In silico evaluation of the thermal stress induced by MRI switched gradient fields in patients with metallic hip implant

This work focuses on the in silico evaluation of the energy deposed by MRI switched gradient fields in bulk metallic implants and the consequent temperature increase in the surrounding tissues. An original computational strategy, based on the subdivision of the gradient coil switching sequences into sub-signals and on the time-harmonic electromagnetic field solution, allows to realistically simulate the evolution of the phenomena produced by the gradient coils fed according to any MRI sequence. Then, Pennes' bioheat equation is solved through a Douglas-Gunn time split scheme to compute the time-dependent temperature increase. The procedure is validated by comparison with laboratory results, using a component of a realistic hip implant embedded within a phantom, obtaining an agreement on the temperature increase better than 5%, lower than the overall measurement uncertainty. The heating generated inside the body of a patient with a unilateral hip implant when undergoing an Echo-Planar Imaging (EPI) MRI sequence is evaluated and the role of the parameters affecting the thermal results (body position, coil performing the frequency encoding, effects of thermoregulation) is discussed. The results show that the gradient coils can generate local increases of temperature up to some kelvin when acting without radiofrequency excitation. Hence, their contribution in general should not be disregarded when evaluating patients' safety

Mathematical methods for magnetic resonance based electric properties tomography

Magnetic resonance-based electric properties tomography (MREPT) is a recent quantitative imaging technique that could provide useful additional information to the results of magnetic resonance imaging (MRI) examinations. Precisely, MREPT is a collective name that gathers all the techniques that elaborate the radiofrequency (RF) magnetic field B1 generated and measured by a MRI scanner in order to map the electric properties inside a human body. The range of uses of MREPT in clinical oncology, patient-specific treatment planning and MRI safety motivates the increasing scientific interest in its development. The main advantage of MREPT with respect to other techniques for electric properties imaging is the knowledge of the input field inside the examined body, which guarantees the possibility of achieving high-resolution. On the other hand, MREPT techniques rely on just the incomplete information that MRI scanners can measure of the RF magnetic field, typically limited to the transmit sensitivity B1+. In this thesis, the state of art is described in detail by analysing the whole bibliography of MREPT, started few years ago but already rich of contents. With reference to the advantages and drawbacks of each technique proposed for MREPT, the particular implementation based on the contrast source inversion method is selected as the most promising approach for MRI safety applications and is denoted by the symbol csiEPT. Motivated by this observation, a substantial part of the thesis is devoted to a thoroughly study of csiEPT. Precisely, a generalised framework based on a functional point of view is proposed for its implementation. In this way, it is possible to adapt csiEPT to various physical situations. In particular, an original formulation, specifically developed to take into account the effects of the conductive shield always employed in RF coils, shows how an accurate modelling of the measurement system leads to more precise estimations of the electric properties. In addition, a preliminary study for the uncertainty assessment of csiEPT, an imperative requirement in order to make the method reliable for in vivo applications, is performed. The uncertainty propagation through csiEPT is studied using the Monte Carlo method as prescribed by the Supplement 1 to GUM (Guide to the expression of Uncertainty in Measurement). The robustness of the method when measurements are performed by multi-channel TEM coils for parallel transmission confirms the eligibility of csiEPT for MRI safety applications

EPTlib: An Open-Source Extensible Collection of Electric Properties Tomography Techniques

open1noElectric properties tomography (EPT) is a novel magnetic resonance imaging–based method to estimate non-invasively the distribution of the electric properties in the human body. In this paper, EPTlib, an open-source extensible C++ library collecting ready-to-use algorithms for electric properties tomography, is presented. Currently, EPTlib implements three techniques, named Helmholtz-EPT, convection-reaction-EPT and gradient-EPT, whose derivation and implementation is deeply discussed. Moreover, the configuration files needed by the terminal application included in EPTlib to apply the implemented techniques are outlined. The three techniques are applied to a couple of model problems in order to highlight their main features and the effects of the tunable parameters.openArduino, AlessandroArduino, Alessandr

Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives

Chronic obstructive pulmonary disease (COPD) is a disabling condition that is characterised by poorly reversible airflow limitation and inflammation. Acute exacerbations of COPD are a common cause of hospitalisation and death among COPD patients. Several biochemical markers have been studied as outcome predictors in COPD; however, their measurement often requires significant time and resources. Relatively simple biomarkers of inflammation calculated from routine complete blood count tests, such as the neutrophil to lymphocyte ratio (NLR), might also predict COPD progression and outcomes. This review discusses the available evidence from studies investigating the associations between the NLR, COPD exacerbations and death in this patient group

