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Borodzicz-Jazdzyk S, Vink CEM, Demirkiran A, Hoek R, de Mooij GW, Hofman MBM, Wilgenhof A, Appelman Y, Benovoy M, Götte MJW. Clinical implementation of a fully automated quantitative perfusion cardiovascular magnetic resonance imaging workflow with a simplified dual-bolus contrast administration scheme. Sci Rep 2024; 14:9665. [PMID: 38671061 PMCID: PMC11053149 DOI: 10.1038/s41598-024-60503-x] [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: 10/02/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
This study clinically implemented a ready-to-use quantitative perfusion (QP) cardiovascular magnetic resonance (QP CMR) workflow, encompassing a simplified dual-bolus gadolinium-based contrast agent (GBCA) administration scheme and fully automated QP image post-processing. Twenty-five patients with suspected obstructive coronary artery disease (CAD) underwent both adenosine stress perfusion CMR and an invasive coronary angiography or coronary computed tomography angiography. The dual-bolus protocol consisted of a pre-bolus (0.0075 mmol/kg GBCA at 0.5 mmol/ml concentration + 20 ml saline) and a main bolus (0.075 mmol/kg GBCA at 0.5 mmol/ml concentration + 20 ml saline) at an infusion rate of 3 ml/s. The arterial input function curves showed excellent quality. Stress MBF ≤ 1.84 ml/g/min accurately detected obstructive CAD (area under the curve 0.79; 95% Confidence Interval: 0.66 to 0.89). Combined visual assessment of color pixel QP maps and conventional perfusion images yielded a diagnostic accuracy of 84%, sensitivity of 70% and specificity of 93%. The proposed easy-to-use dual-bolus QP CMR workflow provides good image quality and holds promise for high accuracy in diagnosis of obstructive CAD. Implementation of this approach has the potential to serve as an alternative to current methods thus increasing the accessibility to offer high-quality QP CMR imaging by a wide range of CMR laboratories.
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Affiliation(s)
- S Borodzicz-Jazdzyk
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097, Warsaw, Poland
| | - C E M Vink
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - A Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - R Hoek
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - G W de Mooij
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - M B M Hofman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - A Wilgenhof
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - Y Appelman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - M Benovoy
- Area19 Medical Inc., Montreal, H2V2X5, Canada
| | - M J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
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Ishida M, Yerly J, Ito H, Takafuji M, Nakamori S, Takase S, Ichiba Y, Komori Y, Dohi K, Piccini D, Bastiaansen JA, Stuber M, Sakuma H. Optimal Protocol for Contrast-enhanced Free-running 5D Whole-heart Coronary MR Angiography at 3T. Magn Reson Med Sci 2024; 23:225-237. [PMID: 36682776 PMCID: PMC11024717 DOI: 10.2463/mrms.tn.2022-0086] [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: 07/14/2022] [Accepted: 11/11/2022] [Indexed: 01/20/2023] Open
Abstract
Free-running 5D whole-heart coronary MR angiography (MRA) is gaining in popularity because it reduces scanning complexity by removing the need for specific slice orientations, respiratory gating, or cardiac triggering. At 3T, a gradient echo (GRE) sequence is preferred in combination with contrast injection. However, neither the injection scheme of the gadolinium (Gd) contrast medium, the choice of the RF excitation angle, nor the dedicated image reconstruction parameters have been established for 3T GRE free-running 5D whole-heart coronary MRA. In this study, a Gd injection scheme, RF excitation angles of lipid-insensitive binominal off-resonance RF excitation (LIBRE) pulse for valid fat suppression and continuous data acquisition, and compressed-sensing reconstruction regularization parameters were optimized for contrast-enhanced free-running 5D whole-heart coronary MRA using a GRE sequence at 3T. Using this optimized protocol, contrast-enhanced free-running 5D whole-heart coronary MRA using a GRE sequence is feasible with good image quality at 3T.
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Affiliation(s)
- Masaki Ishida
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Jérôme Yerly
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Haruno Ito
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | | | - Shiro Nakamori
- Department of Cardiology, Mie University Hospital, Tsu, Mie, Japan
| | - Shinichi Takase
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | | | | | - Kaoru Dohi
- Department of Cardiology, Mie University Hospital, Tsu, Mie, Japan
| | - Davide Piccini
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Jessica A.M. Bastiaansen
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Stuber
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
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Guo W, Zhao S, Xu H, He W, Yin L, Yao Z, Xu Z, Jin H, Wu D, Li C, Yang S, Zeng M. Comparison of machine learning-based CT fractional flow reserve with cardiac MR perfusion mapping for ischemia diagnosis in stable coronary artery disease. Eur Radiol 2024:10.1007/s00330-024-10650-6. [PMID: 38409549 DOI: 10.1007/s00330-024-10650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/16/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVES To compare the diagnostic performance of machine learning (ML)-based computed tomography-derived fractional flow reserve (CT-FFR) and cardiac magnetic resonance (MR) perfusion mapping for functional assessment of coronary stenosis. METHODS Between October 2020 and March 2022, consecutive participants with stable coronary artery disease (CAD) were prospectively enrolled and underwent coronary CTA, cardiac MR, and invasive fractional flow reserve (FFR) within 2 weeks. Cardiac MR perfusion analysis was quantified by stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR). Hemodynamically significant stenosis was defined as FFR ≤ 0.8 or > 90% stenosis on invasive coronary angiography (ICA). The diagnostic performance of CT-FFR, MBF, and MPR was compared, using invasive FFR as a reference. RESULTS The study protocol was completed in 110 participants (mean age, 62 years ± 8; 73 men), and hemodynamically significant stenosis was detected in 36 (33%). Among the quantitative perfusion indices, MPR had the largest area under receiver operating characteristic curve (AUC) (0.90) for identifying hemodynamically significant stenosis, which is in comparison with ML-based CT-FFR on the vessel level (AUC 0.89, p = 0.71), with comparable sensitivity (89% vs 79%, p = 0.20), specificity (87% vs 84%, p = 0.48), and accuracy (88% vs 83%, p = 0.24). However, MPR outperformed ML-based CT-FFR on the patient level (AUC 0.96 vs 0.86, p = 0.03), with improved specificity (95% vs 82%, p = 0.01) and accuracy (95% vs 81%, p < 0.01). CONCLUSION ML-based CT-FFR and quantitative cardiac MR showed comparable diagnostic performance in detecting vessel-specific hemodynamically significant stenosis, whereas quantitative perfusion mapping had a favorable performance in per-patient analysis. CLINICAL RELEVANCE STATEMENT ML-based CT-FFR and MPR derived from cardiac MR performed well in diagnosing vessel-specific hemodynamically significant stenosis, both of which showed no statistical discrepancy with each other. KEY POINTS • Both machine learning (ML)-based computed tomography-derived fractional flow reserve (CT-FFR) and quantitative perfusion cardiac MR performed well in the detection of hemodynamically significant stenosis. • Compared with stress myocardial blood flow (MBF) from quantitative perfusion cardiac MR, myocardial perfusion reserve (MPR) provided higher diagnostic performance for detecting hemodynamically significant coronary artery stenosis. • ML-based CT-FFR and MPR from quantitative cardiac MR perfusion yielded similar diagnostic performance in assessing vessel-specific hemodynamically significant stenosis, whereas MPR had a favorable performance in per-patient analysis.
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Affiliation(s)
- Weifeng Guo
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, Shanghai Geriatric Medical Center, 2560 Chunshen Road, Minhang District, Shanghai, 201104, China
| | - Shihai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, Shanghai Geriatric Medical Center, 2560 Chunshen Road, Minhang District, Shanghai, 201104, China
| | - Haijia Xu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China
| | - Wei He
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Lekang Yin
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, Shanghai Geriatric Medical Center, 2560 Chunshen Road, Minhang District, Shanghai, 201104, China
| | - Zhifeng Yao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zhihan Xu
- Siemens Healthineers China, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, Shanghai Geriatric Medical Center, 2560 Chunshen Road, Minhang District, Shanghai, 201104, China
| | - Dong Wu
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, Shanghai Geriatric Medical Center, 2560 Chunshen Road, Minhang District, Shanghai, 201104, China
| | - Chenguang Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Shan Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
- Department of Radiology, Shanghai Geriatric Medical Center, 2560 Chunshen Road, Minhang District, Shanghai, 201104, China.
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Jiang L, Yan WF, Zhang L, Xu HY, Guo YK, Li ZL, Liu KL, Zeng LM, Li Y, Yang ZG. Early left ventricular microvascular dysfunction in diabetic pigs: a longitudinal quantitative myocardial perfusion CMR study. Cardiovasc Diabetol 2024; 23:9. [PMID: 38184602 PMCID: PMC10771679 DOI: 10.1186/s12933-023-02106-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/27/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Microvascular pathology is one of the main characteristics of diabetic cardiomyopathy; however, the early longitudinal course of diabetic microvascular dysfunction remains uncertain. This study aimed to investigate the early dynamic changes in left ventricular (LV) microvascular function in diabetic pig model using the cardiac magnetic resonance (CMR)-derived quantitative perfusion technique. METHODS Twelve pigs with streptozotocin-induced diabetes mellitus (DM) were included in this study, and longitudinal CMR scanning was performed before and 2, 6, 10, and 16 months after diabetic modeling. CMR-derived semiquantitative parameters (upslope, maximal signal intensity, perfusion index, and myocardial perfusion reserve index [MPRI]) and fully quantitative perfusion parameters (myocardial blood flow [MBF] and myocardial perfusion reserve [MPR]) were analyzed to evaluate longitudinal changes in LV myocardial microvascular function. Pearson correlation was used to analyze the relationship between LV structure and function and myocardial perfusion function. RESULTS With the progression of DM duration, the upslope at rest showed a gradually increasing trend (P = 0.029); however, the upslope at stress and MBF did not change significantly (P > 0.05). Regarding perfusion reserve function, both MPRI and MPR showed a decreasing trend with the progression of disease duration (MPRI, P = 0.001; MPR, P = 0.042), with high consistency (r = 0.551, P < 0.001). Furthermore, LV MPR is moderately associated with LV longitudinal strain (r = - 0.353, P = 0.022), LV remodeling index (r = - 0.312, P = 0.033), fasting blood glucose (r = - 0.313, P = 0.043), and HbA1c (r = - 0.309, P = 0.046). Microscopically, pathological results showed that collagen volume fraction increased gradually, whereas no significant decrease in microvascular density was observed with the progression of DM duration. CONCLUSIONS Myocardial microvascular reserve function decreased gradually in the early stage of DM, which is related to both structural (but not reduced microvascular density) and functional abnormalities of microvessels, and is associated with increased blood glucose, reduced LV deformation, and myocardial remodeling.
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Affiliation(s)
- Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Lu Zhang
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Zhen-Lin Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ke-Ling Liu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ling-Ming Zeng
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
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Xu J, Zhuang B, Cui C, Yang W, He J, Wang X, Duan X, Zhou D, Wang Y, Zhu L, Sirajuddin A, Zhao S, Lu M. Adenosine Triphosphate Stress Myocardial Strain in Ischemic Heart Disease: An Animal Study with Histological Validation. Acad Radiol 2024; 31:221-232. [PMID: 37330355 DOI: 10.1016/j.acra.2023.05.020] [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: 04/12/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/19/2023]
Abstract
RATIONALE AND OBJECTIVES It is still challenging for cardiac magnetic resonance (CMR) to detect ischemic heart disease (IHD) without the use of gadolinium contrast. We aimed to evaluate the potential value of adenosine triphosphate (ATP) stress myocardial strain derived from feature tracking (FT) as a novel method for detecting IHD in a swine model. MATERIALS AND METHODS CMR cines, myocardial perfusion imaging at rest and during ATP stress, and late gadolinium enhancement were obtained in both control and IHD swine. Normal, remote, ischemic, and infarcted myocardium were analyzed. The diagnostic accuracy of myocardial strain for infarction and ischemia was assessed using coronary angiography and pathology as reference. RESULTS Eleven IHD swine and five healthy control swine were enrolled in this study. Strain parameters, even at rest, were associated with myocardial ischemia and infarction(all p < 0.05). The area under receiver operating characteristic curve (AUC) values of all strain parameters for detecting infarcted myocardium exceeded 0.900 (all p < 0.05). The AUC values for detecting ischemic myocardium were as follows: 0.906 and 0.847 for stress and rest radial strain, 0.763 and 0.716 for stress and rest circumferential strain, 0.758 and 0.663 for stress and rest longitudinal strain (all p < 0.001). Heat maps demonstrated that all strain parameters showed mild to moderate correlations with the stress myocardial blood flow and myocardial perfusion reserve (all p < 0.05). CONCLUSION CMR-FT-derived ATP stress myocardial strain shows promise as a noninvasive method for detecting myocardial ischemia and infarction in an IHD swine model, with rest strain parameters offering potential as a needle-free diagnostic option.
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Affiliation(s)
- Jing Xu
- Department of Magnetic Resonance Imaging, 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.X., B.Z., C.C., W.Y., J.H., D.Z., Y.W., L.Z., S.Z., M.L.)
| | - Baiyan Zhuang
- Department of Magnetic Resonance Imaging, 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.X., B.Z., C.C., W.Y., J.H., D.Z., Y.W., L.Z., S.Z., M.L.)
| | - Chen Cui
- Department of Magnetic Resonance Imaging, 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.X., B.Z., C.C., W.Y., J.H., D.Z., Y.W., L.Z., S.Z., M.L.)
| | - Wenjing Yang
- Department of Magnetic Resonance Imaging, 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.X., B.Z., C.C., W.Y., J.H., D.Z., Y.W., L.Z., S.Z., M.L.)
| | - Jian He
- Department of Magnetic Resonance Imaging, 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.X., B.Z., C.C., W.Y., J.H., D.Z., Y.W., L.Z., S.Z., M.L.)
| | - Xin Wang
- Department of Animal Experimental 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.W.)
| | - Xuejing Duan
- Department of Pathology, 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.D.)
| | - Di Zhou
- Department of Magnetic Resonance Imaging, 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.X., B.Z., C.C., W.Y., J.H., D.Z., Y.W., L.Z., S.Z., M.L.)
| | - Yining Wang
- Department of Magnetic Resonance Imaging, 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.X., B.Z., C.C., W.Y., J.H., D.Z., Y.W., L.Z., S.Z., M.L.)
| | - Leyi Zhu
- Department of Magnetic Resonance Imaging, 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.X., B.Z., C.C., W.Y., J.H., D.Z., Y.W., L.Z., S.Z., M.L.)
| | - Arlene Sirajuddin
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland (A.S.)
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, 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.X., B.Z., C.C., W.Y., J.H., D.Z., Y.W., L.Z., S.Z., M.L.)
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, 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.X., B.Z., C.C., W.Y., J.H., D.Z., Y.W., L.Z., S.Z., M.L.); Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.).
