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Wang J, Salerno M. Deep learning-based rapid image reconstruction and motion correction for high-resolution cartesian first-pass myocardial perfusion imaging at 3T. Magn Reson Med 2024; 92:1104-1114. [PMID: 38576068 DOI: 10.1002/mrm.30106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE To develop and evaluate a deep learning (DL) -based rapid image reconstruction and motion correction technique for high-resolution Cartesian first-pass myocardial perfusion imaging at 3T with whole-heart coverage for both single-slice (SS) and simultaneous multi-slice (SMS) acquisitions. METHODS 3D physics-driven unrolled network architectures were utilized for the reconstruction of high-resolution Cartesian perfusion imaging. The SS and SMS multiband (MB) = 2 networks were trained from 135 slices from 20 subjects. Structural similarity index (SSIM), peak SNR (PSNR), and normalized RMS error (NRMSE) were assessed, and prospective images were blindly graded by two experienced cardiologists (5, excellent; 1, poor). For respiratory motion correction, a 2D U-Net based motion corrected network was proposed, and the temporal fidelity and second-order derivative were calculated to assess the performance of the motion correction. RESULTS Excellent performance was demonstrated in the proposed technique with high SSIM and PSNR, and low NRMSE. Image quality scores were (4.3 [4.3, 4.4], 4.5 [4.4, 4.6], 4.3 [4.3, 4.4], and 4.5 [4.3, 4.5]) for SS DL and SS L1-SENSE, MB = 2 DL and MB = 2 SMS-L1-SENSE, respectively, showing no statistically significant difference (p > 0.05 for SS and SMS) between (SMS)-L1-SENSE and the proposed DL technique. The network inference time was around 4 s per dynamic perfusion series with 40 frames while the time of (SMS)-L1-SENSE with GPU acceleration was approximately 30 min. CONCLUSION The proposed DL-based image reconstruction and motion correction technique enabled rapid and high-quality reconstruction for SS and SMS MB = 2 high-resolution Cartesian first-pass perfusion imaging at 3T.
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Affiliation(s)
- Junyu Wang
- Department of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Michael Salerno
- Department of Cardiovascular Medicine, Stanford University, Stanford, California, USA
- Department of Radiology, Cardiovascular Imaging, Stanford University, Stanford, California, USA
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Chen W, Ni M, Huang H, Cong H, Fu X, Gao W, Yang Y, Yu M, Song X, Liu M, Yuan Z, Zhang B, Wang Z, Wang Y, Chen Y, Zhang C, Zhang Y. Chinese expert consensus on the diagnosis and treatment of coronary microvascular diseases (2023 Edition). MedComm (Beijing) 2023; 4:e438. [PMID: 38116064 PMCID: PMC10729292 DOI: 10.1002/mco2.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/11/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023] Open
Abstract
Since the four working groups of the Chinese Society of Cardiology issued first expert consensus on coronary microvascular diseases (CMVD) in 2017, international consensus documents on CMVD have increased rapidly. Although some of these documents made preliminary recommendations for the diagnosis and treatment of CMVD, they did not provide classification of recommendations and levels of evidence. In order to summarize recent progress in the field of CMVD, standardize the methods and procedures of diagnosis and treatment, and identify the scientific questions for future research, the four working groups of the Chinese Society of Cardiology updated the 2017 version of the Chinese expert consensus on CMVD and adopted a series of measures to ensure the quality of this document. The current consensus has raised a new classification of CMVD, summarized new epidemiological findings for different types of CMVD, analyzed key pathological and molecular mechanisms, evaluated classical and novel diagnostic technologies, recommended diagnostic pathways and criteria, and therapeutic strategies and medications, for patients with CMVD. In view of the current progress and knowledge gaps of CMVD, future directions were proposed. It is hoped that this expert consensus will further expedite the research progress of CMVD in both basic and clinical scenarios.
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Affiliation(s)
- Wenqiang Chen
- The National Key Laboratory for Innovation and Transformation of Luobing TheoryThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical ScienceDepartment of CardiologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Mei Ni
- The National Key Laboratory for Innovation and Transformation of Luobing TheoryThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical ScienceDepartment of CardiologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - He Huang
- Department of CardiologySir Run Run Shaw Hospital affiliated with Zhejiang University School of MedicineHangzhouChina
| | - Hongliang Cong
- Department of CardiologyTianjin Chest Hospital, Tianjin UniversityTianjinChina
| | - Xianghua Fu
- Department of CardiologyThe Second Hospital of Hebei Medical UniversityShijiazhuangHebeiChina
| | - Wei Gao
- Department of CardiologyPeking University Third HospitalBeijingChina
| | - Yuejin Yang
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Mengyue Yu
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiantao Song
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Meilin Liu
- Department of GeriatricsPeking University First HospitalBeijingChina
| | - Zuyi Yuan
- Department of CardiologyThe First Affiliated Hospital of Xian Jiaotong UniversityXianChina
| | - Bo Zhang
- Department of CardiologyFirst Affiliated Hospital, Dalian Medical UniversityDalianLiaoningChina
| | - Zhaohui Wang
- Department of CardiologyUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Yan Wang
- Department of CardiologyXiamen Cardiovascular Hospital, Xiamen UniversityXiamenChina
| | - Yundai Chen
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China; for the Basic Research Group, Atherosclerosis and Coronary Heart Disease Group, Interventional Cardiology Group, and Women's Heart Health Group of the Chinese Society of Cardiology
| | - Cheng Zhang
- The National Key Laboratory for Innovation and Transformation of Luobing TheoryThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical ScienceDepartment of CardiologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Yun Zhang
- The National Key Laboratory for Innovation and Transformation of Luobing TheoryThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical ScienceDepartment of CardiologyQilu Hospital of Shandong UniversityJinanShandongChina
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Leo I, Nakou E, Artico J, Androulakis E, Wong J, Moon JC, Indolfi C, Bucciarelli-Ducci C. Strengths and weaknesses of alternative noninvasive imaging approaches for microvascular ischemia. J Nucl Cardiol 2023; 30:227-238. [PMID: 35918590 DOI: 10.1007/s12350-022-03066-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/19/2022] [Indexed: 11/26/2022]
Abstract
Structural and functional abnormalities of coronary microvasculature are highly prevalent in several clinical settings and often associated with worse clinical outcomes. Therefore, there is a growing interest in the detection and treatment of this, often overlooked, disease. Coronary angiography allows the assessment of the Coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR). However, the measurement of these parameters is not always feasible because of limited technical availability and the need for a cardiac catheterization with a small but real risk of potential complications. Recent advances in non-invasive imaging techniques allow the assessment of coronary microvascular function with good accuracy and reproducibility. The objective of this review is to discuss the strengths and weaknesses of alternative non-invasive approaches used in the diagnosis of coronary microvascular dysfunction (CMD), highlighting the most recent advances for each imaging modality.
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Affiliation(s)
- Isabella Leo
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Eleni Nakou
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
| | - Jessica Artico
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- St Bartholomew's Hospital, Barts Heart Centre, West Smithfield, London, UK
| | - Emmanouil Androulakis
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
| | - Joyce Wong
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- St Bartholomew's Hospital, Barts Heart Centre, West Smithfield, London, UK
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK.
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College University, London, UK.
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Pons-Lladó G, Kellman P. State-of-the-Art of Myocardial Perfusion by CMR: A Practical View. Rev Cardiovasc Med 2022; 23:325. [PMID: 39077124 PMCID: PMC11267340 DOI: 10.31083/j.rcm2310325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 07/31/2024] Open
Abstract
Ischemic heart disease (IHD) outstands among diseases threatening public health. Essential for its management are the continuous advances in medical and interventional therapies, although a prompt and accurate diagnosis and prognostic stratification are equally important. Besides information on the anatomy of coronary arteries, well covered nowadays by invasive and non-invasive angiographic techniques, there are also other components of the disease with clinical impact, as the presence of myocardial necrosis, the extent of pump function impairment, and the presence and extent of inducible myocardial ischemia, that must be considered in every patient. Cardiovascular Magnetic Resonance (CMR) is a multiparametric diagnostic imaging technique that provides reliable information on these issues. Regarding the detection and grading of inducible ischemia in particular, the technique has been widely adopted in the form of myocardial perfusion sequences under vasodilator stress, which is the subject of this review. While the analysis of images is conventionally performed by visual inspection of dynamic first-pass studies, with the inherent dependency on the operator capability, the recent introduction of a reliable application of quantitative perfusion (QP) represents a significant advance in the field. QP is based on a dual-sequence strategy for conversion of signal intensities into contrast agent concentration units and includes a full automatization of processes such as myocardial blood flow (MBF) calculation (in mL/min/g), generation of a pixel-wise flow mapping, myocardial segmentation, based on machine learning, and allocation of MBF values to myocardial segments. The acquisition of this protocol during induced vasodilation and at rest gives values of stress/rest MBF (in mL/min/g) and myocardial perfusion reserve (MPR), both global and per segment. Dual-sequence QP has been successfully validated against different reference methods, and its prognostic value has been shown in large longitudinal studies. The fact of the whole process being automated, without operator interaction, permits to conceive new interesting scenarios of integration of CMR into systems of entirely automated diagnostic workflow in patients with IHD.
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Affiliation(s)
- Guillem Pons-Lladó
- Head (Emeritus), Cardiac Imaging Unit, Cardiology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Clínica Creu Banca, 08034 Barcelona, Spain
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
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Hoh T, Vishnevskiy V, Polacin M, Manka R, Fuetterer M, Kozerke S. Free-breathing motion-informed locally low-rank quantitative 3D myocardial perfusion imaging. Magn Reson Med 2022; 88:1575-1591. [PMID: 35713206 PMCID: PMC9544898 DOI: 10.1002/mrm.29295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/30/2022] [Accepted: 04/19/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To propose respiratory motion-informed locally low-rank reconstruction (MI-LLR) for robust free-breathing single-bolus quantitative 3D myocardial perfusion CMR imaging. Simulation and in-vivo results are compared to locally low-rank (LLR) and compressed sensing reconstructions (CS) for reference. METHODS Data were acquired using a 3D Cartesian pseudo-spiral in-out k-t undersampling scheme (R = 10) and reconstructed using MI-LLR, which encompasses two stages. In the first stage, approximate displacement fields are derived from an initial LLR reconstruction to feed a motion-compensated reference system to a second reconstruction stage, which reduces the rank of the inverse problem. For comparison, data were also reconstructed with LLR and frame-by-frame CS using wavelets as sparsifying transform ( ℓ 1 $$ {\ell}_1 $$ -wavelet). Reconstruction accuracy relative to ground truth was assessed using synthetic data for realistic ranges of breathing motion, heart rates, and SNRs. In-vivo experiments were conducted in healthy subjects at rest and during adenosine stress. Myocardial blood flow (MBF) maps were derived using a Fermi model. RESULTS Improved uniformity of MBF maps with reduced local variations was achieved with MI-LLR. For rest and stress, intra-volunteer variation of absolute and relative MBF was lower in MI-LLR (±0.17 mL/g/min [26%] and ±1.07 mL/g/min [33%]) versus LLR (±0.19 mL/g/min [28%] and ±1.22 mL/g/min [36%]) and versus ℓ 1 $$ {\ell}_1 $$ -wavelet (±1.17 mL/g/min [113%] and ±6.87 mL/g/min [115%]). At rest, intra-subject MBF variation was reduced significantly with MI-LLR. CONCLUSION The combination of pseudo-spiral Cartesian undersampling and dual-stage MI-LLR reconstruction improves free-breathing quantitative 3D myocardial perfusion CMR imaging under rest and stress condition.
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Affiliation(s)
- Tobias Hoh
- Institute for Biomedical EngineeringUniversity and ETH ZurichZurichSwitzerland
| | - Valery Vishnevskiy
- Institute for Biomedical EngineeringUniversity and ETH ZurichZurichSwitzerland
| | - Malgorzata Polacin
- Institute for Biomedical EngineeringUniversity and ETH ZurichZurichSwitzerland
- Institute of Diagnostic and Interventional RadiologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Robert Manka
- Institute for Biomedical EngineeringUniversity and ETH ZurichZurichSwitzerland
- Institute of Diagnostic and Interventional RadiologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
- Department of CardiologyUniversity Heart Center, University Hospital Zurich, University of ZurichZurichSwitzerland
| | | | - Sebastian Kozerke
- Institute for Biomedical EngineeringUniversity and ETH ZurichZurichSwitzerland
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Wang Y, Healy JJ. Automated filter selection for suppression of Gibbs ringing artefacts in MRI. Magn Reson Imaging 2022; 93:3-10. [PMID: 35905936 DOI: 10.1016/j.mri.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/10/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022]
Abstract
Gibbs ringing creates artefacts in magnetic resonance images that can mislead clinicians. Reconstruction algorithms attempt to suppress Gibbs ringing, or an additional ringing suppression algorithm may be applied post reconstruction. Novel reconstruction algorithms are often compared with filtered Fourier reconstruction, but the choices of filters and filter parameters can be arbitrary and sub-optimal. Evaluation of different reconstruction and post-processing algorithms is difficult to automate or subjective: many metrics have been used in the literature. In this paper, we evaluate twelve of those metrics and demonstrate that none of them are fit for purpose. We propose a novel metric and demonstrate its efficacy in 1D and 2D simulations. We use our new metric to optimise and compare 17 smoothing filters for suppression of Gibbs artefacts. We examine the transfer functions of the optimised filters, with counter-intuitive results regarding the highest-performing filters. Our results will simplify and improve the comparison of novel MRI reconstruction and post-processing algorithms, and lead to the automation of ringing suppression in MRI. They also apply more generally to other applications in which data is captured in the Fourier domain.
