1
|
Simon J, Fung K, Raisi-Estabragh Z, Aung N, Khanji MY, Zsarnóczay E, Merkely B, Munroe PB, Harvey NC, Piechnik SK, Neubauer S, Leeson P, Petersen SE, Maurovich-Horvat P. Association between subclinical atherosclerosis and cardiac structure and function-results from the UK Biobank Study. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad010. [PMID: 37822973 PMCID: PMC10563379 DOI: 10.1093/ehjimp/qyad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/03/2023] [Indexed: 10/13/2023]
Abstract
Aims Heart failure (HF) is a major health problem and early diagnosis is important. Atherosclerosis is the main cause of HF and carotid intima-media thickness (IMT) is a recognized early measure of atherosclerosis. This study aimed to investigate whether increased carotid IMT is associated with changes in cardiac structure and function in middle-aged participants of the UK Biobank Study without overt cardiovascular disease. Methods and results Participants of the UK Biobank who underwent CMR and carotid ultrasound examinations were included in this study. Patients with heart failure, angina, atrial fibrillation, and history of myocardial infarction or stroke were excluded. We used multivariable linear regression models adjusted for age, sex, physical activity, body mass index, body surface area, hypertension, diabetes, smoking, ethnicity, socioeconomic status, alcohol intake, and laboratory parameters. In total, 4301 individuals (61.6 ± 7.5 years, 45.9% male) were included. Multivariable linear regression analyses showed that increasing quartiles of IMT was associated with increased left and right ventricular (LV and RV) and left atrial volumes and greater LV mass. Moreover, increased IMT was related to lower LV end-systolic circumferential strain, torsion, and both left and right atrial ejection fractions (all P < 0.05). Conclusion Increased IMT showed an independent association over traditional risk factors with enlargement of all four cardiac chambers, decreased function in both atria, greater LV mass, and subclinical LV dysfunction. There may be additional risk stratification that can be derived from the IMT to identify those most likely to have early cardiac structural/functional changes.
Collapse
Affiliation(s)
- Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Üllői út 78, H-1082 Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary, Városmajor u 68, H-1122 Budapest, Hungary
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
- Barts Health NHS Trust, Newham University Hospital, Glen Road, Plaistow, London E1 1BB, United Kingdom
| | - Emese Zsarnóczay
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Üllői út 78, H-1082 Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary, Városmajor u 68, H-1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary, Városmajor u 68, H-1122 Budapest, Hungary
| | - Patricia B Munroe
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Stefan K Piechnik
- National Institute for Health Research, Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Stefan Neubauer
- National Institute for Health Research, Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 1, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Üllői út 78, H-1082 Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary, Városmajor u 68, H-1122 Budapest, Hungary
| |
Collapse
|
2
|
Khanji MY, Karim S, Cooper J, Chahal A, Aung N, Somers VK, Neubauer S, Petersen SE. Impact of Sleep Duration and Chronotype on Cardiac Structure and Function: The UK Biobank Study. Curr Probl Cardiol 2023; 48:101688. [PMID: 36906161 DOI: 10.1016/j.cpcardiol.2023.101688] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
Sleep duration and chronotype have been associated with increased morbidity and mortality. We assessed for associations between sleep duration and chronotype on cardiac structure and function. UK Biobank participants with CMR data and without known cardiovascular disease were included. Self-reported sleep duration was categorized as short (<7 h/d), normal (7-9 h/d) and long (>9 h/d). Self-reported chronotype was categories as "definitely morning" or "definitely evening." Analysis included 3903 middle-aged adults: 929 short, 2924 normal and 50 long sleepers; with 966 definitely-morning and 355 definitely-evening chronotypes. Long sleep was independently associated with lower left ventricular (LV) mass (-4.8%, P = 0.035), left atrial maximum volume (-8.1%, P = 0.041) and right ventricular (RV) end-diastolic volume (-4.8%, P = 0.038) compared to those with normal sleep duration. Evening chronotype was independently associated with lower LV end-diastolic volume (-2.4%, P = 0.021), RV end-diastolic volume (-3.6%, P = 0.0006), RV end systolic volume (-5.1%, P = 0.0009), RV stroke volume (RVSV -2.7%, P = 0.033), right atrial maximal volume (-4.3%, P = 0.011) and emptying fraction (+1.3%, P = 0.047) compared to morning chronotype. Sex interactions existed for sleep duration and chronotype and age interaction for chronotype even after considering potential confounders. In conclusion, longer sleep duration was independently associated with smaller LV mass, left atrial volume and RV volume. Evening chronotype was independently associated with smaller LV and RV and reduced RV function compared to morning chronotype. Sex interactions exist with cardiac remodeling most evident in males with long sleep duration and evening chronotype. Recommendations for sleep chronotype and duration may need to be individualized based on sex.
Collapse
Affiliation(s)
- Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, Charterhouse Square, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK; Newham University Hospital, Barts Health NHS Trust, London, UK.
| | - Shahid Karim
- William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, Charterhouse Square, London, UK; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, Charterhouse Square, London, UK
| | - Anwar Chahal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, Charterhouse Square, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, UK
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, Charterhouse Square, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Cheng HLM. Emerging MRI techniques for molecular and functional phenotyping of the diseased heart. Front Cardiovasc Med 2022; 9:1072828. [PMID: 36545017 PMCID: PMC9760746 DOI: 10.3389/fcvm.2022.1072828] [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: 10/18/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Recent advances in cardiac MRI (CMR) capabilities have truly transformed its potential for deep phenotyping of the diseased heart. Long known for its unparalleled soft tissue contrast and excellent depiction of three-dimensional (3D) structure, CMR now boasts a range of unique capabilities for probing disease at the tissue and molecular level. We can look beyond coronary vessel blockages and detect vessel disease not visible on a structural level. We can assess if early fibrotic tissue is being laid down in between viable cardiac muscle cells. We can measure deformation of the heart wall to determine early presentation of stiffening. We can even assess how cardiomyocytes are utilizing energy, where abnormalities are often precursors to overt structural and functional deficits. Finally, with artificial intelligence gaining traction due to the high computing power available today, deep learning has proven itself a viable contender with traditional acceleration techniques for real-time CMR. In this review, we will survey five key emerging MRI techniques that have the potential to transform the CMR clinic and permit early detection and intervention. The emerging areas are: (1) imaging microvascular dysfunction, (2) imaging fibrosis, (3) imaging strain, (4) imaging early metabolic changes, and (5) deep learning for acceleration. Through a concerted effort to develop and translate these areas into the CMR clinic, we are committing ourselves to actualizing early diagnostics for the most intractable heart disease phenotypes.
Collapse
Affiliation(s)
- Hai-Ling Margaret Cheng
- The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada,Ted Rogers Centre for Heart Research, Translational Biology & Engineering Program, Toronto, ON, Canada,*Correspondence: Hai-Ling Margaret Cheng,
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Yassine IA, Ghanem AM, Metwalli NS, Hamimi A, Ouwerkerk R, Matta JR, Solomon MA, Elinoff JM, Gharib AM, Abd-Elmoniem KZ. Native-resolution myocardial principal Eulerian strain mapping using convolutional neural networks and Tagged Magnetic Resonance Imaging. Comput Biol Med 2022; 141:105041. [PMID: 34836627 PMCID: PMC8900530 DOI: 10.1016/j.compbiomed.2021.105041] [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: 09/14/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Assessment of regional myocardial function at native pixel-level resolution can play a crucial role in recognizing the early signs of the decline in regional myocardial function. Extensive data processing in existing techniques limits the effective resolution and accuracy of the generated strain maps. The purpose of this study is to compute myocardial principal strain maps εp1 and εp2 from tagged MRI (tMRI) at the native image resolution using deep-learning local patch convolutional neural network (CNN) models (DeepStrain). METHODS For network training, validation, and testing, realistic tMRI datasets were generated and consisted of 53,606 cine images simulating the heart, the liver, blood pool, and backgrounds, including ranges of shapes, positions, motion patterns, noise, and strain. In addition, 102 in-vivo image datasets from three healthy subjects, and three Pulmonary Arterial Hypertension patients, were acquired and used to assess the network's in-vivo performance. Four convolutional neural networks were trained for mapping input tagging patterns to corresponding ground-truth principal strains using different cost functions. Strain maps using harmonic phase analysis (HARP) were obtained with various spectral filtering settings for comparison. CNN and HARP strain maps were compared at the pixel level versus the ground-truth and versus the least-loss in-vivo maps using Pearson correlation coefficients (R) and the median error and Inter-Quartile Range (IQR) histograms. RESULTS CNN-based local patch DeepStrain maps at a phantom resolution of 1.1mm × 1.1 mm and in-vivo resolution of 2.1mm × 1.6 mm were artifact-free with multiple fold improvement with εp1 ground-truth median error of 0.009(0.007) vs. 0.32(0.385) using HARP and εp2 ground-truth error of 0.016(0.021) vs. 0.181(0.08) using HARP. CNN-based strain maps showed substantially higher agreement with the ground-truth maps with correlation coefficients R > 0.91 for εp1 and εp2 compared to R < 0.21 and R < 0.82 for HARP-generated maps, respectively. CONCLUSION CNN-generated Eulerian strain mapping permits artifact-free visualization of myocardial function at the native image resolution.
Collapse
Affiliation(s)
- Inas A. Yassine
- Systems and Biomedical Engineering Department, Faculty of Engineering, Cairo University, Egypt
| | - Ahmed M. Ghanem
- Biomedical and Metabolic Imaging Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Nader S. Metwalli
- Biomedical and Metabolic Imaging Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Ahmed Hamimi
- Biomedical and Metabolic Imaging Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Ronald Ouwerkerk
- Biomedical and Metabolic Imaging Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Jatin R. Matta
- Biomedical and Metabolic Imaging Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Michael A. Solomon
- Cardiovascular Branch of the National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD, USA.,Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | - Jason M. Elinoff
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | - Ahmed M. Gharib
- Biomedical and Metabolic Imaging Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Khaled Z. Abd-Elmoniem
- Biomedical and Metabolic Imaging Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA,Corresponding author: Khaled Z Abd-Elmoniem, PhD, MHS, Biomedical and Metabolic Imaging Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 10 Center Drive, Bldg. 10, CRC, Rm. 3-5340, Bethesda, MD 20892, Tel: 301-451-8982/Fax: 301-480-3166,
| |
Collapse
|
10
|
Mella H, Mura J, Sotelo J, Uribe S. A comprehensive comparison between shortest-path HARP refinement, SinMod, and DENSEanalysis processing tools applied to CSPAMM and DENSE images. Magn Reson Imaging 2021; 83:14-26. [PMID: 34242693 DOI: 10.1016/j.mri.2021.07.001] [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: 11/23/2020] [Revised: 03/26/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
We addressed comprehensively the performance of Shortest-Path HARP Refinement (SP-HR), SinMod, and DENSEanalysis using 2D slices of synthetic CSPAMM and DENSE images with realistic contrasts obtained from 3D phantoms. The three motion estimation techniques were interrogated under ideal and no-ideal conditions (with MR induced artifacts, noise, and through-plane motion), considering several resolutions and noise levels. Under noisy conditions, and for isotropic pixel sizes of 1.5 mm and 3.0 mm in CSPAMM and DENSE images respectively, the nRMSE obtained for the circumferential and radial strain components were 10.7 ± 10.8% and 25.5 ± 14.8% using SP-HR, 11.9 ± 2.5% and 29.3 ± 6.5% using SinMod, and 6.4 ± 2.0% and 18.2 ± 4.6% using DENSEanalysis. Overall, the results showed that SP-HR tends to fail for large tissue motions, whereas SinMod and DENSEanalysis gave accurate displacement and strain field estimations, being the last which performed the best.
Collapse
Affiliation(s)
- Hernán Mella
- Department of Electrical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile; Biomedical Imaging Centre, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile.
| | - Joaquín Mura
- Department of Mechanical Engineering, Universidad Técnica Federico Santa María, Santiago, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile.
| | - Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile; Biomedical Imaging Centre, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile.
| | - Sergio Uribe
- Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Biomedical Imaging Centre, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile.
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
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.
