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Ibrahim F, Cadour F, Campbell-Washburn AE, Allen BD, Vosshenrich J, Brown MJ, Thavendiranathan P, Hanneman K. Energy and Greenhouse Gas Emission Savings Associated with Implementation of an Abbreviated Cardiac MRI Protocol. Radiology 2024; 311:e240588. [PMID: 38652029 DOI: 10.1148/radiol.240588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Supplemental material is available for this article. See also the article by Lenkinski and Rofsky in this issue. See also the article by McKee et al in this issue.
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Affiliation(s)
- Fadi Ibrahim
- From the Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T., K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada (M.J.B.); Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Farah Cadour
- From the Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T., K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada (M.J.B.); Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Adrienne E Campbell-Washburn
- From the Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T., K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada (M.J.B.); Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Bradley D Allen
- From the Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T., K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada (M.J.B.); Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Jan Vosshenrich
- From the Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T., K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada (M.J.B.); Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Maura J Brown
- From the Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T., K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada (M.J.B.); Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T., K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada (M.J.B.); Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
| | - Kate Hanneman
- From the Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada (F.I., F.C., P.T., K.H.); Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (B.D.A.); Department of Radiology, University Hospital Basel, Basel, Switzerland (J.V.); Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada (M.J.B.); Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada (P.T.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2 (P.T., K.H.)
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Maroun A, Scott MB, Catania R, Berhane H, Jarvis K, Allen BD, Barker AJ, Markl M. Multiyear Interval Changes in Aortic Wall Shear Stress in Patients with Bicuspid Aortic Valve Assessed by 4D Flow MRI. J Magn Reson Imaging 2024. [PMID: 38426608 DOI: 10.1002/jmri.29305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND In patients with bicuspid aortic valve (BAV), 4D flow MRI can quantify regions exposed to abnormal aortic hemodynamics, including high wall shear stress (WSS), a known stimulus for arterial wall dysfunction. However, the long-term multiscan reproducibility of 4D flow MRI-derived hemodynamic parameters is unknown. PURPOSE To investigate the long-term stability of 4D flow MRI-derived peak velocity, WSS, and WSS-derived heatmaps in patients with BAV undergoing multiyear surveillance imaging. STUDY TYPE Retrospective. POPULATION 20 BAV patients (mean age 48.4 ± 13.9 years; 14 males) with five 4D flow MRI scans, with intervals of at least 6 months between scans, and 125 controls (mean age: 50.7 ± 15.8 years; 67 males). FIELD STRENGTH/SEQUENCE 1.5 and 3.0T, prospectively ECG and respiratory navigator-gated aortic 4D flow MRI. ASSESSMENT Automated AI-based 4D flow analysis pipelines were used for data preprocessing, aorta 3D segmentation, and quantification of ascending aorta (AAo) peak velocity, peak systolic WSS, and heatmap-derived relative area of elevated WSS compared to WSS ranges in age and sex-matched normative control populations. Growth rate was derived from the maximum AAo diameters measured on the first and fifth MRI scans. STATISTICAL TESTS One-way repeated measures analysis of variance. P < 0.05 indicated significance. RESULTS One hundred 4D flow MRI exams (five per patient) were analyzed. The mean total follow-up duration was 5.5 ± 1.1 years, and the average growth rate was 0.3 ± 0.2 mm/year. Peak velocity, peak systolic WSS, and relative area of elevated WSS did not change significantly over the follow-up period (P = 0.64, P = 0.69, and P = 0.35, respectively). The patterns and areas of elevated WSS demonstrated good reproducibility on semiquantitative assessment. CONCLUSION 4D flow MRI-derived peak velocity, WSS, and WSS-derived heatmaps showed good multiyear and multiscan stability in BAV patients with low aortic growth rates. These findings underscore the reliability of these metrics in monitoring BAV patients for potential risk of dilation. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Anthony Maroun
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael B Scott
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Roberta Catania
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Haben Berhane
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kelly Jarvis
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Zhao M, Shen D, Fan L, Hong K, Feng L, Benefield BC, Allen BD, Lee DC, Kim D. Incorporation of view sharing and KWIC filtering into GRASP-Pro improves spatial resolution of single-shot, multi-TI, late gadolinium enhancement MRI. NMR Biomed 2024; 37:e5059. [PMID: 37872862 PMCID: PMC10922561 DOI: 10.1002/nbm.5059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/14/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023]
Abstract
While single-shot late gadolinium enhancement (LGE) is useful for imaging patients with arrhythmia and/or dyspnea, it produces low spatial resolution. One approach to improve spatial resolution is to accelerate data acquisition using compressed sensing (CS). Our previous work described a single-shot, multi-inversion time (TI) LGE pulse sequence using radial k-space sampling and CS, but over-regularization resulted in significant image blurring that muted the benefits of data acceleration. The purpose of the present study was to improve the spatial resolution of the single-shot, multi-TI LGE pulse sequence by incorporating view sharing (VS) and k-space weighted contrast (KWIC) filtering into a GRASP-Pro reconstruction. In 24 patients (mean age = 61 ± 16 years; 9/15 females/males), we compared the performance of our improved multi-TI LGE and standard multi-TI LGE, where clinical standard LGE was used as a reference. Two clinical raters independently graded multi-TI images and clinical LGE images visually on a five-point Likert scale (1, nondiagnostic; 3, clinically acceptable; 5, best) for three categories: the conspicuity of myocardium or scar, artifact, and noise. The summed visual score (SVS) was defined as the sum of the three scores. Myocardial scar volume was quantified using the full-width at half-maximum method. The SVS was not significantly different between clinical breath-holding LGE (median 13.5, IQR 1.3) and multi-TI LGE (median 12.5, IQR 1.6) (P = 0.068). The myocardial scar volumes measured from clinical standard LGE and multi-TI LGE were strongly correlated (coefficient of determination, R2 = 0.99) and in good agreement (mean difference = 0.11%, lower limit of the agreement = -2.13%, upper limit of the agreement = 2.34%). The inter-rater agreement in myocardial scar volume quantification was strong (intraclass correlation coefficient = 0.79). The incorporation of VS and KWIC into GRASP-Pro improved spatial resolution. Our improved 25-fold accelerated, single-shot LGE sequence produces clinically acceptable image quality, multi-TI reconstruction, and accurate myocardial scar volume quantification.
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Affiliation(s)
- Mingyue Zhao
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Biomedical Engineering, Northwestern University, Evanston, IL
| | | | - Lexiaozi Fan
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kyungpyo Hong
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Li Feng
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University Grossman School of Medicine, New York, NY
| | - Brandon C. Benefield
- Division of Cardiology, Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley D. Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Daniel C. Lee
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Cardiology, Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Biomedical Engineering, Northwestern University, Evanston, IL
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4
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Fan L, Hong K, Allen BD, Paul R, Carr JC, Zhang S, Passman R, Robinson JD, Lee DC, Rigsby CK, Kim D. Ultra-rapid, Free-breathing, Real-time Cardiac Cine MRI Using GRASP Amplified with View Sharing and KWIC Filtering. Radiol Cardiothorac Imaging 2024; 6:e230107. [PMID: 38358330 PMCID: PMC10912880 DOI: 10.1148/ryct.230107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 12/06/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024]
Abstract
Purpose To achieve ultra-high temporal resolution (approximately 20 msec) in free-breathing, real-time cardiac cine MRI using golden-angle radial sparse parallel (GRASP) reconstruction amplified with view sharing (VS) and k-space-weighted image contrast (KWIC) filtering. Materials and Methods Fourteen pediatric patients with congenital heart disease (mean age [SD], 9 years ± 2; 13 male) and 10 adult patients with arrhythmia (mean age, 62 years ± 8; nine male) who underwent both standard breath-hold cine and free-breathing real-time cine using GRASP were retrospectively identified. To achieve high temporal resolution, each time frame was reconstructed using six radial spokes, corresponding to acceleration factors ranging from 24 to 32. To compensate for loss in spatial resolution resulting from over-regularization in GRASP, VS and KWIC filtering were incorporated. The blur metric, visual image quality scores, and biventricular parameters were compared between clinical and real-time cine images. Results In pediatric patients, the incorporation of VS and KWIC into GRASP (ie, GRASP + VS + KWIC) produced significantly (P < .05) sharper x-y-t (blur metric: 0.36 ± 0.03, 0.41 ± 0.03, 0.48 ± 0.03, respectively) and x-y-f (blur metric: 0.28 ± 0.02, 0.31 ± 0.03, 0.37 ± 0.03, respectively) component images compared with GRASP + VS and conventional GRASP. Only the noise score differed significantly between GRASP + VS + KWIC and clinical cine; all visual scores were above the clinically acceptable (3.0) cutoff point. Biventricular volumetric parameters strongly correlated (R2 > 0.85) between clinical and real-time cine images reconstructed with GRASP + VS + KWIC and were in good agreement (relative error < 6% for all parameters). In adult patients, the visual scores of all categories were significantly lower (P < .05) for clinical cine compared with real-time cine with GRASP + VS + KWIC, except for noise (P = .08). Conclusion Incorporating VS and KWIC filtering into GRASP reconstruction enables ultra-high temporal resolution (approximately 20 msec) without significant loss in spatial resolution. Keywords: Cine, View Sharing, k-Space-weighted Image Contrast Filtering, Radial k-Space, Pediatrics, Arrhythmia, GRASP, Compressed Sensing, Real-Time, Free-Breathing Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Lexiaozi Fan
- From the Department of Radiology (L.F., K.P.H., B.D.A., R.P., J.C.C.,
S.Z., J.D.R., C.K.R., D.K.), Department of Preventive Medicine, Bluhm
Cardiovascular Institute (R.P.), Department of Pediatrics (J.D.R., C.K.R.), and
Division of Cardiology, Department of Internal Medicine (D.C.L.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Ste 1600, Chicago,
IL 60611; Department of Biomedical Engineering, Northwestern University,
Evanston, Ill (L.F., D.K.); and Division of Cardiology (J.D.R.) and Department
of Medical Imaging (C.K.R.), Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, Ill
| | - KyungPyo Hong
- From the Department of Radiology (L.F., K.P.H., B.D.A., R.P., J.C.C.,
S.Z., J.D.R., C.K.R., D.K.), Department of Preventive Medicine, Bluhm
Cardiovascular Institute (R.P.), Department of Pediatrics (J.D.R., C.K.R.), and
Division of Cardiology, Department of Internal Medicine (D.C.L.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Ste 1600, Chicago,
IL 60611; Department of Biomedical Engineering, Northwestern University,
Evanston, Ill (L.F., D.K.); and Division of Cardiology (J.D.R.) and Department
of Medical Imaging (C.K.R.), Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, Ill
| | - Bradley D. Allen
- From the Department of Radiology (L.F., K.P.H., B.D.A., R.P., J.C.C.,
S.Z., J.D.R., C.K.R., D.K.), Department of Preventive Medicine, Bluhm
Cardiovascular Institute (R.P.), Department of Pediatrics (J.D.R., C.K.R.), and
Division of Cardiology, Department of Internal Medicine (D.C.L.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Ste 1600, Chicago,
IL 60611; Department of Biomedical Engineering, Northwestern University,
Evanston, Ill (L.F., D.K.); and Division of Cardiology (J.D.R.) and Department
of Medical Imaging (C.K.R.), Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, Ill
| | - Rupsa Paul
- From the Department of Radiology (L.F., K.P.H., B.D.A., R.P., J.C.C.,
S.Z., J.D.R., C.K.R., D.K.), Department of Preventive Medicine, Bluhm
Cardiovascular Institute (R.P.), Department of Pediatrics (J.D.R., C.K.R.), and
Division of Cardiology, Department of Internal Medicine (D.C.L.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Ste 1600, Chicago,
IL 60611; Department of Biomedical Engineering, Northwestern University,
Evanston, Ill (L.F., D.K.); and Division of Cardiology (J.D.R.) and Department
of Medical Imaging (C.K.R.), Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, Ill
| | - James C. Carr
- From the Department of Radiology (L.F., K.P.H., B.D.A., R.P., J.C.C.,
S.Z., J.D.R., C.K.R., D.K.), Department of Preventive Medicine, Bluhm
Cardiovascular Institute (R.P.), Department of Pediatrics (J.D.R., C.K.R.), and
Division of Cardiology, Department of Internal Medicine (D.C.L.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Ste 1600, Chicago,
IL 60611; Department of Biomedical Engineering, Northwestern University,
Evanston, Ill (L.F., D.K.); and Division of Cardiology (J.D.R.) and Department
of Medical Imaging (C.K.R.), Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, Ill
| | - Sarah Zhang
- From the Department of Radiology (L.F., K.P.H., B.D.A., R.P., J.C.C.,
S.Z., J.D.R., C.K.R., D.K.), Department of Preventive Medicine, Bluhm
Cardiovascular Institute (R.P.), Department of Pediatrics (J.D.R., C.K.R.), and
Division of Cardiology, Department of Internal Medicine (D.C.L.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Ste 1600, Chicago,
IL 60611; Department of Biomedical Engineering, Northwestern University,
Evanston, Ill (L.F., D.K.); and Division of Cardiology (J.D.R.) and Department
of Medical Imaging (C.K.R.), Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, Ill
| | - Rod Passman
- From the Department of Radiology (L.F., K.P.H., B.D.A., R.P., J.C.C.,
S.Z., J.D.R., C.K.R., D.K.), Department of Preventive Medicine, Bluhm
Cardiovascular Institute (R.P.), Department of Pediatrics (J.D.R., C.K.R.), and
Division of Cardiology, Department of Internal Medicine (D.C.L.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Ste 1600, Chicago,
IL 60611; Department of Biomedical Engineering, Northwestern University,
Evanston, Ill (L.F., D.K.); and Division of Cardiology (J.D.R.) and Department
of Medical Imaging (C.K.R.), Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, Ill
| | - Joshua D. Robinson
- From the Department of Radiology (L.F., K.P.H., B.D.A., R.P., J.C.C.,
S.Z., J.D.R., C.K.R., D.K.), Department of Preventive Medicine, Bluhm
Cardiovascular Institute (R.P.), Department of Pediatrics (J.D.R., C.K.R.), and
Division of Cardiology, Department of Internal Medicine (D.C.L.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Ste 1600, Chicago,
IL 60611; Department of Biomedical Engineering, Northwestern University,
Evanston, Ill (L.F., D.K.); and Division of Cardiology (J.D.R.) and Department
of Medical Imaging (C.K.R.), Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, Ill
| | - Daniel C. Lee
- From the Department of Radiology (L.F., K.P.H., B.D.A., R.P., J.C.C.,
S.Z., J.D.R., C.K.R., D.K.), Department of Preventive Medicine, Bluhm
Cardiovascular Institute (R.P.), Department of Pediatrics (J.D.R., C.K.R.), and
Division of Cardiology, Department of Internal Medicine (D.C.L.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Ste 1600, Chicago,
IL 60611; Department of Biomedical Engineering, Northwestern University,
Evanston, Ill (L.F., D.K.); and Division of Cardiology (J.D.R.) and Department
of Medical Imaging (C.K.R.), Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, Ill
| | - Cynthia K. Rigsby
- From the Department of Radiology (L.F., K.P.H., B.D.A., R.P., J.C.C.,
S.Z., J.D.R., C.K.R., D.K.), Department of Preventive Medicine, Bluhm
Cardiovascular Institute (R.P.), Department of Pediatrics (J.D.R., C.K.R.), and
Division of Cardiology, Department of Internal Medicine (D.C.L.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Ste 1600, Chicago,
IL 60611; Department of Biomedical Engineering, Northwestern University,
Evanston, Ill (L.F., D.K.); and Division of Cardiology (J.D.R.) and Department
of Medical Imaging (C.K.R.), Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, Ill
| | - Daniel Kim
- From the Department of Radiology (L.F., K.P.H., B.D.A., R.P., J.C.C.,
S.Z., J.D.R., C.K.R., D.K.), Department of Preventive Medicine, Bluhm
Cardiovascular Institute (R.P.), Department of Pediatrics (J.D.R., C.K.R.), and
Division of Cardiology, Department of Internal Medicine (D.C.L.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Ste 1600, Chicago,
IL 60611; Department of Biomedical Engineering, Northwestern University,
Evanston, Ill (L.F., D.K.); and Division of Cardiology (J.D.R.) and Department
of Medical Imaging (C.K.R.), Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, Ill
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Hamid A, Gupta M, Rajiah PS, Abbara S, Hanneman K, Allen BD. The current and future role of imaging of thoracic aortic disease: a North American society for cardiovascular imaging commentary on the 2022 AHA/ACC guidelines for the diagnosis and management of aortic disease. Int J Cardiovasc Imaging 2024; 40:5-14. [PMID: 37948028 DOI: 10.1007/s10554-023-02964-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 11/12/2023]
Abstract
The 2022 AHA/ACC Guidelines for the Diagnosis and Management of Aortic Disease introduced important updates for managing thoracic aorta aortic disease (TAD). In particular, the Guidelines underscore multimodality imaging's role in diagnosis, risk assessment, and monitoring of patients with TAD. This commentary aims to distill key imaging aspects from the Guidelines to provide a concise reference for the cardiovascular imaging community. Primary areas of focus include: (1) The importance of imagers in the multidisciplinary TAD care team, (2) Appropriate imaging techniques along with their strengths and weaknesses, (3) Aortic measurement methods and how aortic size and growth should contribute to TAD risk assessment, (4) Imaging evaluation of acute aortic syndrome. We have also highlighted several areas of ongoing uncertainty and confusion, specifically related to aortic measurement techniques and descriptive terminology. Finally, a perspective on the future of TAD imaging is discussed with a focus on advanced imaging tools and techniques as well as the potential role of artificial intelligence.
