1
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Huang J, Ferreira PF, Wang L, Wu Y, Aviles-Rivero AI, Schönlieb CB, Scott AD, Khalique Z, Dwornik M, Rajakulasingam R, De Silva R, Pennell DJ, Nielles-Vallespin S, Yang G. Deep learning-based diffusion tensor cardiac magnetic resonance reconstruction: a comparison study. Sci Rep 2024; 14:5658. [PMID: 38454072 PMCID: PMC10920645 DOI: 10.1038/s41598-024-55880-2] [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: 05/05/2023] [Accepted: 02/27/2024] [Indexed: 03/09/2024] Open
Abstract
In vivo cardiac diffusion tensor imaging (cDTI) is a promising Magnetic Resonance Imaging (MRI) technique for evaluating the microstructure of myocardial tissue in living hearts, providing insights into cardiac function and enabling the development of innovative therapeutic strategies. However, the integration of cDTI into routine clinical practice poses challenging due to the technical obstacles involved in the acquisition, such as low signal-to-noise ratio and prolonged scanning times. In this study, we investigated and implemented three different types of deep learning-based MRI reconstruction models for cDTI reconstruction. We evaluated the performance of these models based on the reconstruction quality assessment, the diffusion tensor parameter assessment as well as the computational cost assessment. Our results indicate that the models discussed in this study can be applied for clinical use at an acceleration factor (AF) of × 2 and × 4 , with the D5C5 model showing superior fidelity for reconstruction and the SwinMR model providing higher perceptual scores. There is no statistical difference from the reference for all diffusion tensor parameters at AF × 2 or most DT parameters at AF × 4 , and the quality of most diffusion tensor parameter maps is visually acceptable. SwinMR is recommended as the optimal approach for reconstruction at AF × 2 and AF × 4 . However, we believe that the models discussed in this study are not yet ready for clinical use at a higher AF. At AF × 8 , the performance of all models discussed remains limited, with only half of the diffusion tensor parameters being recovered to a level with no statistical difference from the reference. Some diffusion tensor parameter maps even provide wrong and misleading information.
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Grants
- Wellcome Trust
- RG/19/1/34160 British Heart Foundation
- This study was supported in part by the UKRI Future Leaders Fellowship (MR/V023799/1), BHF (RG/19/1/34160), the ERC IMI (101005122), the H2020 (952172), the MRC (MC/PC/21013), the Royal Society (IEC/NSFC/211235), the NVIDIA Academic Hardware Grant Program, EPSRC (EP/V029428/1, EP/S026045/1, EP/T003553/1, EP/N014588/1, EP/T017961/1), and the Cambridge Mathematics of Information in Healthcare Hub (CMIH) Partnership Fund.
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Affiliation(s)
- Jiahao Huang
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK.
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW7 2AZ, UK.
- Bioengineering Department and Imperial-X, Imperial College London, London, W12 7SL, UK.
| | - Pedro F Ferreira
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW7 2AZ, UK
| | - Lichao Wang
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
- Department of Computing, Imperial College London, London, UK
| | - Yinzhe Wu
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW7 2AZ, UK
| | - Angelica I Aviles-Rivero
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
| | - Carola-Bibiane Schönlieb
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
| | - Andrew D Scott
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW7 2AZ, UK
| | - Zohya Khalique
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW7 2AZ, UK
| | - Maria Dwornik
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW7 2AZ, UK
| | - Ramyah Rajakulasingam
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW7 2AZ, UK
| | - Ranil De Silva
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW7 2AZ, UK
| | - Dudley J Pennell
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW7 2AZ, UK
| | - Sonia Nielles-Vallespin
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW7 2AZ, UK
| | - Guang Yang
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK.
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW7 2AZ, UK.
- Bioengineering Department and Imperial-X, Imperial College London, London, W12 7SL, UK.
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2
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Alwan L, Benz DC, Cuddy SAM, Dobner S, Shiri I, Caobelli F, Bernhard B, Stämpfli SF, Eberli F, Reyes M, Kwong RY, Falk RH, Dorbala S, Gräni C. Current and Evolving Multimodality Cardiac Imaging in Managing Transthyretin Amyloid Cardiomyopathy. JACC Cardiovasc Imaging 2024; 17:195-211. [PMID: 38099914 DOI: 10.1016/j.jcmg.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 01/29/2024]
Abstract
Amyloid transthyretin (ATTR) amyloidosis is a protein-misfolding disease characterized by fibril accumulation in the extracellular space that can result in local tissue disruption and organ dysfunction. Cardiac involvement drives morbidity and mortality, and the heart is the major organ affected by ATTR amyloidosis. Multimodality cardiac imaging (ie, echocardiography, scintigraphy, and cardiac magnetic resonance) allows accurate diagnosis of ATTR cardiomyopathy (ATTR-CM), and this is of particular importance because ATTR-targeting therapies have become available and probably exert their greatest benefit at earlier disease stages. Apart from establishing the diagnosis, multimodality cardiac imaging may help to better understand pathogenesis, predict prognosis, and monitor treatment response. The aim of this review is to give an update on contemporary and evolving cardiac imaging methods and their role in diagnosing and managing ATTR-CM. Further, an outlook is presented on how artificial intelligence in cardiac imaging may improve future clinical decision making and patient management in the setting of ATTR-CM.
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Affiliation(s)
- Louhai Alwan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik C Benz
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; CV Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiac Imaging, Department of Cardiology and Nuclear Medicine, Zurich University Hospital, Zurich, Switzerland
| | - Sarah A M Cuddy
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; CV Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Stephan Dobner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Isaac Shiri
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico Caobelli
- University Clinic of Nuclear Medicine, Inselspital, Bern University Hospital, Switzerland
| | - Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; CV Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Simon F Stämpfli
- Department of Cardiology, Heart Centre Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Franz Eberli
- Department of Cardiology, Triemli Hospital (Triemlispital), Zurich, Switzerland
| | - Mauricio Reyes
- Insel Data Science Center, Inselspital, Bern University Hospital, Bern, Switzerland; Artificial Intelligence in Medical Imaging, ARTORG Center for Biomedical Research, University of Bern, Bern, Switzerland
| | - Raymond Y Kwong
- CV Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rodney H Falk
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sharmila Dorbala
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; CV Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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3
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Li X, Chen R, Xu X, Xiao Z, Wei X, Yang Y, Zhang Z, Wu Z, Zhu Y, Liu H. The comparison of diffusion tensor imaging in human hearts between 1.5 T and 3.0 T. BMC Med Imaging 2023; 23:14. [PMID: 36698134 PMCID: PMC9875455 DOI: 10.1186/s12880-023-00969-9] [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: 01/20/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The aim was to compare the diffusion tensor imaging (DTI) indices derived from human hearts between 1.5 T and 3.0 T scanners. Additionally, the reproducibility of DTI indices was assessed between 1.5 T and 3.0 T scanners. METHODS A total of 18 ex-vivo hearts were derived from patients who underwent heart transplantation. The DTI schemes were performed at 1.5 T and 3.0 T, respectively. Then, the same slices from each ex-vivo heart were selected for image analysis. The student's t-test or Wilcoxon-rank test was used to compare the statistical differences. The agreement of DTI indices was mainly reported as the interclass correlation coefficient (ICC). RESULTS No significant differences (all P > 0.05) were found in the DTI indices between 1.5 T and 3.0 T scanners. Interestingly, the ICC of all DTI indices was relatively lower with a low b-value. The reproducibility of the helix angle (HA) was relatively lower when compared to the other DTI indices. CONCLUSION The DTI indices of ex-vivo human hearts between 1.5 T and 3.0 T scanners had no significant differences. The consistency of DTI indices needed caution using a low b-value with different field strengths, and the relatively low reproducibility of HA should be considered.
