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Jenista ER, Wendell DC, Azevedo CF, Klem I, Judd RM, Kim RJ, Kim HW. Revisiting how we perform late gadolinium enhancement CMR: insights gleaned over 25 years of clinical practice. J Cardiovasc Magn Reson 2023; 25:18. [PMID: 36922844 PMCID: PMC10018965 DOI: 10.1186/s12968-023-00925-0] [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] [Indexed: 03/18/2023] Open
Affiliation(s)
- Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, DUMC-3934, Durham, NC, 27710, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - David C Wendell
- Duke Cardiovascular Magnetic Resonance Center, DUMC-3934, Durham, NC, 27710, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Clerio F Azevedo
- Duke Cardiovascular Magnetic Resonance Center, DUMC-3934, Durham, NC, 27710, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, DUMC-3934, Durham, NC, 27710, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Robert M Judd
- Duke Cardiovascular Magnetic Resonance Center, DUMC-3934, Durham, NC, 27710, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, DUMC-3934, Durham, NC, 27710, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, DUMC-3934, Durham, NC, 27710, USA.
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA.
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Kaolawanich Y, Azevedo CF, Kim HW, Jenista ER, Wendell DC, Chen EL, Parker MA, Judd RM, Kim RJ. Native T1 Mapping for the Diagnosis of Myocardial Fibrosis in Patients With Chronic Myocardial Infarction. JACC Cardiovasc Imaging 2022; 15:2069-2079. [PMID: 36481075 DOI: 10.1016/j.jcmg.2022.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/02/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Myocardial fibrosis is a fundamental process in cardiac injury. Cardiac magnetic resonance native T1 mapping has been proposed for diagnosing myocardial fibrosis without the need for gadolinium contrast. However, recent studies suggest that T1 measurements can be erroneous in the presence of intramyocardial fat. OBJECTIVES The purpose of this study was to investigate whether the presence of fatty metaplasia affects the accuracy of native T1 maps for the diagnosis of myocardial replacement fibrosis in patients with chronic myocardial infarction (MI). METHODS Consecutive patients (n = 312) with documented chronic MI (>6 months old) and controls without MI (n = 50) were prospectively enrolled. Presence and size of regions with elevated native T1 and infarction were quantitatively determined (mean + 5SD) on modified look-locker inversion-recovery and delayed-enhancement images, respectively, at 3.0-T. The presence of fatty metaplasia was determined using an out-of-phase steady-state free-precession cine technique and further verified with standard fat-water Dixon methods. RESULTS Native T1 mapping detected chronic MI with markedly higher sensitivity in patients with fatty metaplasia than those without fatty metaplasia (85.6% vs 13.3%) with similar specificity (100% vs 98.9%). In patients with fatty metaplasia, the size of regions with elevated T1 significantly underestimated infarct size and there was a better correlation with fatty metaplasia size than infarct size (r = 0.76 vs r = 0.49). In patients without fatty metaplasia, most of the modest elevation in T1 appeared to be secondary to subchronic infarcts that were 6 to 12 months old; the T1 of infarcts >12 months old was not different from noninfarcted myocardium. CONCLUSIONS Native T1 mapping is poor at detecting replacement fibrosis but may indirectly detect chronic MI if there is associated fatty metaplasia. Native T1 mapping for the diagnosis and characterization of myocardial fibrosis is unreliable.
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Affiliation(s)
- Yodying Kaolawanich
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Clerio F Azevedo
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - David C Wendell
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Enn-Ling Chen
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michele A Parker
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Robert M Judd
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.
