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Li XM, Jiang L, Min CY, Yan WF, Shen MT, Liu XJ, Guo YK, Yang ZG. Myocardial Perfusion Imaging by Cardiovascular Magnetic Resonance: Research Progress and Current Implementation. Curr Probl Cardiol 2023; 48:101665. [PMID: 36828047 DOI: 10.1016/j.cpcardiol.2023.101665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
Cardiovascular diseases pose a significant health and economic burden worldwide, with coronary artery disease still recognized as a major problem. It is closely associated with hypertension, diabetes, obesity, smoking, lack of exercise, poor diet, and excessive alcohol consumption, which may lead to macro- and microvascular abnormalities in the heart. Coronary artery stenosis reduces the local supply of oxygen and nutrients to the myocardium and results in reduced levels of myocardial perfusion, which can lead to more severe conditions and irreversible damage to myocardial tissues. Therefore, accurate evaluation of myocardial perfusion abnormalities in patients with these risk factors is critical. As technology advances, magnetic resonance myocardial perfusion imaging has become more accurate at evaluating the myocardial microcirculation and has shown a powerful ability to detect myocardial ischemia. The purpose of this review is to summarize the principle, research progress of acquisition and analysis, and clinical implementation of cardiovascular magnetic resonance (CMR) myocardial perfusion imaging.
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Affiliation(s)
- Xue-Ming Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Cardiovascular Diseases, Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chen-Yan Min
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiao-Jing Liu
- Laboratory of Cardiovascular Diseases, Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Quinaglia T, Jerosch-Herold M, Coelho-Filho OR. State-of-the-Art Quantitative Assessment of Myocardial Ischemia by Stress Perfusion Cardiac Magnetic Resonance. Magn Reson Imaging Clin N Am 2020; 27:491-505. [PMID: 31279452 DOI: 10.1016/j.mric.2019.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Ischemic heart disease remains the foremost determinant of death and disability across the world. Quantification of the ischemia burden is currently the preferred approach to predict event risk and to trigger adequate treatment. Cardiac magnetic resonance (CMR) can be a prime protagonist in this scenario due to its synergistic features. It allows assessment of wall motility, myocardial perfusion, and tissue scar by means of late gadolinium enhancement imaging. We discuss the clinical and preclinical aspects of gadolinium-based, perfusion CMR imaging, including the relevance of high spatial resolution and 3-dimensional whole-heart coverage, among important features of this auspicious method.
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Affiliation(s)
- Thiago Quinaglia
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Rua Tessália Viera de Camargo, 126 - Cidade Universitária "Zeferino Vaz", Campinas, São Paulo 13083-887, Brazil
| | - Michael Jerosch-Herold
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Room L1-RA050, Mailbox #22, Boston, MA 02115, USA
| | - Otávio R Coelho-Filho
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Rua Tessália Viera de Camargo, 126 - Cidade Universitária "Zeferino Vaz", Campinas, São Paulo 13083-887, Brazil; Department of Internal Medicine, Hospital das Clínicas, State University of Campinas, UNICAMP, Rua Vital Brasil, 251- Cidade Universitária "Zeferino Vaz", Campinas, São Paulo 13083-888, Brazil.
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Adluru G, Gur Y, Chen L, Feinberg D, Anderson J, DiBella EVR. MRI reconstruction of multi-image acquisitions using a rank regularizer with data reordering. Med Phys 2016; 42:4734-44. [PMID: 26233201 DOI: 10.1118/1.4926777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To improve rank constrained reconstructions for undersampled multi-image MRI acquisitions. METHODS Motivated by the recent developments in low-rank matrix completion theory and its applicability to rapid dynamic MRI, a new reordering-based rank constrained reconstruction of undersampled multi-image data that uses prior image information is proposed. Instead of directly minimizing the nuclear norm of a matrix of estimated images, the nuclear norm of reordered matrix values is minimized. The reordering is based on the prior image estimates. The method is tested on brain diffusion imaging data and dynamic contrast enhanced myocardial perfusion data. RESULTS Good quality images from data undersampled by a factor of three for diffusion imaging and by a factor of 3.5 for dynamic cardiac perfusion imaging with respiratory motion were obtained. Reordering gave visually improved image quality over standard nuclear norm minimization reconstructions. Root mean squared errors with respect to ground truth images were improved by ∼18% and ∼16% with reordering for diffusion and perfusion applications, respectively. CONCLUSIONS The reordered low-rank constraint is a way to inject prior image information that offers improvements over a standard low-rank constraint for undersampled multi-image MRI reconstructions.
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Affiliation(s)
- Ganesh Adluru
- UCAIR, Department of Radiology, University of Utah, Salt Lake City, Utah 84108
| | - Yaniv Gur
- IBM Almaden Research Center, San Jose, California 95120
| | - Liyong Chen
- Advanced MRI Technologies, Sebastpool, California, 95472
| | - David Feinberg
- Advanced MRI Technologies, Sebastpool, California, 95472
| | - Jeffrey Anderson
- UCAIR, Department of Radiology, University of Utah, Salt Lake City, Utah 84108
| | - Edward V R DiBella
- UCAIR, Department of Radiology, University of Utah, Salt Lake City, Utah 84108 and Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
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Quantitative Myocardial Perfusion with Dynamic Contrast-Enhanced Imaging in MRI and CT: Theoretical Models and Current Implementation. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1734190. [PMID: 27088083 PMCID: PMC4806267 DOI: 10.1155/2016/1734190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/11/2016] [Indexed: 01/21/2023]
Abstract
Technological advances in magnetic resonance imaging (MRI) and computed tomography (CT), including higher spatial and temporal resolution, have made the prospect of performing absolute myocardial perfusion quantification possible, previously only achievable with positron emission tomography (PET). This could facilitate integration of myocardial perfusion biomarkers into the current workup for coronary artery disease (CAD), as MRI and CT systems are more widely available than PET scanners. Cardiac PET scanning remains expensive and is restricted by the requirement of a nearby cyclotron. Clinical evidence is needed to demonstrate that MRI and CT have similar accuracy for myocardial perfusion quantification as PET. However, lack of standardization of acquisition protocols and tracer kinetic model selection complicates comparison between different studies and modalities. The aim of this overview is to provide insight into the different tracer kinetic models for quantitative myocardial perfusion analysis and to address typical implementation issues in MRI and CT. We compare different models based on their theoretical derivations and present the respective consequences for MRI and CT acquisition parameters, highlighting the interplay between tracer kinetic modeling and acquisition settings.