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Affiliation(s)
- Xiaodan Li
- grid.284723.80000 0000 8877 7471Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province China
| | - Rui Chen
- grid.284723.80000 0000 8877 7471Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province China ,grid.79703.3a0000 0004 1764 3838School of Medicine, South China University of Technology, Guangzhou, Guangdong Province China
| | - Xi Xu
- grid.9227.e0000000119573309Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China ,grid.410726.60000 0004 1797 8419Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Zebin Xiao
- grid.284723.80000 0000 8877 7471Department of Pathology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province China
| | - Xiaoyu Wei
- grid.284723.80000 0000 8877 7471Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province China ,grid.79703.3a0000 0004 1764 3838School of Medicine, South China University of Technology, Guangzhou, Guangdong Province China
| | - Yuelong Yang
- grid.284723.80000 0000 8877 7471Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province China
| | | | - Zhigang Wu
- Philips Healthcare China, Guangzhou, China
| | - Yanjie Zhu
- grid.9227.e0000000119573309Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China ,grid.410726.60000 0004 1797 8419Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Hui Liu
- grid.284723.80000 0000 8877 7471Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province China ,grid.79703.3a0000 0004 1764 3838School of Medicine, South China University of Technology, Guangzhou, Guangdong Province China ,grid.284723.80000 0000 8877 7471Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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4
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Silva-Verissimo W, El Louali F, Godio-Raboutet Y, Leblond L, Sourdon J, Rapacchi S, Evin M. Traction mechanical characterization of porcine mitral valve annulus. J Biomech 2023; 146:111396. [PMID: 36459849 DOI: 10.1016/j.jbiomech.2022.111396] [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: 05/20/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
The Mitral Annulus (MA) is an anisotropic, fibrous, flexible and dynamical structure. While MA dynamics are well documented, its passive mechanical properties remain poorly investigated to complete the design of adequate prostheses. Mechanical properties in traction on four sections of the MA (aortic, left, posterior and right segments) were assessed using a traction test system with a 30 N load cell and pulling jaws for sample fixation. Samples were submitted to a 1.5 N pre-load, 10 pre-conditioning cycles. Three strain rates were tested (5 %/min, 7 %/min and 13 %/min), the first two up to 10 % strain and the last until rupture. High-resolution diffusion-MRI provided microstructural mapping of fractional anisotropy and mean diffusion within muscle and collagen fibres. Ten MA from porcine hearts were excised resulting in 40 tested samples, out of which 28 were frozen prior to testing. Freezing samples significantly increased Young Moduli for all strain rates. No significant differences were found between Young Moduli at different strain rates (fresh samples 2.4 ± 1.1 MPa, 3.8 ± 2.2 MPa and 3.1 ± 1.8 MPa for increasing strain rates in fresh samples), while significant differences were found when comparing aortic with posterior and posterior with lateral (p < 0.012). Aortic segments deformed the most (24.1 ± 9.4 %) while lateral segments endured the highest stress (>0.3 MPa), corresponding to higher collagen fraction (0.46) and fractional anisotropy. Passive machinal properties differed between aortic and lateral segments of the MA. The process of freezing samples altered their mechanical properties. Underlying microstructural differences could be linked to changes in strain response.
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Affiliation(s)
| | - F El Louali
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France; AP-HM, Marseille, France
| | | | | | - Joevin Sourdon
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
| | - S Rapacchi
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
| | - Morgane Evin
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.
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5
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Ferreira PF, Banerjee A, Scott AD, Khalique Z, Yang G, Rajakulasingam R, Dwornik M, De Silva R, Pennell DJ, Firmin DN, Nielles‐Vallespin S. Accelerating Cardiac Diffusion Tensor Imaging With a U-Net Based Model: Toward Single Breath-Hold. J Magn Reson Imaging 2022; 56:1691-1704. [PMID: 35460138 PMCID: PMC9790699 DOI: 10.1002/jmri.28199] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In vivo cardiac diffusion tensor imaging (cDTI) characterizes myocardial microstructure. Despite its potential clinical impact, considerable technical challenges exist due to the inherent low signal-to-noise ratio. PURPOSE To reduce scan time toward one breath-hold by reconstructing diffusion tensors for in vivo cDTI with a fitting-free deep learning approach. STUDY TYPE Retrospective. POPULATION A total of 197 healthy controls, 547 cardiac patients. FIELD STRENGTH/SEQUENCE A 3 T, diffusion-weighted stimulated echo acquisition mode single-shot echo-planar imaging sequence. ASSESSMENT A U-Net was trained to reconstruct the diffusion tensor elements of the reference results from reduced datasets that could be acquired in 5, 3 or 1 breath-hold(s) (BH) per slice. Fractional anisotropy (FA), mean diffusivity (MD), helix angle (HA), and sheetlet angle (E2A) were calculated and compared to the same measures when using a conventional linear-least-square (LLS) tensor fit with the same reduced datasets. A conventional LLS tensor fit with all available data (12 ± 2.0 [mean ± sd] breath-holds) was used as the reference baseline. STATISTICAL TESTS Wilcoxon signed rank/rank sum and Kruskal-Wallis tests. Statistical significance threshold was set at P = 0.05. Intersubject measures are quoted as median [interquartile range]. RESULTS For global mean or median results, both the LLS and U-Net methods with reduced datasets present a bias for some of the results. For both LLS and U-Net, there is a small but significant difference from the reference results except for LLS: MD 5BH (P = 0.38) and MD 3BH (P = 0.09). When considering direct pixel-wise errors the U-Net model outperformed significantly the LLS tensor fit for reduced datasets that can be acquired in three or just one breath-hold for all parameters. DATA CONCLUSION Diffusion tensor prediction with a trained U-Net is a promising approach to minimize the number of breath-holds needed in clinical cDTI studies. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Pedro F. Ferreira
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | | | - Andrew D. Scott
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Zohya Khalique
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Guang Yang
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Ramyah Rajakulasingam
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Maria Dwornik
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Ranil De Silva
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Dudley J. Pennell
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - David N. Firmin
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Sonia Nielles‐Vallespin
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
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6
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Scott AD, Jackson T, Khalique Z, Gorodezky M, Pardoe B, Begum L, Bruno VD, Chowdhury RA, Ferreira PF, Nielles‐Vallespin S, Roehl M, McCarthy KP, Sarathchandra P, Rose JN, Doorly DJ, Pennell DJ, Ascione R, de Silva R, Firmin DN. Development of a cardiovascular magnetic resonance-compatible large animal isolated heart model for direct comparison of beating and arrested hearts. NMR IN BIOMEDICINE 2022; 35:e4692. [PMID: 35040195 PMCID: PMC9286060 DOI: 10.1002/nbm.4692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/21/2021] [Accepted: 01/07/2022] [Indexed: 06/02/2023]
Abstract
Cardiac motion results in image artefacts and quantification errors in many cardiovascular magnetic resonance (CMR) techniques, including microstructural assessment using diffusion tensor cardiovascular magnetic resonance (DT-CMR). Here, we develop a CMR-compatible isolated perfused porcine heart model that allows comparison of data obtained in beating and arrested states. Ten porcine hearts (8/10 for protocol optimisation) were harvested using a donor heart retrieval protocol and transported to the remote CMR facility. Langendorff perfusion in a 3D-printed chamber and perfusion circuit re-established contraction. Hearts were imaged using cine, parametric mapping and STEAM DT-CMR at cardiac phases with the minimum and maximum wall thickness. High potassium and lithium perfusates were then used to arrest the heart in a slack and contracted state, respectively. Imaging was repeated in both arrested states. After imaging, tissue was removed for subsequent histology in a location matched to the DT-CMR data using fiducial markers. Regular sustained contraction was successfully established in six out of 10 hearts, including the final five hearts. Imaging was performed in four hearts and one underwent the full protocol, including colocalised histology. The image quality was good and there was good agreement between DT-CMR data in equivalent beating and arrested states. Despite the use of autologous blood and dextran within the perfusate, T2 mapping results, DT-CMR measures and an increase in mass were consistent with development of myocardial oedema, resulting in failure to achieve a true diastolic-like state. A contiguous stack of 313 5-μm histological sections at and a 100-μm thick section showing cell morphology on 3D fluorescent confocal microscopy colocalised to DT-CMR data were obtained. A CMR-compatible isolated perfused beating heart setup for large animal hearts allows direct comparisons of beating and arrested heart data with subsequent colocalised histology, without the need for onsite preclinical facilities.