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Affiliation(s)
- Aws Hamid
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Monesha Gupta
- Division of Pediatric Cardiology, Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX, USA
| | | | - Suhny Abbara
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kate Hanneman
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, ON, Canada
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave Suite 1600, Chicago, IL, 60611, USA.
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Zhao TY, Johnson EMI, Elisha G, Halder S, Smith BC, Allen BD, Markl M, Patankar NA. Blood-wall fluttering instability as a physiomarker of the progression of thoracic aortic aneurysms. Nat Biomed Eng 2023; 7:1614-1626. [PMID: 38082182 DOI: 10.1038/s41551-023-01130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/16/2023] [Indexed: 12/20/2023]
Abstract
The diagnosis of aneurysms is informed by empirically tracking their size and growth rate. Here, by analysing the growth of aortic aneurysms from first principles via linear stability analysis of flow through an elastic blood vessel, we show that abnormal aortic dilatation is associated with a transition from stable flow to unstable aortic fluttering. This transition to instability can be described by the critical threshold for a dimensionless number that depends on blood pressure, the size of the aorta, and the shear stress and stiffness of the aortic wall. By analysing data from four-dimensional flow magnetic resonance imaging for 117 patients who had undergone cardiothoracic imaging and for 100 healthy volunteers, we show that the dimensionless number is a physiomarker for the growth of thoracic ascending aortic aneurysms and that it can be used to accurately discriminate abnormal versus natural growth. Further characterization of the transition to blood-wall fluttering instability may aid the understanding of the mechanisms underlying aneurysm progression in patients.
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Affiliation(s)
- Tom Y Zhao
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.
| | - Ethan M I Johnson
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Guy Elisha
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Sourav Halder
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Ben C Smith
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Michael Markl
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Neelesh A Patankar
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.
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Rai A, Allen BD, Fuss C, Dennie C, Hanneman K. Standardized medical terminology for cardiac computed tomography 2023 update- commentary by North American Society of Cardiovascular Imaging (NASCI). Int J Cardiovasc Imaging 2023; 39:2255-2257. [PMID: 37589871 DOI: 10.1007/s10554-023-02922-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Archana Rai
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Cristina Fuss
- Department of Radiology and Biomedical imaging, Yale Medicine, New Haven, Connecticut, USA
| | - Carole Dennie
- Department of Radiology, Radiation Oncology and Medical Physics, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Kate Hanneman
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, ON, Canada.
- Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
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8
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Allen BD. Editorial for "Deep Learning-Based Acceleration of Compressed Sensing Noncontrast-Enhanced Coronary Magnetic Resonance Angiography in Patients With Suspected Coronary Artery Disease". J Magn Reson Imaging 2023; 58:1531-1532. [PMID: 36807692 DOI: 10.1002/jmri.28654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/23/2023] Open
Affiliation(s)
- Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Maroun A, Quinn S, Dushfunian D, Weiss EK, Allen BD, Carr JC, Markl M. Clinical Applications of Four-Dimensional Flow MRI. Magn Reson Imaging Clin N Am 2023; 31:451-460. [PMID: 37414471 DOI: 10.1016/j.mric.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Four-dimensional flow MRI is a powerful phase contrast technique used for assessing three-dimensional (3D) blood flow dynamics. By acquiring a time-resolved velocity field, it enables flexible retrospective analysis of blood flow that can include qualitative 3D visualization of complex flow patterns, comprehensive assessment of multiple vessels, reliable placement of analysis planes, and calculation of advanced hemodynamic parameters. This technique provides several advantages over routine two-dimensional flow imaging techniques, allowing it to become part of clinical practice at major academic medical centers. In this review, we present the current state-of-the-art cardiovascular, neurovascular, and abdominal applications.
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Affiliation(s)
- Anthony Maroun
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA.
| | - Sandra Quinn
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - David Dushfunian
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - Elizabeth K Weiss
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - James C Carr
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
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Bissell MM, Raimondi F, Ait Ali L, Allen BD, Barker AJ, Bolger A, Burris N, Carhäll CJ, Collins JD, Ebbers T, Francois CJ, Frydrychowicz A, Garg P, Geiger J, Ha H, Hennemuth A, Hope MD, Hsiao A, Johnson K, Kozerke S, Ma LE, Markl M, Martins D, Messina M, Oechtering TH, van Ooij P, Rigsby C, Rodriguez-Palomares J, Roest AAW, Roldán-Alzate A, Schnell S, Sotelo J, Stuber M, Syed AB, Töger J, van der Geest R, Westenberg J, Zhong L, Zhong Y, Wieben O, Dyverfeldt P. 4D Flow cardiovascular magnetic resonance consensus statement: 2023 update. J Cardiovasc Magn Reson 2023; 25:40. [PMID: 37474977 PMCID: PMC10357639 DOI: 10.1186/s12968-023-00942-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/30/2023] [Indexed: 07/22/2023] Open
Abstract
Hemodynamic assessment is an integral part of the diagnosis and management of cardiovascular disease. Four-dimensional cardiovascular magnetic resonance flow imaging (4D Flow CMR) allows comprehensive and accurate assessment of flow in a single acquisition. This consensus paper is an update from the 2015 '4D Flow CMR Consensus Statement'. We elaborate on 4D Flow CMR sequence options and imaging considerations. The document aims to assist centers starting out with 4D Flow CMR of the heart and great vessels with advice on acquisition parameters, post-processing workflows and integration into clinical practice. Furthermore, we define minimum quality assurance and validation standards for clinical centers. We also address the challenges faced in quality assurance and validation in the research setting. We also include a checklist for recommended publication standards, specifically for 4D Flow CMR. Finally, we discuss the current limitations and the future of 4D Flow CMR. This updated consensus paper will further facilitate widespread adoption of 4D Flow CMR in the clinical workflow across the globe and aid consistently high-quality publication standards.
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Affiliation(s)
- Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9NL, UK.
| | | | - Lamia Ait Ali
- Institute of Clinical Physiology CNR, Massa, Italy
- Foundation CNR Tuscany Region G. Monasterio, Massa, Italy
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, Aurora, USA
| | - Ann Bolger
- Department of Medicine, University of California, San Francisco, CA, USA
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Nicholas Burris
- Department of Radiology, University of Michigan, Ann Arbor, USA
| | - Carl-Johan Carhäll
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | | | - Tino Ebbers
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | | | - Alex Frydrychowicz
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck and Universität Zu Lübeck, Lübeck, Germany
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hojin Ha
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, South Korea
| | - Anja Hennemuth
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Albert Hsiao
- Department of Radiology, University of California, San Diego, CA, USA
| | - Kevin Johnson
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Liliana E Ma
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Duarte Martins
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Marci Messina
- Department of Radiology, Northwestern Medicine, Chicago, IL, USA
| | - Thekla H Oechtering
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck and Universität Zu Lübeck, Lübeck, Germany
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Pim van Ooij
- Department of Radiology & Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cynthia Rigsby
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Imaging, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jose Rodriguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d´Hebron,Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red-CV, CIBER CV, Madrid, Spain
| | - Arno A W Roest
- Department of Pediatric Cardiology, Willem-Alexander's Children Hospital, Leiden University Medical Center and Center for Congenital Heart Defects Amsterdam-Leiden, Leiden, The Netherlands
| | | | - Susanne Schnell
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Physics, Institute of Physics, University of Greifswald, Greifswald, Germany
| | - Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering - iHEALTH, Santiago, Chile
| | - Matthias Stuber
- Département de Radiologie Médicale, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Ali B Syed
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Johannes Töger
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Rob van der Geest
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos Westenberg
- CardioVascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Liang Zhong
- National Heart Centre Singapore, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Yumin Zhong
- Department of Radiology, School of Medicine, Shanghai Children's Medical Center Affiliated With Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Oliver Wieben
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Petter Dyverfeldt
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Maroun A, Baraboo JJ, Gunasekaran S, Hwang JM, Liu SZ, Passman RS, Kim D, Allen BD, Markl M, Pradella M. Comparison of Biplane Area-Length Method and 3D Volume Quantification by Using Cardiac MRI for Assessment of Left Atrial Volume in Atrial Fibrillation. Radiol Cardiothorac Imaging 2023; 5:e220133. [PMID: 37124639 PMCID: PMC10141302 DOI: 10.1148/ryct.220133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 02/06/2023] [Accepted: 03/13/2023] [Indexed: 05/02/2023]
Abstract
Purpose To compare maximum left atrial (LA) volume (LAV) from the routinely used biplane area-length (BAL) method with three-dimensional (3D)-based volumetry from late gadolinium-enhanced MRI (3D LGE MRI) and contrast-enhanced MR angiography (3D CE-MRA) in patients with atrial fibrillation (AF). Materials and Methods Sixty-four patients with AF (mean age, 63 years ± 9 [SD]; 40 male patients) were retrospectively included from a prospective cohort acquired between October 2018 and February 2021. All patients underwent a research MRI examination that included standard two- and four-chamber cine acquisitions, 3D CE-MRA, and 3D LGE MRI performed prior to the atrial kick. Contour delineation on cine imaging and LA 3D segmentations were performed by a radiologist. Maximum LAV (BALmax) was extracted from the BAL volume-time curve and compared with LAV from 3D CE-MRA and 3D LGE MRI. The Kruskal-Wallis test was performed, followed by the Dunn post hoc test and Bland-Altman analyses. Interobserver variability was assessed in 10 patients. Results BALmax underestimated LAV compared with 3D CE-MRA (bias: -23.5 mL ± 46.2, P < .001) and 3D LGE MRI (bias: -31.3 mL ± 58.3, P < .001), whereas 3D LGE MRI volumes showed no evidence of a difference from 3D CE-MRA (bias: 7.8 mL ± 45.7, P = .38). Interobserver variability yielded excellent agreement for each method (intraclass correlation coefficient, 0.96-0.98). Conclusion BALmax underestimated LAV in patients with AF compared with 3D LGE MRI and 3D CE-MRA, suggesting that the geometric assumption of an ellipsoidal LA shape in BAL does not reflect LA geometry in patients with AF.Keywords: Left Atrial Volume, Biplane Area-Length, Late Gadolinium-enhanced 3D MRI, Contrast-enhanced 3D MR Angiography, Atrial Fibrillation Supplemental material is available for this article. © RSNA, 2023.
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12
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Cerne JW, Shehata C, Ragin A, Pathrose A, Veer M, Subedi K, Allen BD, Avery RJ, Markl M, Carr JC. Potential Prognostic Value of Native T1 in Pulmonary Hypertension Patients. Life (Basel) 2023; 13:775. [PMID: 36983931 PMCID: PMC10051677 DOI: 10.3390/life13030775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
Native T1, extracellular volume fraction (ECV), and late gadolinium enhancement (LGE) characterize myocardial tissue and relate to patient prognosis in a variety of diseases, including pulmonary hypertension. The purpose of this study was to evaluate if left ventricle (LV) fibrosis measurements have prognostic value for cardiac outcomes in pulmonary hypertension subgroups. 54 patients with suspected pulmonary hypertension underwent right-heart catheterization and were classified into pulmonary hypertension subgroups: pre-capillary component (PreCompPH) and isolated post-capillary (IpcPH). Cardiac magnetic resonance imaging (MRI) scans were performed with the acquisition of balanced cine steady-state free precession, native T1, and LGE pulse sequences to measure cardiac volumes and myocardial fibrosis. Associations between cardiac events and cardiac MRI measurements were analyzed within PreCompPH and IpcPH patients. IpcPH: LV native T1 was higher in patients who experienced a cardiac event within two years vs. those who did not. In patients with LV native T1 > 1050 ms, the rate of cardiac events was higher. ECV and quantitative LGE did not differ between groups. PreCompPH: native T1, ECV, and quantitative/qualitative LGE did not differ between patients who experienced a cardiac event within two years vs. those who did not. LV native T1 may have potential value for forecasting cardiac events in IpcPH, but not in PreCompPH, patients.
