Importance of k-space trajectory in echo-planar myocardial tagging at rest and during dobutamine stress.

Hybrid fast gradient echo/echo-planar imaging (FGRE-EPI) can be used to increase temporal resolution, enhance tag contrast, and/or decrease scan time for breathhold myocardial tagging. However, off-resonance effects and motion can lead to local phase discontinuities in FGRE-EPI raw data when a conventional interleaved bottom-up k-space trajectory is used. These discontinuities can be particularly problematic for myocardial tagging, where the image energy is not only concentrated near the k-space origin, but is also concentrated in multiple spectral peaks centered throughout k-space. In this study, tag distortion artifacts in FGRE-EPI tagging due to off-resonance and velocity-induced phase discontinuities were characterized at rest and dobutamine stress, and the flyback and gradient moment smoothing (GMS) methods were shown to reduce these artifacts. For the specific parameters used in this study, flyback and GMS resulted in improved image quality at rest and stress, increased myocardium-tag contrast-to-noise ratio (11.4 +/- 2.1 vs. 10.0 +/- 2.9, P < 0.01 at rest; 11.1 +/- 1.8 vs. 8.1 +/- 2.4, P < 0.01 at stress), and reduced full width at half maximum of the tag profile (3.6 vs. 3.8 pixels at rest; 4.0 vs. 5.1 pixels at stress) compared to the conventional trajectory. A limitation of the improved trajectory is a parameter-dependent decrease in data acquisition efficiency. For the specific imaging protocol used, the repetition time of the improved trajectory increased by 36% compared to the conventional trajectory.     

Strain‐encoded (SENC) magnetic resonance imaging to evaluate regional heterogeneity of myocardial strain in healthy volunteers: Comparison with conventional tagging

Purpose

To evaluate the ability of strain‐encoded (SENC) magnetic resonance imaging (MRI) for regional systolic and diastolic strain analysis of the myocardium in healthy volunteers.

Materials and Methods

Circumferential and longitudinal peak systolic strain values of 75 healthy volunteers (35 women and 40 men, mean age 44 ± 12 years) were measured using SENC at 1.5T. MR tagging was used as the reference standard for measuring regional function. Diastolic function was assessed in the 10 youngest (24 ± 8 years) and 10 oldest (62 ± 5 years) subjects.

Results

Peak strain values assessed with SENC were comparable to those obtained by MR tagging, showing narrow limits of agreement (limits of agreement ?5.6% to 8.1%). Regional heterogeneity was observed between different segments of the left ventricle (LV) by both techniques (P < 0.001). Longitudinal strain obtained by SENC was also heterogenous (P < 0.001). Interestingly, no age‐ or gender‐specific differences in peak systolic strain were observed, whereas the peak rate of relaxation of circumferential strain rate was decreased in the older group.

Conclusion

SENC is a reliable tool for accurate and objective quantification of regional myocardial systolic as well as diastolic function. In agreement with tagged MRI, SENC detected slightly heterogeneous myocardial strain within LV segments. J. Magn. Reson. Imaging 2009;29:99–105. © 2008 Wiley‐Liss, Inc.

     

Comparison of dobutamine stress echocardiography, dobutamine SPECT, and adenosine SPECT myocardial perfusion imaging in patients with end-stage renal disease

Objectives  We sought to assess and compare the diagnostic accuracy and prognostic value of dobutamine stress echocardiography (DSE), dobutamine SPECT, and adenosine SPECT myocardial perfusion imaging (MPI) in patients with end-stage renal disease (ESRD). Background  The optimal stress imaging modality for patients with ESRD has not yet been determined. Methods  Forty-nine patients with ESRD underwent DSE, dobutamine SPECT MPI, and adenosine SPECT MPI. The primary endpoint of the trial was concordance between stress tests with respect to the presence or absence of ischemia. Results  Agreement on the presence or absence of ischemia between adenosine SPECT MPI and DSE was 69% (kappa = .25, P = NS). Agreement on the presence or absence of ischemia between adenosine and dobutamine SPECT MPI was 77% (kappa = .37, P = <.009). Summed stress scores for adenosine and dobutamine SPECT MPI studies were highly correlated (r = .9, P = <.0001). DSE and SPECT MPI results provided incremental prognostic information when added to clinical variables. Conclusions  There is moderate concordance between DSE and adenosine SPECT MPI in ESRD patients referred for stress testing. Interobserver agreement was higher for SPECT MPI compared to DSE. Based on these observations, the optimal approach for diagnosing severe coronary artery disease and assessing risk in patients with ESRD has yet to be determined, but appears to warrant further investigation. Supported by grants from Hennepin Faculty Associates, the Minneapolis Medical Research Foundation, and DuPont Pharmaceuticals.     

