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Yang H, Hong K, Baraboo JJ, Fan L, Larsen A, Markl M, Robinson JD, Rigsby CK, Kim D. GRASP reconstruction amplified with view-sharing and KWIC filtering reduces underestimation of peak velocity in highly-accelerated real-time phase-contrast MRI: A preliminary evaluation in pediatric patients with congenital heart disease. Magn Reson Med 2024; 91:1965-1977. [PMID: 38084397 PMCID: PMC10950531 DOI: 10.1002/mrm.29974] [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: 08/10/2023] [Revised: 10/27/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE To develop a highly-accelerated, real-time phase contrast (rtPC) MRI pulse sequence with 40 fps frame rate (25 ms effective temporal resolution). METHODS Highly-accelerated golden-angle radial sparse parallel (GRASP) with over regularization may result in temporal blurring, which in turn causes underestimation of peak velocity. Thus, we amplified GRASP performance by synergistically combining view-sharing (VS) and k-space weighted image contrast (KWIC) filtering. In 17 pediatric patients with congenital heart disease (CHD), the conventional GRASP and the proposed GRASP amplified by VS and KWIC (or GRASP + VS + KWIC) reconstruction for rtPC MRI were compared with respect to clinical standard PC MRI in measuring hemodynamic parameters (peak velocity, forward volume, backward volume, regurgitant fraction) at four locations (aortic valve, pulmonary valve, left and right pulmonary arteries). RESULTS The proposed reconstruction method (GRASP + VS + KWIC) achieved better effective spatial resolution (i.e., image sharpness) compared with conventional GRASP, ultimately reducing the underestimation of peak velocity from 17.4% to 6.4%. The hemodynamic metrics (peak velocity, volumes) were not significantly (p > 0.99) different between GRASP + VS + KWIC and clinical PC, whereas peak velocity was significantly (p < 0.007) lower for conventional GRASP. RtPC with GRASP + VS + KWIC also showed the ability to assess beat-to-beat variation and detect the highest peak among peaks. CONCLUSION The synergistic combination of GRASP, VS, and KWIC achieves 25 ms effective temporal resolution (40 fps frame rate), while minimizing the underestimation of peak velocity compared with conventional GRASP.
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Affiliation(s)
- Huili Yang
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - KyungPyo Hong
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Justin J Baraboo
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Lexiaozi Fan
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Andrine Larsen
- Department of Biomedical Engineering, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Joshua D Robinson
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Cynthia K Rigsby
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
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Pradella M, Baraboo JJ, Maroun A, Liu SZ, DiCarlo AL, Chu SH, Hwang JM, Collins MA, Passman R, Heckbert SR, Greenland P, Markl M. Associations between 3D-based Left Atrial Volumetric and Blood Flow Parameters in a Single-Site Cohort of the Multi-Ethnic Study of Atherosclerosis. Radiol Cardiothorac Imaging 2024; 6:e230148. [PMID: 38451190 PMCID: PMC11056754 DOI: 10.1148/ryct.230148] [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: 06/06/2023] [Revised: 01/03/2024] [Accepted: 01/18/2024] [Indexed: 03/08/2024]
Abstract
Purpose To investigate associations between left atrial volume (LAV) and function with impaired three-dimensional hemodynamics from four-dimensional flow MRI. Materials and Methods A subcohort of participants from the Multi-Ethnic Study of Atherosclerosis from Northwestern University underwent prospective 1.5-T cardiac MRI including whole-heart four-dimensional flow and short-axis cine imaging between 2019 and 2020. Four-dimensional flow MRI analysis included manual three-dimensional segmentations of the LA and LA appendage (LAA), which were used to quantify LA and LAA peak velocity and blood stasis (% voxels < 0.1 m/sec). Short-axis cine data were used to delineate LA contours on all cardiac time points, and the resulting three-dimensional-based LAVs were extracted for calculation of LA emptying fractions (LAEFtotal, LAEFactive, LAEFpassive). Stepwise multivariable linear models were calculated for each flow parameter (LA stasis, LA peak velocity, LAA stasis, LAA peak velocity) to determine associations with LAV and LAEF. Results This study included 158 participants (mean age, 73 years ± 7 [SD]; 83 [52.5%] female and 75 [47.4%] male participants). In multivariable models, a 1-unit increase of LAEFtotal was associated with decreased LA stasis (β coefficient, -0.47%; P < .001), while increased LAEFactive was associated with increased LA peak velocity (β coefficient, 0.21 cm/sec; P < .001). Furthermore, increased minimum LAV indexed was most associated with impaired LAA flow (higher LAA stasis [β coefficient, 0.65%; P < .001] and lower LAA peak velocity [β coefficient, -0.35 cm/sec; P < .001]). Conclusion Higher minimum LAV and reduced LA function were associated with impaired flow characteristics in the LA and LAA. LAV assessment might therefore be a surrogate measure for LA and LAA flow abnormalities. Keywords: Atherosclerosis, Left Atrial Volume, Left Atrial Blood Flow, 4D Flow MRI Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Maurice Pradella
- From the Department of Radiology (M.P., J.J.B., A.M., S.Z.L., A.L.D.,
S.H.C., J.M.H., M.A.C., M.M.), Department of Medicine, Division of Cardiology
(R.P., P.G.), and Department of Preventive Medicine (P.G.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago,
IL 60611; Department of Radiology, University Hospital Basel, University of
Basel, Basel, Switzerland (M.P.); and Department of Epidemiology, University of
Washington, Seattle, Wash (S.R.H.)
