3D left ventricular strain from unwrapped harmonic phase measurements

HARP-I: A Harmonic Phase Interpolation Method for the Estimation of Motion From Tagged MR Images

We proposed a novel method called HARP-I, which enhances the estimation of motion from tagged Magnetic Resonance Imaging (MRI). The harmonic phase of the images is unwrapped and treated as noisy measurements of reference coordinates on a deformed domain, obtaining motion with high accuracy using Radial Basis Functions interpolations. Results were compared against Shortest Path HARP Refinement (SP-HR) and Sine-wave Modeling (SinMod), two harmonic image-based techniques for motion estimation from tagged images. HARP-I showed a favorable similarity with both methods under noise-free conditions, whereas a more robust performance was found in the presence of noise. Cardiac strain was better estimated using HARP-I at almost any motion level, giving strain maps with less artifacts. Additionally, HARP-I showed better temporal consistency as a new method was developed to fix phase jumps between frames. In conclusion, HARP-I showed to be a robust method for the estimation of motion and strain under ideal and non-ideal conditions.

Magnetic Resonance Imaging of Cardiac Strain Pattern Following Transplantation of Human Tissue Engineered Heart Muscles

BACKGROUND

The use of tissue engineering approaches in combination with exogenously produced cardiomyocytes offers the potential to restore contractile function after myocardial injury. However, current techniques assessing changes in global cardiac performance after such treatments are plagued by relatively low detection ability. Since the treatment is locally performed, this detection could be improved by myocardial strain imaging that measures regional contractility.

METHODS AND RESULTS

Tissue engineered heart muscles (EHMs) were generated by casting human embryonic stem cell-derived cardiomyocytes with collagen in preformed molds. EHMs were transplanted (n=12) to cover infarct and border zones of recipient rat hearts 1 month after ischemia reperfusion injury. A control group (n=10) received only sham placement of sutures without EHMs. To assess the efficacy of EHMs, magnetic resonance imaging and ultrasound-based strain imaging were performed before and 4 weeks after transplantation. In addition to strain imaging, global cardiac performance was estimated from cardiac magnetic resonance imaging. Although no significant differences were found for global changes in left ventricular ejection fraction (control -9.6±1.3% versus EHM -6.2±1.9%; P=0.17), regional myocardial strain from tagged magnetic resonance imaging was able to detect preserved systolic function in EHM-treated animals compared with control (control 4.4±1.0% versus EHM 1.0±0.6%; P=0.04). However, ultrasound-based strain failed to detect any significant change (control 2.1±3.0% versus EHM 6.3±2.9%; P=0.46).

CONCLUSIONS

This study highlights the feasibility of using cardiac strain from tagged magnetic resonance imaging to assess functional changes in rat models following localized regenerative therapies, which may not be detected by conventional measures of global systolic performance.

A graph theoretic approach for computing 3D+time biventricular cardiac strain from tagged MRI data

Tagged magnetic resonance imaging (tMRI) is a well-established method for evaluating regional mechanical function of the heart. Many techniques have been developed to compute 2D or 3D cardiac deformation and strain from tMRI images. In this paper, we present a new method for measuring 3D plus time biventricular myocardial strain from tMRI data. The method is composed of two parts. First, we use a Gabor filter bank to extract tag points along tag lines. Second, each tag point is classified to one of a set of indexed reference tag lines using a point classification with graph cuts (PCGC) algorithm and a motion compensation technique. 3D biventricular deformation and strain is computed at each image time frame from the classified tag points using a previously published finite difference method. The strain computation is fully automatic after myocardial contours are defined near end-diastole and end-systole. An in-vivo dataset composed of 30 human imaging studies with a range of pathologies was used for validation. Strains computed with the PCGC method with no manual corrections were compared to strains computed from both manually placed tag points and a manually-corrected unwrapped phase method. A typical cardiac imaging study with 10 short-axis slices and 6 long-axis slices required 30 min for contouring followed by 44 min of automated processing. The results demonstrate that the proposed method can reconstruct accurate 3D plus time cardiac strain maps with minimal user intervention.

