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Cohen J, Duong SQ, Arivazhagan N, Barris DM, Bebiya S, Castaldo R, Gayanilo M, Hopkins K, Kailas M, Kong G, Ma X, Marshall M, Paul EA, Tan M, Yau JL, Nadkarni GN, Ezon D. Machine Learning Quantification of Pulmonary Regurgitation Fraction from Echocardiography. Pediatr Cardiol 2024:10.1007/s00246-024-03511-y. [PMID: 38730015 DOI: 10.1007/s00246-024-03511-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024]
Abstract
Assessment of pulmonary regurgitation (PR) guides treatment for patients with congenital heart disease. Quantitative assessment of PR fraction (PRF) by echocardiography is limited. Cardiac MRI (cMRI) is the reference-standard for PRF quantification. We created an algorithm to predict cMRI-quantified PRF from echocardiography using machine learning (ML). We retrospectively performed echocardiographic measurements paired to cMRI within 3 months in patients with ≥ mild PR from 2009 to 2022. Model inputs were vena contracta ratio, PR index, PR pressure half-time, main and branch pulmonary artery diastolic flow reversal (BPAFR), and transannular patch repair. A gradient boosted trees ML algorithm was trained using k-fold cross-validation to predict cMRI PRF by phase contrast imaging as a continuous number and at > mild (PRF ≥ 20%) and severe (PRF ≥ 40%) thresholds. Regression performance was evaluated with mean absolute error (MAE), and at clinical thresholds with area-under-the-receiver-operating-characteristic curve (AUROC). Prediction accuracy was compared to historical clinician accuracy. We externally validated prior reported studies for comparison. We included 243 subjects (median age 21 years, 58% repaired tetralogy of Fallot). The regression MAE = 7.0%. For prediction of > mild PR, AUROC = 0.96, but BPAFR alone outperformed the ML model (sensitivity 94%, specificity 97%). The ML model detection of severe PR had AUROC = 0.86, but in the subgroup with BPAFR, performance dropped (AUROC = 0.73). Accuracy between clinicians and the ML model was similar (70% vs. 69%). There was decrement in performance of prior reported algorithms on external validation in our dataset. A novel ML model for echocardiographic quantification of PRF outperforms prior studies and has comparable overall accuracy to clinicians. BPAFR is an excellent marker for > mild PRF, and has moderate capacity to detect severe PR, but more work is required to distinguish moderate from severe PR. Poor external validation of prior works highlights reproducibility challenges.
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Affiliation(s)
- Jennifer Cohen
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Son Q Duong
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA.
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Naveen Arivazhagan
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David M Barris
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Surkhay Bebiya
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Rosalie Castaldo
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Marjorie Gayanilo
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Kali Hopkins
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Adult Congenital Heart Disease, Mount Sinai Heart, The Mount Sinai Hospital, New York, NY, USA
| | - Maya Kailas
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Grace Kong
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Xiye Ma
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Molly Marshall
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Erin A Paul
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Melanie Tan
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Jen Lie Yau
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
| | - Girish N Nadkarni
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Ezon
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, The Mount Sinai Hospital, 1468 Madison Ave, Annenberg 3rd Floor, New York, NY, 10029, USA
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Schulz A, Mittelmeier H, Wagenhofer L, Backhaus SJ, Lange T, Evertz R, Kutty S, Kowallick JT, Hasenfuß G, Schuster A. Assessment of the cardiac output at rest and during exercise stress using real-time cardiovascular magnetic resonance imaging in HFpEF-patients. Int J Cardiovasc Imaging 2024; 40:853-862. [PMID: 38236362 PMCID: PMC11052864 DOI: 10.1007/s10554-024-03054-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
This methodological study aimed to validate the cardiac output (CO) measured by exercise-stress real-time phase-contrast cardiovascular magnetic resonance imaging (CMR) in patients with heart failure and preserved ejection fraction (HFpEF). 68 patients with dyspnea on exertion (NYHA ≥ II) and echocardiographic signs of diastolic dysfunction underwent rest and exercise stress right heart catheterization (RHC) and CMR within 24 h. Patients were diagnosed as overt HFpEF (pulmonary capillary wedge pressure (PCWP) ≥ 15mmHg at rest), masked HFpEF (PCWP ≥ 25mmHg during exercise stress but < 15mmHg at rest) and non-cardiac dyspnea. CO was calculated using RHC as the reference standard, and in CMR by the volumetric stroke volume, conventional phase-contrast and rest and stress real-time phase-contrast imaging. At rest, the CMR based CO showed good agreement with RHC with an ICC of 0.772 for conventional phase-contrast, and 0.872 for real-time phase-contrast measurements. During exercise stress, the agreement of real-time CMR and RHC was good with an ICC of 0.805. Real-time measurements underestimated the CO at rest (Bias:0.71 L/min) and during exercise stress (Bias:1.4 L/min). Patients with overt HFpEF had a significantly lower cardiac index compared to patients with masked HFpEF and with non-cardiac dyspnea during exercise stress, but not at rest. Real-time phase-contrast CO can be assessed with good agreement with the invasive reference standard at rest and during exercise stress. While moderate underestimation of the CO needs to be considered with non-invasive testing, the CO using real-time CMR provides useful clinical information and could help to avoid unnecessary invasive procedures in HFpEF patients.
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Affiliation(s)
- Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Hannah Mittelmeier
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Lukas Wagenhofer
- Institute of Biomedical Imaging, University of Technology Graz, Graz, Austria
| | - Sören J Backhaus
- Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, 21287, USA
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
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Long D, McMurdo C, Ferdian E, Mauger CA, Marlevi D, Nash MP, Young AA. Super-resolution 4D flow MRI to quantify aortic regurgitation using computational fluid dynamics and deep learning. Int J Cardiovasc Imaging 2023; 39:1189-1202. [PMID: 36820960 PMCID: PMC10220149 DOI: 10.1007/s10554-023-02815-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
Changes in cardiovascular hemodynamics are closely related to the development of aortic regurgitation (AR), a type of valvular heart disease. Metrics derived from blood flows are used to indicate AR onset and evaluate its severity. These metrics can be non-invasively obtained using four-dimensional (4D) flow magnetic resonance imaging (MRI), where accuracy is primarily dependent on spatial resolution. However, insufficient resolution often results from limitations in 4D flow MRI and complex aortic regurgitation hemodynamics. To address this, computational fluid dynamics simulations were transformed into synthetic 4D flow MRI data and used to train a variety of neural networks. These networks generated super-resolution, full-field phase images with an upsample factor of 4. Results showed decreased velocity error, high structural similarity scores, and improved learning capabilities from previous work. Further validation was performed on two sets of in vivo 4D flow MRI data and demonstrated success in de-noising flow images. This approach presents an opportunity to comprehensively analyse AR hemodynamics in a non-invasive manner.
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Affiliation(s)
- Derek Long
- Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Cameron McMurdo
- Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Edward Ferdian
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Charlène A. Mauger
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - David Marlevi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA USA
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - Martyn P. Nash
- Department of Engineering Science, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Alistair A. Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Department of Biomedical Engineering, King’s College London, London, UK
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Sinharoy A, Reddy N, Lin JK, Nambi V, Yang EY, Kougias P, Taylor AA, Lumsden AB, Ballantyne CM, Morrisett JD, Brunner G. Magnetic resonance imaging based superficial femoral artery velocity measurements in peripheral artery disease. Magn Reson Imaging 2022; 93:128-134. [DOI: 10.1016/j.mri.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/07/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022]
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Terada M, Takehara Y, Isoda H, Wakayama T, Nozaki A. Technical Background for 4D Flow MR Imaging. Magn Reson Med Sci 2022; 21:267-277. [PMID: 35153275 PMCID: PMC9680548 DOI: 10.2463/mrms.rev.2021-0104] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/20/2021] [Indexed: 10/27/2023] Open
Abstract
Recently, the hemodynamic assessments with 3D cine phase-contrast (PC) MRI (4D flow MRI) have attracted considerable attention from clinicians. Unlike 2D cine PC MRI, the technique allows for cardiac phase-resolved data acquisitions of flow velocity vectors within the entire FOV during a clinically viable period. Thus, the method has enabled retrospective flowmetry in the spatial and temporal axes, which are essential to derive hemodynamic parameters related to vascular homeostasis and those to the progression of the pathologies. Accelerations in imaging are critical for this technology to be clinically viable; however, a high SNR or velocity-to-noise ratio (VNR) is also vital for accurate flow measurements. In this chapter, the technologies enabling this difficult balance are discussed.
