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Bhatt N, Orbach A, Biswas L, Strauss BH, Connelly K, Ghugre NR, Wright GA, Roifman I. Evaluating a novel accelerated free-breathing late gadolinium enhancement imaging sequence for assessment of myocardial injury. Magn Reson Imaging 2024; 108:40-46. [PMID: 38309379 DOI: 10.1016/j.mri.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Cardiac magnetic resonance imaging (MRI), including late gadolinium enhancement (LGE), plays an important role in the diagnosis and prognostication of ischemic and non-ischemic myocardial injury. Conventional LGE sequences require patients to perform multiple breath-holds and require long acquisition times. In this study, we compare image quality and assessment of myocardial LGE using an accelerated free-breathing sequence to the conventional standard-of-care sequence. METHODS In this prospective cohort study, a total of 41 patients post Coronavirus 2019 (COVID-19) infection were included. Studies were performed on a 1.5 Tesla scanner with LGE imaging acquired using a conventional inversion recovery rapid gradient echo (conventional LGE) sequence followed by the novel accelerated free-breathing (FB-LGE) sequence. Image quality was visually scored (ordinal scale from 1 to 5) and compared between conventional and free-breathing sequences using the Wilcoxon rank sum test. Presence of per-segment LGE was identified according to the American Heart Association 16-segment myocardial model and compared across both conventional LGE and FB-LGE sequences using a two-sided chi-square test. The perpatient LGE extent was also evaluated using both sequences and compared using the Wilcoxon rank sum test. Interobserver variability in detection of per-segment LGE and per-patient LGE extent was evaluated using Cohen's kappa statistic and interclass correlation (ICC), respectively. RESULTS The mean acquisition time for the FB-LGE sequence was 17 s compared to 413 s for the conventional LGE sequence (P < 0.001). Assessment of image quality was similar between both sequences (P = 0.19). There were no statistically significant differences in LGE assessed using the FB-LGE versus conventional LGE on a per-segment (P = 0.42) and per-patient (P = 0.06) basis. Interobserver variability in LGE assessment for FB-LGE was good for per-segment (= 0.71) and per-patient extent (ICC = 0.92) analyses. CONCLUSIONS The accelerated FB-LGE sequence performed comparably to the conventional standard-of-care LGE sequence in a cohort of patients post COVID-19 infection in a fraction of the time and without the need for breath-holding. Such a sequence could impact clinical practice by increasing cardiac MRI throughput and accessibility for frail or acutely ill patients unable to perform breath-holding.
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Affiliation(s)
- Nitish Bhatt
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ady Orbach
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Labonny Biswas
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Bradley H Strauss
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kim Connelly
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | - Nilesh R Ghugre
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Graham A Wright
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Idan Roifman
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Contijoch F, Rasche V, Seiberlich N, Peters DC. The future of CMR: All-in-one vs. real-time CMR (Part 2). J Cardiovasc Magn Reson 2024; 26:100998. [PMID: 38237901 PMCID: PMC11211235 DOI: 10.1016/j.jocmr.2024.100998] [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: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 02/20/2024] Open
Abstract
Cardiac Magnetic Resonance (CMR) protocols can be lengthy and complex, which has driven the research community to develop new technologies to make these protocols more efficient and patient-friendly. Two different approaches to improving CMR have been proposed, specifically "all-in-one" CMR, where several contrasts and/or motion states are acquired simultaneously, and "real-time" CMR, in which the examination is accelerated to avoid the need for breathholding and/or cardiac gating. The goal of this two-part manuscript is to describe these two different types of emerging rapid CMR protocols. To this end, the vision of all-in-one and real-time imaging are described, along with techniques which have been devised and tested along the pathway of clinical implementation. The pros and cons of the different methods are presented, and the remaining open needs of each are detailed. Part 1 tackles the "All-in-One" approaches, and Part 2 focuses on the "Real-Time" approaches along with an overall summary of these emerging methods.
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Affiliation(s)
| | - Volker Rasche
- Ulm University Medical Center, Department of Internal Medicine II, Ulm, Germany
| | - Nicole Seiberlich
- Michigan Institute for Imaging Technology and Translation, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Proffitt EK, Kaproth-Joslin K, Chaturvedi A, Hobbs SK. Role of Magnetic Resonance Imaging in Transcatheter Structural Heart Disease Interventions. Semin Roentgenol 2024; 59:20-31. [PMID: 38388093 DOI: 10.1053/j.ro.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/25/2023] [Accepted: 12/01/2023] [Indexed: 02/24/2024]
Affiliation(s)
| | | | - Abhishek Chaturvedi
- Department of Imaging Sciences, Division of Cardiothoracic Imaging, University of Rochester Medical Center, Rochester, NY.
| | - Susan K Hobbs
- University of Rochester Medical Center, Rochester, NY
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Yang J, Wang F, Wang Z, Zhang W, Xie L, Wang L. Evaluation of late gadolinium enhancement cardiac MRI using deep learning reconstruction. Acta Radiol 2023; 64:2714-2721. [PMID: 37700572 DOI: 10.1177/02841851231192786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND Deep learning (DL)-based methods have been used to improve the imaging quality of magnetic resonance imaging (MRI) by denoising. PURPOSE To assess the effects of DL-based MR reconstruction (DLR) method on late gadolinium enhancement (LGE) image quality. MATERIAL AND METHODS A total of 85 patients who underwent cardiovascular magnetic resonance (CMR) examination, including LGE imaging using conventional construction and DLR with varying levels of noise reduction (NR) levels, were included. Both magnitude LGE (MLGE) and phase-sensitive LGE (PSLGE) images were reviewed independently by double-blinded observers who used a 5-point Likert scale for multiple measures regarding image quality. Meanwhile, the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and edge sharpness of images were calculated and compared between conventional LGE imaging and DLR LGE imaging. RESULTS Both MLGE and PSLGE with DLR at 50% and 75% noise reduction levels received significantly higher scores than conventional imaging for overall imaging quality (all P < 0.01). In addition, the SNR, CNR, and edge sharpness of all DLR LGE imaging are higher than conventional imaging (all P < 0.01). The highest subjective score and best image quality is obtained when the DLR noise reduction level is at 75%. CONCLUSION DLR reduced image noise while improving image contrast and sharpness in the cardiovascular LGE imaging.
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Affiliation(s)
- Jing Yang
- Hebei University of Chinese Medicine, Shijiazhuang, PR China
- Department of Cardiovascular Disease, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou, PR China
| | - Feng Wang
- Department of Cardiovascular Disease, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou, PR China
| | - Zhirong Wang
- Department of Cardiovascular Disease, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou, PR China
| | - Wei Zhang
- Department of Radiology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou, PR China
| | - Lizhi Xie
- GE Healthcare, MR Research China, Beijing, PR China
| | - LiXin Wang
- Hebei University of Chinese Medicine, Shijiazhuang, PR China
- Department of Cardiovascular Disease, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou, PR China
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Olausson E, Wertz J, Fridman Y, Bering P, Maanja M, Niklasson L, Wong TC, Fukui M, Cavalcante JL, Cater G, Kellman P, Bukhari S, Miller CA, Saba S, Ugander M, Schelbert EB. Diffuse myocardial fibrosis associates with incident ventricular arrhythmia in implantable cardioverter defibrillator recipients. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.15.23285925. [PMID: 36824921 PMCID: PMC9949189 DOI: 10.1101/2023.02.15.23285925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Background Diffuse myocardial fibrosis (DMF) quantified by extracellular volume (ECV) may represent a vulnerable phenotype and associate with life threatening ventricular arrhythmias more than focal myocardial fibrosis. This principle remains important because 1) risk stratification for implantable cardioverter defibrillators (ICD) remains challenging, and 2) DMF may respond to current or emerging medical therapies (reversible substrate). Objectives To evaluate the association between quantified by ECV in myocardium without focal fibrosis by late gadolinium enhancement (LGE) with time from ICD implantation to 1) appropriate shock, or 2) shock or anti-tachycardia pacing. Methods Among patients referred for cardiovascular magnetic resonance (CMR) without congenital disease, hypertrophic cardiomyopathy, or amyloidosis who received ICDs (n=215), we used Cox regression to associate ECV with incident ICD therapy. Results After a median of 2.9 (IQR 1.5-4.2) years, 25 surviving patients experienced ICD shock and 44 experienced shock or anti-tachycardia pacing. ECV ranged from 20.2% to 39.4%. No patient with ECV<25% experienced an ICD shock. ECV associated with both endpoints, e.g., hazard ratio 2.17 (95%CI 1.17-4.00) for every 5% increase in ECV, p=0.014 in a stepwise model for ICD shock adjusting for ICD indication, age, smoking, atrial fibrillation, and myocardial infarction, whereas focal fibrosis by LGE and global longitudinal strain (GLS) did not. Conclusions DMF measured by ECV associates with ventricular arrhythmias requiring ICD therapy in a dose-response fashion, even adjusting for potential confounding variables, focal fibrosis by LGE, and GLS. ECV-based risk stratification and DMF representing a therapeutic target to prevent ventricular arrhythmia warrant further investigation.
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Affiliation(s)
- Eric Olausson
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | | | - Yaron Fridman
- Asheville Cardiology Associates, Mission Hospital, Asheville, NC, USA
| | | | - Maren Maanja
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Louise Niklasson
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Timothy C Wong
- Heart and Vascular Institute, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Cardiovascular Magnetic Resonance Center, Pittsburgh, PA, USA
| | - Miho Fukui
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - João L. Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - George Cater
- Heart and Vascular Institute, UPMC, Pittsburgh, PA, USA
- UPMC Cardiovascular Magnetic Resonance Center, Pittsburgh, PA, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Syed Bukhari
- Department of Medicine, Temple University, Philadelphia, PA, USA
| | - Christopher A. Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- Kolling Institute, Royal North Shore Hospital, and Sydney Medical School, Northern Clinical School, University of Sydney, Sydney, Australia
| | - Samir Saba
- Heart and Vascular Institute, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- Kolling Institute, Royal North Shore Hospital, and Sydney Medical School, Northern Clinical School, University of Sydney, Sydney, Australia
| | - Erik B. Schelbert
- Heart and Vascular Institute, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Cardiovascular Magnetic Resonance Center, Pittsburgh, PA, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
- Minneapolis Heart Institute East, United Hospital, Saint Paul, Minnesota
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Shah R, Sharma A, Assis F, De Vasconcellos HD, Alugubelli N, Pandey P, Akhtar T, Gasperetti A, Zhou S, Halperin H, Zimmerman SL, Tandri H, Kolandaivelu A. Quality assessment of cardiac magnetic resonance myocardial scar imaging prior to ventricular arrhythmia ablation. Int J Cardiovasc Imaging 2023; 39:411-421. [PMID: 36331683 PMCID: PMC9870828 DOI: 10.1007/s10554-022-02734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
High-resolution scar characterization using late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) is useful for guiding ventricular arrhythmia (VA) treatment. However, imaging study quality may be degraded by breath-holding difficulties, arrhythmias, and implantable cardioverter-defibrillators (ICDs). We evaluated the effect of image quality on left ventricle (LV) base to apex scar interpretation in pre-VA ablation LGE-CMR. 43 consecutive patients referred for VA ablation underwent gradient-recalled-echo LGE-CMR. In ICD patients (n = 24), wide-bandwidth inversion-recovery suppressed ICD artifacts. In non-ICD patients, single-shot steady-state free-precession LGE-CMR could also be performed to reduce respiratory motion/arrhythmia artifacts. Study quality was assessed for adequate/limited scar interpretation due to cardiac/respiratory motion artifacts, ICD-related artifacts, and image contrast. 28% of non-ICD patients had studies where image quality limited scar interpretation in at least one image compared to 71% of ICD patient studies (p = 0.012). A median of five image slices had limited quality per ICD patient study, compared to 0 images per non-ICD patient study. Poorer quality in ICD patients was largely due to motion-related artifacts (54% ICD vs 6% non-ICD studies, p = 0.001) as well as ICD-related image artifacts (25% of studies). In VA ablation patients with ICDs, conventional CMR protocols frequently have image slices with limited scar interpretation, which can limit whole-heart scar assessment. Motion artifacts contribute to suboptimal image quality, particularly in ICD patients. Improved methods for motion and ICD artifact suppression may better delineate high-resolution LGE scar features of interest for guiding VA ablation.
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Affiliation(s)
- Rushil Shah
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Apurva Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Fabrizio Assis
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Henrique Doria De Vasconcellos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Navya Alugubelli
- Division of Cardiology, Department of Medicine, Creighton University, Omaha, NE USA
| | - Pallavi Pandey
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Tauseef Akhtar
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Shijie Zhou
- Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, OH USA ,Department of Electrical and Chemical Engineering, Miami University, Oxford, OH USA
| | - Henry Halperin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Stefan L. Zimmerman
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Aravindan Kolandaivelu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 528, 600 N. Wolfe St, Baltimore, MD 21287 USA
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Maanja M, Schlegel TT, Fröjdh F, Niklasson L, Wieslander B, Bacharova L, Schelbert EB, Ugander M. An electrocardiography score predicts heart failure hospitalization or death beyond that of cardiovascular magnetic resonance imaging. Sci Rep 2022; 12:18364. [PMID: 36319723 PMCID: PMC9626618 DOI: 10.1038/s41598-022-22501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 10/17/2022] [Indexed: 11/08/2022] Open
Abstract
The electrocardiogram (ECG) and cardiovascular magnetic resonance imaging (CMR) provide powerful prognostic information. The aim was to determine their relative prognostic value. Patients (n = 783) undergoing CMR and 12-lead ECG with a QRS duration < 120 ms were included. Prognosis scores for one-year event-free survival from hospitalization for heart failure or death were derived using continuous ECG or CMR measures, and multivariable logistic regression, and compared. Patients (median [interquartile range] age 55 [43-64] years, 44% female) had 155 events during 5.7 [4.4-6.6] years. The ECG prognosis score included (1) frontal plane QRS-T angle, and (2) heart rate corrected QT duration (QTc) (log-rank 55). The CMR prognosis score included (1) global longitudinal strain, and (2) extracellular volume fraction (log-rank 85). The combination of positive scores for both ECG and CMR yielded the highest prognostic value (log-rank 105). Multivariable analysis showed an association with outcomes for both the ECG prognosis score (log-rank 8.4, hazard ratio [95% confidence interval] 1.29 [1.09-1.54]) and the CMR prognosis score (log-rank 47, hazard ratio 1.90 [1.58-2.28]). An ECG prognosis score predicted outcomes independently of CMR. Combining the results of ECG and CMR using both prognosis scores improved the overall prognostic performance.
