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Crabb MG, Kunze KP, Littlewood SJ, Tripp D, Fotaki A, Prieto C, Botnar RM. 3D joint T 1/T 1 ρ/T 2 mapping and water-fat imaging for contrast-agent free myocardial tissue characterization at 1.5T. Magn Reson Med 2025; 93:2297-2310. [PMID: 39981990 PMCID: PMC11971512 DOI: 10.1002/mrm.30397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 10/09/2024] [Accepted: 11/18/2024] [Indexed: 02/22/2025]
Abstract
PURPOSE To develop a novel, free-breathing, 3D jointT 1 $$ {T}_1 $$ /T 1 ρ $$ {T}_{1\rho } $$ /T 2 $$ {T}_2 $$ mapping sequence with Dixon encoding to provide co-registered 3DT 1 $$ {T}_1 $$ ,T 1 ρ $$ {T}_{1\rho } $$ , andT 2 $$ {T}_2 $$ maps and water-fat volumes with isotropic spatial resolution in a single≈ 7 $$ \approx 7 $$ min scan for comprehensive contrast-agent-free myocardial tissue characterization and simultaneous evaluation of the whole-heart anatomy. METHODS An interleaving sequence over 5 heartbeats is proposed to provideT 1 $$ {T}_1 $$ ,T 1 ρ $$ {T}_{1\rho } $$ , andT 2 $$ {T}_2 $$ encoding, with 3D data acquired with Dixon gradient-echo readout and 2D image navigators to enable100 % $$ 100\% $$ respiratory scan efficiency. Images were reconstructed with a non-rigid motion-corrected, low-rank patch-based reconstruction, and maps were generated through dictionary matching. The proposed sequence was compared against conventional 2D techniques in phantoms, 10 healthy subjects, and 1 patient. RESULTS The proposed 3DT 1 $$ {T}_1 $$ ,T 1 ρ $$ {T}_{1\rho } $$ , andT 2 $$ {T}_2 $$ measurements showed excellent correlation with 2D reference measurements in phantoms. For healthy subjects, the mapping values of septal myocardial tissue wereT 1 = 1060 ± 48 ms $$ {T}_1=1060\pm 48\kern0.2778em \mathrm{ms} $$ ,T 1 ρ = 48 . 1 ± 3 . 9 ms $$ {T}_{1\rho }=48.1\pm 3.9\kern0.2778em \mathrm{ms} $$ , andT 2 = 44 . 2 ± 3 . 2 ms $$ {T}_2=44.2\pm 3.2\kern0.2778em \mathrm{ms} $$ for the proposed sequence, againstT 1 = 959 ± 15 ms $$ {T}_1=959\pm 15\kern0.2778em \mathrm{ms} $$ ,T 1 ρ = 56 . 4 ± 1 . 9 ms $$ {T}_{1\rho }=56.4\pm 1.9\kern0.2778em \mathrm{ms} $$ , andT 2 = 47 . 3 ± 1 . 5 ms $$ {T}_2=47.3\pm 1.5\kern0.2778em \mathrm{ms} $$ for 2D MOLLI, 2DT 1 ρ $$ {T}_{1\rho } $$ -prep bSSFP and 2DT 2 $$ {T}_2 $$ -prep bSSFP, respectively. Promising results were obtained when comparing the proposed mapping to 2D references in 1 patient with active myocarditis. CONCLUSION The proposed approach enables simultaneous 3D whole-heart jointT 1 $$ {T}_1 $$ /T 1 ρ $$ {T}_{1\rho } $$ /T 2 $$ {T}_2 $$ mapping and water/fat imaging in≈ $$ \approx $$ 7 min scan time, demonstrating good agreement with conventional mapping techniques in phantoms and healthy subjects and promising results in 1 patient with suspected cardiovascular disease.
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Affiliation(s)
- Michael G. Crabb
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Karl P. Kunze
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- MR Research CollaborationsSiemens Healthcare LimitedCamberleyUK
| | - Simon J. Littlewood
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Donovan Tripp
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Anastasia Fotaki
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- School of EngineeringPontificia Universidad Católica de ChileSantiagoChile
- Millenium Institute for Intelligent Healthcare EngineeringSantiagoChile
| | - René M. Botnar
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- School of EngineeringPontificia Universidad Católica de ChileSantiagoChile
- Millenium Institute for Intelligent Healthcare EngineeringSantiagoChile
- Institute for Biological and Medical EngineeringPontificia Universidad Católica de ChileSantiagoChile
- Institute for Advanced StudyTechnical University of MunichGarchingGermany
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Malomo S, Oswald T, Stephenson E, Yip A, Alway T, Hadjivassilev S, Coombs S, Ellery S, Lee J, James R, Phillips C, Philips B, Hildick-Smith D, Parish V, Liu A. Characterisation of Post-Sepsis Cardiomyopathy Using Cardiovascular Magnetic Resonance. Diagnostics (Basel) 2025; 15:997. [PMID: 40310393 PMCID: PMC12025626 DOI: 10.3390/diagnostics15080997] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2025] [Revised: 03/26/2025] [Accepted: 04/04/2025] [Indexed: 05/02/2025] Open
Abstract
Background: Post-sepsis cardiomyopathy is associated with an increased risk of adverse cardiovascular outcomes. It remains poorly understood, which limits therapeutic development. This study characterised post-sepsis cardiomyopathy using cardiovascular magnetic resonance (CMR) imaging. Methods: Patients admitted with acute sepsis and suspected cardiac injury or heart failure who subsequently (47 days [IQR: 22-122]) underwent CMR at a UK tertiary cardiac centre were included. Age- and gender-matched controls (n = 16) were also included. Subjects underwent CMR at 1.5 Tesla with cines, native T1- and T2-mapping, and late gadolinium enhancement (LGE) imaging. Results: Of the 22 post-sepsis patients (age 50 ± 13 years; 64% males), 13 patients (59%) had left ventricular (LV) dilatation. Patients had significantly elevated left ventricular (LV) end-diastolic and end-systolic volume indices compared to controls (p = 0.011 and p = 0.013, respectively). Eleven patients (50%) had LV systolic dysfunction (ejection fraction < 50%), most of whom (8/11) had non-ischaemic patterns of LGE (n = 7 mid-wall; n = 1 mid-wall/patchy). In the eleven patients with preserved LV systolic function (ejection fraction ≥ 50%), three patients (27%) had significant LGE (n = 1 mid-wall; n = 1 subepicardial/mid-wall; n = 1 patchy). Compared to controls, patients had elevated septal native myocardial T1 values (p < 0.001) but similar septal native myocardial T2 values (p = 0.090), suggesting the presence of myocardial fibrosis without significant oedema. Conclusions: Post-sepsis cardiomyopathy is characterised by LV dilatation, systolic dysfunction, and myocardial fibrosis in a non-ischaemic distribution. Significant myocardial oedema is not prominent several weeks post-recovery. Further work is needed to test these findings on a multi-centre basis and to develop novel therapies for post-sepsis cardiomyopathy.
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Affiliation(s)
- Samuel Malomo
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (S.M.); (T.O.); (E.S.); (A.Y.); (T.A.); (S.H.); (S.C.); (S.E.); (J.L.); (R.J.); (D.H.-S.); (V.P.)
| | - Thomas Oswald
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (S.M.); (T.O.); (E.S.); (A.Y.); (T.A.); (S.H.); (S.C.); (S.E.); (J.L.); (R.J.); (D.H.-S.); (V.P.)
| | - Edward Stephenson
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (S.M.); (T.O.); (E.S.); (A.Y.); (T.A.); (S.H.); (S.C.); (S.E.); (J.L.); (R.J.); (D.H.-S.); (V.P.)
| | - Anthony Yip
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (S.M.); (T.O.); (E.S.); (A.Y.); (T.A.); (S.H.); (S.C.); (S.E.); (J.L.); (R.J.); (D.H.-S.); (V.P.)
| | - Thomas Alway
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (S.M.); (T.O.); (E.S.); (A.Y.); (T.A.); (S.H.); (S.C.); (S.E.); (J.L.); (R.J.); (D.H.-S.); (V.P.)
| | - Stanislav Hadjivassilev
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (S.M.); (T.O.); (E.S.); (A.Y.); (T.A.); (S.H.); (S.C.); (S.E.); (J.L.); (R.J.); (D.H.-S.); (V.P.)
| | - Steven Coombs
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (S.M.); (T.O.); (E.S.); (A.Y.); (T.A.); (S.H.); (S.C.); (S.E.); (J.L.); (R.J.); (D.H.-S.); (V.P.)
| | - Susan Ellery
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (S.M.); (T.O.); (E.S.); (A.Y.); (T.A.); (S.H.); (S.C.); (S.E.); (J.L.); (R.J.); (D.H.-S.); (V.P.)
| | - Joon Lee
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (S.M.); (T.O.); (E.S.); (A.Y.); (T.A.); (S.H.); (S.C.); (S.E.); (J.L.); (R.J.); (D.H.-S.); (V.P.)
| | - Rachael James
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (S.M.); (T.O.); (E.S.); (A.Y.); (T.A.); (S.H.); (S.C.); (S.E.); (J.L.); (R.J.); (D.H.-S.); (V.P.)
| | - Claire Phillips
- Intensive Care Unit, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (C.P.); (B.P.)
| | - Barbara Philips
- Intensive Care Unit, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (C.P.); (B.P.)
- Brighton and Sussex Medical School, Brighton BN1 9PX, UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (S.M.); (T.O.); (E.S.); (A.Y.); (T.A.); (S.H.); (S.C.); (S.E.); (J.L.); (R.J.); (D.H.-S.); (V.P.)
| | - Victoria Parish
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (S.M.); (T.O.); (E.S.); (A.Y.); (T.A.); (S.H.); (S.C.); (S.E.); (J.L.); (R.J.); (D.H.-S.); (V.P.)
| | - Alexander Liu
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton BN2 5BE, UK; (S.M.); (T.O.); (E.S.); (A.Y.); (T.A.); (S.H.); (S.C.); (S.E.); (J.L.); (R.J.); (D.H.-S.); (V.P.)
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Pontré BP, Mandija S, Aubert MM, Schakel T, Akdag O, Keijnemans K, Borman PT, van Lier AL, van den Berg CA, Fast MF. Respiratory navigator-guided multi-slice free-breathing cardiac T 1 mapping on a magnetic resonance-guided linear accelerator. Phys Imaging Radiat Oncol 2025; 34:100739. [PMID: 40207350 PMCID: PMC11979436 DOI: 10.1016/j.phro.2025.100739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 12/20/2024] [Accepted: 02/24/2025] [Indexed: 04/11/2025] Open
Abstract
Background and Purpose Image-guided cardiac radioablation on a magnetic resonance-guided linear accelerator (MR-linac) is emerging as a non-invasive treatment alternative for patients with cardiac arrhythmia. Precise target identification is required for such treatments. However, owing to concerns with the use of gadolinium-based contrast agents during treatment with high-energy radiation, non-contrast alternatives must be considered. Native T1 mapping is a promising technique to delineate myocardial scar which can serve as a surrogate for the treatment target. Further, the likely presence of an implantable cardioverter defibrillator (ICD) in arrhythmia patients necessitates approaches that are robust to metal-related artefacts. Materials and Methods We implemented an electrocardiogram (ECG)-triggered free-breathing cardiac T1 mapping approach on an MR-linac, making use of a respiratory navigator to account for respiratory motion. The technique was validated in a motion phantom and tested in healthy volunteers. We also compared the use of different readout schemes to evaluate performance in the presence of an ICD. Results The free-breathing cardiac T1 mapping approach agreed within 5% compared with ground truth T1 in a motion phantom. In healthy volunteers, an average difference in T1 of -3.5% was seen between the free-breathing and breath-hold approaches, but T1 quantification was impacted by data discarded by the respiratory navigator. Compared to balanced SSFP, the spoiled gradient echo readout was much less susceptible to artefacts caused by an ICD, but the lower signal adversely affected T1 quantification. Conclusions Free-breathing cardiac T1 mapping is feasible on an MR-linac. Further optimisation is required to reduce scan times and improve accuracy.
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Affiliation(s)
- Beau P. Pontré
- University of Auckland, Department of Anatomy and Medical Imaging, Auckland, New Zealand
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, the Netherlands
| | - Stefano Mandija
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, the Netherlands
- University Medical Center Utrecht, Computational Imaging Group for MR Diagnostics and Therapy, Image Sciences Institute, Utrecht, the Netherlands
| | - Manon M.N. Aubert
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, the Netherlands
| | - Tim Schakel
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, the Netherlands
- University Medical Center Utrecht, Computational Imaging Group for MR Diagnostics and Therapy, Image Sciences Institute, Utrecht, the Netherlands
| | - Osman Akdag
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, the Netherlands
| | - Katrinus Keijnemans
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, the Netherlands
| | - Pim T.S. Borman
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, the Netherlands
| | | | - Cornelis A.T. van den Berg
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, the Netherlands
- University Medical Center Utrecht, Computational Imaging Group for MR Diagnostics and Therapy, Image Sciences Institute, Utrecht, the Netherlands
| | - Martin F. Fast
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, the Netherlands
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Christopher AB, Gurijala N, Cross RR, Olivieri LJ, Chow K. Free-breathing multi-parametric SASHA (mSASHA) mapping provides reliable non-contrast myocardial characterization in a pediatric and adult congenital population. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2025; 41:549-557. [PMID: 39875701 DOI: 10.1007/s10554-025-03341-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Accepted: 01/17/2025] [Indexed: 01/30/2025]
Abstract
Parametric mapping has become a standard of care technique for the non-invasive assessment of myocardial edema and fibrosis. Conventional MOLLI-based T1 mapping is susceptible to many confounding effects particularly in the pediatric population. The requirement for compliant breath holds is a major limitation for younger or more ill patients. The advent of free-breathing SASHA-based multi-parametric mapping with motion correction therefore offers a significant advantage in pediatric cohorts. With IRB approval and consent/assent, children and adults with congenital heart disease underwent both conventional breath-held MOLLI-based T1 and T2 TrueFISP mapping as well as free-breathing multi-parametric SASHA assessment in the context of a clinically indicated study on a 1.5T magnet. A total of 71 subjects with mean age of 19.3 ± 8.6 years were scanned. Free-breathing multiparametric SASHA T1 and T2 values were moderately correlated with breath-held MOLLI/T2p-bSSFP (r = 0.52). Importantly free-breathing SASHA-based T1 maps were able to discriminate between patients with late gadolinium enhancement with a statistically significant difference in mean T1 values (p = 0.03). Free-breathing multiparametric SASHA allows for reliable myocardial characterization with moderate correlation to conventional breath-held T1 and T2 mapping techniques in a small and heterogenous sample of pediatric and congenital cardiac subjects.
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MESH Headings
- Humans
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/pathology
- Predictive Value of Tests
- Male
- Female
- Child
- Young Adult
- Adolescent
- Reproducibility of Results
- Adult
- Age Factors
- Myocardium/pathology
- Fibrosis
- Image Interpretation, Computer-Assisted/methods
- Respiration
- Magnetic Resonance Imaging/methods
- Edema, Cardiac/diagnostic imaging
- Edema, Cardiac/physiopathology
- Edema, Cardiac/etiology
- Edema, Cardiac/pathology
- Child, Preschool
- Contrast Media/administration & dosage
- Infant
- Middle Aged
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Affiliation(s)
- Adam B Christopher
- Division of Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | | | - Russell R Cross
- Division of Cardiology, Nemours Children's Health, Wilmington, DE, USA
| | - Laura J Olivieri
- Division of Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Kelvin Chow
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, IL, USA
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5
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Wang J, Zhang J, Liu W, Pu L, Qi W, Xu Y, Wan K, Gkoutos GV, Han Y, Chen Y. Prognostic Value of Myocardial T1 Mapping for Predicting Adverse Events in Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2025; 18:e017174. [PMID: 39957669 DOI: 10.1161/circimaging.124.017174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 12/10/2024] [Indexed: 02/18/2025]
Abstract
BACKGROUND In patients with hypertrophic cardiomyopathy, the prognostic value of myocardial T1 and extracellular volume fraction for adverse cardiovascular events has not been well defined. METHODS A total of 663 consecutive participants with hypertrophic cardiomyopathy who underwent 3T cardiovascular magnetic resonance were recruited. The follow-up end points included heart failure (HF)-related death, HF hospitalization, and sudden cardiac death or aborted sudden cardiac death. RESULTS On Cox proportional hazards regression multivariable analyses, global native T1 excluding late gadolinium enhancement areas (hazard ratio [HR], 1.04 [95% CI, 0.99-1.09]; P=0.094) and global extracellular volume fraction excluding late gadolinium enhancement (HR, 1.02 [95% CI, 0.95-1.10]; P=0.565) were not associated with sudden cardiac death. Conversely, global native T1 (HR, 1.08 per 10 ms increase [95% CI, 1.02-1.16], P=0.014; HR, 1.05 per 10 ms increase [95% CI, 1.01-1.09]; P=0.009) and global extracellular volume fraction (HR, 1.23 per 1% increase [95% CI, 1.11-1.36], P<0.001; HR, 1.10 per 1% increase [95% CI, 1.04-1.16]; P<0.001) were independently associated with HF-related death and the composite end point of HF-related death or HF hospitalization in multivariable Cox models, respectively. CONCLUSIONS In this study of patients with hypertrophic cardiomyopathy, we found global native T1 and global extracellular volume fraction (excluding late gadolinium enhancement) to be both independently associated with HF-related events, but not sudden cardiac death in multivariable analysis. These findings are hypothesis-generating and will require external validation in larger cohorts. REGISTRATION URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1900024094.
