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Smailovic H, Wilk B, Wisenberg G, Sykes J, Butler J, Hicks J, Thiessen JD, Prato FS. Simultaneous measurements of myocardial glucose metabolism and extracellular volumes with hybrid PET/MRI using concurrent injections of Gd-DTPA and [ 18F]FDG. J Nucl Cardiol 2022; 29:1304-1314. [PMID: 33502694 DOI: 10.1007/s12350-020-02486-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/28/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aims of this study were to investigate the application of a constant infusion (CI) to mitigate the issue of constantly changing Gd-DTPA contrast levels in a bolus injection for extracellular volume (ECV) measurements by (a) comparing a CI alone to a bolus alone and a bolus followed by CI in healthy myocardium, (b) evaluating the impact of glucose suppression using heparin on ECV. METHODS Five healthy canine subjects were imaged to compare three different protocols for injecting Gd-DTPA and FDG: bolus alone, CI alone, bolus followed by CI. Suppression of myocardial glucose uptake was induced using a continuous infusion of 20% lipid at a rate of 0.25 mL·min-1·kg-1 as well as 2000 units of intravenous heparin injected 20 minutes prior to FDG/Gd-DTPA injection. RESULTS There was no significant effect on ECV measurement when heparin was used for glucose suppression at equilibrium irrespective of infusion protocol). Measurements of ECV in myocardium, regardless of infusion protocol showed no significant difference at all time points (P = 0.21) prior to washout. CONCLUSIONS The suppression of myocardial uptake of [18F]FDG with heparin did not alter the determination of myocardial ECV though a larger sample size may show differences. Further, the infusion protocol (bolus or constant infusion) had no effect on the calculated ECV.
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Affiliation(s)
- H Smailovic
- Department of Medical Imaging, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
| | - B Wilk
- Department of Medical Imaging, Western University, London, Canada.
- Lawson Health Research Institute, London, Canada.
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada.
- Department of Medical Biophysics, Western University, London, Canada.
| | | | - J Sykes
- Lawson Health Research Institute, London, Canada
| | - J Butler
- Lawson Health Research Institute, London, Canada
| | - J Hicks
- Lawson Health Research Institute, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
| | - J D Thiessen
- Department of Medical Imaging, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
- Department of Medical Biophysics, Western University, London, Canada
| | - F S Prato
- Department of Medical Imaging, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
- Department of Medical Biophysics, Western University, London, Canada
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Wilk B, Smailovic H, Wisenberg G, Sykes J, Butler J, Kovacs M, Thiessen JD, Prato FS. Tracking the progress of inflammation with PET/MRI in a canine model of myocardial infarction. J Nucl Cardiol 2022; 29:1315-1325. [PMID: 33462785 DOI: 10.1007/s12350-020-02487-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Following myocardial infarction, tissue undergoes pathophysiological changes involving inflammation and scar tissue formation. However, little is known about the pathophysiology and prognostic significance of any corresponding changes in remote myocardium. The aim of this study was to investigate the potential application of a combined constant infusion of 18F-FDG and Gd-DTPA to quantitate inflammation and extracellular volume (ECV) from 3 to 40 days after myocardial infarction. METHODS Eight canine subjects were imaged at multiple time points following induction of an MI with a 60-minute concurrent constant infusion of Gd-DTPA and 18F-FDG using a hybrid PET/MRI scanner. RESULTS There was a significant increase in ECV in remote myocardium on day 14 post-MI (P = .034) and day 21 (P = .021) compared to the baseline. ECV was significantly elevated in the infarcted myocardium compared to remote myocardium at all time points post-MI (days 3, 7, 14, 21, and 40) (P < .001) while glucose uptake was also increased within the infarct on days 3, 7, 14, and 21 but not 40. CONCLUSIONS The significant increase in ECV in remote tissue may be due to an ongoing inflammatory process in the early weeks post-infarct.
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Affiliation(s)
- B Wilk
- Lawson Health Research Institute, London, Canada.
- Department of Medical Biophysics, Western University, London, Canada.
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada.
| | - H Smailovic
- Lawson Health Research Institute, London, Canada
- Department of Medical Imaging, Western University, London, Canada
| | - G Wisenberg
- Lawson Health Research Institute, London, Canada
- MyHealth Centre, Arva, Canada
| | - J Sykes
- Lawson Health Research Institute, London, Canada
| | - J Butler
- Lawson Health Research Institute, London, Canada
| | - M Kovacs
- Lawson Health Research Institute, London, Canada
- Department of Medical Biophysics, Western University, London, Canada
- Department of Medical Imaging, Western University, London, Canada
| | - J D Thiessen
- Lawson Health Research Institute, London, Canada
- Department of Medical Biophysics, Western University, London, Canada
- Department of Medical Imaging, Western University, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
| | - F S Prato
- Lawson Health Research Institute, London, Canada
- Department of Medical Biophysics, Western University, London, Canada
- Department of Medical Imaging, Western University, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
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Wilk B, Wisenberg G, Dharmakumar R, Thiessen JD, Goldhawk DE, Prato FS. Hybrid PET/MR imaging in myocardial inflammation post-myocardial infarction. J Nucl Cardiol 2020; 27:2083-2099. [PMID: 31797321 PMCID: PMC7391987 DOI: 10.1007/s12350-019-01973-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 01/24/2023]
Abstract
Hybrid PET/MR imaging is an emerging imaging modality combining positron emission tomography (PET) and magnetic resonance imaging (MRI) in the same system. Since the introduction of clinical PET/MRI in 2011, it has had some impact (e.g., imaging the components of inflammation in myocardial infarction), but its role could be much greater. Many opportunities remain unexplored and will be highlighted in this review. The inflammatory process post-myocardial infarction has many facets at a cellular level which may affect the outcome of the patient, specifically the effects on adverse left ventricular remodeling, and ultimately prognosis. The goal of inflammation imaging is to track the process non-invasively and quantitatively to determine the best therapeutic options for intervention and to monitor those therapies. While PET and MRI, acquired separately, can image aspects of inflammation, hybrid PET/MRI has the potential to advance imaging of myocardial inflammation. This review contains a description of hybrid PET/MRI, its application to inflammation imaging in myocardial infarction and the challenges, constraints, and opportunities in designing data collection protocols. Finally, this review explores opportunities in PET/MRI: improved registration, partial volume correction, machine learning, new approaches in the development of PET and MRI pulse sequences, and the use of novel injection strategies.