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Zarinabad N, Hautvast GLTF, Sammut E, Arujuna A, Breeuwer M, Nagel E, Chiribiri A. Effects of tracer arrival time on the accuracy of high-resolution (voxel-wise) myocardial perfusion maps from contrast-enhanced first-pass perfusion magnetic resonance. IEEE Trans Biomed Eng 2015; 61:2499-2506. [PMID: 24833413 DOI: 10.1109/tbme.2014.2322937] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
First-pass perfusion cardiac magnetic resonance(CMR) allows the quantitative assessment of myocardial blood flow(MBF). However, flow estimates are sensitive to the delay between the arterial and myocardial tissue tracer arrival time (tOnset) and the accurate estimation of MBF relies on the precise identification of tOnset . The aim of this study is to assess the sensitivity of the quantification process to tOnset at voxel level. Perfusion data were obtained from series of simulated data, a hardware perfusion phantom, and patients. Fermi deconvolution has been used for analysis. A novel algorithm, based on sequential deconvolution,which minimizes the error between myocardial curves and fitted curves obtained after deconvolution, has been used to identify the optimal tOnset for each region. Voxel-wise analysis showed to be more sensitive to tOnset compared to segmental analysis. The automated detection of the tOnset allowed a net improvement of the accuracy of MBF quantification and in patients the identification of perfusion abnormalities in territories that were missed when a constant user-selected tOnset was used. Our results indicate that high-resolution MBF quantification should be performed with optimized tOnset values at voxel level.
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Affiliation(s)
- Niloufar Zarinabad
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas¿ Hospital, London, U.K
| | - Gilion L T F Hautvast
- Philips Group Innovation¿Healthcare Incubators, Philips Research High Tech Campus, Eindhoven, AE, The Netherlands
| | - Eva Sammut
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas¿ Hospital, London, U.K
| | - Aruna Arujuna
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas¿ Hospital, London, U.K
| | - Marcel Breeuwer
- Philips Healthcare, Imaging Systems¿MR, Best, DA, The Netherlands
| | - Eike Nagel
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas¿ Hospital, London, U.K
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas¿ Hospital, London, U.K
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Basha TA, Roujol S, Kissinger KV, Goddu B, Berg S, Manning WJ, Nezafat R. Free-breathing cardiac MR stress perfusion with real-time slice tracking. Magn Reson Med 2014; 72:689-98. [PMID: 24123153 PMCID: PMC3979504 DOI: 10.1002/mrm.24977] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/09/2013] [Accepted: 09/11/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE To develop a free-breathing cardiac MR perfusion sequence with slice tracking for use after physical exercise. METHODS We propose to use a leading navigator, placed immediately before each 2D slice acquisition, for tracking the respiratory motion and updating the slice location in real-time. The proposed sequence was used to acquire CMR perfusion datasets in 12 healthy adult subjects and 8 patients. Images were compared with the conventional perfusion (i.e., without slice tracking) results from the same subjects. The location and geometry of the myocardium were quantitatively analyzed, and the perfusion signal curves were calculated from both sequences to show the efficacy of the proposed sequence. RESULTS The proposed sequence was significantly better compared with the conventional perfusion sequence in terms of qualitative image scores. Changes in the myocardial location and geometry decreased by 50% in the slice tracking sequence. Furthermore, the proposed sequence had signal curves that are smoother and less noisy. CONCLUSION The proposed sequence significantly reduces the effect of the respiratory motion on the image acquisition in both rest and stress perfusion scans.
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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
| | - Sébastien Roujol
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Kraig V. Kissinger
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Beth Goddu
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Sophie Berg
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Warren J. Manning
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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Abstract
Diabetes and insulin resistance have a variety of detrimental effects on cardiovascular health and outcomes. Cardiac magnetic resonance offers a non-invasive means to obtain many layers of information at a tissue level, including fibrosis, edema, intramyocardial motion, triglyceride content, and myocardial energetics. The role of cardiovascular magnetic resonance is particularly important in the evaluation of recognized and unrecognized coronary artery disease. In this review, we address the current state-of-the-art in cardiac magnetic resonance imaging - for both clinical and investigational use - as it applies to diabetic cardiovascular disease.