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MESH Headings
- Humans
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Cardiomyopathy, Hypertrophic/mortality
- Cardiomyopathy, Hypertrophic/physiopathology
- Cardiomyopathy, Hypertrophic/complications
- Male
- Female
- Middle Aged
- Prognosis
- Magnetic Resonance Imaging, Cine/methods
- Predictive Value of Tests
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/epidemiology
- Aged
- Risk Factors
- Contrast Media/administration & dosage
- Heart Failure/etiology
- Heart Failure/mortality
- Heart Failure/physiopathology
- Heart Failure/therapy
- Risk Assessment
- Adult
- Myocardium/pathology
- Ventricular Function, Left
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Affiliation(s)
- Jie Wang
- Department of Cardiology (J.W., W.L., L.P., W.Q., Y.X., Y.C.), West China Hospital, Sichuan University, Chengdu, China
- Cardiac Imaging and Target Therapy Lab (J.W., Y.C.), West China Hospital, Sichuan University, Chengdu, China
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences (J.W., G.V.G.), University of Birmingham, United Kingdom
| | - Jinquan Zhang
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (J.Z.)
| | - Wei Liu
- Department of Cardiology (J.W., W.L., L.P., W.Q., Y.X., Y.C.), West China Hospital, Sichuan University, Chengdu, China
| | - Lutong Pu
- Department of Cardiology (J.W., W.L., L.P., W.Q., Y.X., Y.C.), West China Hospital, Sichuan University, Chengdu, China
| | - Weitang Qi
- Department of Cardiology (J.W., W.L., L.P., W.Q., Y.X., Y.C.), West China Hospital, Sichuan University, Chengdu, China
| | - Yuanwei Xu
- Department of Cardiology (J.W., W.L., L.P., W.Q., Y.X., Y.C.), West China Hospital, Sichuan University, Chengdu, China
| | - Ke Wan
- Department of Geriatrics (K.W.), West China Hospital, Sichuan University, Chengdu, China
| | - Georgios V Gkoutos
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences (J.W., G.V.G.), University of Birmingham, United Kingdom
- Center for Health Data Sciences (G.V.G.), University of Birmingham, United Kingdom
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, United Kingdom (G.V.G.)
- Health Data Research UK, Midlands Site (G.V.G.)
| | - Yuchi Han
- Cardiovascular Division, Wexner Medical Center, The Ohio State University, Columbus (Y.H.)
| | - Yucheng Chen
- Department of Cardiology (J.W., W.L., L.P., W.Q., Y.X., Y.C.), West China Hospital, Sichuan University, Chengdu, China
- Cardiac Imaging and Target Therapy Lab (J.W., Y.C.), West China Hospital, Sichuan University, Chengdu, China
- Center of Rare Diseases (Y.C.), West China Hospital, Sichuan University, Chengdu, China
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Pan NY, Huang TY, Yu JJ, Peng HH, Chuang TC, Lin YR, Chung HW, Wu MT. Virtual MOLLI Target: Generative Adversarial Networks Toward Improved Motion Correction in MRI Myocardial T1 Mapping. J Magn Reson Imaging 2025; 61:209-219. [PMID: 38563660 DOI: 10.1002/jmri.29373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The modified Look-Locker inversion recovery (MOLLI) sequence is commonly used for myocardial T1 mapping. However, it acquires images with different inversion times, which causes difficulty in motion correction for respiratory-induced misregistration to a given target image. HYPOTHESIS Using a generative adversarial network (GAN) to produce virtual MOLLI images with consistent heart positions can reduce respiratory-induced misregistration of MOLLI datasets. STUDY TYPE Retrospective. POPULATION 1071 MOLLI datasets from 392 human participants. FIELD STRENGTH/SEQUENCE Modified Look-Locker inversion recovery sequence at 3 T. ASSESSMENT A GAN model with a single inversion time image as input was trained to generate virtual MOLLI target (VMT) images at different inversion times which were subsequently used in an image registration algorithm. Four VMT models were investigated and the best performing model compared with the standard vendor-provided motion correction (MOCO) technique. STATISTICAL TESTS The effectiveness of the motion correction technique was assessed using the fitting quality index (FQI), mutual information (MI), and Dice coefficients of motion-corrected images, plus subjective quality evaluation of T1 maps by three independent readers using Likert score. Wilcoxon signed-rank test with Bonferroni correction for multiple comparison. Significance levels were defined as P < 0.01 for highly significant differences and P < 0.05 for significant differences. RESULTS The best performing VMT model with iterative registration demonstrated significantly better performance (FQI 0.88 ± 0.03, MI 1.78 ± 0.20, Dice 0.84 ± 0.23, quality score 2.26 ± 0.95) compared to other approaches, including the vendor-provided MOCO method (FQI 0.86 ± 0.04, MI 1.69 ± 0.25, Dice 0.80 ± 0.27, quality score 2.16 ± 1.01). DATA CONCLUSION Our GAN model generating VMT images improved motion correction, which may assist reliable T1 mapping in the presence of respiratory motion. Its robust performance, even with considerable respiratory-induced heart displacements, may be beneficial for patients with difficulties in breath-holding. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Nai-Yu Pan
- Department of Electrical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Teng-Yi Huang
- Department of Electrical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Jui-Jung Yu
- Department of Electrical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Hsu-Hsia Peng
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Tzu-Chao Chuang
- Department of Electrical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yi-Ru Lin
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Hsiao-Wen Chung
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Ming-Ting Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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7
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Huang C, Sun L, Liang D, Wang H, Zeng H, Zhu Y. RS-MOCO: A deep learning-based topology-preserving image registration method for cardiac T1 mapping. Comput Biol Med 2025; 184:109442. [PMID: 39608033 DOI: 10.1016/j.compbiomed.2024.109442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 10/04/2024] [Accepted: 11/12/2024] [Indexed: 11/30/2024]
Abstract
Cardiac T1 mapping can evaluate various clinical symptoms of myocardial tissue. However, there is currently a lack of effective, robust, and efficient methods for motion correction in cardiac T1 mapping. In this paper, we propose a deep learning-based and topology-preserving image registration framework for motion correction in cardiac T1 mapping. Notably, our proposed implicit consistency constraint dubbed BLOC, to some extent preserves the image topology in registration by bidirectional consistency constraint and local anti-folding constraint. To address the contrast variation issue, we introduce a weighted image similarity metric for multimodal registration of cardiac T1-weighted images. Besides, a semi-supervised myocardium segmentation network and a dual-domain attention module are integrated into the framework to further improve the performance of the registration. Numerous comparative experiments, as well as ablation studies, demonstrated the effectiveness and high robustness of our method. The results also indicate that the proposed weighted image similarity metric, specifically crafted for our network, contributes a lot to the enhancement of the motion correction efficacy, while the bidirectional consistency constraint combined with the local anti-folding constraint ensures a more desirable topology-preserving registration mapping.
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Affiliation(s)
- Chiyi Huang
- Paul C.Lauterbur Research Center For Biomedical lmaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Guangdong, 518055, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Longwei Sun
- Department of Radiology, Shenzhen Children's Hospital, Guangdong, 518034, China
| | - Dong Liang
- Paul C.Lauterbur Research Center For Biomedical lmaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Guangdong, 518055, China
| | - Haifeng Wang
- Paul C.Lauterbur Research Center For Biomedical lmaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Guangdong, 518055, China
| | - Hongwu Zeng
- Department of Radiology, Shenzhen Children's Hospital, Guangdong, 518034, China.
| | - Yanjie Zhu
- Paul C.Lauterbur Research Center For Biomedical lmaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Guangdong, 518055, China.
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Zhang C, Yao L, Liu M, Zhou Y. Features of cardiovascular magnetic resonance native T1 mapping in maintenance hemodialysis patients and their related factors. Ren Fail 2024; 46:2310078. [PMID: 38293793 PMCID: PMC10833117 DOI: 10.1080/0886022x.2024.2310078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/21/2024] [Indexed: 02/01/2024] Open
Abstract
PURPOSE Increased myocardial T1 values on cardiovascular MRI (CMRI) have been shown to be a surrogate marker for myocardial fibrosis. The use of CMRI in patients on hemodialysis (HD) remains limited. This research aimed to explore the characteristics of native T1 values in HD patients and identify factors related to T1 values. METHODS A total of thirty-two patients on HD and fourteen healthy controls were included in this study. All participants underwent CMRI. Using modified Look-Locker inversion recovery (MOLLI) sequence, native T1 mapping was achieved. Native CMRI T1 values were compared between the two groups. In order to analyze the relationship between T1 values and clinical parameters, correlation analysis was performed in patients on HD. RESULTS Patients on HD exhibited elevated global native T1 values compared to control subjects. In the HD group, the global native T1 value correlated positively with intact parathyroid hormone (iPTH) (r = 0.418, p = 0.017) and negatively with triglycerides (r= -0.366, p = 0.039). Moreover, the global native T1 value exhibited a positive correlation with the left ventricular end-diastolic volume indexed to body surface area (BSA; r = 0.528, p = 0.014), left ventricular end-systolic volume indexed to BSA (r = 0.506, p = 0.019), and left ventricular mass indexed to BSA (r = 0.600, p = 0.005). A negative correlation was observed between the global native T1 value and ejection fraction (r = 0.-0.551, p = 0.010). CONCLUSION The global native T1 value was prolonged in HD patients compared with controls. In the HD group, the global T1 value correlated strongly with iPTH, triglycerides, and cardiac structural and functional parameters.
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Affiliation(s)
- Changqin Zhang
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lijing Yao
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yilun Zhou
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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9
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Gravina M, Casavecchia G, Mangini F, Mautone F, Ruggeri D, Guglielmi G, Macarini L, Brunetti ND. Magnetic resonance mapping for the assessment of cardiomyopathies and myocardial disease. Int J Cardiol 2024; 415:132440. [PMID: 39153509 DOI: 10.1016/j.ijcard.2024.132440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/02/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
In recent years, the use of cardiac magnetic resonance (CMR) has grown exponentially in clinical practice. The keys for this success are represented by the possibility of tissue characterization, cardiac volumes and myocardial perfusion assessment, biventricular function evaluation, with no use of ionizing radiations and with an extremely interesting profile of reproducibility. The use of late gadolinium enhancement (LGE) nearly compares a non-invasive biopsy for cardiac fibrosis quantification. LGE, however, is partly unable to detect diffuse myocardial disease. These limits are overcome by new acquisition techniques, mainly T1 and T2 mapping, which allow the diagnosis and characterization of various cardiomyopathies, both ischemic and non-ischemic, such as amyloidosis (high T1), Fabry's disease (low T1), hemochromatosis (low T1), dilated and hypertrophic cardiomyopathy and myocarditis. In this review we detail and summarize principal evidence on the use of T1 and T2 mapping for the study and clinical management of cardiomyopathies.
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Affiliation(s)
- Matteo Gravina
- Radiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy.
| | - Grazia Casavecchia
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy.
| | - Francesco Mangini
- Cardiac Magnetic Resonance Unit, "Di Summa-Perrino" Hospital, Brindisi, Italy
| | - Francesco Mautone
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Debora Ruggeri
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Giuseppe Guglielmi
- Radiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy.
| | - Luca Macarini
- Radiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy.
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10
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Muser D, Chahal AA, Selvanayagam JB, Nucifora G. Clinical Applications of Cardiac Magnetic Resonance Parametric Mapping. Diagnostics (Basel) 2024; 14:1816. [PMID: 39202304 PMCID: PMC11353869 DOI: 10.3390/diagnostics14161816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/03/2024] [Accepted: 07/01/2024] [Indexed: 09/03/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging is widely regarded as the gold-standard technique for myocardial tissue characterization, allowing for the detection of structural abnormalities such as myocardial fatty replacement, myocardial edema, myocardial necrosis, and/or fibrosis. Historically, the identification of abnormal myocardial regions relied on variations in tissue signal intensity, often necessitating the use of exogenous contrast agents. However, over the past two decades, innovative parametric mapping techniques have emerged, enabling the direct quantitative assessment of tissue magnetic resonance (MR) properties on a voxel-by-voxel basis. These mapping techniques offer significant advantages by providing comprehensive and precise information that can be translated into color-coded maps, facilitating the identification of subtle or diffuse myocardial abnormalities. As unlikely conventional methods, these techniques do not require a substantial amount of structurally altered tissue to be visually identifiable as an area of abnormal signal intensity, eliminating the reliance on contrast agents. Moreover, these parametric mapping techniques, such as T1, T2, and T2* mapping, have transitioned from being primarily research tools to becoming valuable assets in the clinical diagnosis and risk stratification of various cardiac disorders. In this review, we aim to elucidate the underlying physical principles of CMR parametric mapping, explore its current clinical applications, address potential pitfalls, and outline future directions for research and development in this field.
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Affiliation(s)
- Daniele Muser
- Cardiac Electrophysiology Unit, Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy;
- Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Anwar A. Chahal
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA 17601, USA;
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London E1 1BB, UK
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Joseph B. Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA 5042, Australia;
| | - Gaetano Nucifora
- Cardiac Imaging Unit, NorthWest Heart Centre, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9PL, UK
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11
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Xie S, Chen M, Chen C, Zhao Y, Qin J, Qiu C, Zhu J, Nickel MD, Kuehn B, Shen W. T1 mapping combined with arterial spin labeling MRI to identify renal injury in patients with liver cirrhosis. Front Endocrinol (Lausanne) 2024; 15:1363797. [PMID: 39184137 PMCID: PMC11341387 DOI: 10.3389/fendo.2024.1363797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 07/08/2024] [Indexed: 08/27/2024] Open
Abstract
Purpose We investigated the capability and imaging criteria of T1 mapping and arterial spin labeling (ASL) MRI to identify renal injury in patients with liver cirrhosis. Methods We recruited 27 patients with cirrhosis and normal renal function (cirrhosis-NR), 10 with cirrhosis and renal dysfunction (cirrhosis-RD) and 23 normal controls (NCs). All participants were examined via renal T1 mapping and ASL imaging. Renal blood flow (RBF) derived from ASL was measured from the renal cortex, and T1 values were measured from the renal parenchyma (cortex and medulla). MRI parameters were compared between groups. Diagnostic performances for detecting renal impairment were statistically analyzed. Results Cortical T1 (cT1) and medullary T1 (mT1) were significantly lower in the NCs than in the cirrhosis-NR group. The cortical RBF showed no significant changes between the NCs and cirrhosis-NR group but was markedly decreased in the cirrhosis-RD group. The areas under the curve (AUCs) for discriminating cirrhosis-NR from NCs were 0.883 and 0.826 by cT1 and mT1, respectively. Cortical RBF identified cirrhosis-RD with AUC of 0.978, and correlated with serum creatinine (r = -0.334) and the estimated glomerular filtration rate (r = 0.483). A classification and regression tree based on cortical RBF and cT1 achieved 85% accuracy in detecting renal impairment in the cirrhosis. Conclusion Renal T1 values might be sensitive predictors of early renal impairment in patients with cirrhosis-NR. RBF enabled quantifying renal perfusion impairment in patients with cirrhosis-RD. The diagnostic algorithm based on cortical RBF and T1 values allowed detecting renal injury during cirrhosis.
