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Jaspers TJM, Martens B, Crawley R, Jada L, Amirrajab S, Breeuwer M, Holtackers RJ, Chiribiri A, Scannell CM. Deep Learning Synthesis of White-Blood From Dark-Blood Late Gadolinium Enhancement Cardiac Magnetic Resonance. Invest Radiol 2024:00004424-990000000-00213. [PMID: 38687025 DOI: 10.1097/rli.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVES Dark-blood late gadolinium enhancement (DB-LGE) cardiac magnetic resonance has been proposed as an alternative to standard white-blood LGE (WB-LGE) imaging protocols to enhance scar-to-blood contrast without compromising scar-to-myocardium contrast. In practice, both DB and WB contrasts may have clinical utility, but acquiring both has the drawback of additional acquisition time. The aim of this study was to develop and evaluate a deep learning method to generate synthetic WB-LGE images from DB-LGE, allowing the assessment of both contrasts without additional scan time. MATERIALS AND METHODS DB-LGE and WB-LGE data from 215 patients were used to train 2 types of unpaired image-to-image translation deep learning models, cycle-consistent generative adversarial network (CycleGAN) and contrastive unpaired translation, with 5 different loss function hyperparameter settings each. Initially, the best hyperparameter setting was determined for each model type based on the Fréchet inception distance and the visual assessment of expert readers. Then, the CycleGAN and contrastive unpaired translation models with the optimal hyperparameters were directly compared. Finally, with the best model chosen, the quantification of scar based on the synthetic WB-LGE images was compared with the truly acquired WB-LGE. RESULTS The CycleGAN architecture for unpaired image-to-image translation was found to provide the most realistic synthetic WB-LGE images from DB-LGE images. The results showed that it was difficult for visual readers to distinguish if an image was true or synthetic (55% correctly classified). In addition, scar burden quantification with the synthetic data was highly correlated with the analysis of the truly acquired images. Bland-Altman analysis found a mean bias in percentage scar burden between the quantification of the real WB and synthetic white-blood images of 0.44% with limits of agreement from -10.85% to 11.74%. The mean image quality of the real WB images (3.53/5) was scored higher than the synthetic white-blood images (3.03), P = 0.009. CONCLUSIONS This study proposed a CycleGAN model to generate synthetic WB-LGE from DB-LGE images to allow assessment of both image contrasts without additional scan time. This work represents a clinically focused assessment of synthetic medical images generated by artificial intelligence, a topic with significant potential for a multitude of applications. However, further evaluation is warranted before clinical adoption.
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Affiliation(s)
- Tim J M Jaspers
- From the Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (T.J.M.J., S.A., M.B., C.M.S.); School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (T.J.M.J., R.C., L.J., R.J.H., A.C., C.M.S.); Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (T.J.M.J.); Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands (B.M., R.J.H.); and Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (B.M., R.J.H.)
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Bijvoet GP, Nies HMJM, Holtackers RJ, Martens BM, Smink J, Linz D, Vernooy K, Wildberger JE, Nijveldt R, Chaldoupi SM, Mihl C. Tissue characterization of acute lesions during cardiac magnetic resonance-guided ablation of cavo-tricuspid isthmus-dependent atrial flutter: a feasibility study. Eur Heart J Cardiovasc Imaging 2024; 25:635-644. [PMID: 38156446 PMCID: PMC11057941 DOI: 10.1093/ehjci/jead334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/18/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
AIMS To characterize acute lesions during cardiac magnetic resonance (CMR)-guided radiofrequency (RF) ablation of cavo-tricuspid isthmus (CTI)-dependent atrial flutter by combining T2-weighted imaging (T2WI), T1 mapping, first-pass perfusion, and late gadolinium enhancement (LGE) imaging. CMR-guided catheter ablation offers a unique opportunity to investigate acute ablation lesions. Until present, studies only used T2WI and LGE CMR to assess acute lesions. METHODS AND RESULTS Fifteen patients with CTI-dependent atrial flutter scheduled for CMR-guided RF ablation were prospectively enrolled. Directly after achieving bidirectional block of the CTI line, CMR imaging was performed using: T2WI (n = 15), T1 mapping (n = 10), first-pass perfusion (n = 12), and LGE (n = 12) imaging. In case of acute reconnection, additional RF ablation was performed. In all patients, T2WI demonstrated oedema in the ablation region. Right atrial T1 mapping was feasible and could be analysed with a high inter-observer agreement (r = 0.931, ICC 0.921). The increase in T1 values post-ablation was significantly lower in regions showing acute reconnection compared with regions without reconnection [37 ± 90 ms vs. 115 ± 69 ms (P = 0.014), and 3.9 ± 9.0% vs. 11.1 ± 6.8% (P = 0.022)]. Perfusion defects were present in 12/12 patients. The LGE images demonstrated hyper-enhancement with a central area of hypo-enhancement in 12/12 patients. CONCLUSION Tissue characterization of acute lesions during CMR-guided CTI-dependent atrial flutter ablation demonstrates oedema, perfusion defects, and necrosis with a core of microvascular damage. Right atrial T1 mapping is feasible, and may identify regions of acute reconnection that require additional RF ablation.
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Affiliation(s)
- G P Bijvoet
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center, P.Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - H M J M Nies
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R J Holtackers
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - B M Martens
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J Smink
- Department of Clinical Research, Philips Healthcare, Best, The Netherlands
| | - D Linz
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center, P.Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K Vernooy
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center, P.Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - J E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S M Chaldoupi
- Department of Cardiology, Maastricht University Medical Center, P.Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - C Mihl
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Jada L, Holtackers RJ, Martens B, Nies HMJM, Van De Heyning CM, Botnar RM, Wildberger JE, Ismail TF, Razavi R, Chiribiri A. Quantification of myocardial scar of different etiology using dark- and bright-blood late gadolinium enhancement cardiovascular magnetic resonance. Sci Rep 2024; 14:5395. [PMID: 38443457 PMCID: PMC10914833 DOI: 10.1038/s41598-024-52058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/12/2024] [Indexed: 03/07/2024] Open
Abstract
Dark-blood late gadolinium enhancement (LGE) has been shown to improve the visualization and quantification of areas of ischemic scar compared to standard bright-blood LGE. Recently, the performance of various semi-automated quantification methods has been evaluated for the assessment of infarct size using both dark-blood LGE and conventional bright-blood LGE with histopathology as a reference standard. However, the impact of this sequence on different quantification strategies in vivo remains uncertain. In this study, various semi-automated scar quantification methods were evaluated for a range of different ischemic and non-ischemic pathologies encountered in clinical practice. A total of 62 patients referred for clinical cardiovascular magnetic resonance (CMR) were retrospectively included. All patients had a confirmed diagnosis of either ischemic heart disease (IHD; n = 21), dilated/non-ischemic cardiomyopathy (NICM; n = 21), or hypertrophic cardiomyopathy (HCM; n = 20) and underwent CMR on a 1.5 T scanner including both bright- and dark-blood LGE using a standard PSIR sequence. Both methods used identical sequence settings as per clinical protocol, apart from the inversion time parameter, which was set differently. All short-axis LGE images with scar were manually segmented for epicardial and endocardial borders. The extent of LGE was then measured visually by manual signal thresholding, and semi-automatically by signal thresholding using the standard deviation (SD) and the full width at half maximum (FWHM) methods. For all quantification methods in the IHD group, except the 6 SD method, dark-blood LGE detected significantly more enhancement compared to bright-blood LGE (p < 0.05 for all methods). For both bright-blood and dark-blood LGE, the 6 SD method correlated best with manual thresholding (16.9% vs. 17.1% and 20.1% vs. 20.4%, respectively). For the NICM group, no significant differences between LGE methods were found. For bright-blood LGE, the 5 SD method agreed best with manual thresholding (9.3% vs. 11.0%), while for dark-blood LGE the 4 SD method agreed best (12.6% vs. 11.5%). Similarly, for the HCM group no significant differences between LGE methods were found. For bright-blood LGE, the 6 SD method agreed best with manual thresholding (10.9% vs. 12.2%), while for dark-blood LGE the 5 SD method agreed best (13.2% vs. 11.5%). Semi-automated LGE quantification using dark-blood LGE images is feasible in both patients with ischemic and non-ischemic scar patterns. Given the advantage in detecting scar in patients with ischemic heart disease and no disadvantage in patients with non-ischemic scar, dark-blood LGE can be readily and widely adopted into clinical practice without compromising on quantification.
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Affiliation(s)
- Lamis Jada
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
- King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Robert J Holtackers
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Bibi Martens
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hedwig M J M Nies
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Caroline M Van De Heyning
- GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Rene M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
- Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tevfik F Ismail
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
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Salatzki J, Giannitsis E, Hegenbarth A, Mueller-Hennessen M, André F, Frey N, Biener M. Absence of visible infarction on cardiac magnetic resonance imaging despite the established diagnosis of myocardial infarction by 4th Universal Definition of Myocardial Infarction. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:24-35. [PMID: 37875124 DOI: 10.1093/ehjacc/zuad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/12/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023]
Abstract
AIMS Myocardial scarring due to acute myocardial infarction (AMI) can be visualized by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging. However, a recent study revealed a group of Type 1 AMI patients with undetectable myocardial injury on LGE. This study aims to describe these cases in detail and explore possible explanations for this new phenomenon. METHODS AND RESULTS A total of 137 patients diagnosed with either ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (non-STEMI) diagnosed according to the 4th Universal Definition of Myocardial Infarction underwent LGE-CMR after invasive coronary angiography. Fourteen of them (10.2%) showed no LGE and were included in the final study population. Most patients presented with acute chest pain, 3 patients were diagnosed as STEMI, and 11 as non-STEMI. Peak high-sensitive cardiac troponin T ranged from 45 to 1173 ng/L. A culprit lesion was identified in 12 patients. Severe coronary stenoses were found in five patients, while seven patients had subtotal to total coronary artery occlusion. Percutaneous coronary intervention was performed in 10 patients, while 2 patients required coronary artery bypass grafting and no intervention was required in 2 patients. Cardiac magnetic resonance was performed 30 (4-140) days after the initial presentation. Most patients showed preserved left ventricular ejection fraction on CMR. No alternative reasons for the rise/fall of high-sensitive cardiac troponin T were found. CONCLUSION The absence of LGE on CMR in patients with Type 1 AMI is a new finding. While insufficient spatial resolution of LGE imaging, delayed CMR performance, spontaneous reperfusion, and coronary collaterals may provide some explanations, further investigations are required to fully understand this phenomenon.