Artifacts reduction in strain maps of tagged magnetic resonance imaging using harmonic phase

Tagged Magnetic Resonance Imaging (MRI) is a noninvasive technique for examining myocardial function and deformation. Tagged MRI can also be used in quasi-static MR elastography to acquire strain maps of other biological soft tissues. Harmonic phase (HARP) provides automatic and rapid analysis of tagged MR images for the quantification and visualization of myocardial strain. We propose a new artifact reduction method in strain maps. Image intensity of the DC component is estimated and subtracted from spatial modulation of magnetization (SPAMM) tagged MR images. DC peak interference in harmonic phase extraction is greatly reduced after DC component subtraction. The proposed method is validated using both simulated and MR acquired tagged images. Strain maps are obtained with better accuracy and smoothness after DC component subtraction.

Meshless deformable models for 3D cardiac motion and strain analysis from tagged MRI

Tagged magnetic resonance imaging (TMRI) provides a direct and noninvasive way to visualize the in-wall deformation of the myocardium. Due to the through-plane motion, the tracking of 3D trajectories of the material points and the computation of 3D strain field call for the necessity of building 3D cardiac deformable models. The intersections of three stacks of orthogonal tagging planes are material points in the myocardium. With these intersections as control points, 3D motion can be reconstructed with a novel meshless deformable model (MDM). Volumetric MDMs describe an object as point cloud inside the object boundary and the coordinate of each point can be written in parametric functions. A generic heart mesh is registered on the TMRI with polar decomposition. A 3D MDM is generated and deformed with MR image tagging lines. Volumetric MDMs are deformed by calculating the dynamics function and minimizing the local Laplacian coordinates. The similarity transformation of each point is computed by assuming its neighboring points are making the same transformation. The deformation is computed iteratively until the control points match the target positions in the consecutive image frame. The 3D strain field is computed from the 3D displacement field with moving least squares. We demonstrate that MDMs outperformed the finite element method and the spline method with a numerical phantom. Meshless deformable models can track the trajectory of any material point in the myocardium and compute the 3D strain field of any particular area. The experimental results on in vivo healthy and patient heart MRI show that the MDM can fully recover the myocardium motion in three dimensions.

3D+time left ventricular strain by unwrapping harmonic phase with graph cuts

In previous work, a three-dimensional left ventricular strain throughout the cardiac cycle was reconstructed using a prolate spheroidal B-spline (PSB) method with displacement measurements obtained from unwrapped tagged MRI (tMRI) harmonic phase images. Manually placed branch cuts were required for each harmonic phase image to resolve phase inconsistencies and to guide the phase unwrapping (mSUP), which is both labor intensive and time consuming and therefore not proper for clinic application. In this paper, we present an automated graph cuts based phase unwrapping method for myocardium displacement measurement (caSUP) which can be used to compute 3D+time cardiac strain. A set of 8 human studies were used to optimize parameters of the energy function and another set of 32 human studies were used to validate the proposed method by comparing resulted strains with those from mSUP and a feature-based (FB) method using the same PSB strain reconstruction. The automated caSUP strains were close to the manual strains and only required 6 minutes after myocardium segmentation versus - 2 hours for the manual method.

Three-dimensional regional strain computation method with displacement encoding with stimulated echoes (DENSE) in non-ischemic, non-valvular dilated cardiomyopathy patients and healthy subjects validated by tagged MRI

PURPOSE

Fast cine displacement encoding with stimulated echoes (DENSE) MR has higher spatial resolution and enables rapid postprocessing. Thus we compared the accuracy of regional strains computation by DENSE with tagged MR in healthy and non-ischemic, non-valvular dilated cardiomyopathy (DCM) subjects.

MATERIALS AND METHODS

Validation of three-dimensional regional strains computed with DENSE was conducted in reference to standard tagged MRI (TMRI) in healthy subjects and patients with DCM. Additional repeatability studies in healthy subjects were conducted to increase confidence in DENSE. A meshfree multiquadrics radial point interpolation method (RPIM) was used for computing Lagrange strains in sixteen left ventricular segments. Bland-Altman analysis and Student's t-tests were conducted to observe similarities in regional strains between sequences and in DENSE repeatability studies.