Collapse
|
16
|
Leng S, Tan RS, Zhao X, Allen JC, Koh AS, Zhong L. Fast long-axis strain: a simple, automatic approach for assessing left ventricular longitudinal function with cine cardiovascular magnetic resonance. Eur Radiol 2020; 30:3672-3683. [PMID: 32107604 DOI: 10.1007/s00330-020-06744-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES In some cardiac pathologies, impairment of left ventricular (LV) longitudinal function may precede reduction in LV ejection fraction. This study investigates the effectiveness of a fast method to quantify long-axis LV function compared to conventional feature tracking and manual approaches. METHODS The study consisted of 50 normal controls and 100 heart failure (HF) patients including 40 with reduced ejection fraction (HFrEF), 30 with mid-range ejection fraction (HFmrEF), and 30 with preserved ejection fraction (HFpEF). Parameters including fast long-axis strain (FLAS) at end-systole and peak strain rates during systole (FLASRs), early diastole (FLASRe), and atrial contraction (FLASRa) were derived by a fast semi-automated approach on cine cardiovascular magnetic resonance. RESULTS FLAS exhibited good agreement with strain values obtained using conventional feature tracking (bias - 2.9%, limits of agreement ± 3.0%) and the manual approach (bias 0.6%, limits of agreement ± 2.1%), where FLAS was more reproducible and required shorter measurement time. The mean FLAS (HFrEF < HFmrEF < HFpEF < controls; 6.1 ± 2.4 < 9.9 ± 2.4 < 11.0 ± 2.5 < 16.9 ± 2.3%, all p < 0.0001) was decreased in all the HF patient groups. A FLAS of 12.3% (mean-2SD of controls) predicted the presence of systolic dysfunction in 67% of patients with HFpEF, and 87% with HFmrEF. Strain parameters using the fast approach were superior to those obtained by conventional feature tracking and manual approaches for discriminating HFpEF from controls. Notable examples are area under the curve, sensitivity, and specificity for FLAS (0.94, 93%, and 86%) and FLASRe (0.96, 90%, and 94%). CONCLUSIONS The fast approach-derived LV strain and strain rate parameters facilitate reproducible, reliable, and effective LV longitudinal function analysis. KEY POINTS • Left ventricular long-axis strain can be rapidly derived from cine CMR with shorter measurement time and higher reproducibility compared to conventional feature tracking and the manual approach. • Progressive reductions in left ventricular long-axis strain and strain rate measurements were observed from HFpEF, HFmrEF, to HFrEF group. • Based on long-axis strain, systolic abnormalities were evident in HFmrEF and HFpEF indicating common coexistence of systolic and diastolic dysfunction in the HF phenotypes.
Collapse
Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - John C Allen
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Angela S Koh
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore. .,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.
| |
Collapse
|
17
|
Ferdian E, Suinesiaputra A, Fung K, Aung N, Lukaschuk E, Barutcu A, Maclean E, Paiva J, Piechnik SK, Neubauer S, Petersen SE, Young AA. Fully Automated Myocardial Strain Estimation from Cardiovascular MRI-tagged Images Using a Deep Learning Framework in the UK Biobank. Radiol Cardiothorac Imaging 2020; 2:e190032. [PMID: 32715298 PMCID: PMC7051160 DOI: 10.1148/ryct.2020190032] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/19/2019] [Accepted: 08/21/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To demonstrate the feasibility and performance of a fully automated deep learning framework to estimate myocardial strain from short-axis cardiac MRI-tagged images. MATERIALS AND METHODS In this retrospective cross-sectional study, 4508 cases from the U.K. Biobank were split randomly into 3244 training cases, 812 validation cases, and 452 test cases. Ground truth myocardial landmarks were defined and tracked by manual initialization and correction of deformable image registration using previously validated software with five readers. The fully automatic framework consisted of (a) a convolutional neural network (CNN) for localization and (b) a combination of a recurrent neural network (RNN) and a CNN to detect and track the myocardial landmarks through the image sequence for each slice. Radial and circumferential strain were then calculated from the motion of the landmarks and averaged on a slice basis. RESULTS Within the test set, myocardial end-systolic circumferential Green strain errors were -0.001 ± 0.025, -0.001 ± 0.021, and 0.004 ± 0.035 in the basal, mid-, and apical slices, respectively (mean ± standard deviation of differences between predicted and manual strain). The framework reproduced significant reductions in circumferential strain in participants with diabetes, hypertensive participants, and participants with a previous heart attack. Typical processing time was approximately 260 frames (approximately 13 slices) per second on a GPU with 12 GB RAM compared with 6-8 minutes per slice for the manual analysis. CONCLUSION The fully automated combined RNN and CNN framework for analysis of myocardial strain enabled unbiased strain evaluation in a high-throughput workflow, with similar ability to distinguish impairment due to diabetes, hypertension, and previous heart attack.Published under a CC BY 4.0 license. Supplemental material is available for this article.
Collapse
Affiliation(s)
- Edward Ferdian
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Avan Suinesiaputra
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Kenneth Fung
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Nay Aung
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Elena Lukaschuk
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Ahmet Barutcu
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Edd Maclean
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Jose Paiva
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Stefan K. Piechnik
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Stefan Neubauer
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Steffen E. Petersen
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Alistair A. Young
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| |
Collapse
|
18
|
Bilchick KC, Auger DA, Abdishektaei M, Mathew R, Sohn MW, Cai X, Sun C, Narayan A, Malhotra R, Darby A, Mangrum JM, Mehta N, Ferguson J, Mazimba S, Mason PK, Kramer CM, Levy WC, Epstein FH. CMR DENSE and the Seattle Heart Failure Model Inform Survival and Arrhythmia Risk After CRT. JACC Cardiovasc Imaging 2019; 13:924-936. [PMID: 31864974 DOI: 10.1016/j.jcmg.2019.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/23/2019] [Accepted: 10/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to determine if combining the Seattle Heart Failure Model (SHFM-D) and cardiac magnetic resonance (CMR) provides complementary prognostic data for patients with cardiac resynchronization therapy (CRT) defibrillators. BACKGROUND The SHFM-D is among the most widely used risk stratification models for overall survival in patients with heart failure and implantable cardioverter-defibrillators (ICDs), and CMR provides highly detailed information regarding cardiac structure and function. METHODS CMR Displacement Encoding with Stimulated Echoes (DENSE) strain imaging was used to generate the circumferential uniformity ratio estimate with singular value decomposition (CURE-SVD) circumferential strain dyssynchrony parameter, and the SHFM-D was determined from clinical parameters. Multivariable Cox proportional hazards regression was used to determine adjusted hazard ratios and time-dependent areas under the curve for the primary endpoint of death, heart transplantation, left ventricular assist device, or appropriate ICD therapies. RESULTS The cohort consisted of 100 patients (65.5 [interquartile range 57.7 to 72.7] years; 29% female), of whom 47% had the primary clinical endpoint and 18% had appropriate ICD therapies during a median follow-up of 5.3 years. CURE-SVD and the SHFM-D were independently associated with the primary endpoint (SHFM-D: hazard ratio: 1.47/SD; 95% confidence interval: 1.06 to 2.03; p = 0.02) (CURE-SVD: hazard ratio: 1.54/SD; 95% confidence interval: 1.12 to 2.11; p = 0.009). Furthermore, a favorable prognostic group (Group A, with CURE-SVD <0.60 and SHFM-D <0.70) comprising approximately one-third of the patients had a very low rate of appropriate ICD therapies (1.5% per year) and a greater (90%) 4-year survival compared with Group B (CURE-SVD ≥0.60 or SHFM-D ≥0.70) patients (p = 0.02). CURE-SVD with DENSE had a stronger correlation with CRT response (r = -0.57; p < 0.0001) than CURE-SVD with feature tracking (r = -0.28; p = 0.004). CONCLUSIONS A combined approach to risk stratification using CMR DENSE strain imaging and a widely used clinical risk model, the SHFM-D, proved to be effective in this cohort of patients referred for CRT defibrillators. The combined use of CMR and clinical risk models represents a promising and novel paradigm to inform prognosis and device selection in the future.
Collapse
Affiliation(s)
- Kenneth C Bilchick
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.
| | - Daniel A Auger
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia
| | - Mohammad Abdishektaei
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia
| | - Roshin Mathew
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Min-Woong Sohn
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia
| | - Xiaoying Cai
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia
| | - Changyu Sun
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia
| | - Aditya Narayan
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia
| | - Rohit Malhotra
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Andrew Darby
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - J Michael Mangrum
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Nishaki Mehta
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - John Ferguson
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Sula Mazimba
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Pamela K Mason
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher M Kramer
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - Wayne C Levy
- Department of Medicine, University of Washington, Seattle, Washington
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| |
Collapse
|
19
|
Jensen MT, Fung K, Aung N, Sanghvi MM, Chadalavada S, Paiva JM, Khanji MY, de Knegt MC, Lukaschuk E, Lee AM, Barutcu A, Maclean E, Carapella V, Cooper J, Young A, Piechnik SK, Neubauer S, Petersen SE. Changes in Cardiac Morphology and Function in Individuals With Diabetes Mellitus: The UK Biobank Cardiovascular Magnetic Resonance Substudy. Circ Cardiovasc Imaging 2019; 12:e009476. [PMID: 31522551 PMCID: PMC7099857 DOI: 10.1161/circimaging.119.009476] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/18/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with increased risk of cardiovascular disease. Detection of early cardiac changes before manifest disease develops is important. We investigated early alterations in cardiac structure and function associated with DM using cardiovascular magnetic resonance imaging. METHODS Participants from the UK Biobank Cardiovascular Magnetic Resonance Substudy, a community cohort study, without known cardiovascular disease and left ventricular ejection fraction ≥50% were included. Multivariable linear regression models were performed. The investigators were blinded to DM status. RESULTS A total of 3984 individuals, 45% men, (mean [SD]) age 61.3 (7.5) years, hereof 143 individuals (3.6%) with DM. There was no difference in left ventricular (LV) ejection fraction (DM versus no DM; coefficient [95% CI]: -0.86% [-1.8 to 0.5]; P=0.065), LV mass (-0.13 g/m2 [-1.6 to 1.3], P=0.86), or right ventricular ejection fraction (-0.23% [-1.2 to 0.8], P=0.65). However, both LV and right ventricular volumes were significantly smaller in DM, (LV end-diastolic volume/m2: -3.46 mL/m2 [-5.8 to -1.2], P=0.003, right ventricular end-diastolic volume/m2: -4.2 mL/m2 [-6.8 to -1.7], P=0.001, LV stroke volume/m2: -3.0 mL/m2 [-4.5 to -1.5], P<0.001; right ventricular stroke volume/m2: -3.8 mL/m2 [-6.5 to -1.1], P=0.005), LV mass/volume: 0.026 (0.01 to 0.04) g/mL, P=0.006. Both left atrial and right atrial emptying fraction were lower in DM (right atrial emptying fraction: -6.2% [-10.2 to -2.1], P=0.003; left atrial emptying fraction:-3.5% [-6.9 to -0.1], P=0.043). LV global circumferential strain was impaired in DM (coefficient [95% CI]: 0.38% [0.01 to 0.7], P=0.045). CONCLUSIONS In a low-risk general population without known cardiovascular disease and with preserved LV ejection fraction, DM is associated with early changes in all 4 cardiac chambers. These findings suggest that diabetic cardiomyopathy is not a regional condition of the LV but affects the heart globally.
Collapse
Affiliation(s)
- Magnus T. Jensen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
- Department of Cardiology, Copenhagen University Hospital Herlev- Gentofte, Hellerup, Denmark (M.T.J.)
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (M.T.J.)
