Fast and Accurate Automatic Registration for MR-Guided Procedures Using Active Microcoils

Automatic Registration between Real-Time Ultrasonography and Pre-Procedural Magnetic Resonance Images: A Prospective Comparison between Two Registration Methods by Liver Surface and Vessel and by Liver Surface Only

Ever since the clinical application of magnetic resonance (MR) imaging became an essential diagnostic tool, the lung has been a challenging area. Although many physicists and radiologists tried to assess different lung diseases as well as mediastinal and cardiac diseases by means of MR imaging during the 1980s and early 1990s, they could neither produce convincing image quality within a reasonable examination time nor demonstrate that MR imaging could serve as a substitute for computed tomography (CT), pulmonary angiography, and/or nuclear medicine studies. However, improvement of the 1.5-tesla (T) MR system and sequences, clinical application of new techniques such as parallel imaging, and utilization of more effective contrast media have continued since the late 1990s. These developments have made it possible to apply lung MR imaging to not only oncologic but also other pulmonary diseases, as well as to not only morphological but also functional assessment of various pulmonary and cardiopulmonary diseases. Moreover, these improvements have been continuing, resulting in the gradual shifting to the use of a higher magnetic strength field (≥3 T) for lung MR imaging during the 2000s.

In the last few years there has been rapid progress in the application of nuclear magnetic resonance clinical imaging as a diagnostic aid (Partain et al, 1983; Steiner, 1983; Worthington, 1983). Records kept by the operators of NMR imaging equipment indicate that about 1800 individuals have now been examined without incident within the United Kingdom. In view of this progress, an advisory group (Appendix) appointed by the National Radiological Protection Board recommends some modifications to the original advice given in 1981 (NRPB, 1981). The principal modifications are that: (1) It is no longer considered necessary to exclude volunteers with a history of epilepsy or cardiac disease. (2) It is not obligatory that a registered medical practitioner trained in resuscitation techniques be present during an exposure. (3) Higher limits are recommended for rates of change of magnetic flux density when the period of change is less than 10 ms. (4) The radiofrequency limit of 15 MHz has been removed. Theoretical considerations indicate that the interaction of an applied magnetic field with the intrinsic magnetic moments of protons and electrons within a molecule could alter its rate of chemical reaction (McLauchlan, 1981). Chemical reactions involving radical pair intermediates are expected to be sensitive to magnetic fields for this reason and a number of enzyme reactions that might be expected to be affected have been identified (A. Cass, personal communication). However, there is no experimental confirmation of these theoretical possibilities at present.

Radiotherapy is a major treatment for head and neck cancer. Currently, computed tomography (CT) is utilized to delineate the target area and make radiotherapy plans. Compared with CT images, magnetic resonance (MR) images have excellent soft tissue contrast, which can distinguish normal surrounding tissues. It is necessary to register MR and CT images since it helps physicists to improve the accuracy of radiotherapy plans. Most of the current registrations require manual intervention to select regions of interest, which increases the workload of doctors and the time of registration to a certain extent. In this paper, an automatic registration method is proposed to delineate the regions of interest. Herein, surface meshes are extracted from the CT and MR images and utilized to perform the surface matching, then the regions of interest are extracted automatically by calculating the overlapped regions between the surface mesh of the surface-aligned MR images and CT images. Furthermore, a multi-level resolution registration mechanism is utilized to improve the registration speed. Surface matching is performed using low-resolution images to obtain transformation parameters as initial parameters for rigid registration followed by deformable registration. The experiments demonstrate that our proposed method performs better in the registration speed and accuracy over the conventional methods of delineating regions of interest manually.

With the development of dedicated receiver coils and increased gradient performance, 3.0-T magnetic resonance (MR) systems are gaining wider acceptance in clinical practice. The expected twofold increase in signal-to-noise ratio (SNR) compared with that of 1.5-T MR systems may help improve spatial resolution or increase temporal resolution when used with parallel acquisition techniques. Several issues must be considered when applying 3.0-T MR in the abdomen, including the alteration of the radiofrequency field and relaxation time, increase in energy deposition and susceptibility effects, and problems associated with motion artifacts. For the evaluation of liver lesions, higher SNR and greater resolution achieved with the 3.0-T system could translate into better detection of malignant lesions on T2-weighted images obtained with adjusted imaging parameters. For the evaluation of pancreatic and biliary diseases, high-resolution T2-weighted imaging using single-shot turbo spin-echo sequences is useful; improvement in SNR was noticeable on two-dimensional MR cholangiopancreatographic images. For the preoperative imaging of rectal cancer, a single-shot sequence is useful for dramatically decreasing imaging time while maintaining image quality. Substantial modification of examination protocols, with optimized imaging parameters and sequence designs along with ongoing development of hardware, could contribute to an increased role of the 3.0-T system for abdominal MR examinations.

