Navigator-free metabolite-cycled proton spectroscopy of the heart

Preliminary experience of cardiac proton spectroscopy at 0.75 T

Recent work on high-performance lower-field MR systems has renewed the interest in assessing relative advantages and disadvantages of magnetic fields less than 1 T. The objective of the present work was to investigate signal-to-noise ratio (SNR) scaling of point-resolved spectroscopy as a function of field strength and to test the feasibility of proton MRS of triglycerides (TGs) in human in vivo myocardium at 0.75 T relative to 1.5 T and 3 T. Measurements at 0.75 T were obtained by temporarily ramping down a clinical 3 T MR scanner. System configurations at 0.75, 1.5 and 3 T featured identical hard- and software, except for differences in transmit/receive coil geometries and receive channel count, which were accounted for in SNR comparisons. Proton MRS was performed at 0.75 T, 1.5 T and 3 T in ex vivo tissue and in vivo calf muscle to measure T₁ and T₂ values as a function of field strength, which in turn served as input to simulations of SNR scaling and field-dependent TG fit errors. Preliminary in vivo spectra of myocardium were acquired at 0.75 T, 1.5 T and 3 T in healthy subjects. Measurements of both ex vivo tissue and in vivo muscle tissue at 0.75 T versus 1.5 T and 3 T confirmed decreasing T₁ and increasing T₂ * for decreasing field strengths. Using measured T₁ , T₂ and T₂ * as input and using field-dependent echo time and bandwidth scaling, simulated Cramér-Rao lower bounds of TG amplitudes at 0.75 T were 2.3 and 4.5 times larger with respect to 1.5 T and 3 T, respectively. In vivo measurements demonstrate that human proton spectroscopy of TGs in cardiac muscle is feasible at 0.75 T, supporting the potential practical value of lower-field high-performance MR systems.

SYSTEMI - systemic organ communication in STEMI: design and rationale of a cohort study of patients with ST-segment elevation myocardial infarction

BACKGROUND

ST-segment elevation myocardial infarction (STEMI) still causes significant mortality and morbidity despite best-practice revascularization and adjunct medical strategies. Within the STEMI population, there is a spectrum of higher and lower risk patients with respect to major adverse cardiovascular and cerebral events (MACCE) or re-hospitalization due to heart failure. Myocardial and systemic metabolic disorders modulate patient risk in STEMI. Systematic cardiocirculatory and metabolic phenotyping to assess the bidirectional interaction of cardiac and systemic metabolism in myocardial ischemia is lacking.

METHODS

Systemic organ communication in STEMI (SYSTEMI) is an all-comer open-end prospective study in STEMI patients > 18 years of age to assess the interaction of cardiac and systemic metabolism in STEMI by systematically collecting data on a regional and systemic level. Primary endpoint will be myocardial function, left ventricular remodelling, myocardial texture and coronary patency at 6 month after STEMI. Secondary endpoint will be all-cause death, MACCE, and re-hospitalisation due to heart failure or revascularisation assessed 12 month after STEMI. The objective of SYSTEMI is to identify metabolic systemic and myocardial master switches that determine primary and secondary endpoints. In SYSTEMI 150-200 patients are expected to be recruited per year. Patient data will be collected at the index event, within 24 h, 5 days as well as 6 and 12 months after STEMI. Data acquisition will be performed in multilayer approaches. Myocardial function will be assessed by using serial cardiac imaging with cineventriculography, echocardiography and cardiovascular magnetic resonance. Myocardial metabolism will be analysed by multi-nuclei magnetic resonance spectroscopy. Systemic metabolism will be approached by serial liquid biopsies and analysed with respect to glucose and lipid metabolism as well as oxygen transport. In summary, SYSTEMI enables a comprehensive data analysis on the levels of organ structure and function alongside hemodynamic, genomic and transcriptomic information to assess cardiac and systemic metabolism.

DISCUSSION

SYSTEMI aims to identify novel metabolic patterns and master-switches in the interaction of cardiac and systemic metabolism to improve diagnostic and therapeutic algorithms in myocardial ischemia for patient-risk assessment and tailored therapy.

TRIAL REGISTRATION

Trial Registration Number: NCT03539133.

Metabolite-cycled echo-planar spectroscopic imaging of the human heart

Purpose

Spectroscopic imaging could provide insights into regional cardiac triglyceride variations, but is hampered by relatively long scan times. It is proposed to synergistically combine echo‐planar spectroscopic imaging (EPSI) with motion‐adapted gating, weighted acquisition and metabolite cycling to reduce scan times to less than 10 min while preserving spatial‐spectral quality. The method is compared to single‐voxel measurements and to metabolite‐cycled EPSI with conventional acquisition for assessing triglyceride‐to‐water (TG/W) ratios in the human heart.

Methods

Measurements were performed on 10 healthy volunteers using a clinical 1.5T system. EPSI data was acquired both without and with motion‐adapted gating in combination with weighted acquisition to assess TG/W ratios and relative Cramér‐Rao lower bounds (CRLB) of TG. For comparison, single‐voxel (PRESS) spectra were acquired in the interventricular septum.

Results

Bland–Altman analyses did not show a significant bias in TG/W when comparing both metabolite‐cycled EPSI methods to PRESS for any of the cardiac segments. Scan time was 8.05 ± 2.06 min and 17.91 ± 3.93 min for metabolite‐cycled EPSI with and without motion‐adapted gating and weighted acquisition, respectively, while relative CRLB of TG did not differ significantly between the two methods for any of the cardiac segments.

