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Ochs MM, Kajzar I, Salatzki J, Ochs AT, Riffel J, Osman N, Katus HA, Friedrich MG. Hyperventilation/Breath-Hold Maneuver to Detect Myocardial Ischemia by Strain-Encoded CMR: Diagnostic Accuracy of a Needle-Free Stress Protocol. JACC Cardiovasc Imaging 2021; 14:1932-1944. [PMID: 33865775 DOI: 10.1016/j.jcmg.2021.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/04/2021] [Accepted: 02/18/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the diagnostic accuracy of a fast, needle-free test for myocardial ischemia using fast Strain-ENCoded (fSENC) cardiovascular MR (CMR) after a hyperventilation/breath-hold maneuver (HVBH). BACKGROUND Myocardial stress testing is one of the most frequent diagnostic tests performed. Recent data indicate that CMR first-pass perfusion outperforms other modalities. Its use, however, is limited by the need for both, a vasodilatory stress and the intravenous application of gadolinium. Both are associated with added cost, safety concerns, and patient inconvenience. The combination of 2 novel CMR approaches, fSENC, an ultrafast technique to visualize myocardial strain, and HVBH, a physiological vasodilator, may overcome these limitations. METHODS Patients referred for CMR stress testing underwent an extended protocol to evaluate 3 different tests: 1) adenosine-perfusion; 2) adenosine-strain; and 3) HVBH-strain. Diagnostic accuracy was assessed using quantitative coronary angiography as reference. RESULTS A total of 122 patients (age 66 ± 11years; 80% men) suspected of obstructive coronary artery disease were enrolled. All participants completed the protocol without significant adverse events. Adenosine-strain and HVBH-strain provided significantly better diagnostic accuracy than adenosine-perfusion, both on a patient level (adenosine-strain: sensitivity 82%, specificity 83%; HVBH-strain: sensitivity 81%, specificity 86% vs. adenosine-perfusion: sensitivity 67%, specificity 92%; p < 0.05) and territory level (adenosine-strain: sensitivity 67%, specificity 93%; HVBH-strain: sensitivity 63%, specificity 95% vs. adenosine-perfusion: sensitivity 49%, specificity 96%; p < 0.05). However, these differences in diagnostic accuracy disappear by excluding patients with history of coronary artery bypass graft or previous myocardial infarction. The response of longitudinal strain differs significantly between ischemic and nonischemic segments to adenosine (ΔLSischemic = 0.6 ± 5.4%, ΔLSnonischemic = -0.9 ± 2.7%; p < 0.05) and HVBH (ΔLSischemic = 1.3% ± 3.8%, ΔLSnonischemic = -0.3 ± 1.8%; p = 0.002). Test duration of HVBH-strain (t = 64 ± 2 s) was significantly shorter compared with adenosine-strain (t = 184 ± 59 s; p < 0.0001) and adenosine-perfusion (t = adenosine-perfusion: 172 ± 59 s; p < 0.0001). CONCLUSIONS HVBH-strain has a high diagnostic accuracy in detecting significant coronary artery stenosis. It is not only significantly faster than any other method but also neither requires contrast agents nor pharmacological stressors.
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Affiliation(s)
- Marco M Ochs
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany.
