A medical device-grade T1 and ECV phantom for global T1 mapping quality assurance-the T1 Mapping and ECV Standardization in cardiovascular magnetic resonance (T1MES) program

T1 and T2 measurements across multiple 0.55T MRI systems using open-source vendor-neutral sequences

PURPOSE

To compare T1 and T2 measurements across commercial and prototype 0.55T MRI systems in both phantom and healthy participants using the same vendor-neutral pulse sequences, reconstruction, and analysis methods.

METHODS

Standard spin echo measurements and abbreviated protocol measurements of T1, B1, and T2 were made on two prototype 0.55 T systems and two commercial 0.55T systems using an ISMRM/NIST system phantom. Additionally, five healthy participants were imaged at each system using the abbreviated protocol for T1, B1, and T2 measurement. The phantom measurements were compared to NMR-based reference measurements to determine accuracy, and both phantom and in vivo measurements were compared to assess reproducibility and differences between the prototype and commercial systems.

RESULTS

Vendor-neutral sequences were implemented across all four systems, and the code for pulse sequences and reconstruction is freely available. For participants, there was no difference in the mean T1 and T2 relaxation times between the prototype and commercial systems. In the phantom, there were no significant differences between the prototype and commercial systems for T1 and T2 measurements using the abbreviated protocol.

CONCLUSION

Quantitative T1 and T2 measurements at 0.55T in phantom and healthy participants are not statistically different across the prototype and commercial systems.

Generalized inhomogeneity-resilient relaxation along a fictitious field (girRAFF) for improved robustness in rotating frame relaxometry at 3T

PURPOSE

To optimize Relaxation along a Fictitious Field (RAFF) pulses for rotating frame relaxometry with improved robustness in the presence ofB 0 $$ {\mathrm{B}}_0 $$ andB 1 + $$ {\mathrm{B}}_1^{+} $$ field inhomogeneities.

METHODS

The resilience of RAFF pulses againstB 0 $$ {\mathrm{B}}_0 $$ andB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities was studied using Bloch simulations. A parameterized extension of the RAFF formulation was introduced and used to derive a generalized inhomogeneity-resilient RAFF (girRAFF) pulse. RAFF and girRAFF preparation efficiency, defined as the ratio of the longitudinal magnetization before and after the preparation (M z ( T p ) / M 0 $$ {M}_z\left({T}_p\right)/{M}_0 $$ ), were simulated and validated in phantom experiments.T RAFF $$ {T}_{\mathrm{RAFF}} $$ andT girRAFF $$ {T}_{\mathrm{girRAFF}} $$ parametric maps were acquired at 3T in phantom, the calf muscle, and the knee cartilage of healthy subjects. The relaxation time maps were analyzed for resilience against artificially induced field inhomogeneities and assessed in terms of in vivo reproducibility.

RESULTS

Optimized girRAFF preparations yielded improved preparation efficiency (0.95/0.91 simulations/phantom) with respect to RAFF (0.36/0.67 simulations/phantom).T girRAFF $$ {T}_{\mathrm{girRAFF}} $$ preparations showed in phantom/calf 6.0/4.8 times higher resilience toB 0 $$ {\mathrm{B}}_0 $$ inhomogeneities than RAFF, and a 4.7/5.3 improved resilience toB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities. In the knee cartilage,T girRAFF $$ {T}_{\mathrm{girRAFF}} $$ (53± $$ \pm $$ 14 ms) was higher thanT RAFF $$ {T}_{\mathrm{RAFF}} $$ (42± $$ \pm $$ 11 ms). Moreover, girRAFF preparations yielded 7.6/4.9 times improved reproducibility acrossB 0 $$ {\mathrm{B}}_0 $$ /B 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneity conditions, 1.9 times better reproducibility across subjects and 1.2 times across slices compared with RAFF. Dixon-based fat suppression led to a further 15-fold improvement in the robustness of girRAFF to inhomogeneities.

CONCLUSIONS

RAFF pulses display residual sensitivity to off-resonance and pronounced sensitivity toB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities. Optimized girRAFF pulses provide increased robustness and may be an appealing alternative for applications where resilience against field inhomogeneities is required.

Preparation-based B 1 + mapping in the heart using Bloch-Siegert shifts

PURPOSE

To develop and evaluate a robust cardiacB 1 + $$ {\mathrm{B}}_1^{+} $$ mapping sequence at 3 T, using Bloch-Siegert shift (BSS)-based preparations.

METHODS

A longitudinal magnetization preparation module was designed to encode| B 1 + | $$ \mid {\mathrm{B}}_1^{+}\mid $$ . After magnetization tip-down, off-resonant Fermi pulses, placed symmetrically around two refocusing pulses, induced BSS, followed by tipping back of the magnetization. Bloch simulations were used to optimize refocusing pulse parameters and to assess the mapping sensitivity. Relaxation-inducedB 1 + $$ {\mathrm{B}}_1^{+} $$ error was simulated for variousT 1 $$ {\mathrm{T}}_1 $$ /T 2 $$ {\mathrm{T}}_2 $$ times. The effective mapping range was determined in phantom experiments, and| B 1 + | $$ \mid {\mathrm{B}}_1^{+}\mid $$ maps were compared to the conventional BSS method and subadiabatic hyperbolic-secant 8 (HS8) pulse-sensitized method. CardiacB 1 + $$ {\mathrm{B}}_1^{+} $$ maps were acquired in healthy subjects, and evaluated for repeatability and imaging plane intersection consistency. The technique was modified for three-dimensional (3D) acquisition of the whole heart in a single breath-hold, and compared to two-dimensional (2D) acquisition.

RESULTS

Simulations indicate that the proposed preparation can be tailored to achieve high mapping sensitivity across variousB 1 + $$ {\mathrm{B}}_1^{+} $$ ranges, with maximum sensitivity at the upperB 1 + $$ {\mathrm{B}}_1^{+} $$ range.T 1 $$ {\mathrm{T}}_1 $$ /T 2 $$ {\mathrm{T}}_2 $$ -induced bias did not exceed 5.2% $$ \% $$ . Experimentally reproducedB 1 + $$ {\mathrm{B}}_1^{+} $$ sensitization closely matched simulations forB 1 + ≥ 0 . 3 B 1 , max + $$ {\mathrm{B}}_1^{+}\ge 0.3{\mathrm{B}}_{1,\max}^{+} $$ (mean difference 0.031± $$ \pm $$ 0.022, compared to 0.018± $$ \pm $$ 0.025 in the HS8-sensitized method), and showed 20-fold reduction in the standard deviation of repeated scans, compared with conventional BSSB 1 + $$ {\mathrm{B}}_1^{+} $$ mapping, and an equivalent 2-fold reduction compared with HS8-sensitization. Robust cardiacB 1 + $$ {\mathrm{B}}_1^{+} $$ map quality was obtained, with an average test-retest variability of 0.027± $$ \pm $$ 0.043 relative to normalizedB 1 + $$ {\mathrm{B}}_1^{+} $$ magnitude, and plane intersection bias of 0.052± $$ \pm $$ 0.031. 3D acquisitions showed good agreement with 2D scans (mean absolute deviation 0.055± $$ \pm $$ 0.061).

CONCLUSION

BSS-based preparations enable robust and tailorable 2D/3D cardiacB 1 + $$ {\mathrm{B}}_1^{+} $$ mapping at 3 T in a single breath-hold.

Simultaneous 3D T 1 $$ {\mathrm{T}}_1 $$ , T 2 $$ {\mathrm{T}}_2 $$ , and fat-signal-fraction mapping with respiratory-motion correction for comprehensive liver tissue characterization at 0.55 T

PURPOSE

To develop a framework for simultaneous three-dimensional (3D) mapping ofT 1 $$ {\mathrm{T}}_1 $$ ,T 2 $$ {\mathrm{T}}_2 $$ , and fat signal fraction in the liver at 0.55 T.

METHODS

The proposed sequence acquires four interleaved 3D volumes with a two-echo Dixon readout.T 1 $$ {\mathrm{T}}_1 $$ andT 2 $$ {\mathrm{T}}_2 $$ are encoded into each volume via preparation modules, and dictionary matching allows simultaneous estimation ofT 1 $$ {\mathrm{T}}_1 $$ ,T 2 $$ {\mathrm{T}}_2 $$ , andM 0 $$ {M}_0 $$ for water and fat separately. 2D image navigators permit respiratory binning, and motion fields from nonrigid registration between bins are used in a nonrigid respiratory-motion-corrected reconstruction, enabling 100% scan efficiency from a free-breathing acquisition. The integrated nature of the framework ensures the resulting maps are always co-registered.

RESULTS

T 1 $$ {\mathrm{T}}_1 $$ ,T 2 $$ {\mathrm{T}}_2 $$ , and fat-signal-fraction measurements in phantoms correlated strongly (adjustedr 2 > 0 . 98 $$ {r}^2>0.98 $$ ) with reference measurements. Mean liver tissue parameter values in 10 healthy volunteers were427 ± 22 $$ 427\pm 22 $$ ,47 . 7 ± 3 . 3   ms $$ 47.7\pm 3.3\;\mathrm{ms} $$ , and7 ± 2 % $$ 7\pm 2\% $$ forT 1 $$ {\mathrm{T}}_1 $$ ,T 2 $$ {\mathrm{T}}_2 $$ , and fat signal fraction, giving biases of71 $$ 71 $$ ,- 30 . 0   ms $$ -30.0\;\mathrm{ms} $$ , and- 5 $$ -5 $$ percentage points, respectively, when compared to conventional methods.

CONCLUSION

A novel sequence for comprehensive characterization of liver tissue at 0.55 T was developed. The sequence provides co-registered 3DT 1 $$ {\mathrm{T}}_1 $$ ,T 2 $$ {\mathrm{T}}_2 $$ , and fat-signal-fraction maps with full coverage of the liver, from a single nine-and-a-half-minute free-breathing scan. Further development is needed to achieve accurate proton-density fat fraction (PDFF) estimation in vivo.

Myocardial T1 mapping using an instantaneous signal loss simulation modeling and a Bayesian estimation method: A robust T1 extraction method free of tuning parameters

The Instantaneous Signal Loss Simulation (InSiL) model is a promising alternative to the classical mono-exponential fitting of the Modified Look-Locker Inversion-recovery (MOLLI) sequence in cardiac T1 mapping applications, which achieves better accuracy and is less sensitive to heart rate (HR) variations. Classical non-linear least squares (NLLS) estimation methods require some parameters of the model to be fixed a priori in order to give reliable T1 estimations and avoid outliers. This introduces further bias in the estimation, reducing the advantages provided by the InSiL model. In this paper, a novel Bayesian estimation method using a hierarchical model is proposed to fit the parameters of the InSiL model. The hierarchical Bayesian modeling has a shrinkage effect that works as a regularizer for the estimated values, by pulling spurious estimated values toward the group-mean, hence reducing greatly the number of outliers. Simulations, physical phantoms, and in-vivo human cardiac data have been used to show that this approach estimates accurately all the InSiL parameters, and achieve high precision estimation of the T1 compared to the classical MOLLI model and NLLS InSiL estimation.

GRASP reconstruction amplified with view-sharing and KWIC filtering reduces underestimation of peak velocity in highly-accelerated real-time phase-contrast MRI: A preliminary evaluation in pediatric patients with congenital heart disease

PURPOSE

To develop a highly-accelerated, real-time phase contrast (rtPC) MRI pulse sequence with 40 fps frame rate (25 ms effective temporal resolution).