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Affiliation(s)
- B Wilk
- Department of Medical Imaging, Western University, London, Canada.
- Lawson Health Research Institute, London, Canada.
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada.
| | - G Wisenberg
- Department of Medical Imaging, Western University, London, Canada
- MyHealth Centre, Arva, Canada
| | - R Dharmakumar
- Biomedical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - J D Thiessen
- Department of Medical Imaging, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
| | - D E Goldhawk
- Department of Medical Imaging, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
| | - F S Prato
- Department of Medical Imaging, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
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4
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Luetkens JA, Klein S, Träber F, Block W, Schmeel FC, Sprinkart AM, Kuetting DLR, Uschner FE, Schierwagen R, Thomas D, Trebicka J, Kukuk GM. Quantification of liver fibrosis: extracellular volume fraction using an MRI bolus-only technique in a rat animal model. Eur Radiol Exp 2019; 3:22. [PMID: 31144201 PMCID: PMC6541689 DOI: 10.1186/s41747-019-0100-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/18/2019] [Indexed: 12/11/2022] Open
Abstract
Background To determine the utility of single-contrast-bolus hepatic extracellular volume (ECV) fraction measurement at different time points to detect and quantify hepatic fibrosis. Methods Different grades of liver fibrosis were induced in 23 male Sprague-Dawley rats by carbon-tetrachloride (CCl4) intoxication. In ten control rats, no fibrosis was induced. Native T1 values and ECV fraction were assessed by using quantitative magnetic resonance imaging (MRI) mapping; only one contrast bolus was applied (gadobutrol 0.1 mmol/kg). ECV values were determined 5, 15, and 25 min after injection. Hepatic fibrosis was quantified histologically by Sirius red staining. Results For the 8-week-CCl4 group, the ECV fraction values obtained 5 (23.5 ± 4.8%, mean ± standard deviation), 15 (23.6 ± 4.8%), and 25 min (23.7 ± 4.7%) after injection were constant over time (p = 0.998); constant data 5–25 min after injection were also observed for the 16-week-CCl4 group and controls. Liver ECV after 15 min significantly increased with the severity of fibrosis: 18.0 ± 3.0% (controls) versus 23.6 ± 4.8% (8-week-CCl4) versus 30.5 ± 3.3% (16-week-CCl4) (p < 0.001). ECV values after 5, 15, and 25 min significantly correlated with Sirius red staining (p < 0.001 for all parameters). Conclusions Hepatic ECV obtained using a single-contrast-bolus technique can be measured 5, 15, and 25 min after injection, obtaining constant values over time, each of them being suitable to detect diffuse hepatic fibrosis. In clinical practice, post-contrast T1 relaxation times for liver ECV fraction determination might be obtained at only one time point.
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Affiliation(s)
- Julian A Luetkens
- Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Sabine Klein
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Frank Träber
- Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Wolfgang Block
- Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Frederic C Schmeel
- Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alois M Sprinkart
- Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel L R Kuetting
- Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Frank E Uschner
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Robert Schierwagen
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Thomas
- Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Jonel Trebicka
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain.,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Institute for Bioengineering of Catalonia, Barcelona, Spain
| | - Guido M Kukuk
- Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Teixeira T, Hafyane T, Jerosch-Herold M, Marcotte F, Mongeon FP. Myocardial Partition Coefficient of Gadolinium: A Pilot Study in Patients With Acute Myocarditis, Chronic Myocardial Infarction, and in Healthy Volunteers. Can J Cardiol 2019; 35:51-60. [PMID: 30595183 DOI: 10.1016/j.cjca.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The tissue-blood partition coefficient (PC) of gadolinium, derived from T1 measurements, reflects myocardial connective tissue fraction and tissue injury, increasing in proportion with edema or fibrosis. We determined the myocardial PC of gadolinium in patients with acute myocarditis, chronic myocardial infarction (MI), and healthy volunteers. We hypothesized that the characteristics of the injured myocardium in patients with MI and myocarditis may differ and that the PC will be higher in chronically injured myocardium (MI) compared with acutely injured myocardium (myocarditis). METHODS We performed late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging and T1 mapping before and after administration of gadolinium (0.1 mmol/kg Gd-BOPTA) at 3 Tesla in 10 healthy volunteers (47.1 ± 12.4 years), 18 patients with chronic MI (62.5 ± 8.1 years), and 16 patients with acute myocarditis (42.5 ± 13.9 years). RESULTS In patients with chronic MI and focal scar by LGE, the whole left ventricular myocardial PC (0.45 ± 0.05) was higher compared with patients with MI without focal scar (0.39 ± 0.03, P = 0.02) but not significantly different from whole myocardial PC in volunteers (0.40 ± 0.05) or patients with myocarditis (0.41 ± 0.05). The PC in myocarditis scars was lower than in chronic MI scars (0.60 ± 0.12 vs 0.77 ± 0.16, P = 0.016). The relationships of PC and scar burden, expressed as % LGE, were similar and significant for the 2 groups (P = 0.042). CONCLUSION The tissue-blood partition coefficient of Gd-BOPTA is elevated in areas of acute and chronic myocardial injury and may serve as a marker for disease activity and density of scars, which was found to be higher in chronic MI than in acute myocarditis.