| | - Isabelle Kajzar
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany
| | - Janek Salatzki
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany
| | - Andreas T Ochs
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany
| | - Nael Osman
- MyocardialSolutions, Morrisville, North Carolina, USA
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany
| | - Matthias G Friedrich
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany; Departments of Medicine and Diagnostic Radiology, McGill University Health Centre, Montreal, Quebec, Canada
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Yang HJ, Oksuz I, Dey D, Sykes J, Klein M, Butler J, Kovacs MS, Sobczyk O, Cokic I, Slomka PJ, Bi X, Li D, Tighiouart M, Tsaftaris SA, Prato FS, Fisher JA, Dharmakumar R. Accurate needle-free assessment of myocardial oxygenation for ischemic heart disease in canines using magnetic resonance imaging. Sci Transl Med 2020; 11:11/494/eaat4407. [PMID: 31142677 DOI: 10.1126/scitranslmed.aat4407] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/08/2019] [Indexed: 12/24/2022]
Abstract
Myocardial oxygenation-the ability of blood vessels to supply the heart muscle (myocardium) with oxygen-is a critical determinant of cardiac function. Impairment of myocardial oxygenation is a defining feature of ischemic heart disease (IHD), which is caused by pathological conditions that affect the blood vessels supplying oxygen to the heart muscle. Detecting altered myocardial oxygenation can help guide interventions and prevent acute life-threatening events such as heart attacks (myocardial infarction); however, current diagnosis of IHD relies on surrogate metrics and exogenous contrast agents for which many patients are contraindicated. An oxygenation-sensitive cardiac magnetic resonance imaging (CMR) approach used previously to demonstrate that CMR signals can be sensitized to changes in myocardial oxygenation showed limited ability to detect small changes in signals in the heart because of physiologic and imaging noise during data acquisition. Here, we demonstrate a CMR-based approach termed cfMRI [cardiac functional magnetic resonance imaging (MRI)] that detects myocardial oxygenation. cfMRI uses carbon dioxide for repeat interrogation of the functional capacity of the heart's blood vessels via a fast MRI approach suitable for clinical adoption without limitations of key confounders (cardiac/respiratory motion and heart rate changes). This method integrates multiple whole-heart images within a computational framework to reduce noise, producing confidence maps of alterations in myocardial oxygenation. cfMRI permits noninvasive monitoring of myocardial oxygenation without requiring ionizing radiation, contrast agents, or needles. This has the potential to broaden our ability to noninvasively identify IHD and a diverse spectrum of heart diseases related to myocardial ischemia.
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Affiliation(s)
- Hsin-Jung Yang
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.,University of California, Los Angeles CA 90095, USA
| | | | - Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.,University of California, Los Angeles CA 90095, USA
| | - Jane Sykes
- Lawson Health Research Institute, University of Western Ontario, London, ON N6C 2R5, Canada
| | - Michael Klein
- University of Toronto and University Health Network, Toronto, ON M5G 2C4, Canada
| | - John Butler
- Lawson Health Research Institute, University of Western Ontario, London, ON N6C 2R5, Canada
| | - Michael S Kovacs
- Lawson Health Research Institute, University of Western Ontario, London, ON N6C 2R5, Canada
| | - Olivia Sobczyk
- University of Toronto and University Health Network, Toronto, ON M5G 2C4, Canada
| | - Ivan Cokic
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Piotr J Slomka
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.,University of California, Los Angeles CA 90095, USA
| | - Xiaoming Bi
- MR R&D Collaborations, Siemens Healthineers, Los Angeles, CA 90048, USA
| | - Debiao Li
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.,University of California, Los Angeles CA 90095, USA
| | | | | | - Frank S Prato
- Lawson Health Research Institute, University of Western Ontario, London, ON N6C 2R5, Canada
| | - Joseph A Fisher
- University of Toronto and University Health Network, Toronto, ON M5G 2C4, Canada
| | - Rohan Dharmakumar
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. .,University of California, Los Angeles CA 90095, USA
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10
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van den Boomen M, Manhard MK, Snel GJH, Han S, Emblem KE, Slart RHJA, Sosnovik DE, Catana C, Rosen BR, Prakken NHJ, Nguyen CT, Borra RJH, Setsompop K. Blood Oxygen Level-Dependent MRI of the Myocardium with Multiecho Gradient-Echo Spin-Echo Imaging. Radiology 2020; 294:538-545. [PMID: 31961241 PMCID: PMC7053244 DOI: 10.1148/radiol.2020191845] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022]