Arginines Plasma Concentration and Oxidative Stress in Mild to Moderate COPD

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background Elevated plasma concentrations of the endogenous nitric oxide synthase (NOS) inhibitor asymmetric dimethylarginine (ADMA) have been observed in respiratory conditions such as asthma and cystic fibrosis. Since oxidative stress has been shown to increase the activity of arginine methylating enzymes, hence increased ADMA synthesis, and to reduce ADMA degrading enzymes, hence increased ADMA concentrations, we assessed methylated arginines concentrations in chronic obstructive pulmonary disease (COPD), a disease characterized by increased oxidative stress. Methods Plasma arginine, ADMA and symmetric dimethylarginine (SDMA), oxidative stress markers (thiobarbituric acid reactive substances, TBARS, and plasma proteins SH, PSH) and antioxidants (taurine and paraoxonase 1, PON1, activity) were measured in 43 COPD patients with mild (n = 29) or moderate (n = 14) disease and 43 age- and sex-matched controls. Results TBARS significantly increased with COPD presence and severity (median 2.93 vs 3.18 vs 3.64 μmol/L, respectively in controls, mild and moderate group, p<0.0001 by ANOVA) whereas PSH decreased (6.69±1.15 vs 6.04±0.85 vs 5.33±0.96 μmol/gr prot, p<0.0001 by ANOVA). Increased ADMA/arginine ratio, primarily due to reduced arginine concentrations, was also observed with COPD presence and severity (median 0.0067 vs 0.0075 vs 0.0100, p<0.0001 by ANOVA). In multiple logistic regression analysis, only TBARS (OR 0.44, 95% CI 0.25–0.77; p = 0.0045) and ADMA/Arginine ratio (OR 1.72, 95% CI 2.27–13.05; p = 0.02) were independently associated with COPD severity. Conclusion COPD presence and severity are associated with increased oxidative stress and alterations in arginine metabolism. The reduced arginine concentrations in COPD may offer a new target for therapeutic interventions increasing arginine availability

Uncertainty propagation in phaseless electric properties tomography

Uncertainty propagation in a phaseless magnetic resonance-based electric properties tomography technique is investigated using the Monte Carlo method. The studied inverse method, which recovers the electric properties distribution at radiofrequency inside a scatterer irradiated by the coils of a magnetic resonance imaging scanner, is based on the contrast source inversion technique adapted to process phaseless input data.Comment: 4 pages, 6 figures. 2019 International Conference on Electromagnetics in Advanced Applications (ICEAA

Efficient prediction of MRI gradient-induced heating for guiding safety testing of conductive implants

PurposeTo propose an efficient numerical method to predict the temperature increase of an implantable medical device induced by any linearly polarized homogeneous magnetic field, according to the ISO 10974 methodology for testing of gradient-induced device heating. Theory and MethodsThe concepts of device-specific power and temperature tensors are introduced to mathematically describe the electromagnetic and thermal anisotropic behavior of the device, from which the device heating for an arbitrary exposure direction can be predicted. The proposed method is compared to a brute-force approach based on simulations, and validated by applying it to four reference orthopedic implants with a commercial simulation software. ResultsThe proposed method requires about 5%$$\%$$ of the time required by the brute-force approach, and 30%$$\%$$ of the memory occupancy. The temperature increase predicted by the proposed method over a range of incident magnetic field exposures deviated from brute-force direct simulations by less than &amp; PLUSMN;$$\pm$$0.3%$$\%$$. ConclusionThe proposed method allows efficient prediction of the heating of an implantable medical device induced by any linearly polarized homogeneous magnetic field using a small fraction of the simulations required by the brute-force approach. The results can be used to predict the worst-case orientation of the gradient field, for subsequent experimental characterization according to the ISO 10974 standard

Polynomial chaos expansion of SAR and temperature increase variability in 3 T MRI due to stochastic input data

Objective. Numerical simulations are largely adopted to estimate dosimetric quantities, e.g. specific absorption rate (SAR) and temperature increase, in tissues to assess the patient exposure to the radiofrequency (RF) field generated during magnetic resonance imaging (MRI). Simulations rely on reference anatomical human models and tabulated data of electromagnetic and thermal properties of biological tissues. However, concerns may arise about the applicability of the computed results to any phenotype, introducing a significant degree of freedom in the simulation input data. In addition, simulation input data can be affected by uncertainty in relative positioning of the anatomical model with respect to the RF coil. The objective of this work is the to estimate the variability of SAR and temperature increase at 3 T head MRI due to different sources of variability in input data, with the final aim to associate a global uncertainty to the dosimetric outcomes. Approach. A stochastic approach based on arbitrary Polynomial Chaos Expansion is used to evaluate the effects of several input variability's (anatomy, tissue properties, body position) on dosimetric outputs, referring to head imaging with a 3 T MRI scanner. Main results. It is found that head anatomy is the prevailing source of variability for the considered dosimetric quantities, rather than the variability due to tissue properties and head positioning. From knowledge of the variability of the dosimetric quantities, an uncertainty can be attributed to the results obtained using a generic anatomical head model when SAR and temperature increase values are compared with safety exposure limits. Significance. This work associates a global uncertainty to SAR and temperature increase predictions, to be considered when comparing the numerically evaluated dosimetric quantities with reference exposure limits. The adopted methodology can be extended to other exposure scenarios for MRI safety purposes