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Fuetterer M, Busch J, Traechtler J, Wespi P, Peereboom SM, Sauer M, Lipiski M, Fleischmann T, Cesarovic N, Stoeck CT, Kozerke S. Quantitative myocardial first-pass cardiovascular magnetic resonance perfusion imaging using hyperpolarized [1- 13C] pyruvate. J Cardiovasc Magn Reson 2018; 20:73. [PMID: 30415642 PMCID: PMC6231262 DOI: 10.1186/s12968-018-0495-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 10/09/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The feasibility of absolute myocardial blood flow quantification and suitability of hyperpolarized [1-13C] pyruvate as contrast agent for first-pass cardiovascular magnetic resonance (CMR) perfusion measurements are investigated with simulations and demonstrated in vivo in a swine model. METHODS A versatile simulation framework for hyperpolarized CMR subject to physical, physiological and technical constraints was developed and applied to investigate experimental conditions for accurate perfusion CMR with hyperpolarized [1-13C] pyruvate. Absolute and semi-quantitative perfusion indices were analyzed with respect to experimental parameter variations and different signal-to-noise ratio (SNR) levels. Absolute myocardial blood flow quantification was implemented with an iterative deconvolution approach based on Fermi functions. To demonstrate in vivo feasibility, velocity-selective excitation with an echo-planar imaging readout was used to acquire dynamic myocardial stress perfusion images in four healthy swine. Arterial input functions were extracted from an additional image slice with conventional excitation that was acquired within the same heartbeat. RESULTS Simulations suggest that obtainable SNR and B0 inhomogeneity in vivo are sufficient for the determination of absolute and semi-quantitative perfusion with ≤25% error. It is shown that for expected metabolic conversion rates, metabolic conversion of pyruvate can be neglected over the short duration of acquisition in first-pass perfusion CMR. In vivo measurements suggest that absolute myocardial blood flow quantification using hyperpolarized [1-13C] pyruvate is feasible with an intra-myocardial variability comparable to semi-quantitative perfusion indices. CONCLUSION The feasibility of quantitative hyperpolarized first-pass perfusion CMR using [1-13C] pyruvate has been investigated in simulations and demonstrated in swine. Using an approved and metabolically active compound is envisioned to increase the value of hyperpolarized perfusion CMR in patients.
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Affiliation(s)
- Maximilian Fuetterer
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse, 35 8092 Zurich, Switzerland
| | - Julia Busch
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse, 35 8092 Zurich, Switzerland
| | - Julia Traechtler
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse, 35 8092 Zurich, Switzerland
| | - Patrick Wespi
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse, 35 8092 Zurich, Switzerland
| | - Sophie M. Peereboom
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse, 35 8092 Zurich, Switzerland
| | - Mareike Sauer
- Division of Surgical Research, University Hospital Zurich, Sternwartstrasse, 14 8091 Zurich, Switzerland
| | - Miriam Lipiski
- Division of Surgical Research, University Hospital Zurich, Sternwartstrasse, 14 8091 Zurich, Switzerland
| | - Thea Fleischmann
- Division of Surgical Research, University Hospital Zurich, Sternwartstrasse, 14 8091 Zurich, Switzerland
| | - Nikola Cesarovic
- Division of Surgical Research, University Hospital Zurich, Sternwartstrasse, 14 8091 Zurich, Switzerland
| | - Christian T. Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse, 35 8092 Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse, 35 8092 Zurich, Switzerland
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Taxt T, Reed RK, Pavlin T, Rygh CB, Andersen E, Jiřík R. Semi-parametric arterial input functions for quantitative dynamic contrast enhanced magnetic resonance imaging in mice. Magn Reson Imaging 2017; 46:10-20. [PMID: 29066294 DOI: 10.1016/j.mri.2017.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 09/15/2017] [Accepted: 10/17/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE An extension of single- and multi-channel blind deconvolution is presented to improve the estimation of the arterial input function (AIF) in quantitative dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). METHODS The Lucy-Richardson expectation-maximization algorithm is used to obtain estimates of the AIF and the tissue residue function (TRF). In the first part of the algorithm, nonparametric estimates of the AIF and TRF are obtained. In the second part, the decaying part of the AIF is approximated by three decaying exponential functions with the same delay, giving an almost noise free semi-parametric AIF. Simultaneously, the TRF is approximated using the adiabatic approximation of the Johnson-Wilson (aaJW) pharmacokinetic model. RESULTS In simulations and tests on real data, use of this AIF gave perfusion values close to those obtained with the corresponding previously published nonparametric AIF, and are more noise robust. CONCLUSION When used subsequently in voxelwise perfusion analysis, these semi-parametric AIFs should give more correct perfusion analysis maps less affected by recording noise than the corresponding nonparametric AIFs, and AIFs obtained from arteries. SIGNIFICANCE This paper presents a method to increase the noise robustness in the estimation of the perfusion parameter values in DCE-MRI.
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Affiliation(s)
- Torfinn Taxt
- Dept. of Biomedicine, University of Bergen, Jonas Lies vei 91, Bergen N-5020, Norway; Dept. of Radiology, Haukeland University Hospital, Jonas Lies vei 83, Bergen N-5020, Norway
| | - Rolf K Reed
- Dept. of Biomedicine, University of Bergen, Jonas Lies vei 91, Bergen N-5020, Norway; Centre for Cancer Biomarkers (CCBIO), University of Bergen, Jonas Lies vei 87, Bergen N-5021, Norway
| | - Tina Pavlin
- Dept. of Biomedicine, University of Bergen, Jonas Lies vei 91, Bergen N-5020, Norway; Dept. of Radiology, Haukeland University Hospital, Jonas Lies vei 83, Bergen N-5020, Norway
| | - Cecilie Brekke Rygh
- Dept. of Biomedicine, University of Bergen, Jonas Lies vei 91, Bergen N-5020, Norway
| | - Erling Andersen
- Dept. of Clinical Engineering, Haukeland University Hospital, Jonas Lies vei 83, Bergen N-5020, Norway
| | - Radovan Jiřík
- Czech Academy of Sciences, Inst. of Scientific Instruments, Královopolská 147, Brno 61264, Czech Republic.
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Wang H, Adluru G, Chen L, Kholmovski EG, Bangerter NK, DiBella EVR. Radial simultaneous multi-slice CAIPI for ungated myocardial perfusion. Magn Reson Imaging 2016; 34:1329-1336. [PMID: 27502698 DOI: 10.1016/j.mri.2016.07.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/30/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Simultaneous multi-slice (SMS) imaging is a slice acceleration technique that acquires multiple slices in the same time as a single slice. Radial controlled aliasing in parallel imaging results in higher acceleration (radial CAIPIRINHA or CAIPI) is a promising SMS method with less severe slice aliasing artifacts as compared to its Cartesian counterpart. Here we use radial CAIPI with data undersampling and constrained reconstruction to improve the utility of ungated cardiac perfusion acquisitions. We test the proposed framework with a traditional saturation recovery fast low-angle shot (turboFLASH) sequence and also without saturation recovery as a steady-state spoiled gradient echo (SPGR) sequence on animal and human studies. METHODS Simulations and phantom studies were performed for both the turboFLASH and the SPGR radial CAIPI methods. Ungated undersampled golden ratio radial CAIPI data with saturation recovery were acquired in 8 dogs and 2 human subjects. The CAIPI data without saturation pulses were acquired in 4 human subjects. For both methods, slice acceleration factors of two and three were used. A new spatio-temporal reconstruction using total variation and patch-based low rank constraints was used to jointly reconstruct the multi-slice multi-coil images. RESULTS Phantom scans and computer simulations showed that ungated SPGR generally provides better contrast to noise ratio (CNR) than the saturation recovery sequence if the saturation recovery time is less than 100ms. Both of the ungated radial CAIPI methods demonstrated promising image quality in terms of preserving dynamics of the contrast agent and maintaining anatomical structures, even with three slices acquired simultaneously. CONCLUSION Ungated simultaneous multi-slice acquisitions with either a saturation recovery turboFLASH sequence or a steady-state gradient echo SPGR sequence are feasible and provide increased slice coverage without loss of temporal resolution. Compared with a sensitivity encoding (SENSE) SMS reconstruction, the constrained reconstruction method provides better image quality for undersampled radial CAIPI data.
