Percutaneous coronary revascularization of chronic total occlusions (CTOs) is difficult due to the presence of a hard proximal fibrous cap and lack of image guidance. The use of x-ray fluoroscopy alone makes it difficult to identify vessel boundaries and occlusive constituents which would aid the process of revascularization. It also can be difficult to keep a guidewire intraluminal without puncturing the vessel wall. Although several imaging modalities are being developed, a technique for measuring the stiffness of occlusions would facilitate revascularization by helping the process of guidewire selection and placement. In this study, a technique known as static magnetic resonance elastography is explored as a method of determining the compliance of CTOs. A finite element simulation was used to determine the response of an artery to deformation, and displacement images were obtained from an artery phantom using a stimulated echo MR imaging pulse sequence and a pneumatic compression system.

Percutaneous coronary revascularization of chronic total occlusions (CTOs) is difficult due to the presence of a hard proximal fibrous cap and lack of image guidance. The use of x-ray fluoroscopy alone makes it difficult to identify vessel boundaries and occlusive constituents which would aid the process of revascularization. It also can be difficult to keep a guidewire intraluminal without puncturing the vessel wall. Although several imaging modalities are being developed, a technique for measuring the stiffness of occlusions would facilitate revascularization by helping the process of guidewire selection and placement. In this study, a technique known as static magnetic resonance elastography is explored as a method of determining the compliance of CTOs. A finite element simulation was used to determine the response of an artery to deformation, and displacement images were obtained from an artery phantom using a stimulated echo MR imaging pulse sequence and a pneumatic compression system.

Magnetic resonance imaging is a non-invasive imaging modality that is used to produce detailed images of soft tissues within the human body. Typically, MRI scanners used in the clinical setting are high field systems because they have a magnetic field strength greater than 1.5 Tesla. The high magnetic field offers the benefit of high spatial resolution and high SNR. However, low filed systems can also produce high resolution MR images with the added benefit of imaging stiffer samples. In this study, a low field 0.5 T MR system was used to image various samples to demonstrate the capability of the low field system in acquiring MR images with resolution comparable to high field systems. Furthermore, the MR system was modified to one capable of performing low field MR Elastography (MRE), a technique that can non-destructively measure the mechanical properties of soft samples. Agarose gel phantom of 0.5% wt. and 1.0% wt. were used to validate the MRE system. Additionally, a rat brain was used to assess the sensitivity of the MRE system in measuring the mechanical properties of small tissues. The results illustrated that the low field MR system can acquire high resolution images and provide sufficient tissue contrast (e.g through long TE times (80 ms), which is not possible with high field systems). MRE results on gel phantoms illustrated the capability of the low field system to accurately measure the mechanical properties and the MRE testing of rat brain demonstrated the potential of the system to study biological tissues. Finally, the capability of low field MRI and MRE to assess the growth of tissue engineered bone has the potential to transform the field of tissue engineering.

