MRI-Guided Cardiac RF Ablation for Comparing MRI Characteristics of Acute Lesions and Associated Electrophysiologic Voltage Reductions

MR-based electrical property tomography using a physics-informed network at 3 and 7 T

Magnetic resonance electrical propert tomography promises to retrieve electrical properties (EPs) quantitatively and non-invasively in vivo, providing valuable information for tissue characterization and pathology diagnosis. However, its clinical implementation has been hindered by, for example, B1 measurement accuracy, reconstruction artifacts resulting from inaccuracies in underlying models, and stringent hardware/software requirements. To address these challenges, we present a novel approach aimed at accurate and high-resolution EPs reconstruction based on water content maps by using a physics-informed network (PIN-wEPT). The proposed method utilizes standard clinical protocols and conventional multi-channel receive arrays that have been routinely equipped in clinical settings, thus eliminating the need for specialized RF sequence/coil configurations. Compared with the original wEPT method, the network generates accurate water content maps that effectively eliminate the influence ofB → 1 + andB → 1 - by incorporating data mismatch with electrodynamic constraints derived from the Helmholtz equation. Subsequent regression analysis develops a broad relationship between water content and EPs across various types of brain tissue. A series of numerical simulations was conducted at 7 T to assess the feasibility and performance of the method, which encompassed four normal head models and models with tumorous tissues incorporated, and the results showed normalized mean square error below 1.0% in water content, below 11.7% in conductivity, and below 1.1% in permittivity reconstructions for normal brain tissues. Moreover, in vivo validations conducted over five healthy subjects at both 3 and 7 T showed reasonably good consistency with empirical EPs values across the white matter, gray matter, and cerebrospinal fluid. The PIN-wEPT method, with its demonstrated efficacy, flexibility, and compatibility with current MRI scanners, holds promising potential for future clinical application.

Bias correction for phase-based cr-MREPT using low resolution B1+ magnitude

ObjectiveFull-form Magnetic Resonance Electrical Properties Tomography (MREPT) requires bothB1+magnitude and phase information. SinceB1+phase can be obtained faster and with higher SNR compared toB1+magnitude, several phase-based methods have been developed for conductivity imaging. However, phase-based methods suffer from a concave bias due to the assumption that∇|B1+|is negligible in the ROI.ApproachIn this paper, we re-derive the central equation of phase-based cr-MREPT without assuming that∇|B1+|is negligible and thus propose a correction method directly integrated into the equation system.Main resultsProposed method successfully corrects the concave bias on both simulated and experimental data and significantly increases image quality.SignificanceThe proposed correction method depends on a very low-resolution|B1+|map, and therefore the imaging time does not increase significantly for obtainingB1+magnitude. Moreover, correction can be achieved using simulatedB1+magnitude, hence completely removing the additional imaging requirement.

Tissue characterization of acute lesions during cardiac magnetic resonance-guided ablation of cavo-tricuspid isthmus-dependent atrial flutter: a feasibility study

AIMS

To characterize acute lesions during cardiac magnetic resonance (CMR)-guided radiofrequency (RF) ablation of cavo-tricuspid isthmus (CTI)-dependent atrial flutter by combining T2-weighted imaging (T2WI), T1 mapping, first-pass perfusion, and late gadolinium enhancement (LGE) imaging. CMR-guided catheter ablation offers a unique opportunity to investigate acute ablation lesions. Until present, studies only used T2WI and LGE CMR to assess acute lesions.

METHODS AND RESULTS

Fifteen patients with CTI-dependent atrial flutter scheduled for CMR-guided RF ablation were prospectively enrolled. Directly after achieving bidirectional block of the CTI line, CMR imaging was performed using: T2WI (n = 15), T1 mapping (n = 10), first-pass perfusion (n = 12), and LGE (n = 12) imaging. In case of acute reconnection, additional RF ablation was performed. In all patients, T2WI demonstrated oedema in the ablation region. Right atrial T1 mapping was feasible and could be analysed with a high inter-observer agreement (r = 0.931, ICC 0.921). The increase in T1 values post-ablation was significantly lower in regions showing acute reconnection compared with regions without reconnection [37 ± 90 ms vs. 115 ± 69 ms (P = 0.014), and 3.9 ± 9.0% vs. 11.1 ± 6.8% (P = 0.022)]. Perfusion defects were present in 12/12 patients. The LGE images demonstrated hyper-enhancement with a central area of hypo-enhancement in 12/12 patients.

CONCLUSION

Tissue characterization of acute lesions during CMR-guided CTI-dependent atrial flutter ablation demonstrates oedema, perfusion defects, and necrosis with a core of microvascular damage. Right atrial T1 mapping is feasible, and may identify regions of acute reconnection that require additional RF ablation.