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Brown JT, Virsinskaite R, Kotecha T, Steeden JA, Fontana M, Karia N, Schreiber BE, Ong VH, Denton CP, Coghlan JG, Muthurangu V, Knight DS. Prognostic utility of exercise cardiovascular magnetic resonance in patients with systemic sclerosis-associated pulmonary arterial hypertension. Eur Heart J Cardiovasc Imaging 2024:jeae177. [PMID: 39159164 DOI: 10.1093/ehjci/jeae177] [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: 01/01/2024] [Revised: 05/03/2024] [Accepted: 07/08/2024] [Indexed: 08/21/2024] Open
Abstract
AIMS Systemic sclerosis complicated by pulmonary arterial hypertension (SSc-PAH) is a rare condition with poor prognosis. The majority of patients are categorized as intermediate risk of mortality. Cardiovascular magnetic resonance (CMR) is well placed to reproducibly assess right heart size and function, but most patients with SSc-PAH have less overtly abnormal right ventricles than other forms of PAH. The aim of this study was to assess if exercise CMR measures of cardiac size and function could better predict outcome in patients with intermediate risk SSc-PAH compared with resting CMR. METHODS AND RESULTS Fifty patients with SSc-PAH categorized as intermediate risk underwent CMR-augmented cardiopulmonary exercise testing. Most patients had normal CMR-defined resting measures of right ventricular (RV) size and function. Nine (18%) patients died during a median follow-up period of 2.1 years (range 0.1-4.6). Peak exercise RV indexed end-systolic volume (ESVi) was the only CMR metric to predict prognosis on stepwise Cox regression analysis, with an optimal threshold < 39 mL/m2 to predict favourable outcome. Intermediate-low risk patients with peak RVESVi < 39 mL/m2 had significantly better survival than all other combinations of intermediate-low/-high risk status and peak RVESVi< or ≥39 mL/m2. In our cohort, ventilatory efficiency and resting oxygen consumption (VO2) were predictive of mortality, but not peak VO2, peak cardiac output, or peak tissue oxygen extraction. CONCLUSION Exercise CMR assessment of RV size and function may help identify SSc-PAH patients with poorer prognosis amongst intermediate risk cohorts, even when resting CMR appears reassuring, and could offer added value to clinical PH risk stratification.
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Affiliation(s)
- James T Brown
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Department of Cardiac MRI, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - Ruta Virsinskaite
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Department of Cardiac MRI, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - Tushar Kotecha
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Department of Cardiac MRI, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - Jennifer A Steeden
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - Marianna Fontana
- Department of Cardiac MRI, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- UCL Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Nina Karia
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Department of Cardiac MRI, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - Benjamin E Schreiber
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Voon H Ong
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Campus, London, UK
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Campus, London, UK
| | - J Gerry Coghlan
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Vivek Muthurangu
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - Daniel S Knight
- National Pulmonary Hypertension Service, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- Department of Cardiac MRI, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
- UCL Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
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2
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Wang F, Zhou J, Pu C, Yu F, Wu Y, Zhang L, Ma S, Hu H. Optimizing Clinical Cardiac MRI Workflow through Single Breath-Hold Compressed Sensing Cine: An Evaluation of Feasibility and Efficiency. J Clin Med 2024; 13:753. [PMID: 38337447 PMCID: PMC10856388 DOI: 10.3390/jcm13030753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Although compressed sensing (CS) accelerated cine holds immense potential to replace conventional cardiovascular magnetic resonance (CMR) cine, how to use CS-based cine appropriately during clinical CMR examinations still needs exploring. METHODS A total of 104 patients (46.5 ± 17.1 years) participated in this prospective study. For each participant, a balanced steady state free precession (bSSFP) cine was acquired as a reference, followed by two CS accelerated cine sequences with identical parameters before and after contrast injection. Lastly, a CS accelerated cine sequence with an increased flip angle was obtained. We subsequently compared scanning time, image quality, and biventricular function parameters between these sequences. RESULTS All CS cine sequences demonstrated significantly shorter acquisition times compared to bSSFPref cine (p < 0.001). The bSSFPref cine showed higher left ventricular ejection fraction (LVEF) than all CS cine sequences (all p < 0.001), but no significant differences in LVEF were observed among the three CS cine sequences. Additionally, CS cine sequences displayed superior global image quality (p < 0.05) and fewer artifacts than bSSFPref cine (p < 0.005). Unenhanced CS cine and enhanced CS cine with increased flip angle showed higher global image quality than other cine sequences (p < 0.005). CONCLUSION Single breath-hold CS cine delivers precise biventricular function parameters and offers a range of benefits including shorter scan time, better global image quality, and diminished motion artifacts. This innovative approach holds great promise in replacing conventional bSSFP cine and optimizing the CMR examination workflow.
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Affiliation(s)
- Fuyan Wang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3# East Qingchun Road, Hangzhou 310016, China; (F.W.); (J.Z.); (C.P.); (F.Y.); (Y.W.); (L.Z.); (S.M.)
| | - Junjie Zhou
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3# East Qingchun Road, Hangzhou 310016, China; (F.W.); (J.Z.); (C.P.); (F.Y.); (Y.W.); (L.Z.); (S.M.)
- Department of Radiology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, 1# Shangcheng Avenuee, Yiwu 322000, China
| | - Cailing Pu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3# East Qingchun Road, Hangzhou 310016, China; (F.W.); (J.Z.); (C.P.); (F.Y.); (Y.W.); (L.Z.); (S.M.)
| | - Feidan Yu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3# East Qingchun Road, Hangzhou 310016, China; (F.W.); (J.Z.); (C.P.); (F.Y.); (Y.W.); (L.Z.); (S.M.)
| | - Yan Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3# East Qingchun Road, Hangzhou 310016, China; (F.W.); (J.Z.); (C.P.); (F.Y.); (Y.W.); (L.Z.); (S.M.)
| | - Lingjie Zhang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3# East Qingchun Road, Hangzhou 310016, China; (F.W.); (J.Z.); (C.P.); (F.Y.); (Y.W.); (L.Z.); (S.M.)
| | - Siying Ma
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3# East Qingchun Road, Hangzhou 310016, China; (F.W.); (J.Z.); (C.P.); (F.Y.); (Y.W.); (L.Z.); (S.M.)
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3# East Qingchun Road, Hangzhou 310016, China; (F.W.); (J.Z.); (C.P.); (F.Y.); (Y.W.); (L.Z.); (S.M.)
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3
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Wang Z, Feng X, Salerno M, Kramer CM, Meyer CH. Dynamic cardiac MRI with high spatiotemporal resolution using accelerated spiral-out and spiral-in/out bSSFP pulse sequences at 1.5 T. MAGMA (NEW YORK, N.Y.) 2023; 36:857-867. [PMID: 37665502 PMCID: PMC10667461 DOI: 10.1007/s10334-023-01116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/06/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To develop two spiral-based bSSFP pulse sequences combined with L + S reconstruction for accelerated ungated, free-breathing dynamic cardiac imaging at 1.5 T. MATERIALS AND METHODS Tiny golden angle rotated spiral-out and spiral-in/out bSSFP sequences combined with view-sharing (VS), compressed sensing (CS), and low-rank plus sparse (L + S) reconstruction were evaluated and compared via simulation and in vivo dynamic cardiac imaging studies. The proposed methods were then validated against the standard cine, in terms of quantitative image assessment and qualitative quality rating. RESULTS The L + S method yielded the least residual artifacts and the best image sharpness among the three methods. Both spiral cine techniques showed clinically diagnostic images (score > 3). Compared to standard cine, there were significant differences in global image quality and edge sharpness for spiral cine techniques, while there was significant difference in image contrast for the spiral-out cine but no significant difference for the spiral-in/out cine. There was good agreement in left ventricular ejection fraction for both the spiral-out cine (- 1.6 [Formula: see text] 3.1%) and spiral-in/out cine (- 1.5 [Formula: see text] 2.8%) against standard cine. DISCUSSION Compared to the time-consuming standard cine (~ 5 min) which requires ECG-gating and breath-holds, the proposed spiral bSSFP sequences achieved ungated, free-breathing cardiac movies at a similar spatial (1.5 × 1.5 × 8 mm3) and temporal resolution (36 ms) per slice for whole heart coverage (10-15 slices) within 45 s, suggesting the clinical potential for improved patient comfort or for imaging patients with arrhythmias or who cannot hold their breath.
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Affiliation(s)
- Zhixing Wang
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Xue Feng
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Michael Salerno
- School of Medicine, University Medical Line, Stanford University, Stanford, CA, USA
| | - Christopher M Kramer
- Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville, VA, USA
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Craig H Meyer
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
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Hauser JA, Burden SJ, Karunakaran A, Muthurangu V, Taylor AM, Jones A. Whole-Body Magnetic Resonance Imaging Assessment of the Contributions of Adipose and Nonadipose Tissues to Cardiovascular Remodeling in Adolescents. J Am Heart Assoc 2023; 12:e030221. [PMID: 37489750 PMCID: PMC10492986 DOI: 10.1161/jaha.123.030221] [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: 03/16/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023]
Abstract
Background Greater body mass index is associated with cardiovascular remodeling in adolescents. However, body mass index cannot differentiate between adipose and nonadipose tissues. We examined how visceral and subcutaneous adipose tissue are linked with markers of early cardiovascular remodeling, independently from nonadipose tissue. Methods and Results Whole-body magnetic resonance imaging was done in 82 adolescents (39 overweight/obese; 36 female; median age, 16.3 [interquartile range, 14.4-18.1] years) to measure body composition and cardiovascular remodeling markers. Left ventricular diastolic function was assessed by echocardiography. Waist, waist:height ratio, and body mass index z scores were calculated. Residualized nonadipose tissue, subcutaneous adipose tissue, and visceral adipose tissue variables, uncorrelated with each other, were constructed using partial regression modeling to allow comparison of their individual contributions in a 3-compartment body composition model. Cardiovascular variables mostly related to nonadipose rather than adipose tissue. Nonadipose tissue was correlated positively with left ventricular mass (r=0.81), end-diastolic volume (r=0.70), stroke volume (r=0.64), left ventricular mass:end-diastolic volume (r=0.37), and systolic blood pressure (r=0.35), and negatively with heart rate (r=-0.33) (all P<0.01). Subcutaneous adipose tissue was associated with worse left ventricular diastolic function (r=-0.42 to -0.48, P=0.0007-0.02) and higher heart rates (r=0.34, P=0.007) but linked with better systemic vascular resistance (r=-0.35, P=0.006). There were no significant relationships with visceral adipose tissue and no associations of any compartment with pulse wave velocity. Conclusions Simple anthropometry does not reflect independent effects of nonadipose tissue and subcutaneous adipose tissue on the adolescent cardiovascular system. This could result in normal cardiovascular adaptations to growth being misinterpreted as pathological sequelae of excess adiposity in studies reliant on such measures.
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Affiliation(s)
- Jakob A. Hauser
- Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Samuel J. Burden
- Department of PaediatricsUniversity of Oxford, John Radcliffe HospitalOxfordUnited Kingdom
- Department of Women and Children’s HealthKing’s College London, St Thomas’ HospitalLondonUnited Kingdom
| | - Ajanthiha Karunakaran
- Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Vivek Muthurangu
- Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
| | - Andrew M. Taylor
- Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUnited Kingdom
| | - Alexander Jones
- Centre for Translational Cardiovascular ImagingUniversity College LondonLondonUnited Kingdom
- Department of PaediatricsUniversity of Oxford, John Radcliffe HospitalOxfordUnited Kingdom
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5
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Haarman MG, Coenraad I, Hagdorn QAJ, Hillege HL, Willems TP, Berger RMF, Douwes JM. Cardiac Magnetic Resonance Derived Left Ventricular Eccentricity Index and Right Ventricular Mass Measurements Predict Outcome in Children with Pulmonary Arterial Hypertension. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040756. [PMID: 37190005 DOI: 10.3390/children10040756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/24/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
Pulmonary arterial hypertension (PAH) is associated with increased right ventricular (RV) afterload, affecting RV remodeling and RV performance, a major determinant of outcome in PAH-patients. In children with PAH, treatment strategy is guided by risk stratification where noninvasive prognosticators are highly needed. The prognostic value of RV characteristics derived by cardiac magnetic resonance (CMR) has been scarcely studied in pediatric PAH. We aimed to identify CMR-derived morphometric and functional RV characteristics prognostic for outcome in children with PAH. From the Dutch National cohort, thirty-eight children with either idiopathic/heritable PAH (IPAH/HPAH) or PAH associated with congenital heart disease (PAH-CHD), who underwent CMR, were included (median (interquartile range) [IQR] age 13.0 years (10.8-15.0), 66% females). Patients had severe PAH, characterized by their World Health Organization Functional Class, increased N-terminal pro-B-type natriuretic peptide and high pulmonary arterial pressure and pulmonary vascular resistance index at time of CMR. RV-ejection fraction (RVEF), indexed RV-mass (RVMi), the ratio between RV and LV mass (RVM/LVM-ratio) and left ventricular eccentricity index (LVEI) all correlated with transplant-free survival from time of CMR. These correlations could not be confirmed in the PAH-CHD group. This study shows that CMR-derived measures reflecting RV function and remodeling (LVEI, RVMi, RVM/LVM-ratio, RVEF) predict transplant-free survival in children with IPAH/HPAH and may be included in risk stratification scores in pediatric PAH.
