3D whole heart k-space-based super-resolution cardiac T1 mapping using rotated stacks

Objective. To provide three-dimensional (3D) whole-heart high-resolution isotropic cardiac T1 maps using a k-space-based through-plane super-resolution reconstruction (SRR) with rotated multi-slice stacks.Approach. Due to limited SNR and cardiac motion, often only 2D T1 maps with low through-plane resolution (4-8 mm) can be obtained. Previous approaches used SRR to calculate 3D high-resolution isotropic cardiac T1 maps. However, they were limited to the ventricles. The proposed approach acquires rotated stacks in long-axis orientation with high in-plane resolution but low through-plane resolution. This results in radially overlapping stacks from which high-resolution T1 maps of the whole heart are reconstructed using a k-space-based SRR framework considering the complete acquisition model. Cardiac and residual respiratory motion between different breath holds is estimated and incorporated into the reconstruction. The proposed approach was evaluated in simulations and phantom experiments and successfully applied to ten healthy subjects.Main results. 3D T1 maps of the whole heart were obtained in the same acquisition time as previous methods covering only the ventricles. T1 measurements were possible even for small structures, such as the atrial wall. The proposed approach provided accurate (P> 0.4;R2> 0.99) and precise T1 values (SD of 64.32 ± 22.77 ms in the proposed approach, 44.73 ± 31.9 ms in the reference). The edge sharpness of the T1 maps was increased by 6.20% and 4.73% in simulation and phantom experiments, respectively. Contrast-to-noise ratios between the septum and blood pool increased by 14.50% inin vivomeasurements with a k-space compared to an image-space-based SRR.Significance. The proposed approach provided whole-heart high-resolution 1.3 mm isotropic T1 maps in an overall acquisition time of approximately three minutes. Small structures, such as the atrial and right ventricular walls, could be visualized in the T1 maps.

Scanner-Independent MyoMapNet for Accelerated Cardiac MRI T1 Mapping Across Vendors and Field Strengths

BACKGROUND

In cardiac T1 mapping, a series of T1 -weighted (T1 w) images are collected and numerically fitted to a two or three-parameter model of the signal recovery to estimate voxel-wise T1 values. To reduce the scan time, one can collect fewer T1 w images, albeit at the cost of precision or/and accuracy. Recently, the feasibility of using a neural network instead of conventional two- or three-parameter fit modeling has been demonstrated. However, prior studies used data from a single vendor and field strength; therefore, the generalizability of the models has not been established.

PURPOSE

To develop and evaluate an accelerated cardiac T1 mapping approach based on MyoMapNet, a convolution neural network T1 estimator that can be used across different vendors and field strengths by incorporating the relevant scanner information as additional inputs to the model.

STUDY TYPE

Retrospective, multicenter.

POPULATION

A total of 1423 patients with known or suspected cardiac disease (808 male, 57 ± 16 years), from three centers, two vendors (Siemens, Philips), and two field strengths (1.5 T, 3 T). The data were randomly split into 60% training, 20% validation, and 20% testing.

FIELD STRENGTH/SEQUENCE

A 1.5 T and 3 T, Modified Look-Locker inversion recovery (MOLLI) for native and postcontrast T1 .

ASSESSMENT

Scanner-independent MyoMapNet (SI-MyoMapNet) was developed by altering the deep learning (DL) architecture of MyoMapNet to incorporate scanner vendor and field strength as inputs. Epicardial and endocardial contours and blood pool (by manually drawing a large region of interest in the blood pool) of the left ventricle were manually delineated by three readers, with 2, 8, and 9 years of experience, and SI-MyoMapNet myocardial and blood pool T1 values (calculated from four T1 w images) were compared with conventional MOLLI T1 values (calculated from 8 to 11 T1 w images).

STATISTICAL TESTS

Equivalency test with 95% confidence interval (CI), linear regression slope, Pearson correlation coefficient (r), Bland-Altman analysis.

RESULTS

The proposed SI-MyoMapNet successfully created T1 maps. Native and postcontrast T1 values measured from SI-MyoMapNet were strongly correlated with MOLLI, despite using only four T1 w images, at both field-strengths and vendors (all r > 0.86). For native T1 , SI-MyoMapNet and MOLLI were in good agreement for myocardial and blood T1 values in institution 1 (myocardium: 5 msec, 95% CI [3, 8]; blood: -10 msec, 95%CI [-16, -4]), in institution 2 (myocardium: 6 msec, 95% CI [0, 11]; blood: 0 msec, [-18, 17]), and in institution 3 (myocardium: 7 msec, 95% CI [-8, 22]; blood: 8 msec, [-14, 30]). Similar results were observed for postcontrast T1 .

DATA CONCLUSION

Inclusion of field strength and vendor as additional inputs to the DL architecture allows generalizability of MyoMapNet across different vendors or field strength.

EVIDENCE LEVEL

2.

TECHNICAL EFFICACY

Stage 2.

Motion-corrected model-based reconstruction for 2D myocardial T1 mapping

PURPOSE

To allow for T1 mapping of the myocardium within 2.3 s for a 2D slice utilizing cardiac motion-corrected, model-based image reconstruction.

