Ultrafast Brain MRI at 3 T for MS: Evaluation of a 51-Second Deep Learning-Enhanced T2-EPI-FLAIR Sequence
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Imaging Protocol and Image Acquisition
2.3. FLAIRUF Sequence
2.4. Image Evaluation
2.4.1. Lesion Assessment
2.4.2. Image Quality Assessment
2.5. Statistical Analysis
3. Results
3.1. Image Acquisitions and Lesions
3.2. Lesion Detection
3.2.1. FLAIRUF Compared with FLAIR3Da
3.2.2. FLAIRUF Compared with FLAIRTSE
3.2.3. Dependence on Size and Location within FLAIRUF
3.3. Image Quality
3.3.1. FLAIRUF Compared with FLAIR3Da
3.3.2. FLAIRUF Compared with FLAIRTSE
3.3.3. Positional Dependence of SNR and CNR in FLAIRUF
4. Discussion
4.1. Main Findings of This Study
4.2. Significance of MRI and Ultrafast MRI
4.3. Limitations of the FLAIRUF Images
4.4. Considerations on Ratings for Lesion Conspicuity in FLAIRUF
4.5. Outcomes Correlated with Technical Features
4.6. Limitations of the Study
4.7. Future Perspectives
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Values |
---|---|
Number of patients | 17 |
Mean age ± standard deviation | 33 ± 10 years |
Median age (range) | 29 (21–60) years |
Distribution between sexes | 71% male (n = 12), 29% female (n = 5) |
Parameter | FLAIRUF | FLAIRTSE | FLAIR3D |
---|---|---|---|
Orientation | Axial | Axial | - |
Sequence type | Multi-shot EPI | TSE | SPACE |
TR (ms) | 8000 | 8800 | 5000 |
TE (ms) | 88 | 87 | 386 |
TI (ms) | 2372 | 2480 | 1800 |
Flip angle (°) | 180 | 150 | 120 (VFA) |
Voxel size (mm) | 0.9 × 0.9 × 4 | 0.7 × 0.7 × 4 | 0.5 × 0.5 × 0.9 1 |
Gap between slices (mm) | 0.8 | 0 | - |
Phase encoding direction | P → A | R → L | A → P |
Acceleration mode | DL-based | GRAPPA | GRAPPA |
Acceleration factor | 2 | 2 | 2 |
In-plane FOV (read × phase; mm) | 230 × 230 | 230 × 187 | 256 × 256 1 |
Number of slices | 32 | 36 | 192 |
Time of acquisition (min:s) | 0:51 | 2:22 | 4:57 |
Total | Sensitivity | PPV | ||||||
---|---|---|---|---|---|---|---|---|
Lesion Size | S | TP | FN | TPGS | FP | 95% CI [LL, UL] | p | 95% CI [LL, UL] |
n | n | n | n | % | % | |||
Large (≥3 mm) | UF | 251 | 37 | 288 | 11 | 87.2 [82.7, 90.8] | <0.001 | 95.8 [92.6, 97.9] |
3Da | 274 | 14 | 11 | 95.1 [92.0, 97.3] | 96.1 [93.2, 98.1] | |||
Wide (×≥2 mm) | UF | 160 | 11 | 171 | 6 | 93.6 [88.8, 96.7] | 0.50 | 96.4 [92.3, 98.7] |
3Da | 163 | 8 | 8 | 95.3 [91.0, 98.0] | 95.3 [91.0, 98.0] | |||
Narrow (×<2 mm) | UF | 91 | 26 | 117 | 5 | 77.8 [69.2, 84.9] | <0.001 | 94.8 [88.3, 98.3] |
3Da | 111 | 6 | 3 | 94.9 [89.2, 98.1] | 97.4 [92.5, 99.5] | |||
Small (<3 mm) | UF | 148 | 132 | 280 | 33 | 52.9 [46.8, 58.8] | <0.001 | 81.8 [75.4, 87.1] |
3Da | 268 | 12 | 15 | 95.7 [92.6, 97.8] | 94.7 [91.4, 97.0] |
