Undersampled cine 3D tagging for rapid assessment of cardiac motion

Highly accelerated free-breathing real-time myocardial tagging for exercise cardiovascular magnetic resonance

BACKGROUND

Exercise cardiovascular magnetic resonance (Ex-CMR) myocardial tagging would enable quantification of myocardial deformation after exercise. However, current electrocardiogram (ECG)-segmented sequences are limited for Ex-CMR.

METHODS

We developed a highly accelerated balanced steady-state free-precession real-time tagging technique for 3 T. A 12-fold acceleration was achieved using incoherent sixfold random Cartesian sampling, twofold truncated outer phase encoding, and a deep learning resolution enhancement model. The technique was tested in two prospective studies. In a rest study of 27 patients referred for clinical CMR and 19 healthy subjects, a set of ECG-segmented for comparison and two sets of real-time tagging images for repeatability assessment were collected in 2-chamber and short-axis views with spatiotemporal resolution 2.0 × 2.0 mm2 and 29 ms. In an Ex-CMR study of 26 patients with known or suspected cardiac disease and 23 healthy subjects, real-time images were collected before and after exercise. Deformation was quantified using measures of short-axis global circumferential strain (GCS). Two experienced CMR readers evaluated the image quality of all real-time data pooled from both studies using a 4-point Likert scale for tagline quality (1-excellent; 2-good; 3-moderate; 4-poor) and artifact level (1-none; 2-minimal; 3-moderate; 4-significant). Statistical evaluation included Pearson correlation coefficient (r), intraclass correlation coefficient (ICC), and coefficient of variation (CoV).

RESULTS

In the rest study, deformation was successfully quantified in 90% of cases. There was a good correlation (r = 0.71) between ECG-segmented and real-time measures of GCS, and repeatability was good to excellent (ICC = 0.86 [0.71, 0.94]) with a CoV of 4.7%. In the Ex-CMR study, deformation was successfully quantified in 96% of subjects pre-exercise and 84% of subjects post-exercise. Short-axis and 2-chamber tagline quality were 1.6 ± 0.7 and 1.9 ± 0.8 at rest and 1.9 ± 0.7 and 2.5 ± 0.8 after exercise, respectively. Short-axis and 2-chamber artifact level was 1.2 ± 0.5 and 1.4 ± 0.7 at rest and 1.3 ± 0.6 and 1.5 ± 0.8 post-exercise, respectively.

CONCLUSION

We developed a highly accelerated real-time tagging technique and demonstrated its potential for Ex-CMR quantification of myocardial deformation. Further studies are needed to assess the clinical utility of our technique.

Quantification of left ventricular strain and torsion by joint analysis of 3D tagging and cine MR images

Cardiovascular magnetic resonance (CMR) imaging is the gold standard for the non-invasive assessment of left-ventricular (LV) function. Prognostic value of deformation metrics extracted directly from regular SSFP CMR images has been shown by numerous studies in the clinical setting, but with some limitations to detect torsion of the myocardium. Tagged CMR introduces trackable features in the myocardium that allow for the assessment of local myocardial deformation, including torsion; it is, however, limited in the quantification of radial strain, which is a decisive metric for assessing the contractility of the heart. In order to improve SSFP-only and tagged-only approaches, we propose to combine the advantages of both image types by fusing global shape motion obtained from SSFP images with the local deformation obtained from tagged images. To this end, tracking is first performed on SSFP images, and subsequently, the resulting motion is utilized to mask and track tagged data. Our implementation is based on a recent finite element-based motion tracking tool with mechanical regularization. Joint SSFP and tagged images registration performance is assessed based on deformation metrics including LV strain and twist using human and in-house porcine datasets. Results show that joint analysis of SSFP and 3DTAG images provides better quantification of LV strain and twist as either data source alone.

In-silico study of accuracy and precision of left-ventricular strain quantification from 3D tagged MRI

Cardiac Magnetic Resonance Imaging (MRI) allows quantifying myocardial tissue deformation and strain based on the tagging principle. In this work, we investigate accuracy and precision of strain quantification from synthetic 3D tagged MRI using equilibrated warping. To this end, synthetic biomechanical left-ventricular tagged MRI data with varying tag distance, spatial resolution and signal-to-noise ratio (SNR) were generated and processed to quantify errors in radial, circumferential and longitudinal strains relative to ground truth. Results reveal that radial strain is more sensitive to image resolution and noise than the other strain components. The study also shows robustness of quantifying circumferential and longitudinal strain in the presence of geometrical inconsistencies of 3D tagged data. In conclusion, our study points to the need for higher-resolution 3D tagged MRI than currently available in practice in order to achieve sufficient accuracy of radial strain quantification.