METHODS

Golden radial data acquisition is continuously carried out for 2.3 s after an inversion pulse. In a first step, dynamic images are reconstructed which show both contrast changes due to T1 recovery and anatomical changes due to the heartbeat. An image registration algorithm with a signal model for T1 recovery is applied to estimate non-rigid cardiac motion. In a second step, estimated motion fields are applied during an iterative model-based T1 reconstruction. The approach was evaluated in numerical simulations, phantom experiments and in in-vivo scans in healthy volunteers.

RESULTS

The accuracy of cardiac motion estimation was shown in numerical simulations with an average motion field error of 0.7 ± 0.6 mm for a motion amplitude of 5.1 mm. The accuracy of T1 estimation was demonstrated in phantom experiments, with no significant difference (p = 0.13) in T1 estimated by the proposed approach compared to an inversion-recovery reference method. In vivo, the proposed approach yielded 1.3 × 1.3 mm T1 maps with no significant difference (p = 0.77) in T1 and SDs in comparison to a cardiac-gated approach requiring 16 s scan time (i.e., seven times longer than the proposed approach). Cardiac motion correction improved the precision of T1 maps, shown by a 40% reduced SD.

CONCLUSION

We have presented an approach that provides T1 maps of the myocardium in 2.3 s by utilizing both cardiac motion correction and model-based T1 reconstruction.

Diffuse myocardial fibrosis precedes subclinical functional myocardial impairment and provides prognostic information in systemic sclerosis

AIMS

Myocardial involvement is common in patients with systemic sclerosis (SSc) and causes myocardial fibrosis and subtle ventricular dysfunction. However, the temporal onset of myocardial involvement during the progression of the disease and its prognostic value are yet unknown. We used cardiovascular magnetic resonance (CMR) to investigate subclinical functional impairment and diffuse myocardial fibrosis in patients with very early diagnosis of SSc (VEDOSS) and established SSc and examined whether this was associated with mortality.

METHODS AND RESULTS

One hundred and ten SSc patients (86 established SSc, 24 VEDOSS) and 15 healthy controls were prospectively recruited. The patients were followed-up for a median duration of 7.0 years (interquartile range 6.0-7.3 years). Study subjects underwent CMR including assessment of myocardial fibrosis [native T1 and extracellular volume (ECV)] and measurement of global longitudinal (GLS) and circumferential (GCS) myocardial strain. Native T1 values and ECV were elevated in VEDOSS and SSc patients compared with controls (P < 0.001). GLS was similar in VEDOSS and controls but significantly impaired in patients with established SSc (P < 0.001). GCS was similar over all groups (P = 0.88). There were 12 deaths during follow-up. Elevated native T1 [hazard ratio (HR) 5.8, 95% confidence interval (CI): 1.7-20.4; P = 0.006] and reduced GLS (HR 6.1, 95% CI: 1.3-29.9; P = 0.038) identified subjects with increased risk of death. Only native T1 was predictive for cardiovascular mortality (P < 0.001).

CONCLUSION

Subclinical myocardial involvement first manifests as diffuse myocardial fibrosis identified by the expansion of ECV and increased native T1 in VEDOSS patients while subtle functional impairment only occurs in established SSc. Native T1 and GLS have prognostic value for all-cause mortality in SSc patients.

3D model-based super-resolution motion-corrected cardiac T1 mapping

Objective. To provide 3D high-resolution cardiac T1 maps using model-based super-resolution reconstruction (SRR).Approach. Due to signal-to-noise ratio limitations and the motion of the heart during imaging, often 2D T1 maps with only low through-plane resolution (i.e. slice thickness of 6-8 mm) can be obtained. Here, a model-based SRR approach is presented, which combines multiple stacks of 2D acquisitions with 6-8 mm slice thickness and generates 3D high-resolution T1 maps with a slice thickness of 1.5-2 mm. Every stack was acquired in a different breath hold (BH) and any misalignment between BH was corrected retrospectively. The novelty of the proposed approach is the BH correction and the application of model-based SRR on cardiac T1 Mapping. The proposed approach was evaluated in numerical simulations and phantom experiments and demonstrated in four healthy subjects.Main results. Alignment of BH states was essential for SRR even in healthy volunteers. In simulations, respiratory motion could be estimated with an RMS error of 0.18 ± 0.28 mm. SRR improved the visualization of small structures. High accuracy and precision (average standard deviation of 69.62 ms) of the T1 values was ensured by SRR while the detectability of small structures increased by 40%.Significance. The proposed SRR approach provided T1 maps with high in-plane and high through-plane resolution (1.3 × 1.3 × 1.5-2 mm³). The approach led to improvements in the visualization of small structures and precise T1 values.

Extracellular Volume Fraction by Computed Tomography Predicts Long-Term Prognosis Among Patients With Cardiac Amyloidosis

BACKGROUND

Light chain (AL) and transthyretin (ATTR) amyloid fibrils are deposited in the extracellular space of the myocardium, resulting in heart failure and premature mortality. Extracellular expansion can be quantified by computed tomography, offering a rapid, cheaper, and more practical alternative to cardiac magnetic resonance, especially among patients with cardiac devices or on renal dialysis.

