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Caullery B, Barone-Rochette G. Is coronary artery disease screening by imaging in patients with chronic kidney disease necessary? Arch Cardiovasc Dis 2024:S1875-2136(24)00286-9. [PMID: 39209692 DOI: 10.1016/j.acvd.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/07/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Benoit Caullery
- Department of Cardiology, University Hospital, 38000 Grenoble, France
| | - Gilles Barone-Rochette
- Department of Cardiology, University Hospital, 38000 Grenoble, France; University Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, 38000 Grenoble, France; French Clinical Research Infrastructure Network, 75018 Paris, France.
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2
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Morrone D, Gentile F, Aimo A, Cameli M, Barison A, Picoi ME, Guglielmo M, Villano A, DeVita A, Mandoli GE, Pastore MC, Barillà F, Mancone M, Pedrinelli R, Indolfi C, Filardi PP, Muscoli S, Tritto I, Pizzi C, Camici PG, Marzilli M, Crea F, Caterina RD, Pontone G, Neglia D, Lanza G. Perspectives in noninvasive imaging for chronic coronary syndromes. Int J Cardiol 2022; 365:19-29. [PMID: 35901907 DOI: 10.1016/j.ijcard.2022.07.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022]
Abstract
Both the latest European guidelines on chronic coronary syndromes and the American guidelines on chest pain have underlined the importance of noninvasive imaging to select patients to be referred to invasive angiography. Nevertheless, although coronary stenosis has long been considered the main determinant of inducible ischemia and symptoms, growing evidence has demonstrated the importance of other underlying mechanisms (e.g., vasospasm, microvascular disease, energetic inefficiency). The search for a pathophysiology-driven treatment of these patients has therefore emerged as an important objective of multimodality imaging, integrating "anatomical" and "functional" information. We here provide an up-to-date guide for the choice and the interpretation of the currently available noninvasive anatomical and/or functional tests, focusing on emerging techniques (e.g., coronary flow velocity reserve, stress-cardiac magnetic resonance, hybrid imaging, functional-coronary computed tomography angiography, etc.), which could provide deeper pathophysiological insights to refine diagnostic and therapeutic pathways in the next future.
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Affiliation(s)
- Doralisa Morrone
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University Hospital of Pisa, Italy.
| | - Francesco Gentile
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University Hospital of Pisa, Italy
| | - Alberto Aimo
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Maria Elena Picoi
- Azienda Tutela Salute Sardegna, Ospedale Giovanni Paolo II, Unità di terapia intensiva Cardiologica, Olbia, Sardegna, Italy
| | - Marco Guglielmo
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan 20138, Italy
| | - Angelo Villano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio DeVita
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesco Barillà
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Policlinico Umberto I, Roma, Italy
| | - Massimo Mancone
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Policlinico Umberto I, Roma, Italy
| | - Roberto Pedrinelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University Hospital of Pisa, Italy
| | - Ciro Indolfi
- Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro - Mediterranea Cardiocentro, Napoli, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy, Mediterranea Cardiocentro, Naples, Italy
| | - Saverio Muscoli
- U.O.C. Cardiologia, Fondazione Policlinico "Tor Vergata", Roma, Italy
| | - Isabella Tritto
- Università di Perugia, Dipartimento di Medicina, Sezione di Cardiologia e Fisiopatologia Cardiovascolare, Perugia, Italy
| | - Carmine Pizzi
- Università di Bologna, Alma Mater Studiorum, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Bologna, Italy
| | - Paolo G Camici
- Vita-Salute University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Mario Marzilli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University Hospital of Pisa, Italy
| | - Filippo Crea
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan 20138, Italy
| | - Raffaele De Caterina
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University Hospital of Pisa, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan 20138, Italy
| | | | - Gaetano Lanza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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3
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Kamphuis ME, de Vries GJ, Kuipers H, Saaltink M, Verschoor J, Greuter MJW, Slart RHJA, Slump CH. Development of a dedicated 3D printed myocardial perfusion phantom: proof-of-concept in dynamic SPECT. Med Biol Eng Comput 2022; 60:1541-1550. [PMID: 35048275 PMCID: PMC9079041 DOI: 10.1007/s11517-021-02490-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
We aim to facilitate phantom-based (ground truth) evaluation of dynamic, quantitative myocardial perfusion imaging (MPI) applications. Current MPI phantoms are static representations or lack clinical hard- and software evaluation capabilities. This proof-of-concept study demonstrates the design, realisation and testing of a dedicated cardiac flow phantom. The 3D printed phantom mimics flow through a left ventricular cavity (LVC) and three myocardial segments. In the accompanying fluid circuit, tap water is pumped through the LVC and thereafter partially directed to the segments using adjustable resistances. Regulation hereof mimics perfusion deficit, whereby flow sensors serve as reference standard. Seven phantom measurements were performed while varying injected activity of 99mTc-tetrofosmin (330–550 MBq), cardiac output (1.5–3.0 L/min) and myocardial segmental flows (50–150 mL/min). Image data from dynamic single photon emission computed tomography was analysed with clinical software. Derived time activity curves were reproducible, showing logical trends regarding selected input variables. A promising correlation was found between software computed myocardial flows and its reference (\documentclass[12pt]{minimal}
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\begin{document}$$\rho$$\end{document}ρ= − 0.98; p = 0.003). This proof-of-concept paper demonstrates we have successfully measured first-pass LV flow and myocardial perfusion in SPECT-MPI using a novel, dedicated, myocardial perfusion phantom.
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Affiliation(s)
- Marije E Kamphuis
- Multi-Modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre 2386, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands. .,Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Gijs J de Vries
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Henny Kuipers
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Marloes Saaltink
- Department of Nuclear Medicine, Ziekenhuis Groep Twente, Hengelo, The Netherlands
| | - Jacqueline Verschoor
- Department of Nuclear Medicine, Ziekenhuis Groep Twente, Hengelo, The Netherlands
| | - Marcel J W Greuter
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Biomedical Photonic Imaging Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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4
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Youssef K, Heydari B, Rivero LZ, Beaulieu T, Cheema K, Dharmakumar R, Sharif B. A Patch-Wise Deep Learning Approach for Myocardial Blood Flow Quantification with Robustness to Noise and Nonrigid Motion. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4045-4051. [PMID: 34892118 PMCID: PMC9989970 DOI: 10.1109/embc46164.2021.9629630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Quantitative analysis of dynamic contrast-enhanced cardiovascular MRI (cMRI) datasets enables the assessment of myocardial blood flow (MBF) for objective evaluation of ischemic heart disease in patients with suspected coronary artery disease. State-of-the-art MBF quantification techniques use constrained deconvolution and are highly sensitive to noise and motion-induced errors, which can lead to unreliable outcomes in the setting of high-resolution MBF mapping. To overcome these limitations, recent iterative approaches incorporate spatial-smoothness constraints to tackle pixel-wise MBF mapping. However, such iterative methods require a computational time of up to 30 minutes per acquired myocardial slice, which is a major practical limitation. Furthermore, they cannot enforce robustness to residual nonrigid motion which can occur in clinical stress/rest studies of patients with arrhythmia. We present a non-iterative patch-wise deep learning approach for pixel-wise MBF quantification wherein local spatio-temporal features are learned from a large dataset of myocardial patches acquired in clinical stress/rest cMRI studies. Our approach is scanner-independent, computationally efficient, robust to noise, and has the unique feature of robustness to motion-induced errors. Numerical and experimental results obtained using real patient data demonstrate the effectiveness of our approach.Clinical Relevance- The proposed patch-wise deep learning approach significantly improves the reliability of high-resolution myocardial blood flow quantification in cMRI by improving its robustness to noise and nonrigid myocardial motion and is up to 300-fold faster than state-of-the-art iterative approaches.
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5
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Juneau D, Wu KY, Kaps N, Yao J, Renaud JM, Beanlands RSB, Ruddy TD, deKemp RA. Internal validation of myocardial flow reserve PET imaging using stress/rest myocardial activity ratios with Rb-82 and N-13-ammonia. J Nucl Cardiol 2021; 28:835-850. [PMID: 33389638 DOI: 10.1007/s12350-020-02464-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Myocardial flow reserve (MFR) measurement provides incremental diagnostic and prognostic information. The objective of the current study was to investigate the application of a simplified model for the estimation of MFR using only the stress/rest myocardial activity ratio (MAR) in patients undergoing rest-stress cardiac PET MPI. METHODS AND RESULTS Rest and dipyridamole stress dynamic PET imaging was performed in consecutive patients using 82Rb or 13NH3 (n = 250 each). Reference standard MFR was quantified using a standard one-tissue compartment model. Stress/rest myocardial activity ratio (MAR) was calculated using the LV-mean activity from 2 to 6 minutes post-injection. Simplified estimates of MFR (MFREST) were then calculated using an inverse power function. For 13NH3, there was good correlation between MFR and MFREST values (R = 0.63), with similar results for 82Rb (R = 0.73). There was no bias in the MFREST values with either tracer. The overall diagnostic performance of MFREST for detection of MFR < 2 was good with ROC area under the curve (AUC) = 83.2 ± 1.2% for 13NH3 and AUC = 90.4 ± 0.7% for 82Rb. CONCLUSION MFR was estimated with good accuracy using 82Rb and 13NH3 with a simplified method that relies only on stress/rest activity ratios. This novel approach does not require dynamic imaging or tracer kinetic modeling. It may be useful for routine quality assurance of PET MFR measurements, or in scanners where full dynamic imaging and tracer kinetic modeling is not feasible for technical or logistical reasons.
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Affiliation(s)
- Daniel Juneau
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada.
- Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
| | - Kai Yi Wu
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
- Department of Medicine and Dentistry (Medicine), University of Alberta, Edmonton, AB, Canada
| | - Nicole Kaps
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Jason Yao
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| | - Jennifer M Renaud
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
- INVIA Medical Imaging Solutions, Ann Arbor, MI, USA
| | - Rob S B Beanlands
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| | - Terrence D Ruddy
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| | - Robert A deKemp
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
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6
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Daviller C, Boutelier T, Giri S, Ratiney H, Jolly MP, Vallée JP, Croisille P, Viallon M. Direct Comparison of Bayesian and Fermi Deconvolution Approaches for Myocardial Blood Flow Quantification: In silico and Clinical Validations. Front Physiol 2021; 12:483714. [PMID: 33912066 PMCID: PMC8072361 DOI: 10.3389/fphys.2021.483714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
Cardiac magnetic resonance myocardial perfusion imaging can detect coronary artery disease and is an alternative to single-photon emission computed tomography or positron emission tomography. However, the complex, non-linear MR signal and the lack of robust quantification of myocardial blood flow have hindered its widespread clinical application thus far. Recently, a new Bayesian approach was developed for brain imaging and evaluation of perfusion indexes (Kudo et al., 2014). In addition to providing accurate perfusion measurements, this probabilistic approach appears more robust than previous approaches, particularly due to its insensitivity to bolus arrival delays. We assessed the performance of this approach against a well-known and commonly deployed model-independent method based on the Fermi function for cardiac magnetic resonance myocardial perfusion imaging. The methods were first evaluated for accuracy and precision using a digital phantom to test them against the ground truth; next, they were applied in a group of coronary artery disease patients. The Bayesian method can be considered an appropriate model-independent method with which to estimate myocardial blood flow and delays. The digital phantom comprised a set of synthetic time-concentration curve combinations generated with a 2-compartment exchange model and a realistic combination of perfusion indexes, arterial input dynamics, noise and delays collected from the clinical dataset. The myocardial blood flow values estimated with the two methods showed an excellent correlation coefficient (r2 > 0.9) under all noise and delay conditions. The Bayesian approach showed excellent robustness to bolus arrival delays, with a similar performance to Fermi modeling when delays were considered. Delays were better estimated with the Bayesian approach than with Fermi modeling. An in vivo analysis of coronary artery disease patients revealed that the Bayesian approach had an excellent ability to distinguish between abnormal and normal myocardium. The Bayesian approach was able to discriminate not only flows but also delays with increased sensitivity by offering a clearly enlarged range of distribution for the physiologic parameters.
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Affiliation(s)
- Clément Daviller
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1294, Lyon, France
| | - Timothé Boutelier
- Department of Research and Innovation, Olea Medical, La Ciotat, France
| | - Shivraman Giri
- Siemens Medical Solutions USA, Inc., Boston, MA, United States
| | - Hélène Ratiney
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1294, Lyon, France
| | | | - Jean-Paul Vallée
- Division of Radiology, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Pierre Croisille
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1294, Lyon, France.,Department of Radiology, CHU de Saint-Etienne, University of Lyon, UJM-Saint-Etienne, Saint-Étienne, France
| | - Magalie Viallon
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1294, Lyon, France.,Department of Radiology, CHU de Saint-Etienne, University of Lyon, UJM-Saint-Etienne, Saint-Étienne, France
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7
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Coronary Artery Disease: From Mechanism to Clinical Practice. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1177:1-36. [PMID: 32246442 DOI: 10.1007/978-981-15-2517-9_1] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In most developed countries, coronary artery disease (CAD), mostly caused by atherosclerosis of coronary arteries, is one of the primary causes of death. From 1990s to 2000s, mortality caused by acute MI declined up to 50%. The incidence of CAD is related with age, gender, economic, etc. Atherosclerosis contains some highly correlative processes such as lipid disturbances, thrombosis, inflammation, vascular smooth cell activation, remodeling, platelet activation, endothelial dysfunction, oxidative stress, altered matrix metabolism, and genetic factors. Risk factors of CAD exist among many individuals of the general population, which includes hypertension, lipids and lipoproteins metabolism disturbances, diabetes mellitus, chronic kidney disease, age, genders, lifestyle, cigarette smoking, diet, obesity, and family history. Angina pectoris is caused by myocardial ischemia in the main expression of pain in the chest or adjoining area, which is usually a result of exertion and related to myocardial function disorder. Typical angina pectoris would last for minutes with gradual exacerbation. Rest, sit, or stop walking are the usual preference for patients with angina, and reaching the maximum intensity in seconds is uncommon. Rest or nitroglycerin usage can relieve typical angina pectoris within minutes. So far, a widely accepted angina pectoris severity grading system included CCS (Canadian Cardiovascular Society) classification, Califf score, and Goldman scale. Patients with ST-segment elevated myocardial infarction (STEMI) may have different symptoms and signs of both severe angina pectoris and various complications. The combination of rising usage of sensitive MI biomarkers and precise imaging techniques, including electrocardiograph (ECG), computed tomography, and cardiac magnetic resonance imaging, made the new MI criteria necessary. Complications of acute myocardial infarction include left ventricular dysfunction, cardiogenic shock, structural complications, arrhythmia, recurrent chest discomfort, recurrent ischemia and infarction, pericardial effusion, pericarditis, post-myocardial infarction syndrome, venous thrombosis pulmonary embolism, left ventricular aneurysm, left ventricular thrombus, and arterial embolism.
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8
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Everaars H, van Diemen PA, Bom MJ, Schumacher SP, de Winter RW, van de Ven PM, Raijmakers PG, Lammertsma AA, Hofman MBM, van der Geest RJ, Götte MJ, van Rossum AC, Nijveldt R, Danad I, Driessen RS, Knaapen P. Comparison between quantitative cardiac magnetic resonance perfusion imaging and [ 15O]H 2O positron emission tomography. Eur J Nucl Med Mol Imaging 2019; 47:1688-1697. [PMID: 31822958 PMCID: PMC7248026 DOI: 10.1007/s00259-019-04641-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022]
Abstract
Purpose To compare cardiac magnetic resonance imaging (CMR) with [15O]H2O positron emission tomography (PET) for quantification of absolute myocardial blood flow (MBF) and myocardial flow reserve (MFR) in patients with coronary artery disease (CAD). Methods Fifty-nine patients with stable CAD underwent CMR and [15O]H2O PET. The CMR imaging protocol included late gadolinium enhancement to rule out presence of scar tissue and perfusion imaging using a dual sequence, single bolus technique. Absolute MBF was determined for the three main vascular territories at rest and during vasodilator stress. Results CMR measurements of regional stress MBF and MFR showed only moderate correlation to those obtained using PET (r = 0.39; P < 0.001 for stress MBF and r = 0.36; P < 0.001 for MFR). Bland-Altman analysis revealed a significant bias of 0.2 ± 1.0 mL/min/g for stress MBF and − 0.5 ± 1.2 for MFR. CMR-derived stress MBF and MFR demonstrated area under the curves of respectively 0.72 (95% CI: 0.65 to 0.79) and 0.76 (95% CI: 0.69 to 0.83) and had optimal cutoff values of 2.35 mL/min/g and 2.25 for detecting abnormal myocardial perfusion, defined as [15O]H2O PET-derived stress MBF ≤ 2.3 mL/min/g and MFR ≤ 2.5. Using these cutoff values, CMR and PET were concordant in 137 (77%) vascular territories for stress MBF and 135 (80%) vascular territories for MFR. Conclusion CMR measurements of stress MBF and MFR showed modest agreement to those obtained with [15O]H2O PET. Nevertheless, stress MBF and MFR were concordant between CMR and [15O]H2O PET in 77% and 80% of vascular territories, respectively.
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Affiliation(s)
- Henk Everaars
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Michiel J Bom
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Ruben W de Winter
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Pieter G Raijmakers
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Mark B M Hofman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Centers, Leiden, the Netherlands
| | - Marco J Götte
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands.
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9
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Nazir MS, Gould SM, Milidonis X, Reyes E, Ismail TF, Neji R, Roujol S, O’Doherty J, Xue H, Barrington SF, Schaeffter T, Razavi R, Marsden P, Kellman P, Plein S, Chiribiri A. Simultaneous 13N-Ammonia and gadolinium first-pass myocardial perfusion with quantitative hybrid PET-MR imaging: a phantom and clinical feasibility study. Eur J Hybrid Imaging 2019; 3:15. [PMID: 31544170 PMCID: PMC6718374 DOI: 10.1186/s41824-019-0062-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/15/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Positron emission tomography (PET) is the non-invasive reference standard for myocardial blood flow (MBF) quantification. Hybrid PET-MR allows simultaneous PET and cardiac magnetic resonance (CMR) acquisition under identical experimental and physiological conditions. This study aimed to determine feasibility of simultaneous 13N-Ammonia PET and dynamic contrast-enhanced CMR MBF quantification in phantoms and healthy volunteers. METHODS Images were acquired using a 3T hybrid PET-MR scanner. Phantom study: MBF was simulated at different physiological perfusion rates and a protocol for simultaneous PET-MR perfusion imaging was developed. Volunteer study: five healthy volunteers underwent adenosine stress. 13N-Ammonia and gadolinium were administered simultaneously. PET list mode data was reconstructed using ordered subset expectation maximisation. CMR MBF was quantified using Fermi function-constrained deconvolution of arterial input function and myocardial signal. PET MBF was obtained using a one-tissue compartment model and image-derived input function. RESULTS Phantom study: PET and CMR MBF measurements demonstrated high repeatability with intraclass coefficients 0.98 and 0.99, respectively. There was high correlation between PET and CMR MBF (r = 0.98, p < 0.001) and good agreement (bias - 0.85 mL/g/min; 95% limits of agreement 0.29 to - 1.98). Volunteer study: Mean global stress MBF for CMR and PET were 2.58 ± 0.11 and 2.60 ± 0.47 mL/g/min respectively. On a per territory basis, there was moderate correlation (r = 0.63, p = 0.03) and agreement (bias - 0.34 mL/g/min; 95% limits of agreement 0.49 to - 1.18). CONCLUSION Simultaneous MBF quantification using hybrid PET-MR imaging is feasible with high test repeatability and good to moderate agreement between PET and CMR. Future studies in coronary artery disease patients may allow cross-validation of techniques.
