Respiratory organ motion in interventional MRI : tracking, guiding and modeling

Respiratory organ motion is one of the major challenges in interventional MRI, particularly in interventions with therapeutic ultrasound in the abdominal region. High-intensity focused ultrasound found an application in interventional MRI for noninvasive treatments of different abnormalities. In order to guide surgical and treatment interventions, organ motion imaging and modeling is commonly required before a treatment start. Accurate tracking of organ motion during various interventional MRI procedures is prerequisite for a successful outcome and safe therapy. In this thesis, an attempt has been made to develop approaches using focused ultrasound which could be used in future clinically for the treatment of abdominal organs, such as the liver and the kidney. Two distinct methods have been presented with its ex vivo and in vivo treatment results. In the first method, an MR-based pencil-beam navigator has been used to track organ motion and provide the motion information for acoustic focal point steering, while in the second approach a hybrid imaging using both ultrasound and magnetic resonance imaging was combined for advanced guiding capabilities. Organ motion modeling and four-dimensional imaging of organ motion is increasingly required before the surgical interventions. However, due to the current safety limitations and hardware restrictions, the MR acquisition of a time-resolved sequence of volumetric images is not possible with high temporal and spatial resolution. A novel multislice acquisition scheme that is based on a two-dimensional navigator, instead of a commonly used pencil-beam navigator, was devised to acquire the data slices and the corresponding navigator simultaneously using a CAIPIRINHA parallel imaging method. The acquisition duration for four-dimensional dataset sampling is reduced compared to the existing approaches, while the image contrast and quality are improved as well. Tracking respiratory organ motion is required in interventional procedures and during MR imaging of moving organs. An MR-based navigator is commonly used, however, it is usually associated with image artifacts, such as signal voids. Spectrally selective navigators can come in handy in cases where the imaging organ is surrounding with an adipose tissue, because it can provide an indirect measure of organ motion. A novel spectrally selective navigator based on a crossed-pair navigator has been developed. Experiments show the advantages of the application of this novel navigator for the volumetric imaging of the liver in vivo, where this navigator was used to gate the gradient-recalled echo sequence

Improved 3D MR Image Acquisition and Processing in Congenital Heart Disease

Congenital heart disease (CHD) is the most common type of birth defect, affecting about 1% of the population. MRI is an essential tool in the assessment of CHD, including diagnosis, intervention planning and follow-up. Three-dimensional MRI can provide particularly rich visualization and information. However, it is often complicated by long scan times, cardiorespiratory motion, injection of contrast agents, and complex and time-consuming postprocessing. This thesis comprises four pieces of work that attempt to respond to some of these challenges. The first piece of work aims to enable fast acquisition of 3D time-resolved cardiac imaging during free breathing. Rapid imaging was achieved using an efficient spiral sequence and a sparse parallel imaging reconstruction. The feasibility of this approach was demonstrated on a population of 10 patients with CHD, and areas of improvement were identified. The second piece of work is an integrated software tool designed to simplify and accelerate the development of machine learning (ML) applications in MRI research. It also exploits the strengths of recently developed ML libraries for efficient MR image reconstruction and processing. The third piece of work aims to reduce contrast dose in contrast-enhanced MR angiography (MRA). This would reduce risks and costs associated with contrast agents. A deep learning-based contrast enhancement technique was developed and shown to improve image quality in real low-dose MRA in a population of 40 children and adults with CHD. The fourth and final piece of work aims to simplify the creation of computational models for hemodynamic assessment of the great arteries. A deep learning technique for 3D segmentation of the aorta and the pulmonary arteries was developed and shown to enable accurate calculation of clinically relevant biomarkers in a population of 10 patients with CHD

Fat-free noncontrast whole-heart CMR with fast and power-optimized off-resonant water excitation pulses