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6
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Thomas A, O'Connell NS, Douglas E, Hatcher S, Park CJ, Dent S, Ansley K, Klem I, Bansal R, Westbrook K, Hundley WG, Bottinor W, Hackney MH, Richardson KM, Sirkisoon SR, D'Agostino RB, Jordan JH. Cardiovascular impact of near complete estrogen deprivation in premenopausal women with breast cancer: The CROWN study. Am Heart J 2024; 267:33-43. [PMID: 37890547 PMCID: PMC10976295 DOI: 10.1016/j.ahj.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023]
Abstract
Survival with operable breast cancer has improved markedly in recent decades, however, treatment-related cardiovascular toxicities threaten to offset these gains. Ovarian function suppression paired with aromatase inhibition, for premenopausal women with hormone receptor (HR)-positive breast cancer, is a newer widely adopted therapy with the potential for significant long-term cardiovascular toxicity. Abrupt estrogen deprivation for non-cancer reasons is associated with accelerated coronary artery disease. Women with breast cancer treated with aromatase inhibition in addition to ovarian function suppression experience a dual hit with regards to estrogen exposure. The CaRdiac Outcomes With Near-complete estrogen deprivation (CROWN) study seeks to understand the early, subclinical natural history of cardiovascular compromise in young women undergoing near-complete estrogen deprivation (NCED) therapy. It is critical to understand the early subclinical development of cardiovascular disease to identify a window for therapeutic intervention before overt cardiovascular events occur. This three-site regional study (Atrium Health Wake Forest, Duke, and Virginia Commonwealth University) uses serial stress cardiac magnetic resonance (CMR) imaging and cardiac computed tomography angiography (CCTA) obtained during the initial two years of NCED therapy to study myocardial prefusion reserve (MPR), large cardiovascular vessel changes, left ventricular function, and other cardiovascular parameters. The CROWN cohort will consist of 90 premenopausal women with breast cancer, 67 with HR-positive disease receiving NCED and 23 comparators with HR-negative disease. Participants will undergo three annual CMR scans and 2 CCTA scans during the 2-year study period. After initial activation hurdles, accrual has been brisk, and the study is expected to complete accrual in December 2024. Efforts are in place to encourage participant retention with the study primary outcome, change in MPR between the two groups, to be reported in 2026 to 2027. The results of this study will enable premenopausal women with breast cancer to balance the health burdens of cancer at a young age and treatment-related cardiovascular morbidity. Finally, the tools developed here can be utilized to study cardiovascular risk across a range of cancer types and cancer therapies with the ultimate goals of both developing generalizable risk stratification tools as well as validating interventions which prevent overt cardiovascular compromise.
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Affiliation(s)
- Alexandra Thomas
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC; Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | | | - Emily Douglas
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC; Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Sarah Hatcher
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC; Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Carolyn J Park
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, NC
| | - Katherine Ansley
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC; Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC
| | - Rani Bansal
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, NC
| | - Kelly Westbrook
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, NC
| | - W Gregory Hundley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
| | - Wendy Bottinor
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
| | - Mary Helen Hackney
- Division of Hematology, Oncology and Palliative Care, Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA
| | - Karl M Richardson
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Sherona R Sirkisoon
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Ralph B D'Agostino
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Jennifer H Jordan
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA; Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA.
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7
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李 晋, 王 岩, 马 剑, 庞 新, 周 围, 田 存, 杨 国, 赵 娜. [Application of micro-bolus injection and piezoelectric sensors to improve the safety of radiopharmaceuticals bolus injection]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2023; 40:982-988. [PMID: 37879928 PMCID: PMC10600418 DOI: 10.7507/1001-5515.202305017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/28/2023] [Indexed: 10/27/2023]
Abstract
Radiopharmaceutical dynamic imaging typically necessitates intravenous injection via the bolus method. However, manual bolus injection carries the risk of handling errors as well as radiological injuries. Hence, there is potential for automated injection devices to replace manual injection methods. In this study, the effect of micro-bolus pulse injection technology was compared and verified by radioactive experiments using a programmable injection pump, and the overall bubble recognition experiment and rat tail vein simulation injection verification were performed using the piezoelectric sensor preloading method. The results showed that at the same injection peak speed, the effective flushing volume of micro-bolus pulse flushing (about 83 μL/pulse) was 49.65% lower than that of uniform injection and 25.77% lower than that of manual flushing. In order to avoid the dilution effect of long pipe on the volume of liquid, the use of piezoelectric sensor for sealing preloading detection could accurately predict the bubbles of more than 100 μL in the syringe. In the simulated injection experiment of rat tail vein, when the needle was placed in different tissues by preloading 100 μL normal saline, the piezoelectric sensor fed back a large difference in pressure attenuation rate within one second, which was 2.78% in muscle, 17.28% in subcutaneous and 54.71% in vein. Micro-bolus pulse injection method and piezoelectric sensor sealing preloading method have application potential in improving the safety of radiopharmaceutical automatic bolus injection.
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Affiliation(s)
- 晋 李
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
- 中核高能(天津)装备有限公司(天津 300300)CNNC High Energy Equipment (Tianjin) Co., Ltd., Tianjin 300300, P. R. China
| | - 岩 王
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
| | - 剑雄 马
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
| | - 新新 庞
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
| | - 围 周
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
| | - 存贵 田
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
| | - 国辉 杨
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
| | - 娜 赵
- 天津大学天津医院(天津 300211)Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
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8
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Ganigara M, Sharma B, Doctor P, Nagiub M, Dzelebdzic S, Sebastian R, Fares M, Dillenbeck J, Greil G, Hussain T. Tolerability and efficacy of a reduced dose adenosine stress cardiac magnetic resonance protocol under general anesthesia in infants and children. Pediatr Radiol 2023; 53:2188-2196. [PMID: 37563320 DOI: 10.1007/s00247-023-05738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Intravenous adenosine induces pharmacological stress by causing vasodilatation and thus carries the risk of severe hypotension when combined with vasodilatory effects of anesthetic agents. OBJECTIVE This study describes our experience with a reduced dose adenosine cardiac magnetic resonance imaging (MRI) protocol in young children under general anesthesia (GA). MATERIALS AND METHODS This is a retrospective report of all patients from birth to 18 years who underwent adenosine stress cardiac MRI under GA between August 2018 and November 2022. Based on our anecdotal experience of severe adverse effects in patients receiving adenosine infusion under GA and in discussion with the pediatric anesthesia team, we developed a modified protocol starting at a dose of 110 mcg/kg/min with incremental escalation to a full dose of 140 mcg/kg/min to achieve desired hemodynamic effect. RESULTS Twenty-two children (mean age 6.5 years, mean weight 28 kg) satisfied the inclusion criteria. The diagnoses included Kawasaki disease (7), anomalous aortic origin of left coronary artery (3), anomalous aortic origin of right coronary artery (2), coronary fistula (3), repaired d-transposition of great arteries (2), repaired anomalous left coronary artery from pulmonary artery (2), repaired truncus arteriosus with left coronary artery occlusion (1), extracardiac-Fontan with left coronary artery myocardial bridge (1), and post heart transplantation (1). Nine patients needed dose escalation beyond 110 mcg/kg/min. Two patients had transient hypotension during testing (systemic blood pressure drop > 25 mmHg). No patient developed significant heart block or bronchospasm. Six patients (repeat study in one) demonstrated inducible perfusion defects (27%) on stress perfusion sequences-5 of whom had confirmed significant coronary abnormalities on angiography or direct surgical inspection. CONCLUSION A reduced/incremental dose adenosine stress cardiac MRI protocol under GA in children is safe and feasible. This avoids severe hypotension which is both unsafe and may result in inaccurate data.
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Affiliation(s)
- Madhusudan Ganigara
- Division of Pediatric Cardiology, Department of Pediatrics, The University of Chicago & Biological Sciences, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
| | - Bharti Sharma
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pezad Doctor
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mohamed Nagiub
- Division of Pediatric Cardiology, University of Virginia Technology, Roanoke, VA, USA
| | - Sanja Dzelebdzic
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roby Sebastian
- Division of Pediatric Anesthesia, Department of Anesthesia, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Munes Fares
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeanne Dillenbeck
- Division of Pediatric Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gerald Greil
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tarique Hussain
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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9
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Chau OW, El-Sherif O, Mouawad M, Sykes JM, Butler J, Biernaski H, deKemp R, Renaud J, Wisenberg G, Prato FS, Gaede S. Changes in myocardial blood flow in a canine model of left sided breast cancer radiotherapy. PLoS One 2023; 18:e0291854. [PMID: 37768966 PMCID: PMC10538714 DOI: 10.1371/journal.pone.0291854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Left-sided breast cancer patients receiving adjuvant radiotherapy are at risk for coronary artery disease, and/or radiation mediated effects on the microvasculature. Previously our laboratory demonstrated in canines with hybrid 18FDG/PET a progressive global inflammatory response during the initial one year following treatment. In this study, the objective is to evaluate corresponding changes in perfusion, in the same cohort, where resting myocardial blood flow (MBF) was quantitatively measured. METHOD In five canines, Ammonia PET (13NH3) derived MBF was measured at baseline, 1-week, 1, 3, 6 and 12-months after cardiac external beam irradiation. MBF measurements were correlated with concurrent 18FDG uptake. Simultaneously MBF was measured using the dual bolus MRI method. RESULTS MBF was significantly increased at all time points, in comparison to baseline, except at 3-months. This was seen globally throughout the entire myocardium independent of the coronary artery territories. MBF showed a modest significant correlation with 18FDG activity for the entire myocardium (r = 0.51, p = 0.005) including the LAD (r = 0.49, p = 0.008) and LCX (r = 0.47, p = 0.013) coronary artery territories. CONCLUSION In this canine model of radiotherapy for left-sided breast cancer, resting MBF increases as early as 1-week and persists for up to one year except at 3-months. This pattern is similar to that of 18FDG uptake. A possible interpretation is that the increase in resting MBF is a response to myocardial inflammation.
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Affiliation(s)
- Oi-Wai Chau
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Department of Physics and Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Omar El-Sherif
- Mayo Clinic, Rochester, Minnesota, United States of America
| | - Matthew Mouawad
- Department of Physics and Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Jane M. Sykes
- Thames Valley Veterinary Services, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - John Butler
- Lawson Health Research Institute, London, Ontario, Canada
| | | | - Robert deKemp
- National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jennifer Renaud
- Division of Cardiology, London Health Sciences Centre, London, Ontario, Canada
| | - Gerald Wisenberg
- Lawson Health Research Institute, London, Ontario, Canada
- Division of Cardiology, London Health Sciences Centre, London, Ontario, Canada
| | - Frank S. Prato
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Stewart Gaede
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Department of Physics and Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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10
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Lacharie M, Villa A, Milidonis X, Hasaneen H, Chiribiri A, Benedetti G. Role of pulmonary perfusion magnetic resonance imaging for the diagnosis of pulmonary hypertension: A review. World J Radiol 2023; 15:256-273. [PMID: 37823020 PMCID: PMC10563854 DOI: 10.4329/wjr.v15.i9.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/16/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023] Open
Abstract
Among five types of pulmonary hypertension, chronic thromboembolic pulmonary hypertension (CTEPH) is the only curable form, but prompt and accurate diagnosis can be challenging. Computed tomography and nuclear medicine-based techniques are standard imaging modalities to non-invasively diagnose CTEPH, however these are limited by radiation exposure, subjective qualitative bias, and lack of cardiac functional assessment. This review aims to assess the methodology, diagnostic accuracy of pulmonary perfusion imaging in the current literature and discuss its advantages, limitations and future research scope.
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Affiliation(s)
- Miriam Lacharie
- Oxford Centre of Magnetic Resonance Imaging, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Adriana Villa
- Department of Diagnostic and Interventional Radiology, German Oncology Centre, Limassol 4108, Cyprus
| | - Xenios Milidonis
- Deep Camera MRG, CYENS Centre of Excellence, Nicosia, Cyprus, Nicosia 1016, Cyprus
| | - Hadeer Hasaneen
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, Kings Coll London, Div Imaging Sci, St Thomas Hospital, London WC2R 2LS, United Kingdom
| | - Giulia Benedetti
- Department of Cardiovascular Imaging and Biomedical Engineering, King’s College London, London WC2R 2LS, United Kingdom
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11
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Leo I, Nakou E, Artico J, Androulakis E, Wong J, Moon JC, Indolfi C, Bucciarelli-Ducci C. Strengths and weaknesses of alternative noninvasive imaging approaches for microvascular ischemia. J Nucl Cardiol 2023; 30:227-238. [PMID: 35918590 DOI: 10.1007/s12350-022-03066-6] [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: 04/03/2022] [Accepted: 06/19/2022] [Indexed: 11/26/2022]
Abstract
Structural and functional abnormalities of coronary microvasculature are highly prevalent in several clinical settings and often associated with worse clinical outcomes. Therefore, there is a growing interest in the detection and treatment of this, often overlooked, disease. Coronary angiography allows the assessment of the Coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR). However, the measurement of these parameters is not always feasible because of limited technical availability and the need for a cardiac catheterization with a small but real risk of potential complications. Recent advances in non-invasive imaging techniques allow the assessment of coronary microvascular function with good accuracy and reproducibility. The objective of this review is to discuss the strengths and weaknesses of alternative non-invasive approaches used in the diagnosis of coronary microvascular dysfunction (CMD), highlighting the most recent advances for each imaging modality.
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Affiliation(s)
- Isabella Leo
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Eleni Nakou
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
| | - Jessica Artico
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- St Bartholomew's Hospital, Barts Heart Centre, West Smithfield, London, UK
| | - Emmanouil Androulakis
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
| | - Joyce Wong
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- St Bartholomew's Hospital, Barts Heart Centre, West Smithfield, London, UK
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys's and St Thomas' NHS Foundation Trust, London, UK.
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College University, London, UK.
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12
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Scannell CM, Alskaf E, Sharrack N, Razavi R, Ourselin S, Young AA, Plein S, Chiribiri A. AI-AIF: artificial intelligence-based arterial input function for quantitative stress perfusion cardiac magnetic resonance. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:12-21. [PMID: 36743875 PMCID: PMC9890084 DOI: 10.1093/ehjdh/ztac074] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/23/2022] [Indexed: 12/12/2022]
Abstract
Aims One of the major challenges in the quantification of myocardial blood flow (MBF) from stress perfusion cardiac magnetic resonance (CMR) is the estimation of the arterial input function (AIF). This is due to the non-linear relationship between the concentration of gadolinium and the MR signal, which leads to signal saturation. In this work, we show that a deep learning model can be trained to predict the unsaturated AIF from standard images, using the reference dual-sequence acquisition AIFs (DS-AIFs) for training. Methods and results A 1D U-Net was trained, to take the saturated AIF from the standard images as input and predict the unsaturated AIF, using the data from 201 patients from centre 1 and a test set comprised of both an independent cohort of consecutive patients from centre 1 and an external cohort of patients from centre 2 (n = 44). Fully-automated MBF was compared between the DS-AIF and AI-AIF methods using the Mann-Whitney U test and Bland-Altman analysis. There was no statistical difference between the MBF quantified with the DS-AIF [2.77 mL/min/g (1.08)] and predicted with the AI-AIF (2.79 mL/min/g (1.08), P = 0.33. Bland-Altman analysis shows minimal bias between the DS-AIF and AI-AIF methods for quantitative MBF (bias of -0.11 mL/min/g). Additionally, the MBF diagnosis classification of the AI-AIF matched the DS-AIF in 669/704 (95%) of myocardial segments. Conclusion Quantification of stress perfusion CMR is feasible with a single-sequence acquisition and a single contrast injection using an AI-based correction of the AIF.