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Affiliation(s)
- Haonan Wang
- Department of Electrical & Computer Engineering, Brigham Young University, Provo, UT, USA
| | - Ganesh Adluru
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Liyong Chen
- Advanced MRI Technologies, Sebastopol, CA, United States
| | - Eugene G Kholmovski
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Neal K Bangerter
- Department of Electrical & Computer Engineering, Brigham Young University, Provo, UT, USA; Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Edward V R DiBella
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
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Wissmann L, Niemann M, Gotschy A, Manka R, Kozerke S. Quantitative three-dimensional myocardial perfusion cardiovascular magnetic resonance with accurate two-dimensional arterial input function assessment. J Cardiovasc Magn Reson 2015; 17:108. [PMID: 26637221 PMCID: PMC4669617 DOI: 10.1186/s12968-015-0212-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/24/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Quantification of myocardial perfusion from first-pass cardiovascular magnetic resonance (CMR) images at high contrast agent (CA) dose requires separate acquisition of blood pool and myocardial tissue enhancement. In this study, a dual-sequence approach interleaving 2D imaging of the arterial input function with high-resolution 3D imaging for myocardial perfusion assessment is presented and validated for low and high CA dose. METHODS A dual-sequence approach interleaving 2D imaging of the aortic root and 3D imaging of the whole left ventricle using highly accelerated k-t PCA was implemented. Rest perfusion imaging was performed in ten healthy volunteers after administration of a Gadolinium-based CA at low (0.025 mmol/kg b.w.) and high dose (0.1 mmol/kg b.w.). Arterial input functions extracted from the 2D and 3D images were analysed for both doses. Myocardial contrast-to-noise ratios (CNR) were compared across volunteers and doses. Variations of myocardial perfusion estimates between volunteers and across myocardial territories were studied. RESULTS High CA dose imaging resulted in strong non-linearity of the arterial input function in the 3D images at peak CA concentration, which was avoided when the input function was derived from the 2D images. Myocardial CNR was significantly increased at high dose compared to low dose, with a 2.6-fold mean CNR gain. Most robust myocardial blood flow estimation was achieved using the arterial input function extracted from the 2D image at high CA dose. In this case, myocardial blood flow estimates varied by 24% between volunteers and by 20% between myocardial territories when analysed on a per-volunteer basis. CONCLUSION Interleaving 2D imaging for arterial input function assessment enables robust quantitative 3D myocardial perfusion imaging at high CA dose.
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Affiliation(s)
- Lukas Wissmann
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
| | - Markus Niemann
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
- Clinic of Cardiology, University Hospital Zurich, Zurich, Switzerland.
- Furtwangen University, Faculty Mechanical and Medical Engineering, Villingen-Schwenningen, Germany.
| | - Alexander Gotschy
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
- Clinic of Cardiology, University Hospital Zurich, Zurich, Switzerland.
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Robert Manka
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
- Clinic of Cardiology, University Hospital Zurich, Zurich, Switzerland.
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
- Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
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Kachenoura N, Besson-Hajji L, Graves MJ, Reid S, Soulat G, Ashrafpoor G, De Cesare A, Hagege A, Redheuil A, Mousseaux E. Kinetic index combining native and postcontrast myocardial T1 in hypertrophic cardiomyopathy. J Magn Reson Imaging 2015; 42:1713-22. [DOI: 10.1002/jmri.24947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/28/2015] [Indexed: 01/19/2023] Open
Affiliation(s)
- Nadjia Kachenoura
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale; F-75013 Paris France
| | - Laila Besson-Hajji
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale; F-75013 Paris France
- Service de Radiologie Cardiovasculaire, Hôpital Européen Georges Pompidou; Paris France
- Paris-Centre de recherche Cardiovasculaire, HEGP, INSERM; Paris France
- Université Paris Descartes, Sorbonne Paris Cité Universités, Faculté de médecine; Paris France
| | - Martin J Graves
- Radiology department; Cambridge University Hospitals NHS Foundation Trust; UK
| | | | - Gilles Soulat
- Service de Radiologie Cardiovasculaire, Hôpital Européen Georges Pompidou; Paris France
- Paris-Centre de recherche Cardiovasculaire, HEGP, INSERM; Paris France
- Université Paris Descartes, Sorbonne Paris Cité Universités, Faculté de médecine; Paris France
| | - Golmehr Ashrafpoor
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale; F-75013 Paris France
- Service de Radiologie Cardiovasculaire, Hôpital Européen Georges Pompidou; Paris France
| | - Alain De Cesare
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale; F-75013 Paris France
| | - Albert Hagege
- Paris-Centre de recherche Cardiovasculaire, HEGP, INSERM; Paris France
- Université Paris Descartes, Sorbonne Paris Cité Universités, Faculté de médecine; Paris France
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology; Paris France
| | - Alban Redheuil
- Department of Cardiovascular Radiology; Institut de Cardiologie, Hôpital Pitié-Salpêtrière; Paris France
- Imaging Core Lab; ICAN; Paris France
| | - Elie Mousseaux
- Service de Radiologie Cardiovasculaire, Hôpital Européen Georges Pompidou; Paris France
- Paris-Centre de recherche Cardiovasculaire, HEGP, INSERM; Paris France
- Université Paris Descartes, Sorbonne Paris Cité Universités, Faculté de médecine; Paris France
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Current state of the art cardiovascular MR imaging techniques for assessment of ischemic heart disease. Radiol Clin North Am 2014; 53:335-44. [PMID: 25726998 DOI: 10.1016/j.rcl.2014.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cardiac magnetic resonance (CMR) imaging is increasingly being used to evaluate patients with known or suspected ischemic heart disease, because of its ability to acquire images in any orientation and the wide variety of sequences available to characterize normal and abnormal structure and function. Substantial improvements have been made in the hardware and software used to perform CMR, resulting in better and more consistent image quality. There has been a greater emphasis recently in developing and validating quantitative CMR techniques. This article reviews advances in CMR techniques for assessing cardiac function, myocardial perfusion, late gadolinium enhancement, and tissue characterization with T1 and T2 mapping sequences.
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Feng Y, Chen F, Ma Z, Dekeyzer F, Yu J, Xie Y, Cona MM, Oyen R, Ni Y. Towards stratifying ischemic components by cardiac MRI and multifunctional stainings in a rabbit model of myocardial infarction. Am J Cancer Res 2013; 4:24-35. [PMID: 24396513 PMCID: PMC3881225 DOI: 10.7150/thno.7188] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/10/2013] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES We sought to identify critical components of myocardial infarction (MI) including area at risk (AAR), MI-core and salvageable zone (SZ) by using cardiac magnetic resonance imaging (cMRI) and multifunctional stainings in rabbits. MATERIALS AND METHODS Fifteen rabbits received 90-min coronary artery (CA) ligation and reopening to induce reperfused MI. First-pass perfusion weighted imaging (PWI(90')) was performed immediately before CA reperfusion. Necrosis avid dye Evans blue (EB) was intravenously injected for later MI-core detection. One-day later, cMRI with T2-weighted imaging (T2WI), PWI(24h) and delayed enhancement (DE) T1WI was performed at a 3.0T clinical scanner. The heart was excised and CA was re-ligated with aorta infused by red-iodized-oil (RIO). The heart was sliced into 3-mm sections for digital radiography (DR), histology and planimetry with myocardial salvage index (MSI) and perfusion density rate (PDR) calculated. RESULTS There was no significant difference between MI-cores defined by DE-T1WI and EB-staining (31.13±8.55% vs 29.80±7.97%; p=0.74). The AAR was defined similarly by PWI90' (39.93±9.51%), RIO (38.82±14.41%) and DR (38.17±15.98%), underestimated by PWI(24h) (36.44±5.31%), but overestimated (p<0.01) by T2WI (56.93±8.87%). Corresponding MSI turned out to be 24.17±9.5% (PWI(90')), 21.97±9.41% (DR) and 22.68±9.65% (RIO), which were significantly (p<0.01) higher and lower than that with PWI(24h) (15.15±7.34%) and T2WI (45.52±7.5%) respectively. The PDR differed significantly (p<0.001) between normal myocardium (350.6±33.1%) and the AAR (31.2±15%), suggesting 11-times greater blood perfusion in normal myocardium over the AAR. CONCLUSION The introduced rabbit platform and new staining techniques together with the use of a 3.0T clinical scanner for cMRI enabled visualization of MI components and may contribute to translational cardiac imaging research for improved theranostic management of ischemic heart disease.