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Affiliation(s)
- Shuangshuang Xie
- Radiology Department, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, School of Medicine, Nankai University, Tianjin, China
| | - Mengyao Chen
- Radiology Department, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, School of Medicine, Nankai University, Tianjin, China
| | - Chiyi Chen
- Liver Surgery Department, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Yumeng Zhao
- Radiology Department, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, School of Medicine, Nankai University, Tianjin, China
| | - Jiaming Qin
- Radiology Department, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, School of Medicine, Nankai University, Tianjin, China
| | - Caixin Qiu
- Radiology Department, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, School of Medicine, Nankai University, Tianjin, China
| | - Jinxia Zhu
- MR Research Collaboration, Siemens Healthineers, Beijing, China
| | | | - Bernd Kuehn
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Wen Shen
- Radiology Department, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, School of Medicine, Nankai University, Tianjin, China
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12
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Youssef K, Zhang X, Yoosefian G, Chen Y, Chan SF, Yang HJ, Vora K, Howarth A, Kumar A, Sharif B, Dharmakumar R. Enabling Reliable Visual Detection of Chronic Myocardial Infarction with Native T1 Cardiac MRI Using Data-Driven Native Contrast Mapping. Radiol Cardiothorac Imaging 2024; 6:e230338. [PMID: 39023374 PMCID: PMC11369652 DOI: 10.1148/ryct.230338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 05/05/2024] [Accepted: 05/30/2024] [Indexed: 07/20/2024]
Abstract
Purpose To investigate whether infarct-to-remote myocardial contrast can be optimized by replacing generic fitting algorithms used to obtain native T1 maps with a data-driven machine learning pixel-wise approach in chronic reperfused infarct in a canine model. Materials and Methods A controlled large animal model (24 canines, equal male and female animals) of chronic myocardial infarction with histologic evidence of heterogeneous infarct tissue composition was studied. Unsupervised clustering techniques using self-organizing maps and t-distributed stochastic neighbor embedding were used to analyze and visualize native T1-weighted pixel-intensity patterns. Deep neural network models were trained to map pixel-intensity patterns from native T1-weighted image series to corresponding pixels on late gadolinium enhancement (LGE) images, yielding visually enhanced noncontrast maps, a process referred to as data-driven native mapping (DNM). Pearson correlation coefficients and Bland-Altman analyses were used to compare findings from the DNM approach against standard T1 maps. Results Native T1-weighted images exhibited distinct pixel-intensity patterns between infarcted and remote territories. Granular pattern visualization revealed higher infarct-to-remote cluster separability with LGE labeling as compared with native T1 maps. Apparent contrast-to-noise ratio from DNM (mean, 15.01 ± 2.88 [SD]) was significantly different from native T1 maps (5.64 ± 1.58; P < .001) but similar to LGE contrast-to-noise ratio (15.51 ± 2.43; P = .40). Infarcted areas based on LGE were more strongly correlated with DNM compared with native T1 maps (R2 = 0.71 for native T1 maps vs LGE; R2 = 0.85 for DNM vs LGE; P < .001). Conclusion Native T1-weighted pixels carry information that can be extracted with the proposed DNM approach to maximize image contrast between infarct and remote territories for enhanced visualization of chronic infarct territories. Keywords: Chronic Myocardial Infarction, Cardiac MRI, Data-Driven Native Contrast Mapping Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Khalid Youssef
- From the Krannert Cardiovascular Research Center, Indiana University
School of Medicine, IU Health Cardiovascular Institute, 1700 N Capitol Ave,
E316, Indianapolis, IN 46202-1228 (K.Y., X.Z., G.Y., S.F.C., K.V., B.S., R.D.);
University of California Los Angeles, Los Angeles, Calif (X.Z.); Zhongshan
Hospital, Fudan University, Shanghai, China (Y.C.); Cedars-Sinai Medical Center,
Los Angeles, Calif (H.J.Y.); Libin Cardiovascular Institute of Alberta,
University of Calgary, Alberta, Canada (A.H.); and Northern Ontario School of
Medicine University, Sudbury, Canada (A.K.)
| | - Xinheng Zhang
- From the Krannert Cardiovascular Research Center, Indiana University
School of Medicine, IU Health Cardiovascular Institute, 1700 N Capitol Ave,
E316, Indianapolis, IN 46202-1228 (K.Y., X.Z., G.Y., S.F.C., K.V., B.S., R.D.);
University of California Los Angeles, Los Angeles, Calif (X.Z.); Zhongshan
Hospital, Fudan University, Shanghai, China (Y.C.); Cedars-Sinai Medical Center,
Los Angeles, Calif (H.J.Y.); Libin Cardiovascular Institute of Alberta,
University of Calgary, Alberta, Canada (A.H.); and Northern Ontario School of
Medicine University, Sudbury, Canada (A.K.)
| | - Ghazal Yoosefian
- From the Krannert Cardiovascular Research Center, Indiana University
School of Medicine, IU Health Cardiovascular Institute, 1700 N Capitol Ave,
E316, Indianapolis, IN 46202-1228 (K.Y., X.Z., G.Y., S.F.C., K.V., B.S., R.D.);
University of California Los Angeles, Los Angeles, Calif (X.Z.); Zhongshan
Hospital, Fudan University, Shanghai, China (Y.C.); Cedars-Sinai Medical Center,
Los Angeles, Calif (H.J.Y.); Libin Cardiovascular Institute of Alberta,
University of Calgary, Alberta, Canada (A.H.); and Northern Ontario School of
Medicine University, Sudbury, Canada (A.K.)
| | - Yinyin Chen
- From the Krannert Cardiovascular Research Center, Indiana University
School of Medicine, IU Health Cardiovascular Institute, 1700 N Capitol Ave,
E316, Indianapolis, IN 46202-1228 (K.Y., X.Z., G.Y., S.F.C., K.V., B.S., R.D.);
University of California Los Angeles, Los Angeles, Calif (X.Z.); Zhongshan
Hospital, Fudan University, Shanghai, China (Y.C.); Cedars-Sinai Medical Center,
Los Angeles, Calif (H.J.Y.); Libin Cardiovascular Institute of Alberta,
University of Calgary, Alberta, Canada (A.H.); and Northern Ontario School of
Medicine University, Sudbury, Canada (A.K.)
| | - Shing Fai Chan
- From the Krannert Cardiovascular Research Center, Indiana University
School of Medicine, IU Health Cardiovascular Institute, 1700 N Capitol Ave,
E316, Indianapolis, IN 46202-1228 (K.Y., X.Z., G.Y., S.F.C., K.V., B.S., R.D.);
University of California Los Angeles, Los Angeles, Calif (X.Z.); Zhongshan
Hospital, Fudan University, Shanghai, China (Y.C.); Cedars-Sinai Medical Center,
Los Angeles, Calif (H.J.Y.); Libin Cardiovascular Institute of Alberta,
University of Calgary, Alberta, Canada (A.H.); and Northern Ontario School of
Medicine University, Sudbury, Canada (A.K.)
| | - Hsin-Jung Yang
- From the Krannert Cardiovascular Research Center, Indiana University
School of Medicine, IU Health Cardiovascular Institute, 1700 N Capitol Ave,
E316, Indianapolis, IN 46202-1228 (K.Y., X.Z., G.Y., S.F.C., K.V., B.S., R.D.);
University of California Los Angeles, Los Angeles, Calif (X.Z.); Zhongshan
Hospital, Fudan University, Shanghai, China (Y.C.); Cedars-Sinai Medical Center,
Los Angeles, Calif (H.J.Y.); Libin Cardiovascular Institute of Alberta,
University of Calgary, Alberta, Canada (A.H.); and Northern Ontario School of
Medicine University, Sudbury, Canada (A.K.)
| | - Keyur Vora
- From the Krannert Cardiovascular Research Center, Indiana University
School of Medicine, IU Health Cardiovascular Institute, 1700 N Capitol Ave,
E316, Indianapolis, IN 46202-1228 (K.Y., X.Z., G.Y., S.F.C., K.V., B.S., R.D.);
University of California Los Angeles, Los Angeles, Calif (X.Z.); Zhongshan
Hospital, Fudan University, Shanghai, China (Y.C.); Cedars-Sinai Medical Center,
Los Angeles, Calif (H.J.Y.); Libin Cardiovascular Institute of Alberta,
University of Calgary, Alberta, Canada (A.H.); and Northern Ontario School of
Medicine University, Sudbury, Canada (A.K.)
| | - Andrew Howarth
- From the Krannert Cardiovascular Research Center, Indiana University
School of Medicine, IU Health Cardiovascular Institute, 1700 N Capitol Ave,
E316, Indianapolis, IN 46202-1228 (K.Y., X.Z., G.Y., S.F.C., K.V., B.S., R.D.);
University of California Los Angeles, Los Angeles, Calif (X.Z.); Zhongshan
Hospital, Fudan University, Shanghai, China (Y.C.); Cedars-Sinai Medical Center,
Los Angeles, Calif (H.J.Y.); Libin Cardiovascular Institute of Alberta,
University of Calgary, Alberta, Canada (A.H.); and Northern Ontario School of
Medicine University, Sudbury, Canada (A.K.)
| | - Andreas Kumar
- From the Krannert Cardiovascular Research Center, Indiana University
School of Medicine, IU Health Cardiovascular Institute, 1700 N Capitol Ave,
E316, Indianapolis, IN 46202-1228 (K.Y., X.Z., G.Y., S.F.C., K.V., B.S., R.D.);
University of California Los Angeles, Los Angeles, Calif (X.Z.); Zhongshan
Hospital, Fudan University, Shanghai, China (Y.C.); Cedars-Sinai Medical Center,
Los Angeles, Calif (H.J.Y.); Libin Cardiovascular Institute of Alberta,
University of Calgary, Alberta, Canada (A.H.); and Northern Ontario School of
Medicine University, Sudbury, Canada (A.K.)
| | - Behzad Sharif
- From the Krannert Cardiovascular Research Center, Indiana University
School of Medicine, IU Health Cardiovascular Institute, 1700 N Capitol Ave,
E316, Indianapolis, IN 46202-1228 (K.Y., X.Z., G.Y., S.F.C., K.V., B.S., R.D.);
University of California Los Angeles, Los Angeles, Calif (X.Z.); Zhongshan
Hospital, Fudan University, Shanghai, China (Y.C.); Cedars-Sinai Medical Center,
Los Angeles, Calif (H.J.Y.); Libin Cardiovascular Institute of Alberta,
University of Calgary, Alberta, Canada (A.H.); and Northern Ontario School of
Medicine University, Sudbury, Canada (A.K.)
| | - Rohan Dharmakumar
- From the Krannert Cardiovascular Research Center, Indiana University
School of Medicine, IU Health Cardiovascular Institute, 1700 N Capitol Ave,
E316, Indianapolis, IN 46202-1228 (K.Y., X.Z., G.Y., S.F.C., K.V., B.S., R.D.);
University of California Los Angeles, Los Angeles, Calif (X.Z.); Zhongshan
Hospital, Fudan University, Shanghai, China (Y.C.); Cedars-Sinai Medical Center,
Los Angeles, Calif (H.J.Y.); Libin Cardiovascular Institute of Alberta,
University of Calgary, Alberta, Canada (A.H.); and Northern Ontario School of
Medicine University, Sudbury, Canada (A.K.)
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13
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Khachatoorian Y, Fuisz A, Frishman WH, Aronow WS, Ranjan P. The Significance of Parametric Mapping in Advanced Cardiac Imaging. Cardiol Rev 2024:00045415-990000000-00243. [PMID: 38595125 DOI: 10.1097/crd.0000000000000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Cardiac magnetic resonance imaging has witnessed a transformative shift with the integration of parametric mapping techniques, such as T1 and T2 mapping and extracellular volume fraction. These techniques play a crucial role in advancing our understanding of cardiac function and structure, providing unique insights into myocardial tissue properties. Native T1 mapping is particularly valuable, correlating with histopathological fibrosis and serving as a marker for various cardiac pathologies. Extracellular volume fraction, an early indicator of myocardial remodeling, predicts adverse outcomes in heart failure. Elevated T2 relaxation time in cardiac MRI indicates myocardial edema, enabling noninvasive and early detection in conditions like myocarditis. These techniques offer precise insights into myocardial properties, enhancing the accuracy of diagnosis and prognosis across a spectrum of cardiac conditions, including myocardial infarction, autoimmune diseases, myocarditis, and sarcoidosis. Emphasizing the significance of these techniques in myocardial tissue analysis, the review provides a comprehensive overview of their applications and contributions to our understanding of cardiac diseases.
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Affiliation(s)
- Yeraz Khachatoorian
- From the Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
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14
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Folco G, Monti CB, Zanardo M, Silletta F, Capra D, Secchi F, Sardanelli F. MRI-derived extracellular volume as a biomarker of cancer therapy cardiotoxicity: systematic review and meta-analysis. Eur Radiol 2024; 34:2699-2710. [PMID: 37823922 PMCID: PMC10957707 DOI: 10.1007/s00330-023-10260-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/23/2023] [Accepted: 08/04/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES MRI-derived extracellular volume (ECV) allows characterization of myocardial changes before the onset of overt pathology, which may be caused by cancer therapy cardiotoxicity. Our purpose was to review studies exploring the role of MRI-derived ECV as an early cardiotoxicity biomarker to guide timely intervention. MATERIALS AND METHODS In April 2022, we performed a systematic search on EMBASE and PubMed for articles on MRI-derived ECV as a biomarker of cancer therapy cardiotoxicity. Two blinded researchers screened the retrieved articles, including those reporting ECV values at least 3 months from cardiotoxic treatment. Data extraction was performed for each article, including clinical and technical data, and ECV values. Pooled ECV was calculated using the random effects model and compared among different treatment regimens and among those who did or did not experience overt cardiac dysfunction. Meta-regression analyses were conducted to appraise which clinical or technical variables yielded a significant impact on ECV. RESULTS Overall, 19 studies were included. Study populations ranged from 9 to 236 patients, for a total of 1123 individuals, with an average age ranging from 12.5 to 74 years. Most studies included patients with breast or esophageal cancer, treated with anthracyclines and chest radiotherapy. Pooled ECV was 28.44% (95% confidence interval, CI, 26.85-30.03%) among subjects who had undergone cardiotoxic cancer therapy, versus 25.23% (95%CI 23.31-27.14%) among those who had not (p = .003). CONCLUSION A higher ECV in patients who underwent cardiotoxic treatment could imply subclinical changes in the myocardium, present even before overt cardiac pathology is detectable. CLINICAL RELEVANCE STATEMENT The ability to detect subclinical changes in the myocardium displayed by ECV suggests its use as an early biomarker of cancer therapy-related cardiotoxicity. KEY POINTS • Cardiotoxicity is a common adverse effect of cancer therapy; therefore, its prompt detection could improve patient outcomes. • Pooled MRI-derived myocardial extracellular volume was higher in patients who underwent cardiotoxic cancer therapy than in those who did not (28.44% versus 25.23%, p = .003). • MRI-derived myocardial extracellular volume represents a potential early biomarker of cancer therapy cardiotoxicity.
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Affiliation(s)
- Gianluca Folco
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Caterina B Monti
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy.
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Francesco Silletta
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Davide Capra
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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15
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Razzaq S, Haririsanati L, Eyre K, Garg R, Chetrit M, Friedrich MG. Inter-scanner comparability of Z-scores for native myocardial T1 and T2 mapping. J Cardiovasc Magn Reson 2024; 26:100004. [PMID: 38211657 PMCID: PMC11211228 DOI: 10.1016/j.jocmr.2023.100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Cardiovascular Magnetic Resonance (CMR) native T1 and T2 mapping serve as robust, contrast-agent-free diagnostic tools, but hardware- and software-specific sources of variability limit the generalizability of data across CMR platforms, consequently limiting the interpretability of patient-specific parametric data. Z-scores are used to describe the relationship of observed values to the mean results as obtained in a sufficiently large normal sample. They have been successfully used to describe the severity of quantifiable abnormalities in medicine, specifically in children and adolescents. The objective of this study was to observe whether z-scores can improve the comparability of T1 and T2 mapping values across CMR scanners, field strengths, and sequences from different vendors in the same participant rather than different participants (as seen in previous studies). METHODS Fifty-one healthy volunteers (26 men/25 women, mean age = 43 ± 13.51) underwent three CMR exams on three different scanners, using a Modified Look-Locker Inversion Recovery (MOLLI) 5-(3)- 3 sequence to quantify myocardial T1. For T2 mapping, a True Fast Imaging with steady-state free precession (TRUFI) sequence was used on a 3 T Skyra™ (Siemens), and a T2 Fast Spin Echo (FSE) sequence was used on 1.5 T Artist™ (GE) and 3.0 T Premier™ (GE) scanners. The averages of basal and mid-ventricular short axis slices were used to derive means and standard deviations of global mapping values. We used intra-class comparisons (ICC), repeated measures ANOVA, and paired Student's t-tests for statistical analyses. RESULTS There was a significant improvement in intra-subject comparability of T1 (ICC of 0.11 (95% CI= -0.018, -0.332) vs 0.78 (95% CI= 0.650, 0.866)) and T2 (ICC of 0.35 (95% CI= -0.053, 0.652) vs 0.83 (95% CI= 0.726, 0.898)) when using z-scores across all three scanners. While the absolute global T1 and T2 values showed a statistically significant difference between scanners (p < 0.001), no such differences were identified using z-scores (T1z: p = 0.771; T2z: p = 0.985). Furthermore, when images were not corrected for motion, T1 z-scores showed significant inter-scanner variability (p < 0.001), resolved by motion correction. CONCLUSION Employing z-scores for reporting myocardial T1 and T2 removes the variation of quantitative mapping results across different MRI systems and field strengths, improving the clinical utility of myocardial tissue characterization in patients with suspected myocardial disease.