OBJECTIVES

This study sought to investigate the association of extracellular volume fraction by computed tomography (ECV_CT), myocardial remodeling, and mortality in patients with systemic amyloidosis.

METHODS

Patients with confirmed systemic amyloidosis and varying degrees of cardiac involvement underwent electrocardiography-gated cardiac computed tomography. Whole heart and septal ECV_CT was analyzed. All patients also underwent clinical assessment, electrocardiography, echocardiography, serum amyloid protein component, and/or technetium-99m (^99mTc) 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy. ECV_CT was compared across different extents of cardiac infiltration (ATTR Perugini grade/AL Mayo stage) and evaluated for its association with myocardial remodeling and all-cause mortality.

RESULTS

A total of 72 patients were studied (AL: n = 35, ATTR: n = 37; median age: 67 [IQR: 59-76] years, 70.8% male). Mean septal ECV_CT was 42.7% ± 13.1% and 55.8% ± 10.9% in AL and ATTR amyloidosis, respectively, and correlated with indexed left ventricular mass (r = 0.426; P < 0.001), left ventricular ejection fraction (r = 0.460; P < 0.001), N-terminal pro-B-type natriuretic peptide (r = 0.563; P < 0.001), and high-sensitivity troponin T (r = 0.546; P < 0.001). ECV_CT increased with cardiac amyloid involvement in both AL and ATTR amyloid. Over a mean follow-up of 5.3 ± 2.4 years, 40 deaths occurred (AL: n = 14 [35.0%]; ATTR: n = 26 [65.0%]). Septal ECV_CT was independently associated with all-cause mortality in ATTR (not AL) amyloid after adjustment for age and septal wall thickness (HR: 1.046; 95% CI: 1.003-1.090; P = 0.037).

CONCLUSIONS

Cardiac amyloid burden quantified by ECV_CT is associated with adverse cardiac remodeling as well as all-cause mortality among ATTR amyloid patients. ECV_CT may address the need for better identification and risk stratification of amyloid patients, using a widely accessible imaging modality.

Impact of deep learning architectures on accelerated cardiac T1 mapping using MyoMapNet

The objective of the current study was to investigate the performance of various deep learning (DL) architectures for MyoMapNet, a DL model for T1 estimation using accelerated cardiac T1 mapping from four T1 -weighted images collected after a single inversion pulse (Look-Locker 4 [LL4]). We implemented and tested three DL architectures for MyoMapNet: (a) a fully connected neural network (FC), (b) convolutional neural networks (VGG19, ResNet50), and (c) encoder-decoder networks with skip connections (ResUNet, U-Net). Modified Look-Locker inversion recovery (MOLLI) images from 749 patients at 3 T were used for training, validation, and testing. The first four T1 -weighted images from MOLLI5(3)3 and/or MOLLI4(1)3(1)2 protocols were extracted to create accelerated cardiac T1 mapping data. We also prospectively collected data from 28 subjects using MOLLI and LL4 to further evaluate model performance. Despite rigorous training, conventional VGG19 and ResNet50 models failed to produce anatomically correct T1 maps, and T1 values had significant errors. While ResUNet yielded good quality maps, it significantly underestimated T1 . Both FC and U-Net, however, yielded excellent image quality with good T1 accuracy for both native (FC/U-Net/MOLLI = 1217 ± 64/1208 ± 61/1199 ± 61 ms, all p < 0.05) and postcontrast myocardial T1 (FC/U-Net/MOLLI = 578 ± 57/567 ± 54/574 ± 55 ms, all p < 0.05). In terms of precision, the U-Net model yielded better T1 precision compared with the FC architecture (standard deviation of 61 vs. 67 ms for the myocardium for native [p < 0.05], and 31 vs. 38 ms [p < 0.05], for postcontrast). Similar findings were observed in prospectively collected LL4 data. It was concluded that U-Net and FC DL models in MyoMapNet enable fast myocardial T1 mapping using only four T1 -weighted images collected from a single LL sequence with comparable accuracy. U-Net also provides a slight improvement in precision.

Improving accuracy of myocardial T1 estimation in MyoMapNet

PURPOSE

To improve the accuracy and robustness of T₁ estimation by MyoMapNet, a deep learning-based approach using 4 inversion-recovery T₁ -weighted images for cardiac T₁ mapping.

METHODS

MyoMapNet is a fully connected neural network for T₁ estimation of an accelerated cardiac T₁ mapping sequence, which collects 4 T₁ -weighted images by a single Look-Locker inversion-recovery experiment (LL4). MyoMapNet was originally trained using in vivo data from the modified Look-Locker inversion recovery sequence, which resulted in significant bias and sensitivity to various confounders. This study sought to train MyoMapNet using signals generated from numerical simulations and phantom MR data under multiple simulated confounders. The trained model was then evaluated by phantom data scanned using new phantom vials that differed from those used for training. The performance of the new model was compared with modified Look-Locker inversion recovery sequence and saturation-recovery single-shot acquisition for measuring native and postcontrast T₁ in 25 subjects.

