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Guan X, Yang HJ, Zhang X, Wang N, Han H, Tang R, Hu Z, Youssef K, Vora K, Krishnam MS, Christodoulou AG, Li D, Sharif B, Dharmakumar R. Non-electrocardiogram-gated, free-breathing, off-resonance reduced, high-resolution, whole-heart myocardial T 2 * mapping at 3 T within 5 min. Magn Reson Med 2024; 91:1936-1950. [PMID: 38174593 DOI: 10.1002/mrm.29968] [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: 04/12/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Widely used conventional 2D T2 * approaches that are based on breath-held, electrocardiogram (ECG)-gated, multi-gradient-echo sequences are prone to motion artifacts in the presence of incomplete breath holding or arrhythmias, which is common in cardiac patients. To address these limitations, a 3D, non-ECG-gated, free-breathing T2 * technique that enables rapid whole-heart coverage was developed and validated. METHODS A continuous random Gaussian 3D k-space sampling was implemented using a low-rank tensor framework for motion-resolved 3D T2 * imaging. This approach was tested in healthy human volunteers and in swine before and after intravenous administration of ferumoxytol. RESULTS Spatial-resolution matched T2 * images were acquired with 2-3-fold reduction in scan time using the proposed T2 * mapping approach relative to conventional T2 * mapping. Compared with the conventional approach, T2 * images acquired with the proposed method demonstrated reduced off-resonance and flow artifacts, leading to higher image quality and lower coefficient of variation in T2 *-weighted images of the myocardium of swine and humans. Mean myocardial T2 * values determined using the proposed and conventional approaches were highly correlated and showed minimal bias. CONCLUSION The proposed non-ECG-gated, free-breathing, 3D T2 * imaging approach can be performed within 5 min or less. It can overcome critical image artifacts from undesirable cardiac and respiratory motion and bulk off-resonance shifts at the heart-lung interface. The proposed approach is expected to facilitate faster and improved cardiac T2 * mapping in those with limited breath-holding capacity or arrhythmias.
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Affiliation(s)
- Xingmin Guan
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hsin-Jung Yang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Xinheng Zhang
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
| | - Nan Wang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hui Han
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Richard Tang
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Zhehao Hu
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Khalid Youssef
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Keyur Vora
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mayil S Krishnam
- Department of Radiology, Stanford University, Palo Alto, California, USA
| | - Anthony G Christodoulou
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
| | - Behzad Sharif
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rohan Dharmakumar
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Xiao J, Poblete RA, Lerner A, Nguyen PL, Song JW, Sanossian N, Wilcox AG, Song SS, Lyden PD, Saver JL, Wasserman BA, Fan Z. MRI in the Evaluation of Cryptogenic Stroke and Embolic Stroke of Undetermined Source. Radiology 2024; 311:e231934. [PMID: 38652031 PMCID: PMC11070612 DOI: 10.1148/radiol.231934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 04/25/2024]
Abstract
Cryptogenic stroke refers to a stroke of undetermined etiology. It accounts for approximately one-fifth of ischemic strokes and has a higher prevalence in younger patients. Embolic stroke of undetermined source (ESUS) refers to a subgroup of patients with nonlacunar cryptogenic strokes in whom embolism is the suspected stroke mechanism. Under the classifications of cryptogenic stroke or ESUS, there is wide heterogeneity in possible stroke mechanisms. In the absence of a confirmed stroke etiology, there is no established treatment for secondary prevention of stroke in patients experiencing cryptogenic stroke or ESUS, despite several clinical trials, leaving physicians with a clinical dilemma. Both conventional and advanced MRI techniques are available in clinical practice to identify differentiating features and stroke patterns and to determine or infer the underlying etiologic cause, such as atherosclerotic plaques and cardiogenic or paradoxical embolism due to occult pelvic venous thrombi. The aim of this review is to highlight the diagnostic utility of various MRI techniques in patients with cryptogenic stroke or ESUS. Future trends in technological advancement for promoting the adoption of MRI in such a special clinical application are also discussed.
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Affiliation(s)
- Jiayu Xiao
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Roy A. Poblete
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Alexander Lerner
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Peggy L. Nguyen
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Jae W. Song
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Nerses Sanossian
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Alison G. Wilcox
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Shlee S. Song
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Patrick D. Lyden
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Jeffrey L. Saver
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Bruce A. Wasserman
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
| | - Zhaoyang Fan
- From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.),
Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.),
Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of
Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033;
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center,
Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of
Neurology, David Geffen School of Medicine, University of California–Los
Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and
Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md
(B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins
University, Baltimore, Md (B.A.W.)
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