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Vollbrecht TM, Bissell MM, Kording F, Geipel A, Isaak A, Strizek BS, Hart C, Barker AJ, Luetkens JA. Fetal Cardiac MRI Using Doppler US Gating: Emerging Technology and Clinical Implications. Radiol Cardiothorac Imaging 2024; 6:e230182. [PMID: 38602469 PMCID: PMC11056758 DOI: 10.1148/ryct.230182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 04/12/2024]
Abstract
Fetal cardiac MRI using Doppler US gating is an emerging technique to support prenatal diagnosis of congenital heart disease and other cardiovascular abnormalities. Analogous to postnatal electrocardiographically gated cardiac MRI, this technique enables directly gated MRI of the fetal heart throughout the cardiac cycle, allowing for immediate data reconstruction and review of image quality. This review outlines the technical principles and challenges of cardiac MRI with Doppler US gating, such as loss of gating signal due to fetal movement. A practical workflow of patient preparation for the use of Doppler US-gated fetal cardiac MRI in clinical routine is provided. Currently applied MRI sequences (ie, cine or four-dimensional flow imaging), with special consideration of technical adaptations to the fetal heart, are summarized. The authors provide a literature review on the clinical benefits of Doppler US-gated fetal cardiac MRI for gaining additional diagnostic information on cardiovascular malformations and fetal hemodynamics. Finally, future perspectives of Doppler US-gated fetal cardiac MRI and further technical developments to reduce acquisition times and eliminate sources of artifacts are discussed. Keywords: MR Fetal, Ultrasound Doppler, Cardiac, Heart, Congenital, Obstetrics, Fetus Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Thomas M. Vollbrecht
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Malenka M. Bissell
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Fabian Kording
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Annegret Geipel
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Alexander Isaak
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Brigitte S. Strizek
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Christopher Hart
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Alex J. Barker
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
| | - Julian A. Luetkens
- From the Department of Diagnostic and Interventional Radiology,
University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (T.M.V., A.I.,
C.H., J.A.L.); Quantitative Imaging Laboratory Bonn (QILaB), University Hospital
Bonn, Bonn, Germany (T.M.V., A.I., C.H., J.A.L.); Department of Biomedical
Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom (M.M.B.); Northh Medical, Hamburg,
Germany (F.K.); Departments of Obstetrics and Prenatal Medicine (A.G., B.S.S.)
and Pediatric Cardiology (C.H.), University Hospital Bonn, Bonn, Germany;
Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora,
Colo (A.J.B.); Department of Pediatric Radiology, Children’s Hospital
Colorado, Aurora, Colo (A.J.B.)
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Pan Y, Varghese J, Tong MS, Yildiz VO, Azzu A, Gatehouse P, Wage R, Nielles-Vallespin S, Pennell DJ, Jin N, Bacher M, Hayes C, Speier P, Simonetti OP. Two-center validation of Pilot Tone based cardiac triggering of a comprehensive cardiovascular magnetic resonance examination. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:261-273. [PMID: 38082073 DOI: 10.1007/s10554-023-03002-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/31/2023] [Indexed: 12/26/2023]
Abstract
The electrocardiogram (ECG) signal is prone to distortions from gradient and radiofrequency interference and the magnetohydrodynamic effect during cardiovascular magnetic resonance imaging (CMR). Although Pilot Tone Cardiac (PTC) triggering has the potential to overcome these limitations, effectiveness across various CMR techniques has yet to be established. To evaluate the performance of PTC triggering in a comprehensive CMR exam. Fifteen volunteers and 20 patients were recruited at two centers. ECG triggered images were collected for comparison in a subset of sequences. The PTC trigger accuracy was evaluated against ECG in cine acquisitions. Two experienced readers scored image quality in PTC-triggered cine, late gadolinium enhancement (LGE), and T1- and T2-weighted dark-blood turbo spin echo (DB-TSE) images. Quantitative cardiac function, flow, and parametric mapping values obtained using PTC and ECG triggered sequences were compared. Breath-held segmented cine used for trigger timing analysis was collected in 15 volunteers and 14 patients. PTC calibration failed in three volunteers and one patient; ECG trigger recording failed in one patient. Out of 1987 total heartbeats, three mismatched trigger PTC-ECG pairs were found. Image quality scores showed no significant difference between PTC and ECG triggering. There was no significant difference found in quantitative measurements in volunteers. In patients, the only significant difference was found in post-contrast T1 (p = 0.04). ICC showed moderate to excellent agreement in all measurements. PTC performance was equivalent to ECG in terms of triggering consistency, image quality, and quantitative image measurements across multiple CMR applications.
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Affiliation(s)
- Yue Pan
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Juliet Varghese
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Matthew S Tong
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vedat O Yildiz
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Alessia Azzu
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Peter Gatehouse
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Rick Wage
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | | | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Malvern, PA, USA
| | - Mario Bacher
- Siemens Healthineers AG, Erlangen, Germany
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | | | - Orlando P Simonetti
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA.
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Pan Y, Varghese J, Tong MS, Yildiz VO, Azzu A, Gatehouse P, Wage R, Nielles-Vallespin S, Pennell D, Jin N, Bacher M, Hayes C, Speier P, Simonetti OP. Two-center validation of Pilot Tone Based Cardiac Triggering of a Comprehensive Cardiovascular Magnetic Resonance Examination. RESEARCH SQUARE 2023:rs.3.rs-3121723. [PMID: 37461505 PMCID: PMC10350216 DOI: 10.21203/rs.3.rs-3121723/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background The electrocardiogram (ECG) signal is prone to distortions from gradient and radiofrequency interference and the magnetohydrodynamic effect during cardiovascular magnetic resonance imaging (CMR). Although Pilot Tone Cardiac (PTC) triggering has the potential to overcome these limitations, effectiveness across various CMR techniques has yet to be established. Purpose To evaluate the performance of PTC triggering in a comprehensive CMR exam. Methods Fifteen volunteers and twenty patients were recruited at two centers. ECG triggered images were collected for comparison in a subset of sequences. The PTC trigger accuracy was evaluated against ECG in cine acquisitions. Two experienced readers scored image quality in PTC-triggered cine, late gadolinium enhancement (LGE), and T1- and T2-weighted dark-blood turbo spin echo (DB-TSE) images. Quantitative cardiac function, flow, and parametric mapping values obtained using PTC and ECG triggered sequences were compared. Results Breath-held segmented cine used for trigger timing analysis was collected in 15 volunteers and 14 patients. PTC calibration failed in three volunteers and one patient; ECG trigger recording failed in one patient. Out of 1987 total heartbeats, three mismatched trigger PTC-ECG pairs were found. Image quality scores showed no significant difference between PTC and ECG triggering. There was no significant difference found in quantitative measurements in volunteers. In patients, the only significant difference was found in post-contrast T1 (p = 0.04). ICC showed moderate to excellent agreement in all measurements. Conclusion PTC performance was equivalent to ECG in terms of triggering consistency, image quality, and quantitative image measurements across multiple CMR applications.