METHODS

Highly-accelerated golden-angle radial sparse parallel (GRASP) with over regularization may result in temporal blurring, which in turn causes underestimation of peak velocity. Thus, we amplified GRASP performance by synergistically combining view-sharing (VS) and k-space weighted image contrast (KWIC) filtering. In 17 pediatric patients with congenital heart disease (CHD), the conventional GRASP and the proposed GRASP amplified by VS and KWIC (or GRASP + VS + KWIC) reconstruction for rtPC MRI were compared with respect to clinical standard PC MRI in measuring hemodynamic parameters (peak velocity, forward volume, backward volume, regurgitant fraction) at four locations (aortic valve, pulmonary valve, left and right pulmonary arteries).

RESULTS

The proposed reconstruction method (GRASP + VS + KWIC) achieved better effective spatial resolution (i.e., image sharpness) compared with conventional GRASP, ultimately reducing the underestimation of peak velocity from 17.4% to 6.4%. The hemodynamic metrics (peak velocity, volumes) were not significantly (p > 0.99) different between GRASP + VS + KWIC and clinical PC, whereas peak velocity was significantly (p < 0.007) lower for conventional GRASP. RtPC with GRASP + VS + KWIC also showed the ability to assess beat-to-beat variation and detect the highest peak among peaks.

CONCLUSION

The synergistic combination of GRASP, VS, and KWIC achieves 25 ms effective temporal resolution (40 fps frame rate), while minimizing the underestimation of peak velocity compared with conventional GRASP.

STEAM-SASHA: a novel approach for blood- and fat-suppressed native T1 measurement in the right ventricular myocardium

OBJECTIVE

The excellent blood and fat suppression of stimulated echo acquisition mode (STEAM) can be combined with saturation recovery single-shot acquisition (SASHA) in a novel STEAM-SASHA sequence for right ventricular (RV) native T1 mapping.

MATERIALS AND METHODS

STEAM-SASHA splits magnetization preparation over two cardiac cycles, nulling blood signal and allowing fat signal to decay. Breath-hold T1 mapping was performed in a T1 phantom and twice in 10 volunteers using STEAM-SASHA and a modified Look-Locker sequence at peak systole at 3T. T1 was measured in 3 RV regions, the septum and left ventricle (LV).

RESULTS

In phantoms, MOLLI under-estimated while STEAM-SASHA over-estimated T1, on average by 3.0% and 7.0% respectively, although at typical 3T myocardial T1 (T1 > 1200 ms) STEAM-SASHA was more accurate. In volunteers, T1 was higher using STEAM-SASHA than MOLLI in the LV and septum (p = 0.03, p = 0.006, respectively), but lower in RV regions (p > 0.05). Inter-study, inter-observer and intra-observer coefficients of variation in all regions were < 15%. Blood suppression was excellent with STEAM-SASHA and noise floor effects were minimal.

DISCUSSION

STEAM-SASHA provides accurate and reproducible T1 in the RV with excellent blood and fat suppression. STEAM-SASHA has potential to provide new insights into pathological changes in the RV in future studies.

Phantom study investigating the repeatability of radiomic features with alteration of image acquisition parameters in magnetic resonance imaging

BACKGROUND

Magnetic resonance imaging (MRI) has many different alterable parameters that affect how an image appears. This is relevant in radiomics which produces quantitative features through analysis of medical images. One significant acknowledged limitation of radiomics is repeatability. This phantom study aims to further investigate the repeatability of radiomic features (RaF), within MRI, across a range of different echo (TE) and repetition times (TR).

METHODS

A phantom was scanned 10 times under identical conditions on a 3T scanner using head coil over 4 months. The TE ranged from 80 to 110 ms while the TR from 3000 to 5000 ms. Radiomics analysis was performed on the same segmented section of the phantom across all TE and TR combinations. Intraclass Correlation Coefficient (ICC) was calculated across the different TE and TR ranges to investigate the repeatability of RaF.

RESULTS

Of 1596 features calculated, 187 features had ICC >0.9 across the range of TE, while 82 features had an ICC >0.9 across a range of TR. 664 had ICC >0.75 across the range of TEs, with 541 across the range of TR values. There was an overlap of 51 features with ICC >0.9.

CONCLUSION

Repeatability of RaF in MRI is dependent on imaging parameters and careful consideration of these, in combination with variable selection, is required when applying radiomics to MRI.

Technical development and feasibility of a reusable vest to integrate cardiovascular magnetic resonance with electrocardiographic imaging

BACKGROUND

Electrocardiographic imaging (ECGI) generates electrophysiological (EP) biomarkers while cardiovascular magnetic resonance (CMR) imaging provides data about myocardial structure, function and tissue substrate. Combining this information in one examination is desirable but requires an affordable, reusable, and high-throughput solution. We therefore developed the CMR-ECGI vest and carried out this technical development study to assess its feasibility and repeatability in vivo.

METHODS

CMR was prospectively performed at 3T on participants after collecting surface potentials using the locally designed and fabricated 256-lead ECGI vest. Epicardial maps were reconstructed to generate local EP parameters such as activation time (AT), repolarization time (RT) and activation recovery intervals (ARI). 20 intra- and inter-observer and 8 scan re-scan repeatability tests.

RESULTS

77 participants were recruited: 27 young healthy volunteers (HV, 38.9 ± 8.5 years, 35% male) and 50 older persons (77.0 ± 0.1 years, 52% male). CMR-ECGI was achieved in all participants using the same reusable, washable vest without complications. Intra- and inter-observer variability was low (correlation coefficients [rs] across unipolar electrograms = 0.99 and 0.98 respectively) and scan re-scan repeatability was high (rs between 0.81 and 0.93). Compared to young HV, older persons had significantly longer RT (296.8 vs 289.3 ms, p = 0.002), ARI (249.8 vs 235.1 ms, p = 0.002) and local gradients of AT, RT and ARI (0.40 vs 0.34 ms/mm, p = 0,01; 0.92 vs 0.77 ms/mm, p = 0.03; and 1.12 vs 0.92 ms/mm, p = 0.01 respectively).

CONCLUSION

Our high-throughput CMR-ECGI solution is feasible and shows good reproducibility in younger and older participants. This new technology is now scalable for high throughput research to provide novel insights into arrhythmogenesis and potentially pave the way for more personalised risk stratification.

CLINICAL TRIAL REGISTRATION

Title: Multimorbidity Life-Course Approach to Myocardial Health-A Cardiac Sub-Study of the MRC National Survey of Health and Development (NSHD) (MyoFit46). National Clinical Trials (NCT) number: NCT05455125. URL: https://clinicaltrials.gov/ct2/show/NCT05455125?term=MyoFit&draw=2&rank=1.

Rapid Whole-Knee Quantification of Cartilage Using T1, T2*, and TRAFF2 Mapping With Magnetic Resonance Fingerprinting

OBJECTIVE

Quantitative Magnetic Resonance Imaging (MRI) holds great promise for the early detection of cartilage deterioration. Here, a Magnetic Resonance Fingerprinting (MRF) framework is proposed for comprehensive and rapid quantification of T1, T2*, and TRAFF2 with whole-knee coverage.

METHODS

A MRF framework was developed to achieve quantification of Relaxation Along a Fictitious Field in the 2nd rotating frame of reference ( TRAFF2) along with T1 and T2*. The proposed sequence acquires 65 measurements of 25 high-resolution slices, interleaved with 7 inversion pulses and 40 RAFF2 trains, for whole-knee quantification in a total acquisition time of 3:25 min. Comparison with reference T1, T2*, and TRAFF2 methods was performed in phantom and in seven healthy subjects at 3 T. Repeatability (test-retest) with and without repositioning was also assessed.

RESULTS

Phantom measurements resulted in good agreement between MRF and the reference with mean biases of -54, 2, and 5 ms for T1, T2*, and TRAFF2, respectively. Complete characterization of the whole-knee cartilage was achieved for all subjects, and, for the femoral and tibial compartments, a good agreement between MRF and reference measurements was obtained. Across all subjects, the proposed MRF method yielded acceptable repeatability without repositioning ( R2 ≥ 0.94) and with repositioning ( R2 ≥ 0.57) for T1, T2*, and TRAFF2.

SIGNIFICANCE

The short scan time combined with the whole-knee coverage makes the proposed MRF framework a promising candidate for the early assessment of cartilage degeneration with quantitative MRI, but further research may be warranted to improve repeatability after repositioning and assess clinical value in patients.

High resolution single-shot myocardial imaging using bSSFP with wave encoding

BACKGROUND

Single-shot balanced steady-state free precession (bSSFP) sequence is widely used in cardiac imaging. However, the limited scan time in one heartbeat greatly hinders its spatial resolution compared to the segmented acquisition mode. Therefore, a highly accelerated single-shot bSSFP imaging technology is needed for clinical use.

PURPOSE

To develop and evaluate a wave-encoded bSSFP sequence with high acceleration rates for single-shot myocardial imaging.

METHODS

The proposed Wave-bSSFP method is implemented by adding a sinusoidal wave gradient in the phase encoding direction during the readout of bSSFP sequence. Uniform undersampling is used for acceleration. Its performance was first validated via phantom studies by comparison with conventional bSSFP. Then it was evaluated in volunteer studies via anatomical imaging, T2 -prepared bSSFP, and T1 mapping in in-vivo cardiac imaging. All methods were compared with accelerated conventional bSSFP reconstructed using iterative SENSE and compressed sensing (CS), to demonstrate the advantage of wave encoding in suppressing the noise amplification and artifacts induced by acceleration.

RESULTS

The proposed Wave-bSSFP method achieved a high acceleration factor of 4 for single-shot acquisitions. The proposed method showed lower average g-factors than bSSFP, and fewer blurring artifacts than CS reconstruction. The Wave-bSSFP with R = 4 achieved higher spatial and temporal resolutions compared with the conventional bSSFP with R = 2 in several applications such as T2 -prepared bSSFP and T1 mapping, and could be applied in systolic imaging.

CONCLUSION

Wave encoding can be used to highly accelerate 2D bSSFP imaging with single-shot acquisitions. Compared with the conventional bSSFP sequence, the proposed Wave-bSSFP method can effectively reduce the g-factor and aliasing artifacts in cardiac imaging.

Robust cardiac T 1 ρ $$ {\mathrm{T}}_{1_{\boldsymbol{\rho}}} $$ mapping at 3T using adiabatic spin-lock preparations

PURPOSE

The aim of this study is to develop and optimize an adiabaticT 1 ρ $$ {\mathrm{T}}_{1\uprho} $$ (T 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ ) mapping method for robust quantification of spin-lock (SL) relaxation in the myocardium at 3T.

METHODS

Adiabatic SL (aSL) preparations were optimized for resilience againstB 0 $$ {\mathrm{B}}_0 $$ andB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities using Bloch simulations. OptimizedB 0 $$ {\mathrm{B}}_0 $$ -aSL, Bal-aSL andB 1 $$ {\mathrm{B}}_1 $$ -aSL modules, each compensating for different inhomogeneities, were first validated in phantom and human calf. MyocardialT 1 ρ $$ {\mathrm{T}}_{1\uprho} $$ mapping was performed using a single breath-hold cardiac-triggered bSSFP-based sequence. Then, optimizedT 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ preparations were compared to each other and to conventional SL-preparedT 1 ρ $$ {\mathrm{T}}_{1\uprho} $$ maps (RefSL) in phantoms to assess repeatability, and in 13 healthy subjects to investigate image quality, precision, reproducibility and intersubject variability. Finally, aSL and RefSL sequences were tested on six patients with known or suspected cardiovascular disease and compared with LGE,T 1 $$ {\mathrm{T}}_1 $$ , and ECV mapping.

