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von Spiczak J, Mannil M, Model H, Schwemmer C, Kozerke S, Ruschitzka F, Alkadhi H, Manka R. Multimodal Multiparametric Three-dimensional Image Fusion in Coronary Artery Disease: Combining the Best of Two Worlds. Radiol Cardiothorac Imaging 2020; 2:e190116. [PMID: 33778554 PMCID: PMC7977970 DOI: 10.1148/ryct.2020190116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/19/2019] [Accepted: 09/26/2019] [Indexed: 11/11/2022]
Abstract
PURPOSE To allow for comprehensive noninvasive diagnostics of coronary artery disease (CAD) by using three-dimensional (3D) image fusion of CT coronary angiography, CT-derived fractional flow reserve (CT FFR), whole-heart dynamic 3D cardiac MRI perfusion, and 3D cardiac MRI late gadolinium enhancement (LGE). MATERIALS AND METHODS Seventeen patients (54 years ± 10 [standard deviation], one female) who underwent cardiac CT and cardiac MRI were included (combined subcohort of three prospective trials). Software facilitating multimodal 3D image fusion was developed. Postprocessing of CT data included segmentation of the coronary tree and heart contours, calculation of CT FFR values, and color coding of the coronary tree according to CT FFR. Postprocessing of cardiac MRI data included segmentation of the left ventricle (LV) in cardiac MRI perfusion and cardiac MRI LGE, co-registration of cardiac MRI to CT data, and projection of cardiac MRI perfusion and LGE values onto the high spatial resolution LV from CT. RESULTS Image quality was rated as good to excellent (scores: 2.5-2.6; 3 = excellent). CT coronary angiography revealed significant stenoses in seven of 17 cases (41%). CT FFR was possible in 16 of 17 cases (94%) and showed pathologic flow in seven of 17 cases (41%), six of which coincided with cases revealing significant stenoses at CT coronary angiography. Cardiac MRI perfusion identified eight of 17 patients (47%) with hypoperfusion (ischemic burden of 17% ± 5). Cardiac MRI LGE showed myocardial scar in three of 17 cases (18%, scar burden of 7% ± 4). Conventional two-dimensional readout of CT coronary angiography and cardiac MRI resulted in eight of 17 cases (47%) with uncertain findings. Most of these divergent findings could be solved when adding information from CT FFR and 3D image fusion (six of eight, 75%). CONCLUSION Multimodal 3D cardiac image fusion is feasible and may help with comprehensive noninvasive CAD diagnostics.Supplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
- Jochen von Spiczak
- From the Institute of Diagnostic and Interventional Radiology (J.v.S., M.M., H.M., H.A., R.M.) and Department of Cardiology, University Heart Center (F.R., R.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Siemens Healthineers, Forchheim, Germany (C.S.); and Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland (J.v.S., S.K., R.M.)
| | - Manoj Mannil
- From the Institute of Diagnostic and Interventional Radiology (J.v.S., M.M., H.M., H.A., R.M.) and Department of Cardiology, University Heart Center (F.R., R.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Siemens Healthineers, Forchheim, Germany (C.S.); and Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland (J.v.S., S.K., R.M.)
| | - Hanna Model
- From the Institute of Diagnostic and Interventional Radiology (J.v.S., M.M., H.M., H.A., R.M.) and Department of Cardiology, University Heart Center (F.R., R.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Siemens Healthineers, Forchheim, Germany (C.S.); and Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland (J.v.S., S.K., R.M.)
| | - Chris Schwemmer
- From the Institute of Diagnostic and Interventional Radiology (J.v.S., M.M., H.M., H.A., R.M.) and Department of Cardiology, University Heart Center (F.R., R.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Siemens Healthineers, Forchheim, Germany (C.S.); and Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland (J.v.S., S.K., R.M.)
