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Bonner BP, Yurista SR, Coll‐Font J, Chen S, Eder RA, Foster AN, Nguyen KD, Caravan P, Gale EM, Nguyen C. Contrast-Enhanced Cardiac Magnetic Resonance Imaging With a Manganese-Based Alternative to Gadolinium for Tissue Characterization of Acute Myocardial Infarction. J Am Heart Assoc 2023; 12:e026923. [PMID: 37042259 PMCID: PMC10227253 DOI: 10.1161/jaha.122.026923] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/05/2023] [Indexed: 04/13/2023]
Abstract
Background Late gadolinium enhancement cardiac magnetic resonance imaging is an effective and reproducible method for characterizing myocardial infarction. However, gadolinium-based contrast agents are contraindicated in patients with acute and chronic renal insufficiency. In addition, several recent studies have noted tissue deposition of free gadolinium in patients who have undergone serial contrast-enhanced magnetic resonance imaging. There is a clinical need for alternative forms of magnetic resonance imaging contrast agents that are acceptable in the setting of renal insufficiency. Methods and Results Three days after 80 minutes of ischemia/reperfusion of the left anterior descending coronary artery, cardiac magnetic resonance imaging was performed to assess myocardial lesion burden using both contrast agents. Late gadolinium enhancement cardiac magnetic resonance imaging was examined 10 and 15 minutes after contrast injection. Contrast agents were administered in alternating manner with a 2- to 3-hour washout period between contrast agent injections. Lesion evaluation and image processing were performed using Segment Medviso software. Mean infarct size and transmurality, measured using RVP-001, were not different compared with those measured using late gadolinium enhancement images. Bland-Altman analysis demonstrated a nominal bias of 0.13 mL (<1% of average total lesion volume) for RVP-001 in terms of gross infarct size measurement. Conclusions The experimental manganese-based contrast agent RVP-001 appears to be an effective agent for assessment of myocardial infarction location, size, and transmurality, and it may be useful as an alternative to gadolinium-based agents.
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Affiliation(s)
- Benjamin P. Bonner
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalBostonMA
- Louisiana State University Health Sciences CenterNew OrleansLA
| | - Salva R. Yurista
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalBostonMA
- Harvard Medical SchoolBostonMA
| | - Jaume Coll‐Font
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalBostonMA
- Harvard Medical SchoolBostonMA
| | - Shi Chen
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalBostonMA
| | - Robert A. Eder
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalBostonMA
| | - Anna N. Foster
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalBostonMA
| | - Khoi D. Nguyen
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalBostonMA
- Harvard Medical SchoolBostonMA
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalBostonMA
- Harvard Medical SchoolBostonMA
| | - Eric M. Gale
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalBostonMA
- Harvard Medical SchoolBostonMA
| | - Christopher Nguyen
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalBostonMA
- Harvard Medical SchoolBostonMA
- Division of Health Science TechnologyHarvard–Massachusetts Institute of TechnologyCambridgeMA
- Cardiovascular Innovation Research CenterHeart, Vascular, and Thoracic Institute, Cleveland ClinicClevelandOH
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2
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Singh T, Joshi S, Kershaw LE, Dweck MR, Semple SI, Newby DE. Manganese-Enhanced Magnetic Resonance Imaging of the Heart. J Magn Reson Imaging 2023; 57:1011-1028. [PMID: 36314991 PMCID: PMC10947173 DOI: 10.1002/jmri.28499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 02/23/2023] Open
Abstract
Manganese-based contrast media were the first in vivo paramagnetic agents to be used in magnetic resonance imaging (MRI). The uniqueness of manganese lies in its biological function as a calcium channel analog, thus behaving as an intracellular contrast agent. Manganese ions are taken up by voltage-gated calcium channels in viable tissues, such as the liver, pancreas, kidneys, and heart, in response to active calcium-dependent cellular processes. Manganese-enhanced magnetic resonance imaging (MEMRI) has therefore been used as a surrogate marker for cellular calcium handling and interest in its potential clinical applications has recently re-emerged, especially in relation to assessing cellular viability and myocardial function. Calcium homeostasis is central to myocardial contraction and dysfunction of myocardial calcium handling is present in various cardiac pathologies. Recent studies have demonstrated that MEMRI can detect the presence of abnormal myocardial calcium handling in patients with myocardial infarction, providing clear demarcation between the infarcted and viable myocardium. Furthermore, it can provide more subtle assessments of abnormal myocardial calcium handling in patients with cardiomyopathies and being excluded from areas of nonviable cardiomyocytes and severe fibrosis. As such, MEMRI offers exciting potential to improve cardiac diagnoses and provide a noninvasive measure of myocardial function and contractility. This could be an invaluable tool for the assessment of both ischemic and nonischemic cardiomyopathies as well as providing a measure of functional myocardial recovery, an accurate prediction of disease progression and a method of monitoring treatment response. EVIDENCE LEVEL: 5: TECHNICAL EFFICACY: STAGE 5.