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Affiliation(s)
- Cian M Scannell
- School of Biomedical Engineering & Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK.,Department of Biomedical Engineering, Eindhoven University of Technology, Gemini-Zuid, Groene Loper 5, 5612 Eindhoven, The Netherlands
| | - Ebraham Alskaf
- School of Biomedical Engineering & Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Noor Sharrack
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Reza Razavi
- School of Biomedical Engineering & Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Alistair A Young
- School of Biomedical Engineering & Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Sven Plein
- School of Biomedical Engineering & Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK.,Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
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13
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Lim RP, Kachel S, Villa ADM, Kearney L, Bettencourt N, Young AA, Chiribiri A, Scannell CM. CardiSort: a convolutional neural network for cross vendor automated sorting of cardiac MR images. Eur Radiol 2022; 32:5907-5920. [PMID: 35368227 PMCID: PMC9381634 DOI: 10.1007/s00330-022-08724-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 01/22/2022] [Accepted: 03/05/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To develop an image-based automatic deep learning method to classify cardiac MR images by sequence type and imaging plane for improved clinical post-processing efficiency. METHODS Multivendor cardiac MRI studies were retrospectively collected from 4 centres and 3 vendors. A two-head convolutional neural network ('CardiSort') was trained to classify 35 sequences by imaging sequence (n = 17) and plane (n = 10). Single vendor training (SVT) on single-centre images (n = 234 patients) and multivendor training (MVT) with multicentre images (n = 434 patients, 3 centres) were performed. Model accuracy and F1 scores on a hold-out test set were calculated, with ground truth labels by an expert radiologist. External validation of MVT (MVTexternal) was performed on data from 3 previously unseen magnet systems from 2 vendors (n = 80 patients). RESULTS Model sequence/plane/overall accuracy and F1-scores were 85.2%/93.2%/81.8% and 0.82 for SVT and 96.1%/97.9%/94.3% and 0.94 MVT on the hold-out test set. MVTexternal yielded sequence/plane/combined accuracy and F1-scores of 92.7%/93.0%/86.6% and 0.86. There was high accuracy for common sequences and conventional cardiac planes. Poor accuracy was observed for underrepresented classes and sequences where there was greater variability in acquisition parameters across centres, such as perfusion imaging. CONCLUSIONS A deep learning network was developed on multivendor data to classify MRI studies into component sequences and planes, with external validation. With refinement, it has potential to improve workflow by enabling automated sequence selection, an important first step in completely automated post-processing pipelines. KEY POINTS • Deep learning can be applied for consistent and efficient classification of cardiac MR image types. • A multicentre, multivendor study using a deep learning algorithm (CardiSort) showed high classification accuracy on a hold-out test set with good generalisation to images from previously unseen magnet systems. • CardiSort has potential to improve clinical workflows, as a vital first step in developing fully automated post-processing pipelines.
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Affiliation(s)
- Ruth P Lim
- Austin Health, Melbourne, Australia.
- Departments of Radiology, The University of Melbourne, Melbourne, Australia.
- Department of Surgery (Austin), The University of Melbourne, Melbourne, Australia.
| | - Stefan Kachel
- Austin Health, Melbourne, Australia
- Departments of Radiology, The University of Melbourne, Melbourne, Australia
- Department of Radiology, Columbia University, New York, USA
| | - Adriana D M Villa
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
| | - Leighton Kearney
- Austin Health, Melbourne, Australia
- I-MED Radiology, Melbourne, Australia
| | | | - Alistair A Young
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
| | - Cian M Scannell
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
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14
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van Herten RLM, Chiribiri A, Breeuwer M, Veta M, Scannell CM. Physics-informed neural networks for myocardial perfusion MRI quantification. Med Image Anal 2022; 78:102399. [PMID: 35299005 PMCID: PMC9051528 DOI: 10.1016/j.media.2022.102399] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/07/2022] [Accepted: 02/18/2022] [Indexed: 11/19/2022]
Abstract
Tracer-kinetic models allow for the quantification of kinetic parameters such as blood flow from dynamic contrast-enhanced magnetic resonance (MR) images. Fitting the observed data with multi-compartment exchange models is desirable, as they are physiologically plausible and resolve directly for blood flow and microvascular function. However, the reliability of model fitting is limited by the low signal-to-noise ratio, temporal resolution, and acquisition length. This may result in inaccurate parameter estimates. This study introduces physics-informed neural networks (PINNs) as a means to perform myocardial perfusion MR quantification, which provides a versatile scheme for the inference of kinetic parameters. These neural networks can be trained to fit the observed perfusion MR data while respecting the underlying physical conservation laws described by a multi-compartment exchange model. Here, we provide a framework for the implementation of PINNs in myocardial perfusion MR. The approach is validated both in silico and in vivo. In the in silico study, an overall decrease in mean-squared error with the ground-truth parameters was observed compared to a standard non-linear least squares fitting approach. The in vivo study demonstrates that the method produces parameter values comparable to those previously found in literature, as well as providing parameter maps which match the clinical diagnosis of patients.
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Affiliation(s)
- Rudolf L M van Herten
- Department of Biomedical Engineering, Medical Image Analysis group, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
| | - Marcel Breeuwer
- Department of Biomedical Engineering, Medical Image Analysis group, Eindhoven University of Technology, Eindhoven, the Netherlands; Philips Healthcare, Best, the Netherlands
| | - Mitko Veta
- Department of Biomedical Engineering, Medical Image Analysis group, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Cian M Scannell
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom.
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15
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Opatřil L, Panovsky R, Mojica-Pisciotti M, Máchal J, Krejčí J, Holeček T, Masárová L, Feitová V, Godava J, Kincl V, Kepák T, Závodná G, Špinarová L. Stress pulmonary circulation parameters assessed by a cardiovascular magnetic resonance in patients after a heart transplant. Sci Rep 2022; 12:6130. [PMID: 35414701 PMCID: PMC9005501 DOI: 10.1038/s41598-022-09739-z] [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: 07/08/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Abstract
Rest pulmonary circulation parameters such as pulmonary transit time (PTT), heart rate corrected PTT (PTTc) and pulmonary transit beats (PTB) can be evaluated using several methods, including the first-pass perfusion from cardiovascular magnetic resonance. As previously published, up to 58% of patients after HTx have diastolic dysfunction detectable only in stress conditions. By using adenosine stress perfusion images, stress analogues of the mentioned parameters can be assessed. By dividing stress to rest biomarkers, potential new ratio parameters (PTT ratio and PTTc ratio) can be obtained. The objectives were to (1) provide more evidence about stress pulmonary circulation biomarkers, (2) present stress to rest ratio parameters, and (3) assess these biomarkers in patients with presumed diastolic dysfunction after heart transplant (HTx) and in childhood cancer survivors (CCS) without any signs of diastolic dysfunction. In this retrospective study, 48 patients after HTx, divided into subgroups based on echocardiographic signs of diastolic dysfunction (41 without, 7 with) and 39 CCS were enrolled. PTT was defined as the difference between the onset time of the signal intensity increase in the left and the right ventricle. PTT in rest conditions were without significant differences when comparing the CCS and HTx subgroup without diastolic dysfunction (4.96 ± 0.93 s vs. 5.51 ± 1.14 s, p = 0.063) or with diastolic dysfunction (4.96 ± 0.93 s vs. 6.04 ± 1.13 s, p = 0.13). However, in stress conditions, both PTT and PTTc were significantly lower in the CCS group than in the HTx subgroups, (PTT: 3.76 ± 0.78 s vs. 4.82 ± 1.03 s, p < 0.001; 5.52 ± 1.56 s, p = 0.002). PTT ratio and PTTc ratio were below 1 in all groups. In conclusion, stress pulmonary circulation parameters obtained from CMR showed prolonged PTT and PTTc in HTx groups compared to CCS, which corresponds with the presumption of underlying diastolic dysfunction. The ratio parameters were less than 1.
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Affiliation(s)
- Lukáš Opatřil
- First Department of Internal Medicine and Cardioangiology, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic.,International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Panovsky
- First Department of Internal Medicine and Cardioangiology, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic. .,International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic. .,Faculty of Medicine, Masaryk University, Brno, Czech Republic. .,First Department of Internal Medicine and Cardioangiology, International Clinical Research Centre, Faculty of Medicine, Masaryk University, St. Anne's University Hospital, Brno, Czech Republic.
| | - Mary Mojica-Pisciotti
- International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic
| | - Jan Máchal
- International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic.,Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Krejčí
- First Department of Internal Medicine and Cardioangiology, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomáš Holeček
- International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic.,Department of Medical Imaging, St. Anne's University Hospital, Brno, Czech Republic
| | - Lucia Masárová
- First Department of Internal Medicine and Cardioangiology, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic.,International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Věra Feitová
- International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic.,Department of Medical Imaging, St. Anne's University Hospital, Brno, Czech Republic
| | - Július Godava
- First Department of Internal Medicine and Cardioangiology, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic
| | - Vladimír Kincl
- First Department of Internal Medicine and Cardioangiology, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic.,International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomáš Kepák
- International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic.,Department of Paediatric Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Lenka Špinarová
- First Department of Internal Medicine and Cardioangiology, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
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16
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Sakuma H, Ishida M. Advances in Myocardial Perfusion MR Imaging: Physiological Implications, the Importance of Quantitative Analysis, and Impact on Patient Care in Coronary Artery Disease. Magn Reson Med Sci 2022; 21:195-211. [PMID: 34108304 PMCID: PMC9199984 DOI: 10.2463/mrms.rev.2021-0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/27/2021] [Indexed: 11/09/2022] Open
Abstract
Stress myocardial perfusion imaging (MPI) is the preferred test in patients with intermediate-to-high clinical likelihood of coronary artery disease (CAD) and can be used as a gatekeeper to avoid unnecessary revascularization. Cardiac magnetic resonance (CMR) has a number of favorable characteristics, including: (1) high spatial resolution that can delineate subendocardial ischemia; (2) comprehensive assessment of morphology, global and regional cardiac functions, tissue characterization, and coronary artery stenosis; and (3) no radiation exposure to patients. According to meta-analysis studies, the diagnostic accuracy of perfusion CMR is comparable to positron emission tomography (PET) and perfusion CT, and is better than single-photon emission CT (SPECT) when fractional flow reserve (FFR) is used as a reference standard. In addition, stress CMR has an excellent prognostic value. One meta-analysis study demonstrated the annual event rate of cardiovascular death or non-fatal myocardial infarction was 4.9% and 0.8%, respectively, in patients with positive and negative stress CMR. Quantitative assessment of perfusion CMR not only allows the objective evaluation of regional ischemia but also provides insights into the pathophysiology of microvascular disease and diffuse subclinical atherosclerosis. For accurate quantification of myocardial perfusion, saturation correction of arterial input function is important. There are two major approaches for saturation correction, one is a dual-bolus method and the other is a dual-sequence method. Absolute quantitative mapping with myocardial perfusion CMR has good accuracy in detecting coronary microvascular dysfunction. Flow measurement in the coronary sinus (CS) with phase contrast cine CMR is an alternative approach to quantify global coronary flow reserve (CFR). The measurement of global CFR by quantitative analysis of perfusion CMR or flow measurement in the CS permits assessment of microvascular disease and diffuse subclinical atherosclerosis, which may provide improved prediction of future event risk in patients with suspected or known CAD. Multi-institutional studies to validate the diagnostic and prognostic values of quantitative perfusion CMR approaches are required.
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Affiliation(s)
- Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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17
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Franks R, Plein S, Chiribiri A. Clinical Application of Dynamic Contrast Enhanced Perfusion Imaging by Cardiovascular Magnetic Resonance. Front Cardiovasc Med 2021; 8:768563. [PMID: 34778420 PMCID: PMC8585782 DOI: 10.3389/fcvm.2021.768563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022] Open
Abstract
Functionally significant coronary artery disease impairs myocardial blood flow and can be detected non-invasively by myocardial perfusion imaging. While multiple myocardial perfusion imaging modalities exist, the high spatial and temporal resolution of cardiovascular magnetic resonance (CMR), combined with its freedom from ionising radiation make it an attractive option. Dynamic contrast enhanced CMR perfusion imaging has become a well-validated non-invasive tool for the assessment and risk stratification of patients with coronary artery disease and is recommended by international guidelines. This article presents an overview of CMR perfusion imaging and its clinical application, with a focus on chronic coronary syndromes, highlighting its strengths and challenges, and discusses recent advances, including the emerging role of quantitative perfusion analysis.
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Affiliation(s)
- Russell Franks
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sven Plein
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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18
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Scannell CM, Hasaneen H, Greil G, Hussain T, Razavi R, Lee J, Pushparajah K, Duong P, Chiribiri A. Automated Quantitative Stress Perfusion Cardiac Magnetic Resonance in Pediatric Patients. Front Pediatr 2021; 9:699497. [PMID: 34540764 PMCID: PMC8446614 DOI: 10.3389/fped.2021.699497] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Myocardial ischemia occurs in pediatrics, as a result of both congenital and acquired heart diseases, and can lead to further adverse cardiac events if untreated. The aim of this work is to assess the feasibility of fully automated, high resolution, quantitative stress myocardial perfusion cardiac magnetic resonance (CMR) in a cohort of pediatric patients and to evaluate its agreement with the coronary anatomical status of the patients. Methods: Fourteen pediatric patients, with 16 scans, who underwent dual-bolus stress perfusion CMR were retrospectively analyzed. All patients also had anatomical coronary assessment with either CMR, CT, or X-ray angiography. The perfusion CMR images were automatically processed and quantified using an analysis pipeline previously developed in adults. Results: Automated perfusion quantification was successful in 15/16 cases. The coronary perfusion territories supplied by vessels affected by a medium/large aneurysm or stenosis (according to the AHA guidelines), induced by Kawasaki disease, an anomalous origin, or interarterial course had significantly reduced myocardial blood flow (MBF) (median (interquartile range), 1.26 (1.05, 1.67) ml/min/g) as compared to territories supplied by unaffected coronaries [2.57 (2.02, 2.69) ml/min/g, p < 0.001] and territories supplied by vessels with a small aneurysm [2.52 (2.45, 2.83) ml/min/g, p = 0.002]. Conclusion: Automatic CMR-derived MBF quantification is feasible in pediatric patients, and the technology could be potentially used for objective non-invasive assessment of ischemia in children with congenital and acquired heart diseases.
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Affiliation(s)
- Cian M. Scannell
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Hadeer Hasaneen
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Gerald Greil
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Jack Lee
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Phuoc Duong
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, United Kingdom
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19
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Paddock S, Tsampasian V, Assadi H, Mota BC, Swift AJ, Chowdhary A, Swoboda P, Levelt E, Sammut E, Dastidar A, Broncano Cabrero J, Del Val JR, Malcolm P, Sun J, Ryding A, Sawh C, Greenwood R, Hewson D, Vassiliou V, Garg P. Clinical Translation of Three-Dimensional Scar, Diffusion Tensor Imaging, Four-Dimensional Flow, and Quantitative Perfusion in Cardiac MRI: A Comprehensive Review. Front Cardiovasc Med 2021; 8:682027. [PMID: 34307496 PMCID: PMC8292630 DOI: 10.3389/fcvm.2021.682027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/04/2021] [Indexed: 01/05/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging is a versatile tool that has established itself as the reference method for functional assessment and tissue characterisation. CMR helps to diagnose, monitor disease course and sub-phenotype disease states. Several emerging CMR methods have the potential to offer a personalised medicine approach to treatment. CMR tissue characterisation is used to assess myocardial oedema, inflammation or thrombus in various disease conditions. CMR derived scar maps have the potential to inform ablation therapy—both in atrial and ventricular arrhythmias. Quantitative CMR is pushing boundaries with motion corrections in tissue characterisation and first-pass perfusion. Advanced tissue characterisation by imaging the myocardial fibre orientation using diffusion tensor imaging (DTI), has also demonstrated novel insights in patients with cardiomyopathies. Enhanced flow assessment using four-dimensional flow (4D flow) CMR, where time is the fourth dimension, allows quantification of transvalvular flow to a high degree of accuracy for all four-valves within the same cardiac cycle. This review discusses these emerging methods and others in detail and gives the reader a foresight of how CMR will evolve into a powerful clinical tool in offering a precision medicine approach to treatment, diagnosis, and detection of disease.