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Azevedo CF, Jenista ER, Kaolawanich Y, Kim HW, Wendell DC, Alenezi F, Chen EL, Parker MA, Judd RM, Kim RJ. Assessment of myocardial lipomatous metaplasia using an optimized out-of-phase cine steady-state free-precession sequence: Validation and clinical implementation. NMR Biomed 2022; 35:e4777. [PMID: 35633068 DOI: 10.1002/nbm.4777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/14/2021] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
Myocardial lipomatous metaplasia, which can serve as substrate for ventricular arrhythmias, is usually composed of regions in which there is an admixture of fat and nonfat tissue. Although dedicated sequences for the detection of fat are available, it would be time-consuming and burdensome to routinely use these techniques to image the entire heart of all patients as part of a typical cardiac MRI exam. Conventional steady-state free-precession (SSFP) cine imaging is insensitive to detecting myocardial regions with partial fatty infiltration. We developed an optimization process for SSFP imaging to set fat signal consistently "out-of-phase" with water throughout the heart, so that intramyocardial regions with partial volume fat would be detected as paradoxically dark regions. The optimized SSFP sequence was evaluated using a fat phantom, through simulations, and in 50 consecutive patients undergoing clinical cardiac MRI. Findings were validated using standard Dixon gradient-recalled-echo (GRE) imaging as the reference. Phantom studies of test tubes with diverse fat concentrations demonstrated good agreement between measured signal intensity and simulated values calculated using Bloch equations. In patients, a line of signal cancellation at the interface between myocardium and epicardial fat was noted in all cases, confirming that SSFP images were consistently out-of-phase throughout the entire heart. Intramyocardial dark regions identified on out-of-phase SSFP images were entirely dark throughout in 33 patients (66%) and displayed an India-ink pattern in 17 (34%). In all cases, dark intramyocardial regions were also seen in the same locations on out-of-phase GRE and were absent on in-phase GRE, confirming that these regions represent areas with partial fat. In conclusion, if appropriately optimized, SSFP cine imaging allows for consistent detection of myocardial fatty metaplasia in patients undergoing routine clinical cardiac MRI without the need for additional image acquisitions using dedicated fat-specific sequences.
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Affiliation(s)
- Clerio F Azevedo
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, Durham, North Carolina, USA
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, Durham, North Carolina, USA
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Yodying Kaolawanich
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, Durham, North Carolina, USA
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, Durham, North Carolina, USA
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - David C Wendell
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, Durham, North Carolina, USA
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Fawaz Alenezi
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, Durham, North Carolina, USA
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Enn-Ling Chen
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, Durham, North Carolina, USA
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michele A Parker
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, Durham, North Carolina, USA
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Robert M Judd
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, Durham, North Carolina, USA
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, Durham, North Carolina, USA
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
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Jenista ER, Jensen CJ, Wendell D, Spatz D, Darty S, Kim HW, Parker M, Klem I, Chen EL, Kim RJ, Rehwald WG. Double spectral attenuated inversion recovery (DSPAIR)-an efficient fat suppression technique for late gadolinium enhancement at 3 tesla. NMR Biomed 2021; 34:e4580. [PMID: 34251717 DOI: 10.1002/nbm.4580] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 06/13/2023]
Abstract
Despite clinical use of late gadolinium enhancement (LGE) for two decades, an efficient, robust fat suppression (FS) technique still does not exist for this CMR mainstay. In ischemic and non-ischemic heart disease, differentiating fibrotic tissue from infiltrating and adjacent fat is crucial. Multiple groups have independently developed an FS technique for LGE, double spectral attenuated inversion recovery (DSPAIR), but no comprehensive evaluation was performed. This study aims to fill this gap. DSPAIR uses two SPAIR pulses and one non-selective IR pulse to enable FS LGE, including compatibility with phase sensitive inversion recovery (PSIR). We implemented a magnitude (MAGN) and a PSIR variant and compared them with LGE without FS (CONTROL) and with spectral presaturation with inversion recovery (SPIR) in simulations, phantoms, and patients. Fat magnetization by SPIR, MAGN DSPAIR, and PSIR DSPAIR was simulated as a function of pulse B1 , readout (RO) pulse number, and fat TI . A phantom with fat, fibrosis, and myocardium compartments was imaged using all FS methods and modifying pulse B1 , RO pulse number, and heart rate. Signal was measured in SNR units. Fat, myocardium, and fibrosis SNR and fibrosis-to-fat CNR were obtained. Patient images were acquired with all FS techniques. Fat, myocardium, and fibrosis SNR, fibrosis-to-fat CNR, and image and FS quality were assessed. In the phantom, both DSPAIR variants provided superior FS compared with SPIR, independent of heart rate and RO pulse number. MAGN DSPAIR reduced fat signal by 99% compared with CONTROL, PSIR DSPAIR by 116%, and SPIR by 67% (25 RO pulses). In patients, both DSPAIR variants substantially reduced fat signal (MAGN DSPAIR by 87.1% ± 10.0%, PSIR DSPAIR by 130.5% ± 36.3%), but SPIR did not (35.8% ± 25.5%). FS quality was good to excellent for MAGN and PSIR DSPAIR, and moderate to poor for SPIR. DSPAIR provided highly effective FS across a wide range of parameters. PSIR DSPAIR performed best.