Abstract
Background Myocardial oxygenation imaging could help determine the presence of microvascular dysfunction associated with increased cardiovascular risk. However, it is challenging to depict the potentially small oxygenation alterations with current noninvasive cardiac MRI blood oxygen level-dependent (BOLD) techniques. Purpose To demonstrate the cardiac application of a gradient-echo spin-echo (GESE) echo-planar imaging sequence for dynamic and quantitative heartbeat-to-heartbeat BOLD MRI and evaluate the sequence in populations both healthy and with hypertension in combination with a breath hold-induced CO2 intervention. Materials and Methods GESE echo-planar imaging sequence was performed in 18 healthy participants and in eight prospectively recruited participants with hypertension on a 3.0-T MRI system. T2 and T2* maps were calculated per heartbeat with a four-parameter fitting technique. Septal regions of interests were used to determine T2 and T2* values per heartbeat and examined over the course of a breath hold to determine BOLD changes. T2 and T2* changes of healthy participants and participants with hypertension were compared by using a nonparametric Mann-Whitney test. Results GESE echo-planar imaging approach gave spatially stable T2 and T2* maps per heartbeat for healthy participants and participants with hypertension, with mean T2 values of 43 msec ± 5 (standard deviation) and 46 msec ± 9, respectively, and mean T2* values of 28 msec ± 5 and 22 msec ± 5, respectively. The healthy participants exhibited increasing T2 and T2* values over the course of a breath hold with a mean positive slope of 0.2 msec per heartbeat ± 0.1 for T2 and 0.2 msec per heartbeat ± 0.1 for T2*, whereas for participants with hypertension these dynamic T2 and T2* values had a mean negative slope of -0.2 msec per heartbeat ± 0.2 for T2 and -0.1 msec per heartbeat ± 0.2 for T2*. The difference in these mean slopes between healthy participants and participants with hypertension was significant for both T2 (P < .001) and T2* (P < .001). Conclusion Gradient-echo spin-echo echo-planar imaging sequence provided quantitative T2 and T2* maps per heartbeat and enabled dynamic heartbeat-to-heartbeat blood oxygen level-dependent (BOLD)-response imaging by analyzing changes in T2 and T2* over the time of a breath-hold intervention. This approach could identify differences in the BOLD response between healthy participants and participants with hypertension. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Friedrich in this issue.
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Affiliation(s)
- Maaike van den Boomen
- From the Departments of Radiology (M.v.d.B., G.J.H.S., N.H.J.P.,
R.J.H.B.) and Nuclear Medicine and Molecular Imaging (R.H.J.A.S.), University
Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ
Groningen, the Netherlands; Department of Radiology, Athinoula A. Martinos
Center for Biomedical Imaging (M.v.d.B., M.K.M., S.H.H., D.E.S., C.C., B.R.R.,
C.T.N., K.S.), and Cardiovascular Research Center (D.E.S., C.T.N.),
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass;
Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
(K.E.E.); Department of Biomedical Photonic Imaging, University of Twente,
Enschede, the Netherlands (R.H.J.A.S., R.J.H.B.); and Division of Health
Sciences and Technology, Harvard-MIT, Cambridge, Mass (D.E.S., K.S.)
| | - Mary Kate Manhard
- From the Departments of Radiology (M.v.d.B., G.J.H.S., N.H.J.P.,
R.J.H.B.) and Nuclear Medicine and Molecular Imaging (R.H.J.A.S.), University
Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ
Groningen, the Netherlands; Department of Radiology, Athinoula A. Martinos
Center for Biomedical Imaging (M.v.d.B., M.K.M., S.H.H., D.E.S., C.C., B.R.R.,
C.T.N., K.S.), and Cardiovascular Research Center (D.E.S., C.T.N.),
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass;
Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
(K.E.E.); Department of Biomedical Photonic Imaging, University of Twente,
Enschede, the Netherlands (R.H.J.A.S., R.J.H.B.); and Division of Health
Sciences and Technology, Harvard-MIT, Cambridge, Mass (D.E.S., K.S.)
| | - Gert Jan H. Snel
- From the Departments of Radiology (M.v.d.B., G.J.H.S., N.H.J.P.,
R.J.H.B.) and Nuclear Medicine and Molecular Imaging (R.H.J.A.S.), University
Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ
Groningen, the Netherlands; Department of Radiology, Athinoula A. Martinos
Center for Biomedical Imaging (M.v.d.B., M.K.M., S.H.H., D.E.S., C.C., B.R.R.,
C.T.N., K.S.), and Cardiovascular Research Center (D.E.S., C.T.N.),
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass;
Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
(K.E.E.); Department of Biomedical Photonic Imaging, University of Twente,
Enschede, the Netherlands (R.H.J.A.S., R.J.H.B.); and Division of Health
Sciences and Technology, Harvard-MIT, Cambridge, Mass (D.E.S., K.S.)
