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<meta name="DC.Title" content="Maximum AmbiGuity Distance for Phase Imaging in Detection of Traumatic Cerebral Microbleeds: An Improvement over Current Imaging Practice" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6774" />
<meta name="DC.Date" content="2020-11-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2020 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Developed using a rigorous mathematic framework, Maximum AmbiGuity distance for Phase Imaging (MAGPI) is a promising phase-imaging technique that provides optimal phase SNR and reduced susceptibility artifacts. We aimed to test the potential of MAGPI over routinely used SWI in the detection of traumatic cerebral microbleeds in athletes diagnosed with mild traumatic brain injury.

MATERIALS AND METHODS: In this prospective study, 10 athletes (18–22 years of age, 3 women/7 men) diagnosed with mild traumatic brain injury were enrolled. Brain MRIs were performed using 3T MR imaging at 2 days, 2 weeks, and 2 months after head trauma. The imaging protocol included whole-brain T1 MPRAGE, T2 FLAIR, conventional SWI, and the MAGPI multiecho sequence. Phase images from MAGPI were put through a previously described SWI process to generate MAGPI-SWI. Conventional and MAGPI-SWI were assessed independently by a board-certified neuroradiologist for the presence of contusions and cerebral microbleeds. All participants had routine neuropsychological assessment and Visuo-Motor Tests.

RESULTS: At initial assessment, 4 of the participants had visuo-motor performance indicative of mild traumatic brain injury, and 4 participants had a Post-Concussion Symptom Scale score of &gt;21, a threshold that has been used to define moderate impairment. Cerebral microbleeds were identified in 6 participants on MAGPI-SWI, 4 of whom had evidence of concurrent contusions on FLAIR imaging. None of these cerebral microbleeds were identified confidently on conventional SWI due to substantial distortion and susceptibility artifacts.

CONCLUSIONS: Optimal phase unwrapping with reduced susceptibility in MAGPI-SWI can clarify small microbleeds that can go undetected with routinely used conventional SWI.

CMB
:   cerebral microbleeds
ImPACT
:   Immediate Post-Concussion Assessment and Cognitive Testing
MAGPI
:   Maximum AmbiGuity distance for Phase Imaging
mTBI
:   mild traumatic brain injury
PCSS
:   Post-Concussion Symptom Scale
VMT
:   Visuo-Motor Test" />
<meta name="DC.Contributor" content="K. Nael" />
<meta name="DC.Contributor" content="J.C. Dagher" />
<meta name="DC.Contributor" content="M.E. Downs" />
<meta name="DC.Contributor" content="M.S. Fine" />
<meta name="DC.Contributor" content="E. Brokaw" />
<meta name="DC.Contributor" content="D. Millward" />
<meta name="article:published_time" content="2020-11-01" />
<meta name="article:section" content="Adult Brain" />
<meta name="citation_title" content="Maximum AmbiGuity Distance for Phase Imaging in Detection of Traumatic Cerebral Microbleeds: An Improvement over Current Imaging Practice" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Developed using a rigorous mathematic framework, Maximum AmbiGuity distance for Phase Imaging (MAGPI) is a promising phase-imaging technique that provides optimal phase SNR and reduced susceptibility artifacts. We aimed to test the potential of MAGPI over routinely used SWI in the detection of traumatic cerebral microbleeds in athletes diagnosed with mild traumatic brain injury.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;In this prospective study, 10 athletes (18–22 years of age, 3 women/7 men) diagnosed with mild traumatic brain injury were enrolled. Brain MRIs were performed using 3T MR imaging at 2 days, 2 weeks, and 2 months after head trauma. The imaging protocol included whole-brain T1 MPRAGE, T2 FLAIR, conventional SWI, and the MAGPI multiecho sequence. Phase images from MAGPI were put through a previously described SWI process to generate MAGPI-SWI. Conventional and MAGPI-SWI were assessed independently by a board-certified neuroradiologist for the presence of contusions and cerebral microbleeds. All participants had routine neuropsychological assessment and Visuo-Motor Tests.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;At initial assessment, 4 of the participants had visuo-motor performance indicative of mild traumatic brain injury, and 4 participants had a Post-Concussion Symptom Scale score of &amp;gt;21, a threshold that has been used to define moderate impairment. Cerebral microbleeds were identified in 6 participants on MAGPI-SWI, 4 of whom had evidence of concurrent contusions on FLAIR imaging. None of these cerebral microbleeds were identified confidently on conventional SWI due to substantial distortion and susceptibility artifacts.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Optimal phase unwrapping with reduced susceptibility in MAGPI-SWI can clarify small microbleeds that can go undetected with routinely used conventional SWI.&lt;/p&gt;" />
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<meta name="twitter:title" content="Maximum AmbiGuity Distance for Phase Imaging in Detection of Traumatic Cerebral Microbleeds: An Improvement over Current Imaging Practice" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Developed using a rigorous mathematic framework, Maximum AmbiGuity distance for Phase Imaging (MAGPI) is a promising phase-imaging technique that provides optimal phase SNR and reduced susceptibility artifacts. We aimed to test the potential of MAGPI over routinely used SWI in the detection of traumatic cerebral microbleeds in athletes diagnosed with mild traumatic brain injury.