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Piek M, Ryd D, Töger J, Testud F, Hedström E, Aletras AH. Fetal 3D cardiovascular cine image acquisition using radial sampling and compressed sensing. Magn Reson Med 2023; 89:594-604. [PMID: 36156292 PMCID: PMC10087603 DOI: 10.1002/mrm.29467] [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: 03/25/2022] [Revised: 08/09/2022] [Accepted: 09/04/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To explore a fetal 3D cardiovascular cine acquisition using a radial image acquisition and compressed-sensing reconstruction and compare image quality and scan time with conventional multislice 2D imaging. METHODS Volumetric fetal cardiac data were acquired in 26 volunteers using a radial 3D balanced SSFP pulse sequence. Cardiac gating was performed using a Doppler ultrasound device. Images were reconstructed using a parallel-imaging and compressed-sensing algorithm. Multiplanar reformatting to standard cardiac views was performed before image analysis. Clinical 2D images were used for comparison. Qualitative and quantitative image evaluation were performed by two experienced observers (scale: 1-4). Volumes, mass, and function were assessed. RESULTS Average scan time for the 3D imaging was 6 min, including one localizer. A 2D imaging stack covering the entire heart including localizer sequences took at least 6.5 min, depending on planning complexity. The 3D acquisition was successful in 7 of 26 subjects (27%). Overall image contrast and perceived resolution were lower in the 3D images. Nonetheless, the 3D images had, on average, a moderate cardiac diagnostic quality (median [range]: 3 [1-4]). Standard clinical 2D acquisitions had a high cardiac diagnostic quality (median [range]: 4 [3, 4]). Cardiac measurements were not different between 2D and 3D images (all p > 0.16). CONCLUSION The presented free-breathing whole-heart fetal 3D radial cine MRI acquisition and reconstruction method enables retrospective visualization of all cardiac views while keeping examination times short. This proof-of-concept work produced images with diagnostic quality, while at the same time reducing the planning complexity to a single localizer.
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Affiliation(s)
- Marjolein Piek
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Johannes Töger
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.,Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anthony H Aletras
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.,Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Qutbi M, Soltanshahi M, FarokhiMoghadam F, Ramandi FL, Kaghazchi F, Ahmadi R. Polarity status of trigger signal during ECG-gating affects parameters of LV function in gated myocardial perfusion SPECT. J Nucl Cardiol 2022; 29:2199-2209. [PMID: 34036529 DOI: 10.1007/s12350-021-02675-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND BACKGROUND The polarity status is one of the important items of specifications of trigger signal from cardiac trigger monitors with two options, either positive or negative. Some systems allow the user to set the polarity of trigger signal before imaging. Efforts should be made to set the polarity status according to the recommendations provided by the manufacturers. In case of inappropriate selection, changes in computation of end-systolic and end-diastolic volumes as well as ejection fraction may occur. OBJECTIVE To investigate the effect of the polarity status of trigger signals in synchronization process during 8- and 16-frame gated SPECT imaging on the systolic and diastolic parameters of LV function. METHODS Thirty-four patients referred for a myocardial perfusion SPECT were consecutively included in the study. The rest scan for each patient was performed with 8- and 16-frame gating simultaneously with positive trigger signal set by the operator in a cardiac trigger monitor and then repeated after manual selection of negative polarity. In total, the 4 imaging modes acquired were 8-frame/positive-trigger, 16-frame/positive-trigger, 8-frame/negative-trigger, and 16-frame/negative-trigger. All SPECT images were reconstructed and processed with the same values of parameters. Systolic and diastolic indices of LV function were derived in QGS of the Cedars-Sinai software and then were compared using various statistical tests, and a reliability analysis was also performed. RESULTS The age of patients recruited in the study was 58.41 ± 8.94, and 16 (47.1%) males and 18 (52.9%) females. All the correlation coefficients between corresponding parameters in positive and negative trigger signals were statistically significant. The difference between the parameters of systolic function including EF, EDV, and ESV in positive and negative trigger signals was statistically significant in paired sample t test. Likewise, a statistically significant difference was also found between mean phase angle in scans with positive and negative trigger signals by a phase difference of 147.91 (41.0% of an average cardiac cycle) and 149 (41.3% of an average cardiac cycle) degrees in 8- and 16-frame gating modes, respectively. Strong agreement (according to high values of intra-class correlation coefficient) was found for all four pairs. According to Bland-Altman results, an offset of about 3 percentage units was found, both between imaging in 8-frame gating compared to 16-frame gating, higher value in favor of 16-frame gating, and also between imaging with positive polarity trigger compared to negative-polarity trigger, again higher value in favor of positive-polarity triggering. CONCLUSION The status of the polarity of trigger signals or similar CTM-camera delays in synchronization process during 8- and 16-frame gated SPECT imaging can be considered as one of the factors that may influence systolic and diastolic indices of LV function.
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Affiliation(s)
- Mohsen Qutbi
- Department of Nuclear Medicine, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mehdi Soltanshahi
- Department of Nuclear Medicine, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farideh FarokhiMoghadam
- Department of Nuclear Medicine, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahime Lamei Ramandi
- Department of Nuclear Medicine, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Kaghazchi
- Department of Nuclear Medicine, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Radiology, University of Pennsylvania Philadelphia, Philadelphia, USA
| | - Reyhane Ahmadi
- Department of Nuclear Medicine and Molecular Imaging, Farshchian Heart Center, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Knapp J, Tavares de Sousa M, Schönnagel BP. Fetal Cardiovascular MRI - A Systemic Review of the Literature: Challenges, New Technical Developments, and Perspectives. ROFO-FORTSCHR RONTG 2022; 194:841-851. [PMID: 35905903 DOI: 10.1055/a-1761-3500] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Fetal magnetic resonance imaging (MRI) has become a valuable adjunct to ultrasound in the prenatal diagnosis of congenital pathologies of the central nervous system, thorax, and abdomen. Fetal cardiovascular magnetic resonance (CMR) was limited, mainly by the lack of cardiac gating, and has only recently evolved due to technical developments. METHOD A literature search was performed on PubMed, focusing on technical advancements to perform fetal CMR. In total, 20 publications on cardiac gating techniques in the human fetus were analyzed. RESULTS Fetal MRI is a safe imaging method with no developmental impairments found to be associated with in utero exposure to MRI. Fetal CMR is challenging due to general drawbacks (e. g., fetal motion) and specific limitations such as the difficulty to generate a cardiac gating signal to achieve high spatiotemporal resolution. Promising technical advancements include new methods for fetal cardiac gating, based on novel post-processing approaches and an external hardware device, as well as motion compensation and acceleration techniques. CONCLUSION Newly developed direct and indirect gating approaches were successfully applied to achieve high-quality morphologic and functional imaging as well as quantitative assessment of fetal hemodynamics in research settings. In cases when prenatal echocardiography is limited, e. g., by an unfavorable fetal position in utero, or when its results are inconclusive, fetal CMR could potentially serve as a valuable adjunct in the prenatal assessment of congenital cardiovascular malformations. However, sufficient data on the diagnostic performance and clinical benefit of new fetal CMR techniques is still lacking. KEY POINTS · New fetal cardiac gating methods allow high-quality fetal CMR.. · Motion compensation and acceleration techniques allow for improvement of image quality.. · Fetal CMR could potentially serve as an adjunct to fetal echocardiography in the future.. CITATION FORMAT · Knapp J, Tavares de Sousa M, Schönnagel BP. Fetal Cardiovascular MRI - A Systemic Review of the Literature: Challenges, New Technical Developments, and Perspectives. Fortschr Röntgenstr 2022; 194: 841 - 851.
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Affiliation(s)
- Janine Knapp
- Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Björn P Schönnagel
- Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Widatalla N, Funamoto K, Kawataki M, Yoshida C, Funamoto K, Saito M, Kasahara Y, Khandoker A, Kimura Y. Model-based estimation of QT intervals of mouse fetal electrocardiogram. Biomed Eng Online 2022; 21:45. [PMID: 35768841 PMCID: PMC9245267 DOI: 10.1186/s12938-022-01015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background Abnormal prolongation in the QT interval or long QT syndrome (LQTS) is associated with several cardiac complications such as sudden infant death syndrome (SIDS). LQTS is believed to be linked to genetic mutations which can be understood by using animal models, such as mice models. Nevertheless, the research related to fetal QT interval in mice is still limited because of challenges associated with T wave measurements in fetal electrocardiogram (fECG). Reliable measurement of T waves is essential for estimating their end timings for QT interval assessment. Results A mathematical model was used to estimate QT intervals. Estimated QT intervals were validated with Q-aortic closure (Q-Ac) intervals of Doppler ultrasound (DUS) and comparison between both showed good agreement with a correlation coefficient higher than 0.88 (r > 0.88, P < 0.05). Conclusion Model-based estimation of QT intervals can help in better understanding of QT intervals in fetal mice.