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Affiliation(s)
- John W. Cerne
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Christina Shehata
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Ann Ragin
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Ashitha Pathrose
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Manik Veer
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Kamal Subedi
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Bradley D. Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Ryan J. Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - James C. Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
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Weiss EK, Jarvis K, Maroun A, Malaisrie SC, Mehta CK, McCarthy PM, Bonow RO, Avery RJ, Allen BD, Carr JC, Rigsby CK, Markl M. Systolic reverse flow derived from 4D flow cardiovascular magnetic resonance in bicuspid aortic valve is associated with aortic dilation and aortic valve stenosis: a cross sectional study in 655 subjects. J Cardiovasc Magn Reson 2023; 25:3. [PMID: 36698129 PMCID: PMC9878800 DOI: 10.1186/s12968-022-00906-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/04/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Bicuspid aortic valve (BAV) disease is associated with increased risk of aortopathy. In addition to current intervention guidelines, BAV mediated changes in aortic 3D hemodynamics have been considered as risk stratification measures. We aimed to evaluate the association of 4D flow cardiovascular magnetic resonance (CMR) derived voxel-wise aortic reverse flow with aortic dilation and to investigate the role of aortic valve regurgitation (AR) and stenosis (AS) on reverse flow in systole and diastole. METHODS 510 patients with BAV (52 ± 14 years) and 120 patients with trileaflet aortic valve (TAV) (61 ± 11 years) and mid-ascending aorta diameter (MAAD) > 35 mm who underwent CMR including 4D flow CMR were retrospectively included. An age and sex-matched healthy control cohort (n = 25, 49 ± 12 years) was selected. Voxel-wise reverse flow was calculated in the aorta and quantified by the mean reverse flow in the ascending aorta (AAo) during systole and diastole. RESULTS BAV patients without AS and AR demonstrated significantly increased systolic and diastolic reverse flow (222% and 13% increases respectively, p < 0.01) compared to healthy controls and also had significantly increased systolic reverse flow compared to TAV patients with aortic dilation (79% increase, p < 0.01). In patients with isolated AR, systolic and diastolic AAo reverse flow increased significantly with AR severity (c = - 83.2 and c = - 205.6, p < 0.001). In patients with isolated AS, AS severity was associated with an increase in both systolic (c = - 253.1, p < 0.001) and diastolic (c = - 87.0, p = 0.02) AAo reverse flow. Right and left/right and non-coronary fusion phenotype showed elevated systolic reverse flow (> 17% increase, p < 0.01). Right and non-coronary fusion phenotype showed decreased diastolic reverse flow (> 27% decrease, p < 0.01). MAAD was an independent predictor of systolic (p < 0.001), but not diastolic, reverse flow (p > 0.1). CONCLUSION 4D flow CMR derived reverse flow associated with BAV was successfully captured even in the absence of AR or AS and in comparison to TAV patients with aortic dilation. Diastolic AAo reverse flow increased with AR severity while AS severity strongly correlated with increased systolic reverse flow in the AAo. Additionally, increasing MAAD was independently associated with increasing systolic AAo reverse flow. Thus, systolic AAo reverse flow may be a valuable metric for evaluating disease severity in future longitudinal outcome studies.
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Affiliation(s)
- Elizabeth K. Weiss
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Kelly Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Anthony Maroun
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - S. Chris Malaisrie
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Christopher K. Mehta
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Patrick M. McCarthy
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Robert O. Bonow
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Ryan J. Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Bradley D. Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - James C. Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Cynthia K. Rigsby
- Department of Medical Imaging, Lurie Children’s Hospital, Chicago, IL USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
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14
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Cerne JW, Pathrose A, Sarnari R, Veer M, Chow K, Subedi K, Allen BD, Avery RJ, Markl M, Carr JC. Left Ventricular Fibrosis Assessment by Native T1, ECV, and LGE in Pulmonary Hypertension Patients. Diagnostics (Basel) 2022; 13:diagnostics13010071. [PMID: 36611364 PMCID: PMC9818262 DOI: 10.3390/diagnostics13010071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Cardiac magnetic resonance imaging (MRI) is emerging as an alternative to right heart catheterization for the evaluation of pulmonary hypertension (PH) patients. The aim of this study was to compare cardiac MRI-derived left ventricle fibrosis indices between pre-capillary PH (PrePH) and isolated post-capillary PH (IpcPH) patients and assess their associations with measures of ventricle function. Global and segmental late gadolinium enhancement (LGE), longitudinal relaxation time (native T1) maps, and extracellular volume fraction (ECV) were compared among healthy controls (N = 25; 37% female; 52 ± 13 years), PH patients (N = 48; 60% female; 60 ± 14 years), and PH subgroups (PrePH: N = 29; 65% female; 55 ± 12 years, IpcPH: N = 19; 53% female; 66 ± 13 years). Cardiac cine measured ejection fraction, end diastolic, and end systolic volumes and were assessed for correlations with fibrosis. LGE mural location was qualitatively assessed on a segmental basis for all subjects. PrePH patients had elevated (apical-, mid-antero-, and mid-infero) septal left ventricle native T1 values (1080 ± 74 ms, 1077 ± 39 ms, and 1082 ± 47 ms) compared to IpcPH patients (1028 ± 53 ms, 1046 ± 36 ms, 1051 ± 44 ms) (p < 0.05). PrePH had a higher amount of insertional point LGE (69%) and LGE patterns characteristic of non-vascular fibrosis (77%) compared to IpcPH (37% and 46%, respectively) (p < 0.05; p < 0.05). Assessment of global LGE, native T1, and ECV burdens did not show a statistically significant difference between PrePH (1.9 ± 2.7%, 1056.2 ± 36.3 ms, 31.2 ± 3.7%) and IpcPH (2.7 ± 2.7%, 1042.4 ± 28.1 ms, 30.7 ± 4.7%) (p = 0.102; p = 0.229 p = 0.756). Global native T1 and ECV were higher in patients (1050.9 ± 33.8 and 31.0 ± 4.1%) than controls (28.2 ± 3.7% and 1012.9 ± 29.4 ms) (p < 0.05). Cardiac MRI-based tissue characterization may augment understanding of cardiac involvement and become a tool to facilitate PH patient classification.
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Affiliation(s)
- John W. Cerne
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
- Correspondence:
| | - Ashitha Pathrose
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Roberto Sarnari
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Manik Veer
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Kelvin Chow
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, IL 60611, USA
| | - Kamal Subedi
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Bradley D. Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Ryan J. Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - James C. Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
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Allen BD, Kilinc O, Pradella M, Chu S, Mehta CK, Malaisrie SC, Hoel AW, Carr JC, Markl M. Entry Tear Hemodynamics Detect Patients With Adverse Aorta-Related Outcomes in Type B Aortic Dissection. JACC Cardiovasc Imaging 2022; 16:711-712. [PMID: 36752444 DOI: 10.1016/j.jcmg.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/27/2022] [Indexed: 01/13/2023]
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16
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Engel JS, Bharadwaj S, Elbaz M, Markl M, Allen BD, Malaisrie SC. Four-dimensional magnetic resonance after ascending aorta replacement and aortic valve repair with HAART 300 internal annuloplasty ring. J Card Surg 2022; 37:3899-3903. [PMID: 36116051 PMCID: PMC9826053 DOI: 10.1111/jocs.16950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/08/2022] [Accepted: 09/03/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The hemispherical aortic annuloplasty reconstructive technology (HAART) is an internal geometric annuloplasty ring designed to restore a natural elliptical shape to the aortic annulus as part of aortic valve repair. We present four-dimensional flow hemodynamic analysis before and after implementation of the HAART ring in patients undergoing ascending aortic replacement. METHODS Aortic hemodynamics over the cardiac cycle were visualized using time-resolved three-dimensional pathlines. Velocity streamlines tangent to the time-resolved velocity vector field were used to demonstrate instantaneous aortic hemodynamics. Peak velocities, forward and retrograde flow were calculated at nine planes placed along the midline of the thoracic aorta. Systolic wall shear stress and peak viscous energy loss over the cardiac cycle were calculated. RESULTS HAART patients displayed similar or improved flow profiles after surgery when compared to a patient undergoing ascending aortic replacement alone. CONCLUSION There may be a trend towards improved flow dynamics in patients undergoing HAART ring implantation.
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Affiliation(s)
- Joshua S. Engel
- Department of RadiologyFeinberg School of Medicine, Northwestern UniversityChicagoIlinoisUSA
| | - Sandeep Bharadwaj
- Department of Surgery, Division of Cardiac SurgeryNorthwestern UniversityChicagoIlinoisUSA
| | - Mohammed Elbaz
- Department of RadiologyFeinberg School of Medicine, Northwestern UniversityChicagoIlinoisUSA,Department of Biomedical EngineeringNorthwestern UniversityChicagoIllinoisUSA
| | - Michael Markl
- Department of RadiologyFeinberg School of Medicine, Northwestern UniversityChicagoIlinoisUSA,Department of Biomedical EngineeringNorthwestern UniversityChicagoIllinoisUSA
| | - Bradley D. Allen
- Department of RadiologyFeinberg School of Medicine, Northwestern UniversityChicagoIlinoisUSA
| | - S. Chris Malaisrie
- Department of Surgery, Division of Cardiac SurgeryNorthwestern UniversityChicagoIlinoisUSA
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17
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Kilinc O, Chu S, Baraboo J, Weiss EK, Engel J, Maroun A, Giese D, Jin N, Chow K, Bi X, Davids R, Mehta C, Malaisrie SC, Hoel A, Carr J, Markl M, Allen BD. Hemodynamic Evaluation of Type B Aortic Dissection Using Compressed Sensing Accelerated 4D Flow MRI. J Magn Reson Imaging 2022; 57:1752-1763. [PMID: 36148924 PMCID: PMC10033465 DOI: 10.1002/jmri.28432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND 4D Flow MRI is a quantitative imaging technique to evaluate blood flow patterns; however, it is unclear how compressed sensing (CS) acceleration would impact aortic hemodynamic quantification in type B aortic dissection (TBAD). PURPOSE To investigate CS-accelerated 4D Flow MRI performance compared to GRAPP-accelerated 4D Flow MRI (GRAPPA) to evaluate aortic hemodynamics in TBAD. STUDY TYPE Prospective. POPULATION Twelve TBAD patients, two volunteers. FIELD STRENGTH/SEQUENCE 1.5T, 3D time-resolved cine phase-contrast gradient echo sequence. ASSESSMENT GRAPPA (acceleration factor [R] = 2) and two CS-accelerated (R = 7.7 [CS7.7] and 10.2 [CS10.2]) 4D Flow MRI scans were acquired twice for interscan reproducibility assessment. Voxelwise kinetic energy (KE), peak velocity (PV), forward flow (FF), reverse flow (RF), and stasis were calculated. Plane-based mid-lumen flows were quantified. Imaging times were recorded. TESTS Repeated measures analysis of variance, Pearson correlation coefficients (r), intraclass correlation coefficients (ICC). P < 0.05 indicated statistical significance. RESULTS The KE and FF in true lumen (TL) and PV in false lumen (FL) did not show difference among three acquisition types (P = 0.818, 0.065, 0.284 respectively). The PV and stasis in TL were higher, KE, FF, and RF in FL were lower, and stasis was higher in GRAPPA compared to CS7.7 and CS10.2. The RF was lower in GRAPPA compared to CS10.2. The correlation coefficients were strong in TL (r = [0.781-0.986]), and low to strong in FL (r = [0.347-0.948]). The ICC levels demonstrated moderate to excellent interscan reproducibility (0.732-0.989). The FF and net flow in mid-descending aorta TL were significantly different between CS7.7 and CS10.2. CONCLUSION CS-accelerated 4D Flow MRI has potential for clinical utilization with shorter scan times in TBAD. Our results suggest similar hemodynamic trends between acceleration types, but CS-acceleration impacts KE, FF, RF, and stasis more in FL. EVIDENCE LEVEL 1 Technical Efficacy: Stage 2.
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Affiliation(s)
- Ozden Kilinc
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Stanley Chu
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Justin Baraboo
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
| | - Elizabeth K Weiss
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
| | - Joshua Engel
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Anthony Maroun
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Cleveland, Ohio, USA
| | - Kelvin Chow
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | - Xiaoming Bi
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | - Rachel Davids
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | - Christopher Mehta
- Department of Surgery (Cardiac Surgery), Northwestern University, Chicago, Illinois, USA
| | - S Chris Malaisrie
- Department of Surgery (Cardiac Surgery), Northwestern University, Chicago, Illinois, USA
| | - Andrew Hoel
- Department of Surgery (Vascular Surgery), Northwestern University, Chicago, Illinois, USA
| | - James Carr
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
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18
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Cerne JW, Liu S, Umair M, Pathrose A, Moore JE, Allen BD, Markl M, Carr JC, Savas H, Wilsbacher L, Avery R. Combined modality PET/MR for the detection of severe large vessel vasculitis. Eur J Hybrid Imaging 2022; 6:16. [PMID: 35965266 PMCID: PMC9376186 DOI: 10.1186/s41824-022-00136-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Large vessel vasculitis (LVV) can be characterized based on symptom severity, and this characterization helps clinicians decide upon treatment approach. Our aim was to compare the imaging findings of combined modality positron emission tomography/magnetic resonance (PET/MR) and inflammatory markers between severe and non-severe LVV. A retrospective query was performed to identify all patients with LVV who underwent PET/MR at our institution between January 2015 and January 2021.