| | - Justin J. Baraboo
- From the Department of Radiology (M.P., J.J.B., A.M., S.Z.L., A.L.D.,
S.H.C., J.M.H., M.A.C., M.M.), Department of Medicine, Division of Cardiology
(R.P., P.G.), and Department of Preventive Medicine (P.G.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago,
IL 60611; Department of Radiology, University Hospital Basel, University of
Basel, Basel, Switzerland (M.P.); and Department of Epidemiology, University of
Washington, Seattle, Wash (S.R.H.)
| | - Anthony Maroun
- From the Department of Radiology (M.P., J.J.B., A.M., S.Z.L., A.L.D.,
S.H.C., J.M.H., M.A.C., M.M.), Department of Medicine, Division of Cardiology
(R.P., P.G.), and Department of Preventive Medicine (P.G.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago,
IL 60611; Department of Radiology, University Hospital Basel, University of
Basel, Basel, Switzerland (M.P.); and Department of Epidemiology, University of
Washington, Seattle, Wash (S.R.H.)
| | - Sophia Z. Liu
- From the Department of Radiology (M.P., J.J.B., A.M., S.Z.L., A.L.D.,
S.H.C., J.M.H., M.A.C., M.M.), Department of Medicine, Division of Cardiology
(R.P., P.G.), and Department of Preventive Medicine (P.G.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago,
IL 60611; Department of Radiology, University Hospital Basel, University of
Basel, Basel, Switzerland (M.P.); and Department of Epidemiology, University of
Washington, Seattle, Wash (S.R.H.)
| | - Amanda L. DiCarlo
- From the Department of Radiology (M.P., J.J.B., A.M., S.Z.L., A.L.D.,
S.H.C., J.M.H., M.A.C., M.M.), Department of Medicine, Division of Cardiology
(R.P., P.G.), and Department of Preventive Medicine (P.G.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago,
IL 60611; Department of Radiology, University Hospital Basel, University of
Basel, Basel, Switzerland (M.P.); and Department of Epidemiology, University of
Washington, Seattle, Wash (S.R.H.)
| | - Stanley H. Chu
- From the Department of Radiology (M.P., J.J.B., A.M., S.Z.L., A.L.D.,
S.H.C., J.M.H., M.A.C., M.M.), Department of Medicine, Division of Cardiology
(R.P., P.G.), and Department of Preventive Medicine (P.G.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago,
IL 60611; Department of Radiology, University Hospital Basel, University of
Basel, Basel, Switzerland (M.P.); and Department of Epidemiology, University of
Washington, Seattle, Wash (S.R.H.)
| | - Julia M. Hwang
- From the Department of Radiology (M.P., J.J.B., A.M., S.Z.L., A.L.D.,
S.H.C., J.M.H., M.A.C., M.M.), Department of Medicine, Division of Cardiology
(R.P., P.G.), and Department of Preventive Medicine (P.G.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago,
IL 60611; Department of Radiology, University Hospital Basel, University of
Basel, Basel, Switzerland (M.P.); and Department of Epidemiology, University of
Washington, Seattle, Wash (S.R.H.)