| | - Sebastian Kozerke
- From the Institute of Diagnostic and Interventional Radiology (J.v.S., M.M., H.M., H.A., R.M.) and Department of Cardiology, University Heart Center (F.R., R.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Siemens Healthineers, Forchheim, Germany (C.S.); and Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland (J.v.S., S.K., R.M.)
| | - Frank Ruschitzka
- From the Institute of Diagnostic and Interventional Radiology (J.v.S., M.M., H.M., H.A., R.M.) and Department of Cardiology, University Heart Center (F.R., R.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Siemens Healthineers, Forchheim, Germany (C.S.); and Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland (J.v.S., S.K., R.M.)
| | - Hatem Alkadhi
- From the Institute of Diagnostic and Interventional Radiology (J.v.S., M.M., H.M., H.A., R.M.) and Department of Cardiology, University Heart Center (F.R., R.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Siemens Healthineers, Forchheim, Germany (C.S.); and Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland (J.v.S., S.K., R.M.)
| | - Robert Manka
- From the Institute of Diagnostic and Interventional Radiology (J.v.S., M.M., H.M., H.A., R.M.) and Department of Cardiology, University Heart Center (F.R., R.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Siemens Healthineers, Forchheim, Germany (C.S.); and Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland (J.v.S., S.K., R.M.)
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Nudi F, Biondi-Zoccai G, Romagnoli A, Schillaci O, Nudi A, Versaci F. Hybrid anatomo-functional imaging of coronary artery disease: Beneficial irrespective of its core components. J Nucl Cardiol 2019; 26:752-762. [PMID: 30565061 DOI: 10.1007/s12350-018-01562-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 09/19/2018] [Indexed: 02/05/2023]
Abstract
Coronary artery disease (CAD) is the most common and important cause of ischemic heart disease, with major implications on global morbidity and mortality. Non-invasive testing is crucial in the diagnostic and prognostic work-up of patients with or at risk of CAD, and also to guide decision making in terms of pharmacologic and revascularization therapy. The traditional paradigm is to view anatomic (i.e., coronary computed tomography) and functional imaging (e.g., myocardial perfusion scintigraphy) tests as opposing alternatives. Such approach is too reductionist and does not capitalize on the strengths of each type of test while risking to overlook the inherent limitations. The combination of anatomic and functional tests in a logic of hybrid imaging holds the promise of overcoming the limitations inherent to anatomic and functional testing, enabling more accurate diagnosis, prognosis, and guidance for revascularization in patients with CAD.
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Affiliation(s)
- Francesco Nudi
- Service of Hybrid Cardio Imaging, Madonna Della Fiducia Clinic, Rome, Italy.
- Ostia Radiologica, Rome, Italy.
- Replycare, Viale Africa 36, 00144, Rome, Italy.
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- IRCCS NEUROMED, Pozzilli, Italy
| | | | - Orazio Schillaci
- IRCCS NEUROMED, Pozzilli, Italy
- Department of Nuclear Medicine, Tor Vergata University, Rome, Italy
| | - Alessandro Nudi
- Service of Hybrid Cardio Imaging, Madonna Della Fiducia Clinic, Rome, Italy
- Replycare, Viale Africa 36, 00144, Rome, Italy
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Patel AR, Maffessanti F, Patel MB, Kebed K, Narang A, Singh A, Medvedofsky D, Zaidi SJ, Mediratta A, Goyal N, Kachenoura N, Lang RM, Mor-Avi V. Hemodynamic impact of coronary stenosis using computed tomography: comparison between noninvasive fractional flow reserve and 3D fusion of coronary angiography with stress myocardial perfusion. Int J Cardiovasc Imaging 2019; 35:1733-1743. [PMID: 31073698 DOI: 10.1007/s10554-019-01618-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/30/2019] [Indexed: 01/06/2023]
Abstract