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Affiliation(s)
- Yue Wang
- School of Electrical and Electronic Engineering, University College Dublin, Belfield, Dublin, Ireland
| | - John J Healy
- School of Electrical and Electronic Engineering, University College Dublin, Belfield, Dublin, Ireland.
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Tourais J, Scannell CM, Schneider T, Alskaf E, Crawley R, Bosio F, Sanchez-Gonzalez J, Doneva M, Schülke C, Meineke J, Keupp J, Smink J, Breeuwer M, Chiribiri A, Henningsson M, Correia T. High-Resolution Free-Breathing Quantitative First-Pass Perfusion Cardiac MR Using Dual-Echo Dixon With Spatio-Temporal Acceleration. Front Cardiovasc Med 2022; 9:884221. [PMID: 35571164 PMCID: PMC9099052 DOI: 10.3389/fcvm.2022.884221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction To develop and test the feasibility of free-breathing (FB), high-resolution quantitative first-pass perfusion cardiac MR (FPP-CMR) using dual-echo Dixon (FOSTERS; Fat-water separation for mOtion-corrected Spatio-TEmporally accelerated myocardial peRfuSion). Materials and Methods FOSTERS was performed in FB using a dual-saturation single-bolus acquisition with dual-echo Dixon and a dynamically variable Cartesian k-t undersampling (8-fold) approach, with low-rank and sparsity constrained reconstruction, to achieve high-resolution FPP-CMR images. FOSTERS also included automatic in-plane motion estimation and T2* correction to obtain quantitative myocardial blood flow (MBF) maps. High-resolution (1.6 x 1.6 mm2) FB FOSTERS was evaluated in eleven patients, during rest, against standard-resolution (2.6 x 2.6 mm2) 2-fold SENSE-accelerated breath-hold (BH) FPP-CMR. In addition, MBF was computed for FOSTERS and spatial wavelet-based compressed sensing (CS) reconstruction. Two cardiologists scored the image quality (IQ) of FOSTERS, CS, and standard BH FPP-CMR images using a 4-point scale (1–4, non-diagnostic – fully diagnostic). Results FOSTERS produced high-quality images without dark-rim and with reduced motion-related artifacts, using an 8x accelerated FB acquisition. FOSTERS and standard BH FPP-CMR exhibited excellent IQ with an average score of 3.5 ± 0.6 and 3.4 ± 0.6 (no statistical difference, p > 0.05), respectively. CS images exhibited severe artifacts and high levels of noise, resulting in an average IQ score of 2.9 ± 0.5. MBF values obtained with FOSTERS presented a lower variance than those obtained with CS. Discussion FOSTERS enabled high-resolution FB FPP-CMR with MBF quantification. Combining motion correction with a low-rank and sparsity-constrained reconstruction results in excellent image quality.
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Affiliation(s)
- Joao Tourais
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of MR R&D – Clinical Science, Philips Healthcare, Best, Netherlands
- Department of Imaging Physics, Magnetic Resonance Systems Lab, Delft University of Technology, Delft, Netherlands
| | - Cian M. Scannell
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | | | - Ebraham Alskaf
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Richard Crawley
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Filippo Bosio
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | | | | | | | | | | | - Jouke Smink
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Marcel Breeuwer
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of MR R&D – Clinical Science, Philips Healthcare, Best, Netherlands
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Markus Henningsson
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linkoping University, Linkoping, Sweden
| | - Teresa Correia
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Centre for Marine Sciences (CCMAR), Faro, Portugal
- *Correspondence: Teresa Correia
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Manso Jimeno M, Ravi KS, Jin Z, Oyekunle D, Ogbole G, Geethanath S. ArtifactID: Identifying artifacts in low-field MRI of the brain using deep learning. Magn Reson Imaging 2022; 89:42-48. [PMID: 35176447 DOI: 10.1016/j.mri.2022.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 01/14/2023]
Abstract
Low-field MR scanners are more accessible in resource-constrained settings where skilled personnel are scarce. Images acquired in such scenarios are prone to artifacts such as wrap-around and Gibbs ringing. Such artifacts negatively affect the diagnostic quality and may be confused with pathology or reduce the region of interest visibility. As a first step solution, ArtifactID identifies wrap-around and Gibbs ringing in low-field brain MRI. We utilized two datasets: 179 T1-weighted pathological brain images from a 0.36 T scanner and 581 publicly available T1-weighted brain images. Individual binary classification models were trained to identify through-plane wrap-around, in-plane wrap-around, and Gibbs ringing. Visual explanations obtained via the GradCAM method helped develop trust in the wrap-around model. The mean precision and recall metrics across the four implemented models were 97.6% and 92.83% respectively. Agreement analysis of the models and the radiologists' labels returned Cohen's kappa values of 0.768 ± 0.062, 1.00 ± 0.000, 0.89 ± 0.085, and 0.878 ± 0.103 for the through-plane wrap-around, in-plane wrap-around, and Gibbs ringing models, respectively.
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Affiliation(s)
- Marina Manso Jimeno
- Department of Biomedical Engineering, Columbia University in the City of New York, New York, NY 10027, USA; Columbia University Magnetic Resonance Research Center, Columbia University in the City of New York, New York, NY 10027, USA
| | - Keerthi Sravan Ravi
- Department of Biomedical Engineering, Columbia University in the City of New York, New York, NY 10027, USA; Columbia University Magnetic Resonance Research Center, Columbia University in the City of New York, New York, NY 10027, USA
| | - Zhezhen Jin
- Mailman School of Public Health, Columbia University in the City of New York, New York, NY 10027, USA
| | - Dotun Oyekunle
- Department of Radiology, University College Hospital, Ibadan 200285, Nigeria
| | - Godwin Ogbole
- Department of Radiology, University College Hospital, Ibadan 200285, Nigeria
| | - Sairam Geethanath
- Columbia University Magnetic Resonance Research Center, Columbia University in the City of New York, New York, NY 10027, USA.
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Nakao R, Nagao M, Yamamoto A, Fukushima K, Watanabe E, Sakai S, Hagiwara N. Papillary muscle ischemia on high-resolution cine imaging of nitrogen-13 ammonia positron emission tomography: Association with myocardial flow reserve and prognosis in coronary artery disease. J Nucl Cardiol 2022; 29:293-303. [PMID: 32566962 DOI: 10.1007/s12350-020-02231-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/01/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The evaluation of papillary muscle (PM) perfusion through existing perfusion imaging, including single-photon emission computed tomography and magnetic resonance imaging, is not possible. Therefore, this study sought to investigate the detection of PM ischemia in coronary artery disease (CAD) using nitrogen-13 (N-13) ammonia positron emission tomography (NH3 PET) and its association with global myocardial flow reserve (MFR) and major adverse cardiac events (MACE). METHODS Data of adenosine-stress NH3 PET for 263 consecutive patients with known or suspected CAD were retrospectively analyzed. PM ischemia was defined as the absence of PM accumulation under stress conditions and PM presence at rest on high-resolution cine imaging derived from PET-computed tomography scanner with time-of-flight technology. The primary outcome was MACE. RESULTS Of 263 patients, 30 experienced mean follow-up period of 910 days (MACE), while 31 (11.8%) presented PM ischemia. Compared to patients without PM ischemia, those with PM ischemia reported a significantly lower global MFR and a significantly higher rate of MACE (P < .0001). CONCLUSION NH3 PET enables the detection of PM ischemia in approximately 10% of patients with known or suspected CAD. PM ischemia is associated with reduced global MFR and is an important sign in predicting prognosis.
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Affiliation(s)
- Risako Nakao
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Michinobu Nagao
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Atsushi Yamamoto
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kenji Fukushima
- Department of Nuclear Medicine Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Eri Watanabe
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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10
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Hutchens JA, Johnson TR, Payne RM. Myocardial Perfusion Reserve in Children with Friedreich Ataxia. Pediatr Cardiol 2021; 42:1834-1840. [PMID: 34245318 DOI: 10.1007/s00246-021-02675-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
Children with Friedreich's ataxia (FA) are at risk of perioperative morbidity and mortality from severe unpredictable heart failure. There is currently no clear way of identifying patients at highest risk. We used myocardial perfusion reserve (MPR), an MRI technique used to assess the maximal myocardial blood flow above baseline, to help determine potential surgical risk in FA subjects. In total, seven children with genetically confirmed FA, ages 8-17 years, underwent MPR stress testing using regadenoson. Six of the seven demonstrated impaired endocardial perfusion during coronary hyperemia. The same six were also found to have evidence of ongoing myocardial damage as illustrated by cardiac troponin I leak (range 0.04-0.17 ng/mL, normal < 0.03 ng/mL). None of the patients had a reduced ejection fraction (range 59-74%) or elevated insulin level (range 2.46-14.23 mCU/mL). This retrospective study shows that children with FA develop MPR defects early in the disease process. It also suggests MPR may be a sensitive tool to evaluate underlying cardiac compromise and could be of use in directing surgical management decisions in children with FA.
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Affiliation(s)
| | - Tiffanie R Johnson
- Indiana University School of Medicine, Indianapolis, IN, USA.,Division of Pediatric Cardiology, Riley Hospital for Children, Indiana University School of Medicine, 1044 West Walnut St, Room R4-302b, Indianapolis, IN, 46202, USA
| | - R Mark Payne
- Indiana University School of Medicine, Indianapolis, IN, USA. .,Division of Pediatric Cardiology, Riley Hospital for Children, Indiana University School of Medicine, 1044 West Walnut St, Room R4-302b, Indianapolis, IN, 46202, USA. .,Herman B Wells Center for Pediatric Research, Indianapolis, IN, USA.
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Unal HB, Beaulieu T, Rivero LZ, Dharmakumar R, Sharif B. Retrospective Detection and Suppression of Dark-Rim Artifacts in First-Pass Perfusion Cardiac MRI Enabled by Deep Learning. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4079-4085. [PMID: 34892125 PMCID: PMC9989969 DOI: 10.1109/embc46164.2021.9630270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The dark-rim artifact (DRA) remains an important challenge in the routine clinical use of first-pass perfusion (FPP) cardiac magnetic resonance imaging (cMRI). The DRA mimics the appearance of perfusion defects in the subendocardial wall and reduces the accuracy of diagnosis in patients with suspected ischemic heart disease. The main causes for DRA are known to be Gibbs ringing and bulk motion of the heart. The goal of this work is to propose a deep-learning-enabled automatic approach for the detection of motion-induced DRAs in FPP cMRI datasets. To this end, we propose a new algorithm that can detect the DRA in individual time frames by analyzing multiple reconstructions of the same time frame (k-space data) with varying temporal windows. In addition to DRA detection, our approach is also capable of suppressing the extent and severity of DRAs as a byproduct of the same reconstruction-analysis process. In this proof-of-concept study, our proposed method showed a good performance for automatic detection of subendocardial DRAs in stress perfusion cMRI studies of patients with suspected ischemic heart disease. To the best of our knowledge, this is the first approach that performs deep-learning-enabled detection and suppression of DRAs in cMRI.Clinical Relevance- Our approach enables clinicians to provide a more accurate diagnosis of ischemic heart disease by detecting and suppressing subendocardial dark-rim artifacts in first-pass perfusion cMRI datasets.
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12
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Abstract
Ischemic cardiomyopathy (ICM) is one of the most common causes of congestive heart failure. In patients with ICM, tissue characterization with cardiac magnetic resonance imaging (CMR) allows for evaluation of myocardial abnormalities in acute and chronic settings. Myocardial edema, microvascular obstruction (MVO), intracardiac thrombus, intramyocardial hemorrhage, and late gadolinium enhancement of the myocardium are easily depicted using standard CMR sequences. In the acute setting, tissue characterization is mainly focused on assessment of ventricular thrombus and MVO, which are associated with poor prognosis. Conversely, in chronic ICM, it is important to depict late gadolinium enhancement and myocardial ischemia using stress perfusion sequences. Overall, with CMR's ability to accurately characterize myocardial tissue in acute and chronic ICM, it represents a valuable diagnostic and prognostic imaging method for treatment planning. In particular, tissue characterization abnormalities in the acute setting can provide information regarding the patients that may develop major adverse cardiac event and show the presence of ventricular thrombus; in the chronic setting, evaluation of viable myocardium can be fundamental for planning myocardial revascularization. In this review, the main findings on tissue characterization are illustrated in acute and chronic settings using qualitative and quantitative tissue characterization.