RESULTS

In the phantom study, T₁ values measured by LL4 with MyoMapNet were highly correlated with reference values from the spin-echo sequence. Furthermore, the estimated T₁ had excellent robustness to changes in flip angle and off-resonance. Native and postcontrast myocardium T₁ at 3 Tesla measured by saturation-recovery single-shot acquisition, modified Look-Locker inversion recovery sequence, and MyoMapNet were 1483 ± 46.6 ms and 791 ± 45.8 ms, 1169 ± 49.0 ms and 612 ± 36.0 ms, and 1443 ± 57.5 ms and 700 ± 57.5 ms, respectively. The corresponding extracellular volumes were 22.90% ± 3.20%, 28.88% ± 3.48%, and 30.65% ± 3.60%, respectively.

CONCLUSION

Training MyoMapNet with numerical simulations and phantom data will improve the estimation of myocardial T₁ values and increase its robustness to confounders while also reducing the overall T₁ mapping estimation time to only 4 heartbeats.

Development of a cardiovascular magnetic resonance-compatible large animal isolated heart model for direct comparison of beating and arrested hearts

Cardiac motion results in image artefacts and quantification errors in many cardiovascular magnetic resonance (CMR) techniques, including microstructural assessment using diffusion tensor cardiovascular magnetic resonance (DT-CMR). Here, we develop a CMR-compatible isolated perfused porcine heart model that allows comparison of data obtained in beating and arrested states. Ten porcine hearts (8/10 for protocol optimisation) were harvested using a donor heart retrieval protocol and transported to the remote CMR facility. Langendorff perfusion in a 3D-printed chamber and perfusion circuit re-established contraction. Hearts were imaged using cine, parametric mapping and STEAM DT-CMR at cardiac phases with the minimum and maximum wall thickness. High potassium and lithium perfusates were then used to arrest the heart in a slack and contracted state, respectively. Imaging was repeated in both arrested states. After imaging, tissue was removed for subsequent histology in a location matched to the DT-CMR data using fiducial markers. Regular sustained contraction was successfully established in six out of 10 hearts, including the final five hearts. Imaging was performed in four hearts and one underwent the full protocol, including colocalised histology. The image quality was good and there was good agreement between DT-CMR data in equivalent beating and arrested states. Despite the use of autologous blood and dextran within the perfusate, T2 mapping results, DT-CMR measures and an increase in mass were consistent with development of myocardial oedema, resulting in failure to achieve a true diastolic-like state. A contiguous stack of 313 5-μm histological sections at and a 100-μm thick section showing cell morphology on 3D fluorescent confocal microscopy colocalised to DT-CMR data were obtained. A CMR-compatible isolated perfused beating heart setup for large animal hearts allows direct comparisons of beating and arrested heart data with subsequent colocalised histology, without the need for onsite preclinical facilities.

Quantification of changes in myocardial T1 * values with exercise cardiac MRI using a free-breathing non-electrocardiograph radial imaging

PURPOSE

To develop and evaluate a free breathing non-electrocardiograph (ECG) myocardial T₁ * mapping sequence using radial imaging to quantify the changes in myocardial T₁ * between rest and exercise (T₁ *_reactivity ) in exercise cardiac MRI (Ex-CMR).

METHODS

A free-running T₁ * sequence was developed using a saturation pulse followed by three Look-Locker inversion-recovery experiments. Each Look-Locker continuously acquired data as radial trajectory using a low flip-angle spoiled gradient-echo readout. Self-navigation was performed with a temporal resolution of ∼100 ms for retrospectively extracting respiratory motion. The mid-diastole phase for every cardiac cycle was retrospectively detected on the recorded electrocardiogram signal using an empirical model. Multiple measurements were performed to obtain mean value to reduce effects from the free-breathing acquisition. Finally, data acquired at both mid-diastole and end-expiration are picked and reconstructed by a low-rank plus sparsity constraint algorithm. The performance of this sequence was evaluated by simulations, phantoms, and in vivo studies at rest and after physiological exercise.

RESULTS

Numerical simulation demonstrated that changes in T₁ * are related to the changes in T₁ ; however, other factors such as breathing motion could influence T₁ * measurements. Phantom T₁ * values measured using free-running T₁ * mapping sequence had good correlation with spin-echo T₁ values and was insensitive to heart rate. In the Ex-CMR study, the measured T₁ * reactivity was 10% immediately after exercise and declined over time.

CONCLUSION

The free-running T₁ * mapping sequence allows free-breathing non-ECG quantification of changes in myocardial T₁ * with physiological exercise. Although, absolute myocardial T₁ * value is sensitive to various confounders such as B₁ and B₀ inhomogeneity, quantification of its change may be useful in revealing myocardial tissue properties with exercise.