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Affiliation(s)
- Sophie Paddock
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vasiliki Tsampasian
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Hosamadin Assadi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Bruno Calife Mota
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Amrit Chowdhary
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Peter Swoboda
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Eva Sammut
- Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, University of Bristol, Bristol, United Kingdom
| | - Amardeep Dastidar
- Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, University of Bristol, Bristol, United Kingdom
| | - Jordi Broncano Cabrero
- Cardiothoracic Imaging Unit, Hospital San Juan De Dios, Ressalta, HT Medica, Córdoba, Spain
| | - Javier Royuela Del Val
- Cardiothoracic Imaging Unit, Hospital San Juan De Dios, Ressalta, HT Medica, Córdoba, Spain
| | - Paul Malcolm
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Julia Sun
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Alisdair Ryding
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Chris Sawh
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Richard Greenwood
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - David Hewson
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vassilios Vassiliou
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Pankaj Garg
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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20
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Duran SR, Huffaker T, Dixon B, Gooty V, Abou Zahr R, Arar Y, Greer JS, Butts RJ, Hussain MT. Feasibility and safety of quantitative adenosine stress perfusion cardiac magnetic resonance imaging in pediatric heart transplant patients with and without coronary allograft vasculopathy. Pediatr Radiol 2021; 51:1311-1321. [PMID: 33791838 DOI: 10.1007/s00247-021-04977-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 11/11/2020] [Accepted: 01/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric heart transplant patients require cardiac catheterization to monitor for coronary allograft vasculopathy. Cardiac catheterization has no safe and consistent method for measuring microvascular disease. Stress perfusion cardiac magnetic resonance imaging (MRI) assessing microvascular disease has been performed in adults. OBJECTIVE To investigate the feasibility and safety of performing cardiac MRI with quantitative adenosine stress perfusion testing in pediatric heart transplant patients with and without coronary allograft vasculopathy. MATERIALS AND METHODS All pediatric heart transplant patients with coronary vasculopathy at our institution were asked to participate. Age- and gender-matched pediatric heart transplant patients without vasculopathy were recruited for comparison. Patients underwent cardiac MRI with adenosine stress perfusion testing. RESULTS Sixteen pediatric heart transplant patients, ages 6-22 years, underwent testing. Nine patients had vasculopathy by angiography. No heart block or other complications occurred during the study. The myocardial perfusion reserve for patients with vasculopathy showed no significant difference with comparison patients (median: 1.43 vs. 1.48; P=0.49). Values for both groups were lower than expected values based on previous adult studies. The patients were also analyzed for time after transplant and the number of rejection episodes. Patients within 6 years of transplantation had a nonsignificant trend toward a higher myocardial perfusion reserve (median: 1.57) versus patients with older transplants (median: 1.47; P=0.46). Intra- and interobserver reproducibility were 97% and 92%, respectively. CONCLUSION Myocardial perfusion reserve is a safe and feasible method for estimating myocardial perfusion in pediatric heart transplant patients. There is no reliable way to monitor microvascular disease in pediatric patients. This method shows potential and deserves investigation in a larger cohort.
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Affiliation(s)
- Silvestre R Duran
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA. .,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA. .,Division of Pediatric Cardiology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA.
| | - Tyler Huffaker
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Bryant Dixon
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Vasu Gooty
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Riad Abou Zahr
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Joshua S Greer
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Ryan J Butts
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Mohammad T Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
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21
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Mia I, Le M, Arendt C, Brand D, Bremekamp S, D’Angelo T, Puntmann VO, Nagel E. Quantitative perfusion-CMR is significantly influenced by the placement of the arterial input function. Int J Cardiovasc Imaging 2021; 37:1023-1031. [PMID: 33047177 PMCID: PMC7969553 DOI: 10.1007/s10554-020-02049-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/26/2020] [Indexed: 11/29/2022]
Abstract
The aim of this study is to provide a systematic assessment of the influence of the position on the arterial input function (AIF) for perfusion quantification. In 39 patients with a wide range of left ventricular function the AIF was determined using a diluted contrast bolus of a cardiac magnetic resonance imaging in three left ventricular levels (basal, mid, apex) as well as aortic sinus (AoS). Time to peak signal intensities, baseline corrected peak signal intensity and upslopes were determined and compared to those obtained in the AoS. The error induced by sampling the AIF in a position different to the AoS was determined by Fermi deconvolution. The time to peak signal intensity was strongly correlated (r2 > 0.9) for all positions with a systematic earlier arrival in the basal (- 2153 ± 818 ms), the mid (- 1429 ± 928 ms) and the apical slice (- 450 ± 739 ms) relative to the AoS (all p < 0.001). Peak signal intensity as well as upslopes were strongly correlated (r2 > 0.9 for both) for all positions with a systematic overestimation in all positions relative to the AoS (all p < 0.001 and all p < 0.05). Differences between the positions were more pronounced for patients with reduced ejection fraction. The error of averaged MBF quantification was 8%, 13% and 27% for the base, mid and apex. The location of the AIF significantly influences core parameters for perfusion quantification with a systematic and ejection fraction dependent error. Full quantification should be based on obtaining the AIF as close as possible to the myocardium to minimize these errors.
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Affiliation(s)
- Ibnul Mia
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Melanie Le
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Christophe Arendt
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Diana Brand
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Sina Bremekamp
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Tommaso D’Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, G. Martino University Hospital Messina, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Valentina O. Puntmann
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital, Goethe University, Frankfurt am Main, Germany
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22
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Kawel-Boehm N, Hetzel SJ, Ambale-Venkatesh B, Captur G, Francois CJ, Jerosch-Herold M, Salerno M, Teague SD, Valsangiacomo-Buechel E, van der Geest RJ, Bluemke DA. Reference ranges ("normal values") for cardiovascular magnetic resonance (CMR) in adults and children: 2020 update. J Cardiovasc Magn Reson 2020; 22:87. [PMID: 33308262 PMCID: PMC7734766 DOI: 10.1186/s12968-020-00683-3] [Citation(s) in RCA: 251] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 10/26/2020] [Indexed: 01/06/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) enables assessment and quantification of morphological and functional parameters of the heart, including chamber size and function, diameters of the aorta and pulmonary arteries, flow and myocardial relaxation times. Knowledge of reference ranges ("normal values") for quantitative CMR is crucial to interpretation of results and to distinguish normal from disease. Compared to the previous version of this review published in 2015, we present updated and expanded reference values for morphological and functional CMR parameters of the cardiovascular system based on the peer-reviewed literature and current CMR techniques. Further, databases and references for deep learning methods are included.
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Affiliation(s)
- Nadine Kawel-Boehm
- Department of Radiology, Kantonsspital Graubuenden, Loestrasse 170, 7000, Chur, Switzerland
- Institute for Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, InselspitalBern, Switzerland
| | - Scott J Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 610 Walnut St, Madison, WI, 53726, USA
| | - Bharath Ambale-Venkatesh
- Department of Radiology, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Gabriella Captur
- MRC Unit of Lifelong Health and Ageing At UCL, 5-19 Torrington Place, Fitzrovia, London, WC1E 7HB, UK
- Inherited Heart Muscle Conditions Clinic, Royal Free Hospital NHS Foundation Trust, Hampstead, London, NW3 2QG, UK
| | - Christopher J Francois
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael Salerno
- Cardiovascular Division, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA, 22908, USA
| | - Shawn D Teague
- Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO, 80206, USA
| | - Emanuela Valsangiacomo-Buechel
- Division of Paediatric Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
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23
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Wilk B, Wisenberg G, Dharmakumar R, Thiessen JD, Goldhawk DE, Prato FS. Hybrid PET/MR imaging in myocardial inflammation post-myocardial infarction. J Nucl Cardiol 2020; 27:2083-2099. [PMID: 31797321 PMCID: PMC7391987 DOI: 10.1007/s12350-019-01973-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 01/24/2023]
Abstract
Hybrid PET/MR imaging is an emerging imaging modality combining positron emission tomography (PET) and magnetic resonance imaging (MRI) in the same system. Since the introduction of clinical PET/MRI in 2011, it has had some impact (e.g., imaging the components of inflammation in myocardial infarction), but its role could be much greater. Many opportunities remain unexplored and will be highlighted in this review. The inflammatory process post-myocardial infarction has many facets at a cellular level which may affect the outcome of the patient, specifically the effects on adverse left ventricular remodeling, and ultimately prognosis. The goal of inflammation imaging is to track the process non-invasively and quantitatively to determine the best therapeutic options for intervention and to monitor those therapies. While PET and MRI, acquired separately, can image aspects of inflammation, hybrid PET/MRI has the potential to advance imaging of myocardial inflammation. This review contains a description of hybrid PET/MRI, its application to inflammation imaging in myocardial infarction and the challenges, constraints, and opportunities in designing data collection protocols. Finally, this review explores opportunities in PET/MRI: improved registration, partial volume correction, machine learning, new approaches in the development of PET and MRI pulse sequences, and the use of novel injection strategies.
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Affiliation(s)
- B Wilk
- Department of Medical Imaging, Western University, London, Canada.
- Lawson Health Research Institute, London, Canada.
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada.
| | - G Wisenberg
- Department of Medical Imaging, Western University, London, Canada
- MyHealth Centre, Arva, Canada
| | - R Dharmakumar
- Biomedical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - J D Thiessen
- Department of Medical Imaging, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
| | - D E Goldhawk
- Department of Medical Imaging, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
| | - F S Prato
- Department of Medical Imaging, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
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24
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Rahman H, Scannell CM, Demir OM, Ryan M, McConkey H, Ellis H, Masci PG, Perera D, Chiribiri A. High-Resolution Cardiac Magnetic Resonance Imaging Techniques for the Identification of Coronary Microvascular Dysfunction. JACC Cardiovasc Imaging 2020; 14:978-986. [PMID: 33248969 DOI: 10.1016/j.jcmg.2020.10.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/01/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study assessed the ability to identify coronary microvascular dysfunction (CMD) in patients with angina and nonobstructive coronary artery disease (NOCAD) using high-resolution cardiac magnetic resonance (CMR) and hypothesized that quantitative perfusion techniques would have greater accuracy than visual analysis. BACKGROUND Half of all patients with angina are found to have NOCAD, while the presence of CMD portends greater morbidity and mortality, it now represents a modifiable therapeutic target. Diagnosis currently requires invasive assessment of coronary blood flow during angiography. With greater reliance on computed tomography coronary angiography as a first-line tool to investigate angina, noninvasive tests for diagnosing CMD warrant validation. METHODS Consecutive patients with angina and NOCAD were enrolled. Intracoronary pressure and flow measurements were acquired during rest and vasodilator-mediated hyperemia. CMR (3-T) was performed and analyzed by visual and quantitative techniques, including calculation of myocardial blood flow (MBF) during hyperemia (stress MBF), transmural myocardial perfusion reserve (MPR: MBFHYPEREMIA / MBFREST), and subendocardial MPR (MPRENDO). CMD was defined dichotomously as an invasive coronary flow reserve <2.5, with CMR readers blinded to this classification. RESULTS A total of 75 patients were enrolled (57 ± 10 years of age, 81% women). Among the quantitative perfusion indices, MPRENDO and MPR had the highest accuracy (area under the curve [AUC]: 0.90 and 0.88) with high sensitivity and specificity, respectively, both superior to visual assessment (both p < 0.001). Visual assessment identified CMD with 58% accuracy (41% sensitivity and 83% specificity). Quantitative stress MBF performed similarly to visual analysis (AUC: 0.64 vs. 0.60; p = 0.69). CONCLUSIONS High-resolution CMR has good accuracy at detecting CMD but only when analyzed quantitatively. Although omission of rest imaging and stress-only protocols make for quicker scans, this is at the cost of accuracy compared with integrating rest and stress perfusion. Quantitative perfusion CMR has an increasingly important role in the management of patients frequently encountered with angina and NOCAD.
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Affiliation(s)
- Haseeb Rahman
- School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, United Kingdom
| | - Cian M Scannell
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ozan M Demir
- School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, United Kingdom
| | - Matthew Ryan
- School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, United Kingdom
| | - Hannah McConkey
- School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, United Kingdom
| | - Howard Ellis
- School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, United Kingdom
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Divaka Perera
- School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King's College London, London, United Kingdom.
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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Scannell CM, Correia T, Villa ADM, Schneider T, Lee J, Breeuwer M, Chiribiri A, Henningsson M. Feasibility of free-breathing quantitative myocardial perfusion using multi-echo Dixon magnetic resonance imaging. Sci Rep 2020; 10:12684. [PMID: 32728198 PMCID: PMC7392760 DOI: 10.1038/s41598-020-69747-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/15/2020] [Indexed: 11/08/2022] Open
Abstract
Dynamic contrast-enhanced quantitative first-pass perfusion using magnetic resonance imaging enables non-invasive objective assessment of myocardial ischemia without ionizing radiation. However, quantification of perfusion is challenging due to the non-linearity between the magnetic resonance signal intensity and contrast agent concentration. Furthermore, respiratory motion during data acquisition precludes quantification of perfusion. While motion correction techniques have been proposed, they have been hampered by the challenge of accounting for dramatic contrast changes during the bolus and long execution times. In this work we investigate the use of a novel free-breathing multi-echo Dixon technique for quantitative myocardial perfusion. The Dixon fat images, unaffected by the dynamic contrast-enhancement, are used to efficiently estimate rigid-body respiratory motion and the computed transformations are applied to the corresponding diagnostic water images. This is followed by a second non-linear correction step using the Dixon water images to remove residual motion. The proposed Dixon motion correction technique was compared to the state-of-the-art technique (spatiotemporal based registration). We demonstrate that the proposed method performs comparably to the state-of-the-art but is significantly faster to execute. Furthermore, the proposed technique can be used to correct for the decay of signal due to T2* effects to improve quantification and additionally, yields fat-free diagnostic images.
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Affiliation(s)
- Cian M Scannell
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Teresa Correia
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Adriana D M Villa
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Jack Lee
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Marcel Breeuwer
- Philips Healthcare, Best, The Netherlands
- Department of Biomedical Engineering, Medical Image Analysis Group, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Markus Henningsson
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
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Im DJ, Hong SJ, Park EA, Kim EY, Jo Y, Kim J, Park CH, Yong HS, Lee JW, Hur JH, Yang DH, Lee BY. Guidelines for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging-Part 3: Perfusion, Delayed Enhancement, and T1- and T2 Mapping. Korean J Radiol 2020; 20:1562-1582. [PMID: 31854146 PMCID: PMC6923208 DOI: 10.3348/kjr.2019.0411] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/20/2019] [Indexed: 12/20/2022] Open
Abstract
This document is the third part of the guidelines for the protocol, the interpretation and post-processing of cardiac magnetic resonance (CMR) studies. These consensus recommendations have been developed by the Consensus Committee of the Korean Society of Cardiovascular Imaging to standardize the requirements for image interpretation and post-processing of CMR. This third part of the recommendations describes tissue characterization modules, including perfusion, late gadolinium enhancement, and T1- and T2 mapping. Additionally, this document provides guidance for visual and quantitative assessment consisting of “What-to-See,” “How-To,” and common pitfalls for the analysis of each module. The Consensus Committee hopes that this document will contribute to the standardization of image interpretation and post-processing of CMR studies.