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Affiliation(s)
- Andrew D. Scott
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Tim Jackson
- Department of PerfusionRoyal Brompton HospitalLondonUK
| | - Zohya Khalique
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Margarita Gorodezky
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Ben Pardoe
- Department of PerfusionRoyal Brompton HospitalLondonUK
| | - Lale Begum
- Department of PerfusionRoyal Brompton HospitalLondonUK
| | - V. Domenico Bruno
- Translational Biomedical Research CentreUniversity of BristolBristolUK
- Bristol Heart InstituteUniversity Hospital Bristol NHS Foundation TrustBristolUK
| | - Rasheda A. Chowdhury
- National Heart and Lung InstituteImperial CollegeLondonUK
- Imperial Centre for Cardiac EngineeringImperial CollegeLondonUK
| | - Pedro F. Ferreira
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Sonia Nielles‐Vallespin
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Malte Roehl
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | | | - Padmini Sarathchandra
- National Heart and Lung InstituteImperial CollegeLondonUK
- Magdi Yacoub Institute, National Heart and Lung InstituteImperial CollegeLondonUK
| | - Jan N. Rose
- Department of AeronauticsImperial CollegeLondonUK
| | | | - Dudley J. Pennell
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Raimondo Ascione
- Translational Biomedical Research CentreUniversity of BristolBristolUK
- Bristol Heart InstituteUniversity Hospital Bristol NHS Foundation TrustBristolUK
| | - Ranil de Silva
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - David N. Firmin
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
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7
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Connecting macroscopic diffusion metrics of cardiac diffusion tensor imaging and microscopic myocardial structures based on simulation. Med Image Anal 2022; 77:102325. [DOI: 10.1016/j.media.2021.102325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/20/2022]
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8
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Palmiero G, Vetrano E, Rubino M, Monda E, Dongiglio F, Lioncino M, Di Fraia F, Caiazza M, Verrillo F, Capodicasa L, Cerciello G, Manganelli F, Catalano M, D'Arienzo D, De Rimini ML, Ascione R, Golino P, Caso P, Ascione L, Limongelli G. The Role of New Imaging Technologies in the Diagnosis of Cardiac Amyloidosis. Heart Fail Clin 2021; 18:61-72. [PMID: 34776084 DOI: 10.1016/j.hfc.2021.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiac amyloidosis is an infiltrative disorder caused by transthyretin or immunoglobulin free light-chain deposition, which determines clinical disease with similar phenotype but different time course, prognosis and therapy. Multimodality imaging is the cornerstone for disease diagnosis and management. Multimodality imaging has revolutionized the approach to the disease favoring its awareness and simplifying its diagnosis, especially in ATTR cardiac amyloidosis. This describes the different imaging tools, from the traditional to the more novel ones, and highlights the different approach in each different setting (prognosis, subtyping, prognosis, monitoring disease progression, and response to therapy).
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Affiliation(s)
- Giuseppe Palmiero
- Department of Cardiology, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy; Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy.
| | - Erica Vetrano
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Francesco Di Fraia
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Laura Capodicasa
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Giuseppe Cerciello
- Haematology Unit (Building n. 2), Department of Clinical Medicine and Surgery, AOU Policlinico "Federico II", via Sergio Pansini 5, 80131 Naples, Italy
| | - Fiore Manganelli
- Neurology Unit (Building n. 17), Department of Neurosciences, Reproductive Medicine and Odontostomatology, AOU Policlinico "Federico II", via Sergio Pansini 5, 80131 Naples, Italy
| | - Mara Catalano
- Department of Nuclear Imaging, AORN Cardarelli Hospital, via Antonio Cardarelli 9, 80131 Naples, Italy
| | - Davide D'Arienzo
- Department of Nuclear Medicine, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Maria Luisa De Rimini
- Department of Nuclear Medicine, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Raffaele Ascione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Paolo Golino
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pio Caso
- Department of Cardiology, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Luigi Ascione
- Department of Cardiology, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, London, UK
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9
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Paddock S, Tsampasian V, Assadi H, Mota BC, Swift AJ, Chowdhary A, Swoboda P, Levelt E, Sammut E, Dastidar A, Broncano Cabrero J, Del Val JR, Malcolm P, Sun J, Ryding A, Sawh C, Greenwood R, Hewson D, Vassiliou V, Garg P. Clinical Translation of Three-Dimensional Scar, Diffusion Tensor Imaging, Four-Dimensional Flow, and Quantitative Perfusion in Cardiac MRI: A Comprehensive Review. Front Cardiovasc Med 2021; 8:682027. [PMID: 34307496 PMCID: PMC8292630 DOI: 10.3389/fcvm.2021.682027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/04/2021] [Indexed: 01/05/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging is a versatile tool that has established itself as the reference method for functional assessment and tissue characterisation. CMR helps to diagnose, monitor disease course and sub-phenotype disease states. Several emerging CMR methods have the potential to offer a personalised medicine approach to treatment. CMR tissue characterisation is used to assess myocardial oedema, inflammation or thrombus in various disease conditions. CMR derived scar maps have the potential to inform ablation therapy—both in atrial and ventricular arrhythmias. Quantitative CMR is pushing boundaries with motion corrections in tissue characterisation and first-pass perfusion. Advanced tissue characterisation by imaging the myocardial fibre orientation using diffusion tensor imaging (DTI), has also demonstrated novel insights in patients with cardiomyopathies. Enhanced flow assessment using four-dimensional flow (4D flow) CMR, where time is the fourth dimension, allows quantification of transvalvular flow to a high degree of accuracy for all four-valves within the same cardiac cycle. This review discusses these emerging methods and others in detail and gives the reader a foresight of how CMR will evolve into a powerful clinical tool in offering a precision medicine approach to treatment, diagnosis, and detection of disease.
