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Bone marrow dosimetry is a topic of high interest in molecular radiotherapy. Predicting the level of hematological toxicity is one of the most important goals of nuclear medicine radiation dosimetry. To achieve this, it is necessary to quantify the absorbed dose to the active bone marrow, thus aiming at administering the most efficient therapy with a minimum level of adverse effects in the patient. The anatomical complexity of trabecular bone and bone marrow leads to the need of applying non-nuclear medicine imaging methods for determining the spatial distribution of soft tissue, adipose tissue, and bone in spongiosa.
Therefore, the two objectives of this dissertation are: i) to apply magnetic resonance imaging (MRI) for quantification of the fat volume fraction, and ii) to validate a method based on dual-energy quantitative computed tomography (DEQCT) for quantification of the trabecular bone volume fraction.
In a first step, an MRI sequence (two-point Dixon) for fat-water separation was validated in a 3 Tesla system by quantifying the fat volume fraction in a phantom and the lumbar vertebrae of volunteers and comparing with magnetic resonance spectroscopy (MRS). After successful validation, the fat volume fraction was retrospectively measured in the five lumbar vertebrae of 44 patient images acquired in the clinical routine. The two-point Dixon showed a good quantification of the fat volume fraction in the phantom experiment (-9.8% maximum relative error with respect to the nominal values). In the volunteers, a non-significant difference between MRI and MRS was found for the quantification of the fat volume fraction in volumes-of-interest with similar dimensions and position in both quantification methodologies (MRI and MRS). In the study with patient data, the marrow conversion (red → yellow marrow) was found to be age-dependent, and slower in males (0.3% per year) than in females (0.5% per year). Also, considerable variability of the fat volume fraction in patients of similar ages and the same gender was observed.
These results enable the use of two-point Dixon MRI in the quantification of the fat volume fraction in the bone marrow. Additionally, the constant marrow conversion during adulthood suggests that a patient-specific approach should replace the assumption of a constant cellularity volume fraction of 0.7 (reference man) (1,2) as proposed by the International Commission on Radiological Protection (ICRP).
In a second step, a quantification method based on DEQCT was validated in two CT systems: i) a clinical CT integrated into a SPECT/CT and ii) a dual-source computed tomography (DSCT) system. The method was applied in two phantoms: the first was used to validate the DEQCT method by the quantification of the hydroxyapatite volume fraction in three vials of 50 ml each and three different hydroxyapatite concentrations (100 mg/cm3, 200 mg/cm3, 300 mg/cm3). The second phantom was the European spine phantom (ESP), an anthropomorphic spine phantom. It was used to quantify the bone mineral content (BMC) on the whole vertebra and the hydroxyapatite volume fraction (VFHA) in the spongiosa region of each vertebra of the phantom. Lastly, the BMC of lumbar vertebrae 1 (LV1) and 2 (LV2) was measured in a patient using DEQCT and dual-energy X-ray absorptiometry (DEXA). Furthermore, the hydroxyapatite volume fraction (VFHA) and the bone volume fraction (VFB) was calculated for both the whole vertebrae and the spongiosa region of LV1 and LV2.
The measured and nominal hydroxyapatite volume fraction in the vial phantom showed a good correlation (maximum relative error: 14.2%). The quantification of the BMC on the whole vertebra and the VFHA on the spongiosa region showed larger relative errors than in the validation phantom. The quantification of BMC on LV1 and LV2 showed relative errors between DEXA and DSCT equal to 7.6% (LV1) and -8.4% (LV2). Also, the values of the VFHA (mineral bone) were smaller than the VFB. This result is consistent with the bone composition (mineral bone plus organic material).
The DEQCT method enables the quantification of hydroxyapatite (mineral bone) and bone (mineral bone plus organic material) in a clinical setting. However, the method showed an overestimation of the quantified mineral bone volume fraction. This overestimation might be related to the lack of detailed information on the CT X-ray spectra and detector sensitivity. Also, the DEQCT method showed a dependency on the CT reconstruction kernel and the chemical description of the materials to be quantified.
Based on the results of this work, the feasibility for quantifying the fat volume fraction and the bone volume fraction in the spongiosa in a clinical setting has been demonstrated/proven. Furthermore, the differences in fat volume fraction in females and males, as well as the variability of the fat volume fraction in subjects of similar ages, questions the approximation of the cellularity volume fraction by only a single ICRP reference value in bone marrow dosimetry for molecular radiotherapy. Lastly, this study presents the first approach for non-invasive quantification of the bone volume fraction (mineral bone plus organic material) for improved bone marrow dosimetry.
Magnetic Resonance Imaging at field strengths up to 3 T, has become a default diagnostic modality for a variety of disorders and injuries, due to multiple reasons ranging from its non-invasive nature to the possibility of obtaining high resolution images of internal organs and soft tissues. Despite tremendous advances, MR imaging of certain anatomical regions and applications present specific challenges to be overcome. One such application is MR Musculo-Skeletal Imaging. This work addresses a few difficult areas within MSK imaging from the hardware perspective, with coil solutions for dynamic imaging of knee and high field imaging of hand.
