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Lacharie M, Villa A, Milidonis X, Hasaneen H, Chiribiri A, Benedetti G. Role of pulmonary perfusion magnetic resonance imaging for the diagnosis of pulmonary hypertension: A review. World J Radiol 2023; 15:256-273. [PMID: 37823020 PMCID: PMC10563854 DOI: 10.4329/wjr.v15.i9.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/16/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023] Open
Abstract
Among five types of pulmonary hypertension, chronic thromboembolic pulmonary hypertension (CTEPH) is the only curable form, but prompt and accurate diagnosis can be challenging. Computed tomography and nuclear medicine-based techniques are standard imaging modalities to non-invasively diagnose CTEPH, however these are limited by radiation exposure, subjective qualitative bias, and lack of cardiac functional assessment. This review aims to assess the methodology, diagnostic accuracy of pulmonary perfusion imaging in the current literature and discuss its advantages, limitations and future research scope.
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Affiliation(s)
- Miriam Lacharie
- Oxford Centre of Magnetic Resonance Imaging, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Adriana Villa
- Department of Diagnostic and Interventional Radiology, German Oncology Centre, Limassol 4108, Cyprus
| | - Xenios Milidonis
- Deep Camera MRG, CYENS Centre of Excellence, Nicosia, Cyprus, Nicosia 1016, Cyprus
| | - Hadeer Hasaneen
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, Kings Coll London, Div Imaging Sci, St Thomas Hospital, London WC2R 2LS, United Kingdom
| | - Giulia Benedetti
- Department of Cardiovascular Imaging and Biomedical Engineering, King’s College London, London WC2R 2LS, United Kingdom
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2
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Scannell CM, Alskaf E, Sharrack N, Razavi R, Ourselin S, Young AA, Plein S, Chiribiri A. AI-AIF: artificial intelligence-based arterial input function for quantitative stress perfusion cardiac magnetic resonance. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:12-21. [PMID: 36743875 PMCID: PMC9890084 DOI: 10.1093/ehjdh/ztac074] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/23/2022] [Indexed: 12/12/2022]
Abstract
Aims One of the major challenges in the quantification of myocardial blood flow (MBF) from stress perfusion cardiac magnetic resonance (CMR) is the estimation of the arterial input function (AIF). This is due to the non-linear relationship between the concentration of gadolinium and the MR signal, which leads to signal saturation. In this work, we show that a deep learning model can be trained to predict the unsaturated AIF from standard images, using the reference dual-sequence acquisition AIFs (DS-AIFs) for training. Methods and results A 1D U-Net was trained, to take the saturated AIF from the standard images as input and predict the unsaturated AIF, using the data from 201 patients from centre 1 and a test set comprised of both an independent cohort of consecutive patients from centre 1 and an external cohort of patients from centre 2 (n = 44). Fully-automated MBF was compared between the DS-AIF and AI-AIF methods using the Mann-Whitney U test and Bland-Altman analysis. There was no statistical difference between the MBF quantified with the DS-AIF [2.77 mL/min/g (1.08)] and predicted with the AI-AIF (2.79 mL/min/g (1.08), P = 0.33. Bland-Altman analysis shows minimal bias between the DS-AIF and AI-AIF methods for quantitative MBF (bias of -0.11 mL/min/g). Additionally, the MBF diagnosis classification of the AI-AIF matched the DS-AIF in 669/704 (95%) of myocardial segments. Conclusion Quantification of stress perfusion CMR is feasible with a single-sequence acquisition and a single contrast injection using an AI-based correction of the AIF.