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Affiliation(s)
- Saad Razzaq
- Faculty of Medicine and Health Sciences, McGill University, 845 Sherbrooke St W, Montreal, Quebec H3A 0G4, Canada; McGill University Health Centre, 1001 Decarie Blvd., Montreal, Quebec H4A 3J1, Canada
| | - Leila Haririsanati
- McGill University Health Centre, 1001 Decarie Blvd., Montreal, Quebec H4A 3J1, Canada
| | - Katerina Eyre
- McGill University Health Centre, 1001 Decarie Blvd., Montreal, Quebec H4A 3J1, Canada
| | - Ria Garg
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, 525 Pine St, Scranton, PA 18510, United States
| | - Michael Chetrit
- Faculty of Medicine and Health Sciences, McGill University, 845 Sherbrooke St W, Montreal, Quebec H3A 0G4, Canada; McGill University Health Centre, 1001 Decarie Blvd., Montreal, Quebec H4A 3J1, Canada
| | - Matthias G Friedrich
- McGill University Health Centre, 1001 Decarie Blvd., Montreal, Quebec H4A 3J1, Canada; Departments of Medicine and Diagnostic Radiology, McGill University, 845 Sherbrooke St W, Montreal, Quebec H3A 0G4, Canada.
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Okubo T, Kawasaki K, Harada R, Nagatari T, Matsumoto M, Maru S. [Novel Application of Post-contrast T 1map for Detection of Subendocardial Infarction]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2023; 79:1352-1358. [PMID: 37967944 DOI: 10.6009/jjrt.2023-1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
In cardiac magnetic resonance (CMR) for myocardial infarction, there have been quite a few cases of obscure image contrast between subendocardial lesion and left ventricular (LV) blood pool on late gadolinium enhancement (LGE) images. This study was motivated by confirmation of usefulness of post-contrast T1map for detection of subendocardial infarction. From June 2017 to May 2018, forty-eight consecutive patients who underwent contrast-enhanced CMR to assess myocardial infarction were reviewed. We measured the contrast ratio (CR) between the infarcted myocardium and LV blood pool on LGE and on post-contrast T1map images, and compared them. The CR (mean±standard deviation) was -0.04±0.11 for LGE images and 0.02±0.04 for post-contrast T1map images (P<0.05). These results suggest that the post-contrast T1map, which uses the difference in T1 value as image contrast rather than magnitude image, can clearly depict the boundary between the infarcted myocardium and LV blood pool. The addition of post-contrast T1map to image interpretation might provide valuable information in the evaluation of subendocardial infarction.
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Affiliation(s)
- Takumi Okubo
- Department of Radiology, Chiba Cerebral and Cardiovascular Center
| | - Kohei Kawasaki
- Department of Radiology, Chiba Cerebral and Cardiovascular Center
| | - Rena Harada
- Department of Radiology, Chiba Cerebral and Cardiovascular Center
| | - Tsutomu Nagatari
- Department of Radiology, Chiba Cerebral and Cardiovascular Center
| | | | - Shigenori Maru
- Department of Radiology, Chiba Cerebral and Cardiovascular Center
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Xiao Z, Zhong J, Zhong L, Dai S, Lu W, Song L, Zhang H, Yang J, Yao W. The prognostic value of myocardial salvage index by cardiac magnetic resonance in ST-segment elevation myocardial infarction patients: a systematic review and meta-analysis. Eur Radiol 2023; 33:8214-8225. [PMID: 37328640 DOI: 10.1007/s00330-023-09739-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/13/2023] [Accepted: 03/27/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To assess the prognostic value of myocardial salvage index (MSI) by cardiac magnetic resonance (CMR) in ST-segment elevation myocardial infarction (STEMI) patients. METHODS We systematically searched PubMed, Embase, Web of Science, Cochrane Central, China National Knowledge Infrastructure, and Wanfang Data to identify primary studies reporting MSI in STEMI patients with major adverse cardiovascular events (MACE) comprised of death, myocardial reinfarction, and congestive heart failure. The MSI and MACE rates were pooled. The bias of risk was assessed using the Quality In Prognosis Studies tool. The evidence level was rated based on the meta-analysis of hazard ratio (HR) and 95% confidence interval (CI) of MSI for predicting MACE. RESULTS Eighteen studies were included covering twelve unique cohorts. Eleven cohorts measured MSI using T2-weighted imaging and T1-weighted late gadolinium enhancement, while one cohort applied T2-mapping and T1-mapping. The pooled MSI (95% CI) was 44% (39 to 49%; 11 studies, 2946 patients), and the pooled MACE rate (95% CI) was 10% (7 to 14%; 12 studies, 311/3011 events/patients). Seven prognostic studies overall showed low risk of bias. The HR (95% CI) per 1% increase of MSI for MACE was 0.95 (0.92 to 0.98; 5 studies, 150/885 events/patients), and HR (95% CI) of MSI < median versus MSI > median for MACE was 5.62 (3.74 to 8.43; 6 studies, 166/1570 events/patients), both rated as weak evidence. CONCLUSIONS MSI presents potential in predicting MACE in STEMI patients. The prognostic value of MSI using advanced CMR techniques for adverse cardiovascular events needs further investigation. CLINICAL RELEVANCE STATEMENT Seven studies supported the MSI to serve as a predictor for MACE in STEMI patients, indicating its potential as a risk stratification tool to help manage expectations for these patients in clinical practice. KEY POINTS • The pooled infarct size (95% CI) and area at risk (95% CI) were 21% (18 to 23%; 11 studies, 2783 patients) and 38% (34 to 43%; 10 studies, 2022 patients), respectively. • The pooled rates (95% CI) of cardiac mortality, myocardial reinfarction, and congestive heart failure were 2% (1 to 3%; 11 studies, 86/2907 events/patients), 4% (3 to 6%; 12 studies, 127/3011 events/patients), and 3% (1 to 5%; 12 studies, 94/3011 events/patients), respectively. • The HRs (95% CI) per 1% increase of MSI for cardiac mortality and congestive heart failure were 0.93 (0.91 to 0.96; 1 study, 14/202 events/patients) and 0.96 (0.93 to 0.99; 1 study, 11/104 events/patients), respectively, but the prognostic value of MSI for myocardial re-infraction has not been measured.
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Affiliation(s)
- Zhengguang Xiao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Jingyu Zhong
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Lingna Zhong
- Electrocardiogram Room, Department of Internal Medicine, International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai Jiao Tong University School of Medicine, 20030, Shanghai, China
| | - Shun Dai
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Wenjie Lu
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Lei Song
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jun Yang
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
| | - Weiwu Yao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
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Segre CAW, de Lemos JA, Assunção Junior AN, Nomura CH, Favarato D, Strunz CMC, Villa AV, Parga Filho JR, Rezende PC, Hueb W, Ramires JAF, Kalil Filho R, Serrano Junior CV. Chronic troponin elevation assessed by myocardial T1 mapping in patients with stable coronary artery disease. Medicine (Baltimore) 2023; 102:e33548. [PMID: 37083772 PMCID: PMC10118361 DOI: 10.1097/md.0000000000033548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/27/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Cardiac troponin detected with sensitive assays can be chronically elevated, in the absence of unstable coronary syndromes. In patients with chronic coronary artery disease, clinically silent ischemic episodes may cause chronic troponin release. T1 mapping is a cardiovascular magnetic resonance technique useful in quantitative cardiac tissue characterization. We selected patients with anatomically and functionally normal hearts to investigate associations between chronic troponin release and myocardial tissue characteristics assessed by T1 mapping. METHODS We investigated the relationship between cardiac troponin I concentrations and cardiovascular magnetic resonance T1 mapping parameters in patients with stable coronary artery disease enrolled in MASS V study before elective revascularization. Participants had no previous myocardial infarction, negative late gadolinium enhancement, normal left ventricular function, chamber dimensions and wall thickness. RESULTS A total of 56 patients were analyzed in troponin tertiles: nativeT1 and extracellular volume (ECV) values (expressed as means ± standard deviations) increased across tertiles: nativeT1 (1006 ± 27 ms vs 1016 ± 27 ms vs 1034 ± 37 ms, ptrend = 0.006) and ECV (22 ± 3% vs 23 ± 1.9% vs 25 ± 3%, ptrend = 0.007). Cardiac troponin I concentrations correlated with native T1(R = 0.33, P = .012) and ECV (R = 0.3, P = .025), and were independently associated with nativeT1 (P = .049) and ventricular mass index (P = .041) in multivariable analysis. CONCLUSION In patients with chronic coronary artery disease and structurally normal hearts, troponin I concentrations correlated with T1 mapping parameters, suggesting that diffuse edema or fibrosis scattered in normal myocardium might be associated with chronic troponin release.
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Affiliation(s)
| | - James A. de Lemos
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Cesar Higa Nomura
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | - Desiderio Favarato
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | | | | | | | - Paulo Cury Rezende
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | - Whady Hueb
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | | | - Roberto Kalil Filho
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
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Pambianchi G, Giannetti M, Marchitelli L, Cundari G, Maestrini V, Mancone M, Francone M, Catalano C, Galea N. Papillary Muscle Involvement during Acute Myocardial Infarction: Detection by Cardiovascular Magnetic Resonance Using T1 Mapping Technique and Papillary Longitudinal Strain. J Clin Med 2023; 12:1497. [PMID: 36836032 PMCID: PMC9963367 DOI: 10.3390/jcm12041497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023] Open
Abstract
Papillary muscle (PPM) involvement in myocardial infarction (MI) increases the risk of secondary mitral valve regurgitation or PPM rupture and may be diagnosed using late gadolinium enhancement (LGE) imaging. The native T1-mapping (nT1) technique and PPM longitudinal strain (PPM-ls) have been used to identify PPM infarction (iPPM) without the use of the contrast agent. This study aimed to assess the diagnostic performance of nT1 and PPM-ls in the identification of iPPM. Forty-six patients, who performed CMR within 14-30 days after MI, were retrospectively enrolled: sixteen showed signs of iPPM on LGE images. nT1 values were measured within the infarcted area (IA), remote myocardium (RM), blood pool (BP), and anterolateral and posteromedial PPMs and compared using ANOVA. PPM-ls values have been assessed on cineMR images as the percentage of shortening between end-diastolic and end-systolic phases. Higher nT1 values and lower PPM-ls were found in infarcted compared to non-infarcted PPMs (nT1: 1219.3 ± 102.5 ms vs. 1052.2 ± 80.5 ms and 17.6 ± 6.3% vs. 21.6 ± 4.3%; p-value < 0.001 for both), with no significant differences between the nT1 of infarcted PPMs and IA and between the non-infarcted PPMs and RM. ROC analysis demonstrated an excellent discriminatory power for nT1 in detecting the iPPM (AUC = 0.874; 95% CI: 0.784-0.963; p < 0.001). nT1 and PPM-ls are valid tools in assessing iPPM with the advantage of avoiding contrast media administration.
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Affiliation(s)
- Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Martina Giannetti
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Livia Marchitelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, “Policlinico Umberto I” Hospital, 00161 Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, “Policlinico Umberto I” Hospital, 00161 Rome, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
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Rempakos A, Papamichail A, Loritis K, Androulakis E, Lama N, Briasoulis A. Non-LGE Cardiac Magnetic Resonance Imaging in Patients with Cardiac Amyloidosis. Curr Pharm Des 2023; 29:527-534. [PMID: 36515044 DOI: 10.2174/1381612829666221212100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/02/2022] [Accepted: 11/12/2022] [Indexed: 12/15/2022]
Abstract
Cardiac involvement is the leading cause of death in patients with cardiac amyloidosis. Early recognition is crucial as it can significantly change the course of the disease. Until now, the imaging modality of choice for diagnosing cardiac amyloidosis has been cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE). LGE-CMR in patients with cardiac amyloidosis reveals characteristic LGE patterns that lead to a diagnosis while also correlating well with disease prognosis. However, LGE-CMR has numerous drawbacks that the newer CMR modality, T1 mapping, aims to improve. T1 mapping can be further subdivided into native T1 mapping, which does not require the use of contrast, and ECV measurement, which requires the use of contrast. Numerous T1 mapping techniques have been developed, each one with its own advantages and disadvantages when it comes to procedure difficulty and image quality. A literature review to identify relevant published articles was performed by two authors. This review aimed to present the value of T1 mapping in diagnosing cardiac amyloidosis, quantifying the amyloid burden, and evaluating the prognosis of patients with amyloidosis with cardiac involvement.
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Affiliation(s)
- Athanasios Rempakos
- Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Adamantia Papamichail
- Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Loritis
- Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Nikki Lama
- Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Briasoulis
- Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa College of Medicine, Iowa City, IA, USA
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Bazmpani MA, Nikolaidou C, Papanastasiou CA, Ziakas A, Karamitsos TD. Cardiovascular Magnetic Resonance Parametric Mapping Techniques for the Assessment of Chronic Coronary Syndromes. J Cardiovasc Dev Dis 2022; 9:jcdd9120443. [PMID: 36547440 PMCID: PMC9782163 DOI: 10.3390/jcdd9120443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
The term chronic coronary syndromes encompasses a variety of clinical presentations of coronary artery disease (CAD), ranging from stable angina due to epicardial coronary artery disease to microvascular coronary dysfunction. Cardiac magnetic resonance (CMR) imaging has an established role in the diagnosis, prognostication and treatment planning of patients with CAD. Recent advances in parametric mapping CMR techniques have added value in the assessment of patients with chronic coronary syndromes, even without the need for gadolinium contrast administration. Furthermore, quantitative perfusion CMR techniques have enabled the non-invasive assessment of myocardial blood flow and myocardial perfusion reserve and can reliably identify multivessel coronary artery disease and microvascular dysfunction. This review summarizes the clinical applications and the prognostic value of the novel CMR parametric mapping techniques in the setting of chronic coronary syndromes and discusses their strengths, pitfalls and future directions.
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Affiliation(s)
- Maria Anna Bazmpani
- Department of First Cardiology, Aristotle University of Thessaloniki School of Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | | | - Christos A. Papanastasiou
- Department of First Cardiology, Aristotle University of Thessaloniki School of Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Antonios Ziakas
- Department of First Cardiology, Aristotle University of Thessaloniki School of Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Theodoros D. Karamitsos
- Department of First Cardiology, Aristotle University of Thessaloniki School of Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-2310994832; Fax: +30-2310994673
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22
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Donà C, Nitsche C, Anegg O, Poschner T, Koschutnik M, Duca F, Aschauer S, Dannenberg V, Schneider M, Schoenbauer R, Beitzke D, Loewe C, Hengstenberg C, Mascherbauer J, Kammerlander A. Bioimpedance Spectroscopy Reveals Important Association of Fluid Status and T 1 -Mapping by Cardiovascular Magnetic Resonance. J Magn Reson Imaging 2022; 56:1671-1679. [PMID: 35352420 PMCID: PMC9790685 DOI: 10.1002/jmri.28159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Extracellular matrix expansion is a key pathophysiologic feature in heart failure and can be quantified noninvasively by cardiac magnetic resonance T1 -mapping. Free water within the interstitial space of the myocardium, however, may also alter T1 -mapping results. PURPOSE To investigate the association between systemic fluid status and T1 -mapping by cardiac magnetic resonance. STUDY TYPE Prospective, observational single-center study. POPULATION Two-hundred eighty-five consecutive patients (44.4% female, 70.0 ± 14.9 years old) scheduled for cardiac MR due to various cardiac diseases. SEQUENCE AND FIELD STRENGTH 1.5-T scanner (Avanto Fit, Siemens Healthineers, Erlangen, Germany). For T1 -mapping, electrocardiographically triggered modified-Look-Locker inversion (MOLLI) recovery sequence using a 5(3)3 prototype on a short-axis mid-cavity slice and with a four-chamber view was performed. ASSESSMENTS MR parameters including native myocardial T1 -times using MOLLI and extracellular volume (MR-ECV) were assessed, and additionally, we performed bioimpedance analysis (BIA). Furthermore, demographic data and comorbidities were assessed. STATISTICS Wilcoxon's rank-sum test, chi-square tests, and for correlation analysis, Pearson's correlation coefficients were used. Regression analyses were performed to investigate the association between patients' fluid status and T1 -mapping results. A P-value <0.05 was considered statistically significant. RESULTS The mixed cohort presented with a mean overhydration (OH) of +0.2 ± 2.4 liters, as determined by BIA. By MR, native T1 -times were 1038 ± 51 msec and MR-ECV was 31 ± 9%. In the multivariable regression analysis, only OH was significantly associated with MR-ECV (adj. beta: 0.711; 95% CI: 0.28 to 1.14) along with male sex (adj. beta: 2.529; 95% CI: 0.51 to 4.55). In linear as well as multivariable analysis, only OH was significantly associated with native T1 times (adj. beta: 3.750; 95% CI: 1.27 to 6.23). CONCLUSION T1 -times and MR-ECV were significantly associated with the degree of OH on BIA measurement. These effects were independent from age, sex, body mass index, and hematocrit. Patients' volume status may thus be an important factor when T1 -time and MR-ECV values are interpreted. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Carolina Donà
- Division of CardiologyMedical University of ViennaViennaAustria
| | | | - Oliver Anegg
- Division of CardiologyMedical University of ViennaViennaAustria
| | - Thomas Poschner
- Division of CardiologyMedical University of ViennaViennaAustria
| | | | - Franz Duca
- Division of CardiologyMedical University of ViennaViennaAustria
| | - Stefan Aschauer
- Division of CardiologyMedical University of ViennaViennaAustria
| | | | | | | | - Dietrich Beitzke
- Department of Cardiovascular and Interventional RadiologyMedical University of ViennaViennaAustria
| | - Christian Loewe
- Department of Cardiovascular and Interventional RadiologyMedical University of ViennaViennaAustria
| | | | - Julia Mascherbauer
- Division of CardiologyMedical University of ViennaViennaAustria,Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3University Hospital St. PöltenKremsAustria
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Kellman P. Can Chronic Myocardial Infarction Be Detected by Native T1 Mapping? JACC. CARDIOVASCULAR IMAGING 2022; 15:2080-2081. [PMID: 36481076 DOI: 10.1016/j.jcmg.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, 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. CARDIOVASCULAR IMAGING 2022; 15:2069-2079. [PMID: 36481075 DOI: 10.1016/j.jcmg.2022.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [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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Eyyupkoca F, Eyerci N, Altintas MS, Felekoglu MA, Biter HI, Hidayet S, Sivri S, Demirtas B, Ates OF. The Relationship between Extracellular Volume Compartments and Matrix Metalloproteinases-2 in Left Ventricular Remodeling after Myocardial Infarction. Arq Bras Cardiol 2022; 119:946-957. [PMID: 36541989 PMCID: PMC9814815 DOI: 10.36660/abc.20220061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Matrix metalloproteinases (MMPs) can affect myocardial extracellular volume (ECV) and its compartments, and this can provide more detailed information about the mechanism of adverse left ventricular (LV) remodeling (AR) after acute myocardial infarction (MI). OBJECTIVES To investigate the role of changes (Δ) in ECV compartments (matrix volume (MVi) and cell volume (CVi)) in the development of AR after MI, and their relationship with MMP-2 expressions. METHODS Ninety-two first MI patients who underwent 3 Tesla cardiovascular magnetic resonance imaging performed 2 weeks (baseline) and 6 months post-MI. We measured T1 mapping with MOLLI sequences. ECV was performed post-gadolinium enhancement. ECV and LV mass were used to calculate MVi and CVi. AR was defined as an increase of ≥ 12% in LV end-diastolic volume in 6 months. MMPs were measured using a bead-based multiplex immunoassay system at first day (baseline) and 2 weeks post-MI. P <0.05 was accepted as statistically significant. RESULTS Mean ECV and mean MVi baseline levels were higher in AR group compared to without AR group (42.9±6.4 vs 39.3±8.2%, p= 0.037; 65.2±13.7 vs 56.7±14.7 mL/m2, p=0.010; respectively). CVi levels was similar between groups. A positive correlation was found between baseline levels of MMP-2 and baseline levels of ECV (r=0.535, p<0.001) and MVi (r=0.549, p<0.001). Increased ΔMVi levels was independently predictor of AR (OR=1.03, p=0.010). ΔMVi had superior diagnostic performance compared to ΔECV in predicting AR (ΔAUC: 0.215±0.07, p<0.001). CONCLUSION High MVi levels are associated with AR, and ΔMVi was independently predictor of AR. This may be associated with MMP-2 release due to increased inflammatory response.