Background: Cardiovascular MRI (CMR) faces challenges due to the interference of bright fat signals in visualizing anatomical structures. Effective fat suppression is crucial when using whole-heart CMR. Conventional methods often fall short due to rapid fat signal recovery and water-selective off-resonant pulses come with tradeoffs between scan time and RF energy deposit. A lipid-insensitive binomial off-resonant (LIBOR) RF pulse is introduced, addressing concerns about RF energy and scan time for CMR at 3T. Methods: A short LIBOR pulse was developed and implemented in a free-breathing respiratory self-navigated whole-heart sequence at 3T. A BORR pulse with matched duration, as well as previously used LIBRE pulses, were implemented and optimized for fat suppression in numerical simulations and validated in healthy subjects (n=3). Whole-heart CMR was performed in healthy subjects (n=5) with all four pulses. The SNR of ventricular blood, skeletal muscle, myocardium, and subcutaneous fat, and the coronary vessel sharpness and length were compared. Results: Experiments validated numerical findings and near homogeneous fat suppression was achieved with all pulses. Comparing the short pulses (1ms), LIBOR reduced the RF power two-fold compared with LIBRE, and three-fold compared with BORR, and LIBOR significantly decreased overall fat SNR. The reduction in RF duration shortened the whole-heart acquisition from 8.5min to 7min. No significant differences in coronary arteries detection and sharpness were found when comparing all four pulses. Conclusion: LIBOR enabled whole-heart CMR under 7 minutes at 3T, with large volume fat signal suppression, while reducing RF power compared with LIBRE and BORR. LIBOR is an excellent candidate to address SAR problems encountered in CMR where fat suppression remains challenging and short RF pulses are required.Comment: 25 pages, 7 figures, 2 table

Steady-state anatomical and quantitative magnetic resonance imaging of the heart using RF-frequencymodulated techniques