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Affiliation(s)
- Cian M Scannell
- School of Biomedical Engineering & Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK.,Department of Biomedical Engineering, Eindhoven University of Technology, Gemini-Zuid, Groene Loper 5, 5612 Eindhoven, The Netherlands
| | - Ebraham Alskaf
- School of Biomedical Engineering & Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Noor Sharrack
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Reza Razavi
- School of Biomedical Engineering & Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Alistair A Young
- School of Biomedical Engineering & Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Sven Plein
- School of Biomedical Engineering & Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK.,Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
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3
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Kräuter C, Reiter U, Reiter C, Nizhnikava V, Schmidt A, Stollberger R, Fuchsjäger M, Reiter G. Impact of the Choice of Native T 1 in Pixelwise Myocardial Blood Flow Quantification. J Magn Reson Imaging 2021; 53:755-765. [PMID: 33034120 PMCID: PMC7891429 DOI: 10.1002/jmri.27375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Quantification of myocardial blood flow (MBF) from dynamic contrast-enhanced (DCE) MRI can be performed using a signal intensity model that incorporates T1 values of blood and myocardium. PURPOSE To assess the impact of T1 values on pixelwise MBF quantification, specifically to evaluate the influence of 1) study population-averaged vs. subject-specific, 2) diastolic vs. systolic, and 3) regional vs. global myocardial T1 values. STUDY TYPE Prospective. SUBJECTS Fifteen patients with chronic coronary heart disease. FIELD STRENGTH/SEQUENCE 3T; modified Look-Locker inversion recovery for T1 mapping and saturation recovery gradient echo for DCE imaging, both acquired in a mid-ventricular short-axis slice in systole and diastole. ASSESSMENT MBF was estimated using Fermi modeling and signal intensity nonlinearity correction with different T1 values: study population-averaged blood and myocardial, subject-specific systolic and diastolic, and segmental T1 values. Myocardial segments with perfusion deficits were identified visually from DCE series. STATISTICAL TESTS The relationships between MBF parameters derived by different methods were analyzed by Bland-Altman analysis; corresponding mean values were compared by t-test. RESULTS Using subject-specific diastolic T1 values, global diastolic MBF was 0.61 ± 0.13 mL/(min·g). It did not differ from global MBF derived from the study population-averaged T1 (P = 0.88), but the standard deviation of differences was large (0.07 mL/(min·g), 11% of mean MBF). Global diastolic and systolic MBF did not differ (P = 0.12), whereas global diastolic MBF using systolic (0.62 ± 0.13 mL/(min·g)) and diastolic T1 values differed (P < 0.05). If regional instead of global T1 values were used, segmental MBF was lower in segments with perfusion deficits (bias = -0.03 mL/(min·g), -7% of mean MBF, P < 0.05) but higher in segments without perfusion deficits (bias = 0.01 mL/(min·g), 1% of mean MBF, P < 0.05). DATA CONCLUSION Whereas cardiac phase-specific T1 values have a minor impact on MBF estimates, subject-specific and myocardial segment-specific T1 values substantially affect MBF quantification. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Corina Kräuter
- Division of General Radiology, Department of RadiologyMedical University of GrazGrazAustria
- Institute of Medical EngineeringGraz University of TechnologyGrazAustria
| | - Ursula Reiter
- Division of General Radiology, Department of RadiologyMedical University of GrazGrazAustria
| | - Clemens Reiter
- Division of General Radiology, Department of RadiologyMedical University of GrazGrazAustria
| | - Volha Nizhnikava
- Division of General Radiology, Department of RadiologyMedical University of GrazGrazAustria
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Rudolf Stollberger
- Institute of Medical EngineeringGraz University of TechnologyGrazAustria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of RadiologyMedical University of GrazGrazAustria
| | - Gert Reiter
- Division of General Radiology, Department of RadiologyMedical University of GrazGrazAustria
- Research and DevelopmentSiemens Healthcare Diagnostics GmbHGrazAustria
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4