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Affiliation(s)
- Masaki Terada
- Department of Diagnostic Radiologic Technology, Iwata City Hospital, Iwata, Shizuoka, Japan
| | - Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Haruo Isoda
- Department of Brain & Mind Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - Atsushi Nozaki
- MR Applications and Workflow, GE Healthcare Japan, Tokyo, Japan
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6
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Haji-Valizadeh H, Guo R, Kucukseymen S, Paskavitz A, Cai X, Rodriguez J, Pierce P, Goddu B, Kim D, Manning W, Nezafat R. Highly accelerated free-breathing real-time phase contrast cardiovascular MRI via complex-difference deep learning. Magn Reson Med 2021; 86:804-819. [PMID: 33720465 DOI: 10.1002/mrm.28750] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/18/2021] [Accepted: 02/05/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To develop and evaluate a real-time phase contrast (PC) MRI protocol via complex-difference deep learning (DL) framework. METHODS DL used two 3D U-nets to separately filter aliasing artifact from radial real-time velocity-compensated and complex-difference images. U-nets were trained with synthetic real-time PC generated from electrocardiograph (ECG) -gated, breath-hold, segmented PC (ECG-gated segmented PC) acquired at the ascending aorta of 510 patients. In 21 patients, free-breathing, ungated real-time (acceleration rate = 28.8) and ECG-gated segmented (acceleration rate = 2) PC were prospectively acquired at the ascending aorta. Hemodynamic parameters (cardiac output [CO], stroke volume [SV], and mean velocity at peak systole [peak mean velocity]) were measured for ECG-gated segmented and DL-filtered synthetic real-time PC and compared using Bland-Altman and linear regression analyses. Additionally, hemodynamic parameters were quantified from DL-filtered, compressed-sensing (CS) -reconstructed, and gridding reconstructed prospective real-time PC and compared to ECG-gated segmented PC. RESULTS Synthetic real-time PC with DL showed strong correlation (R > 0.98) and good agreement with ECG-gated segmented PC for quantified hemodynamic parameters (mean-difference: CO = -0.3 L/min, SV = -4.3 mL, peak mean velocity = -2.3 cm/s). On average, DL required 0.39 s/frame to filter prospective real-time PC, which was 4.6-fold faster than CS. Compared to CS, DL showed superior correlation, tighter limits of agreement (LOAs), better bias for peak mean velocity, and worse bias for CO and SV. Compared to gridding, DL showed similar correlation, tighter LOAs for CO and SV, similar bias for CO, and worse bias for SV and peak mean velocity. CONCLUSION The complex-difference DL framework accelerated real-time PC-MRI by nearly 28-fold, enabling rapid free-running real-time assessment of flow hemodynamics.
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Affiliation(s)
- Hassan Haji-Valizadeh
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Rui Guo
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Selcuk Kucukseymen
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Amanda Paskavitz
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Xiaoying Cai
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.,Siemens Medical Solutions USA, Inc., Boston, Massachusetts, USA
| | - Jennifer Rodriguez
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick Pierce
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Beth Goddu
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Warren Manning
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Hamilton MCK, Neumann S, Szantho G, Rydon L, Lawton CB, Hart E, Manghat NE, Turner MS. The design and use of a simple device for the MRI assessment of changes in cardiovascular function by lower-body negative-pressure-simulated reduction of central blood volume. Clin Radiol 2021; 76:471.e9-471.e16. [PMID: 33637308 DOI: 10.1016/j.crad.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Abstract
AIM To use a locally designed and simple lower-body negative-pressure (LBNP) device and 1.5 T magnetic resonance imaging (MRI) to demonstrate the ability to assess changes in cardiovascular function during preload reduction. These effects were evaluated on ventricular volumes and great vessel flow in healthy volunteers, for which there are limited published data. MATERIAL AND METHODS After ethical review, 14 volunteers (mean age 33.9 ± 7 years, mean body mass index [BMI] 23.1 ± 2.5) underwent LBNP prospectively at 0, -5, -10, and -20 mmHg pressure, using a locally designed LBNP box. Expiratory breath-hold biventricular volumes, and free-breathing flow imaging of the ascending aorta and main pulmonary artery were acquired at each level of LBNP. RESULTS At -5 mmHg, there was no change in aortic flow or left ventricular volumes versus baseline. Right ventricular output (p=0.013) and pulmonary net flow (p=0.026) decreased. At -20 mmHg, aortic and pulmonary net flow (p<0.001) decreased, as were left and right ventricular end diastolic volume (p<0.001) and left and right end systolic volumes (p=0.038 and p=0.003 respectively). CONCLUSIONS Use of a MRI-compatible LBNP device is feasible to measure changes in ventricular volume and great arterial flow in the same experiment. This may enhance further research into the effects of preload reduction by MRI in a wide range of important cardiovascular pathologies.
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Affiliation(s)
- M C K Hamilton
- Department of Clinical Radiology, Bristol Royal Infirmary, Bristol BS28HW, UK.
| | - S Neumann
- School of Physiology, Pharmacology and Neurosciences, University of Bristol, Bristol BS8 1TD, UK
| | - G Szantho
- Department of Cardiology, Bristol Heart Institute, Bristol BS28HW, UK
| | - L Rydon
- MEMO Clinical Engineering, Bristol Royal Infirmary, Bristol BS28HW, UK
| | - C B Lawton
- Department of Clinical Radiology, Bristol Royal Infirmary, Bristol BS28HW, UK
| | - E Hart
- School of Physiology, Pharmacology and Neurosciences, University of Bristol, Bristol BS8 1TD, UK
| | - N E Manghat
- Department of Clinical Radiology, Bristol Royal Infirmary, Bristol BS28HW, UK
| | - M S Turner
- Department of Cardiology, Bristol Heart Institute, Bristol BS28HW, UK
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Santini F, Pansini M, Hrabak-Paar M, Yates D, Langenickel TH, Bremerich J, Bieri O, Schubert T. On the optimal temporal resolution for phase contrast cardiovascular magnetic resonance imaging: establishment of baseline values. J Cardiovasc Magn Reson 2020; 22:72. [PMID: 33012283 PMCID: PMC7534161 DOI: 10.1186/s12968-020-00669-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 09/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study is to quantify the frequency content of the blood velocity waveform in different body regions by means of phase contrast (PC) cardiovascular magnetic resonance (CMR) and Doppler ultrasound. The highest frequency component of the spectrum is inversely proportional to the ideal temporal resolution to be used for the acquisition of flow-sensitive imaging (Shannon-Nyquist theorem). METHODS Ten healthy subjects (median age 33y, range 24-40) were scanned with a high-temporal-resolution PC-CMR and with Doppler ultrasound on three body regions (carotid arteries, aorta and femoral arteries). Furthermore, 111 patients (median age 61y) with mild to moderate arterial hypertension and 58 patients with aortic aregurgitation, atrial septal defect, or repaired tetralogy of Fallot underwent aortic CMR scanning. The frequency power distribution was calculated for each location and the maximum frequency component, fmax, was extracted and expected limits for the general population were inferred. RESULTS In the healthy subject cohort, significantly different fmax values were found across the different body locations, but they were nonsignificant across modalities. No significant correlation was found with heart rate. The measured fmax ranged from 7.7 ± 1.1 Hz in the ascending aorta, up to 12.3 ± 5.1 Hz in the femoral artery (considering PC-CMR data). The calculated upper boundary for the general population ranged from 11.0 Hz to 27.5 Hz, corresponding to optimal temporal resolutions of 45 ms and 18 ms, respectively. The patient cohort exhibited similar values for the frequencies in the aorta, with no correlation between blood pressure and frequency content. CONCLUSIONS The temporal resolution of PC-CMR acquisitions can be adapted based on the scanned body region and in the adult population, should approach approximately 20 ms in the peripheral arteries and 40 ms in the aorta. TRIAL REGISTRATION This study presents results from a restrospective analysis of the clinical study NCT01870739 (ClinicalTrials.gov).
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Affiliation(s)
- Francesco Santini
- Department of Radiology, Division of Radiological Physics, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.
| | | | - Maja Hrabak-Paar
- University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Denise Yates
- Novartis Institutes of Biomedical Research, Cambridge, MA, USA
| | - Thomas H Langenickel
- Novartis Institutes for Biomedical Research, Translational Medicine, Basel, Switzerland
- Ethris GmbH, Planegg, Germany
| | - Jens Bremerich
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Oliver Bieri
- Department of Radiology, Division of Radiological Physics, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Tilman Schubert
- Department of Neuroradiology, Zurich University Hospital, Zurich, Switzerland
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9
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Lee JW, Hur JH, Yang DH, Lee BY, Im DJ, Hong SJ, Kim EY, Park EA, Jo Y, Kim J, Park CH, Yong HS. Guidelines for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging-Part 2: Interpretation of Cine, Flow, and Angiography Data. Korean J Radiol 2020; 20:1477-1490. [PMID: 31606953 PMCID: PMC6791819 DOI: 10.3348/kjr.2019.0407] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 07/19/2019] [Indexed: 11/15/2022] Open
Abstract
Cardiovascular magnetic resonance imaging (CMR) is expected to be increasingly used in Korea due to technological advances and the expanded national insurance coverage of CMR assessments. For improved patient care, proper acquisition of CMR images as well as their accurate interpretation by well-trained personnel are equally important. In response to the increased demand for CMR, the Korean Society of Cardiovascular Imaging (KOSCI) has issued interpretation guidelines in conjunction with the Korean Society of Radiology. KOSCI has also created a formal Committee on CMR guidelines to create updated practices. The members of this committee review previously published interpretation guidelines and discuss the patterns of CMR use in Korea.
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Affiliation(s)
- Jae Wook Lee
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon, Korea
| | - Jee Hye Hur
- Department of Radiology, Hanil General Hospital, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Bae Young Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Dong Jin Im
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Hong
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Eun Young Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yeseul Jo
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - JeongJae Kim
- Department of Radiology, Jeju National University Hospital, Jeju, Korea
| | - Chul Hwan Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
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Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG, Kim RJ, von Knobelsdorff-Brenkenhoff F, Kramer CM, Pennell DJ, Plein S, Nagel E. Standardized image interpretation and post-processing in cardiovascular magnetic resonance - 2020 update : Society for Cardiovascular Magnetic Resonance (SCMR): Board of Trustees Task Force on Standardized Post-Processing. J Cardiovasc Magn Reson 2020; 22:19. [PMID: 32160925 PMCID: PMC7066763 DOI: 10.1186/s12968-020-00610-6] [Citation(s) in RCA: 472] [Impact Index Per Article: 118.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/17/2020] [Indexed: 01/04/2023] Open
Abstract
With mounting data on its accuracy and prognostic value, cardiovascular magnetic resonance (CMR) is becoming an increasingly important diagnostic tool with growing utility in clinical routine. Given its versatility and wide range of quantitative parameters, however, agreement on specific standards for the interpretation and post-processing of CMR studies is required to ensure consistent quality and reproducibility of CMR reports. This document addresses this need by providing consensus recommendations developed by the Task Force for Post-Processing of the Society for Cardiovascular Magnetic Resonance (SCMR). The aim of the Task Force is to recommend requirements and standards for image interpretation and post-processing enabling qualitative and quantitative evaluation of CMR images. Furthermore, pitfalls of CMR image analysis are discussed where appropriate. It is an update of the original recommendations published 2013.
