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Schwartz SM, Pathrose A, Serhal AM, Ragin AB, Charron J, Knight BP, Passman RS, Avery RJ, Kim D. Evaluation of image quality of wideband single-shot late gadolinium-enhancement MRI in patients with a cardiac implantable electronic device. J Cardiovasc Electrophysiol 2020; 32:138-147. [PMID: 33146422 DOI: 10.1111/jce.14798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION While wideband segmented, breath-hold late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) has been shown to suppress image artifacts associated with cardiac-implanted electronic devices (CIEDs), it may produce image artifacts in patients with arrhythmia and/or dyspnea. Single-shot LGE is capable of suppressing said artifacts. We sought to compare the performance of wideband single-shot free-breathing LGE against the standard and wideband-segmented LGEs in CIED patients. METHODS AND RESULTS We retrospectively identified all 54 consecutive patients (mean age: 61 ± 15 years; 31% females) with CIED who had undergone CMR with standard segmented, wideband segmented, and/or wideband single-shot LGE sequences as part of quality assurance for determining best clinical practice at 1.5 T. Two raters independently graded the conspicuity of myocardial scar or normal myocardium and the presence of device artifact level on a 5-point Likert scale (1: worst; 3: acceptable; 5: best). Summed visual score (SVS) was calculated as the sum of conspicuity and artifact scores (SVS ≥ 6 defined as diagnostically interpretable). Median conspicuity and artifact scores were significantly better for wideband single-shot LGE (F = 24.2, p < .001) and wideband-segmented LGE (F = 20.6, p < .001) compared to standard-segmented LGE. Among evaluated myocardial segments, 72% were deemed diagnostically interpretable-defined as SVS ≥ 6-for standard-segmented LGE, 89% were deemed diagnostically interpretable for wideband-segmented LGE, and 94% segments were deemed diagnostically interpretable for wideband single-shot LGE. CONCLUSIONS Wideband single-shot LGE and wideband-segmented LGE produced similarly improved image quality compared to standard LGE.
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Affiliation(s)
- Sarah M Schwartz
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ali M Serhal
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ann B Ragin
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jessica Charron
- Department of Internal Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bradley P Knight
- Department of Internal Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rod S Passman
- Department of Internal Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryan J Avery
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Hanspach J, Nagel AM, Hensel B, Uder M, Koros L, Laun FB. Sample size estimation: Current practice and considerations for original investigations in MRI technical development studies. Magn Reson Med 2020; 85:2109-2116. [PMID: 33058265 DOI: 10.1002/mrm.28550] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate and to provide guidance for sample size selection based on the current practice in MR technical development studies in which healthy volunteers are examined. METHODS All original articles published in Magnetic Resonance in Medicine between 2017 and 2019 were investigated and categorized according to technique, anatomical region, and magnetic field strength. The number of examined healthy volunteers (ie, the sample size) was collected and evaluated, whereas the number of patients was not considered. Papers solely measuring patients, animals, phantoms, specimens, or studies using existing data, for example, from an open databank, or consisting only of theoretical work or simulations were excluded. RESULTS The median sample size of the 882 included studies was 6. There were some peaks in the sample size distribution (eg, 1, 5, and 10). In 49.9%, 82.1%, and 95.6% of the studies, the sample size was smaller or equal to 5, 10, and 20, respectively. CONCLUSION We observed a large variance in sample sizes reflecting the variety of studies published in Magnetic Resonance in Medicine. Therefore, it can be concluded that it is current practice to balance the need for statistical power with the demand to minimize experiments involving healthy humans, often by choosing small sample sizes between 1 and 10. Naturally, this observation does not release an investigator from ensuring that sufficient data are acquired to reach statistical conclusions.