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Gulsin GS, Henson J, Brady EM, Sargeant JA, Wilmot EG, Athithan L, Htike ZZ, Marsh AM, Biglands JD, Kellman P, Khunti K, Webb D, Davies MJ, Yates T, McCann GP. Cardiovascular Determinants of Aerobic Exercise Capacity in Adults With Type 2 Diabetes. Diabetes Care 2020; 43:2248-2256. [PMID: 32680830 PMCID: PMC7440912 DOI: 10.2337/dc20-0706] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/09/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the relationship between subclinical cardiac dysfunction and aerobic exercise capacity (peak VO2) in adults with type 2 diabetes (T2D), a group at high risk of developing heart failure. RESEARCH DESIGN AND METHODS Cross-sectional study. We prospectively enrolled a multiethnic cohort of asymptomatic adults with T2D and no history, signs, or symptoms of cardiovascular disease. Age-, sex-, and ethnicity-matched control subjects were recruited for comparison. Participants underwent bioanthropometric profiling, cardiopulmonary exercise testing, and cardiovascular magnetic resonance with adenosine stress perfusion imaging. Multivariable linear regression analysis was undertaken to identify independent associations between measures of cardiovascular structure and function and peak VO2. RESULTS A total of 247 adults with T2D (aged 51.8 ± 11.9 years, 55% males, 37% black or south Asian ethnicity, HbA1c 7.4 ± 1.1% [57 ± 12 mmol/mol], and duration of diabetes 61 [32-120] months) and 78 control subjects were included. Subjects with T2D had increased concentric left ventricular remodeling, reduced myocardial perfusion reserve (MPR), and markedly lower aerobic exercise capacity (peak VO2 18.0 ± 6.6 vs. 27.8 ± 9.0 mL/kg/min; P < 0.001) compared with control subjects. In a multivariable linear regression model containing age, sex, ethnicity, smoking status, and systolic blood pressure, only MPR (β = 0.822; P = 0.006) and left ventricular diastolic filling pressure (E/e') (β = -0.388; P = 0.001) were independently associated with peak VO2 in subjects with T2D. CONCLUSIONS In a multiethnic cohort of asymptomatic people with T2D, MPR and diastolic function are key determinants of aerobic exercise capacity, independent of age, sex, ethnicity, smoking status, or blood pressure.
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Affiliation(s)
- Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K.
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Jack A Sargeant
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Emma G Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, U.K
| | - Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Zin Z Htike
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, U.K
| | - Anna-Marie Marsh
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | | | - Peter Kellman
- National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - David Webb
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K.
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5
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Scannell CM, Chiribiri A, Villa ADM, Breeuwer M, Lee J. Hierarchical Bayesian myocardial perfusion quantification. Med Image Anal 2020; 60:101611. [PMID: 31760191 PMCID: PMC6880627 DOI: 10.1016/j.media.2019.101611] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 01/25/2023]
Abstract
Myocardial blood flow can be quantified from dynamic contrast-enhanced magnetic resonance (MR) images through the fitting of tracer-kinetic models to the observed imaging data. The use of multi-compartment exchange models is desirable as they are physiologically motivated and resolve directly for both blood flow and microvascular function. However, the parameter estimates obtained with such models can be unreliable. This is due to the complexity of the models relative to the observed data which is limited by the low signal-to-noise ratio, the temporal resolution, the length of the acquisitions and other complex imaging artefacts. In this work, a Bayesian inference scheme is proposed which allows the reliable estimation of the parameters of the two-compartment exchange model from myocardial perfusion MR data. The Bayesian scheme allows the incorporation of prior knowledge on the physiological ranges of the model parameters and facilitates the use of the additional information that neighbouring voxels are likely to have similar kinetic parameter values. Hierarchical priors are used to avoid making a priori assumptions on the health of the patients. We provide both a theoretical introduction to Bayesian inference for tracer-kinetic modelling and specific implementation details for this application. This approach is validated in both in silico and in vivo settings. In silico, there was a significant reduction in mean-squared error with the ground-truth parameters using Bayesian inference as compared to using the standard non-linear least squares fitting. When applied to patient data the Bayesian inference scheme returns parameter values that are in-line with those previously reported in the literature, as well as giving parameter maps that match the independant clinical diagnosis of those patients.
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Affiliation(s)
- Cian M Scannell
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom; The Alan Turing Institute London, United Kingdom.
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom.
| | - Adriana D M Villa
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom.
| | - Marcel Breeuwer
- Philips Healthcare, Best, the Netherlands; Department of Biomedical Engineering, Medical Image Analysis group, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Jack Lee
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom.