Cardiovascular disease (CVD) is the leading cause of death in the United States and Europe and generates healthcare costs of hundreds of billions of dollars annually. Conventional methods of diagnosing CVD are often invasive and carry risks for the patient. For example, the gold standard for diagnosing coronary artery disease, a major class of CVD, is x-ray coronary angiography, which has the disadvantages of being invasive, being expensive, using ionizing radiation, and having a ris k of complications. Conversely, coronary MR angiography (MRA) does not use ionizing radiation, can effectively visualize tissues without the need for exogenous contrast agents, and benefits from an adaptable temporal resolution. However, the acquisition time of cardiac MRI is far longer than the temporal scales of cardiac and respiratory motion, necessitating some method of compensating for this motion. The free-running framework is a novel development in our lab, benefitting from advances over the past three decades, that attempts to address disadvantages of previous cardiac MRI approaches: it provides fully self-gated 5D cardiac MRI with a simplified workflow, improved ease-of-use, reduced operator dependence, and automatic patient-specific motion detection. Free-running imaging increases the amount of information available to the clinician and is flexible enough to be translated to different app lications within cardiac MRI. Moreover, the self-gating of the free-running framework decoupled the acquisition from the motion compensation and thereby opened up cardiac MRI to the wider class of steady-state-based techniques utilizing balanced steady-state free precession (bSSFP) sequences, which have the benefits of practical simplicity and high signal-to-noise ratio. The focus of this thesis was therefore on the application of steady- state techniques to cardiac MRI. The first part addressed the long acquisition time of the current free-running framework and focused on anatomical coronary imaging. The published protocol of the free- running framework used an interrupted bSSFP acquisition where CHESS fat saturation modules were inserted to provide blood-fat contrast, as they suppress the signal of fat tissue surrounding the coronary arteries, and were followed by ramp-up pulses to reduce artefacts arising from the return to steady-state. This interrupted acquisition, however, suffered from an interrupted steady-state, reduced time efficiency, and higher specific absorption rate (SAR). Using novel lipid-insensitive binomial off-resonant RF excitation (LIBRE) pulses developed in our lab, the first project showed that LIBRE pulses incorporated into an uninterrupted free-running bSSFP sequence could be successfully used for 5D cardiac MRI at 1.5T. The free-running LIBRE approach reduced the acquisition time and SAR relative to the previous interrupted approach while maintaining image quality and vessel conspicuity. Furthermore, this had been the first successful use of a fat-suppressing RF excitation pulse in an uninterrupted bSSFP sequence for cardiac imaging, demonstrating that uninterrupted bSSFP can be used for cardiac MRI and addressing the problem of clinical sequence availability. Inspired by the feasibility of uninterrupted bSSFP for cardiac MRI, the second part investigated the potential of PLANET, a novel 3D multiparametric mapping technique, for free-running 5D myocardial mapping. PLANET utilizes a phase-cycled bSSFP acquisition and a direct ellipse-fitting algorithm to calculate T1 and T2 relaxation times, which suggested that it could be readily integrated into the free-running framework without interrupting the steady-state. After initially calibrating the acquisition, the possibility of accelerating the static PLANET acquisition was explored prior to applying it to the moving heart. It was shown that PLANET accuracy and precision could be maintained with two-fold acceleration with a 3D Cartesian spiral trajectory, suggesting that PLANET for myocardial mapping with the free-running 5D radial acquisition is feasible. Further work should investigate optimizing the reconstruction scheme, improving the coil sensitivity estimate, and examining the use of the radial trajectory with a view to implementing free-running 5D myocardial T1 and T2 mapping. This thesis presents two approaches utilizing RF-frequency-modulated steady-state techniques for cardiac MRI. The first approach involved the novel application of an uninterrupted bSSFP acquisition with off-resonant RF excitation for anatomical coronary imaging. The second approach investigated the use of phase-cycled bSSFP for free-running 5D myocardial T1 and T2 mapping. Both methods addressed the challenge of clinical availability of sequences in cardiac MRI, by showing that a common and simple sequence like bSSFP can be used for acquisition while the steps of motion compensation and reconstruction can be handled offline, and thus have the potential to improve adoption of cardiac MRI. -- Les maladies cardiovasculaires (MCV) représentent la principale cause de décès aux États-Unis et en Europe et génèrent des coûts de santé de plusieurs centaines de milliards de dollars par an. Les méthodes conventionnelles de diagnostic des MCV sont souvent invasives et comportent des risques pour le patient. Par exemple, la méthode de référence pour le diagnostic de la maladie coronarienne, une catégorie majeure de MCV, est la coronarographie par rayons X qui a comme inconvénients son caractère invasif, son