Optimized spiral imaging for measurement of myocardial T2 relaxation.

Microcirculation oxygen levels and blood volumes should be reflected in measurements of myocardial T(2) relaxation. This work describes the optimization of a spiral imaging strategy for robust myocardial T(2) measurement to minimize the standard deviation of T(2) measurement (sigmaT(2)). Theoretical and experimental studies of blurring at muscle/blood interfaces enabled the derivation of parameter sets which reduce sigma T(2) to the level of 5%. T(2) relaxation mapping within healthy volunteers provided estimation of residual sigmaT(2) within the optimized technique. The standard deviation in T(2) measurement across regions of interest (ROIs) in different locations is about 9%. The standard deviation in T(2) measurement in an ROI across different time points is about 5%.     

T2-prepared steady-state free precession blood oxygen level-dependent MR imaging of myocardial perfusion in a dog stenosis model

PURPOSE: To assess the ability of a T2-prepared steady-state free precession blood oxygen level-dependent (BOLD) magnetic resonance (MR) imaging sequence to depict changes in myocardial perfusion during stress testing in a dog stenosis model. MATERIALS AND METHODS: Study was approved by the institutional Animal Care and Use Committee. A hydraulic occluder was placed in the left circumflex coronary artery (LCX) in 10 dogs. Adenosine was administered intravenously to increase coronary blood flow, and stenosis was achieved in the LCX with the occluder. A T2-prepared two-dimensional steady-state free precession sequence was used for BOLD imaging at a spatial resolution of 1.5 x 1.2 x 5.0 mm3, and first-pass perfusion images were acquired for visual comparison. Microspheres were injected to provide regional perfusion information. Mixed-effect regression analysis was performed to assess normalized MR signal intensity ratios and microsphere-measured perfusion differences. For the same data, 95% prediction intervals were calculated to determine the smallest perfusion change detectable. Means +/- standard deviations were calculated for myocardial regional comparison data. A two-tailed Student t test was used to determine if significant differences (P < .01) existed between different myocardial regions. RESULTS: Under maximal adenosine stress, MR clearly depicted stenotic regions and showed regional signal differences between the left anterior descending coronary artery (LAD)-fed myocardium and the stenosed LCX-fed myocardium. Visual comparisons with first-pass images were also excellent. Regional MR signal intensity differences between LAD and LCX-fed myocardium (1.24 +/- 0.08) were significantly different (P < .01) from differences between LAD and septal-fed myocardium (1.02 +/- 0.07), which was in agreement with microsphere-measured flow differences (LAD/LCX, 3.38 +/- 0.83; LAD/septal, 1.26 +/- 0.49). The linear mixed-effect regression model showed good correlation (R = 0.79) between MR differences and microsphere-measured flow differences. CONCLUSION: On T2-prepared steady-state free precession BOLD MR images in dogs, signal intensity differences were linearly related to flow differences in myocardium, with a high degree of correlation. Supplemental material: radiology.rsnajnls.org/cgi/content/full/236/2/503/DC1     

Assessment of regional differences in myocardial blood flow using T2-weighted 3D BOLD imaging.

The feasibility of detecting regional differences in myocardial blood flow based on the blood oxygen level-dependent (BOLD) effect was evaluated in vivo in dogs (N = 9) using a 3D T2-prepared segmented gradient-echo sequence at 1.5 T. Regional differences in myocardial blood flow were created by administering adenosine through a catheter placed in the left circumflex coronary artery (LCX). The difference in the R2 (1/T2) relaxation rate between the left ventricular myocardial region supplied by the LCX and regions supplied by the left anterior descending coronary artery (LAD) or septal artery during adenosine administration was correlated to the corresponding regional myocardial blood flow difference determined using fluorescent microspheres. A correlation coefficient of 0.80 was found between the MR BOLD measurements and the myocardial flow assessment. Our results show that the sequence used in this study allows fast 3D BOLD imaging of the heart, and is a promising technique for detecting regional myocardial perfusion differences.     