| | - Mitchell A. Collins
- From the Department of Radiology (M.P., J.J.B., A.M., S.Z.L., A.L.D.,
S.H.C., J.M.H., M.A.C., M.M.), Department of Medicine, Division of Cardiology
(R.P., P.G.), and Department of Preventive Medicine (P.G.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago,
IL 60611; Department of Radiology, University Hospital Basel, University of
Basel, Basel, Switzerland (M.P.); and Department of Epidemiology, University of
Washington, Seattle, Wash (S.R.H.)
| | - Rod Passman
- From the Department of Radiology (M.P., J.J.B., A.M., S.Z.L., A.L.D.,
S.H.C., J.M.H., M.A.C., M.M.), Department of Medicine, Division of Cardiology
(R.P., P.G.), and Department of Preventive Medicine (P.G.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago,
IL 60611; Department of Radiology, University Hospital Basel, University of
Basel, Basel, Switzerland (M.P.); and Department of Epidemiology, University of
Washington, Seattle, Wash (S.R.H.)
| | - Susan R. Heckbert
- From the Department of Radiology (M.P., J.J.B., A.M., S.Z.L., A.L.D.,
S.H.C., J.M.H., M.A.C., M.M.), Department of Medicine, Division of Cardiology
(R.P., P.G.), and Department of Preventive Medicine (P.G.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago,
IL 60611; Department of Radiology, University Hospital Basel, University of
Basel, Basel, Switzerland (M.P.); and Department of Epidemiology, University of
Washington, Seattle, Wash (S.R.H.)
| | - Philip Greenland
- From the Department of Radiology (M.P., J.J.B., A.M., S.Z.L., A.L.D.,
S.H.C., J.M.H., M.A.C., M.M.), Department of Medicine, Division of Cardiology
(R.P., P.G.), and Department of Preventive Medicine (P.G.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago,
IL 60611; Department of Radiology, University Hospital Basel, University of
Basel, Basel, Switzerland (M.P.); and Department of Epidemiology, University of
Washington, Seattle, Wash (S.R.H.)
| | - Michael Markl
- From the Department of Radiology (M.P., J.J.B., A.M., S.Z.L., A.L.D.,
S.H.C., J.M.H., M.A.C., M.M.), Department of Medicine, Division of Cardiology
(R.P., P.G.), and Department of Preventive Medicine (P.G.), Northwestern
University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago,
IL 60611; Department of Radiology, University Hospital Basel, University of
Basel, Basel, Switzerland (M.P.); and Department of Epidemiology, University of
Washington, Seattle, Wash (S.R.H.)
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Pradella M, Baraboo JJ, Prabhakaran S, Zhao L, Hijaz T, McComb EN, Naidich MJ, Heckbert SR, Nasrallah IM, Bryan RN, Passman RS, Markl M, Greenland P. MRI Investigation of the Association of Left Atrial and Left Atrial Appendage Hemodynamics with Silent Brain Infarction. J Magn Reson Imaging 2024. [PMID: 38490945 DOI: 10.1002/jmri.29349] [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: 12/28/2023] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Left atrial (LA) myopathy is thought to be associated with silent brain infarctions (SBI) through changes in blood flow hemodynamics leading to thrombogenesis. 4D-flow MRI enables in-vivo hemodynamic quantification in the left atrium (LA) and LA appendage (LAA). PURPOSE To determine whether LA and LAA hemodynamic and volumetric parameters are associated with SBI. STUDY TYPE Prospective observational study. POPULATION A single-site cohort of 125 Participants of the multiethnic study of atherosclerosis (MESA), mean age: 72.3 ± 7.2 years, 56 men. FIELD STRENGTH/SEQUENCE 1.5T. Cardiac MRI: Cine balanced steady state free precession (bSSFP) and 4D-flow sequences. Brain MRI: T1- and T2-weighted SE and FLAIR. ASSESSMENT Presence of SBI was determined from brain MRI by neuroradiologists according to routine diagnostic criteria in all participants without a history of stroke based on the MESA database. Minimum and maximum LA volumes and ejection fraction were calculated from bSSFP data. Blood stasis (% of voxels <10 cm/sec) and peak velocity (cm/sec) in the LA and LAA were assessed by a radiologist using an established 4D-flow workflow. STATISTICAL TESTS Student's t test, Mann-Whitney U test, one-way ANOVA, chi-square test. Multivariable stepwise logistic regression with