3D single breath-hold MR methodology for measuring cardiac parametric mapping at 3T

Mención Internacional en el título de doctorOne of the foremost and challenging subfields of MRI is cardiac magnetic resonance imaging (CMR). CMR is becoming an indispensable tool in cardiovascular medicine by acquiring data about anatomy and function simultaneously. For instance, it allows the non-invasive characterization of myocardial tissues via parametric mapping techniques. These mapping techniques provide a spatial visualization of quantitative changes in the myocardial parameters. Inspired by the need to develop novel high-quality parametric sequences for 3T, this thesis's primary goal is to introduce an accurate and efficient 3D single breath-hold MR methodology for measuring cardiac parametric mapping at 3T. This thesis is divided into two main parts: i) research and development of a new 3D T1 saturation recovery mapping technique (3D SACORA), together with a feasibility study regarding the possibility of adding a T2 mapping feature to 3D SACORA concepts, and ii) research and implementation of a deep learning-based post-processing method to improve the T1 maps obtained with 3D SACORA. In the first part of the thesis, 3D SACORA was developed as a new 3D T1 mapping sequence to speed up T1 mapping acquisition of the whole heart. The proposed sequence was validated in phantoms against the gold standard technique IR-SE and in-vivo against the reference sequence 3D SASHA. The 3D SACORA pulse sequence design was focused on acquiring the entire left ventricle in a single breath-hold while achieving good quality T1 mapping and stability over a wide range of heart rates (HRs). The precision and accuracy of 3D SACORA were assessed in phantom experiments. Reference T1 values were obtained using IR-SE. In order to further validate 3D SACORA T1 estimation accuracy and precision, T1 values were also estimated using an in-house version of 3D SASHA. For in-vivo validation, seven large healthy pigs were scanned with 3D SACORA and 3D SASHA. In all pigs, images were acquired before and after administration of MR contrast agent. The phantom results showed good agreement and no significant bias between methods. In the in-vivo experiments, all T1-weighted images showed good contrast and quality, and the T1 maps correctly represented the information contained in the T1-weighted images. Septal T1s and coefficients of variation did not considerably differ between the two sequences, confirming good accuracy and precision. 3D SACORA images showed good contrast, homogeneity and were comparable to corresponding 3D SASHA images, despite the shorter acquisition time (15s vs. 188s, for a heart rate of 60 bpm). In conclusion, the proposed 3D SACORA successfully acquired a whole-heart 3D T1 map in a single breath-hold at 3T, estimating T1 values in agreement with those obtained with the IR-SE and 3D SASHA sequences. Following the successful validation of 3D SACORA, a feasibility study was performed to assess the potential of modifying the acquisition scheme of 3D SACORA in order to obtain T1 and T2 maps simultaneously in a single breath-hold. This 3D T1/T2 sequence was named 3D dual saturation-recovery compressed SENSE rapid acquisition (3D dual-SACORA). A phantom of eight tubes was built to validate the proposed sequence. The phantom was scanned with 3D dual-SACORA with a simulated heart rate of 60 bpm. Reference T1 and T2 values were estimated using IR-SE and GraSE sequences, respectively. An in-vivo study was performed with a healthy volunteer to evaluate the parametric maps' image quality obtained with the 3D dual-SACORA sequence. T1 and T2 maps of the phantom were successfully obtained with the 3D dual-SACORA sequence. The results show that the proposed sequence achieved good precision and accuracy for most values. A volunteer was successfully scanned with the proposed sequence (acquisition duration of approximately 20s) in a single breath-hold. The saturation time images and the parametric maps obtained with the 3D dual-SACORA sequence showed good contrast and homogeneity. The septal T1 and T2 values are in good agreement with reference sequences and published work. In conclusion, this feasibility study's findings open the door to the possibility of using 3D SACORA concepts to develop a successful 3D T1/T2 sequence. In the second part of the thesis, a deep learning-based super-resolution model was implemented to improve the image quality of the T1 maps of 3D SACORA, and a comprehensive study of the performance of the model in different MR image datasets and sequences was performed. After careful consideration, the selected convolutional neural network to improve the image quality of the T1 maps was the Residual Dense Network (RDN). This network has shown outstanding performance against state-of-the-art methods on benchmark datasets; however, it has not been validated on MR datasets. In this way, the RDN model was initially validated on cardiac and brain benchmark datasets. After this validation, the model was validated on a self-acquired cardiac dataset and on improving T1 maps. The RDN model improved the images successfully for the two benchmark datasets, achieving better performance with the brain dataset than with the cardiac dataset. This result was expected as the brain images have more well-defined edges than the cardiac images, making the resolution enhancement more evident. On the self-acquired cardiac dataset, the model also obtained an enhanced performance on image quality assessment metrics and improved visual assessment, particularly on well-defined edges. Regarding the T1 mapping sequences, the model improved the image quality of the saturation time images and the T1 maps. The model was able to enhance the T1 maps analytically and visually. Analytically, the model did not considerably modify the T1 values while improving the standard deviation in both myocardium and blood. Visually, the model improved the T1 maps by removing noise and motion artifacts without losing resolution on the edges. In conclusion, the RDN model was validated on three different MR datasets and used to improve the image quality of the T1 maps obtained with 3D SACORA and 3D SASHA. In summary, a 3D single breath-hold MR methodology was introduced, including a ready to-go 3D single breath-hold T1 mapping sequence for 3T (3D SACORA), together with the ideas for a new 3D T1/T2 mapping sequence (3D dual-SACORA); and a deep learning-based post-processing implementation capable of improving the image quality of 3D SACORA T1 maps.This thesis has received funding from the European Union Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement N722427.Programa de Doctorado en Multimedia y Comunicaciones por la Universidad Carlos III de Madrid y la Universidad Rey Juan CarlosPresidente: Carlos Alberola López.- Secretario: María Jesús Ledesma Carbayo.- Vocal: Nathan Mewto