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Affiliation(s)
- Namareq Widatalla
- School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | | | | | - Chihiro Yoshida
- School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Kenichi Funamoto
- School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Masatoshi Saito
- School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Yoshiyuki Kasahara
- School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | | | - Yoshitaka Kimura
- School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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Madore B, Belsley G, Cheng CC, Preiswerk F, Foley Kijewski M, Wu PH, Martell LB, Pluim JPW, Di Carli M, Moore SC. Ultrasound-based sensors for respiratory motion assessment in multimodality PET imaging. Phys Med Biol 2021; 67. [PMID: 34891142 DOI: 10.1088/1361-6560/ac4213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/10/2021] [Indexed: 11/11/2022]
Abstract
Breathing motion can displace internal organs by up to several cm; as such, it is a primary factor limiting image quality in medical imaging. Motion can also complicate matters when trying to fuse images from different modalities, acquired at different locations and/or on different days. Currently available devices for monitoring breathing motion often do so indirectly, by detecting changes in the outline of the torso rather than the internal motion itself, and these devices are often fixed to floors, ceilings or walls, and thus cannot accompany patients from one location to another. We have developed small ultrasound-based sensors, referred to as 'organ configuration motion' (OCM) sensors, that attach to the skin and provide rich motion-sensitive information. In the present work we tested the ability of OCM sensors to enable respiratory gating during in vivo PET imaging. A motion phantom involving an FDG solution was assembled, and two cancer patients scheduled for a clinical PET/CT exam were recruited for this study. OCM signals were used to help reconstruct phantom and in vivo data into time series of motion-resolved images. As expected, the motion-resolved images captured the underlying motion. In Patient #1, a single large lesion proved to be mostly stationary through the breathing cycle. However, in Patient #2, several small lesions were mobile during breathing, and our proposed new approach captured their breathing-related displacements. In summary, a relatively inexpensive hardware solution was developed here for respiration monitoring. Because the proposed sensors attach to the skin, as opposed to walls or ceilings, they can accompany patients from one procedure to the next, potentially allowing data gathered in different places and at different times to be combined and compared in ways that account for breathing motion.
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Affiliation(s)
- Bruno Madore
- Harvard Medical School, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts, 02115, UNITED STATES
| | - Gabriela Belsley
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, University of Oxford, Oxford, Oxford, OX3 9DU, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Cheng-Chieh Cheng
- Computer Science and Engineering, National Sun Yat-sen University, 70 Lianhai Road, Kaohsiung, 804, TAIWAN
| | - Frank Preiswerk
- Amazon Robotics, Westborough, MA, USA, Amazon Robotics, 50 Otis St, Westborough, Massachusetts, 01581, UNITED STATES
| | - Marie Foley Kijewski
- Harvard Medical School, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts, 02115, UNITED STATES
| | - Pei-Hsin Wu
- Electrical Engineering, National Sun Yat-sen University, 70 Lianhai Road, Kaohsiung, 804, TAIWAN
| | - Laurel B Martell
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts, 02115, UNITED STATES
| | - Josien P W Pluim
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, Eindhoven, PO Box 513, NETHERLANDS
| | - Marcelo Di Carli
- Harvard Medical School, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts, 02115, UNITED STATES
| | - Stephen C Moore
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, Pennsylvania, 19104, UNITED STATES
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9
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Fok WYR, Chan YCI, Romanowicz J, Jang J, Powell AJ, Moghari MH. Accelerated free-breathing 3D whole-heart magnetic resonance angiography with a radial phyllotaxis trajectory, compressed sensing, and curvelet transform. Magn Reson Imaging 2021; 83:57-67. [PMID: 34147592 DOI: 10.1016/j.mri.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/22/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To develop and validate an accelerated free-breathing 3D whole-heart magnetic resonance angiography (MRA) technique using a radial k-space trajectory with compressed sensing and curvelet transform. METHOD A 3D radial phyllotaxis trajectory was implemented to traverse the centerline of k-space immediately before the segmented whole-heart MRA data acquisition at each cardiac cycle. The k-space centerlines were used to correct the respiratory-induced heart motion in the acquired MRA data. The corrected MRA data were then reconstructed by a novel compressed sensing algorithm using curvelets as the sparsifying domain. The proposed 3D whole-heart MRA technique (radial CS curvelet) was then prospectively validated against compressed sensing with a conventional wavelet transform (radial CS wavelet) and a standard Cartesian acquisition in terms of scan time and border sharpness. RESULTS Fifteen patients (females 10, median age 34-year-old) underwent 3D whole-heart MRA imaging using a standard Cartesian trajectory and our proposed radial phyllotaxis trajectory. Scan time for radial phyllotaxis was significantly shorter than Cartesian (4.88 ± 0.86 min. vs. 6.84 ± 1.79 min., P-value = 0.004). Radial CS curvelet border sharpness was slightly lower than Cartesian and, for the majority of vessels, was significantly better than radial CS wavelet (P-value < 0.050). CONCLUSION The proposed technique of 3D whole-heart MRA acquisition with a radial CS curvelet has a shorter scan time and slightly lower vessel sharpness compared to the Cartesian acquisition with radial profile ordering, and has slightly better sharpness than radial CS wavelet. Future work on this technique includes additional clinical trials and extending this technique to 3D cine imaging.
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Affiliation(s)
- Wai Yan Ryana Fok
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Computer Science, Technical University of Munich, Garching, Germany.
| | - Yan Chi Ivy Chan
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Computer Science, Technical University of Munich, Garching, Germany
| | - Jennifer Romanowicz
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jihye Jang
- Philips Healthcare, Gainesville, FL, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Mehdi H Moghari
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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10
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Ladrova M, Martinek R, Nedoma J, Hanzlikova P, Nelson MD, Kahankova R, Brablik J, Kolarik J. Monitoring and Synchronization of Cardiac and Respiratory Traces in Magnetic Resonance Imaging: A Review. IEEE Rev Biomed Eng 2021; 15:200-221. [PMID: 33513108 DOI: 10.1109/rbme.2021.3055550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Synchronization of human vital signs, namely the cardiac cycle and respiratory excursions, is necessary during magnetic resonance imaging of the cardiovascular system and the abdominal cavity to achieve optimal image quality with minimized artifacts. This review summarizes techniques currently available in clinical practice, as well as methods under development, outlines the benefits and disadvantages of each approach, and offers some unique solutions for consideration.
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11
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Markenroth Bloch K, Kording F, Töger J. Doppler ultrasound cardiac gating of intracranial flow at 7T. BMC Med Imaging 2020; 20:128. [PMID: 33297985 PMCID: PMC7724705 DOI: 10.1186/s12880-020-00523-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ultra-high field magnetic resonance imaging (MR) may be used to improve intracranial blood flow measurements. However, standard cardiac synchronization methods tend to fail at ultra-high field MR. Therefore, this study aims to investigate an alternative synchronization technique using Doppler ultrasound. METHODS Healthy subjects (n = 9) were examined with 7T MR. Flow was measured in the M1-branch of the middle cerebral artery (MCA) and in the cerebral aqueduct (CA) using through-plane phase contrast (2D flow). Flow in the circle of Willis was measured with three-dimensional, three-directional phase contrast (4D flow). Scans were gated with Doppler ultrasound (DUS) and electrocardiogram (ECG), and pulse oximetry data (POX) was collected simultaneously. False negative and false positive trigger events were counted for ECG, DUS and POX, and quantitative flow measures were compared. RESULTS There were fewer false positive triggers for DUS compared to ECG (5.3 ± 11 vs. 25 ± 31, p = 0.031), while no other measured parameters differed significantly. Net blood flow in M1 was similar between DUS and ECG for 2D flow (1.5 ± 0.39 vs. 1.6 ± 0.41, bias ± 1.96SD: - 0.021 ± 0.36) and 4D flow (1.8 ± 0.48 vs. 9 ± 0.59, bias ± 1.96SD: - 0.086 ± 0.57 ml). Net CSF flow per heart beat in the CA was also similar for DUS and ECG (3.6 ± 2.1 vs. 3.0 ± 5.8, bias ± 1.96SD: 0.61 ± 13.6 μl). CONCLUSION Gating with DUS produced fewer false trigger events than using ECG, with similar quantitative flow values. DUS gating is a promising technique for cardiac synchronization at 7T.