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Affiliation(s)
- Jannis Hanspach
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Bernhard Hensel
- Center for Medical Physics and Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Leon Koros
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Frederik B Laun
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Holtstiege V, Meier C, Bietenbeck M, Chatzantonis G, Florian A, Köbe J, Reinke F, Eckardt L, Yilmaz A. Clinical experience regarding safety and diagnostic value of cardiovascular magnetic resonance in patients with a subcutaneous implanted cardioverter/defibrillator (S-ICD) at 1.5 T. J Cardiovasc Magn Reson 2020; 22:35. [PMID: 32418537 PMCID: PMC7232845 DOI: 10.1186/s12968-020-00626-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) studies in patients with implanted cardioverter/defibrillators (ICD) are increasingly required in daily clinical practice. However, the clinical experience regarding the feasibility as well as clinical value of CMR studies in patients with subcutaneous ICD (S-ICD) is still limited. Besides safety issues, image quality and analysis can be impaired primarily due the presence of image artefacts associated with the generator. METHODS Twenty-three patients with an implanted S-ICD (EMBLEM, Boston Scientific, Marlborough, Massachusetts, USA; MR-conditional) with suspected cardiomyopathy and/or myocarditis underwent multi-parametric CMR imaging. Studies were performed on a 1.5 T CMR scanner after device interrogation and comprised standard a) balanced steady state free precession cine, b) T2 weighted-edema, c) velocity-encoded cine flow, d) myocardial perfusion, e) late-gadolinium-enhancement (LGE)-imaging and f) 3D-CMR angiography of the aorta. In case of substantial artefacts, alternative CMR techniques such as spoiled gradient-echo cine-sequences and wide-band inversion-recovery LGE (wb-LGE) sequences were applied. RESULTS Successful CMR studies could be performed in all patients without any case of unexpected early termination or relevant technical complication other than permanent loss of the S-ICD system beeper volume in 52% of our patients. Assessment of cine-CMR images was predominantly impaired in the left ventricular (LV) anterior, lateral and inferior wall segments and a switch to spoiled gradient echo-based cine-CMR allowed an accurate assessment of cine-images in N = 17 (74%) patients with only limited artefacts. Hyperintensity artefacts in conventional LGE-images were predominantly observed in the LV anterior, lateral and inferior wall segments and image optimisation by use of the wb-LGE was helpful in 15 (65%) cases. Aortic flow measurements and 3D-CMR angiography were assessable in all patients Perfusion imaging artefacts precluded a meaningful assessment in at least one half of the patients. A benefit in clinical-decision making was documented in 17 (74%) patients in the present study. CONCLUSION Safe 1.5 T CMR imaging was possible in all patients with an S-ICD, though the majority had permanent loss of the S-ICD beeper volume. Achieving good image quality may be challenging in some patients - particularly for perfusion imaging. Using spoiled gradient echo-based cine-sequences and wb-LGE sequences may help to reduce the extent of artefacts, thereby allowing accurate cardiac assessment. Thus, 1.5 T CMR studies should not be withhold in patients with S-ICD for safety concerns and/or fear of extensive imaging artefacts precluding successful image analysis.
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Affiliation(s)
- Viktoria Holtstiege
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Claudia Meier
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Michael Bietenbeck
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Grigorios Chatzantonis
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Anca Florian
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Julia Köbe
- Department of Cardiology II – Electrophysiology, University Hospital Münster, Münster, Germany
| | - Florian Reinke
- Department of Cardiology II – Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II – Electrophysiology, University Hospital Münster, Münster, Germany
| | - Ali Yilmaz
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
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Hong K, Collins JD, Freed BH, Fan L, Arai AE, Hsu LY, Lee DC, Kim D. Accelerated Wideband Myocardial Perfusion Pulse Sequence with Compressed Sensing Reconstruction for Myocardial Blood Flow Quantification in Patients with a Cardiac Implantable Electronic Device. Radiol Cardiothorac Imaging 2020; 2:e190114. [PMID: 32420548 DOI: 10.1148/ryct.2020190114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/17/2019] [Accepted: 10/02/2019] [Indexed: 11/11/2022]
Abstract
Purpose To develop an accelerated wideband cardiac perfusion pulse sequence and test whether it can produce diagnostically acceptable image quality and whether it can be used to reliably quantify myocardial blood flow (MBF) in patients with a cardiac implantable electronic device (CIED). Materials and Methods A fivefold-accelerated wideband perfusion pulse sequence was developed using compressed sensing to sample one arterial input function plane and three myocardial perfusion (MP) planes per heartbeat in patients with a CIED with heart rates as high as 102 beats per minute. Resting perfusion scans were performed in 10 patients with a CIED and in 10 patients with no device as a control group. Two clinical readers compared the resulting images and retrospective images of the 10 patients with a CIED, which were obtained by using a previously described twofold-accelerated wideband perfusion pulse sequence with temporal generalized autocalibrating partially parallel acquisition. Summed visual score (SVS) was defined as the sum of conspicuity, artifact, and noise scores individually ranging from 1 (worst) to 5 (best). Resting MBF in the remote zones was quantified using Fermi deconvolution. Results Median SVS was significantly different (P < .05) between the prospective and retrospective CIED groups (13 vs nine) and between the nondevice group and the retrospective CIED group (13.5 vs nine); all median SVSs were nine or greater (clinically acceptable cut point). The median resting MBF in remote zones was not significantly different (P = .27) between patients with a CIED (1.1 mL/min/g; median left ventricular ejection fraction [LVEF], 52.5%) and patients with no device (1.3 mL/min/g; median LVEF, 64.0%). Mean MBF values were consistent with those (mean resting MBF range, 1.0-1.2 mL/min/g) reported by two prior state-of-the-art cardiac perfusion MRI studies. Conclusion The proposed scan yielded diagnostically acceptable image quality and enabled reliable quantification of MBF with three MP planes per heartbeat in patients with a CIED with heart rates as high as 102 beats per minute. Supplemental material is available for this article. © RSNA, 2020.
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Affiliation(s)
- KyungPyo Hong
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
| | - Jeremy D Collins
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
| | - Benjamin H Freed
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
| | - Lexiaozi Fan
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
| | - Andrew E Arai
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
| | - Li-Yueh Hsu
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
| | - Daniel C Lee
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
| | - Daniel Kim
- Department of Radiology (K.P.H., L.F., D.K.) and Division of Cardiology, Department of Internal Medicine (B.H.F., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C.); Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.A., L.Y.H.); and Department of Biomedical Engineering, Northwestern University, Evanston, Ill (L.F., D.K.)
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