automatic forward and backward selection. Significance level P < 0.05. RESULTS 26 (20.8%) had at least one SBI. After Bonferroni correction, participants with SBI were significantly older and had significantly lower peak velocities in the LAA. In multivariable analyses, age (per 10-years) (odds ratio (OR) = 1.99 (95% confidence interval (CI): 1.30-3.04)) and LAA peak velocity (per cm/sec) (OR = 0.87 (95% CI: 0.81-0.93)) were significantly associated with SBI. CONCLUSION Older age and lower LAA peak velocity were associated with SBI in multivariable analyses whereas volumetric-based measures from cardiac MRI or cardiovascular risk factors were not. Cardiac 4D-flow MRI showed potential to serve as a novel imaging marker for SBI. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Maurice Pradella
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Justin J Baraboo
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tarek Hijaz
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erin N McComb
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michelle J Naidich
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Ilya M Nasrallah
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rod S Passman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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4
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Falcão MBL, Rossi GMC, Rutz T, Prša M, Tenisch E, Ma L, Weiss EK, Baraboo JJ, Yerly J, Markl M, Stuber M, Roy CW. Focused navigation for respiratory-motion-corrected free-running radial 4D flow MRI. Magn Reson Med 2023; 90:117-132. [PMID: 36877140 PMCID: PMC10149606 DOI: 10.1002/mrm.29634] [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: 08/25/2022] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE To validate a respiratory motion correction method called focused navigation (fNAV) for free-running radial whole-heart 4D flow MRI. METHODS Using fNAV, respiratory signals derived from radial readouts are converted into three orthogonal displacements, which are then used to correct respiratory motion in 4D flow datasets. Hundred 4D flow acquisitions were simulated with non-rigid respiratory motion and used for validation. The difference between generated and fNAV displacement coefficients was calculated. Vessel area and flow measurements from 4D flow reconstructions with (fNAV) and without (uncorrected) motion correction were compared to the motion-free ground-truth. In 25 patients, the same measurements were compared between fNAV 4D flow, 2D flow, navigator-gated Cartesian 4D flow, and uncorrected 4D flow datasets. RESULTS For simulated data, the average difference between generated and fNAV displacement coefficients was 0.04± $$ \pm $$ 0.32 mm and 0.31± $$ \pm $$ 0.35 mm in the x and y directions, respectively. In the z direction, this difference was region-dependent (0.02± $$ \pm $$ 0.51 mm up to 5.85± $$ \pm $$ 3.41 mm). For all measurements (vessel area, net volume, and peak flow), the average difference from ground truth was higher for uncorrected 4D flow datasets (0.32± $$ \pm $$ 0.11 cm2 , 11.1± $$ \pm $$ 3.5 mL, and 22.3± $$ \pm $$ 6.0 mL/s) than for fNAV 4D flow datasets (0.10± $$ \pm $$ 0.03 cm2 , 2.6± $$ \pm $$ 0.7 mL, and 5.1± 0 $$ \pm 0 $$ .9 mL/s, p < 0.05). In vivo, average vessel area measurements were 4.92± $$ \pm $$ 2.95 cm2 , 5.06± $$ \pm $$ 2.64 cm2 , 4.87± $$ \pm $$ 2.57 cm2 , 4.87± $$ \pm $$ 2.69 cm2 , for 2D flow and fNAV, navigator-gated and uncorrected 4D flow datasets, respectively. In the ascending aorta, all 4D flow datasets except for the fNAV reconstruction had significantly different vessel area measurements from 2D flow. Overall, 2D flow datasets demonstrated the strongest correlation to fNAV 4D flow for both net volume (r2 = 0.92) and peak flow (r2 = 0.94), followed by navigator-gated 4D flow (r2 = 0.83 and r2 = 0.86, respectively), and uncorrected 4D flow (r2 = 0.69 and r2 = 0.86, respectively). CONCLUSION fNAV corrected respiratory motion in vitro and in vivo, resulting in fNAV 4D flow measurements that are comparable to those derived from 2D flow and navigator-gated Cartesian 4D flow datasets, with improvements over those from uncorrected 4D flow.