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Affiliation(s)
- Meindina G Haarman
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Iris Coenraad
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Quint A J Hagdorn
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Hans L Hillege
- Department of Epidemiology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Department of Cardiology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Tineke P Willems
- Department of Radiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Johannes M Douwes
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
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Kleineisel J, Heidenreich JF, Eirich P, Petri N, Köstler H, Petritsch B, Bley TA, Wech T. Real-time cardiac MRI using an undersampled spiral k-space trajectory and a reconstruction based on a variational network. Magn Reson Med 2022; 88:2167-2178. [PMID: 35692042 DOI: 10.1002/mrm.29357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Cardiac MRI represents the gold standard to determine myocardial function. However, the current clinical standard protocol, a segmented Cartesian acquisition, is time-consuming and can lead to compromised image quality in the case of arrhythmia or dyspnea. In this article, a machine learning-based reconstruction of undersampled spiral k-space data is presented to enable free breathing real-time cardiac MRI with good image quality and short reconstruction times. METHODS Data were acquired in free breathing with a 2D spiral trajectory corrected by the gradient system transfer function. Undersampled data were reconstructed by a variational network (VN), which was specifically adapted to the non-Cartesian sampling pattern. The network was trained with data from 11 subjects. Subsequently, the imaging technique was validated in 14 subjects by quantifying the difference to a segmented reference acquisition, an expert reader study, and by comparing derived volumes and functional parameters with values obtained using the current clinical gold standard. RESULTS The scan time for the entire heart was below 1 min. The VN reconstructed data in about 0.9 s per image, which is considerably shorter than conventional model-based approaches. The VN furthermore performed better than a U-Net and not inferior to a low-rank plus sparse model in terms of achieved image quality. Functional parameters agreed, on average, with reference data. CONCLUSIONS The proposed VN method enables real-time cardiac imaging with both high spatial and temporal resolution in free breathing and with short reconstruction time.
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Affiliation(s)
- Jonas Kleineisel
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Julius F Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Philipp Eirich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Nils Petri
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Herbert Köstler
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Tobias Wech
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
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7
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Brown JT, Saigal A, Karia N, Patel RK, Razvi Y, Constantinou N, Steeden JA, Mandal S, Kotecha T, Fontana M, Goldring J, Muthurangu V, Knight DS. Ongoing Exercise Intolerance Following COVID-19: A Magnetic Resonance-Augmented Cardiopulmonary Exercise Test Study. J Am Heart Assoc 2022; 11:e024207. [PMID: 35470679 PMCID: PMC9238618 DOI: 10.1161/jaha.121.024207] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Ongoing exercise intolerance of unclear cause following COVID-19 infection is well recognized but poorly understood. We investigated exercise capacity in patients previously hospitalized with COVID-19 with and without self-reported exercise intolerance using magnetic resonance-augmented cardiopulmonary exercise testing. Methods and Results Sixty subjects were enrolled in this single-center prospective observational case-control study, split into 3 equally sized groups: 2 groups of age-, sex-, and comorbidity-matched previously hospitalized patients following COVID-19 without clearly identifiable postviral complications and with either self-reported reduced (COVIDreduced) or fully recovered (COVIDnormal) exercise capacity; a group of age- and sex-matched healthy controls. The COVIDreducedgroup had the lowest peak workload (79W [Interquartile range (IQR), 65-100] versus controls 104W [IQR, 86-148]; P=0.01) and shortest exercise duration (13.3±2.8 minutes versus controls 16.6±3.5 minutes; P=0.008), with no differences in these parameters between COVIDnormal patients and controls. The COVIDreduced group had: (1) the lowest peak indexed oxygen uptake (14.9 mL/minper kg [IQR, 13.1-16.2]) versus controls (22.3 mL/min per kg [IQR, 16.9-27.6]; P=0.003) and COVIDnormal patients (19.1 mL/min per kg [IQR, 15.4-23.7]; P=0.04); (2) the lowest peak indexed cardiac output (4.7±1.2 L/min per m2) versus controls (6.0±1.2 L/min per m2; P=0.004) and COVIDnormal patients (5.7±1.5 L/min per m2; P=0.02), associated with lower indexed stroke volume (SVi:COVIDreduced 39±10 mL/min per m2 versus COVIDnormal 43±7 mL/min per m2 versus controls 48±10 mL/min per m2; P=0.02). There were no differences in peak tissue oxygen extraction or biventricular ejection fractions between groups. There were no associations between COVID-19 illness severity and peak magnetic resonance-augmented cardiopulmonary exercise testing metrics. Peak indexed oxygen uptake, indexed cardiac output, and indexed stroke volume all correlated with duration from discharge to magnetic resonance-augmented cardiopulmonary exercise testing (P<0.05). Conclusions Magnetic resonance-augmented cardiopulmonary exercise testing suggests failure to augment stroke volume as a potential mechanism of exercise intolerance in previously hospitalized patients with COVID-19. This is unrelated to disease severity and, reassuringly, improves with time from acute illness.
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Affiliation(s)
- James T. Brown
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | - Anita Saigal
- Department of Respiratory MedicineRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Nina Karia
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | - Rishi K. Patel
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- National Amyloidosis CentreDivision of MedicineUniversity College LondonUnited Kingdom
| | - Yousuf Razvi
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- National Amyloidosis CentreDivision of MedicineUniversity College LondonUnited Kingdom
| | - Natalie Constantinou
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | | | - Swapna Mandal
- Department of Respiratory MedicineRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Tushar Kotecha
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Marianna Fontana
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- National Amyloidosis CentreDivision of MedicineUniversity College LondonUnited Kingdom
| | - James Goldring
- Department of Respiratory MedicineRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Vivek Muthurangu
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
| | - Daniel S. Knight
- National Pulmonary Hypertension ServiceRoyal Free London NHS Foundation TrustLondonUnited Kingdom
- UCL Department of Cardiac MRIUniversity College London (Royal Free Campus)LondonUnited Kingdom
- Institute of Cardiovascular ScienceUniversity College LondonUnited Kingdom
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
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8
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Nayak KS, Lim Y, Campbell-Washburn AE, Steeden J. Real-Time Magnetic Resonance Imaging. J Magn Reson Imaging 2022; 55:81-99. [PMID: 33295674 PMCID: PMC8435094 DOI: 10.1002/jmri.27411] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 01/03/2023] Open
Abstract
Real-time magnetic resonance imaging (RT-MRI) allows for imaging dynamic processes as they occur, without relying on any repetition or synchronization. This is made possible by modern MRI technology such as fast-switching gradients and parallel imaging. It is compatible with many (but not all) MRI sequences, including spoiled gradient echo, balanced steady-state free precession, and single-shot rapid acquisition with relaxation enhancement. RT-MRI has earned an important role in both diagnostic imaging and image guidance of invasive procedures. Its unique diagnostic value is prominent in areas of the body that undergo substantial and often irregular motion, such as the heart, gastrointestinal system, upper airway vocal tract, and joints. Its value in interventional procedure guidance is prominent for procedures that require multiple forms of soft-tissue contrast, as well as flow information. In this review, we discuss the history of RT-MRI, fundamental tradeoffs, enabling technology, established applications, and current trends. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Krishna S. Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA,Address reprint requests to: K.S.N., 3740 McClintock Ave, EEB 400C, Los Angeles, CA 90089-2564, USA.
| | - Yongwan Lim
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Adrienne E. Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer Steeden
- Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, University College London, London, UK
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Brown JT, Kotecha T, Steeden JA, Fontana M, Denton CP, Coghlan JG, Knight DS, Muthurangu V. Reduced exercise capacity in patients with systemic sclerosis is associated with lower peak tissue oxygen extraction: a cardiovascular magnetic resonance-augmented cardiopulmonary exercise study. J Cardiovasc Magn Reson 2021; 23:118. [PMID: 34706740 PMCID: PMC8554852 DOI: 10.1186/s12968-021-00817-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/24/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Exercise intolerance in systemic sclerosis (SSc) is typically attributed to cardiopulmonary limitations. However, problems with skeletal muscle oxygen extraction have not been fully investigated. This study used cardiovascular magnetic resonance (CMR)-augmented cardiopulmonary exercise testing (CMR-CPET) to simultaneously measure oxygen consumption and cardiac output. This allowed calculation of arteriovenous oxygen content gradient, a recognized marker of oxygen extraction. We performed CMR-CPET in 4 groups: systemic sclerosis (SSc); systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH); non-connective tissue disease pulmonary hypertension (NC-PAH); and healthy controls. METHODS We performed CMR-CPET in 60 subjects (15 in each group) using a supine ergometer following a ramped exercise protocol until exhaustion. Values for oxygen consumption, cardiac output and oxygen content gradient, as well as ventricular volumes, were obtained at rest and peak-exercise for all subjects. In addition, T1 and T2 maps were acquired at rest, and the most recent clinical measures (hemoglobin, lung function, 6-min walk, cardiac and catheterization) were collected. RESULTS All patient groups had reduced peak oxygen consumption compared to healthy controls (p < 0.022). The SSc and SSc-PAH groups had reduced peak oxygen content gradient compared to healthy controls (p < 0.03). Conversely, the SSc-PAH and NC-PH patients had reduced peak cardiac output compared to healthy controls and SSc patients (p < 0.006). Higher hemoglobin was associated with higher peak oxygen content gradient (p = 0.025) and higher myocardial T1 was associated with lower peak stroke volume (p = 0.011). CONCLUSIONS Reduced peak oxygen consumption in SSc patients is predominantly driven by reduced oxygen content gradient and in SSc-PAH patients this was amplified by reduced peak cardiac output. Trial registration The study is registered with ClinicalTrials.gov Protocol Registration and Results System (ClinicalTrials.gov ID: 100358).
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Affiliation(s)
- James T Brown
- Institute of Cardiovascular Science, University College London, London, UK
- Royal Free Hospital, London, UK
| | - Tushar Kotecha
- Institute of Cardiovascular Science, University College London, London, UK
- Royal Free Hospital, London, UK
| | - Jennifer A Steeden
- Institute of Cardiovascular Science, University College London, London, UK
| | - Marianna Fontana
- Royal Free Hospital, London, UK
- Division of Medicine, University College London, London, UK
| | - Christopher P Denton
- Royal Free Hospital, London, UK
- Division of Medicine, University College London, London, UK
| | | | - Daniel S Knight
- Institute of Cardiovascular Science, University College London, London, UK
- Royal Free Hospital, London, UK
| | - Vivek Muthurangu
- Institute of Cardiovascular Science, University College London, London, UK.
- Centre for Cardiovascular Imaging, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
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10
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Zou Q, Xu HY, Fu C, Zhou XY, Xu R, Yang MX, Yang ZG, Guo YK. Utility of single-shot compressed sensing cardiac magnetic resonance cine imaging for assessment of biventricular function in free-breathing and arrhythmic pediatric patients. Int J Cardiol 2021; 338:258-264. [PMID: 34181995 DOI: 10.1016/j.ijcard.2021.06.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 06/11/2021] [Accepted: 06/23/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to explore the feasibility and accuracy of single-shot compressed-sensing (CS) cardiac magnetic resonance cine technology for the assessment of biventricular function and morphology in free-breathing (FB) pediatrics, especially those with arrhythmia. METHODS Seventy consecutive pediatric participants (6.27 ± 3.8 years, range:0.5-14 years) were enrolled between August 2019 and July 2020. Single-shot CS and conventional balanced steady-state free-precession (bSSFP) cine were obtained. The total scanning time, image quality and biventricular function parameters were compared for both sequences. RESULTS Single-shot CS cine had shorter acquisition time compared with the conventional bSSFP cine (all P < 0.001). The single-shot CS cine also had fewer artifacts than conventional bSSFP cine (breath-hold (BH): 4.6 ± 0.6 vs. 4.3 ± 0.6; FB without ongoing arrhythmia: 4.5 ± 0.6 vs. 3.6 ± 0.9; FB with ongoing arrhythmia: 4.7 ± 0.5 vs. 2.6 ± 1.1; all P < 0.05). No statistical difference of left ventricular parameters and right ventricular end-systolic volume/ejection fraction were found between the single-shot CS and conventional bSSFP cine in both BH and FB without ongoing arrhythmia group. There was an excellent correlation (R2 = 0.60-0.98, all P < 0.001) and good intra-(range: R2 = 0.57-0.99, P < 0.001)/inter-observer agreements (range: R2 = 0.76-1, P < 0.001) for single-shot CS cine images in terms of biventricular function parameters. CONCLUSIONS The single-shot CS cine can significantly reduce the image acquisition time, offering reliable quantification of biventricular function in free breathing condition for arrhythmic patients.
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Affiliation(s)
- Qing Zou
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan 610041, China; Department of Radiology, Deyang People's Hospital, 173# Section 3 Tai Shan Road, Deyang, Sichuan 618400, China
| | - Hua-Yan Xu
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan 610041, China
| | - Chuan Fu
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan 610041, China
| | - Xiao-Yue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China
| | - Rong Xu
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan 610041, China
| | - Meng-Xi Yang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Ying-Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan 610041, China.
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11
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Juaneda E, Catalfamo D, Fregapani JP, Peirone A, Juaneda I, Kreutzer C, Lucino S. Magnetic resonance lymphangiography in group 1 paediatric pulmonary arterial hypertension. Pulm Circ 2021; 11:20458940211004777. [PMID: 33868641 PMCID: PMC8020108 DOI: 10.1177/20458940211004777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
Pulmonary hypertension could have thoracic lymphatic abnormalities caused by
right ventricular failure. Since there is no description of such abnormalities,
the purpose of this study was to investigate them with magnetic resonance.