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Affiliation(s)
- Ferhat Eyyupkoca
- Dr. Nafiz Korez Sincan State HospitalDepartamento de CardiologiaAnkaraTurquiaDepartamento de Cardiologia, Dr. Nafiz Korez Sincan State Hospital, Ankara – Turquia,Correspondência: Ferhat Eyyupkoc • Dr Nafiz Korez Sincan State Hospital – Osmanli district, metropolitan street, Ankara, 06940 – Turquia, E-mail:
| | - Nilnur Eyerci
- Departamento de Biologia MédicaKafkas University Faculty of MedicineKarsTurquiaDepartamento de Biologia Médica, Kafkas University Faculty of Medicine, Kars – Turquia
| | - Mehmet Sait Altintas
- Istanbul Yedikule Chest Diseases and Thoracic Surgery Training and Research HospitalDepartamento de CardiologiaIstanbulTurquiaDepartamento de Cardiologia, Istanbul Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul – Turquia
| | - Mehmet Ali Felekoglu
- Atakent HospitalDepartamento de CardiologiaYalovaTurquiaDepartamento de Cardiologia, Atakent Hospital, Yalova – Turquia
| | - Halil Ibrahim Biter
- Istanbul Haseki Training And Research HospitalDepartamento de CardiologiaIstanbulTurquiaDepartamento de Cardiologia, Istanbul Haseki Training And Research Hospital, Istanbul – Turquia
| | - Siho Hidayet
- Departamento de CardiologiaInonu University Faculty of MedicineMalatyaTurquiaDepartamento de Cardiologia, Inonu University Faculty of Medicine, Malatya – Turquia
| | - Serkan Sivri
- Kirsehir State HospitalDepartamento de CardiologiaKirşehirTurquiaDepartamento de Cardiologia, Kirsehir State Hospital, Kirşehir – Turquia
| | - Bekir Demirtas
- Cankiri State HospitalDepartamento de CardiologiaCankiriTurquiaDepartamento de Cardiologia, Cankiri State Hospital, Cankiri – Turquia
| | - Omer Faruk Ates
- Sakarya University Faculty of MedicineDepartamento de CardiologiaSakaryaTurquiaDepartamento de Cardiologia, Sakarya University Faculty of Medicine, Sakarya – Turquia
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26
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Zhang Q, Burrage MK, Shanmuganathan M, Gonzales RA, Lukaschuk E, Thomas KE, Mills R, Leal Pelado J, Nikolaidou C, Popescu IA, Lee YP, Zhang X, Dharmakumar R, Myerson SG, Rider O, Channon KM, Neubauer S, Piechnik SK, Ferreira VM. Artificial Intelligence for Contrast-Free MRI: Scar Assessment in Myocardial Infarction Using Deep Learning-Based Virtual Native Enhancement. Circulation 2022; 146:1492-1503. [PMID: 36124774 PMCID: PMC9662825 DOI: 10.1161/circulationaha.122.060137] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/17/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Myocardial scars are assessed noninvasively using cardiovascular magnetic resonance late gadolinium enhancement (LGE) as an imaging gold standard. A contrast-free approach would provide many advantages, including a faster and cheaper scan without contrast-associated problems. METHODS Virtual native enhancement (VNE) is a novel technology that can produce virtual LGE-like images without the need for contrast. VNE combines cine imaging and native T1 maps to produce LGE-like images using artificial intelligence. VNE was developed for patients with previous myocardial infarction from 4271 data sets (912 patients); each data set comprises slice position-matched cine, T1 maps, and LGE images. After quality control, 3002 data sets (775 patients) were used for development and 291 data sets (68 patients) for testing. The VNE generator was trained using generative adversarial networks, using 2 adversarial discriminators to improve the image quality. The left ventricle was contoured semiautomatically. Myocardial scar volume was quantified using the full width at half maximum method. Scar transmurality was measured using the centerline chord method and visualized on bull's-eye plots. Lesion quantification by VNE and LGE was compared using linear regression, Pearson correlation (R), and intraclass correlation coefficients. Proof-of-principle histopathologic comparison of VNE in a porcine model of myocardial infarction also was performed. RESULTS VNE provided significantly better image quality than LGE on blinded analysis by 5 independent operators on 291 data sets (all P<0.001). VNE correlated strongly with LGE in quantifying scar size (R, 0.89; intraclass correlation coefficient, 0.94) and transmurality (R, 0.84; intraclass correlation coefficient, 0.90) in 66 patients (277 test data sets). Two cardiovascular magnetic resonance experts reviewed all test image slices and reported an overall accuracy of 84% for VNE in detecting scars when compared with LGE, with specificity of 100% and sensitivity of 77%. VNE also showed excellent visuospatial agreement with histopathology in 2 cases of a porcine model of myocardial infarction. CONCLUSIONS VNE demonstrated high agreement with LGE cardiovascular magnetic resonance for myocardial scar assessment in patients with previous myocardial infarction in visuospatial distribution and lesion quantification with superior image quality. VNE is a potentially transformative artificial intelligence-based technology with promise in reducing scan times and costs, increasing clinical throughput, and improving the accessibility of cardiovascular magnetic resonance in the near future.
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Affiliation(s)
- Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Matthew K. Burrage
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Faculty of Medicine, University of Queensland, Brisbane, Australia (M.K.B.)
| | - Mayooran Shanmuganathan
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Ricardo A. Gonzales
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Elena Lukaschuk
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Katharine E. Thomas
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Rebecca Mills
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Joana Leal Pelado
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Chrysovalantou Nikolaidou
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Iulia A. Popescu
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Yung P. Lee
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Xinheng Zhang
- Krannert Cardiovascular Research Center, Indiana School of Medicine/IU Health Cardiovascular Institute, Indianapolis (X.Z., R.D.)
- Department of Bioengineering, University of California in Los Angeles (X.Z.)
| | - Rohan Dharmakumar
- Krannert Cardiovascular Research Center, Indiana School of Medicine/IU Health Cardiovascular Institute, Indianapolis (X.Z., R.D.)
| | - Saul G. Myerson
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Oliver Rider
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Keith M. Channon
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
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Bhatt N, Ramanan V, Orbach A, Biswas L, Ng M, Guo F, Qi X, Guo L, Jimenez-Juan L, Roifman I, Wright GA, Ghugre NR. A Deep Learning Segmentation Pipeline for Cardiac T1 Mapping Using MRI Relaxation-based Synthetic Contrast Augmentation. Radiol Artif Intell 2022; 4:e210294. [PMID: 36523641 PMCID: PMC9745444 DOI: 10.1148/ryai.210294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 05/17/2023]
Abstract
PURPOSE To design and evaluate an automated deep learning method for segmentation and analysis of cardiac MRI T1 maps with use of synthetic T1-weighted images for MRI relaxation-based contrast augmentation. MATERIALS AND METHODS This retrospective study included MRI scans acquired between 2016 and 2019 from 100 patients (mean age ± SD, 55 years ± 13; 72 men) across various clinical abnormalities with use of a modified Look-Locker inversion recovery, or MOLLI, sequence to quantify native T1 (T1native), postcontrast T1 (T1post), and extracellular volume (ECV). Data were divided into training (n = 60) and internal (n = 40) test subsets. "Synthetic" T1-weighted images were generated from the T1 exponential inversion-recovery signal model at a range of optimal inversion times, yielding high blood-myocardium contrast, and were used for contrast-based image augmentation during training and testing of a convolutional neural network for myocardial segmentation. Automated segmentation, T1, and ECV were compared with experts with use of Dice similarity coefficients (DSCs), correlation coefficients, and Bland-Altman analysis. An external test dataset (n = 147) was used to assess model generalization. RESULTS Internal testing showed high myocardial DSC relative to experts (0.81 ± 0.08), which was similar to interobserver DSC (0.81 ± 0.08). Automated segmental measurements strongly correlated with experts (T1native, R = 0.87; T1post, R = 0.91; ECV, R = 0.92), which were similar to interobserver correlation (T1native, R = 0.86; T1post, R = 0.94; ECV, R = 0.95). External testing showed strong DSC (0.80 ± 0.09) and T1native correlation (R = 0.88) between automatic and expert analysis. CONCLUSION This deep learning method leveraging synthetic contrast augmentation may provide accurate automated T1 and ECV analysis for cardiac MRI data acquired across different abnormalities, centers, scanners, and T1 sequences.Keywords: MRI, Cardiac, Tissue Characterization, Segmentation, Convolutional Neural Network, Deep Learning Algorithms, Machine Learning Algorithms, Supervised Learning Supplemental material is available for this article. © RSNA, 2022.
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28
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Cao T, Wang N, Kwan AC, Lee HL, Mao X, Xie Y, Nguyen KL, Colbert CM, Han F, Han P, Han H, Christodoulou AG, Li D. Free-breathing, non-ECG, simultaneous myocardial T 1 , T 2 , T 2 *, and fat-fraction mapping with motion-resolved cardiovascular MR multitasking. Magn Reson Med 2022; 88:1748-1763. [PMID: 35713184 PMCID: PMC9339519 DOI: 10.1002/mrm.29351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/18/2022] [Accepted: 05/17/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To develop a free-breathing, non-electrocardiogram technique for simultaneous myocardial T1 , T2 , T2 *, and fat-fraction (FF) mapping in a single scan. METHODS The MR Multitasking framework is adapted to quantify T1 , T2 , T2 *, and FF simultaneously. A variable TR scheme is developed to preserve temporal resolution and imaging efficiency. The underlying high-dimensional image is modeled as a low-rank tensor, which allows accelerated acquisition and efficient reconstruction. The accuracy and/or repeatability of the technique were evaluated on static and motion phantoms, 12 healthy volunteers, and 3 patients by comparing to the reference techniques. RESULTS In static and motion phantoms, T1 /T2 /T2 */FF measurements showed substantial consistency (R > 0.98) and excellent agreement (intraclass correlation coefficient > 0.93) with reference measurements. In human subjects, the proposed technique yielded repeatable T1 , T2 , T2 *, and FF measurements that agreed with those from references. CONCLUSIONS The proposed free-breathing, non-electrocardiogram, motion-resolved Multitasking technique allows simultaneous quantification of myocardial T1 , T2 , T2 *, and FF in a single 2.5-min scan.
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Affiliation(s)
- Tianle Cao
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA
| | - Nan Wang
- Radiology Department, Stanford University, Stanford, California, USA
| | - Alan C. Kwan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Imaging and Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hsu-Lei Lee
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Xianglun Mao
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kim-Lien Nguyen
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA
- David Geffen School of Medicine and VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Caroline M. Colbert
- David Geffen School of Medicine and VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Physics and Biology in Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Fei Han
- Siemens Medical Solutions USA, Inc., Los Angeles, California, USA
| | - Pei Han
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA
| | - Hui Han
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA
| | - Anthony G. Christodoulou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA
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Li Y, Wang G, Wang X, Li Y, Zhao Y, Gu X, Xu B, Cui J, Wang X, Sun Y, Liu S, Yu B. Prognostic significance of myocardial salvage assessed by cardiac magnetic resonance in reperfused ST-segment elevation myocardial infarction. Front Cardiovasc Med 2022; 9:924428. [PMID: 36110410 PMCID: PMC9468362 DOI: 10.3389/fcvm.2022.924428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Aims Myocardial salvage index (MSI) is attracting increasing attention for predicting prognosis in acute myocardial infarction (AMI); however, the evaluation of MSI is mainly based on contrast agent-dependent cardiac magnetic resonance (CMR) scanning sequences. This study aims to investigate the prognostic value of MSI in reperfused ST-segment elevation myocardial infarction (STEMI) through the contrast agent-free CMR technique. Methods and results Nighty-two patients with acute STEMI, who underwent CMR after primary percutaneous coronary intervention (PPCI), were finally enrolled. Patients were subcategorized into two groups according to median MSI. T1 and T2 mapping were conducted for measuring infarct size (IS) and area at risk (AAR). IS was significantly larger in < median MSI group than ≥ median MSI group (P < 0.001). AAR between the two groups showed no obvious differences (P = 0.108). Left ventricular ejection fraction (LVEF) was lower in < median MSI group than ≥ median MSI group (P = 0.014). There was an obvious inverse correlation between MSI and reperfusion time (R = –0.440, P < 0.001) and a strong inverse correlation between MSI and IS (R = –0.716, P = 0.011). As for the relationship LVEF, MSI showed positive but weak correlation (R = 0.2265, P < 0.001). Over a median follow-up period of 263 (227–238) days, prevalence of MACEs was significantly higher in the < median MSI group [HR: 0.15 (0.04–0.62); Log-rank P = 0.008]. The univariate Cox regression analysis revealed that LVEF, IS, and MSI were significant predictors for major adverse cardiovascular events (MACEs) (all P < 0.05). In the stepwise multivariate Cox regression analysis, LVEF and MSI were identified as independent parameters for predicting MACEs (both P < 0.05). In the receiver-operating characteristic analysis, LVEF, IS, and MSI showed prognostic value in predicting MACEs with AUCs of 0.809, 0.779, and 0.896, respectively, all (P < 0.05). A combination of MSI with LVEF showed the strongest prognostic value of MACEs (AUC: 0.901, sensitivity: 77.78%, specificity: 98.80%, P < 0.001). Delong’s test showed that the combination of LVEF with MSI had an incremental value than LVEF itself in predicting MACEs (P = 0.026). Conclusion Contrast agent-free CMR technique provides a reliable evaluation of MSI, which contributes to assessing the efficacy of reperfusion therapy and predicting the occurrence of MACEs.