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Affiliation(s)
- Elizabeth R Jenista
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Christoph J Jensen
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - David Wendell
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Deneen Spatz
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen Darty
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Han W Kim
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Michele Parker
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Igor Klem
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Enn-Ling Chen
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Raymond J Kim
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Wolfgang G Rehwald
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
- Siemens Medical Solutions North America, Malvern, Pennsylvania, USA
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Abstract
Importance Vaccine-associated myocarditis is an unusual entity that has been described for the smallpox vaccine, but only anecdotal case reports have been described for other vaccines. Whether COVID-19 vaccination may be linked to the occurrence of myocarditis is unknown. Objective To describe a group of 7 patients with acute myocarditis over 3 months, 4 of whom had recent messenger RNA (mRNA) COVID-19 vaccination. Design, Setting, and Participants All patients referred for cardiovascular magnetic resonance imaging at Duke University Medical Center were asked to participate in a prospective outcomes registry. Two searches of the registry database were performed: first, to identify patients with acute myocarditis for the 3-month period between February 1 and April 30 for 2017 through 2021, and second, to identify all patients with possible vaccine-associated myocarditis for the past 20 years. Once patients with possible vaccine-associated myocarditis were identified, data available in the registry were supplemented by additional data collection from the electronic health record and a telephone interview. Exposures mRNA COVID-19 vaccine. Main Outcomes and Measures Occurrence of acute myocarditis by cardiovascular magnetic resonance imaging. Results In the 3-month period between February 1 and April 30, 2021, 7 patients with acute myocarditis were identified, of which 4 occurred within 5 days of COVID-19 vaccination. Three were younger male individuals (age, 23-36 years) and 1 was a 70-year-old female individual. All 4 had received the second dose of an mRNA vaccine (2 received mRNA-1273 [Moderna], and 2 received BNT162b2 [Pfizer]). All presented with severe chest pain, had biomarker evidence of myocardial injury, and were hospitalized. Coincident testing for COVID-19 and respiratory viruses provided no alternative explanation. Cardiac magnetic resonance imaging findings were typical for myocarditis, including regional dysfunction, late gadolinium enhancement, and elevated native T1 and T2. Conclusions and Relevance In this study, magnetic resonance imaging findings were found to be consistent with acute myocarditis in 7 patients; 4 of whom had preceding COVID-19 vaccination. Further investigation is needed to determine associations of COVID-19 vaccination and myocarditis.
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Affiliation(s)
- Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - David C Wendell
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Clerio F Azevedo
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Michael J Campbell
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.,Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Stephen N Darty
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina
| | - Michele A Parker
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina.,Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Zhang Q, Werys K, Popescu IA, Biasiolli L, Ntusi NAB, Desai M, Zimmerman SL, Shah DJ, Autry K, Kim B, Kim HW, Jenista ER, Huber S, White JA, McCann GP, Mohiddin SA, Boubertakh R, Chiribiri A, Newby D, Prasad S, Radjenovic A, Dawson D, Schulz-Menger J, Mahrholdt H, Carbone I, Rimoldi O, Colagrande S, Calistri L, Michels M, Hofman MBM, Anderson L, Broberg C, Andrew F, Sanz J, Bucciarelli-Ducci C, Chow K, Higgins D, Broadbent DA, Semple S, Hafyane T, Wormleighton J, Salerno M, He T, Plein S, Kwong RY, Jerosch-Herold M, Kramer CM, Neubauer S, Ferreira VM, Piechnik SK. Quality assurance of quantitative cardiac T1-mapping in multicenter clinical trials - A T1 phantom program from the hypertrophic cardiomyopathy registry (HCMR) study. Int J Cardiol 2021; 330:251-258. [PMID: 33535074 PMCID: PMC7994017 DOI: 10.1016/j.ijcard.2021.01.026] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/07/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Quantitative cardiovascular magnetic resonance T1-mapping is increasingly used for myocardial tissue characterization. However, the lack of standardization limits direct comparability between centers and wider roll-out for clinical use or trials. PURPOSE To develop a quality assurance (QA) program assuring standardized T1 measurements for clinical use. METHODS MR phantoms manufactured in 2013 were distributed, including ShMOLLI T1-mapping and reference T1 and T2 protocols. We first studied the T1 and T2 dependency on temperature and phantom aging using phantom datasets from a single site over 4 years. Based on this, we developed a multiparametric QA model, which was then applied to 78 scans from 28 other multi-national sites. RESULTS T1 temperature sensitivity followed a second-order polynomial to baseline T1 values (R2 > 0.996). Some phantoms showed aging effects, where T1 drifted up to 49% over 40 months. The correlation model based on reference T1 and T2, developed on 1004 dedicated phantom scans, predicted ShMOLLI-T1 with high consistency (coefficient of variation 1.54%), and was robust to temperature variations and phantom aging. Using the 95% confidence interval of the correlation model residuals as the tolerance range, we analyzed 390 ShMOLLI T1-maps and confirmed accurate sequence deployment in 90%(70/78) of QA scans across 28 multiple centers, and categorized the rest with specific remedial actions. CONCLUSIONS The proposed phantom QA for T1-mapping can assure correct method implementation and protocol adherence, and is robust to temperature variation and phantom aging. This QA program circumvents the need of frequent phantom replacements, and can be readily deployed in multicenter trials.