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Affiliation(s)
- Maren Maanja
- grid.24381.3c0000 0000 9241 5705Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Todd T. Schlegel
- grid.24381.3c0000 0000 9241 5705Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden ,Nicollier-Schlegel SARL, Trélex, Switzerland
| | - Fredrika Fröjdh
- grid.24381.3c0000 0000 9241 5705Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Louise Niklasson
- grid.24381.3c0000 0000 9241 5705Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Björn Wieslander
- grid.24381.3c0000 0000 9241 5705Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Ljuba Bacharova
- grid.419374.c0000 0004 0388 1966International Laser Center CVTI, Bratislava, Slovak Republic ,grid.7634.60000000109409708Institute of Pathophysiology, Medical School, Comenius University, Bratislava, Slovak Republic
| | - Erik B. Schelbert
- grid.412689.00000 0001 0650 7433Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Martin Ugander
- grid.24381.3c0000 0000 9241 5705Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden ,grid.1013.30000 0004 1936 834XKolling Institute, Royal North Shore Hospital, and Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Gorecka M, Jex N, Thirunavukarasu S, Chowdhary A, Corrado J, Davison J, Tarrant R, Poenar AM, Sharrack N, Parkin A, Sivan M, Swoboda PP, Xue H, Vassiliou V, Kellman P, Plein S, Halpin SJ, Simms AD, Greenwood JP, Levelt E. Cardiovascular magnetic resonance imaging and spectroscopy in clinical long-COVID-19 syndrome: a prospective case-control study. J Cardiovasc Magn Reson 2022; 24:50. [PMID: 36089591 PMCID: PMC9464490 DOI: 10.1186/s12968-022-00887-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The underlying pathophysiology of post-coronavirus disease 2019 (long-COVID-19) syndrome remains unknown, but increased cardiometabolic demand and state of mitochondrial dysfunction have emerged as candidate mechanisms. Cardiovascular magnetic resonance (CMR) provides insight into pathophysiological mechanisms underlying cardiovascular disease and 31-phosphorus CMR spectroscopy (31P-CMRS) allows non-invasive assessment of the myocardial energetic state. The main aim of the study was to assess whether long COVID-19 syndrome is associated with abnormalities of myocardial structure, function, perfusion and energy metabolism. METHODS Prospective case-control study. A total of 20 patients with a clinical diagnosis of long COVID-19 syndrome (seropositive) and no prior underlying cardiovascular disease (CVD) and 10 matching healthy controls underwent 31P-CMRS and CMR at 3T at a single time point. All patients had been symptomatic with acute COVID-19, but none required hospital admission. RESULTS Between the long COVID-19 syndrome patients and matched contemporary healthy controls there were no differences in myocardial energetics (phosphocreatine to ATP ratio), in cardiac structure (biventricular volumes), function (biventricular ejection fractions, global longitudinal strain), tissue characterization (T1 mapping and late gadolinium enhancement) or perfusion (myocardial rest and stress blood flow, myocardial perfusion reserve). One patient with long COVID-19 syndrome showed subepicardial hyperenhancement on late gadolinium enhancement imaging compatible with prior myocarditis, but no accompanying abnormality in cardiac size, function, perfusion, extracellular volume fraction, native T1, T2 or cardiac energetics. CONCLUSIONS In this prospective case-control study, the overwhelming majority of patients with a clinical long COVID-19 syndrome with no prior CVD did not exhibit any abnormalities in myocardial energetics, structure, function, blood flow or tissue characteristics.
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Affiliation(s)
- Miroslawa Gorecka
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Nicholas Jex
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Sharmaine Thirunavukarasu
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Amrit Chowdhary
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Joanna Corrado
- Department of Rehabilitation Medicine, Leeds Teaching Hospitals Trust, Leeds, UK
| | | | | | - Ana-Maria Poenar
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Noor Sharrack
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Amy Parkin
- Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Manoj Sivan
- Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive MSC-1061, Bethesda, MD, 20892, USA
| | - Vassilios Vassiliou
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive MSC-1061, Bethesda, MD, 20892, USA
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Stephen J Halpin
- Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK.
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Comparative assessment of motion averaged free-breathing or breath-held cardiac magnetic resonance imaging protocols in a porcine myocardial infarction model. Sci Rep 2022; 12:3727. [PMID: 35260600 PMCID: PMC8904807 DOI: 10.1038/s41598-022-07566-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 02/11/2022] [Indexed: 11/08/2022] Open
Abstract
Breath-held (BH) cardiac magnetic resonance imaging (CMR) is the gold standard for volumetric quantification. However, large animals for pre-clinical research are unable to voluntarily breath-hold, necessitating general anaesthesia and mechanical ventilation, increasing research costs and affecting cardiovascular physiology. Conducting CMR in lightly sedated, free-breathing (FB) animal subjects is an alternative strategy which can overcome these constraints, however, may result in poorer image quality due to breathing motion artefact. We sought to assess the reproducibility of CMR metrics between FB and BH CMR in a porcine model of ischaemic cardiomyopathy. FB or BH CMR was performed in 38 porcine subjects following percutaneous induction of myocardial infarction. Analysis was performed by two independent, blinded observers according to standard reporting guidelines. Subjective and objective image quality was significantly improved in the BH cohort (image quality score: 3.9/5 vs. 2.4/5; p < 0.0001 and myocardium:blood pool intensity ratio: 2.6-3.3 vs. 1.9-2.3; p < 0.001), along with scan acquisition time (4 min 06 s ± 1 min 55 s vs. 8 min 53 s ± 2 min 39 s; p < 0.000). Intra- and inter-observer reproducibility of volumetric analysis was substantially improved in BH scans (correlation coefficients: 0.94-0.99 vs. 0.76-0.91; coefficients of variation: < 5% in BH and > 5% in FB; Bland-Altman limits of agreement: < 10 in BH and > 10 in FB). Interstudy variation between approaches was used to calculate sample sizes, with BH CMR resulting in greater than 85% reduction in animal numbers required to show clinically significant treatment effects. In summary, BH porcine CMR produces superior image quality, shorter scan acquisition, greater reproducibility, and requires smaller sample sizes for pre-clinical trials as compared to FB acquisition.
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10
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Krittayaphong R, Zhang S, Tanapibunpon P, Kaolawanich Y, Nakyen S. Dark-blood late gadolinium-enhancement cardiac magnetic resonance imaging for myocardial scar detection based on simplified timing scheme: single-center experience in patients with suspected coronary artery disease. Quant Imaging Med Surg 2022; 12:1037-1050. [PMID: 35111603 DOI: 10.21037/qims-21-704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022]
Abstract
Background This study aims to examine scar detectability using dark-blood late gadolinium enhancement (LGE) with simplified timing scheme and fixed parameters comparing to two conventional bright-blood approaches in patients with known or suspected coronary artery disease. Methods Three LGE techniques were performed in all patients with known or suspected coronary artery disease at 3 T: dark blood two-dimensional (2D) phase-sensitive inversion recovery (PSIR) preceded with a T2-preparation pulse (DB-LGE), conventional three-dimensional (3D) gradient-echo inversion recovery (3D-IR) and conventional 2D PSIR. Timing parameters in DB-LGE were tested in five clinically confirmed coronary artery disease patients with scars and fixed for the rest of the study. Two independent readers evaluated images at both patient and segment levels. Image quality and contrast ratio between scar and adjacent tissues were assessed. Concordance between the three techniques and detection rate based on expert consensus were reported. Results Forty-six patients were recruited in the study (average age 66.8 years, 69.6% male). DB-LGE demonstrated superior image quality (P=0.001 vs. 3D-IR) and scar-to-blood contrast ratio (P<0.001 vs. 3D-IR and PSIR). Among 41 patients with suspected coronary artery disease, myocardial scar was present in 30 patients (73.2%), all detected by DB-LGE, yielding a detection rate of 100% compared to 93.3% and 96.7% for bright-blood 3D-IR and PSIR. For subendocardial scar detection among 656 segments, DB-LGE had a detection rate of 99.4% compared to 57.8% for 3D-IR and 61.0% for PSIR (both P<0.001). Conclusions DB-LGE improves detection of myocardial scar compared with conventional bright-blood LGE techniques, particularly of subendocardial scar.
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Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Shuo Zhang
- Philips Healthcare, Singapore.,Philips Healthcare, Hamburg, Germany
| | - Prajak Tanapibunpon
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yodying Kaolawanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaporn Nakyen
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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11
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Wang K, Zhang W, Li S, Bi X, Schmidt M, An J, Zheng J, Cheng J. Prognosis in patients with coronary heart disease and breath-holding limitations: a free-breathing cardiac magnetic resonance protocol at 3.0 T. BMC Cardiovasc Disord 2021; 21:580. [PMID: 34876015 PMCID: PMC8650562 DOI: 10.1186/s12872-021-02402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background and purpose Conventional cardiac magnetic resonance (CCMR) imaging is usually performed with breath-holding (BH), which is adverse in patients with BH limitations. We explored the ability of a free-breathing CMR (fCMR) protocol to prognosticate in patients with coronary heart diseases (CHD) and limited BH ability.
Methods Sixty-seven patients with CHD and limited BH abilities were prospectively enrolled in this study. All patients underwent comprehensive fCMR imaging at 3.0 T. The fCMR protocols included compressed sensing (CS) single-shot cine acceleration imaging, and motion-corrected (MOCO), single-shot late gadolinium enhancement (LGE) imaging. Image quality (IQ) of the cine and LGE images was evaluated based on the 5-point Likert scale. The value of fMRI in providing a prognosis in patients with CHD was assessed. Statistical methods included the T test, Mann–Whitney test, Kappa test, Kaplan–Meier curve, Log-rank test, Cox proportional hazard regression analysis, and receiver operating characteristic curves. Results All IQ scores of the short axis CS-cine and both the short and long axes MOCO LGE images were ≥ 3 points. Over a median follow-up of 31 months (range 3.8–38.2), 25 major adverse cardiovascular events (MACE) occurred. In the univariate analysis, infarction size (IS), left ventricular ejection fraction (LVEF), 3D-Global peak longitudinal strain (3D-GPLS), heart failure classification were significantly associated with MACE. When the significantly univariate MACE predictors, added to the multivariate analysis, which showed IS (HR 1.02; 95% CI 1.00–1.05; p = 0.048) and heart failure with preserved EF (HR 0.20; 95% CI 0.04–0.98; p = 0.048) correlated positively with MACE. The optimal cutoff value for LVEF, 3D-GPLS, and IS in predicting MACE was 34.2%, − 5.7%, and 26.1% respectively, with a sensitivity of 90.5%, 64%, and 96.0% and specificity of 72%, 95.2%, and 85.7% respectively. Conclusions The fCMR protocol can be used to make prognostic assessments in patients with CHD and BH limitations by calculating IS and LVEF.
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Affiliation(s)
- Keyan Wang
- MRI Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenbo Zhang
- MRI Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuman Li
- MRI Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoming Bi
- Siemens Medical Solulations USA, Inc., Los Angeles, USA
| | | | - Jing An
- Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jingliang Cheng
- MRI Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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12
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Xue H, Artico J, Fontana M, Moon JC, Davies RH, Kellman P. Landmark Detection in Cardiac MRI by Using a Convolutional Neural Network. Radiol Artif Intell 2021; 3:e200197. [PMID: 34617022 PMCID: PMC8489464 DOI: 10.1148/ryai.2021200197] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 04/28/2021] [Accepted: 06/15/2021] [Indexed: 12/03/2022]
Abstract
PURPOSE To develop a convolutional neural network (CNN) solution for landmark detection in cardiac MRI (CMR). MATERIALS AND METHODS This retrospective study included cine, late gadolinium enhancement (LGE), and T1 mapping examinations from two hospitals. The training set included 2329 patients (34 089 images; mean age, 54.1 years; 1471 men; December 2017 to March 2020). A hold-out test set included 531 patients (7723 images; mean age, 51.5 years; 323 men; May 2020 to July 2020). CNN models were developed to detect two mitral valve plane and apical points on long-axis images. On short-axis images, anterior and posterior right ventricular (RV) insertion points and left ventricular (LV) center points were detected. Model outputs were compared with manual labels assigned by two readers. The trained model was deployed to MRI scanners. RESULTS For the long-axis images, successful detection of cardiac landmarks ranged from 99.7% to 100% for cine images and from 99.2% to 99.5% for LGE images. For the short-axis images, detection rates were 96.6% for cine, 97.6% for LGE, and 98.7% for T1 mapping. The Euclidean distances between model-assigned and manually assigned labels ranged from 2 to 3.5 mm for different landmarks, indicating close agreement between model-derived landmarks and manually assigned labels. For all views and imaging sequences, no differences between the models' assessment of images and the readers' assessment of images were found for the anterior RV insertion angle or LV length. Model inference for a typical cardiac cine series took 610 msec with the graphics processing unit and 5.6 seconds with central processing unit. CONCLUSION A CNN was developed for landmark detection on both long- and short-axis CMR images acquired with cine, LGE, and T1 mapping sequences, and the accuracy of the CNN was comparable with the interreader variation.Keywords: Cardiac, Heart, Convolutional Neural Network (CNN), Deep Learning Algorithms, Machine Learning Algorithms, Feature Detection, Quantification, Supervised Learning, MR Imaging Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Hui Xue
- From the National Heart, Lung, and Blood Institute, National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892 (H.X., P.K.); Barts Heart
Centre, National Health Service, London, England (J.A., J.C.M., R.H.D.); and
National Amyloidosis Centre, Royal Free Hospital, London, England (M.F.)
| | - Jessica Artico
- From the National Heart, Lung, and Blood Institute, National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892 (H.X., P.K.); Barts Heart
Centre, National Health Service, London, England (J.A., J.C.M., R.H.D.); and
National Amyloidosis Centre, Royal Free Hospital, London, England (M.F.)
| | - Marianna Fontana
- From the National Heart, Lung, and Blood Institute, National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892 (H.X., P.K.); Barts Heart
Centre, National Health Service, London, England (J.A., J.C.M., R.H.D.); and
National Amyloidosis Centre, Royal Free Hospital, London, England (M.F.)
| | - James C. Moon
- From the National Heart, Lung, and Blood Institute, National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892 (H.X., P.K.); Barts Heart
Centre, National Health Service, London, England (J.A., J.C.M., R.H.D.); and
National Amyloidosis Centre, Royal Free Hospital, London, England (M.F.)
| | - Rhodri H. Davies
- From the National Heart, Lung, and Blood Institute, National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892 (H.X., P.K.); Barts Heart
Centre, National Health Service, London, England (J.A., J.C.M., R.H.D.); and
National Amyloidosis Centre, Royal Free Hospital, London, England (M.F.)
| | - Peter Kellman
- From the National Heart, Lung, and Blood Institute, National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892 (H.X., P.K.); Barts Heart
Centre, National Health Service, London, England (J.A., J.C.M., R.H.D.); and
National Amyloidosis Centre, Royal Free Hospital, London, England (M.F.)