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Affiliation(s)
- Janek Salatzki
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Anastasia Hegenbarth
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Matthias Mueller-Hennessen
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Moritz Biener
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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Chen YC, Zheng G, Donner DG, Wright DK, Greenwood JP, Marwick TH, McMullen JR. Cardiovascular magnetic resonance imaging for sequential assessment of cardiac fibrosis in mice: technical advancements and reverse translation. Am J Physiol Heart Circ Physiol 2024; 326:H1-H24. [PMID: 37921664 PMCID: PMC11213480 DOI: 10.1152/ajpheart.00437.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Cardiovascular magnetic resonance (CMR) imaging has become an essential technique for the assessment of cardiac function and morphology, and is now routinely used to monitor disease progression and intervention efficacy in the clinic. Cardiac fibrosis is a common characteristic of numerous cardiovascular diseases and often precedes cardiac dysfunction and heart failure. Hence, the detection of cardiac fibrosis is important for both early diagnosis and the provision of guidance for interventions/therapies. Experimental mouse models with genetically and/or surgically induced disease have been widely used to understand mechanisms underlying cardiac fibrosis and to assess new treatment strategies. Improving the appropriate applications of CMR to mouse studies of cardiac fibrosis has the potential to generate new knowledge, and more accurately examine the safety and efficacy of antifibrotic therapies. In this review, we provide 1) a brief overview of different types of cardiac fibrosis, 2) general background on magnetic resonance imaging (MRI), 3) a summary of different CMR techniques used in mice for the assessment of cardiac fibrosis including experimental and technical considerations (contrast agents and pulse sequences), and 4) provide an overview of mouse studies that have serially monitored cardiac fibrosis during disease progression and/or therapeutic interventions. Clinically established CMR protocols have advanced mouse CMR for the detection of cardiac fibrosis, and there is hope that discovery studies in mice will identify new antifibrotic therapies for patients, highlighting the value of both reverse translation and bench-to-bedside research.
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Affiliation(s)
- Yi Ching Chen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Gang Zheng
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - Daniel G Donner
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - John P Greenwood
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Department of Cardiology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Julie R McMullen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia
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Gertz RJ, Wagner A, Sokolowski M, Lennartz S, Gietzen C, Grunz JP, Goertz L, Kaya K, ten Freyhaus H, Persigehl T, Bunck AC, Doerner J, Naehle CP, Maintz D, Weiss K, Katemann C, Pennig L. Compressed SENSE accelerated 3D single-breath-hold late gadolinium enhancement cardiovascular magnetic resonance with isotropic resolution: clinical evaluation. Front Cardiovasc Med 2023; 10:1305649. [PMID: 38099228 PMCID: PMC10720442 DOI: 10.3389/fcvm.2023.1305649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Aim The purpose of this study was to investigate the clinical application of Compressed SENSE accelerated single-breath-hold LGE with 3D isotropic resolution compared to conventional LGE imaging acquired in multiple breath-holds. Material & Methods This was a retrospective, single-center study including 105 examinations of 101 patients (48.2 ± 16.8 years, 47 females). All patients underwent conventional breath-hold and 3D single-breath-hold (0.96 × 0.96 × 1.1 mm3 reconstructed voxel size, Compressed SENSE factor 6.5) LGE sequences at 1.5 T in clinical routine for the evaluation of ischemic or non-ischemic cardiomyopathies. Two radiologists independently evaluated the left ventricle (LV) for the presence of hyperenhancing lesions in each sequence, including localization and transmural extent, while assessing their scar edge sharpness (SES). Confidence of LGE assessment, image quality (IQ), and artifacts were also rated. The impact of LV ejection fraction (LVEF), heart rate, body mass index (BMI), and gender as possible confounders on IQ, artifacts, and confidence of LGE assessment was evaluated employing ordinal logistic regression analysis. Results Using 3D single-breath-hold LGE readers detected more hyperenhancing lesions compared to conventional breath-hold LGE (n = 246 vs. n = 216 of 1,785 analyzed segments, 13.8% vs. 12.1%; p < 0.0001), pronounced at subendocardial, midmyocardial, and subepicardial localizations and for 1%-50% of transmural extent. SES was rated superior in 3D single-breath-hold LGE (4.1 ± 0.8 vs. 3.3 ± 0.8; p < 0.001). 3D single-breath-hold LGE yielded more artifacts (3.8 ± 1.0 vs. 4.0 ± 3.8; p = 0.002) whereas IQ (4.1 ± 1.0 vs. 4.2 ± 0.9; p = 0.122) and confidence of LGE assessment (4.3 ± 0.9 vs. 4.3 ± 0.8; p = 0.374) were comparable between both techniques. Female gender negatively influenced artifacts in 3D single-breath-hold LGE (p = 0.0028) while increased heart rate led to decreased IQ in conventional breath-hold LGE (p = 0.0029). Conclusions In clinical routine, Compressed SENSE accelerated 3D single-breath-hold LGE yields image quality and confidence of LGE assessment comparable to conventional breath-hold LGE while providing improved delineation of smaller LGE lesions with superior scar edge sharpness. Given the fast acquisition of 3D single-breath-hold LGE, the technique holds potential to drastically reduce the examination time of CMR.
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Affiliation(s)
- Roman Johannes Gertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anton Wagner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute for Diagnostic and Interventional Radiology, Krankenhaus der Augustinerinnen, Cologne, Germany
| | - Marcel Sokolowski
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carsten Gietzen
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Lukas Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kenan Kaya
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Henrik ten Freyhaus
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alexander Christian Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jonas Doerner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Kontraste Radiologie-Praxis Köln West, Cologne, Germany
| | - Claas Philip Naehle
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Radiologische Allianz Hamburg, Hamburg, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Gonzalez de Alba C, Moghari MH, Browne LP, Friesen RM, Fonseca B, Malone LJ. Feasibility of gray-blood late gadolinium enhancement evaluation in young patients with congenital and acquired heart disease. Front Cardiovasc Med 2023; 10:1269412. [PMID: 37915741 PMCID: PMC10616296 DOI: 10.3389/fcvm.2023.1269412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023] Open
Abstract
Background Late gadolinium enhancement (LGE) sequences have become common in pediatric cardiovascular magnetic resonance (CMR) to assess for myocardial fibrosis. Bright-blood late gadolinium enhancement (BB-LGE) by conventional phase-sensitive inversion recovery (PSIR) is commonly utilized, but similar inversion time (TI) value of fibrosis and left ventricular (LV) blood pool can make subendocardial areas difficult to assess. A gray-blood LGE (GB-LGE) technique has been described, targeting nulling of the LV blood pool and demonstrating improvement in ischemic scar detection over BB-LGE in adult patients. We sought to evaluate the feasibility of the GB-LGE technique in a young population with congenital and acquired heart disease and compare its ability to detect subendocardial scar to conventional BB-LGE. Methods Seventy-six consecutive patients referred for clinical CMR underwent both BB-LGE and GB-LGE on 1.5 T and 3 T scanners. Conventional PSIR sequences were obtained with TI to null the myocardium (BB-LGE) in short-axis and horizontal long-axis stacks. Same PSIR stacks were immediately repeated with TI to null the blood pool (GB-LGE). Both sequences were reviewed separately a week apart by two readers, blinded to the initial clinical interpretation. Studies were analyzed for overall image quality, confidence in scar detection, confidence in detection of LGE, LGE class, inter- and intra-observer agreement for the presence of scar, and intraclass correlation coefficient (ICC) for total scar burden. Results Overall confidence in myocardial scar detection by BB-LGE or GB-LGE as well as grading of image quality were not statistically different [(p = 1 and p = 1) and (p = 0.53, p = 0.18), respectively]. There was very good inter-observer agreement for the presence of scar on BB-LGE (K = 0.88, 95% CI 0.77-0.99) and GB-LGE (K = 0.84, 95% CI 0.7-0.96), as well as excellent intra-observer agreement for both readers (K = 0.93, 95% CI 0.87-0.99; and K = 0.81, 95% CI 0.69-0.95). Interclass correlation coefficient for total scar burden was excellent for BB-LGE (ICC = 0.98, 95% CI 0.96-0.99) and GB-LGE (ICC = 0.94, 95% CI 0.91-0.97). Conclusions The GB-LGE technique is feasible in the pediatric population with congenital and acquired heart disease. It can detect subendocardial/ischemic scar similar to conventional bright-blood PSIR sequences in the pediatric population.
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Affiliation(s)
- Cesar Gonzalez de Alba
- Division of Cardiology, Heart Institute, Children’s Hospital Colorado, University of Colorado, Aurora, CO, United States
| | - Mehdi H. Moghari
- Department of Radiology, University of Colorado, Aurora, CO, United States
- Department of Radiology, Children’s Hospital Colorado, Aurora, CO, United States
| | - Lorna P. Browne
- Department of Radiology, University of Colorado, Aurora, CO, United States
- Department of Radiology, Children’s Hospital Colorado, Aurora, CO, United States
| | - Richard M. Friesen
- Division of Cardiology, Heart Institute, Children’s Hospital Colorado, University of Colorado, Aurora, CO, United States
| | - Brian Fonseca
- Division of Cardiology, Heart Institute, Children’s Hospital Colorado, University of Colorado, Aurora, CO, United States
| | - LaDonna J. Malone
- Department of Radiology, University of Colorado, Aurora, CO, United States
- Department of Radiology, Children’s Hospital Colorado, Aurora, CO, United States
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8
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Xiang C, Zhang H, Li H, Zhou X, Huang L, Xia L. The value of cardiac magnetic resonance post-contrast T1 mapping in improving the evaluation of myocardial infarction. Front Cardiovasc Med 2023; 10:1238451. [PMID: 37908503 PMCID: PMC10613640 DOI: 10.3389/fcvm.2023.1238451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023] Open
Abstract
Objective To explore the additional value of cardiac magnetic resonance (CMR) post-contrast T1 mapping in the detection of myocardial infarction, compared with late gadolinium enhancement (LGE). Materials and methods A CMR database of consecutive patients with myocardial infarction was retrospectively analyzed. All patients were scanned at 3 T magnetic resonance; they underwent conventional CMR (including LGE) and post-contrast T1 mapping imaging. Two radiologists interpreted the CMR images using a 16-segment model. The first interpretation included only LGE images. After 30 days, the same radiologists performed a second analysis of random LGE images, with the addition of post-contrast T1 mapping images. Images were analyzed to diagnose myocardial scars, and the transmural extent of each scar was visually evaluated. Diagnoses retained after LGE were compared with diagnoses retained after the addition of post-contrast T1 mapping. Results In total, 80 patients (1,280 myocardial segments) were included in the final analysis. After the addition of post-contrast T1 mapping, eight previously unidentified subendocardial scars were detected. Compared with LGE images, the percentage of infarcted segments was higher after the addition of post-contrast T1 mapping images (21.7% vs. 22.3%, P = 0.008), the percentage of uncertain segments was lower after the addition of post-contrast T1 mapping (0.8% vs. 0.1%, P = 0.004), and the percentage of uncertain transmural extent of scarring was lower after the addition of post-contrast T1 mapping (0.9% vs. 0.1%, P = 0.001). Conclusion The addition of post-contrast T1 mapping after LGE helps to improve the detection of myocardial infarction, as well as the assessment of the transmural extent of scarring.