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Affiliation(s)
- Muhummad Sohaib Nazir
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Sarah-May Gould
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Xenios Milidonis
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Eliana Reyes
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Tevfik F. Ismail
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Radhouene Neji
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
- Siemens Healthcare Limited, Sir William Siemens Square, Frimley, Camberley, GU16 8QD UK
| | - Sébastien Roujol
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Jim O’Doherty
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD USA
| | - Sally F. Barrington
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Tobias Schaeffter
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
- Physikalisch-Technische Bundesanstalt, Berlin, Germany
| | - Reza Razavi
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Paul Marsden
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD USA
| | - Sven Plein
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
| | - Amedeo Chiribiri
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
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10
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Daviller C, Grenier T, Ratiney H, Sdika M, Croisille P, Viallon M. Automatic myocardial ischemic lesion detection on magnetic resonance perfusion weighted imaging prior perfusion quantification: A pre-modeling strategy. Comput Biol Med 2019; 110:108-119. [PMID: 31153004 DOI: 10.1016/j.compbiomed.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/24/2019] [Accepted: 05/01/2019] [Indexed: 11/18/2022]
Abstract
Even if cardiovascular magnetic resonance (CMR) perfusion imaging has proven its relevance for visual detection of ischemia, myocardial blood flow (MBF) quantification at the voxel observation scale remains challenging. Integration of an automated segmentation step, prior to perfusion index estimation, might be a significant reconstruction component that could allow sustainable assumptions and constraint enlargement prior to advanced modeling. Current clustering techniques, such as bullseye representation or manual delineation, are not designed to discriminate voxels belonging to the lesion from healthy areas. Hence, the resulting average time-intensity curve, which is assumed to represent the dynamic contrast enhancement inside of a lesion, might be contaminated by voxels with perfectly healthy microcirculation. This study introduces a hierarchical lesion segmentation approach based on time-intensity curve features that considers the spatial particularities of CMR myocardial perfusion. A first k-means clustering approach enables this method to perform coarse clustering, which is refined by a novel spatiotemporal region-growing (STRG) segmentation, thus ensuring spatial and time-intensity curve homogeneity. Over a cohort of 30 patients, myocardial blood flow (MBF) measured in voxels of lesion regions detected with STRG was significantly lower than in regions drawn manually (mean difference = 0.14, 95% CI [0.07, 0.2]) and defined with the bullseye template (mean difference = 0.25, 95% CI [0.17, 0.36]). Over the 90 analyzed slices, the median Dice score calculated against the ground truth ranged between 0.62 and 0.67, the inclusion coefficients ranged between 0.62 and 0.76 and the centroid distances ranged between 0.97 and 3.88 mm. Therefore, though these metrics highlight spatial differences, they could not be used as an index to evaluate the accuracy and performance of the method, which can only be attested by the variability of the MBF clinical index.
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Affiliation(s)
- Clément Daviller
- Univ. Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5520, U1206, F-69621, Villeurbanne, France
| | - Thomas Grenier
- Univ. Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5520, U1206, F-69621, Villeurbanne, France
| | - Hélène Ratiney
- Univ. Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5520, U1206, F-69621, Villeurbanne, France
| | - Michaël Sdika
- Univ. Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5520, U1206, F-69621, Villeurbanne, France
| | - Pierre Croisille
- Univ Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France; Radiology Dept. CHU de Saint Etienne, Univ Lyon, UJM-Saint-Etienne, F-42023, Saint-Etienne, France
| | - Magalie Viallon
- Univ Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France; Radiology Dept. CHU de Saint Etienne, Univ Lyon, UJM-Saint-Etienne, F-42023, Saint-Etienne, France.
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11
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Gewirtz H. Coronary circulation: Pressure/flow parameters for assessment of ischemic heart disease. J Nucl Cardiol 2019; 26:459-470. [PMID: 29637523 DOI: 10.1007/s12350-018-1270-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/23/2018] [Indexed: 01/10/2023]
Abstract
Both invasive and non-invasive parameters have been reported for assessment of the physiological status of the coronary circulation. Fractional flow reserve and coronary (or myocardial) flow reserve may be obtained by invasive or non-invasive means. These metrics of coronary stenosis severity have achieved wide clinical acceptance for guiding revascularization decisions and risk stratification. Other indices are obtained invasively (e.g., instantaneous wave-free ratio, iFR; hyperemic stenosis resistance) or non-invasively (e.g., PET absolute myocardial blood flow (mL/min/g)) and have been used for the same purposes. Both iFR, and whole-cycle distal coronary to aortic mean pressure (Pd/Pa) are measured under basal condition and used for assessment of hemodynamic stenosis severity as is index of basal stenosis resistance (BSR). These metrics typically are dichotomized at an empirically derived cut point into "normal" and "abnormal" categories for purposes of clinical decision making and data analysis. Once dichotomized the indices do not always point in the same direction and so confusion may arise. This review, therefore, will present basic principles relevant to understanding commonly employed metrics of the physiological status of the coronary circulation, potential strengths and weaknesses, and hopefully an improved appreciation of the clinical information provided by each.
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Affiliation(s)
- Henry Gewirtz
- Department of Medicine (Cardiology Division), Harvard Medical School, Massachusetts General Hospital, Boston, MA, 02114, USA.
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12
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Contemporary Issues in Quantitative Myocardial Perfusion CMR Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Lehnert J, Wübbeler G, Kolbitsch C, Chiribiri A, Coquelin L, Ebrard G, Smith N, Schaeffter T, Elster C. Pixel-wise quantification of myocardial perfusion using spatial Tikhonov regularization. Phys Med Biol 2018; 63:215017. [PMID: 30372423 DOI: 10.1088/1361-6560/aae758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Quantification of myocardial perfusion by contrast-enhanced cardiovascular magnetic resonance imaging (CMR) aims for an observer independent and reproducible risk assessment of cardiovascular disease. Currently, the data used for the pixel-wise analysis of cardiac perfusion are either filtered prior to a fitting procedure, which inherently reduces the spatial resolution of data; or all pixels are considered without any regularization or prior filtering, which yields an unstable fit in the presence of low signal-to-noise ratio. Here, we propose a new pixel-wise analysis based on spatial Tikhonov regularization which exploits the spatial smoothness of the data and ensures accurate quantification even for images with low signal-to-noise ratio. The regularization parameter is determined automatically by an L-curve criterion. We study the performance of our method on a numerical phantom and demonstrate that the method reduces significantly the root-mean square error in the perfusion estimate compared to a non-regularized fit. In patient data our method allows us to recover the myocardial perfusion and to distinguish between healthy and ischemic regions.
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Affiliation(s)
- Judith Lehnert
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany. Author to whom any correspondence should be addressed
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14
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CT Myocardial Perfusion Imaging: A New Frontier in Cardiac Imaging. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7295460. [PMID: 30406139 PMCID: PMC6204157 DOI: 10.1155/2018/7295460] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/09/2018] [Indexed: 12/21/2022]
Abstract
The past two decades have witnessed rapid and remarkable technical improvement of multidetector computed tomography (CT) in both image quality and diagnostic accuracy. These improvements include higher temporal resolution, high-definition and wider detectors, the introduction of dual-source and dual-energy scanners, and advanced postprocessing. Current new generation multidetector row (≥64 slices) CT systems allow an accurate and reliable assessment of both coronary epicardial stenosis and myocardial CT perfusion (CTP) imaging at rest and during pharmacologic stress in the same examination. This novel application makes CT the unique noninvasive "one-stop-shop" method for a comprehensive assessment of both anatomical coronary atherosclerosis and its physiological consequences. Myocardial CTP imaging can be performed with different approaches such as static arterial first-pass imaging, and dynamic CTP imaging, with their own advantages and disadvantages. Static CTP can be performed using single-energy or dual-energy CT, employing qualitative or semiquantitative analysis. In addition, dynamic CTP can obtain quantitative data of myocardial blood flow and coronary flow reserve. The purpose of this review was to summarize all available evidence about the emerging role of myocardial CTP to identify ischemia-associated lesions, focusing on technical considerations, clinical applications, strengths, limitations, and the more promising future fields of interest in the broad spectra of ischemic heart disease.
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15
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Bietenbeck M, Florian A, Shomanova Z, Meier C, Yilmaz A. Reduced global myocardial perfusion reserve in DCM and HCM patients assessed by CMR-based velocity-encoded coronary sinus flow measurements and first-pass perfusion imaging. Clin Res Cardiol 2018; 107:1062-1070. [PMID: 29774406 DOI: 10.1007/s00392-018-1279-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/14/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is an independent predictor of poor prognosis in patients suffering from dilative or hypertrophic cardiomyopathy (DCM/HCM). To assess CMD, quantitative myocardial first-pass perfusion (1P) cardiovascular magnetic resonance (CMR) can be performed. Coronary sinus flow (CSF) measurements at rest and during maximal vasodilatation are an alternative and well-validated approach for the quantification of global myocardial blood flow (MBF) in CMR. METHODS Global myocardial perfusion reserve (MPR) was used to compare both methods, 1P and CSF. This measure reflects the ratio of myocardial blood flow during maximal coronary vasodilatation over rest. 1P-MPR and CSF-MPR were calculated in 17 HCM patients, 14 DCM patients and 16 controls, who underwent a stress CMR study to rule out obstructive coronary artery disease. All patients were examined on a 1.5-T system and the study protocol comprised both, first-pass myocardial perfusion imaging (MPI) and velocity-encoded (VENC) phase-contrast imaging of CSF during rest and adenosine stress. RESULTS 1P-MPR was significantly decreased only in HCM patients compared to controls (1.14 vs. 1.43, p = 0.045) whereas CSF-MPR was significantly reduced in both patient groups, HCM and DCM, compared to controls (2.38 and 2.07 vs. 3.18, p = 0.041 and p = 0.032). CSF-MBF at maximal stress was significantly lower in HCM and DCM patients compared to the control group (0.11 and 1.23 vs. 1.58 ml/min/g, p = 0.008 and p = 0.040). A moderate but significant correlation between CSF-MPR and 1P-MPR was observed (r = 0.39, p = 0.011). A negative correlation between LV wall thickness and CSF-MBF at rest and stress was found in the DCM group using VENC-based CSF measurements (r = - 0.64, p = 0.013 and r = - 0.69, p = 0.006)-but not using 1P-MPI. Post-proceeding analysis regarding 1P-MPR and CSF-MPR measurements required 20.1 and 6.5 min, respectively (p < 0.001). CONCLUSION The presence of microvascular disease can be non-invasively and quickly detected by VENC-based CSF-MPR measurements during routine stress perfusion CMR in both HCM and DCM patients. Compared to conventional 1P-MPI, VENC-based CSF-MPR is particularly useful in DCM patients with thinned ventricular walls.