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13
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Ferrazzi G, McElroy S, Neji R, Kunze KP, Nazir MS, Speier P, Stäb D, Forman C, Razavi R, Chiribiri A, Roujol S. All-systolic first-pass myocardial rest perfusion at a long saturation time using simultaneous multi-slice imaging and compressed sensing acceleration. Magn Reson Med 2021; 86:663-676. [PMID: 33749026 PMCID: PMC7611406 DOI: 10.1002/mrm.28712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To enable all-systolic first-pass rest myocardial perfusion with long saturation times. To investigate the change in perfusion contrast and dark rim artefacts through simulations and surrogate measurements. METHODS Simulations were employed to investigate optimal saturation time for myocardium-perfusion defect contrast and blood-to-myocardium signal ratios. Two saturation recovery blocks with long/short saturation times (LTS/STS) were employed to image 3 slices at end-systole and diastole. Simultaneous multi-slice balanced steady state free precession imaging and compressed sensing acceleration were combined. The sequence was compared to a 3 slice-by-slice clinical protocol in 10 patients. Quantitative assessment of myocardium-peak pre contrast and blood-to-myocardium signal ratios, as well as qualitative assessment of perceived SNR, image quality, blurring, and dark rim artefacts, were performed. RESULTS Simulations showed that with a bolus of 0.075 mmol/kg, a LTS of 240-470 ms led to a relative increase in myocardium-perfusion defect contrast of 34% ± 9%-28% ± 27% than a STS = 120 ms, while reducing blood-to-myocardium signal ratio by 18% ± 10%-32% ± 14% at peak myocardium. With a bolus of 0.05 mmol/kg, LTS was 320-570 ms with an increase in myocardium-perfusion defect contrast of 63% ± 13%-62% ± 29%. Across patients, LTS led to an average increase in myocardium-peak pre contrast of 59% (P < .001) at peak myocardium and a lower blood-to-myocardium signal ratio of 47% (P < .001) and 15% (P < .001) at peak blood/myocardium. LTS had improved motion robustness (P = .002), image quality (P < .001), and decreased dark rim artefacts (P = .008) than the clinical protocol. CONCLUSION All-systolic rest perfusion can be achieved by combining simultaneous multi-slice and compressed sensing acceleration, enabling 3-slice cardiac coverage with reduced motion and dark rim artefacts. Numerical simulations indicate that myocardium-perfusion defect contrast increases at LTS.
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Affiliation(s)
- Giulio Ferrazzi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- IRCCS San Camillo Hospital, Venice, Italy
| | - Sarah McElroy
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, United Kingdom
| | - Karl P. Kunze
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, United Kingdom
| | - Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Peter Speier
- Cardiovascular MR predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Daniel Stäb
- MR Research Collaborations, Siemens Healthcare Limited, Melbourne, Australia
| | - Christoph Forman
- Cardiovascular MR predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
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14
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Wang J, Yang Y, Weller DS, Zhou R, Van Houten M, Sun C, Epstein FH, Meyer CH, Kramer CM, Salerno M. High spatial resolution spiral first-pass myocardial perfusion imaging with whole-heart coverage at 3 T. Magn Reson Med 2021; 86:648-662. [PMID: 33709415 DOI: 10.1002/mrm.28701] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/16/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE To develop and evaluate a high spatial resolution (1.25 × 1.25 mm2 ) spiral first-pass myocardial perfusion imaging technique with whole-heart coverage at 3T, to better assess transmural differences in perfusion between the endocardium and epicardium, to quantify the myocardial ischemic burden, and to improve the detection of obstructive coronary artery disease. METHODS Whole-heart high-resolution spiral perfusion pulse sequences and corresponding motion-compensated reconstruction techniques for both interleaved single-slice (SS) and simultaneous multi-slice (SMS) acquisition with or without outer-volume suppression (OVS) were developed. The proposed techniques were evaluated in 34 healthy volunteers and 8 patients (55 data sets). SS and SMS images were reconstructed using motion-compensated L1-SPIRiT and SMS-Slice-L1-SPIRiT, respectively. Images were blindly graded by 2 experienced cardiologists on a 5-point scale (5, excellent; 1, poor). RESULTS High-quality perfusion imaging was achieved for both SS and SMS acquisitions with or without OVS. The SS technique without OVS had the highest scores (4.5 [4, 5]), which were greater than scores for SS with OVS (3.5 [3.25, 3.75], P < .05), MB = 2 without OVS (3.75 [3.25, 4], P < .05), and MB = 2 with OVS (3.75 [2.75, 4], P < .05), but significantly higher than those for MB = 3 without OVS (4 [4, 4], P = .95). SMS image quality was improved using SMS-Slice-L1-SPIRiT as compared to SMS-L1-SPIRiT (P < .05 for both reviewers). CONCLUSION We demonstrated the successful implementation of whole-heart spiral perfusion imaging with high resolution at 3T. Good image quality was achieved, and the SS without OVS showed the best image quality. Evaluation in patients with expected ischemic heart disease is warranted.
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Affiliation(s)
- Junyu Wang
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Yang Yang
- Biomedical Engineering and Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Daniel S Weller
- Department of Electrical and Computer Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Ruixi Zhou
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew Van Houten
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Changyu Sun
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA.,Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Craig H Meyer
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA.,Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher M Kramer
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA.,Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michael Salerno
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA.,Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA.,Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
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15
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Fair MJ, Gatehouse PD, Reyes E, Adluru G, Mendes J, Khan T, de Silva R, Wage R, DiBella EVR, Firmin DN. Initial investigation of free-breathing 3D whole-heart stress myocardial perfusion MRI. Glob Cardiol Sci Pract 2020; 2020:e202038. [PMID: 33598498 PMCID: PMC7868101 DOI: 10.21542/gcsp.2020.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective: Myocardial first-pass perfusion imaging with MRI is well-established clinically. However, it is potentially weakened by limited myocardial coverage compared to nuclear medicine. Clinical evaluations of whole-heart MRI perfusion by 3D methods, while promising, have to date had the limit of breathhold requirements at stress. This work aims to develop a new free-breathing 3D myocardial perfusion method, and to test its performance in a small patient population. Methods: This work required tolerance to respiratory motion for stress investigations, and therefore employed a “stack-of-stars” hybrid Cartesian-radial MRI acquisition method. The MRI sequence was highly optimised for rapid acquisition and combined with a compressed sensing reconstruction. Stress and rest datasets were acquired in four healthy volunteers, and in six patients with coronary artery disease (CAD), which were compared against clinical reference information. Results: This free-breathing method produced datasets that appeared consistent with clinical reference data in detecting moderate-to-strong induced perfusion abnormalities. However, the majority of the mild defects identified clinically were not detected by the method, potentially due to the presence of transient myocardial artefacts present in the images. Discussion: The feasibility of detecting CAD using this 3D first-pass perfusion sequence during free-breathing is demonstrated. Good agreement on typical moderate-to-strong CAD cases is promising, however, questions still remain on the sensitivity of the technique to milder cases.
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Affiliation(s)
- Merlin J Fair
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Peter D Gatehouse
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Eliana Reyes
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK
| | - Ganesh Adluru
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Jason Mendes
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Tina Khan
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK
| | - Ranil de Silva
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Rick Wage
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK
| | - Edward V R DiBella
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - David N Firmin
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK.,National Heart & Lung Institute, Imperial College London, London, UK
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16
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McElroy S, Ferrazzi G, Nazir MS, Kunze KP, Neji R, Speier P, Stäb D, Forman C, Razavi R, Chiribiri A, Roujol S. Combined simultaneous multislice bSSFP and compressed sensing for first-pass myocardial perfusion at 1.5 T with high spatial resolution and coverage. Magn Reson Med 2020; 84:3103-3116. [PMID: 32530064 PMCID: PMC7611375 DOI: 10.1002/mrm.28345] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To implement and evaluate a pseudorandom undersampling scheme for combined simultaneous multislice (SMS) balanced SSFP (bSSFP) and compressed-sensing (CS) reconstruction to enable myocardial perfusion imaging with high spatial resolution and coverage at 1.5 T. METHODS A prospective pseudorandom undersampling scheme that is compatible with SMS-bSSFP phase-cycling requirements and CS was developed. The SMS-bSSFP CS with pseudorandom and linear undersampling schemes were compared in a phantom. A high-resolution (1.4 × 1.4 mm2 ) six-slice SMS-bSSFP CS perfusion sequence was compared with a conventional (1.9 × 1.9 mm2 ) three-slice sequence in 10 patients. Qualitative assessment of image quality, perceived SNR, and number of diagnostic segments and quantitative measurements of sharpness, upslope index, and contrast ratio were performed. RESULTS In phantom experiments, pseudorandom undersampling resulted in residual artifact (RMS error) reduction by a factor of 7 compared with linear undersampling. In vivo, the proposed sequence demonstrated higher perceived SNR (2.9 ± 0.3 vs. 2.2 ± 0.6, P = .04), improved sharpness (0.35 ± 0.03 vs. 0.32 ± 0.05, P = .01), and a higher number of diagnostic segments (100% vs. 94%, P = .03) compared with the conventional sequence. There were no significant differences between the sequences in terms of image quality (2.5 ± 0.4 vs. 2.8 ± 0.2, P = .08), upslope index (0.11 ± 0.02 vs. 0.10 ± 0.01, P = .3), or contrast ratio (3.28 ± 0.35 vs. 3.36 ± 0.43, P = .7). CONCLUSION A pseudorandom k-space undersampling compatible with SMS-bSSFP and CS reconstruction has been developed and enables cardiac MR perfusion imaging with increased spatial resolution and myocardial coverage, increased number of diagnostic segments and perceived SNR, and no difference in image quality, upslope index, and contrast ratio.
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Affiliation(s)
- Sarah McElroy
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Giulio Ferrazzi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Karl P. Kunze
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, United Kingdom
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, United Kingdom
| | - Peter Speier
- Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany
| | - Daniel Stäb
- MR Research Collaborations, Siemens Healthcare Pty Ltd, Melbourne, Australia
| | | | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
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17
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Buffa V, Di Renzi P. CMR in the diagnosis of ischemic heart disease. Radiol Med 2020; 125:1114-1123. [PMID: 32936388 DOI: 10.1007/s11547-020-01278-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
Cardiovascular magnetic resonance has always been more often used in the last 10 years in evaluation of heart disease. Role in diagnosis of ischemia and in evaluation of myocardial infarction is well established by many scientific papers and included in current guidelines. High accuracy in evaluation of stress-induced ischemia, tissue characterization and functional parameters are the pillars the make the method widely used. In this paper are described role and techniques in diagnosis of ischemia, myocardial infarction and its sequelae.
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Affiliation(s)
- Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
| | - Paolo Di Renzi
- Department of Radiology, Ospedale San Giovanni Calibita FBF, Rome, Italy
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18
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Husso M, Afara IO, Nissi MJ, Kuivanen A, Halonen P, Tarkia M, Teuho J, Saunavaara V, Vainio P, Sipola P, Manninen H, Ylä-Herttuala S, Knuuti J, Töyräs J. Quantification of Myocardial Blood Flow by Machine Learning Analysis of Modified Dual Bolus MRI Examination. Ann Biomed Eng 2020; 49:653-662. [PMID: 32820382 PMCID: PMC7851105 DOI: 10.1007/s10439-020-02591-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
Contrast-enhanced magnetic resonance imaging (MRI) is a promising method for estimating myocardial blood flow (MBF). However, it is often affected by noise from imaging artefacts, such as dark rim artefact obscuring relevant features. Machine learning enables extracting important features from such noisy data and is increasingly applied in areas where traditional approaches are limited. In this study, we investigate the capacity of machine learning, particularly support vector machines (SVM) and random forests (RF), for estimating MBF from tissue impulse response signal in an animal model. Domestic pigs (n = 5) were subjected to contrast enhanced first pass MRI (MRI-FP) and the impulse response at different regions of the myocardium (n = 24/pig) were evaluated at rest (n = 120) and stress (n = 96). Reference MBF was then measured using positron emission tomography (PET). Since the impulse response may include artefacts, classification models based on SVM and RF were developed to discriminate noisy signal. In addition, regression models based on SVM, RF and linear regression (for comparison) were developed for estimating MBF from the impulse response at rest and stress. The classification and regression models were trained on data from 4 pigs (n = 168) and tested on 1 pig (n = 48). Models based on SVM and RF outperformed linear regression, with higher correlation (RSVM2 = 0.81, RRF2 = 0.74, Rlinear_regression2 = 0.60; ρSVM = 0.76, ρRF = 0.76, ρlinear_regression = 0.71) and lower error (RMSESVM = 0.67 mL/g/min, RMSERF = 0.77 mL/g/min, RMSElinear_regression = 0.96 mL/g/min) for predicting MBF from MRI impulse response signal. Classifier based on SVM was optimal for detecting impulse response signals with artefacts (accuracy = 92%). Modified dual bolus MRI signal, combined with machine learning, has potential for accurately estimating MBF at rest and stress states, even from signals with dark rim artefacts. This could provide a protocol for reliable and easy estimation of MBF, although further research is needed to clinically validate the approach.