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Affiliation(s)
- Sophie Paddock
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vasiliki Tsampasian
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Hosamadin Assadi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Bruno Calife Mota
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Amrit Chowdhary
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Peter Swoboda
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Eva Sammut
- Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, University of Bristol, Bristol, United Kingdom
| | - Amardeep Dastidar
- Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, University of Bristol, Bristol, United Kingdom
| | - Jordi Broncano Cabrero
- Cardiothoracic Imaging Unit, Hospital San Juan De Dios, Ressalta, HT Medica, Córdoba, Spain
| | - Javier Royuela Del Val
- Cardiothoracic Imaging Unit, Hospital San Juan De Dios, Ressalta, HT Medica, Córdoba, Spain
| | - Paul Malcolm
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Julia Sun
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Alisdair Ryding
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Chris Sawh
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Richard Greenwood
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - David Hewson
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vassilios Vassiliou
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Pankaj Garg
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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10
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Chowdhury RA, Debney MT, Protti A, Handa BS, Patel KHK, Lyon AR, Shah AM, Ng FS, Peters NS. Rotigaptide Infusion for the First 7 Days After Myocardial Infarction-Reperfusion Reduced Late Complexity of Myocardial Architecture of the Healing Border-Zone and Arrhythmia Inducibility. J Am Heart Assoc 2021; 10:e020006. [PMID: 33870715 PMCID: PMC8200720 DOI: 10.1161/jaha.120.020006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Survivors of myocardial infarction are at increased risk of late ventricular arrhythmias, with infarct size and scar heterogeneity being key determinants of arrhythmic risk. Gap junctions facilitate the passage of small ions and morphogenic cell signaling between myocytes. We hypothesized that gap junctions enhancement during infarction–reperfusion modulates structural and electrophysiological remodeling and reduces late arrhythmogenesis. Methods and Results Infarction–reperfusion surgery was carried out in male Sprague‐Dawley rats followed by 7 days of rotigaptide or saline administration. The in vivo and ex vivo arrhythmogenicity was characterized by programmed electrical stimulation 3 weeks later, followed by diffusion‐weighted magnetic resonance imaging and Masson's trichrome histology. Three weeks after 7‐day postinfarction administration of rotigaptide, ventricular tachycardia/ventricular fibrillation was induced on programmed electrical stimulation in 20% and 53% of rats, respectively (rotigaptide versus control), resulting in reduction of arrhythmia score (3.2 versus 1.4, P=0.018), associated with the reduced magnetic resonance imaging parameters fractional anisotropy (fractional anisotropy: −5% versus −15%; P=0.062) and mean diffusivity (mean diffusivity: 2% versus 6%, P=0.042), and remodeling of the 3‐dimensional laminar structure of the infarct border zone with reduction of the mean (16° versus 19°, P=0.013) and the dispersion (9° versus 12°, P=0.015) of the myofiber transverse angle. There was no change in ECG features, spontaneous arrhythmias, or mortality. Conclusions Enhancement of gap junctions function by rotigaptide administered during the early healing phase in reperfused infarction reduces later complexity of infarct scar morphology and programmed electrical stimulation–induced arrhythmias, and merits further exploration as a feasible and practicable intervention in the acute myocardial infarction management to reduce late arrhythmic risk.
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Affiliation(s)
- Rasheda A Chowdhury
- National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom
| | - Michael T Debney
- National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom
| | - Andrea Protti
- King's British Heart Foundation Centre School of Cardiovascular Medicine and Sciences Kings College London London United Kingdom
| | - Balvinder S Handa
- National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom
| | - Kiran H K Patel
- National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom
| | - Alexander R Lyon
- National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom
| | - Ajay M Shah
- King's British Heart Foundation Centre School of Cardiovascular Medicine and Sciences Kings College London London United Kingdom
| | - Fu Siong Ng
- National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom
| | - Nicholas S Peters
- National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom
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11
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Abstract
Classification of heart failure is based on the left ventricular ejection fraction (EF): preserved EF, midrange EF, and reduced EF. There remains an unmet need for further heart failure phenotyping of ventricular structure-function relationships. Because of high spatiotemporal resolution, cardiac magnetic resonance (CMR) remains the reference modality for quantification of ventricular contractile function. The authors aim to highlight novel frameworks, including theranostic use of ferumoxytol, to enable more efficient evaluation of ventricular function in heart failure patients who are also frequently anemic, and to discuss emerging quantitative CMR approaches for evaluation of ventricular structure-function relationships in heart failure.
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12
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Le B, Ferreira P, Merchant S, Zheng G, Sutherland MR, Dahl MJ, Albertine KH, Black MJ. Microarchitecture of the hearts in term and former-preterm lambs using diffusion tensor imaging. Anat Rec (Hoboken) 2020; 304:803-817. [PMID: 33015923 DOI: 10.1002/ar.24516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/31/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Abstract
Diffusion tensor imaging (DTI) is an MRI technique that can be used to map cardiomyocyte tracts and estimate local cardiomyocyte and sheetlet orientation within the heart. DTI measures diffusion distances of water molecules within the myocardium, where water diffusion generally occurs more freely along the long axis of cardiomyocytes and within the extracellular matrix, but is restricted by cell membranes such that transverse diffusion is limited. DTI can be undertaken in fixed hearts and it allows the three-dimensional mapping of the cardiac microarchitecture, including cardiomyocyte organization, within the whole heart. The objective of this study was to use DTI to compare the cardiac microarchitecture and cardiomyocyte organization in archived fixed left ventricles of lambs that were born either preterm (n = 5) or at term (n = 7), at a postnatal timepoint equivalent to about 6 years of age in children. Although the findings support the feasibility of retrospective DTI scanning of fixed hearts, several hearts were excluded from DTI analysis because of poor scan quality, such as ghosting artifacts. The preliminary findings from viable DTI scans (n = 3/group) suggest that the extracellular compartment is altered and that there is an immature microstructural phenotype early in postnatal life in the LV of lambs born preterm. Our findings support a potential time-efficient imaging role for DTI in detecting abnormal changes in the microstructure of fixed hearts of former-preterm neonates, although further investigation into factors that affect scan quality is required.
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Affiliation(s)
- Bianca Le
- Department of Anatomy and Developmental Biology and Biomedicine Discovery Institute, Monash University, Victoria, Australia
| | | | - Samer Merchant
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA
| | - Gang Zheng
- Monash Biomedical Imaging, Monash University, Victoria, Australia
| | - Megan R Sutherland
- Department of Anatomy and Developmental Biology and Biomedicine Discovery Institute, Monash University, Victoria, Australia
| | - Mar Janna Dahl
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Kurt H Albertine
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Mary Jane Black
- Department of Anatomy and Developmental Biology and Biomedicine Discovery Institute, Monash University, Victoria, Australia
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13
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Khalique Z, Ferreira PF, Scott AD, Nielles-Vallespin S, Martinez-Naharro A, Fontana M, Hawkins P, Firmin DN, Pennell DJ. Diffusion Tensor Cardiovascular Magnetic Resonance in Cardiac Amyloidosis. Circ Cardiovasc Imaging 2020; 13:e009901. [PMID: 32408830 DOI: 10.1161/circimaging.119.009901] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Cardiac amyloidosis (CA) is a disease of interstitial myocardial infiltration, usually by light chains or transthyretin. We used diffusion tensor cardiovascular magnetic resonance (DT-CMR) to noninvasively assess the effects of amyloid infiltration on the cardiac microstructure. Methods DT-CMR was performed at diastole and systole in 20 CA, 11 hypertrophic cardiomyopathy, and 10 control subjects with calculation of mean diffusivity, fractional anisotropy, and sheetlet orientation (secondary eigenvector angle). Results Mean diffusivity was elevated and fractional anisotropy reduced in CA compared with both controls and hypertrophic cardiomyopathy (P<0.001). In CA, mean diffusivity was correlated with extracellular volume (r=0.68, P=0.004), and fractional anisotropy was inversely correlated with circumferential strain (r=-0.65, P=0.02). In CA, diastolic secondary eigenvector angle was elevated, and secondary eigenvector angle mobility was reduced compared with controls (both P<0.001). Diastolic secondary eigenvector angle was correlated with amyloid burden measured by extracellular volume in transthyretin, but not light chain amyloidosis. Conclusions DT-CMR can characterize the microstructural effects of amyloid infiltration and is a contrast-free method to identify the location and extent of the expanded disorganized myocardium. The diffusion biomarkers mean diffusivity and fractional anisotropy effectively discriminate CA from hypertrophic cardiomyopathy. DT-CMR demonstrated that failure of sheetlet relaxation in diastole correlated with extracellular volume in transthyretin, but not light chain amyloidosis. This indicates that different mechanisms may be responsible for impaired contractility in CA, with an amyloid burden effect in transthyretin, but an idiosyncratic effect in light chain amyloidosis. Consequently, DT-CMR offers a contrast-free tool to identify novel pathophysiology, improve diagnostics, and monitor disease through noninvasive microstructural assessment.