Results
Eleven patients (nine females; age 62.2 ± 16.4 years) underwent 15 PET/MR scans. Positivity was defined by findings indicative of active LVV on each modality: PET positive if vessel metabolic activity > liver metabolic activity; MR positive if wall thickening or contrast enhancement. When positive PET or positive MR findings were considered a positive scan, LVV patients with severe disease (n = 9 scans) showed a higher number of positive scans (n = 9) compared to the number of positive scans in non-severe patients (n = 3) (p < 0.05). The sensitivity and specificity for the detection of severe LVV were 1.00 and 0.50, respectively. When only the presence of both positive PET and positive MR findings were considered a positive scan, inflammatory marker levels were not significantly different between severe and non-severe LVV groups (severe: erythrocyte sedimentation rate (ESR) = 9.8 ± 10.6 mm/h; C-reactive protein (CRP) = 0.6 ± 0.4 mg/dL) (non-severe: ESR = 14.3 ± 22.4 mm/h; CRP = 0.5 ± 0.6 mg/dL). Blood- and liver-normalized maximum standardized uptake values were not significantly different between severe and non-severe patients (1.4 ± 0.3 vs 1.5 ± 0.4; 1.1 ± 0.4 vs 1.0 ± 0.3, respectively).
Conclusions
Because of the differences observed, PET/MR appears to be better suited to facilitate the characterization of LVV as severe or non-severe compared to inflammatory marker measurements and quantitative measurements of metabolic activity. Qualitative assessment of PET and MR positivity by 18F-fluorodeoxyglucose PET/MR may be able to supplement clinical symptoms-based LVV classification decisions and may be helpful when clinical symptoms overlap with other disease processes.
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Chu S, Kilinc O, Pradella M, Weiss E, Baraboo J, Maroun A, Jarvis K, Mehta CK, Malaisrie SC, Hoel AW, Carr JC, Markl M, Allen BD. Baseline 4D Flow-Derived in vivo Hemodynamic Parameters Stratify Descending Aortic Dissection Patients With Enlarging Aortas. Front Cardiovasc Med 2022; 9:905718. [PMID: 35757320 PMCID: PMC9218246 DOI: 10.3389/fcvm.2022.905718] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/16/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of our study was to assess the value of true lumen and false lumen hemodynamics compared to aortic morphological measurements for predicting adverse-aorta related outcomes (AARO) and aortic growth in patients with type B aortic dissection (TBAD). Materials and Methods Using an IRB approved protocol, we retrospectively identified patients with descending aorta (DAo) dissection at a large tertiary center. Inclusion criteria includes known TBAD with ≥ 6 months of clinical follow-up after initial presentation for TBAD or after ascending aorta intervention for patients with repaired type A dissection with residual type B aortic dissection (rTAAD). Patients with prior descending aorta intervention were excluded. The FL and TL of each patient were manually segmented from 4D flow MRI data, and 3D parametric maps of aortic hemodynamics were generated. Groups were divided based on (1) presence vs. absence of AARO and (2) growth rate ≥ vs. < 3 mm/year. True and false lumen kinetic energy (KE), stasis, peak velocity (PV), reverse/forward flow (RF/FF), FL to TL KE ratio, as well as index aortic diameter were compared between groups using the Mann–Whitney U or independent t-test. Results A total of n = 51 patients (age: 58.4 ± 15.0 years, M/F: 31/20) were included for analysis of AARO. This group contained n = 26 patients with TBAD and n = 25 patients with rTAAD. In the overall cohort, AARO patients had larger baseline diameters, lower FL-RF, FL stasis, TL-KE, TL-FF and TL-PV. Among patients with de novo TBAD, those with AAROs had larger baseline diameter, lower FL stasis and TL-PV. In both the overall cohort and in the subgroup of de novo TBAD, subjects with aortic growth ≥ 3mm/year, patients had a higher KE ratio. Conclusion Our study suggests that 4D flow MRI is a promising tool for TBAD evaluation that can provide information beyond traditional MRA or CTA. 4D flow has the potential to become an integral aspect of TBAD work-up, as hemodynamic assessment may allow earlier identification of at-risk patients who could benefit from earlier intervention.
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Affiliation(s)
- Stanley Chu
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Ozden Kilinc
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Maurice Pradella
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Elizabeth Weiss
- Department of Radiology, Northwestern University, Chicago, IL, United States.,Department of Biomedical Engineering, Northwestern University, Chicago, IL, United States
| | - Justin Baraboo
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, United States
| | - Anthony Maroun
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Kelly Jarvis
- Department of Radiology, Northwestern University, Chicago, IL, United States.,Department of Biomedical Engineering, Northwestern University, Chicago, IL, United States
| | - Christopher K Mehta
- Department of Surgery (Cardiac Surgery), Northwestern University, Chicago, IL, United States
| | - S Chris Malaisrie
- Department of Surgery (Cardiac Surgery), Northwestern University, Chicago, IL, United States
| | - Andrew W Hoel
- Department of Surgery (Vascular Surgery), Northwestern University, Chicago, IL, United States
| | - James C Carr
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, IL, United States.,Department of Biomedical Engineering, Northwestern University, Chicago, IL, United States
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Chicago, IL, United States
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20
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Fan L, Hong K, Hsu LY, Carr JC, Allen BD, Lee DC, Kim D. Optimal saturation recovery time for minimizing the underestimation of arterial input function in quantitative cardiac perfusion MRI. Magn Reson Med 2022; 88:832-839. [PMID: 35377476 PMCID: PMC9321550 DOI: 10.1002/mrm.29240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/04/2022] [Accepted: 02/28/2022] [Indexed: 11/07/2022]
Abstract
Purpose The purpose of this study was to determine an optimal saturation‐recovery time (TS) for minimizing the underestimation of arterial input function (AIF) in quantitative cardiac perfusion MRI without multiple gadolinium injections per subject. Methods We scanned 18 subjects (mean age = 59 ± 14 years, 9/9 males/females) to acquire resting perfusion data and 1 additional subject (age = 38 years, male) to obtain stress‐rest perfusion data using a 5‐fold accelerated pulse sequence with radial k‐space sampling and applied k‐space weighted image contrast (KWIC) filters on the same k‐space data to retrospectively reconstruct five AIF images with effective TS ranging from 10 to 21.2 ms (2.8 ms steps). Undersampled images were reconstructed using a compressed sensing framework with temporal‐total‐variation and temporal‐principal‐component as 2 orthogonal sparsifying transforms. The image processing steps included, same motion correction across five different AIF images, signal normalization by the proton‐density‐weighted‐image, signal‐to‐T1 conversion using a Bloch equation, T1‐to‐gadolinium‐concentration conversion assuming fast water exchange, T2* correction to the AIF, and gadolinium‐concentration to myocardial blood flow (MBF) conversion based on a Fermi model. Results Among five TS values, the shortest TS (10 ms) produced significantly (P < 0.05) higher peak AIF and lower resting MBF (13.73 mM, 0.73 mL g−1 min−1) than 12.8 ms (11.24 mM, 0.89 mL g−1 min−1), 15.6 ms (9.56 mM, 1.05 mL g−1 min−1), 18.4 ms (8.55 mM, 1.17 mL g−1 min−1), and 21.2 ms (7.95 mM, 1.27 mL g−1 min−1). Similarly, shorter TS reduced underestimation of AIF (or overestimation of MBF) for both during stress and at rest, but this effect was canceled in myocardial‐perfusion‐reserve (MPR). Conclusion This study demonstrates that TS of 10 ms reduces the underestimation of AIF and, hence, the overestimation of MBF compared with longer TS values (12.8‐21.2 ms).
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Affiliation(s)
- Lexiaozi Fan
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Kyungpyo Hong
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Li-Yueh Hsu
- Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel C Lee
- Division of Cardiology, Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
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21
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Raman SV, Markl M, Patel AR, Bryant J, Allen BD, Plein S, Seiberlich N. 30-minute CMR for common clinical indications: a Society for Cardiovascular Magnetic Resonance white paper. J Cardiovasc Magn Reson 2022; 24:13. [PMID: 35232470 PMCID: PMC8886348 DOI: 10.1186/s12968-022-00844-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/16/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite decades of accruing evidence supporting the clinical utility of cardiovascular magnetic resonance (CMR), adoption of CMR in routine cardiovascular practice remains limited in many regions of the world. Persistent use of long scan times of 60 min or more contributes to limited adoption, though techniques available on most scanners afford routine CMR examination within 30 min. Incorporating such techniques into standardize protocols can answer common clinical questions in daily practice, including those related to heart failure, cardiomyopathy, ventricular arrhythmia, ischemic heart disease, and non-ischemic myocardial injury. BODY: In this white paper, we describe CMR protocols of 30 min or shorter duration with routine techniques with or without stress perfusion, plus specific approaches in patient and scanner room preparation for efficiency. Minimum requirements for the scanner gradient system, coil hardware and pulse sequences are detailed. Recent advances such as quantitative myocardial mapping and other add-on acquisitions can be incorporated into the proposed protocols without significant extension of scan duration for most patients. CONCLUSION Common questions in clinical cardiovascular practice can be answered in routine CMR protocols under 30 min; their incorporation warrants consideration to facilitate increased access to CMR worldwide.
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Affiliation(s)
- Subha V. Raman
- Division of Cardiovascular Medicine and Krannert CV Research Center, Indiana University School of Medicine, Indianapolis, IN USA
- Cardiovascular Institute, IU Health, Indianapolis, IN USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL USA
| | - Amit R. Patel
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL USA
| | - Jennifer Bryant
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Bradley D. Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Nicole Seiberlich
- Department of Radiology, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI 48109 USA
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22
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Soulat G, Scott M, Allen BD, Avery R, Bonow RO, Malaisrie C, McCarthy P, Fedak P, Barker AJ, Markl M. Association of Regional Wall Shear Stress and Progressive Ascending Aorta Dilation in Bicuspid Aortic Valve. JACC Cardiovasc Imaging 2022; 15:33-42. [PMID: 34419402 PMCID: PMC8741630 DOI: 10.1016/j.jcmg.2021.06.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the role of wall shear stress (WSS) as a predictor of ascending aorta (AAo) growth at 5 years or greater follow-up. BACKGROUND Aortic 4-dimensional flow cardiac magnetic resonance (CMR) can quantify regions exposed to high WSS, a known stimulus for arterial wall dysfunction. However, its association with longitudinal changes in aortic dilation in patients with bicuspid aortic valve (BAV) is unknown. METHODS This retrospective study identified 72 patients with BAV (age 45 ± 12 years) who underwent CMR for surveillance of aortic dilation at baseline and ≥5 years of follow-up. Four-dimensional flow CMR analysis included the calculation of WSS heat maps to compare regional WSS in individual patients with population averages of healthy age- and sex-matched subjects (database of 136 controls). The relative areas of the AAo and aorta (in %) exposed to elevated WSS (outside the 95% CI of healthy population averages) were quantified. RESULTS At a median follow-up duration of 6.0 years, the mean AAo growth rate was 0.24 ± 0.20 mm/y. The fraction of the AAo exposed to elevated WSS at baseline was increased for patients with higher growth rates (>0.24 mm/y, n = 32) compared with those with growth rates <0.24 mm/y (19.9% [IQR: 10.2%-25.5%] vs 5.7% [IQR: 1.5%-21.3%]; P = 0.008). Larger areas of elevated WSS in the AAo and entire aorta were associated with higher rates of AAo dilation >0.24 mm/y (odds ratio: 1.51; 95% CI: 1.05-2.17; P = 0.026 and odds ratio: 1.70; 95% CI: 1.01-3.15; P = 0.046, respectively). CONCLUSIONS The area of elevated AAo WSS as assessed by 4-dimensional flow CMR identified BAV patients with higher rates of aortic dilation and thus might determine which patients require closer follow-up.
