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Lindsay AC, Choudhury RP. MRI of acute vascular syndromes: the emerging role of cardiovascular MRI in the diagnosis and treatment of AMI and stroke. Expert Rev Cardiovasc Ther 2012; 10:1101-8. [PMID: 23098146 DOI: 10.1586/erc.12.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
MRI is a safe and reproducible noninvasive method of obtaining high-resolution images of the heart and vascular system. As MRI has developed a more widespread clinical application over the last decade, attention has been increasing on how this technique can be used to aid the diagnosis of cardio- and cerebro-vascular diseases in the acute setting. While much of the initial development of cardiac MRI was based around describing the myocardium in the chronic stable state, much recent research has investigated the use of MRI to assess acute coronary syndromes. Similarly, arterial wall imaging using MRI was initially confined to relatively stable research populations; however, more recent work has suggested a possible future clinical role for vascular MRI techniques in acute settings. This study highlights recent advances in MRI of the cardiovascular system, with a particular emphasis on those techniques that can be of use in the setting of acute vascular syndromes, namely acute coronary syndrome, transient ischemic attack and stroke.
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van der Hulst AE, Roest AAW, Westenberg JJM, Kroft LJM, de Roos A. Cardiac MRI in postoperative congenital heart disease patients. J Magn Reson Imaging 2012; 36:511-28. [PMID: 22903653 DOI: 10.1002/jmri.23604] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Annelies E van der Hulst
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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53
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Kawel N, Turkbey EB, Carr JJ, Eng J, Gomes AS, Hundley WG, Johnson C, Masri SC, Prince MR, van der Geest RJ, Lima JAC, Bluemke DA. Normal left ventricular myocardial thickness for middle-aged and older subjects with steady-state free precession cardiac magnetic resonance: the multi-ethnic study of atherosclerosis. Circ Cardiovasc Imaging 2012; 5:500-8. [PMID: 22705587 DOI: 10.1161/circimaging.112.973560] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Increased left ventricular myocardial thickness (LVMT) is a feature of several cardiac diseases. The purpose of this study was to establish standard reference values of normal LVMT with cardiac magnetic resonance and to assess variation with image acquisition plane, demographics, and left ventricular function. METHODS AND RESULTS End-diastolic LVMT was measured on cardiac magnetic resonance steady-state free precession cine long and short axis images in 300 consecutive participants free of cardiac disease (169 women; 65.6 ± 8.5 years) of the Multi-Ethnic Study of Atherosclerosis cohort. Mean LVMT on short axis images at the mid-cavity level was 5.3 ± 0.9 mm and 6.3 ± 1.1 mm for women and men, respectively. The average of the maximum LVMT at the mid-cavity for women/men was 7/9 mm (long axis) and 7/8 mm (short axis). Mean LVMT was positively associated with weight (0.02 mm/kg; P=0.01) and body surface area (1.1 mm/m(2); P<0.001). No relationship was found between mean LVMT and age or height. Greater mean LVMT was associated with lower left ventricular end-diastolic volume (0.01 mm/mL; P<0.01), a lower left ventricular end-systolic volume (-0.01 mm/mL; P=0.01), and lower left ventricular stroke volume (-0.01 mm/mL; P<0.05). LVMT measured on long axis images at the basal and mid-cavity level were slightly greater (by 6% and 10%, respectively) than measurements obtained on short axis images; apical LVMT values on long axis images were 20% less than those on short axis images. CONCLUSIONS Normal values for wall thickness are provided for middle-aged and older subjects. Normal LVMT is lower for women than men. Observed values vary depending on the imaging plane for measurement.
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Affiliation(s)
- Nadine Kawel
- Radiology and Imaging Sciences Department and National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892, USA
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Achenbach S, Barkhausen J, Beer M, Beerbaum P, Dill T, Eichhorn J, Fratz S, Gutberlet M, Hoffmann M, Huber A, Hunold P, Klein C, Krombach G, Kreitner KF, Kühne T, Lotz J, Maintz D, Marholdt H, Merkle N, Messroghli D, Miller S, Paetsch I, Radke P, Steen H, Thiele H, Sarikouch S, Fischbach R. Konsensusempfehlungen der DRG/DGK/DGPK zum Einsatz der Herzbildgebung mit Computertomographie und Magnetresonanztomographie. KARDIOLOGE 2012. [DOI: 10.1007/s12181-012-0417-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Maffei E, Messalli G, Martini C, Nieman K, Catalano O, Rossi A, Seitun S, Guaricci AI, Tedeschi C, Mollet NR, Cademartiri F. Left and right ventricle assessment with Cardiac CT: validation study vs. Cardiac MR. Eur Radiol 2012; 22:1041-9. [PMID: 22270140 PMCID: PMC3321142 DOI: 10.1007/s00330-011-2345-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 10/05/2011] [Accepted: 10/08/2011] [Indexed: 12/03/2022]
Abstract
Objectives To compare Magnetic Resonance (MR) and Computed Tomography (CT) for the assessment of left (LV) and right (RV) ventricular functional parameters. Methods Seventy nine patients underwent both Cardiac CT and Cardiac MR. Images were acquired using short axis (SAX) reconstructions for CT and 2D cine b-SSFP (balanced-steady state free precession) SAX sequence for MR, and evaluated using dedicated software. Results CT and MR images showed good agreement: LV EF (Ejection Fraction) (52 ± 14% for CT vs. 52 ± 14% for MR; r = 0.73; p > 0.05); RV EF (47 ± 12% for CT vs. 47 ± 12% for MR; r = 0.74; p > 0.05); LV EDV (End Diastolic Volume) (74 ± 21 ml/m² for CT vs. 76 ± 25 ml/m² for MR; r = 0.59; p > 0.05); RV EDV (84 ± 25 ml/m² for CT vs. 80 ± 23 ml/m² for MR; r = 0.58; p > 0.05); LV ESV (End Systolic Volume)(37 ± 19 ml/m² for CT vs. 38 ± 23 ml/m² for MR; r = 0.76; p > 0.05); RV ESV (46 ± 21 ml/m² for CT vs. 43 ± 18 ml/m² for MR; r = 0.70; p > 0.05). Intra- and inter-observer variability were good, and the performance of CT was maintained for different EF subgroups. Conclusions Cardiac CT provides accurate and reproducible LV and RV volume parameters compared with MR, and can be considered as a reliable alternative for patients who are not suitable to undergo MR. Key Points • Cardiac-CT is able to provide Left and Right Ventricular function. • Cardiac-CT is accurate as MR for LV and RV volume assessment. • Cardiac-CT can provide accurate evaluation of coronary arteries and LV and RV function. Electronic supplementary material The online version of this article (doi:10.1007/s00330-011-2345-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erica Maffei
- Cardiovascular Radiology Unit, Giovanni XXIII Hospital, 31050, Monastier di Treviso, Italy
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Weinsaft JW, Kim HW, Crowley AL, Klem I, Shenoy C, Van Assche L, Brosnan R, Shah DJ, Velazquez EJ, Parker M, Judd RM, Kim RJ. LV thrombus detection by routine echocardiography: insights into performance characteristics using delayed enhancement CMR. JACC Cardiovasc Imaging 2011; 4:702-12. [PMID: 21757159 DOI: 10.1016/j.jcmg.2011.03.017] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/16/2011] [Accepted: 03/10/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study sought to evaluate performance characteristics of routine echo for left ventricular thrombus (LVT). BACKGROUND Although the utility of dedicated echocardiography (echo) for LVT is established, echo is widely used as a general test for which LVT is rarely the primary indication. We used delayed-enhancement cardiac magnetic resonance (DE-CMR) as a reference to evaluate LVT detection by routine echo. METHODS Dedicated LVT assessment using DE-CMR was prospectively performed in patients with left ventricular systolic dysfunction. Echoes were done as part of routine clinical care. Echo and CMR were independently read for LVT and related indexes of LVT size, shape, and image quality/diagnostic confidence. Follow-up was done for embolic events and pathology validation of LVT. RESULTS In this study, 243 patients had routine clinical echo and dedicated CMR within 1 week without intervening events. Follow-up supported DE-CMR as a reference standard, with >5-fold difference in endpoints between patients with versus without LVT by DE-CMR (p = 0.02). LVT prevalence was 10% by DE-CMR. Echo contrast was used in 4% of patients. Echo sensitivity and specificity were 33% and 91%, with positive and negative predictive values of 29% and 93%. Among patients with possible LVT as the clinical indication for echo, sensitivity and positive predictive value were markedly higher (60%, 75%). Regarding sensitivity, echo performance related to LVT morphology and mirrored cine-CMR, with protuberant thrombus typically missed when small (p ≤ 0.02). There was also a strong trend to miss mural thrombus irrespective of size (p = 0.06). Concerning positive predictive value, echo performance related to image quality, with lower diagnostic confidence scores for echoes read positive for LVT in discordance with DE-CMR compared with echoes concordant with DE-CMR (p < 0.02). CONCLUSIONS Routine echo with rare contrast use can yield misleading results concerning LVT. Echo performance is improved when large protuberant thrombus is present and when the clinical indication is specifically for LVT assessment.