High resolution magnetic resonance (MR) imaging of the coronary artery wall in vivo has been limited by the cardiac and respiratory motion, flow artifacts as well as the relatively small size of the coronary arteries. We sought to validate in vivo black blood MR imaging of the coronary artery wall using a double inversion recovery fast spin echo MR imaging sequence with limited breath-holding and cardiac gating for suppression of motion artifacts by comparison with ex vivo MR imaging. Yorkshire albino swine (n = 6) were used in this study and coronary lesions were induced with balloon angioplasty. Four weeks after balloon injury of the coronary arteries MR imaging of the coronary artery lesions was performed. High resolution in vivo and ex vivo images of the coronary artery wall and lesions were obtained using a double inversion recovery fast spin echo sequence in a 1.5 T MR system. There was a statistically significant agreement (p < 0.0001) between measurements of vessel wall area (r = 0.87, slope = 0.87) and maximal wall thickness (r = 0.84, slope = 0.88) from in vivo and ex vivo MR images of the coronary arteries. The mean differences between in vivo and ex vivo measurements were 0.56 +/- 1.98 mm2 for vessel wall area and 0.02 +/- 0.36 mm for maximal wall thickness. Using breathholding and cardiac gating, it is possible to perform high resolution MR imaging of the coronary artery wall in vivo with good suppression of motion artifacts with a double inversion recovery fast spin echo black blood imaging sequence.

To prospectively examine whether sodium 23 (23Na) magnetic resonance (MR) imaging can be used to visualize acute intracellular Na+ accumulation and the effects of specific therapy in patients with paramyotonia congenita (PC). Ethics committee approval and informed consent were obtained. Sixteen patients (four women, 12 men; mean age, 46.7 years +/- 16.7 [standard deviation]) with confirmed PC and 10 healthy volunteers (three women, seven men; mean age, 26.6 years +/- 3) were examined by using a 1.5-T MR system with a 16.8-MHz surface coil. 23Na MR imaging was performed before and after local cooling of the nondominant lower leg and exercising, with experimentally induced weakness scored by a neurologist. The 23Na MR examination was repeated in 13 patients and all volunteers after 3 days and, additionally, in seven patients after 4 days of oral administration of mexiletine, which blocks Na+ channels. The 23Na MR protocol comprised two-dimensional (2D) fast low-angle shot (FLASH), 2D radial, and free induction decay (FID) sequences. The FID data were fitted to a biexponential decay curve to evaluate the slow and fast components of the T2 relaxation time. Fast and slow components were assigned to intra- and extracellular Na+ concentrations, respectively. Radial and FLASH MR images were evaluated by means of a region-of-interest analysis by using 0.3% saline solution for reference. T1- and T2-weighted MR imaging were also performed. Data were analyzed by using a parametric t test. After exercising, all patients developed considerable weakness exclusively in the cooled lower leg; no weakness was observed in volunteers. In patients, all 23Na MR images showed a significant increase in 23Na signal intensity in the cooled lower leg (P < .001) in comparison with nonsignificant findings in volunteers. After treatment with mexiletine, cooling and exercise induced almost no muscle weakness and no changes in 23Na MR signal intensity in patients. 23Na MR imaging enables visualization of muscular Na+ accumulation associated with muscle weakness in patients with PC, and effects of specific therapy can be detected.

Recently, there has been increased interest in interventional magnetic resonance (MR) imaging and minimally invasive cancer therapy via radio frequency (RF) thermal ablation. In this work, we examined RF thermal lesion generation in phantoms and ex vivo bovine liver and correlated them with MR images under a variety of conditions, which begins our assessment of the role of MR imaging in this new method for cancer treatment. Radio frequency lesions were created in gel phantoms and ex vivo bovine liver, using stationary (bovine liver) and variable speed (gel) moving electrodes to create lesions with shapes mimicking tumors. Ex vivo bovine liver lesions were made with the tissue held at room temperature (n = 4) and in a 37 degrees C saline bath (n = 3) using a 16-gauge electrode (tip temperature: 70 degrees C, 80 degrees C, and 90 degrees C; ablation time: 1-13 minutes). Electrical impedance and RF power were plotted during ablation. After ablation, RF-induced lesions were imaged with a 0.2-tesla (T) MR system using a variety of pulse sequences. Complex shaped lesions were created successfully in phantoms. Averaged maximum ex vivo lesion volume made at 90 degrees C ablation experiments holding the tissue temperature at 37 degrees C and at room temperature were 1.58 +/- 0.35 cm3 and 1.0 +/- 0.26 cm3 respectively (confidence interval: 90%). The aspect ratios and RF power of the lesions decreased as ablations proceeded. Impedance dropped during the first 2 minutes of the ablation. Ex vivo lesions appeared as regions of low-signal amplitude in T2-weighted MR images. Phantom ablation experience may be useful and applicable in thermotherapy planning. Lesions made in ex vivo bovine liver held at 37 degrees C via a saline bath are larger than those created at room temperature. Lesions shapes are ablation time dependent until thermal equilibrium is reached. Impedance reduction and lesion formation are related; 0.2-T MR systems can image RF energy-induced thermal lesions.