FLAIRUF | FLAIR3Da | ||||||
---|---|---|---|---|---|---|---|
Presumed Type of Cause | FNUF Total | FNUF and TP3Da | FNUF and FN3Da | FN3Da and TPUF | FN3Da Total | ||
n | n | n | n | n | n | ||
Not detectable | SR/CNR/SNR 2 | 28 | 22 | 6 | 0 | 1 | 1 |
Mistaken for natural structure 1 | 7 | 4 | 3 | 3 | 0 | 3 | |
Mistaken for/masked by pulsation artifact | 0 | 0 | 0 | 7 3 | 3 3 | 10 3 | |
Masked by distortion artifact | 2 | 1 | 1 | 0 | 0 | 0 | |
Total | 37 | 27 | 10 | 4 | 14 |
FLAIRUF | FLAIR3Da | ||||||
---|---|---|---|---|---|---|---|
Presumed Type of Cause | FNUF Total | FNUF and TP3Da | FNUF and FN3Da | FN3Da and TPUF | FN3Da Total | ||
n | n | n | n | n | n | ||
Not detectable | SR/CNR/SNR 2 | 110 | 105 | 5 | 0 | 3 | 3 |
Mistaken for natural structure 1 | 21 | 19 | 2 | 3 | 1 | 4 | |
Mistaken for/masked by pulsation artifact | 0 | 0 | 0 | 5 3 | 0 | 5 3 | |
Masked by distortion artifact | 1 | 0 | 1 | 0 | 0 | 0 | |
Total | 132 | 124 | 8 | 4 | 12 |
FLAIRUF | FLAIR3Da | ||||||
---|---|---|---|---|---|---|---|
Presumed Causal Phenomenon | FPUF Large (≥3 mm) | FPUF Small (<3 mm) | FPUF Total | FP3Da Large (≥3 mm) | FP3Da Small (<3 mm) | FP3Da Total | |
n | n | n | n | n | n | ||
Partially imaged natural structure 1 | SR 2 | 9 | 24 | 33 | 6 | 7 | 13 |
Partially imaged nearby large lesion | 0 | 2 | 2 | 0 | 1 | 1 | |
Pulsation artifact | 2 3 | 7 3 | 9 3 | 5 4 | 7 5 | 12 5 | |
Total | 11 | 33 | 44 | 11 | 15 | 26 |
Total | Sensitivity | |||||
---|---|---|---|---|---|---|
Lesion Size | S | tseTP | tseFN | tseTPGS | 95% CI [LL, UL] | p |
n | n | n | % | |||
Large (≥3 mm) | UF | 48 | 5 | 53 | 90.6 [79.3, 96.9] | 0.68 |
TSE | 48 | 5 | 90.6 [79.3, 96.9] | |||
Wide (×≥2 mm) | UF | 33 | 2 | 35 | 94.3 [80.8, 99.3] | >0.99 |
TSE | 34 | 1 | 97.1 [85.1, 99.9] | |||
Narrow (×<2 mm) | UF | 15 | 3 | 18 | 83.3 [58.6, 96.4] | >0.99 |
TSE | 14 | 4 | 77.8 [52.4, 93.6] | |||
Small (<3 mm) | UF | 19 | 15 | 34 | 55.9 [37.9, 72.8] | 0.08 |
TSE | 27 | 7 | 79.4 [62.1, 91.3] |
FLAIRUF | FLAIRTSE | ||||||
---|---|---|---|---|---|---|---|
Presumed Type of Cause | tseFNUF Total | tseFNUF and TPTSE | tseFNUF and FNTSE | FNTSE and tseTPUF | FNTSE Total | ||
n | n | n | n | n | n | ||
Not detectable | SR/CNR/SNR 2 | 3 | 3 | 0 | 0 | 3 | 3 |
Mistaken for natural structure 1 | 2 | 0 | 2 | 2 | 0 | 2 | |
Total | 5 | 3 | 2 | 3 | 5 |
FLAIRUF | FLAIRTSE | ||||||
---|---|---|---|---|---|---|---|
Presumed Type of Cause | tseFNUF Total | tseFNUF and TPTSE | tseFNUF and FNTSE | FNTSE and tseTPUF | FNTSE Total | ||
n | n | n | n | n | n | ||
Not detectable | SR/CNR/SNR 2 | 13 | 10 | 3 | 3 | 3 | 6 |
Mistaken for natural structure 1 | 2 | 2 | 0 | 0 | 1 | 1 | |