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Affiliation(s)
- Chunlin Xiang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongyan Zhang
- Department of Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haojie Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyue Zhou
- Siemens Healthineers Digital Technology (Shanghai) Co., Ltd., Shanghai, China
| | - Lu Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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9
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Brendel JM, Holtackers RJ, Geisel JN, Kübler J, Hagen F, Gawaz M, Nikolaou K, Greulich S, Krumm P. Dark-Blood Late Gadolinium Enhancement MRI Is Noninferior to Bright-Blood LGE in Non-Ischemic Cardiomyopathies. Diagnostics (Basel) 2023; 13:1634. [PMID: 37175026 PMCID: PMC10178168 DOI: 10.3390/diagnostics13091634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/29/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background and Objectives: Dark-blood late gadolinium enhancement has been shown to be a reliable cardiac magnetic resonance (CMR) method for assessing viability and depicting myocardial scarring in ischemic cardiomyopathy. The aim of this study was to evaluate dark-blood LGE imaging compared with conventional bright-blood LGE for the detection of myocardial scarring in non-ischemic cardiomyopathies. (2) Materials and Methods: Patients with suspected non-ischemic cardiomyopathy were prospectively enrolled in this single-centre study from January 2020 to March 2023. All patients underwent 1.5 T CMR with both dark-blood and conventional bright-blood LGE imaging. Corresponding short-axis stacks of both techniques were analysed for the presence, distribution, pattern, and localisation of LGE, as well as the quantitative scar size (%). (3) Results: 343 patients (age 44 ± 17 years; 124 women) with suspected non-ischemic cardiomyopathy were examined. LGE was detected in 123 of 343 cases (36%) with excellent inter-reader agreement (κ 0.97-0.99) for both LGE techniques. Dark-blood LGE showed a sensitivity of 99% (CI 98-100), specificity of 99% (CI 98-100), and an accuracy of 99% (CI 99-100) for the detection of non-ischemic scarring. No significant difference in total scar size (%) was observed. Dark-blood imaging with mean 5.35 ± 4.32% enhanced volume of total myocardial volume, bright-blood with 5.24 ± 4.28%, p = 0.84. (4) Conclusions: Dark-blood LGE imaging is non-inferior to conventional bright-blood LGE imaging in detecting non-ischemic scarring. Therefore, dark-blood LGE imaging may become an equivalent method for the detection of both ischemic and non-ischemic scars.
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Affiliation(s)
- Jan M. Brendel
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Robert J. Holtackers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Jan N. Geisel
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Jens Kübler
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Florian Hagen
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Meinrad Gawaz
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Simon Greulich
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
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10
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Abstract
Myocardial inflammation occurs following activation of the cardiac immune system, producing characteristic changes in the myocardial tissue. Cardiovascular magnetic resonance is the non-invasive imaging gold standard for myocardial tissue characterization, and is able to detect image signal changes that may occur resulting from inflammation, including edema, hyperemia, capillary leak, necrosis, and fibrosis. Conventional cardiovascular magnetic resonance for the detection of myocardial inflammation and its sequela include T2-weighted imaging, parametric T1- and T2-mapping, and gadolinium-based contrast-enhanced imaging. Emerging techniques seek to image several parameters simultaneously for myocardial tissue characterization, and to depict subtle immune-mediated changes, such as immune cell activity in the myocardium and cardiac cell metabolism. This review article outlines the underlying principles of current and emerging cardiovascular magnetic resonance methods for imaging myocardial inflammation.
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Affiliation(s)
- Katharine E Thomas
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (K.E.T., V.M.F.)
| | - Anastasia Fotaki
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, United Kingdom (A.F., R.M.B.)
| | - René M Botnar
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, United Kingdom (A.F., R.M.B.)
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B.)
- Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.M.B.)
| | - Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (K.E.T., V.M.F.)
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11
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Muscogiuri G, Guaricci AI, Soldato N, Cau R, Saba L, Siena P, Tarsitano MG, Giannetta E, Sala D, Sganzerla P, Gatti M, Faletti R, Senatieri A, Chierchia G, Pontone G, Marra P, Rabbat MG, Sironi S. Multimodality Imaging of Sudden Cardiac Death and Acute Complications in Acute Coronary Syndrome. J Clin Med 2022; 11:jcm11195663. [PMID: 36233531 PMCID: PMC9573273 DOI: 10.3390/jcm11195663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/07/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Sudden cardiac death (SCD) is a potentially fatal event usually caused by a cardiac arrhythmia, which is often the result of coronary artery disease (CAD). Up to 80% of patients suffering from SCD have concomitant CAD. Arrhythmic complications may occur in patients with acute coronary syndrome (ACS) before admission, during revascularization procedures, and in hospital intensive care monitoring. In addition, about 20% of patients who survive cardiac arrest develop a transmural myocardial infarction (MI). Prevention of ACS can be evaluated in selected patients using cardiac computed tomography angiography (CCTA), while diagnosis can be depicted using electrocardiography (ECG), and complications can be evaluated with cardiac magnetic resonance (CMR) and echocardiography. CCTA can evaluate plaque, burden of disease, stenosis, and adverse plaque characteristics, in patients with chest pain. ECG and echocardiography are the first-line tests for ACS and are affordable and useful for diagnosis. CMR can evaluate function and the presence of complications after ACS, such as development of ventricular thrombus and presence of myocardial tissue characterization abnormalities that can be the substrate of ventricular arrhythmias.
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Affiliation(s)
- Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, Piazzale Brescia 20, 20149 Milan, Italy
- School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy
- Correspondence:
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Nicola Soldato
- University Cardiology Unit, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09124 Cagliari, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09124 Cagliari, Italy
| | - Paola Siena
- University Cardiology Unit, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Maria Grazia Tarsitano
- Department of Medical and Surgical Science, University Magna Grecia, 88100 Catanzaro, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Davide Sala
- Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Paolo Sganzerla
- Department of Cardiac, Neurological and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy
| | - Alberto Senatieri
- School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy
| | | | | | - Paolo Marra
- School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Mark G. Rabbat
- Division of Cardiology, Loyola University of Chicago, Chicago, IL 60611, USA
- Edward Hines Jr. VA Hospital, Hines, IL 60141, USA
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
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12
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Nies HMJM, Gommers S, Bijvoet GP, Heckman LIB, Prinzen FW, Vogel G, Van De Heyning CM, Chiribiri A, Wildberger JE, Mihl C, Holtackers RJ. Histopathological validation of semi-automated myocardial scar quantification techniques for dark-blood late gadolinium enhancement magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2022; 24:364-372. [PMID: 35723673 PMCID: PMC9936958 DOI: 10.1093/ehjci/jeac107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS To evaluate the performance of various semi-automated techniques for quantification of myocardial infarct size on both conventional bright-blood and novel dark-blood late gadolinium enhancement (LGE) images using histopathology as reference standard. METHODS AND RESULTS In 13 Yorkshire pigs, reperfused myocardial infarction was experimentally induced. At 7 weeks post-infarction, both bright-blood and dark-blood LGE imaging were performed on a 1.5 T magnetic resonance scanner. Following magnetic resonance imaging (MRI), the animals were sacrificed, and histopathology was obtained. The percentage of infarcted myocardium was assessed per slice using various semi-automated scar quantification techniques, including the signal threshold vs. reference mean (STRM, using 3 to 8 SDs as threshold) and full-width at half-maximum (FWHM) methods, as well as manual contouring, for both LGE methods. Infarct size obtained by histopathology was used as reference. In total, 24 paired LGE MRI slices and histopathology samples were available for analysis. For both bright-blood and dark-blood LGE, the STRM method with a threshold of 5 SDs led to the best agreement to histopathology without significant bias (-0.23%, 95% CI [-2.99, 2.52%], P = 0.862 and -0.20%, 95% CI [-2.12, 1.72%], P = 0.831, respectively). Manual contouring significantly underestimated infarct size on bright-blood LGE (-1.57%, 95% CI [-2.96, -0.18%], P = 0.029), while manual contouring on dark-blood LGE outperformed semi-automated quantification and demonstrated the most accurate quantification in this study (-0.03%, 95% CI [-0.22, 0.16%], P = 0.760). CONCLUSION The signal threshold vs. reference mean method with a threshold of 5 SDs demonstrated the most accurate semi-automated quantification of infarcted myocardium, without significant bias compared to histopathology, for both conventional bright-blood and novel dark-blood LGE.
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Affiliation(s)
| | - Suzanne Gommers
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
| | - Geertruida P Bijvoet
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Luuk I B Heckman
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Frits W Prinzen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Gaston Vogel
- Pie Medical Imaging, Maastricht, The Netherlands
| | - Caroline M Van De Heyning
- Department of Cardiology, Antwerp University Hospital and GENCOR, University of Antwerp, Antwerp, Belgium
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
| | - Casper Mihl
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
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13
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Polacin M, Karolyi M, Blüthgen C, Pilz N, Eberhard M, Alkadhi H, Kozerke S, Manka R. Simplified image acquisition and detection of ischemic and non-ischemic myocardial fibrosis with fixed short inversion time magnetic resonance late gadolinium enhancement. Br J Radiol 2022; 95:20210966. [PMID: 35195448 PMCID: PMC10993981 DOI: 10.1259/bjr.20210966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Late gadolinium enhancement with fixed short inversion time (LGEshort) provides excellent tissue contrast with dark scar and bright blood pool and does not need prior myocardial nulling. We hypothesize better visibility of ischemic scars and equal visibility of non-ischemic LGE in LGEshort compared to clinically established LGE (LGEstandard). METHODS LGEshort and LGEstandard were retrospectively evaluated in 179 patients (3043 segments) with suspected or known coronary artery disease by four blinded readers (reader A: most experienced - D: least experienced). The amount of ischemic and non-ischemic LGE as well as visibility (4: very good - 1: poor) of ischemic LGE was visually assessed. RESULTS All readers detected more infarcted segments in LGEshort compared to LGEstandard (378 segments reported as infarcted; A:p = 0.5, B:p = 0.8, C,D:p = 0.03). Scar visibility was scored higher in LGEshort by all readers (A,B:p = 0.03; C,D:p = 0.02), especially for subendocardial infarcts (A,B:p = 0.04, C,D:p = 0.02). Less experienced readers detected significantly more infarcted papillary muscles (C:p = 0.02, D:p = 0.03) in a shorter reading time in LGEshort (C:p = 0.04, D:p = 0.02). Non-ischemic LGE was equally visible in both sequences (A:p = 0.9, B:p = 0.8, C,D:p = 0.6). CONCLUSIONS LGEshort detects more ischemic LGE with improved scar visibility compared to LGEstandard, independent of experience level. The visibility of non-ischemic LGE is equivalent to LGEstandard. Less experienced readers can diagnose ischemic and non-ischemic LGE faster in LGEshort. ADVANCES IN KNOWLEDGE LGEshort with its maximal operational simplicity can be used for visualization of all types of fibrosis - ischemic and non-ischemic - instead of LGEstandard, independent of experience level.