Cardiac Alterations on 3T MRI in Young Adults With Sedentary Lifestyle-Related Risk Factors

Background

Young adult populations with the sedentary lifestyle-related risk factors overweight, hypertension, and type 2 diabetes (T2D) are growing, and associated cardiac alterations could overlap early findings in non-ischemic cardiomyopathy on cardiovascular MRI. We aimed to investigate cardiac morphology, function, and tissue characteristics for these cardiovascular risk factors.

Methods

Non-athletic non-smoking asymptomatic adults aged 18-45 years were prospectively recruited and underwent 3Tesla cardiac MRI. Multivariate linear regression was performed to investigate independent associations of risk factor-related parameters with cardiac MRI values.

Results

We included 311 adults (age, 32 ± 7 years; men, 49%). Of them, 220 subjects had one or multiple risk factors, while 91 subjects were free of risk factors. For overweight, increased body mass index (per SD = 5.3 kg/m2) was associated with increased left ventricular (LV) mass (+7.3 g), biventricular higher end-diastolic (LV, +8.6 ml), and stroke volumes (SV; +5.0 ml), higher native T1 (+7.3 ms), and lower extracellular volume (ECV, -0.38%), whereas the higher waist-hip ratio was associated with lower biventricular volumes. Regarding hypertension, increased systolic blood pressure (per SD = 14 mmHg) was associated with increased LV mass (+6.9 g), higher LV ejection fraction (EF; +1.0%), and lower ECV (-0.48%), whereas increased diastolic blood pressure was associated with lower LV EF. In T2D, increased HbA1c (per SD = 9.0 mmol/mol) was associated with increased LV mass (+2.2 g), higher right ventricular end-diastolic volume (+3.2 ml), and higher ECV (+0.27%). Increased heart rate was linked with decreased LV mass, lower biventricular volumes, and lower T2 values.

Conclusions

Young asymptomatic adults with overweight, hypertension, and T2D show subclinical alterations in cardiac morphology, function, and tissue characteristics. These alterations should be considered in cardiac MRI-based clinical decision making.

Emerging Techniques in Cardiac Magnetic Resonance Imaging

Cardiovascular disease is the leading cause of death and a significant contributor of health care costs. Noninvasive imaging plays an essential role in the management of patients with cardiovascular disease. Cardiac magnetic resonance (MR) can noninvasively assess heart and vascular abnormalities, including biventricular structure/function, blood hemodynamics, myocardial tissue composition, microstructure, perfusion, metabolism, coronary microvascular function, and aortic distensibility/stiffness. Its ability to characterize myocardial tissue composition is unique among alternative imaging modalities in cardiovascular disease. Significant growth in cardiac MR utilization, particularly in Europe in the last decade, has laid the necessary clinical groundwork to position cardiac MR as an important imaging modality in the workup of patients with cardiovascular disease. Although lack of availability, limited training, physician hesitation, and reimbursement issues have hampered widespread clinical adoption of cardiac MR in the United States, growing clinical evidence will ultimately overcome these challenges. Advances in cardiac MR techniques, particularly faster image acquisition, quantitative myocardial tissue characterization, and image analysis have been critical to its growth. In this review article, we discuss recent advances in established and emerging cardiac MR techniques that are expected to strengthen its capability in managing patients with cardiovascular disease. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 1.

Myocardial Tissue Characterization in Heart Failure with Preserved Ejection Fraction: From Histopathology and Cardiac Magnetic Resonance Findings to Therapeutic Targets

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome responsible for high mortality and morbidity rates. It has an ever growing social and economic impact and a deeper knowledge of molecular and pathophysiological basis is essential for the ideal management of HFpEF patients. The association between HFpEF and traditional cardiovascular risk factors is known. However, myocardial alterations, as well as pathophysiological mechanisms involved are not completely defined. Under the definition of HFpEF there is a wide spectrum of different myocardial structural alterations. Myocardial hypertrophy and fibrosis, coronary microvascular dysfunction, oxidative stress and inflammation are only some of the main pathological detectable processes. Furthermore, there is a lack of effective pharmacological targets to improve HFpEF patients' outcomes and risk factors control is the primary and unique approach to treat those patients. Myocardial tissue characterization, through invasive and non-invasive techniques, such as endomyocardial biopsy and cardiac magnetic resonance respectively, may represent the starting point to understand the genetic, molecular and pathophysiological mechanisms underlying this complex syndrome. The correlation between histopathological findings and imaging aspects may be the future challenge for the earlier and large-scale HFpEF diagnosis, in order to plan a specific and effective treatment able to modify the disease's natural course.

An under-recognized phenomenon: Myocardial volume change during the cardiac cycle

BACKGROUND

Myocardial volume is assumed to be constant over the cardiac cycle in the echocardiographic models used by professional guidelines, despite evidence that suggests otherwise. The aim of this paper is to use literature-derived myocardial strain values from healthy patients to determine if myocardial volume changes during the cardiac cycle.

METHODS

A systematic review for studies with longitudinal, radial, and circumferential strain from echocardiography in healthy volunteers ultimately yielded 16 studies, corresponding to 2917 patients. Myocardial volume in systole (MVs) and diastole (MVd) was used to calculate MVs/MVd for each study by applying this published strain data to three models: the standard ellipsoid geometric model, a thin-apex geometric model, and a strain-volume ratio.