Cardiac T2* and lipid measurement at 3.0 T-initial experience

This study was designed to assess whether breath-hold cardiac multiecho imaging at 3.0 T is achievable without significant image artefacts and if fat/water phase interference modulates the exponential T2* signal decay. Twelve healthy volunteers (mean age 39) were imaged on a Philips Intera 3.0 T MRI scanner. Multiecho imaging was performed with a breath-hold spoiled gradient echo sequence with a seven echo readout (echo times 1.15–8.05 ms, repetition time 11 ms) using a black-blood prepulse and volume shimming. T2* values were calculated with both mono- and biexpoential fits from the mean signal intensity of the interventricular septum. The global mean T2* was 27.3 ms ± 6.4. The mean signal-to-noise ratio (SNR) of the septum was 22.8 ± 9.9, and the contrast-to-noise ratio (CNR) of the septum to the left ventricular cavity 20.3 ± 9.4. A better fit was obtained with a biexponential model and the mean fat fraction derived was 3.7%. Cardiac functional parameters were in the normal range and showed no correlation with T2*. Cardiac T2* estimation with gradient multiecho imaging at 3.0 T can be achieved with minimal artefact and modelling the signal decay with a biexponential function allows estimation of myocardial lipid content as well as T2* decay.     

T2-weighted balanced SSFP imaging (T2-TIDE) using variable flip angles.

A new technique for acquiring T2-weighted, balanced steady-state free precession (b-SSFP) images is presented. Based on the recently proposed transition into driven equilibrium (TIDE) method, T2-TIDE uses a special flip angle scheme to achieve T2-weighted signal decay during the transient phase. In combination with half-Fourier image acquisition, T2-weighted images can be obtained using T2-TIDE. Numerical simulations were performed to analyze the signal behavior of T2-TIDE in comparison with TSE and b-SSFP. The results indicate identical signal evolution of T2-TIDE and TSE during the transient phase. T2-TIDE was used in phantom experiments, and quantitative ROI analysis shows a linear relationship between TSE and T2-TIDE SNR values. T2-TIDE was also applied to abdominal and head imaging on healthy volunteers. The resulting images were analyzed quantitatively and compared with standard T2-weighted and standard b-SSFP methods. T2-TIDE images clearly revealed T2 contrast and less blurring compared to T2-HASTE images. In combination with a magnetization preparation technique, STIR-weighted images were obtained. T2-TIDE is a robust technique for acquiring T2-weighted images while exploiting the advantages of b-SSFP imaging, such as high signal-to-noise ratio (SNR) and short TRs.     

Increased anterior temporal lobe T2 times in cases of hippocampal sclerosis: a multi-echo T2 relaxometry study at 3 T

BACKGROUND AND PURPOSE: Increased T2 relaxation times in the ipsilateral hippocampus are present in patients with hippocampal sclerosis. Visual assessment of T2-weighted images of these patients suggests increased signal intensity in the anterior temporal lobe as well. Our aim was to assess hippocampal and anterior temporal T2 relaxation times in patients with partial epilepsy by using a new T2-relaxometry sequence implemented by using a 3-T General Electric imaging unit. METHODS: Coronal view T2 maps were generated by using an eight-echo Carr-Purcell-Meiboom-Gill sequence (TE, 28-231) with an acquisition time of 7 min on a 3-T General Electric Signa Horizon LX imaging unit. T2 relaxation times were measured in the hippocampus and anterior temporal lobe of 30 healthy control volunteers and 20 patients with partial epilepsy. RESULTS: For the 30 control volunteers, the mean hippocampal T2 relaxation time was 98 +/- 2.8 ms. In all measured areas, the asymmetry index was small (<0.01). For the 15 patients with independent evidence of hippocampal sclerosis established by visual, volumetric, and, when available, pathologic criteria, mean hippocampal T2 relaxation times were 118 +/- 7 ms (P <.0001) on the ipsilateral side and 101 +/- 4 ms (P =.005) on the contralateral side. The T2 values were also increased in the anterior temporal lobe (ipsilateral: 82 +/- 6 ms, P <.0001; contralateral: 79 +/- 6 ms, P =.01) as compared with the values for the control volunteers (75 +/- 3 ms). The five patients with focal cortical dysplasia had hippocampal T2 relaxation times that were not different from control values. CONCLUSION: T2 relaxometry at 3 T is feasible and useful and confirmed marked ipsilateral hippocampal signal intensity increase in patients with hippocampal sclerosis. Importantly, definite signal intensity change was also present in the anterior temporal lobe. T2 relaxometry is a sensitive means of identifying abnormalities in the hippocampus and other brain structures.     

