Real-time fast strain-encoded magnetic resonance imaging to evaluate regional myocardial function at 3.0 Tesla: comparison to conventional tagging

PURPOSE: To compare the utility of the real-time technique fast strain-encoded magnetic resonance imaging (fast-SENC) for the quantification of regional myocardial function to conventional tagged magnetic resonance imaging (MRI). MATERIALS AND METHODS: Healthy volunteers (N = 12) and patients with heart failure (N = 7) were examined using tagged MRI and fast-SENC at 3.0T. Circumferential strain was measured using fast-SENC in six endo- and six subepicardial regions in the basal-, mid-, and apical-septum and the basal-, mid-, and apical-lateral wall from the four-chamber view. These measurements were plotted to tagging, in corresponding myocardial segments. RESULTS: Peak systolic strain (Ecc) and early diastolic strain rate (Ecc/second) acquired by fast-SENC correlated closely to tagged MRI (r = 0.90 for Ecc and r = 0.91 for Ecc/second, P < 0.001 for both). Both fast-SENC and tagging identified differences in regional systolic and diastolic function between normal myocardium and dysfunctional segments in patients with heart failure (for fast-SENC: Ecc = -21.7 +/- 2.7 in healthy volunteers vs. -12.8 +/- 4.2 in hypokinetic vs. 0.6 +/- 3.8 in akinetic/dyskinetic segments, P < 0.001 between all; Ecc/second = 104 +/- 20/second in healthy volunteers vs. 37 +/- 9/second in hypokinetic vs. -16 +/- 15/second in akinetic/dyskinetic segments, P < 0.001 between all). Quantitative analysis was more time-consuming for conventional tagging than for fast-SENC (time-spent of 3.8 +/- 0.7 minutes vs. 9.5 +/- 0.7 minutes per patient, P < 0.001). CONCLUSION: Fast-SENC allows the rapid and accurate quantification of regional myocardial function. The information derived from fast-SENC during a single heartbeat seems to be superior or equal to that acquired by conventional tagging during several heart cycles and prolonged breathholds.     

Detecting stiff masses using strain-encoded (SENC) imaging.

A method is proposed for detecting stiff masses using strain-encoded (SENC) magnetic resonance imaging (MRI). An object of interest is compressed to produce local strain distribution that depends on local elasticity, where intensities correlate with the local through-imaging-plane strain component. Because the strain is lower inside a stiff mass than in the surrounding soft tissue, an intensity contrast in the resulting images would enable direct detection of the mass without postprocessing. The technique was validated by a phantom experiment in which a gel phantom with a stiff region was used. The advantages of the proposed method include short imaging time and uncomplicated postprocessing. However, in its current form the technique does not measure elasticity.     

Strain‐encoded cardiac MR during high‐dose dobutamine stress testing: Comparison to cine imaging and to myocardial tagging

Purpose

To investigate regional strain response during high‐dose dobutamine stress cardiac magnetic resonance imaging (DS‐CMR) using myocardial tagging and Strain‐Encoded MR (SENC).

Materials and Methods

Stress induced ischemia was assessed by wall motion analysis, by tagged CMR and by SENC in 65 patients with suspected or known CAD who underwent DS‐CMR in a clinical 1.5 Tesla scanner. Coronary angiography deemed as the standard reference for the presence or absence of CAD (≥50% diameter stenosis) in all patients.

Results

SENC and conventional tagging detected abnormal strain response in six and five additional patients, respectively, who were missed by cine images and proved to have CAD by angiography (P < 0.05 for SENC versus cine, P = 0.06 for tagging versus cine and p = NS for SENC versus tagging). On a per‐vessel level, wall motion analysis on cine images showed high specificity (95%) but moderate sensitivity (70%) for the detection of CAD. Tagging and SENC yielded significantly higher sensitivity of 81% and 89%, respectively (P < 0.05 for tagging and P < 0.01 for SENC versus wall motion analysis, and p = NS for SENC versus tagging), while specificity was equally high (96% and 94%, respectively, P = NS for all).

Conclusion

Both the direct color‐coded visualization of strain on CMR images and the generation of additional visual markers within the myocardium with tagged CMR represent useful adjuncts for DS‐CMR, which may provide incremental value for the detection of CAD in humans. J. Magn. Reson. Imaging 2009;29:1053–1061. © 2009 Wiley‐Liss, Inc.     