Vasodilator-stress CT perfusion imaging in addition to CT coronary angiography (CTCA) may provide a single-test alternative to nuclear stress testing, commonly used to assess hemodynamic significance of stenosis. Another alternative is fractional flow reserve (FFR) calculated from cardiac CT images. We studied the concordance between these two approaches and their relationship to outcomes. We prospectively studied 150 patients with chest pain, who underwent CTCA and regadenoson CT. CTCA images were interpreted for presence and severity of stenosis. Fused 3D displays of subendocardial X-ray attenuation with coronary arteries were created to detect stress perfusion defects (SPD) in each coronary territory. In patients with stenosis > 25%, CT-FFR was quantified. Significant stenosis was determined by: (1) combination of stenosis > 50% with an SPD, (2) CT-FFR ≤ 0.80. Patients were followed-up for 36 ± 25 months for death, myocardial infarction or revascularization. After excluding patients with normal arteries and technical/quality issues, in final analysis of 76 patients, CTCA depicted stenosis > 70% in 13/224 arteries, 50-70% in 24, and < 50% in 187. CT-FFR ≤ 0.80 was found in 41/224 arteries, and combination of SPD with > 50% stenosis in 31/224 arteries. Inter-technique agreement was 89%. Despite high incidence of abnormal CT-FFR (30/76 patients), only 7 patients experienced adverse outcomes; 6/7 also had SPDs. Only 1/9 patients with CT-FFR ≤ 0.80 but normal perfusion had an event. Fusion of CTCA and stress perfusion can help determine the hemodynamic impact of stenosis in one test, in good agreement with CT-FFR. Adding stress CT perfusion analysis may help risk-stratify patients with abnormal CT-FFR.
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Affiliation(s)
- Amit R Patel
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Francesco Maffessanti
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA.,Institute of Computational Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Mita B Patel
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Kalie Kebed
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Akhil Narang
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Amita Singh
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Diego Medvedofsky
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - S Javed Zaidi
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA.,Cardiology Department, Advocate Children's Hospital, Chicago, IL, USA
| | - Anuj Mediratta
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Neha Goyal
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Nadjia Kachenoura
- Laboratoire d'Imagerie Biomédicale, INSERM, CNRS, Sorbonne Université, Paris, France
| | - Roberto M Lang
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA
| | - Victor Mor-Avi
- Department of Medicine, Section of Cardiology, University of Chicago Medical Center, 5758 South Maryland Avenue, M.C. 9067, Chicago, IL, 60637, USA.
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Maffessanti F, Patel AR, Patel MB, Walter JJ, Mediratta A, Medvedofsky D, Kachenoura N, Lang RM, Mor-Avi V. Non-invasive assessment of the haemodynamic significance of coronary stenosis using fusion of cardiac computed tomography and 3D echocardiography. Eur Heart J Cardiovasc Imaging 2018; 18:670-680. [PMID: 27461212 DOI: 10.1093/ehjci/jew147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/21/2016] [Indexed: 12/23/2022] Open
Abstract
Aims Abnormal computed tomography coronary angiography (CTCA) often leads to stress testing to determine haemodynamic significance of stenosis. We hypothesized that instead, this could be achieved by fusion imaging of the coronary anatomy with 3D echocardiography (3DE)-derived resting myocardial deformation. Methods and results We developed fusion software that creates combined 3D displays of the coronary arteries with colour maps of longitudinal strain and tested it in 28 patients with chest pain, referred for CTCA (256 Philips scanner) who underwent 3DE (Philips iE33) and regadenoson stress CT. To obtain a reference for stenosis significance, coronaries were also fused with colour maps of stress myocardial perfusion. 3D displays were used to detect stress perfusion defect (SPD) and/or resting strain abnormality (RSA) in each territory. CTCA showed 56 normal arteries, stenosis <50% in 17, and >50% in 8 arteries. Of the 81 coronary territories, SPDs were noted in 20 and RSAs in 29. Of the 59 arteries with no stenosis >50% and no SPDs, considered as normal, 12 (20%) had RSAs. Conversely, with stenosis >50% and SPDs (haemodynamically significant), RSAs were considerably more frequent (5/6 = 83%). Overall, resting strain and stress perfusion findings were concordant in 64/81 arteries (79% agreement). Conclusions Fusion of CTCA and 3DE-derived data allows direct visualization of each coronary artery and strain in its territory. In this feasibility study, resting strain showed good agreement with stress perfusion, indicating that it may be potentially used to assess haemodynamic impact of coronary stenosis, as an alternative to stress testing that entails additional radiation exposure.