Magnetic resonance imaging of chronic myocardial infarcts in man

To evaluate the magnetic resonance imaging (MRI) features of chronic myocardial infarction (MI), 22 patients and several normal volunteers were studied with a 0.35-T cryogenic imaging system. The MIs were 9 months to 16 years old. The patients also had either left ventriculography (17 patients) or two-dimensional echocardiography (17 patients). At least one abnormality indicative of prior infarction was demonstrated on MRI in 20 of the 22 patients. Wall thinning was seen in 20 patients; in six of these, the thinning resulted in aneurysm formation. The other 14 patients had sufficient residual wall thickness to permit measurement of T2 relaxation times and MR signal intensity in the infarcted region. Ten of these 14 patients demonstrated low intensity and shortened T2 of the thinned segments (mean T2 = 28.7 msec) compared to adjacent normal myocardium (mean T2 = 45.4 msec) and to the myocardium of volunteers (mean T2 = 41.3 msec). The percentage of difference in intensity between thinned and normal myocardium was greater on 56-msec-TE images (98.2%) than on 28-msec-TE images (46.1%). In the other four patients, no difference in intensity of the myocardium was perceptible in the thinned region of the myocardial wall. Thus MRI shows regional wall thinning at the site of prior MI. In some patients, the chronic infarct is characterized as decreased spin-echo signal intensity and shortened T2 consistent with replacement of myocardium by fibrous scar.     

The relationship between the BOLD-induced T(2) and T(2)(*): a theoretical approach for the vasculature of myocardium.

Recently the blood oxygenation level-dependent (BOLD)-related T(2)* of myocardium was derived as an analytical function of intracapillary blood volume, blood oxygenation, and nuclear spin diffusion. The basis of this approach was to approximate the diffusion-induced field fluctuations a nuclear spin is subjected to by strong collision dynamics, i.e., the field fluctuations are uncorrelated. The same analysis is now performed for spin echo experiments that gives myocardial T(2) as a function of the parameters above and the echotime. An analytical relationship between T(2) and T(2)* relaxation is derived. The dependence of T(2) on diffusion, echo time, and blood oxygenation is congruent with simulation and experimental data. Magn Reson Med 42:1004-1010, 1999.     

T2-prepared SSFP improves diagnostic confidence in edema imaging in acute myocardial infarction compared to turbo spin echo.

T2-weighted MRI of edema in acute myocardial infarction (MI) provides a means of differentiating acute and chronic MI, and assessing the area at risk of infarction. Conventional T2-weighted imaging of edema uses a turbo spin-echo (TSE) readout with dark-blood preparation. Clinical applications of dark-blood TSE methods can be limited by artifacts such as posterior wall signal loss due to through-plane motion, and bright subendocardial artifacts due to stagnant blood. Single-shot imaging with a T2-prepared SSFP readout provides an alternative to dark-blood TSE and may be conducted during free breathing. We hypothesized that T2-prepared SSFP would be a more reliable method than dark-blood TSE for imaging of edema in patients with MI. In patients with MI (22 acute and nine chronic MI cases), T2-weighted imaging with both methods was performed prior to contrast administration and delayed-enhancement imaging. The T2-weighted images using TSE were nondiagnostic in three of 31 cases, while six additional cases rated as being of diagnostic quality yielded incorrect diagnoses. In all 31 cases the T2-prepared SSFP images were rated as diagnostic quality, correctly differentiated acute or chronic MI, and correctly determined the coronary territory. Free-breathing T2 prepared SSFP provides T2-weighted images of acute MI with fewer artifacts and better diagnostic accuracy than conventional dark-blood TSE.     

Changes in myocardial oxygenation and perfusion under pharmacological stress with dipyridamole: assessment using T*2 and T1 measurements.