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Affiliation(s)
- Malgorzata Polacin
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH
Zurich, Zurich,
Switzerland
| | - Mihaly Karolyi
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Christian Blüthgen
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Nik Pilz
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Matthias Eberhard
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH
Zurich, Zurich,
Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH
Zurich, Zurich,
Switzerland
- Department of Cardiology, University Heart Center, University
Hospital Zurich, University of Zurich,
Zurich, Switzerland
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14
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Determination of scar area using native and post-contrast T1 mapping: Agreement with late gadolinium enhancement. Eur J Radiol 2022; 150:110242. [DOI: 10.1016/j.ejrad.2022.110242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/15/2022]
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15
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Pradella S, Mazzoni LN, Letteriello M, Tortoli P, Bettarini S, De Amicis C, Grazzini G, Busoni S, Palumbo P, Belli G, Miele V. FLORA software: semi-automatic LGE-CMR analysis tool for cardiac lesions identification and characterization. Radiol Med 2022; 127:589-601. [DOI: 10.1007/s11547-022-01491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
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16
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McElroy S, Ferrazzi G, Nazir MS, Evans C, Ferreira J, Bosio F, Mughal N, Kunze KP, Neji R, Speier P, Stäb D, Ismail TF, Masci PG, Villa ADM, Razavi R, Chiribiri A, Roujol S. Simultaneous multislice steady-state free precession myocardial perfusion with full left ventricular coverage and high resolution at 1.5 T. Magn Reson Med 2022; 88:663-675. [PMID: 35344593 PMCID: PMC9310832 DOI: 10.1002/mrm.29229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 12/27/2022]
Abstract
Purpose To implement and evaluate a simultaneous multi‐slice balanced SSFP (SMS‐bSSFP) perfusion sequence and compressed sensing reconstruction for cardiac MR perfusion imaging with full left ventricular (LV) coverage (nine slices/heartbeat) and high spatial resolution (1.4 × 1.4 mm2) at 1.5T. Methods A preliminary study was performed to evaluate the performance of blipped controlled aliasing in parallel imaging (CAIPI) and RF‐CAIPI with gradient‐controlled local Larmor adjustment (GC‐LOLA) in the presence of fat. A nine‐slice SMS‐bSSFP sequence using RF‐CAIPI with GC‐LOLA with high spatial resolution (1.4 × 1.4 mm2) and a conventional three‐slice sequence with conventional spatial resolution (1.9 × 1.9 mm2) were then acquired in 10 patients under rest conditions. Qualitative assessment was performed to assess image quality and perceived signal‐to‐noise ratio (SNR) on a 4‐point scale (0: poor image quality/low SNR; 3: excellent image quality/high SNR), and the number of myocardial segments with diagnostic image quality was recorded. Quantitative measurements of myocardial sharpness and upslope index were performed. Results Fat signal leakage was significantly higher for blipped CAIPI than for RF‐CAIPI with GC‐LOLA (7.9% vs. 1.2%, p = 0.010). All 10 SMS‐bSSFP perfusion datasets resulted in 16/16 diagnostic myocardial segments. There were no significant differences between the SMS and conventional acquisitions in terms of image quality (2.6 ± 0.6 vs. 2.7 ± 0.2, p = 0.8) or perceived SNR (2.8 ± 0.3 vs. 2.7 ± 0.3, p = 0.3). Inter‐reader variability was good for both image quality (ICC = 0.84) and perceived SNR (ICC = 0.70). Myocardial sharpness was improved using the SMS sequence compared to the conventional sequence (0.37 ± 0.08 vs 0.32 ± 0.05, p < 0.001). There was no significant difference between measurements of upslope index for the SMS and conventional sequences (0.11 ± 0.04 vs. 0.11 ± 0.03, p = 0.84). Conclusion SMS‐bSSFP with multiband factor 3 and compressed sensing reconstruction enables cardiac MR perfusion imaging with three‐fold increased spatial coverage and improved myocardial sharpness compared to a conventional sequence, without compromising perceived SNR, image quality, upslope index or number of diagnostic segments.
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Affiliation(s)
- Sarah McElroy
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Carl Evans
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Joana Ferreira
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Filippo Bosio
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nabila Mughal
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Karl P Kunze
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, England, UK
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,MR Research Collaborations, Siemens Healthcare Limited, Frimley, England, UK
| | - Peter Speier
- Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany
| | - Daniel Stäb
- MR Research Collaborations, Siemens Healthcare Limited, Melbourne, Australia
| | - Tevfik F Ismail
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Adriana D M Villa
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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17
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Holtackers RJ, Emrich T, Botnar RM, Kooi ME, Wildberger JE, Kreitner KF. Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging: From Basic Concepts to Emerging Methods. ROFO-FORTSCHR RONTG 2022; 194:491-504. [PMID: 35196714 DOI: 10.1055/a-1718-4355] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) is a widely used cardiac magnetic resonance imaging (MRI) technique to diagnose a broad range of ischemic and non-ischemic cardiomyopathies. Since its development and validation against histology already more than two decades ago, the clinical utility of LGE and its span of applications have increased considerably. METHODS In this review we will present the basic concepts of LGE imaging and its diagnostic and prognostic value, elaborate on recent developments and emerging methods, and finally discuss future prospects. RESULTS Continuous developments in 3 D imaging methods, motion correction techniques, water/fat-separated imaging, dark-blood methods, and scar quantification improved the performance and further expanded the clinical utility of LGE imaging. CONCLUSION LGE imaging is the current noninvasive reference standard for the assessment of myocardial viability. Improvements in spatial resolution, scar-to-blood contrast, and water/fat-separated imaging further strengthened its position. KEY POINTS · LGE MRI is the reference standard for the noninvasive assessment of myocardial viability. · LGE MRI is used to diagnose a broad range of non-ischemic cardiomyopathies in everyday clinical practice.. · Improvements in spatial resolution and scar-to-blood contrast further strengthened its position. · Continuous developments improve its performance and further expand its clinical utility. CITATION FORMAT · Holtackers RJ, Emrich T, Botnar RM et al. Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging: From Basic Concepts to Emerging Methods. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1718-4355.
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Affiliation(s)
- Robert J Holtackers
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands.,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, the Netherlands.,School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.,Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - René M Botnar
- School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom.,Pontificia Universidad Católica de Chile, Escuela de Ingeniería, Santiago, Chile
| | - M Eline Kooi
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands.,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, the Netherlands
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands.,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, the Netherlands
| | - K-F Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Germany
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18
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Krittayaphong R, Zhang S, Tanapibunpon P, Kaolawanich Y, Nakyen S. Dark-blood late gadolinium-enhancement cardiac magnetic resonance imaging for myocardial scar detection based on simplified timing scheme: single-center experience in patients with suspected coronary artery disease. Quant Imaging Med Surg 2022; 12:1037-1050. [PMID: 35111603 DOI: 10.21037/qims-21-704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022]
Abstract
Background This study aims to examine scar detectability using dark-blood late gadolinium enhancement (LGE) with simplified timing scheme and fixed parameters comparing to two conventional bright-blood approaches in patients with known or suspected coronary artery disease. Methods Three LGE techniques were performed in all patients with known or suspected coronary artery disease at 3 T: dark blood two-dimensional (2D) phase-sensitive inversion recovery (PSIR) preceded with a T2-preparation pulse (DB-LGE), conventional three-dimensional (3D) gradient-echo inversion recovery (3D-IR) and conventional 2D PSIR. Timing parameters in DB-LGE were tested in five clinically confirmed coronary artery disease patients with scars and fixed for the rest of the study. Two independent readers evaluated images at both patient and segment levels. Image quality and contrast ratio between scar and adjacent tissues were assessed. Concordance between the three techniques and detection rate based on expert consensus were reported. Results Forty-six patients were recruited in the study (average age 66.8 years, 69.6% male). DB-LGE demonstrated superior image quality (P=0.001 vs. 3D-IR) and scar-to-blood contrast ratio (P<0.001 vs. 3D-IR and PSIR). Among 41 patients with suspected coronary artery disease, myocardial scar was present in 30 patients (73.2%), all detected by DB-LGE, yielding a detection rate of 100% compared to 93.3% and 96.7% for bright-blood 3D-IR and PSIR. For subendocardial scar detection among 656 segments, DB-LGE had a detection rate of 99.4% compared to 57.8% for 3D-IR and 61.0% for PSIR (both P<0.001). Conclusions DB-LGE improves detection of myocardial scar compared with conventional bright-blood LGE techniques, particularly of subendocardial scar.
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Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Shuo Zhang
- Philips Healthcare, Singapore.,Philips Healthcare, Hamburg, Germany
| | - Prajak Tanapibunpon
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yodying Kaolawanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaporn Nakyen
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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19
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Pype LL, Holtackers RJ, Paelinck BP, Bekelaar T, Heidbuchel H, Van De Heyning CM. Persistent microvascular obstruction-like lesion after ventricular tachycardia ablation detected by novel dark-blood late gadolinium enhancement. BJR Case Rep 2022; 8:20210124. [PMID: 36101728 PMCID: PMC9461736 DOI: 10.1259/bjrcr.20210124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/22/2021] [Accepted: 01/15/2022] [Indexed: 12/02/2022] Open
Abstract
Microvascular obstruction is a transient phenomenon of “no reflow” after myocardial infarction or radiofrequency ablation, diagnosed using late gadolinium enhancement cardiac MRI. We present a patient with a persistent microvascular obstruction-like lesion following radiofrequency ventricular tachycardia ablation post-myocardial infarction, which was best characterized by a novel dark-blood late gadolinium enhancement technique.
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Affiliation(s)
- Lobke L Pype
- Department of Cardiology, Antwerp University Hospital Drie Eikenstraat, Antwerp (Edegem), Belgium
- Research group Cardiovascular Diseases, GENCOR, Antwerp University Universiteitsplein, Antwerp, Belgium
| | - Robert J Holtackers
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre P. Debyelaan, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Duboisdomein, Maastricht, the Netherlands
| | - Bernard P Paelinck
- Research group Cardiovascular Diseases, GENCOR, Antwerp University Universiteitsplein, Antwerp, Belgium
- Department of Cardiac Surgery, Antwerp University Hospital, Drie Eikenstraat, Antwerp (Edegem), Belgium
| | - Thalia Bekelaar
- Department of Cardiology, Antwerp University Hospital Drie Eikenstraat, Antwerp (Edegem), Belgium
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital Drie Eikenstraat, Antwerp (Edegem), Belgium
- Research group Cardiovascular Diseases, GENCOR, Antwerp University Universiteitsplein, Antwerp, Belgium
| | - Caroline M Van De Heyning
- Department of Cardiology, Antwerp University Hospital Drie Eikenstraat, Antwerp (Edegem), Belgium
- Research group Cardiovascular Diseases, GENCOR, Antwerp University Universiteitsplein, Antwerp, Belgium
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20
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Van De Heyning CM, Holtackers RJ, Nazir MS, Grapsa J, Demetrescu C, Pype L, Chiribiri A. Dark-blood late gadolinium enhancement CMR improves detection of papillary muscle fibrosis in patients with mitral valve prolapse. Eur J Radiol 2021; 147:110118. [PMID: 34972057 DOI: 10.1016/j.ejrad.2021.110118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Papillary muscle fibrosis may act as an arrhythmogenic substrate in patients with mitral valve prolapse (MVP). Previous studies used conventional bright-blood late gadolinium enhancement cardiovascular magnetic resonance (LGE CMR) imaging to assess papillary muscle fibrosis, although this technique suffers from poor scar-to-blood contrast which may limit its sensitivity, in contrast to dark-blood LGE. This study sought to compare bright-blood and dark-blood LGE for the detection of papillary muscle fibrosis in patients with MVP. METHOD 60 patients with known isolated MVP referred for CMR were prospectively recruited. A routine CMR protocol was used to obtain cine imaging, dark-blood LGE and bright-blood LGE in three long-axis views and a stack of short-axis views. Flow mapping of the proximal aorta was performed to calculate mitral regurgitant volume. Images were analysed for cardiac volumes, ejection fraction, mitral regurgitation severity, MVP characteristics (mitral annular disjunction, prolapse volume) and presence of LGE at the papillary muscles and myocardium. RESULTS Dark-blood LGE detected significantly more subjects with LGE at the papillary muscles than bright-blood LGE (35% vs 15%, p = 0.002). There was no difference between LGE techniques regarding myocardial (non-papillary muscle) fibrosis (present in 25% each). No statistical differences were observed between patients with or without LGE at the papillary muscles regarding demographics, clinical data (including ventricular arrhythmia) and MVP characteristics. Furthermore, no association was found between LGE at the papillary muscles and at the myocardium. CONCLUSIONS Compared to bright-blood LGE, dark-blood LGE CMR improves the detection of LGE at the papillary muscles in patients with MVP.
