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Bivona DJ, Ghadimi S, Wang Y, Oomen PJA, Malhotra R, Darby A, Mangrum JM, Mason PK, Mazimba S, Patel AR, Epstein FH, Bilchick KC. Machine learning of ECG waveforms and cardiac magnetic resonance for response and survival after cardiac resynchronization therapy. Comput Biol Med 2024; 178:108627. [PMID: 38850959 PMCID: PMC11265973 DOI: 10.1016/j.compbiomed.2024.108627] [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: 02/16/2024] [Revised: 04/22/2024] [Accepted: 05/18/2024] [Indexed: 06/10/2024]
Abstract
Cardiac resynchronization therapy (CRT) can lead to marked symptom reduction and improved survival in selected patients with heart failure with reduced ejection fraction (HFrEF); however, many candidates for CRT based on clinical guidelines do not have a favorable response. A better way to identify patients expected to benefit from CRT that applies machine learning to accessible and cost-effective diagnostic tools such as the 12-lead electrocardiogram (ECG) could have a major impact on clinical care in HFrEF by helping providers personalize treatment strategies and avoid delays in initiation of other potentially beneficial treatments. This study addresses this need by demonstrating that a novel approach to ECG waveform analysis using functional principal component decomposition (FPCD) performs better than measures that require manual ECG analysis with the human eye and also at least as well as a previously validated but more expensive approach based on cardiac magnetic resonance (CMR). Analyses are based on five-fold cross validation of areas under the curve (AUCs) for CRT response and survival time after the CRT implant using Cox proportional hazards regression with stratification of groups using a Gaussian mixture model approach. Furthermore, FPCD and CMR predictors are shown to be independent, which demonstrates that the FPCD electrical findings and the CMR mechanical findings together provide a synergistic model for response and survival after CRT. In summary, this study provides a highly effective approach to prognostication after CRT in HFrEF using an accessible and inexpensive diagnostic test with a major expected impact on personalization of therapies.
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Affiliation(s)
- Derek J Bivona
- Department of Medicine, University of Virginia Health System, Charlottesville, VA 22903, USA; Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22903, USA
| | - Sona Ghadimi
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22903, USA
| | - Yu Wang
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22903, USA
| | - Pim J A Oomen
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA 92697, USA
| | - Rohit Malhotra
- Department of Medicine, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - Andrew Darby
- Department of Medicine, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - J Michael Mangrum
- Department of Medicine, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - Pamela K Mason
- Department of Medicine, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - Sula Mazimba
- Advent Health Transplant Institute, AdventHealth, Orlando, FL 32804, USA
| | - Amit R Patel
- Department of Medicine, University of Virginia Health System, Charlottesville, VA 22903, USA; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22903, USA; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - Kenneth C Bilchick
- Department of Medicine, University of Virginia Health System, Charlottesville, VA 22903, USA.
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Zhu H, Miller EY, Lee W, Wilson RL, Neu CP. In vivo human knee varus-valgus loading apparatus for analysis of MRI-based intratissue strain and relaxometry. J Biomech 2024; 171:112171. [PMID: 38861862 DOI: 10.1016/j.jbiomech.2024.112171] [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: 08/31/2023] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/13/2024]
Abstract
The diagnosis of early-stage osteoarthritis remains as an unmet challenge in medicine and a roadblock to evaluating the efficacy of disease-modifying treatments. Recent studies demonstrate that unique patterns of intratissue cartilage deformation under cyclic loading can serve as potential biomarkers to detect early disease pathogenesis. However, a workflow to obtain deformation, strain maps, and quantitative MRI metrics due to the loading of articular cartilage in vivo has not been fully developed. In this study, we characterize and demonstrate an apparatus that is capable of applying a varus-valgus load to the human knee in vivo within an MRI environment to enable the measurement of cartilage structure and mechanical function. The apparatus was first tested in a lab environment, then the functionality and utility of the apparatus were examined during varus loading in a clinical 3T MRI system for human imaging. We found that the device enables quantitative MRI metrics for biomechanics and relaxometry data acquisition during joint loading leading to compression of the medial knee compartment. Integration with spiral DENSE MRI during cyclic loading provided time-dependent displacement and strain maps within the tibiofemoral cartilage. The results from these procedures demonstrate that the performance of this loading apparatus meets the design criteria and enables a simple and practical workflow for future studies of clinical cohorts, and the identification and validation of imaging-based biomechanical biomarkers.
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Affiliation(s)
- Hongtian Zhu
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Emily Y Miller
- Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, USA
| | - Woowon Lee
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Robert L Wilson
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Corey P Neu
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA; Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, USA; BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA.
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Xu K, Xu R, Xu HY, Xie LJ, Yang ZG, Fu H, Bai W, Zhang L, Zhou XY, Guo YK. Free-Breathing Compressed Sensing Cine Cardiac MRI for Assessment of Left Ventricular Strain by Feature Tracking in Children. J Magn Reson Imaging 2024; 59:1832-1840. [PMID: 37681476 DOI: 10.1002/jmri.29003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Cardiac MRI feature-tracking (FT) with breath-holding (BH) cine balanced steady state free precession (bSSFP) imaging is well established. It is unclear whether FT-strain measurements can be reliably derived from free-breathing (FB) compressed sensing (CS) bSSFP imaging. PURPOSE To compare left ventricular (LV) strain analysis and image quality of an FB CS bSSFP cine sequence with that of a conventional BH bSSFP sequence in children. STUDY TYPE Prospective. SUBJECTS 40 children able to perform BHs (cohort 1 [12.1 ± 2.2 years]) and 17 children unable to perform BHs (cohort 2 [5.2 ± 1.8 years]). FIELD STRENGTH/SEQUENCE 3T, bSSFP sequence with and without CS. ASSESSMENT Acquisition times and image quality were assessed. LV myocardial deformation parameters were compared between BH cine and FB CS cine studies in cohort 1. Strain indices and image quality of FB CS cine studies were also assessed in cohort 2. Intraobserver and interobserver variability of strain parameters was determined. STATISTICAL TESTS Paired t-test, Wilcoxon signed-rank test, intraclass correlation coefficient (ICC), and Bland-Altman analysis. A P-value <0.05 was considered statistically significant. RESULTS In cohort 1, the mean acquisition time of the FB CS cine study was significantly lower than for conventional BH cine study (15.6 s vs. 209.4 s). No significant difference were found in global circumferential strain rate (P = 0.089), global longitudinal strain rate (P = 0.366) and EuroCMR image quality scores (P = 0.128) between BH and FB sequences in cohort 1. The overall image quality score of FB CS cine in cohort 2 was 3.5 ± 0.5 with acquisition time of 14.7 ± 2.1 s. Interobserver and intraobserver variabilities were good to excellent (ICC = 0.810 to 0.943). DATA CONCLUSION FB CS cine imaging may be a promising alternative technique for strain assessment in pediatric patients with poor BH ability. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Ke Xu
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Rong Xu
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lin-Jun Xie
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Fu
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wei Bai
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lu Zhang
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiao-Yue Zhou
- Siemens Healthineers Digital Technology (Shanghai) Co., Ltd., Shanghai, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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Kar J, Cohen MV, McQuiston SA, Poorsala T, Malozzi CM. Automated segmentation of the left-ventricle from MRI with a fully convolutional network to investigate CTRCD in breast cancer patients. J Med Imaging (Bellingham) 2024; 11:024003. [PMID: 38510543 PMCID: PMC10950093 DOI: 10.1117/1.jmi.11.2.024003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/01/2022] [Indexed: 03/22/2024] Open
Abstract
Purpose: The goal of this study was to develop a fully convolutional network (FCN) tool to automatedly segment the left-ventricular (LV) myocardium in displacement encoding with stimulated echoes MRI. The segmentation results are used for LV chamber quantification and strain analyses in breast cancer patients susceptible to cancer therapy-related cardiac dysfunction (CTRCD). Approach: A DeepLabV3+ FCN with a ResNet-101 backbone was custom-designed to conduct chamber quantification on 45 female breast cancer datasets (23 training, 11 validation, and 11 test sets). LV structural parameters and LV ejection fraction (LVEF) were measured, and myocardial strains estimated with the radial point interpolation method. Myocardial classification validation was against quantization-based ground-truth with computations of accuracy, Dice score, average perpendicular distance (APD), Hausdorff-distance, and others. Additional validations were conducted with equivalence tests and Cronbach's alpha (C - α ) intraclass correlation coefficients between the FCN and a vendor tool on chamber quantification and myocardial strain computations. Results: Myocardial classification results against ground-truth were Dice = 0.89 , APD = 2.4 mm , and accuracy = 97 % for the validation set and Dice = 0.90 , APD = 2.5 mm , and accuracy = 97 % for the test set. The confidence intervals (CI) and two one-sided t-test results of equivalence tests between the FCN and vendor-tool were CI = - 1.36 % to 2.42%, p-value < 0.001 for LVEF (58 ± 5 % versus 57 ± 6 % ), and CI = - 0.71 % to 0.63%, p-value < 0.001 for longitudinal strain (- 15 ± 2 % versus - 15 ± 3 % ). Conclusions: The validation results were found equivalent to the vendor tool-based parameter estimates, which show that accurate LV chamber quantification followed by strain analysis for CTRCD investigation can be achieved with our proposed FCN methodology.
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Affiliation(s)
- Julia Kar
- University of South Alabama, Departments of Mechanical Engineering and Pharmacology, Alabama, United States
| | - Michael V. Cohen
- University of South Alabama, Department of Cardiology, College of Medicine, Alabama, United States
| | - Samuel A. McQuiston
- University of South Alabama, Department of Radiology, Alabama, United States
| | - Teja Poorsala
- University of South Alabama, Departments of Oncology and Hematology, Alabama, United States
| | - Christopher M. Malozzi
- University of South Alabama, Department of Cardiology, College of Medicine, Alabama, United States
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Morales FL, Bivona DJ, Abdi M, Malhotra R, Monfredi O, Darby A, Mason PK, Mangrum JM, Mazimba S, Stadler RW, Epstein FH, Bilchick KC, Oomen PJA. Noninvasive Electrical Mapping Compared with the Paced QRS Complex for Optimizing CRT Programmed Settings and Predicting Multidimensional Response. J Cardiovasc Transl Res 2023; 16:1448-1460. [PMID: 37674046 PMCID: PMC10721664 DOI: 10.1007/s12265-023-10418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/21/2023] [Indexed: 09/08/2023]
Abstract
The aim was to test the hypothesis that left ventricular (LV) and right ventricular (RV) activation from body surface electrical mapping (CardioInsight 252-electrode vest, Medtronic) identifies optimal cardiac resynchronization therapy (CRT) pacing strategies and outcomes in 30 patients. The LV80, RV80, and BIV80 were defined as the times to 80% LV, RV, or biventricular electrical activation. Smaller differences in the LV80 and RV80 (|LV80-RV80|) with synchronized LV pacing predicted better LV function post-CRT (p = 0.0004) than the LV-paced QRS duration (p = 0.32). Likewise, a lower RV80 was associated with a better pre-CRT RV ejection fraction by CMR (r = - 0.40, p = 0.04) and predicted post-CRT improvements in myocardial oxygen uptake (p = 0.01) better than the biventricular-paced QRS (p = 0.38), while a lower LV80 with BIV pacing predicted lower post-CRT B-type natriuretic peptide (BNP) (p = 0.02). RV pacing improved LV function with smaller |LV80-RV80| (p = 0.009). In conclusion, 3-D electrical mapping predicted favorable post-CRT outcomes and informed effective pacing strategies.
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Affiliation(s)
- Frances L Morales
- University of Virginia Health System, Charlottesville, VA, 22901, USA
| | - Derek J Bivona
- University of Virginia Health System, Charlottesville, VA, 22901, USA
| | - Mohamad Abdi
- University of Virginia Health System, Charlottesville, VA, 22901, USA
| | - Rohit Malhotra
- University of Virginia Health System, Charlottesville, VA, 22901, USA
| | - Oliver Monfredi
- University of Virginia Health System, Charlottesville, VA, 22901, USA
| | - Andrew Darby
- University of Virginia Health System, Charlottesville, VA, 22901, USA
| | - Pamela K Mason
- University of Virginia Health System, Charlottesville, VA, 22901, USA
| | - J Michael Mangrum
- University of Virginia Health System, Charlottesville, VA, 22901, USA
| | - Sula Mazimba
- University of Virginia Health System, Charlottesville, VA, 22901, USA
| | | | | | | | - Pim J A Oomen
- Department of Biomedical Engineeering, Edwards Lifesciences Foundation Cardiovascular Innovation and Research Center, University of California, Irvine, Irvine, CA, USA
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Sillanmäki S, Vainio HL, Ylä-Herttuala E, Husso M, Hedman M. Measuring Cardiac Dyssynchrony with DENSE (Displacement Encoding with Stimulated Echoes)-A Systematic Review. Rev Cardiovasc Med 2023; 24:261. [PMID: 39076380 PMCID: PMC11270089 DOI: 10.31083/j.rcm2409261] [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: 05/07/2023] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 07/31/2024] Open
Abstract
Background In this review, we introduce the displacement encoding with stimulated echoes (DENSE) method for measuring myocardial dyssynchrony using cardiovascular magnetic resonance (CMR) imaging. We provide an overview of research findings related to DENSE from the past two decades and discuss other techniques used for dyssynchrony evaluation. Additionally, the review discusses the potential uses of DENSE in clinical practice. Methods A search was conducted to identify relevant articles published from January 2000 through January 2023 using the Scopus, Web of Science, PubMed and Cochrane databases. The following search term was used: (DENSE OR 'displacement encoding with stimulated echoes' OR CURE) AND (dyssynchrony* OR asynchron* OR synchron*) AND (MRI OR 'magnetic resonance' OR CMR). Results After removing duplicates, researchers screened a total of 174 papers. Papers that were not related to the topic, reviews, general overview articles and case reports were excluded, leaving 35 articles for further analysis. Of these, 14 studies focused on cardiac dyssynchrony estimation with DENSE, while the remaining 21 studies served as background material. The studies used various methods for presenting synchronicity, such as circumferential uniformity ratio estimate (CURE), CURE-singular value decomposition (SVD), radial uniformity ratio estimate (RURE), longitudinal uniformity ratio estimate (LURE), time to onset of shortening (TOS) and dyssynchrony index (DI). Most of the dyssynchrony studies concentrated on human heart failure, but congenital heart diseases and obesity were also evaluated. The researchers found that DENSE demonstrated high reproducibility and was found useful for detecting cardiac resynchronisation therapy (CRT) responders, optimising CRT device settings and assessing right ventricle synchronicity. In addition, studies showed a correlation between cardiac fibrosis and mechanical dyssynchrony in humans, as well as a decrease in the synchrony of contraction in the left ventricle in obese mice. Conclusions DENSE shows promise as a tool for quantifying myocardial function and dyssynchrony, with advantages over other cardiac dyssynchrony evaluation methods. However, there remain challenges related to DENSE due to the relatively time-consuming imaging and analysis process. Improvements in imaging and analysing technology, as well as possible artificial intelligence solutions, may help overcome these challenges and lead to more widespread clinical use of DENSE.