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Affiliation(s)
- Jonathan W Weinsaft
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina 27710, USA
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Presence of endothelial colony-forming cells is associated with reduced microvascular obstruction limiting infarct size and left ventricular remodelling in patients with acute myocardial infarction. Basic Res Cardiol 2011; 106:1397-410. [PMID: 21904841 DOI: 10.1007/s00395-011-0220-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 08/04/2011] [Accepted: 08/29/2011] [Indexed: 12/24/2022]
Abstract
Endothelial colony-forming cells (ECFCs) are known to increase after acute myocardial infarction (AMI). We examined whether the presence of ECFCs is associated with preserved microvascular integrity in the myocardium at risk by reducing microvascular obstruction (MVO). We enrolled 88 patients with a first ST elevation AMI. ECFC colonies and circulating progenitor cells were characterized at admission. MVO was evaluated at 5 days and infarct size at 5 days and at 6-month follow-up by magnetic resonance imaging. ECFC colonies were detected in 40 patients (ECFC(pos) patients). At 5 days, MVO was of greater magnitude in ECFC(neg) versus ECFC(pos) patients (7.7 ± 5.3 vs. 3.2 ± 5%, p = 0.0002). At 6 months, in ECFC(pos) patients, there was a greater reduction in infarct size (-32.4 ± 33 vs. -12.8 ± 24%; p = 0.003) and a significant improvement in left ventricular (LV) volumes and ejection fraction. Level of circulating CD34+/VEGF-R2+ cells was correlated with the number of ECFC colonies (r = 0.54, p < 0.001) and relative change in infarct size (r = 0.71, p < 0.0001). The results showed that the presence of ECFC colonies is associated with reduced MVO after AMI, leading to reduced infarct size and less LV remodelling and can be considered a marker of preserved microvascular integrity in AMI patients.
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Evolution of acute coronary syndrome with normal coronary arteries and normal cardiac magnetic resonance imaging. Arch Cardiovasc Dis 2011; 104:509-17. [PMID: 22044703 DOI: 10.1016/j.acvd.2011.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/12/2011] [Accepted: 05/17/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute coronary syndrome (ACS) with normal coronary angiography is a frequent clinical situation with an uncertain prognosis. Cardiac magnetic resonance imaging (CMRI) is a powerful tool for differential diagnosis between myocardial infarction (MI), acute myocarditis and Tako-tsubo cardiomyopathy (TTC). Data are sparse regarding the evolution of patients presenting an ACS with normal coronary arteries and normal CMRI. AIMS To evaluate the evolution of patients presenting an ACS with normal coronary arteries and normal CMRI, with a 1-year follow-up. METHODS Eighty-seven consecutive patients (mean age, 53 years; 40.2% men) presenting an ACS with troponin elevation and normal coronary arteries by angiography were prospectively included. All patients underwent CMRI at 3-Tesla. Adverse events were recorded with 1-year follow-up. RESULTS A likely aetiology for the acute clinical presentation was established by CMRI in 63.2% of patients (22.7% MI, 26.4% acute myocarditis, 11.5% TTC). During follow-up, one patient in the MI group had a stroke (1.2%). In the myocarditis group, there was one initial cardiogenic shock, one episode of congestive heart failure (1.2%) and nine patients had recurrent chest pain without troponin elevation (10.3%). Two TTC group patients initially presented with cardiogenic shock (2.4%); there were no other adverse events in this group during follow-up. In the remaining 36.7% patients, no clear diagnosis could be identified by CMRI, and no adverse events occurred during follow-up. CONCLUSION CMRI is a useful tool for the management of ACS presenting with normal coronary angiography, as it helps to ascertain the diagnosis and adapt treatment in a large proportion of cases. Nonetheless, patients with no abnormalities identified by CMRI have an excellent evolution.
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Fonseca CG, Backhaus M, Bluemke DA, Britten RD, Chung JD, Cowan BR, Dinov ID, Finn JP, Hunter PJ, Kadish AH, Lee DC, Lima JAC, Medrano-Gracia P, Shivkumar K, Suinesiaputra A, Tao W, Young AA. The Cardiac Atlas Project--an imaging database for computational modeling and statistical atlases of the heart. ACTA ACUST UNITED AC 2011; 27:2288-95. [PMID: 21737439 PMCID: PMC3150036 DOI: 10.1093/bioinformatics/btr360] [Citation(s) in RCA: 195] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Motivation: Integrative mathematical and statistical models of cardiac anatomy and physiology can play a vital role in understanding cardiac disease phenotype and planning therapeutic strategies. However, the accuracy and predictive power of such models is dependent upon the breadth and depth of noninvasive imaging datasets. The Cardiac Atlas Project (CAP) has established a large-scale database of cardiac imaging examinations and associated clinical data in order to develop a shareable, web-accessible, structural and functional atlas of the normal and pathological heart for clinical, research and educational purposes. A goal of CAP is to facilitate collaborative statistical analysis of regional heart shape and wall motion and characterize cardiac function among and within population groups. Results: Three main open-source software components were developed: (i) a database with web-interface; (ii) a modeling client for 3D + time visualization and parametric description of shape and motion; and (iii) open data formats for semantic characterization of models and annotations. The database was implemented using a three-tier architecture utilizing MySQL, JBoss and Dcm4chee, in compliance with the DICOM standard to provide compatibility with existing clinical networks and devices. Parts of Dcm4chee were extended to access image specific attributes as search parameters. To date, approximately 3000 de-identified cardiac imaging examinations are available in the database. All software components developed by the CAP are open source and are freely available under the Mozilla Public License Version 1.1 (http://www.mozilla.org/MPL/MPL-1.1.txt). Availability:http://www.cardiacatlas.org Contact:a.young@auckland.ac.nz Supplementary information:Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Carissa G Fonseca
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, CA 90095, USA
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Muzzarelli S, Ordovas K, Higgins CB. Cardiovascular MRI for the assessment of heart failure: focus on clinical management and prognosis. J Magn Reson Imaging 2011; 33:275-86. [PMID: 21274968 DOI: 10.1002/jmri.22433] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Cardiovascular MR (CMR) has an emerging role in the noninvasive diagnostic assessment of heart failure (HF). Different imaging sequences allow for a detailed assessment of cardiac morphology, function, myocardial perfusion, tissue characterization, and blood flow measurement. This article reviews the key applications of CMR in HF, with special focus on how CMR may influence the diagnostic and therapeutic approach of HF patients.
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Affiliation(s)
- Stefano Muzzarelli
- Department of Radiology, University of California, San Francisco, California 94143-0628, USA.