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Affiliation(s)
- Trisha Singh
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh Heart CentreRoyal Infirmary of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - Shruti Joshi
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh Heart CentreRoyal Infirmary of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - Lucy E Kershaw
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - Marc R Dweck
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh Heart CentreRoyal Infirmary of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - Scott I Semple
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - David E Newby
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh Heart CentreRoyal Infirmary of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
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3
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Abstract
Major advances in biomedical imaging have occurred over the last 2 decades and now allow many physiological, cellular, and molecular processes to be imaged noninvasively in small animal models of cardiovascular disease. Many of these techniques can be also used in humans, providing pathophysiological context and helping to define the clinical relevance of the model. Ultrasound remains the most widely used approach, and dedicated high-frequency systems can obtain extremely detailed images in mice. Likewise, dedicated small animal tomographic systems have been developed for magnetic resonance, positron emission tomography, fluorescence imaging, and computed tomography in mice. In this article, we review the use of ultrasound and positron emission tomography in small animal models, as well as emerging contrast mechanisms in magnetic resonance such as diffusion tensor imaging, hyperpolarized magnetic resonance, chemical exchange saturation transfer imaging, magnetic resonance elastography and strain, arterial spin labeling, and molecular imaging.
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Affiliation(s)
- David E Sosnovik
- Cardiology Division, Cardiovascular Research Center (D.E.S.), Massachusetts General Hospital and Harvard Medical School, Boston.,A.A. Martinos Center for Biomedical Imaging (D.E.S.), Massachusetts General Hospital and Harvard Medical School, Boston.,Harvard-MIT Program in Health Sciences and Technology, Harvard Medical School and Massachusetts Institute of Technology, Cambridge (D.E.S.)
| | - Marielle Scherrer-Crosbie
- Cardiology Division, Hospital of the University of Pennsylvania and Perelman School of Medicine, Philadelphia (M.S.-C)
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4
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Singh T, Kite TA, Joshi SS, Spath NB, Kershaw L, Baker A, Jordan H, Gulsin GS, Williams MC, van Beek EJR, Arnold JR, Semple SIK, Moss AJ, Newby DE, Dweck M, McCann GP. MRI and CT coronary angiography in survivors of COVID-19. Heart 2022; 108:46-53. [PMID: 34615668 PMCID: PMC8503921 DOI: 10.1136/heartjnl-2021-319926] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/10/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To determine the contribution of comorbidities on the reported widespread myocardial abnormalities in patients with recent COVID-19. METHODS In a prospective two-centre observational study, patients hospitalised with confirmed COVID-19 underwent gadolinium and manganese-enhanced MRI and CT coronary angiography (CTCA). They were compared with healthy and comorbidity-matched volunteers after blinded analysis. RESULTS In 52 patients (median age: 54 (IQR 51-57) years, 39 males) who recovered from COVID-19, one-third (n=15, 29%) were admitted to intensive care and a fifth (n=11, 21%) were ventilated. Twenty-three patients underwent CTCA, with one-third having underlying coronary artery disease (n=8, 35%). Compared with younger healthy volunteers (n=10), patients demonstrated reduced left (ejection fraction (EF): 57.4±11.1 (95% CI 54.0 to 60.1) versus 66.3±5 (95 CI 62.4 to 69.8)%; p=0.02) and right (EF: 51.7±9.1 (95% CI 53.9 to 60.1) vs 60.5±4.9 (95% CI 57.1 to 63.2)%; p≤0.0001) ventricular systolic function with elevated native T1 values (1225±46 (95% CI 1205 to 1240) vs 1197±30 (95% CI 1178 to 1216) ms;p=0.04) and extracellular volume fraction (ECV) (31±4 (95% CI 29.6 to 32.1) vs 24±3 (95% CI 22.4 to 26.4)%; p<0.0003) but reduced myocardial manganese uptake (6.9±0.9 (95% CI 6.5 to 7.3) vs 7.9±1.2 (95% CI 7.4 to 8.5) mL/100 g/min; p=0.01). Compared with comorbidity-matched volunteers (n=26), patients had preserved left ventricular function but reduced right ventricular systolic function (EF: 51.7±9.1 (95% CI 53.9 to 60.1) vs 59.3±4.9 (95% CI 51.0 to 66.5)%; p=0.0005) with comparable native T1 values (1225±46 (95% CI 1205 to 1240) vs 1227±51 (95% CI 1208 to 1246) ms; p=0.99), ECV (31±4 (95% CI 29.6 to 32.1) vs 29±5 (95% CI 27.0 to 31.2)%; p=0.35), presence of late gadolinium enhancement and manganese uptake. These findings remained irrespective of COVID-19 disease severity, presence of myocardial injury or ongoing symptoms. CONCLUSIONS Patients demonstrate right but not left ventricular dysfunction. Previous reports of left ventricular myocardial abnormalities following COVID-19 may reflect pre-existing comorbidities. TRIAL REGISTRATION NUMBER NCT04625075.