The aim of this pilot-study was to evaluate changes in myocardial oxygenation and perfusion under pharmacological stress with dipyridamole (DIP) by means of MRI. Twenty healthy volunteers were examined using a multi-echo gradient-echo sequence. The differential myocardial signal response due to the blood oxygen level dependent (BOLD) effect was studied under variable conditions of myocardial oxygen supply caused by the vasodilator DIP. Unlike contrast agents (CA) methods, which require at least two injections of CA and DIP, the presented methods require only a single infusion of DIP. To assess changes in myocardial perfusion, a saturation recovery TurboFLASH (SRTFL) sequence with centric reordering for T1 measurements was used with global and slice-selective spin-preparation (five volunteers). The signal response was measured at baseline conditions and when myocardial blood flow was increased during pharmacological stress with DIP. Administration of DIP induced a 17 +/- 9% increase in T2*. Enhanced perfusion resulted in a 15 +/- 5% decrease of T1 after slice-selective spin preparation and a calculated increase in absolute perfusion of about 5.1 ml/(g x min), which reflects coronary reserve. The study shows that DIP-induced alterations in the relationship between myocardial oxygen supply and demand are detectable in healthy volunteers using T2* and T1 measurements. A combination of T2* and T1 examinations could become a useful diagnostic tool for the non-invasive assessment of myocardial oxygenation and perfusion in patients with coronary artery disease (CAD).     

Quantitative assessment of myocardial T2 relaxation times in cardiac amyloidosis

Purpose

To evaluate cardiac MRI (CMR) in the diagnosis of cardiac amyloidosis by comparing the T2 relaxation times of left ventricular myocardium in a pilot patient group to a normal range established in healthy controls.

Materials and Methods

Forty‐nine patients with suspected amyloidosis‐related cardiomyopathy underwent comprehensive CMR examination, which included assessment of myocardial T2 relaxation times, ventricular function, resting myocardial perfusion, and late gadolinium enhancement (LGE) imaging. T2‐weighted basal, mid, and apical left ventricular slices were acquired in each patient using a multislice T2 magnetization preparation spiral sequence. Slice averaged T2 relaxation times were subsequently calculated offline and compared to the previously established normal range.

Results

Twelve of the 49 patients were confirmed to have cardiac amyloidosis by biopsy. There was no difference in mean T2 relaxation times between the amyloid cases and normal controls (51.3 ± 8.1 vs. 52.1 ± 3.1 msec, P = 0.63). Eleven of the 12 amyloid patients had abnormal findings by CMR, eight having LGE involving either ventricles or atria and four demonstrating resting subendocardial perfusion defects.

Conclusion

CMR is a potentially valuable tool in the diagnosis of cardiac amyloidosis. However, calculation of myocardial T2 relaxation times does not appear useful in distinguishing areas of amyloid deposition from normal myocardium. J. Magn. Reson. Imaging 2009. © 2009 Wiley‐Liss, Inc.     

Three-dimensional true-FISP imaging of the coronary arteries: improved contrast with T2-preparation

PURPOSE: To evaluate the effectiveness of a T2-magnetization preparation scheme for improving coronary artery imaging with true fast imaging with steady-state precession (True-FISP). MATERIALS AND METHODS: Simulations were performed to compare the blood-myocardium signal difference with no T2-preparation to that with various T2-preparation times (24, 40, and 60 msec) using an electrocardiogram (ECG)-triggered, segmented True-FISP acquisition. Seven volunteers were imaged to evaluate the effectiveness of T2-preparation for coronary artery delineation using True- FISP and to optimize the T2-preparation time. RESULTS: Simulations showed that T2-preparation improved the signal difference between blood and myocardium over that without T2-preparation. The optimal T2- preparation time was determined to be 40 msec. In volunteer studies, a T2- preparation time of 40 msec provided a significant improvement in contrast- to-noise ratio (CNR) between the coronary arteries and myocardium over that without T2-preparation. It also showed a significant improvement in visualizing the distal portions of the coronary arteries. CONCLUSION: T2-preparation improves coronary artery delineation with True-FISP.     

Cyclic CINE-balanced steady-state free precession image intensity variations: implications for the detection of myocardial edema

Purpose

To evaluate the dependence of CINE‐balanced steady‐state free precession (bSSFP) image intensities on spatial location, cardiac phase, and disease state.