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Affiliation(s)
- Jeanette Schulz-Menger
- Department of Cardiology and Nephrology, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany.
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Jens Bremerich
- Department of Radiology of the University Hospital Basel, Basel, Switzerland
| | - Scott D Flamm
- Imaging, and Heart and Vascular Institutes, Cleveland Clinic, Cleveland, OH, USA
| | - Mark A Fogel
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, Montreal, QC, Canada
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, and Departments of Medicine and Radiology, Duke University Medical Center, Durham, NC, USA
| | | | - Christopher M Kramer
- Departments of Medicine and Radiology and the Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Sven Plein
- Leeds Institute for Genetics Health and Therapeutics & Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, partner site RheinMain, University Hospital Frankfurt, Frankfurt am Main, Germany
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11
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Dunn TS, Patel P, Abazid B, Nagaraj HM, Desai RV, Gupta H, Lloyd SG. Quantification of pulmonary/systemic shunt ratio by single-acquisition phase-contrast cardiovascular magnetic resonance. Echocardiography 2019; 36:1181-1190. [PMID: 31087463 DOI: 10.1111/echo.14358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/14/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Phase-contrast cardiovascular magnetic resonance (PC-CMR) quantification of intracardiac shunt (measuring the pulmonary to systemic flow ratio, Qp/Qs) is typically determined by measuring flow through planes perpendicular the pulmonary trunk (PA) and ascending aorta (Ao). This method is subject to error from presence of background velocity offsets and requires two scan acquisitions. We evaluated an alternate PC-CMR technique for quantifying Qp/Qs using a single modified plane that encompasses both the PA and Ao. MATERIAL AND METHODS In 53 patients evaluated for intracardiac shunting, PC-CMR measurement in the individual Ao and PA planes and also in a single-acquisition plane was obtained and Qp/Qs calculated by each method. Bland-Altman analysis was performed to evaluate the agreement between the two methods. RESULTS The 95% confidence limits of agreement ranged from -0.52 to +0.34 indicating good agreement between the two methods. There was excellent agreement on the clinically relevant threshold value of Qp/Qs ratio of 1.5 (representing criteria for surgical correction of shunt). CONCLUSIONS Qp/Qs determined from the single-acquisition approach agrees well with that of the individual PA and Ao method and offers potential improved accuracy (due to background velocity offset).
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Affiliation(s)
- Terence Sean Dunn
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pratik Patel
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bassem Abazid
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hosakote M Nagaraj
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ravi V Desai
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Himanshu Gupta
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Birmingham VA Medical Center, Birmingham, Alabama
| | - Steven G Lloyd
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Birmingham VA Medical Center, Birmingham, Alabama
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12
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Contribution of flow MRI in the therapeutic management of middle face high flow arteriovenous malformation: A case report. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 120:361-365. [PMID: 30528922 DOI: 10.1016/j.jormas.2018.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/27/2018] [Indexed: 11/23/2022]
Abstract
BACKROUND The radiosurgical management of high flow arteriovenous malformations (HFAVM) in the "destructive" stage requires a precise hemodynamic and anatomical assessment. PATIENT AND METHODS/CASE REPORT We report the case of a 32 years-old patient with a large ulcerated face HFAVM, on which Doppler ultrasound was impossible to perform. We show that, by combining 3D PCA and 2D CINE PC-MRI sequences, magnetic resonance imaging is capable to provide a complete morphometric and velocimetric mapping of the nidus and feeding arteries of the HFAVM. CONCLUSION Although Doppler ultrasound is the reference examination in the HFAVM, Flow MRI without contrast agent provides an advantageous alternative to assess vascular pathologies and choose the therapeutic strategy.
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Medero R, Hoffman C, Roldán-Alzate A. Comparison of 4D Flow MRI and Particle Image Velocimetry Using an In Vitro Carotid Bifurcation Model. Ann Biomed Eng 2018; 46:2112-2122. [PMID: 30112708 DOI: 10.1007/s10439-018-02109-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/27/2018] [Indexed: 01/13/2023]
Abstract
Four-dimensional (4D) Flow magnetic resonance imaging (MRI) enables the acquisition and assessment of complex hemodynamics in vivo from different vascular territories. This study investigated the viability of stereoscopic and tomographic particle image velocimetry (stereo- and tomo-PIV, respectively) as experimental validation techniques for 4D Flow MRI. The experiments were performed using continuous and pulsatile flows through an idealized carotid artery bifurcation model. Transverse and longitudinal planes were extracted from the acquired velocity data sets at different regions of interest and were analyzed with a point-by-point comparison. An overall root-mean-square error (RMSE) was calculated resulting in errors as low as 0.06 and 0.03 m/s when comparing 4D Flow MRI with stereo- and tomo-PIV, respectively. Quantitative agreement between techniques was determined by evaluating the relationship for individual velocity components and their magnitudes. These resulted in correlation coefficients (R2) of 4D Flow MRI with stereo- and tomo-PIV, as low as 0.76 and 0.73, respectively. The 3D velocity measurements from PIV showed qualitative agreement when compared to 4D Flow MRI, especially with tomo-PIV due to the addition of volumetric velocity measurements. These results suggest that tomo-PIV can be used as a validation technique for 4D Flow MRI, serving as the basis for future validation protocols.
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Affiliation(s)
- Rafael Medero
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA. .,Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA. .,, 1415 Engineering Drive, Madison, WI, 53706, USA.
| | - Carson Hoffman
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.,Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
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14
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Bettoni J, Pagé G, Salsac AV, Constans JM, Testelin S, Devauchelle B, Balédent O, Dakpé S. 3T non-injected phase-contrast MRI sequences for the mapping of the external carotid branches: In vivo radio-anatomical pilot study for feasibility analysis. J Craniomaxillofac Surg 2018; 46:98-106. [DOI: 10.1016/j.jcms.2017.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/19/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022] Open
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15
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Krämer M, Motaal AG, Herrmann KH, Löffler B, Reichenbach JR, Strijkers GJ, Hoerr V. Cardiac 4D phase-contrast CMR at 9.4 T using self-gated ultra-short echo time (UTE) imaging. J Cardiovasc Magn Reson 2017; 19:39. [PMID: 28359292 PMCID: PMC5374606 DOI: 10.1186/s12968-017-0351-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/02/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Time resolved 4D phase contrast (PC) cardiovascular magnetic resonance (CMR) in mice is challenging due to long scan times, small animal ECG-gating and the rapid blood flow and cardiac motion of small rodents. To overcome several of these technical challenges we implemented a retrospectively self-gated 4D PC radial ultra-short echo-time (UTE) acquisition scheme and assessed its performance in healthy mice by comparing the results with those obtained with an ECG-triggered 4D PC fast low angle shot (FLASH) sequence. METHODS Cardiac 4D PC CMR images were acquired at 9.4 T in healthy mice using the proposed self-gated radial center-out UTE acquisition scheme (TE/TR of 0.5 ms/3.1 ms) and a standard Cartesian 4D PC imaging sequence (TE/TR of 2.1 ms/5.0 ms) with a four-point Hadamard flow encoding scheme. To validate the proposed UTE flow imaging technique, experiments on a flow phantom with variable pump rates were performed. RESULTS The anatomical images and flow velocity maps of the proposed 4D PC UTE technique showed reduced artifacts and an improved SNR (left ventricular cavity (LV): 8.9 ± 2.5, myocardium (MC): 15.7 ± 1.9) compared to those obtained using a typical Cartesian FLASH sequence (LV: 5.6 ± 1.2, MC: 10.1 ± 1.4) that was used as a reference. With both sequences comparable flow velocities were obtained in the flow phantom as well as in the ascending aorta (UTE: 132.8 ± 18.3 cm/s, FLASH: 134.7 ± 13.4 cm/s) and pulmonary artery (UTE: 78.5 ± 15.4 cm/s, FLASH: 86.6 ± 6.2 cm/s) of the animals. Self-gated navigator signals derived from information of the oversampled k-space center were successfully extracted for all animals with a higher gating efficiency of time spent on acquiring gated data versus total measurement time (UTE: 61.8 ± 11.5%, FLASH: 48.5 ± 4.9%). CONCLUSIONS The proposed self-gated 4D PC UTE sequence enables robust and accurate flow velocity mapping of the mouse heart in vivo at high magnetic fields. At the same time SNR, gating efficiency, flow artifacts and image quality all improved compared to the images obtained using the well-established, ECG-triggered, 4D PC FLASH sequence.