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Mihir M. Sanghvi
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Sucharitha Chadalavada
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Jose M. Paiva
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Mohammed Y. Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Martina C. de Knegt
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Elena Lukaschuk
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Aaron M. Lee
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Ahmet Barutcu
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Edd Maclean
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
| | - Valentina Carapella
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
| | - Alistair Young
- Department of Biomedical Engineering, King’s College London, United Kingdom (A.Y.)
| | - Stefan K. Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Steffen E. Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| |
Collapse
|
20
|
Mangion K, Carrick D, Clerfond G, Rush C, McComb C, Oldroyd KG, Petrie MC, Eteiba H, Lindsay M, McEntegart M, Hood S, Watkins S, Davie A, Auger DA, Zhong X, Epstein FH, Haig CE, Berry C. Predictors of segmental myocardial functional recovery in patients after an acute ST-Elevation myocardial infarction. Eur J Radiol 2019; 112:121-129. [PMID: 30777200 PMCID: PMC6390173 DOI: 10.1016/j.ejrad.2019.01.010] [Citation(s) in RCA: 15] [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: 11/10/2018] [Revised: 01/08/2019] [Accepted: 01/12/2019] [Indexed: 01/28/2023]
Abstract
Objective We hypothesized that Displacement Encoding with Stimulated Echoes (DENSE) and feature-tracking derived circumferential strain would provide incremental prognostic value over the extent of infarction for recovery of segmental myocardial function. Methods Two hundred and sixty-one patients (mean age 59 years, 73% male) underwent MRI 2 days post-ST elevation myocardial infarction (STEMI) and 241 (92%) underwent repeat imaging 6 months later. The MRI protocol included cine, 2D-cine DENSE, T2 mapping and late enhancement. Wall motion scoring was assessed by 2-blinded observers and adjudicated by a third. (WMS: 1=normal, 2=hypokinetic, 3=akinetic, 4=dyskinetic). WMS improvement was defined as a decrease in WMS ≥ 1, and normalization where WMS = 1 on follow-up. Segmental circumferential strain was derived utilizing DENSE and feature-tracking. A generalized linear mixed model with random effect of subject was constructed and used to account for repeated sampling when investigating predictors of segmental myocardial improvement or normalization Results At baseline and follow-up, 1416 segments had evaluable data for all parameters. Circumferential strain by DENSE (p < 0.001) and feature-tracking (p < 0.001), extent of oedema (p < 0.001), infarct size (p < 0.001), and microvascular obstruction (p < 0.001) were associates of both improvement and normalization of WMS. Circumferential strain provided incremental predictive value even after accounting for infarct size, extent of oedema and microvascular obstruction, for segmental improvement (DENSE: odds ratio, 95% confidence intervals: 1.08 per −1% peak strain, 1.05–1.12, p < 0.001, feature-tracking: odds ratio, 95% confidence intervals: 1.05 per −1% peak strain, 1.03–1.07, p < 0.001) and segmental normalization (DENSE: 1.08 per −1% peak strain, 1.04–1.12, p < 0.001, feature-tracking: 1.06 per −1% peak strain, 1.04–1.08, p < 0.001). Conclusions Circumferential strain provides incremental prognostic value over segmental infarct size in patients post STEMI for predicting segmental improvement or normalization by wall-motion scoring.
Collapse
Affiliation(s)
- Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - David Carrick
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Guillaume Clerfond
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK
| | - Christopher Rush
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Christie McComb
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Mark C Petrie
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Andrew Davie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Daniel A Auger
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Los Angeles, CA, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Caroline E Haig
- Robertson Centre for Biostatistics, University of Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.
| |
Collapse
|
21
|
Mangion K, Carrick D, Carberry J, Mahrous A, McComb C, Oldroyd KG, Eteiba H, Lindsay M, McEntegart M, Hood S, Petrie MC, Watkins S, Davie A, Zhong X, Epstein FH, Haig CE, Berry C. Circumferential Strain Predicts Major Adverse Cardiovascular Events Following an Acute ST-Segment-Elevation Myocardial Infarction. Radiology 2018; 290:329-337. [PMID: 30457480 DOI: 10.1148/radiol.2018181253] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose To investigate the prognostic value of circumferential left ventricular (LV) strain measured by using cardiac MRI for prediction of major adverse cardiac events (MACE) following an acute ST-segment-elevation myocardial infarction (STEMI). Materials and Methods Participants with acute STEMI were prospectively enrolled from May 11, 2011, to November 22, 2012. Cardiac MRI was performed at 1.5 T during the index hospitalization. Displacement encoding with stimulated echoes (DENSE) and feature tracking of cine cardiac MRI was used to assess circumferential LV strain. MACE that occurred after discharge were independently assessed by cardiologists blinded to the baseline observations. Results A total of 259 participants (mean age, 58 years ± 11 [standard deviation]; 198 men [mean age, 58 years ± 11] and 61 women [mean age, 58 years ± 12]) underwent cardiac MRI 2.2 days ± 1.9 after STEMI. Average infarct size was 18% ± 13 of LV mass and circumferential strain was -13% ± 3 (DENSE method) and -24% ± 7 (feature- tracking method). Fifty-one percent (131 of 259 participants) had presence of microvascular obstruction. During a median follow-up period of 4 years, 8% (21 of 259) experienced MACE. Area under the curve (AUC) for DENSE was different from that of feature tracking (AUC, 0.76 vs 0.62; P = .03). AUC for DENSE was similar to that of initial infarct size (P = .06) and extent of microvascular obstruction (P = .08). DENSE-derived strain provided incremental prognostic benefit over infarct size for prediction of MACE (hazard ratio, 1.3; P < .01). Conclusion Circumferential strain has independent prognostic importance in study participants with acute ST-segment-elevation myocardial infarction. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Kramer in this issue.
Collapse
Affiliation(s)
- Kenneth Mangion
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - David Carrick
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Jaclyn Carberry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Ahmed Mahrous
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Christie McComb
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Keith G Oldroyd
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Hany Eteiba
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Mitchell Lindsay
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Margaret McEntegart
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Stuart Hood
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Mark C Petrie
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Stuart Watkins
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Andrew Davie
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Xiaodong Zhong
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Frederick H Epstein
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Caroline E Haig
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| | - Colin Berry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (K.M., D.C., J.C., C.M., M.C.P., C.B.), and Robertson Centre for Biostatistics (C.E.H.), University of Glasgow, 126 University Place, Glasgow G12 8TA, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland (K.M., D.C., A.M., K.G.O., H.E., M.L., M.M., S.H., M.C.P., S.W., A.D., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, Scotland (C.M.); Department of MR R&D Collaborations, Siemens Healthcare, Atlanta, Ga (X.Z.); and Department of Biomedical Engineering, University of Virginia, Charlottesville, Va (F.H.E.)
| |
Collapse
|
22
|
Cai X, Epstein FH. Free-breathing cine DENSE MRI using phase cycling with matchmaking and stimulated-echo image-based navigators. Magn Reson Med 2018; 80:1907-1921. [PMID: 29607538 PMCID: PMC6107388 DOI: 10.1002/mrm.27199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/19/2018] [Accepted: 03/06/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE This study aimed to develop a self-navigated method for free-breathing spiral cine displacement encoding with stimulated echoes (DENSE), a myocardial strain imaging technique that uses phase-cycling for artifact suppression. The method needed to address 2 consequences of motion for DENSE: striping artifacts from incomplete suppression of the T1 -relaxation echo and blurring. METHODS The method identifies phase-cycled spiral interleaves at matched respiratory phases by minimizing the residual signal due to T1 relaxation after phase-cycling subtraction. Next, the method reconstructs image-based navigators from matched phase-cycled interleaves that are comprised of the stimulated echo (ste-iNAVs). Ste-iNAVs are used for motion estimation and compensation of k-space data. The method was demonstrated in phantoms and compared to diaphragm-based navigator (dNAV) and conventional iNAV (c-iNAV) methods for the reconstruction of free-breathing volunteer data sets (N = 10). RESULTS Phantom experiments demonstrated that the proposed method removes striping artifacts and blurring due to motion. Volunteer results showed that respiratory motion measured by ste-iNAVs was better correlated than c-iNAVs to dNAV data (R2 = 0.82 ± 0.03 vs. 0.70 ± 0.05, P < 0.05). Match-making reconstructions of free-breathing data sets achieved lower residual T1 -relaxation echo energy (1.04 ± 0.01 vs. 1.18 ± 0.04 for dNAV and 1.18 ± 0.03 for c-iNAV, P < 0.05), higher apparent SNR (11.93 ± 1.05 vs. 10.68 ± 1.06 for dNAV and 10.66 ± 0.99 for c-iNAV, P < 0.05), and better phase quality (0.147 ± 0.012 vs. 0.166 ± 0.017 for dNAV, P = 0.06, and 0.168 ± 0.015 for c-iNAV, P < 0.05) than dNAV and c-iNAV methods. CONCLUSION For free-breathing cine DENSE, the proposed method addresses both types of breathing-induced artifacts and provides better quality images than conventional dNAV and iNAV methods.
Collapse
Affiliation(s)
- Xiaoying Cai
- Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Frederick H. Epstein
- Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
- Radiology, University of Virginia, Charlottesville, VA, United States
| |
Collapse
|
23
|
Iffrig E, Wilson JS, Zhong X, Oshinski JN. Demonstration of circumferential heterogeneity in displacement and strain in the abdominal aortic wall by spiral cine DENSE MRI. J Magn Reson Imaging 2018; 49:731-743. [PMID: 30295345 DOI: 10.1002/jmri.26304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/30/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Knowledge of tissue properties of the abdominal aorta can improve understanding of vascular disease and guide interventional approaches. Existing MRI methods to quantify aortic wall displacement and strain are unable to discern circumferential heterogeneity. PURPOSE To assess regional variation in abdominal aortic wall displacement and strain as a function of circumferential position using spiral cine displacement encoding with stimulated echoes (DENSE). STUDY TYPE Prospective. POPULATION Cardiovascular disease-free men (n = 8) and women (n = 9) ages 30-42. SEQUENCES Prospective electrocardiogram (ECG)-gated and navigator echo-gated spiral, cine 2D DENSE and retrospective ECG-gated phase contrast MR (PCMR) sequences at 3T. ASSESSMENT In-plane displacement values of the aortic wall acquired with DENSE were used to determine radial and circumferential aortic wall motion. A quadrilateral-based 2D strain calculation method was implemented to determine strain from the displacement field. Peak displacement and its radial and circumferential contributions as well as peak circumferential strain were compared among eight circumferential wall segments. Distensibility was calculated using PCMR and compared with homogenized circumferential strain. STATISTICAL TESTS To account for repeated measurements in volunteers, linear mixed models for mean sector values were created for displacement magnitude, circumferential displacement, radial displacement, and circumferential strain. Comparisons were made between sectors. Calculated distensibility and homogenized circumferential strain were compared using Bland-Altman analysis. Statistical significance was defined as P < 0.05. RESULTS Displacement was highest in the anterior wall (1.5 ± 0.7 mm) and was primarily in the radial as compared with circumferential direction (1.04 ± 0.05 mm vs. 0.81 ± 0.42 mm). Circumferential strain was highest in the lateral walls (left 0.16 ± 0.05 and right 0.21 ± 0.12) with homogenized circumferential strain of 0.14 ± 0.05. DATA CONCLUSION DENSE imaging in the abdominal aortic wall demonstrated that the anterior aortic wall exhibits the greatest displacement, while the lateral wall experiences the largest circumferential strain. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:731-743.
Collapse
Affiliation(s)
- Elizabeth Iffrig
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - John S Wilson
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Xiadong Zhong
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - John N Oshinski
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| |
Collapse
|
24
|
Puntmann VO, Valbuena S, Hinojar R, Petersen SE, Greenwood JP, Kramer CM, Kwong RY, McCann GP, Berry C, Nagel E. Society for Cardiovascular Magnetic Resonance (SCMR) expert consensus for CMR imaging endpoints in clinical research: part I - analytical validation and clinical qualification. J Cardiovasc Magn Reson 2018; 20:67. [PMID: 30231886 PMCID: PMC6147157 DOI: 10.1186/s12968-018-0484-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/05/2018] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease remains a leading cause of morbidity and mortality globally. Changing natural history of the disease due to improved care of acute conditions and ageing population necessitates new strategies to tackle conditions which have more chronic and indolent course. These include an increased deployment of safe screening methods, life-long surveillance, and monitoring of both disease activity and tailored-treatment, by way of increasingly personalized medical care. Cardiovascular magnetic resonance (CMR) is a non-invasive, ionising radiation-free method, which can support a significant number of clinically relevant measurements and offers new opportunities to advance the state of art of diagnosis, prognosis and treatment. The objective of the SCMR Clinical Trial Taskforce was to summarizes the evidence to emphasize where currently CMR-guided clinical care can indeed translate into meaningful use and efficient deployment of resources results in meaningful and efficient use. The objective of the present initiative was to provide an appraisal of evidence on analytical validation, including the accuracy and precision, and clinical qualification of parameters in disease context, clarifying the strengths and weaknesses of the state of art, as well as the gaps in the current evidence This paper is complementary to the existing position papers on standardized acquisition and post-processing ensuring robustness and transferability for widespread use. Themed imaging-endpoint guidance on trial design to support drug-discovery or change in clinical practice (part II), will be presented in a follow-up paper in due course. As CMR continues to undergo rapid development, regular updates of the present recommendations are foreseen.
