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Dohy Z, Kiss M, Suhai FI, Kunze K, Neji R, Orbán G, Drobni Z, Czimbalmos C, Juhász V, Szabó L, Botnar R, Prieto C, Merkely B, Szegedi N, Vágó H. Feasibility and image quality of bright-blood and black-blood phase-sensitive inversion recovery (BOOST) sequence in clinical practice using for left atrial visualization in patients with atrial fibrillation. Eur Radiol 2024; 34:2689-2698. [PMID: 37804340 PMCID: PMC10957673 DOI: 10.1007/s00330-023-10257-3] [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: 01/13/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES Visualizing left atrial anatomy including the pulmonary veins (PVs) is important for planning the procedure of pulmonary vein isolation with ablation in patients with atrial fibrillation (AF). The aims of our study are to investigate the feasibility of the 3D whole-heart bright-blood and black-blood phase-sensitive (BOOST) inversion recovery sequence in patients with AF scheduled for ablation or electro-cardioversion, and to analyze the correlation between image quality and heart rate and rhythm of patients. METHODS BOOST was performed for assessing PVs both with T2 preparation pre-pulse (T2prep) and magnetization transfer preparation (MTC) in 45 patients with paroxysmal or permanent AF scheduled for ablation or electro-cardioversion. Image quality analyses were performed by two independent observers. Qualitative assessment was made using the Likert scale; for quantitative analysis, signal to noise ratios (SNR) and contrast to noise ratios (CNR) were calculated for each PV. Heart rate and rhythm were analyzed based on standard 12-lead ECGs. RESULTS All MTC-BOOST acquisitions achieved diagnostic quality in the PVs, while a significant proportion of T2prep-BOOST images were not suitable for assessing PVs. SNR and CNR values of the MTC-BOOST bright-blood images were higher if patients had sinus rhythm. We found a significant or nearly significant negative correlation between heart rate and the SNR and CNR values of MTC-BOOST bright-blood images. CONCLUSION 3D whole-heart MTC-BOOST bright-blood imaging is suitable for visualizing the PVs in patients with AF, producing diagnostic image quality in 100% of cases. However, image quality was influenced by heart rate and rhythm. CLINICAL RELEVANCE STATEMENT The novel 3D whole-heart BOOST CMR sequence needs no contrast administration and is performed during free-breathing; therefore, it is easy to use for a wide range of patients and is suitable for visualizing the PVs in patients with AF. KEY POINTS • The applicability of the novel 3D whole-heart bright-blood and black-blood phase-sensitive sequence to pulmonary vein imaging in clinical practice is unknown. • Magnetization transfer-bright-blood and black-blood phase-sensitive imaging is suitable for visualizing the pulmonary veins in patients with atrial fibrillation with excellent or good image quality. • Bright-blood and black-blood phase-sensitive cardiac magnetic resonance sequence is easy to use for a wide range of patients as it needs no contrast administration and is performed during free-breathing.
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Affiliation(s)
- Zsófia Dohy
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor St, Budapest, H-1122, Hungary
| | - Máté Kiss
- Siemens Healthcare Hungary, Budapest, Hungary
| | - Ferenc Imre Suhai
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor St, Budapest, H-1122, Hungary
| | | | | | - Gábor Orbán
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor St, Budapest, H-1122, Hungary
| | - Zsófia Drobni
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor St, Budapest, H-1122, Hungary
| | - Csilla Czimbalmos
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor St, Budapest, H-1122, Hungary
| | - Vencel Juhász
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor St, Budapest, H-1122, Hungary
| | - Liliána Szabó
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor St, Budapest, H-1122, Hungary
| | - Rene Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Béla Merkely
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor St, Budapest, H-1122, Hungary
| | - Nándor Szegedi
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor St, Budapest, H-1122, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor St, Budapest, H-1122, Hungary.