Hyperpolarized gas magnetic resonance imaging (MRI) generates highly detailed maps of lung ventilation and physiological function while CT provides corresponding anatomical and structural information. Fusion of such complementary images enables quantitative analysis of pulmonary structure-function. However, direct image registration of hyperpolarized gas MRI to CT is problematic, particularly in lungs whose boundaries are difficult to delineate due to ventilation heterogeneity. This study presents a novel indirect method of registering hyperpolarized gas MRI to CT utilizing 1H-structural MR images that are acquired in the same breath-hold as the gas MRI. The feasibility of using this technique for regional quantification of ventilation of specific pulmonary structures is demonstrated for the lobes.The direct and indirect methods of hyperpolarized gas MRI to CT image registration were compared using lung images from 15 asthma patients. Both affine and diffeomorphic image transformations were implemented. Registration accuracy was evaluated using the target registration error (TRE) of anatomical landmarks identified on 1H MRI and CT. The Wilcoxon signed-rank test was used to test statistical significance.For the affine transformation, the indirect method of image registration was significantly more accurate than the direct method (TRE = 14.7 ± 3.2 versus 19.6 ± 12.7 mm, p = 0.036). Using a deformable transformation, the indirect method was also more accurate than the direct method (TRE = 13.5 ± 3.3 versus 20.4 ± 12.8 mm, p = 0.006).Accurate image registration is critical for quantification of regional lung ventilation with hyperpolarized gas MRI within the anatomy delineated by CT. Automatic deformable image registration of hyperpolarized gas MRI to CT via same breath-hold 1H MRI is more accurate than direct registration. Potential applications include improved multi-modality image fusion, functionally weighted radiotherapy planning, and quantification of lobar ventilation in obstructive airways disease.

Image distortion is one of the major deficits of magnetic resonance (MR) imaging for use in 3DMRI, velocity MRI, fMRI and radiotherapy treatment planning (RTTP). It is widely known the most obviously effect of inhomogenity of magnetic fields and the nonlinearity of gradient is the Geometric Distortion of MR tomograms. In this study, the accuracy of MR images considered by phantom study and the reproducibility of images evaluated by repeated phantom measurements. A cube-shaped Perspex phantom, 20×20×5 cm, was designed for measurement of geometric distortion. There is a grid pattern inside the phantom, with grid space of 10 mm, the thickness grids of 2 mm and the depth of 40 mm contains 4mM/l magnevist solution. MR scans were performed with two 1.5 Tesla super-conductive MR systems (Picker VISTA TM HPQ & GE Signa Echo Speed), using head coil. For Geometric Distortion reproducibility the T1W, PDW and T2W SE protocols with TR/TE=500ms/20ms, 1000ms/20ms, 1000ms/100ms respectively and ST/FOV/MATRIX/NEX=5mm/24cm/256×256/1 were used. The Geometric Distortion was measured manually and by an edge detection program in MATLAB. The geometric distortion generally tended to be large in peripheral area of the images than in central area in all images. Average of displacements in Picker MRI were 3 pixel in y and 1 pixel in x direction and in GE MRI were 1 pixel in x and y directions for 24 cm FOV (1 pixel=0.9mm). Since the positional variation were within 1 to 3 pixels for head coil, it will be possible to use this MR system in 3DMRI, velocity MRI, FMRI and RTTP. For decreasing of geometric distortion use of suitable coil and protocol are expected.