L’élastographie-IRM du sein (MRE) est une technique d’imagerie fonctionnelle non invasive utilisant les propriétés visco-élastiques des tissus et qui permet comme en élastographie-échographie d’évaluer la rigidité d’une lésion. Il est également possible, à la différence de l’élastographie-échographie, d’évaluer le degré de viscosité d’une lésion, et ainsi grâce à la combinaison élasticité/viscosité, comparée à l’analyse des paramètres IRM classiques comme la morphologie ou la cinétique de rehaussement, d’améliorer la caractérisation lésionnelle. Très peu d’études en élastographie-IRM du sein ont été menées à ce jour, essentiellement du fait d’une problématique instrumentale et de mise à disposition d’une antenne dédiée sein équipé d’un dispositif de génération des ondes de cisaillement dans le sein. Dans un premier temps, nous avons pu établir et optimiser une séquence élasto-IRM du sein sur une série de 10 volontaires saines. Cette séquence basée sur un principe de séquence Spin Echo EPI-MRE 3D, a permis l’acquisition de 50 coupes en 10 minutes sur un sein, compatible avec la pratique clinique en IRM du sein. Une approche multifréquence à 37,5 Hz, 75 Hz et 112,5 Hz a été ensuite testée sur les trois dernières volontaires puis transférées à notre population de patientes. Cette séquence multifréquence permettait la continuité de diffusion des ondes dans le sein. 50 patientes présentant des lésions indéterminées ou suspectes du sein (37 cancers, 13 bénins) ont ensuite été incluses dans ce protocole et examinées par IRM du sein classique avec séquence supplémentaire élasto-IRM. Certaines patientes étaient aussi examinées en élasto-échographie. Les données IRM morphologiques, dynamiques et de visco-élasticité IRM ont été corrélées à l’histologie. Nous avons pu montrer que les paramètres visco-élastiques IRM étaient fortement corrélés avec le score de malignité d’une lésion (Bi-RADS ACR) et avec le caractère différentiel bénin/malin. C’est notamment le paramètre Gd qui représente l’élasticité, qui était plus faible en cas de lésion suspecte BI-RADS 5. Le paramètre Gl était plus élevé dans les lésions malignes par rapport aux lésions bénignes, avec un niveau de viscosité statistiquement supérieur dans les lésions malignes. Le meilleur paramètre semble être le rapport y (Gl/Gd) qui était aussi significativement élevé dans les lésions malignes par comparaison avec les lésions bénignes du sein, et qui a été analysé comme un facteur indépendant. En pratique, l’ajout de la séquence MRE à un examen IRM du sein classique a permis dans notre étude d’améliorer significativement la sensibilité de l’IRM (de 78 à 91 %) sans perte de spécificité, celle-ci étant initialement très bonne dans cette étude. Nous n’avons pas en revanche établi de lien entre la fibrose, la quantification vasculaire ou la nécrose pour expliquer ces phénomènes de visco-élasticité des tumeurs. En conclusion, l’élasto-IRM peut s’avérer utile pour améliorer le diagnostic de lésions du sein en IRM. Une poursuite des travaux avec optimisation de la séquence pour qu’elle puisse permettre l’analyse des deux seins sera nécessaire pour sa diffusion en pratique clinique. Ce travail pourrait idéalement se poursuivre sur une plus grande série de patientes. / MR-elastography (MRE) is a non-invasive functional Imaging technique using tissue mechanical visco-elastic properties to evaluate tissue stifness. MRE is different from elasticity Imaging in ultrasound, as it is possible to evaluate tumour viscosity. Combining viscosity and elasticity may improve MRI accuracy, in comparison with classical morphological and kinetics criteria. Only very few studies are focused on breast MRE, because of low availability of dedicated breast coils with MRE devices. Firstly, we developed and optimized a breast MRE sequence on a population of 10 volunteers. This sequence is based on a Spin Echo EPI-MRE 3D, and it was possible to acquire 50 slices on one breast in 10 minutes, which is applicable in a clinical routine in breast MRI. Secondly, a multi-frequency approach 37,5 Hz, 75 Hz and 112,5 Hz has been evaluated on the last three volunteers, then transferred to our patient’s population. A continous diffusion of waves within the breast was possible with this multifrequency approach sequence. 50 patients presenting undetermined or suspicious breast lesions (37 cancers, 13 benign lesions) were included in this study and examined with a standard breast MRI and MRE sequence. Some patients were also examined with shear-wave ultrasound elastography (ARFI mode, Siemens ®). Morphological, kinetic and visco-elastic MR parameters were correlated to pathology. We demonstrated that MR visco-elastic properties were strongly correlated with Bi-RADS ACR malignancy score of a breast lesion and with malignant and benign status. The best parameter was Gd (dynamic modulus), which corresponded to lesion stiffness. Gd was lower in case of BI-RADS 5 lesions. Gl parameter (Loss modulus) was higher in malignant lesions in comparison with benign lesions, with viscosity level statistically higher in malignant lesions. The best criterion was the ratio y (Gl/Gd), which was significantly higher in malignant lesions in comparison with benign lesions; ratio y was statistically an independent factor. In practice, addition of a MRE sequence to a standard breast MRI improved significantly breast MRI Sensitity (78 to 91 %) without reduction in specificity; Sp was anyway initially high in our study. Nevertheless, we didn’t demonstrate a statistical correlation with fibrosis, vascular grading or necrosis with MRE parameters, to explain visco-elastic properties of breast tumours. In conclusion, MR-elastography may be useful to improve breast MRI accuracy. In future studies, MRE sequence may be optimized to allow a bilateral acquisition on both breasts, which would be useful in clinical practice. Future works could include higher number of patients to confirm our results.

Magnetic resonance elastography (MRE) is an imaging technique that allows for non-invasive access to the physical properties of body tissues. MRE has great potential, but it is difficult to conduct research due to the time-consuming estimation of stiffness maps, which could be speeded up by using neural network. However, there is not enough real data to train one, thus, synthetic data is needed. To create synthetic data three techniques of simulating tissue displacement due to wave propagation was explored, including solving differential equations for a system of coupled harmonic oscillators (CHO method) and using two different functions from the k-Wave toolbox. Each of the three methods demonstrated the ability to replicate the displacement pattern in a phantom with a simple structure. The CHO method and \texttt{kspaceFirstOrder} function of the k-Wave toolbox showed the best performance when simulating displacement in a 2D brain slice. The models are not very accurate, but capture general features of displacement in a brain and hold potential for future improvement. / Magnetresonans-elastografi (MRE) är en avbildningsteknik som möjliggör icke-invasiv åtkomst till de fysiska egenskaperna hos olika vävnader. MRE har stor potential, men forskning inom ämnet försvåras på grund av den tidskrävande beräkningen av elasticitetskartorna, vilket kan påskyndas med hjälp av ett neuralt nätverk. Dock finns det inte tillräckligt med experimentiell data för att träna ett sådant nätverk, och därför behövs syntetisk data. För att skapa sådan syntetisk MRE-data utforskades tre tekniker för att simulera vågrörelser i hjärnvävnad; dessa tekniker inkluderar lösning av differentialekvationer för ett system av kopplade harmoniska oscillatorer (CHO-metoden) och användning av två olika funktioner från det Matlab-baserade programmet k-Wave. Var och en av de tre metoderna visade potential att återskapa vågsmönstret i en enkel strukturerad fantom. CHO-metoden och funktionen kspaceFirstOrder från k-Wave visade bäst prestanda vid simulering av vågrörelser i ett 2D-segment av hjärnan. Modellerna visade sig inte vara särskilt precisa, men fångar allmänna, kvalitativa, egenskaper av vågrörelser i hjärnan och uppvisar potential för framtida förbättring.

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