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Affiliation(s)
- Saara Sillanmäki
- Institute of Medicine, University of Eastern Finland, 70210 Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Hanna-Liina Vainio
- Institute of Medicine, University of Eastern Finland, 70210 Kuopio, Finland
| | - Elias Ylä-Herttuala
- Diagnostic Imaging Center, Kuopio University Hospital, 70029 Kuopio, Finland
- A.I. Virtanen Institute, University of Eastern Finland, 70210 Kuopio, Finland
| | - Minna Husso
- Diagnostic Imaging Center, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Marja Hedman
- Institute of Medicine, University of Eastern Finland, 70210 Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, 70029 Kuopio, Finland
- Heart Center, Kuopio University Hospital, 70029 Kuopio, Finland
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7
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Lee W, Miller EY, Zhu H, Schneider SE, Reiter DA, Neu CP. Multi-frame biomechanical and relaxometry analysis during in vivo loading of the human knee by spiral dualMRI and compressed sensing. Magn Reson Med 2023; 90:995-1009. [PMID: 37213087 PMCID: PMC10330244 DOI: 10.1002/mrm.29690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Knee cartilage experiences repetitive loading during physical activities, which is altered during the pathogenesis of diseases like osteoarthritis. Analyzing the biomechanics during motion provides a clear understanding of the dynamics of cartilage deformation and may establish essential imaging biomarkers of early-stage disease. However, in vivo biomechanical analysis of cartilage during rapid motion is not well established. METHODS We used spiral displacement encoding with stimulated echoes (DENSE) MRI on in vivo human tibiofemoral cartilage during cyclic varus loading (0.5 Hz) and used compressed sensing on the k-space data. The applied compressive load was set for each participant at 0.5 times body weight on the medial condyle. Relaxometry methods were measured on the cartilage before (T1ρ , T2 ) and after (T1ρ ) varus load. RESULTS Displacement and strain maps showed a gradual shift of displacement and strain in time. Compressive strain was observed in the medial condyle cartilage and shear strain was roughly half of the compressive strain. Male participants had more displacement in the loading direction compared to females, and T1ρ values did not change after cyclic varus load. Compressed sensing reduced the scanning time up to 25% to 40% when comparing the displacement maps and substantially lowered the noise levels. CONCLUSION These results demonstrated the ease of which spiral DENSE MRI could be applied to clinical studies because of the shortened imaging time, while quantifying realistic cartilage deformations that occur through daily activities and that could serve as biomarkers of early osteoarthritis.
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Affiliation(s)
- Woowon Lee
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Emily Y. Miller
- Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, USA
| | - Hongtian Zhu
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Stephanie E. Schneider
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - David A. Reiter
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Corey P. Neu
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
- Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA
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Wang Y, Sun C, Ghadimi S, Auger DC, Croisille P, Viallon M, Mangion K, Berry C, Haggerty CM, Jing L, Fornwalt BK, Cao JJ, Cheng J, Scott AD, Ferreira PF, Oshinski JN, Ennis DB, Bilchick KC, Epstein FH. StrainNet: Improved Myocardial Strain Analysis of Cine MRI by Deep Learning from DENSE. Radiol Cardiothorac Imaging 2023; 5:e220196. [PMID: 37404792 PMCID: PMC10316292 DOI: 10.1148/ryct.220196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/16/2023] [Accepted: 03/15/2023] [Indexed: 07/06/2023]
Abstract
Purpose To develop a three-dimensional (two dimensions + time) convolutional neural network trained with displacement encoding with stimulated echoes (DENSE) data for displacement and strain analysis of cine MRI. Materials and Methods In this retrospective multicenter study, a deep learning model (StrainNet) was developed to predict intramyocardial displacement from contour motion. Patients with various heart diseases and healthy controls underwent cardiac MRI examinations with DENSE between August 2008 and January 2022. Network training inputs were a time series of myocardial contours from DENSE magnitude images, and ground truth data were DENSE displacement measurements. Model performance was evaluated using pixelwise end-point error (EPE). For testing, StrainNet was applied to contour motion from cine MRI. Global and segmental circumferential strain (Ecc) derived from commercial feature tracking (FT), StrainNet, and DENSE (reference) were compared using intraclass correlation coefficients (ICCs), Pearson correlations, Bland-Altman analyses, paired t tests, and linear mixed-effects models. Results The study included 161 patients (110 men; mean age, 61 years ± 14 [SD]), 99 healthy adults (44 men; mean age, 35 years ± 15), and 45 healthy children and adolescents (21 males; mean age, 12 years ± 3). StrainNet showed good agreement with DENSE for intramyocardial displacement, with an average EPE of 0.75 mm ± 0.35. The ICCs between StrainNet and DENSE and FT and DENSE were 0.87 and 0.72, respectively, for global Ecc and 0.75 and 0.48, respectively, for segmental Ecc. Bland-Altman analysis showed that StrainNet had better agreement than FT with DENSE for global and segmental Ecc. Conclusion StrainNet outperformed FT for global and segmental Ecc analysis of cine MRI.Keywords: Image Postprocessing, MR Imaging, Cardiac, Heart, Pediatrics, Technical Aspects, Technology Assessment, Strain, Deep Learning, DENSE Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Yu Wang
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Changyu Sun
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Sona Ghadimi
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Daniel C. Auger
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Pierre Croisille
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Magalie Viallon
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Kenneth Mangion
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Colin Berry
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Christopher M. Haggerty
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Linyuan Jing
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Brandon K. Fornwalt
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - J. Jane Cao
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Joshua Cheng
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Andrew D. Scott
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Pedro F. Ferreira
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - John N. Oshinski
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Daniel B. Ennis
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Kenneth C. Bilchick
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
| | - Frederick H. Epstein
- From the Department of Biomedical Engineering, University of
Virginia, Biomedical Engineering and Medical Science Building, Room 2013, MR5,
Charlottesville, VA 22903 (Y.W., C.S., S.G., D.C.A., F.H.E.); Department of
Biomedical, Biological and Chemical Engineering and Department of Radiology,
University of Missouri, Columbia, Mo (C.S.); Department of Radiology, University
Hospital of Saint Etienne, Saint Etienne, France (P.C.); CREATIS (UMR CNRS 5220,
U1206 INSERM), INSA Lyon, Lyon, France (P.C., M.V.); BHF Glasgow Cardiovascular
Research Centre, University of Glasgow, Glasgow, Scotland (K.M., C.B.);
Department of Translational Data Science and Informatics, Geisinger Health
System, Danville, Pa (C.M.H., L.J., B.K.F.); Cardiovascular Research Center,
University of Kentucky, Lexington, Ky (C.M.H., L.J., B.K.F.); The Heart Center,
St Francis Hospital, Roslyn, NY (J.J.C., J.C.); Cardiovascular Magnetic
Resonance Unit, The Royal Brompton Hospital and National Heart and Lung
Institute, Imperial College London, London, England (A.D.S., P.F.F.); Department
of Radiology & Imaging Sciences and Biomedical Engineering, Emory
University, Atlanta, Ga (J.N.O.); Department of Radiology, Stanford University,
Stanford, Calif (D.B.E.); Department of Medicine (K.C.B.) and Department of
Radiology and Medical Imaging (F.H.E.), University of Virginia Health System,
Charlottesville, Va
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9
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Abdi M, Bilchick KC, Epstein FH. Compensation for respiratory motion-induced signal loss and phase corruption in free-breathing self-navigated cine DENSE using deep learning. Magn Reson Med 2023; 89:1975-1989. [PMID: 36602032 PMCID: PMC9992273 DOI: 10.1002/mrm.29582] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/25/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE To introduce a model that describes the effects of rigid translation due to respiratory motion in displacement encoding with stimulated echoes (DENSE) and to use the model to develop a deep convolutional neural network to aid in first-order respiratory motion compensation for self-navigated free-breathing cine DENSE of the heart. METHODS The motion model includes conventional position shifts of magnetization and further describes the phase shift of the stimulated echo due to breathing. These image-domain effects correspond to linear and constant phase errors, respectively, in k-space. The model was validated using phantom experiments and Bloch-equation simulations and was used along with the simulation of respiratory motion to generate synthetic images with phase-shift artifacts to train a U-Net, DENSE-RESP-NET, to perform motion correction. DENSE-RESP-NET-corrected self-navigated free-breathing DENSE was evaluated in human subjects through comparisons with signal averaging, uncorrected self-navigated free-breathing DENSE, and breath-hold DENSE. RESULTS Phantom experiments and Bloch-equation simulations showed that breathing-induced constant phase errors in segmented DENSE leads to signal loss in magnitude images and phase corruption in phase images of the stimulated echo, and that these artifacts can be corrected using the known respiratory motion and the model. For self-navigated free-breathing DENSE where the respiratory motion is not known, DENSE-RESP-NET corrected the signal loss and phase-corruption artifacts and provided reliable strain measurements for systolic and diastolic parameters. CONCLUSION DENSE-RESP-NET is an effective method to correct for breathing-associated constant phase errors. DENSE-RESP-NET used in concert with self-navigation methods provides reliable free-breathing DENSE myocardial strain measurement.
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Affiliation(s)
- Mohamad Abdi
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia
| | - Kenneth C. Bilchick
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Frederick H. Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia
- Department of Radiology, University of Virginia Health System, Charlottesville, Virginia
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10
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Kar J, Cohen MV, McQuiston SA, Malozzi CM. Can global longitudinal strain (GLS) with magnetic resonance prognosticate early cancer therapy-related cardiac dysfunction (CTRCD) in breast cancer patients, a prospective study? Magn Reson Imaging 2023; 97:68-81. [PMID: 36581216 PMCID: PMC10292191 DOI: 10.1016/j.mri.2022.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE To determine if Artificial Intelligence-based computation of global longitudinal strain (GLS) from left ventricular (LV) MRI is an early prognostic factor of cancer therapy-related cardiac dysfunction (CTRCD) in breast cancer patients. The main hypothesis based on the patients receiving antineoplastic chemotherapy treatment was CTRCD risk analysis with GLS that was independent of LV ejection fraction (LVEF). METHODS Displacement Encoding with Stimulated Echoes (DENSE) MRI was acquired on 32 breast cancer patients at baseline and 3- and 6-month follow-ups after chemotherapy. Two DeepLabV3+ Fully Convolutional Networks (FCNs) were deployed to automate image segmentation for LV chamber quantification and phase-unwrapping for 3D strains, computed with the Radial Point Interpolation Method. CTRCD risk (cardiotoxicity and adverse cardiac events) was analyzed with Cox Proportional Hazards (PH) models with clinical and contractile prognostic factors. RESULTS GLS worsened from baseline to the 3- and 6-month follow-ups (-19.1 ± 2.1%, -16.0 ± 3.1%, -16.1 ± 3.0%; P < 0.001). Univariable Cox regression showed the 3-month GLS significantly associated as an agonist (hazard ratio [HR]-per-SD: 2.1; 95% CI: 1.4-3.1; P < 0.001) and LVEF as a protector (HR-per-SD: 0.8; 95% CI: 0.7-0.9; P = 0.001) for CTRCD occurrence. Bivariable regression showed the 3-month GLS (HR-per-SD: 2.0; 95% CI: 1.2-3.4; P = 0.01) as a CTRCD prognostic factor independent of other covariates, including LVEF (HR-per-SD: 1.0; 95% CI: 0.9-1.2; P = 0.9). CONCLUSIONS The end-point analyses proved the hypothesis that GLS is an early, independent prognosticator of incident CTRCD risk. This novel GLS-guided approach to CTRCD risk analysis could improve antineoplastic treatment with further validation in a larger clinical trial.
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Affiliation(s)
- Julia Kar
- Departments of Mechanical Engineering and Pharmacology, University of South Alabama, 150 Jaguar Drive, Mobile, AL 36688, USA.
| | - Michael V Cohen
- Division of Cardiology, Department of Medicine, University Hospital, 2451 USA Medical Center Drive, Mobile, AL 36617, USA; Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, 5851 USA Dr N, Mobile, AL 36688, USA
| | - Samuel A McQuiston
- Department of Radiology, University Hospital, 2451 USA Medical Center Drive, Mobile, AL 36617, USA
| | - Christopher M Malozzi
- Division of Cardiology, Department of Medicine, University Hospital, 2451 USA Medical Center Drive, Mobile, AL 36617, USA
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11
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Barbaroux H, Kunze KP, Neji R, Nazir MS, Pennell DJ, Nielles-Vallespin S, Scott AD, Young AA. Automated segmentation of long and short axis DENSE cardiovascular magnetic resonance for myocardial strain analysis using spatio-temporal convolutional neural networks. J Cardiovasc Magn Reson 2023; 25:16. [PMID: 36991474 PMCID: PMC10061808 DOI: 10.1186/s12968-023-00927-y] [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: 11/03/2022] [Accepted: 02/01/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Cine Displacement Encoding with Stimulated Echoes (DENSE) facilitates the quantification of myocardial deformation, by encoding tissue displacements in the cardiovascular magnetic resonance (CMR) image phase, from which myocardial strain can be estimated with high accuracy and reproducibility. Current methods for analyzing DENSE images still heavily rely on user input, making this process time-consuming and subject to inter-observer variability. The present study sought to develop a spatio-temporal deep learning model for segmentation of the left-ventricular (LV) myocardium, as spatial networks often fail due to contrast-related properties of DENSE images. METHODS 2D + time nnU-Net-based models have been trained to segment the LV myocardium from DENSE magnitude data in short- and long-axis images. A dataset of 360 short-axis and 124 long-axis slices was used to train the networks, from a combination of healthy subjects and patients with various conditions (hypertrophic and dilated cardiomyopathy, myocardial infarction, myocarditis). Segmentation performance was evaluated using ground-truth manual labels, and a strain analysis using conventional methods was performed to assess strain agreement with manual segmentation. Additional validation was performed using an externally acquired dataset to compare the inter- and intra-scanner reproducibility with respect to conventional methods. RESULTS Spatio-temporal models gave consistent segmentation performance throughout the cine sequence, while 2D architectures often failed to segment end-diastolic frames due to the limited blood-to-myocardium contrast. Our models achieved a DICE score of 0.83 ± 0.05 and a Hausdorff distance of 4.0 ± 1.1 mm for short-axis segmentation, and 0.82 ± 0.03 and 7.9 ± 3.9 mm respectively for long-axis segmentations. Strain measurements obtained from automatically estimated myocardial contours showed good to excellent agreement with manual pipelines, and remained within the limits of inter-user variability estimated in previous studies. CONCLUSION Spatio-temporal deep learning shows increased robustness for the segmentation of cine DENSE images. It provides excellent agreement with manual segmentation for strain extraction. Deep learning will facilitate the analysis of DENSE data, bringing it one step closer to clinical routine.
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Affiliation(s)
- Hugo Barbaroux
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), London, UK.
| | - Karl P Kunze
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
| | - Radhouene Neji
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
| | - Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sonia Nielles-Vallespin
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew D Scott
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alistair A Young
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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12
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Ghadimi S, Abdi M, Epstein FH. Improved computation of Lagrangian tissue displacement and strain for cine DENSE MRI using a regularized spatiotemporal least squares method. Front Cardiovasc Med 2023; 10:1095159. [PMID: 37008315 PMCID: PMC10061004 DOI: 10.3389/fcvm.2023.1095159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/06/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionIn displacement encoding with stimulated echoes (DENSE), tissue displacement is encoded in the signal phase such that the phase of each pixel in space and time provides an independent measurement of absolute tissue displacement. Previously for DENSE, estimation of Lagrangian displacement used two steps: first a spatial interpolation and, second, least squares fitting through time to a Fourier or polynomial model. However, there is no strong rationale for such a through-time model,MethodsTo compute the Lagrangian displacement field from DENSE phase data, a minimization problem is introduced to enforce fidelity with the acquired Eulerian displacement data while simultaneously providing model-independent regularization in space and time, enforcing only spatiotemporal smoothness. A regularized spatiotemporal least squares (RSTLS) method is used to solve the minimization problem, and RSTLS was tested using two-dimensional DENSE data from 71 healthy volunteers.ResultsThe mean absolute percent error (MAPE) between the Lagrangian displacements and the corresponding Eulerian displacements was significantly lower for the RSTLS method vs. the two-step method for both x- and y-directions (0.73±0.59 vs 0.83 ±0.1, p < 0.05) and (0.75±0.66 vs 0.82 ±0.1, p < 0.05), respectively. Also, peak early diastolic strain rate (PEDSR) was higher (1.81±0.58 (s-1) vs. 1.56±0. 63 (s-1), p<0.05) and the strain rate during diastasis was lower (0.14±0.18 (s-1) vs 0.35±0.2 (s-1), p < 0.05) for the RSTLS vs. the two-step method, with the former suggesting that the two-step method was over-regularized.DiscussionThe proposed RSTLS method provides more realistic measurements of Lagrangian displacement and strain from DENSE images without imposing arbitrary motion models.