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Affiliation(s)
- M. Krämer
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Philosophenweg 3, D-07743 Jena, Germany
| | - A. G. Motaal
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - K-H. Herrmann
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Philosophenweg 3, D-07743 Jena, Germany
| | - B. Löffler
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - J. R. Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Philosophenweg 3, D-07743 Jena, Germany
- Michael Stifel Center for Data-driven and Simulation Science Jena, Friedrich Schiller University Jena, Jena, Germany
- Abbe School of Photonics, Friedrich Schiller University Jena, Jena, Germany
- Center of Medical Optics and Photonics, Friedrich Schiller University Jena, Jena, Germany
| | - G. J. Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, Netherlands
| | - V. Hoerr
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
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16
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Owen JW, Raptis CA. Emerging Clinical Applications of 4D Flow MR in the Heart and Aorta. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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She HL, Roest AA, Calkoen EE, van den Boogaard PJ, van der Geest RJ, Hazekamp MG, de Roos A, Westenberg JJ. Comparative Evaluation of Flow Quantification across the Atrioventricular Valve in Patients with Functional Univentricular Heart after Fontan's Surgery and Healthy Controls: Measurement by 4D Flow Magnetic Resonance Imaging and Streamline Visualization. CONGENIT HEART DIS 2016; 12:40-48. [DOI: 10.1111/chd.12397] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Hoi Lam She
- Department of Radiology; Princess Margaret Hospital; Hong Kong SAR
| | - Arno A.W. Roest
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center; Leiden The Netherlands
| | - Emmeline E. Calkoen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center; Leiden The Netherlands
| | | | - Rob J. van der Geest
- Department of Radiology, Leiden University Medical Center; Leiden The Netherlands
| | - Mark G. Hazekamp
- Department of Thoracic Surgery; Leiden University Medical Center; Leiden The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center; Leiden The Netherlands
| | - Jos J.M. Westenberg
- Department of Radiology, Leiden University Medical Center; Leiden The Netherlands
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18
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Mutnuru PC, Singh SN, D'Souza J, Perubhotla LM. Cardiac MR Imaging in the Evaluation of Rheumatic Valvular Heart Diseases. J Clin Diagn Res 2016; 10:TC06-9. [PMID: 27134962 DOI: 10.7860/jcdr/2016/18059.7405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/31/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Rheumatic heart disease is the most common cause of valvular heart disease throughout the world. Echocardiography is the dominant imaging investigation in the assessment of cardiac valvular disease and the role of Magnetic Resonance Imaging (MRI) is so far limited. However, due to rapid improvements in the cardiac MRI technology in past few years, this non invasive technique is gaining interest in the examination of cardiac valves. AIM Our study was undertaken to define the role of MRI in the evaluation of Rheumatic valvular heart disease and to compare the role of MRI with transthoracic echocardiography with regard to quantity of stenosis and volume regurgitation. MATERIALS AND METHODS ECG gated Cardiac MRI was performed with a 1.5-Tesla system (MAGNETOM SYMPHONY- Model 2005) using basic cardiac software (Argus viewer) by a phased-array multicoil on 50 subjects who were known cases of Rheumatic valvular heart disease. A chest radiograph and echocardiography were done in all patients before MR examination. Informed consent was taken from all patients. RESULTS Mitral stenosis either as an isolated valvular abnormality or in combination with other valvular abnormalities constituted the major bulk of Rheumatic valvular heart disease in our study population. The average ejection fraction by ECHO is 64.94±7.11 and by MRI 67.52±7.84. The average mitral valve area by ECHO is 1.79±0.43 cm(2) and by MRI 1.82±0.47 cm(2). The average aortic valve area by ECHO is 1.10±0.21 cm(2) and by MRI 1.12±0.25 cm(2). The Coefficient of Correlation (r) is 0.82 for ejection fraction, 0.98 for mitral valve area and 0.92 for aortic valve area which means a strong positive association between the results by ECHO and MRI. In all instances, the p-value is <0.00001, suggesting that the test is highly significant. CONCLUSION In our study echocardiography was found to be the gold standard for the diagnosis of Rheumatic valvular heart disease and the role of MRI remained only complimentary to Echocardiography. However with advanced cardiac software, more advanced techniques, and faster imaging sequences, MRI may become a valuable procedure for investigation and follow-up of patients with valvular heart disease.
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Affiliation(s)
- Phani Chakravarty Mutnuru
- Assistant Professor, Department of Radiology, Nizam's Institute of Medical Sciences , Punjagutta, Hyderabad, India
| | - S N Singh
- Head of Department, Department of Radiology, INHS Kalyani , Visakhapatnam, India
| | - John D'Souza
- Professor, Department of Radiology, Bharati Vidyapeeth Medical Foundation , Pune, India
| | - Lakshmi Manasa Perubhotla
- Ex Lecturer, Department of Pathology, Nizam's Institute of Medical Sciences , Punjagutta, Hyderabad, India
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19
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Harms HJ, Tolbod LP, Hansson NHS, Kero T, Orndahl LH, Kim WY, Bjerner T, Bouchelouche K, Wiggers H, Frøkiær J, Sörensen J. Automatic extraction of forward stroke volume using dynamic PET/CT: a dual-tracer and dual-scanner validation in patients with heart valve disease. EJNMMI Phys 2015; 2:25. [PMID: 26501826 PMCID: PMC4883637 DOI: 10.1186/s40658-015-0133-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/15/2015] [Indexed: 02/01/2023] Open
Abstract
Background The aim of this study was to develop and validate an automated method for extracting forward stroke volume (FSV) using indicator dilution theory directly from dynamic positron emission tomography (PET) studies for two different tracers and scanners. Methods 35 subjects underwent a dynamic 11C-acetate PET scan on a Siemens Biograph TruePoint-64 PET/CT (scanner I). In addition, 10 subjects underwent both dynamic 15O-water PET and 11C-acetate PET scans on a GE Discovery-ST PET/CT (scanner II). The left ventricular (LV)-aortic time-activity curve (TAC) was extracted automatically from PET data using cluster analysis. The first-pass peak was isolated by automatic extrapolation of the downslope of the TAC. FSV was calculated as the injected dose divided by the product of heart rate and the area under the curve of the first-pass peak. Gold standard FSV was measured using phase-contrast cardiovascular magnetic resonance (CMR). Results FSVPET correlated highly with FSVCMR (r = 0.87, slope = 0.90 for scanner I, r = 0.87, slope = 1.65, and r = 0.85, slope = 1.69 for scanner II for 15O-water and 11C-acetate, respectively) although a systematic bias was observed for both scanners (p < 0.001 for all). FSV based on 11C-acetate and 15O-water correlated highly (r = 0.99, slope = 1.03) with no significant difference between FSV estimates (p = 0.14). Conclusions FSV can be obtained automatically using dynamic PET/CT and cluster analysis. Results are almost identical for 11C-acetate and 15O-water. A scanner-dependent bias was observed, and a scanner calibration factor is required for multi-scanner studies. Generalization of the method to other tracers and scanners requires further validation.
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Affiliation(s)
- Hendrik Johannes Harms
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | | | - Tanja Kero
- Departments of Nuclear Medicine & PET, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden.
| | - Lovisa Holm Orndahl
- Department of Cardiology, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden.
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Tomas Bjerner
- Department of Radiology, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden.
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Jens Sörensen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. .,Departments of Nuclear Medicine & PET, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden.
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Boye D, Springer O, Wassmer F, Scheidegger S, Remonda L, Berberat J. Effects of contour propagation and background corrections in different MRI flow software packages. Acta Radiol Open 2015; 4:2058460115589124. [PMID: 26346318 PMCID: PMC4548733 DOI: 10.1177/2058460115589124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/07/2015] [Indexed: 11/23/2022] Open
Abstract
Background Velocity-encoded magnetic resonance imaging (VENC-MRI) is a commonly used technique in cardiac examinations. This technique utilizes the phase shift properties of protons moving along a magnetic field gradient. VENC-MRI offers a unique way of measuring the severity of valve regurgitation by directly quantifying the regurgitation flow volume. Purpose To compare flow analysis results of different software programs and to assess the effect of background correction in sample patient cases. Material and Methods A phantom was built out of Polymethyl methacrylate (PMMA) which provides tubes of different diameters. These tubes can be connected to an external water circuit to generate a water flow inside the tubes. Expected absolute flow quantities inside the tubes were determined from preset tube- and flow-parameters. Different flow conditions were measured with a VENC-MRI sequence and the images evaluated using different software packages. In a second step six randomly selected patients showing different degrees of aortic insufficiency were evaluated in clinical terms. Results The contour propagation algorithms used in the software packages performed differently even on static phantom geometry. In terms of clinical evaluation the software packages performed similarly. Enabling background correction or leaving out manual correction of propagated contours changed results for severity of aortic insufficiency. Conclusion Turning on background correction and manual correction of propagated contours in MRI flow volume measurements is strongly recommended.
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Affiliation(s)
- D Boye
- Cantonal Hospital Aarau, Department of Neuroradiology, Aarau, Switzerland
| | - O Springer
- Cantonal Hospital Aarau, Department of Radiology, Aarau, Switzerland
| | - F Wassmer
- Zurich University of Applied Sciences, Institute of Applied Mathematics and Physics, Winterthur, Switzerland
| | - S Scheidegger
- Zurich University of Applied Sciences, Institute of Applied Mathematics and Physics, Winterthur, Switzerland
| | - L Remonda
- Cantonal Hospital Aarau, Department of Neuroradiology, Aarau, Switzerland
| | - J Berberat
- Cantonal Hospital Aarau, Department of Neuroradiology, Aarau, Switzerland
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Nayak KS, Nielsen JF, Bernstein MA, Markl M, D Gatehouse P, M Botnar R, Saloner D, Lorenz C, Wen H, S Hu B, Epstein FH, N Oshinski J, Raman SV. Cardiovascular magnetic resonance phase contrast imaging. J Cardiovasc Magn Reson 2015; 17:71. [PMID: 26254979 PMCID: PMC4529988 DOI: 10.1186/s12968-015-0172-7] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/16/2015] [Indexed: 11/10/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) phase contrast imaging has undergone a wide range of changes with the development and availability of improved calibration procedures, visualization tools, and analysis methods. This article provides a comprehensive review of the current state-of-the-art in CMR phase contrast imaging methodology, clinical applications including summaries of past clinical performance, and emerging research and clinical applications that utilize today's latest technology.