RESULTS

The highestT 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ preparation efficiency was obtained in simulations for modules comprising 2 HS pulses of 30 ms each. In vivoT 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ maps yielded significantly higher quality than RefSL maps. Average myocardialT 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ values were 183.28± $$ \pm $$ 25.53 ms, compared with 38.21± $$ \pm $$ 14.37 ms RefSL-preparedT 1 ρ $$ {\mathrm{T}}_{1\uprho} $$ .T 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ maps showed a significant improvement in precision (avg. 14.47± $$ \pm $$ 3.71% aSL, 37.61± $$ \pm $$ 19.42% RefSL, p < 0.01) and reproducibility (avg. 4.64± $$ \pm $$ 2.18% aSL, 47.39± $$ \pm $$ 12.06% RefSL, p < 0.0001), with decreased inter-subject variability (avg. 8.76± $$ \pm $$ 3.65% aSL, 51.90± $$ \pm $$ 15.27% RefSL, p < 0.0001). Among aSL preparations,B 0 $$ {\mathrm{B}}_0 $$ -aSL achieved the better inter-subject variability. In patients,B 1 $$ {\mathrm{B}}_1 $$ -aSL preparations showed the best artifact resilience among the adiabatic preparations.T 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ times show focal alteration colocalized with areas of hyper-enhancement in the LGE images.

CONCLUSION

Adiabatic preparations enable robust in vivo quantification of myocardial SL relaxation times at 3T.

Effect of Migalastat on cArdiac InvOlvement in FabRry DiseAse: MAIORA study

BACKGROUND

A small but significant reduction in left ventricular (LV) mass after 18 months of migalastat treatment has been reported in Fabry disease (FD). This study aimed to assess the effect of migalastat on FD cardiac involvement, combining LV morphology and tissue characterisation by cardiac magnetic resonance (CMR) with cardiopulmonary exercise testing (CPET).

METHODS

Sixteen treatment-naïve patients with FD (4 women, 46.4±16.2 years) with cardiac involvement (reduced T1 values on CMR and/or LV hypertrophy) underwent ECG, echocardiogram, troponin T and NT-proBNP (N-Terminal prohormone of Brain Natriuretic Peptide) assay, CMR with T1 mapping, and CPET before and after 18 months of migalastat.

RESULTS

No change in LV mass was detected at 18 months compared to baseline (95.2 g/m2 (66.0-184.0) vs 99.0 g/m2 (69.0-121.0), p=0.55). Overall, there was an increase in septal T1 of borderline significance (870.0 ms (848-882) vs 860.0 ms (833.0-875.0), p=0.056). Functional capacity showed an increase in oxygen consumption (VO2) at anaerobic threshold (15.50 mL/kg/min (13.70-21.50) vs 14.50 mL/kg/min (11.70-18.95), p=0.02), and a trend towards an increase in percent predicted peak VO2 (72.0 (63.0-80.0) vs 69.0 (53.0-77.0), p=0.056) was observed. The subset of patients who showed an increase in T1 value and a reduction in LV mass (n=7, 1 female, age 40.5 (28.6-76.0)) was younger and at an earlier disease stage compared to the others, and also exhibited greater improvement in exercise tolerance.

CONCLUSION

In treatment-naïve FD patients with cardiac involvement, 18-month treatment with migalastat stabilised LV mass and was associated with a trend towards an improvement in exercise tolerance. A tendency to T1 increase was detected by CMR. The subset of patients who had significant benefits from the treatment showed an earlier cardiac disease compared to the others.

TRIAL REGISTRATION NUMBER

NCT03838237.

Magnetic resonance myocardial T1ρ mapping : Technical overview, challenges, emerging developments, and clinical applications

The potential of cardiac magnetic resonance to improve cardiovascular care and patient management is considerable. Myocardial T1-rho (T1ρ) mapping, in particular, has emerged as a promising biomarker for quantifying myocardial injuries without exogenous contrast agents. Its potential as a contrast-agent-free ("needle-free") and cost-effective diagnostic marker promises high impact both in terms of clinical outcomes and patient comfort. However, myocardial T1ρ mapping is still at a nascent stage of development and the evidence supporting its diagnostic performance and clinical effectiveness is scant, though likely to change with technological improvements. The present review aims at providing a primer on the essentials of myocardial T1ρ mapping, and to describe the current range of clinical applications of the technique to detect and quantify myocardial injuries. We also delineate the important limitations and challenges for clinical deployment, including the urgent need for standardization, the evaluation of bias, and the critical importance of clinical testing. We conclude by outlining technical developments to be expected in the future. If needle-free myocardial T1ρ mapping is shown to improve patient diagnosis and prognosis, and can be effectively integrated in cardiovascular practice, it will fulfill its potential as an essential component of a cardiac magnetic resonance examination.

Retrospective motion correction through multi-average k-space data elimination (REMAKE) for free-breathing cardiac cine imaging

PURPOSE

To develop a motion-robust reconstruction technique for free-breathing cine imaging with multiple averages.

METHOD

Retrospective motion correction through multiple average k-space data elimination (REMAKE) was developed using iterative removal of k-space segments (from individual k-space samples) that contribute most to motion corruption while combining any remaining segments across multiple signal averages. A variant of REMAKE, termed REMAKE+, was developed to address any losses in SNR due to k-space information removal. With REMAKE+, multiple reconstructions using different initial conditions were performed, co-registered, and averaged. Both techniques were validated against clinical "standard" signal averaging reconstruction in a static phantom (with simulated motion) and 15 patients undergoing free-breathing cine imaging with multiple averages. Quantitative analysis of myocardial sharpness, blood/myocardial SNR, myocardial-blood contrast-to-noise ratio (CNR), as well as subjective assessment of image quality and rate of diagnostic quality images were performed.

RESULTS

In phantom, motion artifacts using "standard" (RMS error [RMSE]: 2.2 ± 0.5) were substantially reduced using REMAKE/REMAKE+ (RMSE: 1.5 ± 0.4/1.0 ± 0.4, p < 0.01). In patients, REMAKE/REMAKE+ led to higher myocardial sharpness (0.79 ± 0.09/0.79 ± 0.1 vs. 0.74 ± 0.12 for "standard", p = 0.004/0.04), higher image quality (1.8 ± 0.2/1.9 ± 0.2 vs. 1.6 ± 0.4 for "standard", p = 0.02/0.008), and a higher rate of diagnostic quality images (99%/100% vs. 94% for "standard"). Blood/myocardial SNR for "standard" (94 ± 30/33 ± 10) was higher vs. REMAKE (80 ± 25/28 ± 8, p = 0.002/0.005) and tended to be lower vs. REMAKE+ (105 ± 33/36 ± 12, p = 0.02/0.06). Myocardial-blood CNR for "standard" (61 ± 22) was higher vs. REMAKE (53 ± 19, p = 0.003) and lower vs. REMAKE+ (69 ± 24, p = 0.007).

CONCLUSIONS

Compared to "standard" signal averaging reconstruction, REMAKE and REMAKE+ provide improved myocardial sharpness, image quality, and rate of diagnostic quality images.

Quantitative myocardial perfusion with a hybrid 2D simultaneous multi-slice sequence

PURPOSE

To evaluate a novel 2D simultaneous multi-slice (SMS) myocardial perfusion acquisition and compare directly to a published quantitative 3D stack-of-stars (SoS) acquisition.

METHODS

A hybrid saturation recovery radial 2D SMS sequence following a single saturation was created for the quantification of myocardial blood flow (MBF). This sequence acquired three slices simultaneously and generated an arterial input function (AIF) using the first 24 rays. Validation was done in a novel way by alternating heartbeats between the hybrid 2D SMS and the 3D SoS acquisitions. Initial studies were done to study the effects of using only every other beat for the 2D SMS in two subjects, and for the 3D SoS in four subjects. The proposed alternating acquisitions were then performed in ten dog studies at rest, four dog studies at adenosine stress, and two human resting studies. Quantitative MBF analysis was performed for 2D SMS and 3D SoS separately, using a compartment model.

RESULTS

Acquiring every-other-beat data resulted in 6 ± 5% ("ideal") and 11 ± 8% ("practical") perfusion changes for both 2D SMS and 3D SoS methods. For alternating acquisitions, 2D SMS and 3D SoS quantitative perfusion values were comparable for both the twelve rest studies (2D SMS: 0.69 ± 0.16 vs 3D: 0.69 ± 0.15 ml/g/min, p = 0.55) and the four stress studies (2D SMS: 1.28 ± 0.22 vs 3D: 1.30 ± 0.24 ml/g/min, p = 0.61).

CONCLUSION

Every-other-beat acquisition changed estimated perfusion values relatively little for both sequences. The quantitative hybrid radial 2D SMS myocardial first-pass perfusion imaging sequence gave results similar to 3D perfusion when compared directly with an alternating beat acquisition.

Developing a medical device-grade T2 phantom optimized for myocardial T2 mapping by cardiovascular magnetic resonance

INTRODUCTION

A long T2 relaxation time can reflect oedema, and myocardial inflammation when combined with increased plasma troponin levels. Cardiovascular magnetic resonance (CMR) T2 mapping therefore has potential to provide a key diagnostic and prognostic biomarkers. However, T2 varies by scanner, software, and sequence, highlighting the need for standardization and for a quality assurance system for T2 mapping in CMR.

AIM

To fabricate and assess a phantom dedicated to the quality assurance of T2 mapping in CMR.

METHOD

A T2 mapping phantom was manufactured to contain 9 T1 and T2 (T1|T2) tubes to mimic clinically relevant native and post-contrast T2 in myocardium across the health to inflammation spectrum (i.e., 43-74 ms) and across both field strengths (1.5 and 3 T). We evaluated the phantom's structural integrity, B0 and B1 uniformity using field maps, and temperature dependence. Baseline reference T1|T2 were measured using inversion recovery gradient echo and single-echo spin echo (SE) sequences respectively, both with long repetition times (10 s). Long-term reproducibility of T1|T2 was determined by repeated T1|T2 mapping of the phantom at baseline and at 12 months.

RESULTS

The phantom embodies 9 internal agarose-containing T1|T2 tubes doped with nickel di-chloride (NiCl2) as the paramagnetic relaxation modifier to cover the clinically relevant spectrum of myocardial T2. The tubes are surrounded by an agarose-gel matrix which is doped with NiCl2 and packed with high-density polyethylene (HDPE) beads. All tubes at both field strengths, showed measurement errors up to ≤ 7.2 ms [< 14.7%] for estimated T2 by balanced steady-state free precession T2 mapping compared to reference SE T2 with the exception of the post-contrast tube of ultra-low T1 where the deviance was up to 16 ms [40.0%]. At 12 months, the phantom remained free of air bubbles, susceptibility, and off-resonance artifacts. The inclusion of HDPE beads effectively flattened the B0 and B1 magnetic fields in the imaged slice. Independent temperature dependency experiments over the 13-38 °C range confirmed the greater stability of shorter vs longer T1|T2 tubes. Excellent long-term (12-month) reproducibility of measured T1|T2 was demonstrated across both field strengths (all coefficients of variation < 1.38%).

CONCLUSION

The T2 mapping phantom demonstrates excellent structural integrity, B0 and B1 uniformity, and reproducibility of its internal tube T1|T2 out to 1 year. This device may now be mass-produced to support the quality assurance of T2 mapping in CMR.