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13
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Lee W, Miller EY, Zhu H, Luetkemeyer CM, Schneider SE, Neu CP. High frame rate deformation analysis of knee cartilage by spiral dualMRI and relaxation mapping. Magn Reson Med 2023; 89:694-709. [PMID: 36300860 PMCID: PMC10017275 DOI: 10.1002/mrm.29487] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Daily activities including walking impose high-frequency cyclic forces on cartilage and repetitive compressive deformation. Analyzing cartilage deformation during walking would provide spatial maps of displacement and strain and enable viscoelastic characterization, which may serve as imaging biomarkers for early cartilage degeneration when the damage is still reversible. However, the time-dependent biomechanics of cartilage is not well described, and how defects in the joint impact the viscoelastic response is unclear. METHODS We used spiral acquisition with displacement-encoding MRI to quantify displacement and strain maps at a high frame rate (25 frames/s) in tibiofemoral joints. We also employed relaxometry methods (T1 , T1ρ , T2 , T2 *) on the cartilage. RESULTS Normal and shear strains were concentrated on the bovine tibiofemoral contact area during loading, and the defected joint exhibited larger compressive strains. We also determined a positive correlation between the change of T1ρ in cartilage after cyclic loading and increased compressive strain on the defected joint. Viscoelastic behavior was quantified by the time-dependent displacement, where the damaged joint showed increased creep behavior compared to the intact joint. This technique was also successfully demonstrated on an in vivo human knee showing the gradual change of displacement during varus load. CONCLUSION Our results indicate that spiral scanning with displacement encoding can quantitatively differentiate the damaged from intact joint using the strain and creep response. The viscoelastic response identified with this methodology could serve as biomarkers to detect defects in joints in vivo and facilitate the early diagnosis of joint diseases such as osteoarthritis.
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Affiliation(s)
- Woowon Lee
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Emily Y. Miller
- Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, USA
| | - Hongtian Zhu
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Callan M. Luetkemeyer
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Stephanie E. Schneider
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Corey P. Neu
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
- Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA
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14
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Scott AD, Jackson T, Khalique Z, Gorodezky M, Pardoe B, Begum L, Bruno VD, Chowdhury RA, Ferreira PF, Nielles‐Vallespin S, Roehl M, McCarthy KP, Sarathchandra P, Rose JN, Doorly DJ, Pennell DJ, Ascione R, de Silva R, Firmin DN. Development of a cardiovascular magnetic resonance-compatible large animal isolated heart model for direct comparison of beating and arrested hearts. NMR IN BIOMEDICINE 2022; 35:e4692. [PMID: 35040195 PMCID: PMC9286060 DOI: 10.1002/nbm.4692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/21/2021] [Accepted: 01/07/2022] [Indexed: 06/02/2023]
Abstract
Cardiac motion results in image artefacts and quantification errors in many cardiovascular magnetic resonance (CMR) techniques, including microstructural assessment using diffusion tensor cardiovascular magnetic resonance (DT-CMR). Here, we develop a CMR-compatible isolated perfused porcine heart model that allows comparison of data obtained in beating and arrested states. Ten porcine hearts (8/10 for protocol optimisation) were harvested using a donor heart retrieval protocol and transported to the remote CMR facility. Langendorff perfusion in a 3D-printed chamber and perfusion circuit re-established contraction. Hearts were imaged using cine, parametric mapping and STEAM DT-CMR at cardiac phases with the minimum and maximum wall thickness. High potassium and lithium perfusates were then used to arrest the heart in a slack and contracted state, respectively. Imaging was repeated in both arrested states. After imaging, tissue was removed for subsequent histology in a location matched to the DT-CMR data using fiducial markers. Regular sustained contraction was successfully established in six out of 10 hearts, including the final five hearts. Imaging was performed in four hearts and one underwent the full protocol, including colocalised histology. The image quality was good and there was good agreement between DT-CMR data in equivalent beating and arrested states. Despite the use of autologous blood and dextran within the perfusate, T2 mapping results, DT-CMR measures and an increase in mass were consistent with development of myocardial oedema, resulting in failure to achieve a true diastolic-like state. A contiguous stack of 313 5-μm histological sections at and a 100-μm thick section showing cell morphology on 3D fluorescent confocal microscopy colocalised to DT-CMR data were obtained. A CMR-compatible isolated perfused beating heart setup for large animal hearts allows direct comparisons of beating and arrested heart data with subsequent colocalised histology, without the need for onsite preclinical facilities.
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Affiliation(s)
- Andrew D. Scott
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Tim Jackson
- Department of PerfusionRoyal Brompton HospitalLondonUK
| | - Zohya Khalique
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Margarita Gorodezky
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Ben Pardoe
- Department of PerfusionRoyal Brompton HospitalLondonUK
| | - Lale Begum
- Department of PerfusionRoyal Brompton HospitalLondonUK
| | - V. Domenico Bruno
- Translational Biomedical Research CentreUniversity of BristolBristolUK
- Bristol Heart InstituteUniversity Hospital Bristol NHS Foundation TrustBristolUK
| | - Rasheda A. Chowdhury
- National Heart and Lung InstituteImperial CollegeLondonUK
- Imperial Centre for Cardiac EngineeringImperial CollegeLondonUK
| | - Pedro F. Ferreira
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Sonia Nielles‐Vallespin
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Malte Roehl
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | | | - Padmini Sarathchandra
- National Heart and Lung InstituteImperial CollegeLondonUK
- Magdi Yacoub Institute, National Heart and Lung InstituteImperial CollegeLondonUK
| | - Jan N. Rose
- Department of AeronauticsImperial CollegeLondonUK
| | | | - Dudley J. Pennell
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Raimondo Ascione
- Translational Biomedical Research CentreUniversity of BristolBristolUK
- Bristol Heart InstituteUniversity Hospital Bristol NHS Foundation TrustBristolUK
| | - Ranil de Silva
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - David N. Firmin
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
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15
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Rajiah PS, Kalisz K, Broncano J, Goerne H, Collins JD, François CJ, Ibrahim ES, Agarwal PP. Myocardial Strain Evaluation with Cardiovascular MRI: Physics, Principles, and Clinical Applications. Radiographics 2022; 42:968-990. [PMID: 35622493 DOI: 10.1148/rg.210174] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Myocardial strain is a measure of myocardial deformation, which is a more sensitive imaging biomarker of myocardial disease than the commonly used ventricular ejection fraction. Although myocardial strain is commonly evaluated by using speckle-tracking echocardiography, cardiovascular MRI (CMR) is increasingly performed for this purpose. The most common CMR technique is feature tracking (FT), which involves postprocessing of routinely acquired cine MR images. Other CMR strain techniques require dedicated sequences, including myocardial tagging, strain-encoded imaging, displacement encoding with stimulated echoes, and tissue phase mapping. The complex systolic motion of the heart can be resolved into longitudinal strain, circumferential strain, radial strain, and torsion. Myocardial strain metrics include strain, strain rate, displacement, velocity, torsion, and torsion rate. Wide variability exists in the reference ranges for strain dependent on the imaging technique, analysis software, operator, patient demographics, and hemodynamic factors. In anticancer therapy cardiotoxicity, CMR myocardial strain can help identify left ventricular dysfunction before the decline of ejection fraction. CMR myocardial strain is also valuable for identifying patients with left ventricle dyssynchrony who will benefit from cardiac resynchronization therapy. CMR myocardial strain is also useful in ischemic heart disease, cardiomyopathies, pulmonary hypertension, and congenital heart disease. The authors review the physics, principles, and clinical applications of CMR strain techniques. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Prabhakar Shantha Rajiah
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
| | - Kevin Kalisz
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
| | - Jordi Broncano
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
| | - Harold Goerne
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
| | - Jeremy D Collins
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
| | - Christopher J François
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
| | - El-Sayed Ibrahim
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
| | - Prachi P Agarwal
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
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Bivona DJ, Tallavajhala S, Abdi M, Oomen PJ, Gao X, Malhotra R, Darby AE, Monfredi OJ, Mangrum JM, Mason PK, Mazimba S, Salerno M, Kramer CM, Epstein FH, Holmes JW, Bilchick KC. Machine learning for multidimensional response and survival after cardiac resynchronization therapy using features from cardiac magnetic resonance. Heart Rhythm O2 2022; 3:542-552. [PMID: 36340495 PMCID: PMC9626744 DOI: 10.1016/j.hroo.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) response is complex, and better approaches are required to predict survival and need for advanced therapies. Objective The objective was to use machine learning to characterize multidimensional CRT response and its relationship with long-term survival. Methods Associations of 39 baseline features (including cardiac magnetic resonance [CMR] findings and clinical parameters such as glomerular filtration rate [GFR]) with a multidimensional CRT response vector (consisting of post-CRT left ventricular end-systolic volume index [LVESVI] fractional change, post-CRT B-type natriuretic peptide, and change in peak VO2) were evaluated. Machine learning generated response clusters, and cross-validation assessed associations of clusters with 4-year survival. Results Among 200 patients (median age 67.4 years, 27.0% women) with CRT and CMR, associations with more than 1 response parameter were noted for the CMR CURE-SVD dyssynchrony parameter (associated with post-CRT brain natriuretic peptide [BNP] and LVESVI fractional change) and GFR (associated with peak VO2 and post-CRT BNP). Machine learning defined 3 response clusters: cluster 1 (n = 123, 90.2% survival [best]), cluster 2 (n = 45, 60.0% survival [intermediate]), and cluster 3 (n = 32, 34.4% survival [worst]). Adding the 6-month response cluster to baseline features improved the area under the receiver operating characteristic curve for 4-year survival from 0.78 to 0.86 (P = .02). A web-based application was developed for cluster determination in future patients. Conclusion Machine learning characterizes distinct CRT response clusters influenced by CMR features, kidney function, and other factors. These clusters have a strong and additive influence on long-term survival relative to baseline features.
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Nita N, Kersten J, Pott A, Weber F, Tesfay T, Benea MT, Metze P, Li H, Rottbauer W, Rasche V, Buckert D. Real-Time Spiral CMR Is Superior to Conventional Segmented Cine-Imaging for Left-Ventricular Functional Assessment in Patients with Arrhythmia. J Clin Med 2022; 11:jcm11082088. [PMID: 35456181 PMCID: PMC9025940 DOI: 10.3390/jcm11082088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Segmented Cartesian Cardiovascular magnetic resonance (CMR) often fails to deliver robust assessment of cardiac function in patients with arrhythmia. We aimed to assess the performance of a tiny golden-angle spiral real-time CMR sequence at 1.5 T for left-ventricular (LV) volumetry in patients with irregular heart rhythm; (2) Methods: We validated the real-time sequence against the standard breath-hold segmented Cartesian sequence in 32 patients, of whom 11 presented with arrhythmia. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) were assessed. In arrhythmic patients, real-time and standard Cartesian acquisitions were compared against a reference echocardiographic modality; (3) Results: In patients with sinus rhythm, good agreements and correlations were found between the segmented and real-time methods, with only minor, non-significant underestimation of EDV for the real-time sequence (135.95 ± 30 mL vs. 137.15 ± 31, p = 0.164). In patients with arrhythmia, spiral real-time CMR yielded superior image quality to the conventional segmented imaging, allowing for excellent agreement with the reference echocardiographic volumetry. In contrast, in this cohort, standard Cartesian CMR showed significant underestimation of LV-ESV (106.72 ± 63.51 mL vs. 125.47 ± 72.41 mL, p = 0.026) and overestimation of LVEF (42.96 ± 10.81% vs. 39.02 ± 11.72%, p = 0.039); (4) Conclusions: Real-time spiral CMR improves image quality in arrhythmic patients, allowing reliable assessment of LV volumetry.
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Affiliation(s)
- Nicoleta Nita
- Department of Internal Medicine II, University Medical Center, 89081 Ulm, Germany; (J.K.); (A.P.); (F.W.); (T.T.); (P.M.); (H.L.); (W.R.); (V.R.); (D.B.)
- Correspondence:
| | - Johannes Kersten
- Department of Internal Medicine II, University Medical Center, 89081 Ulm, Germany; (J.K.); (A.P.); (F.W.); (T.T.); (P.M.); (H.L.); (W.R.); (V.R.); (D.B.)
| | - Alexander Pott
- Department of Internal Medicine II, University Medical Center, 89081 Ulm, Germany; (J.K.); (A.P.); (F.W.); (T.T.); (P.M.); (H.L.); (W.R.); (V.R.); (D.B.)
| | - Fabian Weber
- Department of Internal Medicine II, University Medical Center, 89081 Ulm, Germany; (J.K.); (A.P.); (F.W.); (T.T.); (P.M.); (H.L.); (W.R.); (V.R.); (D.B.)
| | - Temsgen Tesfay
- Department of Internal Medicine II, University Medical Center, 89081 Ulm, Germany; (J.K.); (A.P.); (F.W.); (T.T.); (P.M.); (H.L.); (W.R.); (V.R.); (D.B.)
| | | | - Patrick Metze
- Department of Internal Medicine II, University Medical Center, 89081 Ulm, Germany; (J.K.); (A.P.); (F.W.); (T.T.); (P.M.); (H.L.); (W.R.); (V.R.); (D.B.)
| | - Hao Li
- Department of Internal Medicine II, University Medical Center, 89081 Ulm, Germany; (J.K.); (A.P.); (F.W.); (T.T.); (P.M.); (H.L.); (W.R.); (V.R.); (D.B.)
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Medical Center, 89081 Ulm, Germany; (J.K.); (A.P.); (F.W.); (T.T.); (P.M.); (H.L.); (W.R.); (V.R.); (D.B.)
| | - Volker Rasche
- Department of Internal Medicine II, University Medical Center, 89081 Ulm, Germany; (J.K.); (A.P.); (F.W.); (T.T.); (P.M.); (H.L.); (W.R.); (V.R.); (D.B.)
| | - Dominik Buckert
- Department of Internal Medicine II, University Medical Center, 89081 Ulm, Germany; (J.K.); (A.P.); (F.W.); (T.T.); (P.M.); (H.L.); (W.R.); (V.R.); (D.B.)
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Auger DA, Ghadimi S, Cai X, Reagan CE, Sun C, Abdi M, Cao JJ, Cheng JY, Ngai N, Scott AD, Ferreira PF, Oshinski JN, Emamifar N, Ennis DB, Loecher M, Liu ZQ, Croisille P, Viallon M, Bilchick KC, Epstein FH. Reproducibility of global and segmental myocardial strain using cine DENSE at 3 T: a multicenter cardiovascular magnetic resonance study in healthy subjects and patients with heart disease. J Cardiovasc Magn Reson 2022. [PMID: 35369885 DOI: 10.1186/s12968-022-00851-7/figures/6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND While multiple cardiovascular magnetic resonance (CMR) methods provide excellent reproducibility of global circumferential and global longitudinal strain, achieving highly reproducible segmental strain is more challenging. Previous single-center studies have demonstrated excellent reproducibility of displacement encoding with stimulated echoes (DENSE) segmental circumferential strain. The present study evaluated the reproducibility of DENSE for measurement of whole-slice or global circumferential (Ecc), longitudinal (Ell) and radial (Err) strain, torsion, and segmental Ecc at multiple centers. METHODS Six centers participated and a total of 81 subjects were studied, including 60 healthy subjects and 21 patients with various types of heart disease. CMR utilized 3 T scanners, and cine DENSE images were acquired in three short-axis planes and in the four-chamber long-axis view. During one imaging session, each subject underwent two separate DENSE scans to assess inter-scan reproducibility. Each subject was taken out of the scanner and repositioned between the scans. Intra-user, inter-user-same-site, inter-user-different-site, and inter-user-Human-Deep-Learning (DL) comparisons assessed the reproducibility of different users analyzing the same data. Inter-scan comparisons assessed the reproducibility of DENSE from scan to scan. The reproducibility of whole-slice or global Ecc, Ell and Err, torsion, and segmental Ecc were quantified using Bland-Altman analysis, the coefficient of variation (CV), and the intraclass correlation coefficient (ICC). CV was considered excellent for CV ≤ 10%, good for 10% < CV ≤ 20%, fair for 20% < CV ≤ 40%, and poor for CV > 40. ICC values were considered excellent for ICC > 0.74, good for ICC 0.6 < ICC ≤ 0.74, fair for ICC 0.4 < ICC ≤ 0.59, poor for ICC < 0.4. RESULTS Based on CV and ICC, segmental Ecc provided excellent intra-user, inter-user-same-site, inter-user-different-site, inter-user-Human-DL reproducibility and good-excellent inter-scan reproducibility. Whole-slice Ecc and global Ell provided excellent intra-user, inter-user-same-site, inter-user-different-site, inter-user-Human-DL and inter-scan reproducibility. The reproducibility of torsion was good-excellent for all comparisons. For whole-slice Err, CV was in the fair-good range, and ICC was in the good-excellent range. CONCLUSIONS Multicenter data show that 3 T CMR DENSE provides highly reproducible whole-slice and segmental Ecc, global Ell, and torsion measurements in healthy subjects and heart disease patients.