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Giri S, Xue H, Maiseyeu A, Kroeker R, Rajagopalan S, White RD, Zuehlsdorff S, Raman SV, Simonetti OP. Steady-state first-pass perfusion (SSFPP): a new approach to 3D first-pass myocardial perfusion imaging. Magn Reson Med 2013; 71:133-44. [PMID: 23440705 DOI: 10.1002/mrm.24638] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 12/12/2012] [Accepted: 12/20/2012] [Indexed: 11/10/2022]
Abstract
PURPOSE To describe and characterize a new approach to first-pass myocardial perfusion utilizing balanced steady-state free precession acquisition without the use of saturation recovery or other magnetization preparation. THEORY The balanced steady-state free precession sequence is inherently sensitive to contrast agent enhancement of the myocardium. This sensitivity can be used to advantage in first-pass myocardial perfusion imaging by eliminating the need for magnetization preparation. METHODS Bloch equation simulations, phantom experiments, and in vivo 2D imaging studies were run comparing the proposed technique with three other methods: saturation recovery spoiled gradient echo, saturation recovery steady-state free precession, and steady-state spoiled gradient echo without magnetization preparation. Additionally, an acquisition-reconstruction strategy for 3D perfusion imaging is proposed and initial experience with this approach is demonstrated in healthy subjects and one patient. RESULTS Phantom experiments verified simulation results showing the sensitivity of the balanced steady-state free precession sequence to contrast agent enhancement in solid tissue is similar to that of magnetization-prepared acquisitions. Images acquired in normal volunteers showed the proposed technique provided superior signal and signal-to-noise ratio compared with all other sequences at baseline as well as postcontrast. CONCLUSIONS A new approach to first-pass myocardial perfusion is presented that obviates the need for magnetization preparation and provides high signal-to-noise ratio.
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Affiliation(s)
- Shivraman Giri
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA; Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA; Siemens Healthcare, Chicago, Illinois, USA
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9
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Oxygenation and flow in the limbs: Novel methods to characterize peripheral artery disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013; 6:150-157. [PMID: 23504569 DOI: 10.1007/s12410-013-9191-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Peripheral arterial disease (PAD) affects approximately 8 million Americans and is associated with high morbidity and increased mortality. Current therapies for PAD are limited and development of new therapeutic agents is needed. Present diagnostic methods for PAD are insensitive to the subtle microvascular and metabolic changes that occur beyond macrovacular stenosis and therefore may be less useful endpoints for clinical trials. Phosphorus-31 magnetic resonance (MR) spectroscopy, MR muscle perfusion, and MR oximetry are novel methods capable of evaluating both the macrovascular and microvascular changes that occur in PAD patients.
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10
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van Nierop BJ, Coolen BF, Dijk WJ, Hendriks AD, de Graaf L, Nicolay K, Strijkers GJ. Quantitative first-pass perfusion MRI of the mouse myocardium. Magn Reson Med 2012; 69:1735-44. [DOI: 10.1002/mrm.24424] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 06/11/2012] [Accepted: 06/27/2012] [Indexed: 01/05/2023]
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Natale L, Napolitano C, Bernardini A, Meduri A, Marano R, Lombardo A, Crea F, Bonomo L. Role of first pass and delayed enhancement in assessment of segmental functional recovery after acute myocardial infarction. Radiol Med 2012; 117:1294-308. [PMID: 22430684 DOI: 10.1007/s11547-012-0812-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 08/03/2011] [Indexed: 12/11/2022]
Abstract
PURPOSE Assessing myocardial viability is crucial in decision making and prognostic restratification after acute myocardial infarction (MI). A number of noninvasive imaging modalities have been employed in viability identification, but contrast-enhanced magnetic resonance (MR) imaging has been shown to be extremely accurate because of its transmural resolution and precise definition of microvascular obstruction. Our purpose was to assess functional recovery after acute MI, with special focus on the role of infarct transmurality and microvascular obstruction. MATERIALS AND METHODS Forty-six consecutive patients with first acute MI, reperfused by primary percutaneous transluminal coronary angioplasty (PTCA) (n=40) or fibrinolysis (n=6), underwent MR imaging within the first week to assess oedema, microvascular obstruction, function and viability and then again after 4-6 months to assess functional recovery and scar. RESULTS At first MR examination, postcontrast images were analysed according to three patterns, based on a combination of first-pass and delayed-enhancement data: pattern 1 (normal first pass and late hyperenhancement <50% thickness) identified viable myocardium, whereas pattern 2 (late hyperenhancement >50% thickness, with or without first-pass perfusion defect) and pattern 3 (perfusion defect at first pass and late hypoenhancement) recognised nonviable myocardium, with 93% sensitivity, 75% specificity, 92% positive predictive value and 78% negative predictive value for identifying viable tissue. Furthermore, by dividing pattern 2 into two subpatterns, 2A and 2B, based on absence or presence of microvascular obstruction in >50% transmural infarcts, we were able to better identify the segments without recovery or that were nonviable with a 1.39 relative risk of failed recovery. CONCLUSIONS After acute MI, not all infarcts with transmurality >50% can be considered nonviable; microvascular obstruction detected at first pass can help to better stratify these cases.
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Affiliation(s)
- L Natale
- Unità di Risonanza Magnetica, Centro Oncologico Fiorentino, Via Attilio Ragionieri 101, 50119, Sesto Fiorentino, Italy.
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Salerno M, Sica CT, Kramer CM, Meyer CH. Optimization of spiral-based pulse sequences for first-pass myocardial perfusion imaging. Magn Reson Med 2011; 65:1602-10. [PMID: 21590802 DOI: 10.1002/mrm.22746] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 10/26/2010] [Accepted: 11/07/2010] [Indexed: 11/10/2022]
Abstract
Although spiral trajectories have multiple attractive features such as their isotropic resolution, acquisition efficiency, and robustness to motion, there has been limited application of these techniques to first-pass perfusion imaging because of potential off-resonance and inconsistent data artifacts. Spiral trajectories may also be less sensitive to dark-rim artifacts that are caused, at least in part, by cardiac motion. By careful consideration of the spiral trajectory readout duration, flip angle strategy, and image reconstruction strategy, spiral artifacts can be abated to create high-quality first-pass myocardial perfusion images with high signal-to-noise ratio. The goal of this article was to design interleaved spiral pulse sequences for first-pass myocardial perfusion imaging and to evaluate them clinically for image quality and the presence of dark-rim, blurring, and dropout artifacts.
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Affiliation(s)
- Michael Salerno
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
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Pack NA, DiBella EVR. Comparison of myocardial perfusion estimates from dynamic contrast-enhanced magnetic resonance imaging with four quantitative analysis methods. Magn Reson Med 2010; 64:125-37. [PMID: 20577976 DOI: 10.1002/mrm.22282] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dynamic contrast-enhanced MRI has been used to quantify myocardial perfusion in recent years. Published results have varied widely, possibly depending on the method used to analyze the dynamic perfusion data. Here, four quantitative analysis methods (two-compartment modeling, Fermi function modeling, model-independent analysis, and Patlak plot analysis) were implemented and compared for quantifying myocardial perfusion. Dynamic contrast-enhanced MRI data were acquired in 20 human subjects at rest with low-dose (0.019 +/- 0.005 mmol/kg) bolus injections of gadolinium. Fourteen of these subjects were also imaged at adenosine stress (0.021 +/- 0.005 mmol/kg). Aggregate rest perfusion estimates were not significantly different between all four analysis methods. At stress, perfusion estimates were not significantly different between two-compartment modeling, model-independent analysis, and Patlak plot analysis. Stress estimates from the Fermi model were significantly higher (approximately 20%) than the other three methods. Myocardial perfusion reserve values were not significantly different between all four methods. Model-independent analysis resulted in the lowest model curve-fit errors. When more than just the first pass of data was analyzed, perfusion estimates from two-compartment modeling and model-independent analysis did not change significantly, unlike results from Fermi function modeling.
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Affiliation(s)
- Nathan A Pack
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA
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Le Y, Stein A, Berry C, Kellman P, Bennett EE, Taylor J, Lucas K, Kopace R, Chefd’Hotel C, Lorenz CH, Croisille P, Wen H. Simultaneous myocardial strain and dark-blood perfusion imaging using a displacement-encoded MRI pulse sequence. Magn Reson Med 2010; 64:787-98. [PMID: 20544714 PMCID: PMC2932773 DOI: 10.1002/mrm.22461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 03/01/2010] [Indexed: 11/06/2022]
Abstract
The purpose of this study is to develop and evaluate a displacement-encoded pulse sequence for simultaneous perfusion and strain imaging. Displacement-encoded images in two to three myocardial slices were repeatedly acquired using a single-shot pulse sequence for 3 to 4 min, which covers a bolus infusion of Gadolinium contrast. The magnitudes of the images were T(1) weighted and provided quantitative measures of perfusion, while the phase maps yielded strain measurements. In an acute coronary occlusion swine protocol (n = 9), segmental perfusion measurements were validated against microsphere reference standard with a linear regression (slope 0.986, R(2) = 0.765, Bland-Altman standard deviation = 0.15 mL/min/g). In a group of ST-elevation myocardial infarction patients (n = 11), the scan success rate was 76%. Short-term contrast washout rate and perfusion are highly correlated (R(2) = 0.72), and the pixelwise relationship between circumferential strain and perfusion was better described with a sigmoidal Hill curve than linear functions. This study demonstrates the feasibility of measuring strain and perfusion from a single set of images.