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Affiliation(s)
- Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK.
| | - Konrad Werys
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Iulia A Popescu
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Luca Biasiolli
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | | | | | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, USA
| | - Kyle Autry
- Houston Methodist DeBakey Heart & Vascular Center, USA
| | - Bette Kim
- Mount Sinai West Hospital; Icahn School of Medicine at Mount Sinai, USA
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, USA
| | - Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, USA
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, USA
| | - James A White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Canada
| | - Gerry P McCann
- Department of cardiovascular sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, UK
| | - Saidi A Mohiddin
- Inherited Cardiovascular Diseases, Barts Heart Centre, London, UK
| | - Redha Boubertakh
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Amedeo Chiribiri
- King's College London and Guy's and St Thomas' NHS Foundation Trust, UK
| | - David Newby
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Sanjay Prasad
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Aleksandra Radjenovic
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, College of Life Sciences and Medicine, University of Aberdeen, UK
| | | | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Stuttgart, Germany
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Italy
| | | | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Michelle Michels
- Erasmus MC, department of cardiology, Rotterdam, the Netherlands
| | - Mark B M Hofman
- dept. Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Lisa Anderson
- Cardiology Clinical Academic Group, St George's University of London, UK
| | - Craig Broberg
- Knight Cardiovascular Institute, Oregon Health and Science University, USA
| | | | | | | | - Kelvin Chow
- Siemens Medical Solutions USA, Inc., Chicago, IL, USA
| | | | - David A Broadbent
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK
| | - Scott Semple
- Edinburgh Imaging, Centre for Cardiovascular Science, University of Edinburgh, UK
| | | | | | | | - Taigang He
- The Cardiology Clinical Academic Group (CAG), St George's University of London, St George's University Hospitals NHS Foundation Trust, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | | | | | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
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Jenista ER, Wendell DC, Kim HW, Rehwald WG, Chen EL, Darty SN, Smith LR, Azevedo CF, Parker MA, Kim RJ. Comparison of magnetization transfer-preparation and T2-preparation for dark-blood delayed-enhancement imaging. NMR Biomed 2020; 33:e4396. [PMID: 32875674 DOI: 10.1002/nbm.4396] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/03/2020] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
Recently developed dark-blood techniques such as Flow-Independent Dark-blood DeLayed Enhancement (FIDDLE) allow simultaneous visualization of tissue contrast-enhancement and blood-pool suppression. Critical to FIDDLE is the magnetization preparation, which accentuates differences between myocardium and blood-pool. Here, we compared magnetization transfer (MT)-preparation and T2-preparation for use with FIDDLE. Variants of FIDDLE were developed with MT- or T2-preparation modules and tested in 35 patients (11 at 1.5 T, 24 at 3 T). Images were acquired with each FIDDLE variant in an interleaved fashion 10 minutes after gadolinium administration with otherwise identical acquisition parameters. Images were visually and quantitatively assessed for artifacts and differences in right ventricle to left ventricle (RV-to-LV) blood-pool suppression. Bright artifacts, reflecting incomplete blood-pool suppression, were frequently observed in the left atrium with T2-preparation FIDDLE at 1.5 and 3 T (82% and up to 100% of patients, respectively). MT-preparation FIDDLE resulted in fewer patients with artifacts (0% at 1.5 T, 22% at 3 T; P < .01). Left atrial blood-pool signal was significantly more homogeneous with MT-preparation than with T2-preparation at 1.5 and 3 T (P < .001 for all comparisons). Visibly different RV-to-LV blood-pool suppression was observed with T2-preparation in 36% of patients at 1.5 T and up to 94% at 3 T. In these patients, RV blood-pool signal was elevated, reducing the conspicuity of the myocardial-RV blood-pool border. Conversely, there were no visible differences in RV-to-LV blood-pool suppression with MT-preparation. Quantitative assessment of differences in blood-pool suppression and blood-pool artifacts was consistent with visual analyses. We conclude that for dark blood-blood delayed-enhancement imaging of the heart, MT-preparation results in fewer bright blood-pool artifacts and more uniform blood-pool suppression than T2-preparation.