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Affiliation(s)
- Ravi V Shah
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Ferré JC, Raoult H, Breil S, Carsin-Nicol B, Ronzière T, Gauvrit JY. Supra-aortic arteries: three-dimensional time-resolved k-t BLAST contrast-enhanced MRA using a nondedicated body coil at 3 tesla in acute ischemic stroke. J Magn Reson Imaging 2013; 40:1056-63. [PMID: 24222649 DOI: 10.1002/jmri.24466] [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: 04/22/2013] [Accepted: 09/14/2013] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To assess the image quality and diagnostic performance achieved by using supra-aortic 3D-TR-CE-k-t BLAST MRA and a nondedicated body coil as compared with conventional CE-MRA in patients with acute ischemic stroke. MATERIALS AND METHODS In this prospective study, 36 consecutive patients with a suspected acute ischemic stroke underwent both k-t BLAST MRA and conventional CE-MRA. Image quality was assessed using visual and quantitative criteria and the techniques were compared. Both techniques were compared for degree of visual and quantitative measurement of carotid stenosis. RESULTS Delineation of vessel lumen and overall diagnostic confidence were significantly better with CE-MRA, respectively 3.4 ± 0.5 and 3.3 ± 0.6 (mean score ± SD), than with k-t BLAST MRA, respectively 2.8 ± 0.4 and 2.9 ± 0.5 (P < 0.02). SNR and CNR were significantly higher for k-t BLAST MRA, respectively 33.5 ± 19.3 and 27.9 ± 19.3, than for CE-MRA, respectively 25.7 ± 10 and 20.4 ± 8.4 (P < 0.03). Intertechnique agreement was good for carotid stenosis characterization (κ = .763). For the 14 relevant stenosis, stenosis measurements were highly correlated between techniques (0.96; P < 0.0001). The Bland-Altman plot showed a low bias in assessment of the degree of stenosis (mean bias 2.1% ± 7.7). CONCLUSION k-t BLAST MRA using a nondedicated coil offering and dynamic information was a effective diagnostic tool for detection and characterization of carotid stenosis.
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Affiliation(s)
- Jean-Christophe Ferré
- CHU Rennes, Department of Neuroradiology, University Hospital of Rennes, Rennes, France
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Lingala SG, DiBella E, Adluru G, McGann C, Jacob M. Accelerating free breathing myocardial perfusion MRI using multi coil radial k-t SLR. Phys Med Biol 2013; 58:7309-27. [PMID: 24077063 DOI: 10.1088/0031-9155/58/20/7309] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The clinical utility of myocardial perfusion MR imaging (MPI) is often restricted by the inability of current acquisition schemes to simultaneously achieve high spatio-temporal resolution, good volume coverage, and high signal to noise ratio. Moreover, many subjects often find it difficult to hold their breath for sufficiently long durations making it difficult to obtain reliable MPI data. Accelerated acquisition of free breathing MPI data can overcome some of these challenges. Recently, an algorithm termed as k - t SLR has been proposed to accelerate dynamic MRI by exploiting sparsity and low rank properties of dynamic MRI data. The main focus of this paper is to further improve k - t SLR and demonstrate its utility in considerably accelerating free breathing MPI. We extend its previous implementation to account for multi-coil radial MPI acquisitions. We perform k - t sampling experiments to compare different radial trajectories and determine the best sampling pattern. We also introduce a novel augmented Lagrangian framework to considerably improve the algorithm's convergence rate. The proposed algorithm is validated using free breathing rest and stress radial perfusion data sets from two normal subjects and one patient with ischemia. k - t SLR was observed to provide faithful reconstructions at high acceleration levels with minimal artifacts compared to existing MPI acceleration schemes such as spatio-temporal constrained reconstruction and k - t SPARSE/SENSE.
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Coelho-Filho OR, Rickers C, Kwong RY, Jerosch-Herold M. MR myocardial perfusion imaging. Radiology 2013; 266:701-15. [PMID: 23431226 DOI: 10.1148/radiol.12110918] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Contrast material-enhanced myocardial perfusion imaging by using cardiac magnetic resonance (MR) imaging has, during the past decade, evolved into an accurate technique for diagnosing coronary artery disease, with excellent prognostic value. Advantages such as high spatial resolution; absence of ionizing radiation; and the ease of routine integration with an assessment of viability, wall motion, and cardiac anatomy are readily recognized. The need for training and technical expertise and the regulatory hurdles, which might prevent vendors from marketing cardiac MR perfusion imaging, may have hampered its progress. The current review considers both the technical developments and the clinical experience with cardiac MR perfusion imaging, which hopefully demonstrates that it has long passed the stage of a research technique. In fact, cardiac MR perfusion imaging is moving beyond traditional indications such as diagnosis of coronary disease to novel applications such as in congenital heart disease, where the imperatives of avoidance of ionizing radiation and achievement of high spatial resolution are of high priority. More wide use of cardiac MR perfusion imaging, and novel applications thereof, are aided by the progress in parallel imaging, high-field-strength cardiac MR imaging, and other technical advances discussed in this review.
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Affiliation(s)
- Otavio R Coelho-Filho
- Division of Cardiology and Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
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Comparison of MR and CT for the Assessment of the Significance of Coronary Artery Disease: a Review. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-012-9186-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Motwani M, Jogiya R, Kozerke S, Greenwood JP, Plein S. Advanced Cardiovascular Magnetic Resonance Myocardial Perfusion Imaging. Circ Cardiovasc Imaging 2013; 6:339-48. [DOI: 10.1161/circimaging.112.000193] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Manish Motwani
- From the Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK (M.M., J.P.G., S.P.); Division of Imaging Sciences, The Rayne Institute, King’s College London, London, UK (R.J., S.P.); and Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (S.K.)
| | - Roy Jogiya
- From the Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK (M.M., J.P.G., S.P.); Division of Imaging Sciences, The Rayne Institute, King’s College London, London, UK (R.J., S.P.); and Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (S.K.)
| | - Sebastian Kozerke
- From the Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK (M.M., J.P.G., S.P.); Division of Imaging Sciences, The Rayne Institute, King’s College London, London, UK (R.J., S.P.); and Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (S.K.)
| | - John P. Greenwood
- From the Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK (M.M., J.P.G., S.P.); Division of Imaging Sciences, The Rayne Institute, King’s College London, London, UK (R.J., S.P.); and Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (S.K.)
| | - Sven Plein
- From the Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK (M.M., J.P.G., S.P.); Division of Imaging Sciences, The Rayne Institute, King’s College London, London, UK (R.J., S.P.); and Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (S.K.)