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61
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Abstract
Prevalence of heart failure with preserved left ventricular ejection fraction amounts to 50% of all cases with heart failure. Diagnosis assessment requires evidence of left ventricular diastolic dysfunction. Currently, echocardiography is the method of choice for diastolic function testing in clinical practice. Various applications are in use and recommended criteria are followed for classifying the severity of dysfunction. Cardiovascular magnetic resonance (CMR) offers a variety of alternative applications for evaluation of diastolic function, some superior to echocardiography in accuracy and reproducibility, some being complementary. In this article, the role of the available CMR applications for diastolic function testing in clinical practice and research is reviewed and compared to echocardiography.
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Affiliation(s)
- Jos J. M. Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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62
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Maffei E, Messalli G, Martini C, Rossi A, van Pelt N, van Geuns RJ, Weustink AC, Mollet NR, Nieman K, Aldrovandi A, Imbriaco M, Bogaert J, Cademartiri F. Magnetic resonance assessment of left ventricular volumes and mass using a single-breath-hold 3D k-t BLAST cine b-SSFP in comparison with multiple-breath-hold 2D cine b-SSFP. Insights Imaging 2011; 2:39-45. [PMID: 22865424 PMCID: PMC3288975 DOI: 10.1007/s13244-010-0056-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/07/2010] [Accepted: 11/25/2010] [Indexed: 11/15/2022] Open
Abstract
Objective To assess the feasibility of single-breath-hold three-dimensional cine b-SSFP (balanced steady-state free precession gradient echo) sequence (3D-cine), accelerated with k-t BLAST (broad-use linear acquisition speed-up technique), compared with multiple-breath-hold 2D cine b-SSFP (2D-cine) sequence for assessment of left ventricular (LV) function. Methods Imaging was performed using 1.5-T MRI (Achieva, Philips, The Netherlands) in 46 patients with different cardiac diseases. Global functional parameters, LV mass, imaging time and reporting time were evaluated and compared in each patient. Results Functional parameters and mass were significantly different in the two sequences [3D end-diastolic volume (EDV) = 129 ± 44 ml vs 2D EDV = 134 ± 49 ml; 3D end-systolic volume (ESV) = 77 ± 44 ml vs 2D ESV = 73 ± 50 ml; 3D ejection fraction (EF) = 43 ± 15% vs 2D EF = 48 ± 15%; p < 0.05], although an excellent correlation was found for LV EF (r = 0.99). Bland-Altman analysis showed small confidence intervals with no interactions on volumes (EF limits of agreement = 2.7; 7.6; mean bias 5%). Imaging time was significantly lower for 3D-cine sequence (18 ± 1 s vs 95 ± 23 s; p < 0.05), although reporting time was significantly longer for the 3D-cine sequence (29 ± 7 min vs 8 ± 3 min; p < 0.05). Conclusions A 3D-cine sequence can be advocated as an alternative to 2D-cine sequence for LV EF assessment in patients for whom shorter imaging time is desirable.
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Affiliation(s)
- Erica Maffei
- Department of Radiology and Cardiology, University Hospital, Parma, Italy
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Ridgway JP. Cardiovascular magnetic resonance physics for clinicians: part I. J Cardiovasc Magn Reson 2010; 12:71. [PMID: 21118531 PMCID: PMC3016368 DOI: 10.1186/1532-429x-12-71] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 11/30/2010] [Indexed: 02/08/2023] Open
Abstract
There are many excellent specialised texts and articles that describe the physical principles of cardiovascular magnetic resonance (CMR) techniques. There are also many texts written with the clinician in mind that provide an understandable, more general introduction to the basic physical principles of magnetic resonance (MR) techniques and applications. There are however very few texts or articles that attempt to provide a basic MR physics introduction that is tailored for clinicians using CMR in their daily practice. This is the first of two reviews that are intended to cover the essential aspects of CMR physics in a way that is understandable and relevant to this group. It begins by explaining the basic physical principles of MR, including a description of the main components of an MR imaging system and the three types of magnetic field that they generate. The origin and method of production of the MR signal in biological systems are explained, focusing in particular on the two tissue magnetisation relaxation properties (T1 and T2) that give rise to signal differences from tissues, showing how they can be exploited to generate image contrast for tissue characterisation. The method most commonly used to localise and encode MR signal echoes to form a cross sectional image is described, introducing the concept of k-space and showing how the MR signal data stored within it relates to properties within the reconstructed image. Before describing the CMR acquisition methods in detail, the basic spin echo and gradient pulse sequences are introduced, identifying the key parameters that influence image contrast, including appearances in the presence of flowing blood, resolution and image acquisition time. The main derivatives of these two pulse sequences used for cardiac imaging are then described in more detail. Two of the key requirements for CMR are the need for data acquisition first to be to be synchronised with the subject's ECG and to be fast enough for the subject to be able to hold their breath. Methods of ECG synchronisation using both triggering and retrospective gating approaches, and accelerated data acquisition using turbo or fast spin echo and gradient echo pulse sequences are therefore outlined in some detail. It is shown how double inversion black blood preparation combined with turbo or fast spin echo pulse sequences acquisition is used to achieve high quality anatomical imaging. For functional cardiac imaging using cine gradient echo pulse sequences two derivatives of the gradient echo pulse sequence; spoiled gradient echo and balanced steady state free precession (bSSFP) are compared. In each case key relevant imaging parameters and vendor-specific terms are defined and explained.
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Affiliation(s)
- John P Ridgway
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, UK.
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64
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Charoenpanichkit C, Hundley WG. The 20 year evolution of dobutamine stress cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2010; 12:59. [PMID: 20977757 PMCID: PMC2984575 DOI: 10.1186/1532-429x-12-59] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 10/26/2010] [Indexed: 01/03/2023] Open
Abstract
Over the past 20 years, investigators world-wide have developed and utilized dobutamine magnetic resonance stress testing procedures for the purpose of identifying ischemia, viability, and cardiac prognosis. This article traces these developments and reviews the data utilized to substantiate this relatively new noninvasive imaging procedure.
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Affiliation(s)
- Charaslak Charoenpanichkit
- Department of Internal Medicine Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - W Gregory Hundley
- Department of Internal Medicine Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Sandner TA, Theisen D, Bauner KU, Picciolo M, Reiser MF, Wintersperger BJ. [Cardiac functional analysis with MRI]. Radiologe 2010; 50:514-22. [PMID: 20445956 DOI: 10.1007/s00117-010-1987-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cardiovascular diseases (CVD) are among the leading causes of death worldwide. Even in the 21(st) century CVD will still be the most frequent cause of morbidity and mortality. Precise evaluation of cardiac function is therefore mandatory for therapy planning and monitoring. In this article the contribution of MRI-based analysis of cardiac function will be addressed. Nowadays cine-MRI is considered as the standard of reference (SOR) in cardiac functional analysis. ECG-triggered steady-state free precession (SSFP) sequences are mainly used as they stand out due to short acquisition times and excellent contrast between the myocardium and the ventricular cavity. An indispensible requirement for cardiac functional analysis is an exact planning of the examination and based on that the coverage of the whole ventricle in short axial slices. By means of dedicated post-processing software, manual or semi-automatic segmentation of the endocardial and epicardial contours is necessary for functional analysis. In this way end-diastolic volume (EDV), end-systolic volume (ESV) and the ejection fraction (EF) are defined and regional wall motion abnormalities (RWMA) can be detected.
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Affiliation(s)
- T A Sandner
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland.