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Affiliation(s)
- Krishna S Nayak
- Ming Hsieh Department of Electrical Engineering, University of Southern California, 3740 McClintock Ave, EEB 406, Los Angeles, California, 90089-2564, USA.
| | - Jon-Fredrik Nielsen
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | | | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, IL, USA.
| | - Peter D Gatehouse
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Rene M Botnar
- Cardiovascular Imaging, Imaging Sciences Division, Kings's College London, London, UK.
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - Christine Lorenz
- Center for Applied Medical Imaging, Siemens Corporation, Baltimore, MD, USA.
| | - Han Wen
- Imaging Physics Laboratory, National Heart Lung and Blood Institute, Bethesda, MD, USA.
| | - Bob S Hu
- Palo Alto Medical Foundation, Palo Alto, CA, USA.
| | - Frederick H Epstein
- Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
| | - John N Oshinski
- Departments of Radiology and Biomedical Engineering, Emory University School of Medicine, Atlanta, GA, USA.
| | - Subha V Raman
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
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Kang CK, Park CA, Lee DS, Lee YB, Park CW, Kim YB, Cho ZH. Velocity measurement of microvessels using phase-contrast magnetic resonance angiography at 7 Tesla MRI. Magn Reson Med 2015; 75:1640-6. [PMID: 25980462 DOI: 10.1002/mrm.25600] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of this study was to measure the velocity and direction of blood flow in microvessels, such as lenticulostriate arteries (LSAs), using PC MRA. METHODS Eleven healthy subjects were scanned with 7 Tesla (T) MRI. Three velocity encoding (VENC) values of 15, 50, and 100 cm/s were tested for detecting the flow velocity in LSAs. The flow directions in Circle of Willis (CoW) were also examined with images obtained by the proposed method. Three subjects were also scanned with 3T MRI to determine the possibility of velocity measurement in LSAs. Difference between 3T and 7T was quantitatively analyzed in terms of signal-to-noise ratio and velocities in vessels and static tissues. RESULTS In 7T MRI, use of VENC = 15 cm/s provided great visualization and velocity measurements in small and slow flowing vessels, such as the LSAs. The mean of peak velocities in LSAs was 9.61 ± 1.78 cm/s. The results obtained with low VENC also clearly depicted the directions of flow in CoW, especially in posterior communicating arteries. However, 3T MRI could not detect the velocity of blood flow in LSAs. CONCLUSION This study demonstrated the potential for measuring the velocity and direction of blood flow in the targeted microvessels using an appropriate VENC and 7T MRI.
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Affiliation(s)
- Chang-Ki Kang
- Neuroscience Research Institute, Gachon University, Incheon, Korea.,Department of Radiological Science, Gachon University, Incheon, Korea
| | - Chan-A Park
- Bioimaging Research Team, Korea Basic Science Institute, Chungcheongbuk-do, Korea
| | - David Soobin Lee
- Department of Biomedical Engineering and Center for Imaging Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yeong-Bae Lee
- Department of Neurology, Gachon University Gil Hospital, Gachon University, Incheon, Korea
| | - Cheol-Wan Park
- Neuroscience Research Institute, Gachon University, Incheon, Korea
| | - Young-Bo Kim
- Neuroscience Research Institute, Gachon University, Incheon, Korea.,Department of Neurosurgery, Gachon University Gil Hospital, Gachon University, Incheon, Korea
| | - Zang-Hee Cho
- Department of Radiological Sciences, University of California, Irvine, California, USA
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Basha TA, Akçakaya M, Goddu B, Berg S, Nezafat R. Accelerated three-dimensional cine phase contrast imaging using randomly undersampled echo planar imaging with compressed sensing reconstruction. NMR IN BIOMEDICINE 2015; 28:30-39. [PMID: 25323208 DOI: 10.1002/nbm.3225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/04/2014] [Accepted: 09/10/2014] [Indexed: 06/04/2023]
Abstract
The aim of this study was to implement and evaluate an accelerated three-dimensional (3D) cine phase contrast MRI sequence by combining a randomly sampled 3D k-space acquisition sequence with an echo planar imaging (EPI) readout. An accelerated 3D cine phase contrast MRI sequence was implemented by combining EPI readout with randomly undersampled 3D k-space data suitable for compressed sensing (CS) reconstruction. The undersampled data were then reconstructed using low-dimensional structural self-learning and thresholding (LOST). 3D phase contrast MRI was acquired in 11 healthy adults using an overall acceleration of 7 (EPI factor of 3 and CS rate of 3). For comparison, a single two-dimensional (2D) cine phase contrast scan was also performed with sensitivity encoding (SENSE) rate 2 and approximately at the level of the pulmonary artery bifurcation. The stroke volume and mean velocity in both the ascending and descending aorta were measured and compared between two sequences using Bland-Altman plots. An average scan time of 3 min and 30 s, corresponding to an acceleration rate of 7, was achieved for 3D cine phase contrast scan with one direction flow encoding, voxel size of 2 × 2 × 3 mm(3) , foot-head coverage of 6 cm and temporal resolution of 30 ms. The mean velocity and stroke volume in both the ascending and descending aorta were statistically equivalent between the proposed 3D sequence and the standard 2D cine phase contrast sequence. The combination of EPI with a randomly undersampled 3D k-space sampling sequence using LOST reconstruction allows a seven-fold reduction in scan time of 3D cine phase contrast MRI without compromising blood flow quantification.
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Affiliation(s)
- Tamer A Basha
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Helbing WA, Ouhlous M. Cardiac magnetic resonance imaging in children. Pediatr Radiol 2015; 45:20-6. [PMID: 25552387 DOI: 10.1007/s00247-014-3175-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/30/2014] [Accepted: 08/22/2014] [Indexed: 02/05/2023]
Abstract
MRI is an important additional tool in the diagnostic work-up of children with congenital heart disease. This review aims to summarise the role MRI has in this patient population. Echocardiography remains the main diagnostic tool in congenital heart disease. In specific situations, MRI is used for anatomical imaging of congenital heart disease. This includes detailed assessment of intracardiac anatomy with 2-D and 3-D sequences. MRI is particularly useful for assessment of retrosternal structures in the heart and for imaging large vessel anatomy. Functional assessment includes assessment of ventricular function using 2-D cine techniques. Of particular interest in congenital heart disease is assessment of right and single ventricular function. Two-dimensional and newer 3-D techniques to quantify flow in these patients are or will soon become an integral part of quantification of shunt size, valve function and complex flow patterns in large vessels. More advanced uses of MRI include imaging of cardiovascular function during stress and tissue characterisation of the myocardium. Techniques used for this purpose need further validation before they can become part of the daily routine of MRI assessment of congenital heart disease.
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Affiliation(s)
- Willem A Helbing
- Department of Radiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands,
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25
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Wentland AL, McWalter EJ, Pal S, Delp SL, Gold GE. Muscle velocity and inertial force from phase contrast MRI. J Magn Reson Imaging 2014; 42:526-32. [PMID: 25425185 DOI: 10.1002/jmri.24807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 11/04/2014] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate velocity waveforms in muscle and to create a tool and algorithm for computing and analyzing muscle inertial forces derived from 2D phase contrast (PC) magnetic resonance imaging (MRI). MATERIALS AND METHODS PC MRI was performed in the forearm of four healthy volunteers during 1 Hz cycles of wrist flexion-extension as well as in the lower leg of six healthy volunteers during 1 Hz cycles of plantarflexion-dorsiflexion. Inertial forces (F) were derived via the equation F = ma. The mass, m, was derived by multiplying voxel volume by voxel-by-voxel estimates of density via fat-water separation techniques. Acceleration, a, was obtained via the derivative of the PC MRI velocity waveform. RESULTS Mean velocities in the flexors of the forearm and lower leg were 1.94 ± 0.97 cm/s and 5.57 ± 2.72 cm/s, respectively, as averaged across all subjects; the inertial forces in the flexors of the forearm and lower leg were 1.9 × 10(-3) ± 1.3 × 10(-3) N and 1.1 × 10(-2) ± 6.1 × 10(-3) N, respectively, as averaged across all subjects. CONCLUSION PC MRI provided a promising means of computing muscle velocities and inertial forces-providing the first method for quantifying inertial forces.
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Affiliation(s)
- Andrew L Wentland
- Department of Medical Physics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Emily J McWalter
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Saikat Pal
- Department of Biomedical Engineering, California Polytechnic State University, San Luis Obispo, California, USA
| | - Scott L Delp
- Department of Bioengineering, Stanford University School of Medicine, Stanford, California, USA
| | - Garry E Gold
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.,Department of Bioengineering, Stanford University School of Medicine, Stanford, California, USA
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Terada M, Matsuyoshi K, Yamada E, Anzawa Y, Oosugi M. [Study of scan parameters using three-dimensional cine phase contrast imaging for pulmonary artery velocity measurement]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2014; 70:1219-24. [PMID: 25410327 DOI: 10.6009/jjrt.2014_jsrt_70.11.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pulmonary artery flow velocity, flow volume and their derived biomarkers, such as acceleration time (AT), acceleration volume (AV) and peak velocity (PV), vary depending on the severity and type of pulmonary disease. Therefore, accurate measurements of pulmonary artery velocity are very important for assessing the severity of pulmonary disease. The purpose of this study was to optimize the imaging parameters for pulmonary artery flow velocity using 3D cine PC MR, and to evaluate AT, AV, and PV for pulmonary hypertension. We changed the flip angle (FA) and view per segment (VPS). FA influenced the signal intensity, which was calculated from the magnitude images. Smaller VPS improved the accuracy of PV. Consequently, optimal setting of FA and VPS was important for hemodynamic analysis. We established the optimal FA and VPS for use in the hemodynamic analysis. AV and PV at the right pulmonary artery differed significantly between healthy volunteers and patients with pulmonary hypertension. Hemodynamic analysis of 3D cine PC MR imaging was considered promising for the evaluation of pulmonary disease.