Optimisation of data acquisition towards continuous cardiac Magnetic Resonance Fingerprinting applications

PURPOSE

Assess and optimise acquisition parameters for continuous cardiac Magnetic Resonance Fingerprinting (MRF).

METHODS

Different acquisition schemes (flip angle amplitude, lobe size, T2-preparation pulses) for cardiac MRF were assessed in simulations and phantom and demonstrated in one healthy volunteer. Three different experimental designs were evaluated using central composite and fractional factorial designs. Relative errors for T1 and T2 were calculated for a wide range of realistic T1 and T2 value combinations. The effect of different designs on the accuracy of T1 and T2 was assessed using response surface modelling and Cohen's f calculations.

RESULTS

Larger flip angle amplitudes lead to an improvement of T2 accuracy and precision for simulations and phantom experiments. Similar effects could also be shown qualitatively in in-vivo scans. Accuracy and precision of T1 were robust to different design parameters with improved values for faster flip angle variation. Cohen's f showed that T2-preparation pulses influence the accuracy of T2. The number of pulses used is the most important parameter. Without T2-preparation pulses, RMSE were 3.0 ± 8.09 % for T1 and 16.24 ± 14.47 % for T2. Using those pulses reduced the RMSE to 2.3 ± 8.4 % for T1 and 14.11 ± 13.46 % for T2. Nonetheless, even if the improvement is significant, RMSE are still too high for reliable quantification.

CONCLUSION

In contrast to previous study using triggered MRF sequences using < 30° flip angles, large flip angle amplitudes led to better results for continuous cardiac MRF sequences. T2-preparation pulse can improve the accuracy of T2 estimation but lead to longer scan times.

Myocardial First-Pass Perfusion With Increased Anatomic Coverage at 3 T Using Autocalibrated Multiband Imaging

BACKGROUND

Myocardial first-pass perfusion (FPP) imaging is a useful cardiac MRI method for the diagnosis of coronary artery disease. However, conventional 2D multislice FPP acquisitions usually have gaps between myocardium slices, which limits the overall assessment of myocardial ischemia.

PURPOSE

To increase the anatomic coverage of myocardial FPP imaging at 3 T by implementing both autocalibrated multiband (MB) acquisition and k-t space acceleration with compress sensing (CS) reconstruction, without the need for additional reference scans.

STUDY TYPE

Phantom and prospective human studies.

PHANTOM/SUBJECTS

A T1MES (T1 Mapping and ECV Standardization in cardiovascular magnetic resonance) phantom and 20 subjects (12 healthy subjects and 8 patients, 10 males, age 42 ± 16 years).

FIELD STRENGTH/SEQUENCE

A 3 T/saturation recovery prepared gradient echo sequence with contrast administration.

ASSESSMENT

Phantom experiments were performed to compare the performance of autocalibrated MB-FPP with k-t acceleration using slice-GRAPPA and CS reconstructions. In vivo experiments were performed to compare the performance of conventional FPP (2.5× acceleration) with autocalibrated MB + CS-FPP (6× acceleration). In phantom experiments, the error maps were calculated. In in vivo experiments, the contrast ratio (CR) and blurring were quantitatively measured, while image quality, perceived signal-to-noise ratio (SNR), and artifact level were qualitatively graded by three cardiologists on a 4-point scale.

STATISTICAL TESTS

Wilcoxon signed-rank test, paired t-test. A P value <0.05 was considered statistically significant.

RESULTS

In phantom experiments, residual artifact was reduced using the MB + CS-FPP reconstruction method compared with using the MB + slice-GRAPPA reconstruction method. In in vivo experiments, the proposed autocalibrated MB + CS-FPP method demonstrated significantly higher CR (3.52 ± 0.78 vs 2.91 ± 0.81) and had significantly better perceived SNR (2.69 ± 0.29 vs 2.48 ± 0.31) compared to the conventional sequence. Compared with conventional FPP, MB + CS-FPP doubled the spatial coverage (MB + CS-FPP vs conventional FPP) without compromising the image quality (2.69 ± 0.26 vs 2.60 ± 0.30) or increasing the artifact level (2.60 ± 0.26 vs 2.52 ± 0.31).

CONCLUSION

Autocalibrated MB + CS-FPP improved the myocardial coverage and achieved comparable image quality with the same spatial resolution and scan time as conventional FPP and is a promising technique for clinical myocardial perfusion imaging.

EVIDENCE LEVEL

2 TECHNICAL EFFICACY: Stage 3.

3D model-based super-resolution motion-corrected cardiac T1 mapping

Objective. To provide 3D high-resolution cardiac T1 maps using model-based super-resolution reconstruction (SRR).Approach. Due to signal-to-noise ratio limitations and the motion of the heart during imaging, often 2D T1 maps with only low through-plane resolution (i.e. slice thickness of 6-8 mm) can be obtained. Here, a model-based SRR approach is presented, which combines multiple stacks of 2D acquisitions with 6-8 mm slice thickness and generates 3D high-resolution T1 maps with a slice thickness of 1.5-2 mm. Every stack was acquired in a different breath hold (BH) and any misalignment between BH was corrected retrospectively. The novelty of the proposed approach is the BH correction and the application of model-based SRR on cardiac T1 Mapping. The proposed approach was evaluated in numerical simulations and phantom experiments and demonstrated in four healthy subjects.Main results. Alignment of BH states was essential for SRR even in healthy volunteers. In simulations, respiratory motion could be estimated with an RMS error of 0.18 ± 0.28 mm. SRR improved the visualization of small structures. High accuracy and precision (average standard deviation of 69.62 ms) of the T1 values was ensured by SRR while the detectability of small structures increased by 40%.Significance. The proposed SRR approach provided T1 maps with high in-plane and high through-plane resolution (1.3 × 1.3 × 1.5-2 mm³). The approach led to improvements in the visualization of small structures and precise T1 values.

3D Extrusion Printing of Biphasic Anthropomorphic Brain Phantoms Mimicking MR Relaxation Times Based on Alginate-Agarose-Carrageenan Blends

The availability of adapted phantoms mimicking different body parts is fundamental to establishing the stability and reliability of magnetic resonance imaging (MRI) methods. The primary purpose of such phantoms is the mimicking of physiologically relevant, contrast-creating relaxation times T1 and T2. For the head, frequently examined by MRI, an anthropomorphic design of brain phantoms would imply the discrimination of gray matter and white matter (WM) within defined, spatially distributed compartments. Multichannel extrusion printing allows the layer-by-layer fabrication of multiple pastelike materials in a spatially defined manner with a predefined shape. In this study, the advantages of this method are used to fabricate biphasic brain phantoms mimicking MR relaxation times and anthropomorphic geometry. The printable ink was based on purely naturally derived polymers: alginate as a calcium-cross-linkable gelling agent, agarose, ι-carrageenan, and GdCl3 in different concentrations (0-280 μmol kg-1) as the paramagnetic component. The suggested inks (e.g., 3Alg-1Agar-6Car) fulfilled the requirements of viscoelastic behavior and printability of large constructs (>150 mL). The microstructure and distribution of GdCl3 were assessed by scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDX). In closely monitored steps of technological development and characterization, from monophasic and biphasic samples as printable inks and cross-linked gels, we describe the construction of large-scale phantom models whose relaxation times were characterized and checked for stability over time.

Impact of deep learning architectures on accelerated cardiac T1 mapping using MyoMapNet

The objective of the current study was to investigate the performance of various deep learning (DL) architectures for MyoMapNet, a DL model for T1 estimation using accelerated cardiac T1 mapping from four T1 -weighted images collected after a single inversion pulse (Look-Locker 4 [LL4]). We implemented and tested three DL architectures for MyoMapNet: (a) a fully connected neural network (FC), (b) convolutional neural networks (VGG19, ResNet50), and (c) encoder-decoder networks with skip connections (ResUNet, U-Net). Modified Look-Locker inversion recovery (MOLLI) images from 749 patients at 3 T were used for training, validation, and testing. The first four T1 -weighted images from MOLLI5(3)3 and/or MOLLI4(1)3(1)2 protocols were extracted to create accelerated cardiac T1 mapping data. We also prospectively collected data from 28 subjects using MOLLI and LL4 to further evaluate model performance. Despite rigorous training, conventional VGG19 and ResNet50 models failed to produce anatomically correct T1 maps, and T1 values had significant errors. While ResUNet yielded good quality maps, it significantly underestimated T1 . Both FC and U-Net, however, yielded excellent image quality with good T1 accuracy for both native (FC/U-Net/MOLLI = 1217 ± 64/1208 ± 61/1199 ± 61 ms, all p < 0.05) and postcontrast myocardial T1 (FC/U-Net/MOLLI = 578 ± 57/567 ± 54/574 ± 55 ms, all p < 0.05). In terms of precision, the U-Net model yielded better T1 precision compared with the FC architecture (standard deviation of 61 vs. 67 ms for the myocardium for native [p < 0.05], and 31 vs. 38 ms [p < 0.05], for postcontrast). Similar findings were observed in prospectively collected LL4 data. It was concluded that U-Net and FC DL models in MyoMapNet enable fast myocardial T1 mapping using only four T1 -weighted images collected from a single LL sequence with comparable accuracy. U-Net also provides a slight improvement in precision.

Development of a standard phantom for diffusion-weighted magnetic resonance imaging quality control studies: A review

Various materials and compounds have been used in the design of diffusion-weighted magnetic resonance imaging (DWMRI) phantoms to mimic biological tissue properties, including diffusion. This review thus provides an overview of the preparations of the various DW-MRI phantoms available in relation to the limitations and strengths of materials/solutions used to fill them. The narrative review conducted from relevant databases shows that synthesizing all relevant compounds from individual liquids, gels, and solutions based on their identified strengths could contribute to the development of a novel multifunctional DW-MRI phantom. The proposed multifunctional material at varied concentrations, when filled into a multi-compartment Perspex container of cylindrical or spherical geometry, could serve as a standard DW-MRI phantom. The standard multifunctional phantom could potentially provide DW-MRI quality control test parameters in one study session.

Quantitative susceptibility mapping (QSM) of the cardiovascular system: challenges and perspectives

Quantitative susceptibility mapping (QSM) is a powerful, non-invasive, magnetic resonance imaging (MRI) technique that relies on measurement of magnetic susceptibility. So far, QSM has been employed mostly to study neurological disorders characterized by iron accumulation, such as Parkinson's and Alzheimer's diseases. Nonetheless, QSM allows mapping key indicators of cardiac disease such as blood oxygenation and myocardial iron content. For this reason, the application of QSM offers an unprecedented opportunity to gain a better understanding of the pathophysiological changes associated with cardiovascular disease and to monitor their evolution and response to treatment. Recent studies on cardiovascular QSM have shown the feasibility of a non-invasive assessment of blood oxygenation, myocardial iron content and myocardial fibre orientation, as well as carotid plaque composition. Significant technical challenges remain, the most evident of which are related to cardiac and respiratory motion, blood flow, chemical shift effects and susceptibility artefacts. Significant work is ongoing to overcome these challenges and integrate the QSM technique into clinical practice in the cardiovascular field.

Improving accuracy of myocardial T1 estimation in MyoMapNet

PURPOSE

To improve the accuracy and robustness of T₁ estimation by MyoMapNet, a deep learning-based approach using 4 inversion-recovery T₁ -weighted images for cardiac T₁ mapping.

