Engineering clinical translation of OGSE diffusion MRI

Oscillating gradient spin echo (OGSE) diffusion MRI (dMRI) can probe the diffusive dynamics on short time scales ≲10 ms, which translates into the sensitivity to tissue microstructure at the short length scales $\lesssim 10\mu$ m. OGSE-based tissue microstructure imaging techniques able to characterize the cell diameter and cellular density have been established in pre-clinical studies. The unique image contrast of OGSE dMRI has been shown to differentiate tumor types and malignancies, enable early diagnosis of treatment effectiveness, and reveal different pathophysiology of lesions in stroke and neurological diseases. Recent innovations in high-performance gradient human MRI systems provide an opportunity to translate OGSE research findings in pre-clinical studies to human research and the clinic. The implementation of OGSE dMRI in human studies has the promise to advance our understanding of human brain microstructure and improve patient care. Compared to the clinical standard (pulsed gradient spin echo), engineering OGSE diffusion encoding for human imaging is more challenging. This review summarizes the impact of hardware and human biophysical safety considerations on the waveform design, imaging parameter space, and image quality of OGSE dMRI. Here we discuss the effects of the gradient amplitude, slew rate, peripheral nerve stimulation, cardiac stimulation, gradient driver, acoustic noise and mechanical vibration, eddy currents, gradient nonlinearity, concomitant gradient, motion and flow, and signal-to-noise ratio. We believe that targeted engineering for safe, high-quality, and reproducible imaging will enable the translation of OGSE dMRI techniques into the clinic.