RESULTS

Regional circumferential strains ranged from -0.21 ± 0.07 (Lateral-Apex) to -0.11 ± 0.05 (Posterorseptal-Base) in healthy subjects and -0.15 ± 0.04 (Anterior-Apex) to -0.02 ± 0.08 (Posterorseptal-Base) in DCM patients. Computed mean differences in regional circumferential strain from the DENSE-TMRI comparison study was 0.01 ± 0.03 (95% limits of agreement) in normal subjects, -0.01 ± 0.06 in DCM patients and 0.0 ± 0.02 in repeatability studies, with similar agreements in longitudinal and radial strains.

CONCLUSION

We found agreement between DENSE and tagged MR in patients and volunteers in terms of evaluation of regional strains.

Inter-study reproducibility of cardiovascular magnetic resonance tagging

BACKGROUND

The aim of this study is to determine the test-retest reliability of the measurement of regional myocardial function by cardiovascular magnetic resonance (CMR) tagging using spatial modulation of magnetization.

METHODS

Twenty-five participants underwent CMR tagging twice over 12 ± 7 days. To assess the role of slice orientation on strain measurement, two healthy volunteers had a first exam, followed by image acquisition repeated with slices rotated ±15 degrees out of true short axis, followed by a second exam in the true short axis plane. To assess the role of slice location, two healthy volunteers had whole heart tagging. The harmonic phase (HARP) method was used to analyze the tagged images. Peak midwall circumferential strain (Ecc), radial strain (Err), Lambda 1, Lambda 2, and Angle α were determined in basal, mid and apical slices. LV torsion, systolic and early diastolic circumferential strain and torsion rates were also determined.

RESULTS

LV Ecc and torsion had excellent intra-, interobserver, and inter-study intra-class correlation coefficients (ICC range, 0.7 to 0.9). Err, Lambda 1, Lambda 2 and angle had excellent intra- and interobserver ICC than inter-study ICC. Angle had least inter-study reproducibility. Torsion rates had superior intra-, interobserver, and inter-study reproducibility to strain rates. The measurements of LV Ecc were comparable in all three slices with different short axis orientations (standard deviation of mean Ecc was 0.09, 0.18 and 0.16 at basal, mid and apical slices, respectively). The mean difference in LV Ecc between slices was more pronounced in most of the basal slices compared to the rest of the heart.

CONCLUSIONS

Intraobserver and interobserver reproducibility of all strain and torsion parameters was excellent. Inter-study reproducibility of CMR tagging by SPAMM varied between different parameters as described in the results above and was superior for Ecc and LV torsion. The variation in LV Ecc measurement due to altered slice orientation is negligible compared to the variation due to slice location.

TRIAL REGISTRATION

This trial is registered as NCT00005487 at National Heart, Lung and Blood institute.

Validation of continuously tagged MRI for the measurement of dynamic 3D skeletal muscle tissue deformation

PURPOSE

Typically spatial modulation of the magnetization (SPAMM) tagged magnetic resonance imaging (MRI) requires many repeated motion cycles limiting the applicability to highly repeatable tissue motions only. This paper describes the validation of a novel SPAMM tagged MRI and post-processing framework for the measurement of complex and dynamic 3D soft tissue deformation following just three motion cycles. Techniques are applied to indentation induced deformation measurement of the upper arm and a silicone gel phantom.

METHODS

A SPAMM tagged MRI methodology is presented allowing continuous (3.3-3.6 Hz) sampling of 3D dynamic soft tissue deformation using non segmented 3D acquisitions. The 3D deformation is reconstructed by the combination of three mutually orthogonal tagging directions, thus requiring only three repeated motion cycles. In addition a fully automatic post-processing framework is presented employing Gabor scale-space and filter-bank analysis for tag extrema segmentation and triangulated surface fitting aided by Gabor filter bank derived surface normals. Deformation is derived following tracking of tag surface triplet triangle intersections. The dynamic deformation measurements were validated using indentation tests (∼20 mm deep at 12 mm/s) on a silicone gel soft tissue phantom containing contrasting markers which provide a reference measure of deformation. In addition, the techniques were evaluated in vivo for dynamic skeletal muscle tissue deformation measurement during indentation of the biceps region of the upper arm in a volunteer.