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Affiliation(s)
- Gilles Soulat
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Scott
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,Department of Biomedical Engineering, McCormick, School of Engineering, Northwestern University, Evanston, IL, USA
| | - Bradley D Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ryan Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert O. Bonow
- Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois
| | - Chris Malaisrie
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Patrick McCarthy
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Paul Fedak
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA,Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Alex J Barker
- Department of Radiology and Bioengineering, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,Department of Biomedical Engineering, McCormick, School of Engineering, Northwestern University, Evanston, IL, USA
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23
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Kalisz K, Scott M, Avery R, Sarnari R, Barker AJ, Carr J, Markl M, Allen BD. Cardiac Magnetic Resonance Imaging Feature Tracking Demonstrates Altered Biventricular Strain in Obese Subjects in the Absence of Clinically Apparent Cardiovascular Disease. J Thorac Imaging 2022; 37:W1-W2. [PMID: 32520847 PMCID: PMC7718327 DOI: 10.1097/rti.0000000000000539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Kevin Kalisz
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael Scott
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ryan Avery
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Roberto Sarnari
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alex J Barker
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - James Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
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24
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Cerne JW, Pathrose A, Singer AM, Moore JE, Serhal A, Aouad P, Umair M, Ragin A, Allen BD, Avery R, Markl M, Carr JC. MRA of the Supraaortic Vasculature: Comparison of Gadobutrol and Gadoterate Meglumine at 1.5 T. J Magn Reson Imaging 2021; 56:440-449. [PMID: 34953154 DOI: 10.1002/jmri.28044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Gadobutrol (GB) and gadoterate meglumine (GM) are contrast agents used for contrast-enhanced magnetic resonance angiography (CEMRA). Supraaortic vasculature (SAV) CEMRAs are used to evaluate stroke risk and neurologic symptoms. There is a need to compare the SAV CEMRA image quality obtained with GB and GM. PURPOSE To intra-individually compare MRA images obtained with equimolar GB and GM at 1.5 T in the SAV. STUDY TYPE Prospective, crossover. POPULATION Twenty-eight subjects (54 ± 13 years; 17 female). FIELD STRENGTH/SEQUENCE 1.5 T; three-dimensional (3D) gradient recalled echo. ASSESSMENT Quantitative image quality was measured by normalized signal intensity (SIn ) [SIn = SI blood/SD blood] and contrast ratio (CR) [CR = SI blood/SI muscle], determined by an observer (JWC) with 1 year of vascular imaging experience. Three radiologists (AS, PA, and MU) with (5, 5, and 6 years of) vascular imaging experience evaluated image quality by Likert-scale ratings (of image impression, wall conspicuity, and artifact absence). STATISTICAL TESTS SIn and CR were compared with paired t-tests or Wilcoxon signed-rank tests and Bland-Altman plots. Qualitative ratings were compared with Wilcoxon signed-rank test. RESULTS No significant difference in SIn was found between GB and GM. CRs with GB were significantly higher than GM at the right common carotid (6.9 ± 2.5 vs. 4.8 ± 1), left internal carotid (7.3 ± 2 vs. 4.4 ± 1.2), right internal carotid (7.7 ± 2.2 vs. 5 ± 1.1), and left vertebral (6.6 ± 2.2 vs. 4.5 ± 1.1) arteries. Bland-Altman plots showed relatively greater differences between GB and GM at higher CRs and SIn s. GM showed significantly higher artifact than GB (3.56 ± 0.52 vs. 3.36 ± 0.46) and significantly lower overall image quality (10.73 ± 1.45 vs. 11.26 ± 1.58) at the left vertebral artery. DATA CONCLUSION At 1.5 T and equimolar demonstration, GB (0.1 mL/kg, i.e., 0.1 mmol/kg) showed higher CRs in the SAV compared to GM (0.2 mL/kg, i.e., 0.1 mmol/kg) at most vessels. Subjective image quality was not significantly different between the two agents for most vessels. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- John W Cerne
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alyssa M Singer
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jackson E Moore
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, Illinois, USA
| | - Ali Serhal
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pascale Aouad
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Muhammad Umair
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ann Ragin
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryan Avery
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, Illinois, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Gupta AN, Avery R, Soulat G, Allen BD, Collins JD, Choudhury L, Bonow RO, Carr J, Markl M, Elbaz MSM. Direct mitral regurgitation quantification in hypertrophic cardiomyopathy using 4D flow CMR jet tracking: evaluation in comparison to conventional CMR. J Cardiovasc Magn Reson 2021; 23:138. [PMID: 34865629 PMCID: PMC8647422 DOI: 10.1186/s12968-021-00828-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/16/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Quantitative evaluation of mitral regurgitation (MR) in hypertrophic cardiomyopathy (HCM) by cardiovascular magnetic resonance (CMR) relies on an indirect volumetric calculation. The aim of this study was to directly assess and quantify MR jets in patients with HCM using 4D flow CMR jet tracking in comparison to standard-of-care CMR indirect volumetric method. METHODS This retrospective study included patients with HCM undergoing 4D flow CMR. By the indirect volumetric method from CMR, MR volume was quantified as left ventricular stroke volume minus forward aortic volume. By 4D flow CMR direct jet tracking, multiplanar reformatted planes were positioned in the peak velocity of the MR jet during systole to calculate through-plane regurgitant flow. MR severity was collected for agreement analysis from a clinical echocardiograms performed within 1 month of CMR. Inter-method and inter-observer agreement were assessed by intraclass correlation coefficient (ICC), Bland-Altman analysis, and Cohen's kappa. RESULTS Thirty-seven patients with HCM were included. Direct jet tracking demonstrated good inter-method agreement of MR volume compared to the indirect volumetric method (ICC = 0.80, p = 0.004) and fair agreement of MR severity (kappa = 0.27, p = 0.03). Direct jet tracking showed higher agreement with echocardiography (kappa = 0.35, p = 0.04) than indirect volumetric method (kappa = 0.16, p = 0.35). Inter-observer reproducibility of indirect volumetric method components revealed the lowest reproducibility in end-systolic volume (ICC = 0.69, p = 0.15). Indirect volumetric method showed good agreement of MR volume (ICC = 0.80, p = 0.003) and fair agreement of MR severity (kappa = 0.38, p < 0.001). Direct jet tracking demonstrated (1) excellent inter-observer reproducibility of MR volume (ICC = 0.97, p < 0.001) and MR severity (kappa = 0.84, p < 0.001) and (2) excellent intra-observer reproducibility of MR volume (ICC = 0.98, p < 0.001) and MR severity (kappa = 0.88, p < 0.001). CONCLUSIONS Quantifying MR and assessing MR severity by indirect volumetric method in HCM patients has limited inter-observer reproducibility. 4D flow CMR jet tracking is a potential alternative technique to directly quantify and assess MR severity with excellent inter- and intra-observer reproducibility and higher agreement with echocardiography in this population.
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Affiliation(s)
- Aakash N Gupta
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA
| | - Ryan Avery
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA
| | - Gilles Soulat
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA
| | | | - Lubna Choudhury
- Department of Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Robert O Bonow
- Department of Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - James Carr
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA
- Department of Biomedical Engineering, Northwestern University, McCormick School of Engineering, Evanston, IL, 60208, USA
| | - Mohammed S M Elbaz
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA.
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Hong S, Hong K, Culver AE, Pathrose A, Allen BD, Wilcox JE, Lee DC, Kim D. Highly Accelerated Real-Time Free-Breathing Cine CMR for Patients With a Cardiac Implantable Electronic Device. Acad Radiol 2021; 28:1779-1786. [PMID: 32888766 DOI: 10.1016/j.acra.2020.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/03/2023]
Abstract
RATIONALE AND OBJECTIVES To develop a 16-fold accelerated real-time, free-breathing cine cardiovascular magnetic resonance (CMR) pulse sequence with compressed sensing reconstruction and test whether it is capable of producing clinically acceptable summed visual scores (SVS) and accurate left ventricular ejection fraction (LVEF) in patients with a cardiac implantable electronic device (CIED). MATERIALS AND METHODS A 16-fold accelerated real-time cine CMR pulse sequence was developed using gradient echo readout, Cartesian k-space sampling, and compressed sensing. We scanned 13 CIED patients (mean age = 59 years; 9/4 males/females) using clinical standard, breath-hold cine and real-time, free-breathing cine. Two clinical readers performed a visual assessment of image quality in four categories (conspicuity of endocardial wall at end diastole, temporal fidelity of wall motion, any artifact level on the heart, noise) using a five-point Likert scale (1: worst; 3: clinically acceptable; 5: best). SVS was calculated as the sum of 4 individual scores, where 12 was defined as clinical acceptable. The Wilcoxon signed-rank test was performed to compare SVS, and the Bland-Altman analysis was conducted to evaluate the agreement of LVEF. RESULTS Median scan time was 3.7 times shorter for real-time (3.5 heartbeats per slice) than clinical standard (13 heartbeats per slice, excluding nonscanning time between successive breath-hold acquisitions). Median SVS was not significantly different between clinical standard (15.0) and real-time (14.5). The mean difference in LVEF was -2% (4.7% of mean), and the limits of agreement was 5.8% (13.5% of mean). CONCLUSION This study demonstrates that the proposed real-time cine method produces clinically acceptable SVS and relatively accurate LVEF in CIED patients.
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Cerne JW, Pathrose A, Gordon DZ, Sarnari R, Veer M, Blaisdell J, Allen BD, Avery R, Markl M, Ragin A, Carr JC. Evaluation of Pulmonary Hypertension Using 4D Flow MRI. J Magn Reson Imaging 2021; 56:234-245. [PMID: 34694050 DOI: 10.1002/jmri.27967] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cardiac magnetic resonance imaging (MRI) is becoming an alternative to right heart catheterization (RHC) for evaluating pulmonary hypertension (PH). A need exists to further evaluate cardiac MRI's ability to characterize PH. PURPOSE To evaluate the potential for four-dimensional (4D) flow MRI-derived pulmonary artery velocities to characterize PH. STUDY TYPE Prospective case-control. POPULATION Fifty-four PH patients (56% female); 25 controls (36% female). FIELD STRENGTH/SEQUENCE 1.5 T; gradient recalled echo 4D flow and balanced steady-state free precession cardiac cine. ASSESSMENT RHC was used to derive patients' pulmonary vascular resistance (PVR). 4D flow measured blood velocities at the main, left, and right pulmonary arteries (MPA, LPA, and RPA); cine measured ejection fraction, end diastolic, and end systolic volumes (EF, EDV, and ESV). EDV and ESV were normalized (indexed) to body surface area (ESVI and EDVI). Parameters were evaluated between, and within, PH subgroups: pulmonary arterial hypertension (PAH); PH due to left heart disease (PH-LHD)/chronic lung disease (PH-CLD)/or chronic thrombo-emboli (CTE-PH). STATISTICAL TESTS Analysis of variance and Kruskal-Wallis tests compared parameters between subgroups. Pearson's r assessed velocity, PVR, and volume correlations. Significance definition: P < 0.05. RESULTS PAH peak and mean velocities were significantly lower than in controls at the LPA (36 ± 12 cm/second and 20 ± 4 cm/second vs. 59 ± 15 cm/second and 32 ± 9 cm/second). At the RPA, mean velocities were significantly lower in PAH vs. controls (27 ± 6 cm/second vs. 40 ± 9 cm/second). Peak velocities significantly correlated with right ventricular EF at the MPA (r = 0.286), RPA (r = 0.400), and LPA (r = 0.401). Peak velocity significantly correlated with right ventricular ESVI at the RPA (r = -0.355) and LPA (r = -0.316). Significant correlations between peak velocities and PVR were moderate at the LPA in PAH (r = -0.641) and in PH-LHD (r = -0.606) patients, and at the MPA in PH-CLD (r = -0.728). CTE-PH showed non-significant correlations between peak velocity and PVR at all locations. DATA CONCLUSION Preliminary findings suggest 4D flow can identify PAH and track PVR changes. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- John W Cerne
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Daniel Z Gordon
- Department of Infectious Diseases, Northwestern University, Chicago, Illinois, USA
| | - Roberto Sarnari
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Manik Veer
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Julie Blaisdell
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Ryan Avery
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Ann Ragin
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - James C Carr
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
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Mehta CK, Son AY, Chia MC, Budd AN, Allen BD, Vassallo P, Hoel AW, Brady WJ, Nable JV. Management of acute aortic syndromes from initial presentation to definitive treatment. Am J Emerg Med 2021; 51:108-113. [PMID: 34735967 DOI: 10.1016/j.ajem.2021.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute aortic syndromes comprise a spectrum of diseases including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcers. Early diagnosis, rapid intervention, and multidisciplinary team care are vital to efficiently manage time-sensitive aortic emergencies, mobilize appropriate resources, and optimize clinical outcomes. OBJECTIVE This comprehensive review outlines the multidisciplinary team approach from initial presentation to definitive interventional treatment and post-operative care. DISCUSSION Acute aortic syndromes can be life-threatening and require prompt diagnosis and aggressive initiation of blood pressure and pain control to prevent subsequent complications. Early time to diagnosis and intervention are associated with improved outcomes. CONCLUSIONS A multidisciplinary team can help promptly diagnose and manage aortic syndromes.
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Affiliation(s)
- Christopher K Mehta
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America.
| | - Andre Y Son
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America
| | - Matthew C Chia
- Division of Vascular Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America
| | - Ashley N Budd
- Department of Anesthesiology, Northwestern Medicine, Chicago, IL, United States of America
| | - Bradley D Allen
- Department of Radiology, Northwestern Medicine, Chicago, IL, United States of America
| | - Patricia Vassallo
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America
| | - Andrew W Hoel
- Division of Vascular Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America
| | - William J Brady
- Departments of Emergency Medicine and Internal Medicine, University of Virginia, Charlottesville, VA, United States of America
| | - Jose V Nable
- Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington D.C., United States of America
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Vogt JT, Allen BD, Paulsen D, Trout Fryxell RT. A Unique Academic-Government Collaboration Yields First Report of Detailed Habitat Description for Haemaphysalis longicornis (Ixodida: Ixodidae) in Madison County, KY. J Med Entomol 2021; 58:1970-1972. [PMID: 33837420 DOI: 10.1093/jme/tjab061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Indexed: 06/12/2023]
Abstract
Haemaphysalis longicornis Neumann, Asian longhorned tick, was collected in Madison County, Kentucky, United States as part of an ongoing collaborative-tick surveillance project. This is the first collection of this invasive tick that includes ancillary data on habitat and landscape features derived from the USDA Forest Service, Forest Inventory and Analysis program.
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Affiliation(s)
- J T Vogt
- USDA Forest Service, Southern Research Station, 320 E. Green Street, Athens, GA 30602, USA
| | - B D Allen
- USDA Forest Service, Southern Research Station, 4700 Old Kingston Pike, Knoxville, TN 37919, USA
| | - D Paulsen
- Department of Entomology and Plant Pathology, 2505, 370 E J. Chapman Drive Plant Biotechnology Building, Knoxville, TN 37996, USA
| | - R T Trout Fryxell
- Department of Entomology and Plant Pathology, 2505, 370 E J. Chapman Drive Plant Biotechnology Building, Knoxville, TN 37996, USA
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30
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Zilber ZA, Boddu A, Malaisrie SC, Hoel AW, Mehta CK, Vassallo P, Burris NS, Roldán-Alzate A, Collins JD, François CJ, Allen BD. Noninvasive Morphologic and Hemodynamic Evaluation of Type B Aortic Dissection: State of the Art and Future Perspectives. Radiol Cardiothorac Imaging 2021; 3:e200456. [PMID: 34235440 DOI: 10.1148/ryct.2021200456] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/21/2022]
Abstract
Stanford type B aortic dissection (TBAD) is associated with relatively high rates of morbidity and mortality, and appropriate treatment selection is important for optimizing patient outcomes. Depending on individualized risk factors, clinical presentation, and imaging findings, patients are generally stratified to optimal medical therapy anchored by antihypertensives or thoracic endovascular aortic repair (TEVAR). Using standard anatomic imaging with CT or MRI, several high-risk features including aortic diameter, false lumen (FL) features, size of entry tears, involvement of major aortic branch vessels, or evidence of visceral malperfusion have been used to select patients likely to benefit from TEVAR. However, even with these measures, the number needed to treat for TEVAR remains, and improved risk stratification is needed. Increasingly, the relationship between FL hemodynamics and adverse aortic remodeling in TBAD has been studied, and evolving noninvasive techniques can measure numerous FL hemodynamic parameters that may improve risk stratification. In addition to summarizing the current clinical state of the art for morphologic TBAD evaluation, this review provides a detailed overview of noninvasive methods for TBAD hemodynamics characterization, including computational fluid dynamics and four-dimensional flow MRI. Keywords: CT, Image Postprocessing, MRI, Cardiac, Vascular, Aorta, Dissection © RSNA, 2021.
