The three-dimensional (3D) turbo spin echo (TSE) sequence with variable flip angle (VFA) has proven to be clinically useful for high resolution intracranial vessel wall imaging (VWI) at 3T. In this study, a T1 weighted 3D TSE sequence was optimized for whole brain isotropic 0.5mm intracranial VWI in 8mins28secs. The optimized VFA design improves the flow suppression in small vessels and the nonlocal denoising effectively reduces the noise amplification after super resolution enhancement while improving the vessel wall boundary definition. This combined imaging and post-processing technique provides a promising tool for intracranial atherosclerosis and stroke investigation.
T1 weighted 3D TSE sequence optimization: A similar VFA design strategy6 was exploited to achieve a low-pass filtering shaped point spread function during TSE signal evolutions and the echo train length of 40 was chosen as a compromise between SNR gain and scan efficiency. In addition, one or two first echoes were skipped to compare with a non-skipping echo scheme in terms of the flow suppression performance in small arterial branches. The corresponding first several refocusing pulses during the initial echo skipping transition period were designed to minimize the impact on the SNR penalty in comparison to its counterpart without echo skipping (figure 1).
Image enhancement with noise reduction and super resolution: Inspired by the nonlocal mean method8, a residual learning based nonlocal NN7 was trained for image denoising using the nonlocal self-similarity property (figure 2). After nonlocal image denoising to suppress the incoherent background noise, the image was processed using another residual learning based convolutional NN for super resolution processing6 to improve the image sharpness. The training and testing of NN models were implemented with tensorflow on a single GPU (Nvidia, Titan Xp).
MR experiments: The optimized T1 weighted 3D TSE whole brain intracranial VWI datasets were acquired on a Philips Ingenia 3.0T MR scanner using a 32-channel head coil with FOV=230x230x210mm3, isotropic 0.5mm resolution, TR=800ms, echo spacing=5ms, adiabatic spectral fat suppression, NSA=1, x6 SENSE acceleration. With different first several skipped echoes, TE can correspondingly vary from 5ms to 15ms. Five healthy volunteers were scanned to optimize and evaluate the performance of the developed data acquisition and processing scheme.
Comparison of flow suppression in small vessels: Figure 3 demonstrates that the flow suppression can be improved by skipping the first several echoes, in particular for certain segments of the internal carotid arteries and intracranial small vessels. However, increasing the number of skipped echoes may also increase TE and reduce SNR and the T1 contrast. Skipping the first two echoes provides a reasonable compromise across flow suppression, SNR and TE.
Evaluation of noise reduction and super resolution: An image quality comparison across different post-processing schemes is provided at the middle cerebral artery slice in figure 4 and basilar artery slice in figure 5. The nonlocal denoised image can effectively reduce the background noise in the originally acquired image particularly within the cerebrospinal fluid region while preserving the vessel wall boundaries. With the denoised image as input for super resolution enhancement, the sharp delineation of intracranial vessel wall boundaries was maintained but the noise artifact amplification was reduced.
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