Prospective review magnetic resonance T2-weighted lymphangiography was performed
between January 2017 and October 2019 through quantitative thoracic duct
diameter, diameter index and qualitative lymphatic abnormalities types: 1 –
little or none abnormalities, 2 – abnormalities in supraclavicular region, 3 –
abnormalities extending into the mediastinum and 4 – abnormalities extending
into the lung. Five patients with group 1 pulmonary arterial hypertension
participated in this study. The mean age was 12.44 ± 4.92 years, three male and
two female. The quantitative analysis yielded the following results: mean
thoracic duct diameter of 2.92 ± 0.16 mm and thoracic duct index 2.28 ± 1.03
mm/m2. Qualitative lymphangiography abnormalities were type 1 in
three patients, type 2 in one, all with low-risk determinants, and type 3 in one
with high-risk determinants and right ventricular failure. Magnetic resonance
T2-weighted lymphangiography in group 1 paediatric pulmonary arterial
hypertension allowed for the identification of the thoracic duct, which was used
to perform both quantitative and qualitative analysis of thoracic lymphatic
abnormalities, in particular when increased high-risk determinants and right
ventricular failure were present. These features represent an extracardiac
finding useful to understand systemic venous congestion impact on lymphatic
system.
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Affiliation(s)
- Ernesto Juaneda
- Hospital de Niños, Hospital Privado Universitario and Instituto Oulton-Catholic University of Córdoba, Córdoba, Argentina
| | - Danilo Catalfamo
- Instituto Oulton, Catholic University of Córdoba, Córdoba, Argentina
| | - Juan P Fregapani
- Instituto Oulton, Catholic University of Córdoba, Córdoba, Argentina
| | - Alejandro Peirone
- Hospital de Niños and Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Ignacio Juaneda
- Hospital de Niños and Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | | | - Sergio Lucino
- Instituto Oulton, Catholic University of Córdoba, Córdoba, Argentina
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Kocaoglu M, Pednekar AS, Wang H, Alsaied T, Taylor MD, Rattan MS. Breath-hold and free-breathing quantitative assessment of biventricular volume and function using compressed SENSE: a clinical validation in children and young adults. J Cardiovasc Magn Reson 2020; 22:54. [PMID: 32713347 PMCID: PMC7384228 DOI: 10.1186/s12968-020-00642-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/29/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although the breath-hold cine balanced steady state free precession (bSSFP) imaging is well established for assessment of biventricular volumes and function, shorter breath-hold times or no breath-holds are beneficial in children and severely ill or sedated patients. METHODS Clinical cardiovascular magnetic resonance (CMR) examinations from September 2019 to October 2019 that included breath-hold (BH) and free-breathing (FB) cine bSSFP imaging accelerated using compressed sensitivity encoding (C-SENSE) factor of 3 in addition to the clinical standard BH cine bSSFP imaging using SENSE factor of 2 were analyzed retrospectively. Patients with structurally normal hearts who could perform consistent BHs were included. Aortic flow measured by phase contrast acquisition was used as a reference for the left ventricular (LV) stroke volume. Comparative analysis was performed for evaluation of biventricular volumes and function, imaging times, quantitative image quality, and qualitative image scoring. RESULTS There were 26 patients who underwent all three cine scans during the study period (16.7 ± 6.4 years, body surface area (BSA) 1.6 ± 0.4 m2, heart rate 83 ± 7 beats/min). BH durations of 8 ± 1 s with C-SENSE = 3 were significantly shorter (p < 0.001) by 33% compared to 12 ± 1 s with SENSE = 2. Actual scan time for BH SENSE (4.9 ± 1.2 min) was comparable to that with FB C-SENSE (5.2 ± 1.5 min; p= NS). Biventricular stroke volume and ejection fraction, and LV mass computed using all three sequences were comparable. There was a small but statistically significant (p < 0.05) difference in LV end-diastolic volume (- 3.0 ± 6.8 ml) between BH SENSE and FB C-SENSE. There was a small but statistically significant (p < 0.005) difference in end-diastolic LV (- 5.0 ± 7.7 ml) and RV (- 6.0 ± 8.5 ml) volume and end-systolic LV (- 3.2 ± 4.3 ml) and RV(- 4.2 ± 6.8 ml) volumes between BH C-SENSE and FB C-SENSE. The LV stroke volumes from all three sequences had excellent correlations (r = 0.96, slope = 0.98-1.02) with aortic flow, with overestimation by 2.7 (5%) to 4.6 (8%) ml/beat. The image quality score was Excellent (16 of 26) to Good (10 of 26) with BH SENSE, Excellent (13 of 26) to Good (13 of 26) with BH C-SENSE, and Excellent (3 of 26) to Good (21 of 26) to Adequate (2 of 26) with FB C-SENSE. CONCLUSIONS Image quality and ventricular volumetric and functional indices using either BH or FB C-SENSE cine bSSFP imaging were comparable to standard BH SENSE cine bSSFP imaging while maintaining nominally identical spatio-temporal resolution. This accelerated image acquisition provides an alternative to accommodate patients with impaired BH capacity.
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Affiliation(s)
- Murat Kocaoglu
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
| | - Amol S. Pednekar
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Hui Wang
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH USA
- MR Clinical Science, Philips Healthcare, Cincinnati, OH USA
| | - Tarek Alsaied
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Michael D. Taylor
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Mantosh S. Rattan
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH USA
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13
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Wang J, Li X, Lin L, Dai JW, Schmidt M, Forman C, An J, Jin ZY, Wang YN. Diagnostic efficacy of 2-shot compressed sensing cine sequence cardiovascular magnetic resonance imaging for left ventricular function. Cardiovasc Diagn Ther 2020; 10:431-441. [PMID: 32695623 DOI: 10.21037/cdt-20-135] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cardiac magnetic resonance cine images are conventionally acquired in breath-hold with a segmented balanced steady-state free precession (bSSFP) sequence, which requires a relatively long acquisition time and high patient cooperation. The single-shot compressed sensing (ss CS) cine sequence is a real-time sequence that has reasonable spatial and temporal resolution and can be applied during free breathing. However, the contrast between the myocardium and surrounding soft tissue is relatively reduced, and the epicardial delineation results are not as accurate with the ss CS cine sequence compared with the bSSFP sequence. In this study, we evaluated the use of a 2-shot CS cine technique in quickly acquiring high-quality images and accurately assessing cardiac function in clinical practice. Methods The patients enrolled in the study underwent cardiovascular magnetic resonance (CMR) on a 3T scanner from Jul. to Dec. 2018. Cine imaging was performed with 3 different methods: a standard segment cine sequence, a real-time ss CS cine sequence, and a 2-shot CS cine sequence prototype. Quantitative analysis of image quality was performed using a 0-4 scoring system, and also edge sharpness was measured, and cardiac function analysis was performed for all 3 types of cine images. Results Thirty-eight patients underwent imaging with the three types of cine sequences. The average scan time of the standard cine sequence was 101±20 s, the average scan time of the ss CS cine sequence was 20±4 s, and the average scan time of the 2-shot CS cine sequence was 30±6 s. The standard cine sequence image score was 3.68±0.64 and edge sharpness was (2.47±0.18) mm, the ss CS cine sequence image score was 3.13±0.35 and edge sharpness was (4.69±0.02) mm, and the 2-shot cine sequence image score was 3.54±0.51 and the edge sharpness was (2.51±0.13) mm. In terms of the quantitative study of cardiac function, the differences between the standard cine sequence and the ss CS cine sequence were not statistically significant, except for those of the imaging score and LV mass. There were no significant differences in the cardiac function parameters between the standard cine sequence and the 2-shot cine sequence. There was a strong correlation between the standard cine and ss CS cine sequences and between the standard cine and 2-shot CS cine sequences (P<0.01) of all the cardiac function parameters. Conclusions The 2-shot CS cine sequence can acquire images with a level of quality comparable to that of the standard cine sequence in a significantly shorter period of time. The functional parameters are similar between the 2-shot CS cine sequence and the standard cine sequence.
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Affiliation(s)
- Jian Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lu Lin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing-Wen Dai
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | | | | | - Jing An
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi-Ning Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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14
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15
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Chieh SW, Kaveh M, Akçakaya M, Moeller S. Self-calibrated interpolation of non-Cartesian data with GRAPPA in parallel imaging. Magn Reson Med 2019; 83:1837-1850. [PMID: 31722128 DOI: 10.1002/mrm.28033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/20/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE To develop a non-Cartesian k-space reconstruction method using self-calibrated region-specific interpolation kernels for highly accelerated acquisitions. METHODS In conventional non-Cartesian GRAPPA with through-time GRAPPA (TT-GRAPPA), the use of region-specific interpolation kernels has demonstrated improved reconstruction quality in dynamic imaging for highly accelerated acquisitions. However, TT-GRAPPA requires the acquisition of a large number of separate calibration scans. To reduce the overall imaging time, we propose Self-calibrated Interpolation of Non-Cartesian data with GRAPPA (SING) to self-calibrate region-specific interpolation kernels from dynamic undersampled measurements. The SING method synthesizes calibration data to adapt to the distinct shape of each region-specific interpolation kernel geometry, and uses a novel local k-space regularization through an extension of TT-GRAPPA. This calibration approach is used to reconstruct non-Cartesian images at high acceleration rates while mitigating noise amplification. The reconstruction quality of SING is compared with conjugate-gradient SENSE and TT-GRAPPA in numerical phantoms and in vivo cine data sets. RESULTS In both numerical phantom and in vivo cine data sets, SING offers visually and quantitatively similar reconstruction quality to TT-GRAPPA, and provides improved reconstruction quality over conjugate-gradient SENSE. Furthermore, temporal fidelity in SING and TT-GRAPPA is similar for the same acceleration rates. G-factor evaluation over the heart shows that SING and TT-GRAPPA provide similar noise amplification at moderate and high rates. CONCLUSION The proposed SING reconstruction enables significant improvement of acquisition efficiency for calibration data, while matching the reconstruction performance of TT-GRAPPA.
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Affiliation(s)
- Seng-Wei Chieh
- Electrical and Computer Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Mostafa Kaveh
- Electrical and Computer Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Mehmet Akçakaya
- Electrical and Computer Engineering, University of Minnesota, Minneapolis, Minnesota.,Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota
| | - Steen Moeller
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota
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16
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Kowalik GT, Knight D, Steeden JA, Muthurangu V. Perturbed spiral real-time phase-contrast MR with compressive sensing reconstruction for assessment of flow in children. Magn Reson Med 2019; 83:2077-2091. [PMID: 31703158 DOI: 10.1002/mrm.28065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/04/2019] [Accepted: 10/14/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE we implemented a golden-angle spiral phase contrast sequence. A commonly used uniform density spiral and a new 'perturbed' spiral that produces more incoherent aliases were assessed. The aim was to ascertain whether greater incoherence enabled more accurate Compressive Sensing reconstruction and superior measurement of flow and velocity. METHODS A range of 'perturbed' spiral trajectories based on a uniform spiral trajectory were formulated. The trajectory that produced the most noise-like aliases was selected for further testing. For in-silico and in-vivo experiments, data was reconstructed using total Variation L1 regularisation in the spatial and temporal domains. In-silico, the reconstruction accuracy of the 'perturbed' golden spiral was compared to uniform density golden-angle spiral. For the in-vivo experiment, stroke volume and peak mean velocity were measured in 20 children using 'perturbed' and uniform density golden-angle spiral sequences. These were compared to a reference standard gated Cartesian sequence. RESULTS In-silico, the perturbed spiral acquisition produced more accurate reconstructions with less temporal blurring (NRMSE ranging from 0.03 to 0.05) than the uniform density acquisition (NRMSE ranging from 0.06 to 0.12). This translated in more accurate results in-vivo with no significant bias in the peak mean velocity (bias: -0.1, limits: -4.4 to 4.1 cm/s; P = 0.98) or stroke volume (bias: -1.8, limits: -9.4 to 5.8 ml, P = 0.19). CONCLUSION We showed that a 'perturbed' golden-angle spiral approach is better suited to Compressive Sensing reconstruction due to more incoherent aliases. This enabled accurate real-time measurement of flow and peak velocity in children.
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Affiliation(s)
- Grzegorz Tomasz Kowalik
- Centre for Cardiovascular Imaging, University College London Institute of Cardiovascular Science, London, United Kingdom
| | - Daniel Knight
- Centre for Cardiovascular Imaging, University College London Institute of Cardiovascular Science, London, United Kingdom.,Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jennifer Anne Steeden
- Centre for Cardiovascular Imaging, University College London Institute of Cardiovascular Science, London, United Kingdom
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, University College London Institute of Cardiovascular Science, London, United Kingdom.,Great Ormond Street Hospital for Children, London, United Kingdom
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Hauser JA, Muthurangu V, Sattar N, Taylor AM, Jones A. Postprandial Vascular Dysfunction Is Associated With Raised Blood Pressure and Adverse Left Ventricular Remodeling in Adolescent Adiposity. Circ Cardiovasc Imaging 2019; 12:e009172. [PMID: 31707792 DOI: 10.1161/circimaging.119.009172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is a major risk factor for cardiovascular disease, including heart failure. Although linked to obesity and hypertension, its pathogenesis is multifactorial. Blunted postprandial sympathetic regulation of gut blood flow has been observed in overweight animals and suggested as a promotor of hypertension and LVH. We hypothesized that blunted postprandial superior mesenteric blood flow responses would be more common in overweight humans and associated with increased blood pressure and LVH. METHODS Left ventricular dimensions and hemodynamic responses to a standardized high-calorie liquid meal were measured in healthy adolescents (n=82; 39 overweight/obese) by magnetic resonance imaging. Covariates such as body mass index, blood pressure, Tanner score, and an index of insulin resistance were included in multiple regression models to examine the independent associations of mesenteric flow response with blood pressure status and LVH. RESULTS Food ingestion increased cardiac output (Δmean, 0.45 [SD, 0.62] L·min-1; P=3.8×10-8) and superior mesenteric artery flow (Δmean, 0.76 [SD, 0.35] L·min-1; P=4.2×10-31). A blunted mesenteric flow response was associated with increased left ventricular mass (B=-12.7 g·m-2.7 per L·min-1·m-0.92; P=6×10-5) and concentric LVH (log likelihood, -9.9; P=0.001), independently of known determinants of LVH, including body mass index. It was also associated with elevated systolic blood pressure (B=-18.0 mm Hg per L·min-1·m-0.92; P=0.001), but this link did not explain the association with left ventricular mass. CONCLUSIONS Postprandial mesenteric vascular dysfunction is associated with LVH and hypertension, independently of common risk factors for those conditions. These findings highlight a new, independent marker of cardiovascular risk in the young.