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Affiliation(s)
- Zachary A Zilber
- Department of Radiology (Z.A.Z., A.B., B.D.A.), Department of Surgery-Division of Cardiac Surgery (S.C.M., C.K.M.), Department of Surgery-Division of Vascular Surgery (A.W.H.), and Department of Medicine-Division of Cardiology (P.V.), Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, University of Michigan, Ann Arbor, Mich (N.S.B.); Departments of Mechanical Engineering and Radiology, University of Wisconsin-Madison, Madison, Wis (A.R.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C., C.J.F.)
| | - Aayush Boddu
- Department of Radiology (Z.A.Z., A.B., B.D.A.), Department of Surgery-Division of Cardiac Surgery (S.C.M., C.K.M.), Department of Surgery-Division of Vascular Surgery (A.W.H.), and Department of Medicine-Division of Cardiology (P.V.), Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, University of Michigan, Ann Arbor, Mich (N.S.B.); Departments of Mechanical Engineering and Radiology, University of Wisconsin-Madison, Madison, Wis (A.R.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C., C.J.F.)
| | - S Chris Malaisrie
- Department of Radiology (Z.A.Z., A.B., B.D.A.), Department of Surgery-Division of Cardiac Surgery (S.C.M., C.K.M.), Department of Surgery-Division of Vascular Surgery (A.W.H.), and Department of Medicine-Division of Cardiology (P.V.), Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, University of Michigan, Ann Arbor, Mich (N.S.B.); Departments of Mechanical Engineering and Radiology, University of Wisconsin-Madison, Madison, Wis (A.R.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C., C.J.F.)
| | - Andrew W Hoel
- Department of Radiology (Z.A.Z., A.B., B.D.A.), Department of Surgery-Division of Cardiac Surgery (S.C.M., C.K.M.), Department of Surgery-Division of Vascular Surgery (A.W.H.), and Department of Medicine-Division of Cardiology (P.V.), Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, University of Michigan, Ann Arbor, Mich (N.S.B.); Departments of Mechanical Engineering and Radiology, University of Wisconsin-Madison, Madison, Wis (A.R.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C., C.J.F.)
| | - Christopher K Mehta
- Department of Radiology (Z.A.Z., A.B., B.D.A.), Department of Surgery-Division of Cardiac Surgery (S.C.M., C.K.M.), Department of Surgery-Division of Vascular Surgery (A.W.H.), and Department of Medicine-Division of Cardiology (P.V.), Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, University of Michigan, Ann Arbor, Mich (N.S.B.); Departments of Mechanical Engineering and Radiology, University of Wisconsin-Madison, Madison, Wis (A.R.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C., C.J.F.)
| | - Patricia Vassallo
- Department of Radiology (Z.A.Z., A.B., B.D.A.), Department of Surgery-Division of Cardiac Surgery (S.C.M., C.K.M.), Department of Surgery-Division of Vascular Surgery (A.W.H.), and Department of Medicine-Division of Cardiology (P.V.), Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, University of Michigan, Ann Arbor, Mich (N.S.B.); Departments of Mechanical Engineering and Radiology, University of Wisconsin-Madison, Madison, Wis (A.R.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C., C.J.F.)
| | - Nicholas S Burris
- Department of Radiology (Z.A.Z., A.B., B.D.A.), Department of Surgery-Division of Cardiac Surgery (S.C.M., C.K.M.), Department of Surgery-Division of Vascular Surgery (A.W.H.), and Department of Medicine-Division of Cardiology (P.V.), Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, University of Michigan, Ann Arbor, Mich (N.S.B.); Departments of Mechanical Engineering and Radiology, University of Wisconsin-Madison, Madison, Wis (A.R.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C., C.J.F.)
| | - Alejandro Roldán-Alzate
- Department of Radiology (Z.A.Z., A.B., B.D.A.), Department of Surgery-Division of Cardiac Surgery (S.C.M., C.K.M.), Department of Surgery-Division of Vascular Surgery (A.W.H.), and Department of Medicine-Division of Cardiology (P.V.), Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, University of Michigan, Ann Arbor, Mich (N.S.B.); Departments of Mechanical Engineering and Radiology, University of Wisconsin-Madison, Madison, Wis (A.R.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C., C.J.F.)
| | - Jeremy D Collins
- Department of Radiology (Z.A.Z., A.B., B.D.A.), Department of Surgery-Division of Cardiac Surgery (S.C.M., C.K.M.), Department of Surgery-Division of Vascular Surgery (A.W.H.), and Department of Medicine-Division of Cardiology (P.V.), Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, University of Michigan, Ann Arbor, Mich (N.S.B.); Departments of Mechanical Engineering and Radiology, University of Wisconsin-Madison, Madison, Wis (A.R.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C., C.J.F.)
| | - Christopher J François
- Department of Radiology (Z.A.Z., A.B., B.D.A.), Department of Surgery-Division of Cardiac Surgery (S.C.M., C.K.M.), Department of Surgery-Division of Vascular Surgery (A.W.H.), and Department of Medicine-Division of Cardiology (P.V.), Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, University of Michigan, Ann Arbor, Mich (N.S.B.); Departments of Mechanical Engineering and Radiology, University of Wisconsin-Madison, Madison, Wis (A.R.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C., C.J.F.)
| | - Bradley D Allen
- Department of Radiology (Z.A.Z., A.B., B.D.A.), Department of Surgery-Division of Cardiac Surgery (S.C.M., C.K.M.), Department of Surgery-Division of Vascular Surgery (A.W.H.), and Department of Medicine-Division of Cardiology (P.V.), Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, University of Michigan, Ann Arbor, Mich (N.S.B.); Departments of Mechanical Engineering and Radiology, University of Wisconsin-Madison, Madison, Wis (A.R.A.); and Department of Radiology, Mayo Clinic, Rochester, Minn (J.D.C., C.J.F.)
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31
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Abstract
For years, magnetic resonance angiography (MRA) has been a leading imaging modality in the assessment of venous disease involving the pelvis and lower extremities. Current advancement in noncontrast MRA techniques enables imaging of a larger subset of patients previously excluded due to allergy or renal insufficiency, allowing for preintervention assessment and planning. In this article, the current status of MR venography, with a focus on current advancements, will be presented. Protocols and parameters for MR venographic imaging of the pelvis and lower extremities, including contrast and noncontrast enhanced techniques, will be reviewed based on a recent literature review of applied MR venographic techniques. Finally, several disease-specific entities, including pelvic congestion and compression syndromes, will be discussed with a focus on imaging parameters that may best characterize these disease processes and optimize anatomical planning prior to intervention.
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Affiliation(s)
- Pamela Lombardi
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - James C Carr
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Robert R Edelman
- Department of Radiology, NorthShore University HealthSystem, Chicago, Illinois
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32
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Wehbe RM, Sheng J, Dutta S, Chai S, Dravid A, Barutcu S, Wu Y, Cantrell DR, Xiao N, Allen BD, MacNealy GA, Savas H, Agrawal R, Parekh N, Katsaggelos AK. DeepCOVID-XR: An Artificial Intelligence Algorithm to Detect COVID-19 on Chest Radiographs Trained and Tested on a Large U.S. Clinical Data Set. Radiology 2021; 299:E167-E176. [PMID: 33231531 PMCID: PMC7993244 DOI: 10.1148/radiol.2020203511] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 12/23/2022]
Abstract
Background There are characteristic findings of coronavirus disease 2019 (COVID-19) on chest images. An artificial intelligence (AI) algorithm to detect COVID-19 on chest radiographs might be useful for triage or infection control within a hospital setting, but prior reports have been limited by small data sets, poor data quality, or both. Purpose To present DeepCOVID-XR, a deep learning AI algorithm to detect COVID-19 on chest radiographs, that was trained and tested on a large clinical data set. Materials and Methods DeepCOVID-XR is an ensemble of convolutional neural networks developed to detect COVID-19 on frontal chest radiographs, with reverse-transcription polymerase chain reaction test results as the reference standard. The algorithm was trained and validated on 14 788 images (4253 positive for COVID-19) from sites across the Northwestern Memorial Health Care System from February 2020 to April 2020 and was then tested on 2214 images (1192 positive for COVID-19) from a single hold-out institution. Performance of the algorithm was compared with interpretations from five experienced thoracic radiologists on 300 random test images using the McNemar test for sensitivity and specificity and the DeLong test for the area under the receiver operating characteristic curve (AUC). Results A total of 5853 patients (mean age, 58 years ± 19 [standard deviation]; 3101 women) were evaluated across data sets. For the entire test set, accuracy of DeepCOVID-XR was 83%, with an AUC of 0.90. For 300 random test images (134 positive for COVID-19), accuracy of DeepCOVID-XR was 82%, compared with that of individual radiologists (range, 76%-81%) and the consensus of all five radiologists (81%). DeepCOVID-XR had a significantly higher sensitivity (71%) than one radiologist (60%, P < .001) and significantly higher specificity (92%) than two radiologists (75%, P < .001; 84%, P = .009). AUC of DeepCOVID-XR was 0.88 compared with the consensus AUC of 0.85 (P = .13 for comparison). With consensus interpretation as the reference standard, the AUC of DeepCOVID-XR was 0.95 (95% CI: 0.92, 0.98). Conclusion DeepCOVID-XR, an artificial intelligence algorithm, detected coronavirus disease 2019 on chest radiographs with a performance similar to that of experienced thoracic radiologists in consensus. © RSNA, 2020 Supplemental material is available for this article. See also the editorial by van Ginneken in this issue.
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Affiliation(s)
- Ramsey M. Wehbe
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
| | - Jiayue Sheng
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
| | - Shinjan Dutta
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
| | - Siyuan Chai
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
| | - Amil Dravid
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
| | - Semih Barutcu
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
| | - Yunan Wu
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
| | - Donald R. Cantrell
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
| | - Nicholas Xiao
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
| | - Bradley D. Allen
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
| | - Gregory A. MacNealy
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
| | - Hatice Savas
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
| | - Rishi Agrawal
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
| | - Nishant Parekh
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
| | - Aggelos K. Katsaggelos
- From the Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute (R.M.W.), Division of Neurointerventional Radiology (D.R.C.), Division of Interventional Radiology (N.X.), and Division of Thoracic Imaging (B.D.A., G.A.M., H.S., R.A., N.P.), Department of Radiology, Northwestern Memorial Hospital, 676 N St Clair St, Chicago, IL 60611; and Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (J.S., S.D., S.C., A.D., S.B., Y.W., A.K.K.)
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Fan L, Allen BD, Culver AE, Hsu LY, Hong K, Benefield BC, Carr JC, Lee DC, Kim D. A theoretical framework for retrospective T 2 ∗ correction to the arterial input function in quantitative myocardial perfusion MRI. Magn Reson Med 2021; 86:1137-1144. [PMID: 33759238 DOI: 10.1002/mrm.28760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE To develop and evaluate a flexible, Bloch-equation based framework for retrospective T 2 ∗ correction to the arterial input function (AIF) obtained with quantitative cardiac perfusion pulse sequences. METHODS Our framework initially calculates the gadolinium concentration [Gd] based on T1 measurements alone. Next, T 2 ∗ is estimated from this initial calculation of [Gd] while assuming fast water exchange and using the literature native T2 and static magnetic field variation (ΔB0 ) values. Finally, the [Gd] is recalculated after performing T 2 ∗ correction to the Bloch equation signal model. Using this approach, we performed T 2 ∗ correction to historical phantom and in vivo, dual-imaging perfusion data sets from 3 different patient groups obtained using different pulse sequences and imaging parameters. Images were processed to quantify both the AIF and resting myocardial blood flow (MBF). We also performed a sensitivity analysis of our T 2 ∗ correction to ±20% variations in native T2 and ΔB0 . RESULTS Compared with the ground truth [Gd] of phantom, the normalized root-means-square-error (NRMSE) in measured [Gd] was 5.1%, 1.3%, and 0.6% for uncorrected, our corrected, and Kellman's corrected, respectively. For in vivo data, both the peak AIF (7.0 ± 3.0 mM vs. 8.6 ± 7.1 mM, 7.2 ± 0.9 mM vs. 8.6 ± 1.7 mM, 7.7 ± 1.8 mM vs. 10.3 ± 5.1 mM, P < .001) and resting MBF (1.3 ± 0.1 mL/g/min vs. 1.1 ± 0.1 mL/g/min, 1.3 ± 0.1 mL/g/min vs. 1.1 ± 0.1 mL/g/min, 1.2 ± 0.1 mL/g/min vs. 0.9 ± 0.1 mL/g/min, P < .001) values were significantly different between uncorrected and corrected for all 3 patient groups. Both the peak AIF and resting MBF values varied by <5% over the said variations in native T2 and ΔB0 . CONCLUSION Our theoretical framework enables retrospective T 2 ∗ correction to the AIF obtained with dual-imaging, cardiac perfusion pulse sequences.
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Affiliation(s)
- Lexiaozi Fan
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Austin E Culver
- Division of Cardiology, Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Li-Yueh Hsu
- Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Kyungpyo Hong
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brandon C Benefield
- Division of Cardiology, Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel C Lee
- Division of Cardiology, Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
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Xiao N, Cooper JG, Godbe JM, Bechel MA, Scott MB, Nguyen E, McCarthy DM, Abboud S, Allen BD, Parekh ND. Chest radiograph at admission predicts early intubation among inpatient COVID-19 patients. Eur Radiol 2020; 31:2825-2832. [PMID: 33051736 PMCID: PMC7553374 DOI: 10.1007/s00330-020-07354-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/14/2020] [Accepted: 09/24/2020] [Indexed: 02/07/2023]
Abstract
Objective The 2019 Coronavirus (COVID-19) results in a wide range of clinical severity and there remains a need for prognostic tools which identify patients at risk of rapid deterioration and who require critical care. Chest radiography (CXR) is routinely obtained at admission of COVID-19 patients. However, little is known regarding correlates between CXR severity and time to intubation. We hypothesize that the degree of opacification on CXR at time of admission independently predicts need and time to intubation. Methods In this retrospective cohort study, we reviewed COVID-19 patients who were admitted to an urban medical center during March 2020 that had a CXR performed on the day of admission. CXRs were divided into 12 lung zones and were assessed by two blinded thoracic radiologists. A COVID-19 opacification rating score (CORS) was generated by assigning one point for each lung zone in which an opacity was observed. Underlying comorbidities were abstracted and assessed for association. Results One hundred forty patients were included in this study and 47 (34%) patients required intubation during the admission. Patients with CORS ≥ 6 demonstrated significantly higher rates of early intubation within 48 h of admission and during the hospital stay (ORs 24 h, 19.8, p < 0.001; 48 h, 28.1, p < 0.001; intubation during hospital stay, 6.1, p < 0.0001). There was no significant correlation between CORS ≥ 6 and age, sex, BMI, or any underlying cardiac or pulmonary comorbidities. Conclusions CORS ≥ 6 at the time of admission predicts need for intubation, with significant increases in intubation at 24 and 48 h, independent of comorbidities. Key Points • Chest radiography at the time of admission independently predicts time to intubation within 48 h and during the hospital stay in COVID-19 patients. • More opacities on chest radiography are associated with several fold increases in early mechanical ventilation among COVID-19 patients. • Chest radiography is useful in identifying COVID-19 patients whom may rapidly deteriorate and help inform clinical management as well as hospital bed and ventilation allocation. Electronic supplementary material The online version of this article (10.1007/s00330-020-07354-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicholas Xiao
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA. .,Division of Vascular and Interventional, Department of Radiology, 676 N. St. Clair, Suite 800, Chicago, IL, USA.
| | - John G Cooper
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Jacqueline M Godbe
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Meagan A Bechel
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Michael B Scott
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Edward Nguyen
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | | | - Samir Abboud
- Department of Radiology, Division of Emergency Radiology, Northwestern University, Chicago, IL, USA
| | - Bradley D Allen
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Nishant D Parekh
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
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35
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Allen BD, Wong TC, Bucciarelli-Ducci C, Bryant J, Chen T, Dall'Armellina E, Finn JP, Fontana M, Francone M, Han Y, Hays AG, Jacob R, Lawton C, Manning WJ, Ordovas K, Parwani P, Plein S, Powell AJ, Raman SV, Salerno M, Carr JC. Society for Cardiovascular Magnetic Resonance (SCMR) guidance for re-activation of cardiovascular magnetic resonance practice after peak phase of the COVID-19 pandemic. J Cardiovasc Magn Reson 2020; 22:58. [PMID: 32772930 PMCID: PMC7415346 DOI: 10.1186/s12968-020-00654-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/12/2020] [Indexed: 12/23/2022] Open
Abstract
During the peak phase of the COVID-19 pandemic, alterations of standard operating procedures were necessary for health systems to protect patients and healthcare workers and ensure access to vital hospital resources. As the peak phase passes, re-activation plans are required to safely manage increasing clinical volumes. In the context of cardiovascular magnetic resonance (CMR), re-activation objectives include continued performance of urgent CMR studies and resumption of CMR in patients with semi-urgent and elective indications in an environment that is safe for both patients and health care workers.