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13
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Toupin S, Pezel T, Bustin A, Cochet H. Whole-Heart High-Resolution Late Gadolinium Enhancement: Techniques and Clinical Applications. J Magn Reson Imaging 2021; 55:967-987. [PMID: 34155715 PMCID: PMC9292698 DOI: 10.1002/jmri.27732] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/15/2022] Open
Abstract
In cardiovascular magnetic resonance, late gadolinium enhancement (LGE) has become the cornerstone of myocardial tissue characterization. It is widely used in clinical routine to diagnose and characterize the myocardial tissue in a wide range of ischemic and nonischemic cardiomyopathies. The recent growing interest in imaging left atrial fibrosis has led to the development of novel whole‐heart high‐resolution late gadolinium enhancement (HR‐LGE) techniques. Indeed, conventional LGE is acquired in multiple breath‐holds with limited spatial resolution: ~1.4–1.8 mm in plane and 6–8 mm slice thickness, according to the Society for Cardiovascular Magnetic Resonance standardized guidelines. Such large voxel size prevents its use in thin structures such as the atrial or right ventricular walls. Whole‐heart 3D HR‐LGE images are acquired in free breathing to increase the spatial resolution (up to 1.3 × 1.3 × 1.3 mm3) and offer a better detection and depiction of focal atrial fibrosis. The downside of this increased resolution is the extended scan time of around 10 min, which hampers the spread of HR‐LGE in clinical practice. Initially introduced for atrial fibrosis imaging, HR‐LGE interest has evolved to be a tool to detect small scars in the ventricles and guide ablation procedures. Indeed, the detection of scars, nonvisible with conventional LGE, can be crucial in the diagnosis of myocardial infarction with nonobstructed coronary arteries, in the detection of the arrhythmogenic substrate triggering ventricular arrhythmia, and improve the confidence of clinicians in the challenging diagnoses such as the arrhythmogenic right ventricular cardiomyopathy. HR‐LGE also offers a precise visualization of left ventricular scar morphology that is particularly useful in planning ablation procedures and guiding them through the fusion of HR‐LGE images with electroanatomical mapping systems. In this narrative review, we attempt to summarize the technical particularities of whole‐heart HR‐LGE acquisition and provide an overview of its clinical applications with a particular focus on the ventricles.
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Affiliation(s)
- Solenn Toupin
- Siemens Healthcare France, Saint-Denis, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Théo Pezel
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Cardiology, Lariboisiere Hospital, APHP, University of Paris, Paris, France
| | - Aurélien Bustin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Bordeaux University Hospital (CHU), Pessac, France
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14
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Gupta S, Ge Y, Singh A, Gräni C, Kwong RY. Multimodality Imaging Assessment of Myocardial Fibrosis. JACC Cardiovasc Imaging 2021; 14:2457-2469. [PMID: 34023250 DOI: 10.1016/j.jcmg.2021.01.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Abstract
Myocardial fibrosis, seen in ischemic and nonischemic cardiomyopathies, is associated with adverse cardiac outcomes. Noninvasive imaging plays a key role in early identification and quantification of myocardial fibrosis with the use of an expanding array of techniques including cardiac magnetic resonance, computed tomography, and nuclear imaging. This review discusses currently available noninvasive imaging techniques, provides insights into their strengths and limitations, and examines novel developments that will affect the future of noninvasive imaging of myocardial fibrosis.
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Affiliation(s)
- Sumit Gupta
- Department of Radiology Brigham and Women's Hospital, Boston, Massachusetts, USA; Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yin Ge
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amitoj Singh
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christoph Gräni
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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15
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Cha MJ, Cho I, Hong J, Kim SW, Shin SY, Paek MY, Bi X, Kim SM. Free-Breathing Motion-Corrected Single-Shot Phase-Sensitive Inversion Recovery Late-Gadolinium-Enhancement Imaging: A Prospective Study of Image Quality in Patients with Hypertrophic Cardiomyopathy. Korean J Radiol 2021; 22:1044-1053. [PMID: 33856138 PMCID: PMC8236358 DOI: 10.3348/kjr.2020.1296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/15/2022] Open
Abstract
Objective Motion-corrected averaging with a single-shot technique was introduced for faster acquisition of late-gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging while free-breathing. We aimed to evaluate the image quality (IQ) of free-breathing motion-corrected single-shot LGE (moco-ss-LGE) in patients with hypertrophic cardiomyopathy (HCM). Materials and Methods Between April and December 2019, 30 patients (23 men; median age, 48.5; interquartile range [IQR], 36.5–61.3) with HCM were prospectively enrolled. Breath-held single-shot LGE (bh-ss-LGE) and free-breathing moco-ss-LGE images were acquired in random order on a 3T MR system. Semi-quantitative IQ scores, contrast-to-noise ratios (CNRs), and quantitative size of myocardial scar were assessed on pairs of bh-ss-LGE and moco-ss-LGE. The mean ± standard deviation of the parameters was obtained. The results were compared using the Wilcoxon signed-rank test. Results The moco-ss-LGE images had better IQ scores than the bh-ss-LGE images (4.55 ± 0.55 vs. 3.68 ± 0.45, p < 0.001). The CNR of the scar to the remote myocardium (34.46 ± 11.85 vs. 26.13 ± 10.04, p < 0.001), scar to left ventricle (LV) cavity (13.09 ± 7.95 vs. 9.84 ± 6.65, p = 0.030), and LV cavity to remote myocardium (33.12 ± 15.53 vs. 22.69 ± 11.27, p < 0.001) were consistently greater for moco-ss-LGE images than for bh-ss-LGE images. Measurements of scar size did not differ significantly between LGE pairs using the following three different quantification methods: 1) full width at half-maximum method; 23.84 ± 12.88% vs. 24.05 ± 12.81% (p = 0.820), 2) 6-standard deviation method, 15.14 ± 10.78% vs. 15.99 ± 10.99% (p = 0.186), and 3) 3-standard deviation method; 36.51 ± 17.60% vs. 37.50 ± 17.90% (p = 0.785). Conclusion Motion-corrected averaging may allow for superior IQ and CNRs with free-breathing in single-shot LGE imaging, with a herald of free-breathing moco-ss-LGE as the scar imaging technique of choice for clinical practice.
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Affiliation(s)
- Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Department of Internal medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.,Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
| | - Joonhwa Hong
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang Wook Kim
- Division of Cardiology, Department of Internal medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung Yong Shin
- Division of Cardiology, Department of Internal medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | | | - Xiaoming Bi
- Siemens Medical Solutions USA, Inc., Los Angeles, CA, USA
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
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16
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Lee S, Lee M, Hor KN. The role of imaging in characterizing the cardiac natural history of Duchenne muscular dystrophy. Pediatr Pulmonol 2021; 56:766-781. [PMID: 33651923 DOI: 10.1002/ppul.25227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/19/2020] [Accepted: 11/12/2020] [Indexed: 01/11/2023]
Abstract
Duchene muscular dystrophy (DMD) is a rare but devastating disease resulting in progressive loss of ambulation, respiratory failure, DMD-associated cardiomyopathy (DMD-CM), and premature death. The use of corticosteroids and supportive respiratory care has improved outcomes, such that DMD-CM is now the leading cause of death. Historically, most programs have focused on skeletal myopathy with less attention to the cardiac phenotype. This omission is rather astonishing since patients with DMD possess an absolute genetic risk of developing cardiomyopathy. Unfortunately, heart failure signs and symptoms are vague due to skeletal muscle myopathy leading to limited ambulation. Traditional assessment of cardiac symptoms by the New York Heart Association American College of Cardiology/American Heart Association Staging (ACC/AHA) classification is of limited utility, even in advanced stages. Echocardiographic assessment can detect cardiac dysfunction late in the disease course, but this has proven to be a poor surrogate marker of early cardiovascular disease and an inadequate predictor of DMD-CM. Indeed, one explanation for the paucity of cardiac therapeutic trials for DMD-CM has been the lack of a suitable end-point. Improved outcomes require a better proactive treatment strategy; however, the barrier to treatment is the lack of a sensitive and specific tool to assess the efficacy of treatment. The use of cardiac imaging has evolved from echocardiography to cardiac magnetic resonance imaging to assess cardiac performance. The purpose of this article is to review the role of cardiac imaging in characterizing the cardiac natural history of DMD-CM, highlighting the prognostic implications and an outlook on how this field might evolve in the future.
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Affiliation(s)
- Simon Lee
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Marc Lee
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Kan N Hor
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
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17
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Myocardial motion-corrected phase-sensitive inversion recovery late gadolinium enhancement in free breathing paediatric patients: a comparison with single-shot coherent gradient echo ("TrueFISP") phase-sensitive inversion recovery. Clin Radiol 2021; 76:471.e17-471.e25. [PMID: 33663913 DOI: 10.1016/j.crad.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/26/2021] [Indexed: 11/23/2022]
Abstract
AIM To investigate the value of motion-corrected (MOCO) phase-sensitive inversion recovery (PSIR) late gadolinium enhancement (LGE) compared with single-shot balanced steady-state gradient echo ("TrueFISP", Siemens) PSIR in free breathing paediatric patients. MATERIALS AND METHODS In this retrospective study, 238 paediatric patients underwent clinical contrast-enhanced cardiovascular magnetic resonance imaging (CMRI). Both the single-shot TrueFISP PSIR and MOCO PSIR sequences were performed on each child. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Two radiologists rated the quality of the images on a scale of 1-5 (1 = poor, 5 = very good). Bland-Altman, linear regression, and intraclass correlation coefficient were used to compared the extent of LGE of the single-shot TrueFISP PSIR and MOCO PSIR. Imaging artefacts were described and compared. RESULTS Children ranged in age from 60 days to 17 years with an average age of 8.1 ± 3.8 years. MOCO PSIR had higher SNR and CNR than the single-shot TrueFISP PSIR (p<0.001). Mean quality ratings for short-axis imaging were 4 (interquartile range, 3-4) for single-shot TrueFISP PSIR and 4 (interquartile range, 4-5) for MOCO PSIR (p<0.001). The scan time was faster for single-shot TrueFISP PSIR than for MOCO PSIR. The myocardial LGE results were similar with high agreement between the single-shot TrueFISP PSIR and MOCO PSIR (ICC = 0.955-0.986). CONCLUSION The MOCO PSIR sequence is feasible in children. MOCO PSIR is robust at high heart rates and can be performed without breath-holding with higher image-quality ratings than the single-shot TrueFISP PSIR.
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18
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Muser D, Santangeli P, Nucifora G. Procainamide for the Rapid Suppression of Premature Ventricular Contractions: An (Almost) Forgotten Tool in the Cardiologist's Armamentarium. Diagnostics (Basel) 2021; 11:diagnostics11020357. [PMID: 33672729 PMCID: PMC7924344 DOI: 10.3390/diagnostics11020357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Daniele Muser
- Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA 3400, USA; (D.M.); (P.S.)
| | - Pasquale Santangeli
- Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA 3400, USA; (D.M.); (P.S.)
| | - Gaetano Nucifora
- Cardiac Imaging Unit, NorthWest Heart Centre, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
- Correspondence: or
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19
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Bolus Intravenous Procainamide in Patients with Frequent Ventricular Ectopics during Cardiac Magnetic Resonance Scanning: A Way to Ensure High Quality Imaging. Diagnostics (Basel) 2021; 11:diagnostics11020178. [PMID: 33513676 PMCID: PMC7911068 DOI: 10.3390/diagnostics11020178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 01/15/2023] Open
Abstract
Acquiring high-quality cardiac magnetic resonance (CMR) images in patients with frequent ventricular arrhythmias remains a challenge. We examined the safety and efficacy of procainamide when administered on the scanner table prior to CMR scanning to suppress ventricular ectopy and acquire high-quality images. Fifty consecutive patients (age 53.0 [42.0–58.0]; 52% female, left ventricular ejection fraction 55 ± 9%) were scanned in a 1.5 T scanner using a standard cardiac protocol. Procainamide was administered at intermittent intravenous bolus doses of 50 mg every minute until suppression of the ectopics or a maximum dose of 10 mg/kg. The average dose of procainamide was 567 ± 197 mg. Procainamide successfully suppressed premature ventricular contractions (PVCs) in 82% of patients, resulting in high-quality images. The baseline blood pressure (BP) was mildly reduced (mean change systolic BP −12 ± 9 mmHg; diastolic BP −4 ± 9 mmHg), while the baseline heart rate (HR) remained relatively unchanged (mean HR change −1 ± 6 bpm). None of the patients developed proarrhythmic changes. Bolus intravenous administration of procainamide prior to CMR scanning is a safe and effective alternative approach for suppressing PVCs and acquiring high-quality images in patients with frequent PVCs and normal or only mildly reduced systolic function.