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Gebker R, Jahnke C, Manka R, Frick M, Hucko T, Kozerke S, Schnackenburg B, Fleck E, Paetsch I. High spatial resolution myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance using k–t SENSE. Int J Cardiol 2012; 158:411-6. [DOI: 10.1016/j.ijcard.2011.01.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 01/17/2011] [Accepted: 01/23/2011] [Indexed: 11/26/2022]
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Chiribiri A, Schuster A, Ishida M, Hautvast G, Zarinabad N, Morton G, Otton J, Plein S, Breeuwer M, Batchelor P, Schaeffter T, Nagel E. Perfusion phantom: An efficient and reproducible method to simulate myocardial first-pass perfusion measurements with cardiovascular magnetic resonance. Magn Reson Med 2012; 69:698-707. [PMID: 22532435 PMCID: PMC3593172 DOI: 10.1002/mrm.24299] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 03/26/2012] [Accepted: 03/26/2012] [Indexed: 01/24/2023]
Abstract
The aim of this article is to describe a novel hardware perfusion phantom that simulates myocardial first-pass perfusion allowing comparisons between different MR techniques and validation of the results against a true gold standard. MR perfusion images were acquired at different myocardial perfusion rates and variable doses of gadolinium and cardiac output. The system proved to be sensitive to controlled variations of myocardial perfusion rate, contrast agent dose, and cardiac output. It produced distinct signal intensity curves for perfusion rates ranging from 1 to 10 mL/mL/min. Quantification of myocardial blood flow by signal deconvolution techniques provided accurate measurements of perfusion. The phantom also proved to be very reproducible between different sessions and different operators. This novel hardware perfusion phantom system allows reliable, reproducible, and efficient simulation of myocardial first-pass MR perfusion. Direct comparison between the results of image-based quantification and reference values of flow and myocardial perfusion will allow development and validation of accurate quantification methods. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Amedeo Chiribiri
- Division of Imaging Sciences, King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre and Wellcome Trust and EPSRC Medical Engineering Centre at Guy's and St Thomas' NHS Foundation Trust, The Rayne Institute, London, United Kingdom.
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de Jong MC, Genders TSS, van Geuns RJ, Moelker A, Hunink MGM. Diagnostic performance of stress myocardial perfusion imaging for coronary artery disease: a systematic review and meta-analysis. Eur Radiol 2012; 22:1881-95. [PMID: 22527375 PMCID: PMC3411304 DOI: 10.1007/s00330-012-2434-1] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 01/23/2012] [Accepted: 02/04/2012] [Indexed: 12/11/2022]
Abstract
Objectives To determine and compare the diagnostic performance of stress myocardial perfusion imaging (MPI) for the diagnosis of obstructive coronary artery disease (CAD), using conventional coronary angiography (CCA) as the reference standard. Methods We searched Medline and Embase for literature that evaluated stress MPI for the diagnosis of obstructive CAD using magnetic resonance imaging (MRI), contrast-enhanced echocardiography (ECHO), single-photon emission computed tomography (SPECT) and positron emission tomography (PET). Results All pooled analyses were based on random effects models. Articles on MRI yielded a total of 2,970 patients from 28 studies, articles on ECHO yielded a sample size of 795 from 10 studies, articles on SPECT yielded 1,323 from 13 studies. For CAD defined as either at least 50 %, at least 70 % or at least 75 % lumen diameter reduction on CCA, the natural logarithms of the diagnostic odds ratio (lnDOR) for MRI (3.63; 95 % CI 3.26–4.00) was significantly higher compared to that of SPECT (2.76; 95 % CI 2.28–3.25; P = 0.006) and that of ECHO (2.83; 95 % CI 2.29–3.37; P = 0.02). There was no significant difference between the lnDOR of SPECT and ECHO (P = 0.52). Conclusion Our results suggest that MRI is superior for the diagnosis of obstructive CAD compared with ECHO and SPECT. ECHO and SPECT demonstrated similar diagnostic performance. Key Points • MRI can assess myocardial perfusion. • MR perfusion diagnoses coronary artery disease better than echocardiography or SPECT. • Echocardiography and SPECT have similar diagnostic performance. • MRI can save coronary artery disease patients from more invasive tests. • MRI and SPECT show evidence of publication bias, implying possible overestimation. Electronic supplementary material The online version of this article (doi:10.1007/s00330-012-2434-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marcus C de Jong
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Motwani M, Maredia N, Fairbairn TA, Kozerke S, Radjenovic A, Greenwood JP, Plein S. High-resolution versus standard-resolution cardiovascular MR myocardial perfusion imaging for the detection of coronary artery disease. Circ Cardiovasc Imaging 2012; 5:306-13. [PMID: 22499848 DOI: 10.1161/circimaging.111.971796] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although accelerated high-spatial-resolution cardiovascular MR (CMR) myocardial perfusion imaging has been shown to be clinically feasible, there has not yet been a direct comparison with standard-resolution methods. We hypothesized that higher spatial resolution detects more subendocardial ischemia and leads to greater diagnostic accuracy for the detection coronary artery disease. This study compared the diagnostic accuracy of high-resolution and standard-resolution CMR myocardial perfusion imaging in patients with suspected coronary artery disease. METHODS AND RESULTS A total of 111 patients were recruited to undergo 2 separate perfusion-CMR studies at 1.5 T, 1 with standard-resolution (2.5×2.5 mm in-plane) and 1 with high-resolution (1.6×1.6 mm in-plane) acquisition. High-resolution acquisition was facilitated by 8-fold k-t broad linear speed-up technique acceleration. Two observers visually graded perfusion in each myocardial segment on a 4-point scale. Segmental scores were summed to produce a perfusion score for each patient. All patients underwent invasive coronary angiography and coronary artery disease was defined as stenosis ≥50% luminal diameter (quantitative coronary angiography). CMR data were successfully obtained in 100 patients. In patients with coronary artery disease (n=70), more segments were determined to have subendocardial ischemia with high-resolution than with standard-resolution acquisition (279 versus 108; P<0.001). High-resolution acquisition had a greater diagnostic accuracy than standard resolution for identifying single-vessel disease (area under the curve, 0.88 versus 0.73; P<0.001) or multivessel disease (area under the curve, 0.98 versus 0.91; P=0.002) and overall (area under the curve, 0.93 versus 0.83; P<0.001). CONCLUSIONS High-resolution perfusion-CMR has greater overall diagnostic accuracy than standard-resolution acquisition for the detection of coronary artery disease in both single- and multivessel disease and detects more subendocardial ischemia.