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Affiliation(s)
- Minna Husso
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029 KYS, Kuopio, Finland.
| | - Isaac O Afara
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Mikko J Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Antti Kuivanen
- A.I. Virtanen Institute for Molecule Sciences, University of Eastern Finland, Kuopio, Finland
| | - Paavo Halonen
- A.I. Virtanen Institute for Molecule Sciences, University of Eastern Finland, Kuopio, Finland
| | - Miikka Tarkia
- Turku PET Centre, University Hospital and University of Turku, Turku, Finland
| | - Jarmo Teuho
- Turku PET Centre, University Hospital and University of Turku, Turku, Finland
| | - Virva Saunavaara
- Turku PET Centre, University Hospital and University of Turku, Turku, Finland.,Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Pauli Vainio
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029 KYS, Kuopio, Finland
| | - Petri Sipola
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029 KYS, Kuopio, Finland
| | - Hannu Manninen
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029 KYS, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecule Sciences, University of Eastern Finland, Kuopio, Finland.,Heart Center and Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
| | - Juhani Knuuti
- Turku PET Centre, University Hospital and University of Turku, Turku, Finland
| | - Juha Töyräs
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029 KYS, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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19
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Westwood M, Knott KD. Stress CMR and Combination Testing in the World of Multimodality Imaging. JACC Cardiovasc Imaging 2020; 13:1161-1162. [DOI: 10.1016/j.jcmg.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/10/2020] [Indexed: 11/29/2022]
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20
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Shin T, Nayak KS. Perceived Dark Rim Artifact in First-Pass Myocardial Perfusion Magnetic Resonance Imaging Due to Visual Illusion. Korean J Radiol 2020; 21:462-470. [PMID: 32193894 PMCID: PMC7082651 DOI: 10.3348/kjr.2019.0449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/25/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To demonstrate that human visual illusion can contribute to sub-endocardial dark rim artifact in contrast-enhanced myocardial perfusion magnetic resonance images. MATERIALS AND METHODS Numerical phantoms were generated to simulate the first-passage of contrast agent in the heart, and rendered in conventional gray scale as well as in color scale with reduced luminance variation. Cardiac perfusion images were acquired from two healthy volunteers, and were displayed by the same gray and color scales used in the numerical study. Before and after k-space windowing, the left ventricle (LV)-myocardium boarders were analyzed visually and quantitatively through intensity profiles perpendicular the boarders. RESULTS k-space windowing yielded monotonically decreasing signal intensity near the LV-myocardium boarder in the phantom images, as confirmed by negative finite difference values near the board ranging -1.07 to -0.14. However, the dark band still appears, which is perceived by visual illusion. Dark rim is perceived in the in-vivo images after k-space windowing that removed the quantitative signal dip, suggesting that the perceived dark rim is a visual illusion. The perceived dark rim is stronger at peak LV enhancement than the peak myocardial enhancement, due to the larger intensity difference between LV and myocardium. In both numerical phantom and in-vivo images, the illusory dark band is not visible in the color map due to reduced luminance variation. CONCLUSION Visual illusion is another potential cause of dark rim artifact in contrast-enhanced myocardial perfusion MRI as demonstrated by illusory rim perceived in the absence of quantitative intensity undershoot.
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Affiliation(s)
- Taehoon Shin
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Seoul, Korea.,Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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21
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Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG, Kim RJ, von Knobelsdorff-Brenkenhoff F, Kramer CM, Pennell DJ, Plein S, Nagel E. Standardized image interpretation and post-processing in cardiovascular magnetic resonance - 2020 update : Society for Cardiovascular Magnetic Resonance (SCMR): Board of Trustees Task Force on Standardized Post-Processing. J Cardiovasc Magn Reson 2020; 22:19. [PMID: 32160925 PMCID: PMC7066763 DOI: 10.1186/s12968-020-00610-6] [Citation(s) in RCA: 472] [Impact Index Per Article: 118.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/17/2020] [Indexed: 01/04/2023] Open
Abstract
With mounting data on its accuracy and prognostic value, cardiovascular magnetic resonance (CMR) is becoming an increasingly important diagnostic tool with growing utility in clinical routine. Given its versatility and wide range of quantitative parameters, however, agreement on specific standards for the interpretation and post-processing of CMR studies is required to ensure consistent quality and reproducibility of CMR reports. This document addresses this need by providing consensus recommendations developed by the Task Force for Post-Processing of the Society for Cardiovascular Magnetic Resonance (SCMR). The aim of the Task Force is to recommend requirements and standards for image interpretation and post-processing enabling qualitative and quantitative evaluation of CMR images. Furthermore, pitfalls of CMR image analysis are discussed where appropriate. It is an update of the original recommendations published 2013.
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Affiliation(s)
- Jeanette Schulz-Menger
- Department of Cardiology and Nephrology, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany.
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Jens Bremerich
- Department of Radiology of the University Hospital Basel, Basel, Switzerland
| | - Scott D Flamm
- Imaging, and Heart and Vascular Institutes, Cleveland Clinic, Cleveland, OH, USA
| | - Mark A Fogel
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, Montreal, QC, Canada
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, and Departments of Medicine and Radiology, Duke University Medical Center, Durham, NC, USA
| | | | - Christopher M Kramer
- Departments of Medicine and Radiology and the Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Sven Plein
- Leeds Institute for Genetics Health and Therapeutics & Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, partner site RheinMain, University Hospital Frankfurt, Frankfurt am Main, Germany
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22
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Xue H, Brown LA, Nielles-Vallespin S, Plein S, Kellman P. Automatic in-line quantitative myocardial perfusion mapping: Processing algorithm and implementation. Magn Reson Med 2020; 83:712-730. [PMID: 31441550 PMCID: PMC8400845 DOI: 10.1002/mrm.27954] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/27/2019] [Accepted: 07/27/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE Quantitative myocardial perfusion mapping has advantages over qualitative assessment, including the ability to detect global flow reduction. However, it is not clinically available and remains a research tool. Building upon the previously described imaging sequence, this study presents algorithm and implementation of an automated solution for inline perfusion flow mapping with step by step performance characterization. METHODS Proposed workflow consists of motion correction (MOCO), arterial input function blood detection, intensity to gadolinium concentration conversion, and pixel-wise mapping. A distributed kinetics model, blood-tissue exchange model, is implemented, computing pixel-wise maps of myocardial blood flow (mL/min/g), permeability-surface-area product (mL/min/g), blood volume (mL/g), and interstitial volume (mL/g). RESULTS Thirty healthy subjects (11 men; 26.4 ± 10.4 years) were recruited and underwent adenosine stress perfusion cardiovascular MR. Mean MOCO quality score was 3.6 ± 0.4 for stress and 3.7 ± 0.4 for rest. Myocardial Dice similarity coefficients after MOCO were significantly improved (P < 1e-6), 0.87 ± 0.05 for stress and 0.86 ± 0.06 for rest. Arterial input function peak gadolinium concentration was 4.4 ± 1.3 mmol/L at stress and 5.2 ± 1.5 mmol/L at rest. Mean myocardial blood flow at stress and rest were 2.82 ± 0.47 mL/min/g and 0.68 ± 0.16 mL/min/g, respectively. The permeability-surface-area product was 1.32 ± 0.26 mL/min/g at stress and 1.09 ± 0.21 mL/min/g at rest (P < 1e-3). Blood volume was 12.0 ± 0.8 mL/100 g at stress and 9.7 ± 1.0 mL/100 g at rest (P < 1e-9), indicating good adenosine vasodilation response. Interstitial volume was 20.8 ± 2.5 mL/100 g at stress and 20.3 ± 2.9 mL/100 g at rest (P = 0.50). CONCLUSIONS An inline perfusion flow mapping workflow is proposed and demonstrated on normal volunteers. Initial evaluation demonstrates this fully automated solution for the respiratory MOCO, arterial input function left ventricle mask detection, and pixel-wise mapping, from free-breathing myocardial perfusion imaging.
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Affiliation(s)
- Hui Xue
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Louise A.E. Brown
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
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23
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Zhang Q, Ruan G, Yang W, Liu Y, Zhao K, Feng Q, Chen W, Wu EX, Feng Y. MRI Gibbs‐ringing artifact reduction by means of machine learning using convolutional neural networks. Magn Reson Med 2019; 82:2133-2145. [DOI: 10.1002/mrm.27894] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 06/11/2019] [Accepted: 06/14/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Qianqian Zhang
- School of Biomedical Engineering Southern Medical University Guangzhou China
- Guangdong Provincial Key Laboratory of Medical Image Processing Southern Medical University Guangzhou China
| | - Guohui Ruan
- School of Biomedical Engineering Southern Medical University Guangzhou China
- Guangdong Provincial Key Laboratory of Medical Image Processing Southern Medical University Guangzhou China
| | - Wei Yang
- School of Biomedical Engineering Southern Medical University Guangzhou China
- Guangdong Provincial Key Laboratory of Medical Image Processing Southern Medical University Guangzhou China
| | - Yilong Liu
- Laboratory of Biomedical Imaging and Signal Processing The University of Hong Kong Hong Kong SAR China
- Department of Electrical and Electronic Engineering The University of Hong Kong Hong Kong SAR China
| | - Kaixuan Zhao
- School of Biomedical Engineering Southern Medical University Guangzhou China
- Guangdong Provincial Key Laboratory of Medical Image Processing Southern Medical University Guangzhou China
| | - Qianjin Feng
- School of Biomedical Engineering Southern Medical University Guangzhou China
- Guangdong Provincial Key Laboratory of Medical Image Processing Southern Medical University Guangzhou China
| | - Wufan Chen
- School of Biomedical Engineering Southern Medical University Guangzhou China
- Guangdong Provincial Key Laboratory of Medical Image Processing Southern Medical University Guangzhou China
| | - Ed X. Wu
- Laboratory of Biomedical Imaging and Signal Processing The University of Hong Kong Hong Kong SAR China
- Department of Electrical and Electronic Engineering The University of Hong Kong Hong Kong SAR China
| | - Yanqiu Feng
- School of Biomedical Engineering Southern Medical University Guangzhou China
- Guangdong Provincial Key Laboratory of Medical Image Processing Southern Medical University Guangzhou China
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24
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Husso M, Nissi MJ, Kuivanen A, Halonen P, Tarkia M, Teuho J, Saunavaara V, Vainio P, Sipola P, Manninen H, Ylä-Herttuala S, Knuuti J, Töyräs J. Quantification of porcine myocardial perfusion with modified dual bolus MRI - a prospective study with a PET reference. BMC Med Imaging 2019; 19:58. [PMID: 31349798 PMCID: PMC6660956 DOI: 10.1186/s12880-019-0359-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 07/17/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The reliable quantification of myocardial blood flow (MBF) with MRI, necessitates the correction of errors in arterial input function (AIF) caused by the T1 saturation effect. The aim of this study was to compare MBF determined by a traditional dual bolus method against a modified dual bolus approach and to evaluate both methods against PET in a porcine model of myocardial ischemia. METHODS Local myocardial ischemia was induced in five pigs, which were subsequently examined with contrast enhanced MRI (gadoteric acid) and PET (O-15 water). In the determination of MBF, the initial high concentration AIF was corrected using the ratio of low and high contrast AIF areas, normalized according to the corresponding heart rates. MBF was determined from the MRI, during stress and at rest, using the dual bolus and the modified dual bolus methods in 24 segments of the myocardium (total of 240 segments, five pigs in stress and rest). Due to image artifacts and technical problems 53% of the segments had to be rejected from further analyses. These two estimates were later compared against respective rest and stress PET-based MBF measurements. RESULTS Values of MBF were determined for 112/240 regions. Correlations for MBF between the modified dual bolus method and PET was rs = 0.84, and between the traditional dual bolus method and PET rs = 0.79. The intraclass correlation was very good (ICC = 0.85) between the modified dual bolus method and PET, but poor between the traditional dual bolus method and PET (ICC = 0.07). CONCLUSIONS The modified dual bolus method showed a better agreement with PET than the traditional dual bolus method. The modified dual bolus method was found to be more reliable than the traditional dual bolus method, especially when there was variation in the heart rate. However, the difference between the MBF values estimated with either of the two MRI-based dual-bolus methods and those estimated with the gold-standard PET method were statistically significant.