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20
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Sharkey SW, Alfadhel M, Thaler C, Lin D, Nowariak M, Cavalcante JL, Henry TD, Saw J. Recognition of acute myocardial infarction caused by spontaneous coronary artery dissection of first septal perforator. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:933-939. [PMID: 33580787 DOI: 10.1093/ehjacc/zuaa036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/05/2020] [Accepted: 12/11/2020] [Indexed: 11/14/2022]
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) diagnosis is challenging as angiographic findings are often subtle and differ from coronary atherosclerosis. Herein, we describe characteristics of patients with acute myocardial infarction (MI) caused by first septal perforator (S1) SCAD. METHODS AND RESULTS Patients were gathered from SCAD registries at Minneapolis Heart Institute and Vancouver General Hospital. First septal perforator SCAD prevalence was 11 of 1490 (0.7%). Among 11 patients, age range was 38-64 years, 9 (82%) were female. Each presented with acute chest pain, troponin elevation, and non-ST-elevation MI diagnosis. Initial electrocardiogram demonstrated ischaemia in 5 (45%); septal wall motion abnormality was present in 4 (36%). Angiographic type 2 SCAD was present in 7 (64%) patients with S1 TIMI 3 flow in 7 (64%) and TIMI 0 flow in 2 (18%). Initial angiographic interpretation failed to recognize S1-SCAD in 6 (55%) patients (no culprit, n = 5, septal embolism, n = 1). First septal perforator SCAD diagnosis was established by review of initial coronary angiogram consequent to cardiovascular magnetic resonance (CMR) demonstrating focal septal late gadolinium enhancement with corresponding oedema (n = 3), occurrence of subsequent SCAD event (n = 2), or second angiogram showing healed S1-SCAD (n = 1). Patients were treated conservatively, each with ejection fraction >50%. CONCLUSION First septal perforator SCAD events may be overlooked at initial angiography and mis-diagnosed as 'no culprit' MI. First septal perforator SCAD prevalence is likely greater than reported herein and dependent on local expertise and availability of CMR imaging. Spontaneous coronary artery dissection events may occur in intra-myocardial coronary arteries, approaching the resolution limits of invasive coronary angiography.
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Affiliation(s)
- Scott W Sharkey
- Division of Cardiovascular Research, Minneapolis Heart Institute and Foundation, 920 East 28th St, Suite 620m, Minneapolis, MN 55407, USA
| | - Mesfer Alfadhel
- Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Christina Thaler
- Division of Cardiovascular Research, Minneapolis Heart Institute and Foundation, 920 East 28th St, Suite 620m, Minneapolis, MN 55407, USA
| | - David Lin
- Division of Cardiovascular Research, Minneapolis Heart Institute and Foundation, 920 East 28th St, Suite 620m, Minneapolis, MN 55407, USA
| | - Meagan Nowariak
- Division of Cardiovascular Research, Minneapolis Heart Institute and Foundation, 920 East 28th St, Suite 620m, Minneapolis, MN 55407, USA
| | - João L Cavalcante
- Division of Cardiovascular Research, Minneapolis Heart Institute and Foundation, 920 East 28th St, Suite 620m, Minneapolis, MN 55407, USA
| | - Timothy D Henry
- Division of Cardiology, Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, USA
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada
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21
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Yu Y, Chen Y, Zhao S, Ge M, Yang S, Yun H, Bi X, Fu C, Zeng M, Jin H. Role of free-breathing motion-corrected late gadolinium enhancement technique for image quality assessment and LGE quantification. Eur J Radiol 2020; 135:109510. [PMID: 33401112 DOI: 10.1016/j.ejrad.2020.109510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 12/19/2020] [Accepted: 12/28/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the image quality and late gadolinium enhancement (LGE) quantification between free-breathing motion-corrected and conventional breath-hold LGE method in a variety of cardiovascular diseases. MATERIALS AND METHODS 149 consecutive patients underwent contrast-enhanced cardiac magnetic resonance examination employing both free-breathing motion-corrected LGE and conventional breath-hold LGE method. Scan time, contrast-to-noise ratio, overall image quality score and LGE mass were measured and analyzed statistically. RESULTS Free-breathing motion-corrected LGE method had a shorter scan time and higher overall image quality score in comparison with conventional breath-hold LGE method (p < 0.001). Univariate/multivariate logistic regression analysis showed that breath-holding difficulty, high heart rate and arrhythmia could be predictive factors possibly for an inferior image quality score (p < 0.05 for all). The contrast-to-noise ratios of free-breathing motion-corrected LGE images were higher than those of conventional breath-hold LGE images (p < 0.001). In the cases with subepicardial and/or transmural myocardial enhancement, the measured LGE masses were larger on free-breathing motion-corrected LGE images in comparison with those on conventional breath-hold LGE images (p < 0.05). CONCLUSION Free-breathing motion-corrected LGE could be a better choice for patients who need contrast-enhanced cardiac MRI and have one or more of the risk factors for an inferior image quality score, including breath-holding difficulty, high heart rate and arrhythmia. However, an overestimation of LGE mass on free-breathing motion-corrected LGE image should be taken into consideration when LGE pattern involves subepicardial and/or transmural myocardium.
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Affiliation(s)
- Yunfei Yu
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yinyin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Shihai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Meiying Ge
- Department of Radiology, The 5th People's Hospital of Shanghai, Fudan University, Shanghai, China.
| | - Shan Yang
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Hong Yun
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Xiaoming Bi
- MR Research and Development, Siemens Healthcare, Los Angeles, CA, 90048, USA
| | - Caixia Fu
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, 518057, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China.
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Pennig L, Lennartz S, Wagner A, Sokolowski M, Gajzler M, Ney S, Laukamp KR, Persigehl T, Bunck AC, Maintz D, Weiss K, Naehle CP, Doerner J. Clinical application of free-breathing 3D whole heart late gadolinium enhancement cardiovascular magnetic resonance with high isotropic spatial resolution using Compressed SENSE. J Cardiovasc Magn Reson 2020; 22:89. [PMID: 33327958 PMCID: PMC7745391 DOI: 10.1186/s12968-020-00673-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/15/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) represents the gold standard for assessment of myocardial viability. The purpose of this study was to investigate the clinical potential of Compressed SENSE (factor 5) accelerated free-breathing three-dimensional (3D) whole heart LGE with high isotropic spatial resolution (1.4 mm3 acquired voxel size) compared to standard breath-hold LGE imaging. METHODS This was a retrospective, single-center study of 70 consecutive patients (45.8 ± 18.1 years, 27 females; February-November 2019), who were referred for assessment of left ventricular myocardial viability and received free-breathing and breath-hold LGE sequences at 1.5 T in clinical routine. Two radiologists independently evaluated global and segmental LGE in terms of localization and transmural extent. Readers scored scans regarding image quality (IQ), artifacts, and diagnostic confidence (DC) using 5-point scales (1 non-diagnostic-5 excellent/none). Effects of heart rate and body mass index (BMI) on IQ, artifacts, and DC were evaluated with ordinal logistic regression analysis. RESULTS Global LGE (n = 33) was identical for both techniques. Using free-breathing LGE (average scan time: 04:33 ± 01:17 min), readers detected more hyperenhanced lesions (28.2% vs. 23.5%, P < .05) compared to breath-hold LGE (05:15 ± 01:23 min, P = .0104), pronounced at subepicardial localization and for 1-50% of transmural extent. For free-breathing LGE, readers graded scans with good/excellent IQ in 80.0%, with low-impact/no artifacts in 78.6%, and with good/high DC in 82.1% of cases. Elevated BMI was associated with increased artifacts (P = .0012) and decreased IQ (P = .0237). Increased heart rate negatively influenced artifacts (P = .0013) and DC (P = .0479) whereas IQ (P = .3025) was unimpaired. CONCLUSIONS In a clinical setting, free-breathing Compressed SENSE accelerated 3D high isotropic spatial resolution whole heart LGE provides good to excellent image quality in 80% of scans independent of heart rate while enabling improved depiction of small and particularly non-ischemic hyperenhanced lesions in a shorter scan time than standard breath-hold LGE.
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Affiliation(s)
- Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
- Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Weyertal 115b, 50931, Cologne, Germany
| | - Anton Wagner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Marcel Sokolowski
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Matej Gajzler
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Svenja Ney
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kai Roman Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Department of Radiology, University Hospitals Cleveland Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Radiology, Case Western Reserve University, 11000 Euclid Ave, Cleveland, OH, 44106, USA
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Alexander Christian Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kilian Weiss
- Philips GmbH, Röntgenstraße 22, 22335, Hamburg, Germany
| | - Claas Philip Naehle
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Jonas Doerner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Zeilinger MG, Wiesmüller M, Forman C, Schmidt M, Munoz C, Piccini D, Kunze KP, Neji R, Botnar RM, Prieto C, Uder M, May M, Wuest W. 3D Dixon water-fat LGE imaging with image navigator and compressed sensing in cardiac MRI. Eur Radiol 2020; 31:3951-3961. [PMID: 33263160 PMCID: PMC8128857 DOI: 10.1007/s00330-020-07517-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/11/2020] [Accepted: 11/13/2020] [Indexed: 12/25/2022]
Abstract
Objectives To evaluate an image-navigated isotropic high-resolution 3D late gadolinium enhancement (LGE) prototype sequence with compressed sensing and Dixon water-fat separation in a clinical routine setting. Material and methods Forty consecutive patients scheduled for cardiac MRI were enrolled prospectively and examined with 1.5 T MRI. Overall subjective image quality, LGE pattern and extent, diagnostic confidence for detection of LGE, and scan time were evaluated and compared to standard 2D LGE imaging. Robustness of Dixon fat suppression was evaluated for 3D Dixon LGE imaging. For statistical analysis, the non-parametric Wilcoxon rank sum test was performed. Results LGE was rated as ischemic in 9 patients and non-ischemic in 11 patients while it was absent in 20 patients. Image quality and diagnostic confidence were comparable between both techniques (p = 0.67 and p = 0.66, respectively). LGE extent with respect to segmental or transmural myocardial enhancement was identical between 2D and 3D (water-only and in-phase). LGE size was comparable (3D 8.4 ± 7.2 g, 2D 8.7 ± 7.3 g, p = 0.19). Good or excellent fat suppression was achieved in 93% of the 3D LGE datasets. In 6 patients with pericarditis, the 3D sequence with Dixon fat suppression allowed for a better detection of pericardial LGE. Scan duration was significantly longer for 3D imaging (2D median 9:32 min vs. 3D median 10:46 min, p = 0.001). Conclusion The 3D LGE sequence provides comparable LGE detection compared to 2D imaging and seems to be superior in evaluating the extent of pericardial involvement in patients suspected with pericarditis due to the robust Dixon fat suppression. Key Points • Three-dimensional LGE imaging provides high-resolution detection of myocardial scarring. • Robust Dixon water-fat separation aids in the assessment of pericardial disease. • The 2D image navigator technique enables 100% respiratory scan efficacy and permits predictable scan times.
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Affiliation(s)
| | - Marco Wiesmüller
- Institute of Diagnostic Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Christoph Forman
- Cardiovascular MR Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Michaela Schmidt
- Cardiovascular MR Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Camila Munoz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Davide Piccini
- Advanced Clinical Imaging Technology, Siemens Healthcare IM BM PI, Lausanne, Switzerland
| | - Karl-Philipp Kunze
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,MR Research Collaborations, Siemens Healthcare GmbH, Frimley, UK
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,MR Research Collaborations, Siemens Healthcare GmbH, Frimley, UK
| | - René Michael Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Michael Uder
- Institute of Diagnostic Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Matthias May
- Institute of Diagnostic Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Wolfgang Wuest
- Institute of Diagnostic Radiology, University Hospital of Erlangen, Erlangen, Germany
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Extracellular Volume and Global Longitudinal Strain Both Associate With Outcomes But Correlate Minimally. JACC Cardiovasc Imaging 2020; 13:2343-2354. [DOI: 10.1016/j.jcmg.2020.04.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/13/2023]
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25
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Motion-corrected cardiac MRI is associated with decreased anesthesia exposure in children. Pediatr Radiol 2020; 50:1709-1716. [PMID: 32696111 PMCID: PMC8351617 DOI: 10.1007/s00247-020-04766-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/20/2020] [Accepted: 07/01/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The benefits of cardiac magnetic resonance imaging (MRI) in the pediatric population must be balanced with the risk and cost of anesthesia. Segmented imaging using multiple averages attempts to avoid breath-holds requiring general anesthesia; however, cardiorespiratory artifacts and prolonged scan times limit its use. Thus, breath-held imaging with general anesthesia is used in many pediatric centers. The advent of free-breathing, motion-corrected (MOCO) cines by real-time re-binned reconstruction offers reduced anesthesia exposure without compromising image quality. OBJECTIVE This study evaluates sedation utilization in our pediatric cardiac MR practice before and after clinical introduction of free-breathing MOCO imaging for cine and late gadolinium enhancement. MATERIALS AND METHODS In a retrospective study, patients referred for a clinical cardiac MR who would typically be offered sedation for their scan (n=295) were identified and divided into two eras, those scanned before the introduction of MOCO cine and late gadolinium enhancement sequences and those scanned following their introduction. Anesthesia use was compared across eras and disease-specific cohorts. RESULTS The incidence of non-sedation studies performed in children nearly tripled following the introduction of MOCO imaging (25% [pre-MOCO] to 69% [post-MOCO], P<0.01), with the greatest effect in patients with simple congenital heart disease. Eleven percent of the post-MOCO cohort comprised infants younger than 3 months of age who could forgo sedation with the combination of MOCO imaging and a "feed-and-bundle" positioning technique. CONCLUSION Implementation of cardiac MR with MOCO cine and late gadolinium enhancement imaging in a pediatric population is associated with significantly decreased sedation utilization.