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Affiliation(s)
- Trisha Singh
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Cardiovascular Science, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas A Kite
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Shruti S Joshi
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Cardiovascular Science, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick B Spath
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Cardiovascular Science, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Lucy Kershaw
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Andrew Baker
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Helen Jordan
- Department of Anesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Gaurav Singh Gulsin
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Michelle Claire Williams
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Jayanth Ranjit Arnold
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Scott I K Semple
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Alastair James Moss
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Cardiovascular Science, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Marc Dweck
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Cardiovascular Science, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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5
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MacAskill MG, Wimberley C, Morgan TEF, Alcaide-Corral CJ, Newby DE, Lucatelli C, Sutherland A, Pimlott SL, Tavares AAS. Modelling [ 18F]LW223 PET data using simplified imaging protocols for quantification of TSPO expression in the rat heart and brain. Eur J Nucl Med Mol Imaging 2021; 49:137-145. [PMID: 34338808 PMCID: PMC8712302 DOI: 10.1007/s00259-021-05482-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To provide a comprehensive assessment of the novel 18 kDa translocator protein (TSPO) radiotracer, [18F]LW223, kinetics in the heart and brain when using a simplified imaging approach. METHODS Naive adult rats and rats with surgically induced permanent coronary artery ligation received a bolus intravenous injection of [18F]LW223 followed by 120 min PET scanning with arterial blood sampling throughout. Kinetic modelling of PET data was applied to estimated rate constants, total volume of distribution (VT) and binding potential transfer corrected (BPTC) using arterial or image-derived input function (IDIF). Quantitative bias of simplified protocols using IDIF versus arterial input function (AIF) and stability of kinetic parameters for PET imaging data of different length (40-120 min) were estimated. RESULTS PET outcome measures estimated using IDIF significantly correlated with those derived with invasive AIF, albeit with an inherent systematic bias. Truncation of the dynamic PET scan duration to less than 100 min reduced the stability of the kinetic modelling outputs. Quantification of [18F]LW223 uptake kinetics in the brain and heart required the use of different outcome measures, with BPTC more stable in the heart and VT more stable in the brain. CONCLUSION Modelling of [18F]LW223 PET showed the use of simplified IDIF is acceptable in the rat and the minimum scan duration for quantification of TSPO expression in rats using kinetic modelling with this radiotracer is 100 min. Carefully assessing kinetic outcome measures when conducting a systems level as oppose to single-organ centric analyses is crucial. This should be taken into account when assessing the emerging role of the TSPO heart-brain axis in the field of PET imaging.
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Affiliation(s)
- Mark G MacAskill
- University/ BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Catriona Wimberley
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Timaeus E F Morgan
- University/ BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Carlos J Alcaide-Corral
- University/ BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- University/ BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | | | - Sally L Pimlott
- West of Scotland PET Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Adriana A S Tavares
- University/ BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK.