RESULTS

For the phantom and volunteer tag point location precision were 44 and 92 μm, respectively resulting in individual displacements precisions of 61 and 91 μm, respectively. For both the phantom and volunteer data cumulative displacement measurement accuracy could be evaluated and the difference between initial and final locations showed a mean and standard deviation of 0.44 and 0.59 mm for the phantom and 0.40 and 0.73 mm for the human data. Finally accuracy of (cumulative) displacement was evaluated using marker tracking in the silicone gel phantom. Differences between true and predicted marker locations showed a mean of 0.35 mm and a standard deviation of 0.63 mm.

CONCLUSIONS

A novel SPAMM tagged MRI and fully automatic post-processing framework for the measurement of complex 3D dynamic soft tissue deformation following just three repeated motion cycles was presented. The techniques demonstrate dynamic measurement of complex 3D soft tissue deformation at subvoxel accuracy and precision and were validated for 3.3-3.6 Hz sampling of deformation speeds up to 12 mm/s.

Accurate two-dimensional cardiac strain calculation using adaptive windowed Fourier transform and Gabor wavelet transform

PURPOSE

Cardiac strain calculated from tagged magnetic resonance (MR) images provides clinicians information about abnormalities of heart-wall motion in patients. It is important to develop an accurate method to determine the cardiac strain efficiently. An adaptive windowed harmonic phase (AWHARP) method is proposed for cardiac strain calculation.

MATERIALS AND METHODS

AWHARP is based on adaptive windowed Fourier transform (AWFT) and 2D Gabor wavelet transform (2D-GWT). The AWFT provides a spatially varying representation of the signal spectra, which allows the harmonic phase (HARP) image to be extracted with high accuracy. Instantaneous spatial frequencies are calculated using 2D-GWT, and the widths of the adaptive windows are then determined according to the instantaneous spatial frequencies for multi-resolution analysis of phase extraction. The proposed method was studied using simulated images and patients' MR images. Both single tagged images (SPAMM) and subtracted tagged images (CSPAMM) were generated using our simulation method, and their results calculated using AWHARP and HARP methods were compared. Normal and pathological tagged MR images were also processed to evaluate the performance of our method.

RESULTS

Our experimental results show that the accuracies of phase and strain images calculated using the AWHARP method are higher than that calculated using the HARP method especially for large tag line deformation. The improvement in accuracies can be up to 3.2 strain (E1) and 17.3 calculation from MR images reveals that the cardiac strain in the end-systolic state is significantly reduced for patients with hypertrophic cardiomyopathy (HCM) compared to that of healthy subjects.

CONCLUSION

The proposed AWHARP is an accurate and efficient method for cardiac strain estimation from MR images. This new algorithm can help clinicians to detect left ventricle dysfunctions and myocardial diseases with accurate cardiac strain analysis.

Myocardial tagging by cardiovascular magnetic resonance: evolution of techniques--pulse sequences, analysis algorithms, and applications

Cardiovascular magnetic resonance (CMR) tagging has been established as an essential technique for measuring regional myocardial function. It allows quantification of local intramyocardial motion measures, e.g. strain and strain rate. The invention of CMR tagging came in the late eighties, where the technique allowed for the first time for visualizing transmural myocardial movement without having to implant physical markers. This new idea opened the door for a series of developments and improvements that continue up to the present time. Different tagging techniques are currently available that are more extensive, improved, and sophisticated than they were twenty years ago. Each of these techniques has different versions for improved resolution, signal-to-noise ratio (SNR), scan time, anatomical coverage, three-dimensional capability, and image quality. The tagging techniques covered in this article can be broadly divided into two main categories: 1) Basic techniques, which include magnetization saturation, spatial modulation of magnetization (SPAMM), delay alternating with nutations for tailored excitation (DANTE), and complementary SPAMM (CSPAMM); and 2) Advanced techniques, which include harmonic phase (HARP), displacement encoding with stimulated echoes (DENSE), and strain encoding (SENC). Although most of these techniques were developed by separate groups and evolved from different backgrounds, they are in fact closely related to each other, and they can be interpreted from more than one perspective. Some of these techniques even followed parallel paths of developments, as illustrated in the article. As each technique has its own advantages, some efforts have been made to combine different techniques together for improved image quality or composite information acquisition. In this review, different developments in pulse sequences and related image processing techniques are described along with the necessities that led to their invention, which makes this article easy to read and the covered techniques easy to follow. Major studies that applied CMR tagging for studying myocardial mechanics are also summarized. Finally, the current article includes a plethora of ideas and techniques with over 300 references that motivate the reader to think about the future of CMR tagging.