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Affiliation(s)
- Daniel A Auger
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA
| | - Sona Ghadimi
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA
| | - Xiaoying Cai
- Siemens Healthineers, Boston, Massachusetts, USA
| | - Claire E Reagan
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA
| | - Changyu Sun
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA
| | - Mohamad Abdi
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA
| | - Jie Jane Cao
- St. Francis Hospital, The Heart Center, Long Island, NY, USA
| | - Joshua Y Cheng
- St. Francis Hospital, The Heart Center, Long Island, NY, USA
| | - Nora Ngai
- St. Francis Hospital, The Heart Center, Long Island, NY, USA
| | - Andrew D Scott
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Pedro F Ferreira
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - John N Oshinski
- Department of Radiology & Imaging Sciences and Biomedical Engineering, Emory University, Atlanta, Georgia
| | - Nick Emamifar
- Department of Radiology & Imaging Sciences and Biomedical Engineering, Emory University, Atlanta, Georgia
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Michael Loecher
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Zhan-Qiu Liu
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Pierre Croisille
- University of Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Etienne, France
- Department of Radiology, University Hospital Saint-Etienne, Saint-Etienne, France
| | - Magalie Viallon
- University of Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Etienne, France
| | - Kenneth C Bilchick
- Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA.
- Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
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Auger DA, Ghadimi S, Cai X, Reagan CE, Sun C, Abdi M, Cao JJ, Cheng JY, Ngai N, Scott AD, Ferreira PF, Oshinski JN, Emamifar N, Ennis DB, Loecher M, Liu ZQ, Croisille P, Viallon M, Bilchick KC, Epstein FH. Reproducibility of global and segmental myocardial strain using cine DENSE at 3 T: a multicenter cardiovascular magnetic resonance study in healthy subjects and patients with heart disease. J Cardiovasc Magn Reson 2022; 24:23. [PMID: 35369885 PMCID: PMC8978361 DOI: 10.1186/s12968-022-00851-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND While multiple cardiovascular magnetic resonance (CMR) methods provide excellent reproducibility of global circumferential and global longitudinal strain, achieving highly reproducible segmental strain is more challenging. Previous single-center studies have demonstrated excellent reproducibility of displacement encoding with stimulated echoes (DENSE) segmental circumferential strain. The present study evaluated the reproducibility of DENSE for measurement of whole-slice or global circumferential (Ecc), longitudinal (Ell) and radial (Err) strain, torsion, and segmental Ecc at multiple centers. METHODS Six centers participated and a total of 81 subjects were studied, including 60 healthy subjects and 21 patients with various types of heart disease. CMR utilized 3 T scanners, and cine DENSE images were acquired in three short-axis planes and in the four-chamber long-axis view. During one imaging session, each subject underwent two separate DENSE scans to assess inter-scan reproducibility. Each subject was taken out of the scanner and repositioned between the scans. Intra-user, inter-user-same-site, inter-user-different-site, and inter-user-Human-Deep-Learning (DL) comparisons assessed the reproducibility of different users analyzing the same data. Inter-scan comparisons assessed the reproducibility of DENSE from scan to scan. The reproducibility of whole-slice or global Ecc, Ell and Err, torsion, and segmental Ecc were quantified using Bland-Altman analysis, the coefficient of variation (CV), and the intraclass correlation coefficient (ICC). CV was considered excellent for CV ≤ 10%, good for 10% < CV ≤ 20%, fair for 20% < CV ≤ 40%, and poor for CV > 40. ICC values were considered excellent for ICC > 0.74, good for ICC 0.6 < ICC ≤ 0.74, fair for ICC 0.4 < ICC ≤ 0.59, poor for ICC < 0.4. RESULTS Based on CV and ICC, segmental Ecc provided excellent intra-user, inter-user-same-site, inter-user-different-site, inter-user-Human-DL reproducibility and good-excellent inter-scan reproducibility. Whole-slice Ecc and global Ell provided excellent intra-user, inter-user-same-site, inter-user-different-site, inter-user-Human-DL and inter-scan reproducibility. The reproducibility of torsion was good-excellent for all comparisons. For whole-slice Err, CV was in the fair-good range, and ICC was in the good-excellent range. CONCLUSIONS Multicenter data show that 3 T CMR DENSE provides highly reproducible whole-slice and segmental Ecc, global Ell, and torsion measurements in healthy subjects and heart disease patients.
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Affiliation(s)
- Daniel A. Auger
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA 22908 USA
| | - Sona. Ghadimi
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA 22908 USA
| | | | - Claire E. Reagan
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA 22908 USA
| | - Changyu Sun
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA 22908 USA
| | - Mohamad Abdi
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA 22908 USA
| | - Jie Jane Cao
- St. Francis Hospital, The Heart Center, Long Island, NY USA
| | | | - Nora Ngai
- St. Francis Hospital, The Heart Center, Long Island, NY USA
| | - Andrew D. Scott
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Pedro F. Ferreira
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - John N. Oshinski
- Department of Radiology & Imaging Sciences and Biomedical Engineering, Emory University, Atlanta, Georgia
| | - Nick Emamifar
- Department of Radiology & Imaging Sciences and Biomedical Engineering, Emory University, Atlanta, Georgia
| | - Daniel B. Ennis
- Department of Radiology, Stanford University, Stanford, CA USA
| | - Michael Loecher
- Department of Radiology, Stanford University, Stanford, CA USA
| | - Zhan-Qiu Liu
- Department of Radiology, Stanford University, Stanford, CA USA
| | - Pierre Croisille
- University of Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Etienne, France
- Department of Radiology, University Hospital Saint-Etienne, Saint-Etienne, France
| | - Magalie Viallon
- University of Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Etienne, France
| | - Kenneth C. Bilchick
- Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA USA
| | - Frederick H. Epstein
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA 22908 USA
- Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA USA
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Bracamonte JH, Saunders SK, Wilson JS, Truong UT, Soares JS. Patient-Specific Inverse Modeling of In Vivo Cardiovascular Mechanics with Medical Image-Derived Kinematics as Input Data: Concepts, Methods, and Applications. APPLIED SCIENCES-BASEL 2022; 12:3954. [PMID: 36911244 PMCID: PMC10004130 DOI: 10.3390/app12083954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inverse modeling approaches in cardiovascular medicine are a collection of methodologies that can provide non-invasive patient-specific estimations of tissue properties, mechanical loads, and other mechanics-based risk factors using medical imaging as inputs. Its incorporation into clinical practice has the potential to improve diagnosis and treatment planning with low associated risks and costs. These methods have become available for medical applications mainly due to the continuing development of image-based kinematic techniques, the maturity of the associated theories describing cardiovascular function, and recent progress in computer science, modeling, and simulation engineering. Inverse method applications are multidisciplinary, requiring tailored solutions to the available clinical data, pathology of interest, and available computational resources. Herein, we review biomechanical modeling and simulation principles, methods of solving inverse problems, and techniques for image-based kinematic analysis. In the final section, the major advances in inverse modeling of human cardiovascular mechanics since its early development in the early 2000s are reviewed with emphasis on method-specific descriptions, results, and conclusions. We draw selected studies on healthy and diseased hearts, aortas, and pulmonary arteries achieved through the incorporation of tissue mechanics, hemodynamics, and fluid-structure interaction methods paired with patient-specific data acquired with medical imaging in inverse modeling approaches.
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Affiliation(s)
- Johane H. Bracamonte
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Sarah K. Saunders
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - John S. Wilson
- Department of Biomedical Engineering and Pauley Heart Center, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Uyen T. Truong
- Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Joao S. Soares
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
- Correspondence:
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Wang R, Chen Y, Li R, Qiu S, Zhang Z, Yan F, Feng Y. Fast magnetic resonance elastography with multiphase radial encoding and harmonic motion sparsity based reconstruction. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac4a42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/11/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Objective. To achieve fast magnetic resonance elastography (MRE) at a low frequency for better shear modulus estimation of the brain. Approach. We proposed a multiphase radial DENSE MRE (MRD-MRE) sequence and an improved GRASP algorithm utilizing the sparsity of the harmonic motion (SH-GRASP) for fast MRE at 20 Hz. For the MRD-MRE sequence, the initial position encoded by spatial modulation of magnetization (SPAMM) was decoded by an arbitrary number of readout blocks without increasing the number of phase offsets. Based on the harmonic motion, a modified total variation and temporal Fourier transform were introduced to utilize the sparsity in the temporal domain. Both phantom and brain experiments were carried out and compared with that from multiphase Cartesian DENSE-MRE (MCD-MRE), and conventional gradient echo sequence (GRE-MRE). Reconstruction performance was also compared with GRASP and compressed sensing. Main results. Results showed the scanning time of a fully sampled image with four phase offsets for MRD-MRE was only 1/5 of that from GRE-MRE. The wave patterns and estimated stiffness maps were similar to those from MCD-MRE and GRE-MRE. With SH-GRASP, the total scan time could be shortened by additional 4 folds, achieving a total acceleration factor of 20. Better metric values were also obtained using SH-GRASP for reconstruction compared with other algorithms. Significance. The MRD-MRE sequence and SH-GRASP algorithm can be used either in combination or independently to accelerate MRE, showing the potentials for imaging the brain as well as other organs.
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Kar J, Cohen MV, McQuiston SA, Poorsala T, Malozzi CM. Direct left-ventricular global longitudinal strain (GLS) computation with a fully convolutional network. J Biomech 2022; 130:110878. [PMID: 34871894 PMCID: PMC8896910 DOI: 10.1016/j.jbiomech.2021.110878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 01/03/2023]
Abstract
This study's purpose was to develop a direct MRI-based, deep-learning semantic segmentation approach for computing global longitudinal strain (GLS), a known metric for detecting left-ventricular (LV) cardiotoxicity in breast cancer. Displacement Encoding with Stimulated Echoes cardiac image phases acquired from 30 breast cancer patients and 30 healthy females were unwrapped via a DeepLabV3 + fully convolutional network (FCN). Myocardial strains were directly computed from the unwrapped phases with the Radial Point Interpolation Method. FCN-unwrapped phases of a phantom's rotating gel were validated against quality-guided phase-unwrapping (QGPU) and robust transport of intensity equation (RTIE) phase-unwrapping. FCN performance on unwrapping human LV data was measured with F1 and Dice scores versus QGPU ground-truth. The reliability of FCN-based strains was assessed against RTIE-based strains with Cronbach's alpha (C-α) intraclass correlation coefficient. Mean squared error (MSE) of unwrapping the phantom experiment data at 0 dB signal-to-noise ratio were 1.6, 2.7 and 6.1 with FCN, QGPU and RTIE techniques. Human data classification accuracies were F1 = 0.95 (Dice = 0.96) with FCN and F1 = 0.94 (Dice = 0.95) with RTIE. GLS results from FCN and RTIE were -16 ± 3% vs. -16 ± 3% (C-α = 0.9) for patients and -20 ± 3% vs. -20 ± 3% (C-α = 0.9) for healthy subjects. The low MSE from the phantom validation demonstrates accuracy of phase-unwrapping with the FCN and comparable human subject results versus RTIE demonstrate GLS analysis accuracy. A deep-learning methodology for phase-unwrapping in medical images and GLS computation was developed and validated in a heterogeneous cohort.
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Affiliation(s)
- Julia Kar
- Departments of Mechanical Engineering and Pharmacology University of South Alabama 150 Jaguar Drive, Mobile, AL 36688 Phone: 251 460 7456
| | - Michael V. Cohen
- Department of Cardiology College of Medicine University of South Alabama 1700 Center Street, Mobile, AL 36604
| | - Samuel A. McQuiston
- Department of Radiology University of South Alabama 2451 USA Medical Center Drive, Mobile, AL 36617
| | - Teja Poorsala
- Departments of Oncology and Hematology University of South Alabama 101 Memorial Hospital Drive, Building 3 Mobile, AL 36608
| | - Christopher M. Malozzi
- Department of Cardiology College of Medicine University of South Alabama 1700 Center Street, Mobile, AL 36604
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Maso Talou GD, Babarenda Gamage TP, Nash MP. Efficient Ventricular Parameter Estimation Using AI-Surrogate Models. Front Physiol 2021; 12:732351. [PMID: 34721062 PMCID: PMC8551833 DOI: 10.3389/fphys.2021.732351] [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: 06/28/2021] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
The onset and progression of pathological heart conditions, such as cardiomyopathy or heart failure, affect its mechanical behaviour due to the remodelling of the myocardial tissues to preserve its functional response. Identification of the constitutive properties of heart tissues could provide useful biomarkers to diagnose and assess the progression of disease. We have previously demonstrated the utility of efficient AI-surrogate models to simulate passive cardiac mechanics. Here, we propose the use of this surrogate model for the identification of myocardial mechanical properties and intra-ventricular pressure by solving an inverse problem with two novel AI-based approaches. Our analysis concluded that: (i) both approaches were robust toward Gaussian noise when the ventricle data for multiple loading conditions were combined; and (ii) estimates of one and two parameters could be obtained in less than 9 and 18 s, respectively. The proposed technique yields a viable option for the translation of cardiac mechanics simulations and biophysical parameter identification methods into the clinic to improve the diagnosis and treatment of heart pathologies. In addition, the proposed estimation techniques are general and can be straightforwardly translated to other applications involving different anatomical structures.