Myocardial tagging and strain analysis at 3 Tesla: comparison with 1.5 Tesla imaging

PURPOSE: To determine whether imaging at 3 T could improve and prolong the tag contrast compared to images acquired at 1.5 T in normal volunteers, and whether such improvement would translate into the ability to perform strain measurements in diastole. MATERIALS AND METHODS: Normal volunteers (N = 13) were scanned at 1.5 T (GE Signa CV/i) and 3.0 T (GE VH/i). An ECG-triggered, segmented k-space, spoiled-gradient-echo grid-tagged sequence was used during cine acquisition. Tag contrast was determined by the difference of the mean signal intensity (SI) of the tagline to the mean SI of the myocardium divided by the standard deviation (SD) of the noise (CNR(tag)). Matched short-axis (SA) slices were analyzed. Strain measurements were performed on images using a 2D strain analysis software program (harmonic phase (HARP)). RESULTS: The average CNR(tag) over the cardiac cycle was superior at 3 T compared to 1.5 T for all slices (3 T: 23.4 +/- 12.1, 1.5 T: 9.8 +/- 8.4; P < 0.0001). This difference remained significant at cycle initiation, end-systole, and the end R-R interval (at cycle termination: 3 T = 14.0 +/- 11.0 vs. 1.5 T = 4.4 +/- 3.5; P < 0.01). Strain measures were obtainable only in early systole for 1.5 T images, but were robust throughout the entire R-R interval for 3 T images. CONCLUSION: Imaging at 3 T had a significant benefit for myocardial tag persistence through the cardiac cycle. The improvement allowed strain analysis to be performed into diastole.     

Noninvasive determination of regional myocardial perfusion with first-pass magnetic resonance (MR) imaging

RATIONALE AND OBJECTIVES: To develop a method to provide absolute values of regional myocardial perfusion by means of color maps, and to determine myocardial perfusion reserve using magnetic resonance imaging during the first pass of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). MATERIALS AND METHODS: The study population consisted of five patients with hypertrophic cardiomyopathy, two with dilated cardiomyopathy, four with coronary artery disease, and one with normal coronary arteries who presented with mildly abnormal electrocardiogram findings. For each heartbeat, six continuous slices were acquired during the first pass of Gd-DTPA (0.05 mmol/kg body weight) before and during adenosine triphosphate (ATP) **stress using an electrocardiogram-triggered fast low-angle shot (FLASH) sequence on a 1.5-T magnetic resonance unit. Myocardial perfusion images were created and displayed by means of a color scale. The parameters were calculated pixel by pixel, using the upslope method. Myocardial perfusion reserve was then calculated, as the quotient of myocardial perfusion during ATP stress and perfusion before ATP stress. RESULTS: Myocardial perfusion during ATP stress in patients with normal coronary arteries (n = 1) or after successful percutaneous coronary intervention (n = 2) was increased compared with that before ATP stress. However, the patients with coronary artery disease (n = 2) failed to show increased myocardial perfusion. The patients with hypertrophic cardiomyopathy showed increased myocardial perfusion during ATP stress, although two with dilated cardiomyopathy did not. CONCLUSION: Our new technique can provide absolute values of regional myocardial perfusion by means of color maps, and has potential for widespread use for evaluation of ischemic and other types of heart disease.     

Assessment of the effect of endurance training on left ventricular relaxation with magnetic resonance imaging

The purpose of the study was to assess the effect of endurance training on the early diastolic global and regional left ventricular (LV) relaxation with three magnetic resonance imaging (MRI) techniques. Fourteen subjects were examined with MRI before and after 3-month endurance training. Global early diastolic LV myocardial relaxation was assessed with mitral flow velocity mapping and regional LV early myocardial relaxation with myocardial tagging. LV end-diastolic and end-systolic volumes and mass were assessed with cine Magnetic resonance imaging (MRI). Mitral flow velocity mapping analysis revealed that the time to peak early filling shortened after training (before 112+/-32 ms, after 97+/-21, P<0.05), indicating more rapid global early myocardial relaxation. LV mass increased (97+/-19 g, 105+/-18, P<0.01) and end-systolic volume decreased (47+/-11 mL, 42+/-13, P<0.05). According to myocardial tagging analysis early myocardial relaxation in the septum and in the LV lateral wall increased (P<0.05). Regional tagging analysis showed enhanced myocardial relaxation in the basal septum (P<0.05). Global and regional LV early diastolic relaxation improved and physiological LV hypertrophy was found after the exercise training period for 3 months in healthy sedentary subjects.     

Quantitative analysis of regional left ventricular function after myocardial infarction in the pig assessed with cine magnetic resonance imaging

To assess the accuracy of quantitative analysis of global and regional wall motion and wall thickening of the left ventricle with cine magnetic resonance (MR), images obtained in eight pigs before and after myocardial infarction were compared with those obtained using gadolinium diethylenetriaminepen-taacetic acid (Gd-DTPA)-enhanced multislice spin-echo MR imaging and determination of pathology. The region with abnormal wall motion and wall thickening, as determined with cine MR imaging, identified the same region of infarction as indicated by Gd-DTPA-enhanced spin-echo MR imaging and pathology. Within the infarcted region wall motion and wall thickening analyzed with the centerline method were significantly reduced. We conclude that the use of quantitative analysis of cine MR images accurately determines localization and extent of regional left ventricular dysfunction in the infarcted heart in vivo. This analysis using dedicated software including the centerline method allows sequential assessment of regional left ventricular function in normal and infarcted hearts.     