coût, l’utilisation de rayonnements ionisants et le risque de complications. A l’inverse, l'angiographie coronarienne par résonance magnétique (ARM) n'utilise pas de rayonnements ionisants, permet de visualiser efficacement les tissus sans avoir recours à des agents de contraste exogènes et bénéficie d'une résolution temporelle ajustable. Cependant, le temps d'acquisition en IRM cardiaque est bien plus long que les échelles temporelles des mouvements cardiaques et respiratoires en jeu, ce qui rend la compensation de ces mouvements indispensable. Le cadre dit de « free -running » est un nouveau développement de notre laboratoire qui bénéficie des progrès réalisés au cours des trois dernières décennies et tente de remédier aux inconvénients des approches précédentes pour l'IRM cardiaque : il fournit une IRM cardiaque en cinq dimensions (5D) complètement « self-gated » , c’est-à-dire capable de détecter les mouvements cardiaques et respiratoires, forte d’une implémentation simplifiée, d’une plus grande facilité d'utilisation, d’une dépendance réduite vis-à-vis de l'opérateur et d’une détection automatique des mouvements spécifiques du patient. L'imagerie « free- running » augmente la quantité d'informations à disposition du clinicien et est suffisamment flexible pour être appliquée à différents domaines de l'IRM cardiaque. De plus, le « self-gating » du cadre « free-running » a découplé l'acquisition de la compensation de mouvement et a ainsi ouvert l'IRM cardiaque à la classe plus large des techniques basées sur l'état stationnaire utilisant des séquences de précession libre équilibrée en état stationnaire (bSSFP), qui se distinguent par leur simplicité d’utilisation et leur rapport signal sur bruit élevé. Le thème de cette thèse est donc l'application des techniques basées sur l'état stationnaire à l'IRM cardiaque. La première partie porte sur le long temps d'acquisition de l'actuel cadre « free-running» et se concentre sur l'imagerie anatomique coronaire. Le protocole publié utilise une acquisition bSSFP interrompue où des modules de saturation de graisse (CHESS) sont insérés de façon à fournir un contraste sang-graisse puisqu’ils suppriment le signal du tissu graisseux entourant les artères coronaires, et sont suivis par des impulsions en rampe pour réduire les artefacts résultant du retour à l'état stable. Cette acquisition interrompue souffre cependant d'un état d'équilibre interrompu, d'une efficacité temporelle réduite et d'un débit d'absorption spécifique (DAS) plus élevé. En utilisant les nouvelles impulsions d'excitation radiofréquence (RF) binomiales hors -résonance insensibles aux lipides (LIBRE) développées dans notre laboratoi re, ce premier projet montre que les impulsions LIBRE incorporées dans une séquence bSSFP ininterrompue et « free-running » peuvent être utilisées avec succès pour l'IRM cardiaque 5D à 1,5 T. L'approche « free-running LIBRE » permet de réduire le temps d'acquisition et le DAS par rapport à l'approche interrompue précédente, tout en maintenant la perceptibilité des artères coronariennes. En outre, il s'agit de la première utilisation réussie d'une impulsion d'excitation RF supprimant la graisse dans une séquence bSSFP ininterrompue pour l'imagerie cardiaque, ce qui démontre le potentiel d’utilisation de la séquence bSSFP ininterrompue pour l'IRM cardiaque et résout le problème de la disponibilité de la séquence en clinique. Inspirée par la faisabilité d’utilisation de la séquence bSSFP ininterrompue pour l'IRM cardiaque, la deuxième partie étudie le potentiel de PLANET, une nouvelle technique de cartographie 3D multiparamétrique, pour la cartographie 5D du myocarde via l’imagerie « free-running ». PLANET utilise une acquisition bSSFP à cycle de phase et un algorithme d'ajustement d'ellipse direct pour calculer les temps de relaxation T1 et T2, ce qui suggère que cette méthode pourrait être facilement intégrée au cadre « free - running » sans interruption de l’état d'équilibre. Après calibration de l'acquisition, nous explorons la possibilité d'accélérer l'acquisition statique de PLANET pour l'appliquer au cœur. Nous démontrons que l'exactitude et la précision de PLANET peuvent être maintenues pour une accélération double avec une trajectoire 3D cartésienne en spirale, ce qui suggère que PLANET est réalisable pour la cartographie du myocarde avec une acquisition radiale 5D « free-running ». D'autres travaux devraient porter sur l'optimisation du schéma de reconstruction, l'amélioration de l'estimation de la sensibilité de l’antenne et l'examen de l'utilisation de la trajectoire radiale en vue de la mise en œuvre de la cartographie 5D « free-running » T1 et T2 du myocarde. Cette thèse présente deux approches utilisant des techniques de modulation de fréquence radio en état stationnaire pour l'IRM cardiaque. La première approche implique l'application nouvelle d'une acquisition bSSFP ininterrompue avec une excitation RF hors résonance pour l'imagerie anatomique coronaire. La seconde approche porte sur l'utilisation d’une séquence bSSFP à cycle de phase pour la cartographie 5D T1 et T2 du myocarde. Ces deux méthodes permettent de répondre au défi posé par la disponibilité des séquences en IRM cardiaque en montrant qu'une séquence commune et simple comme la bSSFP peut être utilisée pour l'acquisition, tandis que les étapes de compensation du mouvement et de reconstruction peuvent être traitées hors ligne. Ainsi, ces méthodes ont le potentiel de favoriser l'adoption de l'IRM cardiaque