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Affiliation(s)
- Zohya Khalique
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital Sydney Street, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.)
| | - Pedro F Ferreira
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital Sydney Street, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.)
| | - Andrew D Scott
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital Sydney Street, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.)
| | - Sonia Nielles-Vallespin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital Sydney Street, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.)
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London Royal Free Hospital, United Kingdom (A.M.-N., M.F., P.H.)
| | - Marianna Fontana
- National Amyloidosis Centre, University College London Royal Free Hospital, United Kingdom (A.M.-N., M.F., P.H.)
| | - Phillip Hawkins
- National Amyloidosis Centre, University College London Royal Free Hospital, United Kingdom (A.M.-N., M.F., P.H.)
| | - David N Firmin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital Sydney Street, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.)
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital Sydney Street, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (Z.K., P.F.F., A.D.S., S.N.-V., D.N.F., D.J.P.)
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14
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Khalique Z, Ferreira PF, Scott AD, Nielles-Vallespin S, Firmin DN, Pennell DJ. Diffusion Tensor Cardiovascular Magnetic Resonance Imaging. JACC Cardiovasc Imaging 2020; 13:1235-1255. [DOI: 10.1016/j.jcmg.2019.07.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 12/15/2022]
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15
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Carruth ED, Teh I, Schneider JE, McCulloch AD, Omens JH, Frank LR. Regional variations in ex-vivo diffusion tensor anisotropy are associated with cardiomyocyte remodeling in rats after left ventricular pressure overload. J Cardiovasc Magn Reson 2020; 22:21. [PMID: 32241289 PMCID: PMC7114814 DOI: 10.1186/s12968-020-00615-1] [Citation(s) in RCA: 5] [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: 07/09/2019] [Accepted: 03/05/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pressure overload left ventricular (LV) hypertrophy is characterized by increased cardiomyocyte width and ventricle wall thickness, however the regional variation of this remodeling is unclear. Cardiovascular magnetic resonance (CMR) diffusion tensor imaging (DTI) may provide a non-invasive, comprehensive, and geometrically accurate method to detect regional differences in structural remodeling in hypertrophy. We hypothesized that DTI parameters, such as fractional and planar anisotropy, would reflect myocyte remodeling due to pressure overload in a regionally-dependent manner. METHODS We investigated the regional distributions of myocyte remodeling in rats with or without transverse aortic constriction (TAC) via direct measurement of myocyte dimensions with confocal imaging of thick tissue sections, and correlated myocyte cross-sectional area and other geometric features with parameters of diffusivity from ex-vivo DTI in the same regions of the same hearts. RESULTS We observed regional differences in several parameters from DTI between TAC hearts and SHAM controls. Consistent with previous studies, helix angles from DTI correlated strongly with those measured directly from histological sections (p < 0.001, R2 = 0.71). There was a transmural gradient in myocyte cross-sectional area in SHAM hearts that was diminished in the TAC group. We also found several regions of significantly altered DTI parameters in TAC LV compared to SHAM, especially in myocyte sheet angle dispersion and planar anisotropy. Among others, these parameters correlated significantly with directly measured myocyte aspect ratios. CONCLUSIONS These results show that structural remodeling in pressure overload LV hypertrophy is regionally heterogeneous, especially transmurally, with a greater degree of remodeling in the sub-endocardium compared to the sub-epicardium. Additionally, several parameters derived from DTI correlated significantly with measurements of myocyte geometry from direct measurement in histological sections. We suggest that DTI may provide a non-invasive, comprehensive method to detect regional structural myocyte LV remodeling during disease.
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Affiliation(s)
- Eric D Carruth
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA
| | - Irvin Teh
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
| | - Jurgen E Schneider
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA
| | - Jeffrey H Omens
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA.
- Department of Medicine, University of California San Diego, La Jolla, California, USA.
| | - Lawrence R Frank
- Department of Radiology, University of California San Diego, La Jolla, California, USA
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16
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Gotschy A, von Deuster C, van Gorkum RJH, Gastl M, Vintschger E, Schwotzer R, Flammer AJ, Manka R, Stoeck CT, Kozerke S. Characterizing cardiac involvement in amyloidosis using cardiovascular magnetic resonance diffusion tensor imaging. J Cardiovasc Magn Reson 2019; 21:56. [PMID: 31484544 PMCID: PMC6727537 DOI: 10.1186/s12968-019-0563-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/15/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In-vivo cardiovascular magnetic resonance (CMR) diffusion tensor imaging (DTI) allows imaging of alterations of cardiac fiber architecture in diseased hearts. Cardiac amyloidosis (CA) causes myocardial infiltration of misfolded proteins with unknown consequences for myocardial microstructure. This study applied CMR DTI in CA to assess microstructural alterations and their consequences for myocardial function compared to healthy controls. METHODS Ten patients with CA (8 AL, 2 ATTR) and ten healthy controls were studied using a diffusion-weighed second-order motion-compensated spin-echo sequence at 1.5 T. Additionally, left ventricular morphology, ejection fraction, strain and native T1 values were obtained in all subjects. In CA patients, T1 mapping was repeated after the administration of gadolinium for extracellular volume fraction (ECV) calculation. CMR DTI analysis was performed to yield the scalar diffusion metrics mean diffusivity (MD) and fractional anisotropy (FA) as well as the characteristics of myofiber orientation including helix, transverse and E2A sheet angle (HA, TA, E2A). RESULTS MD and FA were found to be significantly different between CA patients and healthy controls (MD 1.77 ± 0.17 10- 3 vs 1.41 ± 0.07 10- 3 mm2/s, p < 0.001; FA 0.25 ± 0.04 vs 0.35 ± 0.03, p < 0.001). MD demonstrated an excellent correlation with native T1 (r = 0.908, p < 0.001) while FA showed a significant correlation with ECV in the CA population (r = - 0.851, p < 0.002). HA exhibited a more circumferential orientation of myofibers in CA patients, in conjunction with a higher TA standard deviation and a higher absolute E2A sheet angle. The transmural HA slope was found to be strongly correlated with the global longitudinal strain (r = 0.921, p < 0.001). CONCLUSION CMR DTI reveals significant alterations of scalar diffusion metrics in CA patients versus healthy controls. Elevated MD and lower FA values indicate myocardial disarray with higher diffusion in CA that correlates well with native T1 and ECV measures. In CA patients, CMR DTI showed pronounced circumferential orientation of the myofibers, which may provide the rationale for the reduction of global longitudinal strain that occurs in amyloidosis patients. Accordingly, CMR DTI captures specific features of amyloid infiltration, which provides a deeper understanding of the microstructural consequences of CA.