RESULTS

MVs/MVd<1 in 14 of the 16 studies, when computed using these three models. A sensitivity analysis of the two geometric models was performed by varying the dimensions of the ellipsoid and calculating MVs/MVd. This demonstrated little variability in MVs/MVd, suggesting that strain values were the primary determinant of MVs/MVd rather than the geometric model used. Another sensitivity analysis using the 97.5th percentile of each orthogonal strain demonstrated that even with extreme values, in the largest two studies of healthy populations, the calculated MVs/MVd was <1.

CONCLUSIONS

Healthy human myocardium appears to decrease in volume during systole. This is seen in MRI studies and is clinically relevant, but this study demonstrates that this characteristic was also present but unrecognized in the existing echocardiography literature.

3D free-breathing cardiac magnetic resonance fingerprinting

PURPOSE

To develop a novel respiratory motion compensated three-dimensional (3D) cardiac magnetic resonance fingerprinting (cMRF) approach for whole-heart myocardial T₁ and T₂ mapping from a free-breathing scan.

METHODS

Two-dimensional (2D) cMRF has been recently proposed for simultaneous, co-registered T₁ and T₂ mapping from a breath-hold scan; however, coverage is limited. Here we propose a novel respiratory motion compensated 3D cMRF approach for whole-heart myocardial T₁ and T₂ tissue characterization from a free-breathing scan. Variable inversion recovery and T₂ preparation modules are used for parametric encoding, respiratory bellows driven localized autofocus is proposed for beat-to-beat translation motion correction and a subspace regularized reconstruction is employed to accelerate the scan. The proposed 3D cMRF approach was evaluated in a standardized T₁ /T₂ phantom in comparison with reference spin echo values and in 10 healthy subjects in comparison with standard 2D MOLLI, SASHA and T₂ -GraSE mapping techniques at 1.5 T.

RESULTS

3D cMRF T₁ and T₂ measurements were generally in good agreement with reference spin echo values in the phantom experiments, with relative errors of 2.9% and 3.8% for T₁ and T₂ (T₂ < 100 ms), respectively. in vivo left ventricle (LV) myocardial T₁ values were 1054 ± 19 ms for MOLLI, 1146 ± 20 ms for SASHA and 1093 ± 24 ms for the proposed 3D cMRF; corresponding T₂ values were 51.8 ± 1.6 ms for T2-GraSE and 44.6 ± 2.0 ms for 3D cMRF. LV coefficients of variation were 7.6 ± 1.6% for MOLLI, 12.1 ± 2.7% for SASHA and 5.8 ± 0.8% for 3D cMRF T₁ , and 10.5 ± 1.4% for T2-GraSE and 11.7 ± 1.6% for 3D cMRF T₂ .

CONCLUSION

The proposed 3D cMRF can provide whole-heart, simultaneous and co-registered T₁ and T₂ maps with accuracy and precision comparable to those of clinical standards in a single free-breathing scan of about 7 min.

FASt single-breathhold 2D multislice myocardial T1 mapping (FAST1) at 1.5T for full left ventricular coverage in three breathholds

Background

Conventional myocardial T₁ mapping techniques such as modified Look–Locker inversion recovery (MOLLI) generate one T₁ map per breathhold. T₁ mapping with full left ventricular coverage may be desirable when spatial T₁ variations are expected. This would require multiple breathholds, increasing patient discomfort and prolonging scan time.

Purpose

To develop and characterize a novel FASt single‐breathhold 2D multislice myocardial T₁ mapping (FAST1) technique for full left ventricular coverage.

Study Type

Prospective.

Population/Phantom

Numerical simulation, agarose/NiCl₂ phantom, 9 healthy volunteers, and 17 patients.

Field Strength/Sequence

1.5T/FAST1.

Assessment

Two FAST1 approaches, FAST1‐BS and FAST1‐IR, were characterized and compared with standard 5‐(3)‐3 MOLLI in terms of accuracy, precision/spatial variability, and repeatability.

Statistical Tests

Kruskal‐Wallis, Wilcoxon signed rank tests, intraclass correlation coefficient analysis, analysis of variance, Student's t‐tests, Pearson correlation analysis, and Bland–Altman analysis.

Results

In simulation/phantom, FAST1‐BS, FAST1‐IR, and MOLLI had an accuracy (expressed as T₁ error) of 0.2%/4%, 6%/9%, and 4%/7%, respectively, while FAST1‐BS and FAST1‐IR had a precision penalty of 1.7/1.5 and 1.5/1.4 in comparison with MOLLI, respectively. In healthy volunteers, FAST1‐BS/FAST1‐IR/MOLLI led to different native myocardial T₁ times (1016 ± 27 msec/952 ±22 msec/987 ± 23 msec, P < 0.0001) and spatial variability (66 ± 10 msec/57 ± 8 msec/46 ± 7 msec, P < 0.001). There were no statistically significant differences between all techniques for T₁ repeatability (P = 0.18). In vivo native and postcontrast myocardial T₁ times in both healthy volunteers and patients using FAST1‐BS/FAST1‐IR were highly correlated with MOLLI (Pearson correlation coefficient ≥0.93).