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Affiliation(s)
| | - Amit R Patel
- University of Chicago Medical Center, Chicago, IL, USA
| | - Mita B Patel
- University of Chicago Medical Center, Chicago, IL, USA
| | | | | | | | - Nadjia Kachenoura
- University of Chicago Medical Center, Chicago, IL, USA.,Laboratoire d'Imagerie Biomédicale, Sorbonne Universités, UPMC University Paris 06, CNRS 7371, INSERM 1146, F-75013, Paris, France
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Fusion of Three-Dimensional Echocardiographic Regional Myocardial Strain with Cardiac Computed Tomography for Noninvasive Evaluation of the Hemodynamic Impact of Coronary Stenosis in Patients with Chest Pain. J Am Soc Echocardiogr 2018; 31:664-673. [PMID: 29576220 DOI: 10.1016/j.echo.2018.01.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Combined evaluation of coronary stenosis and the extent of ischemia is essential in patients with chest pain. Intermediate-grade stenosis on computed tomographic coronary angiography (CTCA) frequently triggers downstream nuclear stress testing. Alternative approaches without stress and/or radiation may have important implications. Myocardial strain measured from echocardiographic images can be used to detect subclinical dysfunction. The authors recently tested the feasibility of fusion of three-dimensional (3D) echocardiography-derived regional resting longitudinal strain with coronary arteries from CTCA to determine the hemodynamic significance of stenosis. The aim of the present study was to validate this approach against accepted reference techniques. METHODS Seventy-eight patients with chest pain referred for CTCA who also underwent 3D echocardiography and regadenoson stress computed tomography were prospectively studied. Left ventricular longitudinal strain data (TomTec) were used to generate fused 3D displays and detect resting strain abnormalities (RSAs) in each coronary territory. Computed tomographic coronary angiographic images were interpreted for the presence and severity of stenosis. Fused 3D displays of subendocardial x-ray attenuation were created to detect stress perfusion defects (SPDs). In patients with stenosis >25% in at least one artery, fractional flow reserve was quantified (HeartFlow). RSA as a marker of significant stenosis was validated against two different combined references: stenosis >50% on CTCA and SPDs seen in the same territory (reference standard A) and fractional flow reserve < 0.80 and SPDs in the same territory (reference standard B). RESULTS Of the 99 arteries with no stenosis >50% and no SPDs, considered as normal, 19 (19%) had RSAs. Conversely, with stenosis >50% and SPDs, RSAs were considerably more frequent (17 of 24 [71%]). The sensitivity, specificity, and accuracy of RSA were 0.71, 0.81, and 0.79, respectively, against reference standard A and 0.83, 0.81, and 0.82 against reference standard B. CONCLUSIONS Fusion of CTCA and 3D echocardiography-derived resting myocardial strain provides combined displays, which may be useful in determination of the hemodynamic or functional impact of coronary abnormalities, without additional ionizing radiation or stress testing.
