Multi‐Planar, Multi‐Contrast and Multi‐Time Point Analysis Tool (MOCHA) for Intracranial Vessel Wall Characterization

Abstract

BackgroundThree‐dimensional (3D) intracranial vessel wall (IVW) magnetic resonance imaging can reliably image intracranial atherosclerotic disease (ICAD). However, an integrated, streamlined, and optimized workflow for IVW analysis to provide qualitative and quantitative measurements is lacking.PurposeTo propose and evaluate an image analysis pipeline (MOCHA) that can register multicontrast and multitime point 3D IVW for multiplanar review and quantitative plaque characterization.Study typeRetrospective.PopulationA total of 11 subjects with ICAD (68 ± 10 years old, 6 males).Field Strength/SequenceA 3.0 T, 3D time‐of‐flight gradient echo sequence and T1‐ and proton density‐weighted fast spin echo sequences.AssessmentEach participant underwent two IVW sessions within 2 weeks. Scan and rescan IVW images were preprocessed using MOCHA. The presence of atherosclerotic lesions was identified in different intracranial arterial segments by two readers (GC and JS, 12 years of vascular MR imaging experience each) following an established review protocol to reach consensus on each of the reviews. For all locations with identified plaques, plaque length, lumen and vessel wall areas, maximum and mean wall thickness values, normalized wall index and contrast enhancement ratio were measured.Statistical TestsPercent agreement and Cohen's κ were used to test scan–rescan reproducibility of detecting plaques using MOCHA. Intraclass correlation coefficient (ICC) and Bland–Altman analysis were used to evaluate scan–rescan reproducibility for plaque morphologic and enhancement measurements.ResultsIn 150 paired intracranial vessel segments, the overall agreement in plaque detection was 92.7% (κ = 0.822). The ICCs (all ICCs > 0.90) and Bland–Altman plots (no bias observed) indicated excellent scan–rescan reproducibility for all morphologic and enhancement measurements.Data ConclusionFindings from this study demonstrate that MOCHA provides high scan–rescan reproducibility for identification and quantification of atherosclerosis along multiple intracranial arterial segments and highlight its potential use in characterizing plaque composition and monitoring plaque development.Evidence Level4Technical EfficacyStage 2

An extended phase graph‐based framework for DANTE‐SPACE simulations including physiological, temporal, and spatial variations

“…DANTE-SPACE consists of a DANTE 1,2 module for suppressing moving spins followed by a variable-flip-angle turbo-spin-echo SPACE readout. 3 It has been used at both 3 T 2,4-15 and 7 T, [16][17][18][19] and with SPACE parameter configurations resulting in T 1 -weighted, [4][5][6][7][8][9][10][11]15,19 T 2 -weighted, 2,13,[16][17][18] and proton density-weighted 2,10,12,15 contrasts. Across different implementations, many different protocol settings have been used, such as DANTE pulse trains ranging from 64 pulses 2 to 300 pulses 2, [14][15][16] and DANTE flip angles ranging from 8 •5,6,8,15 to 14 • .…”

VWI‐APP: Vessel wall imaging–dedicated automated processing pipeline for intracranial atherosclerotic plaque quantification

“…A more recent work focused on multi-contrast and multi-time point image registration to facilitate intracranial atherosclerotic plaque analysis but still relied on manual delineation and physician's observation. 9 Deep learning has increasingly been utilized to achieve automated lesion detection, fast centerline tracking, or vessel wall segmentation on VWI. [10][11][12][13] Excellent accuracy and time efficiency have been demonstrated in individual tasks.…”

“…However, the active contour‐based segmentation approach requires iterative computation with a long computational time. A more recent work focused on multi‐contrast and multi‐time point image registration to facilitate intracranial atherosclerotic plaque analysis but still relied on manual delineation and physician's observation 9 …”

Editorial for “Multi‐planar, multi‐contrast and multi‐time point analysis tool (MOCHA) for intracranial vessel wall characterization”

“…Intracranial vessel wall (IVW) magnetic resonance imaging (MRI) has emerged as a qualitative and quantitative method in the evaluation of intracranial atherosclerotic plaques 1,2 . In this issue of JMRI , the authors presented and evaluated a pipeline of multi‐planar, multi‐contrast, and multi‐time point analysis tool for IVW characterization (MOCHA) 3 . Three‐dimensional (3D) IVW MRI has been considered as an optimal imaging technique for evaluating the characteristics of intracranial atherosclerotic disease (ICAD) 4,5 .…”

“…1,2 In this issue of JMRI, the authors presented and evaluated a pipeline of multi-planar, multi-contrast, and multi-time point analysis tool for IVW characterization (MOCHA). 3 Threedimensional (3D) IVW MRI has been considered as an optimal imaging technique for evaluating the characteristics of intracranial atherosclerotic disease (ICAD). 4,5 Although its application has enabled a significant advancement in the diagnosis and treatment of patients with ICAD, comprehensive assessment of ICAD with 3D multi-contrast serial IVW imaging remains challenging.…”