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Affiliation(s)
- Yuan Le
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ashley Stein
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Colin Berry
- Western Infirmary & Associated Hospital, Dept. Cardiology, Glasgow, Scotland
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric E. Bennett
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joni Taylor
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Katherine Lucas
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rael Kopace
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Pierre Croisille
- Departement de Radiologie, Hôpital Cardiologique et Pneumologique, L. Pradel, Lyon, France
| | - Han Wen
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Head to head comparison of quantitative versus visual analysis of contrast CMR in the setting of myocardial stunning after STEMI: implications on late systolic function and patient outcome. Int J Cardiovasc Imaging 2010; 26:559-69. [DOI: 10.1007/s10554-010-9601-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
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17
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Abstract
Approximately two thirds of patients with heart failure have underlying coronary artery disease. In the setting of ischemic heart disease, cardiovascular magnetic resonance has demonstrated usefulness in two ways: for the detection of coronary artery disease and for the assessment of myocardial viability in consideration for revascularization. This article discusses the use of cardiovascular magnetic resonance for the detection of coronary artery disease. The purpose of this article is to provide readers with a brief overview of each of the cardiovascular magnetic resonance techniques, their relative strengths, and their relative weaknesses. Because adenosine stress cardiovascular magnetic resonance is currently the most widely used clinically, it is the primary focus of this article.
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Affiliation(s)
- Dipan J Shah
- Weill Cornell Medical College, New York, NY, USA.
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18
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Oechsner M, Mühlhäusler M, Ritter CO, Weininger M, Beissert M, Jakob PM, Beer M, Hahn D, Köstler H. Quantitative contrast-enhanced perfusion measurements of the human lung using the prebolus approach. J Magn Reson Imaging 2009; 30:104-11. [DOI: 10.1002/jmri.21793] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Patel AR, Epstein FH, Kramer CM. Evaluation of the microcirculation: advances in cardiac magnetic resonance perfusion imaging. J Nucl Cardiol 2009; 15:698-708. [PMID: 18761273 DOI: 10.1016/j.nuclcard.2008.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amit R Patel
- Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
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20
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Pack NA, DiBella EVR, Rust TC, Kadrmas DJ, McGann CJ, Butterfield R, Christian PE, Hoffman JM. Estimating myocardial perfusion from dynamic contrast-enhanced CMR with a model-independent deconvolution method. J Cardiovasc Magn Reson 2008; 10:52. [PMID: 19014509 PMCID: PMC2596132 DOI: 10.1186/1532-429x-10-52] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 11/12/2008] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Model-independent analysis with B-spline regularization has been used to quantify myocardial blood flow (perfusion) in dynamic contrast-enhanced cardiovascular magnetic resonance (CMR) studies. However, the model-independent approach has not been extensively evaluated to determine how the contrast-to-noise ratio between blood and tissue enhancement affects estimates of myocardial perfusion and the degree to which the regularization is dependent on the noise in the measured enhancement data. We investigated these questions with a model-independent analysis method that uses iterative minimization and a temporal smoothness regularizer. Perfusion estimates using this method were compared to results from dynamic 13N-ammonia PET. RESULTS An iterative model-independent analysis method was developed and tested to estimate regional and pixelwise myocardial perfusion in five normal subjects imaged with a saturation recovery turboFLASH sequence at 3 T CMR. Estimates of myocardial perfusion using model-independent analysis are dependent on the choice of the regularization weight parameter, which increases nonlinearly to handle large decreases in the contrast-to-noise ratio of the measured tissue enhancement data. Quantitative perfusion estimates in five subjects imaged with 3 T CMR were 1.1 +/- 0.8 ml/min/g at rest and 3.1 +/- 1.7 ml/min/g at adenosine stress. The perfusion estimates correlated with dynamic 13N-ammonia PET (y = 0.90x + 0.24, r = 0.85) and were similar to results from other validated CMR studies. CONCLUSION This work shows that a model-independent analysis method that uses iterative minimization and temporal regularization can be used to quantify myocardial perfusion with dynamic contrast-enhanced perfusion CMR. Results from this method are robust to choices in the regularization weight parameter over relatively large ranges in the contrast-to-noise ratio of the tissue enhancement data.
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Affiliation(s)
- Nathan A Pack
- Department of Bioengineering, University of Utah, Salt Lake City, Salt Lake County, Utah, USA
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Salt Lake County, Utah, USA
| | - Edward VR DiBella
- Department of Bioengineering, University of Utah, Salt Lake City, Salt Lake County, Utah, USA
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Salt Lake County, Utah, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Salt Lake County, Utah, USA
| | - Thomas C Rust
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Salt Lake County, Utah, USA
| | - Dan J Kadrmas
- Department of Bioengineering, University of Utah, Salt Lake City, Salt Lake County, Utah, USA
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Salt Lake County, Utah, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Salt Lake County, Utah, USA
| | - Christopher J McGann
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Salt Lake County, Utah, USA
| | - Regan Butterfield
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Salt Lake County, Utah, USA
| | - Paul E Christian
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Salt Lake County, Utah, USA
| | - John M Hoffman
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Salt Lake County, Utah, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Salt Lake County, Utah, USA
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Christian TF, Aletras AH, Arai AE. Estimation of absolute myocardial blood flow during first-pass MR perfusion imaging using a dual-bolus injection technique: comparison to single-bolus injection method. J Magn Reson Imaging 2008; 27:1271-7. [PMID: 18421683 DOI: 10.1002/jmri.21383] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To compare the dual-bolus to single-bolus quantitative first-pass magnetic resonance myocardial perfusion imaging for estimation of absolute myocardial blood flow (MBF). MATERIALS AND METHODS Dogs had local hyperemia of MBF in the left anterior descending (LAD) coronary artery (intracoronary adenosine). Animals (n = 6) had sequential single- and dual-bolus perfusion studies with microsphere determination of absolute MBF. Perfusion imaging was performed using a saturation-recovery gradient-echo sequence. Absolute MBF was by Fermi function deconvolution and compared to transmural, endocardial, and epicardial microsphere values in the same region of interest (ROI). RESULTS Signal and contrast were significantly higher for the dual-bolus perfusion images. The correlation with MBF by microspheres was r = 0.94 for the dual-bolus method and r = 0.91 for the single-bolus method. There was no significant difference between MRI and microsphere MBF values for control or hyperemic zones for transmural segments for either technique. When the ROI was reduced to define endocardial and epicardial zones, single-bolus MR first-pass imaging significantly overestimated MBF and had a significantly larger absolute error vs. microspheres when compared to dual-bolus perfusion. CONCLUSION Both single-bolus and dual-bolus perfusion methods correlate closely with MBF but the signal and contrast of the dual-bolus images are greater. With smaller nontransmural ROIs where signal is reduced, the dual-bolus method appeared to provide slightly more accurate results.
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Affiliation(s)
- Timothy F Christian
- Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont 05495, USA.
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Saremi F, Grizzard JD, Kim RJ. Optimizing Cardiac MR Imaging: Practical Remedies for Artifacts. Radiographics 2008; 28:1161-87. [DOI: 10.1148/rg.284065718] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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23
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Gonzalez FM, Shiva S, Vincent PS, Ringwood LA, Hsu LY, Hon YY, Aletras AH, Cannon RO, Gladwin MT, Arai AE. Nitrite anion provides potent cytoprotective and antiapoptotic effects as adjunctive therapy to reperfusion for acute myocardial infarction. Circulation 2008; 117:2986-94. [PMID: 18519850 DOI: 10.1161/circulationaha.107.748814] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Accumulating evidence suggests that the ubiquitous anion nitrite (NO2-) is a physiological signaling molecule, with roles in intravascular endocrine nitric oxide transport, hypoxic vasodilation, signaling, and cytoprotection. Thus, nitrite could enhance the efficacy of reperfusion therapy for acute myocardial infarction. The specific aims of this study were (1) to assess the efficacy of nitrite in reducing necrosis and apoptosis in canine myocardial infarction and (2) to determine the relative role of nitrite versus chemical intermediates, such as S-nitrosothiols. METHODS AND RESULTS We evaluated infarct size, microvascular perfusion, and left ventricular function by histopathology, microspheres, and magnetic resonance imaging in 27 canines subjected to 120 minutes of coronary artery occlusion. This was a blinded, prospective study comparing a saline control group (n=9) with intravenous nitrite during the last 60 minutes of ischemia (n=9) and during the last 5 minutes of ischemia (n=9). In saline-treated control animals, 70+/-10% of the area at risk was infarcted compared with 23+/-5% in animals treated with a 60-minute nitrite infusion. Remarkably, a nitrite infusion in the last 5 minutes of ischemia also limited the extent of infarction (36+/-8% of area at risk). Nitrite improved microvascular perfusion, reduced apoptosis, and improved contractile function. S-Nitrosothiol and iron-nitrosyl-protein adducts did not accumulate in the 5-minute nitrite infusion, suggesting that nitrite is the bioactive intravascular nitric oxide species accounting for cardioprotection. CONCLUSIONS Nitrite has significant potential as adjunctive therapy to enhance the efficacy of reperfusion therapy for acute myocardial infarction.