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von Spiczak J, Manka R, Mannil M, Oebel S, Hamada S, Higashigaito K, Klotz E, Ruschitzka F, Alkadhi H. 3D fusion of coronary CT angiography and CT myocardial perfusion imaging: Intuitive assessment of morphology and function. J Cardiovasc Comput Tomogr 2017; 11:437-443. [DOI: 10.1016/j.jcct.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 09/04/2017] [Indexed: 10/18/2022]
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Fusion of CT coronary angiography and whole-heart dynamic 3D cardiac MR perfusion: building a framework for comprehensive cardiac imaging. Int J Cardiovasc Imaging 2017; 34:649-660. [DOI: 10.1007/s10554-017-1260-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
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Wang G, Kalra M, Murugan V, Xi Y, Gjesteby L, Getzin M, Yang Q, Cong W, Vannier M. Vision 20/20: Simultaneous CT-MRI--Next chapter of multimodality imaging. Med Phys 2016; 42:5879-89. [PMID: 26429262 DOI: 10.1118/1.4929559] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Multimodality imaging systems such as positron emission tomography-computed tomography (PET-CT) and MRI-PET are widely available, but a simultaneous CT-MRI instrument has not been developed. Synergies between independent modalities, e.g., CT, MRI, and PET/SPECT can be realized with image registration, but such postprocessing suffers from registration errors that can be avoided with synchronized data acquisition. The clinical potential of simultaneous CT-MRI is significant, especially in cardiovascular and oncologic applications where studies of the vulnerable plaque, response to cancer therapy, and kinetic and dynamic mechanisms of targeted agents are limited by current imaging technologies. The rationale, feasibility, and realization of simultaneous CT-MRI are described in this perspective paper. The enabling technologies include interior tomography, unique gantry designs, open magnet and RF sequences, and source and detector adaptation. Based on the experience with PET-CT, PET-MRI, and MRI-LINAC instrumentation where hardware innovation and performance optimization were instrumental to construct commercial systems, the authors provide top-level concepts for simultaneous CT-MRI to meet clinical requirements and new challenges. Simultaneous CT-MRI fills a major gap of modality coupling and represents a key step toward the so-called "omnitomography" defined as the integration of all relevant imaging modalities for systems biology and precision medicine.
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Affiliation(s)
- Ge Wang
- Biomedical Imaging Center/Cluster, Rensselaer Polytechnic Institute, Troy, New York 12180
| | - Mannudeep Kalra
- Department of Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114
| | - Venkatesh Murugan
- Department of Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114
| | - Yan Xi
- Biomedical Imaging Center/Cluster, Rensselaer Polytechnic Institute, Troy, New York 12180
| | - Lars Gjesteby
- Biomedical Imaging Center/Cluster, Rensselaer Polytechnic Institute, Troy, New York 12180
| | - Matthew Getzin
- Biomedical Imaging Center/Cluster, Rensselaer Polytechnic Institute, Troy, New York 12180
| | - Qingsong Yang
- Biomedical Imaging Center/Cluster, Rensselaer Polytechnic Institute, Troy, New York 12180
| | - Wenxiang Cong
- Biomedical Imaging Center/Cluster, Rensselaer Polytechnic Institute, Troy, New York 12180
| | - Michael Vannier
- Department of Radiology, University of Chicago, Chicago, Illinois 60637
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Cardiac hybrid imaging. Eur J Nucl Med Mol Imaging 2014; 41 Suppl 1:S91-103. [DOI: 10.1007/s00259-013-2566-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 08/27/2013] [Indexed: 01/07/2023]
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A historical overview of magnetic resonance imaging, focusing on technological innovations. Invest Radiol 2013; 47:725-41. [PMID: 23070095 DOI: 10.1097/rli.0b013e318272d29f] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Magnetic resonance imaging (MRI) has now been used clinically for more than 30 years. Today, MRI serves as the primary diagnostic modality for many clinical problems. In this article, historical developments in the field of MRI will be discussed with a focus on technological innovations. Topics include the initial discoveries in nuclear magnetic resonance that allowed for the advent of MRI as well as the development of whole-body, high field strength, and open MRI systems. Dedicated imaging coils, basic pulse sequences, contrast-enhanced, and functional imaging techniques will also be discussed in a historical context. This article describes important technological innovations in the field of MRI, together with their clinical applicability today, providing critical insights into future developments.
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