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Affiliation(s)
- Minna Husso
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029, Kuopio, KYS, Finland.
| | - Mikko J Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Antti Kuivanen
- A.I. Virtanen Institute for Molecule Sciences, University of Eastern Finland, Kuopio, Finland
| | - Paavo Halonen
- A.I. Virtanen Institute for Molecule Sciences, University of Eastern Finland, Kuopio, Finland
| | - Miikka Tarkia
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Jarmo Teuho
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Virva Saunavaara
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland.,Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Pauli Vainio
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029, Kuopio, KYS, Finland
| | - Petri Sipola
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029, Kuopio, KYS, Finland
| | - Hannu Manninen
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029, Kuopio, KYS, Finland
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecule Sciences, University of Eastern Finland, Kuopio, Finland.,Heart Center and Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Juha Töyräs
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029, Kuopio, KYS, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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25
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Yang Y, Meyer CH, Epstein FH, Kramer CM, Salerno M. Whole-heart spiral simultaneous multi-slice first-pass myocardial perfusion imaging. Magn Reson Med 2019; 81:852-862. [PMID: 30311689 PMCID: PMC6289615 DOI: 10.1002/mrm.27412] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/23/2018] [Accepted: 05/30/2018] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop and evaluate a simultaneous multislice (SMS) spiral perfusion pulse sequence with whole-heart coverage. METHODS An orthogonal set of phase cycling angles following a Hadamard pattern was incorporated into a golden-angle (GA) variable density spiral perfusion sequence to perform SMS imaging at different multiband (MB) factors. Images were reconstructed using an SMS extension of L1-SPIRiT that we have termed SMS-L1-SPIRiT. The proposed sequence was evaluated in 40 subjects (10 each for MB factors of 1, 2, 3, and 4). Images were blindly graded by 2 cardiologists on a 5-point scale (5, excellent). To quantitatively evaluate the reconstruction performance against images acquired without SMS, the MB =1 data were used to retrospectively simulate data acquired at MB factors of 2 to 4. RESULTS Analysis of the SMS point-spread function for the desired slice showed that the proposed sampling strategy significantly canceled the main-lobe energy of the other slices and has low side-lobe energy resulting in an incoherent temporal aliasing pattern when rotated by the GA. Retrospective experiments demonstrated the SMS-L1-SPIRiT method removed aliasing from the interfering slices and showed excellent agreement with the ground-truth MB =1 images. Clinical evaluation demonstrated high-quality perfusion images with average image-quality scores of 4.3 ± 0.5 (MB =2), 4.2 ± 0.5 (MB =3), and 4.4 ± 0.4 (MB =4) with no significant quality difference in image quality between MB factors (P = 0.38). CONCLUSION SMS spiral perfusion at MB factors 2, 3, and 4 produces high-quality perfusion images with whole-heart coverage in a clinical setting with high sampling efficiency.
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Affiliation(s)
- Yang Yang
- Departments of Medicine, Cardiovascular Division, University of Virginia Health System
| | - Craig H. Meyer
- Radiology and Medical Imaging, University of Virginia Health System
- Department of Biomedical Engineering, University of Virginia
| | - Frederick H. Epstein
- Radiology and Medical Imaging, University of Virginia Health System
- Department of Biomedical Engineering, University of Virginia
| | - Christopher M. Kramer
- Departments of Medicine, Cardiovascular Division, University of Virginia Health System
- Radiology and Medical Imaging, University of Virginia Health System
| | - Michael Salerno
- Departments of Medicine, Cardiovascular Division, University of Virginia Health System
- Radiology and Medical Imaging, University of Virginia Health System
- Department of Biomedical Engineering, University of Virginia
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26
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Value of adenosine stress cardiovascular magnetic resonance in the evaluation of vessels supplying previously infarcted territories. Coron Artery Dis 2019; 30:222-231. [PMID: 30633029 DOI: 10.1097/mca.0000000000000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The diagnostic performance of adenosine stress cardiovascular magnetic resonance (CMR) for the detection of significant stenosis in infarct-related arteries is widely unknown. Two different types of perfusion defects can be observed: (a) larger than or (b) equal size as scar.We hypothesized that: (a) defect>scar predicts significant coronary stenosis, and (b) defect=scar predicts an unobstructed infarct-related artery, and (c) angina symptoms might be of additional value in stratification. PATIENTS AND METHODS Patients with previous myocardial infarction referred for work-up of myocardial ischemia undergoing adenosine stress CMR were included if they had coronary angiography within 4 weeks of CMR. RESULTS Two hundred patients with a mean age of 66±11 years, ischemic scars (subendocardial/transmural), and a mean left ventricular ejection fraction of 53% were included. In patients with defect>scar, the positive predictive value was excellent (88%) and typical angina was reported only in the stenosis group (P=0.002). However, patients with defect=scar (with 50% showing subendocardial scar) had a prevalence of 37% for stenosis, yielding a low negative predictive value of 63%. In this group, symptoms of typical angina were independent of stenosis (P=1.0). CONCLUSION A perfusion defect larger than scar is highly predictive for significant stenosis in infarct-related arteries. However, more than a third of the patients with perfusion defect of equal size as scar also showed significant coronary stenosis. As half of these patients showed still viable (subendocardial) scars, there is a high-risk of reinfarction. The addition of angina symptoms seems to increase diagnostic accuracy only in patients with perfusion defects larger than scar.
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27
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Identifying Myocardial Ischemia due to Coronary Microvascular Dysfunction in the Emergency Department: Introducing a New Paradigm in Acute Chest Pain Evaluation. Clin Ther 2018; 40:1920-1930. [PMID: 30458932 DOI: 10.1016/j.clinthera.2018.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 09/06/2018] [Accepted: 09/13/2018] [Indexed: 12/20/2022]
Abstract
Chest pain stands as one of the most frequent patient presentations in the emergency department (ED). Despite established diagnostic algorithms for identifying several important causes of chest pain, such as acute myocardial infarction (AMI), aortic dissection, and pulmonary embolism, guidance on managing patients with recurrent chest pain, one of the top 3 reasons for repeated hospitalization in the United States, is less defined. The assessment of symptoms, serial ECG, and necrosis biomarkers plays a major role in patient management. Notably, the recently introduced high-sensitivity troponin T (hs-TnT) assay is helping to identify ischemia in patients previously undiagnosed by conventional testing. In Europe, with the use of this assay for over a decade, the identification of patients with AMI has substantially increased, particularly of patients with type 2 AMI, which is seen in the absence of atherosclerotic obstruction of the epicardial coronaries on angiography. Use of hs-TnT is in particular relevant in women, in whom the use of a sex-specific threshold for elevated hs-TnT has almost doubled the diagnosis of AMI. With the advent of the hs-TnT assay in the United States in 2017, a similar phenomenon is expected. Thus, it is important to learn from the European experience and to develop sex-specific nuanced algorithms for the evaluation of additional causes of myocardial ischemia/necrosis, such as coronary artery vasomotor disorders and coronary microvascular dysfunction. The latter has a high prevalence among symptomatic women presenting to the ED, a group in whom recurrent chest pain is common. This commentary describes the tools available for diagnosing epicardial- and non-epicardial-related myocardial ischemia in patients with recurrent chest pain in the ED setting. A sex-specific, nuanced approach applied to select groups of patients being observed in the ED has the potential to reduce admissions and to allow for the initiation of timely, appropriate medical treatment and outpatient follow-up in an at-risk population. The costs and availability of advanced diagnostics may pose some limitation to the widespread adoption of such protocols.
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28
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Ntsinjana HN, Tann O, Hughes M, Derrick G, Secinaro A, Schievano S, Muthurangu V, Taylor AM. Utility of adenosine stress perfusion CMR to assess paediatric coronary artery disease. Eur Heart J Cardiovasc Imaging 2018; 18:898-905. [PMID: 27461210 DOI: 10.1093/ehjci/jew151] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/28/2016] [Indexed: 12/30/2022] Open
Abstract
Aims Cardiovascular magnetic resonance (CMR), using adenosine stress perfusion and late-gadolinium enhancement (LGE), is becoming the 'gold standard' non-invasive imaging modality in the assessment of adults with coronary artery disease (CAD). However, despite its proved feasibility in paediatric patients, clinical utility has not been demonstrated. Therefore, this study aims to establish the role of adenosine stress perfusion CMR as a screening test in paediatric patients with acquired or congenital CAD. Methods and results A total of 58 paediatric patients underwent 61 consecutive clinically indicated coronary artery assessments for diagnostic and clinical decision-making purposes. The diagnosis was based on X-ray or computed tomography coronary angiography for anatomy, adenosine stress CMR imaging for myocardial perfusion and LGE for tissue characterization. Two studies were aborted because of unwanted side effects of adenosine stress, thus 59 studies were completed in 56 patients [median age 14.1 years (interquartile range 10.9-16.2)]. When compared with coronary anatomical imaging, adenosine stress perfusion CMR performed as follows: sensitivity 100% (95% confidence interval, CI: 71.6-100%), specificity 98% (95% CI: 86.7-99.9%), positive predictive value (PPV) 92.9% (95% CI: 64.2-99.6%), and negative predictive value 100% (95% CI: 89.9-100%). Conclusion In paediatric CAD, adenosine stress perfusion CMR imaging is adequate as an initial, non-invasive screening test for the identification of significant coronary artery lesions, with anatomical imaging used to confirm the extent of the culprit lesion.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK.,Deparetment of Paediatrics, Paediatric Cardiology Division, CH Baragwanath Academic Hospital and University of the Wiwatersrand, Johannesburg, South Africa
| | - Oliver Tann
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Marina Hughes
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Graham Derrick
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Aurelio Secinaro
- Department of Imaging, Bambino Gesù Children's Hospital, Rome, Italy
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, Level 7, Nurses Home, Great Ormond Street, London WC1N 3JH, UK
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29
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von Spiczak J, Mannil M, Kozerke S, Alkadhi H, Manka R. 3D image fusion of whole-heart dynamic cardiac MR perfusion and late gadolinium enhancement: Intuitive delineation of myocardial hypoperfusion and scar. J Magn Reson Imaging 2018; 48:1129-1138. [DOI: 10.1002/jmri.26020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/01/2018] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jochen von Spiczak
- Institute of Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
| | - Manoj Mannil
- Institute of Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering; University and ETH Zurich; Zurich Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology; University Hospital Zurich; Zurich Switzerland
- Institute for Biomedical Engineering; University and ETH Zurich; Zurich Switzerland
- Department of Cardiology; University Heart Center, University Hospital Zurich; Zurich Switzerland
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30
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Ta AD, Hsu LY, Conn HM, Winkler S, Greve AM, Shanbhag SM, Chen MY, Patricia Bandettini W, Arai AE. Fully quantitative pixel-wise analysis of cardiovascular magnetic resonance perfusion improves discrimination of dark rim artifact from perfusion defects associated with epicardial coronary stenosis. J Cardiovasc Magn Reson 2018; 20:16. [PMID: 29514708 PMCID: PMC5842542 DOI: 10.1186/s12968-018-0436-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 02/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dark rim artifacts in first-pass cardiovascular magnetic resonance (CMR) perfusion images can mimic perfusion defects and affect diagnostic accuracy for coronary artery disease (CAD). We evaluated whether quantitative myocardial blood flow (MBF) can differentiate dark rim artifacts from true perfusion defects in CMR perfusion. METHODS Regadenoson perfusion CMR was performed at 1.5 T in 76 patients. Significant CAD was defined by quantitative invasive coronary angiography (QCA) ≥ 50% diameter stenosis. Non-significant CAD (NonCAD) was defined as stenosis by QCA < 50% diameter stenosis or computed tomographic coronary angiography (CTA) < 30% in all major epicardial arteries. Dark rim artifacts had study specific and guideline-based definitions for comparison purposes. MBF was quantified at the pixel-level and sector-level. RESULTS In a NonCAD subgroup with dark rim artifacts, stress MBF was lower in the subendocardial than midmyocardial and epicardial layers (2.17 ± 0.61 vs. 3.06 ± 0.75 vs. 3.24 ± 0.80 mL/min/g, both p < 0.001) and was also 30% lower than in remote regions (2.17 ± 0.61 vs. 2.83 ± 0.67 mL/min/g, p < 0.001). However, subendocardial stress MBF in dark rim artifacts was 37-56% higher than in true perfusion defects (2.17 ± 0.61 vs. 0.95 ± 0.43 mL/min/g, p < 0.001). Absolute stress MBF differentiated CAD from NonCAD with an accuracy ranging from 86 to 89% (all p < 0.001) using pixel-level analyses. Similar results were seen at a sector level. CONCLUSION Quantitative stress MBF is lower in dark rim artifacts than remote myocardium but significantly higher than in true perfusion defects. If confirmed in larger series, this approach may aid the interpretation of clinical stress perfusion exams. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00027170 ; first posted 11/28/2001; updated 11/27/2017.