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Affiliation(s)
- Michael Bietenbeck
- Department of Cardiovascular Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Anca Florian
- Department of Cardiovascular Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Zornitsa Shomanova
- Department of Cardiovascular Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Claudia Meier
- Department of Cardiovascular Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Ali Yilmaz
- Department of Cardiovascular Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
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16
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Borrazzo C, Galea N, Pacilio M, Altabella L, Preziosi E, Carnì M, Ciolina F, Vullo F, Francone M, Catalano C, Carbone I. Myocardial blood flow estimates from dynamic contrast-enhanced magnetic resonance imaging: three quantitative methods. ACTA ACUST UNITED AC 2018; 63:035008. [DOI: 10.1088/1361-6560/aaa2a8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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17
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Levelt E, Piechnik SK, Liu A, Wijesurendra RS, Mahmod M, Ariga R, Francis JM, Greiser A, Clarke K, Neubauer S, Ferreira VM, Karamitsos TD. Adenosine stress CMR T1-mapping detects early microvascular dysfunction in patients with type 2 diabetes mellitus without obstructive coronary artery disease. J Cardiovasc Magn Reson 2017; 19:81. [PMID: 29070069 PMCID: PMC5655826 DOI: 10.1186/s12968-017-0397-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 10/12/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with coronary microvascular dysfunction in the absence of obstructive coronary artery disease (CAD). Cardiovascular magnetic resonance (CMR) T1-mapping at rest and during adenosine stress can assess coronary vascular reactivity. We hypothesised that the non-contrast T1 response to vasodilator stress will be altered in patients with T2DM without CAD compared to controls due to coronary microvascular dysfunction. METHODS Thirty-one patients with T2DM and sixteen matched healthy controls underwent CMR (3 T) for cine, rest and adenosine stress non-contrast T1-mapping (ShMOLLI), first-pass perfusion and late gadolinium enhancement (LGE) imaging. Significant CAD (>50% coronary luminal stenosis) was excluded in all patients by coronary computed tomographic angiography. RESULTS All subjects had normal left ventricular (LV) ejection and LV mass index, with no LGE. Myocardial perfusion reserve index (MPRI) was lower in T2DM than in controls (1.60 ± 0.44 vs 2.01 ± 0.42; p = 0.008). There was no difference in rest native T1 values (p = 0.59). During adenosine stress, T1 values increased significantly in both T2DM patients (from 1196 ± 32 ms to 1244 ± 44 ms, p < 0.001) and controls (from 1194 ± 26 ms to 1273 ± 44 ms, p < 0.001). T2DM patients showed blunted relative stress non-contrast T1 response (T2DM: ΔT1 = 4.1 ± 2.9% vs. CONTROLS ΔT1 = 6.6 ± 2.6%, p = 0.007) due to a blunted maximal T1 during adenosine stress (T2DM 1244 ± 44 ms vs. controls 1273 ± 44 ms, p = 0.045). CONCLUSIONS Patients with well controlled T2DM, even in the absence of arterial hypertension and significant CAD, exhibit blunted maximal non-contrast T1 response during adenosine vasodilatory stress, likely reflecting coronary microvascular dysfunction. Adenosine stress and rest T1 mapping can detect subclinical abnormalities of the coronary microvasculature, without the need for gadolinium contrast agents. CMR may identify early features of the diabetic heart phenotype and subclinical cardiac risk markers in patients with T2DM, providing an opportunity for early therapeutic intervention.
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Affiliation(s)
- Eylem Levelt
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Stefan K Piechnik
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alexander Liu
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rohan S Wijesurendra
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Masliza Mahmod
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rina Ariga
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jane M Francis
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Theodoros D Karamitsos
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
- 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital St. Kyriakidi 1, 54636, Thessaloniki, Greece.
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18
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Farge D, Burt RK, Oliveira MC, Mousseaux E, Rovira M, Marjanovic Z, de Vries-Bouwstra J, Del Papa N, Saccardi R, Shah SJ, Lee DC, Denton C, Alexander T, Kiely DG, Snowden JA. Cardiopulmonary assessment of patients with systemic sclerosis for hematopoietic stem cell transplantation: recommendations from the European Society for Blood and Marrow Transplantation Autoimmune Diseases Working Party and collaborating partners. Bone Marrow Transplant 2017; 52:1495-1503. [PMID: 28530671 PMCID: PMC5671927 DOI: 10.1038/bmt.2017.56] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/29/2017] [Indexed: 02/07/2023]
Abstract
Systemic sclerosis (SSc) is a rare disabling autoimmune disease with a similar mortality to many cancers. Two randomized controlled trials of autologous hematopoietic stem cell transplantation (AHSCT) for SSc have shown significant improvement in organ function, quality of life and long-term survival compared to standard therapy. However, transplant-related mortality (TRM) ranged from 3–10% in patients undergoing HSCT. In SSc, the main cause of non-transplant and TRM is cardiac related. We therefore updated the previously published guidelines for cardiac evaluation, which should be performed in dedicated centers with expertize in HSCT for SSc. The current recommendations are based on pre-transplant cardiopulmonary evaluations combining pulmonary function tests, echocardiography, cardiac magnetic resonance imaging and invasive hemodynamic testing, initiated at Northwestern University (Chicago) and subsequently discussed and endorsed within the EBMT ADWP in 2016.
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Affiliation(s)
- D Farge
- Department of Internal Medicine, Unité Clinique de Médecine Interne, Maladies Auto-immunes et Pathologie Vasculaire, UF 04, Hôpital Saint-Louis, AP-HP Assistance Publique des Hôpitaux de Paris, INSERM UMRS 1160, Paris Denis Diderot University, Paris, France
| | - R K Burt
- Department of Medicine, Division of Immunotherapy, Northwestern University, Chicago, IL, USA
| | - M-C Oliveira
- Departamento de Clínica Médica, Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - E Mousseaux
- Hôpital Européen Georges Pompidou, AP-HP Assistance Publique des Hôpitaux de Paris, INSERM UMR 970, Université Paris Descartes, Paris, France
| | - M Rovira
- Department of Hematology, HSCT Unit, Hospital Clinic, Barcelona, Spain
| | - Z Marjanovic
- Department of Hematology, Saint-Antoine Hospital Paris, Assistance Publique des Hôpitaux de Paris, APHP, Paris, France
| | | | - N Del Papa
- Department of Rheumatology, Scleroderma Clinic, Osp. G. Pini, Milan, Italy
| | - R Saccardi
- Department of Hematology, Cord Blood Bank, Careggi University Hospital, Florence, Italy
| | - S J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D C Lee
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - C Denton
- UCL Division of Medicine Royal Free Campus, London, UK
| | - T Alexander
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - D G Kiely
- Sheffield Pulmonary Vascular Disease Unit, M-floor, Royal Hallamshire Hospital, Sheffield, UK
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, UK
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Balfour PC, Gonzalez JA, Kramer CM. Non-invasive assessment of low- and intermediate-risk patients with chest pain. Trends Cardiovasc Med 2016; 27:182-189. [PMID: 27717538 DOI: 10.1016/j.tcm.2016.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/28/2016] [Accepted: 08/16/2016] [Indexed: 01/26/2023]
Abstract
Coronary artery disease (CAD) remains a significant global public health burden despite advancements in prevention and therapeutic strategies. Common non-invasive imaging modalities, anatomic and functional, are available for the assessment of patients with stable chest pain. Exercise electrocardiography is a long-standing method for evaluation for CAD and remains the initial test for the majority of patients who can exercise adequately with a baseline interpretable electrocardiogram. The addition of cardiac imaging to exercise testing provides incremental benefit for accurate diagnosis for CAD and is particularly useful in patients who are unable to exercise adequately and/or have uninterpretable electrocardiograms. Radionuclide myocardial perfusion imaging and echocardiography with exercise or pharmacological stress provide high sensitivity and specificity in the detection and further risk stratification of patients with CAD. Recently, coronary computed tomography angiography has demonstrated its growing role to rule out significant CAD given its high negative predictive value. Although less available, stress cardiac magnetic resonance provides a comprehensive assessment of cardiac structure and function and provides a high diagnostic accuracy in the detection of CAD. The utilization of non-invasive testing is complex due to various advantages and limitations, particularly in the assessment of low- and intermediate-risk patients with chest pain, where no single study is suitable for all patients. This review will describe currently available non-invasive modalities, along with current evidence-based guidelines and appropriate use criteria in the assessment of low- and intermediate-risk patients with suspected, stable CAD.
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Affiliation(s)
- Pelbreton C Balfour
- Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA
| | - Jorge A Gonzalez
- Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA
| | - Christopher M Kramer
- Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA; Department of Radiology, University of Virginia Health System, Charlottesville, VA.