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Affiliation(s)
- Alexander Gotschy
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich, 8092 Switzerland
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Constantin von Deuster
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich, 8092 Switzerland
| | - Robbert J. H. van Gorkum
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich, 8092 Switzerland
| | - Mareike Gastl
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich, 8092 Switzerland
| | - Ella Vintschger
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich, 8092 Switzerland
| | - Rahel Schwotzer
- Division of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas J. Flammer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Christian T. Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich, 8092 Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich, 8092 Switzerland
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17
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Khalique Z, Pennell D. Diffusion tensor cardiovascular magnetic resonance. Postgrad Med J 2019; 95:433-438. [DOI: 10.1136/postgradmedj-2019-136429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/16/2019] [Accepted: 04/28/2019] [Indexed: 11/03/2022]
Abstract
Cardiac structure and function are complex and inter-related. Current in vivo techniques assess the heart on a macroscopic scale, but a novel technique called diffusion tensor cardiovascular magnetic resonance (DT-CMR) can now assess the cardiac microstructure non-invasively. It provides information on the helical arrangement of cardiomyocytes that drives torsion and offers dynamic assessment of the sheetlets (aggregated cardiomyocytes) that rotate through the cardiac cycle to facilitate wall thickening. Through diffusion biomarkers, the expansion and organisation of the underlying myocardium can be described. DT-CMR has already identified novel microstructural abnormalities in cardiomyopathy, and ischaemic and congenital heart disease. This new knowledge supports the potential of DT-CMR to improve diagnostics and prognostication in various cardiac diseases.
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18
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Gorodezky M, Ferreira PF, Nielles-Vallespin S, Gatehouse PD, Pennell DJ, Scott AD, Firmin DN. High resolution in-vivo DT-CMR using an interleaved variable density spiral STEAM sequence. Magn Reson Med 2018; 81:1580-1594. [PMID: 30408238 DOI: 10.1002/mrm.27504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Diffusion tensor cardiovascular magnetic resonance (DT-CMR) has a limited spatial resolution. The purpose of this study was to demonstrate high-resolution DT-CMR using a segmented variable density spiral sequence with correction for motion, off-resonance, and T2*-related blurring. METHODS A single-shot stimulated echo acquisition mode (STEAM) echo-planar-imaging (EPI) DT-CMR sequence at 2.8 × 2.8 × 8 mm3 and 1.8 × 1.8 × 8 mm3 was compared to a single-shot spiral at 2.8 × 2.8 × 8 mm3 and an interleaved spiral sequence at 1.8 × 1.8 × 8 mm3 resolution in 10 healthy volunteers at peak systole and diastasis. Motion-induced phase was corrected using the densely sampled central k-space data of the spirals. STEAM field maps and T2* measures were obtained using a pair of stimulated echoes each with a double spiral readout, the first used to correct the motion-induced phase of the second. RESULTS The high-resolution spiral sequence produced similar DT-CMR results and quality measures to the standard-resolution sequence in both cardiac phases. Residual differences in fractional anisotropy and helix angle gradient between the resolutions could be attributed to spatial resolution and/or signal-to-noise ratio. Data quality increased after both motion-induced phase correction and off-resonance correction, and sharpness increased after T2* correction. The high-resolution EPI sequence failed to provide sufficient data quality for DT-CMR reconstruction. CONCLUSION In this study, an in vivo DT-CMR acquisition at 1.8 × 1.8 mm2 in-plane resolution was demonstrated using a segmented spiral STEAM sequence. Motion-induced phase and off-resonance corrections are essential for high-resolution spiral DT-CMR. Segmented variable density spiral STEAM was found to be the optimal method for acquiring high-resolution DT-CMR data.
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Affiliation(s)
- Margarita Gorodezky
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Pedro F Ferreira
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Peter D Gatehouse
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Andrew D Scott
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - David N Firmin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
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19
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Gorodezky M, Scott AD, Ferreira PF, Nielles-Vallespin S, Pennell DJ, Firmin DN. Diffusion tensor cardiovascular magnetic resonance with a spiral trajectory: An in vivo comparison of echo planar and spiral stimulated echo sequences. Magn Reson Med 2017; 80:648-654. [PMID: 29266435 DOI: 10.1002/mrm.27051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Diffusion tensor cardiovascular MR (DT-CMR) using stimulated echo acquisition mode (STEAM) with echo-planar-imaging (EPI) readouts is a low signal-to-noise-ratio (SNR) technique and therefore typically has a low spatial resolution. Spiral trajectories are more efficient than EPI, and could increase the SNR. The purpose of this study was to compare the performance of a novel STEAM spiral DT-CMR sequence with an equivalent established EPI technique. METHODS A STEAM DT-CMR sequence was implemented with a spiral readout and a reduced field of view. An in vivo comparison of DT-CMR parameters and data quality between EPI and spiral was performed in 11 healthy volunteers imaged in peak systole and diastasis at 3 T. The SNR was compared in a phantom and in vivo. RESULTS There was a greater than 49% increase in the SNR in vivo and in the phantom measurements (in vivo septum, systole: SNREPI = 8.0 ± 2.2, SNRspiral = 12.0 ± 2.7; diastasis: SNREPI = 8.1 ± 1.6, SNRspiral = 12.0 ± 3.7). There were no significant differences in helix angle gradient (HAG) (systole: HAGEPI = -0.79 ± 0.07 °/%; HAGspiral = -0.74 ± 0.16 °/%; P = 0.11; diastasis: HAGEPI = -0.63 ± 0.05 °/%; HAGspiral = -0.56 ± 0.14 °/%; P = 0.20), mean diffusivity (MD) in systole (MDEPI = 0.99 ± 0.06 × 10-3 mm2 /s, MDspiral = 1.00 ± 0.09 × 10-3 mm2 /s, P = 0.23) and secondary eigenvector angulation (E2A) (systole: E2AEPI = 61 ± 10 °; E2Aspiral = 63 ± 10 °; P = 0.77; diastasis: E2AEPI = 18 ± 11 °; E2Aspiral = 15 ± 8 °; P = 0.20) between the sequences. There was a small difference (≈ 20%) in fractional anisotropy (FA) (systole: FAEPI = 0.49 ± 0.03, FAspiral = 0.41 ± 0.04; P < 0.01; diastasis: FAEPI = 0.66 ± 0.05, FAspiral = 0.55 ± 0.03; P < 0.01) and mean diffusivity in diastasis (10%; MDEPI = 1.00 ± 0.12 × 10-3 mm2 /s, MDspiral = 1.10 ± 0.09 × 10-3 mm2 /s, P = 0.02). CONCLUSION This is the first study to demonstrate DT-CMR STEAM using a spiral trajectory. The SNR was increased by using a spiral rather than the more established EPI readout, and the DT-CMR parameters were largely similar between the two sequences. Magn Reson Med 80:648-654, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Margarita Gorodezky
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, United Kingdom.,National Heart and Lung Institute, Imperial College, Sydney Street, London, SW3 6NP, United Kingdom
| | - Andrew D Scott
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, United Kingdom.,National Heart and Lung Institute, Imperial College, Sydney Street, London, SW3 6NP, United Kingdom
| | - Pedro F Ferreira
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, United Kingdom.,National Heart and Lung Institute, Imperial College, Sydney Street, London, SW3 6NP, United Kingdom
| | - Sonia Nielles-Vallespin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, United Kingdom.,National Heart and Lung Institute, Imperial College, Sydney Street, London, SW3 6NP, United Kingdom.,National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, United Kingdom.,National Heart and Lung Institute, Imperial College, Sydney Street, London, SW3 6NP, United Kingdom
| | - David N Firmin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, United Kingdom.,National Heart and Lung Institute, Imperial College, Sydney Street, London, SW3 6NP, United Kingdom
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20
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Germain P, El Ghannudi S, Labani A, Jeung MY, Gangi A, Ohlmann P, Roy C. A dual flip angle 3D bSSFP magnetization transfer-like method to differentiate between recent and old myocardial infarction. J Magn Reson Imaging 2017; 47:798-808. [PMID: 28727209 DOI: 10.1002/jmri.25821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/07/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) tissue signal is modulated by magnetization transfer (MT) phenomena, intrinsically induced by balanced steady-state free precession (bSSFP) imaging. PURPOSE To investigate the possible value of such a MT-like bSSFP approach in two clinical settings involving focal myocardial lesions highligthed by late gadolinium enhancement (LGE+): edema induced by recent myocardial infarction (MI) and fibrotic scar related to chronic infarction. MATERIALS AND METHODS Population: 48 LGE + patients were studied: 26 with recent MI, 22 with chronic MI. 20 LGE-normal subjects were considered the control group. Field strength/sequence: Navigator-based short axis 3D-bSSFP sequences with 20° and 90° excitation flip angles were acquired (1.5T). ASSESSMENT Pixel-wise normalized MT Ratio (nMTR) parametric images were calculated according to: nMTR = 100*(S20 -S90 *k)/S20 , with S20 and S90 signal intensity in 20° and 90° flip angle images and k = Blood20 /Blood90 as a normalization ratio. Statistical tests: analysis of variance (ANOVA), receiver operating characteristic (ROC) analysis. RESULTS Overall normal myocardial nMTR was 50.2 ± 3.6%. In recent MI, nMTR values were significantly reduced in LGE + regions (-22.3 ± 9.9%, P < 0.0001). In cases of chronic infarct, nMTR was significantly increased in LGE + regions (14.2 ± 11.4%, P < 0.0001). Comparison between observed results and theoretical values obtained with the Freeman-Hill formula showed that most variations observed in MI are related to MT effects instead of relaxation effects. CONCLUSION In contrast to LGE imaging, which may show a similar hyperenhancement in recent and old infarctions, nMTR imaging demonstrates an opposite pattern: decreased values for recent infarction and increased values for old infarction, thus allowing to discriminate between these two clinical conditions without gadolinium injection. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:798-808.