Multimodality image registration quality assurance for conformal three-dimensional treatment planning

This work presents a complete and automatic software application to aid radiologists in breast cancer diagnosis. The application is a fully automated method that performs a complete registration of magnetic resonance (MR) images and x-ray (XR) images in both directions (from MR to XR and from XR to MR) and for both x-ray mammograms, craniocaudal (CC), and mediolateral oblique (MLO). This new approximation allows radiologists to mark points in the MR images and, without any manual intervention, it provides their corresponding points in both types of XR mammograms and vice versa. The application automatically segments magnetic resonance images and x-ray images using the C-Means method and the Otsu method, respectively. It compresses the magnetic resonance images in both directions, CC and MLO, using a biomechanical model of the breast that distinguishes the specific biomechanical behavior of each one of its three tissues (skin, fat, and glandular tissue) separately. It makes a projection of both compressions and registers them with the original XR images using affine transformations and nonrigid registration methods. The application has been validated by two expert radiologists. This was carried out through a quantitative validation on 14 data sets in which the Euclidean distance between points marked by the radiologists and the corresponding points obtained by the application were measured. The results showed a mean error of 4.2 ± 1.9 mm for the MRI to CC registration, 4.8 ± 1.3 mm for the MRI to MLO registration, and 4.1 ± 1.3 mm for the CC and MLO to MRI registration. A complete software application that automatically registers XR and MR images of the breast has been implemented. The application permits radiologists to estimate the position of a lesion that is suspected of being a tumor in an imaging modality based on its position in another different modality with a clinically acceptable error. The results show that the application can accelerate the mammographic screening process for high risk populations or for dense breasts.

PurposeKilovoltage cone beam computed tomography (kVCBCT)‐guided adaptive radiation therapy (ART) uses daily deformed CT (dCT), which is generated automatically through deformable registration methods. These registration methods may perform poorly in reproducing volumes of the target organ, rectum, and bladder during treatment. We analyzed the registration errors between the daily kVCBCTs and corresponding dCTs for these organs using the default optical flow algorithm and two registration procedures. We validated the effectiveness of these registration methods in replicating the geometry for dose calculation on kVCBCT for ART.MethodsWe evaluated three deformable image registration (DIR) methods to assess their registration accuracy and dose calculation effeciency in mapping target and critical organs. The DIR methods include (1) default intensity‐based deformable registration, (2) hybrid deformable registration, and (3) a two‐step deformable registration process. Each technique was applied to a computerized imaging reference system (CIRS) phantom (Model 062 M) and to five patients who received volumetric modulated arc therapy to the prostate. Registration accuracy was assessed using the 95% Hausdorff distance (HD95) and Dice similarity coefficient (DSC), and each method was compared with the intensity‐based registration method. The improvement in the dCT image quality of the CIRS phantom and five patients was assessed by comparing dCT with kVCBCT. Image quality quantitative metrics for the phantom included the signal‐to‐noise ratio (SNR), uniformity, and contrast‐to‐noise ratio (CNR), whereas those for the patients included the mean absolute error (MAE), mean error, peak signal‐to‐noise ratio (PSNR), and structural similarity index measure (SSIM). To determine dose metric differences, we used a dose‐volume histogram (DVH) and 3.0%/0.3 mm gamma analysis to compare planning computed tomography (pCT) and kVCBCT recalculations with restimulated CT images used as a reference.ResultsThe dCT images generated by the hybrid (dCTH) and two‐step (dCTC) registration methods resulted in significant improvements compared to kVCBCT in the phantom model. Specifically, the SNR improved by 107% and 107.2%, the uniformity improved by 90% and 75%, and the CNR improved by 212.2% and 225.6 for dCTH and dCTC methods, respectively. For the patient images, the MAEs improved by 98% and 94%, the PSNRs improved by 16.3% and 22.9%, and the SSIMs improved by 1% and 1% in the dCTH and dCTC methods, respectively. For the geometric evaluation, only the two‐step registration method improved registration accuracy. The dCTH method yielded an average HD95 of 12 mm and average DSC of 0.73, whereas dCTC yielded an average HD95 of 2.9 mm and average DSC of 0.902. The DVH showed that the dCTC‐based dose calculations differed by <2% from the expected results for treatment targets and volumes of organs at risk. Additionally, gamma indices for dCTC‐based treatment plans were >95% at all points, whereas they were <95% for kVCBCT‐based treatment plans.ConclusionThe two‐step registration method outperforms the intensity‐based and hybrid registration methods. While the hybrid and two‐step‐based methods improved the image quality of kVCBCT in a linear accelerator, only the two‐step method improved the registration accuracy of the corresponding structures among the pCT and kVCBCT datasets. A two‐step registration process is recommended for applying kVCBCT to ART, which achieves better registration accuracy for local and global image structures. This method appears to be beneficial for radiotherapy dose calculation in patients with pelvic cancer.

3-Dimensional Elastic Registration System of Prostate Biopsy Location by Real-Time 3-Dimensional Transrectal Ultrasound Guidance With Magnetic Resonance/Transrectal Ultrasound Image Fusion

A review of MRI studies in Africa with special focus on quantitative MRI: Historical development, current status and the role of medical physicists