Measurement of regional left ventricular function using labelled magnetic resonance imaging

Automatic 3D tracking of cardiac material markers using slice-following and harmonic-phase MRI

A method to track a grid of cardiac material points in three dimensions using slice-following (SF) tagged magnetic resonance imaging (MRI) and harmonic-phase MRI is presented. A three-dimensional grid of material points on the lines of intersections of short-axis (SA) and long-axis (LA) planes is automatically tracked by combining two-dimensional pathlines that are computed on both SA and LA image planes. This process yields the true three-dimensional motion of points originating on the image plane intersections. Experimental data from normal volunteers, each obtained in four short breath-holds using the SF harmonic phase MRI pulse sequence, is presented. A validation of two-dimensional in-plane tracks using this pulse sequence on a moving phantom is also presented.

Cardiac MRI: recent progress and continued challenges

Cardiac MRI continues to develop and advance. MRI accurately depicts cardiac structure, function, perfusion, and myocardial viability with an overall capacity unmatched by any other single imaging modality. MRI is an accepted and widely utilized tool for cardiovascular research. Its clinical use has been limited, but is increasing because of its proven clinical efficacy, the proliferation of cardiac-capable MRI systems, and the development of improved pulse sequences. The following article reviews the landmark developments in this field, with an emphasis on recent progress in the evaluation of ischemic or acquired heart disease.

SPAMM, cine phase contrast imaging and fast spin-echo T2-weighted imaging in the study of intracranial cerebrospinal fluid (CSF) flow

AIM

To compare the qualitative assessment of cerebrospinal fluid (CSF) flow using a SPAMM (spatial modulation of magnetization) technique with cine phase contrast images (cine PC) and fast spin echo (FSE) T2-weighted images.

MATERIALS AND METHODS

SPAMM, PC and T2-weighted sequences were performed on 22 occasions in 19 patients. Eleven of the studies were performed following a neuroendoscopic third ventriculostomy (NTV), and in these cases, the success of the NTV was determined by clinical follow-up. Two observers used consensus to grade the presence of CSF flow at nine different sites for each study.

RESULTS

At 14 of the 178 matched sites, which could be assessed by both SPAMM and cine PC, SPAMM CSF flow grade was higher than that of cine PC. At a further 14/178 matched sites, the cine PC grade was higher than that of SPAMM. There was definite CSF flow at 113/182 (62%) of all the cine PC sites assessed, and 110/181 (61%) of all SPAMM sites assessed whilst 108/198 (54%) of FSE T2-weighted image sites demonstrated flow voids. Cine PC grades were higher than SPAMM at the cerebral aqueduct (P < 0.05, Wilcoxon sign rank test). Definite CSF flow within the anterior third ventricle was present in 4/5 (SPAMM) and 3/5 (cine PC) successful NTVs, 0/2 (SPAMM and cine PC) unsuccessful NTVs and 1/10 (SPAMM and cine PC) patients without NTV.

CONCLUSION

SPAMM provides a comparable assessment of intracranial CSF flow to that of cine phase contrast imaging at all CSF sites except the cerebral aqueduct.

Quantification of regional contractile function after infarction: strain analysis superior to wall thickening analysis in discriminating infarct from remote myocardium

OBJECTIVES

Using two-dimensional wall thickening (WT) (expressed as percentage) and strain analysis, regional contractile myocardial function was quantified and compared in 13 control subjects and 13 patients with a first myocardial infarction (MI). The findings in the patient group were related to global ventricular function and infarct size.

BACKGROUND

In patients with coronary artery disease, regions with dysfunctional myocardium cannot be differentiated easily from regions with normal function by planar WT analysis. Physiologic factors, in combination with limitations of conventional imaging techniques, affect the calculation of WT. Quantitative assessment of contractile function by magnetic resonance (MR) tissue tagging and strain analysis may be less affected by these factors.

METHODS

Two-dimensional regional WT and strain were calculated in three short-axis MR cine and tagged images, respectively. Left ventricular volumes and ejection fraction (EF) were obtained from a series of contiguous short-axis cine images.