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Affiliation(s)
- Manish Motwani
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
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Zarinabad N, Chiribiri A, Hautvast GLTF, Ishida M, Schuster A, Cvetkovic Z, Batchelor PG, Nagel E. Voxel-wise quantification of myocardial perfusion by cardiac magnetic resonance. Feasibility and methods comparison. Magn Reson Med 2012; 68:1994-2004. [PMID: 22354744 DOI: 10.1002/mrm.24195] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/20/2011] [Accepted: 01/13/2011] [Indexed: 11/10/2022]
Abstract
The purpose of this study is to enable high spatial resolution voxel-wise quantitative analysis of myocardial perfusion in dynamic contrast-enhanced cardiovascular MR, in particular by finding the most favorable quantification algorithm in this context. Four deconvolution algorithms--Fermi function modeling, deconvolution using B-spline basis, deconvolution using exponential basis, and autoregressive moving average modeling--were tested to calculate voxel-wise perfusion estimates. The algorithms were developed on synthetic data and validated against a true gold-standard using a hardware perfusion phantom. The accuracy of each method was assessed for different levels of spatial averaging and perfusion rate. Finally, voxel-wise analysis was used to generate high resolution perfusion maps on real data acquired from five patients with suspected coronary artery disease and two healthy volunteers. On both synthetic and perfusion phantom data, the B-spline method had the highest error in estimation of myocardial blood flow. The autoregressive moving average modeling and exponential methods gave accurate estimates of myocardial blood flow. The Fermi model was the most robust method to noise. Both simulations and maps in the patients and hardware phantom showed that voxel-wise quantification of myocardium perfusion is feasible and can be used to detect abnormal regions.
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Affiliation(s)
- Niloufar Zarinabad
- Division of Imaging Sciences and Biomedical Engineering, Wellcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, The Rayne Institute, St. Thomas' Hospital, London, United Kingdom.
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18
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Jahnke C, Kozerke S, Schnackenburg B, Marx N, Paetsch I. Three-dimensional contrast-enhanced and non-contrast-enhanced cardiac magnetic resonance imaging for the assessment of myocardial ischemic reactions: the practice of looking deeply into the myocardium. J Nucl Cardiol 2011; 18:937-51. [PMID: 21567282 DOI: 10.1007/s12350-011-9391-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Cosima Jahnke
- Department of Cardiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
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Hautvast GLTF, Chiribiri A, Lockie T, Breeuwer M, Nagel E, Plein S. Quantitative analysis of transmural gradients in myocardial perfusion magnetic resonance images. Magn Reson Med 2011; 66:1477-87. [PMID: 21630344 DOI: 10.1002/mrm.22930] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 02/11/2011] [Accepted: 02/26/2011] [Indexed: 12/22/2022]
Abstract
Conventional quantitative assessments of myocardial perfusion analyze the temporal relation between the arterial input function and the myocardial signal intensity curves, thereby neglecting the important spatial relation between the myocardial signal intensity curves. The new method presented in this article enables characterization of sub-endocardial to sub-epicardial gradients in myocardial perfusion based on a two dimensional, "gradientogram" representation, which displays the evolution of the transmural gradient in myocardial contrast uptake over time in all circumferential positions of the acquired images. Moreover, based on segmentation in these gradientograms, several new measurements that characterize transmural myocardial perfusion distribution over time are defined. In application to clinical image data, the new two-dimensional representations, as well as the newly defined measurements revealed a clear distinction between normal perfusion and inducible ischaemia. Thus, the new measurements may serve as diagnostic markers for the detection and characterization of epicardial coronary and microvascular disease.