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Velocity mapping of the aortic flow at 9.4 T in healthy mice and mice with induced heart failure using time-resolved three-dimensional phase-contrast MRI (4D PC MRI). MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2014; 28:315-27. [PMID: 25381179 PMCID: PMC4515240 DOI: 10.1007/s10334-014-0466-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/23/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022]
Abstract
Objectives In this study, we established and validated a time-resolved three-dimensional phase-contrast magnetic resonance imaging method (4D PC MRI) on a 9.4 T small-animal MRI system. Herein we present the feasibility of 4D PC MRI in terms of qualitative and quantitative flow pattern analysis in mice with transverse aortic constriction (TAC). Materials and methods 4D PC FLASH images of a flow phantom and mouse heart were acquired at 9.4 T using a four-point phase-encoding scheme. The method was compared with slice-selective PC FLASH and ultrasound using Bland–Altman analysis. Advanced 3D streamlines were visualized utilizing Voreen volume-rendering software. Results In vitro, 4D PC MRI flow profiles showed the transition between laminar and turbulent flow with increasing velocities. In vivo, 4D PC MRI data of the ascending aorta and the pulmonary artery were confirmed by ultrasound, resulting in linear regressions of R2 > 0.93. Magnitude- and direction-encoded streamlines differed substantially pre- and post-TAC surgery. Conclusions 4D PC MRI is a feasible tool for in vivo velocity measurements on high-field small-animal scanners. Similar to clinical measurement, this method provides a complete spatially and temporally resolved dataset of the murine cardiovascular blood flow and allows for three-dimensional flow pattern analysis. Electronic supplementary material The online version of this article (doi:10.1007/s10334-014-0466-z) contains supplementary material, which is available to authorized users.
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Quantitative magnetic resonance imaging of pulmonary hypertension: a practical approach to the current state of the art. J Thorac Imaging 2014; 29:68-79. [PMID: 24552882 DOI: 10.1097/rti.0000000000000079] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pulmonary hypertension is a condition of varied etiology, commonly associated with poor clinical outcome. Patients are categorized on the basis of pathophysiological, clinical, radiologic, and therapeutic similarities. Pulmonary arterial hypertension (PAH) is often diagnosed late in its disease course, with outcome dependent on etiology, disease severity, and response to treatment. Recent advances in quantitative magnetic resonance imaging (MRI) allow for better initial characterization and measurement of the morphologic and flow-related changes that accompany the response of the heart-lung axis to prolonged elevation of pulmonary arterial pressure and resistance and provide a reproducible, comprehensive, and noninvasive means of assessing the course of the disease and response to treatment. Typical features of PAH occur primarily as a result of increased pulmonary vascular resistance and the resultant increased right ventricular (RV) afterload. Several MRI-derived diagnostic markers have emerged, such as ventricular mass index, interventricular septal configuration, and average pulmonary artery velocity, with diagnostic accuracy similar to that of Doppler echocardiography. Furthermore, prognostic markers have been identified with independent predictive value for identification of treatment failure. Such markers include large RV end-diastolic volume index, low left ventricular end-diastolic volume index, low RV ejection fraction, and relative area change of the pulmonary trunk. MRI is ideally suited for longitudinal follow-up of patients with PAH because of its noninvasive nature and high reproducibility and is advantageous over other biomarkers in the study of PAH because of its sensitivity to change in morphologic, functional, and flow-related parameters. Further study on the role of MRI image based biomarkers in the clinical environment is warranted.
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Widya RL, Hammer S, Boon MR, van der Meer RW, Smit JWA, de Roos A, Rensen PCN, Lamb HJ. Effects of short-term nutritional interventions on right ventricular function in healthy men. PLoS One 2013; 8:e76406. [PMID: 24086738 PMCID: PMC3781057 DOI: 10.1371/journal.pone.0076406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 08/26/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A physiological model of increased plasma nonesterified fatty acid (NEFA) levels result in myocardial triglyceride (TG) accumulation, which is related to cardiac dysfunction. A pathophysiological model of increased plasma NEFA levels result in hepatic steatosis, which has been linked to abnormal myocardial energy metabolism. Hepatic steatosis is accompanied by hepatic inflammation, reflected by plasma cholesteryl ester transfer protein (CETP) levels. The current study aimed to investigate effects of these models via different nutritional interventions on right ventricular (RV) function. METHODS Fifteen men (age 25.0±6.6 years) were included and underwent magnetic resonance imaging and spectroscopy in this prospective crossover intervention study. RV function, myocardial and hepatic TG content, and CETP levels were assessed on three occasions: after normal diet, very low-calorie diet (VLCD, physiological model) and high-fat high-energy (HFHE, pathophysiological model) diet (all 3-days diets, randomly ordered, washout phase at least 14 days). RESULTS VLCD induced a decrease in mean E deceleration by 27%. Myocardial TG content increased by 55%, whereas hepatic TG content decreased by 32%. Plasma CETP levels decreased by 14% (all P<0.05). HFHE diet induced a decrease in E/A by 19% (P<0.05). Myocardial TG content did not change, whereas hepatic TG content increased by 112% (P<0.01). Plasma CETP levels increased by 14% (P<0.05). CONCLUSIONS These findings show that RV diastolic function is impaired after short-term VLCD and HFHE diet in healthy men, respectively a physiological and a pathophysiological model of increased plasma NEFA levels. After short-term VLCD, myocardial lipotoxicity may be of importance in decreased RV diastolic function. RV diastolic dysfunction is accompanied by increased hepatic TG content and plasma CETP levels after short-term HFHE diet, suggesting that systemic inflammation reflecting local macrophage infiltration in the heart may be involved in RV dysfunction.
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Affiliation(s)
- Ralph L. Widya
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, the Netherlands
- * E-mail:
| | - Sebastiaan Hammer
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mariëtte R. Boon
- Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Johannes W. A. Smit
- Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, the Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Patrick C. N. Rensen
- Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, the Netherlands
| | - Hildo J. Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Impaired cardiac reserve in asymptomatic patients with moderate pulmonary restenosis late after relief of severe pulmonary stenosis: Evidence for diastolic dysfunction. Int J Cardiol 2013; 167:2836-40. [DOI: 10.1016/j.ijcard.2012.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 07/20/2012] [Accepted: 07/21/2012] [Indexed: 11/21/2022]
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Fratz S, Chung T, Greil GF, Samyn MM, Taylor AM, Valsangiacomo Buechel ER, Yoo SJ, Powell AJ. Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease. J Cardiovasc Magn Reson 2013; 15:51. [PMID: 23763839 PMCID: PMC3686659 DOI: 10.1186/1532-429x-15-51] [Citation(s) in RCA: 310] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/08/2013] [Indexed: 01/12/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) has taken on an increasingly important role in the diagnostic evaluation and pre-procedural planning for patients with congenital heart disease. This article provides guidelines for the performance of CMR in children and adults with congenital heart disease. The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols. Variations in practice are highlighted and expert consensus recommendations are provided. Indications and appropriate use criteria for CMR examination are not specifically addressed.
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Affiliation(s)
- Sohrab Fratz
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (German Heart Center Munich) of the Technical University Munich, Munich, Germany
| | - Taylor Chung
- Department of Diagnostic Imaging, Children’s Hospital & Research Center Oakland, Oakland, California, USA
| | - Gerald F Greil
- Department of Pediatric Cardiology, Evelina Children’s Hospital/Guy’s and St. Thomas’ Hospital NHS Foundation Trust; Division of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
| | - Margaret M Samyn
- The Herma Heart Center, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, & Great Ormond Street Hospital for Children, London, UK
| | | | - Shi-Joon Yoo
- Department of Diagnostic Imaging and Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Powell
- Department of Cardiology, Boston Children’s Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG, Kim RJ, von Knobelsdorff-Brenkenhoff F, Kramer CM, Pennell DJ, Plein S, Nagel E. Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) board of trustees task force on standardized post processing. J Cardiovasc Magn Reson 2013; 15:35. [PMID: 23634753 PMCID: PMC3695769 DOI: 10.1186/1532-429x-15-35] [Citation(s) in RCA: 834] [Impact Index Per Article: 75.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/05/2013] [Indexed: 01/29/2023] Open
Abstract
With mounting data on its accuracy and prognostic value, cardiovascular magnetic resonance (CMR) is becoming an increasingly important diagnostic tool with growing utility in clinical routine. Given its versatility and wide range of quantitative parameters, however, agreement on specific standards for the interpretation and post-processing of CMR studies is required to ensure consistent quality and reproducibility of CMR reports. This document addresses this need by providing consensus recommendations developed by the Task Force for Post Processing of the Society for Cardiovascular MR (SCMR). The aim of the task force is to recommend requirements and standards for image interpretation and post processing enabling qualitative and quantitative evaluation of CMR images. Furthermore, pitfalls of CMR image analysis are discussed where appropriate.