RESULTS

In patients with infarct-related ventricles, WT and strain analysis both revealed reduced myocardial function, as compared with control subjects (p < 0.005 and p < 0.001, respectively). However, WT analysis yielded no significant regional differences in function between infarct-related and remote myocardium (p = 0.064), whereas strain analysis did (p < 0.005). For detecting dysfunctional myocardium of electrocardiographically and angiographically defined infarct areas, WT analysis had a sensitivity of 69% and a specificity of 92%, whereas strain analysis demonstrated a sensitivity of 92% and a specificity of 99%. The EF correlated with WT (r = 0.76, p < 0.005) and strain (r = 0.89, p < 0.001).

CONCLUSIONS

Two-dimensional strain analysis is more accurate than planar WT analysis in discriminating dysfunctional from functional myocardium, and it provides a strong correlation between regional myocardial and global ventricular function.

Ultrafast MR grid-tagging sequence for assessment of local mechanical properties of the lungs

While MR imaging with tagged magnetization has shown great utility in the study of muscle mechanics, the evaluation of pulmonary mechanics has long been hindered by the technical difficulties in MR imaging of lung parenchyma. In this study, a fast MR grid-tagging technique is described for dynamic assessment of regional pulmonary deformation. The method is based on a fast FLASH sequence with short TR and short TE. Tagging was achieved by using double DANTE pulse train or inversion pulses. Our results show that this technique is able to detect changes of the tagging grid caused by physiological deformation of the lung. Quantitative analysis of the data shows that this method is capable of assessing local pulmonary mechanics. The application of this technique could improve our understanding of ventilatory control, and thus provide a unique metric for assessing pulmonary disorders. Magn Reson Med 45:24-28, 2001.

Coupled B-snake grids and constrained thin-plate splines for analysis of 2-D tissue deformations from tagged MRI

Magnetic resonance imaging (MRI) is unique in its ability to noninvasively and selectively alter tissue magnetization and create tagged patterns within a deforming body such as the heart muscle. The resulting patterns define a time-varying curvilinear coordinate system on the tissue, which we track with coupled B-snake grids. B-spline bases provide local control of shape, compact representation, and parametric continuity. Efficient spline warps are proposed which warp an area in the plane such that two embedded snake grids obtained from two tagged frames are brought into registration, interpolating a dense displacement vector field. The reconstructed vector field adheres to the known displacement information at the intersections, forces corresponding snakes to be warped into one another, and for all other points in the plane, where no information is available, a C1 continuous vector field is interpolated. The implementation proposed in this paper improves on our previous variational-based implementation and generalizes warp methods to include biologically relevant contiguous open curves, in addition to standard landmark points. The methods are validated with a cardiac motion simulator, in addition to in-vivo tagging data sets.

Simulation of two-dimensional tagged MRI

MR tagging is a recent imaging development that, in cardiac applications, makes possible the tracking of points in the myocardium during the cardiac cycle. Researchers have developed semiautomated, computer-based methods for analyzing tagged images, but the images are complex and present a challenge to automated tracking systems. Simulation can provide an inexhaustible supply of images for testing and validation of tag tracking software and preview the effect of parameter changes in acquisition. SIMTAG is an interactive computer program that simulates two-dimensional tagged-MR experiments. The mathematic model used in the simulation and algorithms for simulating image noise and object deformation are described. Examples of the use of simulated images in SPAMM parameter selection, a comparison of tag contrast in signal-averaged SPAMM and CSPAMM, and simulated images as test sets for tag-tracking software are presented.

Detection and quantification of dysfunctional myocardium by magnetic resonance imaging. A new three-dimensional method for quantitative wall-thickening analysis

BACKGROUND

Regional left ventricular dysfunction is a major consequence of myocardial ischemia, and its extent determines long-term prognosis. Accurate and reproducible analysis of left ventricular dysfunction is therefore useful for risk stratification and patient management.