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6
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Riazy L, Schaeffter T, Olbrich M, Schueler J, von Knobelsdorff-Brenkenhoff F, Niendorf T, Schulz-Menger J. Porous medium 3D flow simulation of contrast media washout in cardiac MRI reflects myocardial injury. Magn Reson Med 2019; 82:775-785. [PMID: 30989720 DOI: 10.1002/mrm.27756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/07/2019] [Accepted: 03/08/2019] [Indexed: 11/06/2022]
Abstract
PURPOSE Myocardial blood-flow simulation based on laws of fluid mechanics is a valuable tool for understanding tissue behavior. Our aim is to evaluate the ability of a porous-media flow model approach to reflect disturbed washout of contrast media (CM) from the myocardium as observed by cardiovascular MR. METHODS A coupled advection-diffusion model is used to describe the CM flow in the vascular and extravascular space as separate compartments. Their exchange of CM is controlled by the exchange rate ExR , which in turn determines the washout behavior. We fitted simulations to CM concentration measurements, derived from T1 maps of the midventricular slice. The CM concentration was extracted from 18 patients with myocarditis in the acute phase and during follow-up after 6 months. The results were compared with 18 sex- and age-matched controls. For each subject, the measurements were acquired before and during the first 10 minutes at 5 time points after CM administration, representing CM washout. Image registration was applied to compensate for motion between different time points. RESULTS Eight matched data sets had to be excluded due to low registration quality. Processing was successful in n = 10 matched data sets of acute and healed myocarditis as well as controls. Significant differences in ExR were observed when comparing patients with acute myocarditis to controls (P < .001), to their follow-up (P < .05), and the follow-up to controls (P < .05). CONCLUSION Our study suggests the feasibility of using the proposed porous-medium flow framework for the simulation of pathologic myocardial tissue.
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Affiliation(s)
- Leili Riazy
- Berlin Ultrahigh Field Facility, Max-Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,DZHK, German Center for Cardiovascular Research, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, ECRC, Cardiology, Berlin, Germany
| | - Tobias Schaeffter
- Medical Physics and Metrological Information Technology, Physikalisch-Technische Bundesanstalt, Berlin, Germany
| | - Marc Olbrich
- Medical Physics and Metrological Information Technology, Physikalisch-Technische Bundesanstalt, Berlin, Germany.,Technical University Berlin, Berlin, Germany
| | - Johannes Schueler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, ECRC, Cardiology, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Florian von Knobelsdorff-Brenkenhoff
- DZHK, German Center for Cardiovascular Research, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, ECRC, Cardiology, Berlin, Germany.,Clinic Agatharied, Department of Cardiology, University of Munich, Hausham, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility, Max-Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,DZHK, German Center for Cardiovascular Research, Berlin, Germany
| | - Jeanette Schulz-Menger
- DZHK, German Center for Cardiovascular Research, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, ECRC, Cardiology, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Klinikum Berlin Buch, Berlin, Germany
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7
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Kunze KP, Nekolla SG, Rischpler C, Zhang SH, Hayes C, Langwieser N, Ibrahim T, Laugwitz KL, Schwaiger M. Myocardial perfusion quantification using simultaneously acquired 13 NH 3 -ammonia PET and dynamic contrast-enhanced MRI in patients at rest and stress. Magn Reson Med 2018; 80:2641-2654. [PMID: 29672922 DOI: 10.1002/mrm.27213] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/11/2018] [Accepted: 03/19/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Systematic differences with respect to myocardial perfusion quantification exist between DCE-MRI and PET. Using the potential of integrated PET/MRI, this study was conceived to compare perfusion quantification on the basis of simultaneously acquired 13 NH3 -ammonia PET and DCE-MRI data in patients at rest and stress. METHODS Twenty-nine patients were examined on a 3T PET/MRI scanner. DCE-MRI was implemented in dual-sequence design and additional T1 mapping for signal normalization. Four different deconvolution methods including a modified version of the Fermi technique were compared against 13 NH3 -ammonia results. RESULTS Cohort-average flow comparison yielded higher resting flows for DCE-MRI than for PET and, therefore, significantly lower DCE-MRI perfusion ratios under the common assumption of equal arterial and tissue hematocrit. Absolute flow values were strongly correlated in both slice-average (R2 = 0.82) and regional (R2 = 0.7) evaluations. Different DCE-MRI deconvolution methods yielded similar flow result with exception of an unconstrained Fermi method exhibiting outliers at high flows when compared with PET. CONCLUSION Thresholds for Ischemia classification may not be directly tradable between PET and MRI flow values. Differences in perfusion ratios between PET and DCE-MRI may be lifted by using stress/rest-specific hematocrit conversion. Proper physiological constraints are advised in model-constrained deconvolution.