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Affiliation(s)
- Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Timothy C Wong
- Department of Medicine (Cardiology), University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Biomedical Research Centre, University Hospitals Bristol and University of Bristol, Bristol, UK
| | - Jennifer Bryant
- National Heart Research Institute Singapore, National Heart Center Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Tiffany Chen
- Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Erica Dall'Armellina
- Leeds Institute of Cardiovascular and Metabolic Medicine, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - J Paul Finn
- Departments of Radiology and Medicine, UCLA, Los Angeles, California, USA
| | | | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Yuchi Han
- Departments of Medicine (Cardiovascular Division) and Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Allison G Hays
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ron Jacob
- The Heart and Vascular Institute, Lancaster General Health/PENN Medicine, Lancaster, PA, USA
| | - Chris Lawton
- Bristol Heart Institute, Bristol NIHR Biomedical Research Centre, University Hospitals Bristol and University of Bristol, Bristol, UK
| | - Warren J Manning
- Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Karen Ordovas
- Departments of Radiology and Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Purvi Parwani
- Department of Medicine (Cardiology), Loma Linda University, Loma Linda, California, USA
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael Salerno
- Departments of Medicine, Radiology, and Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
Pulmonary vascular assessment commonly relies on computed tomography angiography (CTA), but continued advances in magnetic resonance angiography have allowed pulmonary magnetic resonance angiography (pMRA) to become a reasonable alternative to CTA without exposing patients to ionizing radiation. pMRA allows the evaluation of pulmonary vascular anatomy, hemodynamic physiology, lung parenchymal perfusion, and (optionally) right and left ventricular function with a single examination. This article discusses pMRA techniques and artifacts; performance in commonly encountered pulmonary vascular diseases, specifically pulmonary embolism and pulmonary hypertension; and recent advances in both contrast-enhanced and noncontrast pMRA.
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Affiliation(s)
- Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611, USA.
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA
| | - Christopher J François
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA
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Allen BD, Zhang Z, Naresh NK, Misener S, Procissi D, Carr JC. Slow-Release Doxorubicin Pellets Generate Myocardial Cardiotoxic Changes in Mice Without Significant Systemic Toxicity. Cardiovasc Toxicol 2020; 19:482-484. [PMID: 31028602 DOI: 10.1007/s12012-019-09521-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An increasing volume of pre-clinical and clinical-translational research is attempting to identify novel biomarkers for improved diagnosis and risk-stratification of chemotherapy-induced cardiotoxicity. Most published animal models have employed weekly intraperitoneal injections of doxorubicin to reach a desired cumulative dose. This approach can be associated with severe systemic toxicity which limits the animal model usefulness, particularly for advanced imaging. In the current study, slow-release subcutaneous doxorubicin pellets demonstrated histopathologic evidence of cardiotoxicity at doses similar to standard human dose-equivalents without limiting animal survival or ability to participate in advanced imaging studies. This approach may provide a more robust cardiotoxicity animal model.
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Affiliation(s)
- Bradley D Allen
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Suite 1600, Chicago, IL, 60611, USA.
| | - Zhuoli Zhang
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Suite 1600, Chicago, IL, 60611, USA
| | - Nivedita K Naresh
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Suite 1600, Chicago, IL, 60611, USA
| | - Sol Misener
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Suite 1600, Chicago, IL, 60611, USA
| | - Daniele Procissi
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Suite 1600, Chicago, IL, 60611, USA
| | - James C Carr
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Suite 1600, Chicago, IL, 60611, USA
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38
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Pruijssen JT, Allen BD, Barker AJ, Bonow RO, Choudhury L, Carr JC, Markl M, van Ooij P. Hypertrophic Cardiomyopathy Is Associated with Altered Left Ventricular 3D Blood Flow Dynamics. Radiol Cardiothorac Imaging 2020; 2:e190038. [PMID: 33778534 DOI: 10.1148/ryct.2020190038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/28/2019] [Accepted: 09/16/2019] [Indexed: 11/11/2022]
Abstract
Purpose To employ four-dimensional (4D) flow MRI to investigate associations between hemodynamic parameters with systolic anterior motion (SAM), mitral regurgitation (MR), stroke volume, and cardiac mass in patients with hypertrophic cardiomyopathy (HCM). Materials and Methods A total of 13 patients with HCM (51 years ± 16 [standard deviation]; 10 men) and 11 age-matched healthy control subjects (54 years ± 15; eight men) underwent cardiac 4D flow MRI data analysis including calculation of peak systolic and diastolic control-averaged left ventricular (LV) velocity maps to quantify volumes of elevated velocity (EVV) in the left ventricle. Standard-of-care cine imaging was performed in short-axis, LV outflow tract (LVOT), and two-, three-, and four-chamber views on which the presence of SAM, presence of MR, total stroke volume, and cardiac mass were assessed. Results Systolic EVV in patients with HCM was 7 mL ± 5, which was significantly associated with elevated aortic peak velocity (R = 0.87; P < .001), decreased LVOT diameter (R = 0.68; P = .01), and increased cardiac mass (R = 0.62; P = .02). In addition, EVV differed significantly between patients with and those without SAM (10 mL ± 4.7 vs 3 mL ± 2.3; P = .03) and those with and those without MR (9.9 mL ± 4.8 vs 4.0 mL ± 3.2; P < .05). In the atrial systolic phase, peak diastolic velocity in the LV correlated with septal thickness (R = 0.66; P = .01). Conclusion Quantification and visualization of EVV in the LV is feasible and may provide further insight into the clinical manifestations of altered hemodynamics in HCM.© RSNA, 2020.
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Affiliation(s)
- Judith T Pruijssen
- Department of Biomedical Engineering and Physics (J.T.P.) and Department of Radiology & Nuclear Medicine (P.v.O.), Academic Medical Center, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology (B.D.A., J.C.C., M.M.), Department of Medicine-Cardiology (R.O.B., L.C.), and Department of Biomedical Engineering (M.M.), Northwestern University, Chicago, Ill; and Department of Radiology & Bioengineering, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Denver, Colo (A.J.B.)
| | - Bradley D Allen
- Department of Biomedical Engineering and Physics (J.T.P.) and Department of Radiology & Nuclear Medicine (P.v.O.), Academic Medical Center, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology (B.D.A., J.C.C., M.M.), Department of Medicine-Cardiology (R.O.B., L.C.), and Department of Biomedical Engineering (M.M.), Northwestern University, Chicago, Ill; and Department of Radiology & Bioengineering, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Denver, Colo (A.J.B.)
| | - Alex J Barker
- Department of Biomedical Engineering and Physics (J.T.P.) and Department of Radiology & Nuclear Medicine (P.v.O.), Academic Medical Center, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology (B.D.A., J.C.C., M.M.), Department of Medicine-Cardiology (R.O.B., L.C.), and Department of Biomedical Engineering (M.M.), Northwestern University, Chicago, Ill; and Department of Radiology & Bioengineering, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Denver, Colo (A.J.B.)
| | - Robert O Bonow
- Department of Biomedical Engineering and Physics (J.T.P.) and Department of Radiology & Nuclear Medicine (P.v.O.), Academic Medical Center, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology (B.D.A., J.C.C., M.M.), Department of Medicine-Cardiology (R.O.B., L.C.), and Department of Biomedical Engineering (M.M.), Northwestern University, Chicago, Ill; and Department of Radiology & Bioengineering, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Denver, Colo (A.J.B.)
| | - Lubna Choudhury
- Department of Biomedical Engineering and Physics (J.T.P.) and Department of Radiology & Nuclear Medicine (P.v.O.), Academic Medical Center, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology (B.D.A., J.C.C., M.M.), Department of Medicine-Cardiology (R.O.B., L.C.), and Department of Biomedical Engineering (M.M.), Northwestern University, Chicago, Ill; and Department of Radiology & Bioengineering, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Denver, Colo (A.J.B.)
| | - James C Carr
- Department of Biomedical Engineering and Physics (J.T.P.) and Department of Radiology & Nuclear Medicine (P.v.O.), Academic Medical Center, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology (B.D.A., J.C.C., M.M.), Department of Medicine-Cardiology (R.O.B., L.C.), and Department of Biomedical Engineering (M.M.), Northwestern University, Chicago, Ill; and Department of Radiology & Bioengineering, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Denver, Colo (A.J.B.)
| | - Michael Markl
- Department of Biomedical Engineering and Physics (J.T.P.) and Department of Radiology & Nuclear Medicine (P.v.O.), Academic Medical Center, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology (B.D.A., J.C.C., M.M.), Department of Medicine-Cardiology (R.O.B., L.C.), and Department of Biomedical Engineering (M.M.), Northwestern University, Chicago, Ill; and Department of Radiology & Bioengineering, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Denver, Colo (A.J.B.)
| | - Pim van Ooij
- Department of Biomedical Engineering and Physics (J.T.P.) and Department of Radiology & Nuclear Medicine (P.v.O.), Academic Medical Center, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology (B.D.A., J.C.C., M.M.), Department of Medicine-Cardiology (R.O.B., L.C.), and Department of Biomedical Engineering (M.M.), Northwestern University, Chicago, Ill; and Department of Radiology & Bioengineering, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Denver, Colo (A.J.B.)
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Jarvis K, Pruijssen JT, Son AY, Allen BD, Soulat G, Vali A, Barker AJ, Hoel AW, Eskandari MK, Malaisrie SC, Carr JC, Collins JD, Markl M. Parametric Hemodynamic 4D Flow MRI Maps for the Characterization of Chronic Thoracic Descending Aortic Dissection. J Magn Reson Imaging 2019; 51:1357-1368. [PMID: 31714648 DOI: 10.1002/jmri.26986] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Systematic evaluation of complex flow in the true lumen and false lumen (TL, FL) is needed to better understand which patients with chronic descending aortic dissection (DAD) are predisposed to complications. PURPOSE To develop quantitative hemodynamic maps from 4D flow MRI for evaluating TL and FL flow characteristics. STUDY TYPE Retrospective. POPULATION In all, 20 DAD patients (age = 60 ± 11 years; 12 male) (six medically managed type B AD [TBAD], 14 repaired type A AD [rTAAD] now with ascending aortic graft [AAo] or elephant trunk [ET1] repair) and 21 age-matched controls (age = 59 ± 10 years; 13 male) were included. FIELD STRENGTH/SEQUENCE 1.5T, 3T, 4D flow MRI. ASSESSMENT 4D flow MRI was acquired in all subjects. Data analysis included 3D segmentation of TL and FL and voxelwise calculation of forward flow, reverse flow, flow stasis, and kinetic energy as quantitative hemodynamics maps. STATISTICAL TESTS Analysis of variance (ANOVA) or Kruskal-Wallis tests were performed for comparing subject groups. Correlation and Bland-Altman analysis was performed for the interobserver study. RESULTS Patients with rTAAD presented with elevated TL reverse flow (AAo repair: P = 0.004, ET1: P = 0.018) and increased TL kinetic energy (AAo repair: P = 0.0002, ET1: P = 0.011) compared to controls. In addition, TL kinetic energy was increased vs. patients with TBAD (AAo repair: P = 0.021, ET1: P = 0.048). rTAAD was associated with higher FL kinetic energy and lower FL stasis compared to patients with TBAD (AAo repair: P = 0.002, ET1: P = 0.024 and AAo repair: P = 0.003, ET1: P = 0.048, respectively). DATA CONCLUSION Quantitative maps from 4D flow MRI demonstrated global and regional hemodynamic differences between DAD patients and controls. Patients with rTAAD vs. TBAD had significantly altered regional TL and FL hemodynamics. These findings indicate the potential of 4D flow MRI-derived hemodynamic maps to help better evaluate patients with DAD. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2020;51:1357-1368.