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Hammood ER, Shirani S, Sadri A, Bahri M, Dehghani S. The Role of Improved Motion-Sensitized Driven Equilibrium Blood Suppression and Fat Saturation on T 2 Relaxation Time, Using GraSE Sequence in Cardiac Magnetic Resonance Imaging. J Magn Reson Imaging 2023. [PMID: 37850682 DOI: 10.1002/jmri.29079] [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: 08/31/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND T2 mapping is a valuable technique in cardiac MR imaging that offers insights into the microstructural characteristics of myocardial tissue. However, it was shown that myocardial T2 relaxation times (T2 ) measured vary significantly depending on sequence, sequence parameters, and field strength. PURPOSE To assess T2 variability and image quality in cardiac T2 maps using four variants of the gradient-spin echo (GraSE) sequence, having different methods of blood signal suppression (double inversion recovery (DIR) and improved motion-sensitized driven equilibrium (iMSDE) and with and without the addition of fat saturation (FS). STUDY TYPE Prospective. POPULATION 48 healthy volunteers (46.7 +/- 21.5 years, 24 male) with no cardiac history. FIELD STRENGTH/SEQUENCE GraSE sequence with DIR (GraSEDIR ), with iMSDE (GraSEiMSDE ) and FS (GraSEDIR -FS) and with both iMSDE and FS (GraSEiMSDE -FS) at 1.5T. ASSESSMENT Global T2 from three short axis myocardial slices. and image quality assessments using a 5-point Lickert scale (1, (non-diagnostic) to 5, (excellent)) were conducted to evaluate the impact of DB and FS techniques on myocardial T2 measurements and image quality. STATISTICAL TESTS Paired t-tests or non-parametric equivalents for comparisons between sequences. The Bland-Altmann plots and Pearson rank correlation analyses, as appropriate. A P value <0.05 was considered statistically significant. RESULTS The mean global T2 values for GraSEDIR , GraSEDIR -FS, GraSEiMSDE , and GraSEiMSDE -FS, were 52.84 ± 5.72 msec, 54.98 ± 3.59 msec, 53.9 ± 4.05 msec, and 55.14 ± 4.28 msec, respectively, with no significant differences (P = 0.092). High image quality scores (>4 out of 5) were obtained for all sequence variants with no significant differences between them (P = 0.11). DATA CONCLUSION All GraSE sequence variants exhibited approximately the same results and variations in the DB technique and addition of FS did not have significant impact on myocardial T2 values. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Ebtihal Raheem Hammood
- Radiation Sciences Department, School of Allied Medical Sciences, International campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Shapoor Shirani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sadri
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medical Radiation Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mousa Bahri
- Radiation Sciences Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadegh Dehghani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Radiation Sciences Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Vuissoz PA. Editorial for "Simultaneous Highly Efficient Contrast-Free Lumen and Vessel Wall MR Imaging for Anatomical Assessment of Aortic Disease". J Magn Reson Imaging 2023; 58:1123-1124. [PMID: 36780125 DOI: 10.1002/jmri.28612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 02/14/2023] Open
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Munoz C, Fotaki A, Hua A, Hajhosseiny R, Kunze KP, Ismail TF, Neji R, Pushparajah K, Botnar RM, Prieto C. Simultaneous Highly Efficient Contrast-Free Lumen and Vessel Wall MR Imaging for Anatomical Assessment of Aortic Disease. J Magn Reson Imaging 2023; 58:1110-1122. [PMID: 36757267 PMCID: PMC10946808 DOI: 10.1002/jmri.28613] [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: 09/20/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Bright-blood lumen and black-blood vessel wall imaging are required for the comprehensive assessment of aortic disease. These images are usually acquired separately, resulting in long examinations and potential misregistration between images. PURPOSE To characterize the performance of an accelerated and respiratory motion-compensated three-dimensional (3D) cardiac MRI technique for simultaneous contrast-free aortic lumen and vessel wall imaging with an interleaved T2 and inversion recovery prepared sequence (iT2Prep-BOOST). STUDY TYPE Prospective. POPULATION A total of 30 consecutive patients with aortopathy referred for a clinically indicated cardiac MRI examination (9 females, mean age ± standard deviation: 32 ± 12 years). FIELD STRENGTH/SEQUENCE 1.5-T; bright-blood MR angiography (diaphragmatic navigator-gated T2-prepared 3D balanced steady-state free precession [bSSFP], T2Prep-bSSFP), breath-held black-blood two-dimensional (2D) half acquisition single-shot turbo spin echo (HASTE), and 3D bSSFP iT2Prep-BOOST. ASSESSMENT iT2Prep-BOOST bright-blood images were compared to T2prep-bSSFP images in terms of aortic vessel dimensions, lumen-to-myocardium contrast ratio (CR), and image quality (diagnostic confidence, vessel