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Affiliation(s)
- Jakob A Hauser
- Centre for Cardiovascular Imaging, University College London, United Kingdom (J.A.H., V.M., A.M.T.)
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Cardiology, Medical University of Vienna, Austria (J.A.H.)
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, University College London, United Kingdom (J.A.H., V.M., A.M.T.)
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (N.S.)
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, University College London, United Kingdom (J.A.H., V.M., A.M.T.)
| | - Alexander Jones
- Department of Paediatrics, University of Oxford, United Kingdom (A.J.)
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Compressed SENSE single-breath-hold and free-breathing cine imaging for accelerated clinical evaluation of the left ventricle. Clin Radiol 2019; 74:325.e9-325.e17. [DOI: 10.1016/j.crad.2018.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 12/19/2018] [Indexed: 11/22/2022]
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The cardiovascular phenotype of childhood hypertension: a cardiac magnetic resonance study. Pediatr Radiol 2019; 49:727-736. [PMID: 31053874 PMCID: PMC6614159 DOI: 10.1007/s00247-019-04393-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/07/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The cardiovascular phenotype is poorly characterized in treated pediatric hypertension. Cardiovascular magnetic resonance imaging (MRI) can be used to better characterize both cardiac and vascular phenotype in children with hypertension. OBJECTIVE To use MRI to determine the cardiac and vascular phenotypes of different forms of treated hypertension and compare the results with those of healthy children. MATERIALS AND METHODS Sixty children (15 with chronic renal disease with hypertension, 15 with renovascular hypertension, 15 with essential hypertension and 15 healthy subjects) underwent MRI with noninvasive blood pressure measurements. Cardiovascular parameters measured include systemic vascular resistance, total arterial compliance, left ventricular mass and volumetric data, ejection fraction and myocardial velocity. Between-group comparisons were used to investigate differences in the hypertension types. RESULTS Renal hypertension was associated with elevated vascular resistance (P≤0.007) and normal arterial compliance. Conversely, children with essential hypertension had normal resistance but increased compliance (P=0.001). Renovascular hypertension was associated with both increased resistance and compliance (P≤0.03). There was no difference in ventricular volumes, mass or cardiac output between groups. Children with renal hypertension also had lower systolic and diastolic myocardial velocities. CONCLUSION Cardiovascular MRI may identify distinct vascular and cardiac phenotypes in different forms of treated childhood hypertension. Future studies are needed to investigate how this may inform further optimisation of blood pressure treatment in different types of hypertension.
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Steeden JA, Kowalik GT, Tann O, Hughes M, Mortensen KH, Muthurangu V. Real-time assessment of right and left ventricular volumes and function in children using high spatiotemporal resolution spiral bSSFP with compressed sensing. J Cardiovasc Magn Reson 2018; 20:79. [PMID: 30518390 PMCID: PMC6282387 DOI: 10.1186/s12968-018-0500-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/23/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Real-time cardiovascular magnetic resonance (CMR) assessment of ventricular volumes and function enables data acquisition during free-breathing. The requirement for high spatiotemporal resolution in children necessitates the use of highly accelerated imaging techniques. METHODS A novel real-time balanced steady state free precession (bSSFP) spiral sequence reconstructed using Compressed Sensing (CS) was prospectively validated against the breath-hold clinical standard for assessment of ventricular volumes in 60 children with congenital heart disease. Qualitative image scoring, quantitative image quality, as well as evaluation of biventricular volumes was performed. Standard BH and real-time measures were compared using the paired t-test and agreement for volumetric measures were evaluated using Bland Altman analysis. RESULTS Acquisition time for the entire short axis stack (~ 13 slices) using the spiral real-time technique was ~ 20 s, compared to ~ 348 s for the standard breath hold technique. Qualitative scores reflected more residual aliasing artefact (p < 0.001) and lower edge definition (p < 0.001) in spiral real-time images than standard breath hold images, with lower quantitative edge sharpness and estimates of image contrast (p < 0.001). There was a small but statistically significant (p < 0.05) overestimation of left ventricular (LV) end-systolic volume (1.0 ± 3.5 mL), and underestimation of LV end-diastolic volume (- 1.7 ± 4.6 mL), LV stroke volume (- 2.6 ± 4.8 mL) and LV ejection fraction (- 1.5 ± 3.0%) using the real-time technique. We also observed a small underestimation of right ventricular stroke volume (- 1.8 ± 4.9 mL) and ejection fraction (- 1.4 ± 3.7%) using the real-time imaging technique. No difference in inter-observer or intra-observer variability were observed between the BH and real-time sequences. CONCLUSIONS Real-time bSSFP imaging using spiral trajectories combined with a compressed sensing reconstruction showed good agreement for quantification of biventricular metrics in children with heart disease, despite slightly lower image quality. This technique holds the potential for free breathing data acquisition, with significantly shorter scan times in children.
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Affiliation(s)
- Jennifer A. Steeden
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH UK
| | - Grzegorz T. Kowalik
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH UK
| | - Oliver Tann
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, WC1N 3JH UK
| | - Marina Hughes
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, WC1N 3JH UK
| | - Kristian H. Mortensen
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, WC1N 3JH UK
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH UK
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21
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Hauptmann A, Arridge S, Lucka F, Muthurangu V, Steeden JA. Real-time cardiovascular MR with spatio-temporal artifact suppression using deep learning-proof of concept in congenital heart disease. Magn Reson Med 2018; 81:1143-1156. [PMID: 30194880 PMCID: PMC6492123 DOI: 10.1002/mrm.27480] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/11/2018] [Accepted: 07/15/2018] [Indexed: 12/25/2022]
Abstract
Purpose Real‐time assessment of ventricular volumes requires high acceleration factors. Residual convolutional neural networks (CNN) have shown potential for removing artifacts caused by data undersampling. In this study, we investigated the ability of CNNs to reconstruct highly accelerated radial real‐time data in patients with congenital heart disease (CHD). Methods A 3D (2D plus time) CNN architecture was developed and trained using synthetic training data created from previously acquired breath hold cine images from 250 CHD patients. The trained CNN was then used to reconstruct actual real‐time, tiny golden angle (tGA) radial SSFP data (13 × undersampled) acquired in 10 new patients with CHD. The same real‐time data was also reconstructed with compressed sensing (CS) to compare image quality and reconstruction time. Ventricular volume measurements made using both the CNN and CS reconstructed images were compared to reference standard breath hold data. Results It was feasible to train a CNN to remove artifact from highly undersampled radial real‐time data. The overall reconstruction time with the CNN (including creation of aliased images) was shown to be >5 × faster than the CS reconstruction. In addition, the image quality and accuracy of biventricular volumes measured from the CNN reconstructed images were superior to the CS reconstructions. Conclusion This article has demonstrated the potential for the use of a CNN for reconstruction of real‐time radial data within the clinical setting. Clinical measures of ventricular volumes using real‐time data with CNN reconstruction are not statistically significantly different from gold‐standard, cardiac‐gated, breath‐hold techniques.
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Affiliation(s)
- Andreas Hauptmann
- Department of Computer Science, University College London, London, United Kingdom
| | - Simon Arridge
- Department of Computer Science, University College London, London, United Kingdom
| | - Felix Lucka
- Department of Computer Science, University College London, London, United Kingdom.,Computational Imaging, Centrum Wiskunde and Informatica (CWI), Amsterdam, Netherlands
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom
| | - Jennifer A Steeden
- UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom
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22
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Cheang MH, Barber NJ, Khushnood A, Hauser JA, Kowalik GT, Steeden JA, Quail MA, Tullus K, Hothi D, Muthurangu V. A comprehensive characterization of myocardial and vascular phenotype in pediatric chronic kidney disease using cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2018; 20:24. [PMID: 29609642 PMCID: PMC5880006 DOI: 10.1186/s12968-018-0444-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 03/08/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Children with chronic kidney disease (CKD) have increased cardiovascular mortality. Identifying high-risk children who may benefit from further therapeutic intervention is difficult as cardiovascular abnormalities are subtle. Although transthoracic echocardiography may be used to detect sub-clinical abnormalities, it has well-known problems with reproducibility that limit its ability to accurately detect these changes. Cardiovascular magnetic resonance (CMR) is the reference standard method for assessing blood flow, cardiac structure and function. Furthermore, recent innovations enable the assessment of radial and longitudinal myocardial velocity, such that detection of sub-clinical changes is now possible. Thus, CMR may be ideal for cardiovascular assessment in pediatric CKD. This study aims to comprehensively assess cardiovascular function in pediatric CKD using CMR and determine its relationship with CKD severity. METHODS A total of 120 children (40 mild, 40 moderate, 20 severe pre-dialysis CKD subjects and 20 healthy controls) underwent CMR with non-invasive blood pressure (BP) measurements. Cardiovascular parameters measured included systemic vascular resistance (SVR), total arterial compliance (TAC), left ventricular (LV) structure, ejection fraction (EF), cardiac timings, radial and longitudinal systolic and diastolic myocardial velocities. Between group comparisons and regression modelling were used to identify abnormalities in CKD and determine the effects of renal severity on myocardial function. RESULTS The elevation in mean BP in CKD was accompanied by significantly increased afterload (SVR), without evidence of arterial stiffness (TAC) or increased fluid overload. Left ventricular volumes and global function were not abnormal in CKD. However, there was evidence of LV remodelling, prolongation of isovolumic relaxation time and reduced systolic and diastolic myocardial velocities. CONCLUSION Abnormal cardiovascular function is evident in pre-dialysis pediatric CKD. Novel CMR biomarkers may be useful for the detection of subtle abnormalities in this population. Further studies are needed to determine to prognostic value of these biomarkers.