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3D Fusion of Functional Cardiac Magnetic Resonance Imaging and Computed Tomography Coronary Angiography. Invest Radiol 2011; 46:331-40. [DOI: 10.1097/rli.0b013e3182056caf] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Otazo R, Kim D, Axel L, Sodickson DK. Combination of compressed sensing and parallel imaging for highly accelerated first-pass cardiac perfusion MRI. Magn Reson Med 2011; 64:767-76. [PMID: 20535813 DOI: 10.1002/mrm.22463] [Citation(s) in RCA: 364] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
First-pass cardiac perfusion MRI is a natural candidate for compressed sensing acceleration since its representation in the combined temporal Fourier and spatial domain is sparse and the required incoherence can be effectively accomplished by k-t random undersampling. However, the required number of samples in practice (three to five times the number of sparse coefficients) limits the acceleration for compressed sensing alone. Parallel imaging may also be used to accelerate cardiac perfusion MRI, with acceleration factors ultimately limited by noise amplification. In this work, compressed sensing and parallel imaging are combined by merging the k-t SPARSE technique with sensitivity encoding (SENSE) reconstruction to substantially increase the acceleration rate for perfusion imaging. We also present a new theoretical framework for understanding the combination of k-t SPARSE with SENSE based on distributed compressed sensing theory. This framework, which identifies parallel imaging as a distributed multisensor implementation of compressed sensing, enables an estimate of feasible acceleration for the combined approach. We demonstrate feasibility of 8-fold acceleration in vivo with whole-heart coverage and high spatial and temporal resolution using standard coil arrays. The method is relatively insensitive to respiratory motion artifacts and presents similar temporal fidelity and image quality when compared to Generalized autocalibrating partially parallel acquisitions (GRAPPA) with 2-fold acceleration.
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Affiliation(s)
- Ricardo Otazo
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.
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22
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Lutz A, Bornstedt A, Manzke R, Etyngier P, Nienhaus GU, Rasche V. Acceleration of tissue phase mapping by k-t BLAST: a detailed analysis of the influence of k-t-BLAST for the quantification of myocardial motion at 3T. J Cardiovasc Magn Reson 2011; 13:5. [PMID: 21223566 PMCID: PMC3024407 DOI: 10.1186/1532-429x-13-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 01/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The assessment of myocardial motion with tissue phase mapping (TPM) provides high spatiotemporal resolution and quantitative motion information in three directions. Today, whole volume coverage of the heart by TPM encoding at high spatial and temporal resolution is limited by long data acquisition times. Therefore, a significant increase in imaging speed without deterioration of the quantitative motion information is required. For this purpose, the k-t BLAST acceleration technique was combined with TPM black-blood functional imaging of the heart. Different k-t factors were evaluated with respect to their impact on the quantitative assessment of cardiac motion. RESULTS It is demonstrated that a k-t BLAST factor of two can be used with a marginal, but statistically significant deterioration of the quantitative motion data. Further increasing the k-t acceleration causes substantial alteration of the peak velocities and the motion pattern, but the temporal behavior of the contraction is well maintained up to an acceleration factor of six. CONCLUSIONS The application of k-t BLAST for the acceleration of TPM appears feasible. A reduction of the acquisition time of almost 45% could be achieved without substantial loss of quantitative motion information.
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Affiliation(s)
- Anja Lutz
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Baden-Württemberg, Germany
| | - Axel Bornstedt
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Baden-Württemberg, Germany
| | | | | | - G Ulrich Nienhaus
- Institute of Applied Physics Karlsruhe, Institute of Technology (KIT), Karlsruhe, Germany
| | - Volker Rasche
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Baden-Württemberg, Germany
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Stolzmann P, Alkadhi H, Scheffel H, Plass A, Leschka S, Falk V, Kozerke S, Wyss C, Donati OF. Combining cardiac magnetic resonance and computed tomography coronary calcium scoring: added value for the assessment of morphological coronary disease? Int J Cardiovasc Imaging 2010; 27:969-77. [PMID: 21052842 DOI: 10.1007/s10554-010-9738-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 10/19/2010] [Indexed: 01/20/2023]
Abstract
To investigate prospectively, in patients with suspicion of coronary artery disease (CAD), the added value of coronary calcium scoring (CS) as adjunct to cardiac magnetic resonance (CMR) for the diagnosis of morphological coronary stenosis in comparison to catheter angiography (CA). Sixty consecutive patients (8 women; 64 ± 10 years) referred to CA underwent CMR (1.5 T) including perfusion and late gadolinium-enhancement imaging as well as CS with computed tomography. Diagnostic performance was evaluated for CMR and CS separately, and for both methods combined, with CA as reference standard. Best CS threshold combined with a specificity >90% to predict significant stenosis in patients without abnormalities on CMR was determined from receiver operator characteristics (ROC) analysis. Abnormal CMR results were considered to indicate significant stenosis regardless of CS; CS above threshold reclassified patients to have CAD regardless of CMR. CA identified 104/960 (11%) coronary segments with coronary artery stenosis >50% in 36/60 (60%) patients. ROC revealed an area-under-the-curve of 0.83 (95%CI: 0.68-0.99) with the best CS threshold of 495 Agatston score (sensitivity 50%). CMR depicted 128/960 (13%) myocardial segments with abnormalities in 31/60 (52%) patients. Sensitivity, specificity, negative (NPV) and positive predictive value (PPV) of CMR were 78, 88, 72 and 90%. When adding CS to CMR, sensitivity and NPV increased to 89 and 83%, while specificity and PPV slightly decreased to 83 and 89%. Accuracy of the combined approach (87%) was significantly (P < 0.05) higher than that of CMR (82%) alone. Adding CS to CMR improves the accuracy for the detection of morphological CAD.
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Affiliation(s)
- Paul Stolzmann
- Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland.
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24
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Jerosch-Herold M. Quantification of myocardial perfusion by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2010; 12:57. [PMID: 20932314 PMCID: PMC2964700 DOI: 10.1186/1532-429x-12-57] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 10/08/2010] [Indexed: 11/10/2022] Open
Abstract
The potential of contrast-enhanced cardiovascular magnetic resonance (CMR) for a quantitative assessment of myocardial perfusion has been explored for more than a decade now, with encouraging results from comparisons with accepted "gold standards", such as microspheres used in the physiology laboratory. This has generated an increasing interest in the requirements and methodological approaches for the non-invasive quantification of myocardial blood flow by CMR. This review provides a synopsis of the current status of the field, and introduces the reader to the technical aspects of perfusion quantification by CMR. The field has reached a stage, where quantification of myocardial perfusion is no longer a claim exclusive to nuclear imaging techniques. CMR may in fact offer important advantages like the absence of ionizing radiation, high spatial resolution, and an unmatched versatility to combine the interrogation of the perfusion status with a comprehensive tissue characterization. Further progress will depend on successful dissemination of the techniques for perfusion quantification among the CMR community.