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Affiliation(s)
- Dong Jin Im
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Hong
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Eun Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
| | - Eun Young Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Yeseul Jo
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - JeongJae Kim
- Department of Radiology, Jeju National University Hospital, Jeju, Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Jae Wook Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jee Hye Hur
- Department of Radiology, Hanil General Hospital, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Bae Young Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Scannell CM, Veta M, Villa AD, Sammut EC, Lee J, Breeuwer M, Chiribiri A. Deep-Learning-Based Preprocessing for Quantitative Myocardial Perfusion MRI. J Magn Reson Imaging 2020; 51:1689-1696. [PMID: 31710769 PMCID: PMC7317373 DOI: 10.1002/jmri.26983] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Quantitative myocardial perfusion cardiac MRI can provide a fast and robust assessment of myocardial perfusion status for the noninvasive diagnosis of myocardial ischemia while being more objective than visual assessment. However, it currently has limited use in clinical practice due to the challenging postprocessing required, particularly the segmentation. PURPOSE To evaluate the efficacy of an automated deep learning (DL) pipeline for image processing prior to quantitative analysis. STUDY TYPE Retrospective. POPULATION In all, 175 (350 MRI scans; 1050 image series) clinical patients under both rest and stress conditions (135/10/30 training/validation/test). FIELD STRENGTH/SEQUENCE 3.0T/2D multislice saturation recovery T1 -weighted gradient echo sequence. ASSESSMENT Accuracy was assessed, as compared to the manual operator, through the mean square error of the distance between landmarks and the Dice similarity coefficient of the segmentation and bounding box detection. Quantitative perfusion maps obtained using the automated DL-based processing were compared to the results obtained with the manually processed images. STATISTICAL TESTS Bland-Altman plots and intraclass correlation coefficient (ICC) were used to assess the myocardial blood flow (MBF) obtained using the automated DL pipeline, as compared to values obtained by a manual operator. RESULTS The mean (SD) error in the detection of the time of peak signal enhancement in the left ventricle was 1.49 (1.4) timeframes. The mean (SD) Dice similarity coefficients for the bounding box and myocardial segmentation were 0.93 (0.03) and 0.80 (0.06), respectively. The mean (SD) error in the RV insertion point was 2.8 (1.8) mm. The Bland-Altman plots showed a bias of 2.6% of the mean MBF between the automated and manually processed MBF values on a per-myocardial segment basis. The ICC was 0.89, 95% confidence interval = [0.87, 0.90]. DATA CONCLUSION We showed high accuracy, compared to manual processing, for the DL-based processing of myocardial perfusion data leading to quantitative values that are similar to those achieved with manual processing. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2020;51:1689-1696.
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Affiliation(s)
- Cian M. Scannell
- School of Biomedical Engineering and Imaging SciencesKing's College LondonUK
- Alan Turing Institute LondonUK
| | - Mitko Veta
- Department of Biomedical Engineering, Medical Image Analysis groupEindhoven University of TechnologyEindhovenThe Netherlands
| | - Adriana D.M. Villa
- School of Biomedical Engineering and Imaging SciencesKing's College LondonUK
| | - Eva C. Sammut
- School of Biomedical Engineering and Imaging SciencesKing's College LondonUK
- Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health ScienceUniversity of BristolUK
| | - Jack Lee
- School of Biomedical Engineering and Imaging SciencesKing's College LondonUK
| | - Marcel Breeuwer
- Department of Biomedical Engineering, Medical Image Analysis groupEindhoven University of TechnologyEindhovenThe Netherlands
- Philips Healthcare, BestThe Netherlands
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging SciencesKing's College LondonUK
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Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG, Kim RJ, von Knobelsdorff-Brenkenhoff F, Kramer CM, Pennell DJ, Plein S, Nagel E. Standardized image interpretation and post-processing in cardiovascular magnetic resonance - 2020 update : Society for Cardiovascular Magnetic Resonance (SCMR): Board of Trustees Task Force on Standardized Post-Processing. J Cardiovasc Magn Reson 2020; 22:19. [PMID: 32160925 PMCID: PMC7066763 DOI: 10.1186/s12968-020-00610-6] [Citation(s) in RCA: 445] [Impact Index Per Article: 111.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/17/2020] [Indexed: 01/04/2023] Open
Abstract
With mounting data on its accuracy and prognostic value, cardiovascular magnetic resonance (CMR) is becoming an increasingly important diagnostic tool with growing utility in clinical routine. Given its versatility and wide range of quantitative parameters, however, agreement on specific standards for the interpretation and post-processing of CMR studies is required to ensure consistent quality and reproducibility of CMR reports. This document addresses this need by providing consensus recommendations developed by the Task Force for Post-Processing of the Society for Cardiovascular Magnetic Resonance (SCMR). The aim of the Task Force is to recommend requirements and standards for image interpretation and post-processing enabling qualitative and quantitative evaluation of CMR images. Furthermore, pitfalls of CMR image analysis are discussed where appropriate. It is an update of the original recommendations published 2013.
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Affiliation(s)
- Jeanette Schulz-Menger
- Department of Cardiology and Nephrology, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany.
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Jens Bremerich
- Department of Radiology of the University Hospital Basel, Basel, Switzerland
| | - Scott D Flamm
- Imaging, and Heart and Vascular Institutes, Cleveland Clinic, Cleveland, OH, USA
| | - Mark A Fogel
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, Montreal, QC, Canada
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, and Departments of Medicine and Radiology, Duke University Medical Center, Durham, NC, USA
| | | | - Christopher M Kramer
- Departments of Medicine and Radiology and the Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Sven Plein
- Leeds Institute for Genetics Health and Therapeutics & Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, partner site RheinMain, University Hospital Frankfurt, Frankfurt am Main, Germany
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Le MTP, Zarinabad N, D’Angelo T, Mia I, Heinke R, Vogl TJ, Zeiher A, Nagel E, Puntmann VO. Sub-segmental quantification of single (stress)-pass perfusion CMR improves the diagnostic accuracy for detection of obstructive coronary artery disease. J Cardiovasc Magn Reson 2020; 22:14. [PMID: 32028980 PMCID: PMC7006214 DOI: 10.1186/s12968-020-0600-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 01/07/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Myocardial perfusion with cardiovascular magnetic resonance (CMR) imaging is an established diagnostic test for evaluation of myocardial ischaemia. For quantification purposes, the 16 segment American Heart Association (AHA) model poses limitations in terms of extracting relevant information on the extent/severity of ischaemia as perfusion deficits will not always fall within an individual segment, which reduces its diagnostic value, and makes an accurate assessment of outcome data or a result comparison across various studies difficult. We hypothesised that division of the myocardial segments into epi- and endocardial layers and a further circumferential subdivision, resulting in a total of 96 segments, would improve the accuracy of detecting myocardial hypoperfusion. Higher (sub-)subsegmental recording of perfusion abnormalities, which are defined relatively to the normal reference using the subsegment with the highest value, may improve the spatial encoding of myocardial blood flow, based on a single stress perfusion acquisition. OBJECTIVE A proof of concept comparison study of subsegmentation approaches based on transmural segments (16 AHA and 48 segments) vs. subdivision into epi- and endocardial (32) subsegments vs. further circumferential subdivision into 96 (sub-)subsegments for diagnostic accuracy against invasively defined obstructive coronary artery disease (CAD). METHODS Thirty patients with obstructive CAD and 20 healthy controls underwent perfusion stress CMR imaging at 3 T during maximal adenosine vasodilation and a dual bolus injection of 0.1 mmol/kg gadobutrol. Using Fermi deconvolution for blood flow estimation, (sub-)subsegmental values were expressed relative to the (sub-)subsegment with the highest flow. In addition, endo-/epicardial flow ratios were calculated based on 32 and 96 (sub-)subsegments. A receiver operating characteristics (ROC) curve analysis was performed to compare the diagnostic performance of discrimination between patients with CAD and healthy controls. Observer reproducibility was assessed using Bland-Altman approaches. RESULTS Subdivision into more and smaller segments revealed greater accuracy for #32, #48 and # 96 compared to the standard #16 approach (area under the curve (AUC): 0.937, 0.973 and 0.993 vs 0.820, p < 0.05). The #96-based endo-/epicardial ratio was superior to the #32 endo-/epicardial ratio (AUC 0.979, vs. 0.932, p < 0.05). Measurements for the #16 model showed marginally better reproducibility compared to #32, #48 and #96 (mean difference ± standard deviation: 2.0 ± 3.6 vs. 2.3 ± 4.0 vs 2.5 ± 4.4 vs. 4.1 ± 5.6). CONCLUSIONS Subsegmentation of the myocardium improves diagnostic accuracy and facilitates an objective cut-off-based description of hypoperfusion, and facilitates an objective description of hypoperfusion, including the extent and severity of myocardial ischaemia. Quantification based on a single (stress-only) pass reduces the overall amount of gadolinium contrast agent required and the length of the overall diagnostic study.
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Affiliation(s)
- Melanie T. P. Le
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Niloufar Zarinabad
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Tommaso D’Angelo
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
- Department of Biomedical Sciences and Morphological and Functional Imaging, G. Martino University Hospital Messina, Via Consolare Valeria 1, Messina, 98100 Italy
| | - Ibnul Mia
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Robert Heinke
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Thomas J. Vogl
- Department of Radiology, University Hospital Frankfurt, Theodor-Stern Kai 7, Frankfurt am Main, Germany
| | - Andreas Zeiher
- Department of Cardiology, University Hospital Frankfurt, Theodor-Stern Kai 7, Frankfurt am Main, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Valentina O. Puntmann
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
- Department of Cardiology, University Hospital Frankfurt, Theodor-Stern Kai 7, Frankfurt am Main, Germany
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Scannell CM, Chiribiri A, Villa ADM, Breeuwer M, Lee J. Hierarchical Bayesian myocardial perfusion quantification. Med Image Anal 2020; 60:101611. [PMID: 31760191 PMCID: PMC6880627 DOI: 10.1016/j.media.2019.101611] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 01/25/2023]
Abstract
Myocardial blood flow can be quantified from dynamic contrast-enhanced magnetic resonance (MR) images through the fitting of tracer-kinetic models to the observed imaging data. The use of multi-compartment exchange models is desirable as they are physiologically motivated and resolve directly for both blood flow and microvascular function. However, the parameter estimates obtained with such models can be unreliable. This is due to the complexity of the models relative to the observed data which is limited by the low signal-to-noise ratio, the temporal resolution, the length of the acquisitions and other complex imaging artefacts. In this work, a Bayesian inference scheme is proposed which allows the reliable estimation of the parameters of the two-compartment exchange model from myocardial perfusion MR data. The Bayesian scheme allows the incorporation of prior knowledge on the physiological ranges of the model parameters and facilitates the use of the additional information that neighbouring voxels are likely to have similar kinetic parameter values. Hierarchical priors are used to avoid making a priori assumptions on the health of the patients. We provide both a theoretical introduction to Bayesian inference for tracer-kinetic modelling and specific implementation details for this application. This approach is validated in both in silico and in vivo settings. In silico, there was a significant reduction in mean-squared error with the ground-truth parameters using Bayesian inference as compared to using the standard non-linear least squares fitting. When applied to patient data the Bayesian inference scheme returns parameter values that are in-line with those previously reported in the literature, as well as giving parameter maps that match the independant clinical diagnosis of those patients.
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Affiliation(s)
- Cian M Scannell
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom; The Alan Turing Institute London, United Kingdom.
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom.
| | - Adriana D M Villa
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom.
| | - Marcel Breeuwer
- Philips Healthcare, Best, the Netherlands; Department of Biomedical Engineering, Medical Image Analysis group, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Jack Lee
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom.
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31
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Rahman H, Ryan M, Lumley M, Modi B, McConkey H, Ellis H, Scannell C, Clapp B, Marber M, Webb A, Chiribiri A, Perera D. Coronary Microvascular Dysfunction Is Associated With Myocardial Ischemia and Abnormal Coronary Perfusion During Exercise. Circulation 2019; 140:1805-1816. [PMID: 31707835 PMCID: PMC6882540 DOI: 10.1161/circulationaha.119.041595] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 10/15/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Coronary microvascular dysfunction (MVD) is defined by impaired flow augmentation in response to a pharmacological vasodilator in the presence of nonobstructive coronary artery disease. It is unknown whether diminished coronary vasodilator response correlates with abnormal exercise physiology or inducible myocardial ischemia. METHODS Patients with angina and nonobstructive coronary artery disease had simultaneous coronary pressure and flow velocity measured using a dual sensor-tipped guidewire during rest, supine bicycle exercise, and adenosine-mediated hyperemia. Microvascular resistance (MR) was calculated as coronary pressure divided by flow velocity. Wave intensity analysis quantified the proportion of accelerating wave energy (perfusion efficiency). Global myocardial blood flow and subendocardial:subepicardial perfusion ratio were quantified using 3-Tesla cardiac magnetic resonance imaging during hyperemia and rest; inducible ischemia was defined as hyperemic subendocardial:subepicardial perfusion ratio <1.0. Patients were classified as having MVD if coronary flow reserve <2.5 and controls if coronary flow reserve ≥2.5, with researchers blinded to the classification. RESULTS Eighty-five patients were enrolled (78% female, 57±10 years), 45 (53%) were classified as having MVD. Of the MVD group, 82% had inducible ischemia compared with 22% of controls (P<0.001); global myocardial perfusion reserve was 2.01±0.41 and 2.68±0.49 (P<0.001). In controls, coronary perfusion efficiency improved from rest to exercise and was unchanged during hyperemia (59±11% vs 65±14% vs 57±18%; P=0.02 and P=0.14). In contrast, perfusion efficiency decreased during both forms of stress in MVD (61±12 vs 44±10 vs 42±11%; both P<0.001). Among patients with a coronary flow reserve <2.5, 62% had functional MVD, with normal minimal MR (hyperemic MR<2.5 mmHg/cm/s), and 38% had structural MVD with elevated hyperemic MR. Resting MR was lower in those with functional MVD (4.2±1.0 mmHg/cm/s) than in those with structural MVD (6.9±1.7 mmHg/cm/s) or controls (7.3±2.2 mmHg/cm/s; both P<0.001). During exercise, the structural group had a higher systolic blood pressure (188±25 mmHg) than did those with functional MVD (161±27 mmHg; P=0.004) and controls (156±30 mmHg; P<0.001). Functional and structural MVD had similar stress myocardial perfusion and exercise perfusion efficiency values. CONCLUSION In patients with angina and nonobstructive coronary artery disease, diminished coronary flow reserve characterizes a cohort with inducible ischemia and a maladaptive physiological response to exercise. We have identified 2 endotypes of MVD with distinctive systemic vascular responses to exercise; whether endotypes have a different prognosis or require different treatments merits further investigation.