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26
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Yan C, Hu J, Li Y, Xie X, Zou Z, Deng Q, Zhou X, Bi X, Zeng M, Liu J. Motion-corrected free-breathing late gadolinium enhancement combined with a gadolinium contrast agent with a high relaxation rate: an optimized cardiovascular magnetic resonance examination protocol. J Int Med Res 2020; 48:300060520964664. [PMID: 33111603 PMCID: PMC7605004 DOI: 10.1177/0300060520964664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This prospective study investigated the feasibility of an optimized cardiovascular magnetic resonance (CMR) examination protocol using the motion-corrected (MOCO), balanced steady-state free precession (bSSFP), phase-sensitive inversion recovery (PSIR) sequence combined with a gadolinium contrast agent with a high relaxation rate in patients who cannot hold their breath. METHODS Fifty-one patients with heart disease underwent CMR examinations twice and these were performed with different late gadolinium enhancement (LGE) imaging sequences (fast low-angle shot [FLASH] sequence vs. MOCO sequence) and different gadolinium contrast agents (gadopentetate dimeglumine vs. gadobenate dimeglumine) with a 48-hour interval. LGE image quality, total time spent in the whole study, and time taken to perform LGE imaging were compared for the two CMR examinations. RESULTS LGE images with the MOCO bSSFP PSIR sequence showed significantly higher image quality compared with those with the segmented FLASH PSIR sequence. There was a significant difference between the total scan time for the two examinations and different LGE sequences. CONCLUSIONS The MOCO bSSFP PSIR sequence effectively improves the quality of LGE images. Changing the CMR scanning protocol by combining the MOCO bSSFP PSIR sequence with a gadolinium contrast agent with a high relaxation rate effectively shortens the scan time.Clinical trial registration number: ChiCTR-ROC-17013978.
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Affiliation(s)
- Cui Yan
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Junjiao Hu
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Yanyu Li
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Xingzhi Xie
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhimin Zou
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Qiyu Deng
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China
| | - Xiaoming Bi
- MR Research and Development, Siemens Medical Solutions, USA Inc., Los Angeles, CA, USA
| | - Mu Zeng
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Jun Liu
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
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Doimo S, Ricci F, Aung N, Cooper J, Boubertakh R, Sanghvi MM, Sinagra G, Petersen SE. Tissue-tracking in the assessment of late gadolinium enhancement in myocarditis and myocardial infarction. Magn Reson Imaging 2020; 73:62-69. [PMID: 32853757 DOI: 10.1016/j.mri.2020.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 07/21/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To test the diagnostic performance of cardiovascular magnetic resonance (CMR) tissue-tracking (TT) to detect the presence of late gadolinium enhancement (LGE) in patients with a diagnosis of myocardial infarction (MI) or myocarditis (MYO), preserved left ventricular ejection fraction (LVEF) and no visual regional wall motion abnormalities (RWMA). METHODS We selected consecutive CMR studies of 50 MI, 50 MYO and 96 controls. Receiving operating characteristic (ROC) curve and net reclassification index (NRI) analyses were used to assess the predictive ability and the incremental diagnostic yield of 2D and 3D TT-derived strain parameters for the detection of LGE and to measure the best cut-off values of strain parameters. RESULTS Overall, cases showed significantly reduced 2D global longitudinal strain (2D-GLS) values compared with controls (-20.1 ± 3.1% vs -21.6 ± 2.7%; p = 0.0008). 2D-GLS was also significantly reduced in MYO patients compared with healthy controls (-19.7 ± 2.9% vs -21.9 ± 2.4%; p = 0.0001). 3D global radial strain (3D-GRS) was significantly reduced in MI patients compared with controls with risk factors (34.3 ± 11.8% vs 40.3 ± 12.5%, p = 0.024) Overall, 2D-GLS yielded good diagnostic accuracy for the detection of LGE in the MYO subgroup (AUROC 0.79; NRI (95% CI) = 0.6 (0.3, 1.02) p = 0.0004), with incremental predictive value beyond risk factors and LV function parameters (p for AUROC difference = 0.048). In the MI subgroup, 2D-GRS (AUROC 0.81; NRI (95% CI) = 0.56 (0.17, 0.95) p = 0.004), 3D-GRS (AUROC 0.82; NRI (95% CI) = 0.57 (0.17, 0.97) p = 0.006) and 3D global circumferential strain (3D-GCS) (AUROC 0.81; NRI (95% CI) = 0.62 (0.22, 1.01) p = 0.002) emerged as potential markers of disease. The best cut-off for 2D-GLS was -21.1%, for 2D- and 3D-GRS were 39.1% and 37.7%, respectively, and for 3D-GCS was -16.4%. CONCLUSIONS At CMR-tissue tracking analysis, 2D-GLS was a significant predictor of LGE in patients with myocarditis but preserved LVEF and no visual RWMA. Both 2D- and 3D-GRS and 2D-GCS yielded good diagnostic accuracy for LGE detection in patients with previous MI but preserved LVEF and no visual RWMA.
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Affiliation(s)
- Sara Doimo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Trieste, Italy.
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy; Department of Clinical Sciences, Malmo, Faculty of Medicine, Lund University, Clinical Research Center, 214 28 Malmo, Sweden; Casa di Cura Villa Serena, Città Sant'Angelo, 65013 Pescara, Italy
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Redha Boubertakh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Mihir M Sanghvi
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Trieste, Italy
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
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Extracellular Volume Associates With Outcomes More Strongly Than Native or Post-Contrast Myocardial T1. JACC Cardiovasc Imaging 2020; 13:44-54. [DOI: 10.1016/j.jcmg.2019.03.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 12/19/2022]
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Maanja M, Schlegel TT, Kozor R, Lundin M, Wieslander B, Wong TC, Schelbert EB, Ugander M. The electrical determinants of increased wall thickness and mass in left ventricular hypertrophy. J Electrocardiol 2020; 58:80-86. [DOI: 10.1016/j.jelectrocard.2019.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/08/2019] [Accepted: 09/20/2019] [Indexed: 01/09/2023]
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Treutlein C, Wiesmüller M, May MS, Heiss R, Hepp T, Uder M, Wuest W. Complete Free-breathing Adenosine Stress Cardiac MRI Using Compressed Sensing and Motion Correction: Comparison of Functional Parameters, Perfusion, and Late Enhancement with the Standard Breath-holding Examination. Radiol Cardiothorac Imaging 2019; 1:e180017. [PMID: 33778508 DOI: 10.1148/ryct.2019180017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 04/30/2019] [Accepted: 05/23/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare free-breathing (FB) stress cardiac MRI examinations with the reference standard breath-holding (BH) examination. MATERIALS AND METHODS A total of 40 consecutive patients were enrolled prospectively and were examined with 3-T MRI. Functional imaging, perfusion, and late gadolinium enhancement (LGE) sequences were performed in BH and FB by using compressed sensing and in-line motion correction. Left ventricle (LV) and right ventricle (RV) functional parameters in BH and FB examinations were compared by using Bland-Altman plots and linear mixed models. Subjective image quality was assessed with a five-point scale (1 = nondiagnostic, 5 = very good). For perfusion and LGE imaging, diagnostic confidence was rated with a three-point scale (1 = low, 3 = high), and image quality was rated with a five-point scale (1 = nondiagnostic, 5 = very good). The Wilcoxon test was used to compare image quality and diagnostic confidence. RESULTS Bland-Altman plots showed good agreement for LV and RV functional parameters in BH and FB sequences. Subjective image quality was significantly better with the BH sequences in the LV (P < .01) but was comparable in the RV (P > .99). Scanning time was 218 seconds (range, 130-385 seconds) for cine BH and 16 seconds (range, 11-27 seconds) for cine FB. Extent of perfusion defects, LGE, and diagnostic confidence was comparable between groups. Scanning time was 371 seconds (range, 239-502 seconds) for the LGE BH sequence and 189 seconds (range, 122-286 seconds) for the LGE FB sequence. CONCLUSION FB adenosine stress cardiac MRI delivers diagnostic image quality and could represent an alternative for use in patients who are unable to meet the demands of multiple BHs and long examination times.© RSNA, 2019.
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Affiliation(s)
- Christoph Treutlein
- University of Erlangen, Radiological Institute, Maximiliansplatz 3, 91054 Erlangen, Germany (C.T., M.W., M.S.M., R.H., M.U., W.W.); Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany (T.H.); and Institute of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.H.)
| | - Marco Wiesmüller
- University of Erlangen, Radiological Institute, Maximiliansplatz 3, 91054 Erlangen, Germany (C.T., M.W., M.S.M., R.H., M.U., W.W.); Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany (T.H.); and Institute of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.H.)
| | - Matthias S May
- University of Erlangen, Radiological Institute, Maximiliansplatz 3, 91054 Erlangen, Germany (C.T., M.W., M.S.M., R.H., M.U., W.W.); Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany (T.H.); and Institute of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.H.)
| | - Rafael Heiss
- University of Erlangen, Radiological Institute, Maximiliansplatz 3, 91054 Erlangen, Germany (C.T., M.W., M.S.M., R.H., M.U., W.W.); Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany (T.H.); and Institute of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.H.)
| | - Tobias Hepp
- University of Erlangen, Radiological Institute, Maximiliansplatz 3, 91054 Erlangen, Germany (C.T., M.W., M.S.M., R.H., M.U., W.W.); Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany (T.H.); and Institute of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.H.)
| | - Michael Uder
- University of Erlangen, Radiological Institute, Maximiliansplatz 3, 91054 Erlangen, Germany (C.T., M.W., M.S.M., R.H., M.U., W.W.); Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany (T.H.); and Institute of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.H.)
| | - Wolfgang Wuest
- University of Erlangen, Radiological Institute, Maximiliansplatz 3, 91054 Erlangen, Germany (C.T., M.W., M.S.M., R.H., M.U., W.W.); Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany (T.H.); and Institute of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany (T.H.)
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Schelbert EB, Fridman Y, Wong TC, Abu Daya H, Piehler KM, Kadakkal A, Miller CA, Ugander M, Maanja M, Kellman P, Shah DJ, Abebe KZ, Simon MA, Quarta G, Senni M, Butler J, Diez J, Redfield MM, Gheorghiade M. Temporal Relation Between Myocardial Fibrosis and Heart Failure With Preserved Ejection Fraction: Association With Baseline Disease Severity and Subsequent Outcome. JAMA Cardiol 2019; 2:995-1006. [PMID: 28768311 DOI: 10.1001/jamacardio.2017.2511] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Among myriad changes occurring during the evolution of heart failure with preserved ejection fraction (HFpEF), cardiomyocyte-extracellular matrix interactions from excess collagen may affect microvascular, mechanical, and electrical function. Objective To investigate whether myocardial fibrosis (MF) is similarly prevalent both in those with HFpEF and those at risk for HFpEF, similarly associating with disease severity and outcomes. Design, Setting, and Participants Observational cohort study from June 1, 2010, to September 17, 2015, with follow-up until December 14, 2015, at a cardiovascular magnetic resonance (CMR) center serving an integrated health system. Consecutive patients with preserved systolic function referred for CMR were eligible. Cardiovascular magnetic resonance was used to exclude patients with cardiac amyloidosis (n = 19). Exposures Myocardial fibrosis quantified by extracellular volume (ECV) CMR measures. Main Outcome and Measures Baseline BNP; subsequent hospitalization for heart failure or death. Results Of 1174 patients identified (537 [46%] female; median [interquartile range {IQR}] age, 56 [44-66] years), 250 were "at risk" for HFpEF given elevated brain-type natriuretic peptide (BNP) level; 160 had HFpEF by documented clinical diagnosis, and 745 did not have HFpEF. Patients either at risk for HFpEF or with HFpEF demonstrated similarly higher prevalence/extent of MF and worse prognosis compared with patients with no HFpEF. Among those at risk for HFpEF or with HFpEF, the actual diagnosis of HFpEF was not associated with significant differences in MF (median ECV, 28.2%; IQR, 26.2%-30.7% vs 28.3%; IQR, 25.5%-31.4%; P = .60) or prognosis (log-rank 0.8; P = .38). Over a median of 1.9 years, 61 patients at risk for HFpEF or with HFpEF experienced adverse events (19 hospitalization for heart failure, 48 deaths, 6 with both). In those with HFpEF, ECV was associated with baseline log BNP (disease severity surrogate) in multivariable linear regression models, and was associated with outcomes in multivariable Cox regression models (eg, hazard ratio 1.75 per 5% increase in ECV, 95% CI, 1.25-2.45; P = .001 in stepwise model) whether grouped with patients at risk for HFpEF or not. Conclusions and Relevance Among myriad changes occurring during the apparent evolution of HFpEF where elevated BNP is prevalent, MF was similarly prevalent in those with or at risk for HFpEF. Conceivably, MF might precede clinical HFpEF diagnosis. Regardless, MF was associated with disease severity (ie, BNP) and outcomes. Whether cells and secretomes mediating MF represent therapeutic targets in HFpEF warrants further evaluation.