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Affiliation(s)
- Felix M Gonzalez
- Translational Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1061, USA
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McGoron AJ, Capille M, Georgiou MF, Sanchez P, Solano J, Gonzalez-Brito M, Kuluz JW. Post traumatic brain perfusion SPECT analysis using reconstructed ROI maps of radioactive microsphere derived cerebral blood flow and statistical parametric mapping. BMC Med Imaging 2008; 8:4. [PMID: 18312639 PMCID: PMC2311288 DOI: 10.1186/1471-2342-8-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 02/29/2008] [Indexed: 11/14/2022] Open
Abstract
Background Assessment of cerebral blood flow (CBF) by SPECT could be important in the management of patients with severe traumatic brain injury (TBI) because changes in regional CBF can affect outcome by promoting edema formation and intracranial pressure elevation (with cerebral hyperemia), or by causing secondary ischemic injury including post-traumatic stroke. The purpose of this study was to establish an improved method for evaluating regional CBF changes after TBI in piglets. Methods The focal effects of moderate traumatic brain injury (TBI) on cerebral blood flow (CBF) by SPECT cerebral blood perfusion (CBP) imaging in an animal model were investigated by parallelized statistical techniques. Regional CBF was measured by radioactive microspheres and by SPECT 2 hours after injury in sham-operated piglets versus those receiving severe TBI by fluid-percussion injury to the left parietal lobe. Qualitative SPECT CBP accuracy was assessed against reference radioactive microsphere regional CBF measurements by map reconstruction, registration and smoothing. Cerebral hypoperfusion in the test group was identified at the voxel level using statistical parametric mapping (SPM). Results A significant area of hypoperfusion (P < 0.01) was found as a response to the TBI. Statistical mapping of the reference microsphere CBF data confirms a focal decrease found with SPECT and SPM. Conclusion The suitability of SPM for application to the experimental model and ability to provide insight into CBF changes in response to traumatic injury was validated by the SPECT SPM result of a decrease in CBP at the left parietal region injury area of the test group. Further study and correlation of this characteristic lesion with long-term outcomes and auxiliary diagnostic modalities is critical to developing more effective critical care treatment guidelines and automated medical imaging processing techniques.
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Affiliation(s)
- Anthony J McGoron
- Department of Biomedical Engineering, Florida International University, 10555 West Flagler Street, EC 2671, Miami, FL 33199, USA.
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25
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In Vivo T2-Weighted Magnetic Resonance Imaging Can Accurately Determine the Ischemic Area at Risk for 2-Day-Old Nonreperfused Myocardial Infarction. Invest Radiol 2008; 43:7-15. [DOI: 10.1097/rli.0b013e3181558822] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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26
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Kocher M, Daire JL, Thevenaz P, Schindler T, Keller PF, Didier D, Vallee JP. Myocardial perfusion assessment by use of system identification method in a one-compartment model. ACTA ACUST UNITED AC 2007; 2007:4492-5. [PMID: 18003003 DOI: 10.1109/iembs.2007.4353337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cardiovascular magnetic resonance has been shown to provide high data quality for myocardial perfusion assessment. However, to analyze the perfusion data, some signal processing and modeling is needed to correct for motion related artifacts and limited spatial resolution. This study describes a method based on system identification, allowing, after a first step of image registration, to integrate and correct the partial volume effect in the myocardium perfusion quantification. This method is then applied to patients with coronary artery disease or hypertrophic obstructive cardiomyopathy.
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Affiliation(s)
- M Kocher
- Biomedical Imaging Group, EPFL, Station 17, 1015 Lausanne, Switzerland.
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27
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Kim HW, Klem I, Kim RJ. Detection of Myocardial Ischemia by Stress Perfusion Cardiovascular Magnetic Resonance. Magn Reson Imaging Clin N Am 2007; 15:527-40, vi. [DOI: 10.1016/j.mric.2007.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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28
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Ripa RS, Nilsson JC, Wang Y, Søndergaard L, Jørgensen E, Kastrup J. Short- and long-term changes in myocardial function, morphology, edema, and infarct mass after ST-segment elevation myocardial infarction evaluated by serial magnetic resonance imaging. Am Heart J 2007; 154:929-36. [PMID: 17967600 DOI: 10.1016/j.ahj.2007.06.038] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 06/27/2007] [Indexed: 01/03/2023]
Abstract
BACKGROUND Knowledge of the natural course after an ST-elevation myocardial infarction (STEMI) treated according to guidelines is limited because comprehensive serial magnetic resonance imaging (MRI) of systolic left ventricular function, edema, perfusion, and infarct size after STEMI has not been undertaken. The aim of this study was to evaluate effects of therapy for STEMI on left ventricular function and perfusion and to test the hypothesis that myocardial perfusion by MRI predicts recovery of left ventricular function. METHODS Cine MRI, edema, first-pass perfusion, and late enhancement imaging were performed in 58 patients at day 2 and at 1 and 6 months after successful primary percutaneous coronary stent intervention for STEMI. RESULTS Ejection fraction increased 6.3% during the first month (P < .001) and 1.9% from 1 to 6 months (P < .06), indicating a maximal recovery very early after the infarction. The systolic wall thickening in the infarct area almost doubled (P < .001), the perfusion of infarcted myocardium increased approximately 50% (P = .02), and perfusion improved in 72% of patients. Edema decreased with a mean of 2 segments (P < .001) during the first month and another 2.5 segments from 1 to 6 months (P < .001). Infarct size decreased to 1 month (P = .01) and was unchanged from 1 to 6 months (P = .5). Baseline perfusion did not predict improvement in ejection fraction (r = 0.2, P = .2) but did predict regional systolic function (P = .03). CONCLUSIONS Left ventricular function, perfusion, and infarct mass recovered substantially after STEMI, with the main part of the change within the first month. First-pass perfusion at rest appeared to predict regional ventricular recovery.
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Isbell DC, Epstein FH, Zhong X, DiMaria JM, Berr SS, Meyer CH, Rogers WJ, Harthun NL, Hagspiel KD, Weltman A, Kramer CM. Calf muscle perfusion at peak exercise in peripheral arterial disease: measurement by first-pass contrast-enhanced magnetic resonance imaging. J Magn Reson Imaging 2007; 25:1013-20. [PMID: 17410566 PMCID: PMC2930771 DOI: 10.1002/jmri.20899] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To develop a contrast-enhanced magnetic resonance (MR) technique to measure skeletal muscle perfusion in peripheral arterial disease (PAD). MATERIALS AND METHODS A total of 11 patients (age = 61 +/- 11 years) with mild to moderate symptomatic PAD (ankle-brachial index [ABI] = 0.75 +/- 0.08) and 22 normals were studied using an MR-compatible ergometer. PAD and normal(max) (Nl(max); N = 11) exercised to exhaustion. Nl(low) (N = 11) exercised to the same workload achieved by PAD. At peak exercise, 0.1 mm/kg of gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) was infused at 3-4 cm(3)/second followed by a saline flush at the same rate. A dual-contrast gradient echo (GRE) sequence enabled simultaneous acquisition of muscle perfusion and arterial input function (AIF). The perfusion index (PI) was defined as the slope of the time-intensity curve (TIC) in muscle divided by the arterial TIC slope. RESULTS Median workload was 120 Joules in PAD, 210 Joules in Nl(low), and 698 Joules in Nl(max) (P < 0.001 vs. Nl(low) and PAD). Median PI was 0.29 in PAD (25th and 75th percentiles [%] = 0.20, 0.40), 0.48 in Nl(low) (25th, 75th % = 0.36, 0.62; P < 0.02 vs. PAD), and 0.69 in Nl(max) (25th, 75th % = 0.5, 0.77; P < 0.001 vs. PAD). Area under the ROC-curve for PI differentiating patients from Nl(max) was 0.95 (95% confidence interval [CI] = 0.77-0.99). CONCLUSION Peak-exercise measurement of lower limb perfusion with dual-contrast, first-pass MR distinguishes PAD from normals. This method may be useful in the study of novel therapies for PAD.