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Vitanis V, Manka R, Giese D, Pedersen H, Plein S, Boesiger P, Kozerke S. High resolution three-dimensional cardiac perfusion imaging using compartment-based k-t principal component analysis. Magn Reson Med 2010; 65:575-87. [PMID: 20928876 DOI: 10.1002/mrm.22620] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 06/29/2010] [Accepted: 08/03/2010] [Indexed: 11/10/2022]
Affiliation(s)
- Viton Vitanis
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
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26
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Maredia N, Radjenovic A, Kozerke S, Larghat A, Greenwood JP, Plein S. Effect of improving spatial or temporal resolution on image quality and quantitative perfusion assessment with k-t SENSE acceleration in first-pass CMR myocardial perfusion imaging. Magn Reson Med 2010; 64:1616-24. [PMID: 20878758 PMCID: PMC3412217 DOI: 10.1002/mrm.22493] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 03/20/2010] [Accepted: 04/06/2010] [Indexed: 12/30/2022]
Abstract
k-t Sensitivity-encoded (k-t SENSE) acceleration has been used to improve spatial resolution, temporal resolution, and slice coverage in first-pass cardiac magnetic resonance myocardial perfusion imaging. This study compares the effect of investing the speed-up afforded by k-t SENSE acceleration in spatial or temporal resolution. Ten healthy volunteers underwent adenosine stress myocardial perfusion imaging using four saturation-recovery gradient echo perfusion sequences: a reference sequence accelerated by sensitivity encoding (SENSE), and three k-t SENSE-accelerated sequences with higher spatial resolution ("k-t High"), shorter acquisition window ("k-t Fast"), or a shared increase in both parameters ("k-t Hybrid") relative to the reference. Dark-rim artifacts and image quality were analyzed. Semiquantitative myocardial perfusion reserve index (MPRI) and Fermi-derived quantitative MPR were also calculated. The k-t Hybrid sequence produced highest image quality scores at rest (P = 0.015). Rim artifact thickness and extent were lowest using k-t High and k-t Hybrid sequences (P < 0.001). There were no significant differences in MPRI and MPR values derived by each sequence. Maximizing spatial resolution by k-t SENSE acceleration produces the greatest reduction in dark rim artifact. There is good agreement between k-t SENSE and standard acquisition methods for semiquantitative and fully quantitative myocardial perfusion analysis.
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Affiliation(s)
- Neil Maredia
- Division of Cardiovascular and Neuronal Remodelling, University of LeedsLeeds, United Kingdom
| | | | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH ZurichSwitzerland
| | - Abdulghani Larghat
- Division of Cardiovascular and Neuronal Remodelling, University of LeedsLeeds, United Kingdom
| | - John P Greenwood
- Division of Cardiovascular and Neuronal Remodelling, University of LeedsLeeds, United Kingdom
| | - Sven Plein
- Division of Cardiovascular and Neuronal Remodelling, University of LeedsLeeds, United Kingdom
- *Correspondence to: Sven Plein, Academic Unit of Cardiovascular Medicine, G Floor, Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, United Kingdom. E-mail:
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Morton G, Schuster A, Perera D, Nagel E. Cardiac magnetic resonance imaging to guide complex revascularization in stable coronary artery disease. Eur Heart J 2010; 31:2209-15. [DOI: 10.1093/eurheartj/ehq256] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Manka R, Vitanis V, Boesiger P, Flammer AJ, Plein S, Kozerke S. Clinical Feasibility of Accelerated, High Spatial Resolution Myocardial Perfusion Imaging. JACC Cardiovasc Imaging 2010; 3:710-7. [DOI: 10.1016/j.jcmg.2010.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 03/18/2010] [Accepted: 03/23/2010] [Indexed: 01/07/2023]
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Combined cardiac CT and MRI for the comprehensive workup of hemodynamically relevant coronary stenoses. AJR Am J Roentgenol 2010; 194:920-6. [PMID: 20308492 DOI: 10.2214/ajr.09.3225] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of our study was to prospectively evaluate the accuracy of a comprehensive assessment of coronary artery disease (CAD) with prospectively ECG-gated coronary CT angiography (CTA) and perfusion-cardiac MRI for the detection of hemodynamically relevant coronary stenoses. SUBJECTS AND METHODS Forty-seven consecutive patients underwent k-space and time broad-use linear acquisition speed-up technique accelerated perfusion-cardiac MRI at 1.5 T and dual-source coronary CTA. Catheter coronary angiography (CA), coronary CTA, and perfusion-cardiac MRI were all performed within a median time interval of 7.5 days. Detection of hemodynamically relevant stenoses by the combination of coronary CTA plus perfusion-cardiac MRI was compared with the combination of CA plus perfusion-cardiac MRI, the latter serving as the standard of reference. RESULTS CA identified stenoses in 75 of 141 coronary arteries (53.2%) in 33 of 47 patients (70.2%). Cardiac MRI revealed perfusion defects in 30 of 47 patients (63.8%). Image quality of coronary CTA was diagnostic in 635 of 638 segments (99.5%). Coronary CTA revealed stenoses greater than 50% in 76 of 141 coronary arteries (53.9%) of 33 of 47 patients (70.2%). Sensitivity, specificity, negative and positive predictive value, and accuracy of coronary CTA and perfusion-cardiac MRI versus CA and perfusion-cardiac MRI for the detection of hemodynamically relevant stenoses were 96.7%, 100%, 94.4%, 100%, and 97.9%, respectively. CONCLUSION The combination of coronary CTA and perfusion-cardiac MRI shows diagnostic performance comparable to that of CA and perfusion-cardiac MRI. Preliminary data suggest that coronary CTA may replace CA in the diagnosis of hemodynamically relevant CAD.