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Affiliation(s)
- Caroline M Van De Heyning
- Cardiovascular Diseases Research Group, GENCOR, University of Antwerp, and Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium; Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Robert J Holtackers
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, and Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Muhummad Sohaib Nazir
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Julia Grapsa
- Department of Cardiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Camelia Demetrescu
- Department of Cardiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Lobke Pype
- Cardiovascular Diseases Research Group, GENCOR, University of Antwerp, and Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Amedeo Chiribiri
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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21
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Peters DC, Lamy J, Sinusas AJ, Baldassarre LA. Left atrial evaluation by cardiovascular magnetic resonance: sensitive and unique biomarkers. Eur Heart J Cardiovasc Imaging 2021; 23:14-30. [PMID: 34718484 DOI: 10.1093/ehjci/jeab221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022] Open
Abstract
Left atrial (LA) imaging is still not routinely used for diagnosis and risk stratification, although recent studies have emphasized its importance as an imaging biomarker. Cardiovascular magnetic resonance is able to evaluate LA structure and function, metrics that serve as early indicators of disease, and provide prognostic information, e.g. regarding diastolic dysfunction, and atrial fibrillation (AF). MR angiography defines atrial anatomy, useful for planning ablation procedures, and also for characterizing atrial shapes and sizes that might predict cardiovascular events, e.g. stroke. Long-axis cine images can be evaluated to define minimum, maximum, and pre-atrial contraction LA volumes, and ejection fractions (EFs). More modern feature tracking of these cine images provides longitudinal LA strain through the cardiac cycle, and strain rates. Strain may be a more sensitive marker than EF and can predict post-operative AF, AF recurrence after ablation, outcomes in hypertrophic cardiomyopathy, stratification of diastolic dysfunction, and strain correlates with atrial fibrosis. Using high-resolution late gadolinium enhancement (LGE), the extent of fibrosis in the LA can be estimated and post-ablation scar can be evaluated. The LA LGE method is widely available, its reproducibility is good, and validations with voltage-mapping exist, although further scan-rescan studies are needed, and consensus regarding atrial segmentation is lacking. Using LGE, scar patterns after ablation in AF subjects can be reproducibly defined. Evaluation of 'pre-existent' atrial fibrosis may have roles in predicting AF recurrence after ablation, predicting new-onset AF and diastolic dysfunction in patients without AF. LA imaging biomarkers are ready to enter into diagnostic clinical practice.
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Affiliation(s)
- Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Department of Cardiology, Yale School of Medicine, New Haven, CT, USA
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22
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Abdelrauof D, Essam M, Elattar M. Light-Weight Localization and Scale-Independent Multi-gate UNET Segmentation of Left and Right Ventricles in MRI Images. Cardiovasc Eng Technol 2021; 13:393-406. [PMID: 34773242 DOI: 10.1007/s13239-021-00591-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Heart segmentation in cardiac magnetic resonance images is heavily used during the assessment of left ventricle global function. Automation of the segmentation is crucial to standardize the analysis. This study aims at developing a CNN-based framework to aid the clinical measurements of the left ventricle and right ventricle in cardiac magnetic resonance images. METHODS We propose a fully automated framework for localization and segmentation of the left ventricle and right ventricle in both short- and long-axis views from cardiac magnetic resonance images. The localization module utilizes a light-weight model that detects the region of interest and feeds it to the segmentation model. Also, we propose the Multi-Gate block as an extension to the UNet to boost the segmentation performance by aggregating multi-scale features. Comparison between our proposed method and the baseline UNet was performed to show the gain in the overall performance. The reliability of the model was assessed by testing the method against cardiac magnetic resonance images with different levels of noise and deformations. RESULTS Heart localization accuracy was 0.59 and 1.75 pixels in both short- and long-axis views respectively. Left and right ventricle blood-pool segmentation Dice was (0.93, 0.90) in end-systole and (0.97, 0.95) in end-diastole. The left ventricle myocardium was segmented accurately with Dice of 0.91 and 0.90 in end-systole and end-diastole respectively. Left ventricle ejection fraction was found to be highly correlated with the gold standard with r = 0.987. Moreover, the proposed pipeline is fast, achieving 0.002 sec per image on average. CONCLUSION Adding the Multi-Gate Dilated Inception Block has boosted the performance of UNet architecture and has shown generalization ability when tested on noisy and deformed cardiac magnetic resonance images. The proposed method has proven its wide applicability and reliability for heart detection when tested on different datasets.
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Affiliation(s)
- Dina Abdelrauof
- Research and Development Division, Intixel Co. S.A.E., Cairo, Egypt.
| | - Mina Essam
- Research and Development Division, Intixel Co. S.A.E., Cairo, Egypt
| | - Mustafa Elattar
- Research and Development Division, Intixel Co. S.A.E., Cairo, Egypt.,Medical Imaging and Image Processing Group, Center for informatics science, Nile University, Giza, Egypt
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23
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Holtackers RJ, Wildberger JE, Wintersperger BJ, Chiribiri A. Impact of Field Strength in Clinical Cardiac Magnetic Resonance Imaging. Invest Radiol 2021; 56:764-772. [PMID: 34261084 DOI: 10.1097/rli.0000000000000809] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSTRACT Cardiac magnetic resonance imaging (MRI) is widely applied for the noninvasive assessment of cardiac structure and function, and for tissue characterization. For more than 2 decades, 1.5 T has been considered the field strength of choice for cardiac MRI. Although the number of 3-T systems significantly increased in the past 10 years and numerous new developments were made, challenges seem to remain that hamper a widespread clinical use of 3-T MR systems for cardiac applications. As the number of clinical cardiac applications is increasing, with each having their own benefits at both field strengths, no "holy grail" field strength exists for cardiac MRI that one should ideally use. This review describes the physical differences between 1.5 and 3 T, as well as the effect of these differences on major (routine) cardiac MRI applications, including functional imaging, edema imaging, late gadolinium enhancement, first-pass stress perfusion, myocardial mapping, and phase contrast flow imaging. For each application, the advantages and limitations at both 1.5 and 3 T are discussed. Solutions and alternatives are provided to overcome potential limitations. Finally, we briefly elaborate on the potential use of alternative field strengths (ie, below 1.5 T and above 3 T) for cardiac MRI and conclude with field strength recommendations for the future of cardiac MRI.
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24
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Franks R, Holtackers RJ, Alskaf E, Nazir MS, Clapp B, Wildberger JE, Perera D, Plein S, Chiribiri A. The impact of dark-blood versus conventional bright-blood late gadolinium enhancement on the myocardial ischemic burden. Eur J Radiol 2021; 144:109947. [PMID: 34700091 DOI: 10.1016/j.ejrad.2021.109947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In perfusion cardiovascular magnetic resonance (CMR), ischemic burden predicts adverse prognosis and is often used to guide revascularization. Ischemic scar tissue can cause stress perfusion defects that do not represent myocardial ischemia. Dark-blood late gadolinium enhancement (LGE) methods detect more scar than conventional bright-blood LGE, however, the impact on the myocardial ischemic burden estimation is unknown and evaluated in this study. METHODS Forty patients with CMR stress perfusion defects and ischemic scar on both dark-blood and bright-blood LGE were included. For dark-blood LGE, phase sensitive inversion recovery imaging with left ventricular blood pool nulling was used. Ischemic scar burden was quantified for both methods using >5 standard deviations above remote myocardium. Perfusion defects were manually contoured, and the myocardial ischemic burden was calculated by subtracting the ischemic scar burden from the perfusion defect burden. RESULTS Ischemic scar burden by dark-blood LGE was higher than bright-blood LGE (13.3 ± 7.4% vs. 10.3 ± 7.1%, p < 0.001). Dark-blood LGE derived myocardial ischemic burden was lower compared with bright-blood LGE (15.6% (IQR: 10.3 to 22.0) vs. 19.3 (10.9 to 25.5), median difference -2.0%, p < 0.001) with a mean bias of -2.8% (95% confidence intervals: -4.0 to -1.6%) and a large effect size (r = 0.62). CONCLUSION Stress perfusion defects are associated with higher ischemic scar burden using dark-blood LGE compared with bright-blood LGE, which leads to a lower estimation of the myocardial ischemic burden. The prognostic value of using a dark-blood LGE derived ischemic burden to guide revascularization is unknown and warrants further investigation.
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Affiliation(s)
- Russell Franks
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.
| | - Robert J Holtackers
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, Netherlands.
| | - Ebraham Alskaf
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.
| | - Muhummad Sohaib Nazir
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.
| | - Brian Clapp
- Cardiovascular Division, King's College London, London, United Kingdom.
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, Netherlands.
| | - Divaka Perera
- Cardiovascular Division, King's College London, London, United Kingdom.
| | - Sven Plein
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom.
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.
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25
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Johnson JN, Mandell JG, Christopher A, Olivieri LJ, Loke YH, Campbell MJ, Darty S, Kim HW, Clark DE, Frischhertz BP, Fish FA, Bailey AL, Mikolaj MB, Hughes SG, Oneugbu A, Chung J, Burdowski J, Marfatia R, Bi X, Craft J, Umairi RA, Kindi FA, Williams JL, Campbell MJ, Kharabish A, Gutierrez M, Arzanauskaite M, Ntouskou M, Ashwath ML, Robinson T, Chiang JB, Lee JCY, Lee MSH, Chen SSM. Society for Cardiovascular Magnetic Resonance 2020 Case of the Week series. J Cardiovasc Magn Reson 2021; 23:108. [PMID: 34629101 PMCID: PMC8504030 DOI: 10.1186/s12968-021-00799-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/26/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). Case of the week is a case series hosted on the SCMR website ( https://www.scmr.org ) that demonstrates the utility and importance of CMR in the clinical diagnosis and management of cardiovascular disease. Each case consists of the clinical presentation and a discussion of the condition and the role of CMR in diagnosis and guiding clinical management. The cases are all instructive and helpful in the approach to patient management. We present a digital archive of the 2020 Case of the Week series of 11 cases as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar search engine.
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Affiliation(s)
- Jason N Johnson
- Division of Pediatric Cardiology and Pediatric Radiology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jason G Mandell
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Adam Christopher
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Laura J Olivieri
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Michael J Campbell
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Steve Darty
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Han W Kim
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Daniel E Clark
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin P Frischhertz
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Frank A Fish
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alison L Bailey
- Division of Cardiovascular Medicine, University of Tennessee College of Medicine Chattanooga/Erlanger Health System, Chattanooga, TN, USA
| | - Michael B Mikolaj
- Division of Cardiovascular Medicine, University of Tennessee College of Medicine Chattanooga/Erlanger Health System, Chattanooga, TN, USA
| | - Sean G Hughes
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Jina Chung
- Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA, USA
| | | | - Ravi Marfatia
- Division of Cardiology, St. Francis Hospital, Roslyn, NY, USA
| | - Xiaoming Bi
- Siemens Medical Solutions, Los Angeles, CA, USA
| | - Jason Craft
- Division of Cardiology, St. Francis Hospital, Roslyn, NY, USA
| | | | - Faiza A Kindi
- Department of Radiology, The Royal Hospital, Muscat, Oman
| | - Jason L Williams
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Michael J Campbell
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Ahmed Kharabish
- Radiology Department, Cairo University Hospitals, Cairo, Egypt
- Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Manuel Gutierrez
- Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Monika Arzanauskaite
- Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
- Cardiovascular Research Center-ICCC, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Marousa Ntouskou
- Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mahi L Ashwath
- Division of Cardiology, University of Iowa Hospitals and Clinic, Iowa City, Iowa, USA
| | - Tommy Robinson
- Division of Cardiology, University of Iowa Hospitals and Clinic, Iowa City, Iowa, USA
| | - Jeanie B Chiang
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, People's Republic of China
| | - Jonan C Y Lee
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, People's Republic of China
| | - M S H Lee
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, People's Republic of China
| | - Sylvia S M Chen
- Department of Cardiology and Adult Congenital Heart Disease, The Prince Charles Hospital, Brisbane, Australia.