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Affiliation(s)
- Mariana B. L. Falcão
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Giulia M. C. Rossi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Tobias Rutz
- Service of Cardiology, Centre de Resonance Magnétique Cardiaque (CRMC), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Milan Prša
- Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Estelle Tenisch
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Liliana Ma
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois USA
| | - Elizabeth K. Weiss
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois USA
| | - Justin J. Baraboo
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois USA
| | - Jérôme Yerly
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois USA
| | - Matthias Stuber
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Christopher W. Roy
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
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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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Liu SZ, Maroun A, Baraboo JJ, DiCarlo AL, Lee DC, Heckbert SR, Passman R, Markl M, Greenland P, Pradella M. Quantification of left atrial function by the area-length method overestimates left atrial emptying fraction. Eur J Radiol 2023; 160:110705. [PMID: 36701824 PMCID: PMC9946095 DOI: 10.1016/j.ejrad.2023.110705] [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: 11/09/2022] [Revised: 12/21/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023]
Abstract
PURPOSE The biplane area-length method is commonly used in cardiac magnetic resonance (CMR) to assess left atrial (LA) volume (LAV) and function. Associations between left atrial emptying fraction (LAEF) and clinical outcomes have been reported. However, only limited data are available on the calculation of LAEF using the biplane method compared to 3D assessment. This study aimed to compare volumetric and functional LA parameters obtained from the biplane method with 3D assessment in a large, multiethnic cohort. METHOD 158 participants of MESA (Multi-Ethnic Study of Atherosclerosis) underwent CMR that included standard two- and four-chamber steady-state free precession (SSFP) cine imaging for the biplane method. For 3D-based assessment, short-axis SSFP cine series covering the entire LA were obtained, followed by manual delineation of LA contours to create a time-resolved 3D LAV dataset. Paired t-tests and Bland-Altman plots were used to analyze the data. RESULTS Standard volumetric assessment showed that LAVmin (bias: -8.35 mL, p < 0.001), LAVmax (bias: -9.38 mL, p < 0.001) and LAVpreA (bias: -10.27 mL, p < 0.001) were significantly smaller using the biplane method compared to 3D assessment. Additionally, the biplane method reported significantly higher LAEFtotal (bias: 7.22 %, p < 0.001), LAEFactive (bias: 6.08 %, p < 0.001), and LAEFpassive (bias: 4.51 %, p < 0.001) with wide limits of agreement. CONCLUSIONS LA volumes were underestimated using the biplane method compared to 3D assessment, while LAEF parameters were overestimated. These findings demonstrate a lack of precision using the biplane method for LAEF assessment. Our results support the usage of 3D assessment in specific settings when LA volumetric and functional parameters are in focus.
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Affiliation(s)
- Sophia Z Liu
- Department of Radiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Anthony Maroun
- Department of Radiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Justin J Baraboo
- Department of Radiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Amanda L DiCarlo
- Department of Radiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA
| | - Daniel C Lee
- Department of Radiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA; Department of Cardiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA 98195, USA.
| | - Rod Passman
- Department of Cardiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Maurice Pradella
- Department of Radiology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA; Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
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7
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Shen D, Pathrose A, Sarnari R, Blake A, Berhane H, Baraboo JJ, Carr JC, Markl M, Kim D. Automated segmentation of biventricular contours in tissue phase mapping using deep learning. NMR Biomed 2021; 34:e4606. [PMID: 34476863 PMCID: PMC8795858 DOI: 10.1002/nbm.4606] [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: 04/05/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
Tissue phase mapping (TPM) is an MRI technique for quantification of regional biventricular myocardial velocities. Despite its potential, clinical use is limited due to the requisite labor-intensive manual segmentation of cardiac contours for all time frames. The purpose of this study was to develop a deep learning (DL) network for automated segmentation of TPM images, without significant loss in segmentation and myocardial velocity quantification accuracy compared with manual segmentation. We implemented a multi-channel 3D (three dimensional; 2D + time) dense U-Net that trained on magnitude and phase images and combined cross-entropy, Dice, and Hausdorff distance loss terms to improve the segmentation accuracy and suppress unnatural boundaries. The dense U-Net was trained and tested with 150 multi-slice, multi-phase TPM scans (114 scans for training, 36 for testing) from 99 heart transplant patients (44 females, 1-4 scans/patient), where the magnitude and velocity-encoded (Vx , Vy , Vz ) images were used as input and the corresponding manual segmentation masks were used as reference. The accuracy of DL segmentation was evaluated using quantitative metrics (Dice scores, Hausdorff distance) and linear regression and Bland-Altman analyses on the resulting peak radial and longitudinal velocities (Vr and Vz ). The mean segmentation time was about 2 h per patient for manual and 1.9 ± 0.3 s for DL. Our network produced good accuracy (median Dice = 0.85 for left ventricle (LV), 0.64 for right ventricle (RV), Hausdorff distance = 3.17 pixels) compared with manual segmentation. Peak Vr and Vz measured from manual and DL segmentations were strongly correlated (R ≥ 0.88) and in good agreement with manual analysis (mean difference and limits of agreement for Vz and Vr were -0.05 ± 0.98 cm/s and -0.06 ± 1.18 cm/s for LV, and -0.21 ± 2.33 cm/s and 0.46 ± 4.00 cm/s for RV, respectively). The proposed multi-channel 3D dense U-Net was capable of reducing the segmentation time by 3,600-fold, without significant loss in accuracy in tissue velocity measurements.