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Affiliation(s)
- Erik B Schelbert
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yaron Fridman
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania
| | - Timothy C Wong
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hussein Abu Daya
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania
| | - Kayla M Piehler
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ajay Kadakkal
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania
| | - Christopher A Miller
- Centre for Imaging Sciences and Biomedical Imaging Institute, University of Manchester, Manchester, England
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Maren Maanja
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Kaleab Z Abebe
- Center for Clinical Trials and Data Coordination, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Marc A Simon
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Giovanni Quarta
- Department of Cardiology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Senni
- Department of Cardiology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Javed Butler
- Cardiology Division, Stony Brook University, Stony Brook, New York
| | - Javier Diez
- Program of Cardiovascular Diseases, Center for Applied Medical Research, Department of Cardiology and Cardiac Surgery, University Clinic, University of Navarra, Pamplona, Spain.,CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | | | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Captur G, Lobascio I, Ye Y, Culotta V, Boubertakh R, Xue H, Kellman P, Moon JC. Motion-corrected free-breathing LGE delivers high quality imaging and reduces scan time by half: an independent validation study. Int J Cardiovasc Imaging 2019; 35:1893-1901. [PMID: 31104178 PMCID: PMC6773664 DOI: 10.1007/s10554-019-01620-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/06/2019] [Indexed: 02/05/2023]
Abstract
Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) sequences have evolved. Free-breathing motion-corrected (MOCO) LGE has potential advantages over breath-held (bh) LGE including minimal user input for the short axis (SAX) stack without breath-holds. It has previously been shown that MOCO-LGE delivers high image quality compared to bh-LGE. We sought to conduct an independent validation study to investigate real-world performance of bh-LGE versus MOCO-LGE in a high-throughput CMR center immediately after the introduction of the MOCO-LGE sequence and with elementary staff induction in its use. Four-hundred consecutive patients, referred for CMR and graded by clinical complexity, underwent CMR on either of two scanners (1.5 T, both Siemens) in a UK tertiary cardiac center. Scar imaging was by bh-LGE or MOCO-LGE (both with phase sensitive inversion recovery). Image quality, scan time, reader confidence and report reproducibility were compared between those scanned by bh-LGE versus MOCO-LGE. Readers had > 3 years CMR experience. Categorical variables were compared by χ2 or Fisher’s exact tests and continuous variables by unpaired Student’s t-test. Inter-rater agreement of LGE reports was by Cohen’s kappa. Image quality (low score = better) was better for MOCO-LGE (median, interquartile range [Q1–Q3]: 0 [0–0] vs. 2 [0–3], P < 0.0001). This persisted when just clinically complex patients were assessed (0 [0–1] vs. 2 [1–4] P < 0.0001). Readers were more confident in their MOCO-LGE rulings (P < 0.001) and reports more reproducible [bh-LGE vs. MOCO-LGE: kappa 0.76, confidence interval (CI) 0.7–0.9 vs. 0.82, CI 0.7–0.9]. MOCO-LGE significantly shortened LGE acquisition times compared to bh-LGE (for left ventricle SAX stack: 03:22 ± 01:14 vs 06:09 ± 01:47 min respectively, P < 0.0001). In a busy clinical service, immediately after its introduction and with elementary staff training, MOCO-LGE is demonstrably faster to bh-LGE, providing better images that are easier to interpret, even in the sickest of patients.
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Affiliation(s)
- Gabriella Captur
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
| | - Ilaria Lobascio
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Yang Ye
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, West Smithfield, London, UK.,Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No. 3 Qingchun East Road, Hangzhou, 310016, Zhejiang, People's Republic of China
| | - Veronica Culotta
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Redha Boubertakh
- Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - James C Moon
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK. .,Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, West Smithfield, London, UK.
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33
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Kellman P. Dark-Blood Late-Enhancement Imaging Improves Detection of Myocardial Infarction. JACC Cardiovasc Imaging 2018; 11:1770-1772. [DOI: 10.1016/j.jcmg.2017.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
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34
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MR Imaging of Patients with Cardiac Implantable Electronic Devices (CIEDs): Implementing a Program and Optimizing CMR. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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35
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Elinoff JM, Agarwal R, Barnett CF, Benza RL, Cuttica MJ, Gharib AM, Gray MP, Hassoun PM, Hemnes AR, Humbert M, Kolb TM, Lahm T, Leopold JA, Mathai SC, McLaughlin VV, Preston IR, Rosenzweig EB, Shlobin OA, Steen VD, Zamanian RT, Solomon MA. Challenges in Pulmonary Hypertension: Controversies in Treating the Tip of the Iceberg. A Joint National Institutes of Health Clinical Center and Pulmonary Hypertension Association Symposium Report. Am J Respir Crit Care Med 2018; 198:166-174. [PMID: 29425462 PMCID: PMC6058980 DOI: 10.1164/rccm.201710-2093pp] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/09/2018] [Indexed: 01/13/2023] Open
Affiliation(s)
| | - Richa Agarwal
- Division of Cardiovascular Disease, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | | | - Raymond L. Benza
- Division of Cardiovascular Disease, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Michael J. Cuttica
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ahmed M. Gharib
- National Institute of Diabetes, Digestive, and Kidney Diseases, and
| | | | - Paul M. Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Anna R. Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marc Humbert
- Service de Pneumologie, Hôpital Bicêtre (Assistance Publique–Hôpitaux de Paris), Institut National de la Santé et de la Recherche Médicale U999, University Paris–Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Todd M. Kolb
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Tim Lahm
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Indiana University, Indianapolis, Indiana
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
| | - Jane A. Leopold
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Vallerie V. McLaughlin
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ioana R. Preston
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Oksana A. Shlobin
- Pulmonary Vascular Disease Program, Inova Fairfax Hospital, Falls Church, Virginia
| | - Virginia D. Steen
- Rheumatology Division, Department of Medicine, Georgetown University, Washington, DC; and
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Bizino MB, Tao Q, Amersfoort J, Siebelink HMJ, van den Bogaard PJ, van der Geest RJ, Lamb HJ. High spatial resolution free-breathing 3D late gadolinium enhancement cardiac magnetic resonance imaging in ischaemic and non-ischaemic cardiomyopathy: quantitative assessment of scar mass and image quality. Eur Radiol 2018; 28:4027-4035. [PMID: 29626239 PMCID: PMC6096581 DOI: 10.1007/s00330-018-5361-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/13/2018] [Accepted: 01/30/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare breath-hold (BH) with navigated free-breathing (FB) 3D late gadolinium enhancement cardiac MRI (LGE-CMR) MATERIALS AND METHODS: Fifty-one patients were retrospectively included (34 ischaemic cardiomyopathy, 14 non-ischaemic cardiomyopathy, three discarded). BH and FB 3D phase sensitive inversion recovery sequences were performed at 3T. FB datasets were reformatted into normal resolution (FB-NR, 1.46x1.46x10mm) and high resolution (FB-HR, isotropic 0.91-mm voxels). Scar mass, scar edge sharpness (SES), SNR and CNR were compared using paired-samples t-test, Pearson correlation and Bland-Altman analysis. RESULTS Scar mass was similar in BH and FB-NR (mean ± SD: 15.5±18.0 g vs. 15.5±16.9 g, p=0.997), with good correlation (r=0.953), and no bias (mean difference ± SD: 0.00±5.47 g). FB-NR significantly overestimated scar mass compared with FB-HR (15.5±16.9 g vs 14.4±15.6 g; p=0.007). FB-NR and FB-HR correlated well (r=0.988), but Bland-Altman demonstrated systematic bias (1.15±2.84 g). SES was similar in BH and FB-NR (p=0.947), but significantly higher in FB-HR than FB-NR (p<0.01). SNR and CNR were lower in BH than FB-NR (p<0.01), and lower in FB-HR than FB-NR (p<0.01). CONCLUSION Navigated free-breathing 3D LGE-CMR allows reliable scar mass quantification comparable to breath-hold. During free-breathing, spatial resolution can be increased resulting in improved sharpness and reduced scar mass. KEY POINTS • Navigated free-breathing 3D late gadolinium enhancement is reliable for myocardial scar quantification. • High-resolution 3D late gadolinium enhancement increases scar sharpness • Ischaemic and non-ischaemic cardiomyopathy patients can be imaged using free-breathing LGE CMR.
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Affiliation(s)
- Maurice B Bizino
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Qian Tao
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Jacob Amersfoort
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Hans-Marc J Siebelink
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Pieter J van den Bogaard
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Fan H, Li S, Lu M, Yin G, Yang X, Lan T, Dai L, Chen X, Li J, Zhang Y, Sirajuddin A, Kellman P, Arai AE, Zhao S. Myocardial late gadolinium enhancement: a head-to-head comparison of motion-corrected balanced steady-state free precession with segmented turbo fast low angle shot. Clin Radiol 2018; 73:593.e1-593.e9. [PMID: 29548551 DOI: 10.1016/j.crad.2018.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 02/08/2018] [Indexed: 02/08/2023]
Abstract
AIM To evaluate the image quality and diagnostic agreement with a head-to-head comparison of late gadolinium enhancement (LGE) images acquired by the motion-corrected (MOCO) balanced steady-state free precession (bSSFP) phase sensitivity inversion recovery (PSIR) and conventional segmented fast low angle shot (FLASH) PSIR methods15,16 in a patient cohort with a wide spectrum of cardiovascular disease. MATERIALS AND METHODS In 59 consecutive patients, signal-to-noise ratios (SNRs), contrast-to-noise ratios (CNRs) of the normal myocardium (NM), LGE, and blood pool (BP) were pair-wise compared between the two different sequences. A further semi-qualitative score system (graded 1 -4) was used to compare the overall image quality (OIQ). The diagnostic agreement of the two techniques were evaluated by both transmural severity and absolutely quantitative size of LGE. RESULTS The SNRs of the NM, LGE, and BP of MOCO bSSFP were 4.8±3.4, 53.6±35.6 and 43.2±29.3, compared with 3.9±3.6 (p=0.126), 27.7±18.5 (p<0.001) and 24.3±13.4 (p<0.001) of FLASH LGE, respectively. The CNRs of LGE to NM, LGE to BP, and BP to NM were 48.3±33.1 versus 23.8±16.7 (p<0.001), 6.5±21.6 versus 3.8±10.8 (p<0.001), and 38.3±27.2 versus 20.3±10.7 (p=0.448), respectively. The OIQ of MOCO bSSFP was higher than that of segmented FLASH (median 4 versus median 3, p<0.001). For quantification of LGE size, there is good agreement and high correlation (r=0.992, p<0.001) between the two methods. CONCLUSIONS MOCO bSSFP is a feasible, robust sequence for LGE imaging, especially for patients with arrhythmia and those incapable of breath-holding due to severe heart failure.
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Affiliation(s)
- H Fan
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, Air Force General Hospital, People's Liberation Army, Beijing, China
| | - S Li
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - M Lu
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA.
| | - G Yin
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - X Yang
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - T Lan
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - L Dai
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - X Chen
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - J Li
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Y Zhang
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - A Sirajuddin
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - P Kellman
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, USA
| | - A E Arai
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - S Zhao
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Francis R, Kellman P, Kotecha T, Baggiano A, Norrington K, Martinez-Naharro A, Nordin S, Knight DS, Rakhit RD, Lockie T, Hawkins PN, Moon JC, Hausenloy DJ, Xue H, Hansen MS, Fontana M. Prospective comparison of novel dark blood late gadolinium enhancement with conventional bright blood imaging for the detection of scar. J Cardiovasc Magn Reson 2017; 19:91. [PMID: 29162123 PMCID: PMC5696884 DOI: 10.1186/s12968-017-0407-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/09/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Conventional bright blood late gadolinium enhancement (bright blood LGE) imaging is a routine cardiovascular magnetic resonance (CMR) technique offering excellent contrast between areas of LGE and normal myocardium. However, contrast between LGE and blood is frequently poor. Dark blood LGE (DB LGE) employs an inversion recovery T2 preparation to suppress the blood pool, thereby increasing the contrast between the endocardium and blood. The objective of this study is to compare the diagnostic utility of a novel DB phase sensitive inversion recovery (PSIR) LGE CMR sequence to standard bright blood PSIR LGE. METHODS One hundred seventy-two patients referred for clinical CMR were scanned. A full left ventricle short axis stack was performed using both techniques, varying which was performed first in a 1:1 ratio. Two experienced observers analyzed all bright blood LGE and DB LGE stacks, which were randomized and anonymized. A scoring system was devised to quantify the presence and extent of gadolinium enhancement and the confidence with which the diagnosis could be made. RESULTS A total of 2752 LV segments were analyzed. There was very good inter-observer correlation for quantifying LGE. DB LGE analysis found 41.5% more segments that exhibited hyperenhancement in comparison to bright blood LGE (248/2752 segments (9.0%) positive for LGE with bright blood; 351/2752 segments (12.8%) positive for LGE with DB; p < 0.05). DB LGE also allowed observers to be more confident when diagnosing LGE (bright blood LGE high confidence in 154/248 regions (62.1%); DB LGE in 275/324 (84.9%) regions (p < 0.05)). Eighteen patients with no bright blood LGE were found to have had DB LGE, 15 of whom had no known history of myocardial infarction. CONCLUSIONS DB LGE significantly increases LGE detection compared to standard bright blood LGE. It also increases observer confidence, particularly for subendocardial LGE, which may have important clinical implications.