MATERIALS AND METHODS: In this prospective study, 10 athletes (18–22 years of age, 3 women/7 men) diagnosed with mild traumatic brain injury were enrolled. Brain MRIs were performed using 3T MR imaging at 2 days, 2 weeks, and 2 months after head trauma. The imaging protocol included whole-brain T1 MPRAGE, T2 FLAIR, conventional SWI, and the MAGPI multiecho sequence. Phase images from MAGPI were put through a previously described SWI process to generate MAGPI-SWI. Conventional and MAGPI-SWI were assessed independently by a board-certified neuroradiologist for the presence of contusions and cerebral microbleeds. All participants had routine neuropsychological assessment and Visuo-Motor Tests.

RESULTS: At initial assessment, 4 of the participants had visuo-motor performance indicative of mild traumatic brain injury, and 4 participants had a Post-Concussion Symptom Scale score of &gt;21, a threshold that has been used to define moderate impairment. Cerebral microbleeds were identified in 6 participants on MAGPI-SWI, 4 of whom had evidence of concurrent contusions on FLAIR imaging. None of these cerebral microbleeds were identified confidently on conventional SWI due to substantial distortion and susceptibility artifacts.

CONCLUSIONS: Optimal phase unwrapping with reduced susceptibility in MAGPI-SWI can clarify small microbleeds that can go undetected with routinely used conventional SWI.

CMB
:   cerebral microbleeds
ImPACT
:   Immediate Post-Concussion Assessment and Cognitive Testing
MAGPI
:   Maximum AmbiGuity distance for Phase Imaging
mTBI
:   mild traumatic brain injury
PCSS
:   Post-Concussion Symptom Scale
VMT
:   Visuo-Motor Test" />
<meta name="og-title" property="og:title" content="Maximum AmbiGuity Distance for Phase Imaging in Detection of Traumatic Cerebral Microbleeds: An Improvement over Current Imaging Practice" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/41/11/2027" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Developed using a rigorous mathematic framework, Maximum AmbiGuity distance for Phase Imaging (MAGPI) is a promising phase-imaging technique that provides optimal phase SNR and reduced susceptibility artifacts. We aimed to test the potential of MAGPI over routinely used SWI in the detection of traumatic cerebral microbleeds in athletes diagnosed with mild traumatic brain injury.

MATERIALS AND METHODS: In this prospective study, 10 athletes (18–22 years of age, 3 women/7 men) diagnosed with mild traumatic brain injury were enrolled. Brain MRIs were performed using 3T MR imaging at 2 days, 2 weeks, and 2 months after head trauma. The imaging protocol included whole-brain T1 MPRAGE, T2 FLAIR, conventional SWI, and the MAGPI multiecho sequence. Phase images from MAGPI were put through a previously described SWI process to generate MAGPI-SWI. Conventional and MAGPI-SWI were assessed independently by a board-certified neuroradiologist for the presence of contusions and cerebral microbleeds. All participants had routine neuropsychological assessment and Visuo-Motor Tests.