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Affiliation(s)
- Karin Markenroth Bloch
- The Swedish National 7T Facility, Lund University Bioimaging Center, Lund University, Klinikgatan 32, BMC D11, 22242, Lund, Sweden.
| | - Fabian Kording
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg- Eppendorf, Hamburg, Germany.,Northh Medical GmbH, Röntgenstraße 24, 22335, Hamburg, Germany
| | - Johannes Töger
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University and Skane University Hospital Lund, Lund, Sweden
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12
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Kupka T, Matonia A, Jezewski M, Jezewski J, Horoba K, Wrobel J, Czabanski R, Martinek R. New Method for Beat-to-Beat Fetal Heart Rate Measurement Using Doppler Ultrasound Signal. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4079. [PMID: 32707863 PMCID: PMC7435740 DOI: 10.3390/s20154079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022]
Abstract
The most commonly used method of fetal monitoring is based on heart activity analysis. Computer-aided fetal monitoring system enables extraction of clinically important information hidden for visual interpretation-the instantaneous fetal heart rate (FHR) variability. Today's fetal monitors are based on monitoring of mechanical activity of the fetal heart by means of Doppler ultrasound technique. The FHR is determined using autocorrelation methods, and thus it has a form of evenly spaced-every 250 ms-instantaneous measurements, where some of which are incorrect or duplicate. The parameters describing a beat-to-beat FHR variability calculated from such a signal show significant errors. The aim of our research was to develop new analysis methods that will both improve an accuracy of the FHR determination and provide FHR representation as time series of events. The study was carried out on simultaneously recorded (during labor) Doppler ultrasound signal and the reference direct fetal electrocardiogram Two subranges of Doppler bandwidths were separated to describe heart wall movements and valve motions. After reduction of signal complexity by determining the Doppler ultrasound envelope, the signal was analyzed to determine the FHR. The autocorrelation method supported by a trapezoidal prediction function was used. In the final stage, two different methods were developed to provide signal representation as time series of events: the first using correction of duplicate measurements and the second based on segmentation of instantaneous periodicity measurements. Thus, it ensured the mean heart interval measurement error of only 1.35 ms. In a case of beat-to-beat variability assessment the errors ranged from -1.9% to -10.1%. Comparing the obtained values to other published results clearly confirms that the new methods provides a higher accuracy of an interval measurement and a better reliability of the FHR variability estimation.
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Affiliation(s)
- Tomasz Kupka
- Łukasiewicz Research Network—Institute of Medical Technology and Equipment, PL41800 Zabrze, Poland; (A.M.); (J.J.); (K.H.); (J.W.)
| | - Adam Matonia
- Łukasiewicz Research Network—Institute of Medical Technology and Equipment, PL41800 Zabrze, Poland; (A.M.); (J.J.); (K.H.); (J.W.)
| | - Michal Jezewski
- Department of Cybernetics, Nanotechnology and Data Processing, Silesian University of Technology, PL44100 Gliwice, Poland; (M.J.); (R.C.)
| | - Janusz Jezewski
- Łukasiewicz Research Network—Institute of Medical Technology and Equipment, PL41800 Zabrze, Poland; (A.M.); (J.J.); (K.H.); (J.W.)
| | - Krzysztof Horoba
- Łukasiewicz Research Network—Institute of Medical Technology and Equipment, PL41800 Zabrze, Poland; (A.M.); (J.J.); (K.H.); (J.W.)
| | - Janusz Wrobel
- Łukasiewicz Research Network—Institute of Medical Technology and Equipment, PL41800 Zabrze, Poland; (A.M.); (J.J.); (K.H.); (J.W.)
| | - Robert Czabanski
- Department of Cybernetics, Nanotechnology and Data Processing, Silesian University of Technology, PL44100 Gliwice, Poland; (M.J.); (R.C.)
| | - Radek Martinek
- Department of Cybernetics and Biomedical Engineering, VSB—Technical University of Ostrava, 70800 Ostrava-Poruba, Czech Republic;
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13
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Haris K, Hedström E, Kording F, Bidhult S, Steding-Ehrenborg K, Ruprecht C, Heiberg E, Arheden H, Aletras AH. Free-breathing fetal cardiac MRI with doppler ultrasound gating, compressed sensing, and motion compensation. J Magn Reson Imaging 2019; 51:260-272. [PMID: 31228302 PMCID: PMC6916642 DOI: 10.1002/jmri.26842] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/04/2019] [Indexed: 12/23/2022] Open
Abstract
Background Fetal cardiovascular MRI complements ultrasound to assess fetal cardiovascular pathophysiology. Purpose To develop a free‐breathing method for retrospective fetal cine MRI using Doppler ultrasound (DUS) cardiac gating and tiny golden angle radial sampling (tyGRASP) for accelerated acquisition capable of detecting fetal movements for motion compensation. Study Type Feasibility study. Subjects Nine volunteers (gestational week 34–40). Short‐axis and four‐chamber views were acquired during maternal free‐breathing and breath‐hold. Field Strength/Sequence 1.5T cine balanced steady‐state free precession. Assessment A self‐gated reconstruction method was improved for clinical application by using 1) retrospective DUS gating, and 2) motion detection and rejection/correction algorithms for compensating for fetal motion. The free‐breathing reconstructions were qualitatively and quantitatively assessed, and DUS‐gating was compared with self‐gating in breath‐hold reconstructions. A scoring of 1–4 for overall image quality, cardiac, and extracardiac diagnostic quality was used. Statistical Tests Friedman's test was used to assess differences in qualitative scoring between observers. A Wilcoxon matched‐pairs signed rank test was used to assess differences between breath‐hold and free‐breathing acquisitions and between observers' quantitative measurements. Results In all cases, 111 free‐breathing and 145 breath‐hold acquisitions, the automatically calculated DUS‐based cardiac gating signal provided reconstructions of diagnostic quality (median score 4, range 1–4). Free‐breathing did not affect the DUS‐based cardiac gated retrospective radial reconstruction with respect to image or diagnostic quality (all P > 0.06). Motion detection with rejection/correction in k‐space produced high‐quality free‐breathing DUS‐based reconstructions [median 3, range (2–4)], whereas free‐breathing self‐gated methods failed in 80 out of 88 cases to produce a stable gating signal. Data Conclusion Free‐breathing fetal cine cardiac MRI based on DUS gating and tyGRASP with motion compensation yields diagnostic images. This simplifies acquisition for the pregnant woman and thus could help increase fetal cardiac MRI acceptance in the clinic. Level of Evidence: 2 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2020;51:260–272.