Total | 15 | 12 | 3 | 4 | 7 |
FLAIRUF | FLAIRTSE | ||||||
---|---|---|---|---|---|---|---|
Presumed Causal Phenomenon | tseFPUF Large (≥3 mm) | tseFPUF Small (<3 mm) | tseFPUF Total | FPTSE Large (≥3 mm) | FPTSE Small (<3 mm) | FPTSE Total | |
n | n | n | n | n | n | ||
Partially imaged natural structure 1 | SR 2 | 1 | 1 | 2 | 1 | 3 | 4 |
Partially imaged nearby large lesion | 0 | 1 | 1 | 0 | 1 | 1 | |
Total | 1 | 2 | 3 | 1 | 4 | 5 |
Conspicuity | ||||||||
---|---|---|---|---|---|---|---|---|
Size | Location | 1 | 2 | 3 | 4 | 5 | TP3Da | p |
n | n | n | n | n | n | |||
Large (≥3 mm total) | All | 37 | 180 | 30 | 13 | 14 | 274 | <0.001 3 |
Small (<3 mm) | All | 12 | 94 | 38 | 44 | 80 | 268 | |
Large (≥3 mm total) | Frontal | 7 | 55 | 4 | 4 | 3 | 73 | 0.002 4 |
Parietal | 5 | 40 | 6 | 4 | 3 | 58 | ||
Temporal | 12 | 48 | 7 | 2 | 3 | 72 | ||
Occipital | 6 | 9 | 0 | 0 | 0 | 15 | ||
Central 1 | 3 | 7 | 8 | 3 | 1 | 22 | ||
Infratentorial 2 | 4 | 21 | 5 | 0 | 4 | 34 | ||
Small (<3 mm) | Frontal | 7 | 46 | 16 | 16 | 25 | 110 | 0.15 4 |
Parietal | 2 | 20 | 10 | 6 | 22 | 60 | ||
Temporal | 3 | 16 | 7 | 14 | 20 | 60 | ||
Occipital | 0 | 0 | 1 | 1 | 1 | 3 | ||
Central 1 | 0 | 11 | 4 | 5 | 11 | 31 | ||
Infratentorial 2 | 0 | 1 | 0 | 2 | 1 | 4 | ||
Large (≥3 mm total) | Frontal | 7 | 55 | 4 | 4 | 3 | 73 | 0.42 4 |
Parietal | 5 | 40 | 6 | 4 | 3 | 58 | ||
Temporal | 12 | 48 | 7 | 2 | 3 | 72 | ||
Infratentorial 2 | 4 | 21 | 5 | 0 | 4 | 34 | ||
Small (≥3 mm total) | Occipital | 6 | 9 | 0 | 0 | 0 | 15 | |
0.002 3 | ||||||||
Frontal and Parietal and Temporal and Infratentorial 2 | 28 | 164 | 22 | 10 | 13 | 237 | ||
0.01 3 | ||||||||
Central 1 | 3 | 7 | 8 | 3 | 1 | 22 |
Location | Large (≥3 mm total) | Small (<3 mm) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
TP3Da | M and 95% CI [LL, UL] | SD | Mdn | p | TP3Da | M and 95% CI [LL, UL] | SD | Mdn | p | |
n | mm | mm | mm | n | mm | mm | mm | |||
Frontal | 73 | 5.1 [4.6, 5.6] | 1.9 | 4.6 | 0.26 | 110 | 2.1 [2.0, 2.2] | 0.5 | 2.3 | 0.06 |
Parietal | 58 | 5.8 [5.0, 6.7] | 3.2 | 4.6 | 60 | 2.1 [1.9, 2.2] | 0.6 | 2.1 | ||
Temporal | 72 | 5.3 [4.7, 5.9] | 2.5 | 4.6 | 60 | 2.0 [1.8, 2.1] | 0.6 | 2.1 | ||
Occipital | 15 | 5.6 [4.6, 6.6] | 1.8 | 5.4 | 3 | 2.8 [2.6, 2.9] | 0.1 | 2.8 | ||
Central | 22 | 5.5 [3.8, 7.2] | 3.8 | 4.5 | 31 | 2.2 [2.1, 2.4] | 0.5 | 2.4 | ||
Infratentorial | 34 | 6.5 [5.4, 7.5] | 3.0 | 5.2 | 4 | 2.3 [1.9, 2.8] | 0.3 | 2.4 | ||
Total | 274 | 5.5 [5.2, 5.9] | 2.7 | 4.7 | 268 | 2.1 [2.0, 2.2] | 0.6 | 2.2 |
Location | Wide (≥3 mm × ≥2 mm) | Narrow (≥3 mm × <2 mm) | Large (≥3 mm Total) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Conspicuity | Total | Conspicuity | Total | TP3Da | |||||||||