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Affiliation(s)
- Allison D. Ta
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
- Duke University School of Medicine, Durham, North Carolina USA
| | - Li-Yueh Hsu
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
| | - Hannah M. Conn
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
| | - Susanne Winkler
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
- Medical University of Vienna, Vienna, Austria
| | - Anders M. Greve
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
| | - Sujata M. Shanbhag
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
| | - Marcus Y. Chen
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
| | - W. Patricia Bandettini
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
| | - Andrew E. Arai
- National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bldg 10, Rm B1D416, MSC 1061, 10 Center Drive, Bethesda, MD 20892-1061 USA
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31
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Yamada A, Ishida M, Kitagawa K, Sakuma H. Assessment of Myocardial Ischemia Using Stress Perfusion Cardiovascular Magnetic Resonance. ACTA ACUST UNITED AC 2018. [DOI: 10.22468/cvia.2017.00178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Akimasa Yamada
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Tsu, Japan
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32
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Greulich S, Kaesemann P, Seitz A, Birkmeier S, Abu-Zaid E, Vecchio F, Sechtem U, Mahrholdt H. Effects of caffeine on the detection of ischemia in patients undergoing adenosine stress cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2017; 19:103. [PMID: 29254482 PMCID: PMC5735931 DOI: 10.1186/s12968-017-0412-0] [Citation(s) in RCA: 10] [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: 07/03/2017] [Accepted: 11/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adenosine stress cardiovascular magnetic resonance (CMR) can detect significant coronary artery stenoses with high diagnostic accuracy. Caffeine is a nonselective competitive inhibitor of adenosine2A-receptors, which might hamper the vasodilator effect of adenosine stress, potentially yielding false-negative results. Much controversy exists about the influence of caffeine on adenosine myocardial perfusion imaging. Our study sought to investigate the effects of caffeine on ischemia detection in patients with suspected or known coronary artery disease (CAD) undergoing adenosine stress CMR. METHODS Thirty patients with evidence of myocardial ischemia on caffeine-naïve adenosine stress CMR were prospectively enrolled and underwent repeat adenosine stress CMR after intake of 200 mg caffeine. Both CMR exams were then compared for evaluation of ischemic burden. RESULTS Despite intake of caffeine, no conversion of a positive to a negative stress study occurred on a per patient basis. Although we found significant lower ischemic burden in CMR exams with caffeine compared to caffeine-naïve CMR exams, absolute differences varied only slightly (1 segment based on a 16-segment model, 3 segments on a 60-segment model, and 1 ml in total ischemic myocardial volume, p < 0.001 each). Moreover, no relevant ischemia (≥2 segments in a 16-segment model) was missed by prior ingestion of caffeine. CONCLUSIONS Although differences were small and no relevant myocardial ischemia had been missed, prior consumption of caffeine led to significant reduction of ischemic burden, and might lower the high diagnostic and prognostic value of adenosine stress CMR. Therefore, we suggest that patients should still refrain from caffeine prior adenosine stress CMR tests.
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Affiliation(s)
- Simon Greulich
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
- Department of Cardiology and Cardiovascular Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Philipp Kaesemann
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Andreas Seitz
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | | | - Eed Abu-Zaid
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Francesco Vecchio
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Udo Sechtem
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
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Fusion of CT coronary angiography and whole-heart dynamic 3D cardiac MR perfusion: building a framework for comprehensive cardiac imaging. Int J Cardiovasc Imaging 2017; 34:649-660. [DOI: 10.1007/s10554-017-1260-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
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Feher A, Sinusas AJ. Quantitative Assessment of Coronary Microvascular Function: Dynamic Single-Photon Emission Computed Tomography, Positron Emission Tomography, Ultrasound, Computed Tomography, and Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006427. [PMID: 28794138 DOI: 10.1161/circimaging.117.006427] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/26/2017] [Indexed: 01/09/2023]
Abstract
A healthy, functional microcirculation in combination with nonobstructed epicardial coronary arteries is the prerequisite of normal myocardial perfusion. Quantitative assessment in myocardial perfusion and determination of absolute myocardial blood flow can be achieved noninvasively using dynamic imaging with multiple imaging modalities. Extensive evidence supports the clinical value of noninvasively assessing indices of coronary flow for diagnosing coronary microvascular dysfunction; in certain diseases, the degree of coronary microvascular impairment carries important prognostic relevance. Although, currently positron emission tomography is the most commonly used tool for the quantification of myocardial blood flow, other modalities, including single-photon emission computed tomography, computed tomography, magnetic resonance imaging, and myocardial contrast echocardiography, have emerged as techniques with great promise for determination of coronary microvascular dysfunction. The following review will describe basic concepts of coronary and microvascular physiology, review available modalities for dynamic imaging for quantitative assessment of coronary perfusion and myocardial blood flow, and discuss their application in distinct forms of coronary microvascular dysfunction.
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Affiliation(s)
- Attila Feher
- From the Section of Cardiovascular Medicine, Department of Internal Medicine (A.F., A.J.S.) and Department of Radiology and Biomedical Imaging (A.J.S.), Yale University School of Medicine, New Haven, CT
| | - Albert J Sinusas
- From the Section of Cardiovascular Medicine, Department of Internal Medicine (A.F., A.J.S.) and Department of Radiology and Biomedical Imaging (A.J.S.), Yale University School of Medicine, New Haven, CT.
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Giacomelli R, Di Cesare E, Cipriani P, Ruscitti P, Di Sibio A, Liakouli V, Gennarelli A, Carubbi F, Splendiani A, Berardicurti O, Di Benedetto P, Ciccia F, Guggino G, Radchenko G, Triolo G, Masciocchi C. Pharmacological stress, rest perfusion and delayed enhancement cardiac magnetic resonance identifies very early cardiac involvement in systemic sclerosis patients of recent onset. Int J Rheum Dis 2017; 20:1247-1260. [DOI: 10.1111/1756-185x.13107] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Roberto Giacomelli
- Division of Rheumatology; Department of Biotechnological and Applied Clinical Science; School of Medicine; University of L'Aquila; L'Aquila Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences; Division of Cardiac Radiology; Laboratory of Radiobiology; University of L'Aquila; L'Aquila Italy
| | - Paola Cipriani
- Division of Rheumatology; Department of Biotechnological and Applied Clinical Science; School of Medicine; University of L'Aquila; L'Aquila Italy
| | - Piero Ruscitti
- Division of Rheumatology; Department of Biotechnological and Applied Clinical Science; School of Medicine; University of L'Aquila; L'Aquila Italy
| | - Alessandra Di Sibio
- Department of Biotechnological and Applied Clinical Sciences; Division of Radiology; Laboratory of Radiobiology; University of L'Aquila; L'Aquila Italy
| | - Vasiliki Liakouli
- Division of Rheumatology; Department of Biotechnological and Applied Clinical Science; School of Medicine; University of L'Aquila; L'Aquila Italy
| | - Antonio Gennarelli
- Department of Biotechnological and Applied Clinical Sciences; Division of Radiology; Laboratory of Radiobiology; University of L'Aquila; L'Aquila Italy
| | - Francesco Carubbi
- Division of Rheumatology; Department of Biotechnological and Applied Clinical Science; School of Medicine; University of L'Aquila; L'Aquila Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences; Division of Radiology; Laboratory of Radiobiology; University of L'Aquila; L'Aquila Italy
| | - Onorina Berardicurti
- Division of Rheumatology; Department of Biotechnological and Applied Clinical Science; School of Medicine; University of L'Aquila; L'Aquila Italy
| | - Paola Di Benedetto
- Division of Rheumatology; Department of Biotechnological and Applied Clinical Science; School of Medicine; University of L'Aquila; L'Aquila Italy
| | - Francesco Ciccia
- Division of Rheumatology; Department of Internal Medicine; University of Palermo; Palermo Italy
| | - Giuliana Guggino
- Division of Rheumatology; Department of Internal Medicine; University of Palermo; Palermo Italy
| | - Ganna Radchenko
- Institute of Cardiology of Ukrainian National Academy of Medical Science; Kyiv Ukraine
| | - Giovanni Triolo
- Division of Rheumatology; Department of Internal Medicine; University of Palermo; Palermo Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences; Division of Radiology; Laboratory of Radiobiology; University of L'Aquila; L'Aquila Italy
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36
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Rapid rest/stress regadenoson ungated perfusion CMR for detection of coronary artery disease in patients with atrial fibrillation. Int J Cardiovasc Imaging 2017; 33:1781-1788. [PMID: 28528431 DOI: 10.1007/s10554-017-1168-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/15/2017] [Indexed: 12/16/2022]
Abstract
Cardiovascular magnetic resonance (CMR) perfusion has been established as a useful imaging modality for the detection of coronary artery disease (CAD). However, there are several limitations when applying standard, ECG-gated stress/rest perfusion CMR to patients with atrial fibrillation (AF). In this study we investigate an approach with no ECG gating and a rapid rest/stress perfusion protocol to determine its accuracy for detection of CAD in patients with AF. 26 patients with AF underwent a rapid rest/regadenoson stress CMR perfusion imaging protocol, and all patients had X-ray coronary angiography. An ungated radial myocardial perfusion sequence was used. Imaging protocol included: rest perfusion image acquisition, followed nearly immediately by administration of regadenoson to induce hyperemia, 60 s wait, and stress image acquisition. CMR perfusion images were interpreted by three blinded readers as normal or abnormal. Diagnostic accuracy was evaluated by comparison to X-ray angiography. 21 of the CMR rest/stress perfusion scans were negative, and 5 were positive by angiography criteria. Majority results of the ungated datasets from all of the readers showed a sensitivity, specificity and accuracy of 80, 100 and 96%, respectively, for detection of CAD. An ungated, rapid rest/stress regadenoson perfusion CMR protocol appears to be useful for the diagnosis of obstructive CAD in patients with AF.
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Kellman P, Hansen MS, Nielles-Vallespin S, Nickander J, Themudo R, Ugander M, Xue H. Myocardial perfusion cardiovascular magnetic resonance: optimized dual sequence and reconstruction for quantification. J Cardiovasc Magn Reson 2017; 19:43. [PMID: 28385161 PMCID: PMC5383963 DOI: 10.1186/s12968-017-0355-5] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/23/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Quantification of myocardial blood flow requires knowledge of the amount of contrast agent in the myocardial tissue and the arterial input function (AIF) driving the delivery of this contrast agent. Accurate quantification is challenged by the lack of linearity between the measured signal and contrast agent concentration. This work characterizes sources of non-linearity and presents a systematic approach to accurate measurements of contrast agent concentration in both blood and myocardium. METHODS A dual sequence approach with separate pulse sequences for AIF and myocardial tissue allowed separate optimization of parameters for blood and myocardium. A systems approach to the overall design was taken to achieve linearity between signal and contrast agent concentration. Conversion of signal intensity values to contrast agent concentration was achieved through a combination of surface coil sensitivity correction, Bloch simulation based look-up table correction, and in the case of the AIF measurement, correction of T2* losses. Validation of signal correction was performed in phantoms, and values for peak AIF concentration and myocardial flow are provided for 29 normal subjects for rest and adenosine stress. RESULTS For phantoms, the measured fits were within 5% for both AIF and myocardium. In healthy volunteers the peak [Gd] was 3.5 ± 1.2 for stress and 4.4 ± 1.2 mmol/L for rest. The T2* in the left ventricle blood pool at peak AIF was approximately 10 ms. The peak-to-valley ratio was 5.6 for the raw signal intensities without correction, and was 8.3 for the look-up-table (LUT) corrected AIF which represents approximately 48% correction. Without T2* correction the myocardial blood flow estimates are overestimated by approximately 10%. The signal-to-noise ratio of the myocardial signal at peak enhancement (1.5 T) was 17.7 ± 6.6 at stress and the peak [Gd] was 0.49 ± 0.15 mmol/L. The estimated perfusion flow was 3.9 ± 0.38 and 1.03 ± 0.19 ml/min/g using the BTEX model and 3.4 ± 0.39 and 0.95 ± 0.16 using a Fermi model, for stress and rest, respectively. CONCLUSIONS A dual sequence for myocardial perfusion cardiovascular magnetic resonance and AIF measurement has been optimized for quantification of myocardial blood flow. A validation in phantoms was performed to confirm that the signal conversion to gadolinium concentration was linear. The proposed sequence was integrated with a fully automatic in-line solution for pixel-wise mapping of myocardial blood flow and evaluated in adenosine stress and rest studies on N = 29 normal healthy subjects. Reliable perfusion mapping was demonstrated and produced estimates with low variability.