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66
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Cardiac chamber quantification using magnetic resonance imaging at 7 Tesla--a pilot study. Eur Radiol 2010; 20:2844-52. [PMID: 20640427 DOI: 10.1007/s00330-010-1888-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 06/25/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Interest in cardiovascular magnetic resonance (CMR) at 7 T is motivated by the expected increase in spatial and temporal resolution, but the method is technically challenging. We examined the feasibility of cardiac chamber quantification at 7 T. METHODS A stack of short axes covering the left ventricle was obtained in nine healthy male volunteers. At 1.5 T, steady-state free precession (SSFP) and fast gradient echo (FGRE) cine imaging with 7 mm slice thickness (STH) were used. At 7 T, FGRE with 7 mm and 4 mm STH were applied. End-diastolic volume, end-systolic volume, ejection fraction and mass were calculated. RESULTS All 7 T examinations provided excellent blood/myocardium contrast for all slice directions. No significant difference was found regarding ejection fraction and cardiac volumes between SSFP at 1.5 T and FGRE at 7 T, while volumes obtained from FGRE at 1.5 T were underestimated. Cardiac mass derived from FGRE at 1.5 and 7 T was larger than obtained from SSFP at 1.5 T. Agreement of volumes and mass between SSFP at 1.5 T and FGRE improved for FGRE at 7 T when combined with an STH reduction to 4 mm. CONCLUSIONS This pilot study demonstrates that cardiac chamber quantification at 7 T using FGRE is feasible and agrees closely with SSFP at 1.5 T.
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Sung K, Lee HL, Hu HH, Nayak KS. Prediction of myocardial signal during CINE balanced SSFP imaging. MAGMA (NEW YORK, N.Y.) 2010; 23:85-91. [PMID: 20229086 PMCID: PMC6570530 DOI: 10.1007/s10334-010-0202-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 02/01/2010] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
Abstract
OBJECT To develop a signal model for accurate prediction of myocardial signal during cine-balanced steady-state free precession (bSSFP) imaging. METHODS We present a signal model that takes into account the effects of non-ideal slice profile, off-resonance, and radio-frequency transmit variation on myocardial signal behavior. Each of the three factors was examined over the range of imaging parameters routinely used in cine bSSFP cardiac imaging at 3 Tesla. RESULTS In five healthy volunteers and over a wide range of prescribed flip angles, the conventional on-resonance signal model exhibited 28.9 +/- 3.9% error, while the proposed model exhibited only 2.9 +/- 1.4% error, and therefore more accurate predictions of myocardial signal behavior. Slice profile effects were found to be significant and accounted for most of the improvement. Off-resonance and RF transmit inhomogeneity effects were less significant but did produce more accurate signal prediction. CONCLUSIONS The proposed signal model produced more accurate predictions of myocardial signal compared to existing models and can be used for the optimization of pulse sequences and protocols.
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Affiliation(s)
- Kyunghyun Sung
- Department of Radiology, Lucas Center for MRI/S, Stanford University, 1201 Welch Road, Stanford, CA 94305-5488, USA.
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Rosendahl L, Ahlander BM, Björklund PG, Blomstrand P, Brudin L, Engvall JE. Image quality and myocardial scar size determined with magnetic resonance imaging in patients with permanent atrial fibrillation: a comparison of two imaging protocols. Clin Physiol Funct Imaging 2010; 30:122-9. [DOI: 10.1111/j.1475-097x.2009.00914.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The gold standard for noninvasive imaging in coronary heart disease: magnetic resonance imaging. Curr Opin Cardiol 2009; 24:567-79. [DOI: 10.1097/hco.0b013e3283315553] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Desch S, Eitel I, Schmitt J, Sareban M, Fuernau G, Schuler G, Thiele H. Effect of coronary collaterals on microvascular obstruction as assessed by magnetic resonance imaging in patients with acute ST-elevation myocardial infarction treated by primary coronary intervention. Am J Cardiol 2009; 104:1204-9. [PMID: 19840563 DOI: 10.1016/j.amjcard.2009.06.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 06/09/2009] [Accepted: 06/09/2009] [Indexed: 10/20/2022]
Abstract
The aim of this study was to determine whether angiographically visible collaterals before reperfusion are associated with beneficial effects on infarct size, microvascular obstruction, and left ventricular function as measured by magnetic resonance imaging (MRI) in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). We examined 235 patients with STEMI and symptoms <12 hours. All patients had Thrombolysis In Myocardial Infarction grade < or =1 flow before PCI. Collateral flow was graded according to Rentrop classification. Patients were divided in 2 groups; group A had absent or weak collateral flow and group B had significant flow. In 166 patients there was absent or weak collateral flow, whereas 69 had significant flow. Extent of microvascular obstruction was significantly smaller in group B at early MRI (3.3% vs 2.1% of left ventricle, p = 0.009). Infarct size measured by peak creatine kinase release showed smaller infarcts in group B (p = 0.02), whereas MRI infarct size showed a weak trend (p = 0.20). At 6 months, a strong trend toward a lower rate of death or nonfatal reinfarction could be seen in group B (4.5% vs 12.2%, p = 0.07). In conclusion, well-developed collaterals before reperfusion by PCI in patients with STEMI are associated with a protective effect on coronary microcirculation.
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Eitel I, Lücke C, Grothoff M, Sareban M, Schuler G, Thiele H, Gutberlet M. Inflammation in takotsubo cardiomyopathy: insights from cardiovascular magnetic resonance imaging. Eur Radiol 2009; 20:422-31. [PMID: 19705125 DOI: 10.1007/s00330-009-1549-5] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 06/18/2009] [Accepted: 07/05/2009] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Takotsubo cardiomyopathy (TTC) is an increasingly recognised acute cardiac syndrome, whose underlying pathophysiological mechanisms remain unknown. Inflammation might play a role as this has been shown in endomyocardial biopsies. The aim of this study was to assess inflammatory parameters in patients with TTC using a comprehensive cardiovascular magnetic resonance imaging (CMR) approach. METHODS Thirty-seven patients with the suspected diagnosis of TTC underwent CMR. T2-weighted imaging to calculate the oedema ratio, T1-weighted imaging before and after contrast agent administration to calculate the global relative enhancement (gRE), and late gadolinium enhancement (LGE) imaging were performed. RESULTS In 11 patients CMR revealed the diagnosis of myocardial infarction (n = 7; 19%) or myocarditis (n = 4; 11%) with typical patterns of LGE. In all other patients (n = 26; 70%), no LGE was detected consistent with the diagnosis of TTC. Of these, in 16 patients (62%) both inflammatory markers (oedema ratio and gRE) were elevated with concomitant pericardial effusion, indicating acute inflammation. Follow-up CMR after 3 months showed complete normalisation of left ventricular function and inflammatory parameters in the absence of LGE and pericardial effusion. CONCLUSION This CMR study provides further insights into the pathophysiological mechanisms in TTC, supporting the contribution of an inflammatory process in the acute setting.
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Affiliation(s)
- Ingo Eitel
- Department of Internal Medicine/Cardiology, University of Leipzig-Heart Centre, Strümpellstr. 39, 04289 Leipzig, Germany.
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Lagerstrand KM, Plewes DB, Vikhoff-Baaz B, Forssell-Aronsson E. Flow-induced disturbances in balanced steady-state free precession images: means to reduce or exploit them. Magn Reson Med 2009; 61:893-8. [PMID: 19191282 DOI: 10.1002/mrm.21656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this work computer simulations and phantom measurements are presented that show the effect of flow on in-plane balanced steady-state free precession images. The images were studied for various flow velocities, excitation regions, relaxation times, RF-pulse angles, and off-resonance frequencies. The work shows that flow-induced disturbances are present in the images, but can be reduced by the application of inhomogeneous excitation regions. Also, a velocity quantification method that utilizes the disturbances was developed and proved to quantify flow velocities accurately. The work concluded that the flow-induced disturbances can be reduced to improve image quality, but can also be exploited to quantify the flow velocity.
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Affiliation(s)
- K M Lagerstrand
- Department of Radiation Physics, Göteborg University, Göteborg, Sweden.