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20
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Chatterjee N, Benefield BC, Harris KR, Fluckiger JU, Carroll T, Lee DC. An empirical method for reducing variability and complexity of myocardial perfusion quantification by dual bolus cardiac MRI. Magn Reson Med 2016; 77:2347-2355. [PMID: 27605488 DOI: 10.1002/mrm.26326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/02/2016] [Accepted: 06/08/2016] [Indexed: 11/07/2022]
Abstract
PURPOSE Myocardial perfusion can be quantified using the "dual bolus" technique, which uses two separate contrast boluses to avoid signal nonlinearity in the blood pool. This technique relies on knowing the precise ratio of contrast concentrations between the two boluses. In this study, we investigated the variability found in these ratios, as well as the error it introduces, and developed a method for correction. METHODS Five dogs received dual bolus myocardial perfusion MRI scans. Perfusion was calculated separately using assumed contrast dilution ratios and empirically determined contrast ratios. Perfusion was compared with reference standard fluorescent microspheres. The same technique was then applied to a cohort of six patients with no significant coronary artery stenosis by cardiac catheterization. RESULTS Assumed contrast dilution ratios were 10:1 for all animal and patient scans. Empirically derived contrast ratios were significantly different for animal (8.51:1 ± 1.53:1, P < 0.001) and patient scans (7.32:1 ± 2.27:1, P < 0.01). Incorporating empirically derived ratios for animal scans improved correlation with microspheres from 0.84 to 0.90 (P < 0.05). CONCLUSION Variability in dual bolus contrast concentration ratios is an important source of experimental error, especially outside of a carefully controlled laboratory setting. Empirically deriving the correct ratio is feasible and improves the accuracy of quantitative perfusion measurements. Magn Reson Med 77:2347-2355, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Neil Chatterjee
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
| | - Brandon C Benefield
- Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, Illinois, USA
| | - Kathleen R Harris
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Jacob U Fluckiger
- GE Medical, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Timothy Carroll
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
- University of Chicago, Department of Medical Physics, University of Chicago, Chicago, Illinois, USA
| | - Daniel C Lee
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
- Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, Illinois, USA
- GE Medical, Department of Medicine, Northwestern University, Chicago, Illinois, USA
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Jacobs M, Benovoy M, Chang LC, Arai AE, Hsu LY. Evaluation of an automated method for arterial input function detection for first-pass myocardial perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2016; 18:17. [PMID: 27055445 PMCID: PMC4825084 DOI: 10.1186/s12968-016-0239-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/29/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Quantitative assessment of myocardial blood flow (MBF) with first-pass perfusion cardiovascular magnetic resonance (CMR) requires a measurement of the arterial input function (AIF). This study presents an automated method to improve the objectivity and reduce processing time for measuring the AIF from first-pass perfusion CMR images. This automated method is used to compare the impact of different AIF measurements on MBF quantification. METHODS Gadolinium-enhanced perfusion CMR was performed on a 1.5 T scanner using a saturation recovery dual-sequence technique. Rest and stress perfusion series from 270 clinical studies were analyzed. Automated image processing steps included motion correction, intensity correction, detection of the left ventricle (LV), independent component analysis, and LV pixel thresholding to calculate the AIF signal. The results were compared with manual reference measurements using several quality metrics based on the contrast enhancement and timing characteristics of the AIF. The median and 95% confidence interval (CI) of the median were reported. Finally, MBF was calculated and compared in a subset of 21 clinical studies using the automated and manual AIF measurements. RESULTS Two clinical studies were excluded from the comparison due to a congenital heart defect present in one and a contrast administration issue in the other. The proposed method successfully processed 99.63% of the remaining image series. Manual and automatic AIF time-signal intensity curves were strongly correlated with median correlation coefficient of 0.999 (95% CI [0.999, 0.999]). The automated method effectively selected bright LV pixels, excluded papillary muscles, and required less processing time than the manual approach. There was no significant difference in MBF estimates between manually and automatically measured AIFs (p = NS). However, different sizes of regions of interest selection in the LV cavity could change the AIF measurement and affect MBF calculation (p = NS to p = 0.03). CONCLUSION The proposed automatic method produced AIFs similar to the reference manual method but required less processing time and was more objective. The automated algorithm may improve AIF measurement from the first-pass perfusion CMR images and make quantitative myocardial perfusion analysis more robust and readily available.
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Affiliation(s)
- Matthew Jacobs
- />National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA
- />Department of Electrical Engineering and Computer Science, Catholic University of America, Washington DC, USA
| | - Mitchel Benovoy
- />National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA
- />Department of Biomedical Engineering, Ecole Polytechnique de Montreal, Montreal, Canada
| | - Lin-Ching Chang
- />Department of Electrical Engineering and Computer Science, Catholic University of America, Washington DC, USA
| | - Andrew E. Arai
- />National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Li-Yueh Hsu
- />National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA
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Sawlani RN, Collins JD. Cardiac MRI and Ischemic Heart Disease: Role in Diagnosis and Risk Stratification. Curr Atheroscler Rep 2016; 18:23. [DOI: 10.1007/s11883-016-0576-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Teixeira T, Nadeshalingam G, Fischer K, Marcotte F, Friedrich MG. Breathing maneuvers as a coronary vasodilator for myocardial perfusion imaging. J Magn Reson Imaging 2016; 44:947-55. [DOI: 10.1002/jmri.25224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/22/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Tiago Teixeira
- Montreal Heart Institute; Departments of Cardiology and Radiology; Université de Montréal; Montréal Canada
- Lenitudes Medical Center and Research; Sta Maria da Feira Portugal
| | - Gobinath Nadeshalingam
- Montreal Heart Institute; Departments of Cardiology and Radiology; Université de Montréal; Montréal Canada
| | - Kady Fischer
- Montreal Heart Institute; Departments of Cardiology and Radiology; Université de Montréal; Montréal Canada
| | - François Marcotte
- Montreal Heart Institute; Departments of Cardiology and Radiology; Université de Montréal; Montréal Canada
| | - Matthias G. Friedrich
- Montreal Heart Institute; Departments of Cardiology and Radiology; Université de Montréal; Montréal Canada
- McGill University Health Centre; Departments of Cardiology and Diagnostic Radiology; McGill University; Montreal Canada
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Clinical use of quantitative cardiac perfusion PET: rationale, modalities and possible indications. Position paper of the Cardiovascular Committee of the European Association of Nuclear Medicine (EANM). Eur J Nucl Med Mol Imaging 2016; 43:1530-45. [PMID: 26846913 DOI: 10.1007/s00259-016-3317-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/12/2016] [Indexed: 02/06/2023]
Abstract
Until recently, PET was regarded as a luxurious way of performing myocardial perfusion scintigraphy, with excellent image quality and diagnostic capabilities that hardly justified the additional cost and procedural effort. Quantitative perfusion PET was considered a major improvement over standard qualitative imaging, because it allows the measurement of parameters not otherwise available, but for many years its use was confined to academic and research settings. In recent years, however, several factors have contributed to the renewal of interest in quantitative perfusion PET, which has become a much more readily accessible technique due to progress in hardware and the availability of dedicated and user-friendly platforms and programs. In spite of this evolution and of the growing evidence that quantitative perfusion PET can play a role in the clinical setting, there are not yet clear indications for its clinical use. Therefore, the Cardiovascular Committee of the European Association of Nuclear Medicine, starting from the experience of its members, decided to examine the current literature on quantitative perfusion PET to (1) evaluate the rationale for its clinical use, (2) identify the main methodological requirements, (3) identify the remaining technical difficulties, (4) define the most reliable interpretation criteria, and finally (5) tentatively delineate currently acceptable and possibly appropriate clinical indications. The present position paper must be considered as a starting point aiming to promote a wider use of quantitative perfusion PET and to encourage the conception and execution of the studies needed to definitely establish its role in clinical practice.
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A Comparison of Theory-Based and Experimentally Determined Myocardial Signal Intensity Correction Methods in First-Pass Perfusion Magnetic Resonance Imaging. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:843741. [PMID: 26491465 PMCID: PMC4605224 DOI: 10.1155/2015/843741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/24/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the impact of correcting myocardial signal saturation on the accuracy of absolute myocardial blood flow (MBF) measurements. MATERIALS AND METHODS We performed 15 dual bolus first-pass perfusion studies in 7 dogs during global coronary vasodilation and variable degrees of coronary artery stenosis. We compared microsphere MBF to MBF calculated from uncorrected and corrected MRI signal. Four correction methods were tested, two theoretical methods (Th1 and Th2) and two empirical methods (Em1 and Em2). RESULTS The correlations with microsphere MBF (n = 90 segments) were: uncorrected (y = 0.47x + 1.1, r = 0.70), Th1 (y = 0.53x + 1.0, r = 0.71), Th2 (y = 0.62x + 0.86, r = 0.73), Em1 (y = 0.82x + 0.86, r = 0.77), and Em2 (y = 0.72x + 0.84, r = 0.75). All corrected methods were not significantly different from microspheres, while uncorrected MBF values were significantly lower. For the top 50% of microsphere MBF values, flows were significantly underestimated by uncorrected SI (31%), Th1 (25%), and Th2 (19%), while Em1 (1%), and Em2 (9%) were similar to microsphere MBF. CONCLUSIONS Myocardial signal saturation should be corrected prior to flow modeling to avoid underestimation of MBF by MR perfusion imaging.
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Delgado V, Bax JJ. Clinical topic: Nuclear imaging in hypertrophic cardiomyopathy. J Nucl Cardiol 2015; 22:408-18. [PMID: 25548121 DOI: 10.1007/s12350-014-0054-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
Abstract
Non-invasive cardiac imaging plays a central role in the diagnosis and management of patients with hypertrophic cardiomyopathy. Transthoracic echocardiography is the imaging technique of first choice to evaluate wall thickness, left ventricular systolic and diastolic function, presence of left ventricular outflow tract obstruction, and abnormal mitral anatomy, whereas cardiac magnetic resonance provides additional information on tissue characterization (replacement fibrosis) using late gadolinium enhancement. Nuclear imaging techniques permit also the assessment of left ventricular systolic and diastolic function in patients with hypertrophic cardiomyopathy but are more frequently used to evaluate myocardial ischemia (particularly assessment of microvascular dysfunction using positron emission tomography) and abnormal sympathetic myocardial innervation. This review article provides an overview of the use of nuclear imaging techniques to refine the phenotyping and risk stratification of patients with hypertrophic cardiomyopathy with particular focus on prediction of progression to overt heart failure, detection of myocardial ischemia, and evaluation of the arrhythmogenic substrate and risk of sudden cardiac death.
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Affiliation(s)
- Victoria Delgado
- Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
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27
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Cheong BYC, Angelini P. Magnetic Resonance Imaging of the Myocardium, Coronary Arteries, and Anomalous Origin of Coronary Arteries. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Wollny G, Kellman P. Free breathing myocardial perfusion data sets for performance analysis of motion compensation algorithms. Gigascience 2014; 3:23. [PMID: 25392734 PMCID: PMC4226922 DOI: 10.1186/2047-217x-3-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/13/2014] [Indexed: 12/02/2022] Open
Abstract
Background Perfusion quantification by using first-pass gadolinium-enhanced myocardial perfusion magnetic resonance imaging (MRI) has proved to be a reliable tool for the diagnosis of coronary artery disease that leads to reduced blood flow to the myocardium. The image series resulting from such acquisition usually exhibits a breathing motion that needs to be compensated for if a further automatic analysis of the perfusion is to be executed. Various algorithms have been presented to facilitate such a motion compensation, but the lack of publicly available data sets hinders a proper, reproducible comparison of these algorithms. Material Free breathing perfusion MRI series of ten patients considered clinically to have a stress perfusion defect were acquired; for each patient a rest and a stress study was executed. Manual segmentations of the left ventricle myocardium and the right-left ventricle insertion point are provided for all images in order to make a unified validation of the motion compensation algorithms and the perfusion analysis possible. In addition, all the scripts and the software required to run the experiments are provided alongside the data, and to enable interested parties to directly run the experiments themselves, the test bed is also provided as a virtual hard disk. Findings To illustrate the utility of the data set two motion compensation algorithms with publicly available implementations were applied to the data and earlier reported results about the performance of these algorithms could be confirmed. Conclusion The data repository alongside the evaluation test bed provides the option to reliably compare motion compensation algorithms for myocardial perfusion MRI. In addition, we encourage that researchers add their own annotations to the data set, either to provide inter-observer comparisons of segmentations, or to make other applications possible, for example, the validation of segmentation algorithms.