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Affiliation(s)
- Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - David C Wendell
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | | | - Enn-Ling Chen
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Stephen N Darty
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Logan R Smith
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
| | - Clerio F Azevedo
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Michele A Parker
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Kim HW, Rehwald WG, Jenista ER, Wendell DC, Filev P, van Assche L, Jensen CJ, Parker MA, Chen EL, Crowley ALC, Klem I, Judd RM, Kim RJ. Dark-Blood Delayed Enhancement Cardiac Magnetic Resonance of Myocardial Infarction. JACC Cardiovasc Imaging 2017; 11:1758-1769. [PMID: 29248655 DOI: 10.1016/j.jcmg.2017.09.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 07/05/2017] [Revised: 09/06/2017] [Accepted: 09/25/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study introduced and validated a novel flow-independent delayed enhancement technique that shows hyperenhanced myocardium while simultaneously suppressing blood-pool signal. BACKGROUND The diagnosis and assessment of myocardial infarction (MI) is crucial in determining clinical management and prognosis. Although delayed enhancement cardiac magnetic resonance (DE-CMR) is an in vivo reference standard for imaging MI, an important limitation is poor delineation between hyperenhanced myocardium and bright LV cavity blood-pool, which may cause many infarcts to become invisible. METHODS A canine model with pathology as the reference standard was used for validation (n = 22). Patients with MI and normal controls were studied to ascertain clinical performance (n = 31). RESULTS In canines, the flow-independent dark-blood delayed enhancement (FIDDLE) technique was superior to conventional DE-CMR for the detection of MI, with higher sensitivity (96% vs. 85%, respectively; p = 0.002) and accuracy (95% vs. 87%, respectively; p = 0.01) and with similar specificity (92% vs, 92%, respectively; p = 1.0). In infarcts that were identified by both techniques, the entire length of the endocardial border between infarcted myocardium and adjacent blood-pool was visualized in 33% for DE-CMR compared with 100% for FIDDLE. There was better agreement for FIDDLE-measured infarct size than for DE-CMR infarct size (95% limits-of-agreement, 2.1% vs. 5.5%, respectively; p < 0.0001). In patients, findings were similar. FIDDLE demonstrated higher accuracy for diagnosis of MI than DE-CMR (100% [95% confidence interval [CI]: 89% to 100%] vs. 84% [95% CI: 66% to 95%], respectively; p = 0.03). CONCLUSIONS The study introduced and validated a novel CMR technique that improves the discrimination of the border between infarcted myocardium and adjacent blood-pool. This dark-blood technique provides diagnostic performance that is superior to that of the current in vivo reference standard for the imaging diagnosis of MI.
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Affiliation(s)
- Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | | | - Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - David C Wendell
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Peter Filev
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
| | - Lowie van Assche
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
| | - Christoph J Jensen
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
| | - Michele A Parker
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Enn-Ling Chen
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Anna Lisa C Crowley
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Robert M Judd
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Department of Radiology, Duke University Medical Center, Durham, North Carolina.
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Jenista ER, Rehwald WG, Chaptini NH, Kim HW, Parker MA, Wendell DC, Chen EL, Kim RJ. Suppression of ghost artifacts arising from long T 1 species in segmented inversion-recovery imaging. Magn Reson Med 2016; 78:1442-1451. [PMID: 27868238 DOI: 10.1002/mrm.26554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 06/17/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE We demonstrate an improved segmented inversion-recovery sequence that suppresses ghost artifacts arising from tissues with long T1 ( > 1.5 s). THEORY AND METHODS Long T1 species such as pericardial fluid can create bright ghost artifacts in segmented, inversion-recovery MRI because of oscillations in longitudinal magnetization between segments. A single dummy acquisition at the beginning of the sequence can reduce oscillations; however, its effectiveness in suppressing long T1 artifacts is unknown. In this study, we systematically evaluated several test sequences, including a prototype (saturation post-pulse readout to eliminate spurious signal: SPPRESS) in simulations, phantoms, and patients. RESULTS SPPRESS reduced artifact signal 90% ± 25% and 74% ± 28% compared with Control and Single-Dummy methods in phantoms. SPPRESS performed well at 1.5 Tesla (T) and 3T, with steady-state free precession (SSFP) and fast low-angle shot (FLASH) readout, with conventional and phase-sensitive reconstruction, and over a range of physiologic heart rates. A review of 100 consecutive clinical cardiac MRI scans revealed large fluid collections (eg, regions with long T1 ) in 14% of patients. In a prospectively enrolled cohort of 16 patients with visible long T1 fluids, SPPRESS appreciably reduced artifacts in all cases compared with Control and Single-Dummy methods. CONCLUSION We developed and validated a new robust method, SPPRESS, for reducing artifacts due to long T1 species across a wide range of imaging and physiologic conditions. Magn Reson Med 78:1442-1451, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Nayla H Chaptini