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Assessment of left ventricular volumes with cardiac MRI: comparison between two semiautomated quantitative software packages. Radiol Med 2009; 114:718-27. [DOI: 10.1007/s11547-009-0423-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 11/18/2008] [Indexed: 11/25/2022]
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Buechel EV, Kaiser T, Jackson C, Schmitz A, Kellenberger CJ. Normal right- and left ventricular volumes and myocardial mass in children measured by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2009; 11:19. [PMID: 19545393 PMCID: PMC2718870 DOI: 10.1186/1532-429x-11-19] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 06/21/2009] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Quantification of ventricular volume by steady state free precession (SSFP) cardiovascular magnetic resonance is accurate and reproducible. Normal values exist for adults, but are lacking for children.We sought to establish normal values for left and right ventricular volumes, mass and function in healthy children by using SSFP. METHODS AND RESULTS Fifty children (27 females, 23 males) without cardiovascular disease were evaluated. Median age was 11 years (range 7 months - 18 years), weight 35 kg (range 7-77 kg), height 146 cm (range 66-181 cm). Thirty-six examinations were performed with breath holding, 14 in freely breathing sedated children.Ventricular volumes and mass were measured in the end systolic and end diastolic phase on SSFP cine images acquired in a short axis plane as a stack of 12 contiguous slices covering full length of both ventricles. Regression analysis showed an exponential relationship between body surface area (BSA) and ventricular volumes and mass (normal value = a*BSAb). Normative curves for males and females are presented in relation to BSA for the end-diastolic volume, end-systolic volume and mass of both ventricles. Intra- and interobserver variability of the measurements was within the limits of 2% and 7% respectively, except for right ventricular mass (10%). CONCLUSION The exponential equation for calculation of normal values for each ventricular parameter and graphical display of normative curves for data acquired in healthy children by SSFP cardiovascular magnetic resonance are provided.
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Affiliation(s)
| | - Thomas Kaiser
- Division of Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland
| | - Clare Jackson
- Division of Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland
| | - Achim Schmitz
- Division of Anesthesiology, University Children's Hospital, Zurich, Switzerland
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Abstract
Diabetes mellitus is a major cardiovascular risk factor and one of the major causes for morbidity and mortality worldwide. Diabetic complications have not only major impact on the quality of life of diabetic patients, but are also potentially life-threatening. Therefore prevention, diagnosis and therapy of these long-term complications are of high importance. However, diagnosis of the variety of complications from diabetes mellitus remains a diagnostic challenge and usually several diagnostic steps are necessary to diagnose or exclude these complications. In the last years whole body magnetic resonance imaging (WB-MRI) including whole body magnetic resonance angiography (WB-MRA) has been introduced for cardiovascular imaging and is now increasingly applied in clinical routine for the workup of patients with cardiovascular disease and for cardiovascular screening. The article summarizes rationales for WB-MRI in diabetes mellitus, technical concepts of disease specific cardiovascular WB-MRI in diabetes mellitus and discusses potential clinical consequences.
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Robbers-Visser D, Boersma E, Helbing WA. Normal biventricular function, volumes, and mass in children aged 8 to 17 years. J Magn Reson Imaging 2009; 29:552-9. [PMID: 19243036 DOI: 10.1002/jmri.21662] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To assess normal values for biventricular function, volumes, and mass with current cardiovascular magnetic resonance (CMR) imaging sequences in children. MATERIALS AND METHODS Included in the study were 60 healthy children aged 8-17 years. A short axis set of contiguous slices was acquired with CMR imaging employing steady-state free precession. Biventricular end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and mass were determined. Uni- and multivariate linear regression analyses were performed to study the interrelation of age, gender, and body surface area (BSA) on biventricular volumes and mass. The coefficient of variation was calculated for intra- and interobserver variability. RESULTS EF did not differ between boys and girls (mean LV-EF 69+/-(SD) 5%, mean RV-EF 65+/-5%). BSA had good (EDV, mass) and modest (ESV) correlation with biventricular measurements. Gender appeared a significant modifier of these relations, whereas age had no independent contribution. The intra- and interobserver coefficient of variation was in the range 2.1%-13.9% for biventricular EDV, ESV, and mass. CONCLUSION This study reveals gender-specific normative data for biventricular function, volumes, and mass in children age 8-17 years that can be used as reference data in the follow-up of pediatric cardiac patients.
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Affiliation(s)
- Daniëlle Robbers-Visser
- Department of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Turkbey EB, Dombroski DA. Cardiac Magnetic Resonance Imaging: Techniques and Clinical Applications. Semin Roentgenol 2009; 44:67-83. [PMID: 19233083 DOI: 10.1053/j.ro.2008.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Systemic Cardiovascular Complications in Patients With Long-Standing Diabetes Mellitus. Invest Radiol 2009; 44:242-50. [DOI: 10.1097/rli.0b013e31819a60d3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Parallel imaging and dobutamine stress magnetic resonance imaging in patients with atypical chest pain or equivocal ECG not suitable for stress echocardiography. Radiol Med 2009; 114:216-28. [DOI: 10.1007/s11547-009-0366-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Accepted: 09/10/2008] [Indexed: 10/21/2022]
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Cain PA, Ahl R, Hedstrom E, Ugander M, Allansdotter-Johnsson A, Friberg P, Arheden H. Age and gender specific normal values of left ventricular mass, volume and function for gradient echo magnetic resonance imaging: a cross sectional study. BMC Med Imaging 2009; 9:2. [PMID: 19159437 PMCID: PMC2657902 DOI: 10.1186/1471-2342-9-2] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 01/21/2009] [Indexed: 11/10/2022] Open
Abstract
Background Knowledge about age-specific normal values for left ventricular mass (LVM), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) by cardiac magnetic resonance imaging (CMR) is of importance to differentiate between health and disease and to assess the severity of disease. The aims of the study were to determine age and gender specific normal reference values and to explore the normal physiological variation of these parameters from adolescence to late adulthood, in a cross sectional study. Methods Gradient echo CMR was performed at 1.5 T in 96 healthy volunteers (11–81 years, 50 male). Gender-specific analysis of parameters was undertaken in both absolute values and adjusted for body surface area (BSA). Results Age and gender specific normal ranges for LV volumes, mass and function are presented from the second through the eighth decade of life. LVM, ESV and EDV rose during adolescence and declined in adulthood. SV and EF decreased with age. Compared to adult females, adult males had higher BSA-adjusted values of EDV (p = 0.006) and ESV (p < 0.001), similar SV (p = 0.51) and lower EF (p = 0.014). No gender differences were seen in the youngest, 11–15 year, age range. Conclusion LV volumes, mass and function vary over a broad age range in healthy individuals. LV volumes and mass both rise in adolescence and decline with age. EF showed a rapid decline in adolescence compared to changes throughout adulthood. These findings demonstrate the need for age and gender specific normal ranges for clinical use.
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Affiliation(s)
- Peter A Cain
- Department of Clinical Physiology, Lund University Hospital, SE-22185, Lund, Sweden.
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Malayeri AA, Johnson WC, Macedo R, Bathon J, Lima JAC, Bluemke DA. Cardiac cine MRI: Quantification of the relationship between fast gradient echo and steady-state free precession for determination of myocardial mass and volumes. J Magn Reson Imaging 2008; 28:60-6. [PMID: 18581356 DOI: 10.1002/jmri.21405] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To determine the correlation function between the steady-state free precession (SSFP) and fast gradient echo (FGRE) cine MRI pulse sequences for measuring the myocardial mass and volumes. MATERIALS AND METHODS Cardiac cine MRI examinations were acquired in 50 individuals (female: 35, male: 15, mean age 64.1 +/- 9.1 years, range 48-83) using SSFP and FGRE cardiac pulse sequences. RESULTS The mean (standard deviation [SD]) left ventricular end diastolic volume measured by SSFP was significantly larger (4.5%) than by FGRE (P < 0.001); this was also the case for end systolic volume (15.0%, P < 0.001). The relationship between SSFP and FGRE measures were linear and highly correlated (P < 0.001) for both left ventricular end diastolic and end systolic volumes (r(2) = 0.90 vs. 0.91, respectively). We determined linear regression models to estimate the SSFP values based on the FGRE measures. Slope (intercept) for ejection fraction, stroke volume, and cardiac output were 0.99 (-2.79), 0.77 (17.5), and 0.76 (1.29), respectively. CONCLUSION Linear relationships exist for key LV function parameters when comparing SSFP and FGRE cine MRI. These results indicate that existing databases and normal values for FGRE LV function may be converted to corresponding LV function values for SSFP MRI.