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26
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Abstract
Ischemic cardiomyopathy (ICM) is one of the most common causes of congestive heart failure. In patients with ICM, tissue characterization with cardiac magnetic resonance imaging (CMR) allows for evaluation of myocardial abnormalities in acute and chronic settings. Myocardial edema, microvascular obstruction (MVO), intracardiac thrombus, intramyocardial hemorrhage, and late gadolinium enhancement of the myocardium are easily depicted using standard CMR sequences. In the acute setting, tissue characterization is mainly focused on assessment of ventricular thrombus and MVO, which are associated with poor prognosis. Conversely, in chronic ICM, it is important to depict late gadolinium enhancement and myocardial ischemia using stress perfusion sequences. Overall, with CMR's ability to accurately characterize myocardial tissue in acute and chronic ICM, it represents a valuable diagnostic and prognostic imaging method for treatment planning. In particular, tissue characterization abnormalities in the acute setting can provide information regarding the patients that may develop major adverse cardiac event and show the presence of ventricular thrombus; in the chronic setting, evaluation of viable myocardium can be fundamental for planning myocardial revascularization. In this review, the main findings on tissue characterization are illustrated in acute and chronic settings using qualitative and quantitative tissue characterization.
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27
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Nazir MS, Preston R, Chiribiri A, Sheikh N. Multimodal Imaging for Diagnosis of Anomalous Coronary Artery With Subsequent Myocardial Infarction. JACC Case Rep 2021; 3:1310-1314. [PMID: 34471884 PMCID: PMC8387804 DOI: 10.1016/j.jaccas.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/21/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022]
Abstract
Chest pain in young adults is not always benign, and clinical suspicion should prompt further investigations. Multimodal imaging with computed tomography coronary angiography and cardiovascular magnetic resonance can be used to identify anomalous coronary arteries, determine adverse imaging features, and guide subsequent clinical decision making. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom
- Department of Cardiology, St Thomas’ Hospital, London, United Kingdom
| | - Rebecca Preston
- Department of Radiology, St Thomas’ Hospital, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom
| | - Nabeel Sheikh
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom
- Department of Cardiology, St Thomas’ Hospital, London, United Kingdom
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Holtackers RJ, Van De Heyning CM, Chiribiri A, Wildberger JE, Botnar RM, Kooi ME. Dark-blood late gadolinium enhancement cardiovascular magnetic resonance for improved detection of subendocardial scar: a review of current techniques. J Cardiovasc Magn Reson 2021; 23:96. [PMID: 34289866 PMCID: PMC8296731 DOI: 10.1186/s12968-021-00777-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/17/2021] [Indexed: 12/02/2022] Open
Abstract
For almost 20 years, late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been the reference standard for the non-invasive assessment of myocardial viability. Since the blood pool often appears equally bright as the enhanced scar regions, detection of subendocardial scar patterns can be challenging. Various novel LGE methods have been proposed that null or suppress the blood signal by employing additional magnetization preparation mechanisms. This review aims to provide a comprehensive overview of these dark-blood LGE methods, discussing the magnetization preparation schemes and findings in phantom, preclinical, and clinical studies. Finally, conclusions on the current evidence and limitations are drawn and new avenues for future research are discussed. Dark-blood LGE methods are a promising new tool for non-invasive assessment of myocardial viability. For a mainstream adoption of dark-blood LGE, however, clinical availability and ease of use are crucial.
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Affiliation(s)
- Robert J. Holtackers
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, Maastricht, 6200 MD The Netherlands
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | | | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Joachim E. Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, Maastricht, 6200 MD The Netherlands
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - René M. Botnar
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M. Eline Kooi
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, Maastricht, 6200 MD The Netherlands
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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Holtackers RJ, Gommers S, Heckman LIB, Van De Heyning CM, Chiribiri A, Prinzen FW. Histopathological Validation of Dark-Blood Late Gadolinium Enhancement MRI Without Additional Magnetization Preparation. J Magn Reson Imaging 2021; 55:190-197. [PMID: 34169603 PMCID: PMC9290659 DOI: 10.1002/jmri.27805] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 12/18/2022] Open
Abstract
Background Conventional bright‐blood late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (MRI) often suffers from poor scar‐to‐blood contrast due to the bright blood pool adjacent to the enhanced scar tissue. Recently, a dark‐blood LGE method was developed which increases scar‐to‐blood contrast without using additional magnetization preparation. Purpose We aim to histopathologically validate this dark‐blood LGE method in a porcine animal model with induced myocardial infarction (MI). Study Type Prospective. Animal Model Thirteen female Yorkshire pigs. Field Strength/Sequence 1.5 T, two‐dimensional phase‐sensitive inversion‐recovery radiofrequency‐spoiled turbo field‐echo. Assessment MI was experimentally induced by transient coronary artery occlusion. At 1‐week and 7‐week post‐infarction, in‐vivo cardiac MRI was performed including conventional bright‐blood and novel dark‐blood LGE. Following the second MRI examination, the animals were sacrificed, and histopathology was obtained. Matching LGE slices and histopathology samples were selected based on anatomical landmarks. Independent observers, while blinded to other data, manually delineated the endocardial, epicardial, and infarct borders on either LGE images or histopathology samples. The percentage of infarcted left‐ventricular myocardium was calculated for both LGE methods on a per‐slice basis, and compared with histopathology as reference standard. Contrast‐to‐noise ratios were calculated for both LGE methods at 1‐week and 7‐week post‐infarction. Statistical Tests Pearson's correlation coefficient and paired‐sample t‐tests were used. Significance was set at P < 0.05. Results A combined total of 24 matched LGE and histopathology slices were available for histopathological validation. Dark‐blood LGE demonstrated a high level of agreement compared to histopathology with no significant bias (−0.03%, P = 0.75). In contrast, bright‐blood LGE showed a significant bias of −1.57% (P = 0.03) with larger 95% limits of agreement than dark‐blood LGE. Image analysis demonstrated significantly higher scar‐to‐blood contrast for dark‐blood LGE compared to bright‐blood LGE, at both 1‐week and 7‐weeks post‐infarction. Data Conclusion Dark‐blood LGE without additional magnetization preparation provides superior visualization and quantification of ischemic scar compared to the current in vivo reference standard. Level of Evidence 1 Technical Efficacy Stage 2
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Affiliation(s)
- Robert J Holtackers
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Suzanne Gommers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Luuk I B Heckman
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | | | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Frits W Prinzen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Physiology, Maastricht University, Maastricht, The Netherlands
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Milotta G, Munoz C, Kunze KP, Neji R, Figliozzi S, Chiribiri A, Hajhosseiny R, Masci PG, Prieto C, Botnar RM. 3D whole-heart grey-blood late gadolinium enhancement cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2021; 23:62. [PMID: 34024276 PMCID: PMC8142497 DOI: 10.1186/s12968-021-00751-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 03/29/2021] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Giorgia Milotta
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK.
| | - Camila Munoz
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
| | - Karl P Kunze
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, UK
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, UK
| | - Stefano Figliozzi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
| | - Reza Hajhosseiny
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - René M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
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Wu X, Sun J, Chen Z, Ding Y, Meng R. Magnetic resonance black-blood thrombus imaging can confirm chronic cerebral venous thrombosis: a case report and literature review. J Int Med Res 2021; 49:3000605211017001. [PMID: 34013759 PMCID: PMC8142535 DOI: 10.1177/03000605211017001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Cerebral venous thrombosis (CVT) is easily missed or misdiagnosed in clinical settings because of its high variability in terms of symptoms and radiological findings. Herein, we aimed to explore a promising modality for confirming presumed CVT in the hope to uncover its superior diagnostic performance to conventional imaging modalities. Case presentation: The patient complained of intolerable pain in her forehead and left eye. Her lumbar puncture opening pressure was 140 mmH2O, and her cerebrospinal fluid composition was normal. No marked abnormalities were observed in routine brain images, including non-contrast computed tomography, magnetic resonance imaging, and contrast-enhanced magnetic resonance venography. However, chronic mural thrombi in the lumen of the left cortical veins, transverse/sigmoid sinus, and superior sagittal sinus were identified in magnetic resonance black-blood thrombus imaging (MRBTI) maps. Conclusions MRBTI can be used to directly and non-invasively visualize thrombi, and may thus be a promising tool over alternative routine techniques for confirming the diagnosis of CVT.
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Affiliation(s)
- Xiaoqin Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jingkun Sun
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhiying Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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32
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Holtackers RJ, Gommers S, Van De Heyning CM, Mihl C, Smink J, Higgins DM, Wildberger JE, Ter Bekke RMA. Steadily Increasing Inversion Time Improves Blood Suppression for Free-Breathing 3D Late Gadolinium Enhancement MRI With Optimized Dark-Blood Contrast. Invest Radiol 2021; 56:335-340. [PMID: 33273374 DOI: 10.1097/rli.0000000000000747] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
MATERIALS AND METHODS Fifty consecutive patients with previous cardiac arrhythmias, scheduled for high-resolution 3D LGE MRI, were prospectively enrolled between October 2017 and February 2020. Free-breathing 3D dark-blood LGE MRI with high isotropic resolution (1.6 × 1.6 × 1.6 mm) was performed using a conventional fixed TI (n = 25) or a dynamic TI (n = 25). The average increase in blood nulling TI per minute was obtained from Look-Locker scans before and after the 3D acquisition in the first fixed TI group. This average increment in TI was used as input to calculate the dynamic increment of the initial blood nulling TI value as set in the second dynamic TI group. Regions of interest were drawn in the left ventricular blood pool to assess mean signal intensity as a measure for blood pool suppression. Overall image quality, observer confidence, and scar demarcation were scored on a 3-point scale. RESULTS Three-dimensional dark-blood LGE data sets were successfully acquired in 46/50 patients (92%). The calculated average TI increase of 2.3 ± 0.5 ms/min obtained in the first fixed TI group was incorporated in the second dynamic TI group and led to a significant decrease of 72% in the mean blood pool signal intensity compared with the fixed TI group (P < 0.001). Overall image quality (P = 0.02), observer confidence (P = 0.02), and scar demarcation (P = 0.01) significantly improved using a dynamic TI. CONCLUSIONS A steadily increasing dynamic TI improves blood pool suppression for optimized dark-blood contrast and increases observer confidence in free-breathing 3D dark-blood LGE MRI with high isotropic resolution.