METHODS

MyoMapNet is a fully connected neural network for T₁ estimation of an accelerated cardiac T₁ mapping sequence, which collects 4 T₁ -weighted images by a single Look-Locker inversion-recovery experiment (LL4). MyoMapNet was originally trained using in vivo data from the modified Look-Locker inversion recovery sequence, which resulted in significant bias and sensitivity to various confounders. This study sought to train MyoMapNet using signals generated from numerical simulations and phantom MR data under multiple simulated confounders. The trained model was then evaluated by phantom data scanned using new phantom vials that differed from those used for training. The performance of the new model was compared with modified Look-Locker inversion recovery sequence and saturation-recovery single-shot acquisition for measuring native and postcontrast T₁ in 25 subjects.

RESULTS

In the phantom study, T₁ values measured by LL4 with MyoMapNet were highly correlated with reference values from the spin-echo sequence. Furthermore, the estimated T₁ had excellent robustness to changes in flip angle and off-resonance. Native and postcontrast myocardium T₁ at 3 Tesla measured by saturation-recovery single-shot acquisition, modified Look-Locker inversion recovery sequence, and MyoMapNet were 1483 ± 46.6 ms and 791 ± 45.8 ms, 1169 ± 49.0 ms and 612 ± 36.0 ms, and 1443 ± 57.5 ms and 700 ± 57.5 ms, respectively. The corresponding extracellular volumes were 22.90% ± 3.20%, 28.88% ± 3.48%, and 30.65% ± 3.60%, respectively.

CONCLUSION

Training MyoMapNet with numerical simulations and phantom data will improve the estimation of myocardial T₁ values and increase its robustness to confounders while also reducing the overall T₁ mapping estimation time to only 4 heartbeats.

Myocardial Approximate Spin-lock Dispersion Mapping using a Simultaneous T2 and TRAFF2 Mapping at 3T MRI

Ischemic heart disease (IHD) is one of the leading causes of death worldwide. Myocardial infarction (MI) represents a third of all IHD cases, and cardiac magnetic resonance imaging (MRI) is often used to assess its damage to myocardial viability. Late gadolinium enhancement (LGE) is the current gold standard, but the use of gadolinium-based agents limits the clinical applicability in some patients. Spin-lock (SL) dispersion has recently been proposed as a promising non-contrast biomarker for the assessment of MI. However, at 3T, the required range of SL preparations acquired at different amplitudes suffers from specific absorption rate (SAR) limitations and off-resonance artifacts. Relaxation Along a Fictitious Field (RAFF) is an alternative to SL preparations with lower SAR requirements, while still sampling relaxation in the rotating frame. In this study, a single breath-hold simultaneous TRAFF2 and T2 mapping sequence is proposed for SL dispersion mapping at 3T. Excellent reproducibility (coefficient of variations lower than 10%) was achieved in phantom experiments, indicating good intrascan repeatability. The average myocardial TRAFF2, T2, and SL dispersion obtained with the proposed sequence (68.0±10.7 ms, 44.0±4.0 ms, and 0.4±0.2 ×10-4 s2, respectively) were comparable to the reference methods (62.7±11.7 ms, 41.2±2.4 ms, and 0.3±0.2x 10-4s2, respectively). High visual map quality, free of B0 and B1+ related artifacts, for T2, TRAFF2, and SL dispersion maps were obtained in phantoms and in vivo, suggesting promise in clinical use at 3T. Clinical relevance - and imaging promises non-contrast assessment of scar and focal fibrosis in a single breath-hold using approximate spin-lock dispersion mapping.

Phantom-based correction for standardization of myocardial native T1 and extracellular volume fraction in healthy subjects at 3-Tesla cardiac magnetic resonance imaging

OBJECTIVES

To investigate the effect of the phantom-based correction method for standardizing myocardial native T1 and extracellular volume fraction (ECV) in healthy subjects.

METHODS

Seventy-one healthy asymptomatic adult (≥ 20 years) volunteers of five different age groups (34 men and 37 women, 45.5 ± 15.5 years) were prospectively enrolled in three academic hospitals. Cardiac MRI including Modified Look - Locker Inversion recovery T1 mapping sequence was performed using a 3-Tesla system with a different type of scanner for each hospital. Native T1 and ECV were measured in the short-axis T1 map and analyzed for mean values of the 16 entire segments. The myocardial T1 value of each subject was corrected based on the site-specific equation derived from the T1 Mapping and ECV Standardization phantom. The global native T1 and ECV were compared between institutions before and after phantom-based correction, and the variation in native T1 and ECV among institutions was assessed using a coefficient of variation (CoV).

RESULTS

The global native T1 value significantly differed between the institutions (1198.7 ± 32.1 ms, institution A; 1217.7 ± 39.9 ms, institution B; 1232.7 ± 31.1 ms, institution C; p = 0.002), but the mean ECV did not (26.6-27.5%, p = 0.355). After phantom-based correction, the global native T1 and ECV were 1289.7 ± 32.4 ms and 25.0 ± 2.7%, respectively, and CoV for native T1 between the three institutions decreased from 3.0 to 2.5%. The corrected native T1 value did not significantly differ between institutions (1284.5 ± 31.5 ms, institution A; 1296.5 ± 39.1 ms, institution B; 1291.3 ± 29.3 ms, institution C; p = 0.440), and neither did the ECV (24.4-25.9%, p = 0.078).

CONCLUSIONS

The phantom-based correction method can provide standardized reference T1 values in healthy subjects.

KEY POINTS

• After phantom-based correction, the global native T1 of 16 entire myocardial segments on 3-T cardiac MRI is 1289.4 ± 32.4 ms, and the extracellular volume fraction was 25.0 ± 2.7% for healthy subjects. • After phantom - based correction was applied, the differences in the global native T1 among institutions became insignificant, and the CoV also decreased from 3.0 to 2.5%.

Quantification of changes in myocardial T1 * values with exercise cardiac MRI using a free-breathing non-electrocardiograph radial imaging

PURPOSE

To develop and evaluate a free breathing non-electrocardiograph (ECG) myocardial T₁ * mapping sequence using radial imaging to quantify the changes in myocardial T₁ * between rest and exercise (T₁ *_reactivity ) in exercise cardiac MRI (Ex-CMR).

METHODS

A free-running T₁ * sequence was developed using a saturation pulse followed by three Look-Locker inversion-recovery experiments. Each Look-Locker continuously acquired data as radial trajectory using a low flip-angle spoiled gradient-echo readout. Self-navigation was performed with a temporal resolution of ∼100 ms for retrospectively extracting respiratory motion. The mid-diastole phase for every cardiac cycle was retrospectively detected on the recorded electrocardiogram signal using an empirical model. Multiple measurements were performed to obtain mean value to reduce effects from the free-breathing acquisition. Finally, data acquired at both mid-diastole and end-expiration are picked and reconstructed by a low-rank plus sparsity constraint algorithm. The performance of this sequence was evaluated by simulations, phantoms, and in vivo studies at rest and after physiological exercise.

RESULTS

Numerical simulation demonstrated that changes in T₁ * are related to the changes in T₁ ; however, other factors such as breathing motion could influence T₁ * measurements. Phantom T₁ * values measured using free-running T₁ * mapping sequence had good correlation with spin-echo T₁ values and was insensitive to heart rate. In the Ex-CMR study, the measured T₁ * reactivity was 10% immediately after exercise and declined over time.

CONCLUSION

The free-running T₁ * mapping sequence allows free-breathing non-ECG quantification of changes in myocardial T₁ * with physiological exercise. Although, absolute myocardial T₁ * value is sensitive to various confounders such as B₁ and B₀ inhomogeneity, quantification of its change may be useful in revealing myocardial tissue properties with exercise.

Repeatability and robustness of MP-GRASP T1 mapping

PURPOSE

To demonstrate the repeatability of fast 3D T1 mapping using Magnetization-Prepared Golden-angle RAdial Sparse Parallel (MP-GRASP) MRI and its robustness to variation of imaging parameters including flip angle and spatial resolution in phantoms and the brain.

THEORY AND METHODS

Multiple imaging experiments were performed to (1) assess the robustness of MP-GRASP T1 mapping to B1 inhomogeneity using a single tube phantom filled with uniform MnCl2 liquid; (2) compare the repeatability of T1 mapping between MP-GRASP and inversion recovery-based spin-echo (IR-SE; over 12 scans), using a commercial T1MES phantom; (3) evaluate the longitudinal variation of T1 estimation using MP-GRASP with varying imaging parameters, including spatial resolution, flip angle, TR/TE, and acceleration rate, using the T1MES phantom (106 scans performed over a period of 12 months); and (4) evaluate the variation of T1 estimation using MP-GRASP with varying imaging parameters in the brain (24 scans in a single visit). In addition, the accuracy of MP-GRASP T1 mapping was also validated against IR-SE by performing linear correlation and calculating the Lin's concordance correlation coefficient (CCC).

RESULTS

MP-GRASP demonstrates good robustness to B1 inhomogeneity, with intra-slice variability below 1% in the single tube phantom experiment. The longitudinal variability is good both in the phantom (below 2.5%) and in the brain (below 2%) with varying imaging parameters. The T1 values estimated from MP-GRASP are accurate compared to that from the IR-SE imaging (R2 = 0.997, Lin's CCC = 0.996).

CONCLUSION

MP-GRASP shows excellent repeatability of T1 estimation over time, and it is also robust to variation of different imaging parameters evaluated in this study.

Free-breathing self-gated continuous-IR spiral T1 mapping: Comparison of dual flip-angle and Bloch-Siegert B1-corrected techniques

Purpose

To develop a B1‐corrrected single flip‐angle continuous acquisition strategy with free‐breathing and cardiac self‐gating for spiral T1 mapping, and compare it to a previous dual flip‐angle technique.

Methods

Data were continuously acquired using a spiral‐out trajectory, rotated by the golden angle in time. During the first 2 s, off‐resonance Fermi RF pulses were applied to generate a Bloch‐Siegert shift B1 map, and the subsequent data were acquired with an inversion RF pulse applied every 4 s to create a T1* map. The final T1 map was generated from the B1 and the T1* maps by using a look‐up table that accounted for slice profile effects, yielding more accurate T1 values. T1 values were compared to those from inversion recovery (IR) spin echo (phantom only), MOLLI, SAturation‐recovery single‐SHot Acquisition (SASHA), and previously proposed dual flip‐angle results. This strategy was evaluated in a phantom and 25 human subjects.

Results

The proposed technique showed good agreement with IR spin‐echo results in the phantom experiment. For in‐vivo studies, the proposed technique and the previously proposed dual flip‐angle method were more similar to SASHA results than to MOLLI results.

Conclusions

B1‐corrected single flip‐angle T1 mapping successfully acquired B1 and T1 maps in a free‐breathing, continuous‐IR spiral acquisition, providing a method with improved accuracy to measure T1 using a continuous Look‐Locker acquisition, as compared to the previously proposed dual excitation flip‐angle technique.

Study protocol: MyoFit46-the cardiac sub-study of the MRC National Survey of Health and Development

BACKGROUND

The life course accumulation of overt and subclinical myocardial dysfunction contributes to older age mortality, frailty, disability and loss of independence. The Medical Research Council National Survey of Health and Development (NSHD) is the world's longest running continued surveillance birth cohort providing a unique opportunity to understand life course determinants of myocardial dysfunction as part of MyoFit46-the cardiac sub-study of the NSHD.

METHODS

We aim to recruit 550 NSHD participants of approximately 75 years+ to undertake high-density surface electrocardiographic imaging (ECGI) and stress perfusion cardiovascular magnetic resonance (CMR). Through comprehensive myocardial tissue characterization and 4-dimensional flow we hope to better understand the burden of clinical and subclinical cardiovascular disease. Supercomputers will be used to combine the multi-scale ECGI and CMR datasets per participant. Rarely available, prospectively collected whole-of-life data on exposures, traditional risk factors and multimorbidity will be studied to identify risk trajectories, critical change periods, mediators and cumulative impacts on the myocardium.