- Department of Cardiology, Advocate Lutheran General Hospital, Chicago, Illinois, USA
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA.,Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Michele A Parker
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - David C Wendell
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Enn-Ling Chen
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA.,Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA.,Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.,Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
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10
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Kim HW, Van Assche L, Jennings RB, Wince WB, Jensen CJ, Rehwald WG, Wendell DC, Bhatti L, Spatz DM, Parker MA, Jenista ER, Klem I, Crowley ALC, Chen EL, Judd RM, Kim RJ. Relationship of T2-Weighted MRI Myocardial Hyperintensity and the Ischemic Area-At-Risk. Circ Res 2015; 117:254-65. [PMID: 25972514 PMCID: PMC4503326 DOI: 10.1161/circresaha.117.305771] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 05/13/2015] [Indexed: 12/15/2022]
Abstract
RATIONALE After acute myocardial infarction (MI), delineating the area-at-risk (AAR) is crucial for measuring how much, if any, ischemic myocardium has been salvaged. T2-weighted MRI is promoted as an excellent method to delineate the AAR. However, the evidence supporting the validity of this method to measure the AAR is indirect, and it has never been validated with direct anatomic measurements. OBJECTIVE To determine whether T2-weighted MRI delineates the AAR. METHODS AND RESULTS Twenty-one canines and 24 patients with acute MI were studied. We compared bright-blood and black-blood T2-weighted MRI with images of the AAR and MI by histopathology in canines and with MI by in vivo delayed-enhancement MRI in canines and patients. Abnormal regions on MRI and pathology were compared by (a) quantitative measurement of the transmural-extent of the abnormality and (b) picture matching of contours. We found no relationship between the transmural-extent of T2-hyperintense regions and that of the AAR (bright-blood-T2: r=0.06, P=0.69; black-blood-T2: r=0.01, P=0.97). Instead, there was a strong correlation with that of infarction (bright-blood-T2: r=0.94, P<0.0001; black-blood-T2: r=0.95, P<0.0001). Additionally, contour analysis demonstrated a fingerprint match of T2-hyperintense regions with the intricate contour of infarcted regions by delayed-enhancement MRI. Similarly, in patients there was a close correspondence between contours of T2-hyperintense and infarcted regions, and the transmural-extent of these regions were highly correlated (bright-blood-T2: r=0.82, P<0.0001; black-blood-T2: r=0.83, P<0.0001). CONCLUSION T2-weighted MRI does not depict the AAR. Accordingly, T2-weighted MRI should not be used to measure myocardial salvage, either to inform patient management decisions or to evaluate novel therapies for acute MI.
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Affiliation(s)
- Han W Kim
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Lowie Van Assche
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Robert B Jennings
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - W Benjamin Wince
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Christoph J Jensen
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Wolfgang G Rehwald
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - David C Wendell
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Lubna Bhatti
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Deneen M Spatz
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Michele A Parker
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Elizabeth R Jenista
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Igor Klem
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Anna Lisa C Crowley
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Enn-Ling Chen
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Robert M Judd
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.)
| | - Raymond J Kim
- From the Duke Cardiovascular Magnetic Resonance Center (DCMRC), Department of Medicine, Division of Cardiology (H.W.K., L.V.A., W.B.W., C.J.J., W.G.R., D.C.W., L.B., D.M.S., M.A.P., E.R.J., I.K., A.L.C.C., E.-L.C.), Department of Pathology (R.B.J.), and Department of Radiology (R.M.J., R.J.K.), Duke University Medical Center, Durham, NC; and Siemens Healthcare, Chicago, IL (W.R.).