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Affiliation(s)
- Gert Wollny
- Biomedical Imaging Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid, Avenida Complutense 30, 28040 Madrid, Spain ; Ciber BBN, Zaragoza, Spain
| | - Peter Kellman
- Laboratory of Cardiac Energetics, National Heart, Lung and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
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Chen D, Sharif B, Dharmakumar R, Thomson LEJ, Bairey Merz CN, Berman DS, Li D. Quantification of myocardial blood flow using non-ECG-triggered MR imaging. Magn Reson Med 2014; 74:765-71. [PMID: 25227935 DOI: 10.1002/mrm.25451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 08/19/2014] [Accepted: 08/22/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE MR myocardial perfusion imaging is dependent on reliable electrocardiogram (ECG) triggering for accurate measurement of myocardial blood flow (MBF). A non-ECG-triggered method for quantitative first-pass imaging may improve clinical feasibility in patients with poor ECG signal. The purpose of this study is to evaluate the feasibility of a non-ECG-triggered method for myocardial perfusion imaging in a single slice. METHODS The proposed non-ECG-triggered technique uses a saturation-recovery magnetization preparation and golden-angle radial acquisition for integrated arterial input function (AIF) measurement. Image based self-gating with a temporal resolution of 42.6 ms is used to generate a first-pass image series with consistent cardiac phase. The AIF is measured using beat-by-beat T1 estimation of the ventricular blood pool. The proposed technique was performed on 14 healthy volunteers and compared against a conventional ECG-triggered dual-bolus acquisition. RESULTS The proposed method produced MBF with no significant difference compared with ECG-triggered technique (mean of 0.63 ± 0.22 mL/min/g to 0.73 ± 0.21 mL/min/g). CONCLUSION We have developed a non-ECG-triggered perfusion imaging method with T1 based measurement of the AIF in a single slice. In this preliminary study, our results demonstrate that MBF measured using the proposed method is comparable to the conventional ECG-triggered method.
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Affiliation(s)
- David Chen
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA.,Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Behzad Sharif
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Louise E J Thomson
- S. Mark Taper Foundation Imaging Center, Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Barbara Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Barbara Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Daniel S Berman
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,S. Mark Taper Foundation Imaging Center, Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Influence of the cardiac cycle on time-intensity curves using multislice dynamic magnetic resonance perfusion. Int J Cardiovasc Imaging 2014; 30:1347-55. [PMID: 24928765 DOI: 10.1007/s10554-014-0466-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 06/07/2014] [Indexed: 10/25/2022]
Abstract
Flow and pressure variations cause potential changes in magnetic resonance imaging (MRI) signal intensity across the cardiac cycle. Nevertheless, cardiac dynamic contrast-enhanced (perfusion) MRI is performed and analyzed regardless of the cardiac phase. We investigate whether the cardiac phase impacts myocardial and left ventricle (LV) cavity time intensity curves (TICs) at rest and during vasodilatation. Fifteen healthy volunteers (seven females, eight males; mean age: 32.5 ± 9.3 years; age range: 19-49 years) were included in this prospective study. They underwent four separate short-axis multislice (apical, mid and basal) LV perfusion MRI, with different electrocardiogram-triggering during normal vasotone and adenosine-stress. TIC parameters were extracted from the myocardium and the LV cavity. General linear mixed model analyses were used to evaluate their variability according to vasotone, cardiac phase and slice-position. Maximal enhancement and normalized Steepest slopes were higher at stress than at rest (p values <0.001). A similar trend towards higher inflow was shown on systole versus diastole in the LV cavity and diastole versus systole in the myocardium (p < 0.05).These TIC parameters were slice-position dependent, as the inflow decreased from the base to the apex in the LV, and peaked on the mid-slice for the myocardium. There are significant variability of both the LV and the myocardial TICs, with respect to the cardiac cycle phase and the slice position where imaging actually takes place. These appeal to measurement standardization for a better intra- and inter-study reproducibility.
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31
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Myocardial Blood Flow Quantification from MRI – an Image Analysis Perspective. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-013-9246-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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32
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Klocke FJ, Lee DC. Probing Transmural Myocardial Perfusion With CMR. JACC Cardiovasc Imaging 2014; 7:23-5. [DOI: 10.1016/j.jcmg.2013.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 09/05/2013] [Indexed: 11/25/2022]
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Bane O, Lee DC, Benefield BC, Harris KR, Chatterjee NR, Carr JC, Carroll TJ. Leakage and water exchange characterization of gadofosveset in the myocardium. Magn Reson Imaging 2013; 32:224-35. [PMID: 24418327 DOI: 10.1016/j.mri.2013.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 08/02/2013] [Accepted: 10/22/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the compartmentalization of the blood pool agent gadofosveset and the effect of its transient binding to albumin on the quantification of steady-state fractional myocardial blood volume (fMBV). METHODS Myocardial vascular fraction measurements were simulated assuming the limiting cases (slow or fast) of two-compartment water exchange for different contrast agent injection concentrations, binding fractions, bound and free relaxivities, and true cardiac vascular fractions. fMBV was measured in five healthy volunteers (4 males, 1 female, average age 33) at 1.5T after administration of five injections of gadofosveset. The measurements in the volunteers were retrospectively compared to measurements of fMBV after three serial injections of the ultra-small, paramagnetic iron oxide (USPIO) blood pool agent ferumoxytol in an experimental animal. The true fMBV and exchange rate of water protons in both human and animal data sets was determined by chi square minimization. RESULTS Simulations showed an error in the measurement of fMBV due to partial binding of gadofosveset of less than 30%. Measured fMBV values over-estimate simulation predictions, and approach cardiac extracellular volume (22%), which suggests that the intravascular assumption may not be appropriate for the myocardium, although it may apply to more distal perfusion beds. In comparison, fMBV measured with ferumoxytol (5%, with slow water proton exchange across vascular wall) agree with published values of myocardial vascular fraction. Further comparison between myocardium relaxation rates induced by gadofosveset and by other extracellular and intravascular contrast agents showed that gadofosveset behaves like an extracellular contrast agent. CONCLUSIONS The distribution of the volunteer data indicates that a three-compartment model, with slow water exchange of gadofosveset and water protons between the vascular and interstitial compartments, and fast water exchange between the interstitium and the myocytes, is appropriate. The ferumoxytol measurements indicate that this USPIO is an intravascular contrast agent that can be used to quantify myocardial blood volume, with the appropriate correction for water exchange using a two-compartment water exchange model.
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Affiliation(s)
- Octavia Bane
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA; Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA; Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Daniel C Lee
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Kathleen R Harris
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Neil R Chatterjee
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Radiology, Northwestern University, Chicago, IL, USA
| | - James C Carr
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Timothy J Carroll
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA; Department of Radiology, Northwestern University, Chicago, IL, USA.
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Bell SP, Adkisson DW, Ooi H, Sawyer DB, Lawson MA, Kronenberg MW. Impairment of subendocardial perfusion reserve and oxidative metabolism in nonischemic dilated cardiomyopathy. J Card Fail 2013; 19:802-10. [PMID: 24331202 DOI: 10.1016/j.cardfail.2013.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 10/22/2013] [Accepted: 10/24/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) and [(11)C]acetate positron emission tomography (PET) were used to assess the hypothesis that patients with nonischemic dilated cardiomyopathy (NIDCM) have decreased subendocardial perfusion reserve and impaired oxidative metabolism, consistent with the concept of "energy starvation" in heart failure (HF). METHODS AND RESULTS CMR myocardial perfusion was evaluated in 13 NIDCM patients and 15 control subjects with coronary risk factors and normal myocardial perfusion. The NIDCM patients underwent [(11)C]acetate PET. The myocardial perfusion index (MPI) was calculated as the normalized rate of myocardial signal augmentation following gadolinium contrast injection. Hyperemic transmural, subendocardial, and subepicardial MPI were reduced in NIDCM compared with control subjects [0.13 vs 0.18 (P < .001), 0.13 vs 0.17 (P < .001), and 0.13 vs 0.17 (P = .008), respectively]. The subendocardial perfusion reserve was 1.59 ± 0.21 vs 1.86 ± 0.32 for the subepicardium (P = .002), demonstrating reduced perfusion reserve. The myocardial oxidative metabolic rate (kmono) per unit demand (rate-pressure product) was reduced in proportion to perfusion reserve (P = .02) CONCLUSIONS: Impaired subendocardial perfusion reserve in NIDCM confirmed results previously attained only in animal models. Impaired perfusion and impaired oxidative metabolism are consistent with subendocardial energy starvation in HF.
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Affiliation(s)
- Susan P Bell
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, and Cardiology Section, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Douglas W Adkisson
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, and Cardiology Section, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Henry Ooi
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, and Cardiology Section, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Douglas B Sawyer
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, and Cardiology Section, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Mark A Lawson
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, and Cardiology Section, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Marvin W Kronenberg
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, and Cardiology Section, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee.
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Fluckiger JU, Benefield BC, Harris KR, Lee DC. Absolute quantification of myocardial blood flow with constrained estimation of the arterial input function. J Magn Reson Imaging 2013; 38:603-9. [PMID: 23371884 DOI: 10.1002/jmri.24025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 12/07/2012] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To evaluate the performance of the constrained alternating minimization with model (CAMM) method for estimating the input function from the myocardial tissue curves. MATERIALS AND METHODS Myocardial perfusion imaging was performed on seven canine models of coronary artery disease in 15 imaging sessions. In each session, stress was induced with intravenous infusion of adenosine and a variable occluder created coronary artery stenosis. A dual bolus protocol was used for each acquisition, and input functions were then estimated using the CAMM method with data acquired from the high dose scan following each imaging session. For each acquisition, myocardial blood flow was measured by injected microspheres. RESULTS The dual bolus and CAMM-derived flows were not significantly different (P = 0.18), and the correlation between the two methods was high (r = 0.97). The correlation between the dual bolus and CAMM methods and microsphere measurements was lower than that for the two MR methods (r = 0.53; r = 0.43, respectively). CONCLUSION The CAMM method presented here shows promise in estimating myocardial blood flow in patients with coronary artery disease at stress with a single injection and without any specialized acquisitions. Further work is needed to validate the approach in a clinical setting.