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6
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Jasmin NH, Thin MZ, Johnson RD, Jackson LH, Roberts TA, David AL, Lythgoe MF, Yang PC, Davidson SM, Camelliti P, Stuckey DJ. Myocardial Viability Imaging using Manganese-Enhanced MRI in the First Hours after Myocardial Infarction. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2003987. [PMID: 34105284 PMCID: PMC8188227 DOI: 10.1002/advs.202003987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/08/2021] [Indexed: 05/19/2023]
Abstract
Early measurements of tissue viability after myocardial infarction (MI) are essential for accurate diagnosis and treatment planning but are challenging to obtain. Here, manganese, a calcium analogue and clinically approved magnetic resonance imaging (MRI) contrast agent, is used as an imaging biomarker of myocardial viability in the first hours after experimental MI. Safe Mn2+ dosing is confirmed by measuring in vitro beating rates, calcium transients, and action potentials in cardiomyocytes, and in vivo heart rates and cardiac contractility in mice. Quantitative T1 mapping-manganese-enhanced MRI (MEMRI) reveals elevated and increasing Mn2+ uptake in viable myocardium remote from the infarct, suggesting MEMRI offers a quantitative biomarker of cardiac inotropy. MEMRI evaluation of infarct size at 1 h, 1 and 14 days after MI quantifies myocardial viability earlier than the current gold-standard technique, late-gadolinium-enhanced MRI. These data, coupled with the re-emergence of clinical Mn2+ -based contrast agents open the possibility of using MEMRI for direct evaluation of myocardial viability early after ischemic onset in patients.
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Affiliation(s)
- Nur Hayati Jasmin
- UCL Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonLondonWC1E 6DDUK
- School of Medical ImagingFaculty of Health SciencesUniversiti Sultan Zainal AbidinKuala Terengganu21300Malaysia
| | - May Zaw Thin
- UCL Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonLondonWC1E 6DDUK
| | - Robert D. Johnson
- School of Biosciences and MedicineUniversity of SurreyGuildfordGU2 7XHUK
| | - Laurence H. Jackson
- School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonSE1 7EHUK
| | - Thomas A. Roberts
- School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonSE1 7EHUK
| | - Anna L. David
- UCL Elizabeth Garrett Anderson Institute for Women's HealthLondonWC1E 6BTUK
| | - Mark F. Lythgoe
- UCL Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonLondonWC1E 6DDUK
| | - Philip C. Yang
- Division of Cardiovascular MedicineDepartment of MedicineStanford UniversityStanfordCA94305USA
| | - Sean M. Davidson
- The Hatter Cardiovascular InstituteUniversity College London67 Chenies MewsLondonWC1E 6HXUK
| | - Patrizia Camelliti
- School of Biosciences and MedicineUniversity of SurreyGuildfordGU2 7XHUK
| | - Daniel J. Stuckey
- UCL Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonLondonWC1E 6DDUK
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7
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MacAskill MG, Stadulyte A, Williams L, Morgan TEF, Sloan NL, Alcaide-Corral CJ, Walton T, Wimberley C, McKenzie CA, Spath N, Mungall W, BouHaidar R, Dweck MR, Gray GA, Newby DE, Lucatelli C, Sutherland A, Pimlott SL, Tavares AAS. Quantification of Macrophage-Driven Inflammation During Myocardial Infarction with 18F-LW223, a Novel TSPO Radiotracer with Binding Independent of the rs6971 Human Polymorphism. J Nucl Med 2021; 62:536-544. [PMID: 32859708 PMCID: PMC8049364 DOI: 10.2967/jnumed.120.243600] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/28/2020] [Indexed: 01/09/2023] Open
Abstract
Myocardial infarction (MI) is one of the leading causes of death worldwide, and inflammation is central to tissue response and patient outcomes. The 18-kDa translocator protein (TSPO) has been used in PET as an inflammatory biomarker. The aims of this study were to screen novel, fluorinated, TSPO radiotracers for susceptibility to the rs6971 genetic polymorphism using in vitro competition binding assays in human brain and heart; assess whether the in vivo characteristics of our lead radiotracer, 18F-LW223, are suitable for clinical translation; and validate whether 18F-LW223 can detect macrophage-driven inflammation in a rat MI model. Methods: Fifty-one human brain and 29 human heart tissue samples were screened for the rs6971 polymorphism. Competition binding assays were conducted with 3H-PK11195 and the following ligands: PK11195, PBR28, and our novel compounds (AB5186 and LW223). Naïve rats and mice were used for in vivo PET kinetic studies, radiometabolite studies, and dosimetry experiments. Rats underwent permanent coronary artery ligation and were scanned using PET/CT with an invasive input function at 7 d after MI. For quantification of PET signal in the hypoperfused myocardium, K1 (rate constant for transfer from arterial plasma to tissues) was used as a surrogate marker of perfusion to correct the binding potential for impaired radiotracer transfer from plasma to tissue (BPTC). Results: LW223 binding to TSPO was not susceptible to the rs6971 genetic polymorphism in human brain and heart samples. In rodents, 18F-LW223 displayed a specific uptake consistent with TSPO expression, a slow metabolism in blood (69% of parent at 120 min), a high plasma free fraction of 38.5%, and a suitable dosimetry profile (effective dose of 20.5-24.5 μSv/MBq). 18F-LW223 BPTC was significantly higher in the MI cohort within the infarct territory of the anterior wall relative to the anterior wall of naïve animals (32.7 ± 5.0 vs. 10.0 ± 2.4 cm3/mL/min, P ≤ 0.001). Ex vivo immunofluorescent staining for TSPO and CD68 (macrophage marker) resulted in the same pattern seen with in vivo BPTC analysis. Conclusion:18F-LW223 is not susceptible to the rs6971 genetic polymorphism in in vitro assays, has favorable in vivo characteristics, and is able to accurately map macrophage-driven inflammation after MI.