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Affiliation(s)
- Karl P Kunze
- Klinikum rechts der Isar der TU München, Department of Nuclear Medicine, Munich, Germany
| | - Stephan G Nekolla
- Klinikum rechts der Isar der TU München, Department of Nuclear Medicine, Munich, Germany.,DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.) partner site Munich Heart Alliance, Munich, Germany
| | - Christoph Rischpler
- Klinikum rechts der Isar der TU München, Department of Nuclear Medicine, Munich, Germany.,DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.) partner site Munich Heart Alliance, Munich, Germany
| | | | | | - Nicolas Langwieser
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.) partner site Munich Heart Alliance, Munich, Germany.,Klinikum rechts der Isar der TU München, Department of Cardiology, Munich, Germany
| | - Tareq Ibrahim
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.) partner site Munich Heart Alliance, Munich, Germany.,Klinikum rechts der Isar der TU München, Department of Cardiology, Munich, Germany
| | - Karl-Ludwig Laugwitz
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.) partner site Munich Heart Alliance, Munich, Germany.,Klinikum rechts der Isar der TU München, Department of Cardiology, Munich, Germany
| | - Markus Schwaiger
- Klinikum rechts der Isar der TU München, Department of Nuclear Medicine, Munich, Germany.,DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.) partner site Munich Heart Alliance, Munich, Germany
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8
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Foley JRJ, Kidambi A, Biglands JD, Maredia N, Dickinson CJ, Plein S, Greenwood JP. A comparison of cardiovascular magnetic resonance and single photon emission computed tomography (SPECT) perfusion imaging in left main stem or equivalent coronary artery disease: a CE-MARC substudy. J Cardiovasc Magn Reson 2017; 19:84. [PMID: 29110669 PMCID: PMC5674685 DOI: 10.1186/s12968-017-0398-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/16/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Assessment of left main stem (LMS) stenosis has prognostic and therapeutic implications. Data on assessment of LMS disease by cardiovascular magnetic resonance (CMR) and single photon emission computed tomography (SPECT) are limited. CE-MARC is the largest prospective comparison of CMR and SPECT against quantitative invasive coronary angiography (QCA) for detection of coronary artery disease (CAD), and provided the framework for this evaluation. The aims of this study were to compare diagnostic accuracy of visual and quantitative perfusion CMR to SPECT in patients with LMS stable CAD. METHODS Fifty-four patients from the CE-MARC study were included: 27 (4%) with significant LMS or LMS-equivalent disease on QCA, and 27 age/sex-matched patients with no flow-limiting CAD. All patients underwent multi-parametric CMR, SPECT and QCA. Performance of visual and quantitative perfusion CMR by Fermi-constrained deconvolution to detect LMS disease was compared with SPECT. RESULTS Of 27 patients in the LMS group, 22 (81%) had abnormal CMR and 16 (59%) had abnormal SPECT. All patients with abnormal CMR had abnormal perfusion by visual analysis. CMR demonstrated significantly higher area under the curve (AUC) for detection of disease (0.95; 0.85-0.99) over SPECT (0.63; 0.49-0.76) (p = 0.0001). Global mean stress myocardial blood flow (MBF) by CMR in LMS patients was significantly lower than controls (1.77 ± 0.72 ml/g/min vs. 3.28 ± 1.20 ml/g/min, p < 0.001). MBF of <2.08 ml/g/min had sensitivity of 78% and specificity of 85% for diagnosis of LMS disease, with an AUC (0.87; 0.75-0.94) not significantly different to visual CMR analysis (p = 0.18), and more accurate than SPECT (p = 0.003). CONCLUSION Visual stress perfusion CMR had higher diagnostic accuracy than SPECT to detect LMS disease. Quantitative perfusion CMR had similar performance to visual CMR perfusion analysis.