Data Conclusion

FAST1 enables myocardial T₁ mapping with full left ventricular coverage in three separated breathholds. In comparison with MOLLI, FAST1 yield a 5‐fold increase of spatial coverage, limited penalty of T₁ precision/spatial variability, no significant difference of T₁ repeatability, and highly correlated T₁ times. FAST1‐IR provides improved T₁ precision/spatial variability but reduced accuracy when compared with FAST1‐BS.

Level of Evidence: 1

Technical Efficacy: Stage 3

J. Magn. Reson. Imaging 2020;51:492–504.

Fast myocardial T1 mapping using shortened inversion recovery based schemes

Background

Myocardial T₁ mapping shows promise for assessment of cardiomyopathies. Most myocardial T₁ mapping techniques, such as modified Look–Locker inversion recovery (MOLLI), generate one T₁ map per breath‐held acquisition (9–17 heartbeats), which prolongs multislice protocols and may be unsuitable for patients with breath‐holding difficulties.

Purpose

To develop and characterize novel shortened inversion recovery based T₁ mapping schemes of 2–5 heartbeats.

Study Type

Prospective.

Population/Phantom

Numerical simulations, agarose/NiCl₂ phantom, 16 healthy volunteers, and 24 patients.

Field Strength/Sequence

1.5T/MOLLI.

Assessment

All shortened T₁ mapping schemes were characterized and compared with a conventional MOLLI scheme (5‐(3)‐3) in terms of accuracy, precision, spatial variability, and repeatability.

Statistical Tests

Kruskal–Wallis, Wilcoxon rank sum tests, analysis of variance, Student's t‐tests, Bland–Altman analysis, and Pearson correlation analysis.

Results

All shortened schemes provided limited T₁ time variations (≤2% for T₁ times ≤1200 msec) and limited penalty of precision (by a factor of ~1.4–1.5) when compared with MOLLI in numerical simulations. In phantom, differences between all schemes in terms of accuracy, spatial variability, and repeatability did not reach statistical significance (P > 0.71). In healthy volunteers, there were no statistically significant differences between all schemes in terms of native T₁ times and repeatability for myocardium (P = 0.21 and P = 0.87, respectively) and blood (P = 0.79 and P = 0.41, respectively). All shortened schemes led to a limited increase of spatial variability for native myocardial T₁ mapping with respect to MOLLI (by a factor of 1.2) (P < 0.0001). In both healthy volunteers and patients, the two‐heartbeat scheme and MOLLI led to highly linearly correlated T₁ times (correlation coefficients ≥0.83).

Data Conclusion

The proposed two‐heartbeat T₁ mapping scheme yields a 5‐fold acceleration compared with MOLLI, with highly linearly correlated T₁ times, no significant difference of repeatability, and limited spatial variability penalty at 1.5T. This approach may enable myocardial T₁ mapping in patients with severe breath‐holding difficulties and reduce the examination time of multislice protocols.

Level of Evidence: 1

Technical Efficacy Stage: 3

J. Magn. Reson. Imaging 2019;50:641–654.

Imaging sequence for joint myocardial T1 mapping and fat/water separation

Purpose

To develop and evaluate an imaging sequence to simultaneously quantify the epicardial fat volume and myocardial T₁ relaxation time.

Methods

We introduced a novel simultaneous myocardial T₁ mapping and fat/water separation sequence (joint T₁‐fat/water separation). Dixon reconstruction is performed on a dual‐echo data set to generate water/fat images. T₁ maps are computed using the water images, whereas the epicardial fat volume is calculated from the fat images. A phantom experiment using vials with different T₁/T₂ values and a bottle of oil was performed. Additional phantom experiment using vials of mixed fat/water was performed to show the potential of this sequence to mitigate the effect of intravoxel fat on estimated T₁ maps. In vivo evaluation was performed in 17 subjects. Epicardial fat volume, native myocardial T₁ measurements and precision were compared among slice‐interleaved T₁ mapping, Dixon, and the proposed sequence.

Results

In the first phantom, the proposed sequence separated oil from water vials and there were no differences in T₁ of the fat‐free vials (P = .1). In the second phantom, the T₁ error decreased from 22%, 36%, 57%, and 73% to 8%, 9%, 16%, and 26%, respectively. In vivo there was no difference between myocardial T₁ values (1067 ± 17 ms versus 1077 ± 24 ms, P = .6). The epicardial fat volume was similar for both sequences (54.3 ± 33 cm³ versus 52.4 ± 32 cm³, P = .8).

Conclusion

The proposed sequence provides simultaneous quantification of native myocardial T₁ and epicardial fat volume. This will eliminate the need for an additional sequence in the cardiac imaging protocol if both measurements are clinically indicated.