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Affiliation(s)
- Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité Medical University Berlin, Berlin, Germany
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Jens Bremerich
- Department of Radiology of the University Hospital Basel, Basel, Switzerland
| | - Scott D Flamm
- Imaging, and Heart and Vascular Institutes, Cleveland Clinic, Cleveland, OH, USA
| | - Mark A Fogel
- Department of Radiology, Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Matthias G Friedrich
- CMR Centre at the Montreal Heart Institute, Department of Cardiology, Université de Montréal, Montreal, Canada
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, and Departments of Medicine and Radiology, Duke University, University Medical Center, Durham, NC, USA
| | - Florian von Knobelsdorff-Brenkenhoff
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité Medical University Berlin, Berlin, Germany
| | - Christopher M Kramer
- Departments of Medicine and Radiology and the Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Sven Plein
- Leeds Institute for Genetics Health and Therapeutics & Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - Eike Nagel
- Division of Imaging Sciences and Biomedical Engineering, Department of Cardiovascular Imaging, King’s College, London, UK
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Kwak Y, Nam S, Akçakaya M, Basha TA, Goddu B, Manning WJ, Tarokh V, Nezafat R. Accelerated aortic flow assessment with compressed sensing with and without use of the sparsity of the complex difference image. Magn Reson Med 2012; 70:851-8. [PMID: 23065722 DOI: 10.1002/mrm.24514] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 09/04/2012] [Accepted: 09/11/2012] [Indexed: 12/22/2022]
Abstract
Phase contrast (PC) cardiac MR is widely used for the clinical assessment of blood flow in cardiovascular disease. One of the challenges of PC cardiac MR is the long scan time which limits both spatial and temporal resolution. Compressed sensing reconstruction with accelerated PC acquisitions is a promising technique to increase the scan efficiency. In this study, we sought to use the sparsity of the complex difference of the two flow-encoded images as an additional constraint term to improve the compressed sensing reconstruction of the corresponding accelerated PC data acquisition. Using retrospectively under-sampled data, the proposed reconstruction technique was optimized and validated in vivo on 15 healthy subjects. Then, prospectively under-sampled data was acquired on 11 healthy subjects and reconstructed with the proposed technique. The results show that there is good agreement between the cardiac output measurements from the fully sampled data and the proposed compressed sensing reconstruction method using complex difference sparsity up to acceleration rate 5. In conclusion, we have developed and evaluated an improved reconstruction technique for accelerated PC cardiac MR that uses the sparsity of the complex difference of the two flow-encoded images.
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Affiliation(s)
- Yongjun Kwak
- Department of Medicine (Cardiovascular Division), Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
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Accurate perioperative flow measurement of the portal vein and hepatic and renal artery: A role for preoperative MRI? Eur J Radiol 2012; 81:2042-8. [DOI: 10.1016/j.ejrad.2011.06.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 05/31/2011] [Accepted: 06/03/2011] [Indexed: 11/21/2022]
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35
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van der Hulst AE, Roest AAW, Westenberg JJM, Kroft LJM, de Roos A. Cardiac MRI in postoperative congenital heart disease patients. J Magn Reson Imaging 2012; 36:511-28. [PMID: 22903653 DOI: 10.1002/jmri.23604] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Annelies E van der Hulst
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Siripornpitak S, Pornkul R, Khowsathit P, Layangool T, Promphan W, Pongpanich B. Cardiac CT angiography in children with congenital heart disease. Eur J Radiol 2011; 82:1067-82. [PMID: 22196744 DOI: 10.1016/j.ejrad.2011.11.042] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiac imaging plays an important role in both congenital and acquired heart diseases. Cardiac computed tomography (angiography) cCT(A) is a non-invasive, increasingly popular, complementary modality to echocardiography in evaluation of congenital heart diseases (CHD) in children. Despite radiation exposure, cCT(A) is now commonly used for evaluation of the complex CHD, giving information of both intra-cardiac and extra-cardiac anatomy, coronary arteries, and vascular structures. This review article will focus on the fundamentals and essentials for performing cCT(A) in children, including radiation dose awareness, basic techniques, and strengths and weaknesses of cCT(A) compared with cardiac magnetic resonance imaging (cMRI), and applications. The limitations of this modality will also be discussed, including the CHD for which cMRI may be substituted.
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Affiliation(s)
- Suvipaporn Siripornpitak
- Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Czum JM, Ho VB. MR of the Thoracic Aorta: A Pulse Sequence Approach to Discrete Feature Analysis. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/10408379991249176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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38
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Black blood MRI has diagnostic and prognostic value in the assessment of patients with pulmonary hypertension. Eur Radiol 2011; 22:695-702. [DOI: 10.1007/s00330-011-2306-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 09/03/2011] [Accepted: 09/28/2011] [Indexed: 02/06/2023]
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Reineke D, Ith M, Goeber V, Rosskopf AB, Hess O, Carrel T, Czerny M, Hoppe H. Comparison of arterial and venous coronary artery bypass flow measurements using 3-T magnetic resonance phase contrast imaging. Eur J Radiol 2011; 81:e502-6. [PMID: 21703795 DOI: 10.1016/j.ejrad.2011.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 06/01/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Comparison of arterial and venous coronary artery bypass flow measurements using 3-T magnetic resonance (MR) phase contrast in correlation with intraoperative Doppler flow measurements. METHODS Fifty-six coronary bypasses (right coronary artery n=18, left internal mammary artery to left anterior descending artery n=16, marginal artery n=7, circumflex artery n=7, diagonal artery n=6, left anterior descending artery n=1, and right internal mammary artery to right coronary artery n=1) were studied in 27 asymptomatic patients. In this prospective study, each bypass was studied intra-operatively using Doppler flow measurement. Within one week post surgery, patients were studied using a 3-T MR scanner (Magnetom Verio, Siemens, Erlangen, Germany) using velocity encoded phase-contrast flow measurements. RESULTS Intraoperative Doppler flow measurements demonstrated regular flow patterns in all vascular territories supplied. All bypasses were patent on MRI and flow measurement results were as follows: median flow 60ml/min (interquartile range (IQR): 37.5-78.5ml/min). For comparison, the corresponding median intraoperative flow was 58ml/min (IQR: 41-80ml/min) (p<0.001; R=0.44). Linear regression analysis demonstrated a significant correlation for venous bypasses (p=0.0002; R=0.48), but not for arterial bypasses (p=0.09; R=0.24). CONCLUSION This study demonstrated that MR flow measurements of venous bypass grafts agreed more with Doppler than arterial bypass grafts. However, bypass patency was confirmed for all patients. In the future, this technique may be used for non invasive coronary bypass graft follow-up.
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Affiliation(s)
- David Reineke
- Cardiovascular Surgery, University Hospital Bern, Switzerland
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Valverde I, Parish V, Tzifa A, Head C, Sarikouch S, Greil G, Schaeffter T, Razavi R, Beerbaum P. Cardiovascular MR dobutamine stress in adult tetralogy of fallot: Disparity between CMR volumetry and flow for cardiovascular function. J Magn Reson Imaging 2011; 33:1341-50. [DOI: 10.1002/jmri.22573] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Di Giovanni P, Ahearn TS, Semple SI, Azlan CA, Lloyd WKC, Gilbert FJ, Redpath TW. Use of a capillary input function with cardiac output for the estimation of lesion pharmacokinetic parameters: preliminary results on a breast cancer patient. Phys Med Biol 2011; 56:1743-53. [DOI: 10.1088/0031-9155/56/6/014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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McLure LER, Brown A, Lee WN, Church AC, Peacock AJ, Johnson MK. Non-invasive stroke volume measurement by cardiac magnetic resonance imaging and inert gas rebreathing in pulmonary hypertension. Clin Physiol Funct Imaging 2011; 31:221-6. [PMID: 21470362 DOI: 10.1111/j.1475-097x.2010.01004.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Right ventricular function determines the prognosis of pulmonary hypertension (PAH). Measurement of stroke volume (SV) non-invasively could be a promising method to monitor disease progression. Cardiac magnetic resonance (CMR) imaging is recognized as an accurate and reproducible method to measure SV. Inert gas rebreathing (IGR) using acetylene is a validated but cumbersome method for pulmonary blood flow (PBF) measurement in PAH. A more convenient rebreathing technique using rapid photoacoustic analysis of nitrous oxide has been introduced and validated in left heart failure. We investigated the accuracy of CMR imaging and IGR using photoacoustic analysis to measure SV in patients under investigation for PAH. METHODS Thirty-three patients (16♀:17♂) with suspected PAH following echocardiography had SV measured by CMR imaging (using pulmonary arterial{CMR PA} and aortic {CMR Ao} flow methods) and IGR. The results were compared with our reference standard: thermodilution (TD) measured during right heart catheterization (RHC). RESULTS All methods showed similar correlation for SV. Bland-Altman analysis confirmed acceptable levels of agreement between the four techniques. TD versus CMR Ao flow had bias (limits of agreement) of -5.41 ml (-22.37 to 11.56 ml), TD versus CMR PA flow 0.12 ml (-20.13 to 20.37 ml) and TD versus IGR 6.25 ml (-16.01 to 28.51 ml). CONCLUSION Cardiac magnetic resonance imaging and IGR using photoacoustic analysis in patients with suspected PAH provided non-invasive measurements of SV that agreed closely with those obtained from TD measured during RHC.