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Affiliation(s)
- Yunling Li
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guokun Wang
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xueying Wang
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ye Li
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yanming Zhao
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xia Gu
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bing Xu
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jinjin Cui
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xuedong Wang
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yong Sun
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Yong Sun,
| | - Shengliang Liu
- Department of Cardiology, Cardiovascular Imaging Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- *Correspondence: Shengliang Liu,
| | - Bo Yu
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Hamilton JI. A Self-Supervised Deep Learning Reconstruction for Shortening the Breathhold and Acquisition Window in Cardiac Magnetic Resonance Fingerprinting. Front Cardiovasc Med 2022; 9:928546. [PMID: 35811730 PMCID: PMC9260051 DOI: 10.3389/fcvm.2022.928546] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/06/2022] [Indexed: 01/14/2023] Open
Abstract
The aim of this study is to shorten the breathhold and diastolic acquisition window in cardiac magnetic resonance fingerprinting (MRF) for simultaneous T1, T2, and proton spin density (M0) mapping to improve scan efficiency and reduce motion artifacts. To this end, a novel reconstruction was developed that combines low-rank subspace modeling with a deep image prior, termed DIP-MRF. A system of neural networks is used to generate spatial basis images and quantitative tissue property maps, with training performed using only the undersampled k-space measurements from the current scan. This approach avoids difficulties with obtaining in vivo MRF training data, as training is performed de novo for each acquisition. Calculation of the forward model during training is accelerated by using GRAPPA operator gridding to shift spiral k-space data to Cartesian grid points, and by using a neural network to rapidly generate fingerprints in place of a Bloch equation simulation. DIP-MRF was evaluated in simulations and at 1.5 T in a standardized phantom, 18 healthy subjects, and 10 patients with suspected cardiomyopathy. In addition to conventional mapping, two cardiac MRF sequences were acquired, one with a 15-heartbeat(HB) breathhold and 254 ms acquisition window, and one with a 5HB breathhold and 150 ms acquisition window. In simulations, DIP-MRF yielded decreased nRMSE compared to dictionary matching and a sparse and locally low rank (SLLR-MRF) reconstruction. Strong correlation (R2 > 0.999) with T1 and T2 reference values was observed in the phantom using the 5HB/150 ms scan with DIP-MRF. DIP-MRF provided better suppression of noise and aliasing artifacts in vivo, especially for the 5HB/150 ms scan, and lower intersubject and intrasubject variability compared to dictionary matching and SLLR-MRF. Furthermore, it yielded a better agreement between myocardial T1 and T2 from 15HB/254 ms and 5HB/150 ms MRF scans, with a bias of −9 ms for T1 and 2 ms for T2. In summary, this study introduces an extension of the deep image prior framework for cardiac MRF tissue property mapping, which does not require pre-training with in vivo scans, and has the potential to reduce motion artifacts by enabling a shortened breathhold and acquisition window.
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Affiliation(s)
- Jesse I. Hamilton
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Jesse I. Hamilton,
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O'Brien AT, Gil KE, Varghese J, Simonetti OP, Zareba KM. T2 mapping in myocardial disease: a comprehensive review. J Cardiovasc Magn Reson 2022; 24:33. [PMID: 35659266 PMCID: PMC9167641 DOI: 10.1186/s12968-022-00866-0] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/27/2022] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is considered the gold standard imaging modality for myocardial tissue characterization. Elevated transverse relaxation time (T2) is specific for increased myocardial water content, increased free water, and is used as an index of myocardial edema. The strengths of quantitative T2 mapping lie in the accurate characterization of myocardial edema, and the early detection of reversible myocardial disease without the use of contrast agents or ionizing radiation. Quantitative T2 mapping overcomes the limitations of T2-weighted imaging for reliable assessment of diffuse myocardial edema and can be used to diagnose, stage, and monitor myocardial injury. Strong evidence supports the clinical use of T2 mapping in acute myocardial infarction, myocarditis, heart transplant rejection, and dilated cardiomyopathy. Accumulating data support the utility of T2 mapping for the assessment of other cardiomyopathies, rheumatologic conditions with cardiac involvement, and monitoring for cancer therapy-related cardiac injury. Importantly, elevated T2 relaxation time may be the first sign of myocardial injury in many diseases and oftentimes precedes symptoms, changes in ejection fraction, and irreversible myocardial remodeling. This comprehensive review discusses the technical considerations and clinical roles of myocardial T2 mapping with an emphasis on expanding the impact of this unique, noninvasive tissue parameter.
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Affiliation(s)
- Aaron T O'Brien
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
| | - Katarzyna E Gil
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Juliet Varghese
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Orlando P Simonetti
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
| | - Karolina M Zareba
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA.
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Kitagawa T, Tatsugami F, Yokomachi K, Akiyama Y, Fujii Y, Awai K, Nakano Y. Native Myocardial T1 Value in Predicting 1-Year Outcomes in Patients with Nonischemic Dilated Cardiomyopathy Experiencing Recent Heart Failure. Int Heart J 2022; 63:531-540. [PMID: 35650153 DOI: 10.1536/ihj.21-801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The evidence for the clinical implications, especially the short-term utility, of native myocardial T1 value (T1native) on cardiac magnetic resonance (CMR) in nonischemic dilated cardiomyopathy (NIDCM) is scant. We investigated the potential of T1native to assess left ventricular (LV) myocardial characteristics and predict 1-year outcomes in patient with NIDCM experiencing recent heart failure (HF).Forty-five patients with NIDCM and HF symptoms within 3 months underwent CMR with cine, non-contrast T1 mapping, and late gadolinium enhancement (LGE). T1native per patient was defined as an averaged T1 value of 5 short-axis slices of base-to-apex LV myocardium. The appearance of LGE was visually examined. T1native correlated with the LV end-diastolic dimension normalized to height (LVEDD) (r = 0.38, P = 0.0103), ejection fraction (r = -0.39, P = 0.009), and serum N-terminal pro-brain natriuretic peptide levels (r = 0.48, P = 0.001), whereas the presence and segmental extent of LGE correlated only with LVEDD. In the 1-year follow-up cohort, the optimal cutoffs of T1native for predicting LV reverse remodeling (LVRR) and combined cardiac events (cardiac death, ventricular tachycardia/fibrillation, heart failure hospitalization) were 1366 ms and 1377 ms, respectively. In multivariate analysis, T1native < 1366 ms and T1native > 1377 ms remained significant predictors of LVRR (odds ratio, 11.3) and cardiac events (hazard ratio, 15.3), respectively, whereas the presence and segmental extent of LGE did not.T1native in patients with NIDCM experiencing recent HF may offer a promising strategy for assessing LV myocardial characteristics and predicting 1-year LVRR and cardiac events.
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Affiliation(s)
- Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Fuminari Tatsugami
- Department of Diagnostic Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences
| | | | - Yuji Akiyama
- Department of Radiology, Hiroshima University Hospital
| | - Yuto Fujii
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
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Ogier AC, Bustin A, Cochet H, Schwitter J, van Heeswijk RB. The Road Toward Reproducibility of Parametric Mapping of the Heart: A Technical Review. Front Cardiovasc Med 2022; 9:876475. [PMID: 35600490 PMCID: PMC9120534 DOI: 10.3389/fcvm.2022.876475] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/11/2022] [Indexed: 01/02/2023] Open
Abstract
Parametric mapping of the heart has become an essential part of many cardiovascular magnetic resonance imaging exams, and is used for tissue characterization and diagnosis in a broad range of cardiovascular diseases. These pulse sequences are used to quantify the myocardial T1, T2, T2*, and T1ρ relaxation times, which are unique surrogate indices of fibrosis, edema and iron deposition that can be used to monitor a disease over time or to compare patients to one another. Parametric mapping is now well-accepted in the clinical setting, but its wider dissemination is hindered by limited inter-center reproducibility and relatively long acquisition times. Recently, several new parametric mapping techniques have appeared that address both of these problems, but substantial hurdles remain for widespread clinical adoption. This review serves both as a primer for newcomers to the field of parametric mapping and as a technical update for those already well at home in it. It aims to establish what is currently needed to improve the reproducibility of parametric mapping of the heart. To this end, we first give an overview of the metrics by which a mapping technique can be assessed, such as bias and variability, as well as the basic physics behind the relaxation times themselves and what their relevance is in the prospect of myocardial tissue characterization. This is followed by a summary of routine mapping techniques and their variations. The problems in reproducibility and the sources of bias and variability of these techniques are reviewed. Subsequently, novel fast, whole-heart, and multi-parametric techniques and their merits are treated in the light of their reproducibility. This includes state of the art segmentation techniques applied to parametric maps, and how artificial intelligence is being harnessed to solve this long-standing conundrum. We finish up by sketching an outlook on the road toward inter-center reproducibility, and what to expect in the future.
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Affiliation(s)
- Augustin C. Ogier
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Aurelien Bustin
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Hubert Cochet
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Juerg Schwitter
- Cardiac MR Center, Cardiology Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Ruud B. van Heeswijk
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- *Correspondence: Ruud B. van Heeswijk
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Kolentinis M, Carerj LM, Vidalakis E, Giokoglu E, Martin S, Arendt C, Vogl TJ, Nagel E, Puntmann VO. Determination of scar area using native and post-contrast T1 mapping: Agreement with late gadolinium enhancement. Eur J Radiol 2022; 150:110242. [PMID: 35290909 DOI: 10.1016/j.ejrad.2022.110242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/15/2022]
Abstract
The purpose of this study is to ascertain agreement in measurements of the scar area between late gadolinium enhancement (LGE), native and post-contrast T1 mapping in patients with known ischemic heart disease. 132 patients (age 60 ± 11 yrs, male 82%) were included in the study. Corresponding 3 short axis slices images of LGE, native and post contrast T1 mapping were used. Scar area was evaluated semi- quantitatively with FWHM methods, in which scar is automatically determined by specialized post-processing software. Agreement per culprit vessel was also assessed. Concordance and inter- intraobserver reproducibility were assessed with Bland-Altman analysis. The results show that scar area amounted to 12.6% of myocardium for LGE, 9.1% for native (p < 0.05) and 19.4% (p < 0.05) for post-contrast T1 mapping. LAD and RCA territory infarcts showed statistical discrepancy for both T1 acquisitions. Intraobserver differences in infarct size were comparable at 0.39% ± 0.28, 2.93% ± 0.03 and 0.97% ± 0.01 respectively (p≫0.05). Interobserver differences were 5.56% ± 0.91 for LGE, 11.87% ± 3.21 (p < 0.05) for native and 5.55% ± 2.87 (p≫0.05) for post-contrast T1 mapping. In conclusion, native T1 acquisitions systematically underestimated infarct size in comparison to LGE, while post-contrast T1 overestimated it. Variances in measurements were most pronounced for LAD and RCA territory infarcts. Intraobserver reproducibility was similar with both methods, whereas interobserver variability for native T1 mapping acquisition was worse.
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Affiliation(s)
- Michael Kolentinis
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, partner site Rhein-Main, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| | - Ludovica M Carerj
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, partner site Rhein-Main, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Piazza Pugliatti 1, 98122, Messina, Italy
| | - Eleftherios Vidalakis
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, partner site Rhein-Main, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Eleni Giokoglu
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, partner site Rhein-Main, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Simon Martin
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, partner site Rhein-Main, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Christophe Arendt
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, partner site Rhein-Main, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Eike Nagel
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, partner site Rhein-Main, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Valentina O Puntmann
- Institute of Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, partner site Rhein-Main, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Rahman T, Moulin K, Perotti LE. Cardiac Diffusion Tensor Biomarkers of Chronic Infarction Based on In Vivo Data. APPLIED SCIENCES-BASEL 2022; 12. [PMID: 36032414 PMCID: PMC9408809 DOI: 10.3390/app12073512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
In vivo cardiac diffusion tensor imaging (cDTI) data were acquired in
swine subjects six to ten weeks post-myocardial infarction (MI) to identify
microstructural-based biomarkers of MI. Diffusion tensor invariants, diffusion
tensor eigenvalues, and radial diffusivity (RD) are evaluated in the infarct,
border, and remote myocardium, and compared with extracellular volume fraction
(ECV) and native T1 values. Additionally, to aid the interpretation of the
experimental results, the diffusion of water molecules was numerically simulated
as a function of ECV. Finally, findings based on in vivo measures were confirmed
using higher-resolution and higher signal-to-noise data acquired ex vivo in the
same subjects. Mean diffusivity, diffusion tensor eigenvalues, and RD increased
in the infarct and border regions compared to remote myocardium, while
fractional anisotropy decreased. Secondary (e2) and tertiary
(e3) eigenvalues increased more significantly than the primary
eigenvalue in the infarct and border regions. These findings were confirmed by
the diffusion simulations. Although ECV presented the largest increase in
infarct and border regions, e2, e3, and RD increased the
most among non-contrast-based biomarkers. RD is of special interest as it
summarizes the changes occurring in the radial direction and may be more robust
than e2 or e3 alone.
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Affiliation(s)
- Tanjib Rahman
- Department of Mechanical and Aerospace Engineering,
University of Central Florida, Orlando, FL 32816, USA
| | - Kévin Moulin
- CREATIS Laboratory, Univ. Lyon, UJM-Saint-Etienne, INSA,
CNRS UMR 5520, INSERM, 69100 Villeurbanne, France
- Department of Radiology, University Hospital Saint-Etienne,
42270 Saint-Priest-en-Jarez, France
| | - Luigi E. Perotti
- Department of Mechanical and Aerospace Engineering,
University of Central Florida, Orlando, FL 32816, USA
- Correspondence:
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Del Torto A, Guaricci AI, Pomarico F, Guglielmo M, Fusini L, Monitillo F, Santoro D, Vannini M, Rossi A, Muscogiuri G, Baggiano A, Pontone G. Advances in Multimodality Cardiovascular Imaging in the Diagnosis of Heart Failure With Preserved Ejection Fraction. Front Cardiovasc Med 2022; 9:758975. [PMID: 35355965 PMCID: PMC8959466 DOI: 10.3389/fcvm.2022.758975] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a syndrome defined by the presence of heart failure symptoms and increased levels of circulating natriuretic peptide (NP) in patients with preserved left ventricular ejection fraction and various degrees of diastolic dysfunction (DD). HFpEF is a complex condition that encompasses a wide range of different etiologies. Cardiovascular imaging plays a pivotal role in diagnosing HFpEF, in identifying specific underlying etiologies, in prognostic stratification, and in therapeutic individualization. Echocardiography is the first line imaging modality with its wide availability; it has high spatial and temporal resolution and can reliably assess systolic and diastolic function. Cardiovascular magnetic resonance (CMR) is the gold standard for cardiac morphology and function assessment, and has superior contrast resolution to look in depth into tissue changes and help to identify specific HFpEF etiologies. Differently, the most important role of nuclear imaging [i.e., planar scintigraphy and/or single photon emission CT (SPECT)] consists in the screening and diagnosis of cardiac transthyretin amyloidosis (ATTR) in patients with HFpEF. Cardiac CT can accurately evaluate coronary artery disease both from an anatomical and functional point of view, but tissue characterization methods have also been developed. The aim of this review is to critically summarize the current uses and future perspectives of echocardiography, nuclear imaging, CT, and CMR in patients with HFpEF.
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Affiliation(s)
- Alberico Del Torto
- Department of Emergency and Acute Cardiac Care, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | - Marco Guglielmo
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Daniela Santoro
- University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Monica Vannini
- University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Giuseppe Muscogiuri
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
- University Milano Bicocca, Milan, Italy
| | - Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
- *Correspondence: Gianluca Pontone
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Mao X, Lee HL, Hu Z, Cao T, Han F, Ma S, Serry FM, Fan Z, Xie Y, Li D, Christodoulou AG. Simultaneous Multi-Slice Cardiac MR Multitasking for Motion-Resolved, Non-ECG, Free-Breathing T1–T2 Mapping. Front Cardiovasc Med 2022; 9:833257. [PMID: 35310971 PMCID: PMC8930916 DOI: 10.3389/fcvm.2022.833257] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/27/2022] [Indexed: 02/05/2023] Open
Abstract
The aim of this study is to simultaneously quantify T1/T2 across three slices of the left-ventricular myocardium without breath-holds or ECG monitoring, all within a 3 min scan. Radial simultaneous multi-slice (SMS) encoding, self-gating, and image reconstruction was incorporated into the cardiovascular magnetic resonance (CMR) Multitasking framework to simultaneously image three short-axis slices. A T2prep-IR FLASH sequence with two flip angles was designed and implemented to allow B1+-robust T1 and T2 mapping. The proposed Multitasking-SMS method was validated in a standardized phantom and 10 healthy volunteers, comparing T1 and T2 measurements and scan-rescan repeatability against corresponding reference methods in one layer of phantom vials and in 16 American Heart Association (AHA) myocardial segments. In phantom, Multitasking-SMS T1/T2 measurements showed substantial correlation (R2 > 0.996) and excellent agreement [intraclass correlation coefficients (ICC) ≥ 0.999)] with reference measurements. In healthy volunteers, Multitasking-SMS T1/T2 maps reported similar myocardial T1/T2 values (1,215 ± 91.0/41.5 ± 6.3 ms) to the reference myocardial T1/T2 values (1,239 ± 67.5/42.7 ± 4.1 ms), with P = 0.347 and P = 0.296, respectively. Bland–Altman analyses also demonstrated good in vivo repeatability in both the multitasking and references, with segment-wise coefficients of variation of 4.7% (multitasking T1), 8.9% (multitasking T2), 2.4% [modified look-locker inversion recovery (MOLLI)], and 4.6% (T2-prep FLASH), respectively. In summary, multitasking-SMS is feasible for free-breathing, non-ECG, myocardial T1/T2 quantification in 16 AHA segments over 3 short-axis slices in 3 min. The method shows the great potential for reducing exam time for quantitative CMR without ECG or breath-holds.