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Jenista ER, Rehwald WG, Chen EL, Kim HW, Klem I, Parker MA, Kim RJ. Motion and flow insensitive adiabatic T2 -preparation module for cardiac MR imaging at 3 Tesla. Magn Reson Med 2012; 70:1360-8. [PMID: 23213005 DOI: 10.1002/mrm.24564] [Citation(s) in RCA: 28] [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: 08/10/2012] [Revised: 10/12/2012] [Accepted: 10/26/2012] [Indexed: 01/13/2023]
Abstract
A versatile method for generating T2 -weighting is a T2 -preparation module, which has been used successfully for cardiac imaging at 1.5T. Although it has been applied at 3T, higher fields (B0 ≥ 3T) can degrade B0 and B1 homogeneity and result in nonuniform magnetization preparation. For cardiac imaging, blood flow and cardiac motion may further impair magnetization preparation. In this study, a novel T2 -preparation module containing multiple adiabatic B1 -insensitive refocusing pulses is introduced and compared with three previously described modules [(a) composite MLEV4, (b) modified BIR-4 (mBIR-4), and (c) Silver-Hoult-pair]. In the static phantom, the proposed module provided similar or better B0 and B1 insensitivity than the other modules. In human subjects (n = 21), quantitative measurement of image signal coefficient of variation, reflecting overall image inhomogeneity, was lower for the proposed module (0.10) than for MLEV4 (0.15, P < 0.0001), mBIR-4 (0.27, P < 0.0001), and Silver-Hoult-pair (0.14, P = 0.001) modules. Similarly, qualitative analysis revealed that the proposed module had the best image quality scores and ranking (both, P < 0.0001). In conclusion, we present a new T2 -preparation module, which is shown to be robust for cardiac imaging at 3T in comparison with existing methods.
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Affiliation(s)
- Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
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Chaptini N, Rehwald WG, Jenista ER, Parker MA, Chen EL, Kim RJ. A new method to suppress ghosting artifacts arising from long-T1 species in segmented inversion recovery (IR) sequences. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106702 DOI: 10.1186/1532-429x-13-s1-p9] [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: 11/10/2022] Open
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Abstract
Intermolecular dipolar interactions between proton and carbon spins can be used to indirectly detect carbon spectra with high sensitivity. In this communication, we present a modified sequence that, in addition to the high sensitivity of heteronuclear intermolecular multiple quantum coherence (iMQC) experiments, retains the line narrowing capability characteristic of homonuclear zero-quantum coherences. We demonstrate that this sequence can be used to obtain high resolution (13)C spectra in the presence of magnetic field inhomogeneities, both for thermal and hyperpolarized samples, and discuss applications to water-hyperpolarized carbon imaging.
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Affiliation(s)
- Rosa T Branca
- Department of Chemistry, Duke University, Durham, NC 27708, USA.
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Jenista ER, Galiana G, Branca RT, Yarmolenko PS, Stokes AM, Dewhirst MW, Warren WS. Application of mixed spin iMQCs for temperature and chemical-selective imaging. J Magn Reson 2010; 204:208-18. [PMID: 20303808 PMCID: PMC2874652 DOI: 10.1016/j.jmr.2010.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 10/03/2009] [Revised: 02/22/2010] [Accepted: 02/22/2010] [Indexed: 05/16/2023]
Abstract
The development of accurate and non-invasive temperature imaging techniques has a wide variety of applications in fields such as medicine, chemistry and materials science. Accurate detection of temperature both in phantoms and in vivo can be obtained using iMQCs (intermolecular multiple quantum coherences), as demonstrated in a recent paper. This paper describes the underlying theory of iMQC temperature detection, as well as extensions of that work allowing not only for imaging of absolute temperature but also for imaging of analyte concentrations through chemically-selective spin density imaging.
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Affiliation(s)
- Elizabeth R Jenista
- Center for Molecular and Biomolecular Imaging, 2220 French Family Science Center, Duke University, Durham, NC 27708, USA.
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15
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Abstract
PURPOSE A review of MRI temperature imaging methods based on intermolecular multiple quantum coherences (iMQCs) is presented. Temperature imaging based on iMQCs can provide absolute temperature maps that circumvent the artefacts that other proton frequency shift techniques suffer from such as distortions to the detected temperature due to susceptibility changes and magnetic field inhomogeneities. Thermometry based on iMQCs is promising in high-fat tissues such as the breast, since it relies on the fat signal as an internal reference. This review covers the theoretical background of iMQCs, and the necessary adaptations for temperature imaging using iMQCs. MATERIALS AND METHODS Data is presented from several papers on iMQC temperature imaging. These studies were done at 7T in both phantoms and in vivo. Results from phantoms of cream (homogeneous mixture of water and fat) are presented as well as in vivo temperature maps in obese mice. RESULTS Thermometry based on iMQCs offers the potential to provide temperature maps which are free of artefacts due to susceptibility and magnetic field inhomogeneities, and detect temperature on an absolute scale. CONCLUSIONS The data presented in the papers reviewed highlights the promise of iMQC-based temperature imaging in fatty tissues such as the breast. The change in susceptibility of fat with temperature makes standard proton frequency shift methods (even with fat suppression) challenging and iMQC-based imaging offers an alternative approach.