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Affiliation(s)
- Tiago Teixeira
- Philippa & Marvin Carsley CMR Center, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada; Centro Hospitalar entre Douro e Vouga, Sta Maria da Feira, Portugal
| | - Tarik Hafyane
- Philippa & Marvin Carsley CMR Center, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - François Marcotte
- Philippa & Marvin Carsley CMR Center, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - François-Pierre Mongeon
- Philippa & Marvin Carsley CMR Center, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
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Nacif MS, Raman FS, Gai N, Jones J, van der Geest RJ, T Sibley C, Liu S, David AB. Myocardial T1 mapping and determination of partition coefficients at 3 tesla: comparison between gadobenate dimeglumine and gadofosveset trisodium. Radiol Bras 2018; 51:13-19. [PMID: 29559761 PMCID: PMC5846320 DOI: 10.1590/0100-3984.2016.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To compare an albumin-bound gadolinium chelate (gadofosveset trisodium) and
an extracellular contrast agent (gadobenate dimeglumine), in terms of their
effects on myocardial longitudinal (T1) relaxation time and partition
coefficient. Materials and Methods Study subjects underwent two imaging sessions for T1 mapping at 3 tesla with
a modified look-locker inversion recovery (MOLLI) pulse sequence to obtain
one pre-contrast T1 map and two post-contrast T1 maps (mean 15 and 21 min,
respectively). The partition coefficient was calculated as
ΔR1myocardium
/ΔR1blood , where
R1 is 1/T1. Results A total of 252 myocardial and blood pool T1 values were obtained in 21
healthy subjects. After gadolinium administration, the myocardial T1 was
longer for gadofosveset than for gadobenate, the mean difference between the
two contrast agents being −7.6 ± 60 ms (p = 0.41).
The inverse was true for the blood pool T1, which was longer for gadobenate
than for gadofosveset, the mean difference being 56.5 ± 67 ms
(p < 0.001). The partition coefficient (λ)
was higher for gadobenate than gadofosveset (0.41 vs. 0.33), indicating
slower blood pool washout for gadofosveset than for gadobenate. Conclusion Myocardial T1 times did not differ significantly between gadobenate and
gadofosveset. At typical clinical doses of the contrast agents, partition
coefficients were significantly lower for the intravascular contrast agent
than for the extravascular agent.
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Affiliation(s)
- Marcelo Souto Nacif
- MD, PhD, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Fabio S Raman
- Biomedical Engineer, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Neville Gai
- MD, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Jacquin Jones
- PhD, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | | | - Christopher T Sibley
- MD, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Songtao Liu
- MD, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - A Bluemke David
- MD, PhD, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
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Al-Wakeel-Marquard N, Rastin S, Muench F, O H-Ici D, Yilmaz S, Berger F, Kuehne T, Messroghli DR. Cardiac T1 mapping in congenital heart disease: bolus vs. infusion protocols for measurements of myocardial extracellular volume fraction. Int J Cardiovasc Imaging 2017; 33:1961-1968. [PMID: 28620681 DOI: 10.1007/s10554-017-1191-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/09/2017] [Indexed: 11/28/2022]
Abstract
Myocardial extracellular volume fraction (ECV) reflecting diffuse myocardial fibrosis can be measured with T1 mapping cardiovascular magnetic resonance (CMR) before and after the application of a gadolinium-based extracellular contrast agent. The equilibrium between blood and myocardium contrast concentration required for ECV measurements can be obtained with a primed contrast infusion (equilibrium contrast-CMR). We hypothesized that equilibrium can also be achieved with a single contrast bolus to accurately measure diffuse myocardial fibrosis in patients with congenital heart disease (CHD). Healthy controls (n = 17; median age 24.0 years) and patients with CHD (n = 19; 25.0 years) were prospectively enrolled. Using modified Look-Locker inversion recovery T1 mapping before, 15 min after bolus injection, and during constant infusion of gadolinium-DOTA, T1 values were obtained for blood pool and myocardium of the left ventricle (LV), the interventricular septum (IVS), and the right ventricle (RV) in a single midventricular plane in short axis or in transverse orientation. ECV of LV, IVS and RV by bolus-only and bolus-infusion correlated significantly in CHD patients (r = 0.94, 0.95, and 0.74; p < 0.01, respectively) and healthy controls (r = 0.96, 0.89, and 0.64; p < 0.05, respectively). Bland-Altman plots revealed no significant bias between the techniques for any of the analyzed regions. ECV of LV and RV myocardium measured by bolus-only T1 mapping agrees well with bolus-infusion measurements in patients with CHD. The use of a bolus-only approach facilitates the integration of ECV measurements into existing CMR imaging protocols, allowing for assessment of diffuse myocardial fibrosis in CHD in clinical routine.