sharpness and presence of artifacts, assessed by three cardiologists on a 4-point scale, 1: nondiagnostic to 4: excellent). The iT2Prep-BOOST black-blood images were compared to 2D HASTE images for quantification of wall thickness. A visual comparison between computed tomography (CT) and iT2Prep-BOOST was performed in a patient with chronic aortic dissection. STATISTICAL TESTS Paired t-tests, Wilcoxon signed-rank tests, intraclass correlation coefficient (ICC), Bland-Altman analysis. A P value < 0.05 was considered statistically significant. RESULTS Bright-blood iT2Prep-BOOST resulted in significantly improved image quality (mean ± standard deviation 3.8 ± 0.5 vs. 3.3 ± 0.8) and CR (2.9 ± 0.8 vs. 1.8 ± 0.5) compared with T2Prep-bSSFP, with a shorter scan time (7.8 ± 1.7 minutes vs. 12.9 ± 3.4 minutes) while providing a complementary 3D black-blood image. Aortic lumen diameter and vessel wall thickness measurements in bright-blood and black-blood images were in good agreement with T2Prep-bSSFP and HASTE images (<0.02 cm and <0.005 cm bias, respectively) and good intrareader (ICC > 0.96) and interreader (ICC > 0.94) agreement was observed for all measurements. DATA CONCLUSION iT2Prep-BOOST might enable time-efficient simultaneous bright- and black-blood aortic imaging, with improved image quality compared to T2Prep-bSSFP and HASTE imaging, and comparable measurements for aortic wall and lumen dimensions. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Camila Munoz
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Anastasia Fotaki
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Alina Hua
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Reza Hajhosseiny
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Karl P. Kunze
- MR Research CollaborationsSiemens Healthcare LimitedFrimleyUK
| | - Tevfik F. Ismail
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- MR Research CollaborationsSiemens Healthcare LimitedFrimleyUK
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - René M. Botnar
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Escuela de Ingeniería, Pontificia Universidad Católica de ChileSantiagoChile
- Instituto de Ingeniería Biológica y Médica, Pontificia Universidad Católica de ChileSantiagoChile
- Millenium Institute for Intelligent Healthcare Engineering iHEALTHSantiagoChile
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Escuela de Ingeniería, Pontificia Universidad Católica de ChileSantiagoChile
- Instituto de Ingeniería Biológica y Médica, Pontificia Universidad Católica de ChileSantiagoChile
- Millenium Institute for Intelligent Healthcare Engineering iHEALTHSantiagoChile
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Hu Z, Xiao J, Mao X, Xie Y, Kwan AC, Song SS, Fong MW, Wilcox AG, Li D, Christodoulou AG, Fan Z. MR Multitasking-based multi-dimensional assessment of cardiovascular system (MT-MACS) with extended spatial coverage and water-fat separation. Magn Reson Med 2023; 89:1496-1505. [PMID: 36336794 PMCID: PMC9892247 DOI: 10.1002/mrm.29522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/25/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To extend the MR MultiTasking-based Multidimensional Assessment of Cardiovascular System (MT-MACS) technique with larger spatial coverage and water-fat separation for comprehensive aortocardiac assessment. METHODS MT-MACS adopts a low-rank tensor image model for 7D imaging, with three spatial dimensions for volumetric imaging, one cardiac motion dimension for cine imaging, one respiratory motion dimension for free-breathing imaging, one T2-prepared inversion recovery time dimension for multi-contrast assessment, and one T2*-decay time dimension for water-fat separation. Nine healthy subjects were recruited for the 3T study. Overall image quality was scored on bright-blood (BB), dark-blood (DB), and gray-blood (GB) contrasts using a 4-point scale (0-poor to 3-excellent) by two independent readers, and their interreader agreement was evaluated. Myocardial wall thickness and left ventricular ejection fraction (LVEF) were quantified on DB and BB contrasts, respectively. The agreement in these metrics between MT-MACS and conventional breath-held, electrocardiography-triggered 2D sequences were evaluated. RESULTS MT-MACS provides both water-only and fat-only images with excellent image quality (average score = 3.725/3.780/3.835/3.890 for BB/DB/GB/fat-only images) and moderate to high interreader agreement (weighted Cohen's kappa value = 0.727/0.668/1.000/1.000 for BB/DB/GB/fat-only images). There were good to excellent agreements in myocardial wall thickness measurements (intraclass correlation coefficients [ICC] = 0.781/0.929/0.680/0.878 for left atria/left ventricle/right atria/right ventricle) and LVEF quantification (ICC = 0.716) between MT-MACS and 2D references. All measurements were within the literature range of healthy subjects. CONCLUSION The refined MT-MACS technique provides multi-contrast, phase-resolved, and water-fat imaging of the aortocardiac systems and allows evaluation of anatomy and function. Clinical validation is warranted.