Collapse
Affiliation(s)
- Valentina O Puntmann
- Institute of Experimental and Translational Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt, Germany
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Silvia Valbuena
- Department of Cardiology, University Hospital La Paz, Madrid, Germany
| | - Rocio Hinojar
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Steffen E Petersen
- William Harvey Research Institute, Queen Mary University of London, Barts and the London NIHR Biomedical Research Centre at Barts, London, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Christopher M Kramer
- Department of Medicine (Cardiology) and Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Womens' Hospital, Boston, Massachusetts, USA
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- the NIHR Leicester Cardiovascular Biomedical Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - 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, Clydebank, UK
| | - Eike Nagel
- Institute of Experimental and Translational Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt, Germany.
| |
Collapse
|
25
|
Wehner GJ, Jing L, Haggerty CM, Suever JD, Chen J, Hamlet SM, Feindt JA, Dimitri Mojsejenko W, Fogel MA, Fornwalt BK. Comparison of left ventricular strains and torsion derived from feature tracking and DENSE CMR. J Cardiovasc Magn Reson 2018; 20:63. [PMID: 30208894 PMCID: PMC6136226 DOI: 10.1186/s12968-018-0485-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 08/20/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) feature tracking is increasingly used to quantify cardiac mechanics from cine CMR imaging, although validation against reference standard techniques has been limited. Furthermore, studies have suggested that commonly-derived metrics, such as peak global strain (reported in 63% of feature tracking studies), can be quantified using contours from just two frames - end-diastole (ED) and end-systole (ES) - without requiring tracking software. We hypothesized that mechanics derived from feature tracking would not agree with those derived from a reference standard (displacement-encoding with stimulated echoes (DENSE) imaging), and that peak strain from feature tracking would agree with that derived using simple processing of only ED and ES contours. METHODS We retrospectively identified 88 participants with 186 pairs of DENSE and balanced steady state free precession (bSSFP) image slices acquired at the same locations across two institutions. Left ventricular (LV) strains, torsion, and dyssynchrony were quantified from both feature tracking (TomTec Imaging Systems, Circle Cardiovascular Imaging) and DENSE. Contour-based strains from bSSFP images were derived from ED and ES contours. Agreement was assessed with Bland-Altman analyses and coefficients of variation (CoV). All biases are reported in absolute percentage. RESULTS Comparison results were similar for both vendor packages (TomTec and Circle), and thus only TomTec Imaging System data are reported in the abstract for simplicity. Compared to DENSE, mid-ventricular circumferential strain (Ecc) from feature tracking had acceptable agreement (bias: - 0.4%, p = 0.36, CoV: 11%). However, feature tracking significantly overestimated the magnitude of Ecc at the base (bias: - 4.0% absolute, p < 0.001, CoV: 18%) and apex (bias: - 2.4% absolute, p = 0.01, CoV: 15%), underestimated torsion (bias: - 1.4 deg/cm, p < 0.001, CoV: 41%), and overestimated dyssynchrony (bias: 26 ms, p < 0.001, CoV: 76%). Longitudinal strain (Ell) had borderline-acceptable agreement (bias: - 0.2%, p = 0.77, CoV: 19%). Contour-based strains had excellent agreement with feature tracking (biases: - 1.3-0.2%, CoVs: 3-7%). CONCLUSION Compared to DENSE as a reference standard, feature tracking was inaccurate for quantification of apical and basal LV circumferential strains, longitudinal strain, torsion, and dyssynchrony. Feature tracking was only accurate for quantification of mid LV circumferential strain. Moreover, feature tracking is unnecessary for quantification of whole-slice strains (e.g. base, apex), since simplified processing of only ED and ES contours yields very similar results to those derived from feature tracking. Current feature tracking technology therefore has limited utility for quantification of cardiac mechanics.
Collapse
Affiliation(s)
- Gregory J. Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - Linyuan Jing
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
| | - Christopher M. Haggerty
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
| | - Jonathan D. Suever
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
| | - Jing Chen
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
| | - Sean M. Hamlet
- Department of Electrical Engineering, University of Kentucky, Lexington, KY USA
| | - Jared A. Feindt
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
| | | | - Mark A. Fogel
- Division of Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Brandon K. Fornwalt
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Electrical Engineering, University of Kentucky, Lexington, KY USA
- Department of Radiology, Geisinger, Danville, PA USA
| |
Collapse
|
26
|
Wehner GJ, Suever JD, Fielden SW, Powell DK, Hamlet SM, Vandsburger MH, Haggerty CM, Zhong X, Fornwalt BK. Typical readout durations in spiral cine DENSE yield blurred images and underestimate cardiac strains at both 3.0 T and 1.5 T. Magn Reson Imaging 2018; 54:90-100. [PMID: 30099059 DOI: 10.1016/j.mri.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/10/2018] [Accepted: 08/08/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Displacement encoding with stimulated echoes (DENSE) is a phase contrast technique that encodes tissue displacement into phase images, which are typically processed into measures of cardiac function such as strains. For improved signal to noise ratio and spatiotemporal resolution, DENSE is often acquired with a spiral readout using an 11.1 ms readout duration. However, long spiral readout durations are prone to blurring due to common phenomena such as off-resonance and T2* decay, which may alter the resulting quantifications of strain. We hypothesized that longer readout durations would reduce image quality and underestimate cardiac strains at both 3.0 T and 1.5 T and that using short readout durations could overcome these limitations. MATERIAL AND METHODS Computational simulations were performed to investigate the relationship between off-resonance and T2* decay, the spiral cine DENSE readout duration, and measured radial and circumferential strain. Five healthy participants subsequently underwent 2D spiral cine DENSE at both 3.0 T and 1.5 T with several different readout durations 11.1 ms and shorter. Pearson correlations were used to assess the relationship between cardiac strains and the spiral readout duration. RESULTS Simulations demonstrated that long readout durations combined with off-resonance and T2* decay yield blurred images and underestimate strains. With the typical 11.1 ms DENSE readout, blurring was present in the anterior and lateral left ventricular segments of participants and was markedly improved with shorter readout durations. Radial and circumferential strains from those segments were significantly correlated with the readout duration. Compared to the 1.9 ms readout, the 11.1 ms readout underestimated radial and circumferential strains in those segments at both field strengths by up to 19.6% and 1.5% (absolute), or 42% and 7% (relative), respectively. CONCLUSIONS Blurring is present in spiral cine DENSE images acquired at both 3.0 T and 1.5 T using the typical 11.1 ms readout duration, which yielded substantially reduced radial strains and mildly reduced circumferential strains. Clinical studies using spiral cine DENSE should consider these limitations, while future technical advances may need to leverage accelerated techniques to improve the robustness and accuracy of the DENSE acquisition rather than focusing solely on reduced acquisition time.
Collapse
Affiliation(s)
- Gregory J Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States.
| | - Jonathan D Suever
- Department of Imaging Science and Innovation, Geisinger, Danville, PA, United States.
| | - Samuel W Fielden
- Department of Imaging Science and Innovation, Geisinger, Danville, PA, United States; Department of Medical & Health Physics, Geisinger, Danville, PA, United States.
| | - David K Powell
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States.
| | - Sean M Hamlet
- Department of Electrical Engineering, University of Kentucky, Lexington, KY, United States.
| | - Moriel H Vandsburger
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States; Department of Physiology, University of Kentucky, Lexington, KY, United States.
| | | | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Atlanta, GA, United States.
| | - Brandon K Fornwalt
- Department of Imaging Science and Innovation, Geisinger, Danville, PA, United States; Department of Radiology, Geisinger, Danville, PA, United States.
| |
Collapse
|
27
|
Mangion K, McComb C, Auger DA, Epstein FH, Berry C. Magnetic Resonance Imaging of Myocardial Strain After Acute ST-Segment-Elevation Myocardial Infarction: A Systematic Review. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006498. [PMID: 28733364 DOI: 10.1161/circimaging.117.006498] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The purpose of this systematic review is to provide a clinically relevant, disease-based perspective on myocardial strain imaging in patients with acute myocardial infarction or stable ischemic heart disease. Cardiac magnetic resonance imaging uniquely integrates myocardial function with pathology. Therefore, this review focuses on strain imaging with cardiac magnetic resonance. We have specifically considered the relationships between left ventricular (LV) strain, infarct pathologies, and their associations with prognosis. A comprehensive literature review was conducted in accordance with the PRISMA guidelines. Publications were identified that (1) described the relationship between strain and infarct pathologies, (2) assessed the relationship between strain and subsequent LV outcomes, and (3) assessed the relationship between strain and health outcomes. In patients with acute myocardial infarction, circumferential strain predicts the recovery of LV systolic function in the longer term. The prognostic value of longitudinal strain is less certain. Strain differentiates between infarcted versus noninfarcted myocardium, even in patients with stable ischemic heart disease with preserved LV ejection fraction. Strain recovery is impaired in infarcted segments with intramyocardial hemorrhage or microvascular obstruction. There are practical limitations to measuring strain with cardiac magnetic resonance in the acute setting, and knowledge gaps, including the lack of data showing incremental value in clinical practice. Critically, studies of cardiac magnetic resonance strain imaging in patients with ischemic heart disease have been limited by sample size and design. Strain imaging has potential as a tool to assess for early or subclinical changes in LV function, and strain is now being included as a surrogate measure of outcome in therapeutic trials.
Collapse
Affiliation(s)
- Kenneth Mangion
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (K.M., C.M., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, United Kingdom (C.M.); and Department of Biomedical Engineering, University of Virginia, Charlottesville (D.A.A., F.H.E.)
| | - Christie McComb
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (K.M., C.M., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, United Kingdom (C.M.); and Department of Biomedical Engineering, University of Virginia, Charlottesville (D.A.A., F.H.E.)
| | - Daniel A Auger
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (K.M., C.M., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, United Kingdom (C.M.); and Department of Biomedical Engineering, University of Virginia, Charlottesville (D.A.A., F.H.E.)
| | - Frederick H Epstein
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (K.M., C.M., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, United Kingdom (C.M.); and Department of Biomedical Engineering, University of Virginia, Charlottesville (D.A.A., F.H.E.)
| | - Colin Berry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (K.M., C.M., C.B.); Department of Clinical Physics, NHS Greater Glasgow and Clyde, United Kingdom (C.M.); and Department of Biomedical Engineering, University of Virginia, Charlottesville (D.A.A., F.H.E.).
| |
Collapse
|
28
|
Schrauben EM, Cowan BR, Greiser A, Young AA. Left ventricular function and regional strain with subtly-tagged steady-state free precession feature tracking. J Magn Reson Imaging 2017; 47:787-797. [PMID: 28722247 DOI: 10.1002/jmri.25819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/06/2017] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To provide regional strain and ventricular volume from a single acquisition, using subtly tagged steady-state free precession (SubTag SSFP) feature tracking. MATERIALS AND METHODS The effects on regional strain of tag strength in gradient recalled echo (GRE) tagging, flip angle in untagged balanced SSFP, and both in SubTag SSFP were examined in the mid left ventricle of 15 healthy volunteers at 3T. Optimal parameters were determined from varying both tag strength and SSFP flip angle using full tag saturation GRE as the reference standard. SubTag SSFP was acquired in 15 additional healthy volunteers for whole-heart volume and strain assessment using the optimized parameters. Values measured by two image analysts were compared to clinical reference standards from untagged SSFP (volumes) and GRE tagging (strains). RESULTS Regional strain accuracy was maintained with decreasing total tagging flip angle (β); less than 3% differences for β ≥ 26°. For untagged SSFP flip angle (α), whole-wall strain differences became statistically significant when α < 40°. A SubTag SSFP acquisition with α = 40° and β = 46° showed the best combination of tagging strength, blood-myocardial contrast, and tag persistence at end-systole for regional strain estimation. SubTag SSFP also showed excellent agreement with untagged SSFP for volumetrics (percent difference: end-diastolic volume = 0.6%, end-systolic volume = 0.4%, stroke volume = 1.2%, ejection fraction = 0.6%, mass = 1.1%). CONCLUSION Feature tracking for regional myocardial strain assessment is dependent on image features, mainly the tag strength, persistence, and image contrast. SubTag SSFP balances these criteria to provide accurate regional strain and volumetric assessment in a single acquisition. LEVEL OF EVIDENCE 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2018;47:787-797.