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Affiliation(s)
- James R. J. Foley
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - John D. Biglands
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Neil Maredia
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
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9
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Likhite D, Suksaranjit P, Adluru G, Wilson B, DiBella E. Estimating extraction fraction and blood flow by combining first-pass myocardial perfusion and T1 mapping results. Quant Imaging Med Surg 2017; 7:480-495. [PMID: 29184761 DOI: 10.21037/qims.2017.08.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Quantifying myocardial perfusion is complicated by the complexity of pharmacokinetic model being used and the reliability of perfusion parameter estimates. More complex modeling provides more information about the underlying physiology, but too many parameters in complex models introduce a new problem of reliable estimation. To overcome the problem of multiple parameters, we have developed a technique that combines knowledge from two different cardiac magnetic resonance (MR) imaging techniques: dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and T1 mapping. Using extracellular volume (ECV) estimates from T1 mapping may allow more robust model parameter estimates. Methods Simulations and human scans were performed. The myocardial perfusion scans used an ungated saturation recovery prepared TurboFLASH pulse sequence. Four short-axis (SA) slices were acquired after a single saturation pulse with a saturation recovery time of ~25 ms before the first slice. Gadoteridol was injected and ~240 frames were acquired over a minute with shallow breathing and no electrocardiograph (ECG) gating. This was followed 20±5 minutes later by an injection of regadenoson to induce hyperemia. The data were acquired using an under-sampled golden angle radial acquisition. Modified look-locker inversion recovery (MOLLI) T1 mapping was performed in 3 slices pre- and post-contrast. The pre- and post-contrast T1 maps were used for ECV estimation. Quantification of perfusion was done using a 4-parameter model with additional information about ECV supplied during model fitting. Phase contrast scans of the coronary sinus (CS) were acquired at rest and immediately after the stress perfusion acquisition to estimate global flow. Results Without ECV information, the 5-parameter model fails to converge to a unique solution and often gives incorrect estimates for the perfusion parameters. The myocardial blood flow (MBF) estimates during rest and stress were 0.9±0.1 and 2.3±0.6 mL/min/g, respectively. The extraction fraction estimates were 0.49±0.04 and 0.34±0.05 during rest and stress, respectively. Conclusions These results show that it is possible to successfully fit a dynamic perfusion model with an extraction fraction parameter by using information from T1 mapping scans. This hybrid approach is especially important when the 5-parameter model alone fails to converge on a unique solution. This work is a good example of exploiting information overlaps between various cardiac MR imaging techniques.
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Affiliation(s)
- Devavrat Likhite
- Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, USA
| | | | - Ganesh Adluru
- Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, USA
| | - Brent Wilson
- Division of Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Edward DiBella
- Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, USA.,Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
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Wissmann L, Gotschy A, Santelli C, Tezcan KC, Hamada S, Manka R, Kozerke S. Analysis of spatiotemporal fidelity in quantitative 3D first-pass perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:11. [PMID: 28125995 PMCID: PMC5270366 DOI: 10.1186/s12968-017-0324-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whole-heart first-pass perfusion cardiovascular magnetic resonance (CMR) relies on highly accelerated image acquisition. The influence of undersampling on myocardial blood flow (MBF) quantification has not been systematically investigated yet. In the present work, the effect of spatiotemporal scan acceleration on image reconstruction accuracy and MBF error was studied using a numerical phantom and validated in-vivo. METHODS Up to 10-fold scan acceleration using k-t PCA and k-t SPARSE-SENSE was simulated using the MRXCAT CMR numerical phantom framework. Image reconstruction results were compared to ground truth data in the k-f domain by means of modulation transfer function (MTF) analysis. In the x-t domain, errors pertaining to specific features of signal intensity-time curves and MBF values derived using Fermi model deconvolution were analysed. In-vivo first-pass CMR data were acquired in ten healthy volunteers using a dual-sequence approach assessing the arterial input function (AIF) and myocardial enhancement. 10x accelerated 3D k-t PCA and k-t SPARSE-SENSE were compared and related to non-accelerated 2D reference images. RESULTS MTF analysis revealed good recovery of data upon k-t PCA reconstruction at 10x undersampling with some attenuation of higher temporal frequencies. For 10x k-t SPARSE-SENSE the MTF was found to decrease to zero at high spatial frequencies for all temporal frequencies indicating a loss in spatial resolution. Signal intensity-time curve errors were most prominent in AIFs from 10x k-t PCA, thereby emphasizing the need for separate AIF acquisition using a dual-sequence approach. These findings were confirmed by MBF estimation based on AIFs from fully sampled and undersampled simulations. Average in-vivo MBF estimates were in good agreement between both accelerated and the fully sampled methods. Intra-volunteer MBF variation for fully sampled 2D scans was lower compared to 10x k-t PCA and k-t SPARSE-SENSE data. CONCLUSION Quantification of highly undersampled 3D first-pass perfusion CMR yields accurate MBF estimates provided the AIF is obtained using fully sampled or moderately undersampled scans as part of a dual-sequence approach. However, relative to fully sampled 2D perfusion imaging, intra-volunteer variation is increased using 3D approaches prompting for further developments.