4D Flow cardiovascular magnetic resonance consensus statement: 2023 update

4D Flow MRI; Hemodynamics; RecommendationsRessonància magnètica de flux 4D; Hemodinàmica; RecomanacionsResonancia magnética de flujo 4D; Hemodinámica; RecomendacionesHemodynamic assessment is an integral part of the diagnosis and management of cardiovascular disease. Four-dimensional cardiovascular magnetic resonance flow imaging (4D Flow CMR) allows comprehensive and accurate assessment of flow in a single acquisition. This consensus paper is an update from the 2015 ‘4D Flow CMR Consensus Statement’. We elaborate on 4D Flow CMR sequence options and imaging considerations. The document aims to assist centers starting out with 4D Flow CMR of the heart and great vessels with advice on acquisition parameters, post-processing workflows and integration into clinical practice. Furthermore, we define minimum quality assurance and validation standards for clinical centers. We also address the challenges faced in quality assurance and validation in the research setting. We also include a checklist for recommended publication standards, specifically for 4D Flow CMR. Finally, we discuss the current limitations and the future of 4D Flow CMR. This updated consensus paper will further facilitate widespread adoption of 4D Flow CMR in the clinical workflow across the globe and aid consistently high-quality publication standards.1R01HL149787-01A1 (S. Schnell, M. Markl), 1R21NS122511-01 (S. Schnell), 1R01CA233878-01 (J.Collins) J.Sotelo thanks to ANID–Millennium Science Initiative Program–ICN2021_004 and FONDECYT de iniciación en investigación #11200481. Dr. Oechtering receives funding from the German Research Foundation (OE 746/1-1)

4D Flow cardiovascular magnetic resonance consensus statement: 2023 update

Hemodynamic assessment is an integral part of the diagnosis and management of cardiovascular disease. Four-dimensional cardiovascular magnetic resonance flow imaging (4D Flow CMR) allows comprehensive and accurate assessment of flow in a single acquisition. This consensus paper is an update from the 2015 '4D Flow CMR Consensus Statement'. We elaborate on 4D Flow CMR sequence options and imaging considerations. The document aims to assist centers starting out with 4D Flow CMR of the heart and great vessels with advice on acquisition parameters, post-processing workflows and integration into clinical practice. Furthermore, we define minimum quality assurance and validation standards for clinical centers. We also address the challenges faced in quality assurance and validation in the research setting. We also include a checklist for recommended publication standards, specifically for 4D Flow CMR. Finally, we discuss the current limitations and the future of 4D Flow CMR. This updated consensus paper will further facilitate widespread adoption of 4D Flow CMR in the clinical workflow across the globe and aid consistently high-quality publication standards