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Low-dose CT and cardiac MR for the diagnosis of coronary artery disease: accuracy of single and combined approaches. Int J Cardiovasc Imaging 2010; 26:579-90. [DOI: 10.1007/s10554-010-9595-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Accepted: 01/20/2010] [Indexed: 10/19/2022]
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31
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Low-dose CT coronary angiography for the prediction of myocardial ischaemia. Eur Radiol 2009; 20:56-64. [DOI: 10.1007/s00330-009-1536-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 06/01/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
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Stadlbauer A, van der Riet W, Globits S, Crelier G, Salomonowitz E. Accelerated phase-contrast MR imaging: comparison of k-t BLAST with SENSE and Doppler ultrasound for velocity and flow measurements in the aorta. J Magn Reson Imaging 2009; 29:817-24. [PMID: 19306404 DOI: 10.1002/jmri.21706] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To evaluate differences in velocity and flow measurements in the aorta between accelerated phase-contrast (PC) magnetic resonance imaging (MRI) using SENSE and k-t BLAST and in peak velocity to Doppler ultrasound. MATERIALS AND METHODS Two-dimensional PC-MRI perpendicular to the ascending and descending aorta was performed in 11 volunteers using SENSE (R = 2) and k-t BLAST (2-, 4-, 6-, and 8-fold). Peak velocity, mean velocity, and stroke volume of the accelerated PC-MRI experiments were correlated. Peak velocities were compared to Doppler ultrasound. RESULTS All acceleration techniques showed significant correlations for peak velocity with Doppler ultrasound. However, k-t BLAST 6 and 8 showed a significant underestimation. Strong correlations between SENSE and k-t BLAST were found for all three parameters. Significant differences in peak velocity were found between SENSE and all k-t BLAST experiments, but not for 2-fold k-t BLAST in the ascending aorta, and 2- and 4-fold k-t BLAST in the descending aorta. For mean velocity no significant differences were found. Stroke volume showed significant differences for all k-t BLAST experiments in the ascending and for 6- and 8-fold k-t BLAST in the descending aorta. CONCLUSION Peak velocity of accelerated PC-MRI correlated with CW Doppler measurements, but high k-t BLAST acceleration factors lead to a significant underestimation. SENSE with R = 2 and 2-fold k-t BLAST are most highly correlated in phase-contrast flow measurements.
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Affiliation(s)
- Andreas Stadlbauer
- MR Physics Group, Department of Radiology, Landesklinikum St. Poelten, Austria
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Plein S, Schwitter J, Suerder D, Greenwood JP, Boesiger P, Kozerke S. k-Space and time sensitivity encoding-accelerated myocardial perfusion MR imaging at 3.0 T: comparison with 1.5 T. Radiology 2008; 249:493-500. [PMID: 18936311 DOI: 10.1148/radiol.2492080017] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the feasibility and diagnostic accuracy of high-spatial-resolution myocardial perfusion magnetic resonance (MR) imaging at 3.0 T by using k-space and time (k-t) domain undersampling with sensitivity encoding (SENSE), or k-t SENSE. Data were compared with results of k-t SENSE-accelerated high-spatial-resolution perfusion MR imaging at 1.5 T and standard-resolution acquisition at 3.0 T. MATERIALS AND METHODS The study was reviewed and approved by the local ethics review board; informed consent was obtained. k-t SENSE perfusion MR imaging was performed at 1.5 and 3.0 T (fivefold k-t SENSE acceleration; spatial resolution, 1.3 x 1.3 x 10 mm). Fourteen volunteers were studied at rest; 37 patients were studied during adenosine-induced stress. In volunteers, comparison was also made with standard-resolution (2.5 x 2.5 x 10 mm) twofold SENSE perfusion MR imaging results at 3.0 T. Image quality, artifact scores, signal-to-noise ratios (SNRs), and contrast enhancement ratios were derived. In patients, diagnostic accuracy of visual analysis to detect stenosis of more than 50% narrowing in diameter at quantitative coronary angiography was determined by using receiver operator characteristic (ROC) analysis. RESULTS In volunteers, image quality and artifact scores were similar for 3.0- and 1.5-T k-t SENSE perfusion MR imaging, while SNR was higher (11.6 vs 5.6) and contrast enhancement ratio was lower (1.1 vs 1.5, P = .012) at 3.0 T. Compared with standard-resolution perfusion MR imaging, image quality was higher for 3.0-T k-t SENSE (3.6 vs 3.1, P = .04), endocardial dark rim artifacts were reduced (artifact thickness, 1.6 vs 2.4 mm, P < .001), and contrast enhancement ratios were similar. In patients, areas under the ROC curve for detection of coronary stenosis were 0.89 and 0.80 (P = .21) for 3.0 and 1.5 T, respectively. CONCLUSION k-t SENSE-accelerated high-spatial-resolution perfusion MR imaging at 3.0 T is feasible, with similar artifacts and diagnostic accuracy as those at 1.5 T. Compared with standard-resolution twofold SENSE perfusion MR imaging, image quality at k-t SENSE MR imaging is improved and artifacts are reduced.
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Affiliation(s)
- Sven Plein
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
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