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Affiliation(s)
- Philippe Germain
- Department of Radiology, University Hospital, Strasbourg, France.,Department of Cardiology, University Hospital, Strasbourg, France
| | - Soraya El Ghannudi
- Department of Radiology, University Hospital, Strasbourg, France.,Department of Nuclear Medicine, University Hospital, Strasbourg, France
| | - Aissam Labani
- Department of Radiology, University Hospital, Strasbourg, France
| | - Mi Y Jeung
- Department of Radiology, University Hospital, Strasbourg, France
| | - Afshin Gangi
- Department of Radiology, University Hospital, Strasbourg, France
| | - Patrick Ohlmann
- Department of Cardiology, University Hospital, Strasbourg, France
| | - Catherine Roy
- Department of Radiology, University Hospital, Strasbourg, France
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21
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Aliotta E, Moulin K, Zhang Z, Ennis DB. Simultaneous measurement of T 2 and apparent diffusion coefficient (T 2 +ADC) in the heart with motion-compensated spin echo diffusion-weighted imaging. Magn Reson Med 2017; 79:654-662. [PMID: 28516485 DOI: 10.1002/mrm.26705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/14/2017] [Accepted: 03/16/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate a technique for simultaneous quantitative T2 and apparent diffusion coefficient (ADC) mapping in the heart (T2 +ADC) using spin echo (SE) diffusion-weighted imaging (DWI). THEORY AND METHODS T2 maps from T2 +ADC were compared with single-echo SE in phantoms and with T2 -prepared (T2 -prep) balanced steady-state free precession (bSSFP) in healthy volunteers. ADC maps from T2 +ADC were compared with conventional DWI in phantoms and in vivo. T2 +ADC was also demonstrated in a patient with acute myocardial infarction (MI). RESULTS Phantom T2 values from T2 +ADC were closer to a single-echo SE reference than T2 -prep bSSFP (-2.3 ± 6.0% vs 22.2 ± 16.3%; P < 0.01), and ADC values were in excellent agreement with DWI (0.28 ± 0.4%). In volunteers, myocardial T2 values from T2 +ADC were significantly shorter than T2 -prep bSSFP (35.8 ± 3.1 vs 46.8 ± 3.8 ms; P < 0.01); myocardial ADC was not significantly (N.S.) different between T2 +ADC and conventional motion-compensated DWI (1.39 ± 0.18 vs 1.38 ± 0.18 mm2 /ms; P = N.S.). In the patient, T2 and ADC were both significantly elevated in the infarct compared with remote myocardium (T2 : 40.4 ± 7.6 vs 56.8 ± 22.0; P < 0.01; ADC: 1.47 ± 0.59 vs 1.65 ± 0.65 mm2 /ms; P < 0.01). CONCLUSION T2 +ADC generated coregistered, free-breathing T2 and ADC maps in healthy volunteers and a patient with acute MI with no cost in accuracy, precision, or scan time compared with DWI. Magn Reson Med 79:654-662, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Eric Aliotta
- Department of Radiological Sciences, University of California, Los Angeles, California, USA.,Biomedical Physics Interdepartmental Program, University of California, Los Angeles, California, USA
| | - Kévin Moulin
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Zhaohuan Zhang
- Department of Radiological Sciences, University of California, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Daniel B Ennis
- Department of Radiological Sciences, University of California, Los Angeles, California, USA.,Biomedical Physics Interdepartmental Program, University of California, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
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22
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Nguyen C, Fan Z, Xie Y, Pang J, Speier P, Bi X, Kobashigawa J, Li D. In vivo diffusion-tensor MRI of the human heart on a 3 tesla clinical scanner: An optimized second order (M2) motion compensated diffusion-preparation approach. Magn Reson Med 2016; 76:1354-1363. [PMID: 27550078 PMCID: PMC5067209 DOI: 10.1002/mrm.26380] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/23/2016] [Accepted: 07/22/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE To optimize a diffusion-prepared balanced steady-state free precession cardiac MRI (CMR) technique to perform diffusion-tensor CMR (DT-CMR) in humans on a 3 Tesla clinical scanner METHODS: A previously developed second order motion compensated (M2) diffusion-preparation scheme was significantly shortened (40%) yielding sufficient signal-to-noise ratio for DT-CMR imaging. In 20 healthy volunteers and 3 heart failure (HF) patients, DT-CMR was performed comparing no motion compensation (M0), first order motion compensation (M1), and the optimized M2. Mean diffusivity (MD), fractional anisotropy (FA), helix angle (HA), and HA transmural slope (HATS) were calculated. Reproducibility and success rate (SR) were investigated. RESULTS M2-derived left ventricular (LV) MD, FA, and HATS (1.4 ± 0.2 μm2 /ms, 0.28 ± 0.06, -1.0 ± 0.2 °/%trans) were significantly (P < 0.001) less than M1 (1.8 ± 0.3 μm2 /ms, 0.46 ± 0.14, -0.1 ± 0.3 °/%trans) and M0 (4.8 ± 1.0 μm2 /ms, 0.70 ± 0.14, 0.1 ± 0.3 °/%trans) indicating less motion corruption and yielding values more consistent with previous literature. M2-derived DT-CMR parameters had higher reproducible (ICC > 0.85) and SR (82%) than M1 (ICC = 0.20-0.85; SR = 37%) and M0 (ICC = 0.20-0.30; SR = 11%). M2 DT-CMR was able to yield HA maps with smooth transmural transition from endocardium to epicardium. CONCLUSION The proposed M2 DT-CMR reproducibly yielded bulk motion robust estimations of mean LV MD, FA, HA, and HATS on a 3T clinical scanner. Magn Reson Med 76:1354-1363, 2016. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Christopher Nguyen
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jianing Pang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Xiaoming Bi
- Siemens Healthcare, Los Angeles, California, USA
| | - Jon Kobashigawa
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA.