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Affiliation(s)
- Gonzalo D Maso Talou
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | - Martyn P Nash
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
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Wilson JS, Islam M, Oshinski JN. In Vitro Validation of Regional Circumferential Strain Assessment in a Phantom Aortic Model Using Cine Displacement Encoding With Stimulated Echoes MRI. J Magn Reson Imaging 2021; 55:1773-1784. [PMID: 34704637 DOI: 10.1002/jmri.27972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A novel application of cine Displacement ENcoding with Stimulated Echoes Magnetic Resonance Imaging (DENSE MRI) has recently been described to assess regional heterogeneities in circumferential strain around the aortic wall in vivo; however, validation is first required for successful clinical translation. PURPOSE To validate the quantification of regional circumferential strain around the wall of an aortic phantom using DENSE MRI. STUDY TYPE In vitro phantom study. POPULATION Three polyvinyl alcohol aortic phantoms with eight axially oriented nitinol wires embedded evenly around the walls. FIELD STRENGTH/SEQUENCE 3 T; gradient-echo aortic DENSE MRI with spiral cine readout, gradient-echo phase-contrast MRI (PCMR) with Cartesian cine readout. ASSESSMENT Phantoms were connected to a pulsatile flow loop and peak DENSE-derived regional circumferential Green strains at 16 equally spaced sectors around the wall were assessed according to previously published algorithms. "True" regional circumferential strains were calculated by manually tracking displacements of the nitinol wires by two independent observers. Normalized circumferential strains (NCS) were calculated by dividing regional strains by the mean strain. Finally, DENSE-derived regional strain was corrected by multiplying regional DENSE NCS by the mean strain calculated from the diameter change on the PCMR. STATISTICAL TESTS One-sample t-test, Paired-sample t-test, and analysis of variance with Bonferroni correction, coefficient of variation (CoV), Bland-Altman analysis; P < 0.05 was considered statistically significant. RESULTS Aortic DENSE MRI significantly overestimated circumferential strain compared to the wire-tracking method (mean difference and SD 0.030 ± 0.014, CoV 0.31). However, NCS demonstrated good agreement between DENSE and wire-tracking data (mean difference 0.000 ± 0.172, CoV 0.15). After correcting the DENSE-derived regional strain, the mean difference in regional circumferential strain between DENSE and wire-tracking was significantly reduced to 0.006 ± 0.008, and the CoV was reduced to 0.18. DATA CONCLUSION For aortic phantoms with mild spatial heterogeneity in circumferential strain, the previously published aortic DENSE MRI technique successfully assessed the regional NCS distribution but overestimated the mean strain. This overestimation is correctable by computing a more accurate mean circumferential strain using a separate cine scan. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- John S Wilson
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA.,Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Muhammad Islam
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - John N Oshinski
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA.,Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
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25
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Abdi M, Feng X, Sun C, Bilchick KC, Meyer CH, Epstein FH. Suppression of artifact-generating echoes in cine DENSE using deep learning. Magn Reson Med 2021; 86:2095-2104. [PMID: 34021628 PMCID: PMC8295221 DOI: 10.1002/mrm.28832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/21/2021] [Accepted: 04/17/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE To use deep learning for suppression of the artifact-generating T1 -relaxation echo in cine displacement encoding with stimulated echoes (DENSE) for the purpose of reducing the scan time. METHODS A U-Net was trained to suppress the artifact-generating T1 -relaxation echo using complementary phase-cycled data as the ground truth. A data-augmentation method was developed that generates synthetic DENSE images with arbitrary displacement-encoding frequencies to suppress the T1 -relaxation echo modulated for a range of frequencies. The resulting U-Net (DAS-Net) was compared with k-space zero-filling as an alternative method. Non-phase-cycled DENSE images acquired in shorter breath-holds were processed by DAS-Net and compared with DENSE images acquired with phase cycling for the quantification of myocardial strain. RESULTS The DAS-Net method effectively suppressed the T1 -relaxation echo and its artifacts, and achieved root Mean Square(RMS) error = 5.5 ± 0.8 and structural similarity index = 0.85 ± 0.02 for DENSE images acquired with a displacement encoding frequency of 0.10 cycles/mm. The DAS-Net method outperformed zero-filling (root Mean Square error = 5.8 ± 1.5 vs 13.5 ± 1.5, DAS-Net vs zero-filling, P < .01; and structural similarity index = 0.83 ± 0.04 vs 0.66 ± 0.03, DAS-Net vs zero-filling, P < .01). Strain data for non-phase-cycled DENSE images with DAS-Net showed close agreement with strain from phase-cycled DENSE. CONCLUSION The DAS-Net method provides an effective alternative approach for suppression of the artifact-generating T1 -relaxation echo in DENSE MRI, enabling a 42% reduction in scan time compared to DENSE with phase-cycling.
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Affiliation(s)
- Mohamad Abdi
- Departments of Biomedical Engineering, University of Virginia, Charlottesville, Virginia
| | - Xue Feng
- Departments of Biomedical Engineering, University of Virginia, Charlottesville, Virginia
| | - Changyu Sun
- Departments of Biomedical Engineering, University of Virginia, Charlottesville, Virginia
| | - Kenneth C. Bilchick
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Craig H. Meyer
- Departments of Biomedical Engineering, University of Virginia, Charlottesville, Virginia
- Departments of Radiology, University of Virginia Health System, Charlottesville, Virginia
| | - Frederick H. Epstein
- Departments of Biomedical Engineering, University of Virginia, Charlottesville, Virginia
- Departments of Radiology, University of Virginia Health System, Charlottesville, Virginia
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Loecher M, Perotti LE, Ennis DB. Using synthetic data generation to train a cardiac motion tag tracking neural network. Med Image Anal 2021; 74:102223. [PMID: 34555661 DOI: 10.1016/j.media.2021.102223] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/15/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
A CNN based method for cardiac MRI tag tracking was developed and validated. A synthetic data simulator was created to generate large amounts of training data using natural images, a Bloch equation simulation, a broad range of tissue properties, and programmed ground-truth motion. The method was validated using both an analytical deforming cardiac phantom and in vivo data with manually tracked reference motion paths. In the analytical phantom, error was investigated relative to SNR, and accurate results were seen for SNR>10 (displacement error <0.3 mm). Excellent agreement was seen in vivo for tag locations (mean displacement difference = -0.02 pixels, 95% CI [-0.73, 0.69]) and calculated cardiac circumferential strain (mean difference = 0.006, 95% CI [-0.012, 0.024]). Automated tag tracking with a CNN trained on synthetic data is both accurate and precise.
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Affiliation(s)
| | - Luigi E Perotti
- Department of Mechanical and Aerospace Engineering, University of Central Florida, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, USA; Cardiovascular Institute, Stanford University, USA; Center for Artificial Intelligence in Medicine & Imaging, Stanford University, USA
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Gao X, Abdi M, Auger DA, Sun C, Hanson CA, Robinson AA, Schumann C, Oomen PJ, Ratcliffe S, Malhotra R, Darby A, Monfredi OJ, Mangrum JM, Mason P, Mazimba S, Holmes JW, Kramer CM, Epstein FH, Salerno M, Bilchick KC. Cardiac Magnetic Resonance Assessment of Response to Cardiac Resynchronization Therapy and Programming Strategies. JACC Cardiovasc Imaging 2021; 14:2369-2383. [PMID: 34419391 DOI: 10.1016/j.jcmg.2021.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 05/05/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective was to determine the feasibility and effectiveness of cardiac magnetic resonance (CMR) cine and strain imaging before and after cardiac resynchronization therapy (CRT) for assessment of response and the optimal resynchronization pacing strategy. BACKGROUND CMR with cardiac implantable electronic devices can safely provide high-quality right ventricular/left ventricular (LV) ejection fraction (RVEF/LVEF) assessments and strain. METHODS CMR with cine imaging, displacement encoding with stimulated echoes for the circumferential uniformity ratio estimate with singular value decomposition (CURE-SVD) dyssynchrony parameter, and scar assessment was performed before and after CRT. Whereas the pre-CRT scan constituted a single "imaging set" with complete volumetric, strain, and scar imaging, multiple imaging sets with complete strain and volumetric data were obtained during the post-CRT scan for biventricular pacing (BIVP), LV pacing (LVP), and asynchronous atrial pacing modes by reprogramming the device outside the scanner between imaging sets. RESULTS 100 CMRs with a total of 162 imaging sets were performed in 50 patients (median age 70 years [IQR: 50 years-86 years]; 48% female). Reduction in LV end-diastolic volumes (P = 0.002) independent of CRT pacing were more prominent than corresponding reductions in right ventricular end-diastolic volumes (P = 0.16). A clear dependence of the optimal CRT pacing mode (BIVP vs LVP) on the PR interval (P = 0.0006) was demonstrated. The LVEF and RVEF improved more with BIVP than LVP with PR intervals ≥240 milliseconds (P = 0.025 and P = 0.002, respectively); the optimal mode (BIVP vs LVP) was variable with PR intervals <240 milliseconds. A lower pre-CRT displacement encoding with stimulated echoes CURE-SVD was associated with greater improvements in the post-CRT CURE-SVD (r = -0.69; P < 0.001), LV end-systolic volume (r = -0.58; P < 0.001), and LVEF (r = -0.52; P < 0.001). CONCLUSIONS CMR evaluation with assessment of multiple pacing modes during a single scan after CRT is feasible and provides useful information for patient care with respect to response and the optimal pacing strategy.
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Affiliation(s)
- Xu Gao
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mohamad Abdi
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Daniel A Auger
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Changyu Sun
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher A Hanson
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Austin A Robinson
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher Schumann
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Pim J Oomen
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sarah Ratcliffe
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Rohit Malhotra
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Andrew Darby
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Oliver J Monfredi
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - J Michael Mangrum
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Pamela Mason
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sula Mazimba
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jeffrey W Holmes
- 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
| | - Frederick H Epstein
- 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
| | - Kenneth C Bilchick
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
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28
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Eppelheimer MS, Nwotchouang BST, Pahlavian SH, Barrow JW, Barrow DL, Amini R, Allen PA, Loth F, Oshinski JN. Cerebellar and Brainstem Displacement Measured with DENSE MRI in Chiari Malformation Following Posterior Fossa Decompression Surgery. Radiology 2021; 301:187-194. [PMID: 34313469 DOI: 10.1148/radiol.2021203036] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Posterior fossa decompression (PFD) surgery is a treatment for Chiari malformation type I (CMI). The goals of surgery are to reduce cerebellar tonsillar crowding and restore posterior cerebral spinal fluid flow, but regional tissue biomechanics may also change. MRI-based displacement encoding with stimulated echoes (DENSE) can be used to assess neural tissue displacement. Purpose To assess neural tissue displacement by using DENSE MRI in participants with CMI before and after PFD surgery and examine associations between tissue displacement and symptoms. Materials and Methods In a prospective, HIPAA-compliant study of patients with CMI, midsagittal DENSE MRI was performed before and after PFD surgery between January 2017 and June 2020. Peak tissue displacement over the cardiac cycle was quantified in the cerebellum and brainstem, averaged over each structure, and compared before and after surgery. Paired t tests and nonparametric Wilcoxon signed-rank tests were used to identify surgical changes in displacement, and Spearman correlations were determined between tissue displacement and presurgery symptoms. Results Twenty-three participants were included (mean age ± standard deviation, 37 years ± 10; 19 women). Spatially averaged (mean) peak tissue displacement demonstrated reductions of 46% (79/171 µm) within the cerebellum and 22% (46/210 µm) within the brainstem after surgery (P < .001). Maximum peak displacement, calculated within a circular 30-mm2 area, decreased by 64% (274/427 µm) in the cerebellum and 33% (100/300 µm) in the brainstem (P < .001). No significant associations were identified between tissue displacement and CMI symptoms (r < .74 and P > .012 for all; Bonferroni-corrected P = .0002). Conclusion Neural tissue displacement was reduced after posterior fossa decompression surgery, indicating that surgical intervention changes brain tissue biomechanics. For participants with Chiari malformation type I, no relationship was identified between presurgery tissue displacement and presurgical symptoms. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Maggie S Eppelheimer
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - Blaise Simplice Talla Nwotchouang
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - Soroush Heidari Pahlavian
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - Jack W Barrow
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - Daniel L Barrow
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - Rouzbeh Amini
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - Philip A Allen
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - Francis Loth
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
| | - John N Oshinski
- From the Conquer Chiari Research Center, Departments of Biomedical Engineering (M.S.E., B.S.T.N., F.L.) and Psychology (P.A.A.), University of Akron, 264 Wolf Ledges Pkwy, #211B, Akron, OH 44325; Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, Calif (S.H.P.); Mercer University School of Medicine, Savannah, Ga (J.W.B.); Departments of Neurosurgery (D.L.B.), Radiology (J.N.O.), and Imaging Sciences and Biomedical Engineering (J.N.O.), Emory University, Atlanta, Ga; and Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Mass (R.A.)
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29
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Carruth ED, Fielden SW, Nevius CD, Fornwalt BK, Haggerty CM. 3D-Encoded DENSE MRI with Zonal Excitation for Quantifying Biventricular Myocardial Strain During a Breath-Hold. Cardiovasc Eng Technol 2021; 12:589-597. [PMID: 34244904 DOI: 10.1007/s13239-021-00561-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/25/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Right ventricular (RV) function is increasingly recognized for its prognostic value in many disease states. As with the left ventricle (LV), strain-based measurements may have better prognostic value than typical chamber volumes or ejection fraction. Complete functional characterization of the RV requires high-resolution, 3D displacement tracking methods, which have been prohibitively challenging to implement. Zonal excitation during Displacement ENcoding with Stimulated Echoes (DENSE) magnetic resonance imaging (MRI) has helped reduce scan time for 2D LV strain quantification. We hypothesized that zonal excitation could alternatively be used to reproducibly acquire higher resolution, 3D-encoded DENSE images for quantification of bi-ventricular strain within a single breath-hold. METHODS We modified sequence parameters for a 3D zonal excitation DENSE sequence to achieve in-plane resolution < 2 mm and acquired two sets of images in eight healthy adult male volunteers with median (IQR) age 32.5 (32.0-33.8) years. We assessed the inter-test reproducibility of this technique, and compared computed strains and torsion with previously published data. RESULTS Data for one subject was excluded based on image artifacts. Reproducibility for LV (CoV: 6.1-9.0%) and RV normal strains (CoV: 6.3-8.2%) and LV torsion (CoV = 7.1%) were all very good. Reproducibility of RV torsion was lower (CoV = 16.7%), but still within acceptable limits. Computed global strains and torsion were within reasonable agreement with published data, but further studies in larger cohorts are needed to confirm. CONCLUSION Reproducible acquisition of 3D-encoded biventricular myocardial strain data in a breath-hold is feasible using DENSE with zonal excitation.
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Affiliation(s)
- Eric D Carruth
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Samuel W Fielden
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.,Medical and Health Physics, Geisinger, Danville, PA, USA
| | - Christopher D Nevius
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.,The Heart Institute, Geisinger, Danville, PA, USA.,Department of Radiology, Geisinger, Danville, PA, USA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA. .,The Heart Institute, Geisinger, Danville, PA, USA.
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30
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Wang VY, Tartibi M, Zhang Y, Selvaganesan K, Haraldsson H, Auger DA, Faraji F, Spaulding K, Takaba K, Collins A, Aguayo E, Saloner D, Wallace AW, Weinsaft JW, Epstein FH, Guccione J, Ge L, Ratcliffe MB. A kinematic model-based analysis framework for 3D Cine-DENSE-validation with an axially compressed gel phantom and application in sheep before and after antero-apical myocardial infarction. Magn Reson Med 2021; 86:2105-2121. [PMID: 34096083 DOI: 10.1002/mrm.28775] [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: 09/24/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE Myocardial strain is increasingly used to assess left ventricular (LV) function. Incorporation of LV deformation into finite element (FE) modeling environment with subsequent strain calculation will allow analysis to reach its full potential. We describe a new kinematic model-based analysis framework (KMAF) to calculate strain from 3D cine-DENSE (displacement encoding with stimulated echoes) MRI. METHODS Cine-DENSE allows measurement of 3D myocardial displacement with high spatial accuracy. The KMAF framework uses cine cardiovascular magnetic resonance (CMR) to facilitate cine-DENSE segmentation, interpolates cine-DENSE displacement, and kinematically deforms an FE model to calculate strain. This framework was validated in an axially compressed gel phantom and applied in 10 healthy sheep and 5 sheep after myocardial infarction (MI). RESULTS Excellent Bland-Altman agreement of peak circumferential (Ecc ) and longitudinal (Ell ) strain (mean difference = 0.021 ± 0.04 and -0.006 ± 0.03, respectively), was found between KMAF estimates and idealized FE simulation. Err had a mean difference of -0.014 but larger variation (±0.12). Cine-DENSE estimated end-systolic (ES) Ecc , Ell and Err exhibited significant spatial variation for healthy sheep. Displacement magnitude was reduced on average by 27%, 42%, and 56% after MI in the remote, adjacent and MI regions, respectively. CONCLUSIONS The KMAF framework allows accurate calculation of 3D LV Ecc and Ell from cine-DENSE.