Collapse
Affiliation(s)
- Eric M Schrauben
- Translational Medicine, the Hospital for Sick Children, Toronto, Canada
| | - Brett R Cowan
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
| | | | - Alistair A Young
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
| |
Collapse
|
29
|
Perotti LE, Magrath P, Verzhbinsky IA, Aliotta E, Moulin K, Ennis DB. Microstructurally Anchored Cardiac Kinematics by Combining In Vivo DENSE MRI and cDTI. FUNCTIONAL IMAGING AND MODELING OF THE HEART : ... INTERNATIONAL WORKSHOP, FIMH ..., PROCEEDINGS. FIMH 2017; 10263:381-391. [PMID: 29450409 DOI: 10.1007/978-3-319-59448-4_36] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Metrics of regional myocardial function can detect the onset of cardiovascular disease, evaluate the response to therapy, and provide mechanistic insight into cardiac dysfunction. Knowledge of local myocardial microstructure is necessary to distinguish between isotropic and anisotropic contributions of local deformation and to quantify myofiber kinematics, a microstructurally anchored measure of cardiac function. Using a computational model we combine in vivo cardiac displacement and diffusion tensor data to evaluate pointwise the deformation gradient tensor and isotropic and anisotropic deformation invariants. In discussing the imaging methods and the model construction, we identify potential improvements to increase measurement accuracy. We conclude by demonstrating the applicability of our method to compute myofiber strain in five healthy volunteers.
Collapse
Affiliation(s)
- Luigi E Perotti
- Department of Radiological Sciences, University of California, Los Angeles, USA.,Department of Bioengineering, University of California, Los Angeles, USA
| | - Patrick Magrath
- Department of Radiological Sciences, University of California, Los Angeles, USA.,Department of Bioengineering, University of California, Los Angeles, USA
| | - Ilya A Verzhbinsky
- Department of Radiological Sciences, University of California, Los Angeles, USA
| | - Eric Aliotta
- Department of Radiological Sciences, University of California, Los Angeles, USA.,Department of Biomedical Physics IDP, University of California, Los Angeles, USA
| | - Kévin Moulin
- Department of Radiological Sciences, University of California, Los Angeles, USA
| | - Daniel B Ennis
- Department of Radiological Sciences, University of California, Los Angeles, USA.,Department of Bioengineering, University of California, Los Angeles, USA.,Department of Biomedical Physics IDP, University of California, Los Angeles, USA
| |
Collapse
|
30
|
Suever JD, Wehner GJ, Jing L, Powell DK, Hamlet SM, Grabau JD, Mojsejenko D, Andres KN, Haggerty CM, Fornwalt BK. Right Ventricular Strain, Torsion, and Dyssynchrony in Healthy Subjects Using 3D Spiral Cine DENSE Magnetic Resonance Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:1076-1085. [PMID: 28055859 PMCID: PMC5711416 DOI: 10.1109/tmi.2016.2646321] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Mechanics of the left ventricle (LV) are important indicators of cardiac function. The role of right ventricular (RV) mechanics is largely unknown due to the technical limitations of imaging its thin wall and complex geometry and motion. By combining 3D Displacement Encoding with Stimulated Echoes (DENSE) with a post-processing pipeline that includes a local coordinate system, it is possible to quantify RV strain, torsion, and synchrony. In this study, we sought to characterize RV mechanics in 50 healthy individuals and compare these values to their LV counterparts. For each cardiac frame, 3D displacements were fit to continuous and differentiable radial basis functions, allowing for the computation of the 3D Cartesian Lagrangian strain tensor at any myocardial point. The geometry of the RV was extracted via a surface fit to manually delineated endocardial contours. Throughout the RV, a local coordinate system was used to transform from a Cartesian strain tensor to a polar strain tensor. It was then possible to compute peak RV torsion as well as peak longitudinal and circumferential strain. A comparable analysis was performed for the LV. Dyssynchrony was computed from the standard deviation of regional activation times. Global circumferential strain was comparable between the RV and LV (-18.0% for both) while longitudinal strain was greater in the RV (-18.1% vs. -15.7%). RV torsion was comparable to LV torsion (6.2 vs. 7.1 degrees, respectively). Regional activation times indicated that the RV contracted later but more synchronously than the LV. 3D spiral cine DENSE combined with a post-processing pipeline that includes a local coordinate system can resolve both the complex geometry and 3D motion of the RV.
Collapse
|
31
|
Auger DA, Bilchick KC, Gonzalez JA, Cui SX, Holmes JW, Kramer CM, Salerno M, Epstein FH. Imaging left-ventricular mechanical activation in heart failure patients using cine DENSE MRI: Validation and implications for cardiac resynchronization therapy. J Magn Reson Imaging 2017; 46:887-896. [PMID: 28067978 DOI: 10.1002/jmri.25613] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/09/2016] [Accepted: 12/10/2016] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To image late mechanical activation and identify effective left-ventricular (LV) pacing sites for cardiac resynchronization therapy (CRT). There is variability in defining mechanical activation time, with some studies using the time to peak strain (TPS) and some using the time to the onset of circumferential shortening (TOS). We developed improved methods for imaging mechanical activation and evaluated them in heart failure (HF) patients undergoing CRT. MATERIALS AND METHODS We applied active contours to cine displacement encoding with stimulated echoes (DENSE) strain images to detect TOS. Six healthy volunteers underwent magnetic resonance imaging (MRI) at 1.5T, and 50 patients underwent pre-CRT MRI (strain, scar, volumes) and echocardiography, assessment of the electrical activation time (Q-LV) at the LV pacing site, and echocardiography assessment of LV reverse remodeling 6 months after CRT. TPS at the LV pacing site was also measured by DENSE. RESULTS The latest TOS was greater in HF patients vs. healthy subjects (112 ± 28 msec vs. 61 ± 7 msec, P < 0.01). The correlation between TOS and Q-LV was strong (r > 0.75; P < 0.001) and better than between TPS and Q-LV (r < 0.62; P ≥ 0.006). Twenty-three of 50 patients had the latest activating segment in a region other than the mid-ventricular lateral wall, the most common site for the CRT LV lead. Using a multivariable model, TOS/QRS was significantly associated with LV reverse remodeling even after adjustment for overall dyssynchrony and scar (P < 0.05), whereas TPS was not (P = 0.49). CONCLUSION Late activation by cine DENSE TOS analysis is associated with improved LV reverse remodeling with CRT and deserves further study as a tool to achieve optimal LV lead placement in CRT. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:887-896.
Collapse
Affiliation(s)
- Daniel A Auger
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Kenneth C Bilchick
- Medicine/Cardiology/Electrophysiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jorge A Gonzalez
- Medicine/Cardiology/Electrophysiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sophia X Cui
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jeffrey W Holmes
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA.,Medicine/Cardiology/Electrophysiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher M Kramer
- Medicine/Cardiology/Electrophysiology, University of Virginia Health System, Charlottesville, Virginia, USA.,Radiology/Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michael Salerno
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA.,Medicine/Cardiology/Electrophysiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA.,Radiology/Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| |
Collapse
|
32
|
A Novel Method for Estimating Myocardial Strain: Assessment of Deformation Tracking Against Reference Magnetic Resonance Methods in Healthy Volunteers. Sci Rep 2016; 6:38774. [PMID: 27941903 PMCID: PMC5150576 DOI: 10.1038/srep38774] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/04/2016] [Indexed: 01/28/2023] Open
Abstract
We developed a novel method for tracking myocardial deformation using cardiac magnetic resonance (CMR) cine imaging. We hypothesised that circumferential strain using deformation-tracking has comparable diagnostic performance to a validated method (Displacement Encoding with Stimulated Echoes- DENSE) and potentially diagnostically superior to an established cine-strain method (feature-tracking). 81 healthy adults (44.6 ± 17.7 years old, 47% male), without any history of cardiovascular disease, underwent CMR at 1.5 T including cine, DENSE, and late gadolinium enhancement in subjects >45 years. Acquisitions were divided into 6 segments, and global and segmental peak circumferential strain were derived and analysed by age and sex. Peak circumferential strain differed between the 3 groups (DENSE: −19.4 ± 4.8%; deformation-tracking: −16.8 ± 2.4%; feature-tracking: −28.7 ± 4.8%) (ANOVA with Tukey post-hoc, F-value 279.93, p < 0.01). DENSE and deformation-tracking had better reproducibility than feature-tracking. Intra-class correlation co-efficient was >0.90. Larger magnitudes of strain were detected in women using deformation-tracking and DENSE, but not feature-tracking. Compared with a reference method (DENSE), deformation-tracking using cine imaging has similar diagnostic performance for circumferential strain assessment in healthy individuals. Deformation-tracking could potentially obviate the need for bespoke strain sequences, reducing scanning time and is more reproducible than feature-tracking.
Collapse
|
33
|
Epstein FH, Vandsburger M. Illuminating the Path Forward in Cardiac Regeneration Using Strain Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005687. [PMID: 27903545 DOI: 10.1161/circimaging.116.005687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Frederick H Epstein
- From the Departments of Biomedical Engineering and Radiology and the Cardiovascular Research Center, University of Virginia, Charlottesville (F.H.E.); and Departments of Physiology and Biomedical Engineering and the Saha Cardiovascular Research Center, University of Kentucky, Lexington (M.V.).
| | - Moriel Vandsburger
- From the Departments of Biomedical Engineering and Radiology and the Cardiovascular Research Center, University of Virginia, Charlottesville (F.H.E.); and Departments of Physiology and Biomedical Engineering and the Saha Cardiovascular Research Center, University of Kentucky, Lexington (M.V.)
| |
Collapse
|
34
|
Wang VY, Casta C, Zhu YM, Cowan BR, Croisille P, Young AA, Clarysse P, Nash MP. Image-Based Investigation of Human in Vivo Myofibre Strain. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:2486-2496. [PMID: 27323360 DOI: 10.1109/tmi.2016.2580573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cardiac myofibre deformation is an important determinant of the mechanical function of the heart. Quantification of myofibre strain relies on 3D measurements of ventricular wall motion interpreted with respect to the tissue microstructure. In this study, we estimated in vivo myofibre strain using 3D structural and functional atlases of the human heart. A finite element modelling framework was developed to incorporate myofibre orientations of the left ventricle (LV) extracted from 7 explanted normal human hearts imaged ex vivo with diffusion tensor magnetic resonance imaging (DTMRI) and kinematic measurements from 7 normal volunteers imaged in vivo with tagged MRI. Myofibre strain was extracted from the DTMRI and 3D strain from the tagged MRI. We investigated: i) the spatio-temporal variation of myofibre strain throughout the cardiac cycle; ii) the sensitivity of myofibre strain estimates to the variation in myofibre angle between individuals; and iii) the sensitivity of myofibre strain estimates to variations in wall motion between individuals. Our analysis results indicate that end systolic (ES) myofibre strain is approximately homogeneous throughout the entire LV, irrespective of the inter-individual variation in myofibre orientation. Additionally, inter-subject variability in myofibre orientations has greater effect on the variabilities in myofibre strain estimates than the ventricular wall motions. This study provided the first quantitative evidence of homogeneity of ES myofibre strain using minimally-invasive medical images of the human heart and demonstrated that image-based modelling framework can provide detailed insight to the mechanical behaviour of the myofibres, which may be used as a biomarker for cardiac diseases that affect cardiac mechanics.