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Affiliation(s)
- Lindsey E R McLure
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, Scotland, UK
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Flow assessment through four heart valves simultaneously using 3-dimensional 3-directional velocity-encoded magnetic resonance imaging with retrospective valve tracking in healthy volunteers and patients with valvular regurgitation. Invest Radiol 2010; 44:669-75. [PMID: 19724233 DOI: 10.1097/rli.0b013e3181ae99b5] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To validate 3-dimensional (3D) 3-directional velocity-encoded (VE) magnetic resonance imaging (MRI) for flow assessment through all 4 heart valves simultaneously with retrospective valve-tracking during off-line analysis in healthy volunteers and in patients with valvular regurgitation. MATERIAL AND METHODS Three-dimensional 3-directional VE MRI was performed in 22 healthy volunteers and in 29 patients with ischemic cardiomyopathy who were suspected of valvular regurgitation and net flow volumes through the 4 heart valves were compared. Furthermore, the analysis was repeated for each valve in 10 healthy volunteers and in 10 regurgitant valves to assess intra- and interobserver agreement for assessment of respectively net flow volumes and regurgitation fraction. RESULTS In healthy volunteers, the average net flow volume through the mitral valve, tricuspid valve, aortic valve, and pulmonary valve was 85 +/- 20 mL, 85 +/- 21 mL, 83 +/- 19 mL, 82 +/- 21 mL, respectively. Strong correlations between net flow volumes through the 4 heart valves were observed (intraclass correlation coefficients [ICC] 0.93-0.95) and the coefficient of variance (CV) was small (6%-9%). The repeated analysis by the same observer and by a second observer yielded good agreement for measurement of net flow volumes (ICC: 0.93-0.99 and CV: 3%-7%). Strong correlations between the net flow volumes through the 4 heart valves were also observed in the patients with valvular regurgitation (ICC: 0.85-0.95 and CV: 7%-18%). The average net flow volume through the mitral valve, tricuspid valve, aortic valve, and pulmonary valve was 63 +/- 20 mL, 63 +/- 20 mL, 63 +/- 20 mL, 63 +/- 20 mL, respectively. Furthermore, the intra- and interobserver agreement for assessment of regurgitation fraction was good (ICC: 0.86 and 0.85, CV: 12% and 13%). CONCLUSIONS Flow assessment using 3D 3-directional VE MR with retrospective valve-tracking during off-line analysis enables accurate quantification of net flow volumes through 4 heart valves within a single acquisition in healthy volunteers and in patients with valvular regurgitation.
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van der Hulst AE, Westenberg JJM, Kroft LJM, Bax JJ, Blom NA, de Roos A, Roest AAW. Tetralogy of fallot: 3D velocity-encoded MR imaging for evaluation of right ventricular valve flow and diastolic function in patients after correction. Radiology 2010; 256:724-34. [PMID: 20634432 DOI: 10.1148/radiol.10092269] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate three-dimensional (3D) velocity-encoded (VE) magnetic resonance (MR) imaging, as compared with two-dimensional (2D) VE MR imaging, for assessment of pulmonary valve (PV) and tricuspid valve (TV) flow, with planimetry as the reference standard, and to evaluate diastolic function in patients with a corrected tetralogy of Fallot (TOF). MATERIALS AND METHODS Local institutional review board approval was obtained, and patients or their parents gave informed consent. Twenty-five patients with a corrected TOF (12 male, 13 female; mean age, 13.1 years +/- 2.7 [standard deviation]; age range, 8-18 years) and 19 control subjects (12 male, seven female; mean age, 14.1 years +/- 2.4; age range, 8-18 years) underwent planimetric MR imaging, 2D VE MR imaging, and 3D VE MR imaging for TV and PV flow evaluation. For evaluation of diastolic function, PV and TV flow were summated. Data were analyzed by using linear regression analysis, paired and unpaired t testing, and Bland-Altman plots. RESULTS Strong correlations between the 2D VE MR and 3D VE MR measurements of PV flow (for forward flow: r = 0.87, P < .01; for backward flow: r = 0.97, P < .01) were observed. With PV effective flow as a reference, 3D TV effective flow measurements were more accurate than 2D TV effective flow measurements: In patients, the mean 2D TV effective flow versus 2D PV effective flow difference was 17.6 mL +/- 11 (P < .001), and the mean 3D TV effective flow versus 3D PV effective flow difference was -1.2 mL +/- 4.7 (P = .22). Diastolic functional impairment in patients could be detected at 3D VE MR imaging diastolic assessment. CONCLUSION Three-dimensional VE MR imaging is accurate for PV flow assessment and is more accurate than 2D VE MR imaging for TV flow evaluation. Assessment of diastolic function with 3D VE MR imaging can facilitate ongoing research of diastolic dysfunction in patients with a corrected TOF.
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Affiliation(s)
- Annelies E van der Hulst
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, RC, Leiden, The Netherlands
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Festa P, Ait-Ali L, Minichilli F, Kristo I, Deiana M, Picano E. A New Simple Method to Estimate Pulmonary Regurgitation by Echocardiography in Operated Fallot: Comparison With Magnetic Resonance Imaging and Performance Test Evaluation. J Am Soc Echocardiogr 2010; 23:496-503. [DOI: 10.1016/j.echo.2010.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Indexed: 11/25/2022]
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Harloff A, Markl M, Frydrychowicz A, Hennig J, Weiller C. [Diagnosing stroke aetiologies. Morphologic and functional analysis of the aorta and carotid arteries by MRI]. DER NERVENARZT 2009; 80:929-40. [PMID: 19319500 DOI: 10.1007/s00115-009-2679-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Magnetic resonance imaging allows detailed visualization of the thoracic aorta and is not limited by air artefacts or insonation angles like transoesophageal echocardiography (TEE). Thus the aortic arch can be investigated with higher accuracy, and additional embolic high-risk sources such as complex plaques can be additionally detected by MRI in patients with cryptogenic stroke. Furthermore, MRI provides exact 3D plaque localisation and can be combined with multidirectional 3D MRI velocity mapping. In this way, previously not demonstrable retrograde flow paths originating at complex descending aortic plaques reaching the supra-aortic great arteries can be identified as the probable stroke mechanism in certain patients. The same technique can also be applied to the carotid arteries. This allows analysing the complex 3D helical flow within the internal carotid artery as well as measuring absolute flow velocities and wall shear stress in combination with data on vessel anatomy derived from conventional MR angiography. It is the purpose of this work to describe the state of the art of these modern MR imaging techniques and their potential to identify potential stroke mechanisms, and to analyse the particular role of individual haemodynamic factors on the development of local atherosclerosis.
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Affiliation(s)
- A Harloff
- Abteilung Neurologie, Neurozentrum, Universitätsklinikum, Breisacher Str. 64, 79106 Freiburg.
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Zhang JL, Rusinek H, Bokacheva L, Chen Q, Storey P, Lee VS. Use of cardiac output to improve measurement of input function in quantitative dynamic contrast-enhanced MRI. J Magn Reson Imaging 2009; 30:656-65. [PMID: 19711414 DOI: 10.1002/jmri.21891] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To validate a new method for converting MR arterial signal intensity versus time curves to arterial input functions (AIFs). MATERIALS AND METHODS The method constrains AIF with patient's cardiac output (Q). Monte Carlo simulations of MR renography and tumor perfusion protocols were carried out for comparison with two alternative methods: direct measurement and population-averaged input function. MR renography was performed to assess the method's inter- and intraday reproducibility for renal parameters. RESULTS In simulations of tumor perfusion, the precision of the parameters (K(trans) and v(e)) computed using the proposed method was improved by at least a factor of three compared to direct measurement. Similar improvements were obtained in simulations of MR renography. Volunteer study for testing interday reproducibility confirmed the improvement of precision in renal parameters when using the proposed method compared to conventional methods. In another patient study (two injections within one session), the proposed method significantly increased the correlation coefficient (R) between GFR of the two exams (0.92 vs. 0.83) compared to direct measurement. CONCLUSION A new method significantly improves the precision of dynamic contrast-enhanced (DCE) parameters. The method may be especially useful for analyzing repeated DCE examinations, such as monitoring tumor therapy or angiotensin converting enzyme-inhibitor renography.
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Affiliation(s)
- Jeff L Zhang
- Department of Radiology, New York University School of Medicine, New York, NY, USA.
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Frydrychowicz A, Stalder AF, Russe MF, Bock J, Bauer S, Harloff A, Berger A, Langer M, Hennig J, Markl M. Three-dimensional analysis of segmental wall shear stress in the aorta by flow-sensitive four-dimensional-MRI. J Magn Reson Imaging 2009; 30:77-84. [PMID: 19557849 DOI: 10.1002/jmri.21790] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the distribution and regional differences of flow and vessel wall parameters such as wall shear stress (WSS) and oscillatory shear index (OSI) in the entire thoracic aorta. MATERIALS AND METHODS Thirty-one healthy volunteers (mean age = 23.7 +/- 3.3 years) were examined by flow-sensitive four-dimensional (4D)-MRI at 3T. For eight retrospectively positioned 2D analysis planes distributed along the thoracic aorta, flow parameters and vectorial WSS and OSI were assessed in 12 segments along the vascular circumference. RESULTS Mean absolute time-averaged WSS ranged between 0.25 +/- 0.04 N/m(2) and 0.33 +/- 0.07 N/m(2) and incorporated a substantial circumferential component (-0.05 +/- 0.04 to 0.07 +/- 0.02 N/m(2)). For each analysis plane, a segment with lowest absolute WSS and highest OSI was identified which differed significantly from mean values within the plane (P < 0.05). The distribution of atherogenic low WSS and high OSI closely resembled typical locations of atherosclerotic lesions at the inner aortic curvature and supraaortic branches. CONCLUSION The normal distribution of vectorial WSS and OSI in the entire thoracic aorta derived from flow-sensitive 4D-MRI data provides a reference constituting an important perquisite for the examination of patients with aortic disease. Marked regional differences in absolute WSS and OSI may help explaining why atherosclerotic lesions predominantly develop and progress at specific locations in the aorta.
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Affiliation(s)
- Alex Frydrychowicz
- Department of Diagnostic Radiology and Medical Physics, University Hospital Freiburg, Freiburg, Germany
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Uribe S, Beerbaum P, Sørensen TS, Rasmusson A, Razavi R, Schaeffter T. Four-dimensional (4D) flow of the whole heart and great vessels using real-time respiratory self-gating. Magn Reson Med 2009; 62:984-92. [DOI: 10.1002/mrm.22090] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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