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Affiliation(s)
- Vicky Y Wang
- Veterans Affairs Medical Center, San Francisco, California, USA
| | - Mehrzad Tartibi
- Veterans Affairs Medical Center, San Francisco, California, USA
| | - Yue Zhang
- Veterans Affairs Medical Center, San Francisco, California, USA
| | - Kartiga Selvaganesan
- Department of Biomedical Engineering, University of Berkeley, Berkeley, California, USA
| | - Henrik Haraldsson
- Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Radiology, University of California, San Francisco, California, USA
| | - Daniel A Auger
- Department of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA.,Medical Metrics, Inc., Houston, Texas, USA
| | - Farshid Faraji
- Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Radiology, University of California, San Francisco, California, USA
| | | | - Kiyoaki Takaba
- Veterans Affairs Medical Center, San Francisco, California, USA
| | | | - Esteban Aguayo
- Veterans Affairs Medical Center, San Francisco, California, USA
| | - David Saloner
- Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Radiology, University of California, San Francisco, California, USA
| | - Arthur W Wallace
- Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Bioengineering, University of California, San Francisco, California, USA.,Department of Anesthesia, University of California, San Francisco, California, USA
| | | | - Frederick H Epstein
- Department of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Julius Guccione
- Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Bioengineering, University of California, San Francisco, California, USA.,Department of Surgery, University of California, San Francisco, California, USA
| | - Liang Ge
- Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Bioengineering, University of California, San Francisco, California, USA.,Department of Surgery, University of California, San Francisco, California, USA
| | - Mark B Ratcliffe
- Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Bioengineering, University of California, San Francisco, California, USA.,Department of Surgery, University of California, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, California, USA
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31
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Liu ZQ, Maforo NG, Renella P, Halnon N, Wu HH, Ennis DB. Reproducibility of Left Ventricular CINE DENSE Strain in Pediatric Subjects with Duchenne Muscular Dystrophy. FUNCTIONAL IMAGING AND MODELING OF THE HEART : ... INTERNATIONAL WORKSHOP, FIMH ..., PROCEEDINGS. FIMH 2021; 12738:232-241. [PMID: 36939420 PMCID: PMC10022706 DOI: 10.1007/978-3-030-78710-3_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cardiomyopathy is the leading cause of mortality in boys with Duchenne muscular dystrophy (DMD). Left ventricular (LV) peak mid-wall circumferential strain (Ecc) is a sensitive early biomarker for evaluating both the subtle and variable onset and the progression of cardiomyopathy in pediatric subjects with DMD. Cine Displacement Encoding with Stimulated Echoes (DENSE) has proven sensitive to changes in Ecc, but its reproducibility has not been reported in a pediatric cohort or a DMD cohort. The objective was to quantify the intra-observer repeatability, and intra-exam and inter-observer reproducibility of global and regional Ecc derived from cine DENSE in DMD patients (N = 10) and age-and sex-matched controls (N = 10). Global and regional Ecc measures were considered reproducible in the intra-exam, intra-observer, and inter-observer comparisons. Intra-observer repeatability was highest, followed by intra-exam reproducibility and then inter-observer reproducibility. The smallest detectable change in Ecc was 0.01 for the intra-observer comparison, which is below the previously reported yearly decrease of 0.013 ± 0.015 in Ecc in DMD patients.
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Affiliation(s)
- Zhan-Qiu Liu
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Nyasha G Maforo
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Pierangelo Renella
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Department of Medicine (Pediatric Cardiology), Children's Hospital, Orange, CA, USA
| | - Nancy Halnon
- Department of Pediatrics, University of California, Los Angeles, CA, USA
| | - Holden H Wu
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Palo Alto, CA, USA
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32
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Nwotchouang BST, Eppelheimer MS, Pahlavian SH, Barrow JW, Barrow DL, Qiu D, Allen PA, Oshinski JN, Amini R, Loth F. Regional Brain Tissue Displacement and Strain is Elevated in Subjects with Chiari Malformation Type I Compared to Healthy Controls: A Study Using DENSE MRI. Ann Biomed Eng 2021; 49:1462-1476. [PMID: 33398617 PMCID: PMC8482962 DOI: 10.1007/s10439-020-02695-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/17/2020] [Indexed: 12/26/2022]
Abstract
While the degree of cerebellar tonsillar descent is considered the primary radiologic marker of Chiari malformation type I (CMI), biomechanical forces acting on the brain tissue in CMI subjects are less studied and poorly understood. In this study, regional brain tissue displacement and principal strains in 43 CMI subjects and 25 controls were quantified using a magnetic resonance imaging (MRI) methodology known as displacement encoding with stimulated echoes (DENSE). Measurements from MRI were obtained for seven different brain regions-the brainstem, cerebellum, cingulate gyrus, corpus callosum, frontal lobe, occipital lobe, and parietal lobe. Mean displacements in the cerebellum and brainstem were found to be 106 and 64% higher, respectively, for CMI subjects than controls (p < .001). Mean compression and extension strains in the cerebellum were 52 and 50% higher, respectively, in CMI subjects (p < .001). Brainstem mean extension strain was 41% higher in CMI subjects (p < .001), but no significant difference in compression strain was observed. The other brain structures revealed no significant differences between CMI and controls. These findings demonstrate that brain tissue displacement and strain in the cerebellum and brainstem might represent two new biomarkers to distinguish between CMI subjects and controls.
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Affiliation(s)
| | - Maggie S Eppelheimer
- Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, OH, 44325-3903, USA
| | | | - Jack W Barrow
- Department of Radiology, University of Tennessee, Knoxville, TN, USA
| | - Daniel L Barrow
- Department of Neurosurgery, Emory University, Atlanta, GA, USA
| | - Deqiang Qiu
- Radiology & Imaging Sciences and Biomedical Engineering, Emory University School of Medicine, Atlanta, USA
| | - Philip A Allen
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, Akron, OH, USA
| | - John N Oshinski
- Radiology & Imaging Sciences and Biomedical Engineering, Emory University School of Medicine, Atlanta, USA
| | - Rouzbeh Amini
- Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, MA, USA
| | - Francis Loth
- Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, OH, 44325-3903, USA
- Department of Mechanical Engineering, The University of Akron, Akron, OH, USA
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33
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Dahiya A, Chao C, Younger J, Kar J, Baldwin BM, Cohen MV, Joseph S, Chowdhry A, Figarola MS, Malozzi C, Nasser MF, Nabeel Y, Shah R, Kennen JM, Aneja A, Khalil S, Ragab S, Mohammed O, Moustafa T, Hamdy A, Ahmed S, Heny A, Taher M, Ganigara M, Dhar A, Misra N, Alzubi J, Pannikottu K, Jabri A, Hedge V, Kanaa'n A, Lahorra J, de Waard D, Horne D, Dhillon S, Sweeney A, Hamilton-Craig C, Katikireddi VS, Wesley AJ, Hammet C, Johnson JN, Chen SSM. Society for Cardiovascular Magnetic Resonance 2019 Case of the Week series. J Cardiovasc Magn Reson 2021; 23:44. [PMID: 33794918 PMCID: PMC8015162 DOI: 10.1186/s12968-020-00671-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). The SCMR web site ( https://www.scmr.org ) hosts a case series designed to present case reports demonstrating the unique attributes of CMR in the diagnosis or management of cardiovascular disease. Each clinical presentation is followed by a brief discussion of the disease and unique role of CMR in disease diagnosis or management guidance. By nature, some of these are somewhat esoteric, but all are instructive. In this publication, we provide a digital archive of the 2019 Case of the Week series as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar search engine.
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Affiliation(s)
- Arun Dahiya
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Griffith University School of Medicine, Gold Coast, QLD, Australia
| | - Charles Chao
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - John Younger
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Julia Kar
- Departments of Mechanical Engineering and Pharmacology, University of South Alabama, Mobile, AL, USA
| | - Bryant M Baldwin
- Departments of Mechanical Engineering and Pharmacology, University of South Alabama, Mobile, AL, USA
| | - Michael V Cohen
- Department of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Shane Joseph
- Department of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Anam Chowdhry
- Department of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Maria S Figarola
- Department of Radiology, University of South Alabama, Mobile, AL, USA
| | | | - M Farhan Nasser
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Yassar Nabeel
- Department of Internal Medicine, Division of Cardiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Rajiv Shah
- Department of Radiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - J Michael Kennen
- Department of Radiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ashish Aneja
- Department of Internal Medicine, Division of Cardiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sameh Khalil
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Sara Ragab
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Omnia Mohammed
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Taher Moustafa
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Ahmed Hamdy
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Shimaa Ahmed
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Ahmed Heny
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Maha Taher
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Madhusudan Ganigara
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York-Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Arushi Dhar
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York-Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Nilanjana Misra
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York-Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Jafar Alzubi
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Kurian Pannikottu
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Ahmad Jabri
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Vinayak Hedge
- Department of Cardiology, Cleveland Clinic Akron General, Akron, OH, USA
| | - Anmar Kanaa'n
- Department of Cardiology, Cleveland Clinic Akron General, Akron, OH, USA
| | - Joseph Lahorra
- Department of Cardiothoracic Surgery, Cleveland Clinic Akron General, Akron, OH, USA
| | | | - David Horne
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Santokh Dhillon
- Isaac Walton Killam Children's Hospital, Halifax, NS, Canada
| | - Aoife Sweeney
- Department of Rheumatology, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Christian Hamilton-Craig
- Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - V S Katikireddi
- Department of Rheumatology, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Allan J Wesley
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Chris Hammet
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | | | - Sylvia S M Chen
- Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia.
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Mella H, Mura J, Wang H, Taylor MD, Chabiniok R, Tintera J, Sotelo J, Uribe S. HARP-I: A Harmonic Phase Interpolation Method for the Estimation of Motion From Tagged MR Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:1240-1252. [PMID: 33434127 DOI: 10.1109/tmi.2021.3051092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We proposed a novel method called HARP-I, which enhances the estimation of motion from tagged Magnetic Resonance Imaging (MRI). The harmonic phase of the images is unwrapped and treated as noisy measurements of reference coordinates on a deformed domain, obtaining motion with high accuracy using Radial Basis Functions interpolations. Results were compared against Shortest Path HARP Refinement (SP-HR) and Sine-wave Modeling (SinMod), two harmonic image-based techniques for motion estimation from tagged images. HARP-I showed a favorable similarity with both methods under noise-free conditions, whereas a more robust performance was found in the presence of noise. Cardiac strain was better estimated using HARP-I at almost any motion level, giving strain maps with less artifacts. Additionally, HARP-I showed better temporal consistency as a new method was developed to fix phase jumps between frames. In conclusion, HARP-I showed to be a robust method for the estimation of motion and strain under ideal and non-ideal conditions.
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Karr J, Cohen M, McQuiston SA, Poorsala T, Malozzi C. Validation of a deep-learning semantic segmentation approach to fully automate MRI-based left-ventricular deformation analysis in cardiotoxicity. Br J Radiol 2021; 94:20201101. [PMID: 33571002 PMCID: PMC8010548 DOI: 10.1259/bjr.20201101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/11/2021] [Accepted: 02/09/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Left-ventricular (LV) strain measurements with the Displacement Encoding with Stimulated Echoes (DENSE) MRI sequence provide accurate estimates of cardiotoxicity damage related to chemotherapy for breast cancer. This study investigated an automated and supervised deep convolutional neural network (DCNN) model for LV chamber quantification before strain analysis in DENSE images. METHODS The DeepLabV3 +DCNN with three versions of ResNet-50 backbone was designed to conduct chamber quantification on 42 female breast cancer data sets. The convolutional layers in the three ResNet-50 backbones were varied as non-atrous, atrous and modified, atrous with accuracy improvements like using Laplacian of Gaussian filters. Parameters such as LV end-diastolic diameter (LVEDD) and ejection fraction (LVEF) were quantified, and myocardial strains analyzed with the Radial Point Interpolation Method (RPIM). Myocardial classification was validated with the performance metrics of accuracy, Dice, average perpendicular distance (APD) and others. Repeated measures ANOVA and intraclass correlation (ICC) with Cronbach's α (C-Alpha) tests were conducted between the three DCNNs and a vendor tool on chamber quantification and myocardial strain analysis. RESULTS Validation results in the same test-set for myocardial classification were accuracy = 97%, Dice = 0.92, APD = 1.2 mm with the modified ResNet-50, and accuracy = 95%, Dice = 0.90, APD = 1.7 mm with the atrous ResNet-50. The ICC results between the modified ResNet-50, atrous ResNet-50 and vendor-tool were C-Alpha = 0.97 for LVEF (55±7%, 54±7%, 54±7%, p = 0.6), and C-Alpha = 0.87 for LVEDD (4.6 ± 0.3 cm, 4.6 ± 0.3 cm, 4.6 ± 0.4 cm, p = 0.7). CONCLUSION Similar performance metrics and equivalent parameters obtained from comparisons between the atrous networks and vendor tool show that segmentation with the modified, atrous DCNN is applicable for automated LV chamber quantification and subsequent strain analysis in cardiotoxicity. ADVANCES IN KNOWLEDGE A novel deep-learning technique for segmenting DENSE images was developed and validated for LV chamber quantification and strain analysis in cardiotoxicity detection.
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Affiliation(s)
- Julia Karr
- Departments of Mechanical Engineering and Pharmacology, University of South Alabama, Mobile, AL, USA
| | - Michael Cohen
- Department of Cardiology, College of Medicine, University of South Alabama, Mobile, AL, USA
| | | | - Teja Poorsala
- Departments of Oncology and Hematology, University of South Alabama, Mobile, AL, USA
| | - Christopher Malozzi
- Department of Cardiology, College of Medicine, University of South Alabama, Mobile, AL, USA
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Ghadimi S, Auger DA, Feng X, Sun C, Meyer CH, Bilchick KC, Cao JJ, Scott AD, Oshinski JN, Ennis DB, Epstein FH. Fully-automated global and segmental strain analysis of DENSE cardiovascular magnetic resonance using deep learning for segmentation and phase unwrapping. J Cardiovasc Magn Reson 2021; 23:20. [PMID: 33691739 PMCID: PMC7949250 DOI: 10.1186/s12968-021-00712-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) cine displacement encoding with stimulated echoes (DENSE) measures heart motion by encoding myocardial displacement into the signal phase, facilitating high accuracy and reproducibility of global and segmental myocardial strain and providing benefits in clinical performance. While conventional methods for strain analysis of DENSE images are faster than those for myocardial tagging, they still require manual user assistance. The present study developed and evaluated deep learning methods for fully-automatic DENSE strain analysis. METHODS Convolutional neural networks (CNNs) were developed and trained to (a) identify the left-ventricular (LV) epicardial and endocardial borders, (b) identify the anterior right-ventricular (RV)-LV insertion point, and (c) perform phase unwrapping. Subsequent conventional automatic steps were employed to compute strain. The networks were trained using 12,415 short-axis DENSE images from 45 healthy subjects and 19 heart disease patients and were tested using 10,510 images from 25 healthy subjects and 19 patients. Each individual CNN was evaluated, and the end-to-end fully-automatic deep learning pipeline was compared to conventional user-assisted DENSE analysis using linear correlation and Bland Altman analysis of circumferential strain. RESULTS LV myocardial segmentation U-Nets achieved a DICE similarity coefficient of 0.87 ± 0.04, a Hausdorff distance of 2.7 ± 1.0 pixels, and a mean surface distance of 0.41 ± 0.29 pixels in comparison with manual LV myocardial segmentation by an expert. The anterior RV-LV insertion point was detected within 1.38 ± 0.9 pixels compared to manually annotated data. The phase-unwrapping U-Net had similar or lower mean squared error vs. ground-truth data compared to the conventional path-following method for images with typical signal-to-noise ratio (SNR) or low SNR (p < 0.05), respectively. Bland-Altman analyses showed biases of 0.00 ± 0.03 and limits of agreement of - 0.04 to 0.05 or better for deep learning-based fully-automatic global and segmental end-systolic circumferential strain vs. conventional user-assisted methods. CONCLUSIONS Deep learning enables fully-automatic global and segmental circumferential strain analysis of DENSE CMR providing excellent agreement with conventional user-assisted methods. Deep learning-based automatic strain analysis may facilitate greater clinical use of DENSE for the quantification of global and segmental strain in patients with cardiac disease.