Comparison of myocardial blood flow and coronary flow reserve during dobutamine and adenosine stress: implications for pharmacologic stress testing in coronary artery disease

BACKGROUND: Mechanistic differences between pharmacologic stressors may offer different clinical benefits. Therefore the effects of dobutamine and adenosine on absolute myocardial blood flow (MBF) and coronary flow reserve (CFR) were compared. METHODS AND RESULTS: We divided 36 patients (mean age, 61 +/- 8 years) with coronary artery disease into 2 groups based on stenosis severity as follows: greater than 50% but less than 75% (n = 16) and greater than 75% (n = 20). In addition, 18 normal volunteers (mean age, 46 +/- 7 years) served as control subjects. Groups of equal sizes received either dobutamine or adenosine. MBF at rest and peak MBF were measured by use of positron emission tomography in territories subtended by the stenosis (ischemic) and remote myocardium (remote), whereas left ventricular MBF was used in control subjects. CFR was calculated as peak MBF divided by MBF at rest. CFR was significantly greater with adenosine than with dobutamine stress in control subjects and remote CFR. Ischemic CFR was blunted to a similar degree with each stressor. Therefore adenosine achieved flow heterogeneity across all coronary stenosis severities greater than 50%. However, dobutamine achieved flow heterogeneity only in the presence of a severe coronary stenosis greater than 75% despite provoking a greater ischemic stimulus. CONCLUSION: Adenosine stress demonstrated a higher sensitivity and dobutamine demonstrated a higher specificity with quantitative perfusion imaging. Therefore adenosine is superior for diagnostic perfusion imaging, whereas dobutamine is better suited in combination with visual imaging and in the functional assessment of a known coronary stenosis.     

Simultaneous myocardial strain and dark‐blood perfusion imaging using a displacement‐encoded MRI pulse sequence

The purpose of this study is to develop and evaluate a displacement‐encoded pulse sequence for simultaneous perfusion and strain imaging. Displacement‐encoded images in two to three myocardial slices were repeatedly acquired using a single‐shot pulse sequence for 3 to 4 min, which covers a bolus infusion of Gadolinium contrast. The magnitudes of the images were T₁ weighted and provided quantitative measures of perfusion, while the phase maps yielded strain measurements. In an acute coronary occlusion swine protocol (n = 9), segmental perfusion measurements were validated against microsphere reference standard with a linear regression (slope 0.986, R² = 0.765, Bland‐Altman standard deviation = 0.15 mL/min/g). In a group of ST‐elevation myocardial infarction patients (n = 11), the scan success rate was 76%. Short‐term contrast washout rate and perfusion are highly correlated (R² = 0.72), and the pixelwise relationship between circumferential strain and perfusion was better described with a sigmoidal Hill curve than linear functions. This study demonstrates the feasibility of measuring strain and perfusion from a single set of images. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

Transmural myocardial strain in mouse: Quantification of high‐resolution MR tagging using harmonic phase (HARP) analysis

MR tagging allows noninvasive examination of regional myocardial function with high accuracy and reproducibility. The current tagging method is limited by low tagging resolution for accurate transmural strain quantification. Previously, a spatial modulation of magnetization (SPAMM)‐based method was proposed to increase the tagging resolution by combining two or more tagged images with different tagging grid positions. However, there has been limited application due to the challenge in image processing of multiple data sets. In the current study, we propose a harmonic phase (HARP)‐based method for automated and fast analysis of high tagging resolution images. First‐order harmonic peaks from low tagging resolution images were combined to generate the composite second‐order harmonic peak for strain computation. The combined images reached a tagging resolution of 0.3 mm. The proposed method was applied to the quantification of transmural myocardial wall strain in seven normal C57BL/6 mice. Principal strains, as well as radial and circumferential strains, were quantified using the current method. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.     

Assessment of contractile response to dobutamine stress by means of ECG-gated myocardial SPECT: Comparison with myocardial perfusion and fatty acid metabolism

The present study assessed left ventricular performance during dobutamine stress measured using gated SPECT, and compared the results to myocardial perfusion and fatty acid metabolism. METHODS: Thirty-six patients with myocardial infarction given (99m)Tc-sestamibi or (99m)Tc-tetrofosmin were examined by gated SPECT at rest and during dobutamine stress (4-20 microg x kg(-1) x min(-1)). After acquiring data at the highest dose, 201TlCl was injected and dual-isotope SPECT was performed to assess myocardial ischemia. Thirty of 36 patients also underwent myocardial SPECT with 123I-BMIPP. Regional wall motion changes during dobutamine infusion were determined from the gated SPECT data and classified as: (1) Improvement, (2) Worsening, (3) No change, and (4) Biphasic response. For myocardial segments of each infarct area, stress 201Tl, rest (99m)Tc and (123)I-BMIPP uptakes were graded on a five-point scoring system of defects from 0 (normal) to 4 (grossly defective). RESULTS: Rest 99mTc defect score index (DSI) in No change area was significantly higher than that in Biphasic area. The ADSI (stress 201Tl - rest (99m)Tc) in Biphasic area was significantly higher than those in Improvement and No change areas. The deltaDSI (BMIPP - (99m)Tc) in Worsening area tended to be higher than that in No Change area. Conclusions: Regional contractile response to dobutamine stress analyzed by gated SPECT showed that the response in-myocardial infarct areas could be classified by rest and stress myocardial perfusion and BMIPP accumulation.     