DISCUSSION

By combining well curated, prospectively acquired longitudinal data of the NSHD with novel CMR-ECGI data and sharing these results and associated pipelines with the CMR community, MyoFit46 seeks to transform our understanding of how early, mid and later-life risk factor trajectories interact to determine the state of cardiovascular health in older age.

TRIAL REGISTRATION

Prospectively registered on ClinicalTrials.gov with trial ID: 19/LO/1774 Multimorbidity Life-Course Approach to Myocardial Health- A Cardiac Sub-Study of the MCRC National Survey of Health and Development (NSHD).

Improved accuracy and precision with three-parameter simultaneous myocardial T1 and T2 mapping using multiparametric SASHA

PURPOSE

To develop and validate a three-parameter model for improved precision multiparametric SAturation-recovery single-SHot Acquisition (mSASHA) cardiac T₁ and T₂ mapping with high accuracy in a single breath-hold.

METHODS

The mSASHA acquisition consists of nine images of variable saturation recovery and T₂ preparation in 11 heartbeats with T₁ and T₂ values calculated using a three-parameter model. It was validated in simulations and phantoms at 3 T with comparison to a four-parameter joint T₁ -T₂ technique. The mSASHA acquisition was compared with MOLLI, SASHA, and T₂ -prepared balanced SSFP in 10 volunteers.

RESULTS

The mSASHA technique had high accuracy in phantoms compared to spin echo, with -0.2 ± 0.3% T₁ error and -2.4 ± 1.3% T₂ error. The mSASHA coefficient of variation in phantoms for T₁ was similar to MOLLI (0.7 ± 0.2% for both) and T₂ -prepared balanced SSFP for T₂ (1.3 ± 0.7% vs 1.4 ± 0.3%, adjusted p > .05 for both). In simulations, three-parameter mSASHA had higher precision than four-parameter joint T₁ -T₂ for both T₁ and T₂ (46% and 11% reductions in T₁ and T₂ interquartile range for native myocardium). In vivo myocardial mSASHA T₁ was similar to SASHA (1523 ± 18 ms vs 1520 ± 18 ms) with similar coefficient of variation to both MOLLI and SASHA (3.3 ± 0.6% vs 3.1 ± 0.6% and 3.3 ± 0.5% respectively, adjusted p > .05 for all). Myocardial mSASHA T₂ was 37.1 ± 1.1 ms with similar precision to T₂ -prepared balanced SSFP (6.7 ± 1.7% vs 6.0 ± 1.6%, adjusted p > .05).

CONCLUSION

Three-parameter mSASHA provides high-accuracy cardiac T₁ and T₂ quantification in a single breath-hold with similar precision to MOLLI and T₂ -prepared balanced SSFP. Further study is required to both establish normative values and demonstrate clinical utility in patient populations.

MR relaxation properties of tissue-mimicking phantoms

High quality tissue-mimicking phantoms (TMPs) have a critical role in the preclinical testing of emerging modalities for diagnosis and therapy. TMPs capable of accurately mimicking real tissue in Magnetic Resonance guided Focused Ultrasound (MRgFUS) applications should be fabricated with precise T1 and T2 relaxation times. Given the current popularity of the MRgFUS technology, we herein performed a systematic review on the MR relaxation properties of different phantoms types. Polyacrylamide (PAA) and agar based phantoms were proven capable of accurately replicating critical thermal, acoustical, and MR relaxation properties of various body tissues. Although gelatin phantoms were also proven factional in this regard, they lack the capacity to withstand ablation temperatures, and thus, are only recommended for hyperthermia applications. Other gelling agents identified in the literature are Poly-vinyl alcohol (PVA), Polyvinyl Chloride (PVC), silicone, and TX-150/ TX-151; however, their efficacy in thermal studies is yet to be established. PAA gels are favorable in that they offer optical transparency enabling direct visualization of coagulative lesions. On the other hand, agar phantoms have lower preparation costs and were proven very promising for use with the MRgFUS technology, without the toxicity issues related to the preparation and storage of PAA materials. Remarkably, agar turned out to be the prominent modifier of the T2 relaxation time even for phantoms containing other types of gelling agents instead of agar. This review could be useful in manufacturing realistic MRgFUS phantoms while simultaneously indicating an opportunity for further research in the field with a particular focus on the MR behavior of agar-based TMPs.

Myocardial T1, T2, T2*, and fat fraction quantification via low-rank motion-corrected cardiac MR fingerprinting

Purpose

Develop a novel 2D cardiac MR fingerprinting (MRF) approach to enable simultaneous T1, T2, T2*, and fat fraction (FF) myocardial tissue characterization in a single breath‐hold scan.

Methods

Simultaneous, co‐registered, multi‐parametric mapping of T1, T2, and FF has been recently achieved with cardiac MRF. Here, we further incorporate T2* quantification within this approach, enabling simultaneous T1, T2, T2*, and FF myocardial tissue characterization in a single breath‐hold scan. T2* quantification is achieved with an eight‐echo readout that requires a long cardiac acquisition window. A novel low‐rank motion‐corrected (LRMC) reconstruction is exploited to correct for cardiac motion within the long acquisition window. The proposed T1/T2/T2*/FF cardiac MRF was evaluated in phantom and in 10 healthy subjects in comparison to conventional mapping techniques.

Results

The proposed approach achieved high quality parametric mapping of T1, T2, T2*, and FF with corresponding normalized RMS error (RMSE) T1 = 5.9%, T2 = 9.6% (T2 values <100 ms), T2* = 3.3% (T2* values <100 ms), and FF = 0.8% observed in phantom scans. In vivo, the proposed approach produced higher left‐ventricular myocardial T1 values than MOLLI (1148 vs 1056 ms), lower T2 values than T2‐GraSE (42.8 vs 50.6 ms), lower T2* values than eight‐echo gradient echo (GRE) (35.0 vs 39.4 ms), and higher FF values than six‐echo GRE (0.8 vs 0.3 %) reference techniques. The proposed approach achieved considerable reduction in motion artifacts compared to cardiac MRF without motion correction, improved spatial uniformity, and statistically higher apparent precision relative to conventional mapping for all parameters.

Conclusion

The proposed cardiac MRF approach enables simultaneous, co‐registered mapping of T1, T2, T2*, and FF in a single breath‐hold for comprehensive myocardial tissue characterization, achieving higher apparent precision than conventional methods.

Accelerated cardiac T1 mapping in four heartbeats with inline MyoMapNet: a deep learning-based T1 estimation approach

PURPOSE

To develop and evaluate MyoMapNet, a rapid myocardial T1 mapping approach that uses fully connected neural networks (FCNN) to estimate T1 values from four T1-weighted images collected after a single inversion pulse in four heartbeats (Look-Locker, LL4).

METHOD

We implemented an FCNN for MyoMapNet to estimate T1 values from a reduced number of T1-weighted images and corresponding inversion-recovery times. We studied MyoMapNet performance when trained using native, post-contrast T1, or a combination of both. We also explored the effects of number of T1-weighted images (four and five) for native T1. After rigorous training using in-vivo modified Look-Locker inversion recovery (MOLLI) T1 mapping data of 607 patients, MyoMapNet performance was evaluated using MOLLI T1 data from 61 patients by discarding the additional T1-weighted images. Subsequently, we implemented a prototype MyoMapNet and LL4 on a 3 T scanner. LL4 was used to collect T1 mapping data in 27 subjects with inline T1 map reconstruction by MyoMapNet. The resulting T1 values were compared to MOLLI.

RESULTS

MyoMapNet trained using a combination of native and post-contrast T1-weighted images had excellent native and post-contrast T1 accuracy compared to MOLLI. The FCNN model using four T1-weighted images yields similar performance compared to five T1-weighted images, suggesting that four T1 weighted images may be sufficient. The inline implementation of LL4 and MyoMapNet enables successful acquisition and reconstruction of T1 maps on the scanner. Native and post-contrast myocardium T1 by MOLLI and MyoMapNet was 1170 ± 55 ms vs. 1183 ± 57 ms (P = 0.03), and 645 ± 26 ms vs. 630 ± 30 ms (P = 0.60), and native and post-contrast blood T1 was 1820 ± 29 ms vs. 1854 ± 34 ms (P = 0.14), and 508 ± 9 ms vs. 514 ± 15 ms (P = 0.02), respectively.

CONCLUSION

A FCNN, trained using MOLLI data, can estimate T1 values from only four T1-weighted images. MyoMapNet enables myocardial T1 mapping in four heartbeats with similar accuracy as MOLLI with inline map reconstruction.

Cartesian dictionary-based native T1 and T2 mapping of the myocardium

PURPOSE

To implement and evaluate a new dictionary-based technique for native myocardial T₁ and T₂ mapping using Cartesian sampling.

METHODS

The proposed technique (Multimapping) consisted of single-shot Cartesian image acquisitions in 10 consecutive cardiac cycles, with inversion pulses in cycle 1 and 5, and T₂ preparation (TE: 30 ms, 50 ms, and 70 ms) in cycles 8-10. Multimapping was simulated for different T₁ and T₂ , where entries corresponding to the k-space centers were matched to acquired data. Experiments were performed in a phantom, 16 healthy subjects, and 3 patients with cardiovascular disease.

RESULTS

Multimapping phantom measurements showed good agreement with reference values for both T₁ and T₂ , with no discernable heart-rate dependency for T₁ and T₂ within the range of myocardium. In vivo mean T₁ in healthy subjects was significantly higher using Multimapping (T₁ = 1114 ± 14 ms) compared to the reference (T₁ = 991 ± 26 ms) (p < 0.01). Mean Multimapping T₂ (47.1 ± 1.3 ms) and T₂ spatial variability (5.8 ± 1.0 ms) was significantly lower compared to the reference (T₂ = 54.7 ± 2.2 ms, p < 0.001; spatial variability = 8.4 ± 2.0 ms, p < 0.01). Increased T₁ and T₂ was detected in all patients using Multimapping.

CONCLUSIONS

Multimapping allows for simultaneous native myocardial T₁ and T₂ mapping with a conventional Cartesian trajectory, demonstrating promising in vivo image quality and parameter quantification results.

A method for T1 and T2 relaxation times validation and harmonization as a support to MRI mapping

We present a proof-of-concept study focusing on a method for the intra- and inter-center validation and harmonization of data obtained from MRI T₁ and T₂ maps. The method is based on a set of MnCl₂ samples that provide in-scan ground-truth reference values regardless of the details of the MRI protocol. The relaxation times of MnCl₂ aqueous solutions were first measured by means of an NMR laboratory relaxometer, as a function of concentration and temperature. The obtained T₁ and T₂ values, once renormalized at the scanner temperature, were used as reference values for the MRI mapping measurements of the MnCl₂ relaxation times. By using different clinical MRI scanners and sequences, we found a good agreement for standard and turbo sequences (limits of agreement: 5% for IR, SE, IR-TSE; 10% for TSE), while an under-estimation and an over-estimation were found respectively for MOLLI and T₂-prep TrueFISP, as already reported in the literature. The linearity of the relaxation rates with the concentration predicted by the Solomon-Bloembergen-Morgan theory was observed for every dataset at all temperatures, except for T₂-prep TrueFISP maps results. Some preliminary results of an in vivo experiment are also presented.