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Affiliation(s)
- Rohin Francis
- Cardiac MRI Unit, Royal Free Hospital, University College London, Rowland Hill Street, London, NW3 2PF UK
- Hatter Cardiovascular Institute, University College London, London, UK
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of health, Bethesda, Maryland USA
| | - Tushar Kotecha
- Cardiac MRI Unit, Royal Free Hospital, University College London, Rowland Hill Street, London, NW3 2PF UK
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
- Department of Cardiology, Royal Free Hospital, London, UK
| | - Andrea Baggiano
- Cardiac MRI Unit, Royal Free Hospital, University College London, Rowland Hill Street, London, NW3 2PF UK
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Karl Norrington
- Cardiac MRI Unit, Royal Free Hospital, University College London, Rowland Hill Street, London, NW3 2PF UK
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Ana Martinez-Naharro
- Cardiac MRI Unit, Royal Free Hospital, University College London, Rowland Hill Street, London, NW3 2PF UK
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Sabrina Nordin
- Cardiac MRI Unit, Royal Free Hospital, University College London, Rowland Hill Street, London, NW3 2PF UK
- Department of Cardiology, Royal Free Hospital, London, UK
| | - Daniel S. Knight
- Cardiac MRI Unit, Royal Free Hospital, University College London, Rowland Hill Street, London, NW3 2PF UK
- Department of Cardiology, Royal Free Hospital, London, UK
| | - Roby D. Rakhit
- Department of Cardiology, Royal Free Hospital, London, UK
| | - Tim Lockie
- Department of Cardiology, Royal Free Hospital, London, UK
| | - Philip N. Hawkins
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - James C. Moon
- Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
| | - Derek J. Hausenloy
- Hatter Cardiovascular Institute, University College London, London, UK
- Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Hui Xue
- National Heart, Lung and Blood Institute, National Institutes of health, Bethesda, Maryland USA
| | - Michael S. Hansen
- National Heart, Lung and Blood Institute, National Institutes of health, Bethesda, Maryland USA
| | - Marianna Fontana
- Cardiac MRI Unit, Royal Free Hospital, University College London, Rowland Hill Street, London, NW3 2PF UK
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
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Feingold B, Salgado CM, Reyes-Múgica M, Drant SE, Miller SA, Kennedy M, Kellman P, Schelbert EB, Wong TC. Diffuse myocardial fibrosis among healthy pediatric heart transplant recipients: Correlation of histology, cardiovascular magnetic resonance, and clinical phenotype. Pediatr Transplant 2017; 21. [PMID: 28574157 DOI: 10.1111/petr.12986] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2017] [Indexed: 02/02/2023]
Abstract
Fibrosis is commonly described in heart allografts lost late after transplantation. CMR-derived ECV is a validated measure of DMF in native adult hearts that may predict heart failure and mortality. We explored associations of ECV with histologic myocardial fibrosis and clinical features after pediatric heart transplantation. Twenty-five recipients (7.0±6.3 years at transplant and 10.7±6.5 years post-transplant) were prospectively recruited for CMR and BNP measurement at the time of surveillance biopsy. All had normal ejection fractions and lacked heart failure symptoms. Fibrosis was quantified on biopsy after picrosirius red staining as CVF. ECV was quantified using contemporaneous hematocrit on basal and mid-short-axis slices. ECV was moderately correlated with CVF (r=.47; P=.019). We found no associations of ECV with hemodynamics, ischemic time, time since transplantation, or number of prior biopsies or acute rejections. Compared to healthy non-transplant controls, there was no significant difference in ECV (25.1±3.0 vs 23.7±2.0%, P=.09). Log-transformed BNP was correlated with ECV (recipients: r=.46, P=.02; recipients and controls: r=.45, P=.006). These findings suggest ECV quantifies DMF and relates to biological indicators of cardiac function after pediatric heart transplantation.
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Affiliation(s)
- Brian Feingold
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cláudia M Salgado
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Miguel Reyes-Múgica
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Stacey E Drant
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Susan A Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mark Kennedy
- Cardiovascular Magnetic Resonance Center, UPMC Heart and Vascular Institute, Pittsburgh, PA, USA
| | - Peter Kellman
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Erik B Schelbert
- Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Cardiovascular Magnetic Resonance Center, UPMC Heart and Vascular Institute, Pittsburgh, PA, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Timothy C Wong
- Cardiovascular Magnetic Resonance Center, UPMC Heart and Vascular Institute, Pittsburgh, PA, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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40
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Bulluck H, Hammond-Haley M, Fontana M, Knight DS, Sirker A, Herrey AS, Manisty C, Kellman P, Moon JC, Hausenloy DJ. Quantification of both the area-at-risk and acute myocardial infarct size in ST-segment elevation myocardial infarction using T1-mapping. J Cardiovasc Magn Reson 2017; 19:57. [PMID: 28764773 PMCID: PMC5539889 DOI: 10.1186/s12968-017-0370-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/04/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A comprehensive cardiovascular magnetic resonance (CMR) in reperfused ST-segment myocardial infarction (STEMI) patients can be challenging to perform and can be time-consuming. We aimed to investigate whether native T1-mapping can accurately delineate the edema-based area-at-risk (AAR) and post-contrast T1-mapping and synthetic late gadolinium (LGE) images can quantify MI size at 1.5 T. Conventional LGE imaging and T2-mapping could then be omitted, thereby shortening the scan duration. METHODS Twenty-eight STEMI patients underwent a CMR scan at 1.5 T, 3 ± 1 days following primary percutaneous coronary intervention. The AAR was quantified using both native T1 and T2-mapping. MI size was quantified using conventional LGE, post-contrast T1-mapping and synthetic magnitude-reconstructed inversion recovery (MagIR) LGE and synthetic phase-sensitive inversion recovery (PSIR) LGE, derived from the post-contrast T1 maps. RESULTS Native T1-mapping performed as well as T2-mapping in delineating the AAR (41.6 ± 11.9% of the left ventricle [% LV] versus 41.7 ± 12.2% LV, P = 0.72; R2 0.97; ICC 0.986 (0.969-0.993); bias -0.1 ± 4.2% LV). There were excellent correlation and inter-method agreement with no bias, between MI size by conventional LGE, synthetic MagIR LGE (bias 0.2 ± 2.2%LV, P = 0.35), synthetic PSIR LGE (bias 0.4 ± 2.2% LV, P = 0.060) and post-contrast T1-mapping (bias 0.3 ± 1.8% LV, P = 0.10). The mean scan duration was 58 ± 4 min. Not performing T2 mapping (6 ± 1 min) and conventional LGE (10 ± 1 min) would shorten the CMR study by 15-20 min. CONCLUSIONS T1-mapping can accurately quantify both the edema-based AAR (using native T1 maps) and acute MI size (using post-contrast T1 maps) in STEMI patients without major cardiovascular risk factors. This approach would shorten the duration of a comprehensive CMR study without significantly compromising on data acquisition and would obviate the need to perform T2 maps and LGE imaging.
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Affiliation(s)
- Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK
| | - Matthew Hammond-Haley
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
| | - Daniel S. Knight
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
| | - Alex Sirker
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Anna S. Herrey
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | | | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, USA
| | - James C. Moon
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Derek J. Hausenloy
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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Paiman EHM, Lamb HJ. When should we use contrast material in cardiac MRI? J Magn Reson Imaging 2017; 46:1551-1572. [PMID: 28480596 DOI: 10.1002/jmri.25754] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/18/2017] [Indexed: 12/29/2022] Open
Abstract
At present, most of the cardiac magnetic resonance imaging (MRI) examinations rely on contrast-enhanced protocols, but noncontrast alternatives are emerging. Late gadolinium enhancement (LGE) imaging for the detection of myocardial scar can be considered the main cause for the embedding of cardiac MRI into the clinical routine. The novel noncontrast technique of native T1 mapping shows promise for tissue characterization in ischemic and nonischemic cardiomyopathy and may provide additional information over conventional LGE imaging. Technical issues, including measurements variability, still need to be resolved to facilitate a wide clinical application. Ischemia detection can be performed with contrast-based stress perfusion and contrast-free stress wall motion imaging. For coronary magnetic resonance angiography (MRA), protocols with and without contrast material have been developed. Research on coronary atherosclerotic plaque characterization has introduced new applications of contrast material. For MRA of the aorta, which traditionally relied on contrast administration, several noncontrast protocols have become available. This review provides an overview of when to use contrast material in cardiac and cardiac-related vascular MRI, summarizes the major imaging building blocks, and describes the diagnostic value of the available contrast-enhanced and noncontrast techniques. Contrast material in cardiac MRI should be used for LGE imaging for tissue characterization in ischemic or nonischemic cardiomyopathy and may be used for stress perfusion imaging for the detection of ischemia. In cardiac-related vascular MRI, use of contrast material should be avoided, unless high-quality angiography is required that cannot be obtained with noncontrast protocols. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1551-1572.
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Affiliation(s)
- Elisabeth H M Paiman
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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42
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Schelbert EB, Elkayam U, Cooper LT, Givertz MM, Alexis JD, Briller J, Felker GM, Chaparro S, Kealey A, Pisarcik J, Fett JD, McNamara DM. Myocardial Damage Detected by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Uncommon in Peripartum Cardiomyopathy. J Am Heart Assoc 2017; 6:JAHA.117.005472. [PMID: 28373243 PMCID: PMC5533034 DOI: 10.1161/jaha.117.005472] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In peripartum cardiomyopathy, the prevalence of focal myocardial damage detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance is important to elucidate mechanisms of myocardial injury and cardiac dysfunction. LGE equates irreversible myocardial injury, but LGE prevalence in peripartum cardiomyopathy is uncertain. METHODS AND RESULTS Among 100 women enrolled within the Investigations of Pregnancy Associated Cardiomyopathy cohort, we recruited 40 women at 13 centers to undergo LGE cardiovascular magnetic resonance, enrolled within the first 13 weeks postpartum. Follow-up scans occurred at 6 months postpartum, and death/transplant rates at 12 months. Baseline characteristics did not differ significantly in the parent cohort according to cardiovascular magnetic resonance enrollment except for mechanical circulatory support. LGE was noted only in 2 women (5%) at baseline. While left ventricular dysfunction with enlargement was prevalent at baseline cardiovascular magnetic resonance scans (eg, ejection fraction 38% [Q1-Q3 31-50%], end diastolic volume index=108 mL/m2 [Q1-Q3 83-134 mL/m2]), most women demonstrated significant improvements at 6 months, consistent with a low prevalence of LGE. LGE was not related to baseline clinical variables, ejection fraction, New York Heart Association heart failure class, or mortality. Neither of the 2 women who died exhibited LGE. LGE was inversely associated with persistent left ventricular ejection fraction at 6 months (P=0.006). CONCLUSIONS Factors other than focal myocardial damage detectable by LGE explain the initial transient depressions in baseline left ventricular ejection fraction, yet focal myocardial damage may contribute to persistent myocardial dysfunction and hinder recovery in a small minority. Most women exhibit favorable changes in ventricular function over 6 months. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01085955.
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Affiliation(s)
| | - Uri Elkayam
- University of Southern California, Los Angeles, CA
| | | | | | - Jeffrey D Alexis
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | | | | | | | | | - James D Fett
- University of Pittsburgh Medical Center, Pittsburgh, PA
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Naoum C, Blanke P, Cavalcante JL, Leipsic J. Cardiac Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Mitral and Tricuspid Valve Disease. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005331. [DOI: 10.1161/circimaging.116.005331] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transcatheter interventions to treat mitral and tricuspid valve disease are becoming increasingly available because of the growing number of elderly patients with significant comorbidities or high operative risk. Thorough clinical and imaging evaluation in these patients is essential. The latter involves both characterization of the mechanism and severity of valvular disease as well as determining the hemodynamic consequences and extent of ventricular remodeling, which is an important predictor of future outcomes. Moreover, an assessment of the suitability and risk of complications associated with device-specific therapies is also an important component of the preprocedural evaluation in this cohort. Although echocardiography including 2-dimensional and 3-dimensional methods has an important role in the initial assessment and procedural guidance, cross-sectional imaging, including both computed tomographic imagning and cardiac magnetic resonance imaging, is increasingly being integrated into the evaluation of mitral and tricuspid valve disease. In this review, we discuss the role of cross-sectional imaging in mitral and tricuspid valve disease, primarily valvular regurgitation assessment, with an emphasis on the preprocedural evaluation and implications for transcatheter interventions.
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Affiliation(s)
- Christopher Naoum
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Philipp Blanke
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - João L. Cavalcante
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Jonathon Leipsic
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
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Maanja M, Wieslander B, Schlegel TT, Bacharova L, Abu Daya H, Fridman Y, Wong TC, Schelbert EB, Ugander M. Diffuse Myocardial Fibrosis Reduces Electrocardiographic Voltage Measures of Left Ventricular Hypertrophy Independent of Left Ventricular Mass. J Am Heart Assoc 2017; 6:JAHA.116.003795. [PMID: 28111363 PMCID: PMC5523623 DOI: 10.1161/jaha.116.003795] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Myocardial fibrosis quantified by myocardial extracellular volume fraction (ECV) and left ventricular mass (LVM) index (LVMI) measured by cardiovascular magnetic resonance might represent independent and opposing contributors to ECG voltage measures of left ventricular hypertrophy (LVH). Diffuse myocardial fibrosis can occur in LVH and interfere with ECG voltage measures. This phenomenon could explain the decreased sensitivity of LVH detectable by ECG, a fundamental diagnostic tool in cardiology. Methods and Results We identified 77 patients (median age, 53 [interquartile range, 26–60] years; 49% female) referred for contrast‐enhanced cardiovascular magnetic resonance with ECV measures and 12‐lead ECG. Exclusion criteria included clinical confounders that might influence ECG measures of LVH. We evaluated ECG voltage‐based LVH measures, including Sokolow‐Lyon index, Cornell voltage, 12‐lead voltage, and the vectorcardiogram spatial QRS voltage, with respect to LVMI and ECV. ECV and LVMI were not correlated (R2=0.02; P=0.25). For all voltage‐related parameters, higher LVMI resulted in greater voltage (r=0.33–0.49; P<0.05 for all), whereas increased ECV resulted in lower voltage (r=−0.32 to −0.57; P<0.05 for all). When accounting for body fat, LV end‐diastolic volume, and mass‐to‐volume ratio, both LVMI (β=0.58, P=0.03) and ECV (β=−0.46, P<0.001) were independent predictors of QRS voltage (multivariate adjusted R2=0.39; P<0.001). Conclusions Myocardial mass and diffuse myocardial fibrosis have independent and opposing effects upon ECG voltage measures of LVH. Diffuse myocardial fibrosis quantified by ECV can obscure the ECG manifestations of increased LVM. This provides mechanistic insight, which can explain the limited sensitivity of the ECG for detecting increased LVM.