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Affiliation(s)
- David C. Isbell
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, Virginia, USA
| | - Frederick H. Epstein
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia, USA
- Department of Biomedical Engineering, University of Virginia Health System, University of Virginia, Charlottesville, Virginia, USA
| | | | - Joseph M. DiMaria
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia, USA
| | - Stuart S. Berr
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia, USA
- Department of Biomedical Engineering, University of Virginia Health System, University of Virginia, Charlottesville, Virginia, USA
| | - Craig H. Meyer
- Department of Biomedical Engineering, University of Virginia Health System, University of Virginia, Charlottesville, Virginia, USA
| | - Walter J. Rogers
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, Virginia, USA
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia, USA
| | - Nancy L. Harthun
- Department of Surgery, University of Virginia Health System, University of Virginia, Charlottesville, Virginia, USA
| | - Klaus D. Hagspiel
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia, USA
| | - Arthur Weltman
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, Virginia, USA
| | - Christopher M. Kramer
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, Virginia, USA
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia, USA
- Address reprint requests to: C.M.K., MD, University of Virginia Health System, Departments of Medicine and Radiology, Lee Street, Box 800170, Charlottesville, VA 22908.
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Kim HW, Klem I, Kim RJ. Detection of Myocardial Ischemia by Stress Perfusion Cardiovascular Magnetic Resonance. Cardiol Clin 2007; 25:57-70, vi. [PMID: 17478240 DOI: 10.1016/j.ccl.2007.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
With recent technical and clinical advances, adenosine stress perfusion MRI has evolved from a promising research tool to an everyday clinical test. This article reviews the current state of stress perfusion MRI. Specifically, it addresses the following topics: validation of stress perfusion MRI in preclinical studies, diagnostic performance in patients, imaging protocol, and image interpretation.
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Affiliation(s)
- Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Health Systems, Durham, NC 27710, USA.
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Ritter C, Brackertz A, Sandstede J, Beer M, Hahn D, Köstler H. Absolute quantification of myocardial perfusion under adenosine stress. Magn Reson Med 2007; 56:844-9. [PMID: 16941620 DOI: 10.1002/mrm.21020] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The prebolus technique allows one to quantify perfusion in the human heart with a low variability by means of MRI. In this study the prebolus technique was used to determine quantitative perfusion values in the human heart under adenosine stress and to measure the myocardial perfusion reserve (MPR). Twelve healthy volunteers were examined using the multislice prebolus technique with 1/4 cc Gd-BOPTA. Signal intensity (SI) time courses were evaluated in 288 manually segmented sectors at rest and stress. Myocardial perfusion was determined by deconvolution of the SI time courses with the arterial input function (AIF) from the prebolus scan. The mean stress perfusion value was 1.78 +/- 0.53 cc/g/min, and the mean rest perfusion was 0.52 +/- 0.11 cc/g/min, resulting in a mean MPR of 3.59 +/- 1.26. The measured values correlate well with data from animal models and human positron emission tomography (PET) studies.
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Affiliation(s)
- Christian Ritter
- Institut für Röntgendiagnostik der Universität Würzburg, Würzburg, Germany.
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Utz W, Niendorf T, Wassmuth R, Messroghli D, Dietz R, Schulz-Menger J. Contrast–dose relation in first-pass myocardial MR perfusion imaging. J Magn Reson Imaging 2007; 25:1131-5. [PMID: 17520736 DOI: 10.1002/jmri.20910] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To determine the regime of linear contrast enhancement in human first-pass perfusion cardiovascular magnetic resonance (CMR) imaging to improve accuracy in myocardial perfusion quantification. MATERIALS AND METHODS A total of 10 healthy subjects were studied on a clinical 1.5T MR scanner. Seven doses of Gd-DTPA ranging from 0.00125 to 0.1 mmol/kg of body weight (b.w.) were administered as equal volumes by rapid bolus injection (6 mL/second). Resting periods of 15 minutes were introduced after delivery of Gd doses >0.01 mmol/kg b.w. For each subject, two series of rest perfusion scans were performed using two different multislice saturation-recovery perfusion sequences. Maximum contrast enhancement and maximum upslope were obtained in the blood pool of the left ventricular (LV) cavity and in the myocardium. The range of linear contrast-dose relation was determined by linear regression analysis. RESULTS MR signal intensity increased linearly for contrast agent concentrations up to 0.01 mmol/kg b.w. in the LV blood pool and up to 0.05 mmol/kg b.w. in the myocardium. For Gd concentrations exceeding these thresholds the signal intensity response was not linear with respect to the contrast agent dose. CONCLUSION Quantitative evaluation of cardiac MR perfusion data needs to account for signal saturation in both the LV blood pool and the myocardium.
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Affiliation(s)
- Wolfgang Utz
- Franz Volhard Klinik, Charite Campus Buch, Helios Klinikum-Berlin at the Max Delbrück Center for Molecular Medicine, Wiltbergstrasse 50, 13125 Berlin, Germany.
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Cardiovascular Magnetic Resonance Imaging. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Magnetic Resonance Imaging of the Myocardium. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Cardiovascular Division, Harvard Medical School, Boston, Massachusetts 02215, USA.
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Hsu LY, Rhoads KL, Holly JE, Kellman P, Aletras AH, Arai AE. Quantitative myocardial perfusion analysis with a dual-bolus contrast-enhanced first-pass MRI technique in humans. J Magn Reson Imaging 2006; 23:315-22. [PMID: 16463299 DOI: 10.1002/jmri.20502] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To compare fully quantitative and semiquantitative analysis of rest and stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) using a dual-bolus first-pass perfusion MRI method in humans. MATERIALS AND METHODS Rest and dipyridamole stress perfusion imaging was performed on 10 healthy humans by administering gadolinium contrast using a dual-bolus protocol. Ventricular and myocardial time-signal intensity curves were generated from a series of T1-weighted images and adjusted for surface-coil intensity variations. Corrected signal intensity curves were then fitted using fully quantitative model constrained deconvolution (MCD) to quantify MBF (mL/min/g) and MPR. The results were compared with semiquantitative contrast enhancement ratio (CER) and upslope index (SLP) measurements. RESULTS MBF (mL/min/g) estimated with MCD averaged 1.02 +/- 0.22 at rest and 3.39 +/- 0.59 for stress with no overlap in measures. MPR was 3.43 +/- 0.71, 1.91 +/- 0.65, and 1.16 +/- 0.19 using MCD, SLP, and CER. Both semiquantitative parameters (SLP and CER) significantly underestimated MPR (P < 0.001) and failed to completely discriminate rest and stress perfusion. CONCLUSION Rest and stress MBF (mL/min/g) and MPR estimated by dual-bolus perfusion MRI fit within published ranges. Semiquantitative methods (SLP and CER) significantly underestimated MPR.
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Affiliation(s)
- Li-Yueh Hsu
- Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health/DHHS, 10 Center Drive, Bethesda, MD 20892, USA
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Ruan C, Yang S, Clarke GD, Amurao MR, Partyka SR, Bradley YC, Cusi K. First-Pass Contrast-Enhanced Myocardial Perfusion MRI Using a Maximum Up-Slope Parametric Map. ACTA ACUST UNITED AC 2006; 10:574-80. [PMID: 16871727 DOI: 10.1109/titb.2006.872058] [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
Magnetic resonance first-pass perfusion imaging offers a noninvasive method for the rapid, accurate, and reproducible assessment of cardiac function without ionizing radiation. Quantitative or semiquantitative analysis of changes in signal intensity (SI) over the whole image sequence yields a more efficient analysis than direct visual inspection. In this paper, a method to generate maximum up-slope myocardial perfusion maps is presented. The maximum up-slope is defined by comparison of the SI variations using frame-to-frame analysis. A map of first-pass transit of the contrast agent is constructed pixel by pixel using a linear curve fitting model. The proposed method was evaluated using data from eight subjects. The data from the parametric maps agreed well with those obtained from traditional, manually derived region-of-interest methods as shown through ANOVA. The straightforward implementation and increase in image analysis efficiency resulting from this method suggests that it may be useful for clinical practice.
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Affiliation(s)
- Chun Ruan
- Department of Radiology, University of Texas Health Science Center at San Antonio, TX 78229, USA.