Collapse
|
35
|
Langton JEN, Lam HI, Cowan BR, Occleshaw CJ, Gabriel R, Lowe B, Lydiard S, Greiser A, Schmidt M, Young AA. Estimation of myocardial strain from non-rigid registration and highly accelerated cine CMR. Int J Cardiovasc Imaging 2016; 33:101-107. [PMID: 27624468 DOI: 10.1007/s10554-016-0978-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/08/2016] [Indexed: 12/01/2022]
Abstract
Sparsely sampled cardiac cine accelerated acquisitions show promise for faster evaluation of left-ventricular function. Myocardial strain estimation using image feature tracking methods is also becoming widespread. However, it is not known whether highly accelerated acquisitions also provide reliable feature tracking strain estimates. Twenty patients and twenty healthy volunteers were imaged with conventional 14-beat/slice cine acquisition (STD), 4× accelerated 4-beat/slice acquisition with iterative reconstruction (R4), and a 9.2× accelerated 2-beat/slice real-time acquisition with sparse sampling and iterative reconstruction (R9.2). Radial and circumferential strains were calculated using non-rigid registration in the mid-ventricle short-axis slice and inter-observer errors were evaluated. Consistency was assessed using intra-class correlation coefficients (ICC) and bias with Bland-Altman analysis. Peak circumferential strain magnitude was highly consistent between STD and R4 and R9.2 (ICC = 0.876 and 0.884, respectively). Average bias was -1.7 ± 2.0 %, p < 0.001, for R4 and -2.7 ± 1.9 %, p < 0.001 for R9.2. Peak radial strain was also highly consistent (ICC = 0.829 and 0.785, respectively), with average bias -11.2 ± 18.4 %, p < 0.001, for R4 and -15.0 ± 21.2 %, p < 0.001 for R9.2. STD circumferential strain could be predicted by linear regression from R9.2 with an R2 of 0.82 and a root mean squared error of 1.8 %. Similarly, radial strain could be predicted with an R2 of 0.67 and a root mean squared error of 21.3 %. Inter-observer errors were not significantly different between methods, except for peak circumferential strain R9.2 (1.1 ± 1.9 %) versus STD (0.3 ± 1.0 %), p = 0.011. Although small systematic differences were observed in strain, these were highly consistent with standard acquisitions, suggesting that accelerated myocardial strain is feasible and reliable in patients who require short acquisition durations.
Collapse
Affiliation(s)
| | - Hoi-Ieng Lam
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Brett R Cowan
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | | | - Ruvin Gabriel
- Auckland District Health Board, Auckland, New Zealand
| | - Boris Lowe
- Auckland District Health Board, Auckland, New Zealand
| | | | | | | | - Alistair A Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, 1142, New Zealand.
| |
Collapse
|
36
|
Lin K, Meng L, Collins JD, Chowdhary V, Markl M, Carr JC. Reproducibility of cine displacement encoding with stimulated echoes (DENSE) in human subjects. Magn Reson Imaging 2016; 35:148-153. [PMID: 27569367 DOI: 10.1016/j.mri.2016.08.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/27/2016] [Accepted: 08/20/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To test the hypothesis that two-dimensional (2D) displacement encoding via stimulated echoes (DENSE) is a reproducible technique for the depiction of segmental myocardial motion in human subjects. MATERIALS AND METHODS Following the approval of the institutional review board (IRB), 17 healthy volunteers without documented history of cardiovascular disease were recruited. For each participant, 2D DENSE were performed twice (at different days) and the images were obtained at basal, midventricular and apical levels of the left ventricle (LV) with a short-axis view. The radial thickening strain (Err), circumferential strain (Ecc), twist and torsion were calculated. The intra-, inter-observer and inter-study variations of DENSE-derived myocardial motion indices were evaluated using coefficient of variation (CoV) and intra-class correlation coefficient (ICC). RESULTS In total, there are 272 pairs of myocardial segments (data points) for comparison. There is good intra- and inter-observer reproducibility for all DENSE-derived measures in 17 participants. There is good inter-study reproducibility for peak Ecc (CoV=19.64%, ICC=0.8896, p<0.001), twist (CoV=33.11%, ICC=0.9135, p<0.001) and torsion (CoV=13.96%, ICC=0.8684, p<0.001). There is moderate inter-study reproducibility for Err (CoV=38.89%, ICC=0.7022, p<0.001). CONCLUSION DENSE is a reproducible technique for characterizing LV regional systolic myocardial motion on a per-segment basis in healthy volunteers.
Collapse
Affiliation(s)
- Kai Lin
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Leng Meng
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jeremy D Collins
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Varun Chowdhary
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Michael Markl
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - James C Carr
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL 60611
| |
Collapse
|
37
|
Hamlet SM, Haggerty CM, Suever JD, Wehner GJ, Andres KN, Powell DK, Zhong X, Fornwalt BK. Optimal configuration of respiratory navigator gating for the quantification of left ventricular strain using spiral cine displacement encoding with stimulated echoes (DENSE) MRI. J Magn Reson Imaging 2016; 45:786-794. [PMID: 27458823 DOI: 10.1002/jmri.25389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/29/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To determine the optimal respiratory navigator gating configuration for the quantification of left ventricular strain using spiral cine displacement encoding with stimulated echoes (DENSE) MRI. MATERIALS AND METHODS Two-dimensional spiral cine DENSE was performed on a 3 Tesla MRI using two single-navigator configurations (retrospective, prospective) and a combined "dual-navigator" configuration in 10 healthy adults and 20 healthy children. The adults also underwent breathhold DENSE as a reference standard for comparisons. Peak left ventricular strains, signal-to-noise ratio (SNR), and navigator efficiency were compared. Subjects also underwent dual-navigator gating with and without visual feedback to determine the effect on navigator efficiency. RESULTS There were no differences in circumferential, radial, and longitudinal strains between navigator-gated and breathhold DENSE (P = 0.09-0.95) (as confidence intervals, retrospective: [-1.0%-1.1%], [-7.4%-2.0%], [-1.0%-1.2%]; prospective: [-0.6%-2.7%], [-2.8%-8.3%], [-0.3%-2.9%]; dual: [-1.6%-0.5%], [-8.3%-3.2%], [-0.8%-1.9%], respectively). The dual configuration maintained SNR compared with breathhold acquisitions (16 versus 18, P = 0.06). SNR for the prospective configuration was lower than for the dual navigator in adults (P = 0.004) and children (P < 0.001). Navigator efficiency was higher (P < 0.001) for both retrospective (54%) and prospective (56%) configurations compared with the dual configuration (35%). Visual feedback improved the dual configuration navigator efficiency to 55% (P < 0.001). CONCLUSION When quantifying left ventricular strains using spiral cine DENSE MRI, a dual navigator configuration results in the highest SNR in adults and children. In adults, a retrospective configuration has good navigator efficiency without a substantial drop in SNR. Prospective gating should be avoided because it has the lowest SNR. Visual feedback represents an effective option to maintain navigator efficiency while using a dual navigator configuration. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:786-794.
Collapse
Affiliation(s)
- Sean M Hamlet
- Department of Electrical and Computer Engineering, University of Kentucky, Lexington, Kentucky, USA.,Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | - Christopher M Haggerty
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.,Institute for Advanced Application, Geisinger Health System, Danville, Pennsylvania, USA
| | - Jonathan D Suever
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.,Institute for Advanced Application, Geisinger Health System, Danville, Pennsylvania, USA
| | - Gregory J Wehner
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.,Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky, USA
| | - Kristin N Andres
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | - David K Powell
- Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky, USA
| | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Atlanta, GA, USA
| | - Brandon K Fornwalt
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.,Institute for Advanced Application, Geisinger Health System, Danville, Pennsylvania, USA.,Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky, USA.,Department of Physiology, University of Kentucky, Lexington, Kentucky, USA.,Department of Medicine, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
38
|
Chen X, Yang Y, Cai X, Auger DA, Meyer CH, Salerno M, Epstein FH. Accelerated two-dimensional cine DENSE cardiovascular magnetic resonance using compressed sensing and parallel imaging. J Cardiovasc Magn Reson 2016; 18:38. [PMID: 27301487 PMCID: PMC4906684 DOI: 10.1186/s12968-016-0253-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/20/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cine Displacement Encoding with Stimulated Echoes (DENSE) provides accurate quantitative imaging of cardiac mechanics with rapid displacement and strain analysis; however, image acquisition times are relatively long. Compressed sensing (CS) with parallel imaging (PI) can generally provide high-quality images recovered from data sampled below the Nyquist rate. The purposes of the present study were to develop CS-PI-accelerated acquisition and reconstruction methods for cine DENSE, to assess their accuracy for cardiac imaging using retrospective undersampling, and to demonstrate their feasibility for prospectively-accelerated 2D cine DENSE imaging in a single breathhold. METHODS An accelerated cine DENSE sequence with variable-density spiral k-space sampling and golden angle rotations through time was implemented. A CS method, Block LOw-rank Sparsity with Motion-guidance (BLOSM), was combined with sensitivity encoding (SENSE) for the reconstruction of under-sampled multi-coil spiral data. Seven healthy volunteers and 7 patients underwent 2D cine DENSE imaging with fully-sampled acquisitions (14-26 heartbeats in duration) and with prospectively rate-2 and rate-4 accelerated acquisitions (14 and 8 heartbeats in duration). Retrospectively- and prospectively-accelerated data were reconstructed using BLOSM-SENSE and SENSE. Image quality of retrospectively-undersampled data was quantified using the relative root mean square error (rRMSE). Myocardial displacement and circumferential strain were computed for functional assessment, and linear correlation and Bland-Altman analyses were used to compare accelerated acquisitions to fully-sampled reference datasets. RESULTS For retrospectively-undersampled data, BLOSM-SENSE provided similar or lower rRMSE at rate-2 and lower rRMSE at rate-4 acceleration compared to SENSE (p < 0.05, ANOVA). Similarly, for retrospective undersampling, BLOSM-SENSE provided similar or better correlation with reference displacement and strain data at rate-2 and better correlation at rate-4 acceleration compared to SENSE. Bland-Altman analyses showed similar or better agreement for displacement and strain data at rate-2 and better agreement at rate-4 using BLOSM-SENSE compared to SENSE for retrospectively-undersampled data. Rate-2 and rate-4 prospectively-accelerated cine DENSE provided good image quality and expected values of displacement and strain. CONCLUSIONS BLOSM-SENSE-accelerated spiral cine DENSE imaging with 2D displacement encoding can be acquired in a single breathhold of 8-14 heartbeats with high image quality and accurate assessment of myocardial displacement and circumferential strain.
Collapse
Affiliation(s)
- Xiao Chen
- Medical Imaging Technologies, Siemens Medical Solutions, USA Inc., 755 College Rd E., Princeton, NJ, 08540, USA
| | - Yang Yang
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, 22908, USA
| | - Xiaoying Cai
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, 22908, USA
| | - Daniel A Auger
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, 22908, USA
| | - Craig H Meyer
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, 22908, USA
- Department of Radiology , University of Virginia, Charlottesville, VA, 22908, USA
| | - Michael Salerno
- Department of Radiology , University of Virginia, Charlottesville, VA, 22908, USA
- Department of Cardiology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, 22908, USA.