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Affiliation(s)
- Ashkan Akhavan Malayeri
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Assessment of left ventricular volumes and function by cine-MR imaging depending on the investigator's experience. Surg Radiol Anat 2008; 31:113-20. [PMID: 18841322 DOI: 10.1007/s00276-008-0415-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 09/03/2008] [Indexed: 12/16/2022]
Abstract
AIMS To analyze the reproducibility of LV volumes calculated by cardiac magnetic resonance imaging (CMRI) and to compare them to those obtained by conventional ventriculography. METHODS A total of 30 patients with stable ischemic heart disease were prospectively included. Each underwent CMRI twice and ventriculography. Left ventricular end diastolic volume (EDV), end systolic volume (ESV) and LV ejection fraction (EF) were calculated by two radiologists at different level of experience. Intraobserver, interobserver and interstudy variabilities were assessed. RESULTS The cut off values were: intraobserver variability (EDV, ESV, EF): 9.4 ml, 5.3 ml, 3.3% for well-trained radiologist; 13.1 ml, 7.5 ml, 4.1% for less-trained radiologist. interobserver variability: EDV: 11.7 and 10.4 ml; ESV: 7.0 and 6.6 ml; EF: 3.9 and 4.2%. interstudy variability (EDV, ESV, EF): 11.6 and 12.6 ml, 7.1 and 7.4 ml, 3.9 and 3.5%, for experienced and less-trained observers. Statistical differences were found between CMRI and ventriculography: CMRI underestimation of EDV and EF, overestimation of ESV. CONCLUSIONS CMRI volumetric quantification of LV volumes and function is highly reproducible at different levels of experience, but not interchangeable with those obtained by ventriculography.
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Effects of papillary muscles and trabeculae on left ventricular quantification: increased impact of methodological variability in patients with left ventricular hypertrophy. J Hypertens 2008; 26:1677-85. [PMID: 18622248 DOI: 10.1097/hjh.0b013e328302ca14] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Accurate quantification of left ventricular mass and ejection fraction is important for patients with left ventricular hypertrophy. Although cardiac magnetic resonance imaging has been proposed as a standard for these indices, prior studies have variably included papillary muscles and trabeculae in myocardial volume. This study investigated the contribution of papillary muscles and trabeculae to left ventricular quantification in relation to the presence and pattern of hypertrophy. METHODS Cardiac magnetic resonance quantification was performed on patients with concentric or eccentric hypertrophy and normal controls (20 per group) using two established methods that included papillary muscles and trabeculae in myocardium (method 1) or intracavitary (method 2) volumes. RESULTS Among all patients, papillary muscles and trabeculae accounted for 10.5% of ventricular mass, with greater contribution with left ventricular hypertrophy than normals (12.6 vs. 6.2%, P < 0.001). Papillary muscles and trabeculae mass correlated with ventricular wall mass (r = 0.53) and end-diastolic volume (r = 0.52; P < 0.001). Papillary muscles and trabeculae inclusion in myocardium (method 1) yielded smaller differences with a standard of mass quantification from linear ventricular measurements than did method 2 (P < 0.001). Method 1 in comparison with method 2 yielded differences in left ventricular mass, ejection fraction and volume in all groups, especially in patients with hypertrophy: the difference in ventricular mass index was three-fold to six-fold greater in hypertrophy than normal groups (P < 0.001). Difference in ejection fraction, greatest in concentric hypertrophy (P < 0.001), was independently related to papillary muscles and trabeculae mass, ventricular wall mass, and smaller ventricular volume (R = 0.56, P < 0.001). CONCLUSION Established cardiac magnetic resonance methods yield differences in left ventricular quantification due to variable exclusion of papillary muscles and trabeculae from myocardium. The relative impact of papillary muscles and trabeculae exclusion on calculated mass and ejection fraction is increased among patients with hypertrophy-associated left ventricular remodeling.
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Gloor M, Scheffler K, Bieri O. Quantitative magnetization transfer imaging using balanced SSFP. Magn Reson Med 2008; 60:691-700. [DOI: 10.1002/mrm.21705] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hamdan A, Kelle S, Schnackenburg B, Wellnhofer E, Fleck E, Nagel E. Single-breathhold four-dimensional assessment of left ventricular volumes and function using k-t BLAST after application of extracellular contrast agent at 3 Tesla. J Magn Reson Imaging 2008; 27:1028-36. [PMID: 18425828 DOI: 10.1002/jmri.21332] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To prospectively determine the feasibility and accuracy of a four-dimensional (4D) k-space over time broad-use linear acquisition speed-up technique (k-t BLAST) for the evaluation of left ventricular (LV) volumes in comparison to standard multiple-breathhold cine imaging, using a 3.0 Tesla (3T) MR system. MATERIALS AND METHODS In 23 subjects, short-axis cine loops completely covering the LV were acquired using conventional turbo gradient echo (GRE) imaging. Immediately after administration of gadobenate dimeglumine, a rapid single-breathhold k-t BLAST 4D dataset with the same coverage was acquired and reconstructed to short-axis views. Quantitative aortic flow measurement for LV stroke volume (LVSV) was used to calibrate both techniques. For GRE and k-t BLAST cine imaging: LV volumes, ejection fraction (EF), and blood-to-myocardium-contrast (BMC) were determined. RESULTS k-t BLAST and GRE sequences showed a strong correlation for LV volumes and EF (r = 0.97-0.99; P < 0.001). Excellent agreement was also found between the LVSV determined by aortic flow measurements and LVSV assessed using GRE sequence and k-t BLAST sequence. BMC of GRE was similar to that of k-t BLAST cine imaging. CONCLUSION The use of the single-breathhold 4D k-t BLAST technique for the assessment of LV volume is feasible and accurate in 3T MRI.
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Affiliation(s)
- Ashraf Hamdan
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany.
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Abstract
Continued advances in radiofrequency hardware and tailored software have, in recent times, greatly increased the power and performance of magnetic resonance imaging for noninvasive evaluation of cardiovascular diseases. Magnetic resonance imaging can uniquely be manipulated to trade temporal resolution and spatial resolution against each other, depending on whether detailed structural or functional information is required. However, to date, a number of cardiovascular magnetic resonance applications have been somewhat limited due to signal-to-noise ratio constraints, reflecting the narrow imaging window imposed by physiological cardiac motion. By increasing the operating field strength from 1.5 to 3 T, it is possible (in principle) to double the signal-to-noise ratio, which in turn may be "traded" for improvements in spatial resolution, coverage, or imaging speed. In this context, the development of parallel imaging has set the stage for impressive performance improvements in contrast-enhanced magnetic resonance angiography at 3 T. Indeed, one could argue that without parallel acquisition, the bang for the buck in going from 1.5 to 3 T would be limited. In this paper, we discuss the current status of 3-T magnetic resonance imaging for cardiovascular imaging, considering the relative gains and limitations relative to 1.5 T.
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Gharib AM, Elagha A, Pettigrew RI. Cardiac magnetic resonance at high field: promises and problems. Curr Probl Diagn Radiol 2008; 37:49-56. [PMID: 18295076 DOI: 10.1067/j.cpradiol.2007.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiac magnetic resonance imaging (CMRI) at high magnetic field (3 Tesla) is rapidly evolving with many promising results. However, the challenges of field inhomogeneities and specific absorption rate limitations need to be addressed before reaping the benefits of high magnetic field for CMRI. This review focuses on the methods to overcome some of these challenges and the current and potential applications of this technology.
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Affiliation(s)
- Ahmed M Gharib
- Diagnostic Radiology Department and NHLBI, National Institutes of Health, Bethesda, MD 20892, USA.