Materials and Methods

Eight subjects with recent myocardial infarctions and eight age‐ and sex‐matched normal volunteers were studied using CINE‐bSSFP imaging to describe cyclic image intensity variations as a function of the cardiac cycle and to optimize and assess the ability of CINE‐bSSFP imaging to depict myocardial edema. Signal intensities of the left ventricular (LV) bloodpool and myocardium were measured using region‐of‐interest analysis across the cardiac cycle. The magnitude and time course of the cyclic variations were evaluated. Mixed‐model analysis of variance was used to examine the influence of physical location, cardiac phase, and presence of myocardial infarction.

Results

The LV bloodpool and myocardial CINE‐bSSFP signal intensities varied significantly with spatial location, cardiac phase, and disease (P < 0.001). Cardiac phase had a significant effect on the signal intensities after adjustments for spatial location. The LV bloodpool signal decreased slowly during systole and rose sharply during LV filling. There were two distinct myocardial intensity peaks, one occurring at peak systole and the other at the end of the LV rapid inflow phase. Myocardial edema was seen as a hyperintense region. Image contrast with adjacent myocardium was the greatest at the end of systole.

Conclusion

Detection of myocardial edema using the conventional CINE‐bSSFP technique is feasible, but is complicated by normal cyclic changes in myocardial image intensities during the cardiac cycle. J. Magn. Reson. Imaging 2011;33:573–581. © 2011 Wiley‐Liss, Inc.     

Modified Look-Locker inversion recovery (MOLLI) for high-resolution T1 mapping of the heart.

A novel pulse sequence scheme is presented that allows the measurement and mapping of myocardial T1 in vivo on a 1.5 Tesla MR system within a single breath-hold. Two major modifications of conventional Look-Locker (LL) imaging are introduced: 1) selective data acquisition, and 2) merging of data from multiple LL experiments into one data set. Each modified LL inversion recovery (MOLLI) study consisted of three successive LL inversion recovery (IR) experiments with different inversion times. We acquired images in late diastole using a single-shot steady-state free-precession (SSFP) technique, combined with sensitivity encoding to achieve a data acquisition window of < 200 ms duration. We calculated T1 using signal intensities from regions of interest and pixel by pixel. T1 accuracy at different heart rates derived from simulated ECG signals was tested in phantoms. T1 estimates showed small systematic error for T1 values from 191 to 1196 ms. In vivo T1 mapping was performed in two healthy volunteers and in one patient with acute myocardial infarction before and after administration of Gd-DTPA. T1 values for myocardium and noncardiac structures were in good agreement with values available from the literature. The region of infarction was clearly visualized. MOLLI provides high-resolution T1 maps of human myocardium in native and post-contrast situations within a single breath-hold.     

Optimization of blood-myocardial contrast in 3D true FISP cardiac imaging at 1.5 T.

Three-dimensional (3D) steady-state free precession (SSFP) MRI sequences are often applied to visualize both intra- and extracardiac pathologies. In the present study the contrast behavior of 3D true fast imaging with steady precession (True-FISP) sequences for cardiac imaging was optimized in numerical simulations and compared with measurements obtained in eight healthy volunteers on a 1.5 T whole-body scanner. Two SS preparation schemes in combination with and without a T(2) preparation were assessed to improve contrast between blood and myocardium using a navigator-gated and ECG-triggered 3D True-FISP sequence. Numerical simulations and experimental studies in volunteers showed that an SS preparation using a constant flip angle (CFA) is preferable to a linear flip angle (LFA) preparation in terms of contrast between blood and myocardium. The optimized 3D True-FISP sequence provides a reliable, accurate, and time-efficient means of obtaining a morphological cardiac diagnosis.     

ACUT2E TSE-SSFP: a hybrid method for T2-weighted imaging of edema in the heart.

ACUT(2)E TSE-SSFP is a hybrid between steady state free precession (SSFP) and turbo spin echo (TSE) for bright-blood T2-weighted imaging with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) similar to dark-blood TSE. TSE-SSFP uses a segmented SSFP readout during diastole with 180 degrees pulses following a 90 degrees preparation. The 180 degrees refocusing pulses make TSE-SSFP similar to TSE but TSE-SSFP uses gradient moment nulling, whereas TSE uses gradient crushing. TSE-SSFP produced T2-weighted images with minimal T1 weighting. TSE-SSFP and TSE had similar SNR (155.9 +/- 6.0 vs 160.9 +/- 7.0; P = NS) for acute myocardial infarction (MI) and twice the SNR of T2-prepared SSFP (73.1 +/- 3.4, P < 0.001). TSE-SSFP and TSE had approximately double the CNR of T2-prepared SSFP for differentiating acute MI from normal myocardium. Imperfect blood suppression, present in all animals on some TSE images, was a problem eliminated by TSE-SSFP and T2-prepared SSFP.     