Equilibrated warping: Finite element image registration with finite strain equilibrium gap regularization

In this paper, we propose a novel continuum finite strain formulation of the equilibrium gap regularization for image registration. The equilibrium gap regularization essentially penalizes any deviation from the solution of a hyperelastic body in equilibrium with arbitrary loads prescribed at the boundary. It thus represents a regularization with strong mechanical basis, especially suited for cardiac image analysis. We describe the consistent linearization and discretization of the regularized image registration problem, in the framework of the finite elements method. The method is implemented using FEniCS & VTK, and distributed as a freely available python library. We show that the equilibrated warping method is effective and robust: regularization strength and image noise have minimal impact on motion tracking, especially when compared to strain-based regularization methods such as hyperelastic warping. We also show that equilibrated warping is able to extract main deformation features on both tagged and untagged cardiac magnetic resonance images.

Second-order motion compensated PRESS for cardiac spectroscopy

PURPOSE

Second-order motion compensation for point-resolved spectroscopy (PRESS) is proposed to allow for robust single-voxel cardiac spectroscopy throughout the entire cardiac cycle and at various heart rates.

METHODS

Bipolar FID spoiling gradient pairs compensating for first and second-order motion were designed and implemented into a cardiac-triggered PRESS sequence on a clinical MR system. A numerical three-dimensional model of cardiac motion was used to optimize and validate the gradient waveforms. In vivo measurements in healthy volunteers were obtained to assess the signal-to-noise ratio (SNR) and triglyceride-to-water ratio (TG/W). SNR gains and variability of TG/W of the proposed approach were evaluated against a conventional PRESS sequence with optimized gradients.

RESULTS

The proposed sequence increases the mean SNR by 32% (W) and 23% (TG) on average with significantly lower variability for different trigger delays. The variability of TG/W quantification over the cardiac cycle is significantly decreased with second-order motion compensated PRESS when compared with conventional PRESS with reduced-spoiler gradients (coefficient of variation: 0.1 ± 0.02 versus 0.37 ± 0.26).

CONCLUSION

Second-order motion compensated PRESS effectively reduces cardiac motion-induced signal degradation during FID spoiling, providing higher SNR and less variability for TG/W quantification. The sequence is considered promising to assess the TG/W modulation during various interventions including pharmacologically induced stress. Magn Reson Med 77:57-64, 2017. © 2016 Wiley Periodicals, Inc.

Multi-oriented windowed harmonic phase reconstruction for robust cardiac strain imaging

The purpose of this paper is to develop a method for direct estimation of the cardiac strain tensor by extending the harmonic phase reconstruction on tagged magnetic resonance images to obtain more precise and robust measurements. The extension relies on the reconstruction of the local phase of the image by means of the windowed Fourier transform and the acquisition of an overdetermined set of stripe orientations in order to avoid the phase interferences from structures outside the myocardium and the instabilities arising from the application of a gradient operator. Results have shown that increasing the number of acquired orientations provides a significant improvement in the reproducibility of the strain measurements and that the acquisition of an extended set of orientations also improves the reproducibility when compared with acquiring repeated samples from a smaller set of orientations. Additionally, biases in local phase estimation when using the original harmonic phase formulation are greatly diminished by the one here proposed. The ideas here presented allow the design of new methods for motion sensitive magnetic resonance imaging, which could simultaneously improve the resolution, robustness and accuracy of motion estimates.

Review of Journal of Cardiovascular Magnetic Resonance 2013

There were 109 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2013, which is a 21% increase on the 90 articles published in 2012. The quality of the submissions continues to increase. The editors are delighted to report that the 2012 JCMR Impact Factor (which is published in June 2013) has risen to 5.11, up from 4.44 for 2011 (as published in June 2012), a 15% increase and taking us through the 5 threshold for the first time. The 2012 impact factor means that the JCMR papers that were published in 2010 and 2011 were cited on average 5.11 times in 2012. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is <25% and has been falling because the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.

Review of Journal of Cardiovascular Magnetic Resonance 2012

There were 90 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2012, which is an 8% increase in the number of articles since 2011. The quality of the submissions continues to increase. The editors are delighted to report that the 2011 JCMR Impact Factor (which is published in June 2012) has risen to 4.44, up from 3.72 for 2010 (as published in June 2011), a 20% increase. The 2011 impact factor means that the JCMR papers that were published in 2009 and 2010 were cited on average 4.44 times in 2011. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is approximately 25%, and has been falling as the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.