METHODS AND RESULTS

Short-axis cardiac cine magnetic resonance (MR) imaging was performed in 25 patients after anterior myocardial infarction at 21 +/- 2.1 days after the acute onset. The MR images were analyzed with the use of a dedicated analytical software package (MASS version 1.0), which includes a modified centerline method and a new three-dimensional analysis approach. A database of 48 healthy volunteers was constructed to objectively depict myocardial dysfunction in the patients; this database was compared with enzymatically determined infarct size. The mean (+/-SEM) quantity of dysfunctional myocardium and enzymatically calculated infarct size equaled 24.0 +/- 3.0 and 22.3 +/- 2.9 g, respectively (P = .69). Enzymatically determined infarct size correlated strongly with left ventricular dysfunction determined by cine MR imaging (y = 0.90x + .92. P < .0001). Segments related to the distribution of the left anterior descending coronary artery showed a significantly lower percentage wall thickening in patients than did corresponding segments of 48 normal subjects (46.0 +/- 8.22% versus 87.1 +/- mean SEM, respectively; P < .001). The mean (+/-SEM) end diastolic wall thickness of the infarcted segment did not differ from that of corresponding normal segments (7.4 +/- 0.33 versus 7.5 +/- 0.15 mm; P = .75).

CONCLUSIONS

We conclude that the use of three-dimensional quantitative analysis of cine MR images accurately quantities the extent of regional left ventricular dysfunction in the infarcted heart. This method of analysis may be useful in assessing the effect of interventional therapies.

Normal nonuniformity of left ventricular contraction. Assessment by cine MR imaging with presaturation myocardial tagging

PURPOSE

To identify the normal performance of left ventricular (LV) regional contraction using cine MR imaging with presaturation myocardial tagging.

MATERIAL AND METHODS

Sixteen normal volunteers were examined on a 1.5 T MR system with tagging cine sequences. Tags were applied at end-diastole as 2 parallel black lines on short-axis and 4-chamber sections, and the fractional shortenings were calculated at 7 LV locations.

RESULTS

The following results were obtained with significance: a transmural gradient of contractility in the short-axis section; prolonged late-systolic endocardial shortening and epicardial early termination in the free wall; initial delay of shortening in the anterior wall; apical predominance of contractility; predominance of circumferential shortening in the free wall and of meridional shortening in the septum. These findings could be associated with myocardial fiber architecture, presumed wall stress and temporal asynergy of excitation.

CONCLUSION

Cine MR imaging with myocardial tagging proved to be useful in assessing the nonuniformity of LV contraction.

Quantitative analysis of regional left ventricular function after myocardial infarction in the pig assessed with cine magnetic resonance imaging

To assess the accuracy of quantitative analysis of global and regional wall motion and wall thickening of the left ventricle with cine magnetic resonance (MR), images obtained in eight pigs before and after myocardial infarction were compared with those obtained using gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA)-enhanced multislice spin-echo MR imaging and determination of pathology. The region with abnormal wall motion and wall thickening, as determined with cine MR imaging, identified the same region of infarction as indicated by Gd-DTPA-enhanced spin-echo MR imaging and pathology. Within the infarcted region wall motion and wall thickening analyzed with the centerline method were significantly reduced. We conclude that the use of quantitative analysis of cine MR images accurately determines localization and extent of regional left ventricular dysfunction in the infarcted heart in vivo. This analysis using dedicated software including the centerline method allows sequential assessment of regional left ventricular function in normal and infarcted hearts.

Assessment of regional left ventricular long-axis motion with MR velocity mapping in healthy subjects

The pattern of left ventricular long-axis motion during early diastole was assessed with magnetic resonance (MR) velocity mapping in 31 healthy volunteers. Regional long-axis velocity varied with time and position around the ventricle. During systole, the base descended toward the apex. The greatest magnitude of long-axis velocity occurred during early diastole. The lateral wall had the highest velocity (140 mm/sec +/- 40 [mean +/- standard deviation]); the anterior and inferior walls had lower velocities (96 mm/sec +/- 27 and 92 mm/sec +/- 34, respectively). The inferoseptal area consistently had the lowest velocities (87 mm/sec +/- 40). Absolute values of peak early-diastolic velocity declined with age (r = -.64, P < .001). Peak early-diastolic velocity was not dependent on heart rate (r = .014, P = .94). Regional variations in left ventricular wall motion were seen. MR velocity mapping is a useful technique for assessing regional left ventricular long-axis heart function.