- Department of Radiology , University of Virginia, Charlottesville, VA, 22908, USA.
| |
Collapse
|
39
|
Mangion K, Clerfond G, McComb C, Carrick D, Rauhalammi SM, McClure J, Corcoran DS, Woodward R, Orchard V, Radjenovic A, Zhong X, Berry C. Myocardial strain in healthy adults across a broad age range as revealed by cardiac magnetic resonance imaging at 1.5 and 3.0T: Associations of myocardial strain with myocardial region, age, and sex. J Magn Reson Imaging 2016; 44:1197-1205. [PMID: 27104306 PMCID: PMC5082565 DOI: 10.1002/jmri.25280] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/29/2016] [Indexed: 01/28/2023] Open
Abstract
Purpose To assess myocardial strain using cine displacement encoding with stimulated echoes (DENSE) using 1.5T and 3.0T MRI in healthy adults. Materials and Methods Healthy adults without any history of cardiovascular disease underwent magnetic resonance imaging (MRI) at 1.5T and 3.0T within 2 days. The MRI protocol included balanced steady‐state free‐precession (b‐SSFP), 2D cine‐echo planar imaging (EPI)‐DENSE, and late gadolinium enhancement in subjects >45 years. Acquisitions were divided into six segments; global and segmental peak longitudinal and circumferential strain were derived and analyzed by field strength, age, and gender. Results In all, 89 volunteers (mean age 44.8 ± 18.0 years, range: 18–87 years) underwent MRI at 1.5T, and 88 of these subjects underwent MRI at 3.0T (1.4 ± 1.4 days between the scans). Compared with 3.0T, the magnitudes of global circumferential (–19.5 ± 2.6% vs. –18.47 ± 2.6%; P = 0.001) and longitudinal (–12.47 ± 3.2% vs. –10.53 ± 3.1%; P = 0.004) strain were greater at 1.5T. At 1.5T, longitudinal strain was greater in females than in males: –10.17 ± 3.4% vs. –13.67 ± 2.4%; P = 0.001. Similar observations occurred for circumferential strain at 1.5T (–18.72 ± 2.2% vs. –20.10 ± 2.7%; P = 0.014) and at 3.0T (–17.92 ± 1.8% vs. –19.1 ± 3.1%; P = 0.047). At 1.5T, longitudinal and circumferential strain were not associated with age after accounting for sex (longitudinal strain P = 0.178, circumferential strain P = 0.733). At 3.0T, longitudinal and circumferential strain were associated with age (P < 0.05). Longitudinal strain values were greater in the apico‐septal, basal‐lateral, and mid‐lateral segments and circumferential strain in the inferior, infero‐lateral, and antero‐lateral LV segments. Conclusion Myocardial strain parameters as revealed by cine‐DENSE at different MRI field strengths were associated with myocardial region, age, and sex. J. Magn. Reson. Imaging 2016;44:1197–1205.
Collapse
Affiliation(s)
- Kenneth Mangion
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | | | - Christie McComb
- Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - David Carrick
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | | | - John McClure
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK
| | - David S Corcoran
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Rosemary Woodward
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK
| | - Vanessa Orchard
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | | | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Atlanta, Georgia, USA
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK. .,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.
| |
Collapse
|
40
|
Cowan BR, Peereboom SM, Greiser A, Guehring J, Young AA. Image Feature Determinants of Global and Segmental Circumferential Ventricular Strain From Cine CMR. JACC Cardiovasc Imaging 2015; 8:1465-1466. [DOI: 10.1016/j.jcmg.2014.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/22/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
|
41
|
Wehner GJ, Grabau JD, Suever JD, Haggerty CM, Jing L, Powell DK, Hamlet SM, Vandsburger MH, Zhong X, Fornwalt BK. 2D cine DENSE with low encoding frequencies accurately quantifies cardiac mechanics with improved image characteristics. J Cardiovasc Magn Reson 2015; 17:93. [PMID: 26538111 PMCID: PMC4634910 DOI: 10.1186/s12968-015-0196-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 10/26/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Displacement Encoding with Stimulated Echoes (DENSE) encodes displacement into the phase of the magnetic resonance signal. The encoding frequency (ke) maps the measured phase to tissue displacement while the strength of the encoding gradients affects image quality. 2D cine DENSE studies have used a ke of 0.10 cycles/mm, which is high enough to remove an artifact-generating echo from k-space, provide high sensitivity to tissue displacements, and dephase the blood pool. However, through-plane dephasing can remove the unwanted echo and dephase the blood pool without relying on high ke. Additionally, the high sensitivity comes with the costs of increased phase wrapping and intra-voxel dephasing. We hypothesized that ke below 0.10 cycles/mm can be used to improve image characteristics and provide accurate measures of cardiac mechanics. METHODS Spiral cine DENSE images were obtained for 10 healthy subjects and 10 patients with a history of heart disease on a 3 T Siemens Trio. A mid-ventricular short-axis image was acquired with different ke: 0.02, 0.04, 0.06, 0.08, and 0.10 cycles/mm. Peak twist, circumferential strain, and radial strain were compared between acquisitions employing different ke using Bland-Altman analyses and coefficients of variation. The percentage of wrapped pixels in the phase images at end-systole was calculated for each ke. The dephasing of the blood signal and signal to noise ratio (SNR) were also calculated and compared. RESULTS Negligible differences were seen in strains and twist for all ke between 0.04 and 0.10 cycles/mm. These differences were of the same magnitude as inter-test differences. Specifically, the acquisitions with 0.04 cycles/mm accurately quantified cardiac mechanics and had zero phase wrapping. Compared to 0.10 cycles/mm, the acquisitions with 0.04 cycles/mm had 9 % greater SNR and negligible differences in blood pool dephasing. CONCLUSIONS For 2D cine DENSE with through-plane dephasing, the encoding frequency can be lowered to 0.04 cycles/mm without compromising the quantification of twist or strain. The amount of wrapping can be reduced with this lower value to greatly simplify the input to unwrapping algorithms. The strain and twist results from studies using different encoding frequencies can be directly compared.
Collapse
Affiliation(s)
- Gregory J Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA.
| | - Jonathan D Grabau
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.
| | - Jonathan D Suever
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.
- Institute for Advanced Application, Geisinger Health System, Danville, PA, USA.
| | - Christopher M Haggerty
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.
- Institute for Advanced Application, Geisinger Health System, Danville, PA, USA.
| | - Linyuan Jing
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.
- Institute for Advanced Application, Geisinger Health System, Danville, PA, USA.
| | - David K Powell
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA.
| | - Sean M Hamlet
- Department of Electrical Engineering, University of Kentucky, Lexington, KY, USA.
| | | | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Atlanta, GA, USA.
| | - Brandon K Fornwalt
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA.
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.
- Department of Physiology, University of Kentucky, Lexington, KY, USA.
- Department of Medicine, University of Kentucky, Lexington, KY, USA.
- Institute for Advanced Application, Geisinger Health System, Danville, PA, USA.
- Institute for Advanced Application, Geisinger Clinic, 100 North Academy Avenue, Danville, PA, 17822-4400, USA.
| |
Collapse
|
42
|
Kihlberg J, Haraldsson H, Sigfridsson A, Ebbers T, Engvall JE. Clinical experience of strain imaging using DENSE for detecting infarcted cardiac segments. J Cardiovasc Magn Reson 2015; 17:50. [PMID: 26104510 PMCID: PMC4478716 DOI: 10.1186/s12968-015-0155-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/10/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We hypothesised that myocardial deformation determined with magnetic resonance imaging (MRI) will detect myocardial scar. METHODS Displacement Encoding with Stimulated Echoes (DENSE) was used to calculate left ventricular strain in 125 patients (29 women and 96 men) with suspected coronary artery disease. The patients also underwent cine imaging and late gadolinium enhancement. 57 patients had a scar area >1% in at least one segment, 23 were considered free from coronary artery disease (control group) and 45 had pathological findings but no scar (mixed group). Peak strain was calculated in eight combinations: radial and circumferential strain in transmural, subendocardial and epicardial layers derived from short axis acquisition, and transmural longitudinal and radial strain derived from long axis acquisitions. In addition, the difference between strain in affected segments and reference segments, "differential strain", from the control group was analysed. RESULTS In receiver-operator-characteristic analysis for the detection of 50% transmurality, circumferential strain performed best with area-under-curve (AUC) of 0.94. Using a cut-off value of -17%, sensitivity was 95% at a specificity of 80%. AUC did not further improve with differential strain. There were significant differences between the control group and global strain circumferential direction (-17% versus -12%) and in the longitudinal direction (-13% versus -10%). Interobserver and scan-rescan reproducibility was high with an intraclass correlation coefficient (ICC) >0.93. CONCLUSIONS DENSE-derived circumferential strain may be used for the detection of myocardial segments with >50 % scar area. The repeatability of strain is satisfactory. DENSE-derived global strain agrees with other global measures of left ventricular ejection fraction.
Collapse
Affiliation(s)
- Johan Kihlberg
- Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Henrik Haraldsson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
| | - Andreas Sigfridsson
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
| | - Tino Ebbers
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Jan E Engvall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| |
Collapse
|
43
|
McComb C, Carrick D, McClure JD, Woodward R, Radjenovic A, Foster JE, Berry C. Assessment of the relationships between myocardial contractility and infarct tissue revealed by serial magnetic resonance imaging in patients with acute myocardial infarction. Int J Cardiovasc Imaging 2015; 31:1201-9. [PMID: 26047771 PMCID: PMC4486782 DOI: 10.1007/s10554-015-0678-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 05/11/2015] [Indexed: 02/06/2023]
Abstract
Imaging changes in left ventricular (LV) volumes during the cardiac cycle and LV ejection fraction do not provide information on regional contractility. Displacement ENcoding with Stimulated Echoes (DENSE) is a strain-encoded cardiac magnetic resonance (CMR) technique that measures strain directly. We investigated the relationships between strain revealed by DENSE and the presence and extent of infarction in patients with recent myocardial infarction (MI). 50 male subjects were invited to undergo serial CMR within 7 days of MI (baseline) and after 6 months (follow-up; n = 47). DENSE and late gadolinium enhancement (LGE) images were acquired to enable localised regional quantification of peak circumferential strain (Ecc) and the extent of infarction, respectively. We assessed: (1) receiver operating characteristic (ROC) analysis for the classification of LGE, (2) strain differences according to LGE status (remote, adjacent, infarcted) and (3) changes in strain revealed between baseline and follow-up. 300 and 258 myocardial segments were available for analysis at baseline and follow-up respectively. LGE was present in 130/300 (43 %) and 97/258 (38 %) segments, respectively. ROC analysis revealed moderately high values for peak Ecc at baseline [threshold 12.8 %; area-under-curve (AUC) 0.88, sensitivity 84 %, specificity 78 %] and at follow-up (threshold 15.8 %; AUC 0.76, sensitivity 85 %, specificity 64 %). Differences were observed between remote, adjacent and infarcted segments. Between baseline and follow-up, increases in peak Ecc were observed in infarcted segments (median difference of 5.6 %) and in adjacent segments (1.5 %). Peak Ecc at baseline was indicative of the change in LGE status between baseline and follow-up. Strain-encoded CMR with DENSE has the potential to provide clinically useful information on contractility and its recovery over time in patients with MI.
Collapse
Affiliation(s)
- Christie McComb
- Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | | | | | | | | | | |
Collapse
|
44
|
Crossman DJ, Young AA, Ruygrok PN, Nason GP, Baddelely D, Soeller C, Cannell MB. T-tubule disease: Relationship between t-tubule organization and regional contractile performance in human dilated cardiomyopathy. J Mol Cell Cardiol 2015; 84:170-8. [PMID: 25953258 DOI: 10.1016/j.yjmcc.2015.04.022] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 11/30/2022]
Abstract
Evidence from animal models suggest that t-tubule changes may play an important role in the contractile deficit associated with heart failure. However samples are usually taken at random with no regard as to regional variability present in failing hearts which leads to uncertainty in the relationship between contractile performance and possible t-tubule derangement. Regional contraction in human hearts was measured by tagged cine MRI and model fitting. At transplant, failing hearts were biopsy sampled in identified regions and immunocytochemistry was used to label t-tubules and sarcomeric z-lines. Computer image analysis was used to assess 5 different unbiased measures of t-tubule structure/organization. In regions of failing hearts that showed good contractile performance, t-tubule organization was similar to that seen in normal hearts, with worsening structure correlating with the loss of regional contractile performance. Statistical analysis showed that t-tubule direction was most highly correlated with local contractile performance, followed by the amplitude of the sarcomeric peak in the Fourier transform of the t-tubule image. Other area based measures were less well correlated. We conclude that regional contractile performance in failing human hearts is strongly correlated with the local t-tubule organization. Cluster tree analysis with a functional definition of failing contraction strength allowed a pathological definition of 't-tubule disease'. The regional variability in contractile performance and cellular structure is a confounding issue for analysis of samples taken from failing human hearts, although this may be overcome with regional analysis by using tagged cMRI and biopsy mapping.