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Affiliation(s)
- Xianglun Mao
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Hsu-Lei Lee
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Zhehao Hu
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Radiology, University of Southern California, Los Angeles, CA, United States
| | - Tianle Cao
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Fei Han
- Siemens Medical Solutions, Inc., Los Angeles, CA, United States
| | - Sen Ma
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Fardad M. Serry
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Zhaoyang Fan
- Department of Radiology, University of Southern California, Los Angeles, CA, United States
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Anthony G. Christodoulou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
- *Correspondence: Anthony G. Christodoulou
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Eyyupkoca F, Karakus G, Gok M, Ozkan C, Altintas MS, Tosu AR, Okutucu S, Ercan K. Association of changes in the infarct and remote zone myocardial tissue with cardiac remodeling after myocardial infarction: a T1 and T2 mapping study. Int J Cardiovasc Imaging 2021; 38:363-373. [PMID: 34902103 DOI: 10.1007/s10554-021-02490-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
Tissue structure in the infarct and remote zone myocardium post-acute myocardial infarction (MI) may offer prognostic information concerning left ventricular remodeling. We aimed to identify or establish a relationship between adverse remodeling (AR) and changes (Δ) in T1, T2 mapping and extracellular volume (ECV) in post MI periods. Fifty-four MI patients underwent 3 Tesla CMR performed 2 weeks (acute phase) and 6 months post-MI. We measured T1 mapping with MOLLI sequences and T2 mapping with TrueFISP sequences. Hematocrit was quantified in scanning time. ECV was performed post-gadolinium enhancement. AR was defined as an increase of ≥ 10% in left ventricular end-diastolic volume in 6 months. In the acute phase post-MI, high T2 relaxation times of the infarct and remote zone myocardium were associated with AR (OR 1.15, p = 0.023 and OR 1.54, p = 0.002, respectively). There was a decrease in T2 relaxation times of the remote zone myocardium at 6 months in patients with AR (42.0 ± 4.0 vs. 39.0 ± 3.5 ms, p < 0.001), while insignificant difference was found in patients without AR. Increased ΔECV (%) and decreased remote ΔT2 values were associated with AR (OR 1.04, p = 0.043 and OR 0.77, p = 0.007, respectively). The diagnostic performance analysis in predicting AR showed that acute-phase remote T2 was similar to that of remote ΔT2 (p = 0.875) but was superior to that of ΔECV (%) (ΔAUC: 0.19 ± 0.09, p = 0.038). In both acute phase and change of 6 months post-MI, the T2 relaxation times in remote myocardium are independently associated with AR, and this suggests higher inflammation in the remote myocardium in the AR group than the other group, even though no significant pathophysiological difference was observed in the healing of the infarct zone between both groups.
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Affiliation(s)
- Ferhat Eyyupkoca
- Department of Cardiology, Dr. Nafiz Korez Sincan State Hospital, Fatih District, Gazi Mustafa Kemal Boulevard, Ankara, Turkey.
| | - Gultekin Karakus
- Department of Cardiology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Murat Gok
- Department of Cardiology, Edirne Sultan Murat I State Hospital, Edirne, Turkey
| | - Can Ozkan
- Department of Cardiology, Mus State Hospital, Mus, Turkey
| | - Mehmet Sait Altintas
- Department of Cardiology, Istanbul Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Aydin Rodi Tosu
- Deparment of Cardiology, Sultangazi Haseki Training and Research Hospital, Istanbul, Turkey
| | - Sercan Okutucu
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
| | - Karabekir Ercan
- Department of Radiology, Ankara Bilkent City Hospital, Ankara, Turkey
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Yan C, Li R, Guo X, Yu H, Li W, Li W, Ren M, Yang M, Li H. Cardiac Involvement in Human Immunodeficiency Virus Infected Patients: An Observational Cardiac Magnetic Resonance Study. Front Cardiovasc Med 2021; 8:756162. [PMID: 34869667 PMCID: PMC8634394 DOI: 10.3389/fcvm.2021.756162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To investigate the subclinical imaging changes in terms of myocardial inflammation and fibrosis and to explore the risk factors associated with myocardial fibrosis by cardiac magnetic resonance (CMR) approach in a Chinese HIV/AIDS cohort. Methods: We evaluated myocardial function (cine), myocardial inflammation (T1, T2), and myocardial fibrosis (through extracellular volume fraction [ECV] and late gadolinium enhancement [LGE]) by a multiparametric CMR scan protocol in a total of 68 participants, including 47 HIV-infected individuals, who were divided into two groups: asymptomatic HIV (HIV+) (n = 30), and acquired immunodeficiency syndrome (AIDS) (n = 17), and 21 healthy controls. Results: HIV-infected patients had lower left (55.3 ± 6.5 vs. 63.0 ± 7.9%, P < 0.001) and right ventricular systolic function (35.9 ± 15.7 vs. 50.8 ± 9.3%, P < 0.001). Radial systolic strain (30.7 ± 9.3 vs. 39.3 ± 9.4%, P = 0.001), circumferential systolic strain (−17.5 ± 2.6 vs. −19.4 ± 2.7%, P = 0.008), and longitudinal systolic strain (−9.4 ± 5.7 vs. −12.8 ± 3.1%, P = 0.012) were also decreased in HIV. Native T1 relaxation time (1,337.2 ± 70.2 vs. 1,249.5 ± 47.0 ms, P < 0.001), ECV value (33.5 ± 6.2 vs. 28.5 ± 2.9 ms, P = 0.026), and T2 relaxation time (45.2 ± 3.5 vs. 42.0 ± 2.6 ms, P = 0.001) were higher in HIV-infected patients compared with controls. Myocardial fibrosis, predominantly in the mid-inferior wall, was detected in 24.4% of the HIV-infected patients. HIV+ had a significantly lower value of ECV [29.1 (26.1, 31.8) vs. 35.2 (31.8, 41.9) %, P < 0.001] and frequency of LGE [3/25 (8%) vs. 7/16 (43.8%), P = 0.014)] compared with AIDS. AIDS was associated with myocardial fibrosis. Conclusions: HIV-infected patients were associated with changes in myocardial function and higher rates of subclinical myocardial inflammation and fibrosis, which were more abnormal with greater severity of the disease. AIDS was associated with myocardial fibrosis, where the observations supported earlier initiation of antiretroviral therapy in the Chinese HIV/AIDS cohort.
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Affiliation(s)
- Chengxi Yan
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruili Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaojuan Guo
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Huan Yu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenhuan Li
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenqiao Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Meiji Ren
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Minglei Yang
- Neusoft Research of Intelligent Healthcare Technology, Co. Ltd., Shenyang, China
| | - Hongjun Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
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Nakou E, Patel RK, Fontana M, Bucciarelli-Ducci C. Cardiovascular Magnetic Resonance Parametric Mapping Techniques: Clinical Applications and Limitations. Curr Cardiol Rep 2021; 23:185. [PMID: 34762189 DOI: 10.1007/s11886-021-01607-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Parametric mapping represents a significant innovation in cardiovascular magnetic resonance (CMR) tissue characterisation, allowing the quantification of myocardial changes based on changes on T1, T2 and T2* relaxation times and extracellular volume (ECV). Its clinical use is rapidly expanding, but it requires availability of dedicated equipment as well as expertise in image acquisition and analysis. This review focuses on the principles of CMR parametric mapping, its current clinical applications, important limitations, as well as future directions of this technique in cardiovascular medicine. RECENT FINDINGS There is increasing evidence that CMR parametric mapping techniques provide accurate diagnostic and prognostic tools that can be applied to and support the clinical management of patients with a range of cardiovascular disease. The unique capability of CMR myocardial tissue characterisation in cardiovascular diseases has further expanded by the introduction of parametric mapping. Its use in clinical practice presents opportunities but has also limitations.
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Affiliation(s)
- Eleni Nakou
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Trust and University of Bristol, Bristol, UK
| | - Rishi K Patel
- Department of Medicine, National Amyloid Centre, Royal Free Hospital, University College London, London, UK
| | - Marianna Fontana
- Department of Medicine, National Amyloid Centre, Royal Free Hospital, University College London, London, UK
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Clinical Partnership, Guys and St Thomas NHS Trust and King's College, London, SW3 6NP, UK.
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41
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Dereli Bulut SS, Nurili F, Öztürkeri B, Sakci Z, Bukte Y, Aras Ö. Preliminary study: myocardial T1 relaxation time in patients with ischemic findings and normal findings on coronary angiography. ACTA ACUST UNITED AC 2021; 67:418-425. [PMID: 34468608 DOI: 10.1590/1806-9282.20200864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the myocardium structure in patients with chest pain who were determined to have moderate and/or high risk for cardiac ischemic heart disease (IHD) but who had normal findings on conventional coronary angiography by using native cardiac magnetic resonance imaging (CMRI) T1 mapping and comparing with healthy volunteers. METHODS A total of 50 patients and 30 healthy volunteers who underwent CMRI were included in our prospective study. Patients whose clinical findings were compatible with stable angina pectoris, with moderate and/or high risk for IHD, but whose conventional coronary angiography was normal, were our patient group. Native T1 values were measured for 17 myocardial segments (segmented based on American Heart Association recommendations) by two radiologists independently. The data obtained were statistically compared with the sample t-test. RESULTS Myocardial native T1 values were found to be significantly prolonged in the patient group compared with the control group (p<0.05). Inter-observer reliability for native T1 value measurements of groups was high for both patient and control groups (α = 0.92 for the patient group and 0.96 for the control group). CONCLUSION Findings suggestive of ischemia were detected by T1 mapping in the myocardium of our patients. For this reason, it is recommended that this patient group should be included in early diagnosis and close follow-up assessments for IHD.
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Affiliation(s)
- Safiye Sanem Dereli Bulut
- Health Sciences University, Istanbul Umraniye Training and Research Hospital, Department of Radiology - Istanbul, Turkey
| | - Fuad Nurili
- Memorial Sloan Kettering Cancer Center, Department of Radiology - New York, USA
| | - Burak Öztürkeri
- Health Sciences University, Istanbul Umraniye Training and Research Hospital, Department of Cardiology - Istanbul, Turkey
| | - Zakir Sakci
- Health Sciences University, Istanbul Umraniye Training and Research Hospital, Department of Radiology - Istanbul, Turkey
| | - Yasar Bukte
- Health Sciences University, Istanbul Umraniye Training and Research Hospital, Department of Radiology - Istanbul, Turkey
| | - Ömer Aras
- Memorial Sloan Kettering Cancer Center, Department of Radiology - New York, USA
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42
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Xue H, Artico J, Fontana M, Moon JC, Davies RH, Kellman P. Landmark Detection in Cardiac MRI by Using a Convolutional Neural Network. Radiol Artif Intell 2021; 3:e200197. [PMID: 34617022 PMCID: PMC8489464 DOI: 10.1148/ryai.2021200197] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 04/28/2021] [Accepted: 06/15/2021] [Indexed: 12/03/2022]
Abstract
PURPOSE To develop a convolutional neural network (CNN) solution for landmark detection in cardiac MRI (CMR). MATERIALS AND METHODS This retrospective study included cine, late gadolinium enhancement (LGE), and T1 mapping examinations from two hospitals. The training set included 2329 patients (34 089 images; mean age, 54.1 years; 1471 men; December 2017 to March 2020). A hold-out test set included 531 patients (7723 images; mean age, 51.5 years; 323 men; May 2020 to July 2020). CNN models were developed to detect two mitral valve plane and apical points on long-axis images. On short-axis images, anterior and posterior right ventricular (RV) insertion points and left ventricular (LV) center points were detected. Model outputs were compared with manual labels assigned by two readers. The trained model was deployed to MRI scanners. RESULTS For the long-axis images, successful detection of cardiac landmarks ranged from 99.7% to 100% for cine images and from 99.2% to 99.5% for LGE images. For the short-axis images, detection rates were 96.6% for cine, 97.6% for LGE, and 98.7% for T1 mapping. The Euclidean distances between model-assigned and manually assigned labels ranged from 2 to 3.5 mm for different landmarks, indicating close agreement between model-derived landmarks and manually assigned labels. For all views and imaging sequences, no differences between the models' assessment of images and the readers' assessment of images were found for the anterior RV insertion angle or LV length. Model inference for a typical cardiac cine series took 610 msec with the graphics processing unit and 5.6 seconds with central processing unit. CONCLUSION A CNN was developed for landmark detection on both long- and short-axis CMR images acquired with cine, LGE, and T1 mapping sequences, and the accuracy of the CNN was comparable with the interreader variation.Keywords: Cardiac, Heart, Convolutional Neural Network (CNN), Deep Learning Algorithms, Machine Learning Algorithms, Feature Detection, Quantification, Supervised Learning, MR Imaging Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Hui Xue
- From the National Heart, Lung, and Blood Institute, National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892 (H.X., P.K.); Barts Heart
Centre, National Health Service, London, England (J.A., J.C.M., R.H.D.); and
National Amyloidosis Centre, Royal Free Hospital, London, England (M.F.)
| | - Jessica Artico
- From the National Heart, Lung, and Blood Institute, National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892 (H.X., P.K.); Barts Heart
Centre, National Health Service, London, England (J.A., J.C.M., R.H.D.); and
National Amyloidosis Centre, Royal Free Hospital, London, England (M.F.)
| | - Marianna Fontana
- From the National Heart, Lung, and Blood Institute, National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892 (H.X., P.K.); Barts Heart
Centre, National Health Service, London, England (J.A., J.C.M., R.H.D.); and
National Amyloidosis Centre, Royal Free Hospital, London, England (M.F.)
| | - James C. Moon
- From the National Heart, Lung, and Blood Institute, National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892 (H.X., P.K.); Barts Heart
Centre, National Health Service, London, England (J.A., J.C.M., R.H.D.); and
National Amyloidosis Centre, Royal Free Hospital, London, England (M.F.)
| | - Rhodri H. Davies
- From the National Heart, Lung, and Blood Institute, National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892 (H.X., P.K.); Barts Heart
Centre, National Health Service, London, England (J.A., J.C.M., R.H.D.); and
National Amyloidosis Centre, Royal Free Hospital, London, England (M.F.)
| | - Peter Kellman
- From the National Heart, Lung, and Blood Institute, National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892 (H.X., P.K.); Barts Heart
Centre, National Health Service, London, England (J.A., J.C.M., R.H.D.); and
National Amyloidosis Centre, Royal Free Hospital, London, England (M.F.)
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Gupta S, Ge Y, Singh A, Gräni C, Kwong RY. Multimodality Imaging Assessment of Myocardial Fibrosis. JACC Cardiovasc Imaging 2021; 14:2457-2469. [PMID: 34023250 DOI: 10.1016/j.jcmg.2021.01.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Abstract
Myocardial fibrosis, seen in ischemic and nonischemic cardiomyopathies, is associated with adverse cardiac outcomes. Noninvasive imaging plays a key role in early identification and quantification of myocardial fibrosis with the use of an expanding array of techniques including cardiac magnetic resonance, computed tomography, and nuclear imaging. This review discusses currently available noninvasive imaging techniques, provides insights into their strengths and limitations, and examines novel developments that will affect the future of noninvasive imaging of myocardial fibrosis.
