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Background: Men with prior negative prostate biopsies have a lower risk of being diagnosed with prostate cancer in comparison with biopsy-naive men. However, the relative clinical utility of identified lesions on multiparametric magnetic resonance imaging (mpMRI) is uncertain between the 2 settings., Methods: Patients from the Prospective Loyola University mpMRI (PLUM) Prostate Biopsy Cohort (January 2015 to June 2020) were examined. The detection of any prostate cancer and clinically significant prostate cancer (Gleason score ≥ 3 + 4) was stratified by Prostate Imaging-Reporting and Data System (PI-RADS) scores in the prior negative and biopsy-naive settings. Multivariable logistic regression models (PLUM models) assessed predictors, and decision curve analyses were used to estimate the clinical utility of PI-RADS cutoffs relative to the models., Results: Nine hundred men (420 prior negative patients and 480 biopsy-naive patients) were included. Prior negative patients had lower risks of any prostate cancer (27.9% vs 54.4%) and clinically significant prostate cancer (20.0% vs 38.3%) in comparison with biopsy-naive patients, and this persisted when they were stratified by PI-RADS (eg, PI-RADS 3: 13.6% vs 27.4% [any prostate cancer] and 5.2% vs 15.4% [clinically significant prostate cancer]). The rate of detection of clinically significant prostate cancer was 5.3% among men with prior negative biopsy and PI-RADS ≤ 3. Family history and Asian ancestry were significant predictors among biopsy-naive patients. PLUM models demonstrated a greater net benefit and reduction in biopsies (45.8%) without missing clinically significant cancer in comparison with PI-RADS cutoffs (PI-RADS 4: 34.0%)., Conclusions: Patients with prior negative biopsies had lower prostate cancer detection by PI-RADS score category in comparison with biopsy-naive men. Decision curve analyses suggested that many biopsies could be avoided by the use of the PLUM models or a PI-RADS 4 cutoff without any clinically significant cancer being missed., Lay Summary: Men with a prior negative prostate biopsy had a lower risk of harboring prostate cancer in comparison with those who never had a biopsy. This was true even when patients in each group had similar multiparametric magnetic resonance imaging (mpMRI) findings in terms of Prostate Imaging-Reporting and Data System (PI-RADS)-graded lesions. Decision curve analyses showed that many biopsies could be avoided by the use of the Prospective Loyola University mpMRI prediction models or a PI-RADS 4 cutoff for patients with prior negative biopsies., (© 2021 American Cancer Society.)

Black blood turbo spin echo (TSE) imaging of the right ventricle (RV) free wall is highly sensitive to cardiac motion, frequently resulting in nondiagnostic images. Temporal and spatial parameters of a black blood TSE pulse sequence were evaluated for visualization of the RV free wall. Seventy-four patient studies were retrospectively evaluated for the effects of acquisition timing on image quality. Axial black blood TSE images were acquired on 10 healthy volunteers to assess the role of spatial misregistration on right ventricle visualization; increasing the double inversion recovery (DIR) slice thickness beyond 300% had no effect on image quality (P = 0.2). Thirty-five patient studies were prospectively evaluated with inversion times (TIs) corresponding to the mid-diastolic rest period and end-systole based on visual analysis of a four chamber cine. When TIs were chosen to be within the patients' RV rest period, mean image quality score was significantly improved (2.3 vs 1.86; P < 0.001) and the number of clinically diagnostic images increased from 32% to 46%. Black blood TSE imaging of the RV free wall is highly sensitive to cardiac motion. Image quality can be improved by choosing TIs concordant with the rest period of the patient's RV that may occur at mid-diastole or end-systole., (Copyright 2009 Wiley-Liss, Inc.)