Study protocol: MyoFit46-the cardiac sub-study of the MRC National Survey of Health and Development

BACKGROUND: The life course accumulation of overt and subclinical myocardial dysfunction contributes to older age mortality, frailty, disability and loss of independence. The Medical Research Council National Survey of Health and Development (NSHD) is the world's longest running continued surveillance birth cohort providing a unique opportunity to understand life course determinants of myocardial dysfunction as part of MyoFit46-the cardiac sub-study of the NSHD. METHODS: We aim to recruit 550 NSHD participants of approximately 75 years+ to undertake high-density surface electrocardiographic imaging (ECGI) and stress perfusion cardiovascular magnetic resonance (CMR). Through comprehensive myocardial tissue characterization and 4-dimensional flow we hope to better understand the burden of clinical and subclinical cardiovascular disease. Supercomputers will be used to combine the multi-scale ECGI and CMR datasets per participant. Rarely available, prospectively collected whole-of-life data on exposures, traditional risk factors and multimorbidity will be studied to identify risk trajectories, critical change periods, mediators and cumulative impacts on the myocardium. DISCUSSION: By combining well curated, prospectively acquired longitudinal data of the NSHD with novel CMR-ECGI data and sharing these results and associated pipelines with the CMR community, MyoFit46 seeks to transform our understanding of how early, mid and later-life risk factor trajectories interact to determine the state of cardiovascular health in older age. TRIAL REGISTRATION: Prospectively registered on ClinicalTrials.gov with trial ID: 19/LO/1774 Multimorbidity Life-Course Approach to Myocardial Health- A Cardiac Sub-Study of the MCRC National Survey of Health and Development (NSHD)

Study protocol: MyoFit46—the cardiac sub-study of the MRC National Survey of Health and Development

Background The life course accumulation of overt and subclinical myocardial dysfunction contributes to older age mortality, frailty, disability and loss of independence. The Medical Research Council National Survey of Health and Development (NSHD) is the world’s longest running continued surveillance birth cohort providing a unique opportunity to understand life course determinants of myocardial dysfunction as part of MyoFit46–the cardiac sub-study of the NSHD. Methods We aim to recruit 550 NSHD participants of approximately 75 years+ to undertake high-density surface electrocardiographic imaging (ECGI) and stress perfusion cardiovascular magnetic resonance (CMR). Through comprehensive myocardial tissue characterization and 4-dimensional flow we hope to better understand the burden of clinical and subclinical cardiovascular disease. Supercomputers will be used to combine the multi-scale ECGI and CMR datasets per participant. Rarely available, prospectively collected whole-of-life data on exposures, traditional risk factors and multimorbidity will be studied to identify risk trajectories, critical change periods, mediators and cumulative impacts on the myocardium. Discussion By combining well curated, prospectively acquired longitudinal data of the NSHD with novel CMR–ECGI data and sharing these results and associated pipelines with the CMR community, MyoFit46 seeks to transform our understanding of how early, mid and later-life risk factor trajectories interact to determine the state of cardiovascular health in older age. Trial registration: Prospectively registered on ClinicalTrials.gov with trial ID: 19/LO/1774 Multimorbidity Life-Course Approach to Myocardial Health- A Cardiac Sub-Study of the MCRC National Survey of Health and Development (NSHD).Sources of funding used for staff salaries, CMR scan costs, consumables and relevant travel costs required for data collection, analysis and interpretation: British Heart Foundation special project grant (to G.C. SP/20/2/34841). This study has undergone peer-review by the funding body. Medical Research Council (Core Unit Level Funding:—MC UU 00019/1).Peer Reviewed"Article signat per 30 autors/es: Matthew Webber, Debbie Falconer, Mashael AlFarih, George Joy, Fiona Chan, Clare Davie, Lee Hamill Howes, Andrew Wong, Alicja Rapala, Anish Bhuva, Rhodri H. Davies, Christopher Morton, Jazmin Aguado-Sierra, Mariano Vazquez, Xuyuan Tao, Gunther Krausz, Slobodan Tanackovic, Christoph Guger, Hui Xue, Peter Kellman, Iain Pierce, Jonathan Schott, Rebecca Hardy, Nishi Chaturvedi, Yoram Rudy, James C. Moon, Pier D. Lambiase, Michele Orini, Alun D. Hughes & Gabriella Captur"Postprint (published version