Conclusions

Metabolite‐cycled EPSI with motion‐adapted gating and weighted acquisition allows detecting TG/W ratios in different regions of the in vivo human heart. Scan time is reduced by more than 2‐fold to less than 10 min as compared to conventional acquisition, while keeping the quality of TG fitting constant.

Click here for author‐reader discussions

In Vivo Magnetic Resonance Spectroscopy Methods for Investigating Cardiac Metabolism

Magnetic resonance spectroscopy (MRS) is a non-invasive and non-ionizing technique, enabling in vivo investigation of cardiac metabolism in normal and diseased hearts. In vivo measurement tools are critical for studying mechanisms that regulate cardiac energy metabolism in disease developments and to assist in early response assessments to novel therapies. For cardiac MRS, proton (1H), phosphorus (31P), and hyperpolarized 13-carbon (13C) provide valuable metabolic information for diagnosis and treatment assessment purposes. Currently, low sensitivity and some technical limitations limit the utility of MRS. An essential step in translating MRS for clinical use involves further technological improvements, particularly in coil design, improving the signal-to-noise ratios, field homogeneity, and optimizing radiofrequency sequences. This review addresses the recent advances in metabolic imaging by MRS from primarily the literature published since 2015.

Water-suppression cycling 3-T cardiac 1 H-MRS detects altered creatine and choline in patients with aortic or mitral stenosis

Cardiac proton spectroscopy (1 H-MRS) is widely used to quantify lipids. Other metabolites (e.g. creatine and choline) are clinically relevant but more challenging to quantify because of their low concentrations (approximately 10 mmol/L) and because of cardiac motion. To quantify cardiac creatine and choline, we added water-suppression cycling (WSC) to two single-voxel spectroscopy sequences (STEAM and PRESS). WSC introduces controlled residual water signals that alternate between positive and negative phases from transient to transient, enabling robust phase and frequency correction. Moreover, a particular weighted sum of transients eliminates residual water signals without baseline distortion. We compared WSC and the vendor's standard 'WET' water suppression in phantoms. Next, we tested repeatability in 10 volunteers (seven males, three females; age 29.3 ± 4.0 years; body mass index [BMI] 23.7 ± 4.1 kg/m2 ). Fat fraction, creatine concentration and choline concentration when quantified by STEAM-WET were 0.30% ± 0.11%, 29.6 ± 7.0 μmol/g and 7.9 ± 6.7 μmol/g, respectively; and when quantified by PRESS-WSC they were 0.30% ± 0.15%, 31.5 ± 3.1 μmol/g and 8.3 ± 4.4 μmol/g, respectively. Compared with STEAM-WET, PRESS-WSC gave spectra whose fitting quality expressed by Cramér-Rao lower bounds improved by 26% for creatine and 32% for choline. Repeatability of metabolite concentration measurements improved by 72% for creatine and 40% for choline. We also compared STEAM-WET and PRESS-WSC in 13 patients with severe symptomatic aortic or mitral stenosis indicated for valve replacement surgery (10 males, three females; age 75.9 ± 6.3 years; BMI 27.4 ± 4.3 kg/m2 ). Spectra were of analysable quality in eight patients for STEAM-WET, and in nine for PRESS-WSC. We observed comparable lipid concentrations with those in healthy volunteers, significantly reduced creatine concentrations, and a trend towards decreased choline concentrations. We conclude that PRESS-WSC offers improved performance and reproducibility for the quantification of cardiac lipids, creatine and choline concentrations in healthy volunteers at 3 T. It also offers improved performance compared with STEAM-WET for detecting altered creatine and choline concentrations in patients with valve disease.

Metabolite cycled liver 1 H MRS on a 7 T parallel transmit system

INTRODUCTION

Single-voxel ¹ H MRS in body applications often suffers from respiratory and other motion induced phase and frequency shifts, which lead to incoherent averaging and hence to suboptimal results.

METHODS

Here we show the application of metabolite cycling (MC) for liver STEAM-localized ¹ H MRS on a 7 T parallel transmit system, using eight transmit-receive fractionated dipole antennas with 16 additional, integrated receive loops. MC-STEAM measurements were made in six healthy, lean subjects and compared with STEAM measurements using VAPOR water suppression. Measurements were performed during free breathing and during synchronized breathing, for which the subjects did breathe in between the MRS acquisitions. Both intra-session repeatability and inter-session reproducibility of liver lipid quantification with MC-STEAM and VAPOR-STEAM were determined.

RESULTS

The preserved water signal in MC-STEAM allowed for robust phase and frequency correction of individual acquisitions before averaging, which resulted in in vivo liver spectra that were of equal quality when measurements were made with free breathing or synchronized breathing. Intra-session repeatability and inter-session reproducibility of liver lipid quantification were better for MC-STEAM than for VAPOR-STEAM. This may also be explained by the more robust phase and frequency correction of the individual MC-STEAM acquisitions as compared with the VAPOR-STEAM acquisitions, for which the low-signal-to-noise ratio lipid signals had to be used for the corrections.

CONCLUSION

Non-water-suppressed MC-STEAM on a 7 T system with parallel transmit is a promising approach for ¹ H MRS applications in the body that are affected by motion, such as in the liver, and yields better repeatability and reproducibility compared with water-suppressed measurements.