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Affiliation(s)
- Mark G MacAskill
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Agne Stadulyte
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Lewis Williams
- School of Chemistry, WestCHEM, University of Glasgow, Glasgow, United Kingdom
| | - Timaeus E F Morgan
- School of Chemistry, WestCHEM, University of Glasgow, Glasgow, United Kingdom
| | - Nikki L Sloan
- School of Chemistry, WestCHEM, University of Glasgow, Glasgow, United Kingdom
| | - Carlos J Alcaide-Corral
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Tashfeen Walton
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Catriona Wimberley
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Chris-Anne McKenzie
- MRC Edinburgh Brain Tissue Bank, University of Edinburgh, Edinburgh, United Kingdom
| | - Nick Spath
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - William Mungall
- Bioresearch and Veterinary Services, University of Edinburgh, Edinburgh, United Kingdom
| | - Ralph BouHaidar
- Forensic Pathology, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R Dweck
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Gillian A Gray
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - David E Newby
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Andrew Sutherland
- School of Chemistry, WestCHEM, University of Glasgow, Glasgow, United Kingdom
| | - Sally L Pimlott
- School of Medicine, University of Glasgow, Glasgow, United Kingdom; and
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Adriana A S Tavares
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
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8
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Willemink MJ, Varga-Szemes A, Schoepf UJ, Codari M, Nieman K, Fleischmann D, Mastrodicasa D. Emerging methods for the characterization of ischemic heart disease: ultrafast Doppler angiography, micro-CT, photon-counting CT, novel MRI and PET techniques, and artificial intelligence. Eur Radiol Exp 2021; 5:12. [PMID: 33763754 PMCID: PMC7991013 DOI: 10.1186/s41747-021-00207-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/22/2021] [Indexed: 12/24/2022] Open
Abstract
After an ischemic event, disruptive changes in the healthy myocardium may gradually develop and may ultimately turn into fibrotic scar. While these structural changes have been described by conventional imaging modalities mostly on a macroscopic scale-i.e., late gadolinium enhancement at magnetic resonance imaging (MRI)-in recent years, novel imaging methods have shown the potential to unveil an even more detailed picture of the postischemic myocardial phenomena. These new methods may bring advances in the understanding of ischemic heart disease with potential major changes in the current clinical practice. In this review article, we provide an overview of the emerging methods for the non-invasive characterization of ischemic heart disease, including coronary ultrafast Doppler angiography, photon-counting computed tomography (CT), micro-CT (for preclinical studies), low-field and ultrahigh-field MRI, and 11C-methionine positron emission tomography. In addition, we discuss new opportunities brought by artificial intelligence, while addressing promising future scenarios and the challenges for the application of artificial intelligence in the field of cardiac imaging.
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Affiliation(s)
- Martin J. Willemink
- grid.168010.e0000000419368956Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94035 USA
| | - Akos Varga-Szemes
- grid.259828.c0000 0001 2189 3475Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC USA
| | - U. Joseph Schoepf
- grid.259828.c0000 0001 2189 3475Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC USA
| | - Marina Codari
- grid.168010.e0000000419368956Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94035 USA
| | - Koen Nieman
- grid.168010.e0000000419368956Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA USA ,Stanford Cardiovascular Institute, Stanford, CA 94305 USA
| | - Dominik Fleischmann
- grid.168010.e0000000419368956Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94035 USA ,Stanford Cardiovascular Institute, Stanford, CA 94305 USA
| | - Domenico Mastrodicasa
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94035, USA. .,Stanford Cardiovascular Institute, Stanford, CA, 94305, USA.
