. In this work, this background phase is processed to obtain Susceptibility weighted Imaging (SWI) contrast. Our preliminary results indicate that the additional SWI contrast (PCA-SWI) images can potentially provide clinically significant information like hemorrhage, calcification and thrombus etc. and are similar to the results obtained from conventional SWI images.

Frank Zijlstra¹, Mateusz C Florkow¹, and Peter R Seevinck^1,2
1Image Sciences Institute, UMC Utrecht, Utrecht, Netherlands, ²MRIguidance BV, Utrecht, Netherlands

We propose an efficient sequence for the acquisition of multiple contrasts for MR-only radiotherapy. By including T2-weighted echoes to a gradient echo sequence, this sequence provides T1- and T2-weighted imaging and water-fat separation in a single 4 minute acquisition. A previously trained deep neural network for synthetic CT generation was successfully applied to this new sequence, demonstrating that synthetic CT-based dose calculations can be performed. Furthermore, increased contrast between the anatomies of interest shows promise for (automatic) segmentation.

Jonas Denck^1,2,3, George William Ferguson³, Jens Guehring³, Andreas Maier¹, and Eva Rothgang^2
1Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany, ²Technical University of Applied Sciences Amberg-Weiden, Amberg, Germany, ³Siemens Healthineers, Erlangen, Germany

Current approaches for the synthesis of MR images are only trained on MR images with a specific set of acquisition parameter values, limiting the clinical value of these methods. We therefore trained a generative adversarial network (GAN) to generate synthetic MR knee images conditioned on various acquisition parameters (TR, TE, imaging orientation). This enables us to synthesize MR images with adjustable image contrast. This work can support radiologists and technologists during the parameterization of MR sequences, can serve as a valuable tool for radiology training, and can be used for customized data generation to support AI training.

Akshay S Chaudhari¹, Murray Grissom², Zhongnan Fang³, Bragi Sveinsson⁴, Jin Hyung Lee¹, Garry E Gold¹, Brian A Hargreaves¹, and Kathryn J Stevens^1
1Stanford University, Stanford, CA, United States, ²Santa Clara Valley Medical Center, San Jose, CA, United States, ³LVIS Corporation, Palo Alto, CA, United States, ⁴Harvard Medical School, Boston, MA, United States

Knee MRI protocols usually require 20+ minutes of scan time, leading to great interest in expedited and high-value imaging examinations. Moreover, despite the popularity of quantitative imaging for osteoarthritis, it is not routinely implemented clinically. In this study, we use a 5-minute quantitative double-echo steady-state (qDESS) sequence that produces simultaneous morphological images and T2 relaxation time measurements. We prospectively enhance the slice-resolution of qDESS using deep learning. We show that qDESS provided high diagnostic accuracy compared to both diagnostic knee MRI and surgical findings. Additionally, automatic T2 maps increased reader diagnostic confidence and sensitivity to cartilage lesions.

John Conklin¹, Bryan Clifford², Steffen Bollmann², Wei-Ching Lo², Berkin Bilgic³, Stephen Cauley³, Kawin Setsompop³, Thorsten Feiweier⁴, John Kirsch³, R. Gilberto Gonzalez³, Pamela Schaefer³, Otto Rapalino³, and Susie Huang^3
1Radiology, Massachusetts General Hospital, Boston, MA, United States, ²Siemens Medical Solutions, Boston, MA, United States, ³Massachusetts General Hospital, Boston, MA, United States, ⁴Siemens Healthcare GmbH, Erlangen, Germany

A comprehensive 3 minute whole-brain MRI exam based on multi-shot echoplanar imaging (ms-EPI) was optimized and evaluated in 5 patients with different clinical pathologies. This approach minimizes artifacts associated with single-shot echoplanar imaging, and provides image quality similar to that of a 10-minute clinical reference protocol based on turbo spin-echo imaging.

Ravi Varma Dandu¹, Rithika Varma Dandu², Karthick Raj Rajendran³, Narayana Rolla⁴, and Indrajit Saha^5
1Citi Neuro Centre, Hyderabad, India, ²RV College of Engineering, Bengaluru, India, ³Philips Healthcare, Eindhoven, Netherlands, ⁴Philips Healthcare, Bangalore, India, ⁵Philips Healthcare, Gurgaon, India

This study compares the performance of spin echo T1 with spiral k-space filling and three other techniques, for post contrast T1-weighted imaging of the brain. The lesion enhancement in each technique was evaluated after incremental fractional doses of gadolinium injection. The enhancement achieved on T1-FFE and T1-TSE techniques with full dose contrast could be achieved with 50% to 75% dose contrast in spiral imaging. Spiral imaging can thus be used to reduce the dose of injected contrast medium (by at least 25% and up to 50%) without compromising on the diagnostic quality of the post contrast study.

Arijitt Borthakur¹, Megan Frame¹, Kristen Martin¹, Melissa Mueller Gildea¹, Charles E. Kahn, Jr¹, and Mitchell D. Schnall^1
1Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

We compare the time savings and reduction in radiologists’ workload after implementing ten new fit-for-purpose MRI protocols for imaging of multiple sclerosis patients at our academic medical center. A 2x2 framework was created to provide a method to monitor implementation of new imaging protocols in order to gauge success of adoption as well as determine areas for operational improvement.

Curtis N Wiens¹, Chad T Harris¹, Andrew T Curtis¹, Philip J Beatty¹, and Jeff A Stainsby^1
1Research and Development, Synaptive Medical, Toronto, ON, Canada

This work examined the feasibility of diffusion tensor imaging (DTI) at 0.5T, a technique performed almost exclusively at field strengths of at least 1.5T.  2D diffusion-weighted axial spin-echo echo-planar imaging and 3D T1 weighted acquisitions were performed in the NIST isotropic diffusion phantom, a DTI phantom, and 5 healthy volunteers on a head-specific 0.5T MRI system.  ADC measurements of the NIST phantom were in excellent agreement with previously recorded 3T measurements while DTI processing and tractography performed using Modus Plan was successful in all of the volunteers.

Hong Wei¹, Hanyu Jiang¹, and Bin Song^1
1Department of Radiology, Sichuan University West China Hospital, Chengdu, China

This study aimed to investigate whether LI-RADS v2018 could indicate some prognostic information for high-risk patients with LR-5 hepatocellular carcinoma (HCC). We retrospectively evaluated 125 patients who underwent gadoxetic acid–enhanced MR examination within 1 month before surgical resection for HCC. The Cox proportional hazards model revealed that corona enhancement, peritumoral hypointensity on hepatobiliary phase, multifocality and serum alpha-fetoprotein were independent risk factors for early recurrence. The combined model derived from predictive biomarkers showed good performance, which could be used to effectively predict early recurrence after curative hepatectomy for LR-5 HCC.