The role of artificial intelligence in paediatric cardiovascular magnetic resonance imaging

Artificial intelligence (AI) offers the potential to change many aspects of paediatric cardiac imaging. At present, there are only a few clinically validated examples of AI applications in this field. This review focuses on the use of AI in paediatric cardiovascular MRI, using examples from paediatric cardiovascular MRI, adult cardiovascular MRI and other radiologic experience

Real-time Cardiovascular MR with Spatio-temporal Artifact Suppression using Deep Learning - Proof of Concept in Congenital Heart Disease

PURPOSE: Real-time assessment of ventricular volumes requires high acceleration factors. Residual convolutional neural networks (CNN) have shown potential for removing artifacts caused by data undersampling. In this study we investigated the effect of different radial sampling patterns on the accuracy of a CNN. We also acquired actual real-time undersampled radial data in patients with congenital heart disease (CHD), and compare CNN reconstruction to Compressed Sensing (CS). METHODS: A 3D (2D plus time) CNN architecture was developed, and trained using 2276 gold-standard paired 3D data sets, with 14x radial undersampling. Four sampling schemes were tested, using 169 previously unseen 3D 'synthetic' test data sets. Actual real-time tiny Golden Angle (tGA) radial SSFP data was acquired in 10 new patients (122 3D data sets), and reconstructed using the 3D CNN as well as a CS algorithm; GRASP. RESULTS: Sampling pattern was shown to be important for image quality, and accurate visualisation of cardiac structures. For actual real-time data, overall reconstruction time with CNN (including creation of aliased images) was shown to be more than 5x faster than GRASP. Additionally, CNN image quality and accuracy of biventricular volumes was observed to be superior to GRASP for the same raw data. CONCLUSION: This paper has demonstrated the potential for the use of a 3D CNN for deep de-aliasing of real-time radial data, within the clinical setting. Clinical measures of ventricular volumes using real-time data with CNN reconstruction are not statistically significantly different from the gold-standard, cardiac gated, BH techniques

Current cardiac imaging techniques for detection of left ventricular mass

Estimation of left ventricular (LV) mass has both prognostic and therapeutic value independent of traditional risk factors. Unfortunately, LV mass evaluation has been underestimated in clinical practice. Assessment of LV mass can be performed by a number of imaging modalities. Despite inherent limitations, conventional echocardiography has fundamentally been established as most widely used diagnostic tool. 3-dimensional echocardiography (3DE) is now feasible, fast and accurate for LV mass evaluation. 3DE is also superior to conventional echocardiography in terms of LV mass assessment, especially in patients with abnormal LV geometry. Cardiovascular magnetic resonance (CMR) and cardiovascular computed tomography (CCT) are currently performed for LV mass assessment and also do not depend on cardiac geometry and display 3-dimensional data, as well. Therefore, CMR is being increasingly employed and is at the present standard of reference in the clinical setting. Although each method demonstrates advantages over another, there are also disadvantages to receive attention. Diagnostic accuracy of methods will also be increased with the introduction of more advanced systems. It is also likely that in the coming years new and more accurate diagnostic tests will become available. In particular, CMR and CCT have been intersecting hot topic between cardiology and radiology clinics. Thus, good communication and collaboration between two specialties is required for selection of an appropriate test