Real-time imaging of two-dimensional cardiac strain using a harmonic phase magnetic resonance imaging (HARP-MRI) pulse sequence.

The harmonic phase (HARP) method provides automatic and rapid analysis of tagged magnetic resonance (MR) images for quantification and visualization of myocardial strain. In this article, the development and implementation of a pulse sequence that acquires HARP images in real time are described. In this pulse sequence, a CINE sequence of images with 1-1 spatial modulation of magnetization (SPAMM) tags are acquired during each cardiac cycle, alternating between vertical and horizontal tags in successive heartbeats. An incrementing train of imaging RF flip angles is used to compensate for the decay of the harmonic peaks due to both T(1) relaxation and the applied imaging pulses. The magnitude images displaying coarse anatomy are automatically reconstructed and displayed in real time after each heartbeat. HARP strain images are generated offline at a rate of four images per second; real-time processing should be possible with faster algorithms or computers. A comparison of myocardial contractility in non-breath-hold and breath-hold experiments in normal humans is presented.     

Real-time MR imaging of myocardial regional function using strain-encoding (SENC) with tissue through-plane motion tracking

PURPOSE: To implement real-time myocardial strain-encoding (SENC) imaging in combination with tracking the tissue displacement in the through-plane direction. MATERIALS AND METHODS: SENC imaging was combined with the slice-following technique by implementing three-dimensional (3D) selective excitation. Certain adjustments were implemented to reduce scan time to one heartbeat. A total of 10 volunteers and five pigs were scanned on a 3T MRI scanner. Spatial modulation of magnetization (SPAMM)-tagged images were acquired on planes orthogonal to the SENC planes for comparison. Myocardial infarction (MI) was induced in two pigs and the resulting SENC images were compared to standard delayed-enhancement (DE) images. RESULTS: The strain values computed from SENC imaging with slice-following showed significant difference from those acquired without slice-following, especially during systole (P < 0.01). The strain curves computed from the SENC images with and without slice-following were similar to those computed from the orthogonal SPAMM images, with and without, respectively, tracking the tag line displacement in the strain direction. The resulting SENC images showed good agreement with the DE images in identifying MI in infarcted pigs. CONCLUSION: Correction of through-plane motion in real-time cardiac functional imaging is feasible using slice-following. The strain measurements are more accurate than conventional SENC measurements in humans and animals, as validated with conventional MRI tagging.     

Myocardial function in infarcted and remote regions early after infarction in man: Assessment by magnetic resonance tagging and strain analysis

Early after infarction in the perfusion bed of the left anterior descending coronary artery, cine MRI with spatial modulation of magnetization (SPAMM) tagging (7-mm grid) was used for short- and long-axis cardiac imaging. Two-dimensional strain analysis of triangular finite elements was performed between end-diastole and end-systole. Patients (n = 10) were compared with age-matched healthy subjects (n = 8). The anteroseptal region at midventricular level was considered representative for “infarcted” and the posterolateral region at basal level was considered “remote”. The left ventricular end-diastolic volume index was larger in the patients (69 ± 15 ml/m² versus 56 ± 4 ml/m², P < 0.05). Short-axis images showed in the infarcted region a decrease of first principal strain (greatest systolic lengthening: 1.10 ±. 06 versus 1.27 ± 0.04, P < 0.0001), and in the remote region an increase (1.48 ± 0.11 versus 1.36 ± 0.07, P < 0.025). The lateral and inferior ventricular regions at mid- and basal levels were found to function normally. Long-axis images yielded similar results. Early after infarction, regions with dysfunction, normal function, and hyperfunction can be delineated with MR tagging. The compensatory increased contraction in the remote region is possibly triggered by the Frank-Starling mechanism.     

Monitoring bone marrow‐originated mesenchymal stem cell traffic to myocardial infarction sites using magnetic resonance imaging

How stem cells promote myocardial repair in myocardial infarction (MI) is not well understood. The purpose of this study was to noninvasively monitor and quantify mesenchymal stem cells (MSC) from bone marrow to MI sites using magnetic resonance imaging (MRI). MSC were dual‐labeled with an enhanced green fluorescent protein and micrometer‐sized iron oxide particles prior to intra‐bone marrow transplantation into the tibial medullary space of C57Bl/6 mice. Micrometer‐sized iron oxide particles labeling caused signal attenuation in T₂*‐weighted MRI and thus allowed noninvasive cell tracking. Longitudinal MRI demonstrated MSC infiltration into MI sites over time. Fluorescence from both micrometer‐sized iron oxide particles and enhanced green fluorescent protein in histology validated the presence of dual‐labeled cells at MI sites. This study demonstrated that MSC traffic to MI sites can be noninvasively monitored in MRI by labeling cells with micrometer‐sized iron oxide particles. The dual‐labeled MSC at MI sites maintained their capability of proliferation and differentiation. The dual‐labeling, intra‐bone marrow transplantation, and MRI cell tracking provided a unique approach for investigating stem cells' roles in the post‐MI healing process. This technique can potentially be applied to monitor possible effects on stem cell mobilization caused by given treatment strategies. Magn Reson Med, 2011. © 2011 Wiley‐Liss, Inc.     