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Affiliation(s)
- Mun Hong Cheang
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
- Great Ormond Street Hospital, London, UK
| | - Nathaniel J. Barber
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
- Great Ormond Street Hospital, London, UK
| | - Abbas Khushnood
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
- Great Ormond Street Hospital, London, UK
| | - Jakob A. Hauser
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
- Great Ormond Street Hospital, London, UK
| | - Gregorz T. Kowalik
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
| | - Jennifer A. Steeden
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
| | - Michael A. Quail
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
- Great Ormond Street Hospital, London, UK
| | | | | | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, 30 Guilford Street, London, WC1N 1EH UK
- Great Ormond Street Hospital, London, UK
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23
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Haji-Valizadeh H, Rahsepar AA, Collins JD, Bassett E, Isakova T, Block T, Adluru G, DiBella EVR, Lee DC, Carr JC, Kim D. Validation of highly accelerated real-time cardiac cine MRI with radial k-space sampling and compressed sensing in patients at 1.5T and 3T. Magn Reson Med 2017; 79:2745-2751. [PMID: 28921631 DOI: 10.1002/mrm.26918] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/17/2017] [Accepted: 08/22/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To validate an optimal 12-fold accelerated real-time cine MRI pulse sequence with radial k-space sampling and compressed sensing (CS) in patients at 1.5T and 3T. METHODS We used two strategies to reduce image artifacts arising from gradient delays and eddy currents in radial k-space sampling with balanced steady-state free precession readout. We validated this pulse sequence against a standard breath-hold cine sequence in two patient cohorts: a myocardial infarction (n = 16) group at 1.5T and chronic kidney disease group (n = 18) at 3T. Two readers independently performed visual analysis of 68 cine sets in four categories (myocardial definition, temporal fidelity, artifact, noise) on a 5-point Likert scale (1 = nondiagnostic, 2 = poor, 3 = adequate or moderate, 4 = good, 5 = excellent). Another reader calculated left ventricular (LV) functional parameters, including ejection fraction. RESULTS Compared with standard cine, real-time cine produced nonsignificantly different visually assessed scores, except for the following categories: 1) temporal fidelity scores were significantly lower (P = 0.013) for real-time cine at both field strengths, 2) artifacts scores were significantly higher (P = 0.013) for real-time cine at both field strengths, and 3) noise scores were significantly (P = 0.013) higher for real-time cine at 1.5T. Standard and real-time cine pulse sequences produced LV functional parameters that were in good agreement (e.g., absolute mean difference in ejection fraction <4%). CONCLUSION This study demonstrates that an optimal 12-fold, accelerated, real-time cine MRI pulse sequence using radial k-space sampling and CS produces good to excellent visual scores and relatively accurate LV functional parameters in patients at 1.5T and 3T. Magn Reson Med 79:2745-2751, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Hassan Haji-Valizadeh
- Biomedical Engineering, Northwestern University, Evanston, Illinois, USA.,Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Amir A Rahsepar
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Jeremy D Collins
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Elwin Bassett
- Physics Department, University of Utah, Salt Lake City, Utah, USA
| | - Tamara Isakova
- Division of Nephrology, Internal Medicine, Northwestern University, Chicago, Illinois, USA
| | - Tobias Block
- Department of Radiology, New York University, New York, New York, USA
| | - Ganesh Adluru
- Department of Radiology and Imaging Science, University of Utah, Salt Lake City, Utah, USA
| | - Edward V R DiBella
- Department of Radiology and Imaging Science, University of Utah, Salt Lake City, Utah, USA
| | - Daniel C Lee
- Department of Radiology, Northwestern University, Chicago, Illinois, USA.,Division of Cardiology, Internal Medicine, Northwestern University, Chicago, Illinois, USA
| | - James C Carr
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
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24
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Kido T, Kido T, Nakamura M, Watanabe K, Schmidt M, Forman C, Mochizuki T. Compressed sensing real-time cine cardiovascular magnetic resonance: accurate assessment of left ventricular function in a single-breath-hold. J Cardiovasc Magn Reson 2016; 18:50. [PMID: 27553656 PMCID: PMC4995641 DOI: 10.1186/s12968-016-0271-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/29/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Cardiovascular cine magnetic resonance (CMR) accelerated by compressed sensing (CS) is used to assess left ventricular (LV) function. However, it is difficult for prospective CS cine CMR to capture the complete end-diastolic phase, which can lead to underestimation of the end-diastolic volume (EDV), stroke volume (SV), and ejection fraction (EF), compared to retrospective standard cine CMR. This prospective study aimed to evaluate the diagnostic quality and accuracy of single-breath-hold full cardiac cycle CS cine CMR, acquired over two heart beats, to quantify LV volume in comparison to multi-breath-hold standard cine CMR. METHODS Eighty-one participants underwent standard segmented breath-hold cine and CS real-time cine CMR examinations to obtain a stack of eight contiguous short-axis images with same high spatial (1.7 × 1.7 mm(2)) and temporal resolution (41 ms). Two radiologists independently performed qualitative analysis of image quality (score, 1 [i.e., "nondiagnostic"] to 5 [i.e., "excellent"]) and quantitative analysis of the LV volume measurements. RESULTS The total examination time was 113 ± 7 s for standard cine CMR and 24 ± 4 s for CS cine CMR (p < 0.0001). The CS cine image quality was slightly lower than standard cine (4.8 ± 0.5 for standard vs. 4.4 ± 0.5 for CS; p < 0.0001). However, all image quality scores for CS cine were above 4 (i.e., good). No significant differences existed between standard and CS cine MR for all quantitative LV measurements. The mean differences with 95 % confidence interval (CI), based on Bland-Altman analysis, were 1.3 mL (95 % CI, -14.6 - 17.2) for LV end-diastolic volume, 0.2 mL (95 % CI, -9.8 to10.3) for LV end-systolic volume, 1.1 mL (95 % CI, -10.5 to 12.7) for LV stroke volume, 1.0 g (95 % CI, -11.2 to 13.3) for LV mass, and 0.4 % (95 % CI, -4.8 - 5.6) for LV ejection fraction. The interobserver and intraobserver variability for CS cine MR ranged from -4.8 - 1.6 % and from -7.3 - 9.3 %, respectively, with slopes of the regressions ranging 0.88-1.0 and 0.86-1.03, respectively. CONCLUSIONS Single-breath-hold full cardiac cycle CS real-time cine CMR could evaluate LV volume with excellent accuracy. It may replace multi-breath-hold standard cine CMR.
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Affiliation(s)
- Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Masashi Nakamura
- Department of Radiology, Saiseikai Matsuyama Hospital, 880-2, Yamanishi, Matsuyama, Ehime 791-8026 Japan
| | - Kouki Watanabe
- Department of Cardiology, Saiseikai Matsuyama Hospital, 880-2, Yamanishi, Matsuyama, Ehime 791-8026 Japan
| | - Michaela Schmidt
- Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052 Erlangen, Germany
| | - Christoph Forman
- Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052 Erlangen, Germany
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
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25
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Hauser JA, Muthurangu V, Steeden JA, Taylor AM, Jones A. Comprehensive assessment of the global and regional vascular responses to food ingestion in humans using novel rapid MRI. Am J Physiol Regul Integr Comp Physiol 2016; 310:R541-5. [DOI: 10.1152/ajpregu.00454.2015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/10/2016] [Indexed: 11/22/2022]
Abstract
Ingestion of food is known to increase mesenteric blood flow. It is not clear whether this increased flow demand is compensated by a rise in cardiac output (CO) alone or by redistribution of blood flow from other organs. We used a new comprehensive imaging method to assess the human cardiovascular response to food ingestion. Following a 12-h fast, blood flow in segments of the aorta and in organ-specific arteries, and ventricular volumes were assessed in 20 healthy adults using MRI at rest and following ingestion of a high-energy liquid meal. Systemic vascular resistance (SVR) fell substantially and CO rose significantly. Blood pressure remained stable. These changes were predominantly driven by a rapid fall in mesenteric vascular resistance, resulting in over four times more intestinal blood flow. Renal vascular resistance also declined but less dramatically. No changes in blood flow to the celiac territory, the brain, or the limbs were observed. In conclusion, this is the first study to fully characterize systemic and regional changes in vascular resistance after food ingestion in humans. Our findings show that the postprandial drop in SVR is fully compensated for by increased CO and not by redistribution of blood from other organs. With the exception of a modest increase in renal blood flow, there was no evidence of altered blood flow to nondigestive organs. The proposed oral food challenge protocol can be applied safely in an MRI environment and may be useful for studying the involvement of the gut in systemic or cardiovascular disease.
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Affiliation(s)
- Jakob A. Hauser
- University College London, Institute of Cardiovascular Science, Centre for Cardiovascular Imaging; London, United Kingdom; and
- Great Ormond Street Hospital for Children, Cardiorespiratory Division; London, United Kingdom
| | - Vivek Muthurangu
- University College London, Institute of Cardiovascular Science, Centre for Cardiovascular Imaging; London, United Kingdom; and
- Great Ormond Street Hospital for Children, Cardiorespiratory Division; London, United Kingdom
| | - Jennifer A. Steeden
- University College London, Institute of Cardiovascular Science, Centre for Cardiovascular Imaging; London, United Kingdom; and
- Great Ormond Street Hospital for Children, Cardiorespiratory Division; London, United Kingdom
| | - Andrew M. Taylor
- University College London, Institute of Cardiovascular Science, Centre for Cardiovascular Imaging; London, United Kingdom; and
- Great Ormond Street Hospital for Children, Cardiorespiratory Division; London, United Kingdom
| | - Alexander Jones
- University College London, Institute of Cardiovascular Science, Centre for Cardiovascular Imaging; London, United Kingdom; and
- Great Ormond Street Hospital for Children, Cardiorespiratory Division; London, United Kingdom
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26
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Mitchell FM, Prasad SK, Greil GF, Drivas P, Vassiliou VS, Raphael CE. Cardiovascular magnetic resonance: Diagnostic utility and specific considerations in the pediatric population. World J Clin Pediatr 2016; 5:1-15. [PMID: 26862497 PMCID: PMC4737683 DOI: 10.5409/wjcp.v5.i1.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/10/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular magnetic resonance is a non-invasive imaging modality which is emerging as important tool for the investigation and management of pediatric cardiovascular disease. In this review we describe the key technical and practical differences between scanning children and adults, and highlight some important considerations that must be taken into account for this patient population. Using case examples commonly seen in clinical practice, we discuss the important clinical applications of cardiovascular magnetic resonance, and briefly highlight key future developments in this field.
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27
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Knight DS, Steeden JA, Moledina S, Jones A, Coghlan JG, Muthurangu V. Left ventricular diastolic dysfunction in pulmonary hypertension predicts functional capacity and clinical worsening: a tissue phase mapping study. J Cardiovasc Magn Reson 2015; 17:116. [PMID: 26715551 PMCID: PMC4696235 DOI: 10.1186/s12968-015-0220-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/15/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The function of the right and left ventricles is intimately related through a shared septum and pericardium. Therefore, right ventricular (RV) disease in pulmonary hypertension (PH) can result in abnormal left ventricular (LV) myocardial mechanics. To assess this, we implemented novel cardiovascular magnetic resonance (CMR) tissue phase mapping (TPM) to assess radial, longitudinal and tangential LV myocardial velocities in patients with PH. METHODS Respiratory self-gated TPM was performed using a rotating golden-angle spiral acquisition with retrospective cardiac gating. TPM of a mid ventricular slice was acquired in 40 PH patients and 20 age- and sex-matched healthy controls. Endocardial and epicardial LV borders were manually defined, and myocardial velocities calculated using in-house software. Patients without proximal CTEPH (chronic thromboembolic PH) and not receiving intravenous prostacyclin therapy (n = 34) were followed up until the primary outcome of disease progression (death, transplantation, or progression to intravenous therapy) or the end of the study. Physicians who determined disease progression were blinded to CMR data. Conventional ventricular volumetric indices and novel TPM metrics were analyzed for prediction of 6-min walk distance (6MWD) and disease progression. RESULTS Peak longitudinal (p < 0.0001) and radial (p = 0.001) early diastolic (E) wave velocities were significantly lower in PH patients compared with healthy volunteers. Reversal of tangential E waves was observed in all patients and was highly discriminative for the presence of PH (p < 0.0001). The global radial E wave (β = 0.41, p = 0.017) and lateral wall radial systolic (S) wave velocities (β = 0.33, p = 0.028) were the only independent predictors of 6MWD in a model including RV ejection fraction (RVEF) and LV stroke volume. Over a median follow-up period of 20 months (IQR 7.9 months), 8 patients commenced intravenous therapy and 1 died. Global longitudinal E wave was the only independent predictor of clinical worsening (6.3× increased risk, p = 0.009) in a model including RVEF and septal curvature. CONCLUSIONS TPM metrics of LV diastolic function are significantly abnormal in PH. More importantly, abnormal LV E wave velocities are the only independent predictors of functional capacity and clinical worsening in a model that includes conventional metrics of biventricular function.
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MESH Headings
- Adult
- Biomechanical Phenomena
- Case-Control Studies
- Diastole
- Disease Progression
- Feasibility Studies
- Female
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/mortality
- Hypertension, Pulmonary/physiopathology
- Hypertension, Pulmonary/therapy
- Image Interpretation, Computer-Assisted/methods
- Magnetic Resonance Imaging/methods
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Stroke Volume
- Time Factors
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/mortality
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/therapy
- Ventricular Function, Left
- Ventricular Function, Right
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Affiliation(s)
- Daniel S Knight
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK.
- UCL Medical School, Royal Free Campus, Rowland Hill Street, London, UK.
| | | | - Shahin Moledina
- UCL Medical School, Royal Free Campus, Rowland Hill Street, London, UK.
| | - Alexander Jones
- UCL Medical School, Royal Free Campus, Rowland Hill Street, London, UK.
| | - J Gerry Coghlan
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK.
| | - Vivek Muthurangu
- UCL Medical School, Royal Free Campus, Rowland Hill Street, London, UK.
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
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28
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Mortensen KH, Jones A, Steeden JA, Taylor AM, Muthurangu V. Isometric stress in cardiovascular magnetic resonance-a simple and easily replicable method of assessing cardiovascular differences not apparent at rest. Eur Radiol 2015. [PMID: 26205639 DOI: 10.1007/s00330-015-3920-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Isometric exercise may unmask cardiovascular disease not evident at rest, and cardiovascular magnetic resonance (CMR) imaging is proven for comprehensive resting assessment. This study devised a simple isometric exercise CMR methodology and assessed the hemodynamic response evoked by isometric exercise. METHODS A biceps isometric exercise technique was devised for CMR, and 75 healthy volunteers were assessed at rest, after 3-minute biceps exercise, and 5-minute of recovery using: 1) blood pressure (BP) and 2) CMR measured aortic flow and left ventricular function. Total peripheral resistance (SVR) and arterial compliance (TAC), cardiac output (CO), left ventricular volumes and function (ejection fraction, stroke volume, power output), blood pressure (BP), heart rate (HR), and rate pressure product were assessed at all time points. RESULTS Image quality was preserved during stress. During exercise there were increases in CO (+14.9 %), HR (+17.0 %), SVR (+9.8 %), systolic BP (+22.4 %), diastolic BP (+25.4 %) and mean BP (+23.2 %). In addition, there were decreases in TAC (-22.0 %) and left ventricular ejection fraction (-6.3 %). Age and body mass index modified the evoked response, even when resting measures were similar. CONCLUSIONS Isometric exercise technique evokes a significant cardiovascular response in CMR, unmasking physiological differences that are not apparent at rest. KEY POINTS • Isometric exercise unmasks cardiovascular differences not evident at rest. • CMR is the reference standard for non-invasive cardiovascular assessment at rest. • A new easily replicable method combines isometric exercise with CMR. • Significant haemodynamic changes occur and differences are unmasked. • The physiological, isometric CMR stressor can be easily replicated.