Three-dimensional plus time biventricular strain from tagged MR images by phase-unwrapped harmonic phase

PURPOSE

To validate a method called bi-ventricular strain unwrapped phase (BiSUP) for reconstructing three-dimensional plus time (3D+t) biventricular strain maps from phase-unwrapped harmonic phase (HARP) images derived from tagged cardiac magnetic resonance imaging (MRI).

MATERIALS AND METHODS

A set of 30 human subjects were imaged with tagged MRI. In each study, HARP phase was computed and unwrapped in each short-axis and long-axis image. Inconsistencies in unwrapped phase were resolved using branch cuts manually placed with a graphical user interface. The 3D strain maps were computed independently in each imaged time frame through systole and mid diastole in each study. The BiSUP strain and displacements were compared with those estimated by a 3D feature-based (FB) technique and a 2D+t HARP technique.

RESULTS

The standard deviation of the difference between strains measured by the FB and the BiSUP methods was less than 4% of the average of the strains from the two methods. The correlation between peak minimum principal strain measured using the BiSUP and HARP techniques was over 83%.

CONCLUSION

The BiSUP technique can reconstruct full 3D+t strain maps from tagged MR images through the cardiac cycle in a reasonable amount of time and user interaction compared with other 3D analysis methods.

Validation of SPAMM tagged MRI based measurement of 3D soft tissue deformation

PURPOSE

This study presents and validates a novel (non-ECG-triggered) MRI sequence based on spatial modulation of the magnetization (SPAMM) to noninvasively measure 3D (quasistatic) soft tissue deformations using only six acquisitions (three static and three indentations). In the current SPAMM tagged MRI approaches, data are typically constructed from many repeated motion cycles. This has so far restricted its application to the measurement of highly repeatable and periodic movements (e.g., cardiac deformation). In biomechanical applications where soft tissue deformation is artificially induced, often by indentation, significant repeatability constraints exist, and for clinical applications, discomfort and health issues generally preclude a large number of repetitions.

METHODS

A novel (non-ECG-triggered) SPAMM tagged MRI sequence is presented, whereby a single 1-1 (first order) SPAMM set is acquired following a 3D transient field echo acquisition. Full 3D deformation measurement is achieved through the combination of only six acquisitions (three static and three motion cycles). The 3D deformation measurements were validated using quasistatic indentation tests and marker tracking in a silicone gel soft tissue phantom. In addition, the technique's ability to measure 3D soft tissue deformation in vivo was evaluated using indentation of the biceps region of the upper arm in a volunteer.

RESULTS

Following comparison to marker tracking in the silicone gel phantom, the SPAMM tagged MRI based displacement measurement demonstrated subvoxel accuracy with a mean displacement difference of 72 microm and a standard deviation of 289 microm. In addition, precision of displacement magnitude was evaluated for both the phantom and the volunteer data. The standard deviations of the displacement magnitude with respect to the average displacement magnitude were 75 and 169 microm for the phantom and volunteer data, respectively.

CONCLUSIONS

The subvoxel accuracy and precision demonstrated in the phantom in combination with the precision comparison between the phantom and the volunteer data provide confidence in the methods presented for measurement of soft tissue deformation in vivo. To the author's knowledge, since only six acquisitions are required, the presented methodology is the fastest SPAMM tagged MRI method currently available for the noninvasive measurement of quasistatic 3D soft tissue deformation.