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9
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Spath NB, Singh T, Papanastasiou G, Kershaw L, Baker AH, Janiczek RL, Gulsin GS, Dweck MR, McCann G, Newby DE, Semple SI. Manganese-enhanced magnetic resonance imaging in dilated cardiomyopathy and hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2020:jeaa273. [PMID: 33200175 DOI: 10.1093/ehjci/jeaa273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/17/2020] [Indexed: 01/07/2023] Open
Abstract
AIMS The aim of this study is to quantify altered myocardial calcium handling in non-ischaemic cardiomyopathy using magnetic resonance imaging. METHODS AND RESULTS Patients with dilated cardiomyopathy (n = 10) or hypertrophic cardiomyopathy (n = 17) underwent both gadolinium and manganese contrast-enhanced magnetic resonance imaging and were compared with healthy volunteers (n = 20). Differential manganese uptake (Ki) was assessed using a two-compartment Patlak model. Compared with healthy volunteers, reduction in T1 with manganese-enhanced magnetic resonance imaging was lower in patients with dilated cardiomyopathy [mean reduction 257 ± 45 (21%) vs. 288 ± 34 (26%) ms, P < 0.001], with higher T1 at 40 min (948 ± 57 vs. 834 ± 28 ms, P < 0.0001). In patients with hypertrophic cardiomyopathy, reductions in T1 were less than healthy volunteers [mean reduction 251 ± 86 (18%) and 277 ± 34 (23%) vs. 288 ± 34 (26%) ms, with and without fibrosis respectively, P < 0.001]. Myocardial manganese uptake was modelled, rate of uptake was reduced in both dilated and hypertrophic cardiomyopathy in comparison with healthy volunteers (mean Ki 19 ± 4, 19 ± 3, and 23 ± 4 mL/100 g/min, respectively; P = 0.0068). In patients with dilated cardiomyopathy, manganese uptake rate correlated with left ventricular ejection fraction (r2 = 0.61, P = 0.009). Rate of myocardial manganese uptake demonstrated stepwise reductions across healthy myocardium, hypertrophic cardiomyopathy without fibrosis and hypertrophic cardiomyopathy with fibrosis providing absolute discrimination between the healthy myocardium and fibrosed myocardium (mean Ki 23 ± 4, 19 ± 3, and 13 ± 4 mL/100 g/min, respectively; P < 0.0001). CONCLUSION The rate of manganese uptake in both dilated and hypertrophic cardiomyopathy provides a measure of altered myocardial calcium handling. This holds major promise for the detection and monitoring of dysfunctional myocardium, with the potential for early intervention and prognostication.
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Affiliation(s)
- N B Spath
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - T Singh
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - G Papanastasiou
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - L Kershaw
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - A H Baker
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
| | - R L Janiczek
- Department of Clinical Imaging, GlaxoSmithKline, Gunnels Wood Road, Stevenage, Hertfordshire, SG1 2NY, UK
| | - G S Gulsin
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - M R Dweck
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - G McCann
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - D E Newby
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - S I Semple
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
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MnDPDP: Contrast Agent for Imaging and Protection of Viable Tissue. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:3262835. [PMID: 32994754 PMCID: PMC7501573 DOI: 10.1155/2020/3262835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/12/2020] [Indexed: 01/22/2023]
Abstract
The semistable chelate manganese (Mn) dipyridoxyl diphosphate (MnDPDP, mangafodipir), previously used as an intravenous (i.v.) contrast agent (Teslascan™, GE Healthcare) for Mn-ion-enhanced MRI (MEMRI), should be reappraised for clinical use but now as a diagnostic drug with cytoprotective properties. Approved for imaging of the liver and pancreas, MnDPDP enhances contrast also in other targets such as the heart, kidney, glandular tissue, and potentially retina and brain. Transmetallation releases paramagnetic Mn2+ for cellular uptake in competition with calcium (Ca2+), and intracellular (IC) macromolecular Mn2+ adducts lower myocardial T1 to midway between native values and values obtained with gadolinium (Gd3+). What is essential is that T1 mapping and, to a lesser degree, T1 weighted imaging enable quantification of viability at a cellular or even molecular level. IC Mn2+ retention for hours provides delayed imaging as another advantage. Examples in humans include quantitative imaging of cardiomyocyte remodeling and of Ca2+ channel activity, capabilities beyond the scope of Gd3+ based or native MRI. In addition, MnDPDP and the metabolite Mn dipyridoxyl diethyl-diamine (MnPLED) act as catalytic antioxidants enabling prevention and treatment of oxidative stress caused by tissue injury and inflammation. Tested applications in humans include protection of normal cells during chemotherapy of cancer and, potentially, of ischemic tissues during reperfusion. Theragnostic use combining therapy with delayed imaging remains to be explored. This review updates MnDPDP and its clinical potential with emphasis on the working mode of an exquisite chelate in the diagnosis of heart disease and in the treatment of oxidative stress.