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Affiliation(s)
- Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive MSC-1061, Bethesda, MD 20892 USA
| | - Michael S. Hansen
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive MSC-1061, Bethesda, MD 20892 USA
| | - Sonia Nielles-Vallespin
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive MSC-1061, Bethesda, MD 20892 USA
| | - Jannike Nickander
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Raquel Themudo
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive MSC-1061, Bethesda, MD 20892 USA
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38
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Yang Y, Zhao L, Chen X, Shaw PW, Gonzalez JA, Epstein FH, Meyer CH, Kramer CM, Salerno M. Reduced field of view single-shot spiral perfusion imaging. Magn Reson Med 2017; 79:208-216. [PMID: 28321908 DOI: 10.1002/mrm.26664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 02/10/2017] [Accepted: 02/11/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE To develop a single-shot spiral perfusion pulse sequence with outer-volume suppression (OVS) to achieve whole-heart coverage with a short temporal footprint of 10 ms per slice location. METHODS A highly accelerated single-shot variable density spiral pulse sequence with an integrated OVS module for reduced field of view (rFOV) perfusion imaging with 2 mm spatial resolution was developed and evaluated in simulations, phantom experiments and in clinical patients with (n = 8) or without (n = 8) OVS. Images were reconstructed by block low-rank sparsity with motion guidance (BLOSM) and graded by two cardiologists on a 5-point scale (1, excellent; 5, poor). RESULTS Simulation and phantom results showed that OVS effectively suppressed the signal outside the desired field of view (FOV). Clinical patient data demonstrated high quality perfusion images with rFOV. The average image quality scores of full FOV cases and rFOV cases were 3.1 ± 0.64 and 2.3 ± 0.46, respectively, (P = 0.02) from cardiologist 1 and 2.5 ± 0.54 and 1.8 ± 0.47, respectively, (P = 0.04) from cardiologist 2, showing superior image quality for the rFOV images compared with the full FOV images. CONCLUSION A single-shot spiral perfusion sequence that uses OVS and BLOSM performs perfusion imaging with a very short temporal footprint per image supporting whole-heart coverage with good image quality. Magn Reson Med 79:208-216, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Yang Yang
- Departments of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Li Zhao
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Xiao Chen
- Medical Imaging Technologies, Siemens Medical Solutions USA, Inc
| | - Peter W Shaw
- Cardiology Professional Services, Berkshire Medical Center, Pittsfield, Massachusetts, USA
| | - Jorge A Gonzalez
- Division of Cardiovascular Disease, Scripps Clinic, John R. Anderson V Medical Pavilion, La Jolla, California, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA.,Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Craig H Meyer
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA.,Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher M Kramer
- Departments of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA.,Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michael Salerno
- Departments of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA.,Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA.,Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
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39
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Yang Y, Kramer CM, Shaw PW, Meyer CH, Salerno M. First-pass myocardial perfusion imaging with whole-heart coverage using L1-SPIRiT accelerated variable density spiral trajectories. Magn Reson Med 2016; 76:1375-1387. [PMID: 26538511 PMCID: PMC4860174 DOI: 10.1002/mrm.26014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/20/2015] [Accepted: 09/21/2015] [Indexed: 11/06/2022]
Abstract
PURPOSE To design and evaluate two-dimensional (2D) L1-SPIRiT accelerated spiral pulse sequences for first-pass myocardial perfusion imaging with whole heart coverage capable of measuring eight slices at 2 mm in-plane resolution at heart rates up to 125 beats per minute (BPM). METHODS Combinations of five different spiral trajectories and four k-t sampling patterns were retrospectively simulated in 25 fully sampled datasets and reconstructed with L1-SPIRiT to determine the best combination of parameters. Two candidate sequences were prospectively evaluated in 34 human subjects to assess in vivo performance. RESULTS A dual density broad transition spiral trajectory with either angularly uniform or golden angle in time k-t sampling pattern had the largest structural similarity and smallest root mean square error from the retrospective simulation, and the L1-SPIRiT reconstruction had well-preserved temporal dynamics. In vivo data demonstrated that both of the sampling patterns could produce high quality perfusion images with whole-heart coverage. CONCLUSION First-pass myocardial perfusion imaging using accelerated spirals with optimized trajectory and k-t sampling pattern can produce high quality 2D perfusion images with whole-heart coverage at the heart rates up to 125 BPM. Magn Reson Med 76:1375-1387, 2016. © 2015 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Yang Yang
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher M Kramer
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Peter W Shaw
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Craig H Meyer
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michael Salerno
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA.
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA.
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA.
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40
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Xie L, Bennett KM, Liu C, Johnson GA, Zhang JL, Lee VS. MRI tools for assessment of microstructure and nephron function of the kidney. Am J Physiol Renal Physiol 2016; 311:F1109-F1124. [PMID: 27630064 DOI: 10.1152/ajprenal.00134.2016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/08/2016] [Indexed: 12/13/2022] Open
Abstract
MRI can provide excellent detail of renal structure and function. Recently, novel MR contrast mechanisms and imaging tools have been developed to evaluate microscopic kidney structures including the tubules and glomeruli. Quantitative MRI can assess local tubular function and is able to determine the concentrating mechanism of the kidney noninvasively in real time. Measuring single nephron function is now a near possibility. In parallel to advancing imaging techniques for kidney microstructure is a need to carefully understand the relationship between the local source of MRI contrast and the underlying physiological change. The development of these imaging markers can impact the accurate diagnosis and treatment of kidney disease. This study reviews the novel tools to examine kidney microstructure and local function and demonstrates the application of these methods in renal pathophysiology.
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Affiliation(s)
- Luke Xie
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah;
| | - Kevin M Bennett
- Department of Biology, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Chunlei Liu
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, North Carolina; and.,Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina
| | - G Allan Johnson
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, North Carolina; and
| | - Jeff Lei Zhang
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah
| | - Vivian S Lee
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah
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41
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Keith GA, Rodgers CT, Chappell MA, Robson MD. A look-locker acquisition scheme for quantitative myocardial perfusion imaging with FAIR arterial spin labeling in humans at 3 tesla. Magn Reson Med 2016; 78:541-549. [PMID: 27604183 PMCID: PMC5516148 DOI: 10.1002/mrm.26388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE A novel method for quantitative measurement of myocardial blood flow (MBF) using arterial spin labeling (ASL) in a single breath-hold is presented, evaluated by simulations, phantom studies and in vivo studies and tested for reproducibility and variability. METHODS A flow-sensitive alternating inversion recovery (FAIR) ASL method with Look-Locker readout (LL-FAIR-ASL) was implemented at 3 tesla. Scans were performed on 10 healthy volunteers and MBF measured in three slices. The method was investigated for reproducibility by Bland-Altman analysis and statistical measures, the coefficients of reproducibility (CR) and variation (CV) are reported. RESULTS The MBF values for the basal, mid, and apical slices were 1.04 ± 0.40, 1.06 ± 0.46, and 1.06 ± 0.38 ml/g/min, respectively (mean ± SD), which compare well with literature values. The CV across all scans, 43%, was greater than the between-session and within-session values, at 16 and 13%, respectively, for the mid-ventricular slice. The change in MBF required for detection, from the CR, was 61% between-session and 53% within-session for the mid-ventricle. CONCLUSION This study shows the feasibility of the LL-FAIR-ASL method for the quantification of MBF. The statistical measures reported will allow the planning of future clinical research studies involving rest and stress measurements. Magn Reson Med 78:541-549, 2017. © 2016 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Affiliation(s)
- Graeme A. Keith
- Oxford Centre for Clinical Magnetic Resonance ResearchUniversity of Oxford, John Radcliffe HospitalOxfordUnited Kingdom
| | - Christopher T. Rodgers
- Oxford Centre for Clinical Magnetic Resonance ResearchUniversity of Oxford, John Radcliffe HospitalOxfordUnited Kingdom
| | - Michael A. Chappell
- Institute of Biomedical EngineeringUniversity of Oxford, Old Road CampusOxfordUnited Kingdom
| | - Matthew D. Robson
- Oxford Centre for Clinical Magnetic Resonance ResearchUniversity of Oxford, John Radcliffe HospitalOxfordUnited Kingdom
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Zhou Z, Bi X, Wei J, Yang HJ, Dharmakumar R, Arsanjani R, Bairey Merz CN, Li D, Sharif B. First-pass myocardial perfusion MRI with reduced subendocardial dark-rim artifact using optimized Cartesian sampling. J Magn Reson Imaging 2016; 45:542-555. [PMID: 27532501 DOI: 10.1002/jmri.25400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The presence of subendocardial dark-rim artifact (DRA) remains an ongoing challenge in first-pass perfusion (FPP) cardiac magnetic resonance imaging (MRI). We propose a free-breathing FPP imaging scheme with Cartesian sampling that is optimized to minimize the DRA and readily enables near-instantaneous image reconstruction. MATERIALS AND METHODS The proposed FPP method suppresses Gibbs ringing effects-a major underlying factor for the DRA-by "shaping" the underlying point spread function through a two-step process: 1) an undersampled Cartesian sampling scheme that widens the k-space coverage compared to the conventional scheme; and 2) a modified parallel-imaging scheme that incorporates optimized apodization (k-space data filtering) to suppress Gibbs-ringing effects. Healthy volunteer studies (n = 10) were performed to compare the proposed method against the conventional Cartesian technique-both using a saturation-recovery gradient-echo sequence at 3T. Furthermore, FPP imaging studies using the proposed method were performed in infarcted canines (n = 3), and in two symptomatic patients with suspected coronary microvascular dysfunction for assessment of myocardial hypoperfusion. RESULTS Width of the DRA and the number of DRA-affected myocardial segments were significantly reduced in the proposed method compared to the conventional approach (width: 1.3 vs. 2.9 mm, P < 0.001; number of segments: 2.6 vs. 8.7; P < 0.0001). The number of slices with severe DRA was markedly lower for the proposed method (by 10-fold). The reader-assigned image quality scores were similar (P = 0.2), although the quantified myocardial signal-to-noise ratio was lower for the proposed method (P < 0.05). Animal studies showed that the proposed method can detect subendocardial perfusion defects and patient results were consistent with the gold-standard invasive test. CONCLUSION The proposed free-breathing Cartesian FPP imaging method significantly reduces the prevalence of severe DRAs compared to the conventional approach while maintaining similar resolution and image quality. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:542-555.
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Affiliation(s)
- Zhengwei Zhou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Xiaoming Bi
- Siemens Healthcare, Los Angeles, California, USA
| | - Janet Wei
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Hsin-Jung Yang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Reza Arsanjani
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Behzad Sharif
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Women and Chest Pain: Recognizing the Different Faces of Angina in the Emergency Department. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2016; 89:227-38. [PMID: 27354848 PMCID: PMC4918863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Emergency departments (ED) in the United States see over eight million cases of chest pain annually. While a cardinal symptom of acute coronary syndrome (ACS), multiple emergent and non-emergent causes can attribute to chest pain. This case-based perspective describes the different sex-specific causes of angina seen in ED patients. Once coronary artery disease (CAD) is ruled out with standard protocols, microvascular dysfunction is perhaps the most prevalent but under-diagnosed cause of non-CAD related angina in ED patients. Additional causes include coronary artery spasm, coronary artery dissection, coronary artery endothelial dysfunction and myocardial bridging. Non-CAD related angina is associated with persistent chest pain causing poor function, quality of life, and recidivism. Clinicians should consider additional diagnostics to routinely screen for non-CAD related causes of angina in patients with recurrent chest pain. Future work is needed to better define the epidemiological, clinical, biological, and genetic correlates of microvascular dysfunction in these patients.
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44
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Greulich S, Steubing H, Birkmeier S, Grün S, Bentz K, Sechtem U, Mahrholdt H. Impact of arrhythmia on diagnostic performance of adenosine stress CMR in patients with suspected or known coronary artery disease. J Cardiovasc Magn Reson 2015; 17:94. [PMID: 26541808 PMCID: PMC4635579 DOI: 10.1186/s12968-015-0195-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/21/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The diagnostic performance of adenosine stress cardiovascular magnetic resonance (CMR) in patients with arrhythmias presenting for work-up of suspected or known CAD is largely unknown, since most CMR studies currently available exclude arrhythmic patients from analysis fearing gating problems, or other artifacts will impair image quality. The primary aim of our study was to evaluate the diagnostic performance of adenosine stress CMR for detection of significant coronary stenosis in patients with arrhythmia presenting for 1) work-up of suspected coronary artery disease (CAD), or 2) work-up of ischemia in known CAD. METHODS Patients with arrhythmia referred for work-up of suspected CAD or work-up of ischemia in known CAD undergoing adenosine stress CMR were included if they had coronary angiography within four weeks of CMR. RESULTS One hundred fifty-nine patients were included (n = 64 atrial fibrillation, n = 87 frequent ventricular extrasystoles, n = 8 frequent supraventricular extrasystoles). Of these, n = 72 had suspected CAD, and n = 87 had known CAD. Diagnostic accuracy of the adenosine stress CMR for detection of significant CAD was 73 % for the entire population (sensitivity 72 %, specificity 76 %). Diagnostic accuracy was 75 % (sensitivity 80 %, specificity 74 %) in patients with suspected CAD, and 74 % (sensitivity 71 %, specificity 79 %) in the group with known CAD. For different types of arrhythmia, diagnostic accuracy of CMR was 70 % in the atrial fibrillation group, and 79 % in patients with ventricular extrasystoles. On a per coronary territory analysis, diagnostic accuracy of CMR was 77 % for stenosis of the left and 82 % for stenosis of the right coronary artery. CONCLUSION The present data demonstrates good diagnostic performance of adenosine stress CMR for detection of significant coronary stenosis in patients with arrhythmia presenting for work-up of suspected CAD, or work-up of ischemia in known CAD. This holds true for a per patient, as well as for a per coronary territory analysis.