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Affiliation(s)
- Nadya Al-Wakeel-Marquard
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
| | - Sanaz Rastin
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Frédéric Muench
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Internal Medicine - Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Darach O H-Ici
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sevim Yilmaz
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Department of Pediatrics, Division of Cardiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Titus Kuehne
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Department of Pediatrics, Division of Cardiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Daniel R Messroghli
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Department of Internal Medicine - Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
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Goldfarb JW, Zhao W. Magnetic resonance imaging dynamic contrast enhancement (DCE) characteristics of healed myocardial infarction differ from viable myocardium. Magn Reson Imaging 2014; 32:1191-7. [PMID: 25176295 DOI: 10.1016/j.mri.2014.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 08/01/2014] [Accepted: 08/09/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine whether healed myocardial infarction alters dynamic contrast-enhancement (DCE) curve shapes as well as late gadolinium-enhancement (LGE). MATERIALS AND METHODS Twenty patients with chronic myocardial infarction underwent MR imaging at 1.5 T with blood and myocardial T1 measurements before and after contrast administration for forty minutes. Viable and infarcted myocardial partition coefficients were calculated using multipoint slope methods for ten different DCE sampling intervals and windows. Partition coefficients and coefficients of determination were compared with paired statistical tests to assess the linearity of DCE curve shapes over the 40 min time period. RESULTS Calculated partition coefficients did not vary significantly between methods (p=0.325) for viable myocardium but did differ for infarcted myocardium (p<0.001), indicating a difference in infarcted DCE. There was a significant difference between viable and infarcted myocardial partition coefficients estimates for all methods with the exception of methods that included measurements during the first 10 min after contrast agent administration. CONCLUSION Myocardial partition coefficients calculated from a slope calculation vary in healed myocardial infarction based on the selection of samples due to non-linear DCE curve shapes. Partition coefficient calculations are insensitive to data sampling effects in viable myocardium due to linear DCE curve shapes.
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Affiliation(s)
- James W Goldfarb
- Department of Research and Education, Saint Francis Hospital, Roslyn, NY, USA; Program in Biomedical Engineering, SUNY Stony Brook, Stony Brook, NY, USA.
| | - Wenguo Zhao
- Department of Research and Education, Saint Francis Hospital, Roslyn, NY, USA
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9
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Neilan TG, Coelho-Filho OR, Shah RV, Abbasi SA, Heydari B, Watanabe E, Chen Y, Mandry D, Pierre-Mongeon F, Blankstein R, Kwong RY, Jerosch-Herold M. Myocardial extracellular volume fraction from T1 measurements in healthy volunteers and mice: relationship to aging and cardiac dimensions. JACC Cardiovasc Imaging 2013; 6:672-83. [PMID: 23643283 DOI: 10.1016/j.jcmg.2012.09.020] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVES This study aimed to test the characteristics of the myocardial extracellular volume fraction (ECV) derived from pre- and post-contrast T1 measurements among healthy volunteers. BACKGROUND Cardiac magnetic resonance (CMR) T1 measurements of myocardium and blood before and after contrast allow quantification of the ECV, a tissue parameter that has been shown to change in proportion to the connective tissue fraction. METHODS Healthy volunteers underwent standard CMR imaging with administration of gadolinium. T1 measurements were performed with a Look-Locker sequence followed by gradient-echo acquisition. We tested the segmental, interslice, inter-, intra-, and test-retest characteristics of the ECV, as well as the association of the ECV with other variables. Juvenile and aged mice underwent a similar protocol, and cardiac sections were harvested for measurement of fibrosis. RESULTS In healthy volunteers (N = 32, 56% female; age 21 to 72 years), the ECV averaged 0.28 ± 0.03 (range 0.23 to 0.33). The intraclass coefficients for the intraobserver, interobserver, and test-retest absolute agreements of the ECV were 0.94 (95% confidence interval: 0.84 to 0.98), 0.93 (95% confidence interval: 0.80 to 0.98), and 0.95 (95% confidence interval: 0.52 to 0.99), respectively. In volunteers, the ECV was associated with age (r = 0.74, p < 0.001), maximal left atrial volume index (r = 0.67, p < 0.001), and indexed left ventricular mass. There were no differences in the ECV between segments in a slice or between slices. In mice (N = 12), the myocardial ECV ranged from 0.20 to 0.32 and increased with age (0.22 ± 0.02 vs. 0.30 ± 0.02, juvenile vs. aged mice, p < 0.001). In mice, the ECV correlated with the extent of myocardial fibrosis (r = 0.94, p < 0.001). CONCLUSIONS In healthy volunteers, the myocardial ECV ranges from 0.23 to 0.33, has acceptable test characteristics, and is associated with age, left atrial volume, and left ventricular mass. In mice, the ECV also increases with age and strongly correlates with the extent of myocardial fibrosis.