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Affiliation(s)
- Haseeb Rahman
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Matthew Ryan
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Matthew Lumley
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Bhavik Modi
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Hannah McConkey
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Howard Ellis
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Cian Scannell
- Biomedical Engineering & Imaging Sciences (A.C., C.S.), King’s College London, United Kingdom
| | - Brian Clapp
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Michael Marber
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Andrew Webb
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
| | - Amedeo Chiribiri
- Biomedical Engineering & Imaging Sciences (A.C., C.S.), King’s College London, United Kingdom
| | - Divaka Perera
- From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King’s College London, United Kingdom
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Nazir MS, Gould SM, Milidonis X, Reyes E, Ismail TF, Neji R, Roujol S, O’Doherty J, Xue H, Barrington SF, Schaeffter T, Razavi R, Marsden P, Kellman P, Plein S, Chiribiri A. Simultaneous 13N-Ammonia and gadolinium first-pass myocardial perfusion with quantitative hybrid PET-MR imaging: a phantom and clinical feasibility study. Eur J Hybrid Imaging 2019; 3:15. [PMID: 31544170 PMCID: PMC6718374 DOI: 10.1186/s41824-019-0062-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/15/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Positron emission tomography (PET) is the non-invasive reference standard for myocardial blood flow (MBF) quantification. Hybrid PET-MR allows simultaneous PET and cardiac magnetic resonance (CMR) acquisition under identical experimental and physiological conditions. This study aimed to determine feasibility of simultaneous 13N-Ammonia PET and dynamic contrast-enhanced CMR MBF quantification in phantoms and healthy volunteers. METHODS Images were acquired using a 3T hybrid PET-MR scanner. Phantom study: MBF was simulated at different physiological perfusion rates and a protocol for simultaneous PET-MR perfusion imaging was developed. Volunteer study: five healthy volunteers underwent adenosine stress. 13N-Ammonia and gadolinium were administered simultaneously. PET list mode data was reconstructed using ordered subset expectation maximisation. CMR MBF was quantified using Fermi function-constrained deconvolution of arterial input function and myocardial signal. PET MBF was obtained using a one-tissue compartment model and image-derived input function. RESULTS Phantom study: PET and CMR MBF measurements demonstrated high repeatability with intraclass coefficients 0.98 and 0.99, respectively. There was high correlation between PET and CMR MBF (r = 0.98, p < 0.001) and good agreement (bias - 0.85 mL/g/min; 95% limits of agreement 0.29 to - 1.98). Volunteer study: Mean global stress MBF for CMR and PET were 2.58 ± 0.11 and 2.60 ± 0.47 mL/g/min respectively. On a per territory basis, there was moderate correlation (r = 0.63, p = 0.03) and agreement (bias - 0.34 mL/g/min; 95% limits of agreement 0.49 to - 1.18). CONCLUSION Simultaneous MBF quantification using hybrid PET-MR imaging is feasible with high test repeatability and good to moderate agreement between PET and CMR. Future studies in coronary artery disease patients may allow cross-validation of techniques.
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Affiliation(s)
- Muhummad Sohaib Nazir
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Sarah-May Gould
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Xenios Milidonis
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Eliana Reyes
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Tevfik F. Ismail
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Radhouene Neji
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
- Siemens Healthcare Limited, Sir William Siemens Square, Frimley, Camberley, GU16 8QD UK
| | - Sébastien Roujol
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Jim O’Doherty
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD USA
| | - Sally F. Barrington
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Tobias Schaeffter
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
- Physikalisch-Technische Bundesanstalt, Berlin, Germany
| | - Reza Razavi
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Paul Marsden
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD USA
| | - Sven Plein
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
| | - Amedeo Chiribiri
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge, 4th Floor Lambeth Wing, London, SE1 7EH UK
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Rasmussen LD, Winther S, Westra J, Isaksen C, Ejlersen JA, Brix L, Kirk J, Urbonaviciene G, Søndergaard HM, Hammid O, Schmidt SE, Knudsen LL, Madsen LH, Frost L, Petersen SE, Gormsen LC, Christiansen EH, Eftekhari A, Holm NR, Nyegaard M, Chiribiri A, Bøtker HE, Böttcher M. Danish study of Non-Invasive testing in Coronary Artery Disease 2 (Dan-NICAD 2): Study design for a controlled study of diagnostic accuracy. Am Heart J 2019; 215:114-128. [PMID: 31323454 DOI: 10.1016/j.ahj.2019.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/27/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Coronary computed tomography angiography (CTA) is the preferred primary diagnostic modality when examining patients with low to intermediate pre-test probability of coronary artery disease (CAD). Only 20-30% of these have potentially obstructive CAD. Because of the relatively poor positive predictive value of coronary CTA, unnecessary invasive coronary angiographies (ICAs) are conducted with the costs and risks associated with the procedure. Hence, an optimized diagnostic CAD algorithm may reduce the numbers of ICAs not followed by revascularization. The Dan-NICAD 2 study has 3 equivalent main aims: (1) To examine the diagnostic precision of a sound-based diagnostic algorithm, The CADScor®System (Acarix A/S, Denmark), in patients with a low to intermediate pre-test risk of CAD referred to a primary examination by coronary CTA. We hypothesize that the CADScor®System provides better stratification prior to coronary CTA than clinical risk stratification scores alone. (2) To compare the diagnostic accuracy of 3T cardiac magnetic resonance imaging (3T CMRI), 82rubidium positron emission tomography (82Rb-PET), and CT-derived fractional flow reserve (FFRCT) in patients where obstructive CAD cannot be ruled out by coronary CTA using ICA fractional flow reserve (FFR) as reference standard. (3) To compare the diagnostic performance of quantitative flow ratio (QFR) and ICA-FFR in patients with low to intermediate pre-test probability of CAD using 82Rb-PET as reference standard. METHODS Dan-NICAD 2 is a prospective, multicenter, cross-sectional study including approximately 2,000 patients with low to intermediate pre-test probability of CAD and without previous history of CAD. Patients are referred to coronary CTA because of symptoms suggestive of CAD, as evaluated by a cardiologist. Patient interviews, sound recordings, and blood samples are obtained in connection with the coronary CTA. If coronary CTA does not rule out obstructive CAD, patients will be examined by 3T CMRI 82Rb-PET, FFRCT, ICA, and FFR. Reference standard is ICA-FFR. Obstructive CAD is defined as an FFR ≤0.80 or as high-grade stenosis (>90% diameter stenosis) by visual assessment. Diagnostic performance will be evaluated as sensitivity, specificity, predictive values, likelihood ratios, calibration, and discrimination. Enrolment started January 2018 and is expected to be completed by June 2020. Patients are followed for 10 years after inclusion. DISCUSSION The results of the Dan-NICAD 2 study are expected to contribute to the improvement of diagnostic strategies for patients suspected of CAD in 3 different steps: risk stratification prior to coronary CTA, diagnostic strategy after coronary CTA, and invasive wireless QFR analysis as an alternative to ICA-FFR.
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Scannell CM, Villa AD, Lee J. Robust Non-Rigid Motion Compensation of Free-Breathing Myocardial Perfusion MRI Data. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:1812-1820. [PMID: 30716032 PMCID: PMC6699991 DOI: 10.1109/tmi.2019.2897044] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Kinetic parameter values, such as myocardial perfusion, can be quantified from dynamic contrast-enhanced magnetic resonance imaging data using tracer-kinetic modeling. However, respiratory motion affects the accuracy of this process. Motion compensation of the image series is difficult due to the rapid local signal enhancement caused by the passing of the gadolinium-based contrast agent. This contrast enhancement invalidates the assumptions of the (global) cost functions traditionally used in intensity-based registrations. The algorithms are unable to distinguish whether the differences in signal intensity between frames are caused by the spatial motion artifacts or the local contrast enhancement. In order to address this problem, a fully automated motion compensation scheme is proposed, which consists of two stages. The first of which uses robust principal component analysis (PCA) to separate the local signal enhancement from the baseline signal, before a refinement stage which uses the traditional PCA to construct a synthetic reference series that is free from motion but preserves the signal enhancement. Validation is performed on 18 subjects acquired in free-breathing and 5 clinical subjects acquired with a breath-hold. The validation assesses the visual quality, the temporal smoothness of tissue curves, and the clinically relevant quantitative perfusion values. The expert observers score the visual quality increased by a mean of 1.58/5 after motion compensation and improvement over the previously published methods. The proposed motion compensation scheme also leads to the improved quantitative performance of motion compensated free-breathing image series [30% reduction in the coefficient of variation across quantitative perfusion maps and 53% reduction in temporal variations (p < 0.001)].
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Affiliation(s)
- Cian M. Scannell
- School of Biomedical Engineering and Imaging Sciences, King’s
College London
| | - Adriana D.M. Villa
- School of Biomedical Engineering and Imaging Sciences, King’s
College London
| | - Jack Lee
- School of Biomedical Engineering and Imaging Sciences, King’s
College London
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Nazir MS, Neji R, Speier P, Reid F, Stäb D, Schmidt M, Forman C, Razavi R, Plein S, Ismail TF, Chiribiri A, Roujol S. Simultaneous multi slice (SMS) balanced steady state free precession first-pass myocardial perfusion cardiovascular magnetic resonance with iterative reconstruction at 1.5 T. J Cardiovasc Magn Reson 2018; 20:84. [PMID: 30526627 PMCID: PMC6287353 DOI: 10.1186/s12968-018-0502-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/24/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Simultaneous-Multi-Slice (SMS) perfusion imaging has the potential to acquire multiple slices, increasing myocardial coverage without sacrificing in-plane spatial resolution. To maximise signal-to-noise ratio (SNR), SMS can be combined with a balanced steady state free precession (bSSFP) readout. Furthermore, application of gradient-controlled local Larmor adjustment (GC-LOLA) can ensure robustness against off-resonance artifacts and SNR loss can be mitigated by applying iterative reconstruction with spatial and temporal regularisation. The objective of this study was to compare cardiovascular magnetic resonance (CMR) myocardial perfusion imaging using SMS bSSFP imaging with GC-LOLA and iterative reconstruction to 3 slice bSSFP. METHODS Two contrast-enhanced rest perfusion sequences were acquired in random order in 8 patients: 6-slice SMS bSSFP and 3 slice bSSFP. All images were reconstructed with TGRAPPA. SMS images were also reconstructed using a non-linear iterative reconstruction with L1 regularisation in wavelet space (SMS-iter) with 7 different combinations for spatial (λσ) and temporal (λτ) regularisation parameters. Qualitative ratings of overall image quality (0 = poor image quality, 1 = major artifact, 2 = minor artifact, 3 = excellent), perceived SNR (0 = poor SNR, 1 = major noise, 2 = minor noise, 3 = high SNR), frequency of sequence related artifacts and patient related artifacts were undertaken. Quantitative analysis of contrast ratio (CR) and percentage of dark rim artifact (DRA) was performed. RESULTS Among all SMS-iter reconstructions, SMS-iter 6 (λσ 0.001 λτ 0.005) was identified as the optimal reconstruction with the highest overall image quality, least sequence related artifact and higher perceived SNR. SMS-iter 6 had superior overall image quality (2.50 ± 0.53 vs 1.50 ± 0.53, p = 0.005) and perceived SNR (2.25 ± 0.46 vs 0.75 ± 0.46, p = 0.010) compared to 3 slice bSSFP. There were no significant differences in sequence related artifact, CR (3.62 ± 0.39 vs 3.66 ± 0.65, p = 0.88) or percentage of DRA (5.25 ± 6.56 vs 4.25 ± 4.30, p = 0.64) with SMS-iter 6 compared to 3 slice bSSFP. CONCLUSIONS SMS bSSFP with GC-LOLA and iterative reconstruction improved image quality compared to a 3 slice bSSFP with doubled spatial coverage and preserved in-plane spatial resolution. Future evaluation in patients with coronary artery disease is warranted.
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Affiliation(s)
- Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 3rd Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SW1 7EH UK
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 3rd Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SW1 7EH UK
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, UK
| | | | - Fiona Reid
- Division of Health and Social Care Research, King’s College London, London, UK
| | - Daniel Stäb
- Siemens Healthcare Pty Ltd, Melbourne, Australia
| | | | | | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 3rd Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SW1 7EH UK
| | - Sven Plein
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 3rd Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SW1 7EH UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT UK
| | - Tevfik F. Ismail
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 3rd Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SW1 7EH UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 3rd Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SW1 7EH UK
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 3rd Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SW1 7EH UK
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Villa ADM, Corsinovi L, Ntalas I, Milidonis X, Scannell C, Di Giovine G, Child N, Ferreira C, Nazir MS, Karady J, Eshja E, De Francesco V, Bettencourt N, Schuster A, Ismail TF, Razavi R, Chiribiri A. Importance of operator training and rest perfusion on the diagnostic accuracy of stress perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2018; 20:74. [PMID: 30454074 PMCID: PMC6245890 DOI: 10.1186/s12968-018-0493-4] [Citation(s) in RCA: 30] [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: 03/01/2018] [Accepted: 10/09/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Clinical evaluation of stress perfusion cardiovascular magnetic resonance (CMR) is currently based on visual assessment and has shown high diagnostic accuracy in previous clinical trials, when performed by expert readers or core laboratories. However, these results may not be generalizable to clinical practice, particularly when less experienced readers are concerned. Other factors, such as the level of training, the extent of ischemia, and image quality could affect the diagnostic accuracy. Moreover, the role of rest images has not been clarified. The aim of this study was to assess the diagnostic accuracy of visual assessment for operators with different levels of training and the additional value of rest perfusion imaging, and to compare visual assessment and automated quantitative analysis in the assessment of coronary artery disease (CAD). METHODS We evaluated 53 patients with known or suspected CAD referred for stress-perfusion CMR. Nine operators (equally divided in 3 levels of competency) blindly reviewed each case twice with a 2-week interval, in a randomised order, with and without rest images. Semi-automated Fermi deconvolution was used for quantitative analysis and estimation of myocardial perfusion reserve as the ratio of stress to rest perfusion estimates. RESULTS Level-3 operators correctly identified significant CAD in 83.6% of the cases. This percentage dropped to 65.7% for Level-2 operators and to 55.7% for Level-1 operators (p < 0.001). Quantitative analysis correctly identified CAD in 86.3% of the cases and was non-inferior to expert readers (p = 0.56). When rest images were available, a significantly higher level of confidence was reported (p = 0.022), but no significant differences in diagnostic accuracy were measured (p = 0.34). CONCLUSIONS Our study demonstrates that the level of training is the main determinant of the diagnostic accuracy in the identification of CAD. Level-3 operators performed at levels comparable with the results from clinical trials. Rest images did not significantly improve diagnostic accuracy, but contributed to higher confidence in the results. Automated quantitative analysis performed similarly to level-3 operators. This is of increasing relevance as recent technical advances in image reconstruction and analysis techniques are likely to permit the clinical translation of robust and fully automated quantitative analysis into routine clinical practice.
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Affiliation(s)
- Adriana D. M. Villa
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Laura Corsinovi
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
- Cardiology Department of the Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Ioannis Ntalas
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
- Cardiology Department, St. Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Xenios Milidonis
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Cian Scannell
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Gabriella Di Giovine
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Nicholas Child
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | | | - Muhummad Sohaib Nazir
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Julia Karady
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | | | - Viola De Francesco
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Nuno Bettencourt
- Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Andreas Schuster
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, Australia
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tevfik F. Ismail
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Reza Razavi
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
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Fuetterer M, Busch J, Traechtler J, Wespi P, Peereboom SM, Sauer M, Lipiski M, Fleischmann T, Cesarovic N, Stoeck CT, Kozerke S. Quantitative myocardial first-pass cardiovascular magnetic resonance perfusion imaging using hyperpolarized [1- 13C] pyruvate. J Cardiovasc Magn Reson 2018; 20:73. [PMID: 30415642 PMCID: PMC6231262 DOI: 10.1186/s12968-018-0495-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 10/09/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The feasibility of absolute myocardial blood flow quantification and suitability of hyperpolarized [1-13C] pyruvate as contrast agent for first-pass cardiovascular magnetic resonance (CMR) perfusion measurements are investigated with simulations and demonstrated in vivo in a swine model. METHODS A versatile simulation framework for hyperpolarized CMR subject to physical, physiological and technical constraints was developed and applied to investigate experimental conditions for accurate perfusion CMR with hyperpolarized [1-13C] pyruvate. Absolute and semi-quantitative perfusion indices were analyzed with respect to experimental parameter variations and different signal-to-noise ratio (SNR) levels. Absolute myocardial blood flow quantification was implemented with an iterative deconvolution approach based on Fermi functions. To demonstrate in vivo feasibility, velocity-selective excitation with an echo-planar imaging readout was used to acquire dynamic myocardial stress perfusion images in four healthy swine. Arterial input functions were extracted from an additional image slice with conventional excitation that was acquired within the same heartbeat. RESULTS Simulations suggest that obtainable SNR and B0 inhomogeneity in vivo are sufficient for the determination of absolute and semi-quantitative perfusion with ≤25% error. It is shown that for expected metabolic conversion rates, metabolic conversion of pyruvate can be neglected over the short duration of acquisition in first-pass perfusion CMR. In vivo measurements suggest that absolute myocardial blood flow quantification using hyperpolarized [1-13C] pyruvate is feasible with an intra-myocardial variability comparable to semi-quantitative perfusion indices. CONCLUSION The feasibility of quantitative hyperpolarized first-pass perfusion CMR using [1-13C] pyruvate has been investigated in simulations and demonstrated in swine. Using an approved and metabolically active compound is envisioned to increase the value of hyperpolarized perfusion CMR in patients.