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Hunold P, Schlosser T, Barkhausen J. Magnetic resonance cardiac perfusion imaging-a clinical perspective. Eur Radiol 2006; 16:1779-88. [PMID: 16670865 DOI: 10.1007/s00330-006-0269-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Revised: 03/22/2006] [Accepted: 03/24/2006] [Indexed: 11/27/2022]
Abstract
Coronary artery disease (CAD) with its clinical appearance of stable or unstable angina and acute myocardial infarction is the leading cause of death in developed countries. In view of increasing costs and the rising number of CAD patients, there has been a major interest in reliable non-invasive imaging techniques to identify CAD in an early (i.e. asymptomatic) stage. Since myocardial perfusion deficits appear very early in the "ischemic cascade", a major breakthrough would be the non-invasive quantification of myocardial perfusion before functional impairment might be detected. Therefore, there is growing interest in other, target-organ-specific parameters, such as relative and absolute myocardial perfusion imaging. Magnetic resonance (MR) imaging has been proven to offer attractive concepts in this respect. However, some important difficulties have not been resolved so far, which still causes uncertainty and prevents the broad application of MR perfusion imaging in a clinical setting. This review explores recent technical developments in MR hardware, software and contrast agents, as well as their impact on the current and future clinical status of MR imaging of first-pass myocardial perfusion imaging.
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Affiliation(s)
- Peter Hunold
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital, Hufelandstrasse 55, 45122 Essen, Germany.
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39
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Croisille P, Revel D, Saeed M. Contrast agents and cardiac MR imaging of myocardial ischemia: from bench to bedside. Eur Radiol 2006; 16:1951-63. [PMID: 16633792 DOI: 10.1007/s00330-006-0244-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Revised: 02/07/2006] [Accepted: 03/02/2006] [Indexed: 01/14/2023]
Abstract
This review paper presents, in the first part, the different classes of contrast media that are already used or are in development for cardiac magnetic resonance imaging. A classification of the different types of contrast media is proposed based on the distribution of the compounds in the body, their type of relaxivity and their potential affinity to particular molecules. In the second part, the different uses of the extracellular type of T1-enhancing contrast agent for myocardial imaging is covered from the detection of stable coronary artery disease to the detection and characterization of chronic infarction. A particular emphasis is placed on the clinical use of gadolinium-chelates, which are the universally used type of MRI contrast agent in the clinical routine. Both approaches, first-pass magnetic resonance imaging (FP-MRI) as well as delayed-enhanced magnetic resonance imaging (DE-MRI), are covered in the different situations of acute and chronic myocardial infarction.
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Affiliation(s)
- Pierre Croisille
- Hôpital Cardiologique L. Pradel, Department of Radiology, Creatis, UMR CNRS 5515 & INSERM U630, 59, Boulevard du Doyen Lépine, 69394, Lyon, Montchat, France.
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Carme S, Maï W, Mazzadi A, Janier M, Revel D, Magnin I, Wiart M, Neyran B, Canet-Soulas E. Importance of Parametric Mapping and Deconvolution in Analyzing Magnetic Resonance Myocardial Perfusion Images. Invest Radiol 2006; 41:374-83. [PMID: 16523020 DOI: 10.1097/01.rli.0000197980.89673.4b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM : We sought to improve the clinical interpretation of first-pass myocardial magnetic resonance perfusion. Parametric analyses of the myocardial distribution of the contrast agent have been proposed. The objective of the present study was to compare the effectiveness of visual analysis and of a parametric approach in an animal model under acquisition conditions as close as possible to clinical reality. METHOD : Experiments were conducted in vivo with various kinds of pharmacological stimulation in normal pigs and in pigs with stenosis of the left circumflex coronary artery. First-pass MR images and parametric maps were first assessed by medical experts. MR parameters, the myocardial signal intensity variation DeltaSI, ascending up-slope, and rMBF (blood flow calculated by fast discrete ARMA deconvolution) were then compared with blood flow measurements using radioactive microspheres. RESULTS AND CONCLUSIONS : Interobserver agreement was 57% and 81% and accuracy 53% and 81%, for visual and for parametric map analysis, respectively. For deconvolution parameters, a linear relationship y = 371 + 1.27x, r = 0.78 was obtained between rMBF calculated by ARMA and the radioactive microsphere blood flow. Moreover, the fast and robust parametric mapping of rMBF by the discrete ARMA method allows MR evaluation of myocardial perfusion independently of hemodynamic conditions.
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Affiliation(s)
- Sabin Carme
- CREATIS UMR 5515 CNRS, Hôpital Cardiologique and INSA, University of Lyon 1, France
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41
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Wang Y, Moin K, Akinboboye O, Reichek N. Myocardial first pass perfusion: steady-state free precession versus spoiled gradient echo and segmented echo planar imaging. Magn Reson Med 2006; 54:1123-9. [PMID: 16217785 DOI: 10.1002/mrm.20700] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The imaging sequences used in first pass (FP) perfusion to date have important limitations in contrast-to-noise ratio (CNR), temporal and spatial resolution, and myocardial coverage. As a result, controversy exists about optimal imaging strategies for FP myocardial perfusion. Since imaging performance varies from subject to subject, it is difficult to form conclusions without direct comparison of different sequences in the same subject. The purpose of this study was to directly compare the saturation recovery SSFP technique to other more commonly used myocardial first pass perfusion techniques, namely spoiled GRE and segmented EPI. Differences in signal-to-noise ratio (SNR), CNR, relative maximal upslope (RMU) of signal amplitude, and artifacts at comparable temporal and spatial resolution among the three sequences were investigated in computer simulation, contrast agent doped phantoms, and 16 volunteers. The results demonstrate that SSFP perfusion images exhibit an improvement of approximately 77% in SNR and 23% in CNR over spoiled GRE and 85% SNR and 50% CNR over segmented EPI. Mean RMU was similar between SSFP and spoiled GRE, but there was a 58% increase in RMU with SSFP versus segmented EPI.
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Affiliation(s)
- Yi Wang
- Research and Education Department, St. Francis Hospital, Roslyn, New York 11576, USA.
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Shah DJ, Judd RM, Kim RJ. Technology insight: MRI of the myocardium. ACTA ACUST UNITED AC 2006; 2:597-605; quiz 606. [PMID: 16258572 DOI: 10.1038/ncpcardio0352] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Accepted: 08/16/2005] [Indexed: 02/08/2023]
Abstract
MRI is emerging as the method of choice for the evaluation of a wide variety of cardiovascular disorders. A major advantage of this technique over the other cardiac imaging modalities is the fact that it allows the operator--via special software programs called pulse sequences--to probe a vast array of biological properties while using the same machine. In this review, we provide the reader with a brief overview of the pulse sequence concept and how it enables MRI practitioners to pursue a multifaceted approach to evaluating the myocardium. We discuss how MRI technology makes this imaging method ideally suited to the assessment of cardiac morphology, contractile function, myocardial perfusion and infarction. In addition, we present clinical scenarios in which the performance of multifaceted imaging by MRI can alter clinical decision making.
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Affiliation(s)
- Dipan J Shah
- Nashville Cardiovascular Magnetic Resonance Institute, The Heart Group, PLLC, Brentwood, TN, USA
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43
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Wang Y, Tägil K, Ripa RS, Nilsson JC, Carstensen S, Jørgensen E, Søndergaard L, Hesse B, Johnsen HE, Kastrup J. Effect of mobilization of bone marrow stem cells by granulocyte colony stimulating factor on clinical symptoms, left ventricular perfusion and function in patients with severe chronic ischemic heart disease. Int J Cardiol 2005; 100:477-83. [PMID: 15837093 DOI: 10.1016/j.ijcard.2004.12.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Accepted: 12/31/2004] [Indexed: 12/23/2022]
Abstract
OBJECTIVES A phase I safety and efficacy study with granulocyte colony stimulating factor (G-CSF) mobilization of bone marrow stem cells to induce vasculogenesis in patients with severe ischemic heart disease (IHD) was conducted. DESIGN, PATIENTS AND RESULTS 29 patients with IHD participated in the study. Thirteen patients were treated with G-CSF for 6 days and 16 patients served as controls. G-CSF treatment was without any serious adverse events. Four patients were "poor mobilizers" with a maximal increase in CD34+ cells to 5,000+/-700/mL blood (mean+/-S.D.) compared to 28,900+/-5,100/mL blood in "mobilizers". At the follow-up, G-CSF treated had improved in CCS classification, NTG consumption and angina attacks, but the controls only in CCS classification. No difference was seen between the two groups. The decline in NTG consumption tended to be significant in "mobilizers" compared to controls. Myocardial perfusion was unchanged at adenosine stress single photon emission computerized tomography (SPECT) or magnetic resonance images (MRI). Left ventricular ejection fraction decreased from 57% to 52% (p<0.01, MRI) and from 48% to 44% (p=0.07, SPECT) in G-CSF treated, but was unchanged measured with echocardiography. CONCLUSIONS Treatment by G-CSF improved symptoms but not signs of myocardial ischemia in patients with severe IHD. The effects seemed related to mobilization of stem cells. An adverse effect on ejection fraction could not be excluded.
