Clinical feasibility of single‐shot fluid‐attenuated inversion recovery with wide inversion recovery pulse designed to reduce cerebrospinal fluid and motion artifacts for evaluation of uncooperative patients in acute stroke protocol

Abstract

Fluid‐attenuated inversion recovery (FLAIR) imaging is a key sequence for stroke assessment. Motion artifact reduction with short acquisition time is still challenging, but necessary in the magnetic resonance (MR) stroke protocol, especially for uncooperative patients suspected of stroke. The aim of this study is to investigate the feasibility of modified single‐shot FLAIR with wide inversion recovery pulses for use in stroke patients. This is a prospective study, which included 30 patients clinically suspected of stroke who were examined by MR stroke protocol from January 2018 to September 2018. A 1.5 T, multi‐shot‐turbo spin‐echo (TSE) conventional FLAIR, and single‐shot‐TSE‐FLAIR with wide inversion recovery pulse were used. Modified single‐shot FLAIR was obtained for 30 patients with suspected stroke who moved during conventional FLAIR scan. Motion artifacts were randomly and independently scored using a 5‐grade scale by three radiologists in blinded fashion. Whether the FLAIR vessel hyperintensity sign was present was visually evaluated. Statistical tests included Wilcoxon‐signed rank test and weighted Cohen's kappa statistics. The motion artifact score was significantly lower in single‐shot FLAIR than in conventional FLAIR (0.37 ± 0.56 vs. 1.83 ± 1.18; p < 0.05. The vessel hyperintensity sign was visualized in 6 and 5 patients on single‐shot and conventional FLAIR images, respectively. This study demonstrates the value of single‐shot FLAIR for stroke assessment. Single‐shot FLAIR reduced motion artifact and visualized vessel hyperintensity sign more than conventional FLAIR. Level of Evidence 2. Technical Efficacy Stage 2.

The clinical feasibility of artificial intelligence-assisted compressed sensing single-shot fluid-attenuated inversion recovery (ACS-SS-FLAIR) for evaluation of uncooperative patients with brain diseases: comparison with the conventional T2-FLAIR with parallel imaging

“…In our cases, no obvious high signal of CSF artifacts was observed in the ACS-SS-FLAIR sequence. Compared with a previous modified SS-FLAIR (scanning time = 1 min 20 s) reported in a recent study, our ACS-assisted SS-FLAIR not only overcame shortcomings (such as signal artifacts) of conventional SS-FLAIR but also allowed for a faster scanning speed (13).…”

“…A single-shot FLAIR (SS-FLAIR) sequence, as an expansion of T2-FLAIR, is developed to further optimize the motion artifacts by improving the acceleration efficacy (11,12). Nevertheless, facing these patients with involuntary head motion, owing to insufficient fluid signal suppression, this involuntary and uncontrollable head motion often leads to high signal artifacts of CSF, significantly interfering with lesion detection and diagnosis (13). Moreover, although the SS-FLAIR sequence improves acquisition efficacy, the acquisition time, often >1 min, is still intolerable for these patients with involuntary head motion, significantly limiting its use in these patients.…”

Editorial for “Diagnostic Performance of Single‐Shot FLAIR With Wide Inversion Recovery Pulse Designed to Reduce Cerebrospinal Fluid and Motion Artifacts for Evaluation of Uncooperative Patients in Acute Stroke Protocol”

“…As we know, obtaining high‐quality image data acquisition is important for patients with acute cerebral infarction. The conventional magnetic resonance imaging (MRI) sequences have substantial limitations in data acquisition such as motion correction and scan time reduction during MRI scanning 2 …”

“…The conventional magnetic resonance imaging (MRI) sequences have substantial limitations in data acquisition such as motion correction and scan time reduction during MRI scanning. 2 So far, despite significant efforts from research to motion correction techniques, 3,4 limitations for motion correction still exist. 5,6 An echo-planar FLAIR (EPI-FLAIR) sequence helps shorten the scan time, but one of the main difficulties is the absence of geometric distortion and signal intensity drop-out, especially at tissue-air boundaries.…”