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Affiliation(s)
- Maximilian Fuetterer
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse, 35 8092 Zurich, Switzerland
| | - Julia Busch
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse, 35 8092 Zurich, Switzerland
| | - Julia Traechtler
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse, 35 8092 Zurich, Switzerland
| | - Patrick Wespi
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse, 35 8092 Zurich, Switzerland
| | - Sophie M. Peereboom
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse, 35 8092 Zurich, Switzerland
| | - Mareike Sauer
- Division of Surgical Research, University Hospital Zurich, Sternwartstrasse, 14 8091 Zurich, Switzerland
| | - Miriam Lipiski
- Division of Surgical Research, University Hospital Zurich, Sternwartstrasse, 14 8091 Zurich, Switzerland
| | - Thea Fleischmann
- Division of Surgical Research, University Hospital Zurich, Sternwartstrasse, 14 8091 Zurich, Switzerland
| | - Nikola Cesarovic
- Division of Surgical Research, University Hospital Zurich, Sternwartstrasse, 14 8091 Zurich, Switzerland
| | - Christian T. Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse, 35 8092 Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse, 35 8092 Zurich, Switzerland
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Lehnert J, Wübbeler G, Kolbitsch C, Chiribiri A, Coquelin L, Ebrard G, Smith N, Schaeffter T, Elster C. Pixel-wise quantification of myocardial perfusion using spatial Tikhonov regularization. Phys Med Biol 2018; 63:215017. [PMID: 30372423 DOI: 10.1088/1361-6560/aae758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Quantification of myocardial perfusion by contrast-enhanced cardiovascular magnetic resonance imaging (CMR) aims for an observer independent and reproducible risk assessment of cardiovascular disease. Currently, the data used for the pixel-wise analysis of cardiac perfusion are either filtered prior to a fitting procedure, which inherently reduces the spatial resolution of data; or all pixels are considered without any regularization or prior filtering, which yields an unstable fit in the presence of low signal-to-noise ratio. Here, we propose a new pixel-wise analysis based on spatial Tikhonov regularization which exploits the spatial smoothness of the data and ensures accurate quantification even for images with low signal-to-noise ratio. The regularization parameter is determined automatically by an L-curve criterion. We study the performance of our method on a numerical phantom and demonstrate that the method reduces significantly the root-mean square error in the perfusion estimate compared to a non-regularized fit. In patient data our method allows us to recover the myocardial perfusion and to distinguish between healthy and ischemic regions.
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Affiliation(s)
- Judith Lehnert
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany. Author to whom any correspondence should be addressed
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O' Doherty J, Chalampalakis Z, Schleyer P, Nazir MS, Chiribiri A, Marsden PK. The effect of high count rates on cardiac perfusion quantification in a simultaneous PET-MR system using a cardiac perfusion phantom. EJNMMI Phys 2017; 4:31. [PMID: 29230607 PMCID: PMC5725400 DOI: 10.1186/s40658-017-0199-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND PET-MRI is under investigation as a new strategy for quantitative myocardial perfusion imaging. Consideration is required as to the maximum scanner count rate in order to limit dead-time losses resulting from administered activity in the scanner field of view during the first pass of the radiotracer. RESULTS We performed a decaying-source experiment to investigate the high count-rate performance of a PET-MR system (Siemens mMR) over the expected range of activities during a clinical study. We also performed imaging of a cardiac perfusion phantom, which provides an experimental simulation of clinical transit of a simultaneous radiotracer (phantom injected activities range 252 to 997 MBq) and gadolinium-based contrast agent (GBCA). Time-activity and time-intensity curves of the aorta and myocardium compartments from PET and MR images were determined, and quantification of perfusion was then performed using a standard cardiac kinetic model. The decaying-source experiment showed a maximum noise equivalent count rate (NECRmax) of 286 kcps at a singles rate of 47.1 Mcps. NECR was maintained within 5% (NECR95%) of the NECRmax with a singles rate of 34.1 Mcps, corresponding to 310 MBq in the phantom. Count-rate performance was degraded above the singles rate of 64.9 Mcps due to the number of detection events impacting the quantitative accuracy of reconstructed images. A 10% bias in image activity concentration was observed between singles rates of 78.2 and 82.9 Mcps. Perfusion phantom experiments showed that image-based activity concentration and quantified values of perfusion were affected by count losses when the total singles rate was greater than 64.9 Mcps. This occurred during the peak arterial input function (AIF) phase of imaging for injected activities to the phantom of 600 MBq and greater. CONCLUSIONS Care should be taken to avoid high count-rate losses in simultaneous PET-MRI studies. Based on our results in phantoms, bias in reconstructed images should be avoided by adhering to a singles rate lower than 64.9 Mcps on the mMR system. Quantification of perfusion values using singles rates higher than 64.9 Mcps on this system may be compromised and should be avoided.
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Affiliation(s)
- Jim O' Doherty
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, UK.
- Department of Molecular Imaging, Sidra Medical and Research Center, Al Luqta St, Doha, Qatar.
| | - Zacharias Chalampalakis
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, UK
| | | | - Muhummad Sohaib Nazir
- BHF Centre of Excellence, NIHR Biomedical Research Centre and Wellcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Amedeo Chiribiri
- BHF Centre of Excellence, NIHR Biomedical Research Centre and Wellcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul K Marsden
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, UK
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Hussain ST, Paul M, Morton G, Schuster A, Chiribiri A, Perera D, Nagel E. Correlation of Fractional Flow Reserve With Ischemic Burden Measured by Cardiovascular Magnetic Resonance Perfusion Imaging. Am J Cardiol 2017; 120:1913-1919. [PMID: 29050683 DOI: 10.1016/j.amjcard.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/27/2017] [Accepted: 08/08/2017] [Indexed: 11/26/2022]
Abstract
Cardiovascular magnetic resonance (CMR) perfusion imaging and fractional flow reserve (FFR) assess myocardial ischemia. FFR measures the pressure loss across a stenosis determining hemodynamic significance but does not assess the area subtended by the stenotic vessel. CMR perfusion imaging measures the extent of myocardial blood flow reduction (=ischemic burden). Both techniques allow for continuous rather than categorical evaluation, but their relationship is poorly understood. This study investigates the relationship between the FFR value and the extent of myocardial ischemia. Forty-nine patients with angina underwent CMR perfusion imaging. FFR was measured in vessels with a visual diameter stenosis >40%. The extent of ischemia for each coronary artery was measured by delineating the perfusion defect on the CMR images and expressing as a percentage of the left ventricular myocardium. The correlation between the extent of ischemia measured by CMR and FFR was good (r = -0.85, p < 0.0005). The mean FFR value was 0.67 ± 0.17, and the mean perfusion defect was 8.9 ± 9.3%. An FFR value of ≥0.75 was not associated with ischemia on CMR. The maximum amount of ischemia (23.0 ± 1.5%) was found at FFR values 0.4 to 0.5. In patients with 1 vessel disease (49%), the mean ischemic burden was 15.3 ± 8.3%. In patients with 2 vessel diseases (18%), the mean ischemic burden was 26.0 ± 12%. Reproducibility for the measurement of ischemic burden was very good with a Kappa coefficient (k = 0.826, p = 0.048). In conclusion, there is good correlation between the FFR value and the amount of myocardial ischemia in the subtended myocardium.
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Sammut EC, Villa ADM, Di Giovine G, Dancy L, Bosio F, Gibbs T, Jeyabraba S, Schwenke S, Williams SE, Marber M, Alfakih K, Ismail TF, Razavi R, Chiribiri A. Prognostic Value of Quantitative Stress Perfusion Cardiac Magnetic Resonance. JACC Cardiovasc Imaging 2017; 11:686-694. [PMID: 29153572 PMCID: PMC5952817 DOI: 10.1016/j.jcmg.2017.07.022] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/15/2017] [Accepted: 07/20/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study sought to evaluate the prognostic usefulness of visual and quantitative perfusion cardiac magnetic resonance (CMR) ischemic burden in an unselected group of patients and to assess the validity of consensus-based ischemic burden thresholds extrapolated from nuclear studies. BACKGROUND There are limited data on the prognostic value of assessing myocardial ischemic burden by CMR, and there are none using quantitative perfusion analysis. METHODS Patients with suspected coronary artery disease referred for adenosine-stress perfusion CMR were included (n = 395; 70% male; age 58 ± 13 years). The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, aborted sudden death, and revascularization after 90 days. Perfusion scans were assessed visually and with quantitative analysis. Cross-validated Cox regression analysis and net reclassification improvement were used to assess the incremental prognostic value of visual or quantitative perfusion analysis over a baseline clinical model, initially as continuous covariates, then using accepted thresholds of ≥2 segments or ≥10% myocardium. RESULTS After a median 460 days (interquartile range: 190 to 869 days) follow-up, 52 patients reached the primary endpoint. At 2 years, the addition of ischemic burden was found to increase prognostic value over a baseline model of age, sex, and late gadolinium enhancement (baseline model area under the curve [AUC]: 0.75; visual AUC: 0.84; quantitative AUC: 0.85). Dichotomized quantitative ischemic burden performed better than visual assessment (net reclassification improvement 0.043 vs. 0.003 against baseline model). CONCLUSIONS This study was the first to address the prognostic benefit of quantitative analysis of perfusion CMR and to support the use of consensus-based ischemic burden thresholds by perfusion CMR for prognostic evaluation of patients with suspected coronary artery disease. Quantitative analysis provided incremental prognostic value to visual assessment and established risk factors, potentially representing an important step forward in the translation of quantitative CMR perfusion analysis to the clinical setting.
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Affiliation(s)
- Eva C Sammut
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Bristol Heart Institute, Bristol, United Kingdom
| | - Adriana D M Villa
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Gabriella Di Giovine
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Luke Dancy
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Filippo Bosio
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Thomas Gibbs
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Swarna Jeyabraba
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | | | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Michael Marber
- Cardiovascular Division, King's College London, London, United Kingdom
| | - Khaled Alfakih
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Tevfik F Ismail
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
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O'Doherty J, Sammut E, Schleyer P, Stirling J, Nazir MS, Marsden PK, Chiribiri A. Feasibility of simultaneous PET-MR perfusion using a novel cardiac perfusion phantom. Eur J Hybrid Imaging 2017; 1:4. [PMID: 29782598 PMCID: PMC5954708 DOI: 10.1186/s41824-017-0008-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/01/2017] [Indexed: 01/29/2023] Open
Abstract
Background PET-MR scanners are beginning to be employed for quantitative myocardial perfusion imaging. In order to examine simultaneous perfusion calculations, this work describes a feasibility study of simultaneous PET-MR of gadolinium-based contrast agent (GBCA) and PET radiotracer in a novel cardiac perfusion phantom. Results [18F]F− and GBCA were injected simultaneously into a cardiac phantom using a range of ground-truth myocardial perfusion rates of 1 to 5 ml/g/min. PET quantification of K1 (ml/g/min) was performed using a single tissue compartment model. MR perfusion was calculated using a model-independent signal deconvolution technique. PET and MR signal traces from the phantom aorta and myocardial sections show true simultaneous PET and MR arterial input functions (AIF) and myocardial uptake respectively at each perfusion rate. Calculation of perfusion parameters showed both K1 and h(t = 0) (PET and MR perfusion parameters respectively) to be linearly related with the ground truth perfusion rate (PT), and also linearly related to each other (R2 = 0.99). The highest difference in perfusion values between K1 and PT was 16% at 1 ml/g/min, and the mean difference for all other perfusion rates was <3%. Conclusions The perfusion phantom allows accurate and reproducible simulation of the myocardial kinetics for simultaneous PET-MR imaging, and may find use in protocol design and development of PET-MR based quantification techniques and direct comparison of quantification of the two modalities.
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Affiliation(s)
- Jim O'Doherty
- 1Division of Imaging Sciences and Biomedical Engineering, PET Imaging Centre, King's College London, St. Thomas' Hospital, 1st Floor Lambeth Wing, St Thomas' Hospital, London, SE1 7EH UK
| | - Eva Sammut
- 2Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St. Thomas' Hospital, London, UK.,3Bristol Heart Institute, Bristol, UK
| | | | - James Stirling
- 1Division of Imaging Sciences and Biomedical Engineering, PET Imaging Centre, King's College London, St. Thomas' Hospital, 1st Floor Lambeth Wing, St Thomas' Hospital, London, SE1 7EH UK
| | - Muhummad Sohaib Nazir
- 2Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St. Thomas' Hospital, London, UK.,5Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul K Marsden
- 1Division of Imaging Sciences and Biomedical Engineering, PET Imaging Centre, King's College London, St. Thomas' Hospital, 1st Floor Lambeth Wing, St Thomas' Hospital, London, SE1 7EH UK
| | - Amedeo Chiribiri
- 2Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St. Thomas' Hospital, London, UK.,5Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Feher A, Sinusas AJ. Quantitative Assessment of Coronary Microvascular Function: Dynamic Single-Photon Emission Computed Tomography, Positron Emission Tomography, Ultrasound, Computed Tomography, and Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006427. [PMID: 28794138 DOI: 10.1161/circimaging.117.006427] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/26/2017] [Indexed: 01/09/2023]
Abstract
A healthy, functional microcirculation in combination with nonobstructed epicardial coronary arteries is the prerequisite of normal myocardial perfusion. Quantitative assessment in myocardial perfusion and determination of absolute myocardial blood flow can be achieved noninvasively using dynamic imaging with multiple imaging modalities. Extensive evidence supports the clinical value of noninvasively assessing indices of coronary flow for diagnosing coronary microvascular dysfunction; in certain diseases, the degree of coronary microvascular impairment carries important prognostic relevance. Although, currently positron emission tomography is the most commonly used tool for the quantification of myocardial blood flow, other modalities, including single-photon emission computed tomography, computed tomography, magnetic resonance imaging, and myocardial contrast echocardiography, have emerged as techniques with great promise for determination of coronary microvascular dysfunction. The following review will describe basic concepts of coronary and microvascular physiology, review available modalities for dynamic imaging for quantitative assessment of coronary perfusion and myocardial blood flow, and discuss their application in distinct forms of coronary microvascular dysfunction.
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Affiliation(s)
- Attila Feher
- From the Section of Cardiovascular Medicine, Department of Internal Medicine (A.F., A.J.S.) and Department of Radiology and Biomedical Imaging (A.J.S.), Yale University School of Medicine, New Haven, CT
| | - Albert J Sinusas
- From the Section of Cardiovascular Medicine, Department of Internal Medicine (A.F., A.J.S.) and Department of Radiology and Biomedical Imaging (A.J.S.), Yale University School of Medicine, New Haven, CT.