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23
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Scott AD, Nielles-Vallespin S, Ferreira PF, McGill LA, Pennell DJ, Firmin DN. The effects of noise in cardiac diffusion tensor imaging and the benefits of averaging complex data. NMR IN BIOMEDICINE 2016; 29:588-599. [PMID: 26891219 DOI: 10.1002/nbm.3500] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 01/07/2016] [Accepted: 01/18/2016] [Indexed: 06/05/2023]
Abstract
There is growing interest in cardiac diffusion tensor imaging (cDTI), but, unlike other diffusion MRI applications, there has been little investigation of the effects of noise on the parameters typically derived. One method of mitigating noise floor effects when there are multiple image averages, as in cDTI, is to average the complex rather than the magnitude data, but the phase contains contributions from bulk motion, which must be removed first. The effects of noise on the mean diffusivity (MD), fractional anisotropy (FA), helical angle (HA) and absolute secondary eigenvector angle (E2A) were simulated with various diffusion weightings (b values). The effect of averaging complex versus magnitude images was investigated. In vivo cDTI was performed in 10 healthy subjects with b = 500, 1000, 1500 and 2000 s/mm(2). A technique for removing the motion-induced component of the image phase present in vivo was implemented by subtracting a low-resolution copy of the phase from the original images before averaging the complex images. MD, FA, E2A and the transmural gradient in HA were compared for un-averaged, magnitude- and complex-averaged reconstructions. Simulations demonstrated an over-estimation of FA and MD at low b values and an under-estimation at high b values. The transition is relatively signal-to-noise ratio (SNR) independent and occurs at a higher b value for FA (b = 1000-1250 s/mm(2)) than MD (b ≈ 250 s/mm(2)). E2A is under-estimated at low and high b values with a transition at b ≈ 1000 s/mm(2), whereas the bias in HA is comparatively small. The under-estimation of FA and MD at high b values is caused by noise floor effects, which can be mitigated by averaging the complex data. Understanding the parameters of interest and the effects of noise informs the selection of the optimal b values. When complex data are available, they should be used to maximise the benefit from the acquisition of multiple averages. The combination of complex data is also a valuable step towards segmented acquisitions.
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Affiliation(s)
- Andrew D Scott
- Cardiovascular Biomedical Research Unit, The Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Sonia Nielles-Vallespin
- Cardiovascular Biomedical Research Unit, The Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
- National Heart Lung and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Pedro F Ferreira
- Cardiovascular Biomedical Research Unit, The Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Laura-Ann McGill
- Cardiovascular Biomedical Research Unit, The Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Dudley J Pennell
- Cardiovascular Biomedical Research Unit, The Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - David N Firmin
- Cardiovascular Biomedical Research Unit, The Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
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24
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McGill LA, Ferreira PF, Scott AD, Nielles-Vallespin S, Giannakidis A, Kilner PJ, Gatehouse PD, de Silva R, Firmin DN, Pennell DJ. Relationship between cardiac diffusion tensor imaging parameters and anthropometrics in healthy volunteers. J Cardiovasc Magn Reson 2016; 18:2. [PMID: 26738482 PMCID: PMC4704390 DOI: 10.1186/s12968-015-0215-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/03/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In vivo cardiac diffusion tensor imaging (cDTI) is uniquely capable of interrogating laminar myocardial dynamics non-invasively. A comprehensive dataset of quantative parameters and comparison with subject anthropometrics is required. METHODS cDTI was performed at 3T with a diffusion weighted STEAM sequence. Data was acquired from the mid left ventricle in 43 subjects during the systolic and diastolic pauses. Global and regional values were determined for fractional anisotropy (FA), mean diffusivity (MD), helix angle gradient (HAg, degrees/%depth) and the secondary eigenvector angulation (E2A). Regression analysis was performed between global values and subject anthropometrics. RESULTS All cDTI parameters displayed regional heterogeneity. The RR interval had a significant, but clinically small effect on systolic values for FA, HAg and E2A. Male sex and increasing left ventricular end diastolic volume were associated with increased systolic HAg. Diastolic HAg and systolic E2A were both directly related to left ventricular mass and body surface area. There was an inverse relationship between E2A mobility and both age and ejection fraction. CONCLUSIONS Future interpretations of quantitative cDTI data should take into account anthropometric variations observed with patient age, body surface area and left ventricular measurements. Further work determining the impact of technical factors such as strain and SNR is required.
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Affiliation(s)
- L A McGill
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College, London, UK.
| | - P F Ferreira
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College, London, UK.
| | - A D Scott
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College, London, UK.
| | - S Nielles-Vallespin
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
| | - A Giannakidis
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College, London, UK.
| | - P J Kilner
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College, London, UK.
| | - P D Gatehouse
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College, London, UK.
| | - R de Silva
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College, London, UK.
| | - D N Firmin
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College, London, UK.
| | - D J Pennell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College, London, UK.
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25
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Nguyen C, Lu M, Fan Z, Bi X, Kellman P, Zhao S, Li D. Contrast-free detection of myocardial fibrosis in hypertrophic cardiomyopathy patients with diffusion-weighted cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2015; 17:107. [PMID: 26631061 PMCID: PMC4668676 DOI: 10.1186/s12968-015-0214-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/24/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUNDS Previous studies have shown that diffusion-weighted cardiovascular magnetic resonance (DW-CMR) is highly sensitive to replacement fibrosis of chronic myocardial infarction. Despite this sensitivity to myocardial infarction, DW-CMR has not been established as a method to detect diffuse myocardial fibrosis. We propose the application of a recently developed DW-CMR technique to detect diffuse myocardial fibrosis in hypertrophic cardiomyopathy (HCM) patients and compare its performance with established CMR techniques. METHODS HCM patients (N = 23) were recruited and scanned with the following protocol: standard morphological localizers, DW-CMR, extracellular volume (ECV) CMR, and late gadolinium enhanced (LGE) imaging for reference. Apparent diffusion coefficient (ADC) and ECV maps were segmented into 6 American Heart Association (AHA) segments. Positive regions for myocardial fibrosis were defined as: ADC > 2.0 μm(2)/ms and ECV > 30%. Fibrotic and non-fibrotic mean ADC and ECV values were compared as well as ADC-derived and ECV-derived fibrosis burden. In addition, fibrosis regional detection was compared between ADC and ECV calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using ECV as the gold-standard reference. RESULTS ADC (2.4 ± 0.2 μm(2)/ms) of fibrotic regions (ADC > 2.0 μm(2)/ms) was significantly (p < 0.01) higher than ADC (1.5 ± 0.2 μm(2)/ms) of non-fibrotic regions. Similarly, ECV (35 ± 4%) of fibrotic regions (ECV > 30%) was significantly (p < 0.01) higher than ECV (26 ± 2%) of non-fibrotic regions. In fibrotic regions defined by ECV, ADC (2.2 ± 0.3 μm(2)/ms) was again significantly (p < 0.05) higher than ADC (1.6 ± 0.3 μm(2)/ms) of non-fibrotic regions. In fibrotic regions defined by ADC criterion, ECV (34 ± 5%) was significantly (p < 0.01) higher than ECV (28 ± 3%) in non-fibrotic regions. ADC-derived and ECV-derived fibrosis burdens were in substantial agreement (intra-class correlation = 0.83). Regional detection between ADC and ECV of diffuse fibrosis yielded substantial agreement (κ = 0.66) with high sensitivity, specificity, PPV, NPV, and accuracy (0.80, 0.85, 0.81, 0.85, and 0.83, respectively). CONCLUSION DW-CMR is sensitive to diffuse myocardial fibrosis and is capable of characterizing the extent of fibrosis in HCM patients.
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Affiliation(s)
- Christopher Nguyen
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, USA.
| | - Minjie Lu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China.
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China.
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Xiaoming Bi
- MR R&D, Siemens Healthcare, Los Angeles, CA, USA.
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Shihua Zhao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China.
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China.
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, USA.
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