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Affiliation(s)
- Maren Maanja
- Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Björn Wieslander
- Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Todd T Schlegel
- Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.,Nicollier-Schlegel SARL, Trélex, Switzerland
| | - Ljuba Bacharova
- International Laser Center, Bratislava, Slovak Republic.,Institute of Pathophysiology, Medical School, Comenius University, Bratislava, Slovak Republic
| | - Hussein Abu Daya
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Yaron Fridman
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Timothy C Wong
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Erik B Schelbert
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
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45
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Bulluck H, Rosmini S, Abdel-Gadir A, Bhuva AN, Treibel TA, Fontana M, Weinmann S, Sirker A, Herrey AS, Manisty C, Moon JC, Hausenloy DJ. Impact of microvascular obstruction on semiautomated techniques for quantifying acute and chronic myocardial infarction by cardiovascular magnetic resonance. Open Heart 2016; 3:e000535. [PMID: 28008358 PMCID: PMC5174824 DOI: 10.1136/openhrt-2016-000535] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/27/2016] [Accepted: 11/17/2016] [Indexed: 02/06/2023] Open
Abstract
Aims The four most promising semiautomated techniques (5-SD, 6-SD, Otsu and the full width half maximum (FWHM)) were compared in paired acute and follow-up cardiovascular magnetic resonance (CMR), taking into account the impact of microvascular obstruction (MVO) and using automated extracellular volume fraction (ECV) maps for reference. Furthermore, their performances on the acute scan were compared against manual myocardial infarct (MI) size to predict adverse left ventricular (LV) remodelling (≥20% increase in end-diastolic volume). Methods 40 patients with reperfused ST segment elevation myocardial infarction (STEMI) with a paired acute (4±2 days) and follow-up CMR scan (5±2 months) were recruited prospectively. All CMR analysis was performed on CVI42. Results Using manual MI size as the reference standard, 6-SD accurately quantified acute (24.9±14.0%LV, p=0.81, no bias) and chronic MI size (17.2±9.7%LV, p=0.88, no bias). The performance of FWHM for acute MI size was affected by the acquisition sequence used. Furthermore, FWHM underestimated chronic MI size in those with previous MVO due to the significantly higher ECV in the MI core on the follow-up scans previously occupied by MVO (82 (75–88)% vs 62 (51–68)%, p<0.001). 5-SD and Otsu were precise but overestimated acute and chronic MI size. All techniques were performed with high diagnostic accuracy and equally well to predict adverse LV remodelling. Conclusions 6-SD was the most accurate for acute and chronic MI size and should be the preferred semiautomatic technique in randomised controlled trials. However, 5-SD, FWHM and Otsu could also be used when precise MI size quantification may be adequate (eg, observational studies).
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Affiliation(s)
- Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK; The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | | | | | - Anish N Bhuva
- Barts Heart Centre, St Bartholomew's Hospital , London , UK
| | | | - Marianna Fontana
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK; National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
| | - Shane Weinmann
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London , London , UK
| | - Alex Sirker
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK; Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Anna S Herrey
- Barts Heart Centre, St Bartholomew's Hospital , London , UK
| | - Charlotte Manisty
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK; Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - James C Moon
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK; Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK; The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
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46
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Kellman P, Xue H, Olivieri LJ, Cross RR, Grant EK, Fontana M, Ugander M, Moon JC, Hansen MS. Dark blood late enhancement imaging. J Cardiovasc Magn Reson 2016; 18:77. [PMID: 27817748 PMCID: PMC5098284 DOI: 10.1186/s12968-016-0297-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/18/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Bright blood late gadolinium enhancement (LGE) imaging typically achieves excellent contrast between infarcted and normal myocardium. However, the contrast between the myocardial infarction (MI) and the blood pool is frequently suboptimal. A large fraction of infarctions caused by coronary artery disease are sub-endocardial and thus adjacent to the blood pool. It is not infrequent that sub-endocardial MIs are difficult to detect or clearly delineate. METHODS In this present work, an inversion recovery (IR) T2 preparation was combined with single shot steady state free precession imaging and respiratory motion corrected averaging to achieve dark blood LGE images with good signal to noise ratio while maintaining the desired spatial and temporal resolution. In this manner, imaging was conducted free-breathing, which has benefits for image quality, patient comfort, and clinical workflow in both adults and children. Furthermore, by using a phase sensitive inversion recovery reconstruction the blood signal may be made darker than the myocardium (i.e., negative signal values) thereby providing contrast between the blood and both the MI and remote myocardium. In the proposed approach, a single T1-map scout was used to measure the myocardial and blood T1 using a MOdified Look-Locker Inversion recovery (MOLLI) protocol and all protocol parameters were automatically calculated from these values within the sequence thereby simplifying the user interface. RESULTS The contrast to noise ratio (CNR) between MI and remote myocardium was measured in n = 30 subjects with subendocardial MI using both bright blood and dark blood protocols. The CNR for the dark blood protocol had a 13 % loss compared to the bright blood protocol. The CNR between the MI and blood pool was positive for all dark blood cases, and was negative in 63 % of the bright blood cases. The conspicuity of subendocardial fibrosis and MI was greatly improved by dark blood (DB) PSIR as well as the delineation of the subendocardial border. CONCLUSIONS Free-breathing, dark blood PSIR LGE imaging was demonstrated to improve the visualization of subendocardial MI and fibrosis in cases with low contrast with adjacent blood pool. The proposed method also improves visualization of thin walled fibrous structures such as atrial walls and valves, as well as papillary muscles.
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Affiliation(s)
- Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive MSC-1061, Bethesda, MD 20892 USA
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive MSC-1061, Bethesda, MD 20892 USA
| | - Laura J. Olivieri
- Children’s National Medical Center, 111 Michigan Ave., N.W, Washington, DC 20010 USA
| | - Russell R. Cross
- Children’s National Medical Center, 111 Michigan Ave., N.W, Washington, DC 20010 USA
| | - Elena K. Grant
- Children’s National Medical Center, 111 Michigan Ave., N.W, Washington, DC 20010 USA
| | - Marianna Fontana
- National Amyloidosis Centre, University College London (UCL) Medical School, Royal Free Hospital, London, UK
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - James C. Moon
- Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
| | - Michael S. Hansen
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive MSC-1061, Bethesda, MD 20892 USA
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47
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van de Schoor FR, Aengevaeren VL, Hopman MTE, Oxborough DL, George KP, Thompson PD, Eijsvogels TMH. Myocardial Fibrosis in Athletes. Mayo Clin Proc 2016; 91:1617-1631. [PMID: 27720455 DOI: 10.1016/j.mayocp.2016.07.012] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/15/2016] [Accepted: 07/15/2016] [Indexed: 12/17/2022]
Abstract
Myocardial fibrosis (MF) is a common phenomenon in the late stages of diverse cardiac diseases and is a predictive factor for sudden cardiac death. Myocardial fibrosis detected by magnetic resonance imaging has also been reported in athletes. Regular exercise improves cardiovascular health, but there may be a limit of benefit in the exercise dose-response relationship. Intense exercise training could induce pathologic cardiac remodeling, ultimately leading to MF, but the clinical implications of MF in athletes are unknown. For this comprehensive review, we performed a systematic search of the PubMed and MEDLINE databases up to June 2016. Key Medical Subject Headings terms and keywords pertaining to MF and exercise (training) were included. Articles were included if they represented primary MF data in athletes. We identified 65 athletes with MF from 19 case studies/series and 14 athletic population studies. Myocardial fibrosis in athletes was predominantly identified in the intraventricular septum and where the right ventricle joins the septum. Although the underlying mechanisms are unknown, we summarize the evidence for genetic predisposition, silent myocarditis, pulmonary artery pressure overload, and prolonged exercise-induced repetitive micro-injury as contributors to the development of MF in athletes. We also discuss the clinical implications and potential treatment strategies of MF in athletes.
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Affiliation(s)
- Freek R van de Schoor
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vincent L Aengevaeren
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria T E Hopman
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David L Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Thijs M H Eijsvogels
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK; Division of Cardiology, Hartford Hospital, Hartford, CT.
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48
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Lamacie MM, Thavendiranathan P, Hanneman K, Greiser A, Jolly MP, Ward R, Wintersperger BJ. Quantification of global myocardial function by cine MRI deformable registration-based analysis: Comparison with MR feature tracking and speckle-tracking echocardiography. Eur Radiol 2016; 27:1404-1415. [DOI: 10.1007/s00330-016-4514-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 07/12/2016] [Accepted: 07/19/2016] [Indexed: 12/01/2022]
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49
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Free-breathing motion-corrected late-gadolinium-enhancement imaging improves image quality in children. Pediatr Radiol 2016; 46:983-90. [PMID: 26886912 DOI: 10.1007/s00247-016-3553-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/16/2015] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The value of late-gadolinium-enhancement (LGE) imaging in the diagnosis and management of pediatric and congenital heart disease is clear; however current acquisition techniques are susceptible to error and artifacts when performed in children because of children's higher heart rates, higher prevalence of sinus arrhythmia, and inability to breath-hold. Commonly used techniques in pediatric LGE imaging include breath-held segmented FLASH (segFLASH) and steady-state free precession-based (segSSFP) imaging. More recently, single-shot SSFP techniques with respiratory motion-corrected averaging have emerged. OBJECTIVE This study tested and compared single-shot free-breathing LGE techniques with standard segmented breath-held techniques in children undergoing LGE imaging. MATERIALS AND METHODS Thirty-two consecutive children underwent clinically indicated late-enhancement imaging using intravenous gadobutrol 0.15 mmol/kg. Breath-held segSSFP, breath-held segFLASH, and free-breathing single-shot SSFP LGE sequences were performed in consecutive series in each child. Two blinded reviewers evaluated the quality of the images and rated them on a scale of 1-5 (1 = poor, 5 = superior) based on blood pool-myocardial definition, presence of cardiac motion, presence of respiratory motion artifacts, and image acquisition artifact. We used analysis of variance (ANOVA) to compare groups. RESULTS Patients ranged in age from 9 months to 18 years, with a mean +/- standard deviation (SD) of 13.3 +/- 4.8 years. R-R interval at the time of acquisition ranged 366-1,265 milliseconds (ms) (47-164 beats per minute [bpm]), mean +/- SD of 843+/-231 ms (72+/-21 bpm). Mean +/- SD quality ratings for long-axis imaging for segFLASH, segSSFP and single-shot SSFP were 3.1+/-0.9, 3.4+/-0.9 and 4.0+/-0.9, respectively (P < 0.01 by ANOVA). Mean +/- SD quality ratings for short-axis imaging for segFLASH, segSSFP and single-shot SSFP were 3.4+/-1, 3.8+/-0.9 and 4.3+/-0.7, respectively (P < 0.01 by ANOVA). CONCLUSION Single-shot late-enhancement imaging with motion-corrected averaging is feasible in children, robust at high heart rates and with variable R-R intervals, and can be performed without breath-holding with higher image quality ratings than standard breath-held techniques. Use of free-breathing single-shot motion-corrected technique does not compromise LGE image quality in children who can hold their breath, and it can significantly improve image quality in children who cannot hold their breath or who have significant arrhythmia.
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50
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Pun SC, Plodkowski A, Matasar MJ, Lakhman Y, Halpenny DF, Gupta D, Moskowitz C, Kim J, Steingart R, Weinsaft JW. Pattern and Prognostic Implications of Cardiac Metastases Among Patients With Advanced Systemic Cancer Assessed With Cardiac Magnetic Resonance Imaging. J Am Heart Assoc 2016; 5:e003368. [PMID: 27146445 PMCID: PMC4889201 DOI: 10.1161/jaha.116.003368] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 03/28/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) imaging is well validated for tissue characterization of cardiac masses but has not been applied to study pattern and prognostic implications of cardiac metastases (CMETs) among patients with systemic cancer. METHODS AND RESULTS The population consisted of 60 patients with stage IV cancer (32 patients with CMETs, 28 diagnosis-matched controls) undergoing CMR. CMET was defined as a discrete mass with vascular tissue properties on delayed enhancement CMR. CMET-positive patients and controls had similar clinical characteristics, cardiac geometry, and function (P=NS). Leading cancer types associated with CMET were sarcoma, melanoma, and gastrointestinal. Patients with CMETs had similar distribution of extracardiac metastatic disease compared with controls (organs involved: 3.4±2.0 versus 2.7±1.9, P=0.17). In 94% of patients with CMETs, there were metastases involving ≥1 extracardiac organ (66% lung involvement). CMET location varied (right ventricle 44%, right atrium 19%, left ventricle 28%, left atrium 9%, pericardial 25%); 22% of cases had multichamber involvement. Right-sided chamber involvement was common in hematologic/lymphatic spread (67%); pericardial involvement was common with direct spread (64%). Regarding tissue properties on delayed enhancement CMR, CMETs commonly (59%) demonstrated heterogeneous enhancement (41% diffuse enhancement). Heterogeneous lesions were larger and had increased border irregularity (P<0.05). Survival 6 months post-CMR was numerically lower among patients with CMETs (56% [95% CI 39-74%]) versus stage IV cancer-matched controls (68% [95% CI 50-86%]), although differences between groups were nonsignificant (P=0.42). CONCLUSIONS CMETs vary regarding etiology, location, and tissue properties on CMR, highlighting need for comprehensive surveillance of cardiac involvement regardless of cancer origin. Prognosis remains poor with for patients with CMETs, albeit similar to that for stage IV cancer controls matched for cancer etiology.
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Affiliation(s)
- Shawn C Pun
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew J Matasar
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Darragh F Halpenny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dipti Gupta
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Chaya Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jiwon Kim
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Richard Steingart
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan W Weinsaft
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY Department of Medicine, Weill Cornell Medical College, New York, NY
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