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Thiele H, Schindler K, Friedenberger J, Eitel I, Fürnau G, Grebe E, Erbs S, Linke A, Möbius-Winkler S, Kivelitz D, Schuler G. Intracoronary compared with intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: the randomized Leipzig immediate percutaneous coronary intervention abciximab IV versus IC in ST-elevation myocardial infarction trial. Circulation 2008; 118:49-57. [PMID: 18559698 DOI: 10.1161/circulationaha.107.747642] [Citation(s) in RCA: 239] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Abciximab reduces major adverse cardiac events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Intracoronary abciximab bolus application results in high local drug concentrations and may be more effective than a standard intravenous bolus. METHODS AND RESULTS Patients undergoing primary PCI were randomized to either intracoronary (n=77) or intravenous (n=77) bolus abciximab administration with subsequent 12-hour intravenous infusion. The primary end point was infarct size and extent of microvascular obstruction as assessed by delayed enhancement magnetic resonance. Secondary end points were ST-segment resolution at 90 minutes, Thrombolysis in Myocardial Infarction flow and perfusion grades after PCI, and the occurrence of major adverse cardiac events within 30 days. The median infarct size was 15.1% (interquartile range, 6.1% to 25.2%) in the intracoronary versus 23.4% (interquartile range, 13.6% to 33.2%) in the intravenous group (P=0.01). Similarly, the extent of microvascular obstruction was significantly smaller in intracoronary compared with intravenous abciximab patients (P=0.01). Myocardial perfusion measured as early ST-segment resolution was significantly improved in intracoronary patients with an absolute ST-segment resolution of 77.8% (interquartile range, 66.7% to 100.0%) versus 70.0% (interquartile range, 45.2% to 83.5%; P=0.006). The Thrombolysis in Myocardial Infarction flow after PCI was not different between treatment groups (P=0.51), but there was a trend toward an improved perfusion grade (P=0.09). There also was a trend toward a lower major adverse cardiac event rate after intracoronary versus intravenous abciximab application (5.2% versus 15.6%; P=0.06; relative risk, 0.33; 95% CI, 0.09 to 1.05). CONCLUSIONS Intracoronary bolus administration of abciximab in primary PCI is superior to standard intravenous treatment with respect to infarct size, extent of microvascular obstruction, and perfusion.
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Affiliation(s)
- Holger Thiele
- Department of Internal Medicine/Cardiology, University of Leipzig, Heart Center, Strümpellstrasse 39, 04289 Leipzig, Germany.
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Eitel I, Behrendt F, Schindler K, Kivelitz D, Gutberlet M, Schuler G, Thiele H. Differential diagnosis of suspected apical ballooning syndrome using contrast-enhanced magnetic resonance imaging. Eur Heart J 2008; 29:2651-9. [DOI: 10.1093/eurheartj/ehn433] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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91
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Stellenwert der kardiovaskulären Magnetresonanztomographie in der Diagnostik der koronaren Herzerkrankung. Wien Med Wochenschr 2008; 158:140-7. [DOI: 10.1007/s10354-008-0513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Accepted: 02/09/2008] [Indexed: 10/22/2022]
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92
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Weinsaft JW, Klem I, Judd RM. MRI for the assessment of myocardial viability. Magn Reson Imaging Clin N Am 2008; 15:505-25, v-vi. [PMID: 17976589 DOI: 10.1016/j.mric.2007.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Accurate distinction between viable and infarcted myocardium is important for assessment of patients who have cardiac dysfunction. Through the technique of delayed-enhancement MRI (DE-MRI), viable and infarcted myocardium can be simultaneously identified in a manner that closely correlates with histopathology findings. This article provides an overview of experimental data establishing the physiologic basis of DE-MRI-evidenced hyperenhancement as a tissue-specific marker of myocardial infarction. Clinical data concerning the utility of transmural extent of hyperenhancement for predicting response to medical and revascularization therapy are reviewed. Studies directly comparing DE-MRI to other viability imaging techniques are presented, and emerging applications for DE-MRI are discussed.
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Affiliation(s)
- Jonathan W Weinsaft
- Greenberg Division of Cardiology, Weill Medical College of Cornell University, 525 East 68th Street, Starr-4, New York, NY 10021, USA.
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93
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Kirschbaum SW, Baks T, van den Ent M, Sianos G, Krestin GP, Serruys PW, de Feyter PJ, van Geuns RJM. Evaluation of left ventricular function three years after percutaneous recanalization of chronic total coronary occlusions. Am J Cardiol 2008; 101:179-85. [PMID: 18178403 DOI: 10.1016/j.amjcard.2007.07.060] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 07/20/2007] [Accepted: 07/20/2007] [Indexed: 12/22/2022]
Abstract
We investigated early and late effects of percutaneous revascularization for chronic total coronary occlusion on left ventricular (LV) function and volumes. Magnetic resonance imaging was performed in 21 patients before and 5 months and 3 years after recanalization. Global LV function and volumes and segmental wall thickening (SWT) were quantified on cine images. The 2 viability indexes used were the transmural extent of infarction (TEI) on delayed contrast enhancement images and end-diastolic wall thickness at baseline. Significant decreases in mean end-diastolic (86 +/- 14 to 78 +/- 15 ml/m2; p = 0.02) and mean end-systolic volume indexes (35 +/- 13 to 30 +/- 13 ml/m2; p = 0.03) were observed 3 years after recanalization. Mean ejection fraction tended to improve (60 +/- 9% to 63 +/- 11%; p = 0.11). SWT significantly increased at 5-months' follow-up (p <0.001), and an additional improvement was found at 3 years' (p = 0.04) follow-up in segments with TEI <25%. In segments with TEI of 25% to 75%, SWT was unchanged at 5-month follow-up (p = 0.89), but improved at 3 years (p = 0.04). SWT was unchanged in segments with transmural scars. For segmental functional recovery, TEI was a better predictor than end-diastolic wall thickness at baseline (odds ratio 5.6, 95% confidence interval 1.5 to 21.1, p = 0.01 vs odds ratio 2.5, 95% confidence interval 0.7 to 8.3, p = 0.14). In conclusion, a positive effect on LV remodeling and ejection fraction was observed up to 3 years after recanalization. Both early and late improvements in regional LV function were observed in the perfusion territory of chronic total coronary occlusion and were related to the transmural extent of infarction on pretreatment magnetic resonance imaging.
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94
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Grothues F, Boenigk H, Graessner J, Kanowski M, Klein HU. Balanced steady-state free precession vs. segmented fast low-angle shot for the evaluation of ventricular volumes, mass, and function at 3 Tesla. J Magn Reson Imaging 2007; 26:392-400. [PMID: 17623890 DOI: 10.1002/jmri.20986] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To compare balanced steady-state free precession (SSFP) and segmented fast low angle shot (FLASH) for quantification of left and right ventricular volumes and function and for left ventricular mass at high field (3 Tesla). MATERIALS AND METHODS A total of 33 patients (19 male, mean age 54 years) with various forms of heart disease underwent ventricular function studies using cine SSFP and FLASH sequences with identical slice orientations. RESULTS Using SSFP, left ventricular end-diastolic (+10 mL [4.7%], P < 0.001) and end-systolic volumes (+9 mL [6.1%], P < 0.001) measured larger whereas mass was considerably smaller (-23 g [-12.9%], P < 0.001) and ejection fraction (-1% [-3.2%], P < 0.01) marginally smaller. Right ventricular end-diastolic (+4 mL [2.6%], P = 0.001) and end-systolic volumes (+4 mL [5.1%], P < 0.01) were also larger, but no significant difference for right ventricular ejection fraction (P = 0.05) was found. CONCLUSION Similar to previous results at 1.5 Tesla, at high magnetic field the cine SSFP technique led to discrete but significantly higher ventricular volume measurements and to a significantly smaller measurement of left ventricular mass in patients. The effect on left and right ventricular ejection fraction was minor, although the difference remained significant for the left ventricle.
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Affiliation(s)
- Frank Grothues
- Department of Cardiology, Otto-von-Guericke-University, Magdeburg, Germany.