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Affiliation(s)
- Jacob U Fluckiger
- Department of Radiology, Northwestern University, Chicago, Illinois, USA.
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Sciagrà R. Quantitative cardiac positron emission tomography: the time is coming! SCIENTIFICA 2012; 2012:948653. [PMID: 24278760 PMCID: PMC3820449 DOI: 10.6064/2012/948653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 08/14/2012] [Indexed: 06/02/2023]
Abstract
In the last 20 years, the use of positron emission tomography (PET) has grown dramatically because of its oncological applications, and PET facilities are now easily accessible. At the same time, various groups have explored the specific advantages of PET in heart disease and demonstrated the major diagnostic and prognostic role of quantitation in cardiac PET. Nowadays, different approaches for the measurement of myocardial blood flow (MBF) have been developed and implemented in user-friendly programs. There is large evidence that MBF at rest and under stress together with the calculation of coronary flow reserve are able to improve the detection and prognostication of coronary artery disease. Moreover, quantitative PET makes possible to assess the presence of microvascular dysfunction, which is involved in various cardiac diseases, including the early stages of coronary atherosclerosis, hypertrophic and dilated cardiomyopathy, and hypertensive heart disease. Therefore, it is probably time to consider the routine use of quantitative cardiac PET and to work for defining its place in the clinical scenario of modern cardiology.
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Affiliation(s)
- Roberto Sciagrà
- Department of Clinical Physiopathology, Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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Zarinabad N, Chiribiri A, Hautvast GLTF, Ishida M, Schuster A, Cvetkovic Z, Batchelor PG, Nagel E. Voxel-wise quantification of myocardial perfusion by cardiac magnetic resonance. Feasibility and methods comparison. Magn Reson Med 2012; 68:1994-2004. [PMID: 22354744 DOI: 10.1002/mrm.24195] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/20/2011] [Accepted: 01/13/2011] [Indexed: 11/10/2022]
Abstract
The purpose of this study is to enable high spatial resolution voxel-wise quantitative analysis of myocardial perfusion in dynamic contrast-enhanced cardiovascular MR, in particular by finding the most favorable quantification algorithm in this context. Four deconvolution algorithms--Fermi function modeling, deconvolution using B-spline basis, deconvolution using exponential basis, and autoregressive moving average modeling--were tested to calculate voxel-wise perfusion estimates. The algorithms were developed on synthetic data and validated against a true gold-standard using a hardware perfusion phantom. The accuracy of each method was assessed for different levels of spatial averaging and perfusion rate. Finally, voxel-wise analysis was used to generate high resolution perfusion maps on real data acquired from five patients with suspected coronary artery disease and two healthy volunteers. On both synthetic and perfusion phantom data, the B-spline method had the highest error in estimation of myocardial blood flow. The autoregressive moving average modeling and exponential methods gave accurate estimates of myocardial blood flow. The Fermi model was the most robust method to noise. Both simulations and maps in the patients and hardware phantom showed that voxel-wise quantification of myocardium perfusion is feasible and can be used to detect abnormal regions.
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Affiliation(s)
- Niloufar Zarinabad
- Division of Imaging Sciences and Biomedical Engineering, Wellcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, The Rayne Institute, St. Thomas' Hospital, London, United Kingdom.
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Abstract
PURPOSE OF REVIEW When present clinically, cardiac involvement in systemic sclerosis (SSc) is a major risk factor for death. It is therefore vitally important to understand the epidemiology, screening, diagnosis, and treatment of the cardiac manifestations of SSc. RECENT FINDINGS The epidemiology of cardiac involvement in SSc has been the subject of several recent studies. Most importantly, the prevalence of overt left ventricular (LV) systolic dysfunction and its associated risk factors have been defined, and patients with diffuse cutaneous SSc appear to be most susceptible to direct cardiac involvement. From a diagnostic and screening standpoint, tissue Doppler echocardiography and natriuretic peptides have provided fresh insight into subclinical cardiac dysfunction in SSc. Newer techniques, such as speckle-tracking echocardiography, diffuse myocardial fibrosis imaging, and absolute myocardial perfusion imaging, are poised to further advance our knowledge. Lastly, there is now consistent observational data to suggest a central role for calcium channel blockers in the treatment of microvascular ischemia and prevention of overt LV systolic dysfunction, although randomized controlled trials are lacking. SUMMARY Recent studies have improved our understanding of cardiac involvement in SSc. Nevertheless, key questions regarding screening, diagnosis, and treatment remain. Novel diagnostic techniques and multicenter studies should yield important new data, which will hopefully ultimately result in improved outcomes.
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Klocke FJ, Lee DC. Absolute myocardial blood flow emerging role in coronary pathophysiology and clinical disease. JACC Cardiovasc Imaging 2012; 4:999-1001. [PMID: 21920338 DOI: 10.1016/j.jcmg.2011.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 07/07/2011] [Indexed: 11/25/2022]
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Tsaftaris SA, Tang R, Zhou X, Li D, Dharmakumar R. Ischemic extent as a biomarker for characterizing severity of coronary artery stenosis with blood oxygen-sensitive MRI. J Magn Reson Imaging 2012; 35:1338-48. [PMID: 22246681 DOI: 10.1002/jmri.23577] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 12/07/2011] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate whether a statistical analysis of myocardial blood-oxygen-level-dependent (mBOLD) signal intensities can lead to the identification and quantification of the ischemic area supplied by the culprit artery. MATERIALS AND METHODS Cardiac BOLD images were acquired in a canine model (n = 9) with controllable LCX stenosis at rest and during adenosine infusion on a 1.5T clinical scanner. Statistical distributions of myocardial pixel-intensities derived from BOLD images were used to compute an area metric (ischemic extent, IE). True myocardial perfusion was estimated from microsphere analysis. IE was compared against a standard metric (segment-intensity-response, SIR). Additional animals (n = 3) were used to investigate the feasibility of the approach for identifying ischemic territories due to LAD stenosis from mBOLD images. RESULTS Regression analyses showed that IE and myocardial flow ratio between rest and adenosine infusion (MFR) were exponentially related (R(2) > 0.70, P < 0.001, for end-systole and end-diastole), while SIR and MFR were linearly related to end-systole (R(2) = 0.51, P < 0.04) and unrelated to end-diastole (R(2) ≈ 0, P = 0.91). Receiver-operating-characteristic analysis that IE was superior to SIR for detecting critical stenosis (MFR ≤ 2) in end-systole and end-diastole. Feasibility studies on LAD narrowing demonstrated that the proposed approach could also identify oxygenation changes in the LAD territories. CONCLUSION The proposed evaluation of cardiac BOLD magnetic resonance imaging (MRI) offers marked improvement in sensitivity and specificity for detecting critical coronary stenosis at 1.5T compared to the mean segmental intensity approach. Patient studies are now warranted to determine its clinical utility.
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Affiliation(s)
- Sotirios A Tsaftaris
- Department of Computer Science and Applications, IMT-Institutions Markets Technologies Institute for Advanced Studies Lucca, Lucca, Italy.
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41
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Ananthasubramaniam K, Dhar R, Cavalcante JL. Role of multimodality imaging in ischemic and non-ischemic cardiomyopathy. Heart Fail Rev 2011; 16:351-67. [PMID: 21165696 DOI: 10.1007/s10741-010-9218-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Chronic heart failure (CHF) is a major and growing problem in the western hemisphere, affecting about 5 million patients in the United States. In daily practice patients with left ventricular systolic dysfunction (LVSD) and significant angiographic coronary artery disease (CAD) are felt to have an ischemic cardiomyopathy (ICMP) and those without CAD or mild-moderate CAD out of proportion to the extent of LVSD are felt to have a non-ischemic cardiomyopathy (NICMP). Although invasive coronary angiography is the gold standard for the diagnosis of CAD, recent advances in non-invasive imaging have created multiple options for evaluating ICMP and NICMP. This review details the role of cardiac imaging in the diagnosis of ICMP and NICMP and outlines an algorithm of use of non-invasive tests in asymtomatic LVSD and symptomatic heart failure.
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Affiliation(s)
- Karthikeyan Ananthasubramaniam
- Heart & Vascular Institute, Department of Internal Medicine, Henry Ford Hospital, 2799 West Grand Blvd, K-14, Detroit, MI 48202, USA.
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42
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Cardiovascular Magnetic Resonance Imaging for the Biomedical Engineer. Cardiovasc Eng Technol 2011. [DOI: 10.1007/s13239-011-0066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shah P, Choi BG, Mazhari R. Positron emission tomography for the evaluation and treatment of cardiomyopathy. Ann N Y Acad Sci 2011; 1228:137-49. [PMID: 21718329 DOI: 10.1111/j.1749-6632.2011.06017.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Congestive heart failure accounts for tremendous morbidity and mortality worldwide. There are numerous causes of cardiomyopathy, the most common of which is coronary artery disease. Positron emission tomography (PET) has an established and expanding role in the evaluation of patients with cardiomyopathy. The specific application of PET to hypertrophic cardiomyopathy, cardiac sarcoidosis, and diabetic cardiomyopathy has been studied extensively and promises to be a useful tool for managing these patients. Furthermore, evaluating the efficacy of standard treatments for congestive heart failure is important as health care costs continue to rise. Recently, there have been significant developments in the field of cardiovascular stem cell research. Familiarity with the mechanisms by which stem cells benefit patients with cardiovascular disease is the key to understanding these advances. Molecular imaging techniques including PET/CT imaging play an important role in monitoring stem cell therapy in both animals and humans. These noninvasive imaging techniques will be highlighted in this paper.
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Affiliation(s)
- Palak Shah
- Division of Cardiology, George Washington University, Washington, DC, USA.