Collapse
Affiliation(s)
| | - Alistair A Young
- Department of Anatomy with Radiology, University of Auckland, New Zealand
| | - Peter N Ruygrok
- Department of Cardiology, Auckland City Hospital, New Zealand
| | - Guy P Nason
- School of Mathematics, University of Bristol, UK
| | - David Baddelely
- Department of Physiology, University of Auckland, New Zealand
| | | | - Mark B Cannell
- Department of Physiology, University of Auckland, New Zealand; School of Physiology and Pharmacology, University of Bristol, UK.
| |
Collapse
|
45
|
Wehner GJ, Suever JD, Haggerty CM, Jing L, Powell DK, Hamlet SM, Grabau JD, Mojsejenko WD, Zhong X, Epstein FH, Fornwalt BK. Validation of in vivo 2D displacements from spiral cine DENSE at 3T. J Cardiovasc Magn Reson 2015; 17:5. [PMID: 25634468 PMCID: PMC4311418 DOI: 10.1186/s12968-015-0119-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 01/13/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Displacement Encoding with Stimulated Echoes (DENSE) encodes displacement into the phase of the magnetic resonance signal. Due to the stimulated echo, the signal is inherently low and fades through the cardiac cycle. To compensate, a spiral acquisition has been used at 1.5T. This spiral sequence has not been validated at 3T, where the increased signal would be valuable, but field inhomogeneities may result in measurement errors. We hypothesized that spiral cine DENSE is valid at 3T and tested this hypothesis by measuring displacement errors at both 1.5T and 3T in vivo. METHODS Two-dimensional spiral cine DENSE and tagged imaging of the left ventricle were performed on ten healthy subjects at 3T and six healthy subjects at 1.5T. Intersection points were identified on tagged images near end-systole. Displacements from the DENSE images were used to project those points back to their origins. The deviation from a perfect grid was used as a measure of accuracy and quantified as root-mean-squared error. This measure was compared between 3T and 1.5T with the Wilcoxon rank sum test. Inter-observer variability of strains and torsion quantified by DENSE and agreement between DENSE and harmonic phase (HARP) were assessed by Bland-Altman analyses. The signal to noise ratio (SNR) at each cardiac phase was compared between 3T and 1.5T with the Wilcoxon rank sum test. RESULTS The displacement accuracy of spiral cine DENSE was not different between 3T and 1.5T (1.2 ± 0.3 mm and 1.2 ± 0.4 mm, respectively). Both values were lower than the DENSE pixel spacing of 2.8 mm. There were no substantial differences in inter-observer variability of DENSE or agreement of DENSE and HARP between 3T and 1.5T. Relative to 1.5T, the SNR at 3T was greater by a factor of 1.4 ± 0.3. CONCLUSIONS The spiral cine DENSE acquisition that has been used at 1.5T to measure cardiac displacements can be applied at 3T with equivalent accuracy. The inter-observer variability and agreement of DENSE-derived peak strains and torsion with HARP is also comparable at both field strengths. Future studies with spiral cine DENSE may take advantage of the additional SNR at 3T.
Collapse
Affiliation(s)
- Gregory J Wehner
- />Department of Biomedical Engineering, University of Kentucky, 741 S Limestone, BBSRB B353, Lexington, KY 40509 USA
| | | | | | - Linyuan Jing
- />Department of Pediatrics, University of Kentucky, Lexington, USA
| | - David K Powell
- />Department of Biomedical Engineering, University of Kentucky, 741 S Limestone, BBSRB B353, Lexington, KY 40509 USA
| | - Sean M Hamlet
- />Department of Electrical Engineering, University of Kentucky, Lexington, USA
| | | | | | - Xiaodong Zhong
- />MR R&D Collaborations, Siemens Healthcare, Atlanta, GA USA
| | - Frederick H Epstein
- />Department of Biomedical Engineering, University of Virginia, Charlottesville, VA USA
| | - Brandon K Fornwalt
- />Department of Biomedical Engineering, University of Kentucky, 741 S Limestone, BBSRB B353, Lexington, KY 40509 USA
- />Department of Pediatrics, University of Kentucky, Lexington, USA
- />Departments of Physiology and Medicine, University of Kentucky, Lexington, USA
| |
Collapse
|
46
|
Gomez AD, Merchant SS, Hsu EW. Accurate high-resolution measurements of 3-D tissue dynamics with registration-enhanced displacement encoded MRI. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:1350-62. [PMID: 24771572 PMCID: PMC4163496 DOI: 10.1109/tmi.2014.2311755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Displacement fields are important to analyze deformation, which is associated with functional and material tissue properties often used as indicators of health. Magnetic resonance imaging (MRI) techniques like DENSE and image registration methods like Hyperelastic Warping have been used to produce pixel-level deformation fields that are desirable in high-resolution analysis. However, DENSE can be complicated by challenges associated with image phase unwrapping, in particular offset determination. On the other hand, Hyperelastic Warping can be hampered by low local image contrast. The current work proposes a novel approach for measuring tissue displacement with both DENSE and Hyperelastic Warping, incorporating physically accurate displacements obtained by the latter to improve phase characterization in DENSE. The validity of the proposed technique is demonstrated using numerical and physical phantoms, and in vivo small animal cardiac MRI.
Collapse
Affiliation(s)
- Arnold D. Gomez
- Bioengineering Department, University of Utah, Salt Lake City, UT 84102 USA, and also with the Cardiothoracic Surgery Division, School of Medicine, University of Utah, UT 84102 USA
| | - Samer S. Merchant
- Bioengineering Department at the University of Utah, Salt Lake City, UT 84102 USA
| | - Edward W. Hsu
- Bioengineering Department at the University of Utah, Salt Lake City, UT 84102 USA
| |
Collapse
|
47
|
Moody WE, Taylor RJ, Edwards NC, Chue CD, Umar F, Taylor TJ, Ferro CJ, Young AA, Townend JN, Leyva F, Steeds RP. Comparison of magnetic resonance feature tracking for systolic and diastolic strain and strain rate calculation with spatial modulation of magnetization imaging analysis. J Magn Reson Imaging 2014; 41:1000-12. [PMID: 24677420 DOI: 10.1002/jmri.24623] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 03/04/2014] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To compare cardiovascular magnetic resonance-feature tracking (CMR-FT) with spatial modulation of magnetization (SPAMM) tagged imaging for the calculation of short and long axis Lagrangian strain measures in systole and diastole. MATERIALS AND METHODS Healthy controls (n = 35) and patients with dilated cardiomyopathy (n = 10) were identified prospectively and underwent steady-state free precession (SSFP) cine imaging and SPAMM imaging using a gradient-echo sequence. A timed offline analysis of images acquired at identical horizontal long and short axis slice positions was performed using CMR-FT and dynamic tissue-tagging (CIMTag2D). Agreement between strain and strain rate (SR) values calculated using these two different methods was assessed using the Bland-Altman technique. RESULTS Across all participants, there was good agreement between CMR-FT and CIMTag for calculation of peak systolic global circumferential strain (-22.7 ± 6.2% vs. -22.5 ± 6.9%, bias 0.2 ± 4.0%) and SR (-1.35 ± 0.42 1/s vs. -1.22 ± 0.42 1/s, bias 0.13 ± 0.33 1/s) and early diastolic global circumferential SR (1.21 ± 0.44 1/s vs. 1.07 ± 0.30 1/s, bias -0.14 ± 0.34 1/s) at the subendocardium. There was satisfactory agreement for derivation of peak systolic global longitudinal strain (-18.1 ± 5.0% vs. -16.7 ± 4.8%, bias 1.3 ± 3.8%) and SR (-1.04 ± 0.29 1/s vs. -0.95 ± 0.32 1/s, bias 0.09 ± 0.26 1/s). The weakest agreement was for early diastolic global longitudinal SR (1.10 ± 0.40 1/s vs. 0.67 ± 0.32 1/s, bias -0.42 ± 0.40 1/s), although the correlation remained significant (r = 0.42, P < 0.01). CMR-FT generated these data over four times quicker than CIMTag. CONCLUSION There is sufficient agreement between systolic and diastolic strain measures calculated using CMR-FT and myocardial tagging for CMR-FT to be considered as a potentially feasible and rapid alternative.
Collapse
Affiliation(s)
- William E Moody
- Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK; Centre for Cardiovascular Sciences, School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, UK
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Kar J, Knutsen AK, Cupps BP, Zhong X, Pasque MK. Three-dimensional regional strain computation method with displacement encoding with stimulated echoes (DENSE) in non-ischemic, non-valvular dilated cardiomyopathy patients and healthy subjects validated by tagged MRI. J Magn Reson Imaging 2014; 41:386-96. [PMID: 24753028 DOI: 10.1002/jmri.24576] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/03/2014] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Fast cine displacement encoding with stimulated echoes (DENSE) MR has higher spatial resolution and enables rapid postprocessing. Thus we compared the accuracy of regional strains computation by DENSE with tagged MR in healthy and non-ischemic, non-valvular dilated cardiomyopathy (DCM) subjects. MATERIALS AND METHODS Validation of three-dimensional regional strains computed with DENSE was conducted in reference to standard tagged MRI (TMRI) in healthy subjects and patients with DCM. Additional repeatability studies in healthy subjects were conducted to increase confidence in DENSE. A meshfree multiquadrics radial point interpolation method (RPIM) was used for computing Lagrange strains in sixteen left ventricular segments. Bland-Altman analysis and Student's t-tests were conducted to observe similarities in regional strains between sequences and in DENSE repeatability studies. RESULTS Regional circumferential strains ranged from -0.21 ± 0.07 (Lateral-Apex) to -0.11 ± 0.05 (Posterorseptal-Base) in healthy subjects and -0.15 ± 0.04 (Anterior-Apex) to -0.02 ± 0.08 (Posterorseptal-Base) in DCM patients. Computed mean differences in regional circumferential strain from the DENSE-TMRI comparison study was 0.01 ± 0.03 (95% limits of agreement) in normal subjects, -0.01 ± 0.06 in DCM patients and 0.0 ± 0.02 in repeatability studies, with similar agreements in longitudinal and radial strains. CONCLUSION We found agreement between DENSE and tagged MR in patients and volunteers in terms of evaluation of regional strains.
Collapse
Affiliation(s)
- Julia Kar
- Department of Surgery School of Medicine, Washington University, St Louis, Missouri, USA
| | | | | | | | | |
Collapse
|
49
|
McComb C, Carrick D, Woodward R, McClure JD, Radjenovic A, Foster J, Berry C. Assessment of longitudinal changes in strain using DENSE in patients with myocardial infarction. J Cardiovasc Magn Reson 2014. [PMCID: PMC4045127 DOI: 10.1186/1532-429x-16-s1-p187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
50
|
Kar J, Knutsen AK, Cupps BP, Pasque MK. A validation of two-dimensional in vivo regional strain computed from displacement encoding with stimulated echoes (DENSE), in reference to tagged magnetic resonance imaging and studies in repeatability. Ann Biomed Eng 2013; 42:541-54. [PMID: 24150239 DOI: 10.1007/s10439-013-0931-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/15/2013] [Indexed: 01/23/2023]
Abstract
Fast cine displacement encoding with stimulated echoes (DENSE) has comparative advantages over tagged MRI (TMRI) including higher spatial resolution and faster post-processing. This study computed regional radial and circumferential myocardial strains with DENSE displacements and validated it in reference to TMRI, according to American Heart Association (AHA) guidelines for standardized segmentation of regions in the left ventricle (LV). This study was therefore novel in examining agreement between the modalities in 16 AHA recommended LV segments. DENSE displacements were obtained with spatiotemporal phase unwrapping and TMRI displacements obtained with a conventional tag-finding algorithm. A validation study with a rotating phantom established similar shear strain between modalities prior to in vivo studies. A novel meshfree nearest node finite element method (NNFEM) was used for rapid computation of Lagrange strain in both phantom and in vivo studies in both modalities. Also novel was conducting in vivo repeatability studies for observing recurring strain patterns in DENSE and increase confidence in it. Comprehensive regional strain agreements via Bland-Altman analysis between the modalities were obtained. Results from the phantom study showed similar radial-circumferential shear strains from the two modalities. Mean differences in regional in vivo circumferential strains were -0.01 ± 0.09 (95% limits of agreement) from comparing the modalities and -0.01 ± 0.07 from repeatability studies. Differences and means from comparison and repeatability studies were uncorrelated (p > 0.05) indicating no increases in differences with increased strain magnitudes. Bland-Altman analysis and similarities in regional strain distribution within the myocardium showed good agreements between DENSE and TMRI and show their interchangeability. NNFEM was also established as a common framework for computing strain in both modalities.
Collapse
Affiliation(s)
- Julia Kar
- Department of Surgery, School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave., St Louis, MO, 63110, USA,
| | | | | | | |
Collapse
|