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95
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Malyar NM, Schlosser T, Barkhausen J, Gutersohn A, Buck T, Bartel T, Erbel R. Assessment of aortic valve area in aortic stenosis using cardiac magnetic resonance tomography: comparison with echocardiography. Cardiology 2007; 109:126-34. [PMID: 17713328 DOI: 10.1159/000105554] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 09/22/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiac magnetic resonance tomography (CMR) is a new imaging technique capable of imaging the aortic valve with high resolution. We assessed the aortic valve area (AVA) in patients with aortic stenosis (AS) using CMR and compared the results to those obtained by transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). METHODS Forty-two patients (36% female, 71 +/- 8 years) symptomatic for AS underwent TTE followed by TEE to determine the AVA; the continuity equation was used with TTE and the planimetry technique with TEE. In 26 of these patients, the AVA was additionally obtained by CMR planimetry. RESULTS The mean AVA derived by TTE, TEE and CMR were 0.74 +/- 0.27, 0.87 +/- 25 and 0.97 +/- 0.30 cm(2), respectively. The mean absolute differences in AVA were 0.13 +/- 0.19 cm(2) for TTE vs. TEE, 0.21 +/- 0.25 cm(2) for TTE vs. CMR and 0.05 +/- 0.11 cm(2) for CMR vs. TEE. CONCLUSION There is a good agreement between CMR and the echocardiographic determination of the AVA. If multicenter, large-scale studies confirm these observations, CMR could serve as a noninvasive alternative to TTE/TEE for the assessment of AVA in AS.
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Affiliation(s)
- Nasser M Malyar
- Department of Cardiology, West German Heart Center, University of Duisburg-Essen, Essen, Germany.
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96
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Cain PA, Ahl R, Hedstrom E, Ugander M, Allansdotter-Johnsson A, Friberg P, Marild S, Arheden H. Physiological determinants of the variation in left ventricular mass from early adolescence to late adulthood in healthy subjects. Clin Physiol Funct Imaging 2007; 27:255-62. [PMID: 17564676 DOI: 10.1111/j.1475-097x.2007.00735.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The physiological determinants of left ventricular mass (LVM) measured by cardiac magnetic resonance (CMR) imaging are not well defined as prior investigators have studied either adults or adolescents in isolation or have not strictly excluded hypertension or accounted for the effects of exercise habits, haemodynamic, demographic, or body shape characteristics. METHODS Ninety-seven healthy volunteers (11-81 years, 51 males) underwent CMR. All parameters [unstandardized and adjusted for body surface area (BSA)] were analysed according to gender and by adolescence versus adulthood (adolescents<20 years, adults>or=20 years). The influence of haemodynamic factors, exercise and demographic factors on LVM were determined with multivariate linear regression. RESULTS Left ventricular mass rose during adolescence and declined in adulthood. LVM and LVMBSA were higher in males both in adults (LVM: 188+/-22 versus 140+/-21 g, P<0.001; LVMBSA: 94+/-11 versus 80+/-11 g m(-2), P<0.001) and in adolescents when adjusted for BSA (LVM: 128+/-29 versus 107+/-20 g, P=0.063; LVMBSA: 82+/-8 versus 71+/-10 g m(-2), P=0.025). In adults, systolic blood pressure (SBP) and self-reported physical activity increased while meridional and circumferential wall stress were constant with age. Multivariate regression analysis revealed age, gender and BSA as the major determinants of LVM (global R2=0.68). CONCLUSIONS Normal LVM shows variation over a broad age range in both genders with a rise in adolescence and subsequent decline with increasing age in adulthood despite an increase in SBP and physical activity. BSA, age and gender were found to be major contributors to the variation in LVM in healthy adults, while haemodynamic factors, exercise and wall stress were not.
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Affiliation(s)
- Peter A Cain
- Department of Clinical Physiology, Lund University Hospital, Lund, Sweden
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97
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Lasalarie JC, Serfaty JM, Carre C, Messika-Zeitoun D, Jeannot C, Schouman-Claeys E, Laissy JP. Accuracy of contrast-enhanced cine-MR sequences in the assessment of left ventricular function: comparison with precontrast cine-MR sequences. Results of a bicentric study. Eur Radiol 2007; 17:2838-44. [PMID: 17486347 DOI: 10.1007/s00330-007-0647-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 03/05/2007] [Accepted: 03/27/2007] [Indexed: 10/23/2022]
Abstract
The accuracy of contrast-enhanced cine magnetic resonance (cine-MR) imaging to determine left ventricular function was assessed by comparison with the established noncontrast cine-MR sequences. Contrast-enhanced balanced steady-state free precession (cine-SSFP) sequences were compared with precontrast cine-SSFP sequences in the assessment of left ventricular contractile function in 30 consecutive patients with various cardiac diseases. Five to eight short-axis image sections were obtained in each patient. Quantitative data were analyzed using a paired t-test and linear regression analysis. Qualitative assessment of images was made following a 16-segment analysis. There was no significant difference between the two sequences in regional wall motion, end-diastolic volumes (EDV) and end-systolic volumes (ESV), stroke volume, left ventricular mass, as well as left ventricular ejection fraction (LVEF), despite slight delayed subendocardial enhancement in ten patients with myocardial infarction. All the values studied above were closely correlated between both cine-SSFP sequences (Spearman r=0.85-0.97, P<0.0001 for all comparisons). Contrast-enhanced cine-SSFP sequences can be used as a similar diagnostic tool as precontrast cine-MR sequences in the assessment of left ventricular contractile function.
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Affiliation(s)
- Jean-Christophe Lasalarie
- Department of Radiology, Centre Hospitalier Sud Réunion, avenue François Mitterrand, 97410, Saint-Pierre, France
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98
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Beckmann N, Kneuer R, Gremlich HU, Karmouty-Quintana H, Blé FX, Müller M. In vivo mouse imaging and spectroscopy in drug discovery. NMR IN BIOMEDICINE 2007; 20:154-85. [PMID: 17451175 DOI: 10.1002/nbm.1153] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Imaging modalities such as micro-computed tomography (micro-CT), micro-positron emission tomography (micro-PET), high-resolution MRI, optical imaging, and high-resolution ultrasound have become invaluable tools in preclinical pharmaceutical research. They can be used to non-invasively investigate, in vivo, rodent biology and metabolism, disease models, and pharmacokinetics and pharmacodynamics of drugs. The advantages and limitations of each approach usually determine its application, and therefore a small-rodent imaging laboratory in a pharmaceutical environment should ideally provide access to several techniques. In this paper we aim to illustrate how these techniques may be used to obtain meaningful information for the phenotyping of transgenic mice and for the analysis of compounds in murine models of disease.
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Affiliation(s)
- Nicolau Beckmann
- Discovery Technologies, Novartis Institutes for BioMedical Research, Lichtstrasse 35, CH-4002 Basel, Switzerland.
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99
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Abstract
Accurate distinction between viable and infarcted myocardium is important for assessment of patients who have cardiac dysfunction. Through the technique of delayed-enhancement MRI (DE-MRI), viable and infarcted myocardium can be simultaneously identified in a manner that closely correlates with histopathology findings. This article provides an overview of experimental data establishing the physiologic basis of DE-MRI-evidenced hyperenhancement as a tissue-specific marker of myocardial infarction. Clinical data concerning the utility of transmural extent of hyperenhancement for predicting response to medical and revascularization therapy are reviewed. Studies directly comparing DE-MRI to other viability imaging techniques are presented, and emerging applications for DE-MRI are discussed.
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Affiliation(s)
- Jonathan W Weinsaft
- Greenberg Division of Cardiology, Weill Medical College of Cornell University, 525 East 68th Street, Starr-4, New York, NY 10021, USA.
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100
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Stehning C, Boernert P, Nehrke K. Advances in Coronary MRA from Vessel Wall to Whole Heart Imaging. Magn Reson Med Sci 2007; 6:157-70. [PMID: 18037796 DOI: 10.2463/mrms.6.157] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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