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Affiliation(s)
- Yongzhong Wang
- Cardiac Catheterization Laboratory, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
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44
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Isbell DC, Kramer CM. Cardiovascular magnetic resonance: structure, function, perfusion, and viability. J Nucl Cardiol 2005; 12:324-36. [PMID: 15944538 DOI: 10.1016/j.nuclcard.2005.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- David C Isbell
- Department of Medicine, (Cardiovascular Disease), University of Virginia Health System, Charlottesville 22908, USA
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Fenchel M, Kramer U, Helber U, Stauder NI, Franow A, Claussen CD, Miller S. Semiquantitative assessment of myocardial perfusion using magnetic resonance imaging: evaluation of appropriate thresholds and segmentation models. Invest Radiol 2004; 39:572-81. [PMID: 15308940 DOI: 10.1097/01.rli.0000133816.83192.38] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of the study was to determine optimal thresholds for semiquantitative perfusion parameters and to evaluate the influence of different segmentation models in detecting malperfused regions. MATERIAL AND METHODS In 6 healthy subjects and 13 patients with coronary artery disease, contrast-enhanced first-pass perfusion imaging was performed using a SR-TrueFISP-sequence. Thresholds for semiquantitative parameters were established, and different segmentation models of the left ventricular myocardium were tested. The standard of reference for patient studies was single photon emission computed tomography. RESULTS Optimal thresholds were determined in healthy subjects for the perfusion parameters upslope, AUC, and peak SI of mv-0.5*std, mv-1.5*std, and mv-1.0*std, respectively. Using the optimal threshold for each parameter/segmentation combination sensitivities and specificities of stress studies were between 66% and 93% and 77% and 92%, respectively. Subdivision of radial segments into subendo/subepicardial segments increased sensitivities for perfusion deficits. CONCLUSIONS Subdivision of radial myocardial segments is essential in analysis of magnetic resonance first-pass perfusion series. Semiquantitative perfusion parameters possess different sensitivities for the detection of perfusion deficits.
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Affiliation(s)
- Michael Fenchel
- Department of Diagnostic Radiology, Division of Cardiology, Eberhard-Karls-University, Tuebingen, Germany.
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Barkhausen J, Hunold P, Jochims M, Debatin JF. Imaging of myocardial perfusion with magnetic resonance. J Magn Reson Imaging 2004; 19:750-7. [PMID: 15170781 DOI: 10.1002/jmri.20073] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Coronary artery disease (CAD) is currently the leading cause of death in developed nations. Reflecting the complexity of cardiac function and morphology, noninvasive diagnosis of CAD represents a major challenge for medical imaging. Although coronary artery stenoses can be depicted with magnetic resonance (MR) and computed tomography (CT) techniques, its functional or hemodynamic impact frequently remains elusive. Therefore, there is growing interest in other, target organ-specific parameters such as myocardial function at stress and first-pass myocardial perfusion imaging to assess myocardial blood flow. This review explores the pathophysiologic background, recent technical developments, and current clinical status of first-pass MR imaging (MRI) of myocardial perfusion.
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Affiliation(s)
- Jörg Barkhausen
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany.
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47
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Croisille P. Cardiopathies ischémiques (perfusion myocardique et viabilité) : techniques et résultats. ACTA ACUST UNITED AC 2004; 85:1811-8. [PMID: 15507837 DOI: 10.1016/s0221-0363(04)97752-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Over the last two decades, the understanding, diagnosis and treatment of patients with suspected or known coronary artery disease have made tremendous progress, in particular with the help of the development of non-invasive methodologies for assessing myocardial perfusion and viability. Clinically, nuclear medicine techniques (particularly SPECT imaging) have predominated. With the recent technical developments allowing for a combined assessment of perfusion and irreversible damage with late enhancement imaging, MRI will now play a major role in the assessment of ischemic heart disease.
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Affiliation(s)
- P Croisille
- Hôpital Cardiologique L. Pradel, UMR CNRS 5515 et INSERM U630 Creatis, 28, avenue Doyen Lépine, 69677 Bron Cedex, France.
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Christian TF, Rettmann DW, Aletras AH, Liao SL, Taylor JL, Balaban RS, Arai AE. Absolute myocardial perfusion in canines measured by using dual-bolus first-pass MR imaging. Radiology 2004; 232:677-84. [PMID: 15284436 DOI: 10.1148/radiol.2323030573] [Citation(s) in RCA: 247] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare fluorescent microsphere measurements of myocardial blood flow (MBF) with qualitative, semiquantitative, and fully quantitative measurements of first-pass perfusion at magnetic resonance (MR) imaging. MATERIALS AND METHODS Coronary artery occlusion or intracoronary adenosine infusion was successfully performed in 16 beagles; both procedures were performed simultaneously in one animal. MBF was assessed at microsphere analysis. First-pass myocardial perfusion MR imaging was performed during a dual-bolus administration of gadopentetate dimeglumine (0.0025 mmol/kg followed by 0.10 mmol/kg). The absolute myocardial perfusion at MR imaging was calculated by using Fermi function deconvolution methods. Qualitative, semiquantitative, and absolute myocardial perfusion MR imaging measurements were compared with microsphere MBF measurements by using paired t tests, linear correlation, and Bland-Altman analysis. RESULTS Fully quantitative (ie, absolute) analysis of MBF at MR imaging correlated with microsphere MBF measurement (r = 0.95, P <.001) across the full range of blood flow rates encountered (from 0 to >5.0 mL/min/g). Similar close correlations were observed in endocardial and epicardial segments (representing approximately 0.85 g of the myocardium). With modest increases in MBF, qualitative measurements plateaued in the hyperemic zones. Semiquantitative measurements did not correlate with MBF as well (r = 0.69-0.89); they plateaued around 3.0 mL/min/g. CONCLUSION Dual-bolus MR imaging enabled accurate measurement of absolute epicardial and endocardial perfusion across a wide range of blood flow rates (0 to >5.0 mL/min/g). Use of qualitative MR imaging measures such as the contrast enhancement ratio led to substantially underestimated hyperemic blood flow measurements.
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Affiliation(s)
- Timothy F Christian
- Laboratory of Cardiac Energetics, National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Dr, Bethesda, MD 20892-1061, USA
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Köstler H, Ritter C, Lipp M, Beer M, Hahn D, Sandstede J. Prebolus quantitative MR heart perfusion imaging. Magn Reson Med 2004; 52:296-9. [PMID: 15282811 DOI: 10.1002/mrm.20160] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to present the prebolus technique for quantitative multislice myocardial perfusion imaging. In quantitative MR perfusion studies the maximum contrast agent dose is limited by the requirement to determine the arterial input function (AIF). The prebolus technique consists of two consecutive contrast agent administrations. The AIF is determined from a first low-dose bolus, while a second, high-dose bolus allows the measurement of the myocardium with improved signal increase. The results of the prebolus technique using a multislice saturation recovery trueFISP sequence in healthy volunteers are presented. In comparison to a standard dose of 3 ml Gd-DTPA, perfusion values are maintained while the signal increase in the concentration time courses was considerably improved, accompanied by reduced standard deviations of the obtained perfusion values (0.72 +/- 0.13 ml/g/min for 1 ml/8 ml and 0.67 +/- 0.10 ml/g/min for 1 ml/12 ml Gd-DTPA, respectively).
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Affiliation(s)
- Herbert Köstler
- Institut für Röntgendiagnostik, Universität Würzburg, Germany.
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Köstler H, Sandstede JJW, Lipke C, Landschütz W, Beer M, Hahn D. Auto-SENSE perfusion imaging of the whole human heart. J Magn Reson Imaging 2004; 18:702-8. [PMID: 14635155 DOI: 10.1002/jmri.10419] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To show the application of auto-sensitivity encoding (SENSE)-a self-calibrating parallel imaging technique-to first pass perfusion imaging of the whole human heart. MATERIALS AND METHODS The self-calibrating parallel imaging method auto-SENSE was implemented for a saturation recovery turbo-fast low-angle shot (FLASH) sequence on a 1.5-T scanner using a standard four-element body phased array coil. By reducing the acquisition time per slice by a factor of two compared to conventional turbo FLASH imaging, the number of imaged slices could be doubled to six to ten with an unchanged temporal resolution of one image per heartbeat. This technique has been tested in eight healthy volunteers for contrast-enhanced heart perfusion imaging. RESULTS Auto-SENSE heart perfusion imaging with improved coverage of the human heart could be performed successfully in all volunteers. A first quantitative comparison of perfusion values between the auto-SENSE and the non-SENSE techniques shows good agreement. CONCLUSION Auto-SENSE allows perfusion imaging of the whole human heart without gaps.
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Affiliation(s)
- Herbert Köstler
- Institut für Röntgendiagnostik, Universität Würzburg, Josef-Schneider Str. 2 - Bau 24, 97080 Würzburg, Germany.
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