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Tandon A, James L, Henningsson M, Botnar RM, Potersnak A, Greil GF, Hussain T. A clinical combined gadobutrol bolus and slow infusion protocol enabling angiography, inversion recovery whole heart, and late gadolinium enhancement imaging in a single study. J Cardiovasc Magn Reson 2016; 18:66. [PMID: 27716273 PMCID: PMC5052797 DOI: 10.1186/s12968-016-0285-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/24/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The use of gadolinium contrast agents in cardiovascular magnetic resonance is well-established and serves to improve both vascular imaging as well as enable late gadolinium enhancement (LGE) imaging for tissue characterization. Currently, gadofosveset trisodium, an intravascular contrast agent, combined with a three-dimensional inversion recovery balanced steady state free precession (3D IR bSSFP) sequence, is commonly used in pediatric cardiac imaging and yields excellent vascular imaging, but cannot be used for late gadolinium enhancement. Gadofosveset use remains limited in clinical practice, and manufacture was recently halted, thus an alternative is needed to allow 3D IR bSSFP and LGE in the same study. METHODS Here we propose a protocol to give a bolus of 0.1 mL/kg = 0.1 mmol/kg gadobutrol (GADAVIST/GADOVIST) for time-resolved magnetic resonance angiography (MRA). Subsequently, 0.1 mmol/kg is diluted up to 5 or 7.5 mL with saline and then loaded into intravenous tubing connected to the patient. A 0.5 mL short bolus is infused, then a slow infusion is given at 0.02 or 0.03 mL/s. Image navigated (iNAV) 3D IR bSSFP imaging is initiated 45-60 s after the initiation of the infusion, with a total image acquisition time of ~5 min. If necessary, LGE imaging using phase sensitive inversion recovery reconstruction (PSIR) is performed at 10 min after the infusion is initiated. RESULTS We have successfully performed the above protocol with good image quality on 10 patients with both time-resolved MRA and 3D IR bSSFP iNAV imaging. Our initial attempts to use pencil beam respiratory navigation failed due to signal labeling in the liver by the navigator. We have also performed 2D PSIR LGE successfully, with both LGE positive and LGE negative results. CONCLUSION A bolus of gadobutrol, followed later by a slow infusion, allows time-resolved MRA, 3D IR bSSFP using the iNAV navigation technique, and LGE imaging, all in a single study with a single contrast agent.
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Affiliation(s)
- Animesh Tandon
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390 Texas USA
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390 Texas USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, 75235 Texas USA
| | - Lorraine James
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390 Texas USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, 75235 Texas USA
| | - Markus Henningsson
- Department of Imaging and Biomedical Engineering, King’s College London, London, UK
| | - René M. Botnar
- Department of Imaging and Biomedical Engineering, King’s College London, London, UK
- Pontificia Universidad Católica de Chile, Escuela de Ingeniería, Santiago, Chile
| | - Amanda Potersnak
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, 75235 Texas USA
| | - Gerald F. Greil
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390 Texas USA
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390 Texas USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, 75235 Texas USA
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390 Texas USA
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390 Texas USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, 75235 Texas USA
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Chatterjee N, Benefield BC, Harris KR, Fluckiger JU, Carroll T, Lee DC. An empirical method for reducing variability and complexity of myocardial perfusion quantification by dual bolus cardiac MRI. Magn Reson Med 2016; 77:2347-2355. [PMID: 27605488 DOI: 10.1002/mrm.26326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/02/2016] [Accepted: 06/08/2016] [Indexed: 11/07/2022]
Abstract
PURPOSE Myocardial perfusion can be quantified using the "dual bolus" technique, which uses two separate contrast boluses to avoid signal nonlinearity in the blood pool. This technique relies on knowing the precise ratio of contrast concentrations between the two boluses. In this study, we investigated the variability found in these ratios, as well as the error it introduces, and developed a method for correction. METHODS Five dogs received dual bolus myocardial perfusion MRI scans. Perfusion was calculated separately using assumed contrast dilution ratios and empirically determined contrast ratios. Perfusion was compared with reference standard fluorescent microspheres. The same technique was then applied to a cohort of six patients with no significant coronary artery stenosis by cardiac catheterization. RESULTS Assumed contrast dilution ratios were 10:1 for all animal and patient scans. Empirically derived contrast ratios were significantly different for animal (8.51:1 ± 1.53:1, P < 0.001) and patient scans (7.32:1 ± 2.27:1, P < 0.01). Incorporating empirically derived ratios for animal scans improved correlation with microspheres from 0.84 to 0.90 (P < 0.05). CONCLUSION Variability in dual bolus contrast concentration ratios is an important source of experimental error, especially outside of a carefully controlled laboratory setting. Empirically deriving the correct ratio is feasible and improves the accuracy of quantitative perfusion measurements. Magn Reson Med 77:2347-2355, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Neil Chatterjee
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
| | - Brandon C Benefield
- Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, Illinois, USA
| | - Kathleen R Harris
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Jacob U Fluckiger
- GE Medical, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Timothy Carroll
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
- University of Chicago, Department of Medical Physics, University of Chicago, Chicago, Illinois, USA
| | - Daniel C Lee
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
- Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, Illinois, USA
- GE Medical, Department of Medicine, Northwestern University, Chicago, Illinois, USA
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Zhang JL, Conlin CC, Carlston K, Xie L, Kim D, Morrell G, Morton K, Lee VS. Optimization of saturation-recovery dynamic contrast-enhanced MRI acquisition protocol: monte carlo simulation approach demonstrated with gadolinium MR renography. NMR IN BIOMEDICINE 2016; 29:969-77. [PMID: 27200499 PMCID: PMC5206992 DOI: 10.1002/nbm.3553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 03/13/2016] [Accepted: 04/11/2016] [Indexed: 05/18/2023]
Abstract
Dynamic contrast-enhanced (DCE) MRI is widely used for the measurement of tissue perfusion and to assess organ function. MR renography, which is acquired using a DCE sequence, can measure renal perfusion, filtration and concentrating ability. Optimization of the DCE acquisition protocol is important for the minimization of the error propagation from the acquired signals to the estimated parameters, thus improving the precision of the parameters. Critical to the optimization of contrast-enhanced T1 -weighted protocols is the balance of the T1 -shortening effect across the range of gadolinium (Gd) contrast concentration in the tissue of interest. In this study, we demonstrate a Monte Carlo simulation approach for the optimization of DCE MRI, in which a saturation-recovery T1 -weighted gradient echo sequence is simulated and the impact of injected dose (D) and time delay (TD, for saturation recovery) is tested. The results show that high D and/or high TD cause saturation of the peak arterial signals and lead to an overestimation of renal plasma flow (RPF) and glomerular filtration rate (GFR). However, the use of low TD (e.g. 100 ms) and low D leads to similar errors in RPF and GFR, because of the Rician bias in the pre-contrast arterial signals. Our patient study including 22 human subjects compared TD values of 100 and 300 ms after the injection of 4 mL of Gd contrast for MR renography. At TD = 100 ms, we computed an RPF value of 157.2 ± 51.7 mL/min and a GFR of 33.3 ± 11.6 mL/min. These results were all significantly higher than the parameter estimates at TD = 300 ms: RPF = 143.4 ± 48.8 mL/min (p = 0.0006) and GFR = 30.2 ± 11.5 mL/min (p = 0.0015). In conclusion, appropriate optimization of the DCE MRI protocol using simulation can effectively improve the precision and, potentially, the accuracy of the measured parameters. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jeff L. Zhang
- Correspondence to: J. L. Zhang, University of Utah School of Medicine, Department of Radiology, 729 Arapeend Dr., Salt Lake City, UT 84108, USA.
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Kober F, Jao T, Troalen T, Nayak KS. Myocardial arterial spin labeling. J Cardiovasc Magn Reson 2016; 18:22. [PMID: 27071861 PMCID: PMC4830031 DOI: 10.1186/s12968-016-0235-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/22/2016] [Indexed: 11/10/2022] Open
Abstract
Arterial spin labeling (ASL) is a cardiovascular magnetic resonance (CMR) technique for mapping regional myocardial blood flow. It does not require any contrast agents, is compatible with stress testing, and can be performed repeatedly or even continuously. ASL-CMR has been performed with great success in small-animals, but sensitivity to date has been poor in large animals and humans and remains an active area of research. This review paper summarizes the development of ASL-CMR techniques, current state-of-the-art imaging methods, the latest findings from pre-clinical and clinical studies, and future directions. We also explain how successful developments in brain ASL and small-animal ASL-CMR have helped to inform developments in large animal and human ASL-CMR.
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Affiliation(s)
- Frank Kober
- />Aix-Marseille Université, CNRS CRMBM UMR 7339, Centre de Résonance Magnétique Biologique et Médicale, Marseille, France
| | - Terrence Jao
- />Department of Biomedical Engineering, University of Southern California, Los Angeles, California USA
| | - Thomas Troalen
- />Aix-Marseille Université, CNRS CRMBM UMR 7339, Centre de Résonance Magnétique Biologique et Médicale, Marseille, France
| | - Krishna S. Nayak
- />Department of Biomedical Engineering, University of Southern California, Los Angeles, California USA
- />Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, California USA
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Villa ADM, Sammut E, Zarinabad N, Carr-White G, Lee J, Bettencourt N, Razavi R, Nagel E, Chiribiri A. Microvascular ischemia in hypertrophic cardiomyopathy: new insights from high-resolution combined quantification of perfusion and late gadolinium enhancement. J Cardiovasc Magn Reson 2016; 18:4. [PMID: 26767610 PMCID: PMC4714488 DOI: 10.1186/s12968-016-0223-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 01/05/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Microvascular ischemia is one of the hallmarks of hypertrophic cardiomyopathy (HCM) and has been associated with poor outcome. However, myocardial fibrosis, seen on cardiovascular magnetic resonance (CMR) as late gadolinium enhancement (LGE), can be responsible for rest perfusion defects in up to 30% of patients with HCM, potentially leading to an overestimation of the ischemic burden. We investigated the effect of left ventricle (LV) scar on the total LV ischemic burden using novel high-resolution perfusion analysis techniques in conjunction with LGE quantification. METHODS 30 patients with HCM and unobstructed epicardial coronary arteries underwent CMR with Fermi constrained quantitative perfusion analysis on segmental and high-resolution data. The latter were corrected for the presence of fibrosis on a pixel-by-pixel basis. RESULTS High-resolution quantification proved more sensitive for the detection of microvascular ischemia in comparison to segmental analysis. Areas of LGE were associated with significant reduction of myocardial perfusion reserve (MPR) leading to an overestimation of the total ischemic burden on non-corrected perfusion maps. Using a threshold MPR of 1.5, the presence of LGE caused an overestimation of the ischemic burden of 28%. The ischemic burden was more severe in patients with fibrosis, also after correction of the perfusion maps, in keeping with more severe disease in this subgroup. CONCLUSIONS LGE is an important confounder in the assessment of the ischemic burden in patients with HCM. High-resolution quantitative analysis with LGE correction enables the independent evaluation of microvascular ischemia and fibrosis and should be used when evaluating patients with HCM.
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Affiliation(s)
- Adriana D M Villa
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | - Eva Sammut
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | - Niloufar Zarinabad
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | | | - Jack Lee
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | | | - Reza Razavi
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | - Eike Nagel
- DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt / Main, Frankfurt am Main, Germany.
| | - Amedeo Chiribiri
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute - 4th Floor Lambeth Wing, St Thomas' Hospital, SE1 7EH, London, UK.
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Chiribiri A, Villa ADM, Sammut E, Breeuwer M, Nagel E. Perfusion dyssynchrony analysis. Eur Heart J Cardiovasc Imaging 2015; 17:1414-1423. [PMID: 26705485 PMCID: PMC5155575 DOI: 10.1093/ehjci/jev326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 11/08/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS We sought to describe perfusion dyssynchrony analysis specifically to exploit the high temporal resolution of stress perfusion CMR. This novel approach detects differences in the temporal distribution of the wash-in of contrast agent across the left ventricular wall. METHODS AND RESULTS Ninety-eight patients with suspected coronary artery disease (CAD) were retrospectively identified. All patients had undergone perfusion CMR at 3T and invasive angiography with fractional flow reserve (FFR) of lesions visually judged >50% stenosis. Stress images were analysed using four different perfusion dyssynchrony indices: the variance and coefficient of variation of the time to maximum signal upslope (V-TTMU and C-TTMU) and the variance and coefficient of variation of the time to peak myocardial signal enhancement (V-TTP and C-TTP). Patients were classified according to the number of vessels with haemodynamically significant CAD indicated by FFR <0.8. All indices of perfusion dyssynchrony were capable of identifying the presence of significant CAD. C-TTP >10% identified CAD with sensitivity 0.889, specificity 0.857 (P < 0.0001). All indices correlated with the number of diseased vessels. C-TTP >12% identified multi-vessel disease with sensitivity 0.806, specificity 0.657 (P < 0.0001). C-TTP was also the dyssynchrony index with the best inter- and intra-observer reproducibility. Perfusion dyssynchrony indices showed weak correlation with other invasive and non-invasive measurements of the severity of ischaemia, including FFR, visual ischaemic burden, and MPR. CONCLUSION These findings suggest that perfusion dyssynchrony analysis is a robust novel approach to the analysis of first-pass perfusion and has the potential to add complementary information to aid assessment of CAD.
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Affiliation(s)
- Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, Department of Cardiovascular Imaging, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Adriana D M Villa
- Division of Imaging Sciences and Biomedical Engineering, Department of Cardiovascular Imaging, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Eva Sammut
- Division of Imaging Sciences and Biomedical Engineering, Department of Cardiovascular Imaging, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Marcel Breeuwer
- Philips Healthcare, Imaging Systems-MR Eindhoven, The Netherlands.,Eindhoven University of Technology, Biomedical Engineering, Biomedical Image Analysis, Eindhoven, The Netherlands
| | - Eike Nagel
- Division of Imaging Sciences and Biomedical Engineering, Department of Cardiovascular Imaging, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK.,DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt/Main, Frankfurt am Main, Germany
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A Comparison of Theory-Based and Experimentally Determined Myocardial Signal Intensity Correction Methods in First-Pass Perfusion Magnetic Resonance Imaging. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:843741. [PMID: 26491465 PMCID: PMC4605224 DOI: 10.1155/2015/843741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/24/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the impact of correcting myocardial signal saturation on the accuracy of absolute myocardial blood flow (MBF) measurements. MATERIALS AND METHODS We performed 15 dual bolus first-pass perfusion studies in 7 dogs during global coronary vasodilation and variable degrees of coronary artery stenosis. We compared microsphere MBF to MBF calculated from uncorrected and corrected MRI signal. Four correction methods were tested, two theoretical methods (Th1 and Th2) and two empirical methods (Em1 and Em2). RESULTS The correlations with microsphere MBF (n = 90 segments) were: uncorrected (y = 0.47x + 1.1, r = 0.70), Th1 (y = 0.53x + 1.0, r = 0.71), Th2 (y = 0.62x + 0.86, r = 0.73), Em1 (y = 0.82x + 0.86, r = 0.77), and Em2 (y = 0.72x + 0.84, r = 0.75). All corrected methods were not significantly different from microspheres, while uncorrected MBF values were significantly lower. For the top 50% of microsphere MBF values, flows were significantly underestimated by uncorrected SI (31%), Th1 (25%), and Th2 (19%), while Em1 (1%), and Em2 (9%) were similar to microsphere MBF. CONCLUSIONS Myocardial signal saturation should be corrected prior to flow modeling to avoid underestimation of MBF by MR perfusion imaging.
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