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Affiliation(s)
- Kostas Haris
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Fabian Kording
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Bidhult
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Christian Ruprecht
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Einar Heiberg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anthony H Aletras
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
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14
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Kording F, Yamamura J, de Sousa MT, Ruprecht C, Hedström E, Aletras AH, Ellen Grant P, Powell AJ, Fehrs K, Adam G, Kooijman H, Schoennagel BP. Dynamic fetal cardiovascular magnetic resonance imaging using Doppler ultrasound gating. J Cardiovasc Magn Reson 2018; 20:17. [PMID: 29530064 PMCID: PMC5846256 DOI: 10.1186/s12968-018-0440-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 02/26/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Fetal cardiovascular magnetic resonance (CMR) imaging may provide a valuable adjunct to fetal echocardiography in the evaluation of congenital cardiovascular pathologies. However, dynamic fetal CMR is difficult due to the lack of direct in-utero cardiac gating. The aim of this study was to investigate the effectiveness of a newly developed Doppler ultrasound (DUS) device in humans for fetal CMR gating. METHODS Fifteen fetuses (gestational age 30-39 weeks) were examined using 1.5 T CMR scanners at three different imaging sites. A newly developed CMR-compatible DUS device was used to generate gating signals from fetal cardiac motion. Gated dynamic balanced steady-state free precession images were acquired in 4-chamber and short-axis cardiac views. Gating signals during data acquisition were analyzed with respect to trigger variability and sensitivity. Image quality was assessed by measuring endocardial blurring (EB) and by image evaluation using a 4-point scale. Left ventricular (LV) volumetry was performed using the single-plane ellipsoid model. RESULTS Gating signals from the fetal heart were detected with a variability of 26 ± 22 ms and a sensitivity of trigger detection of 96 ± 4%. EB was 2.9 ± 0.6 pixels (4-chamber) and 2.5 ± 0.1 pixels (short axis). Image quality scores were 3.6 ± 0.6 (overall), 3.4 ± 0.7 (mitral valve), 3.4 ± 0.7 (foramen ovale), 3.6 ± 0.7 (atrial septum), 3.7 ± 0.5 (papillary muscles), 3.8 ± 0.4 (differentiation myocardium/lumen), 3.7 ± 0.5 (differentiation myocardium/lung), and 3.9 ± 0.4 (systolic myocardial thickening). Inter-observer agreement for the scores was moderate to very good (kappa 0.57-0.84) for all structures. LV volumetry revealed mean values of 2.8 ± 1.2 ml (end-diastolic volume), 0.9 ± 0.4 ml (end systolic volume), 1.9 ± 0.8 ml (stroke volume), and 69.1 ± 8.4% (ejection fraction). CONCLUSION High-quality dynamic fetal CMR was successfully performed using a newly developed DUS device for direct fetal cardiac gating. This technique has the potential to improve the utility of fetal CMR in the evaluation of congenital pathologies.
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Affiliation(s)
- Fabian Kording
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Manuela Tavares de Sousa
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Christian Ruprecht
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Anthony H. Aletras
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - P. Ellen Grant
- Departments of Radiology and Medicine, Boston Children’s Hospital, and Harvard Medical School, Boston, MA USA
| | - Andrew J. Powell
- Department of Cardiology and Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Kai Fehrs
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | | | - Bjoern P. Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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15
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Kording F, Schoennagel BP, de Sousa MT, Fehrs K, Adam G, Yamamura J, Ruprecht C. Evaluation of a Portable Doppler Ultrasound Gating Device for Fetal Cardiac MR Imaging: Initial Results at 1.5T and 3T. Magn Reson Med Sci 2018; 17:308-317. [PMID: 29467359 PMCID: PMC6196307 DOI: 10.2463/mrms.mp.2017-0100] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: Fetal cardiac MRI has the potential to play an important role in the assessment of fetal cardiac pathologies, but it is up to now not feasible due to a missing gating method. The purpose of this work was the evaluation of Doppler ultrasound (DUS) for external fetal cardiac gating with regard to compatibility, functionality, and reliability. Preliminary results were assessed performing fetal cardiac MRI. Methods: An MRI conditional DUS device was developed to obtain a gating signal from the fetal heart. The MRI compatibility was evaluated at 1.5T and 3T using B1 field maps and gradient echo images. The quality and sensitivity of the DUS device to detect the fetal heart motion for cardiac gating were evaluated outside the MRI room in 15 fetuses. A dynamic fetal cardiac phantom was employed to evaluate distortions of the DUS device and gating signal due to electromagnetic interferences at 1.5T and 3T. In the first in vivo experience, dynamic fetal cardiac images were acquired in four-chamber view at 1.5T and 3T in two fetuses. Results: The maximum change in the B1 field and signal intensity with and without the DUS device was <6.5% for 1.5T and 3T. The sensitivity of the DUS device to detect the fetal heartbeat was 99.1%. Validation of the DUS device using the fetal cardiac phantom revealed no electromagnetic interferences at 1.5T or 3T and a high correlation to the simulated heart frequencies. Fetal cardiac cine images were successfully applied and showed good image quality. Conclusion: An MR conditional DUS gating device was developed and evaluated revealing safety, compatibility, and reliability for different field strengths. In a preliminary experience, the DUS device was successfully applied for in vivo fetal cardiac imaging at 1.5T and 3T.
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Affiliation(s)
- Fabian Kording
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf.,northh medical GmbH
| | - Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf
| | | | - Kai Fehrs
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf.,northh medical GmbH
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf
| | - Christian Ruprecht
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf.,northh medical GmbH
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16
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Duan AQ, Darby JRT, Soo JY, Lock MC, Zhu MY, Flynn LV, Perumal SR, Macgowan CK, Selvanayagam JB, Morrison JL, Seed M. Feasibility of phase-contrast cine magnetic resonance imaging for measuring blood flow in the sheep fetus. Am J Physiol Regul Integr Comp Physiol 2017; 317:R780-R792. [PMID: 29351431 DOI: 10.1152/ajpregu.00273.2017] [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] [Indexed: 12/24/2022]
Abstract
Phase-contrast cine MRI (PC-MRI) is the gold-standard noninvasive technique for measuring vessel blood flow and has previously been applied in the human fetal circulation. We aimed to assess the feasibility of using PC-MRI to define the distribution of the fetal circulation in sheep. Fetuses were catheterized at 119-120 days of gestation (term, 150 days) and underwent MRI at ∼123 days of gestation under isoflurane anesthesia, ventilated at a FIO2 of 1.0. PC-MRI was performed using a fetal arterial blood pressure catheter signal for cardiac triggering. Blood flows were measured in the major fetal vessels, including the main pulmonary artery, ascending and descending aorta, superior vena cava, ductus arteriosus, left and right pulmonary arteries, umbilical vein, ductus venosus, and common carotid artery and were indexed to estimated fetal weight. The combined ventricular output, pulmonary blood flow, and flow across the foramen ovale were calculated from vessel flows. Intraobserver and interobserver agreement and reproducibility was assessed. Blood flow measurements were successfully obtained in 61 out of 74 vessels (82.4%) interrogated in 9 fetuses. There was good intraobserver [R = 0.998, P < 0.0001; intraclass correlation (ICC) = 0.997] and interobserver agreement (R = 0.996, P < 0.0001; ICC = 0.996). Repeated MRI measurements showed good reproducibility (R = 0.989, P = 0.0002; ICC = 0.990). We conclude that PC-MRI using fetal catheters for gating triggers is feasible in the major vessels of late gestation fetal sheep. This approach may provide a useful new tool for assessing the circulatory characteristics of fetal sheep models of human disease, including fetal growth restriction and congenital heart disease.