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Affiliation(s)
- Simon Greulich
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Hannah Steubing
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Stefan Birkmeier
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Stefan Grün
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Kerstin Bentz
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Udo Sechtem
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
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Xie L, Layton AT, Wang N, Larson PEZ, Zhang JL, Lee VS, Liu C, Johnson GA. Dynamic contrast-enhanced quantitative susceptibility mapping with ultrashort echo time MRI for evaluating renal function. Am J Physiol Renal Physiol 2015; 310:F174-82. [PMID: 26447222 DOI: 10.1152/ajprenal.00351.2015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/06/2015] [Indexed: 12/30/2022] Open
Abstract
Dynamic contrast-enhanced (DCE) MRI can provide key insight into renal function. DCE MRI is typically achieved through an injection of a gadolinium (Gd)-based contrast agent, which has desirable T1 quenching and tracer kinetics. However, significant T2* blooming effects and signal voids can arise when Gd becomes very concentrated, especially in the renal medulla and pelvis. One MRI sequence designed to alleviate T2* effects is the ultrashort echo time (UTE) sequence. In the present study, we observed T2* blooming in the inner medulla of the mouse kidney, despite using UTE at an echo time of 20 microseconds and a low dose of 0.03 mmol/kg Gd. We applied quantitative susceptibility mapping (QSM) and resolved the signal void into a positive susceptibility signal. The susceptibility values [in parts per million (ppm)] were converted into molar concentrations of Gd using a calibration curve. We determined the concentrating mechanism (referred to as the concentrating index) as a ratio of maximum Gd concentration in the inner medulla to the renal artery. The concentrating index was assessed longitudinally over a 17-wk course (3, 5, 7, 9, 13, 17 wk of age). We conclude that the UTE-based DCE method is limited in resolving extreme T2* content caused by the kidney's strong concentrating mechanism. QSM was able to resolve and confirm the source of the blooming effect to be the large positive susceptibility of concentrated Gd. UTE with QSM can complement traditional magnitude UTE and offer a powerful tool to study renal pathophysiology.
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Affiliation(s)
- Luke Xie
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, North Carolina; Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah
| | - Anita T Layton
- Department of Mathematics, Duke University, Durham, North Carolina
| | - Nian Wang
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina
| | - Peder E Z Larson
- Department of Radiology and Biomedical Engineering, University of California, San Francisco, California; and
| | - Jeff L Zhang
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah
| | - Vivian S Lee
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah
| | - Chunlei Liu
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, North Carolina; Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina
| | - G Allan Johnson
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Guaricci AI, Brunetti ND, Marra MP, Tarantini G, di Biase M, Pontone G. Diagnosis and prognosis of ischemic heart disease. J Cardiovasc Med (Hagerstown) 2015; 16:653-62. [DOI: 10.2459/jcm.0000000000000267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Saeed M, Van TA, Krug R, Hetts SW, Wilson MW. Cardiac MR imaging: current status and future direction. Cardiovasc Diagn Ther 2015; 5:290-310. [PMID: 26331113 DOI: 10.3978/j.issn.2223-3652.2015.06.07] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/17/2015] [Indexed: 12/12/2022]
Abstract
Coronary artery disease is currently a worldwide epidemic with increasing impact on healthcare systems. Magnetic resonance imaging (MRI) sequences give complementary information on LV function, regional perfusion, angiogenesis, myocardial viability and orientations of myocytes. T2-weighted short-tau inversion recovery (T2-STIR), fat suppression and black blood sequences have been frequently used for detecting edematous area at risk (AAR) of infarction. T2 mapping, however, indicated that the edematous reaction in acute myocardial infarct (AMI) is not stable and warranted the use of edematous area in evaluating therapies. On the other hand, cine MRI demonstrated reproducible data on LV function in healthy volunteers and LV remodeling in patients. Noninvasive first pass perfusion, using exogenous tracer (gadolinium-based contrast media) and arterial spin labeling MRI, using endogenous tracer (water), are sensitive and useful techniques for evaluating myocardial perfusion and angiogenesis. Recently, new strategies have been developed to quantify myocardial viability using T1-mapping and equilibrium contrast enhanced MR techniques because existing delayed contrast enhancement MRI (DE-MRI) sequences are limited in detecting patchy microinfarct and diffuse fibrosis. These new techniques were successfully used for characterizing diffuse myocardial fibrosis associated with myocarditis, amyloidosis, sarcoidosis heart failure, aortic hypertrophic cardiomyopathy, congenital heart disease, restrictive cardiomyopathy, arrhythmogenic right ventricular dysplasia and hypertension). Diffusion MRI provides information regarding microscopic tissue structure, while diffusion tensor imaging (DTI) helps to characterize the myocardium and monitor the process of LV remodeling after AMI. Novel trends in hybrid imaging, such as cardiac positron emission tomography (PET)/MRI and optical imaging/MRI, are recently under intensive investigation. With the promise of higher spatial-temporal resolution and 3D coverage in the near future, cardiac MRI will be an indispensible tool in the diagnosis of cardiac diseases, coronary intervention and myocardial therapeutic delivery.
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Affiliation(s)
- Maythem Saeed
- 1 Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, CA, USA ; 2 Zentralinstitut für Medizintechnik, Technical University of Munich, Munich, Germany
| | - Tu Anh Van
- 1 Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, CA, USA ; 2 Zentralinstitut für Medizintechnik, Technical University of Munich, Munich, Germany
| | - Roland Krug
- 1 Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, CA, USA ; 2 Zentralinstitut für Medizintechnik, Technical University of Munich, Munich, Germany
| | - Steven W Hetts
- 1 Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, CA, USA ; 2 Zentralinstitut für Medizintechnik, Technical University of Munich, Munich, Germany
| | - Mark W Wilson
- 1 Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, CA, USA ; 2 Zentralinstitut für Medizintechnik, Technical University of Munich, Munich, Germany
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Fair MJ, Gatehouse PD, DiBella EVR, Firmin DN. A review of 3D first-pass, whole-heart, myocardial perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2015; 17:68. [PMID: 26231784 PMCID: PMC4522116 DOI: 10.1186/s12968-015-0162-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 06/23/2015] [Indexed: 01/19/2023] Open
Abstract
A comprehensive review is undertaken of the methods available for 3D whole-heart first-pass perfusion (FPP) and their application to date, with particular focus on possible acceleration techniques. Following a summary of the parameters typically desired of 3D FPP methods, the review explains the mechanisms of key acceleration techniques and their potential use in FPP for attaining 3D acquisitions. The mechanisms include rapid sequences, non-Cartesian k-space trajectories, reduced k-space acquisitions, parallel imaging reconstructions and compressed sensing. An attempt is made to explain, rather than simply state, the varying methods with the hope that it will give an appreciation of the different components making up a 3D FPP protocol. Basic estimates demonstrating the required total acceleration factors in typical 3D FPP cases are included, providing context for the extent that each acceleration method can contribute to the required imaging speed, as well as potential limitations in present 3D FPP literature. Although many 3D FPP methods are too early in development for the type of clinical trials required to show any clear benefit over current 2D FPP methods, the review includes the small but growing quantity of clinical research work already using 3D FPP, alongside the more technical work. Broader challenges concerning FPP such as quantitative analysis are not covered, but challenges with particular impact on 3D FPP methods, particularly with regards to motion effects, are discussed along with anticipated future work in the field.
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Affiliation(s)
- Merlin J Fair
- National Heart & Lung Institute, Imperial College London, London, UK.
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
| | - Peter D Gatehouse
- National Heart & Lung Institute, Imperial College London, London, UK.
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
| | - Edward V R DiBella
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, USA.
| | - David N Firmin
- National Heart & Lung Institute, Imperial College London, London, UK.
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
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Ahlander BM, Maret E, Brudin L, Starck SA, Engvall J. An echo-planar imaging sequence is superior to a steady-state free precession sequence for visual as well as quantitative assessment of cardiac magnetic resonance stress perfusion. Clin Physiol Funct Imaging 2015; 37:52-61. [PMID: 26147785 DOI: 10.1111/cpf.12267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 05/08/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND To assess myocardial perfusion, steady-state free precession cardiac magnetic resonance (SSFP, CMR) was compared with gradient-echo-echo-planar imaging (GRE-EPI) using myocardial perfusion scintigraphy (MPS) as reference. METHODS Cardiac magnetic resonance perfusion was recorded in 30 patients with SSFP and in another 30 patients with GRE-EPI. Timing and extent of inflow delay to the myocardium was visually assessed. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated. Myocardial scar was visualized with a phase-sensitive inversion recovery sequence (PSIR). All scar positive segments were considered pathologic. In MPS, stress and rest images were used as in clinical reporting. The CMR contrast wash-in slope was calculated and compared with the stress score from the MPS examination. CMR scar, CMR perfusion and MPS were assessed separately by one expert for each method who was blinded to other aspects of the study. RESULTS Visual assessment of CMR had a sensitivity for the detection of an abnormal MPS at 78% (SSFP) versus 91% (GRE-EPI) and a specificity of 58% (SSFP) versus 84% (GRE-EPI). Kappa statistics for SSFP and MPS was 0·29, for GRE-EPI and MPS 0·72. The ANOVA of CMR perfusion slopes for all segments versus MPS score (four levels based on MPS) had correlation r = 0·64 (SSFP) and r = 0·96 (GRE-EPI). SNR was for normal segments 35·63 ± 11·80 (SSFP) and 17·98 ± 8·31 (GRE-EPI), while CNR was 28·79 ± 10·43 (SSFP) and 13·06 ± 7·61 (GRE-EPI). CONCLUSION GRE-EPI displayed higher agreement with the MPS results than SSFP despite significantly lower signal intensity, SNR and CNR.
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Affiliation(s)
| | - Eva Maret
- Department of Radiology, Ryhov County Hospital, Jonkoping, Sweden.,Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Brudin
- Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden
| | - Sven-Ake Starck
- Department of Natural Science and Biomedicine, School of Health Sciences, Jonkoping University, Jonkoping, Sweden.,Department of Oncology, Hospital Physics, Ryhov County Hospital, Jonkoping, Sweden
| | - Jan Engvall
- Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden.,Department of Clinical Physiology, County Council of Ostergotland, Linkoping, Sweden.,Center of Medical Image Science and Visualisation, Linkoping University, Linkoping, Sweden
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Rajiah P, Bolen MA. Cardiovascular MR imaging at 3 T: opportunities, challenges, and solutions. Radiographics 2015; 34:1612-35. [PMID: 25310420 DOI: 10.1148/rg.346140048] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Although 3-T magnetic resonance (MR) imaging is well established in neuroradiology and musculoskeletal imaging, it is in the nascent stages in cardiovascular imaging applications, and there is limited literature on this topic. The primary advantage of 3 T over 1.5 T is a higher signal-to-noise ratio (SNR), which can be used as such or traded off to improve spatial or temporal resolution and decrease acquisition time. However, the actual gain in SNR is limited by other factors and modifications in sequences adapted for use at 3 T. Higher resonance frequencies result in improved spectral resolution, which is beneficial for fat suppression and spectroscopy. The higher T1 values of tissues at 3 T aid in myocardial tagging, angiography, and perfusion and delayed-enhancement sequences. However, there are substantial challenges with 3-T cardiac MR imaging, including higher magnetic field and radiofrequency inhomogeneities and susceptibility effects, which diminish image quality. Off-resonance artifacts are particularly challenging, especially with steady-state free precession sequences. These artifacts can be managed by using higher-order shimming, frequency scouts, or low repetition times. B1 inhomogeneities can be managed by using radiofrequency shimming, multitransmit coils, or adiabatic pulses. Chemical shifts are also increased at 3 T. The higher radiofrequency results in higher radiofrequency deposition power and a higher specific absorption rate. MR angiography, dynamic first-pass perfusion sequences, myocardial tagging, and MR spectroscopy are more effective at 3 T, whereas delayed-enhancement, flow quantification, and black-blood sequences are comparable at 1.5 T and 3 T. Knowledge of the relevant physics helps in identifying artifacts and modifying sequences to optimize image quality. Online supplemental material is available for this article.
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Affiliation(s)
- Prabhakar Rajiah
- From the Cardiothoracic Imaging Section, Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106 (P.R.); and Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.A.B.)
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