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Affiliation(s)
- Sona Ghadimi
- Department of Biomedical Engineering, University of Virginia, Health System, Box 800759, Charlottesville, VA 22908 USA
| | - Daniel A. Auger
- Department of Biomedical Engineering, University of Virginia, Health System, Box 800759, Charlottesville, VA 22908 USA
| | - Xue Feng
- Department of Biomedical Engineering, University of Virginia, Health System, Box 800759, Charlottesville, VA 22908 USA
| | - Changyu Sun
- Department of Biomedical Engineering, University of Virginia, Health System, Box 800759, Charlottesville, VA 22908 USA
| | - Craig H. Meyer
- Department of Biomedical Engineering, University of Virginia, Health System, Box 800759, Charlottesville, VA 22908 USA
| | - Kenneth C. Bilchick
- Department of Medicine, University of Virginia Health System, Charlottesville, VA USA
| | - Jie Jane Cao
- Department of Cardiology, St. Francis Hospital, New York, NY USA
| | - Andrew D. Scott
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital, London, United Kingdom
| | - John N. Oshinski
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA USA
| | - Daniel B. Ennis
- Department of Radiology, Stanford University, Stanford, CA USA
| | - Frederick H. Epstein
- Department of Biomedical Engineering, University of Virginia, Health System, Box 800759, Charlottesville, VA 22908 USA
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Wang ZJ, Santiago A, Zhou X, Wang L, Margara F, Levrero-Florencio F, Das A, Kelly C, Dall'Armellina E, Vazquez M, Rodriguez B. Human biventricular electromechanical simulations on the progression of electrocardiographic and mechanical abnormalities in post-myocardial infarction. Europace 2021; 23:i143-i152. [PMID: 33751088 PMCID: PMC7943362 DOI: 10.1093/europace/euaa405] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/14/2020] [Indexed: 01/16/2023] Open
Abstract
AIMS Develop, calibrate and evaluate with clinical data a human electromechanical modelling and simulation framework for multiscale, mechanistic investigations in healthy and post-myocardial infarction (MI) conditions, from ionic to clinical biomarkers. METHODS AND RESULTS Human healthy and post-MI electromechanical simulations were conducted with a novel biventricular model, calibrated and evaluated with experimental and clinical data, including torso/biventricular anatomy from clinical magnetic resonance, state-of-the-art human-based membrane kinetics, excitation-contraction and active tension models, and orthotropic electromechanical coupling. Electromechanical remodelling of the infarct/ischaemic region and the border zone were simulated for ischaemic, acute, and chronic states in a fully transmural anterior infarct and a subendocardial anterior infarct. The results were compared with clinical electrocardiogram and left ventricular ejection fraction (LVEF) data at similar states. Healthy model simulations show LVEF 63%, with 11% peak systolic wall thickening, QRS duration and QT interval of 100 ms and 330 ms. LVEF in ischaemic, acute, and chronic post-MI states were 56%, 51%, and 52%, respectively. In linking the three post-MI simulations, it was apparent that elevated resting potential due to hyperkalaemia in the infarcted region led to ST-segment elevation, while a large repolarization gradient corresponded to T-wave inversion. Mechanically, the chronic stiffening of the infarct region had the benefit of improving systolic function by reducing infarct bulging at the expense of reducing diastolic function by inhibiting inflation. CONCLUSION Our human-based multiscale modelling and simulation framework enables mechanistic investigations into patho-physiological electrophysiological and mechanical behaviour and can serve as testbed to guide the optimization of pharmacological and electrical therapies.
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Affiliation(s)
- Zhinuo J Wang
- Department of Computer Science, University of Oxford, Wolfson Building, Parks Road, Oxford OX1 3QD, UK
| | - Alfonso Santiago
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Centre (BSC), Barcelona, Spain
- ELEM Biotech, Barcelona, Spain
| | - Xin Zhou
- Department of Computer Science, University of Oxford, Wolfson Building, Parks Road, Oxford OX1 3QD, UK
| | - Lei Wang
- Department of Computer Science, University of Oxford, Wolfson Building, Parks Road, Oxford OX1 3QD, UK
| | - Francesca Margara
- Department of Computer Science, University of Oxford, Wolfson Building, Parks Road, Oxford OX1 3QD, UK
| | | | - Arka Das
- Department of Biomedical Imaging Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Chris Kelly
- Department of Biomedical Imaging Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Erica Dall'Armellina
- Department of Biomedical Imaging Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Mariano Vazquez
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Centre (BSC), Barcelona, Spain
- ELEM Biotech, Barcelona, Spain
| | - Blanca Rodriguez
- Department of Computer Science, University of Oxford, Wolfson Building, Parks Road, Oxford OX1 3QD, UK
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Kido T, Hirai K, Ogawa R, Tanabe Y, Nakamura M, Kawaguchi N, Kurata A, Watanabe K, Schmidt M, Forman C, Mochizuki T, Kido T. Comparison between conventional and compressed sensing cine cardiovascular magnetic resonance for feature tracking global circumferential strain assessment. J Cardiovasc Magn Reson 2021; 23:10. [PMID: 33618722 PMCID: PMC7898736 DOI: 10.1186/s12968-021-00708-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Feature tracking (FT) has become an established tool for cardiovascular magnetic resonance (CMR)-based strain analysis. Recently, the compressed sensing (CS) technique has been applied to cine CMR, which has drastically reduced its acquisition time. However, the effects of CS imaging on FT strain analysis need to be carefully studied. This study aimed to investigate the use of CS cine CMR for FT strain analysis compared to conventional cine CMR. METHODS Sixty-five patients with different left ventricular (LV) pathologies underwent both retrospective conventional cine CMR and prospective CS cine CMR using a prototype sequence with the comparable temporal and spatial resolution at 3 T. Eight short-axis cine images covering the entire LV were obtained and used for LV volume assessment and FT strain analysis. Prospective CS cine CMR data over 1.5 heartbeats were acquired to capture the complete end-diastolic data between the first and second heartbeats. LV volume assessment and FT strain analysis were performed using a dedicated software (ci42; Circle Cardiovasacular Imaging, Calgary, Canada), and the global circumferential strain (GCS) and GCS rate were calculated from both cine CMR sequences. RESULTS There were no significant differences in the GCS (- 17.1% [- 11.7, - 19.5] vs. - 16.1% [- 11.9, - 19.3; p = 0.508) and GCS rate (- 0.8 [- 0.6, - 1.0] vs. - 0.8 [- 0.7, - 1.0]; p = 0.587) obtained using conventional and CS cine CMR. The GCS obtained using both methods showed excellent agreement (y = 0.99x - 0.24; r = 0.95; p < 0.001). The Bland-Altman analysis revealed that the mean difference in the GCS between the conventional and CS cine CMR was 0.1% with limits of agreement between -2.8% and 3.0%. No significant differences were found in all LV volume assessment between both types of cine CMR. CONCLUSION CS cine CMR could be used for GCS assessment by CMR-FT as well as conventional cine CMR. This finding further enhances the clinical utility of high-speed CS cine CMR imaging.
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Affiliation(s)
- Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Kuniaki Hirai
- Department of Radiology, Uwajima City Hospital, Uwajima, Japan
| | - Ryo Ogawa
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Masashi Nakamura
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kouki Watanabe
- Department of Cardiology, Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | | | | | - Teruhito Mochizuki
- Department of Radiology, Yoshino Hospital, Imabari, Japan
- Department of Radiology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
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Moulin K, Croisille P, Viallon M, Verzhbinsky IA, Perotti LE, Ennis DB. Myofiber strain in healthy humans using DENSE and cDTI. Magn Reson Med 2021; 86:277-292. [PMID: 33619807 DOI: 10.1002/mrm.28724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/15/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Myofiber strain, Eff , is a mechanistically relevant metric of cardiac cell shortening and is expected to be spatially uniform in healthy populations, making it a prime candidate for the evaluation of local cardiomyocyte contractility. In this study, a new, efficient pipeline was proposed to combine microstructural cDTI and functional DENSE data in order to estimate Eff in vivo. METHODS Thirty healthy volunteers were scanned with three long-axis (LA) and three short-axis (SA) DENSE slices using 2D displacement encoding and one SA slice of cDTI. The total acquisition time was 11 minutes ± 3 minutes across volunteers. The pipeline first generates 3D SA displacements from all DENSE slices which are then combined with cDTI data to generate a cine of myofiber orientations and compute Eff . The precision of the post-processing pipeline was assessed using a computational phantom study. Transmural myofiber strain was compared to circumferential strain, Ecc , in healthy volunteers using a Wilcoxon sign rank test. RESULTS In vivo, computed Eff was found uniform transmurally compared to Ecc (-0.14[-0.15, -0.12] vs -0.18 [-0.20, -0.16], P < .001, -0.14 [-0.16, -0.12] vs -0.16 [-0.17, -0.13], P < .001 and -0.14 [-0.16, -0.12] vs Ecc_C = -0.14 [-0.15, -0.11], P = .002, Eff_C vs Ecc_C in the endo, mid, and epi layers, respectively). CONCLUSION We demonstrate that it is possible to measure in vivo myofiber strain in a healthy human population in 10 minutes per subject. Myofiber strain was observed to be spatially uniform in healthy volunteers making it a potential biomarker for the evaluation of local cardiomyocyte contractility in assessing cardiovascular dysfunction.
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Affiliation(s)
- Kévin Moulin
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Pierre Croisille
- University of Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Etienne, France.,Department of Radiology, University Hospital Saint-Etienne, Saint-Etienne, France
| | - Magalie Viallon
- University of Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Etienne, France.,Department of Radiology, University Hospital Saint-Etienne, Saint-Etienne, France
| | - Ilya A Verzhbinsky
- Medical Scientist Training Program, University of California - San Diego, La Jolla, CA, USA
| | - Luigi E Perotti
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, CA, USA
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40
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Kar BJ, Cohen MV, McQuiston SP, Malozzi CM. A deep-learning semantic segmentation approach to fully automated MRI-based left-ventricular deformation analysis in cardiotoxicity. Magn Reson Imaging 2021; 78:127-139. [PMID: 33571634 DOI: 10.1016/j.mri.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/26/2020] [Accepted: 01/31/2021] [Indexed: 12/21/2022]
Abstract
Left-ventricular (LV) strain measurements with the Displacement Encoding with Stimulated Echoes (DENSE) MRI sequence provide accurate estimates of cardiotoxicity damage related to breast cancer chemotherapy. This study investigated an automated LV chamber quantification tool via segmentation with a supervised deep convolutional neural network (DCNN) before strain analysis with DENSE images. Segmentation for chamber quantification analysis was conducted with a custom DeepLabV3+ DCNN with ResNet-50 backbone on 42 female breast cancer datasets (22 training-sets, eight validation-sets and 12 independent test-sets). Parameters such as LV end-diastolic diameter (LVEDD) and ejection fraction (LVEF) were quantified, and myocardial strains analyzed with the Radial Point Interpolation Method (RPIM). Myocardial classification was validated against ground-truth with sensitivity-specificity analysis, the metrics of Dice, average perpendicular distance (APD) and Hausdorff-distance. Following segmentation, validation was conducted with the Cronbach's Alpha (C-Alpha) intraclass correlation coefficient between LV chamber quantification results with DENSE and Steady State Free Precession (SSFP) acquisitions and a vendor tool-based method to segment the DENSE data, and similarly for myocardial strain analysis in the chambers. The results of myocardial classification from segmentation of the DENSE data were accuracy = 97%, Dice = 0.89 and APD = 2.4 mm in the test-set. The C-Alpha correlations from comparing chamber quantification results between the segmented DENSE and SSFP data and vendor tool-based method were 0.97 for LVEF (56 ± 7% vs 55 ± 7% vs 55 ± 6%, p = 0.6) and 0.77 for LVEDD (4.6 ± 0.4 cm vs 4.5 ± 0.3 cm vs 4.5 ± 0.3 cm, p = 0.8). The validation metrics against ground-truth and equivalent parameters obtained from the SSFP segmentation and vendor tool-based comparisons show that the DCNN approach is applicable for automated LV chamber quantification and subsequent strain analysis in cardiotoxicity.
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Affiliation(s)
- By Julia Kar
- Departments of Mechanical Engineering and Pharmacology, University of South Alabama, 150 Jaguar Drive, Mobile, AL 36688, United States of America.
| | - Michael V Cohen
- Department of Cardiology, College of Medicine, University of South Alabama, 1700 Center Street, Mobile, AL 36604, United States of America
| | - Samuel P McQuiston
- Department of Radiology, University of South Alabama, 2451 USA Medical Center Drive, Mobile, AL 36617, United States of America
| | - Christopher M Malozzi
- Department of Cardiology, College of Medicine, University of South Alabama, 1700 Center Street, Mobile, AL 36604, United States of America
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41
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Eirich P, Wech T, Heidenreich JF, Stich M, Petri N, Nordbeck P, Bley TA, Köstler H. Cardiac real-time MRI using a pre-emphasized spiral acquisition based on the gradient system transfer function. Magn Reson Med 2020; 85:2747-2760. [PMID: 33270942 DOI: 10.1002/mrm.28621] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/21/2020] [Accepted: 11/10/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE Segmented Cartesian acquisition in breath hold represents the current gold standard for cardiac functional MRI. However, it is also associated with long imaging times and severe restrictions in arrhythmic or dyspneic patients. Therefore, we introduce a real-time imaging technique based on a spoiled gradient-echo sequence with undersampled spiral k-space trajectories corrected by a gradient pre-emphasis. METHODS A fully automatic gradient waveform pre-emphasis based on the gradient system transfer function was implemented to compensate for gradient inaccuracies, to optimize fast double-oblique spiral MRI. The framework was tested in a phantom study and subsequently transferred to compressed sensing-accelerated cardiac functional MRI in real time. Spiral acquisitions during breath hold and free breathing were compared with this reference method for healthy subjects (N = 7) as well as patients (N = 2) diagnosed with heart failure and arrhythmia. Left-ventricular volumes and ejection fractions were determined and analyzed using a Wilcoxon signed-rank test. RESULTS The pre-emphasis successfully reduced typical artifacts caused by k-space misregistrations. Dynamic cardiac imaging was possible in real time (temporal resolution < 50 ms) with high spatial resolution (1.34 × 1.34 mm2 ), resulting in a total scan time of less than 50 seconds for whole heart coverage. Comparable image quality, as well as similar left-ventricular volumes and ejection fractions, were observed for the accelerated and the reference method. CONCLUSION The proposed technique enables high-resolution real-time cardiac MRI with no need for breath holds and electrocardiogram gating, shortening the duration of an entire functional cardiac exam to less than 1 minute.
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Affiliation(s)
- Philipp Eirich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center Würzburg, Würzburg, Germany
| | - Tobias Wech
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Julius F Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Manuel Stich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Nils Petri
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Herbert Köstler
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
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42
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Kar J, Cohen MV, McQuiston SA, Malozzi CM. Comprehensive enhanced methodology of an MRI-based automated left-ventricular chamber quantification algorithm and validation in chemotherapy-related cardiotoxicity. J Med Imaging (Bellingham) 2020; 7:064002. [DOI: 10.1117/1.jmi.7.6.064002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/23/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Julia Kar
- University of South Alabama, Department of Mechanical Engineering, Mobile, Alabama
| | - Michael V. Cohen
- University of South Alabama, Department of Cardiology, Mobile, Alabama
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MacGregor RM, Guo A, Masood MF, Cupps BP, Ewald GA, Pasque MK, Foraker R. Machine Learning Outcome Prediction in Dilated Cardiomyopathy Using Regional Left Ventricular Multiparametric Strain. Ann Biomed Eng 2020; 49:922-932. [PMID: 33006006 DOI: 10.1007/s10439-020-02639-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/24/2020] [Indexed: 01/17/2023]
Abstract
The clinical presentation of idiopathic dilated cardiomyopathy (IDCM) heart failure (HF) patients who will respond to medical therapy (responders) and those who will not (non-responders) is often similar. A machine learning (ML)-based clinical tool to identify responders would prevent unnecessary surgery, while targeting non-responders for early intervention. We used regional left ventricular (LV) contractile injury patterns in ML models to identify IDCM HF non-responders. MRI-based multiparametric strain analysis was performed in 178 test subjects (140 normal subjects and 38 IDCM patients), calculating longitudinal, circumferential, and radial strain over 18 LV sub-regions for inclusion in ML analyses. Patients were identified as responders based upon symptomatic and contractile improvement on medical therapy. We tested the predictive accuracy of support vector machines (SVM), logistic regression (LR), random forest (RF), and deep neural networks (DNN). The DNN model outperformed other models, predicting response to medical therapy with an area under the receiver operating characteristic curve (AUC) of 0.94. The top features were longitudinal strain in (1) basal: anterior, posterolateral and (2) mid: posterior, anterolateral, and anteroseptal sub-regions. Regional contractile injury patterns predict response to medical therapy in IDCM HF patients, and have potential application in ML-based HF patient care.