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Affiliation(s)
- Tomas G Neilan
- Noninvasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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10
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Kawel N, Nacif M, Santini F, Liu S, Bremerich J, Arai AE, Bluemke DA. Partition coefficients for gadolinium chelates in the normal myocardium: comparison of gadopentetate dimeglumine and gadobenate dimeglumine. J Magn Reson Imaging 2012; 36:733-7. [PMID: 22488770 PMCID: PMC3396792 DOI: 10.1002/jmri.23651] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 02/29/2012] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the influence of contrast agents with different relaxivity on the partition coefficient (λ) and timing of equilibration using a modified Look-Locker inversion recovery (MOLLI) sequence in cardiac magnetic resonance imaging (MRI). MATERIALS AND METHODS MOLLI was acquired in 20 healthy subjects (1.5T) at the mid-ventricular short axis precontrast and 5, 10, 20, 25, and 30 minutes after administration of a bolus of 0.15 mmol/kg gadobenate dimeglumine (Gd-BOPTA) (n = 10) or gadopentetate dimeglumine (Gd-DTPA) (n = 10). T1 times were measured in myocardium and blood pool. λ was approximated by ΔR1(myocardium) /ΔR1(blood) . Values for Gd-BOPTA and Gd-DTPA were compared. Interobserver agreement was evaluated (intraclass correlation coefficient [ICC]). RESULTS T1 times of myocardium and blood pool (P < 0.001) and λ (0.42 ± 0.03 and 0.47 ± 0.04, respectively, P < 0.001; excluding 5 minutes for Gd-BOPTA) were significantly lower for Gd-BOPTA than Gd-DTPA. The λ((Gd-DTPA)) showed no significant variation between 5 and 30 minutes. The λ((Gd-BOPTA)) values were significantly lower at 5 minutes compared to other times (0.38 vs. 0.42; P < 0.05). Interobserver agreement for λ values was excellent with Gd-BOPTA (ICC = 0.818) and good for Gd-DTPA (ICC = 0.631). CONCLUSION The λ((Gd-BOPTA)) values were significantly lower compared to λ((Gd-DTPA)) at the same administered dose. Using Gd-BOPTA, the equilibrium between myocardium and blood pool was not achieved at 5 minutes postcontrast.
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Affiliation(s)
- Nadine Kawel
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Marcelo Nacif
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Francesco Santini
- Department of Radiological Physics, University Hospital Basel, Basel, Switzerland
| | - Songtao Liu
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
- Molecular Biomediacal Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Jens Bremerich
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Andrew E. Arai
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - David A. Bluemke
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
- Molecular Biomediacal Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
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11
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Mongeon FP, Jerosch-Herold M, Coelho-Filho OR, Blankstein R, Falk RH, Kwong RY. Quantification of extracellular matrix expansion by CMR in infiltrative heart disease. JACC Cardiovasc Imaging 2012; 5:897-907. [PMID: 22974802 PMCID: PMC3954504 DOI: 10.1016/j.jcmg.2012.04.006] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 02/23/2012] [Accepted: 04/09/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of this study was to perform direct quantification of myocardial extracellular volume fraction (ECF) with T1-weighted cardiac magnetic resonance (CMR) imaging in patients suspected to have infiltrative heart disease. BACKGROUND Infiltrative heart disease refers to accumulation of abnormal substances within the myocardium. Qualitative assessment of late gadolinium enhancement (LGE) remains the most commonly used method for CMR evaluation of patients suspected with myocardial infiltration. This technique is widely available and can be performed in a reproducible and standardized manner. However, the degree of extracellular matrix expansion due to myocardial infiltration in the intercellular space has, to date, not been amenable to noninvasive quantification with LGE. METHODS We performed 3-T CMR in 38 patients (mean age 68 ± 15 years) who were referred for assessment of infiltrative heart disease and also in 9 healthy volunteers as control subjects. The T1 quantification by Look-Locker gradient-echo before and after contrast determined segmental myocardial partition coefficients. The ECF was obtained by referencing the tissue partition coefficient for gadolinium to the plasma volume fraction in blood, derived from serum hematocrit. Cine CMR and LGE imaging in matching locations were also performed. RESULTS Seventeen patients (45%) had cardiac amyloidosis (CA) (biopsy-confirmed or clinically highly probable), 20 (53%) had a non-amyloid cardiomyopathy, and 1 had lysosomal storage disease. Median global ECF was substantially higher in CA patients (0.49) compared with non-amyloid cardiomyopathy patients (0.33, p < 0.0001) and volunteers (0.24, p = 0.0001). The ECF strongly correlated with visually assessed segmental LGE (r = 0.80, p < 0.0001) and LV mass index (r = 0.69, p < 0.0001), reflecting severity of myocardial infiltration. In patients with CA, ECF was highest in segments with LGE, although it remained elevated in segments without qualitative LGE. CONCLUSIONS The CMR ECF quantification identified substantial expansion of the interstitial space in patients with CA compared with volunteers. Further studies using this technique for diagnosis and assessment of the severity of myocardial infiltration are warranted.