| | - SoHyun Han
- From the Departments of Radiology (M.v.d.B., G.J.H.S., N.H.J.P.,
R.J.H.B.) and Nuclear Medicine and Molecular Imaging (R.H.J.A.S.), University
Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ
Groningen, the Netherlands; Department of Radiology, Athinoula A. Martinos
Center for Biomedical Imaging (M.v.d.B., M.K.M., S.H.H., D.E.S., C.C., B.R.R.,
C.T.N., K.S.), and Cardiovascular Research Center (D.E.S., C.T.N.),
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass;
Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
(K.E.E.); Department of Biomedical Photonic Imaging, University of Twente,
Enschede, the Netherlands (R.H.J.A.S., R.J.H.B.); and Division of Health
Sciences and Technology, Harvard-MIT, Cambridge, Mass (D.E.S., K.S.)
| | - Kyrre E. Emblem
- From the Departments of Radiology (M.v.d.B., G.J.H.S., N.H.J.P.,
R.J.H.B.) and Nuclear Medicine and Molecular Imaging (R.H.J.A.S.), University
Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ
Groningen, the Netherlands; Department of Radiology, Athinoula A. Martinos
Center for Biomedical Imaging (M.v.d.B., M.K.M., S.H.H., D.E.S., C.C., B.R.R.,
C.T.N., K.S.), and Cardiovascular Research Center (D.E.S., C.T.N.),
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass;
Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
(K.E.E.); Department of Biomedical Photonic Imaging, University of Twente,
Enschede, the Netherlands (R.H.J.A.S., R.J.H.B.); and Division of Health
Sciences and Technology, Harvard-MIT, Cambridge, Mass (D.E.S., K.S.)
| | - Riemer H. J. A. Slart
- From the Departments of Radiology (M.v.d.B., G.J.H.S., N.H.J.P.,
R.J.H.B.) and Nuclear Medicine and Molecular Imaging (R.H.J.A.S.), University
Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ
Groningen, the Netherlands; Department of Radiology, Athinoula A. Martinos
Center for Biomedical Imaging (M.v.d.B., M.K.M., S.H.H., D.E.S., C.C., B.R.R.,
C.T.N., K.S.), and Cardiovascular Research Center (D.E.S., C.T.N.),
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass;
Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
(K.E.E.); Department of Biomedical Photonic Imaging, University of Twente,
Enschede, the Netherlands (R.H.J.A.S., R.J.H.B.); and Division of Health
Sciences and Technology, Harvard-MIT, Cambridge, Mass (D.E.S., K.S.)
| | - David E. Sosnovik
- From the Departments of Radiology (M.v.d.B., G.J.H.S., N.H.J.P.,
R.J.H.B.) and Nuclear Medicine and Molecular Imaging (R.H.J.A.S.), University
Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ
Groningen, the Netherlands; Department of Radiology, Athinoula A. Martinos
Center for Biomedical Imaging (M.v.d.B., M.K.M., S.H.H., D.E.S., C.C., B.R.R.,
C.T.N., K.S.), and Cardiovascular Research Center (D.E.S., C.T.N.),
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass;
Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
(K.E.E.); Department of Biomedical Photonic Imaging, University of Twente,
Enschede, the Netherlands (R.H.J.A.S., R.J.H.B.); and Division of Health
Sciences and Technology, Harvard-MIT, Cambridge, Mass (D.E.S., K.S.)
| | - Ciprian Catana
- From the Departments of Radiology (M.v.d.B., G.J.H.S., N.H.J.P.,
R.J.H.B.) and Nuclear Medicine and Molecular Imaging (R.H.J.A.S.), University
Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ
Groningen, the Netherlands; Department of Radiology, Athinoula A. Martinos
Center for Biomedical Imaging (M.v.d.B., M.K.M., S.H.H., D.E.S., C.C., B.R.R.,
C.T.N., K.S.), and Cardiovascular Research Center (D.E.S., C.T.N.),
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass;
Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
(K.E.E.); Department of Biomedical Photonic Imaging, University of Twente,
Enschede, the Netherlands (R.H.J.A.S., R.J.H.B.); and Division of Health
Sciences and Technology, Harvard-MIT, Cambridge, Mass (D.E.S., K.S.)