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Kachenoura N, Cluzel P, Frouin F, Toledano D, Grenier P, Cuenod CA, Balvay D. Evaluation of an edge-based registration method: application to magnetic resonance first-pass myocardial perfusion data. Magn Reson Imaging 2011; 29:853-60. [DOI: 10.1016/j.mri.2011.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 02/25/2011] [Accepted: 02/26/2011] [Indexed: 11/26/2022]
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Sherif HM, Nekolla SG, Saraste A, Reder S, Yu M, Robinson S, Schwaiger M. Simplified quantification of myocardial flow reserve with flurpiridaz F 18: validation with microspheres in a pig model. J Nucl Med 2011; 52:617-24. [PMID: 21441533 DOI: 10.2967/jnumed.110.083196] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The novel PET flow tracer flurpiridaz F 18 shows high myocardial extraction and slow washout. flurpiridaz F 18 PET data analysis with tracer kinetic modeling provides accurate absolute myocardial blood flow (MBF) measurements but requires in-scanner injection and complex processing. We evaluated the hypothesis that myocardial retention and standardized uptake values (SUVs) based on late uptake provide accurate estimates of myocardial flow reserve (MFR) and, thus, might allow simplified quantification after tracer injection outside the scanner. METHODS Nine pigs had dynamic PET scans after repeated injections of flurpiridaz F 18 at rest and combined adenosine and dobutamine stress. flurpiridaz F 18 PET with a 3-compartment model and coinjected radioactive microspheres were used to delineate MBF. These quantitative measurements were compared with myocardial retention (%/min) and SUV of flurpiridaz F 18 after summing data over 5-10, 5-12, 5-15, 10-15, and 10-20 min after tracer injection. RESULTS MBF ranged from 0.5 to 2.8 mL/min/g. There was a good correlation between both flurpiridaz F 18 retention and SUVs from 5 to 12 min after injection and MBF measured using 3-compartment model- or microsphere-derived MBF (r = 0.73, P < 0.05, and r = 0.68, P < 0.05, respectively, for retention; r = 0.88, P < 0.001, and r = 0.92, P < 0.001, respectively, for SUV). At later time points, retention and SUV underestimated stress microsphere flow (at 10-20 min: r = 0.41, P = not significant, and r = 0.46, P = not significant, respectively, for retention; r = 0.41, P = not significant, and r = 0.65, P < 0.05, respectively, for SUV). When measured 5-12 min after injection, there was a close agreement between MFR measured with either flurpiridaz F 18 retention or SUV and MFR measured using microspheres (mean difference, -0.08 ± 0.36 and -0.18 ± 0.25, respectively). CONCLUSION Myocardial retention and SUVs of the (18)F-labeled flow tracer flurpiridaz F 18 accurately reflect the MFR. These simplified analysis methods may facilitate the combination of quantitative assessment of perfusion reserve and rapid clinical imaging protocols.
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Affiliation(s)
- Hossam M Sherif
- Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Munich, Germany.
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Fluckiger JU, Schabel MC, DiBella EVR. Constrained estimation of the arterial input function for myocardial perfusion cardiovascular magnetic resonance. Magn Reson Med 2011; 66:419-27. [PMID: 21446030 DOI: 10.1002/mrm.22809] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 12/02/2010] [Accepted: 12/10/2010] [Indexed: 12/21/2022]
Abstract
Accurate quantification of myocardial perfusion remains challenging due to saturation of the arterial input function at high contrast concentrations. A method for estimating the arterial input function directly from tissue curves in the myocardium that avoids these difficulties is presented. In this constrained alternating minimization with model (CAMM) algorithm, a portion of the left ventricular blood pool signal is also used to constrain the estimation process. Extensive computer simulations assessing the accuracy of kinetic parameter estimation were performed. In 5000 noise realizations, the use of the AIF given by the estimation method returned kinetic parameters with mean Ktrans error of -2% and mean kep error of 0.4%. Twenty in vivo resting perfusion datasets were also processed with this method, and pharmacokinetic parameter values derived from the blind AIF were compared with those derived from a dual-bolus measured AIF. For 17 of the 20 datasets, there were no statistically significant differences in Ktrans estimates, and in aggregate the kinetic parameters were not significantly different from the dual-bolus method. The cardiac constrained alternating minimization with model method presented here provides a promising approach to quantifying perfusion of myocardial tissue with a single injection of contrast agent and without a special pulse sequence though further work is needed to validate the approach in a clinical setting.
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Affiliation(s)
- Jacob U Fluckiger
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah 84108, USA
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Greene ER. Noninvasive transthoracic and transesophageal Doppler echocardiographic measurements of human coronary blood flow velocity: In vitro flow phantom validation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:3784-7. [PMID: 21096876 DOI: 10.1109/iembs.2010.5627566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Coronary angiography is limited in assessing the hemodynamic significance of a coronary lesion or the state of the coronary microcirculation. Noninvasive transthoracic (TTE) and transesophageal (TEE) Doppler echocardiography have been used to measure coronary blood flow velocity and coronary flow reserve and thus the physiology of the coronary vasculature (normal, stable or unstable lesions). A fundamental, in vitro validation of these methods with a tissue and blood mimicking flow phantom has not been reported. Accordingly, Bland-Altman 95% confidence levels for precision (repeated measures) and accuracy (comparison with time collection) were determined for both TTE and TEE measurements of simulated coronary diastolic blood velocities in 2 mm and 4 mm vessels at the normal in vivo depths of 40 mm and 60 mm. The Doppler angle was set at 45 degrees and flow velocities were varied within a normal in vivo range of 0- 150 cm/s. Confidence levels for precisions and accuracies were similar between TTE and TEE and ranged from ± 6 cm/s to ± 13 cm/s or approximately 10-15% over the range of the measured velocities. These in vitro results in a controlled flow phantom suggest that technically adequate TTE and TEE can be used to reliably measure epicardial coronary conduit artery blood flow velocities.
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Affiliation(s)
- E R Greene
- Departments of Biology and Chemistry and Computer and Mathematical Sciences, New Mexico, USA
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Shikata F, Imagawa H, Kawachi K, Kido T, Kurata A, Inoue Y, Hosokawa K, Nagao M, Higashino H, Mochizuki T, Ryugo M, Nagashima M. Regional myocardial blood flow measured by stress multidetector computed tomography as a predictor of recovery of left ventricular function after coronary artery bypass grafting. Am Heart J 2010; 160:528-34. [PMID: 20826263 DOI: 10.1016/j.ahj.2010.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 06/16/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multidetector-row computed tomography (MDCT) applications have expanded to evaluation of myocardial blood flow (MBF) and viability. We quantified regional MBF pre- and post-coronary artery bypass grafting (CABG) using adenosine stress and cardiac 64-MDCT, and investigated whether the results predict MBF and left ventricular (LV) function recovery after CABG. METHODS We studied 321 regions in 19 CABG patients who underwent adenosine stress 64-row MDCT perfusion imaging and cine magnetic resonance imaging pre- and post-CABG. Myocardial blood flow was estimated from linear regression equation slopes using Patlak plot analyses and compared with LV function by measuring wall thickening (%WT) using cine magnetic resonance imaging. RESULTS Overall mean MBFs were 1.39 +/- 0.49 and 1.95 +/- 0.49 mL/(g min) pre- and post-CABG (P < .0001). Myocardial blood flow in revascularized areas increased significantly (pre-CABG 1.18 +/- 0.45, post-CABG 1.99 +/- 0.66 mL/[g min], P < .001), whereas nonischemic areas showed no difference (1.79 +/- 0.70 and 1.97 +/- 0.46 mL/[g min], P = .14). Revascularized areas with preoperative MBF > or = 0.9 mL/(g min) showed significantly greater MBF improvement than those with preoperative MBF <0.9 mL/(g min) (P = .04). In patients with preoperative LV dysfunction (ejection fraction <40%), %WT in revascularized areas with pre-CABG MBF > or = 0.9 mL/(g min) improved significantly after CABG (pre-%WT 40.9 +/- 22.9, post-%WT 52.8 +/- 20.6, P = .03) versus those with pre-CABG MBF <0.9 mL/(g min) (pre-%WT 53.2 +/- 35.5, post-%WT 42.5 +/- 17.0, P = .40). CONCLUSIONS Our results demonstrated more significantly increased MBF post-CABG than pre-CABG, particularly in revascularized areas. Regional MBF before CABG may predict MBF and LV function recovery, in the short term, after CABG.
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Schabel MC, Fluckiger JU, DiBella EVR. A model-constrained Monte Carlo method for blind arterial input function estimation in dynamic contrast-enhanced MRI: I. Simulations. Phys Med Biol 2010; 55:4783-806. [PMID: 20679691 DOI: 10.1088/0031-9155/55/16/011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Widespread adoption of quantitative pharmacokinetic modeling methods in conjunction with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has led to increased recognition of the importance of obtaining accurate patient-specific arterial input function (AIF) measurements. Ideally, DCE-MRI studies use an AIF directly measured in an artery local to the tissue of interest, along with measured tissue concentration curves, to quantitatively determine pharmacokinetic parameters. However, the numerous technical and practical difficulties associated with AIF measurement have made the use of population-averaged AIF data a popular, if sub-optimal, alternative to AIF measurement. In this work, we present and characterize a new algorithm for determining the AIF solely from the measured tissue concentration curves. This Monte Carlo blind estimation (MCBE) algorithm estimates the AIF from the subsets of D concentration-time curves drawn from a larger pool of M candidate curves via nonlinear optimization, doing so for multiple (Q) subsets and statistically averaging these repeated estimates. The MCBE algorithm can be viewed as a generalization of previously published methods that employ clustering of concentration-time curves and only estimate the AIF once. Extensive computer simulations were performed over physiologically and experimentally realistic ranges of imaging and tissue parameters, and the impact of choosing different values of D and Q was investigated. We found the algorithm to be robust, computationally efficient and capable of accurately estimating the AIF even for relatively high noise levels, long sampling intervals and low diversity of tissue curves. With the incorporation of bootstrapping initialization, we further demonstrated the ability to blindly estimate AIFs that deviate substantially in shape from the population-averaged initial guess. Pharmacokinetic parameter estimates for K(trans), k(ep), v(p) and v(e) all showed relative biases and uncertainties of less than 10% for measurements having a temporal sampling rate of 4 s and a concentration measurement noise level of sigma = 0.04 mM. A companion paper discusses the application of the MCBE algorithm to DCE-MRI data acquired in eight patients with malignant brain tumors.
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Affiliation(s)
- Matthias C Schabel
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah Health Sciences Center, 729 Arapeen Drive, Salt Lake City, UT 84108-1218, USA.
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50
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Schuleri KH, George RT, Lardo AC. Assessment of coronary blood flow with computed tomography and magnetic resonance imaging. J Nucl Cardiol 2010; 17:582-90. [PMID: 20585916 DOI: 10.1007/s12350-010-9257-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Karl H Schuleri
- Image Guided Cardiotherapy Laboratory, Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University - School of Medicine, Baltimore, MD 21205, USA
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