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Affiliation(s)
- François-Pierre Mongeon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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12
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Kawel N, Nacif M, Zavodni A, Jones J, Liu S, Sibley CT, Bluemke DA. T1 mapping of the myocardium: intra-individual assessment of post-contrast T1 time evolution and extracellular volume fraction at 3T for Gd-DTPA and Gd-BOPTA. J Cardiovasc Magn Reson 2012; 14:26. [PMID: 22540153 PMCID: PMC3405486 DOI: 10.1186/1532-429x-14-26] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 04/28/2012] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Myocardial T1 relaxation time (T1 time) and extracellular volume fraction (ECV) are altered in patients with diffuse myocardial fibrosis. The purpose of this study was to perform an intra-individual assessment of normal T1 time and ECV for two different contrast agents. METHODS A modified Look-Locker Inversion Recovery (MOLLI) sequence was acquired at 3 T in 24 healthy subjects (8 men; 28 ± 6 years) at mid-ventricular short axis pre-contrast and every 5 min between 5-45 min after injection of a bolus of 0.15 mmol/kg gadopentetate dimeglumine (Gd-DTPA; Magnevist®) (exam 1) and 0.1 mmol/kg gadobenate dimeglumine (Gd-BOPTA; Multihance®) (exam 2) during two separate scanning sessions. T1 times were measured in myocardium and blood on generated T1 maps. ECVs were calculated as ΔR1 myocardium/ΔR1 blood*1-hematocrit. RESULTS Mean pre-contrast T1 relaxation times for myocardium and blood were similar for both the first and second CMR exam (p > 0.5). Overall mean post-contrast myocardial T1 time was 15 ± 2 ms (2.5 ± 0.7%) shorter for Gd-DTPA at 0.15 mmol/kg compared to Gd-BOPTA at 0.1 mmol/kg (p < 0.01) while there was no significant difference for T1 time of blood pool (p > 0.05). Between 5 and 45 minutes after contrast injection, mean ECV values increased linearly with time for both contrast agents from 0.27 ± 0.03 to 0.30 ± 0.03 (p < 0.0001). Mean ECV values were slightly higher (by 0.01, p < 0.05) for Gd-DTPA compared to Gd-BOPTA. Inter-individual variation of ECV was higher (CV 8.7% [exam 1, Gd-DTPA] and 9.4% [exam 2, Gd-BOPTA], respectively) compared to variation of pre-contrast myocardial T1 relaxation time (CV 4.5% [exam 1] and 3.0% [exam 2], respectively). ECV with Gd-DTPA was highly correlated to ECV by Gd-BOPTA (r = 0.803; p < 0.0001). CONCLUSION In comparison to pre-contrast myocardial T1 relaxation time, variation in ECV values of normal subjects is larger. However, absolute differences in ECV between Gd-DTPA and Gd-BOPTA were small and rank correlation was high. There is a small and linear increase in ECV over time, therefore ideally images should be acquired at the same delay after contrast injection.
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Affiliation(s)
- Nadine Kawel
- Radiology and Imaging Sciences, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1074, USA
- Molecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1074, USA
| | - Marcelo Nacif
- Radiology and Imaging Sciences, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1074, USA
- Molecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1074, USA
| | - Anna Zavodni
- Radiology and Imaging Sciences, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1074, USA
- Molecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1074, USA
| | - Jacquin Jones
- Radiology and Imaging Sciences, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1074, USA
| | - Songtao Liu
- Radiology and Imaging Sciences, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1074, USA
- Molecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1074, USA
| | - Christopher T Sibley
- Radiology and Imaging Sciences, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1074, USA
- Molecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1074, USA
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1074, USA
- Molecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892-1074, USA
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13
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Jao JC, Chen PC, Ting YN, Hsiao CC, Pan HB. THE IMPACT OF FACTOR TE ON THE MEASUREMENT OF T1 RELAXIVITY. BIOMEDICAL ENGINEERING-APPLICATIONS BASIS COMMUNICATIONS 2012. [DOI: 10.4015/s1016237208000891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Relaxivity is a very important indicator to evaluate the signal enhancement caused by MRI contrast agents. Many factors can affect the relaxivity values. The aim of this study is to investigate the influence of factor TE in the curve-fitting equation for T1 measurements. A spin echo pulse sequence was used as the scanning method. The relaxivity of Gd -DTPA doped saline at a 1.5 T MR scanner was under investigation. Gd -DTPA is the most widely used MRI contrast agent nowadays. In this study, both computer simulations and phantom studies were performed. T1 values were calculated by using both spin echo MR signal equations: one with the TE factor included and the other with the TE factor omitted. Then, the relaxivity values obtained from these two sets of T1 values would be compiled and compared. The results show that the T1 values are longer and the relaxivity is smaller when the factor TE is omitted from the curve-fitting equation. Therefore, it is more desirable to keep the factor TE in the curve-fitting equation to obtain more accurate relaxivity values.