State feedback control for human inspiratory system

The mathematical modeling of human respiratory system is an essentially part in saving precision information of diagnostic about the disease of cardiovascular respiratory system. The physics of respiratory system and cardiovascular are completely interconnected with each other. In this paper, we will study the state feedback control for the inspiratory system during study the characteristics of the response output with the stability. The model of system is nonlinear and linearized it by Tayler method to be simple to matching with the control theory. We convert the system from differential equation to state equation to find the optimal control that helps to drive the respiratory system. Simulations are managed to indicate the proposed method effectiveness. The results of simulations are validated by using a real information form the health center

MR coronary angiography with breath-hold targeted volumes: preliminary clinical results

PURPOSE: To assess the clinical value of a magnetic resonance (MR) coronary angiography strategy involving a small targeted volume to image one coronary segment in a single breath hold for the detection of greater than 50% stenosis. MATERIALS AND METHODS: Thirty-eight patients referred for elective coronary angiography were included. The coronary arteries were localized during single-breath-hold, three-dimensional imaging of the entire heart. MR coronary angiography was then performed along the major coronary branches with a double-oblique, three-dimensional, gradient-echo sequence. Conventional coronary angiography was the reference-standard method. RESULTS: Adequate visualization was achieved with MR coronary angiography in 85%-91% of the proximal coronary arterial branches and in 38%-76% of the middle and distal branches. Overall, 187 (69%) of 272 segments were suitable for comparison between conventional and MR coronary angiography. The diagnostic accuracy of MR coronary angiography for the detection of hemodynamically significant stenoses was 92%; sensitivity, 68%; and specificity, 97%. The sensitivity in individual segments was 50%-77%, whereas the specificity was 94%-100%. CONCLUSION: Adequate visualization of the major coronary arterial branches was possible in the majority of patients. The observed accuracy of MR coronary angiography for detection of hemodynamically significant coronary arterial stenosis is promising, but it needs to be higher before this modality can be used reliably in a clinical setting

Imaging Atherosclerosis.

Advances in atherosclerosis imaging technology and research have provided a range of diagnostic tools to characterize high-risk plaque in vivo; however, these important vascular imaging methods additionally promise great scientific and translational applications beyond this quest. When combined with conventional anatomic- and hemodynamic-based assessments of disease severity, cross-sectional multimodal imaging incorporating molecular probes and other novel noninvasive techniques can add detailed interrogation of plaque composition, activity, and overall disease burden. In the catheterization laboratory, intravascular imaging provides unparalleled access to the world beneath the plaque surface, allowing tissue characterization and measurement of cap thickness with micrometer spatial resolution. Atherosclerosis imaging captures key data that reveal snapshots into underlying biology, which can test our understanding of fundamental research questions and shape our approach toward patient management. Imaging can also be used to quantify response to therapeutic interventions and ultimately help predict cardiovascular risk. Although there are undeniable barriers to clinical translation, many of these hold-ups might soon be surpassed by rapidly evolving innovations to improve image acquisition, coregistration, motion correction, and reduce radiation exposure. This article provides a comprehensive review of current and experimental atherosclerosis imaging methods and their uses in research and potential for translation to the clinic.J.M.T. is supported by a Wellcome Trust research training fellowship (104492/Z/14/Z). M.D is supported by the British Heart Foundation (FS/14/78/31020). N.R.E. is supported by a research training fellowship from the Dunhill Medical Trust (RTF44/0114). A.J.B. is supported by the British Heart Foundation. J.H.F.R. is part-supported by the HEFCE, the NIHR Cambridge Biomedical Research Centre, the British Heart Foundation, and the Wellcome Trust.This is the final version of the article. It first appeared from the American Heart Association via http://dx.doi.org/10.1161/CIRCRESAHA.115.30624

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

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)

Comprehensive 4D velocity mapping of the heart and great vessels by cardiovascular magnetic resonance

<p>Abstract</p> <p>Background</p> <p>Phase contrast cardiovascular magnetic resonance (CMR) is able to measure all three directional components of the velocities of blood flow relative to the three spatial dimensions and the time course of the heart cycle. In this article, methods used for the acquisition, visualization, and quantification of such datasets are reviewed and illustrated.</p> <p>Methods</p> <p>Currently, the acquisition of 3D cine (4D) phase contrast velocity data, synchronized relative to both cardiac and respiratory movements takes about ten minutes or more, even when using parallel imaging and optimized pulse sequence design. The large resulting datasets need appropriate post processing for the visualization of multidirectional flow, for example as vector fields, pathlines or streamlines, or for retrospective volumetric quantification.</p> <p>Applications</p> <p>Multidirectional velocity acquisitions have provided 3D visualization of large scale flow features of the healthy heart and great vessels, and have shown altered patterns of flow in abnormal chambers and vessels. Clinically relevant examples include retrograde streams in atheromatous descending aortas as potential thrombo-embolic pathways in patients with cryptogenic stroke and marked variations of flow visualized in common aortic pathologies. Compared to standard clinical tools, 4D velocity mapping offers the potential for retrospective quantification of flow and other hemodynamic parameters.</p> <p>Conclusions</p> <p>Multidirectional, 3D cine velocity acquisitions are contributing to the understanding of normal and pathologically altered blood flow features. Although more rapid and user-friendly strategies for acquisition and analysis may be needed before 4D velocity acquisitions come to be adopted in routine clinical CMR, their capacity to measure multidirectional flows throughout a study volume has contributed novel insights into cardiovascular fluid dynamics in health and disease.</p