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Affiliation(s)
- Kristian H Mortensen
- UCL Centre for Cardiovascular MR, UCL Institute of Cardiovascular Science, Level 6 Old Nurses Home, Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - Alexander Jones
- UCL Centre for Cardiovascular MR, UCL Institute of Cardiovascular Science, Level 6 Old Nurses Home, Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Jennifer A Steeden
- UCL Centre for Cardiovascular MR, UCL Institute of Cardiovascular Science, Level 6 Old Nurses Home, Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Andrew M Taylor
- UCL Centre for Cardiovascular MR, UCL Institute of Cardiovascular Science, Level 6 Old Nurses Home, Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular MR, UCL Institute of Cardiovascular Science, Level 6 Old Nurses Home, Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
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29
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Contijoch F, Witschey WRT, Rogers K, Rears H, Hansen M, Yushkevich P, Gorman J, Gorman RC, Han Y. User-initialized active contour segmentation and golden-angle real-time cardiovascular magnetic resonance enable accurate assessment of LV function in patients with sinus rhythm and arrhythmias. J Cardiovasc Magn Reson 2015; 17:37. [PMID: 25994390 PMCID: PMC4440288 DOI: 10.1186/s12968-015-0146-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 05/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data obtained during arrhythmia is retained in real-time cardiovascular magnetic resonance (rt-CMR), but there is limited and inconsistent evidence to show that rt-CMR can accurately assess beat-to-beat variation in left ventricular (LV) function or during an arrhythmia. METHODS Multi-slice, short axis cine and real-time golden-angle radial CMR data was collected in 22 clinical patients (18 in sinus rhythm and 4 patients with arrhythmia). A user-initialized active contour segmentation (ACS) software was validated via comparison to manual segmentation on clinically accepted software. For each image in the 2D acquisitions, slice volume was calculated and global LV volumes were estimated via summation across the LV using multiple slices. Real-time imaging data was reconstructed using different image exposure times and frame rates to evaluate the effect of temporal resolution on measured function in each slice via ACS. Finally, global volumetric function of ectopic and non-ectopic beats was measured using ACS in patients with arrhythmias. RESULTS ACS provides global LV volume measurements that are not significantly different from manual quantification of retrospectively gated cine images in sinus rhythm patients. With an exposure time of 95.2 ms and a frame rate of > 89 frames per second, golden-angle real-time imaging accurately captures hemodynamic function over a range of patient heart rates. In four patients with frequent ectopic contractions, initial quantification of the impact of ectopic beats on hemodynamic function was demonstrated. CONCLUSION User-initialized active contours and golden-angle real-time radial CMR can be used to determine time-varying LV function in patients. These methods will be very useful for the assessment of LV function in patients with frequent arrhythmias.
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Affiliation(s)
- Francisco Contijoch
- Department of Bioengineering, University of Pennsylvania, Smilow Center for Translational Research, 3400 Civic Center Blvd, Bldg 421, 7th Floor, Rm 103, Philadelphia, PA, 1903, USA.
| | | | - Kelly Rogers
- Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Hannah Rears
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
| | | | - Paul Yushkevich
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Joseph Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 1903, USA.
| | - Robert C Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 1903, USA.
| | - Yuchi Han
- Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Knight DS, Schwaiger JP, Krupickova S, Davar J, Muthurangu V, Coghlan JG. Accuracy and Test-Retest Reproducibility of Two-Dimensional Knowledge-Based Volumetric Reconstruction of the Right Ventricle in Pulmonary Hypertension. J Am Soc Echocardiogr 2015; 28:989-98. [PMID: 25857546 PMCID: PMC4533235 DOI: 10.1016/j.echo.2015.02.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Indexed: 11/18/2022]
Abstract
Background Right heart function is the key determinant of symptoms and prognosis in pulmonary hypertension (PH), but the right ventricle has a complex geometry that is challenging to quantify by two-dimensional (2D) echocardiography. A novel 2D echocardiographic technique for right ventricular (RV) quantitation involves knowledge-based reconstruction (KBR), a hybrid of 2D echocardiography–acquired coordinates localized in three-dimensional space and connected by reference to a disease-specific RV shape library. The aim of this study was to determine the accuracy of 2D KBR against cardiac magnetic resonance imaging in PH and the test-retest reproducibility of both conventional 2D echocardiographic RV fractional area change (FAC) and 2D KBR. Methods Twenty-eight patients with PH underwent same-day echocardiography and cardiac magnetic resonance imaging. Two operators performed serial RV FAC and 2D KBR acquisition and postprocessing to assess inter- and intraobserver test-retest reproducibility. Results Bland-Altman analysis (mean bias ± 95% limits of agreement) showed good agreement for end-diastolic volume (3.5 ± 25.0 mL), end-systolic volume (0.9 ± 19.9 mL), stroke volume (2.6 ± 23.1 mL), and ejection fraction (0.4 ± 10.2%) measured by 2D KBR and cardiac magnetic resonance imaging. There were no significant interobserver or intraobserver test-retest differences for 2D KBR RV metrics, with acceptable limits of agreement (interobserver end-diastolic volume, −0.9 ± 21.8 mL; end-systolic volume, −1.3 ± 25.8 mL; stroke volume, −0.2 ± 24.2 mL; ejection fraction, 0.7 ± 14.4%). Significant test-retest variability was observed for 2D echocardiographic RV areas and FAC. Conclusions Two-dimensional KBR is an accurate, novel technique for RV volumetric quantification in PH, with superior test-retest reproducibility compared with conventional 2D echocardiographic RV FAC.
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Affiliation(s)
- Daniel S Knight
- University College London Medical School, London, United Kingdom; Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom; UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom.
| | - Johannes P Schwaiger
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Sylvia Krupickova
- UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom
| | - Joseph Davar
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom
| | - J Gerry Coghlan
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
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31
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Quail MA, Knight DS, Steeden JA, Taelman L, Moledina S, Taylor AM, Segers P, Coghlan GJ, Muthurangu V. Noninvasive pulmonary artery wave intensity analysis in pulmonary hypertension. Am J Physiol Heart Circ Physiol 2015; 308:H1603-11. [PMID: 25659483 PMCID: PMC4469876 DOI: 10.1152/ajpheart.00480.2014] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 02/02/2015] [Indexed: 01/09/2023]
Abstract
Pulmonary wave reflections are a potential hemodynamic biomarker for pulmonary hypertension (PH) and can be analyzed using wave intensity analysis (WIA). In this study we used pulmonary vessel area and flow obtained using cardiac magnetic resonance (CMR) to implement WIA noninvasively. We hypothesized that this method could detect differences in reflections in PH patients compared with healthy controls and could also differentiate certain PH subtypes. Twenty patients with PH (35% CTEPH and 75% female) and 10 healthy controls (60% female) were recruited. Right and left pulmonary artery (LPA and RPA) flow and area curves were acquired using self-gated golden-angle, spiral, phase-contrast CMR with a 10.5-ms temporal resolution. These data were used to perform WIA on patients and controls. The presence of a proximal clot in CTEPH patients was determined from contemporaneous computed tomography/angiographic data. A backwards-traveling compression wave (BCW) was present in both LPA and RPA of all PH patients but was absent in all controls (P = 6e−8). The area under the BCW was associated with a sensitivity of 100% [95% confidence interval (CI) 63–100%] and specificity of 91% (95% CI 75–98%) for the presence of a clot in the proximal PAs of patients with CTEPH. In conclusion, WIA metrics were significantly different between patients and controls; in particular, the presence of an early BCW was specifically associated with PH. The magnitude of the area under the BCW showed discriminatory capacity for the presence of proximal PA clot in patients with CTEPH. We believe that these results demonstrate that WIA could be used in the noninvasive assessment of PH.
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Affiliation(s)
- Michael A Quail
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Daniel S Knight
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom; Department of Cardiology, Royal Free London National Health Services Foundation Trust, London, United Kingdom; and
| | - Jennifer A Steeden
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Liesbeth Taelman
- IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium
| | - Shahin Moledina
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Patrick Segers
- IBiTech-bioMMeda, iMinds Medical IT, Ghent University, Gent, Belgium
| | - Gerry J Coghlan
- Department of Cardiology, Royal Free London National Health Services Foundation Trust, London, United Kingdom; and
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom;
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Knight DS, Grasso AE, Quail MA, Muthurangu V, Taylor AM, Toumpanakis C, Caplin ME, Coghlan JG, Davar J. Accuracy and reproducibility of right ventricular quantification in patients with pressure and volume overload using single-beat three-dimensional echocardiography. J Am Soc Echocardiogr 2014; 28:363-74. [PMID: 25499839 PMCID: PMC4346278 DOI: 10.1016/j.echo.2014.10.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Indexed: 11/23/2022]
Abstract
Background The right ventricle is a complex structure that is challenging to quantify by two-dimensional (2D) echocardiography. Unlike disk summation three-dimensional (3D) echocardiography (3DE), single-beat 3DE can acquire large volumes at high volume rates in one cardiac cycle, avoiding stitching artifacts or long breath-holds. The aim of this study was to assess the accuracy and test-retest reproducibility of single-beat 3DE for quantifying right ventricular (RV) volumes in adult populations of acquired RV pressure or volume overload, namely, pulmonary hypertension (PH) and carcinoid heart disease, respectively. Three-dimensional and 2D echocardiographic indices were also compared for identifying RV dysfunction in PH. Methods A prospective cross-sectional study was performed in 100 individuals who underwent 2D echocardiography, 3DE, and cardiac magnetic resonance imaging: 49 patients with PH, 20 with carcinoid heart disease, 11 with metastatic carcinoid tumors without cardiac involvement, and 20 healthy volunteers. Two operators performed test-retest acquisition and postprocessing for inter- and intraobserver reproducibility in 20 subjects. Results: RV single-beat 3DE was attainable in 96% of cases, with mean volume rates of 32 to 45 volumes/sec. Bland-Altman analysis of all subjects (presented as mean bias ± 95% limits of agreement) revealed good agreement for end-diastolic volume (−2.3 ± 27.4 mL) and end-systolic volume (5.2 ± 19.0 mL) measured by 3DE and cardiac magnetic resonance imaging, with a tendency to underestimate stroke volume (−7.5 ± 23.6 mL) and ejection fraction (−4.6 ± 13.8%) by 3DE. Subgroup analysis demonstrated a greater bias for volumetric underestimation, particularly in healthy volunteers (end-diastolic volume, −11.9 ± 18.0 mL; stroke volume, −11.2 ± 20.2 mL). Receiver operating characteristic curve analysis showed that 3DE-derived ejection fraction was significantly superior to 2D echocardiographic parameters for identifying RV dysfunction in PH (sensitivity, 94%; specificity, 88%; area under the curve, 0.95; P = .031). There was significant interobserver test-retest bias for RV volume underestimation (end-diastolic volume, −12.5 ± 28.1 mL; stroke volume, −10.6 ± 23.2 mL). Conclusions Single-beat 3DE is feasible and clinically applicable for volumetric quantification in acquired RV pressure or volume overload. It has improved limits of agreement compared with previous disk summation 3D echocardiographic studies and has incremental value over standard 2D echocardiographic measures for identifying RV dysfunction. Despite the ability to obtain and postprocess a full-volume 3D echocardiographic RV data set, the quality of the raw data did influence the accuracy of the data obtained. The technique performs better with dilated rather than nondilated RV cavities, with a learning curve that might affect the test-retest reproducibility for serial RV studies.
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Affiliation(s)
- Daniel S Knight
- University College London Medical School, Royal Free Campus, London, United Kingdom; Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom; UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom.
| | - Agata E Grasso
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Michael A Quail
- UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom
| | - Andrew M Taylor
- UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Martyn E Caplin
- Neuroendocrine Tumour Unit, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - J Gerry Coghlan
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Joseph Davar
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
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Fernández-Pérez G, Franco López Á, García Fernández M, Corral de la Calle M, Encinas de la Iglesia J, Velasco Casares M. Función sistólica del ventrículo izquierdo: cómo comprenderla y analizarla. RADIOLOGIA 2014; 56:505-14. [DOI: 10.1016/j.rx.2013.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 09/09/2013] [Accepted: 09/20/2013] [Indexed: 11/29/2022]
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Pandya B, Quail MA, Steeden JA, McKee A, Odille F, Taylor AM, Schulze-Neick I, Derrick G, Moledina S, Muthurangu V. Real-Time Magnetic Resonance Assessment of Septal Curvature Accurately Tracks Acute Hemodynamic Changes in Pediatric Pulmonary Hypertension. Circ Cardiovasc Imaging 2014; 7:706-13. [DOI: 10.1161/circimaging.113.001156] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Bejal Pandya
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Michael A. Quail
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Jennifer A. Steeden
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Andrea McKee
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Freddy Odille
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Andrew M. Taylor
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Ingram Schulze-Neick
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Graham Derrick
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Shahin Moledina
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
| | - Vivek Muthurangu
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, United Kingdom (B.P., M.A.Q., J.A.S., A.M.T., V.M.); Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, United Kingdom (I.S.-N., G.D., S.M.); Adult Congenital Heart Disease Department, The Heart Hospital, University College London Hospitals, London, United Kingdom (B.P.); Pediatric Respiratory Medicine, The Royal Brompton Hospital, London, United Kingdom (A.M.); INSERM, U947,
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Moghari MH, Komarlu R, Annese D, Geva T, Powell AJ. Free-breathing steady-state free precession cine cardiac magnetic resonance with respiratory navigator gating. Magn Reson Med 2014; 73:1555-61. [PMID: 24777586 DOI: 10.1002/mrm.25275] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/09/2014] [Accepted: 04/10/2014] [Indexed: 12/23/2022]
Abstract
PURPOSE To develop and validate a respiratory motion compensation method for free-breathing cardiac cine imaging. METHODS A free-breathing navigator-gated cine steady-state free precession acquisition (Cine-Nav) was developed which preserves the equilibrium state of the net magnetization vector, maintains the high spatial and temporal resolutions of standard breath-hold (BH) acquisition, and images entire cardiac cycle. Cine image data is accepted only from cardiac cycles occurring entirely during end-expiration. Prospective validation was performed in 10 patients by obtaining in each three complete ventricular image stacks with different respiratory motion compensation approaches: (1) BH, (2) free-breathing with 3 signal averages (3AVG), and (3) free-breathing with Cine-Nav. RESULTS The subjective image quality score (1 = worst, 4 = best) for Cine-Nav (3.8 ± 0.4) was significantly better than for 3AVG (2.2 ± 0.5, P = 0.002), and similar to BH (4.0 ± 0.0, P = 0.13). The blood-to-myocardium contrast ratio for Cine-Nav (6.3 ± 1.5) was similar to BH (5.9 ± 1.6, P = 0.52) and to 3AVG (5.6 ± 2.5, P = 0.43). There were no significant differences between Cine-Nav and BH for the ventricular volumes and mass. In contrast, there were significant differences between 3AVG and BH in all of these measurements but right ventricular mass. CONCLUSION Free-breathing cine imaging with Cine-Nav yielded comparable image quality and ventricular measurements to BH, and was superior to 3AVG.