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11
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New Strategies in the Design of Paramagnetic CAs. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:4327479. [PMID: 33071681 PMCID: PMC7537686 DOI: 10.1155/2020/4327479] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022]
Abstract
Nowadays, magnetic resonance imaging (MRI) is the first diagnostic imaging modality for numerous indications able to provide anatomical information with high spatial resolution through the use of magnetic fields and gradients. Indeed, thanks to the characteristic relaxation time of each tissue, it is possible to distinguish between healthy and pathological ones. However, the need to have brighter images to increase differences and catch important diagnostic details has led to the use of contrast agents (CAs). Among them, Gadolinium-based CAs (Gd-CAs) are routinely used in clinical MRI practice. During these last years, FDA highlighted many risks related to the use of Gd-CAs such as nephrotoxicity, heavy allergic effects, and, recently, about the deposition within the brain. These alerts opened a debate about the opportunity to formulate Gd-CAs in a different way but also to the use of alternative and safer compounds to be administered, such as manganese- (Mn-) based agents. In this review, the physical principle behind the role of relaxivity and the T1 boosting will be described in terms of characteristic correlation times and inner and outer spheres. Then, the recent advances in the entrapment of Gd-CAs within nanostructures will be analyzed in terms of relaxivity boosting obtained without the chemical modification of CAs as approved in the chemical practice. Finally, a critical evaluation of the use of manganese-based CAs will be illustrated as an alternative ion to Gd due to its excellent properties and endogenous elimination pathway.
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12
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Kwiecinski J, Lennen RJ, Gray GA, Borthwick G, Boswell L, Baker AH, Newby DE, Dweck MR, Jansen MA. Progression and regression of left ventricular hypertrophy and myocardial fibrosis in a mouse model of hypertension and concomitant cardiomyopathy. J Cardiovasc Magn Reson 2020; 22:57. [PMID: 32758255 PMCID: PMC7409657 DOI: 10.1186/s12968-020-00655-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 07/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Myocardial fibrosis is observed in multiple cardiac conditions including hypertension and aortic stenosis. Excessive fibrosis is associated with adverse clinical outcomes, but longitudinal human data regarding changes in left ventricular remodelling and fibrosis over time are sparse because of the slow progression, thereby making longitudinal studies challenging. The purpose of this study was to establish and characterize a mouse model to study the development and regression of left ventricular hypertrophy and myocardial fibrosis in response to increased blood pressure and to understand how these processes reverse remodel following normalisation of blood pressure. METHODS We performed a longitudinal study with serial cardiovascular magnetic resonance (CMR) imaging every 2 weeks in mice (n = 31) subjected to angiotensin II-induced hypertension for 6 weeks and investigated reverse remodelling following normalisation of afterload beyond 6 weeks (n = 9). Left ventricular (LV) volumes, mass, and function as well as myocardial fibrosis were measured using cine CMR and the extracellular volume fraction (ECV) s. RESULTS Increased blood pressure (65 ± 12 vs 85 ± 9 mmHg; p < 0.001) resulted in higher indices of LV hypertrophy (0.09 [0.08, 0.10] vs 0.12 [0.11, 0.14] g; p < 0.001) and myocardial fibrosis (ECV: 0.24 ± 0.03 vs 0.30 ± 0.02; p < 0.001) whilst LV ejection fraction fell (LVEF, 59.3 [57.6, 59.9] vs 46.9 [38.5, 49.6] %; p < 0.001). We found a strong correlation between ECV and histological myocardial fibrosis (r = 0.89, p < 0.001). Following cessation of angiotensin II and normalisation of blood pressure (69 ± 5 vs baseline 65 ± 12 mmHg; p = 0.42), LV mass (0.11 [0.10, 0.12] vs 0.09 [0.08, 0.11] g), ECV (0.30 ± 0.02 vs 0.27 ± 0.02) and LVEF (51.1 [42.9, 52.8] vs 59.3 [57.6, 59.9] %) improved but remained impaired compared to baseline (p < 0.05 for all). There was a strong inverse correlation between LVEF and %ECV during both systemic hypertension (r = - 0.88, p < 0.001) and the increases in ECV observed in the first two weeks of increased blood pressure predicted the reduction in LVEF after 6 weeks (r = - 0.77, p < 0.001). CONCLUSIONS We have established and characterized angiotensin II infusion and repeated CMR imaging as a model of LV hypertrophy and reverse remodelling in response to systemic hypertension. Changes in myocardial fibrosis and alterations in cardiac function are only partially reversible following relief of hypertension.