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Affiliation(s)
| | - Suzanne Gommers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
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WITHDRAWN: The impact of dark-blood versus conventional bright-blood late gadolinium enhancement on the myocardial ischemic burden. Eur J Radiol 2021. [DOI: 10.1016/j.ejrad.2021.109728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Emrich T, Halfmann M, Schoepf UJ, Kreitner KF. CMR for myocardial characterization in ischemic heart disease: state-of-the-art and future developments. Eur Radiol Exp 2021; 5:14. [PMID: 33763757 PMCID: PMC7990980 DOI: 10.1186/s41747-021-00208-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/22/2021] [Indexed: 01/25/2023] Open
Abstract
Ischemic heart disease and its sequelae are one of the major contributors to morbidity and mortality worldwide. Over the last decades, technological developments have strengthened the role of noninvasive imaging for detection, risk stratification, and management of patients with ischemic heart disease. Cardiac magnetic resonance (CMR) imaging incorporates both functional and morphological characterization of the heart to determine presence, acuteness, and severity of ischemic heart disease by evaluating myocardial wall motion and function, the presence and extent of myocardial edema, ischemia, and scarring. Currently established clinical protocols have already demonstrated their diagnostic and prognostic value. Nevertheless, there are emerging imaging technologies that provide additional information based on advanced quantification of imaging biomarkers and improved diagnostic accuracy, therefore potentially allowing reduction or avoidance of contrast and/or stressor agents. The aim of this review is to summarize the current state of the art of CMR imaging for ischemic heart disease and to provide insights into promising future developments.
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Affiliation(s)
- Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz; Langenbeckstraße 1, 55131, Mainz, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. .,Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA.
| | - Moritz Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz; Langenbeckstraße 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz; Langenbeckstraße 1, 55131, Mainz, Germany
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Bannan B, Aguet J, House AV, Gill N, Tassos VP, Amirabadi A, Seed M, Lam CZ, Yoo SJ. Usefulness of TI-scout images in the assessment of late gadolinium enhancement in children. J Cardiovasc Magn Reson 2021; 23:28. [PMID: 33731161 PMCID: PMC7972209 DOI: 10.1186/s12968-021-00719-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/31/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) requires identification of the normal myocardial nulling time using inversion time (TI)-scout imaging sequence. Although TI-scout images are not primarily used for myocardial assessment, they provide information regarding different signal recovery patterns of normal and abnormal myocardium facilitating identification of LGE in instances where standard LGE images alone are not diagnostic. We aimed to assess the diagnostic performance of TI-scout as compared to that of standard LGE images. METHODS CMR studies with LGE imaging in 519 patients (345 males, 1-17 years) were reviewed to assess the diagnostic performance of LGE imaging in terms of the location of LGE and the pathologic entities. The diagnostic performance of the TI-scout and standard LGE imaging was classified into four categories: (1) equally diagnostic, (2) TI-scout superior to standard LGE, (3) standard LGE superior to TI-scout, and (4) complementary, by the consensus of the two observers. RESULTS The study cohort consisted of 440 patients with negative LGE and 79 with evidence for LGE. For a negative diagnosis of LGE, TI-scout and standard LGE images were equally diagnostic in 75% of the cases and were complementary in 12%. For patients with LGE, TI-scout images were superior to standard LGE images in 52% of the cases and were complementary in 19%. The diagnostic performance of TI-scout images was superior to that of standard LGE images in all locations. TI-scout images were superior to standard LGE images in 11 of 12 (92%) cases with LGE involving the papillary muscles, in 7 /12 (58%) cases with subendocardial LGE, and in 4/7 (57%) cases with transmural LGE. TI-scout images were particularly useful assessing the presence and extent of LGE in hypertrophic cardiomyopathy (HCM). TI-scout was superior to standard LGE in 6/10 (60%) and was complementary in 3/10 (30%) of the positive cases with HCM. CONCLUSIONS TI-scout images enhance the diagnostic performance of LGE imaging in children.
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Affiliation(s)
- Badr Bannan
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Julien Aguet
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Aswathy Vaikom House
- Department of Pediatrics, Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Navjot Gill
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Vivian P Tassos
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Afsaneh Amirabadi
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Mike Seed
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G1X8, Canada
- Department of Pediatrics, Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Christopher Z Lam
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Shi-Joon Yoo
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G1X8, Canada.
- Department of Pediatrics, Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Abstract
There were 79 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2019, including 65 original research papers, 2 reviews, 8 technical notes, 1 Society for Cardiovascular Magnetic Resonacne (SCMR) guideline, and 3 corrections. The volume was down slightly from 2018 (n = 89) with a corresponding 5.5% increase in manuscript submissions from 345 to 366. This led to a slight decrease in the acceptance rate from 25 to 22%. The quality of the submissions continues to be high. The 2019 JCMR Impact Factor (which is published in June 2020) increased from 5.07 to 5.36. The 2020 impact factor means that on average, each JCMR published in 2017 and 2018 was cited 5.36 times in 2019. Our 5 year impact factor was 5.2. We are now finishing the 13th year of JCMR as an open-access publication with BMC. As outlined in this report, the Open-Access system has dramatically increased the reading and citation of JCMR publications. I hope that our authors will continue to send their very best, high quality manuscripts for JCMR consideration and that our readers will continue to look to JCMR for the very best/state-of-the-art publications in our field. It takes a village to run a journal. JCMR is blessed to have very dedicated Associate Editors, Guest Editors, and Reviewers. I thank each of them for their efforts to ensure that the review process occurs in a timely and responsible manner. These efforts have allowed the JCMR to continue as the premier journal of our field. My role, and the entire process would not be possible without the dedication and efforts of our managing editor, Diana Gethers (who will leaving the journal in the coming months) and our assistant managing editor, Jennifer Rodriguez, who has agreed to increase her reponsibilities. Finally, I thank you for entrusting me with the editorship of the JCMR. As I begin my 5th year as your editor-in-chief, please know that I fully recognize we are not perfect in our review process. We try our best to objectively assess every submission in a timely manner, but sometimes don't get it "right." The editorial process is a tremendously fulfilling experience for me. The opportunity to review manuscripts that reflect the best in our field remains a great joy and a highlight of my week!
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.
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Holtackers RJ, Ter Bekke RMA, Bijvoet GP, Gommers S, Chiribiri A, Lorusso R. A Boolean Dilemma: True or False Aneurysm? JACC Case Rep 2020; 3:112-116. [PMID: 34317481 PMCID: PMC8305069 DOI: 10.1016/j.jaccas.2020.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/11/2022]
Abstract
A feared complication of acute myocardial infarction is the formation of a cardiac pseudoaneurysm. We report a case of a gargantuan, arrhythmogenic left-ventricular pseudoaneurysm with contradictory morphological characteristics. The integrative use of high-resolution 3-dimensional magnetic resonance imaging and computed tomography proved essential for the diagnostic discrimination and successful therapeutic intervention. (Level of Difficulty: Advanced.)
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Key Words
- 3D, 3-dimensional
- CT, computed tomography
- ECG, electrocardiogram
- IABP, intra-aortic balloon pump
- ICD, implantable cardioverter-defibrillator
- LGE, late gadolinium enhancement
- LV, left ventricular
- MRI, magnetic resonance imaging
- V-A ECLS, veno-arterial extracorporeal life support
- VT, ventricular tachycardia
- computed tomography
- echocardiography
- false aneurysm
- magnetic resonance imaging
- myocardial infarction
- pseudoaneurysm
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Affiliation(s)
- Robert J Holtackers
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Rachel M A Ter Bekke
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Geertruida P Bijvoet
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Suzanne Gommers
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Roberto Lorusso
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.,Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
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Pennig L, Lennartz S, Wagner A, Sokolowski M, Gajzler M, Ney S, Laukamp KR, Persigehl T, Bunck AC, Maintz D, Weiss K, Naehle CP, Doerner J. Clinical application of free-breathing 3D whole heart late gadolinium enhancement cardiovascular magnetic resonance with high isotropic spatial resolution using Compressed SENSE. J Cardiovasc Magn Reson 2020; 22:89. [PMID: 33327958 PMCID: PMC7745391 DOI: 10.1186/s12968-020-00673-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/15/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) represents the gold standard for assessment of myocardial viability. The purpose of this study was to investigate the clinical potential of Compressed SENSE (factor 5) accelerated free-breathing three-dimensional (3D) whole heart LGE with high isotropic spatial resolution (1.4 mm3 acquired voxel size) compared to standard breath-hold LGE imaging. METHODS This was a retrospective, single-center study of 70 consecutive patients (45.8 ± 18.1 years, 27 females; February-November 2019), who were referred for assessment of left ventricular myocardial viability and received free-breathing and breath-hold LGE sequences at 1.5 T in clinical routine. Two radiologists independently evaluated global and segmental LGE in terms of localization and transmural extent. Readers scored scans regarding image quality (IQ), artifacts, and diagnostic confidence (DC) using 5-point scales (1 non-diagnostic-5 excellent/none). Effects of heart rate and body mass index (BMI) on IQ, artifacts, and DC were evaluated with ordinal logistic regression analysis. RESULTS Global LGE (n = 33) was identical for both techniques. Using free-breathing LGE (average scan time: 04:33 ± 01:17 min), readers detected more hyperenhanced lesions (28.2% vs. 23.5%, P < .05) compared to breath-hold LGE (05:15 ± 01:23 min, P = .0104), pronounced at subepicardial localization and for 1-50% of transmural extent. For free-breathing LGE, readers graded scans with good/excellent IQ in 80.0%, with low-impact/no artifacts in 78.6%, and with good/high DC in 82.1% of cases. Elevated BMI was associated with increased artifacts (P = .0012) and decreased IQ (P = .0237). Increased heart rate negatively influenced artifacts (P = .0013) and DC (P = .0479) whereas IQ (P = .3025) was unimpaired. CONCLUSIONS In a clinical setting, free-breathing Compressed SENSE accelerated 3D high isotropic spatial resolution whole heart LGE provides good to excellent image quality in 80% of scans independent of heart rate while enabling improved depiction of small and particularly non-ischemic hyperenhanced lesions in a shorter scan time than standard breath-hold LGE.
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Affiliation(s)
- Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
- Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Weyertal 115b, 50931, Cologne, Germany
| | - Anton Wagner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Marcel Sokolowski
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Matej Gajzler
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Svenja Ney
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kai Roman Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Department of Radiology, University Hospitals Cleveland Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Radiology, Case Western Reserve University, 11000 Euclid Ave, Cleveland, OH, 44106, USA
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Alexander Christian Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kilian Weiss
- Philips GmbH, Röntgenstraße 22, 22335, Hamburg, Germany
| | - Claas Philip Naehle
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Jonas Doerner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Sakrana AA, Alzubaidi SAA, Shahat AM, Mahmoud AS, Naeim HA. Cardiovascular magnetic resonance and echocardiographic findings of a large thrombosed intramyocardial dissecting hematoma: a case report and a brief review of literature. BJR Case Rep 2020; 6:20200028. [PMID: 33299588 PMCID: PMC7709072 DOI: 10.1259/bjrcr.20200028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 11/05/2022] Open
Abstract
Intramyocardial dissecting hematoma (IMDH) is an uncommon fatal complication after acute myocardial infarction. It is usually under identified. Transthoracic echocardiography is the first-line modality that can detect IMDH. Cardiac magnetic resonance could confirm the diagnosis. In this paper, we reported a unique partially thrombosed large left ventricle IMDH that mimics thrombosed true aneurysm aiming to highlight the supporting diagnostic transthoracic echocardiography and cardiac magnetic resonance criteria of IMDH.