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Affiliation(s)
- Lukas Wissmann
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Alexander Gotschy
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Claudio Santelli
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Kerem Can Tezcan
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Sandra Hamada
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Department of Cardiology, RWTH Aachen University, Aachen, Germany
| | - Robert Manka
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
- Division of Imaging Sciences, King’s College London, London, UK
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11
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Likhite D, Suksaranjit P, Adluru G, Hu N, Weng C, Kholmovski E, McGann C, Wilson B, DiBella E. Interstudy repeatability of self-gated quantitative myocardial perfusion MRI. J Magn Reson Imaging 2015; 43:1369-78. [PMID: 26663511 DOI: 10.1002/jmri.25107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/14/2015] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To evaluate the interstudy repeatability of multislice quantitative cardiovascular magnetic resonance myocardial blood flow (MBF), myocardial perfusion reserve (MPR), and extracellular volume (ECV). A unique saturation recovery self-gated acquisition was used for the perfusion scans. MATERIALS AND METHODS An ungated golden angle radial turboFLASH pulse sequence was used to scan 10 subjects on two separate days on a 3T scanner. A single saturation pulse was followed by a set of four slices. Rest and hyperemia scans were acquired during free breathing. The images were reconstructed using an iterative algorithm with spatiotemporal constraints. The ungated images were retrospectively binned (self-gated) into near-systole and near-diastole. Deformable registration was performed to adjust for respiratory and residual cardiac motion, and the data were fit with a Fermi model to estimate the interstudy repeatability of quantitative self-gated MBF and MPR. RESULTS The coefficient of variation (CoV) of the territorial MPR using the self-gated near-systole data was 18.6%. The self-gated near-diastole data gave less good CoV of MPR, equal to 46.2%. For MBFs, and using smaller (segmental) regions, the CoVs were 20.1% and 22.7% for the estimation of myocardial blood flow at stress and rest, respectively, using the self-gated near-systole data. The self-gated near-diastole data gave CoV = 48.6% and 44.9% for stress and rest. CONCLUSION The self-gated free-breathing technique for quantification of myocardial blood flow showed good repeatability for near-systole, with results comparable to published studies on interstudy repeatability of quantitative myocardial perfusion MRI using ECG-gating and breath-holds. Self-gated near-diastole data results were less repeatable. J. Magn. Reson. Imaging 2016;43:1369-1378.