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Affiliation(s)
- Kelly Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Judith T Pruijssen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Andre Y Son
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Gilles Soulat
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alireza Vali
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology, University of Colorado, Denver, Colorado, USA
| | - Andrew W Hoel
- Division of Vascular Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mark K Eskandari
- Division of Vascular Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James C Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Allen BD, Aouad PJ, Burris NS, Rahsepar AA, Jarvis KB, Francois CJ, Barker AJ, Malaisrie SC, Carr JC, Collins JD, Markl M. Detection and Hemodynamic Evaluation of Flap Fenestrations in Type B Aortic Dissection with 4D Flow MRI: Comparison with Conventional MRI and CTA. Radiol Cardiothorac Imaging 2019; 1. [PMID: 31598608 DOI: 10.1148/ryct.2019180009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose The purpose of this study was to compare dissection flap fenestration visualization between 4D flow MRI, clinical MRI/MRA, and clinical CTA studies and describe the presence of hemodynamically active fenestration flow using 4D flow. Materials and Methods Nineteen patients with type B dissection (age: 57±5 years) who had undergone standard of-care MRI/MRA of the chest including 4D flow MRI were retrospectively identified. Fourteen of the 19 patients also had CTA performed within 2 years of the MRI/MRA study with no interval surgery. Image review was performed independently by two radiologists. The number of fenestrations (including entry and exit tears), location, and flow directionality were recorded. Differences in the rate of detection between techniques was assessed using a Wilcoxon signed rank test. Results 4D flow detected more fenestrations relative to MRI/MRA [rev 1: +3 (10%), rev 2: +5 (20%)]. There were similar numbers of fenestrations detected by 4D flow relative to CTA [rev 1: +1 (4%), rev 2: -3 (-12%)]. MRI/MRA detected fewer fenestration relative to CTA in this cohort [rev 1: -6 (-24%), rev 2: -5 (-19%)]. No differences were significant. Combining 4D flow and MRI/MRA resulted in additional fenestration detection. Most fenestrations demonstrated biphasic flow over the cardiac cycle (flow entering false lumen in systole and exiting during diastole, rev 1:18/33, rev 2: 16/30). Conclusions 4D flow MRI can detect small flap fenestration in type B dissection patients while providing additional information about flow through fenestrations throughout the cardiac cycle relative to CTA and conventional MRI.
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Affiliation(s)
- Bradley D Allen
- Radiology, Northwestern University, Chicago, IL USA.,Radiology, University of Wisconsin, Madison, WI USA
| | | | | | | | | | | | | | | | - James C Carr
- Radiology, Northwestern University, Chicago, IL USA
| | | | - Michael Markl
- Radiology, Northwestern University, Chicago, IL USA.,Biomedical Engineering, Northwestern University, Chicago, IL USA
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Brown MR, Baptista JC, Lunn M, Swan DL, Smith SJ, Davenport RJ, Allen BD, Sloan WT, Curtis TP. Coupled virus - bacteria interactions and ecosystem function in an engineered microbial system. Water Res 2019; 152:264-273. [PMID: 30682570 DOI: 10.1016/j.watres.2019.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 06/09/2023]
Abstract
Viruses are thought to control bacterial abundance, affect community composition and influence ecosystem function in natural environments. Yet their dynamics have seldom been studied in engineered systems, or indeed in any system, for long periods of time. We measured virus abundance in a full-scale activated sludge plant every week for two years. Total bacteria and ammonia oxidising bacteria (AOB) abundances, bacterial community profiles, and a suite of environmental and operational parameters were also monitored. Mixed liquor virus abundance fluctuated over an order of magnitude (3.18 × 108-3.41 × 109 virus's mL-1) and that variation was statistically significantly associated with total bacterial and AOB abundance, community composition, and effluent concentrations of COD and NH4+- N and thus system function. This suggests viruses play a far more important role in the dynamics of activated sludge systems than previously realised and could be one of the key factors controlling bacterial abundance, community structure and functional stability and may cause reactors to fail. These findings are based on statistical associations, not mechanistic models. Nevertheless, viral associations with abiotic factors, such as pH, make physical sense, giving credence to these findings and highlighting the role that physical factors play in virus ecology. Further work is needed to identify and quantify specific bacteriophage and their hosts to enable us to develop mechanistic models of the ecology of viruses in wastewater treatment systems. However, since we have shown that viruses can be related to effluent quality and virus quantification is simple and cheap, practitioners would probably benefit from quantifying viruses now.
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Affiliation(s)
- M R Brown
- School of Engineering, Newcastle University, NE1 7RU, UK.
| | - J C Baptista
- School of Engineering, Newcastle University, NE1 7RU, UK
| | - M Lunn
- Department of Statistics, University of Oxford, OX1 3TG, UK
| | - D L Swan
- School of Engineering, Newcastle University, NE1 7RU, UK
| | - S J Smith
- School of Engineering, Newcastle University, NE1 7RU, UK
| | - R J Davenport
- School of Engineering, Newcastle University, NE1 7RU, UK
| | - B D Allen
- School of Engineering, Newcastle University, NE1 7RU, UK
| | - W T Sloan
- Department of Civil Engineering, University of Glasgow, G12 8LT, UK
| | - T P Curtis
- School of Engineering, Newcastle University, NE1 7RU, UK
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Rose MJ, Jarvis KB, Barker AJ, Schnell S, Allen BD, Robinson JD, Markl M, Rigsby CK. Evaluating the disease progression of pediatric bicuspid aortic valve patients using 4D flow MRI data. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032329 DOI: 10.1186/1532-429x-18-s1-p170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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43
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Keller EJ, Smith PM, Freed B, Allen BD, Spottiswoode BS, Carr ML, Jolly MP, Lin K, Carr JC, Collins JD. Comparison of derived strain values of myocardial regions, levels, and segments by field strength and temporal resolution via cine bSSFP MR imaging. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032394 DOI: 10.1186/1532-429x-18-s1-q16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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44
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Bogachkov A, Ayache JB, Allen BD, Murphy IG, Carr ML, Schmidt M, Zenge MO, Carr JC, Collins JD. Right-ventricular assessment using a segmented cine acquisition employing iterative SENSE reconstruction with spatio-temporal L1 regularization: Initial clinical experience. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032061 DOI: 10.1186/1532-429x-18-s1-w18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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45
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Rose MJ, Jarvis K, Chowdhary V, Barker AJ, Allen BD, Robinson JD, Markl M, Rigsby CK, Schnell S. Efficient method for volumetric assessment of peak blood flow velocity using 4D flow MRI. J Magn Reson Imaging 2016; 44:1673-1682. [PMID: 27192153 DOI: 10.1002/jmri.25305] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To test the feasibility and effectiveness of using maximum intensity plots (MIPs) based on 4D flow magnetic resonance imaging (MRI) velocity data to assess systolic peak velocities in a cohort of bicuspid aortic valve (BAV) patients. MATERIALS AND METHODS 4D flow MRI at 1.5T was performed on 51 BAV patients. MIPs were generated from the 4D flow MRI velocity data and used by two users to determine peak velocities in three regions of interest (ROIs): ascending aorta (AAo), aortic arch, and descending aorta. 4D flow MRI peak velocities in the AAo were compared to peak velocities recorded by 2D phase contrast MRI (2D PCMRI) in a subcohort of 36 patients and by Doppler echocardiography in a subcohort of 34 patients. 4D flow MRI peak velocities recorded by each observer were compared for all ROIs to test for interobserver variability. RESULTS 4D flow MRI recorded significantly higher velocities compared to 2D PCMRI (2.04 ± 0.71 m/s vs. 1.69 ± 0.79 m/s, 17.2% difference, P < 0.001) and similar velocities compared to Doppler echocardiography. There was excellent agreement between the observers, with a mean difference of 0.005 m/s and an intraclass correlation coefficient of 0.98. CONCLUSION 4D flow MRI velocity MIPs allow for efficient measurement of peak velocities in BAV patients with higher accuracy than 2D PCMRI and similar accuracy to Doppler echocardiography. J. Magn. Reson. Imaging 2016;44:1673-1682.
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Affiliation(s)
- Michael J Rose
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Kelly Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA
| | - Varun Chowdhary
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joshua D Robinson
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Susanne Schnell
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Bogachkov A, Ayache JB, Allen BD, Murphy I, Carr ML, Spottiswoode B, Schmidt M, Zenge MO, Nadar MS, Zuehlsdorff S, Freed BH, Carr JC, Collins JD. Right ventricular assessment at cardiac MRI: initial clinical experience utilizing an IS-SENSE reconstruction. Int J Cardiovasc Imaging 2016; 32:1081-91. [PMID: 27091733 DOI: 10.1007/s10554-016-0874-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/09/2016] [Indexed: 10/21/2022]
Abstract
Cardiac MR is considered the gold standard in assessing RV function. The purpose of this study is to evaluate the clinical utility of an investigational iterative reconstruction algorithm in the quantitative assessment of RV function. This technique has the potential to improve the clinical utility of CMR in the evaluation of RV pathologies, particularly in patients with dyspnea, by shortening acquisition times without adversely influencing imaging performance. Segmented cine images were acquired on 9 healthy volunteers and 29 patients without documented RV pathologies using conventional GRAPPA acquisition with factor 2 acceleration (GRAPPA 2), a spatio-temporal TSENSE acquisition with factor 4 acceleration (TSENSE 4), and iteratively reconstructed Sparse SENSE acquisition with factor 4 acceleration (IS-SENSE 4). 14 subjects were re-analyzed and intraclass correlation coefficients (ICC) were calculated and Bland-Altman plots generated to assess agreement. Two independent reviewers qualitatively scored images. Comparison of acquisition techniques was performed using univariate analysis of variance (ANOVA). Differences in RV EF, BSA-indexed ESV (ESVi), BSA-indexed EDV (EDVi), and BSA-indexed SV (SVi) were shown to be statistically insignificant via ANOVA testing. R(2) values for linear regression of TSENSE 4 and IS-SENSE 4 versus GRAPPA 2 were 0.34 and 0.72 for RV-EF, and 0.61 and 0.76 for RV-EDVi. ICC values for intraobserver and interobserver quantification yielded excellent agreement, and Bland-Altman plots assessing agreement were generated as well. Qualitative review yielded small, but statistically significant differences in image quality and noise between TSENSE 4 and IS-SENSE 4. All three techniques were rated nearly artifact free. Segmented imaging acquisitions with IS-SENSE reconstruction and an acceleration factor of 4 accurately and reliably quantitates RV systolic function parameters, while maintaining image quality. TSENSE-4 accelerated acquisitions showed poorer correlation to standard imaging, and inferior interobserver and intraobserver agreement. IS-SENSE has the potential to shorten cine acquisition times by 50 %, improving imaging options in patients with intermittent arrhythmias or difficulties with breath holding.
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Affiliation(s)
- Abraham Bogachkov
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jad Bou Ayache
- Department of Radiology, Northwestern University, 737 N. Michigan Ave Suite 1600, Chicago, IL, 60611, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University, 737 N. Michigan Ave Suite 1600, Chicago, IL, 60611, USA
| | - Ian Murphy
- Department of Radiology, Northwestern University, 737 N. Michigan Ave Suite 1600, Chicago, IL, 60611, USA
| | - Maria L Carr
- Department of Radiology, Northwestern University, 737 N. Michigan Ave Suite 1600, Chicago, IL, 60611, USA
| | | | | | | | - Mariappan S Nadar
- Medical Imaging Technologies, Siemens Corporation, Princeton, NJ, USA
| | | | - Benjamin H Freed
- Department of Cardiology, Northwestern University, Chicago, IL, USA
| | - James C Carr
- Department of Radiology, Northwestern University, 737 N. Michigan Ave Suite 1600, Chicago, IL, 60611, USA
| | - Jeremy D Collins
- Department of Radiology, Northwestern University, 737 N. Michigan Ave Suite 1600, Chicago, IL, 60611, USA.
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Allen BD, Anderle M, Misener S, Murtagh G, Furiasse N, Akhter N, Procissi D, Carr JC. CMR myocardial tissue characterization in a mouse model of doxorubicin-induced cardiotoxicity. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328718 DOI: 10.1186/1532-429x-17-s1-q135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Allen BD, Chatterjee N, Ayache JB, Freed BH, Lee DC, Carroll T, Markl M, Collins JD, Carr JC. Stress perfusion cardiac MRI with regadenoson and gadofoveset trisodium. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328754 DOI: 10.1186/1532-429x-17-s1-p113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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49
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Collins JD, Botelho M, Stark M, Lee DC, Kalisz K, Smith PM, Allen BD, Carr ML, Spottiswoode BS, Carr JC, Freed BH. Cardiac MR feature tracking identifies abnormal biventricular global strain values in biopsy-proven non-ischemic cardiomyopathies. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328348 DOI: 10.1186/1532-429x-17-s1-q8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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50
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van Ooij P, Allen BD, Contaldi C, Garcia J, Collins J, Carr J, Choudhury L, Bonow RO, Barker AJ, Markl M. 4D flow MRI and T1 -Mapping: Assessment of altered cardiac hemodynamics and extracellular volume fraction in hypertrophic cardiomyopathy. J Magn Reson Imaging 2015; 43:107-14. [PMID: 26227419 DOI: 10.1002/jmri.24962] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/15/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Hypertrophic cardiomyopathy (HCM) is associated with altered hemodynamics in the left ventricular outflow tract (LVOT) and myocardial tissue abnormalities such as fibrosis. The aim of this study was to quantify changes in LVOT 3D hemodynamics and myocardial extracellular volume fraction (ECV, measure of fibrosis) and to investigate relationships between elevated flow metrics and left ventricular (LV) tissue abnormalities. MATERIALS AND METHODS Cardiac magnetic resonance imaging (MRI) including 4D flow (field strength = 1.5T, resolution = 2.1-4.0 × 2.1-4.0 × 2.5-3.2 mm(3) ; venc = 150-250 cm/s; TE/TR/FA = 2.2-2.5msec/4.6-4.9msec/15°) for the in vivo assessment of 3D blood flow velocities with full coverage of the LVOT was applied in 35 patients with HCM (54 ± 15 years) and 10 age-matched healthy controls (45 ± 14 years). In addition, pre- and postcontrast myocardial T1 -mapping (resolution = 2.3 × 1.8 mm, slice thickness = 8 mm, TE/TR-FA = 1.0-1.1msec/2.0-2.2msec/35°) of the LV (basal, mid-ventricular, apical short axis) was performed in a subgroup of 23 HCM patients. Analysis included the segmentation of the LVOT and quantification of peak systolic LVOT pressure gradients and rate of viscous energy loss EL ' as well as left ventricular ECV. RESULTS HCM patients demonstrated significantly elevated peak systolic LVOT pressure gradients (21 ± 16 mmHg vs. 9 ± 2 mmHg) and energy loss EL ' (3.8 ± 2.5 mW vs. 1.5 ± 0.7 mW, P < 0.005) compared to controls. There was a significant relationship between increased LV fibrosis (ECV) with both elevated pressure gradients (R(2) = 0.44, P < 0.001) and energy loss EL ' (R(2) = 0.46, P < 0.001). CONCLUSIONS The integration of 4D-flow and T1 -mapping-MRI allowed for the evaluation of tissue and flow abnormalities in HCM patients. Our findings suggest a mechanistic link between abnormal LVOT flow, increased LV loading, and adverse myocardial remodeling in HCM.
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Affiliation(s)
- Pim van Ooij
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Carla Contaldi
- Department of Medicine-Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Julio Garcia
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jeremy Collins
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lubna Choudhury
- Department of Medicine-Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Robert O Bonow
- Department of Medicine-Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA
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