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Affiliation(s)
- Mehdi H Moghari
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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36
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Li S, Chan C, Stockmann JP, Tagare H, Adluru G, Tam LK, Galiana G, Constable RT, Kozerke S, Peters DC. Algebraic reconstruction technique for parallel imaging reconstruction of undersampled radial data: application to cardiac cine. Magn Reson Med 2014; 73:1643-53. [PMID: 24753213 DOI: 10.1002/mrm.25265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 11/07/2022]
Abstract
PURPOSE To investigate algebraic reconstruction technique (ART) for parallel imaging reconstruction of radial data, applied to accelerated cardiac cine. METHODS A graphics processing unit (GPU)-accelerated ART reconstruction was implemented and applied to simulations, point spread functions and in 12 subjects imaged with radial cardiac cine acquisitions. Cine images were reconstructed with radial ART at multiple undersampling levels (192 Nr × Np = 96 to 16). Images were qualitatively and quantitatively analyzed for sharpness and artifacts, and compared to filtered back-projection, and conjugate gradient SENSE. RESULTS Radial ART provided reduced artifacts and mainly preserved spatial resolution, for both simulations and in vivo data. Artifacts were qualitatively and quantitatively less with ART than filtered back-projection using 48, 32, and 24 Np , although filtered back-projection provided quantitatively sharper images at undersampling levels of 48-24 Np (all P < 0.05). Use of undersampled radial data for generating auto-calibrated coil-sensitivity profiles resulted in slightly reduced quality. ART was comparable to conjugate gradient SENSE. GPU-acceleration increased ART reconstruction speed 15-fold, with little impact on the images. CONCLUSION GPU-accelerated ART is an alternative approach to image reconstruction for parallel radial MR imaging, providing reduced artifacts while mainly maintaining sharpness compared to filtered back-projection, as shown by its first application in cardiac studies.
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Affiliation(s)
- Shu Li
- Department of Radiology, Yale Medical School, New Haven, Connecticut, USA; Institute for Biomedical Engineering, University and ETH Zurich, Switzerland
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Bassett EC, Kholmovski EG, Wilson BD, DiBella EVR, Dosdall DJ, Ranjan R, McGann CJ, Kim D. Evaluation of highly accelerated real-time cardiac cine MRI in tachycardia. NMR IN BIOMEDICINE 2014; 27:175-182. [PMID: 24259281 DOI: 10.1002/nbm.3049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 06/02/2023]
Abstract
Electrocardiogram (ECG)-gated breath-hold cine MRI is considered to be the gold standard test for the assessment of cardiac function. However, it may fail in patients with arrhythmia, impaired breath-hold capacity and poor ECG gating. Although ungated real-time cine MRI may mitigate these problems, commercially available real-time cine MRI pulse sequences using parallel imaging typically yield relatively poor spatiotemporal resolution because of their low image acquisition efficiency. As an extension of our previous work, the purpose of this study was to evaluate the diagnostic quality and accuracy of eight-fold-accelerated real-time cine MRI with compressed sensing (CS) for the quantification of cardiac function in tachycardia, where it is challenging for real-time cine MRI to provide sufficient spatiotemporal resolution. We evaluated the performances of eight-fold-accelerated cine MRI with CS, three-fold-accelerated real-time cine MRI with temporal generalized autocalibrating partially parallel acquisitions (TGRAPPA) and ECG-gated breath-hold cine MRI in 21 large animals with tachycardia (mean heart rate, 104 beats per minute) at 3T. For each cine MRI method, two expert readers evaluated the diagnostic quality in four categories (image quality, temporal fidelity of wall motion, artifacts and apparent noise) using a Likert scale (1-5, worst to best). One reader evaluated the left ventricular functional parameters. The diagnostic quality scores were significantly different between the three cine pulse sequences, except for the artifact level between CS and TGRAPPA real-time cine MRI. Both ECG-gated breath-hold cine MRI and eight-fold accelerated real-time cine MRI yielded all four scores of ≥ 3.0 (acceptable), whereas three-fold-accelerated real-time cine MRI yielded all scores below 3.0, except for artifact (3.0). The left ventricular ejection fraction (LVEF) measurements agreed better between ECG-gated cine MRI and eight-fold-accelerated real-time cine MRI (mean difference, -1.6%) than between ECG-gated cine MRI and three-fold-accelerated real-time cine MRI (mean difference, -5.7%). Eight-fold-accelerated real-time cine MRI with CS yields acceptable diagnostic quality and relatively accurate LVEF measurements in the challenging setting of tachycardia.
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Affiliation(s)
- Elwin C Bassett
- Department of Physics, University of Utah, Salt Lake City, UT, USA; UCAIR, Department of Radiology, University of Utah, Salt Lake City, UT, USA
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Xue H, Kellman P, LaRocca G, Arai AE, Hansen MS. High spatial and temporal resolution retrospective cine cardiovascular magnetic resonance from shortened free breathing real-time acquisitions. J Cardiovasc Magn Reson 2013; 15:102. [PMID: 24228930 PMCID: PMC3842803 DOI: 10.1186/1532-429x-15-102] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 10/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cine cardiovascular magnetic resonance (CMR) is challenging in patients who cannot perform repeated breath holds. Real-time, free-breathing acquisition is an alternative, but image quality is typically inferior. There is a clinical need for techniques that achieve similar image quality to the segmented cine using a free breathing acquisition. Previously, high quality retrospectively gated cine images have been reconstructed from real-time acquisitions using parallel imaging and motion correction. These methods had limited clinical applicability due to lengthy acquisitions and volumetric measurements obtained with such methods have not previously been evaluated systematically. METHODS This study introduces a new retrospective reconstruction scheme for real-time cine imaging which aims to shorten the required acquisition. A real-time acquisition of 16-20s per acquired slice was inputted into a retrospective cine reconstruction algorithm, which employed non-rigid registration to remove respiratory motion and SPIRiT non-linear reconstruction with temporal regularization to fill in missing data. The algorithm was used to reconstruct cine loops with high spatial (1.3-1.8 × 1.8-2.1 mm²) and temporal resolution (retrospectively gated, 30 cardiac phases, temporal resolution 34.3 ± 9.1 ms). Validation was performed in 15 healthy volunteers using two different acquisition resolutions (256 × 144/192 × 128 matrix sizes). For each subject, 9 to 12 short axis and 3 long axis slices were imaged with both segmented and real-time acquisitions. The retrospectively reconstructed real-time cine images were compared to a traditional segmented breath-held acquisition in terms of image quality scores. Image quality scoring was performed by two experts using a scale between 1 and 5 (poor to good). For every subject, LAX and three SAX slices were selected and reviewed in the random order. The reviewers were blinded to the reconstruction approach and acquisition protocols and scores were given to segmented and retrospective cine series. Volumetric measurements of cardiac function were also compared by manually tracing the myocardium for segmented and retrospective cines. RESULTS Mean image quality scores were similar for short axis and long axis views for both tested resolutions. Short axis scores were 4.52/4.31 (high/low matrix sizes) for breath-hold vs. 4.54/4.56 for real-time (paired t-test, P = 0.756/0.011). Long axis scores were 4.09/4.37 vs. 3.99/4.29 (P = 0.475/0.463). Mean ejection fraction was 60.8/61.4 for breath-held acquisitions vs. 60.3/60.3 for real-time acquisitions (P = 0.439/0.093). No significant differences were seen in end-diastolic volume (P = 0.460/0.268) but there was a trend towards a small overestimation of end-systolic volume of 2.0/2.5 ml, which did not reach statistical significance (P = 0.052/0.083). CONCLUSIONS Real-time free breathing CMR can be used to obtain high quality retrospectively gated cine images in 16-20s per slice. Volumetric measurements and image quality scores were similar in images from breath-held segmented and free breathing, real-time acquisitions. Further speedup of image reconstruction is still needed.
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Affiliation(s)
- Hui Xue
- National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA
| | - Gina LaRocca
- National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA
| | - Andrew E Arai
- National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA
| | - Michael S Hansen
- National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA
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Ntsinjana HN, Tann O, Taylor AM. Trends in pediatric cardiovascular magnetic resonance imaging. Acta Radiol 2013; 54:1063-74. [PMID: 23390156 DOI: 10.1177/0284185113475609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiac magnetic resonance (CMR) imaging has significantly evolved over the last decade, becoming an integral part of the contemporary assessment of both congenital and acquired pediatric heart disease. Recent trends show that there is a growing interest in clinical applications and research in this field. An attempt to discuss the evolving technologies, techniques, and applications of CMR in pediatrics is not complete without understanding the current strengths of the modality. CMR complements readily available echocardiography, in many cases information from CMR can remove the need for invasive angiographic catheterization, and in other cases can be used to augment cardiac catheterisation.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular Imaging, UCL
Institute of Cardiovascular Sciences, London
- Cardiorespiratory Unit, Great Ormond
Street Hospital for Children, London, UK
| | - Oliver Tann
- Centre for Cardiovascular Imaging, UCL
Institute of Cardiovascular Sciences, London
- Cardiorespiratory Unit, Great Ormond
Street Hospital for Children, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL
Institute of Cardiovascular Sciences, London
- Cardiorespiratory Unit, Great Ormond
Street Hospital for Children, London, UK
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Moledina S, Pandya B, Bartsota M, Mortensen KH, McMillan M, Quyam S, Taylor AM, Haworth SG, Schulze-Neick I, Muthurangu V. Prognostic Significance of Cardiac Magnetic Resonance Imaging in Children With Pulmonary Hypertension. Circ Cardiovasc Imaging 2013; 6:407-14. [DOI: 10.1161/circimaging.112.000082] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
There are very few validated prognostic markers in pediatric pulmonary hypertension. Cardiac MRI is a useful, noninvasive method for determining prognosis in adults. The present study is the first to assess its prognostic value in children.
Methods and Results—
A total of 100 children with pulmonary hypertension (median, 10.4 years; range, 0.5–17.6 years) were evaluated (idiopathic, n=60; repaired congenital heart disease, n=22; miscellaneous, n=18). In all patients, ventricular volumes and great vessel flow were measured. Volumetric data were obtained using retrospectively gated cine imaging (n=37) or real-time imaging (n=63), depending on the patient’s ability to hold his or her breath. During a median follow-up of 1.9 years, 11 patients died and 3 received lung transplantation. Of the cardiac MR parameters measured, right ventricular ejection fraction and left ventricular stroke volume index were most strongly predictive of survival on univariate analysis (2.6- and 2.5-fold increase in mortality for every 1-SD decrease, respectively;
P
<0.05). These results were reflected in good separation of tertile-based Kaplan-Meier survival curves for these variables.
Conclusions—
Cardiac MR measures correlate with clinical status and prognosis in children with pulmonary hypertension. Cardiac MR is feasible and may be useful in clinical decision making in pediatric pulmonary hypertension.
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Affiliation(s)
- Shahin Moledina
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Bejal Pandya
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Margarita Bartsota
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Kristian H. Mortensen
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Merlin McMillan
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Sadia Quyam
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Andrew M. Taylor
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Sheila G. Haworth
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Ingram Schulze-Neick
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
| | - Vivek Muthurangu
- From the Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK (S.M., B.P., K.H.M., A.M.T., V.M.);and National Pulmonary Hypertension Service, Great Ormond Street Hospital for Children, London, UK (S.M., M.B., M.M., S.Q., S.G.H., I.S.-N.)
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Li S, Galiana G, Tam L, Kozerke S, Stockmann JP, Constable RT, Peters DC. Cardiac cine with ART for radial parallel imaging reconstruction. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559413 DOI: 10.1186/1532-429x-15-s1-e34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Zhu B, Zhang B, Li M, Xi S, Yu D, Ding Y. An evaluation of a superfast MRI sequence in the diagnosis of suspected acute appendicitis. Quant Imaging Med Surg 2012; 2:280-7. [PMID: 23289088 PMCID: PMC3533601 DOI: 10.3978/j.issn.2223-4292.2012.12.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 12/04/2012] [Indexed: 11/14/2022]
Abstract
BACKGROUND A lack of typical symptoms in acute appendicitis may delay the appropriate therapy. We hypothesized that a superfast MRI sequence with fat suppression could assist in the diagnosis of acute appendicitis. OBJECTIVE To evaluate the sensitivity and specificity of MRI in the diagnosis of suspected acute appendicitis especially in the early stages and before surgery. METHODS Subject images were acquired with a 1.5-T clinical MRI scanner (Achieva Nova Dual, Philips, Netherlands) with a four-element phased array abdominal coil with a SENSE factor of 1.8. A total of 41 cases with suspected acute appendicitis were recruited. SENSE-BTFE-SPIR sequence, sensitivity encoding (SENSE) with balanced turbo field echo (BTFE) and spectral presaturation and inversion recovery (SPIR), was adopted in this study. RESULTS The sensitivity and specificity were 91.7% and 100%, respectively, in the diagnosis of acute appendicitis by SENSE-BTFE-SPIR in this series. Cases with simple acute appendicitis showed a higher T2 signal in the appendiceal wall, with local fluid surrounding appendix. Cases with purulent appendicitis showed an increased T2 signal within the cavity of the appendix, along with appendiceal wall thickening, or increased T2 signals around effusions in cases with gangrenous appendicitis. A periappendiceal abscess showed a localized, high-signal fluid collection that may have had extensive effects on the adjacent bowel loops, into which the entire appendix may disappear. CONCLUSIONS The fast SENSE-BTFE-SPIR sequence is capable of demonstrating the location and position of the appendix, the presence of acute appendicitis and its complications, and the clinical stages.