1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 | ||||
n | n | n | n | n | n | n | n | n | n | n | n | n | |
Frontal | 7 | 35 | 0 | 0 | 1 | 43 | 0 | 20 | 4 | 4 | 2 | 30 | 73 |
Parietal | 2 | 28 | 2 | 1 | 0 | 33 | 3 | 12 | 4 | 3 | 3 | 25 | 58 |
Temporal | 5 | 30 | 4 | 1 | 0 | 40 | 7 | 18 | 3 | 1 | 3 | 32 | 72 |
Occipital | 4 | 8 | 0 | 0 | 0 | 12 | 2 | 1 | 0 | 0 | 0 | 3 | 15 |
Central | 0 | 4 | 5 | 1 | 0 | 10 | 3 | 3 | 3 | 2 | 1 | 12 | 22 |
Infratentorial | 3 | 17 | 3 | 0 | 2 | 25 | 1 | 4 | 2 | 0 | 2 | 9 | 34 |
Total | 21 | 122 | 14 | 3 | 3 | 163 | 16 | 58 | 16 | 10 | 11 | 111 | 274 |
Parameter | FLAIRUF | FLAIR3Da | p | ||||
---|---|---|---|---|---|---|---|
Mdn (IQR) | M ± SD | L/H | Mdn (IQR) | M ± SD | L/H | ||
SNR | 3 (3–3) | 3.00 ± 0.00 | 3/3 | 1 (1–1) | 1.18 ± 0.39 | 1/2 | <0.001 |
CNR | 3 (2–3) | 2.53 ± 0.51 | 2/3 | 1 (1–1) | 1.18 ± 0.39 | 1/2 | <0.001 |
Artifacts | FLAIRUF | FLAIR3Da | p | ||||
---|---|---|---|---|---|---|---|
Mdn (IQR) | M ± SD | L/H | Mdn (IQR) | M ± SD | L/H | ||
Distortions | |||||||
Frontal | 3 (2–3) | 2.6 ± 0.6 | 1/3 | 0 (0–0) | 0.0 ± 0.0 | 0/0 | <0.001 |
Frontobasal | 3 (2–3) | 2.7 ± 0.5 | 2/3 | 0 (0–0) | 0.0 ± 0.0 | 0/0 | <0.001 |
Temporopolar | 3 (2.5–3) | 2.8 ± 0.4 | 2/3 | 0 (0–0) | 0.0 ± 0.0 | 0/0 | <0.001 |
Infratentorial | 1 (1–1) | 1.1 ± 0.3 | 1/2 | 0 (0–0) | 0.0 ± 0.0 | 0/0 | <0.001 |
Pulsatile flow | |||||||
infratentorial | 1 (1–4) | 2.2 ± 1.6 | 0/4 | 3 (3–4) | 3.4 ± 0.7 | 2/4 | 0.02 |
supratentorial | 1 (0–1) | 0.7 ± 0.8 | 0/3 | 0 (0–0) | 0.0 ± 0.0 | 0/0 | 0.004 |
Chemical shift | |||||||
Frontal | 0 (0–0) | 0.1 ± 0.3 | 0/1 | 0 (0–0) | 0.0 ± 0.0 | 0/0 | 0.16 |
Residual Aliasing | |||||||
Central | 0 (0–0) | 0.2 ± 0.6 | 0/2 | 0 (0–0) | 0.0 ± 0.0 | 0/0 | 0.10 |
Spikes 1 | 0 (0–1) | 0.4 ± 0.6 | 0/2 | 0 (0–0) | 0.0 ± 0.0 | 0/0 | 0.03 |
Subject motion | 0 (0–0) | 0.0 ± 0.0 | 0/0 | 0 (0–0) | 0.1 ± 0.2 | 0/1 | 0.32 |
Parameter | FLAIRUF | FLAIRTSE | ||||
---|---|---|---|---|---|---|
Mdn (IQR) | M ± SD | L/H | Mdn (IQR) | M ± SD | L/H | |
SNR | 3 (3–3) | 3.00 ± 0.00 | 3/3 | 3 (3–3) | 3.00 ± 0.00 | 3/3 |
CNR | 3 (2.5–3) | 2.67 ± 0.58 | 2/3 | 2 (2–2) | 2.00 ± 0.00 | 2/2 |
Artifacts | FLAIRUF | FLAIRTSE | ||||
---|---|---|---|---|---|---|
Mdn (IQR) | M ± SD | L/H | Mdn (IQR) | M ± SD | L/H | |
Distortions | ||||||
Frontal | 3 (3–3) | 3.0 ± 0.0 | 3/3 | 0 (0–0) | 0.0 ± 0.0 | 0/0 |
Frontobasal | 3 (3–3) | 3.0 ± 0.0 | 3/3 | 0 (0–0) | 0.0 ± 0.0 | 0/0 |
Temporopolar | 3 (3–3) | 3.0 ± 0.0 | 3/3 | 0 (0–0) | 0.0 ± 0.0 | 0/0 |
Infratentorial | 1 (1–1) | 1.0 ± 0.0 | 1/1 | 0 (0–0) | 0.0 ± 0.0 | 0/0 |
Pulsatile flow | ||||||
infratentorial | 1 (1–1) | 1.0 ± 0.0 | 1/1 | 2 (1.5–3) | 2.3 ± 1.5 | 1/4 |