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Affiliation(s)
- Devavrat Likhite
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Promporn Suksaranjit
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ganesh Adluru
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Nan Hu
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Cindy Weng
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Eugene Kholmovski
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Chris McGann
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Brent Wilson
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Edward DiBella
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah, USA.,Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA
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12
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Wissmann L, Niemann M, Gotschy A, Manka R, Kozerke S. Quantitative three-dimensional myocardial perfusion cardiovascular magnetic resonance with accurate two-dimensional arterial input function assessment. J Cardiovasc Magn Reson 2015; 17:108. [PMID: 26637221 PMCID: PMC4669617 DOI: 10.1186/s12968-015-0212-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/24/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Quantification of myocardial perfusion from first-pass cardiovascular magnetic resonance (CMR) images at high contrast agent (CA) dose requires separate acquisition of blood pool and myocardial tissue enhancement. In this study, a dual-sequence approach interleaving 2D imaging of the arterial input function with high-resolution 3D imaging for myocardial perfusion assessment is presented and validated for low and high CA dose. METHODS A dual-sequence approach interleaving 2D imaging of the aortic root and 3D imaging of the whole left ventricle using highly accelerated k-t PCA was implemented. Rest perfusion imaging was performed in ten healthy volunteers after administration of a Gadolinium-based CA at low (0.025 mmol/kg b.w.) and high dose (0.1 mmol/kg b.w.). Arterial input functions extracted from the 2D and 3D images were analysed for both doses. Myocardial contrast-to-noise ratios (CNR) were compared across volunteers and doses. Variations of myocardial perfusion estimates between volunteers and across myocardial territories were studied. RESULTS High CA dose imaging resulted in strong non-linearity of the arterial input function in the 3D images at peak CA concentration, which was avoided when the input function was derived from the 2D images. Myocardial CNR was significantly increased at high dose compared to low dose, with a 2.6-fold mean CNR gain. Most robust myocardial blood flow estimation was achieved using the arterial input function extracted from the 2D image at high CA dose. In this case, myocardial blood flow estimates varied by 24% between volunteers and by 20% between myocardial territories when analysed on a per-volunteer basis. CONCLUSION Interleaving 2D imaging for arterial input function assessment enables robust quantitative 3D myocardial perfusion imaging at high CA dose.
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Affiliation(s)
- Lukas Wissmann
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
| | - Markus Niemann
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
- Clinic of Cardiology, University Hospital Zurich, Zurich, Switzerland.
- Furtwangen University, Faculty Mechanical and Medical Engineering, Villingen-Schwenningen, Germany.
| | - Alexander Gotschy
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
- Clinic of Cardiology, University Hospital Zurich, Zurich, Switzerland.
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Robert Manka
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
- Clinic of Cardiology, University Hospital Zurich, Zurich, Switzerland.
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
- Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
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13
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Tran-Gia J, Lohr D, Weng AM, Ritter CO, Stäb D, Bley TA, Köstler H. A model-based reconstruction technique for quantitative myocardial perfusion imaging. Magn Reson Med 2015; 76:880-7. [PMID: 26414857 DOI: 10.1002/mrm.25921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/19/2015] [Accepted: 08/14/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE To reduce saturation effects in the arterial input function (AIF) estimation of quantitative myocardial first-pass saturation recovery perfusion imaging by employing a model-based reconstruction. THEORY AND METHODS Imaging was performed with a saturation recovery prepared radial FLASH sequence. A model-based reconstruction was applied for reconstruction. By exploiting prior knowledge about the relaxation process, an image series with different saturation recovery times was reconstructed. By evaluating images with an effective saturation time of approximately 3 ms, saturation effects in the AIF determination were reduced. In a volunteer study, this approach was compared with a standard prebolus technique. RESULTS In comparison to the low-dose injection of a prebolus acquisition, saturation effects were further reduced in the AIFs determined using the model-based approach. These effects, which were clearly visible for all six volunteers, were reflected in a statistically significant difference of up to 20% in the absolute perfusion values. CONCLUSION The application of model-based reconstruction algorithms in quantitative myocardial perfusion imaging promises a significant improvement of the AIF determination. In addition to greatly reducing saturation effects that occur even for the prebolus methods, only a single bolus has to be applied. Magn Reson Med 76:880-887, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Johannes Tran-Gia
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Germany.,Department of Nuclear Medicine, University of Würzburg, Germany
| | - David Lohr
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Germany.,Comprehensive Heart Failure Center Würzburg, University of Würzburg, Germany
| | - Andreas Max Weng
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Germany
| | - Christian Oliver Ritter
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Germany.,Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Germany
| | - Daniel Stäb
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Germany.,Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
| | | | - Herbert Köstler
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Germany.,Comprehensive Heart Failure Center Würzburg, University of Würzburg, Germany
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