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Affiliation(s)
- An Qi Duan
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jack R T Darby
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Jia Yin Soo
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Mitchell C Lock
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Meng Yuan Zhu
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lucy V Flynn
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Sunthara Rajan Perumal
- Preclinical, Imaging, and Research Laboratories, South Australian Health and Medical Research Institute, Gilles Plains, Adelaide, Australia
| | - Christopher K Macgowan
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Division of Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Janna L Morrison
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Mike Seed
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
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Kording F, Ruprecht C, Schoennagel B, Fehrs K, Yamamura J, Adam G, Goebel J, Nassenstein K, Maderwald S, Quick H, Kraff O. Doppler ultrasound triggering for cardiac MRI at 7T. Magn Reson Med 2017; 80:239-247. [DOI: 10.1002/mrm.27032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/09/2017] [Accepted: 11/13/2017] [Indexed: 01/31/2023]
Affiliation(s)
- F. Kording
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - C. Ruprecht
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - B. Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - K. Fehrs
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - J. Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - G. Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - J. Goebel
- Erwin L. Hahn Institute for Magnetic Resonance Imaging; University Duisburg-Essen; Essen Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology; University Hospital, University Duisburg-Essen; Essen Germany
| | - K. Nassenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology; University Hospital, University Duisburg-Essen; Essen Germany
| | - S. Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance Imaging; University Duisburg-Essen; Essen Germany
| | - H.H. Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging; University Duisburg-Essen; Essen Germany
- High Field and Hybrid MR Imaging; University Hospital, University Duisburg-Essen; Essen Germany
| | - O. Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging; University Duisburg-Essen; Essen Germany
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18
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Crowe LA, Manasseh G, Chmielewski A, Hachulla AL, Speicher D, Greiser A, Muller H, de Perrot T, Vallee JP, Salomir R. Spatially Resolved MR-Compatible Doppler Ultrasound: Proof of Concept for Triggering of Diagnostic Quality Cardiovascular MRI for Function and Flow Quantification at 3T. IEEE Trans Biomed Eng 2017; 65:294-306. [PMID: 29053451 DOI: 10.1109/tbme.2017.2764111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We demonstrate the use of a magnetic-resonance (MR)-compatible ultrasound (US) imaging probe using spatially resolved Doppler for diagnostic quality cardiovascular MR imaging (MRI) as an initial step toward hybrid US/MR fetal imaging. METHODS A newly developed technology for a dedicated MR-compatible phased array ultrasound-imaging probe acquired pulsed color Doppler carotid images, which were converted in near-real time to a trigger signal for cardiac cine and flow quantification MRI. Ultrasound and MR data acquired simultaneously were interference free. Conventional electrocardiogram (ECG) and the proposed spatially resolved Doppler triggering were compared in 10 healthy volunteers. A synthetic "false-triggered" image was retrospectively processed using metric optimized gating (MOG). Images were scored by expert readers, and sharpness, cardiac function and aortic flow were quantified. Four-dimensional (4-D) flow (two volunteers) showed feasibility of Doppler triggering over a long acquisition time. RESULTS Imaging modalities were compatible. US probe positioning was stable and comfortable. Image quality scores and quantified sharpness were statistically equal for Doppler- and ECG-triggering (p ). ECG-, Doppler-triggered, and MOG ejection fractions were equivalent (p ), with false-triggered values significantly lower (p < 0.0005). Aortic flow showed no difference between ECG- and Doppler-triggered and MOG (p > 0.05). 4-D flow quantification gave consistent results between ECG and Doppler triggering. CONCLUSION We report interference-free pulsed color Doppler ultrasound during MR data acquisition. Cardiovascular MRI of diagnostic quality was successfully obtained with pulsed color Doppler triggering. SIGNIFICANCE The hardware platform could further enable advanced free-breathing cardiac imaging. Doppler ultrasound triggering is applicable where ECG is compromised due to pathology or interference at higher magnetic fields, and where direct ECG is impossible, i.e., fetal imaging.
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19
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Duan AQ, Lock MC, Perumal SR, Darby JR, Soo JY, Selvanayagam JB, Macgowan CK, Seed M, Morrison JL. Feasibility of detecting myocardial infarction in the sheep fetus using late gadolinium enhancement CMR imaging. J Cardiovasc Magn Reson 2017; 19:69. [PMID: 28903760 PMCID: PMC5598048 DOI: 10.1186/s12968-017-0383-1] [Citation(s) in RCA: 21] [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: 11/14/2016] [Accepted: 08/29/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging has enabled the accurate assessment of myocardial infarction (MI). However, LGE CMR has not been performed successfully in the fetus, where it could be useful for animal studies of interventions to promote cardiac regeneration. We believe that LGE imaging could allow us to document the presence, extent and effect of MI in utero and would thereby expand our capacity for conducting fetal sheep MI research. We therefore aimed to investigate the feasibility of using LGE to detect MI in sheep fetuses. METHODS Six sheep fetuses underwent a thoracotomy and ligation of a left anterior descending (LAD) coronary artery branch; while two fetuses underwent a sham surgery. LGE CMR was performed in a subset of fetuses immediately after the surgery and three days later. Early gadolinium enhancement (EGE) CMR was also performed in a subset of fetuses on both days. Cine imaging of the heart was performed to measure ventricular function. RESULTS The imaging performed immediately after LAD ligation revealed no evidence of infarct on LGE (n=3). Two of four infarcted fetuses (50%) showed hypoenhancement at the infarct site on the EGE images. Three days after the ligation, LGE images revealed a clear, hyper-enhanced infarct zone in four of the five infarcted fetuses (80%). No hyper-enhanced infarct zone was seen on the one sham fetus that underwent LGE CMR. No hypoenhancement could be seen in the EGE images in either the sham (n=1) or the infarcted fetus (n=1). No regional wall motion abnormalities were apparent in two of the five infarcted fetuses. CONCLUSION LGE CMR detected the MI three days after LAD ligation, but not immediately after. Using available methods, EGE imaging was less useful for detecting deficits in perfusion. Our study provides evidence for the ability of a non-invasive tool to monitor the progression of cardiac repair and damage in fetuses with MI. However, further investigation into the optimal timing of LGE and EGE scans and improvement of the sequences should be pursued with the aim of expanding our capacity to monitor cardiac regeneration after MI in fetal sheep.
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Affiliation(s)
- An Qi Duan
- Institute of Medical Science, Faculty of Medicine, University of Toronto, 1 King’s College Circle, Room 2374, Toronto, ON M5S 1A8 Canada
| | - Mitchell C. Lock
- Early Origins of Adult Health Research Group, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, South Australia 5000 Australia
| | - Sunthara Rajan Perumal
- Preclinical, Imaging and Research Laboratories, South Australian Health and Medical Research Institute, 101 Blacks Road, Gilles Plains, Adelaide, South Australia 5086 Australia
| | - Jack R. Darby
- Early Origins of Adult Health Research Group, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, South Australia 5000 Australia
| | - Jia Yin Soo
- Early Origins of Adult Health Research Group, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, South Australia 5000 Australia
| | - Joseph B. Selvanayagam
- Cardiac Imaging Research Group, Department of Heart Health, South Australian Health & Medical Research Institute, and Flinders University, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - Christopher K. Macgowan
- Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Room 08.9714, 686 Bay Street, Toronto, ON M5G 0A4 Canada
| | - Mike Seed
- Division of Cardiology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Janna L. Morrison
- Early Origins of Adult Health Research Group, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, South Australia 5000 Australia
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20
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Oster J, Clifford GD. Acquisition of electrocardiogram signals during magnetic resonance imaging. Physiol Meas 2017; 38:R119-R142. [PMID: 28430109 DOI: 10.1088/1361-6579/aa6e8c] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The recording of the electrocardiogram (ECG) during magnetic resonance imaging (MRI) acquisition is of great interest and importance. Firstly, MRI acquisition is a relatively slow process, which therefore complicates the imaging of moving organs. Cardiac MRI requires the development of strategies for acquiring high quality images, which is mainly achieved by synchronising the image acquisition with a specific time during the cardiac cycle. The ECG is used to monitor the heart's activity, and the detection of the largest and steepest peak in the cardiac cycle (the QRS complex) triggers the acquisition of slices of the k-space. Secondly, patients undergoing an MRI examination need to be monitored for safety during the procedure, and therefore ECG signals are used to track their cardiovascular state in real time. However, there are significant barriers to the accurate observation and processing of the ECG during MRI acquisition. In particular, the flow of charged blood particles through the large applied magnetic field leads to an extra current source, known as the magnetohdrodymanic (MHD) effect. This review article discusses these barriers and state-of-the-art solutions. An overview of the relevant technology including hardware and applications are described. The development of new software tools for the processing of the ECG signals acquired during MRI is also detailed. These developments include the design of specific QRS detection algorithms, which are able to distinguish QRS complexes from the MHD effect but also the gradient artefacts. Different techniques for the suppression of the gradient artefacts are also presented as well as the most challenging problem to-date-the problem of separating the MHD effect from the ECG. The article concludes by summarising the advantages of using ECG signals during MRI, but also presents the current limitations of modern analysis techniques in this domain. The most promising avenues of research are also discussed and suggestions for new methodological analyses for the development of this field are given.