supratentorial | 0 (0–0) | 0.0 ± 0.0 | 0/0 | 0 (0–0.5) | 0.3 ± 0.6 | 0/1 |
Chemical shift | ||||||
Frontal | 0 (0–0) | 0.0 ± 0.0 | 0/0 | 0 (0–0) | 0.0 ± 0.0 | 0/0 |
Residual Aliasing | ||||||
Central | 0 (0–1) | 0.7 ± 1.2 | 0/2 | 0 (0–0) | 0.0 ± 0.0 | 0/0 |
Spikes 1 | 0 (0–0.5) | 0.3 ± 0.6 | 0/1 | 0 (0–0) | 0.0 ± 0.0 | 0/0 |
Subject motion | 0 (0–0) | 0.0 ± 0.0 | 0/0 | 0 (0–0.5) | 0.3 ± 0.6 | 0/1 |
SNR Substandard | Yes Percentage | |||||||
---|---|---|---|---|---|---|---|---|
Location | Yes | No | TPGS | 95% CI [LL, UL] | p | |||
n | n | n | % | |||||
All | 147 | 421 | 568 | 25.9 [22.3, 29.7] | ||||
Frontal | 27 | 163 | 190 | 14.2 [9.6, 20.0] | <0.001 | 0.07 | ||
Parietal | 29 | 91 | 120 | 24.2 [16.8, 32.8] | ||||
Temporal | 24 | 111 | 135 | 17.8 [11.7, 25.3] | ||||
Occipital | 1 | 17 | 18 | 5.6 [0.1, 27.3] | ||||
Central | 35 | 19 | 54 | 64.8 [50.6, 77.3] | 0.67 | |||
Infratentorial | 31 | 20 | 51 | 60.8 [46.1, 74.2] | ||||
Frontal and Parietal and Temporal and Occipital | 81 | 382 | 463 | 17.5 [14.1, 21.3] | <0.001 | |||
Central and Infratentorial | 66 | 39 | 105 | 62.9 [52.9, 72.1] |
CNR Substandard | Yes Percentage | |||||||
---|---|---|---|---|---|---|---|---|
Location | Yes | No | TPGS | 95% CI [LL, UL] | p | |||
n | n | n | % | |||||
All | 33 | 535 | 568 | 5.8 [4.0, 8.1] | ||||
Frontal | 6 | 184 | 190 | 3.2 [1.2, 6.8] | <0.001 | 0.15 | ||
Parietal | 7 | 113 | 120 | 5.8 [2.4, 11.6] | ||||
Temporal | 2 | 133 | 135 | 1.5 [0.2, 5.2] | ||||
Occipital | 0 | 18 | 18 | 0.0 [0.0, 18.5] | ||||
Central | 0 | 54 | 54 | 0.0 [0.0, 6.6] | ||||
Infratentorial | 18 | 33 | 51 | 35.3 [22.4, 49.9] | ||||
Frontal and Parietal and Temporal and Occipital and Central | 15 | 502 | 517 | 2.9 [1.6, 4.7] | <0.001 | |||
Infratentorial | 18 | 33 | 51 | 35.3 [22.4, 49.9] |
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Schuhholz, M.; Ruff, C.; Bürkle, E.; Feiweier, T.; Clifford, B.; Kowarik, M.; Bender, B. Ultrafast Brain MRI at 3 T for MS: Evaluation of a 51-Second Deep Learning-Enhanced T2-EPI-FLAIR Sequence. Diagnostics 2024, 14, 1841. https://doi.org/10.3390/diagnostics14171841
Schuhholz M, Ruff C, Bürkle E, Feiweier T, Clifford B, Kowarik M, Bender B. Ultrafast Brain MRI at 3 T for MS: Evaluation of a 51-Second Deep Learning-Enhanced T2-EPI-FLAIR Sequence. Diagnostics. 2024; 14(17):1841. https://doi.org/10.3390/diagnostics14171841
Chicago/Turabian StyleSchuhholz, Martin, Christer Ruff, Eva Bürkle, Thorsten Feiweier, Bryan Clifford, Markus Kowarik, and Benjamin Bender. 2024. "Ultrafast Brain MRI at 3 T for MS: Evaluation of a 51-Second Deep Learning-Enhanced T2-EPI-FLAIR Sequence" Diagnostics 14, no. 17: 1841. https://doi.org/10.3390/diagnostics14171841