Development, validation, qualification, and dissemination of quantitative MR methods: Overview and recommendations by the ISMRM quantitative MR study group

On behalf of the International Society for Magnetic Resonance in Medicine (ISMRM) Quantitative MR Study Group, this article provides an overview of considerations for the development, validation, qualification, and dissemination of quantitative MR (qMR) methods. This process is framed in terms of two central technical performance properties, i.e., bias and precision. Although qMR is confounded by undesired effects, methods with low bias and high precision can be iteratively developed and validated. For illustration, two distinct qMR methods are discussed throughout the manuscript: quantification of liver proton-density fat fraction, and cardiac T₁ . These examples demonstrate the expansion of qMR methods from research centers toward widespread clinical dissemination. The overall goal of this article is to provide trainees, researchers, and clinicians with essential guidelines for the development and validation of qMR methods, as well as an understanding of necessary steps and potential pitfalls for the dissemination of quantitative MR in research and in the clinic.

Simultaneous T1 , T2 , and T1ρ cardiac magnetic resonance fingerprinting for contrast agent-free myocardial tissue characterization

PURPOSE

To develop a simultaneous T₁ , T₂ , and T_1ρ cardiac magnetic resonance fingerprinting (MRF) approach to enable comprehensive contrast agent-free myocardial tissue characterization in a single breath-hold scan.

METHODS

A 2D gradient-echo electrocardiogram-triggered cardiac MRF sequence with low flip angles, varying magnetization preparation, and spiral trajectory was acquired at 1.5 T to encode T₁ , T₂ , and T_1⍴ simultaneously. The MRF images were reconstructed using low-rank inversion, regularized with a multicontrast patch-based higher-order reconstruction. Parametric maps were generated and matched in the singular value domain to extended phase graph-based dictionaries. The proposed approach was tested in phantoms and 10 healthy subjects and compared against conventional methods in terms of coefficients of determination and best fits for the phantom study, and in terms of Bland-Altman agreement, average values and coefficient of variation of T₁ , T₂ , and T_1⍴ for the healthy subjects study.

RESULTS

The T₁ , T₂ , and T_1⍴ MRF values showed excellent correlation with conventional spin-echo and clinical mapping methods in phantom studies (r² > 0.97). Measured MRF values in myocardial tissue (mean ± SD) were 1133 ± 33 ms, 38.8 ± 3.5 ms, and 52.0 ± 4.0 ms for T₁ , T₂ and T1_⍴ , respectively, against 1053 ± 47 ms, 50.4 ± 3.9 ms, and 55.9 ± 3.3 ms for T₁ modified Look-Locker inversion imaging, T₂ gradient and spin echo, and T_1⍴ turbo field echo, respectively.

CONCLUSION

A cardiac MRF approach for simultaneous quantification of myocardial T₁ , T₂ , and T_1ρ in a single breath-hold MR scan of about 16 seconds has been proposed. The approach has been investigated in phantoms and healthy subjects showing good agreement with reference spin echo measurements and conventional clinical maps.

Simultaneous comprehensive liver T1 , T2 , T 2 ∗ , T1ρ , and fat fraction characterization with MR fingerprinting

PURPOSE

To develop a novel simultaneous co-registered T₁ , T₂ , T 2 ∗ , T_1ρ , and fat fraction abdominal MR fingerprinting (MRF) approach for fully comprehensive liver-tissue characterization in a single breath-hold scan.

METHODS

A gradient-echo liver MRF sequence with low fixed flip angle, multi-echo radial readout, and varying magnetization preparation pulses for multiparametric encoding is performed at 1.5 T. The T 2 ∗ and fat fraction are estimated from a graph/cut water/fat separation method using a six-peak fat model. Water/fat singular images obtained are then matched to an MRF dictionary, estimating water-specific T₁ , T₂ , and T_1ρ . The proposed approach was tested in phantoms and 10 healthy subjects and compared against conventional sequences.

RESULTS

For the phantom studies, linear fits show excellent coefficients of determination (r² > 0.9) for every parametric map. For in vivo studies, the average values measured within regions of interest drawn on liver, spleen, muscle, and fat are statistically different from the reference scans (p < 0.05) for T₁ , T₂ , and T_1⍴ but not for T 2 ∗ and fat fraction, whereas correlation between MRF and reference scans is excellent for each parameter (r² > 0.92 for every parameter).

CONCLUSION

The proposed multi-echo inversion-recovery, T₂ , and T_1⍴ prepared liver MRF sequence presented in this work allows for quantitative T₁ , T₂ , T 2 ∗ , T_1⍴ , and fat fraction liver-tissue characterization in a single breath-hold scan of 18 seconds. The approach showed good agreement and correlation with respect to reference clinical maps.

Myocardial changes on 3T cardiovascular magnetic resonance imaging in response to haemodialysis with fluid removal

BACKGROUND

Mapping of left ventricular (LV) native T1 is a promising non-invasive, non-contrast imaging biomarker. Native myocardial T1 times are prolonged in patients requiring dialysis, but there are concerns that the dialysis process and fluctuating fluid status may confound results in this population. We aimed to assess the changes in cardiac parameters on 3T cardiovascular magnetic resonance (CMR) before and after haemodialysis, with a specific focus on native T1 mapping.

METHODS

This is a single centre, prospective observational study in which maintenance haemodialysis patients underwent CMR before and after dialysis (both scans within 24 h). Weight measurement, bio-impedance body composition monitoring, haemodialysis details and fluid intake were recorded. CMR protocol included cine imaging and mapping native T1 and T2.

RESULTS

Twenty-six participants (16 male, 65 ± 9 years) were included in the analysis. The median net ultrafiltration volume on dialysis was 2.3 L (IQR 1.8, 2.5), resulting in a median weight reduction at post-dialysis scan of 1.35 kg (IQR 1.0, 1.9), with a median reduction in over-hydration (as measured by bioimpedance) of 0.75 L (IQR 0.5, 1.4). Significant reductions were observed in LV end-diastolic volume (- 25 ml, p = 0.002), LV stroke volume (- 13 ml, p = 0.007), global T1 (21 ms, p = 0.02), global T2 (- 1.2 ms, p = 0.02) following dialysis. There was no change in LV mass (p = 0.35), LV ejection fraction (p = 0.13) or global longitudinal strain (p = 0.22). On linear regression there was no association between baseline over-hydration (as defined by bioimpedance) and global native T1 or global T2, nor was there an association between the change in over-hydration and the change in these parameters.

CONCLUSIONS

Acute changes in cardiac volumes and myocardial native T1 are detectable on 3T CMR following haemodialysis with fluid removal. The reduction in global T1 suggests that the abnormal native T1 observed in patients on haemodialysis is not entirely due to myocardial fibrosis.

Prospective Case-Control Study of Cardiovascular Abnormalities 6 Months Following Mild COVID-19 in Healthcare Workers

OBJECTIVES

The purpose of this study was to detect cardiovascular changes after mild severe acute respiratory syndrome-coronavirus-2 infection.

BACKGROUND

Concern exists that mild coronavirus disease 2019 may cause myocardial and vascular disease.

METHODS

Participants were recruited from COVIDsortium, a 3-hospital prospective study of 731 health care workers who underwent first-wave weekly symptom, polymerase chain reaction, and serology assessment over 4 months, with seroconversion in 21.5% (n = 157). At 6 months post-infection, 74 seropositive and 75 age-, sex-, and ethnicity-matched seronegative control subjects were recruited for cardiovascular phenotyping (comprehensive phantom-calibrated cardiovascular magnetic resonance and blood biomarkers). Analysis was blinded, using objective artificial intelligence analytics where available.

RESULTS

A total of 149 subjects (mean age 37 years, range 18 to 63 years, 58% women) were recruited. Seropositive infections had been mild with case definition, noncase definition, and asymptomatic disease in 45 (61%), 18 (24%), and 11 (15%), respectively, with 1 person hospitalized (for 2 days). Between seropositive and seronegative groups, there were no differences in cardiac structure (left ventricular volumes, mass, atrial area), function (ejection fraction, global longitudinal shortening, aortic distensibility), tissue characterization (T1, T2, extracellular volume fraction mapping, late gadolinium enhancement) or biomarkers (troponin, N-terminal pro-B-type natriuretic peptide). With abnormal defined by the 75 seronegatives (2 SDs from mean, e.g., ejection fraction <54%, septal T1 >1,072 ms, septal T2 >52.4 ms), individuals had abnormalities including reduced ejection fraction (n = 2, minimum 50%), T1 elevation (n = 6), T2 elevation (n = 9), late gadolinium enhancement (n = 13, median 1%, max 5% of myocardium), biomarker elevation (borderline troponin elevation in 4; all N-terminal pro-B-type natriuretic peptide normal). These were distributed equally between seropositive and seronegative individuals.

CONCLUSIONS

Cardiovascular abnormalities are no more common in seropositive versus seronegative otherwise healthy, workforce representative individuals 6 months post-mild severe acute respiratory syndrome-coronavirus-2 infection.

Accelerating compressed sensing reconstruction of subsampled radial k-space data using geometrically-derived density compensation

Objective.To accelerate compressed sensing (CS) reconstruction of subsampled radial k-space data using a geometrically-derived density compensation function (gDCF) without significant loss in image quality.Approach.We developed a theoretical framework to calculate a gDCF based on Nyquist distance along the radial and circumferential directions of a discrete polar coordinate system. Our gDCF was compared against standard DCF (e.g. ramp filter) and another commonly used DCF (modified Shepp-Logan (SL) filter). The resulting image quality produced by each DCF was quantified using normalized root-mean-square-error (NRMSE), blur metric (1 = blurriest; 0 = sharpest), and structural similarity index (SSIM; 1 = perfect match; 0 = no match) compared with the reference. For filtered backprojection (FBP) of phantom data obtained at the Nyquist sampling rate, Cartesian k-space sampling was used as the reference. For CS reconstruction of subsampled cardiac magnetic resonance imaging datasets (real-time cardiac cine data with 11 projections per frame,n = 20 patients; cardiac perfusion data with 30 projections per frame,n = 19 patients), CS reconstruction without DCF was used as the reference.Main results.The NRMSE, SSIM, and blur metrics of the phantom data were good for all DCFs, confirming that our gDCF produces uniform densities at the upper limit (Nyquist). For CS reconstruction of subsampled real-time cine and cardiac perfusion datasets, the image quality metrics (SSIM, NRMSE) were significantly (p < 0.05) higher for our gDCF than other DCFs, and the reconstruction time was significantly (p < 0.05) faster for our gDCF (reference) than no DCF (11.9%-52.9% slower), standard DCF (23.9%-57.6% slower), and modified SL filter (13.5%-34.8% slower).Significance.The proposed gDCF accelerates CS reconstruction of subsampled radial k-space data without significant loss in image quality compared with no DCF as the reference.

Generalized low-rank nonrigid motion-corrected reconstruction for MR fingerprinting

PURPOSE

Develop a novel low-rank motion-corrected (LRMC) reconstruction for nonrigid motion-corrected MR fingerprinting (MRF).

METHODS

Generalized motion-corrected (MC) reconstructions have been developed for steady-state imaging. Here we extend this framework to enable nonrigid MC for transient imaging applications with varying contrast, such as MRF. This is achieved by integrating low-rank dictionary-based compression into the generalized MC model to reconstruct MC singular images, reducing motion artifacts in the resulting parametric maps. The proposed LRMC reconstruction was applied for cardiac motion correction in 2D myocardial MRF (T₁ and T₂ ) with extended cardiac acquisition window (~450 ms) and for respiratory MC in free-breathing 3D myocardial and 3D liver MRF. Experiments were performed in phantom and 22 healthy subjects. The proposed approach was compared with reference spin echo (phantom) and with 2D electrocardiogram-triggered/breath-hold MOLLI and T₂ gradient-and-spin echo conventional maps (in vivo 2D and 3D myocardial MRF).