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Affiliation(s)
- Julien Oster
- IADI, U947, INSERM, Université de Lorraine, CHRU Nancy, Vandoeuvre-les-Nancy, France
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21
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Jezewski J, Wrobel J, Matonia A, Horoba K, Martinek R, Kupka T, Jezewski M. Is Abdominal Fetal Electrocardiography an Alternative to Doppler Ultrasound for FHR Variability Evaluation? Front Physiol 2017; 8:305. [PMID: 28559852 PMCID: PMC5432618 DOI: 10.3389/fphys.2017.00305] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/27/2017] [Indexed: 12/02/2022] Open
Abstract
Great expectations are connected with application of indirect fetal electrocardiography (FECG), especially for home telemonitoring of pregnancy. Evaluation of fetal heart rate (FHR) variability, when determined from FECG, uses the same criteria as for FHR signal acquired classically—through ultrasound Doppler method (US). Therefore, the equivalence of those two methods has to be confirmed, both in terms of recognizing classical FHR patterns: baseline, accelerations/decelerations (A/D), long-term variability (LTV), as well as evaluating the FHR variability with beat-to-beat accuracy—short-term variability (STV). The research material consisted of recordings collected from 60 patients in physiological and complicated pregnancy. The FHR signals of at least 30 min duration were acquired dually, using two systems for fetal and maternal monitoring, based on US and FECG methods. Recordings were retrospectively divided into normal (41) and abnormal (19) fetal outcome. The complex process of data synchronization and validation was performed. Obtained low level of the signal loss (4.5% for US and 1.8% for FECG method) enabled to perform both direct comparison of FHR signals, as well as indirect one—by using clinically relevant parameters. Direct comparison showed that there is no measurement bias between the acquisition methods, whereas the mean absolute difference, important for both visual and computer-aided signal analysis, was equal to 1.2 bpm. Such low differences do not affect the visual assessment of the FHR signal. However, in the indirect comparison the inconsistencies of several percent were noted. This mainly affects the acceleration (7.8%) and particularly deceleration (54%) patterns. In the signals acquired using the electrocardiography the obtained STV and LTV indices have shown significant overestimation by 10 and 50% respectively. It also turned out, that ability of clinical parameters to distinguish between normal and abnormal groups do not depend on the acquisition method. The obtained results prove that the abdominal FECG, considered as an alternative to the ultrasound approach, does not change the interpretation of the FHR signal, which was confirmed during both visual assessment and automated analysis.
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Affiliation(s)
- Janusz Jezewski
- Institute of Medical Technology and Equipment ITAMZabrze, Poland
| | - Janusz Wrobel
- Institute of Medical Technology and Equipment ITAMZabrze, Poland
| | - Adam Matonia
- Institute of Medical Technology and Equipment ITAMZabrze, Poland
| | - Krzysztof Horoba
- Institute of Medical Technology and Equipment ITAMZabrze, Poland
| | - Radek Martinek
- Department of Cybernetics and Biomedical Engineering, VSB-Technical University of OstravaOstrava, Czechia
| | - Tomasz Kupka
- Institute of Medical Technology and Equipment ITAMZabrze, Poland
| | - Michal Jezewski
- Institute of Electronics, Silesian University of TechnologyGliwice, Poland
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22
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Kraff O, Quick HH. 7T: Physics, safety, and potential clinical applications. J Magn Reson Imaging 2017; 46:1573-1589. [DOI: 10.1002/jmri.25723] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/17/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Oliver Kraff
- Erwin L. Hahn Institute for MR Imaging; University of Duisburg-Essen; Essen Germany
| | - Harald H. Quick
- Erwin L. Hahn Institute for MR Imaging; University of Duisburg-Essen; Essen Germany
- High Field and Hybrid MR Imaging; University Hospital Essen; Essen Germany
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23
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Roy CW, Seed M, Kingdom JC, Macgowan CK. Motion compensated cine CMR of the fetal heart using radial undersampling and compressed sensing. J Cardiovasc Magn Reson 2017; 19:29. [PMID: 28316282 PMCID: PMC5357808 DOI: 10.1186/s12968-017-0346-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 02/18/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To develop and evaluate a reconstruction framework for high resolution time-resolved CMR of the fetal heart in the presence of motion. METHODS Data were acquired using a golden angle radial trajectory in seven fetal subjects and reconstructed as real-time images to detect fetal movement. Data acquired during through-plane motion were discarded whereas in-plane motion was corrected. A fetal cardiac gating signal was extracted to sort the corrected data by cardiac phase, allowing reconstruction of cine images. The quality of motion corrected images and the effect of data undersampling were quantified using separate expressions for spatial blur and image error. RESULTS Motion corrected reordered cine reconstructions (127 slices) showed improved image quality relative to both uncorrected cines and corresponding real-time images across a range of root-mean-squared (RMS) displacements (0.3-3.7 mm) and fetal heart rates (119-176 bpm). The relative spatial blur between cines with and without motion correction increased with in-plane RMS displacement leading to an effective decrease in the effective spatial resolution for images without motion correction. Image error between undersampled and reference images was less than 10% for reconstructions using 750 or more spokes, yielding a minimum acceptable scan time of approximately 4 s/slice during quiescent through plane motion. CONCLUSIONS By rejecting data corrupted by through-plane motion, and correcting data corrupted by in-plane translation, the proposed reconstruction framework accounts for common sources of motion artifact (gross fetal movement, maternal respiration, fetal cardiac contraction) to produce high quality images of the fetal heart.
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Affiliation(s)
- Christopher W. Roy
- Department of Medical Biophysics, University of Toronto, Toronto, ON Canada
- Division of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, ON Canada
| | - Mike Seed
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, ON Canada
- Departments of Pediatrics and Diagnostic Imaging, University of Toronto, Toronto, ON Canada
| | - John C. Kingdom
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON Canada
| | - Christopher K. Macgowan
- Department of Medical Biophysics, University of Toronto, Toronto, ON Canada
- Division of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, ON Canada
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24
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Stäb D, Roessler J, O'Brien K, Hamilton-Craig C, Barth M. ECG Triggering in Ultra-High Field Cardiovascular MRI. ACTA ACUST UNITED AC 2016; 2:167-174. [PMID: 30042961 PMCID: PMC6024401 DOI: 10.18383/j.tom.2016.00193] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cardiac magnetic resonance imaging at ultra-high field (B0 ≥ 7 T) potentially provides improved resolution and new opportunities for tissue characterization. Although an accurate synchronization of the acquisition to the cardiac cycle is essential, electrocardiogram (ECG) triggering at ultra-high field can be significantly impacted by the magnetohydrodynamic (MHD) effect. Blood flow within a static magnetic field induces a voltage, which superimposes the ECG and often affects the recognition of the R-wave. The MHD effect scales with B0 and is particularly pronounced at ultra-high field creating triggering-related image artifacts. Here, we investigated the performance of a conventional 3-lead ECG trigger device and a state-of-the-art trigger algorithm for cardiac ECG synchronization at 7 T. We show that by appropriate subject preparation and by including a learning phase for the R-wave detection outside of the magnetic field, reliable ECG triggering is feasible in healthy subjects at 7 T without additional equipment. Ultra-high field cardiac imaging was performed with the ECG signal and the trigger events recorded in 8 healthy subjects. Despite severe ECG signal distortions, synchronized imaging was successfully performed. Recorded ECG signals, vectorcardiograms, and large consistency in trigger event spacing indicate high accuracy for R-wave detection.