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Affiliation(s)
- Amal Abdelsattar Sakrana
- Madina Cardiac Center, 23411 AL Madinah Al munawwrah, Khaled Bin Al Waleed Road, AL Madinah Al munawwrah, Saudi Arabia
- Department of Diagnostic and Interventional radiology, Mansoura University Hospital, 35112 12 El-Gomhoreya street, Mansoura, Egypt
| | - Shadha A. Ahmed Alzubaidi
- Madina Cardiac Center, 23411 AL Madinah Al munawwrah, Khaled Bin Al Waleed Road, AL Madinah Al munawwrah, Saudi Arabia
| | - Abdulhameed Mohmmed Shahat
- Madina Cardiac Center, 23411 AL Madinah Al munawwrah, Khaled Bin Al Waleed Road, AL Madinah Al munawwrah, Saudi Arabia
| | - Abeer Sabri Mahmoud
- Madina Cardiac Center, 23411 AL Madinah Al munawwrah, Khaled Bin Al Waleed Road, AL Madinah Al munawwrah, Saudi Arabia
| | - Hesham Abdo Naeim
- Madina Cardiac Center, 23411 AL Madinah Al munawwrah, Khaled Bin Al Waleed Road, AL Madinah Al munawwrah, Saudi Arabia
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40
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Henningsson M, Malik S, Botnar R, Castellanos D, Hussain T, Leiner T. Black-Blood Contrast in Cardiovascular MRI. J Magn Reson Imaging 2020; 55:61-80. [PMID: 33078512 PMCID: PMC9292502 DOI: 10.1002/jmri.27399] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022] Open
Abstract
MRI is a versatile technique that offers many different options for tissue contrast, including suppressing the blood signal, so‐called black‐blood contrast. This contrast mechanism is extremely useful to visualize the vessel wall with high conspicuity or for characterization of tissue adjacent to the blood pool. In this review we cover the physics of black‐blood contrast and different techniques to achieve blood suppression, from methods intrinsic to the imaging readout to magnetization preparation pulses that can be combined with arbitrary readouts, including flow‐dependent and flow‐independent techniques. We emphasize the technical challenges of black‐blood contrast that can depend on flow and motion conditions, additional contrast weighting mechanisms (T1, T2, etc.), magnetic properties of the tissue, and spatial coverage. Finally, we describe specific implementations of black‐blood contrast for different vascular beds.
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Affiliation(s)
- Markus Henningsson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Shaihan Malik
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Rene Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Daniel Castellanos
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tarique Hussain
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
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41
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Cochet H, Sacher F. Hello Doctor, Can I Get My MRI? JACC Clin Electrophysiol 2020; 6:736-738. [DOI: 10.1016/j.jacep.2019.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 10/24/2022]
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42
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Novel Magnetic Resonance Late Gadolinium Enhancement With Fixed Short Inversion Time in Ischemic Myocardial Scars. Invest Radiol 2020; 55:445-450. [DOI: 10.1097/rli.0000000000000655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Song L, Ma X, Zhao X, Zhao L, DeLano M, Fan Y, Wu B, Lu A, Tian J, He L. Validation of black blood late gadolinium enhancement (LGE) for evaluation of myocardial infarction in patients with or without pathological Q-wave on electrocardiogram (ECG). Cardiovasc Diagn Ther 2020; 10:124-134. [PMID: 32420092 DOI: 10.21037/cdt.2019.12.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The pathological Q-wave (QW) is an important indicator of infarcted myocardial volume indicating a worse prognosis compared to non-Q-wave (NQW) infarctions. Traditional classification divides infarcts into transmural and non-transmural based on QW and NQW. This view has been challenged by the advent of late gadolinium enhancement (LGE) MR imaging. Conventional LGE (Conv-LGE) detection of subendocardial MI is limited by bright blood pool. Dark Blood LGE imaging (DB-LGE) nulls the blood pool improving the conspicuity and accuracy of detection of subendocardial infarcts. We hypothesize that improved detection of subendocardial enhancement with DB-LGE will result in improved correlation of electrocardiogram (ECG) and extent of infarction. Methods Sixty-four clinically confirmed infarction patients were enrolled in this prospective study. All the participants underwent cardiac MR imaging including conv-LGE and DB-LGE. Twelve-lead ECG were performed on the same day. The patients were divided into QW and NQW groups by one experienced cardiologist. MI quantitation was by MI% (the ratio of MI volume to whole myocardial volume) and transmural grading, compared using paired t-test and Wilcoxon-test, respectively. The image quality obtained by Conv-LGE and DB-LGE were evaluated according to the signal intensity ratio (SIR) and contrast-to-noise ratio (CNR). Results Fifty-six subjects were enrolled in the final analysis [23 (41%) QW and 33 (59%) NQW infarcts]. For the QW cohort, both sequences classified infarcts as transmural in 21/23 (91%) subjects and subendocardial in 2/23 (9%). For the NQW cohort, both sequences classified infarcts as transmural in 16/33 (48%) subjects and subendocardial in 17/33 (52%). Using BB-LGE there were significant differences in detecting subendocardial infarcts in QW and NQW cohorts (Z=-5.85, P<0.001). The MI% of QW group was greater than in NQW group (24.2±10.3 vs.15.9±9.8, P=0.003). Compared to Conv-LGE, BB-LGE provided higher CNR and SIR between infarcted myocardium and blood pool (6.3±2.6 vs. 2.1±1.3, P<0.001; 5.4±1.9 vs. 1.3±0.2, P<0.001). BB-LGE detected more subendocardial infarcted segments in the QW group and NQW group (Z=-4.24, P<0.001; Z=-5.57, P<0.001). The larger MI% was displayed in BB-LGE than in Conv-LGE in both QW group and NQW group (24.2±10.3 vs. 22.6±10.3, P<0.001; 15.9±9.8 vs.14.6±9.6, P=0.001). Conclusions Compared to conventional LGE, DB-LGE can provide more accurate detection and characterization of infarction in terms of transmurality and subendocardial extent. This is important for evaluating QW and NQW MIs. Due to nulling the high signal of blood pool, DB-LGE can effectively improve the identification of subendocardial MI which may be missed on conventional LGE. Therefore, in both QW and NQW MIs, DB-LGE detects more subendocardial MIs and larger MI% is found. This may facilitate more accurate quantitative MR assessment of both QW and NQW MIs and further empower LGE volume as a predictive biomarker.
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Affiliation(s)
- Linsheng Song
- Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, China.,Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xiaohai Ma
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xinxiang Zhao
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - Lei Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Mark DeLano
- Division of Radiology and Biomedical Imaging, College of Human Medicine, Michigan State University, Advanced Radiology Services, PC, Spectrum Health, Grand Rapids, Michigan, USA
| | - Yang Fan
- GE Healthcare, Beijing 100176, China
| | - Bin Wu
- GE Healthcare, Beijing 100176, China
| | - Aijia Lu
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jie Tian
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Liping He
- Department of Epidemiology and Biostatistics, School of Public Health, Kunming Medical University, Kunming 650500, China
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44
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Qi H, Bustin A, Kuestner T, Hajhosseiny R, Cruz G, Kunze K, Neji R, Botnar RM, Prieto C. Respiratory motion-compensated high-resolution 3D whole-heart T1ρ mapping. J Cardiovasc Magn Reson 2020; 22:12. [PMID: 32014001 PMCID: PMC6998259 DOI: 10.1186/s12968-020-0597-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/03/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) T1ρ mapping can be used to detect ischemic or non-ischemic cardiomyopathy without the need of exogenous contrast agents. Current 2D myocardial T1ρ mapping requires multiple breath-holds and provides limited coverage. Respiratory gating by diaphragmatic navigation has recently been exploited to enable free-breathing 3D T1ρ mapping, which, however, has low acquisition efficiency and may result in unpredictable and long scan times. This study aims to develop a fast respiratory motion-compensated 3D whole-heart myocardial T1ρ mapping technique with high spatial resolution and predictable scan time. METHODS The proposed electrocardiogram (ECG)-triggered T1ρ mapping sequence is performed under free-breathing using an undersampled variable-density 3D Cartesian sampling with spiral-like order. Preparation pulses with different T1ρ spin-lock times are employed to acquire multiple T1ρ-weighted images. A saturation prepulse is played at the start of each heartbeat to reset the magnetization before T1ρ preparation. Image navigators are employed to enable beat-to-beat 2D translational respiratory motion correction of the heart for each T1ρ-weighted dataset, after which, 3D translational registration is performed to align all T1ρ-weighted volumes. Undersampled reconstruction is performed using a multi-contrast 3D patch-based low-rank algorithm. The accuracy of the proposed technique was tested in phantoms and in vivo in 11 healthy subjects in comparison with 2D T1ρ mapping. The feasibility of the proposed technique was further investigated in 3 patients with suspected cardiovascular disease. Breath-hold late-gadolinium enhanced (LGE) images were acquired in patients as reference for scar detection. RESULTS Phantoms results revealed that the proposed technique provided accurate T1ρ values over a wide range of simulated heart rates in comparison to a 2D T1ρ mapping reference. Homogeneous 3D T1ρ maps were obtained for healthy subjects, with septal T1ρ of 58.0 ± 4.1 ms which was comparable to 2D breath-hold measurements (57.6 ± 4.7 ms, P = 0.83). Myocardial scar was detected in 1 of the 3 patients, and increased T1ρ values (87.4 ± 5.7 ms) were observed in the infarcted region. CONCLUSIONS An accelerated free-breathing 3D whole-heart T1ρ mapping technique was developed with high respiratory scan efficiency and near-isotropic spatial resolution (1.7 × 1.7 × 2 mm3) in a clinically feasible scan time of ~ 6 mins. Preliminary patient results suggest that the proposed technique may find applications in non-contrast myocardial tissue characterization.
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Affiliation(s)
- Haikun Qi
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rd Floor, Lambeth Wing, St Thomas' Hospital, Lambeth Palace Rd, London, SE1 7EH, UK.
| | - Aurelien Bustin
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rd Floor, Lambeth Wing, St Thomas' Hospital, Lambeth Palace Rd, London, SE1 7EH, UK
| | - Thomas Kuestner
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rd Floor, Lambeth Wing, St Thomas' Hospital, Lambeth Palace Rd, London, SE1 7EH, UK
| | - Reza Hajhosseiny
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rd Floor, Lambeth Wing, St Thomas' Hospital, Lambeth Palace Rd, London, SE1 7EH, UK
| | - Gastao Cruz
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rd Floor, Lambeth Wing, St Thomas' Hospital, Lambeth Palace Rd, London, SE1 7EH, UK
| | - Karl Kunze
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rd Floor, Lambeth Wing, St Thomas' Hospital, Lambeth Palace Rd, London, SE1 7EH, UK
- Siemens Healthcare, MR Research Collaborations, Frimley, UK
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rd Floor, Lambeth Wing, St Thomas' Hospital, Lambeth Palace Rd, London, SE1 7EH, UK
- Siemens Healthcare, MR Research Collaborations, Frimley, UK
| | - René M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rd Floor, Lambeth Wing, St Thomas' Hospital, Lambeth Palace Rd, London, SE1 7EH, UK
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, 3rd Floor, Lambeth Wing, St Thomas' Hospital, Lambeth Palace Rd, London, SE1 7EH, UK
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
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