Non‐contrast‐enhanced MR portography with time‐spatial labeling inversion pulses: Comparison of imaging with three‐dimensional half‐fourier fast spin‐echo and true steady‐state free‐precession sequences

Purpose

To compare and evaluate images acquired with two different MR angiography (MRA) sequences, three‐dimensional (3D) half‐Fourier fast spin‐echo (FSE) and 3D true steady‐state free‐precession (SSFP) combined with two time‐spatial labeling inversion pulses (T‐SLIPs), for selective and non‐contrast‐enhanced (non‐CE) visualization of the portal vein.

Materials and Methods

Twenty healthy volunteers were examined using half‐Fourier FSE and true SSFP sequences on a 1.5T MRI system with two T‐SLIPs, one placed on the liver and thorax, and the other on the lower abdomen. For quantitative analysis, vessel‐to‐liver contrast (Cv‐l) ratios of the main portal vein (MPV), right portal vein (RPV), and left portal vein (LPV) were measured. The quality of visualization was also evaluated.

Results

In both pulse sequences, selective visualization of the portal vein was successfully conducted in all 20 volunteers. Quantitative evaluation showed significantly better Cv‐l at the RPVs and LPVs in half‐Fourier FSE (P < 0.0001). At the MPV, Cv‐l was better in true SSFP, but was not statistically different. Visualization scores were significantly better only at branches of segments four and eight for half‐Fourier FSE (P = 0.001 and 0.03, respectively).

Conclusion

Both 3D half‐Fourier FSE and true SSFP scans with T‐SLIPs enabled selective non‐CE visualization of the portal vein. Half‐Fourier FSE was considered appropriate for intrahepatic portal vein visualization, and true SSFP may be preferable when visualization of the MPV is required. J. Magn. Reson. Imaging 2009;29:1140–1146. © 2009 Wiley‐Liss, Inc.     

Measuring aortic diameter with different MR techniques: Comparison of three‐dimensional (3D) navigated steady‐state free‐precession (SSFP), 3D contrast‐enhanced magnetic resonance angiography (CE‐MRA), 2D T2 black blood,and 2D cine SSFP

Purpose:

To compare nongated three‐dimensional (3D) contrast‐enhanced magnetic resonance angiography (CE‐MRA) with 3D‐navigated cardiac‐gated steady‐state free‐precession bright blood (3D‐nav SSFP) and noncontrast 2D techniques for ascending aorta dimension measurements.

Materials and Methods:

Twenty‐five clinical exams were reviewed to evaluate the ascending aorta at 1.5T using: breathhold cine bright blood (SSFP), cardiac‐triggered T2 black blood (T2 BB), axial 3D‐nav SSFP, and nongated 3D CE‐MRA. Three radiologists independently measured aortic size at three specified locations for each sequence. Means, SDs, interobserver correlation, and vessel edge sharpness were statistically evaluated.

Results:

Measurements were greatest for 3D‐nav SSFP and 3D CE‐MRA and smallest for T2 BB. There was no significant difference between 3D‐nav SSFP and 3D CE‐MRA (P = 0.43–0.86), but significance was observed comparing T2 BB to all sequences. Interobserver agreement was uniformly >0.9, with T2 BB best, followed closely by 3D‐nav SSFP and 2D cine SSFP, and 3D CE‐MRA being the worst. Edge sharpness was significantly poorer for 3D CE‐MRA compared to the other sequences (P < 0.001).

Conclusion:

If diameter measurements are the main clinical concern, 3D‐nav SSFP appears to be the best choice, as it has a sharp edge profile, is easy to acquire and postprocess, and shows very good interobserver correlation. J. Magn. Reson. Imaging 2010;31:177–184. © 2009 Wiley‐Liss, Inc.     

Phase‐contrast magnetic resonance imaging measurements in intracranial aneurysms in vivo of flow patterns,velocity fields,and wall shear stress: Comparison with computational fluid dynamics

Evolution of intracranial aneurysms is known to be related to hemodynamic forces such as wall shear stress (WSS) and maximum shear stress (MSS). Estimation of these parameters can be performed using numerical simulations with computational fluid dynamics (CFD), but can also be directly measured with magnetic resonance imaging (MRI) using a time‐dependent 3D phase‐contrast sequence with encoding of each of the three components of the velocity vectors (7D‐MRV). To study the accuracy of 7D‐MRV in estimating these parameters in vivo, in comparison with CFD, 7D‐MRV and patient‐specific CFD modeling was performed for 3 patients who had intracranial aneurysms. Visual and quantitative analyses of the flow pattern and distribution of velocities, MSS, and WSS were performed using the two techniques. Spearman's coefficients of correlation between the two techniques were 0.56 for the velocity field, 0.48 for MSS, and 0.59 for WSS. Visual analysis and Bland–Altman plots showed good agreement for flow pattern and velocities but large discrepancies for MSS and WSS. These results indicate that 7D‐MRV can be used in vivo to measure velocity flow fields and for estimating MSS and WSS. Currently, however, this method cannot accurately quantify the latter two parameters. Magn Reson Med 61:409–417, 2009. © 2009 Wiley‐Liss, Inc.