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Affiliation(s)
- Jacek Kwiecinski
- Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Ross J Lennen
- Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Gillian A Gray
- Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Gary Borthwick
- Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Lyndsey Boswell
- Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Andrew H Baker
- Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Maurits A Jansen
- Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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13
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Spath N, Tavares A, Gray GA, Baker AH, Lennen RJ, Alcaide-Corral CJ, Dweck MR, Newby DE, Yang PC, Jansen MA, Semple SI. Manganese-enhanced T 1 mapping to quantify myocardial viability: validation with 18F-fluorodeoxyglucose positron emission tomography. Sci Rep 2020; 10:2018. [PMID: 32029765 PMCID: PMC7005182 DOI: 10.1038/s41598-020-58716-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/08/2020] [Indexed: 11/19/2022] Open
Abstract
Gadolinium chelates are widely used in cardiovascular magnetic resonance imaging (MRI) as passive intravascular and extracellular space markers. Manganese, a biologically active paramagnetic calcium analogue, provides novel intracellular myocardial tissue characterisation. We previously showed manganese-enhanced MRI (MEMRI) more accurately quantifies myocardial infarction than gadolinium delayed-enhancement MRI (DEMRI). Here, we evaluated the potential of MEMRI to assess myocardial viability compared to gold-standard 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) viability. Coronary artery ligation surgery was performed in male Sprague-Dawley rats (n = 13) followed by dual MEMRI and 18F-FDG PET imaging at 10-12 weeks. MEMRI was achieved with unchelated (EVP1001-1) or chelated (mangafodipir) manganese. T1 mapping MRI was followed by 18F-FDG micro-PET, with tissue taken for histological correlation. MEMRI and PET demonstrated good agreement with histology but native T1 underestimated infarct size. Quantification of viability by MEMRI, PET and MTC were similar, irrespective of manganese agent. MEMRI showed superior agreement with PET than native T1. MEMRI showed excellent agreement with PET and MTC viability. Myocardial MEMRI T1 correlated with 18F-FDG standard uptake values and influx constant but not native T1. Our findings indicate that MEMRI identifies and quantifies myocardial viability and has major potential for clinical application in myocardial disease and regenerative therapies.
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Affiliation(s)
- Nick Spath
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - Adriana Tavares
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Gillian A Gray
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Andrew H Baker
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Ross J Lennen
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Preclinical Imaging, University of Edinburgh, Edinburgh, UK
| | | | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Phillip C Yang
- Department of Cardiology, Stanford University, Stanford, CA, US
| | - Maurits A Jansen
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Preclinical Imaging, University of Edinburgh, Edinburgh, UK
| | - Scott I Semple
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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14
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Spath NB, Thompson G, Baker AH, Dweck MR, Newby DE, Semple SIK. Manganese-enhanced MRI of the myocardium. Heart 2019; 105:1695-1700. [PMID: 31337670 PMCID: PMC6855794 DOI: 10.1136/heartjnl-2019-315227] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 01/12/2023] Open
Abstract
Gadolinium-based contrast media are widely used in cardiovascular MRI to identify and to highlight the intravascular and extracellular space. After gadolinium, manganese has the second highest paramagnetic moment and was one of the first MRI contrast agents assessed in humans. Over the last 50 years, manganese-enhanced MRI (MEMRI) has emerged as a complementary approach enabling intracellular myocardial contrast imaging that can identify functional myocardium through its ability to act as a calcium analogue. Early progress was limited by its potential to cause myocardial depression. To overcome this problem, two clinical formulations of manganese were developed using either chelation (manganese dipyridoxyl diphosphate) or coadministration with a calcium compound (EVP1001-1, Eagle Vision Pharmaceuticals). Preclinical studies have demonstrated the efficacy of MEMRI in quantifying myocardial infarction and detecting myocardial viability as well as tracking altered contractility and calcium handling in cardiomyopathy. Recent clinical data suggest that MEMRI has exciting potential in the quantification of myocardial viability in ischaemic cardiomyopathy, the early detection of abnormalities in myocardial calcium handling, and ultimately, in the development of novel therapies for myocardial infarction or heart failure by actively quantifying viable myocardium. The stage is now set for wider clinical translational study of this novel and promising non-invasive imaging modality.
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Affiliation(s)
- Nick B Spath
- BHF/University Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Gerard Thompson
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Andrew H Baker
- BHF/University Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- BHF/University Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David E Newby
- BHF/University Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Scott I K Semple
- BHF/University Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
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