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Affiliation(s)
- Jo-Chi Jao
- Faculty of Medical Radiation Technology, Kaohsiung Medical University, Kaohsiung 807, Taiwan, ROC
| | - Po-Chou Chen
- Department of Medical Imaging and Radiological Sciences, I-SHOU University, Kaohsiung 824, Taiwan, ROC
| | - Yun-Ni Ting
- Department of Biomedical Engineering, I-SHOU University, Kaohsiung 840, Taiwan, ROC
| | - Chia-Chi Hsiao
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan, ROC
| | - Huay-Ben Pan
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan, ROC
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14
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Schelbert EB, Testa SM, Meier CG, Ceyrolles WJ, Levenson JE, Blair AJ, Kellman P, Jones BL, Ludwig DR, Schwartzman D, Shroff SG, Wong TC. Myocardial extravascular extracellular volume fraction measurement by gadolinium cardiovascular magnetic resonance in humans: slow infusion versus bolus. J Cardiovasc Magn Reson 2011; 13:16. [PMID: 21375743 PMCID: PMC3059279 DOI: 10.1186/1532-429x-13-16] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 03/04/2011] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Myocardial extravascular extracellular volume fraction (Ve) measures quantify diffuse fibrosis not readily detectable by conventional late gadolinium (Gd) enhancement (LGE). Ve measurement requires steady state equilibrium between plasma and interstitial Gd contrast. While a constant infusion produces steady state, it is unclear whether a simple bolus can do the same. Given the relatively slow clearance of Gd, we hypothesized that a bolus technique accurately measures Ve, thus facilitating integration of myocardial fibrosis quantification into cardiovascular magnetic resonance (CMR) workflow routines. Assuming equivalence between techniques, we further hypothesized that Ve measures would be reproducible across scans. METHODS In 10 volunteers (ages 20-81, median 33 yr, 3 females), we compared serial Ve measures from a single short axis slice from two scans: first, during a constant infusion, and second, 12-50 min after a bolus (0.2 mmol/kg gadoteridol) on another day. Steady state during infusion was defined when serial blood and myocardial T1 data varied <5%. We measured T1 on a 1.5 T Siemens scanner using a single-shot modified Look Locker inversion recovery sequence (MOLLI) with balanced SSFP. To shorten breath hold times, T1 values were measured with a shorter sampling scheme that was validated with spin echo relaxometry (TR = 15 sec) in CuSO4-Agar phantoms. Serial infusion vs. bolus Ve measures (n = 205) from the 10 subjects were compared with generalized estimating equations (GEE) with exchangeable correlation matrices. LGE images were also acquired 12-30 minutes after the bolus. RESULTS No subject exhibited LGE near the short axis slices where Ve was measured. The Ve range was 19.3-29.2% and 18.4-29.1% by constant infusion and bolus, respectively. In GEE models, serial Ve measures by constant infusion and bolus did not differ significantly (difference = 0.1%, p = 0.38). For both techniques, Ve was strongly related to age (p < 0.01 for both) in GEE models, even after adjusting for heart rate. Both techniques identically sorted older individuals with higher mean Ve values. CONCLUSION Myocardial Ve can be measured reliably and accurately 12-50 minutes after a simple bolus. Ve measures are also reproducible across CMR scans. Ve estimation can be integrated into CMR workflow easily, which may simplify research applications involving the quantification of myocardial fibrosis.
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Affiliation(s)
- Erik B Schelbert
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Cardiovascular Magnetic Resonance Center, Pittsburgh, PA, USA
- Cardiovascular Institute, UPMC, Pittsburgh, PA, USA
| | - Stephen M Testa
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christopher G Meier
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - William J Ceyrolles
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joshua E Levenson
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Peter Kellman
- National Heart, Lung, Blood Institute, Bethesda, MD, USA
| | - Bobby L Jones
- Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel R Ludwig
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David Schwartzman
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Cardiovascular Institute, UPMC, Pittsburgh, PA, USA
| | - Sanjeev G Shroff
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Timothy C Wong
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Cardiovascular Magnetic Resonance Center, Pittsburgh, PA, USA
- Cardiovascular Institute, UPMC, Pittsburgh, PA, USA
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15
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Wisenberg G, Lekx K, Zabel P, Kong H, Mann R, Zeman PR, Datta S, Culshaw CN, Merrifield P, Bureau Y, Wells G, Sykes J, Prato FS. Cell tracking and therapy evaluation of bone marrow monocytes and stromal cells using SPECT and CMR in a canine model of myocardial infarction. J Cardiovasc Magn Reson 2009; 11:11. [PMID: 19397809 PMCID: PMC2680401 DOI: 10.1186/1532-429x-11-11] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 04/27/2009] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The clinical application of stem cell therapy for myocardial infarction will require the development of methods to monitor treatment and pre-clinical assessment in a large animal model, to determine its effectiveness and the optimum cell population, route of delivery, timing, and flow milieu. OBJECTIVES To establish a model for a) in vivo tracking to monitor cell engraftment after autologous transplantation and b) concurrent measurement of infarct evolution and remodeling. METHODS We evaluated 22 dogs (8 sham controls, 7 treated with autologous bone marrow monocytes, and 7 with stromal cells) using both imaging of 111Indium-tropolone labeled cells and late gadolinium enhancement CMR for up to12 weeks after a 3 hour coronary occlusion. Hearts were also examined using immunohistochemistry for capillary density and presence of PKH26 labeled cells. RESULTS In vivo Indium imaging demonstrated an effective biological clearance half-life from the injection site of ~5 days. CMR demonstrated a pattern of progressive infarct shrinkage over 12 weeks, ranging from 67-88% of baseline values with monocytes producing a significant treatment effect. Relative infarct shrinkage was similar through to 6 weeks in all groups, following which the treatment effect was manifest. There was a trend towards an increase in capillary density with cell treatment. CONCLUSION This multi-modality approach will allow determination of the success and persistence of engraftment, and a correlation of this with infarct size shrinkage, regional function, and left ventricular remodeling. There were overall no major treatment effects with this particular model of transplantation immediately post-infarct.