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Affiliation(s)
- Robert M MacGregor
- Department of Surgery, Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, Campus Box 8234, 660 S. Euclid Ave., St. Louis, MO, 63110, USA
| | - Aixia Guo
- Institute for Informatics, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Muhammad F Masood
- Department of Surgery, Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, Campus Box 8234, 660 S. Euclid Ave., St. Louis, MO, 63110, USA
| | - Brian P Cupps
- Department of Surgery, Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, Campus Box 8234, 660 S. Euclid Ave., St. Louis, MO, 63110, USA
| | - Gregory A Ewald
- John T. Milliken Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael K Pasque
- Department of Surgery, Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, Campus Box 8234, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| | - Randi Foraker
- Institute for Informatics, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
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Tay JCK, Yap J. Myocardial compressibility: Debunking an age-old paradigm to discriminate diseased from normal myocardium. Int J Cardiol 2020; 322:284-285. [PMID: 32987055 DOI: 10.1016/j.ijcard.2020.09.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | - Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore.
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Shah SA, Cui SX, Waters CD, Sano S, Wang Y, Doviak H, Leor J, Walsh K, French BA, Epstein FH. Nitroxide-enhanced MRI of cardiovascular oxidative stress. NMR IN BIOMEDICINE 2020; 33:e4359. [PMID: 32648316 PMCID: PMC7904044 DOI: 10.1002/nbm.4359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/08/2020] [Accepted: 06/03/2020] [Indexed: 06/07/2023]
Abstract
BACKGROUND In vivo imaging of oxidative stress can facilitate the understanding and treatment of cardiovascular diseases. We evaluated nitroxide-enhanced MRI with 3-carbamoyl-proxyl (3CP) for the detection of myocardial oxidative stress. METHODS Three mouse models of cardiac oxidative stress were imaged, namely angiotensin II (Ang II) infusion, myocardial infarction (MI), and high-fat high-sucrose (HFHS) diet-induced obesity (DIO). For the Ang II model, mice underwent MRI at baseline and after 7 days of Ang II (n = 8) or saline infusion (n = 8). For the MI model, mice underwent MRI at baseline (n = 10) and at 1 (n = 8), 4 (n = 9), and 21 (n = 8) days after MI. For the HFHS-DIO model, mice underwent MRI at baseline (n = 20) and 18 weeks (n = 13) after diet initiation. The 3CP reduction rate, Kred , computed using a tracer kinetic model, was used as a metric of oxidative stress. Dihydroethidium (DHE) staining of tissue sections was performed on Day 1 after MI. RESULTS For the Ang II model, Kred was higher after 7 days of Ang II versus other groups (p < 0.05). For the MI model, Kred , in the infarct region was significantly elevated on Days 1 and 4 after MI (p < 0.05), whereas Kred in the noninfarcted region did not change after MI. DHE confirmed elevated oxidative stress in the infarct zone on Day 1 after MI. After 18 weeks of HFHS diet, Kred was higher in mice after diet versus baseline (p < 0.05). CONCLUSIONS Nitroxide-enhanced MRI noninvasively quantifies tissue oxidative stress as one component of a multiparametric preclinical MRI examination. These methods may facilitate investigations of oxidative stress in cardiovascular disease and related therapies.
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Affiliation(s)
- Soham A Shah
- Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Sophia X Cui
- Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | | | - Soichi Sano
- Hematovascular Biology Center, Robert M. Berne Cardiovascular Research Center, University of Virginia, Virginia, USA
| | - Ying Wang
- Hematovascular Biology Center, Robert M. Berne Cardiovascular Research Center, University of Virginia, Virginia, USA
| | - Heather Doviak
- Hematovascular Biology Center, Robert M. Berne Cardiovascular Research Center, University of Virginia, Virginia, USA
| | - Jonathan Leor
- Neufield Cardiac Research Institute, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Ramat Gan, Israel
| | - Kenneth Walsh
- Hematovascular Biology Center, Robert M. Berne Cardiovascular Research Center, University of Virginia, Virginia, USA
| | - Brent A French
- Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Frederick H Epstein
- Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
- Radiology, University of Virginia, Charlottesville, Virginia, USA
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46
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Nwotchouang BST, Eppelheimer MS, Biswas D, Pahlavian SH, Zhong X, Oshinski JN, Barrow DL, Amini R, Loth F. Accuracy of cardiac-induced brain motion measurement using displacement-encoding with stimulated echoes (DENSE) magnetic resonance imaging (MRI): A phantom study. Magn Reson Med 2020; 85:1237-1247. [PMID: 32869349 DOI: 10.1002/mrm.28490] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/07/2020] [Accepted: 08/02/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The goal of this study was to determine the accuracy of displacement-encoding with stimulated echoes (DENSE) MRI in a tissue motion phantom with displacements representative of those observed in human brain tissue. METHODS The phantom was comprised of a plastic shaft rotated at a constant speed. The rotational motion was converted to a vertical displacement through a camshaft. The phantom generated repeatable cyclical displacement waveforms with a peak displacement ranging from 92 µm to 1.04 mm at 1-Hz frequency. The surface displacement of the tissue was obtained using a laser Doppler vibrometer (LDV) before and after the DENSE MRI scans to check for repeatability. The accuracy of DENSE MRI displacement was assessed by comparing the laser Doppler vibrometer and DENSE MRI waveforms. RESULTS Laser Doppler vibrometer measurements of the tissue motion demonstrated excellent cycle-to-cycle repeatability with a maximum root mean square error of 9 µm between the ensemble-averaged displacement waveform and the individual waveforms over 180 cycles. The maximum difference between DENSE MRI and the laser Doppler vibrometer waveforms ranged from 15 to 50 µm. Additionally, the peak-to-peak difference between the 2 waveforms ranged from 1 to 18 µm. CONCLUSION Using a tissue phantom undergoing cyclical motion, we demonstrated the percent accuracy of DENSE MRI to measure displacement similar to that observed for in vivo cardiac-induced brain tissue.
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Affiliation(s)
| | - Maggie S Eppelheimer
- Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, Ohio, USA
| | - Dipankar Biswas
- Fluids and Structure (FaST) Laboratory, Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, Florida, USA
| | - Soroush Heidari Pahlavian
- Laboratory of FMRI Technology (LOFT), USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA
| | | | - John N Oshinski
- Radiology & Imaging Sciences and Biomedical Engineering, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel L Barrow
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Rouzbeh Amini
- Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Francis Loth
- Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, Ohio, USA.,Department of Mechanical Engineering, The University of Akron, Akron, Ohio, USA
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Mangion K, Loughrey CM, Auger DA, McComb C, Lee MM, Corcoran D, McEntegart M, Davie A, Good R, Lindsay M, Eteiba H, Rocchiccioli P, Watkins S, Hood S, Shaukat A, Haig C, Epstein FH, Berry C. Displacement Encoding With Stimulated Echoes Enables the Identification of Infarct Transmurality Early Postmyocardial Infarction. J Magn Reson Imaging 2020; 52:1722-1731. [PMID: 32720405 DOI: 10.1002/jmri.27295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Segmental extent of infarction assessed by late gadolinium enhancement (LGE) imaging early post-ST-segment elevation myocardial infarction (STEMI) has utility in predicting left ventricular functional recovery. HYPOTHESIS We hypothesized that segmental circumferential strain with displacement encoding with stimulated echoes (DENSE) would be a stronger predictor of infarct transmurality than feature-tracking strain, and noninferior to extracellular volume fraction (ECV). STUDY TYPE Prospective. POPULATION Fifty participants (mean ± SD, 59 ± 9 years, 40 [80%] male) underwent cardiac MRI on day 1 post-STEMI. FIELD-STRENGTH/SEQUENCES 1.5T/cine, DENSE, T1 mapping, ECV, LGE. ASSESSMENT Two observers assessed segmental percentage LGE extent, presence of microvascular obstruction (MVO), circumferential and radial strain with DENSE and feature-tracking, T1 relaxation times, and ECV. STATISTICAL TESTS Normality was tested using the Shapiro-Wilk test. Skewed distributions were analyzed utilizing Mann-Whitney or Kruskal-Wallis tests and normal distributed data using independent t-tests. Diagnostic cutoff values were identified using the Youden index. The difference in area under the curve was compared using the z-statistic. RESULTS Segmental circumferential strain with DENSE was associated with the extent of infarction ≥50% (AUC [95% CI], cutoff value = 0.9 [0.8, 0.9], -10%) similar to ECV (AUC = 0.8 [0.8, 0.9], 37%) (P = 0.117) and superior to feature-tracking circumferential strain (AUC = 0.7[0.7, 0.8], -19%) (P < 0.05). For the detection of segmental infarction ≥75%, circumferential strain with DENSE (AUC = 0.9 [0.8, 0.9], -10%) was noninferior to ECV (AUC = 0.8 [0.7, 0.9], 42%) (P = 0.132) and superior to feature-tracking (AUC = 0.7 [0.7, 0.8], -13%) (P < 0.05). For MVO detection, circumferential strain with DENSE (AUC = 0.8 [0.8, 0.9], -12%) was superior to ECV (AUC = 0.8 [0.7, 0.8] 34%) (P < 0.05) and feature-tracking (AUC = 0.7 [0.6, 0.7] -21%) (P < 0.05). DATA CONCLUSION Circumferential strain with DENSE is a functional measure of infarct severity and may remove the need for gadolinium contrast agents in some circumstances. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 5 J. MAGN. RESON. IMAGING 2020;52:1722-1731.
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Affiliation(s)
- Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Christopher M Loughrey
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Daniel A Auger
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Christie McComb
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Matthew M Lee
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew Davie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Hany Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Paul Rocchiccioli
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
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Avazmohammadi R, Soares JS, Li DS, Eperjesi T, Pilla J, Gorman RC, Sacks MS. On the in vivo systolic compressibility of left ventricular free wall myocardium in the normal and infarcted heart. J Biomech 2020; 107:109767. [PMID: 32386714 PMCID: PMC7433024 DOI: 10.1016/j.jbiomech.2020.109767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/26/2020] [Indexed: 01/01/2023]
Abstract
Although studied for many years, there remain continued gaps in our fundamental understanding of cardiac kinematics, such as the nature and extent of heart wall volumetric changes that occur over the cardiac cycle. Such knowledge is especially important for accurate in silico simulations of cardiac pathologies and in the development of novel therapies for their treatment. A prime example is myocardial infarction (MI), which induces profound, regionally variant maladaptive remodeling of the left ventricle (LV) wall. To address this problem, we conducted an in vivo fiduciary marker-based study in an established ovine model of MI to generate detailed, time-evolving transmural in vivo volumetric measurements of LV free wall deformations in the normal state, as well as up to 12 h post-MI. This was accomplished using a transmural array of sonomicrometry crystals that acquired fiducial positions at ∼250 Hz with a positional accuracy of ∼0.1 mm, covering the entire infarct, border, and remote zones. A convex-hull method was used to directly calculate the Jacobian J(t)=Δv(t)/ΔVED from sonocrystal positions over the entire cardiac cycle, where ΔV is the volume of each convex polyhedral at end diastole (ED) (typically ∼1 cc). We demonstrated significant in vivo compressibility in normal functioning LV free wall myocardium, with JES=0.85±0.07 at end systole (ES). We also observed substantial regional variations, with the largest reduction in local myocardial tissue volume during systole in the base region accompanied by substantial transmural gradients. These patterns changed profoundly following loss of perfusion post-MI, with the apical region showing the greatest loss of volume reduction at ES. To verify that the sonocrystals did not affect local volumetric measurements, JES measures were also verified by non-invasive magnetic resonance imaging, exhibiting very similar changes in regional volume. We note that while our estimates of regional compressibility were in close agreement with the values previously reported for large animals, ranging from 5% to 20%, the direct, comprehensive measurements of wall compressibility presented herein improved on the limitations of previous reports. These limitations included dependency on the small local volumes used for analysis and often indirect measurement of compressibility. Our novel findings suggest that proper accounting for the myocardial effective compressibility at the ∼1 cc volume scale can improve the accuracy of existing kinematic indices, such as wall thickening and axial shortening, and simulations of LV remodeling following MI.
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Affiliation(s)
- Reza Avazmohammadi
- James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA; Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Joao S Soares
- Department of Mechanical and Nuclear Engineering, Virginia Commonweath University, Richmond VA 23284, USA
| | - David S Li
- James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - Thomas Eperjesi
- Gorman Cardiovascular Research Group, Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James Pilla
- Gorman Cardiovascular Research Group, Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michael S Sacks
- James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
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Verzhbinsky IA, Perotti LE, Moulin K, Cork TE, Loecher M, Ennis DB. Estimating Aggregate Cardiomyocyte Strain Using In Vivo Diffusion and Displacement Encoded MRI. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:656-667. [PMID: 31398112 PMCID: PMC7325525 DOI: 10.1109/tmi.2019.2933813] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Changes in left ventricular (LV) aggregate cardiomyocyte orientation and deformation underlie cardiac function and dysfunction. As such, in vivo aggregate cardiomyocyte "myofiber" strain ( [Formula: see text]) has mechanistic significance, but currently there exists no established technique to measure in vivo [Formula: see text]. The objective of this work is to describe and validate a pipeline to compute in vivo [Formula: see text] from magnetic resonance imaging (MRI) data. Our pipeline integrates LV motion from multi-slice Displacement ENcoding with Stimulated Echoes (DENSE) MRI with in vivo LV microstructure from cardiac Diffusion Tensor Imaging (cDTI) data. The proposed pipeline is validated using an analytical deforming heart-like phantom. The phantom is used to evaluate 3D cardiac strains computed from a widely available, open-source DENSE Image Analysis Tool. Phantom evaluation showed that a DENSE MRI signal-to-noise ratio (SNR) ≥20 is required to compute [Formula: see text] with near-zero median strain bias and within a strain tolerance of 0.06. Circumferential and longitudinal strains are also accurately measured under the same SNR requirements, however, radial strain exhibits a median epicardial bias of -0.10 even in noise-free DENSE data. The validated framework is applied to experimental DENSE MRI and cDTI data acquired in eight ( N=8 ) healthy swine. The experimental study demonstrated that [Formula: see text] has decreased transmural variability compared to radial and circumferential strains. The spatial uniformity and mechanistic significance of in vivo [Formula: see text] make it a compelling candidate for characterization and early detection of cardiac dysfunction.
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Real-time 3T MRI-guided cardiovascular catheterization in a porcine model using a glass-fiber epoxy-based guidewire. PLoS One 2020; 15:e0229711. [PMID: 32102092 PMCID: PMC7043930 DOI: 10.1371/journal.pone.0229711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/13/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Real-time magnetic resonance imaging (MRI) is a promising alternative to X-ray fluoroscopy for guiding cardiovascular catheterization procedures. Major challenges, however, include the lack of guidewires that are compatible with the MRI environment, not susceptible to radiofrequency-induced heating, and reliably visualized. Preclinical evaluation of new guidewire designs has been conducted at 1.5T. Here we further evaluate the safety (device heating), device visualization, and procedural feasibility of 3T MRI-guided cardiovascular catheterization using a novel MRI-visible glass-fiber epoxy-based guidewire in phantoms and porcine models. METHODS To evaluate device safety, guidewire tip heating (GTH) was measured in phantom experiments with different combinations of catheters and guidewires. In vivo cardiovascular catheterization procedures were performed in both healthy (N = 5) and infarcted (N = 5) porcine models under real-time 3T MRI guidance using a glass-fiber epoxy-based guidewire. The times for each procedural step were recorded separately. Guidewire visualization was assessed by measuring the dimensions of the guidewire-induced signal void and contrast-to-noise ratio (CNR) between the guidewire tip signal void and the blood signal in real-time gradient-echo MRI (specific absorption rate [SAR] = 0.04 W/kg). RESULTS In the phantom experiments, GTH did not exceed 0.35°C when using the real-time gradient-echo sequence (SAR = 0.04 W/kg), demonstrating the safety of the glass-fiber epoxy-based guidewire at 3T. The catheter was successfully placed in the left ventricle (LV) under real-time MRI for all five healthy subjects and three out of five infarcted subjects. Signal void dimensions and CNR values showed consistent visualization of the glass-fiber epoxy-based guidewire in real-time MRI. The average time (minutes:seconds) for the catheterization procedure in all subjects was 4:32, although the procedure time varied depending on the subject's specific anatomy (standard deviation = 4:41). CONCLUSIONS Real-time 3T MRI-guided cardiovascular catheterization using a new MRI-visible glass-fiber epoxy-based guidewire is feasible in terms of visualization and guidewire navigation, and safe in terms of radiofrequency-induced guidewire tip heating.
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