RESULTS: At initial assessment, 4 of the participants had visuo-motor performance indicative of mild traumatic brain injury, and 4 participants had a Post-Concussion Symptom Scale score of &gt;21, a threshold that has been used to define moderate impairment. Cerebral microbleeds were identified in 6 participants on MAGPI-SWI, 4 of whom had evidence of concurrent contusions on FLAIR imaging. None of these cerebral microbleeds were identified confidently on conventional SWI due to substantial distortion and susceptibility artifacts.

CONCLUSIONS: Optimal phase unwrapping with reduced susceptibility in MAGPI-SWI can clarify small microbleeds that can go undetected with routinely used conventional SWI.

CMB
:   cerebral microbleeds
ImPACT
:   Immediate Post-Concussion Assessment and Cognitive Testing
MAGPI
:   Maximum AmbiGuity distance for Phase Imaging
mTBI
:   mild traumatic brain injury
PCSS
:   Post-Concussion Symptom Scale
VMT
:   Visuo-Motor Test" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node80899--5" data-node-nid="80899" id="top-node-80899--61608728572" data-pisa="ajnr;41/11/2027" data-pisa-master="ajnr;ajnr.A6774" data-apath="/ajnr/41/11/2027.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Adult Brain</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Maximum AmbiGuity Distance for Phase Imaging in Detection of Traumatic Cerebral Microbleeds: An Improvement over Current Imaging Practice</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">K. Nael</span>, <span class="highwire-citation-author" data-delta="1">J.C. Dagher</span>, <span class="highwire-citation-author" data-delta="2">M.E. Downs</span>, <span class="highwire-citation-author" data-delta="3">M.S. Fine</span>, <span class="highwire-citation-author" data-delta="4">E. Brokaw</span> and <span class="highwire-citation-author" data-delta="5">D. Millward</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">November 2020,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2027-2033; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6774 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-80899--61608728572" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">K. Nael </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the David Geffen School of Medicine (K.N.), University of California, Los Angeles, Los Angeles, California</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.%2BNael%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Nael%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AK.%2BNael%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-4194-9488" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. Nael</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J.C. Dagher </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Emerging Technologies (J.C.D., M.E.D., M.S.F., E.B.), MITRE Corporation, McLean, Virginia</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.C.%2BDagher%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Dagher%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.C.%2BDagher%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-6956-7767" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.C. Dagher</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">M.E. Downs </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Emerging Technologies (J.C.D., M.E.D., M.S.F., E.B.), MITRE Corporation, McLean, Virginia</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.E.%2BDowns%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Downs%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.E.%2BDowns%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-6115-3156" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.E. Downs</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">M.S. Fine </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Emerging Technologies (J.C.D., M.E.D., M.S.F., E.B.), MITRE Corporation, McLean, Virginia</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.S.%2BFine%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Fine%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.S.%2BFine%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-5717-179X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.S. Fine</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">E. Brokaw </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Emerging Technologies (J.C.D., M.E.D., M.S.F., E.B.), MITRE Corporation, McLean, Virginia</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.%2BBrokaw%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Brokaw%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AE.%2BBrokaw%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-5183-2550" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E. Brokaw</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">D. Millward </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Athletics Department (D.M.), University of Arizona, Tucson, Arizona</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.%2BMillward%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Millward%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.%2BMillward%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-2396-8861" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D. Millward</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-web" id="cit-41.11.2027.1"><div class="cit-metadata"><cite><span class="cit-article-title">Centers for Disease Control and Prevention. Surveillance Report of Traumatic Brain Injury-related Emergency Department Visits, Hospitalizations, and Deaths—United States, 2014</span>. <span class="cit-pub-date">2019</span>. <a href="https://www.cdc.gov/traumaticbraininjury/pdf/TBI-Surveillance-Report-FINAL_508.pdf">https://www.cdc.gov/traumaticbraininjury/pdf/TBI-Surveillance-Report-FINAL_508.pdf</a>. <span class="cit-date-in-citation">Accessed March 29, 2019</span></cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-41.11.2027.2" data-doi="10.1097/00001199-199912000-00009"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Thurman</span>  <span class="cit-name-given-names">DJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Alverson</span>  <span 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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 41</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 11 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Nov 2020 </div></div>
      
      
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