Cardiac MRI Anatomy and Function as a Substrate for Arrhythmias

The use of cardiovascular magnetic resonance (CMR) has been implemented in the diagnostic work-up of patients with cardiomyopathies by providing an accurate assessment of biventricular volumes and function and a detailed myocardial tissue characterization in a one-stop-shop multi-parametric imaging technique. Its unique capability to perform an accurate tissue characterization of the myocardium, which is superior to other imaging modalities, has prompt its use in the analysis of myocardial arrhythmic substrates and in the prognostic risk stratification of patients. Although left ventricular ejection fraction (LVEF) has always been the best-known predictor of arrhythmic risk, the quantification of myocardial scar by CMR has been recognised as a powerful risk stratification tool, independent of LVEF. Moreover, due to its ability to identify myocardial arrhythmic substrate, both ventricular but more recently also atrial, CMR is increasingly offered as a guide to ablation procedures.

Multicontrast reconstruction using compressed sensing with low rank and spatially varying edge-preserving constraints for high-resolution MR characterization of myocardial infarction

PURPOSE

To enable robust reconstruction for highly accelerated three-dimensional multicontrast late enhancement imaging to provide improved MR characterization of myocardial infarction with isotropic high spatial resolution.

THEORY AND METHODS

A new method using compressed sensing with low rank and spatially varying edge-preserving constraints (CS-LASER) is proposed to improve the reconstruction of fine image details from highly undersampled data. CS-LASER leverages the low rank feature of the multicontrast volume series in MR relaxation and integrates spatially varying edge preservation into the explicit low rank constrained compressed sensing framework using weighted total variation. With an orthogonal temporal basis pre-estimated, a multiscale iterative reconstruction framework is proposed to enable the practice of CS-LASER with spatially varying weights of appropriate accuracy.

RESULTS

In in vivo pig studies with both retrospective and prospective undersamplings, CS-LASER preserved fine image details better and presented tissue characteristics with a higher degree of consistency with histopathology, particularly in the peri-infarct region, than an alternative technique for different acceleration rates. An isotropic resolution of 1.5 mm was achieved in vivo within a single breath-hold using the proposed techniques.

CONCLUSION

Accelerated three-dimensional multicontrast late enhancement with CS-LASER can achieve improved MR characterization of myocardial infarction with high spatial resolution. Magn Reson Med 78:598-610, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Myocardial effective transverse relaxation time T2* Correlates with left ventricular wall thickness: A 7.0 T MRI study

PURPOSE

Myocardial effective relaxation time T2* is commonly regarded as a surrogate for myocardial tissue oxygenation. However, it is legitimate to assume that there are multiple factors that influence T2*. To this end, this study investigates the relationship between T2* and cardiac macromorphology given by left ventricular (LV) wall thickness and left ventricular radius, and provides interpretation of the results in the physiological context.

METHODS

High spatio-temporally resolved myocardial CINE T2* mapping was performed in 10 healthy volunteers using a 7.0 Tesla (T) full-body MRI system. Ventricular septal wall thickness, left ventricular inner radius, and T2* were analyzed. Macroscopic magnetic field changes were elucidated using cardiac phase-resolved magnetic field maps.

RESULTS

Ventricular septal T2* changes periodically over the cardiac cycle, increasing in systole and decreasing in diastole. Ventricular septal wall thickness and T2* showed a significant positive correlation, whereas the inner LV radius and T2* were negatively correlated. The effect of macroscopic magnetic field gradients on T2* can be considered minor in the ventricular septum.

CONCLUSION

Our findings suggest that myocardial T2* is related to tissue blood volume fraction. Temporally resolved T2* mapping could be beneficial for myocardial tissue characterization and for understanding cardiac (patho)physiology in vivo. Magn Reson Med 77:2381-2389, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Adaptive registration of varying contrast-weighted images for improved tissue characterization (ARCTIC): application to T1 mapping

PURPOSE

To propose and evaluate a novel nonrigid image registration approach for improved myocardial T1 mapping.

METHODS

Myocardial motion is estimated as global affine motion refined by a novel local nonrigid motion estimation algorithm. A variational framework is proposed, which simultaneously estimates motion field and intensity variations, and uses an additional regularization term to constrain the deformation field using automatic feature tracking. The method was evaluated in 29 patients by measuring the DICE similarity coefficient and the myocardial boundary error in short axis and four chamber data. Each image series was visually assessed as "no motion" or "with motion." Overall T1 map quality and motion artifacts were assessed in the 85 T1 maps acquired in short axis view using a 4-point scale (1-nondiagnostic/severe motion artifact, 4-excellent/no motion artifact).

RESULTS

Increased DICE similarity coefficient (0.78 ± 0.14 to 0.87 ± 0.03, P < 0.001), reduced myocardial boundary error (1.29 ± 0.72 mm to 0.84 ± 0.20 mm, P < 0.001), improved overall T1 map quality (2.86 ± 1.04 to 3.49 ± 0.77, P < 0.001), and reduced T1 map motion artifacts (2.51 ± 0.84 to 3.61 ± 0.64, P < 0.001) were obtained after motion correction of "with motion" data (∼56% of data).

CONCLUSIONS

The proposed nonrigid registration approach reduces the respiratory-induced motion that occurs during breath-hold T1 mapping, and significantly improves T1 map quality.