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Affiliation(s)
- Gerald Wisenberg
- Department of Medicine, University of Western Ontario, Ontario, Canada
| | - Katie Lekx
- Department of Medical Biophysics, University of Western Ontario, Ontario, Canada
| | - Pam Zabel
- Department of Medical Biophysics, University of Western Ontario, Ontario, Canada
| | - Huafu Kong
- Department of Medical Biophysics, University of Western Ontario, Ontario, Canada
| | - Rupinder Mann
- Department of Medical Biophysics, University of Western Ontario, Ontario, Canada
| | - Peter R Zeman
- Department of Medicine, University of Western Ontario, Ontario, Canada
| | - Sudip Datta
- Department of Medicine, University of Western Ontario, Ontario, Canada
| | - Caroline N Culshaw
- Department of Anatomy and Cell Biology, University of Western Ontario, Ontario, Canada
| | - Peter Merrifield
- Department of Anatomy and Cell Biology, University of Western Ontario, Ontario, Canada
| | - Yves Bureau
- Department of Medical Biophysics, University of Western Ontario, Ontario, Canada
| | - Glenn Wells
- Department of Medicine, University of Ottawa, Ontario, Canada
| | - Jane Sykes
- Department of Medical Biophysics, University of Western Ontario, Ontario, Canada
| | - Frank S Prato
- Department of Medical Biophysics, University of Western Ontario, Ontario, Canada
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16
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Jerosch-Herold M, Sheridan DC, Kushner JD, Nauman D, Burgess D, Dutton D, Alharethi R, Li D, Hershberger RE. Cardiac magnetic resonance imaging of myocardial contrast uptake and blood flow in patients affected with idiopathic or familial dilated cardiomyopathy. Am J Physiol Heart Circ Physiol 2008; 295:H1234-H1242. [PMID: 18660445 DOI: 10.1152/ajpheart.00429.2008] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Idiopathic dilated cardiomyopathy (IDC) is characterized by left ventricular (LV) enlargement with systolic dysfunction, other causes excluded. When inherited, it represents familial dilated cardiomyopathy (FDC). We hypothesized that IDC or FDC would show with cardiac magnetic resonance (CMR) increased myocardial accumulation of gadolinium contrast at steady state and decreased baseline myocardial blood flow (MBF) due to structural alterations of the extracellular matrix compared with normal myocardium. CMR was performed in nine persons affected with IDC/FDC. Healthy controls came from the general population (n = 6) or were unaffected family members of FDC patients (n = 3) without signs or symptoms of IDC/FDC or any structural cardiac abnormalities. The myocardial partition coefficient for gadolinium contrast (lambda(Gd)) was determined by T1 measurements. LV shape and function and MBF were assessed by standard CMR methods. lambda(Gd) was elevated in IDC/FDC patients vs. healthy controls (lambda(Gd) = 0.56 +/- 0.15 vs. 0.41 +/- 0.06; P = 0.002), and correlated with LV enlargement (r = 0.61 for lambda(Gd) vs. end-diastolic volume indexed by height; P < 0.01) and with ejection fraction (r = -0.80; P < 0.001). The extracellular volume fraction was higher in IDC patients than in healthy controls (0.31 +/- 0.05 vs. 0.24 +/- 0.03; P = 0.002). Resting MBF was lower in IDC patients (0.64 +/- 0.13 vs. 0.91 +/- 0.22; P = 0.01) than unaffected controls and correlated with both the partition coefficient (r = -0.57; P = 0.012) and the extracellular volume fraction (r = -0.56; P = 0.019). The expansion of the extracellular space correlated with reduced MBF and ventricular dilation. Expansion of the extracellular matrix may be a key contributor to contractile dysfunction in IDC patients.
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Affiliation(s)
- Michael Jerosch-Herold
- Division of Cardiology, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
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Pack NA, Dibella EVR, Wilson BD, McGann CJ. Quantitative myocardial distribution volume from dynamic contrast-enhanced MRI. Magn Reson Imaging 2008; 26:532-42. [PMID: 18068931 DOI: 10.1016/j.mri.2007.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 08/29/2007] [Accepted: 10/08/2007] [Indexed: 10/22/2022]
Abstract
The objective of this study was to investigate if dynamic contrast-enhanced magnetic resonance imaging (MRI) can be used to quantitate the distribution volume (v(e)) in regions of normal and infarcted myocardium. v(e) reflects the volume of the extracellular, extravascular space within the myocardial tissue. In regions of the heart where an infarct has occurred, the loss of viable cardiac cells results in an elevated v(e) compared to normal regions. A quantitative estimate of the magnitude and spatial distribution of v(e) is significant because it may provide information complementary to delayed enhancement MRI alone. Using a hybrid gradient echo-echoplanar imaging pulse sequence on a 1.5T MRI scanner, 12 normal subjects and four infarct patients were imaged dynamically, during the injection of a contrast agent, to measure the regional blood and tissue enhancement in the left ventricular (LV) myocardium. Seven of the normal subjects and all of the infarct patients were also imaged at steady-state contrast enhancement to estimate the steady-state ratio of contrast agent in the tissue and blood (Ct/Cb) - a validated measure of v(e). Normal and infarct regions of the LV were manually selected, and the blood and tissue enhancement curves were fit to a compartment model to estimate v(e). Also, the effect of the vascular blood signal on estimates of v(e) was evaluated using simulations and in the dynamic and steady-state studies. Aggregate estimates of v(e) were 23.6+/-6.3% in normal myocardium and 45.7+/-3.4% in regions of infarct. These results were not significantly different from the reference standards of Ct/Cb (22.9+/-6.8% and 42.6+/-6.3%, P=.073). From the dynamic contrast-enhanced studies, approximately 1 min of scan time was necessary to estimate v(e) in the normal myocardium to within 10% of the steady-state estimate. In regions of infarct, up to 3 min of dynamic data were required to estimate v(e) to within 10% of the steady-state v(e) value. By measuring the kinetics of blood and tissue enhancement in the myocardium during an extended dynamic contrast enhanced MRI study, v(e) may be estimated using compartment modeling.
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Affiliation(s)
- Nathan A Pack
- Department of Bioengineering, University of Utah, SLC, UT, USA
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