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Jenista ER, Stokes AM, Branca RT, Warren WS. Optimized, unequal pulse spacing in multiple echo sequences improves refocusing in magnetic resonance. J Chem Phys 2009; 131:204510. [PMID: 19947697 PMCID: PMC2802196 DOI: 10.1063/1.3263196] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [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: 07/22/2009] [Accepted: 10/22/2009] [Indexed: 01/25/2023] Open
Abstract
A recent quantum computing paper (G. S. Uhrig, Phys. Rev. Lett. 98, 100504 (2007)) analytically derived optimal pulse spacings for a multiple spin echo sequence designed to remove decoherence in a two-level system coupled to a bath. The spacings in what has been called a "Uhrig dynamic decoupling (UDD) sequence" differ dramatically from the conventional, equal pulse spacing of a Carr-Purcell-Meiboom-Gill (CPMG) multiple spin echo sequence. The UDD sequence was derived for a model that is unrelated to magnetic resonance, but was recently shown theoretically to be more general. Here we show that the UDD sequence has theoretical advantages for magnetic resonance imaging of structured materials such as tissue, where diffusion in compartmentalized and microstructured environments leads to fluctuating fields on a range of different time scales. We also show experimentally, both in excised tissue and in a live mouse tumor model, that optimal UDD sequences produce different T(2)-weighted contrast than do CPMG sequences with the same number of pulses and total delay, with substantial enhancements in most regions. This permits improved characterization of low-frequency spectral density functions in a wide range of applications.
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Affiliation(s)
- Elizabeth R Jenista
- Department of Chemistry and Center for Molecular and Biomolecular Imaging, Duke University, North Carolina 27708-0346, USA
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Branca RT, Chen YM, Mouraviev V, Galiana G, Jenista ER, Kumar C, Leuschner C, Warren WS. iDQC anisotropy map imaging for tumor tissue characterization in vivo. Magn Reson Med 2009; 61:937-43. [PMID: 19215050 DOI: 10.1002/mrm.21925] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intermolecular double quantum coherences (iDQCs), signals that result from simultaneous transitions of two or more separated spins, are known to produce images that are highly sensitive to subvoxel structure, particularly local anisotropy. Here we demonstrate how iDQCs signal can be used to efficiently detect the anisotropy created in breast tumor tissues and prostate tumor tissues by targeted (LHRH-conjugated) superparamagnetic nanoparticles (SPIONs), thereby distinguishing the necrotic area from the surrounding tumor tissue.
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Affiliation(s)
- Rosa T Branca
- Center for Molecular and Biomolecular Imaging, Duke University, Durham, North Carolina 27710, USA.
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Jenista ER, Branca RT, Warren WS. Hyperpolarized carbon-carbon intermolecular multiple quantum coherences. J Magn Reson 2009; 196:74-7. [PMID: 18926750 PMCID: PMC2637247 DOI: 10.1016/j.jmr.2008.09.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [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: 07/17/2008] [Revised: 09/17/2008] [Accepted: 09/19/2008] [Indexed: 05/06/2023]
Abstract
Intermolecular multiple quantum coherences (iMQCs) can provide unique contrast with sub-voxel resolution. However, the characteristic growth rate of iMQCs mostly limits these effects to either hydrogen or hydrogen-coupled systems for thermally polarized samples. Hyperpolarization techniques such as dynamic nuclear polarization (DNP) allow for significant increases in the carbon signal (even more signal than that from hydrogen), making carbon iMQCs achievable. We present the first intermolecular multiple quantum signal between two carbon nuclei.
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Affiliation(s)
- Elizabeth R Jenista
- Center for Molecular and Biomolecular Imaging, 2220 French Family Science Center, Duke University, Durham, NC 27708, USA.
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Abstract
Conventional magnetic resonance methods that provide interior temperature profiles, which find use in clinical applications such as hyperthermic therapy, can develop inaccuracies caused by the inherently inhomogeneous magnetic field within tissues or by probe dynamics, and work poorly in important applications such as fatty tissues. We present a magnetic resonance method that is suitable for imaging temperature in a wide range of environments. It uses the inherently sharp resonances of intermolecular zero-quantum coherences, in this case flipping up a water spin while flipping down a nearby fat spin. We show that this method can rapidly and accurately assign temperatures in vivo on an absolute scale.
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Affiliation(s)
- Gigi Galiana
- Department of Chemistry, Princeton University, Princeton, NJ 08544, USA
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