RESULTS

Phantom results were in general agreement with reference spin-echo measurements, presenting relative errors of approximately 5.4% and 5.5% for T₁ and short T₂ (<100 ms), respectively. The proposed LRMC MRF reduced residual blurring artifacts with respect to no MC for cardiac or respiratory motion in all cases (2D and 3D myocardial, 3D abdominal). In 2D myocardial MRF, left-ventricle T₁ values were 1150 ± 41 ms for LRMC MRF and 1010 ± 56 ms for MOLLI; T₂ values were 43.8 ± 2.3 ms for LRMC MRF and 49.5 ± 4.5 ms for T₂ gradient and spin echo. Corresponding measurements for 3D myocardial MRF were 1085 ± 30 ms and 1062 ± 29 ms for T₁ , and 43.5 ± 1.9 ms and 51.7 ± 1.7 ms for T₂ . For 3D liver, LRMC MRF measured liver T₁ at 565 ± 44 ms and liver T₂ at 35.4 ± 2.4 ms.

CONCLUSION

The proposed LRMC reconstruction enabled generalized (nonrigid) MC for 2D and 3D MRF, both for cardiac and respiratory motion. The proposed approach reduced motion artifacts in the MRF maps with respect to no motion compensation and achieved good agreement with reference measurements.

Magnetization-prepared GRASP MRI for rapid 3D T1 mapping and fat/water-separated T1 mapping

PURPOSE

This study aimed to (i) develop Magnetization-Prepared Golden-angle RAdial Sparse Parallel (MP-GRASP) MRI using a stack-of-stars trajectory for rapid free-breathing T1 mapping and (ii) extend MP-GRASP to multi-echo acquisition (MP-Dixon-GRASP) for fat/water-separated (water-specific) T1 mapping.

METHODS

An adiabatic non-selective 180° inversion-recovery pulse was added to a gradient-echo-based golden-angle stack-of-stars sequence for magnetization-prepared 3D single-echo or 3D multi-echo acquisition. In combination with subspace-based GRASP-Pro reconstruction, the sequence allows for standard T1 mapping (MP-GRASP) or fat/water-separated T1 mapping (MP-Dixon-GRASP), respectively. The accuracy of T1 mapping using MP-GRASP was evaluated in a phantom and volunteers (brain and liver) against clinically accepted reference methods. The repeatability of T1 estimation was also assessed in the phantom and volunteers. The performance of MP-Dixon-GRASP for water-specific T1 mapping was evaluated in a fat/water phantom and volunteers (brain and liver).

RESULTS

ROI-based mean T1 values are correlated between the references and MP-GRASP in the phantom (R2 = 1.0), brain (R2 = 0.96), and liver (R2 = 0.73). MP-GRASP achieved good repeatability of T1 estimation in the phantom (R2 = 1.0), brain (R2 = 0.99), and liver (R2 = 0.82). Water-specific T1 is different from in-phase and out-of-phase composite T1 (composite T1 when fat and water signal are mixed in phase or out of phase) both in the phantom and volunteers.

CONCLUSION

This work demonstrated the initial performance of MP-GRASP and MP-Dixon-GRASP MRI for rapid 3D T1 mapping and 3D fat/water-separated T1 mapping in the brain (without motion) and in the liver (during free breathing). With fat/water-separated T1 estimation, MP-Dixon-GRASP could be potentially useful for imaging patients with fatty-liver diseases.

Dual-excitation flip-angle simultaneous cine and T1 mapping using spiral acquisition with respiratory and cardiac self-gating

PURPOSE

To develop a free-breathing cardiac self-gated technique that provides cine images and B1+ slice profile-corrected T₁ maps from a single acquisition.

METHODS

Without breath-holding or electrocardiogram gating, data were acquired continuously on a 3T scanner using a golden-angle gradient-echo spiral pulse sequence, with an inversion RF pulse applied every 4 seconds. Flip angles of 3° and 15° were used for readouts after the first four and second four inversions. Self-gating cardiac triggers were extracted from heart image navigators, and respiratory motion was corrected by rigid registration on each heartbeat. Cine images were reconstructed from the steady-state portion of 15° readouts using a low-rank plus sparse reconstruction. The T₁ maps were fit using a projection onto convex sets approach from images reconstructed using slice profile-corrected dictionary learning. This strategy was evaluated in a phantom and 14 human subjects.

RESULTS

The self-gated signal demonstrated close agreement with the acquired electrocardiogram signal. The image quality for the proposed cine images and standard clinical balanced SSFP images were 4.31 (±0.50) and 4.65 (±0.30), respectively. The slice profile-corrected T₁ values were similar to those of the inversion-recovery spin-echo technique in phantom, and had a higher global T₁ value than that of MOLLI in human subjects.

CONCLUSIONS

Cine and T₁ mapping using spiral acquisition with respiratory and cardiac self-gating successfully acquired T₁ maps and cine images in a single acquisition without the need for electrocardiogram gating or breath-holding. This dual-excitation flip-angle approach provides a novel approach for measuring T₁ while accounting for B1+ and slice profile effect on the apparent T1∗ .

Multi-site, multi-platform comparison of MRI T1 measurement using the system phantom

Recent innovations in quantitative magnetic resonance imaging (MRI) measurement methods have led to improvements in accuracy, repeatability, and acquisition speed, and have prompted renewed interest to reevaluate the medical value of quantitative T₁. The purpose of this study was to determine the bias and reproducibility of T₁ measurements in a variety of MRI systems with an eye toward assessing the feasibility of applying diagnostic threshold T₁ measurement across multiple clinical sites. We used the International Society of Magnetic Resonance in Medicine/National Institute of Standards and Technology (ISMRM/NIST) system phantom to assess variations of T₁ measurements, using a slow, reference standard inversion recovery sequence and a rapid, commonly-available variable flip angle sequence, across MRI systems at 1.5 tesla (T) (two vendors, with number of MRI systems n = 9) and 3 T (three vendors, n = 18). We compared the T₁ measurements from inversion recovery and variable flip angle scans to ISMRM/NIST phantom reference values using Analysis of Variance (ANOVA) to test for statistical differences between T₁ measurements grouped according to MRI scanner manufacturers and/or static field strengths. The inversion recovery method had minor over- and under-estimations compared to the NMR-measured T₁ values at both 1.5 T and 3 T. Variable flip angle measurements had substantially greater deviations from the NMR-measured T₁ values than the inversion recovery measurements. At 3 T, the measured variable flip angle T₁ for one vendor is significantly different than the other two vendors for most of the samples throughout the clinically relevant range of T₁. There was no consistent pattern of discrepancy between vendors. We suggest establishing rigorous quality control procedures for validating quantitative MRI methods to promote confidence and stability in associated measurement techniques and to enable translation of diagnostic threshold from the research center to the entire clinical community.

3D whole-heart grey-blood late gadolinium enhancement cardiovascular magnetic resonance imaging

PURPOSE

To develop a free-breathing whole-heart isotropic-resolution 3D late gadolinium enhancement (LGE) sequence with Dixon-encoding, which provides co-registered 3D grey-blood phase-sensitive inversion-recovery (PSIR) and complementary 3D fat volumes in a single scan of < 7 min.

METHODS

A free-breathing 3D PSIR LGE sequence with dual-echo Dixon readout with a variable density Cartesian trajectory with acceleration factor of 3 is proposed. Image navigators are acquired to correct both inversion recovery (IR)-prepared and reference volumes for 2D translational respiratory motion, enabling motion compensated PSIR reconstruction with 100% respiratory scan efficiency. An intermediate PSIR reconstruction is performed between the in-phase echoes to estimate the signal polarity which is subsequently applied to the IR-prepared water volume to generate a water grey-blood PSIR image. The IR-prepared water volume is obtained using a water/fat separation algorithm from the corresponding dual-echo readout. The complementary fat-volume is obtained after water/fat separation of the reference volume. Ten patients (6 with myocardial scar) were scanned with the proposed water/fat grey-blood 3D PSIR LGE sequence at 1.5 T and compared to breath-held grey-blood 2D LGE sequence in terms of contrast ratio (CR), contrast-to-noise ratio (CNR), scar depiction, scar transmurality, scar mass and image quality.

RESULTS

Comparable CRs (p = 0.98, 0.40 and 0.83) and CNRs (p = 0.29, 0.40 and 0.26) for blood-myocardium, scar-myocardium and scar-blood respectively were obtained with the proposed free-breathing 3D water/fat LGE and 2D clinical LGE scan. Excellent agreement for scar detection, scar transmurality, scar mass (bias = 0.29%) and image quality scores (from 1: non-diagnostic to 4: excellent) of 3.8 ± 0.42 and 3.6 ± 0.69 (p > 0.99) were obtained with the 2D and 3D PSIR LGE approaches with comparable total acquisition time (p = 0.29). Similar agreement in intra and inter-observer variability were obtained for the 2D and 3D acquisition respectively.

CONCLUSION

The proposed approach enabled the acquisition of free-breathing motion-compensated isotropic-resolution 3D grey-blood PSIR LGE and fat volumes. The proposed approach showed good agreement with conventional 2D LGE in terms of CR, scar depiction and scan time, while enabling free-breathing acquisition, whole-heart coverage, reformatting in arbitrary views and visualization of both water and fat information.

Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance

BACKGROUND

Troponin elevation is common in hospitalized COVID-19 patients, but underlying aetiologies are ill-defined. We used multi-parametric cardiovascular magnetic resonance (CMR) to assess myocardial injury in recovered COVID-19 patients.

METHODS AND RESULTS

One hundred and forty-eight patients (64 ± 12 years, 70% male) with severe COVID-19 infection [all requiring hospital admission, 48 (32%) requiring ventilatory support] and troponin elevation discharged from six hospitals underwent convalescent CMR (including adenosine stress perfusion if indicated) at median 68 days. Left ventricular (LV) function was normal in 89% (ejection fraction 67% ± 11%). Late gadolinium enhancement and/or ischaemia was found in 54% (80/148). This comprised myocarditis-like scar in 26% (39/148), infarction and/or ischaemia in 22% (32/148) and dual pathology in 6% (9/148). Myocarditis-like injury was limited to three or less myocardial segments in 88% (35/40) of cases with no associated LV dysfunction; of these, 30% had active myocarditis. Myocardial infarction was found in 19% (28/148) and inducible ischaemia in 26% (20/76) of those undergoing stress perfusion (including 7 with both infarction and ischaemia). Of patients with ischaemic injury pattern, 66% (27/41) had no past history of coronary disease. There was no evidence of diffuse fibrosis or oedema in the remote myocardium (T1: COVID-19 patients 1033 ± 41 ms vs. matched controls 1028 ± 35 ms; T2: COVID-19 46 ± 3 ms vs. matched controls 47 ± 3 ms).

CONCLUSIONS

During convalescence after severe COVID-19 infection with troponin elevation, myocarditis-like injury can be encountered, with limited extent and minimal functional consequence. In a proportion of patients, there is evidence of possible ongoing localized inflammation. A quarter of patients had ischaemic heart disease, of which two-thirds had no previous history. Whether these observed findings represent pre-existing clinically silent disease or de novo COVID-19-related changes remain undetermined. Diffuse oedema or fibrosis was not detected.