Starting with a brief introduction to MR physics, different types of RF coils are introduced in chapter 1, followed by sections on design of birdcage coils, phased arrays and their characterization in chapter 2. Measurements, calculations and simulations, done during the course of this work, have been added to this chapter to give a quantitative feel of the concepts explained.
Chapter 3 deals with the construction of a phased array receiver for dynamic imaging of knee of a large animal model, i.e. minipig, at 1.5 T. Starting with details on the various aspects of an application that need to be considered when an MR RF array is designed, the chapter details the complex geometry of the region of interest in a minipig and reasons that necessitate a high density array. The sizes of the individual elements that constitute the array have been arrived at by studying the ratio of unloaded to loaded Q factors and choosing a size that provides the best ratio but still maintains a uniform SNR throughout the movement of the knee. To have a minimum weight and to allow mechanical movement of the knee, the Preamplifiers were located in a separate box. A movement device was constructed to achieve adjustable periodic movement of the knee of the anesthetized animal. The constructed array has been characterized for its SNR and compared with an existing product coil to show the improvement. The movement device was also characterized for its reproducibility. High resolution static images with anatomical details marked have been presented. The 1/g maps show the accelerations possible with the array. Snapshots of obtained dynamic images trace the cruciate ligaments through a cycle of movement of the animal's knee.
The hardware combination of a high density phased array and a movement device designed for a minipig's knee was used as a 'reference' and extended in chapter 4 for a human knee. In principle the challenges are similar for dynamic imaging of a human knee with regards to optimization of the elements, the associated electronics and the construction of the movement device. The size of the elements were optimized considering the field penetration / sensitivity required for the internal tissues. They were distributed around the curvature of the knee keeping in mind the acceleration required for dynamic imaging and the direction of the movement. The constructed movement device allows a periodic motion of the lower half of the leg, with the knee placed within the coil, enabling visualization of the tissues inside, while the leg is in motion. Imaging has been performed using dynamic interleaved acquisition sequence where higher effective TR and flip angles are achieved due to a combination of interleaving and segmentation of the sequence. The movement device has been characterized for its reproducibility while the SNR distribution of the constructed RF array has been compared with that of a commercially available standard 8 channel array. The results show the improvement in SNR and acceleration with the constructed geometry. High resolution static images, dynamic snapshots and the 3D segmentation of the obtained images prove the usefulness of the complete package provided in the design, for performing dynamic imaging at a clinically relevant field strength.
A simple study is performed in chapter 5 to understand the effects of changes in overlap for coil configurations with different loads and at different frequencies. The noise levels of individual channels and the correlation between them are plotted against subtle changes in overlap, at 64 and 123 MHz. SNR for every overlap setup is also measured and plotted. Results show that achieving critical overlap is crucial to obtain the best possible SNR in those coil setups where the load offered by the sample is low.
Chapter 6 of the thesis work deals with coil design for high field imaging of hand and wrists at 7 T, with an aim to achieve ultra high resolution imaging. At this field strength due to the increase in dielectric effects and the resulting decrease in homogeneity, whole body transmit coils are impractical and this has led engineers to design local transmit coils, for specific anatomies. While transmit or transceive arrays are usually preferred, to mitigate SAR effects, the spatial resolution obtained is limited. It is shown that a solution to this, with regards to hand imaging, can be a single volume transmit coil, along with high density receive arrays optimized for different regions of the hand. The use of a phased array for reception provides an increased SNR / penetration under high resolution. A volume transmit coil could pose issues in homogeneity at 7 T, but the specific anatomy of hand and wrist, with comparatively less water content, limits dielectric effects to have homogeneous B_1+ profile over the hand. To this effect, a bandpass birdcage and a 12 channel receive array are designed and characterized. Images of very high spatial resolution (0.16 x 0.16 x 0.16 mm3) with internal tissues marked are presented. In vivo 1/g maps show that an acceleration of up to 3 is possible and the EM simulation results presented show the uniform field along with SAR hotspots in the hand. To reduce the stress created due to the 'superman' position of imaging, provisions in the form of a holder and a hand rest have been designed and presented. Factors that contributed to the stability of the presented design are also listed, which would help future designs of receive arrays at high field strengths.
In conclusion, the coils and related hardware presented in this thesis address the following two aspects of MSK imaging: Dynamic imaging of knee and High resolution imaging of hand / wrist. The presented hardware addresses specific challenges and provides solutions. It is hoped that these designs are steps in the direction of improving the existing coils to get a better knowledge and understanding of MSK diseases such as Rheumatoid Arthritis and Osteoarthritis. The hardware can aid our study of ligament reconstruction and development. The high density array and transmit coil design for hand / wrist also demonstrates the benefits of the obtained SNR at 7 T while maintaining SAR within limits. This design is a contribution towards optimizing hardware at high field strength, to make it clinically acceptable and approved by regulatory bodies.