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Affiliation(s)
- Daming Shen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Roberto Sarnari
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Allison Blake
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Haben Berhane
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
| | - Justin J Baraboo
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
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8
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Zhang J, Rothenberger SM, Brindise MC, Scott MB, Berhane H, Baraboo JJ, Markl M, Rayz VL, Vlachos PP. Divergence-Free Constrained Phase Unwrapping and Denoising for 4D Flow MRI Using Weighted Least-Squares. IEEE Trans Med Imaging 2021; 40:3389-3399. [PMID: 34086567 PMCID: PMC8714458 DOI: 10.1109/tmi.2021.3086331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A novel divergence-free constrained phase unwrapping method was proposed and evaluated for 4D flow MRI. The unwrapped phase field was obtained by integrating the phase variations estimated from the wrapped phase data using weighted least-squares. The divergence-free constraint for incompressible blood flow was incorporated to regulate and denoise the resulting phase field. The proposed method was tested on synthetic phase data of left ventricular flow and in vitro 4D flow measurement of Poiseuille flow. The method was additionally applied to in vivo 4D flow measurements in the thoracic aorta from 30 human subjects. The performance of the proposed method was compared to the state-of-the-art 4D single-step Laplacian algorithm. The synthetic phase data were completely unwrapped by the proposed method for all the cases with velocity encoding (venc) as low as 20% of the maximum velocity and signal-to-noise ratio as low as 5. The in vitro Poiseuille flow data were completely unwrapped with a 60% increase in the velocity-to-noise ratio. For the in-vivo aortic datasets with venc ratio less than 0.4, the proposed method significantly improved the success rate by as much as 40% and reduced the velocity error levels by a factor of 10 compared to the state-of-the-art method. The divergence-free constrained method exhibits reliability and robustness on phase unwrapping and shows improved accuracy of velocity and hemodynamic quantities by unwrapping the low-venc 4D flow MRI data.
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Baraboo JJ, Dinakarpandian D, Chan SS. Automated Prediction of Hepatic Arterial Stenosis. AMIA Jt Summits Transl Sci Proc 2017; 2017:58-65. [PMID: 28815106 PMCID: PMC5543337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Several thousand life-saving liver transplants are performed each year. One of the most common causes of early transplant failure is arterial stenosis of the anastomotic junction. Early detection of transplant arterial stenosis can help prevent transplant failure and the need to re-transplant. Doppler ultrasound is the most common screening method, but it suffers from poor specificity. Positive screening cases proceed to angiography which is an invasive and expensive procedure. A more accurate test could decrease the number of normal patients who would have to undergo this invasive diagnostic procedure. We present a turnkey clinical decision support tool for automated prediction of stenosis based on Fourier spectrum analysis of Doppler sonograms to compute a Stenosis Index that has been shown to have higher accuracy than traditional measures. The results of the automated approach compare favorably with the manual approach. Software is available from the authors on request.
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Affiliation(s)
| | | | - Sherwin S. Chan
- University of Missouri, Kansas City, MO;,Children’s Mercy Hospital, Kansas City, MO
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