In this study, we investigated a method for accurately measuring myocardial T(1) for the quantification of myocardial blood flow (MBF) with arterial spin labeling (ASL). A single-shot gradient-echo (GE)-based ASL sequence with an adiabatic hyperbolic secant inversion recovery pulse was modified to acquire a pair of myocardial T(1)'s within a breath-hold. A multivariable regression algorithm that accounted for the magnetization saturation effects was developed to calculate T(1). The MBF was then determined with a well-developed model. The accuracy of our T(1) calculation was first evaluated in a phantom, and then in six dogs for the MBF calculation, with (N = 4) and without (N = 2) coronary artery stenosis. In the phantom study, the accuracy of T(1) measured with a slice-selective inversion prepared pulse was within 2.5% of error. In healthy dogs, the MBF increased 2-5 times during vasodilation. In contrast, regional differences of MBF were well visualized in the stenotic dogs during vasodilation (perfusion reserve of 2.75 +/- 0.83 in normal myocardium, and 1.46 +/- 0.75 in the stenotic area). A correlation analysis revealed a close agreement in MBF between the ASL and microsphere (MS) in both healthy and stenotic dogs. In summary, the modified ASL technique and T(1) regression algorithm proposed here provide an accurate measurement of myocardial T(1) and demonstrate potential for reliably assessing MBF at steady state., (Copyright 2005 Wiley-Liss, Inc.)

The presence of resonance frequency offsets often causes artifacts in images acquired with true fast imaging with steady-state precession (true-FISP). One source of resonance offsets is a suboptimal setting of the synthesizer frequency. The goal of this work was to demonstrate that shifting the synthesizer frequency could minimize the off-resonance related image artifacts in true-FISP. A simple scouting method was developed to estimate the optimal synthesizer frequency for the volume of interest (VOI). To improve fat suppression, a similar scouting method was also developed to determine the optimal frequency offset for the fat saturation pulse. Coronary artery imaging was performed in healthy subjects using a 3D true-FISP sequence to validate the effectiveness of the frequency corrections. Substantial reduction in image artifacts and improvement in fat suppression were observed by using the water and fat frequencies estimated by the scouting scans. Frequency shifting is a useful and practical method for improving coronary artery imaging using true-FISP., (Copyright 2003 Wiley-Liss, Inc.)

An electrocardiogram (ECG)-triggered, magnetization-prepared, segmented, 3D true fast imaging with steady-state precession (true-FISP) sequence with fat saturation was recently proposed for coronary artery imaging. A magnetization preparation scheme consisting of an alpha/2 radiofrequency (RF) pulse followed by 20 constant flip angle dummy RF cycles was used to reduce signal oscillations in the approach to steady state. However, if large resonance offsets on the order of 70-100 Hz are present, significant magnetization oscillations will still occur during data acquisition, which will result in image ghosting and blurring. The goal of this work was to validate that a linear flip angle (LFA) series can be used during magnetization preparation to reduce these image artifacts. Computer simulations, phantom studies, and coronary artery imaging in healthy volunteers were performed to compare this magnetization preparation scheme with that of an alpha/2 pulse followed by constant flip angle dummy RF cycles. The results demonstrated substantial reduction in the apparent image artifacts when using linearly increasing flip angles during magnetization preparation., (Copyright 2003 Wiley-Liss, Inc.)

The purpose of this work was to develop an ECG-triggered, segmented 3D true-FISP (fast imaging with steady-state precession) technique to improve the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of breath-hold coronary artery imaging. The major task was to optimize an appropriate magnetization preparation scheme to permit saturation of the epicardial fat signal. An alpha/2 preparation pulse was used to speed up the approach to steady-state following a frequency-selective fat-saturation pulse in each heartbeat. The application of dummy cycles was found to reduce the oscillation of the magnetization during data acquisition. The fat saturation and magnetization preparation scheme was validated with simulations and phantom studies. Volunteer studies demonstrated substantially increased SNR (55%) and CNR (178%) for coronary arteries compared to FLASH (fast low-angle shot) with the same imaging time. In conclusion, true-FISP is a promising technique for coronary artery imaging., (Copyright 2001 Wiley-Liss, Inc.)