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Affiliation(s)
- Bin Zhu
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, P. R. China
| | - Bing Zhang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, P. R. China
| | - Ming Li
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, P. R. China
| | - Shifu Xi
- Department of General surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, P. R. China
| | - Decai Yu
- Department of General surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, P. R. China
| | - Yitao Ding
- Department of General surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, P. R. China
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Feng L, Srichai MB, Lim RP, Harrison A, King W, Adluru G, Dibella EVR, Sodickson DK, Otazo R, Kim D. Highly accelerated real-time cardiac cine MRI using k-t SPARSE-SENSE. Magn Reson Med 2012; 70:64-74. [PMID: 22887290 DOI: 10.1002/mrm.24440] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 06/20/2012] [Accepted: 07/03/2012] [Indexed: 01/19/2023]
Abstract
For patients with impaired breath-hold capacity and/or arrhythmias, real-time cine MRI may be more clinically useful than breath-hold cine MRI. However, commercially available real-time cine MRI methods using parallel imaging typically yield relatively poor spatio-temporal resolution due to their low image acquisition speed. We sought to achieve relatively high spatial resolution (∼2.5 × 2.5 mm(2)) and temporal resolution (∼40 ms), to produce high-quality real-time cine MR images that could be applied clinically for wall motion assessment and measurement of left ventricular function. In this work, we present an eightfold accelerated real-time cardiac cine MRI pulse sequence using a combination of compressed sensing and parallel imaging (k-t SPARSE-SENSE). Compared with reference, breath-hold cine MRI, our eightfold accelerated real-time cine MRI produced significantly worse qualitative grades (1-5 scale), but its image quality and temporal fidelity scores were above 3.0 (adequate) and artifacts and noise scores were below 3.0 (moderate), suggesting that acceptable diagnostic image quality can be achieved. Additionally, both eightfold accelerated real-time cine and breath-hold cine MRI yielded comparable left ventricular function measurements, with coefficient of variation <10% for left ventricular volumes. Our proposed eightfold accelerated real-time cine MRI with k-t SPARSE-SENSE is a promising modality for rapid imaging of myocardial function.
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Affiliation(s)
- Li Feng
- Department of Radiology, The Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, New York 10016, USA.
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Steeden JA, Jones A, Pandya B, Atkinson D, Taylor AM, Muthurangu V. High-resolution slice-selective Fourier velocity encoding in congenital heart disease using spiral SENSE with velocity unwrap. Magn Reson Med 2012; 67:1538-46. [DOI: 10.1002/mrm.24293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 02/28/2012] [Accepted: 03/22/2012] [Indexed: 11/09/2022]
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45
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Hansen MS, Sørensen TS, Arai AE, Kellman P. Retrospective reconstruction of high temporal resolution cine images from real-time MRI using iterative motion correction. Magn Reson Med 2011; 68:741-50. [PMID: 22190255 DOI: 10.1002/mrm.23284] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/20/2011] [Accepted: 10/16/2011] [Indexed: 11/06/2022]
Abstract
Cardiac function has traditionally been evaluated using breath-hold cine acquisitions. However, there is a great need for free breathing techniques in patients who have difficulty in holding their breath. Real-time cardiac MRI is a valuable alternative to the traditional breath-hold imaging approach, but the real-time images are often inferior in spatial and temporal resolution. This article presents a general method for reconstruction of high spatial and temporal resolution cine images from a real-time acquisition acquired over multiple cardiac cycles. The method combines parallel imaging and motion correction based on nonrigid registration and can be applied to arbitrary k-space trajectories. The method is demonstrated with real-time Cartesian imaging and Golden Angle radial acquisitions, and the motion-corrected acquisitions are compared with raw real-time images and breath-hold cine acquisitions in 10 (N = 10) subjects. Acceptable image quality was obtained in all motion-corrected reconstructions, and the resulting mean image quality score was (a) Cartesian real-time: 2.48, (b) Golden Angle real-time: 1.90 (1.00-2.50), (c) Cartesian motion correction: 3.92, (d) Radial motion correction: 4.58, and (e) Breath-hold cine: 5.00. The proposed method provides a flexible way to obtain high-quality, high-resolution cine images in patients with difficulty holding their breath.
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Affiliation(s)
- Michael S Hansen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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46
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Ntsinjana HN, Hughes ML, Taylor AM. The role of cardiovascular magnetic resonance in pediatric congenital heart disease. J Cardiovasc Magn Reson 2011; 13:51. [PMID: 21936913 PMCID: PMC3210092 DOI: 10.1186/1532-429x-13-51] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 09/21/2011] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease (CHD) and acquired heart disease in pediatric patients. Ongoing technological advancements in both data acquisition and data presentation have enabled CMR to be integrated into clinical practice with increasing understanding of the advantages and limitations of the technique by pediatric cardiologists and congenital heart surgeons. Importantly, the combination of exquisite 3D anatomy with physiological data enables CMR to provide a unique perspective for the management of many patients with CHD. Imaging small children with CHD is challenging, and in this article we will review the technical adjustments, imaging protocols and application of CMR in the pediatric population.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Marina L Hughes
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
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Jones A, Steeden JA, Pruessner JC, Deanfield JE, Taylor AM, Muthurangu V. Detailed assessment of the hemodynamic response to psychosocial stress using real-time MRI. J Magn Reson Imaging 2011; 33:448-54. [PMID: 21274988 DOI: 10.1002/jmri.22438] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To demonstrate that combining the Montreal Imaging Stress Task (MIST) with real-time cardiac magnetic resonance imaging (MRI) allows detailed assessment of the cardiovascular mental stress response. MATERIALS AND METHODS 22 healthy volunteers (1:1 M:F, 26-64 years) underwent MRI during rest and the MIST. Real-time spiral phase contrast MR, accelerated with sensitivity encoding (SENSE) was used to assess stroke volume (SV), and radial k-t SENSE was used to assess ventricular volumes. Simultaneous heart rate (HR) and blood pressure (BP) measures allowed calculation of cardiac output (CO), systemic vascular resistance (SVR), and arterial compliance (TAC). Endocrine responses were assessed using salivary cortisol. RESULTS In response to stress, BP increased due to increased CO and reduced TAC but not increased SVR, which fell. HR, not SV, determined CO increases. Greater BP responses occurred in men due to greater CO increases and relatively higher SVR. Older participants had greater BP responses due to greater falls in TAC. Greater cortisol response was correlated with greater falls in TAC but resting cortisol and TAC were not related. CONCLUSION This new approach allows detailed, accurate assessment of stress physiology. Preliminary findings suggest stress exposes relationships, not seen at rest, of cardiovascular function with age, sex, and endocrine function.
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Affiliation(s)
- Alexander Jones
- Centre for Cardiovascular Imaging, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, United Kingdom.
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Steeden JA, Atkinson D, Taylor AM, Muthurangu V. Split-acquisition real-time CINE phase-contrast MR flow measurements. Magn Reson Med 2011; 64:1664-70. [PMID: 20939086 DOI: 10.1002/mrm.22615] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The temporal and spatial resolution of real-time phase-contrast magnetic resonance (PCMR) is restricted by the need to acquire two interleaved phase images. In this article, we propose a split-acquisition real-time CINE PCMR technique, where the acquisition of flow-encoded and flow-compensated data is divided into separate blocks. By comparing magnitude images, automatic matching of data in cardio-respiratory space allows subtraction of background phase offsets. Thus, the data is acquired in real-time but with phase correction originating from a different heart beat. This effectively doubles the frame rate, allowing either higher temporal or spatial resolution. Two split-acquisition sequences were tested: one with high-temporal resolution and one with high-spatial resolution. Both sequences showed excellent agreement in stroke volumes in 20 adults when validated against cardiac-gated PCMR and interleaved real-time PCMR (cardiac gated: 95.2 ± 20.0 mL, interleaved real-time: 96.2 ± 20.7 mL, high-temporal resolution: 95.6 ± 20.1 mL, high-spatial resolution: 95.5 ± 20.4 mL). In six children, the high-spatial resolution sequence provided more accurate flow measurements than interleaved real-time PCMR, when compared with cardiac-gated PCMR (cardiac gated: 20.6 ± 7.6 mL, interleaved real-time: 24.3 ± 9.2 mL, high-spatial resolution: 20.8 ± 7.8 mL), due to the increased spatial resolution. The matching technique is shown to be accurate (truth: 94.6 ± 21.8, split-acquisition: 95.0 ± 21.9 mL) and quantitative image quality (signal-to-noise ratio, velocity-to-noise ratio and edge sharpness) is acceptable.
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Affiliation(s)
- Jennifer A Steeden
- Centre for Medical Image Computing, UCL Department of Medical Physics and Bioengineering, London, United Kingdom
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Steeden JA, Atkinson D, Hansen MS, Taylor AM, Muthurangu V. Rapid flow assessment of congenital heart disease with high-spatiotemporal-resolution gated spiral phase-contrast MR imaging. Radiology 2011; 260:79-87. [PMID: 21415248 DOI: 10.1148/radiol.11101844] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To validate a prospectively triggered spiral phase-contrast magnetic resonance (MR) sequence accelerated with sensitivity encoding (SENSE) in a population of children and adults with congenital heart disease. MATERIALS AND METHODS The local research ethics committee approved this study, and written consent was obtained from all patients or guardians. Stroke volumes were quantified in 40 patients (mean age ± standard deviation: 21.4 years ± 13.8, age range: 3.0-61.3 years; 22 male patients aged 3.0-38.0 years [mean age, 17.2 years ± 10.5], 18 female patients aged 4.7-61.3 years [mean age, 26.6 years ± 15.9]) with congenital heart disease in the aorta (n = 40), main pulmonary artery (n = 38), right pulmonary artery (n = 22), and left pulmonary artery (n = 24). Stroke volumes were obtained with (a) breath-hold spiral phase-contrast MR imaging with SENSE, (b) conventional breath-hold cartesian phase-contrast MR imaging, and (c) reference free-breathing phase-contrast MR imaging. Stroke volumes were compared by using repeated-measures analysis of variance, Bland-Altman analysis, and correlation coefficients. RESULTS Imaging time with the breath-hold spiral phase-contrast MR sequence was significantly lower than that with the conventional breath-hold phase-contrast MR sequence (~5 seconds vs ~16 seconds, respectively; P < .0001). There was excellent agreement in stroke volumes in all vessels between the reference free-breathing sequence (mean volume, 60.3 mL ± 27.3) and the two breath-hold sequences-spiral SENSE phase-contrast MR imaging (mean volume, 59.5 mL ± 27.1; P < .001) and conventional cartesian phase-contrast MR imaging (mean volume, 59.8 mL ± 27.6; P = .268). The limits of agreement were smaller with the spiral breath-hold sequence than with the conventional breath-hold sequence (-4.4 mL, 2.9 mL vs -10.3 mL, 9.3 mL, respectively); correlation was similar (r = 0.998 vs r = 0.984, respectively). CONCLUSION Flow volumes can be accurately and reliably quantified by using a spiral SENSE phase-contrast MR sequence, with high spatiotemporal resolution obtained in a short breath hold.
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Affiliation(s)
- Jennifer A Steeden
- Centre for Medical Image Computing, UCL Department of Medical Physics & Bioengineering, London, England
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Steeden JA, Atkinson D, Taylor AM, Muthurangu V. Assessing vascular response to exercise using a combination of real-time spiral phase contrast MR and noninvasive blood pressure measurements. J Magn Reson Imaging 2010; 31:997-1003. [PMID: 20373446 DOI: 10.1002/jmri.22105] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To measure the hemodynamic response to exercise using real-time velocity mapping magnetic resonance imaging (MRI), incorporating a high temporal resolution spiral phase contrast (PC) sequence accelerated with sensitivity encoding (SENSE). MATERIALS AND METHODS Twenty healthy adults underwent MRI at rest and during supine exercise at two different exercise levels. Flow volumes were assessed in the ascending aorta using a spiral SENSE real-time PC sequence. The sequence was validated at rest against a vendor supplied gated PC sequence, and also at rest and during exercise against left ventricular volumes assessed using a radial k-t SENSE real-time sequence. Combining the measured flow volumes with simultaneous oscillometric blood pressure measurements, enabled the noninvasive calculations of systemic vascular resistance (SVR) and arterial compliance (C). RESULTS Measured flow volumes correlated very well between the sequences at rest and during exercise. Cardiac output (CO) and heart rate were found to significantly increase during exercise, while SVR and C were found to decrease significantly. CONCLUSION Hemodynamic response to exercise can be accurately quantified using a high temporal resolution spiral SENSE real-time flow imaging. This may allow early detection of hypertension and a greater understanding of the early changes in this condition.
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Affiliation(s)
- Jennifer A Steeden
- Centre for Medical Image Computing, UCL Department of Medical Physics & Bioengineering, London, United Kingdom
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