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Affiliation(s)
- Sumit Gupta
- Department of Radiology Brigham and Women's Hospital, Boston, Massachusetts, USA; Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yin Ge
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amitoj Singh
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christoph Gräni
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Di Renzi P, Coniglio A, Abella A, Belligotti E, Rossi P, Pasqualetti P, Simonelli I, Della Longa G. Volumetric histogram-based analysis of cardiac magnetic resonance T1 mapping: A tool to evaluate myocardial diffuse fibrosis. Phys Med 2021; 82:185-191. [PMID: 33662882 DOI: 10.1016/j.ejmp.2021.01.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/09/2020] [Accepted: 01/29/2021] [Indexed: 01/19/2023] Open
Affiliation(s)
- P Di Renzi
- S. Giovanni Calibita Hospital, Fatebenefratelli Hospital, Isola Tiberina, Department of Radiology, Rome, Italy
| | - A Coniglio
- S. Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Department of Medical Physics, Rome, Italy; ASL Roma 1, PO San Filippo Neri, Department of Medical Physics, Rome, Italy.
| | - A Abella
- S. Giovanni Calibita Hospital, Fatebenefratelli Hospital, Isola Tiberina, Department of Radiology, Rome, Italy
| | - E Belligotti
- Ospedali Riuniti Marche Nord, Department of Medical Physics and High Technologies, Pesaro, Italy
| | - P Rossi
- S. Giovanni Calibita Hospital, Fatebenefratelli Hospital, Isola Tiberina, Arrhythmology Unit, Rome, Italy
| | - P Pasqualetti
- Department of Public Health and Infectious Diseases, Section of Health Statistics and Biometry, Sapienza University of Rome, Italy
| | - I Simonelli
- Fatebenefratelli Foundation for Health Research and Education, AFaR Division, Rome, Italy
| | - G Della Longa
- S. Giovanni Calibita Hospital, Fatebenefratelli Hospital, Isola Tiberina, Department of Radiology, Rome, Italy
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Kräuter C, Reiter U, Reiter C, Nizhnikava V, Schmidt A, Stollberger R, Fuchsjäger M, Reiter G. Impact of the Choice of Native T 1 in Pixelwise Myocardial Blood Flow Quantification. J Magn Reson Imaging 2021; 53:755-765. [PMID: 33034120 PMCID: PMC7891429 DOI: 10.1002/jmri.27375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Quantification of myocardial blood flow (MBF) from dynamic contrast-enhanced (DCE) MRI can be performed using a signal intensity model that incorporates T1 values of blood and myocardium. PURPOSE To assess the impact of T1 values on pixelwise MBF quantification, specifically to evaluate the influence of 1) study population-averaged vs. subject-specific, 2) diastolic vs. systolic, and 3) regional vs. global myocardial T1 values. STUDY TYPE Prospective. SUBJECTS Fifteen patients with chronic coronary heart disease. FIELD STRENGTH/SEQUENCE 3T; modified Look-Locker inversion recovery for T1 mapping and saturation recovery gradient echo for DCE imaging, both acquired in a mid-ventricular short-axis slice in systole and diastole. ASSESSMENT MBF was estimated using Fermi modeling and signal intensity nonlinearity correction with different T1 values: study population-averaged blood and myocardial, subject-specific systolic and diastolic, and segmental T1 values. Myocardial segments with perfusion deficits were identified visually from DCE series. STATISTICAL TESTS The relationships between MBF parameters derived by different methods were analyzed by Bland-Altman analysis; corresponding mean values were compared by t-test. RESULTS Using subject-specific diastolic T1 values, global diastolic MBF was 0.61 ± 0.13 mL/(min·g). It did not differ from global MBF derived from the study population-averaged T1 (P = 0.88), but the standard deviation of differences was large (0.07 mL/(min·g), 11% of mean MBF). Global diastolic and systolic MBF did not differ (P = 0.12), whereas global diastolic MBF using systolic (0.62 ± 0.13 mL/(min·g)) and diastolic T1 values differed (P < 0.05). If regional instead of global T1 values were used, segmental MBF was lower in segments with perfusion deficits (bias = -0.03 mL/(min·g), -7% of mean MBF, P < 0.05) but higher in segments without perfusion deficits (bias = 0.01 mL/(min·g), 1% of mean MBF, P < 0.05). DATA CONCLUSION Whereas cardiac phase-specific T1 values have a minor impact on MBF estimates, subject-specific and myocardial segment-specific T1 values substantially affect MBF quantification. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Corina Kräuter
- Division of General Radiology, Department of RadiologyMedical University of GrazGrazAustria
- Institute of Medical EngineeringGraz University of TechnologyGrazAustria
| | - Ursula Reiter
- Division of General Radiology, Department of RadiologyMedical University of GrazGrazAustria
| | - Clemens Reiter
- Division of General Radiology, Department of RadiologyMedical University of GrazGrazAustria
| | - Volha Nizhnikava
- Division of General Radiology, Department of RadiologyMedical University of GrazGrazAustria
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Rudolf Stollberger
- Institute of Medical EngineeringGraz University of TechnologyGrazAustria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of RadiologyMedical University of GrazGrazAustria
| | - Gert Reiter
- Division of General Radiology, Department of RadiologyMedical University of GrazGrazAustria
- Research and DevelopmentSiemens Healthcare Diagnostics GmbHGrazAustria
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Zhou Z, Wang R, Wang H, Liu Y, Lu D, Sun Z, Yang G, Xu L. Myocardial extracellular volume fraction quantification in an animal model of the doxorubicin-induced myocardial fibrosis: a synthetic hematocrit method using 3T cardiac magnetic resonance. Quant Imaging Med Surg 2021; 11:510-520. [PMID: 33532252 DOI: 10.21037/qims-20-501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Visualization of diffuse myocardial fibrosis is challenging and mainly relies on histology. Cardiac magnetic resonance (CMR), which uses extracellular contrast agents, is a rapidly developing technique for measuring the extracellular volume (ECV). The objective of this study was to evaluate the feasibility of the synthetic myocardial ECV fraction based on 3.0 T CMR compared with the conventional ECV fraction. Methods This study was approved by the local animal care and ethics committee. Fifteen beagle models with diffuse myocardial fibrosis, including 12 experimental and three control subjects, were generated by injecting doxorubicin 30 mg/m2 intravenously every three weeks for 24 weeks. Short-axis (SAX) and 4-chamber long-axis (LAX) T1 maps were acquired for both groups. The association between hematocrit (Hct) and native T1blood was derived from 9 non-contrast CMR T1 maps of 3 control beagles using regression analysis. Synthetic ECV was then calculated using the synthetic Hct and compared with conventional ECV at baseline and the 16th and 24th week after doxorubicin administration. The collagen volume fraction (CVF) value was measured on digital biopsy samples. Bland-Altman plots were used to analyze the agreement between conventional and synthetic ECV. Correlation analyses were performed to explore the association among conventional ECV, synthetic ECV, CVF, and left ventricular ejection fraction (LVEF). Results The regression model synthetic Hct = 816.46*R1blood - 0.01 (R2=0.617; P=0.012) was used to predict the Hct from native T1blood values. The conventional and synthetic ECV fractions of experimental animals at the 16th and 24th week after modeling were significantly higher than those measured at the baseline (31.4%±2.2% and 36.3%±2.1% vs. 22.9%±1.7%; 29.9%±2.4% and 36.1%±2.6% vs. 22.0%±2.4%; all with P<0.05). Bland-Altman plots showed a bias (1.0%) between conventional and synthetic ECV with 95% limits of agreement of -2.5% to 4.4% in the per-subject analysis (n=21) and a bias (1.0%) between conventional and synthetic ECV with 95% limits of agreement of -2.4% to 4.3% in the per-segment analysis (n=294). Conventional and synthetic ECV were well correlated with CVF (r=0.937 and 0.925, all with P<0.001, n=10). Conclusions Our study showed promising results for using synthetic ECV compared with the conventional ECV for providing accurate quantification of myocardial ECV without the need for blood sampling.
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Affiliation(s)
- Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dongxu Lu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, Curtin University, Perth, WA, Australia
| | - Guang Yang
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Zhou Z, Gao Y, Wang H, Wang W, Zhang H, Wang S, Sun Z, Xu L. Myocardial extracellular volume fraction analysis in doxorubicin-induced beagle models: comparison of dual-energy CT with equilibrium contrast-enhanced single-energy CT. Cardiovasc Diagn Ther 2021; 11:102-110. [PMID: 33708482 DOI: 10.21037/cdt-20-798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Dual-energy CT (DECT) permits the simultaneous operation of two different kV levels, providing a potential method toward the assessment of diffuse myocardial fibrosis. The purpose of this study was to determine the accuracy of DECT for evaluation of the myocardial extracellular volume (ECV) fraction in comparison with single-energy CT (SECT). Methods Myocardial ECV was quantified in fifteen dogs using DECT and dynamic equilibrium SECT before and after doxorubicin administration. Cardiac magnetic resonance imaging (CMRI) was used to assess myocardial function. The histological collagen volume fraction (CVF) was calculated as the gold standard. The Bland-Altman analysis was performed to compare the agreement between DECT-ECV and SECT-ECV. The association among ECV values derived from DECT and SECT, CVF, and left ventricular ejection fraction (LVEF) were determined by correlation analysis. The variations of these values were evaluated using repeated ANOVA. Results The DECT- and SECT-ECV were increased with the elongation of modeling time (pre-modeling vs. 16-week models vs. 24-week models: DECT-ECV 24.1%±1.1%, 35.1%±1.3% and 37.6%±1.4%; SECT-ECV 22.9%±0.8%, 33.6%±1.2% and 36.3%±1.0%; n=30 in per-subject analysis, all P<0.05). Both ECV values of DECT and SECT correlated well with the histological CVF results (R=0.935 and 0.952 for the DECT-ECV and SECT-ECV; all P<0.001; n=13). Bland-Altman plots showed no significant differences between DECT- and SECT-ECV. Conclusions DECT-ECV correlated well with both SECT-ECV and histology, showing the feasibility of DECT in evaluating doxorubicin-induced diffuse myocardial interstitial fibrosis.
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Affiliation(s)
- Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yifeng Gao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongwei Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenjing Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongkai Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, Curtin Medical School, Curtin University, Perth, Australia
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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48
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Markousis-Mavrogenis G, Bacopoulou F, Vlachakis D, Mavrogeni S. Tissue Characterization in Cardiology: Moving Beyond Function. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1337:89-97. [DOI: 10.1007/978-3-030-78771-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Liu B, Neil DAH, Premchand M, Bhabra M, Patel R, Barker T, Nikolaidis N, Billing JS, Treibel TA, Moon JC, González A, Hodson J, Edwards NC, Steeds RP. Myocardial fibrosis in asymptomatic and symptomatic chronic severe primary mitral regurgitation and relationship to tissue characterisation and left ventricular function on cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2020; 22:86. [PMID: 33308240 PMCID: PMC7734760 DOI: 10.1186/s12968-020-00674-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/18/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Myocardial fibrosis occurs in end-stage heart failure secondary to mitral regurgitation (MR), but it is not known whether this is present before onset of symptoms or myocardial dysfunction. This study aimed to characterise myocardial fibrosis in chronic severe primary MR on histology, compare this to tissue characterisation on cardiovascular magnetic resonance (CMR) imaging, and investigate associations with symptoms, left ventricular (LV) function, and exercise capacity. METHODS Patients with class I or IIa indications for surgery underwent CMR and cardiopulmonary exercise testing. LV biopsies were taken at surgery and the extent of fibrosis was quantified on histology using collagen volume fraction (CVFmean) compared to autopsy controls without cardiac pathology. RESULTS 120 consecutive patients (64 ± 13 years; 71% male) were recruited; 105 patients underwent MV repair while 15 chose conservative management. LV biopsies were obtained in 86 patients (234 biopsy samples in total). MR patients had more fibrosis compared to 8 autopsy controls (median: 14.6% [interquartile range 7.4-20.3] vs. 3.3% [2.6-6.1], P < 0.001); this difference persisted in the asymptomatic patients (CVFmean 13.6% [6.3-18.8], P < 0.001), but severity of fibrosis was not significantly higher in NYHA II-III symptomatic MR (CVFmean 15.7% [9.9-23.1] (P = 0.083). Fibrosis was patchy across biopsy sites (intraclass correlation 0.23, 95% CI 0.08-0.39, P = 0.001). No significant relationships were identified between CVFmean and CMR tissue characterisation [native T1, extracellular volume (ECV) or late gadolinium enhancement] or measures of LV function [LV ejection fraction (LVEF), global longitudinal strain (GLS)]. Although the range of ECV was small (27.3 ± 3.2%), ECV correlated with multiple measures of LV function (LVEF: Rho = - 0.22, P = 0.029, GLS: Rho = 0.29, P = 0.003), as well as NTproBNP (Rho = 0.54, P < 0.001) and exercise capacity (%PredVO2max: R = - 0.22, P = 0.030). CONCLUSIONS Patients with chronic primary MR have increased fibrosis before the onset of symptoms. Due to the patchy nature of fibrosis, CMR derived ECV may be a better marker of global myocardial status. Clinical trial registration Mitral FINDER study; Clinical Trials NCT02355418, Registered 4 February 2015, https://clinicaltrials.gov/ct2/show/NCT02355418.
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Affiliation(s)
- Boyang Liu
- Department of Cardiology, University Hospital Birmingham, Birmingham, UK
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
| | - Desley A H Neil
- Department of Cellular Pathology, University Hospital Birmingham, Birmingham, UK
- School of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Monisha Premchand
- Department of Cardiology, University Hospital Birmingham, Birmingham, UK
| | - Moninder Bhabra
- Department of Cardiothoracic Surgery, University Hospital Birmingham, Birmingham, UK
| | - Ramesh Patel
- Department of Cardiothoracic Surgery, University Hospital Coventry, Coventry, UK
| | - Thomas Barker
- Department of Cardiothoracic Surgery, University Hospital Coventry, Coventry, UK
| | - Nicolas Nikolaidis
- Department of Cardiothoracic Surgery, New Cross Hospital, Wolverhampton, UK
| | - J Stephen Billing
- Department of Cardiothoracic Surgery, New Cross Hospital, Wolverhampton, UK
| | - Thomas A Treibel
- Institute for Cardiovascular Sciences, University College London, London, UK
- Department for Cardiac Imaging, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - James C Moon
- Institute for Cardiovascular Sciences, University College London, London, UK
- Department for Cardiac Imaging, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Arantxa González
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - James Hodson
- Department of Statistics, Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Nicola C Edwards
- Green Lane Cardiovascular Service, Department of Cardiology, Auckland City Hospital, Auckland, New Zealand
| | - Richard P Steeds
- Department of Cardiology, University Hospital Birmingham, Birmingham, UK.
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK.
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Farrag NA, Lochbihler A, White JA, Ukwatta E. Evaluation of fully automated myocardial segmentation techniques in native and contrast-enhanced T1-mapping cardiovascular magnetic resonance images using fully convolutional neural networks. Med Phys 2020; 48:215-226. [PMID: 33131085 DOI: 10.1002/mp.14574] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 07/28/2020] [Accepted: 10/25/2020] [Indexed: 11/07/2022] Open
Abstract
PURPOSE T1-mapping cardiac magnetic resonance (CMR) imaging permits noninvasive quantification of myocardial fibrosis (MF); however, manual delineation of myocardial boundaries is time-consuming and introduces user-dependent variability for such measurements. In this study, we compare several automated pipelines for myocardial segmentation of the left ventricle (LV) in native and contrast-enhanced T1-maps using fully convolutional neural networks (CNNs). METHODS Sixty patients with known MF across three distinct cardiomyopathy states (20 ischemic (ICM), 20 dilated (DCM), and 20 hypertrophic (HCM)) underwent a standard CMR imaging protocol inclusive of cinematic (CINE), late gadolinium enhancement (LGE), and pre/post-contrast T1 imaging. Native and contrast-enhanced T1-mapping was performed using a shortened modified Look-Locker imaging (shMOLLI) technique at the basal, mid-level, and/or apex of the LV. Myocardial segmentations in native and post-contrast T1-maps were performed using three state-of-the-art CNN-based methods: standard U-Net, densely connected neural networks (Dense Nets), and attention networks (Attention Nets) after dividing the dataset using fivefold cross validation. These direct segmentation techniques were compared to an alternative registration-based segmentation method, wherein spatially corresponding CINE images are segmented automatically using U-Net, and a nonrigid registration technique transforms and propagates CINE contours to the myocardial regions of T1-maps. The methodologies were validated in 125 native and 100 contrast-enhanced T1-maps using standard segmentation accuracy metrics. Pearson correlation coefficient r and Bland-Altman analysis were used to compare the computed global T1 values derived by manual, U-Net, and CINE registration methodologies. RESULTS The U-Net-based method yielded optimal results in myocardial segmentation of native, contrast-enhanced, and CINE images compared to Dense Nets and Attention Nets. The direct U-Net-based method outperformed the CINE registration-based method in native T1-maps, yielding Dice similarity coefficient (DSC) of 82.7 ± 12% compared to 81.4 ± 6.9% (P < 0.0001). However, in contrast-enhanced T1-maps, the CINE-registration-based method outperformed direct U-Net segmentation, yielding DSC of 77.0 ± 9.6% vs 74.2 ± 18% across all patient groups (P = 0.0014) and specifically 73.2 ± 7.3% vs 65.5 ± 18% in the ICM patient group. High linear correlation of global T1 values was demonstrated in Pearson analysis of the U-Net-based technique and the CINE-registration technique in both native T1-maps (r = 0.93, P < 0.0001 and r = 0.87, P < 0.0001, respectively) and contrast-enhanced T1-maps (r = 0.93, P < 0.0001 and r = 0.98, P < 0.0001, respectively). CONCLUSIONS The direct U-Net-based myocardial segmentation technique provided accurate, fully automated segmentations in native and contrast-enhanced T1-maps. Myocardial borders can alternatively be segmented from spatially matched CINE images and applied to T1-maps via deformation and propagation through a modality-independent neighborhood descriptor (MIND). The direct U-Net approach is more efficient in myocardial segmentation of native T1-maps and eliminates cross-technique dependence. However, the CINE-registration-based technique may be more appropriate for contrast-enhanced T1-maps and/or for patients with dense regions of replacement fibrosis, such as those with ICM.
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Affiliation(s)
- Nadia A Farrag
- Department of Systems and Computer Engineering, Carleton University, 1125 Colonel By Drive, Mackenzie 4456, Ottawa, ON, K1S5B6, Canada
| | - Aidan Lochbihler
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - James A White
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Eranga Ukwatta
- School of Engineering, University of Guelph, Guelph, ON, N1G 2W1, Canada
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