Simultaneous myocardial and fat suppression in magnetic resonance myocardial delayed enhancement imaging

PURPOSE: To develop a method for fat suppression in myocardial delayed enhancement (MDE) studies that achieves effective signal intensity reduction in fat but does not perturb myocardial signal suppression. MATERIALS AND METHODS: A new approach to fat suppression that uses a spectrally-selective inversion-recovery (SPEC-IR) tip-up radio frequency (RF) pulse following the conventional nonselective IR RF pulse together with a second SPEC-IR RF pulse is proposed. The tip-up pulse restores the fat longitudinal magnetization after the nonselective IR pulse and allows the fat magnetization to recover more fully toward its equilibrium value, providing for better fat suppression by the second SPEC-IR RF pulse. This new approach was validated in phantom studies and in five patients. RESULTS: Effective fat suppression was achieved using the proposed technique with minimal impact on normal myocardial signal suppression. Mean fat suppression achieved using this approach was 67% +/- 8%, as measured in the chest wall immediately opposite the heart. CONCLUSION: The results indicate this modular-type approach optimizes fat suppression in myocardial delayed enhancement studies but does not perturb the basic IR pulse sequence or change basic acquisition parameters.     

Importance of perfusion in myocardial viability studies using delayed contrast-enhanced magnetic resonance imaging

PURPOSE: To investigate whether an extracellular gadolinium-(Gd)-based contrast agent (CA) enters nonperfused myocardium during acute coronary occlusion, and whether nonperfused myocardium presents as hyperintense in delayed contrast-enhanced (DE) MR images in the absence of CA in that region. MATERIALS AND METHODS: The left anterior descending coronary artery (LAD) was occluded for 200 minutes in six pigs. The longitudinal relaxation rate (R(1)) in blood, perfused myocardium, and nonperfused myocardium was repeatedly measured using a Look-Locker sequence before and during the first hour after administration of Gd-DTPA-BMA. RESULTS: While blood and perfused myocardium showed a major increase in R(1) after CA administration, nonperfused myocardium did not. R(1) in nonperfused myocardium was significantly lower than in blood and perfused myocardium during the first hour after CA administration. When the signal from perfused myocardium was nulled, demarcation of the hyperintense nonperfused myocardium was achieved in all of the study animals. CONCLUSION: Gd-DTPA-BMA does not enter ischemic myocardium within one hour after administration during acute coronary occlusion. The ischemic region with complete absence of CA still appears bright when the signal from perfused myocardium is nulled using inversion-recovery DE-MRI. This finding is important for understanding the basic pathophysiology of inversion-recovery viability imaging, as well as for imaging of acute coronary syndromes.     

Single‐shot magnetic resonance spectroscopic imaging with partial parallel imaging

A magnetic resonance spectroscopic imaging (MRSI) pulse sequence based on proton–echo‐planar‐spectroscopic‐imaging (PEPSI) is introduced that measures two‐dimensional metabolite maps in a single excitation. Echo‐planar spatial–spectral encoding was combined with interleaved phase encoding and parallel imaging using SENSE to reconstruct absorption mode spectra. The symmetrical k‐space trajectory compensates phase errors due to convolution of spatial and spectral encoding. Single‐shot MRSI at short TE was evaluated in phantoms and in vivo on a 3‐T whole‐body scanner equipped with a 12‐channel array coil. Four‐step interleaved phase encoding and fourfold SENSE acceleration were used to encode a 16 × 16 spatial matrix with a 390‐Hz spectral width. Comparison with conventional PEPSI and PEPSI with fourfold SENSE acceleration demonstrated comparable sensitivity per unit time when taking into account g‐factor–related noise increases and differences in sampling efficiency. LCModel fitting enabled quantification of inositol, choline, creatine, and N‐acetyl‐aspartate (NAA) in vivo with concentration values in the ranges measured with conventional PEPSI and SENSE‐accelerated PEPSI. Cramer–Rao lower bounds were comparable to those obtained with conventional SENSE‐accelerated PEPSI at the same voxel size and measurement time. This single‐shot MRSI method is therefore suitable for applications that require high temporal resolution to monitor temporal dynamics or to reduce sensitivity to tissue movement. Magn Reson Med, 2009. © 2008 Wiley‐Liss, Inc.