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Affiliation(s)
- Zhehao Hu
- Department of RadiologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Biomedical Imaging Research InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of BioengineeringUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Jiayu Xiao
- Department of RadiologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Xianglun Mao
- Biomedical Imaging Research InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Yibin Xie
- Biomedical Imaging Research InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Alan C. Kwan
- Biomedical Imaging Research InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Smidt Heart InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Shlee S. Song
- Department of NeurologyCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Michael W. Fong
- Division of Cardiovascular MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Cardiovascular Thoracic InstituteUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Alison G. Wilcox
- Department of RadiologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Debiao Li
- Biomedical Imaging Research InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of BioengineeringUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Anthony G. Christodoulou
- Biomedical Imaging Research InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of BioengineeringUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Zhaoyang Fan
- Department of RadiologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Biomedical Imaging Research InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of Radiation OncologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Ojha V, Khalique OK, Khurana R, Lorenzatti D, Leung SW, Lawton B, Slesnick TC, Cavalcante JC, Ducci CB, Patel AR, Prieto CC, Plein S, Raman SV, Salerno M, Parwani P. Highlights of the Virtual Society for Cardiovascular Magnetic Resonance 2022 Scientific Conference: CMR: improving cardiovascular care around the world. J Cardiovasc Magn Reson 2022; 24:38. [PMID: 35725565 PMCID: PMC9207863 DOI: 10.1186/s12968-022-00870-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
The 25th Society for Cardiovascular Magnetic Resonance (SCMR) Annual Scientific Sessions saw 1524 registered participants from more than 50 countries attending the meeting virtually. Supporting the theme "CMR: Improving Cardiovascular Care Around the World", the meeting included 179 invited talks, 52 sessions including 3 plenary sessions, 2 keynote talks, and a total of 93 cases and 416 posters. The sessions were designed so as to showcase the multifaceted role of cardiovascular magnetic resonance (CMR) in identifying and prognosticating various myocardial pathologies. Additionally, various social networking sessions as well as fun activities were organized. The major areas of focus for the future are likely to be rapid efficient and high value CMR exams, automated and quantitative acquisition and post-processing using artificial intelligence and machine learning, multi-contrast imaging and advanced vascular imaging including 4D flow.
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Affiliation(s)
- Vineeta Ojha
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Steve W Leung
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | | | | | | | | | - Amit R Patel
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Claudia C Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Subha V Raman
- Indiana University Cardiovascular Institute and Krannert Cardiovascular Research Center, Indianapolis, IN, USA
| | - Michael Salerno
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda University Medical Center, Loma Linda, CA, USA.
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Henningsson M, Malik S, Botnar R, Castellanos D, Hussain T, Leiner T. Black-Blood Contrast in Cardiovascular MRI. J Magn Reson Imaging 2020; 55:61-80. [PMID: 33078512 PMCID: PMC9292502 DOI: 10.1002/jmri.27399] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022] Open
Abstract
MRI is a versatile technique that offers many different options for tissue contrast, including suppressing the blood signal, so‐called black‐blood contrast. This contrast mechanism is extremely useful to visualize the vessel wall with high conspicuity or for characterization of tissue adjacent to the blood pool. In this review we cover the physics of black‐blood contrast and different techniques to achieve blood suppression, from methods intrinsic to the imaging readout to magnetization preparation pulses that can be combined with arbitrary readouts, including flow‐dependent and flow‐independent techniques. We emphasize the technical challenges of black‐blood contrast that can depend on flow and motion conditions, additional contrast weighting mechanisms (T1, T2, etc.), magnetic properties of the tissue, and spatial coverage. Finally, we describe specific implementations of black‐blood contrast for different vascular beds.
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Affiliation(s)
- Markus Henningsson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Shaihan Malik
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Rene Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Daniel Castellanos
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tarique Hussain
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
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