| | - Bruce R. Rosen
- From the Departments of Radiology (M.v.d.B., G.J.H.S., N.H.J.P.,
R.J.H.B.) and Nuclear Medicine and Molecular Imaging (R.H.J.A.S.), University
Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ
Groningen, the Netherlands; Department of Radiology, Athinoula A. Martinos
Center for Biomedical Imaging (M.v.d.B., M.K.M., S.H.H., D.E.S., C.C., B.R.R.,
C.T.N., K.S.), and Cardiovascular Research Center (D.E.S., C.T.N.),
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass;
Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
(K.E.E.); Department of Biomedical Photonic Imaging, University of Twente,
Enschede, the Netherlands (R.H.J.A.S., R.J.H.B.); and Division of Health
Sciences and Technology, Harvard-MIT, Cambridge, Mass (D.E.S., K.S.)
| | - Niek H. J. Prakken
- From the Departments of Radiology (M.v.d.B., G.J.H.S., N.H.J.P.,
R.J.H.B.) and Nuclear Medicine and Molecular Imaging (R.H.J.A.S.), University
Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ
Groningen, the Netherlands; Department of Radiology, Athinoula A. Martinos
Center for Biomedical Imaging (M.v.d.B., M.K.M., S.H.H., D.E.S., C.C., B.R.R.,
C.T.N., K.S.), and Cardiovascular Research Center (D.E.S., C.T.N.),
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass;
Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
(K.E.E.); Department of Biomedical Photonic Imaging, University of Twente,
Enschede, the Netherlands (R.H.J.A.S., R.J.H.B.); and Division of Health
Sciences and Technology, Harvard-MIT, Cambridge, Mass (D.E.S., K.S.)
| | - Christopher T. Nguyen
- From the Departments of Radiology (M.v.d.B., G.J.H.S., N.H.J.P.,
R.J.H.B.) and Nuclear Medicine and Molecular Imaging (R.H.J.A.S.), University
Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ
Groningen, the Netherlands; Department of Radiology, Athinoula A. Martinos
Center for Biomedical Imaging (M.v.d.B., M.K.M., S.H.H., D.E.S., C.C., B.R.R.,
C.T.N., K.S.), and Cardiovascular Research Center (D.E.S., C.T.N.),
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass;
Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
(K.E.E.); Department of Biomedical Photonic Imaging, University of Twente,
Enschede, the Netherlands (R.H.J.A.S., R.J.H.B.); and Division of Health
Sciences and Technology, Harvard-MIT, Cambridge, Mass (D.E.S., K.S.)
| | - Ronald J. H. Borra
- From the Departments of Radiology (M.v.d.B., G.J.H.S., N.H.J.P.,
R.J.H.B.) and Nuclear Medicine and Molecular Imaging (R.H.J.A.S.), University
Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ
Groningen, the Netherlands; Department of Radiology, Athinoula A. Martinos
Center for Biomedical Imaging (M.v.d.B., M.K.M., S.H.H., D.E.S., C.C., B.R.R.,
C.T.N., K.S.), and Cardiovascular Research Center (D.E.S., C.T.N.),
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass;
Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
(K.E.E.); Department of Biomedical Photonic Imaging, University of Twente,
Enschede, the Netherlands (R.H.J.A.S., R.J.H.B.); and Division of Health
Sciences and Technology, Harvard-MIT, Cambridge, Mass (D.E.S., K.S.)
| | - Kawin Setsompop
- From the Departments of Radiology (M.v.d.B., G.J.H.S., N.H.J.P.,
R.J.H.B.) and Nuclear Medicine and Molecular Imaging (R.H.J.A.S.), University
Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ
Groningen, the Netherlands; Department of Radiology, Athinoula A. Martinos
Center for Biomedical Imaging (M.v.d.B., M.K.M., S.H.H., D.E.S., C.C., B.R.R.,
C.T.N., K.S.), and Cardiovascular Research Center (D.E.S., C.T.N.),
Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass;
Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
(K.E.E.); Department of Biomedical Photonic Imaging, University of Twente,
Enschede, the Netherlands (R.H.J.A.S., R.J.H.B.); and Division of Health
Sciences and Technology, Harvard-MIT, Cambridge, Mass (D.E.S., K.S.)
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