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Affiliation(s)
- Daniel Stäb
- The Centre for Advanced Imaging, The University of Queensland, Brisbane, Queensland, Australia.,Department of Diagnostic and Interventional Radiology, University of Würzburg, Würzburg, Germany
| | | | | | - Christian Hamilton-Craig
- Richard Slaughter Centre of Excellence in CVMRI, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Markus Barth
- The Centre for Advanced Imaging, The University of Queensland, Brisbane, Queensland, Australia
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25
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Rutz T, Piccini D, Coppo S, Chaptinel J, Ginami G, Vincenti G, Stuber M, Schwitter J. Improved border sharpness of post-infarct scar by a novel self-navigated free-breathing high-resolution 3D whole-heart inversion recovery magnetic resonance approach. Int J Cardiovasc Imaging 2016; 32:1735-1744. [DOI: 10.1007/s10554-016-0963-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/13/2016] [Indexed: 10/21/2022]
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26
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Kording F, Yamamura J, Lund G, Ueberle F, Jung C, Adam G, Schoennagel BP. Doppler Ultrasound Triggering for Cardiovascular MRI at 3T in a Healthy Volunteer Study. Magn Reson Med Sci 2016; 16:98-108. [PMID: 27001390 PMCID: PMC5600068 DOI: 10.2463/mrms.mp.2015-0104] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: Electrocardiogram (ECG) triggering for cardiac magnetic resonance (CMR) may be influenced by electromagnetic interferences with increasing magnetic field strength. The aim of this study was to evaluate the performance of Doppler ultrasound (DUS) as an alternative trigger technique for CMR in comparison to ECG and pulse oximetry (POX) at 3T and using different sequence types. Methods: Balanced turbo field echo two-dimensional (2D) short axis cine CMR and 2D phase-contrast angiography of the ascending aorta was performed in 11 healthy volunteers at 3T using ECG, DUS, and POX for cardiac triggering. DUS and POX triggering were compared to the reference standard of ECG in terms of trigger quality (trigger detection and temporal variability), image quality [endocardial blurring (EB)], and functional measurements [left ventricular (LV) volumetry and aortic blood flow velocimetry]. Results: Trigger signal detection and temporal variability did not differ significantly between ECG/DUS (I = 0.6) and ECG/POX (P = 0.4). Averaged EB was similar for ECG, DUS, and POX (pECG/DUS = 0.4, pECG/POX = 0.9). Diastolic EB was significantly decreased for DUS in comparison to ECG (P = 0.02) and POX (P = 0.04). The LV function assessment and aortic blood flow were not significantly different. Conclusion: This study demonstrated the feasibility of DUS for gating human CMR at 3T. The magnetohydrodynamic effect did not significantly disturb ECG triggering in this small healthy volunteer study. DUS showed a significant improvement in diastolic EB but could not be identified as a superior trigger method. The potential benefit of DUS has to be evaluated in a larger clinical patient population.
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Affiliation(s)
- Fabian Kording
- University Medical Center Hamburg-Eppendorf, Center for Radiology and Endoscopy, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf
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27
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Vardoulis O, Monney P, Bermano A, Vaxman A, Gotsman C, Schwitter J, Stuber M, Stergiopulos N, Schwitter J. Single breath-hold 3D measurement of left atrial volume using compressed sensing cardiovascular magnetic resonance and a non-model-based reconstruction approach. J Cardiovasc Magn Reson 2015; 17:47. [PMID: 26062814 PMCID: PMC4464709 DOI: 10.1186/s12968-015-0147-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 05/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left atrial (LA) dilatation is associated with a large variety of cardiac diseases. Current cardiovascular magnetic resonance (CMR) strategies to measure LA volumes are based on multi-breath-hold multi-slice acquisitions, which are time-consuming and susceptible to misregistration. AIM To develop a time-efficient single breath-hold 3D CMR acquisition and reconstruction method to precisely measure LA volumes and function. METHODS A highly accelerated compressed-sensing multi-slice cine sequence (CS-cineCMR) was combined with a non-model-based 3D reconstruction method to measure LA volumes with high temporal and spatial resolution during a single breath-hold. This approach was validated in LA phantoms of different shapes and applied in 3 patients. In addition, the influence of slice orientations on accuracy was evaluated in the LA phantoms for the new approach in comparison with a conventional model-based biplane area-length reconstruction. As a reference in patients, a self-navigated high-resolution whole-heart 3D dataset (3D-HR-CMR) was acquired during mid-diastole to yield accurate LA volumes. RESULTS Phantom studies. LA volumes were accurately measured by CS-cineCMR with a mean difference of -4.73 ± 1.75 ml (-8.67 ± 3.54%, r2 = 0.94). For the new method the calculated volumes were not significantly different when different orientations of the CS-cineCMR slices were applied to cover the LA phantoms. Long-axis "aligned" vs "not aligned" with the phantom long-axis yielded similar differences vs the reference volume (-4.87 ± 1.73 ml vs. -4.45 ± 1.97 ml, p = 0.67) and short-axis "perpendicular" vs. "not-perpendicular" with the LA long-axis (-4.72 ± 1.66 ml vs. -4.75 ± 2.13 ml; p = 0.98). The conventional bi-plane area-length method was susceptible for slice orientations (p = 0.0085 for the interaction of "slice orientation" and "reconstruction technique", 2-way ANOVA for repeated measures). To use the 3D-HR-CMR as the reference for LA volumes in patients, it was validated in the LA phantoms (mean difference: -1.37 ± 1.35 ml, -2.38 ± 2.44%, r2 = 0.97). Patient study: The CS-cineCMR LA volumes of the mid-diastolic frame matched closely with the reference LA volume (measured by 3D-HR-CMR) with a difference of -2.66 ± 6.5 ml (3.0% underestimation; true LA volumes: 63 ml, 62 ml, and 395 ml). Finally, a high intra- and inter-observer agreement for maximal and minimal LA volume measurement is also shown. CONCLUSIONS The proposed method combines a highly accelerated single-breathhold compressed-sensing multi-slice CMR technique with a non-model-based 3D reconstruction to accurately and reproducibly measure LA volumes and function.
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Affiliation(s)
- Orestis Vardoulis
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Swiss Federal Institute of Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | - Pierre Monney
- Division of Cardiology and Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
| | - Amit Bermano
- Computer Graphics lab, ETH Zurich & Disney Research Zurich, Zurich, Switzerland.
| | - Amir Vaxman
- Geometric Modeling and Industrial Geometry group, Vienna University of Technology, Vienna, Austria.
| | - Craig Gotsman
- Jacobs Technion-Cornell Institute at Cornell Tech, New York, USA.
| | - Janine Schwitter
- University of Fribourg, Biomedical Sciences, Fribourg, Switzerland.
| | - Matthias Stuber
- Department of Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland.
- Center for Biomedical Imaging, Lausanne, Switzerland.
| | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Swiss Federal Institute of Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | - Juerg Schwitter
- Division of Cardiology and Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
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