Comparison of spiral imaging and SENSE‐EPI at 1.5 and 3.0 T using a controlled cerebrovascular challenge

Purpose

To quantitatively compare spiral imaging and sensitivity‐encoded‐echo‐planar‐imaging (SENSE‐EPI) methods for blood oxygen level‐dependent (BOLD) imaging using controlled changes in the end‐tidal partial pressure of CO₂ (PetCO₂) to provide a global BOLD response. Specifically, we examined susceptibility‐field‐gradient effects on the BOLD sensitivity throughout the brain.

Materials and Methods

We quantified cerebrovascular reactivity (CVR) using the BOLD response to cyclic changes in PetCO₂ in five healthy volunteers at 1.5 and 3.0 T using spiral imaging and SENSE‐EPI. We compared the two techniques with respect to susceptibility‐induced signal dropout and CVR t‐statistic.

Results

Compared to spiral imaging, SENSE‐EPI significantly reduced the volume of signal dropout by 32 ± 18% at 3.0 T. In regions with large susceptibility gradients, SENSE‐EPI demonstrated a trend for a greater t‐statistic than spiral imaging, particularly at 3.0 T. However, no statistically significant between‐technique differences existed.

Conclusion

The results at 3.0 T suggest that, compared with spiral imaging, SENSE‐EPI reduces signal loss associated with susceptibility field gradients in affected regions without affecting BOLD sensitivity. This study also demonstrates a unique application of controlled PetCO₂ changes to quantitatively compare BOLD techniques, which may be useful for the design of future fMRI studies. J. Magn. Reson. Imaging 2009;29:1206–1210. © 2009 Wiley‐Liss, Inc.     

T2-weighted cardiovascular magnetic resonance imaging

Technical advances in T2-weighted cardiovascular MR (CMR) imaging allow for accurate identification and quantification of tissue injuries that alter myocardial T2 relaxation. Of these, myocardial edema is of special relevance. Increased myocardial water content is an important feature of ischemic as well as nonischemic cardiomyopathies, which are often associated with acute myocardial inflammation. In this article, we review technical considerations and discuss clinical indications of myocardial T2-weighted imaging.     

Assessment of regional myocardial oxygenation changes in the presence of coronary artery stenosis with balanced SSFP imaging at 3.0 T: theory and experimental evaluation in canines

PURPOSE: To examine the dependence of steady-state free-precession (SSFP) -based myocardial blood-oxygen-level-dependent (BOLD) contrast on field strength using theoretical and experimental models. MATERIALS AND METHODS: Numerical simulations using a two-pool exchange model and a surgically prepared dog model were used to assess the SSFP-based myocardial BOLD signal changes at 1.5T and 3.0T. Experimental studies were performed in eight canines with pharmacological vasodilation under various levels of left circumflex coronary artery stenosis. Experimentally obtained BOLD signal changes were correlated against microsphere-based true flow changes. RESULTS: Theoretical results showed that, at 3.0T, relative to 1.5T, a threefold increase in oxygen sensitivity can be expected. Experimental studies in canines showed near similar results-a 2.5 +/- 0.2-fold increase in BOLD sensitivity at 3.0T relative to 1.5T (P < 0.05). Based on the scatter gram of BOLD data and microsphere data, it was found that the minimum regional flow difference that can be detected with SSFP-based myocardial BOLD imaging at 1.5T and 3.0T were 2.9 and 1.6, respectively (P < 0.05). CONCLUSION: This study demonstrated that SSFP-based myocardial BOLD sensitivity is substantially greater at 3.0T compared with 1.5T. The findings here suggest that SSFP-based myocardial BOLD imaging at 3.0T may have the necessary sensitivity to detect the clinically required minimum flow difference of 2.0.