Fetal cardiac cine magnetic resonance imaging in utero.

Fast magnetic resonance imaging (MRI) led to the emergence of 'cine MRI' techniques, which enable the visualization of the beating heart and the assessment of cardiac morphology and dynamics. However, established cine MRI methods are not suitable for fetal heart imaging in utero, where anatomical structures are considerably smaller and recording an electrocardiogram signal for synchronizing MRI data acquisition is difficult. Here we present a framework to overcome these challenges. We use methods for image acquisition and reconstruction that robustly produce images with sufficient spatial and temporal resolution to detect the heart contractions of the fetus, enabling a retrospective gating of the images and thus the generation of images of the beating heart. To underline the potential of our approach, we acquired in utero images in six pregnant patients and compared these with their echocardiograms. We found good agreement in terms of diameter and area measurements, and low inter- and intra- observer variability. These results establish MRI as a reliable modality for fetal cardiac imaging, with a substantial potential for prenatal evaluation of congenital heart defects

Évaluation de la dose locale pour une blessure contaminée

Les blessures contaminées présentent une grande variabilité pour ce qui concerne le type de plaie. L'évaluation de la dose locale est un des facteurs d'aide à la décision pour l'intervention chirurgicale. Un modèle simple a été utilisé pour calculer les doses dans un volume typique, celui d'une phalange par exemple. Les débits de dose sont donnés pour des radionucléides courants. La méthode de calcul est suffisamment simple pour pouvoir être utilisée par les praticiens dans les cas impliquant d'autres radionucléides. La dose engagée dépend de la période biologique qu'il est possible d'évaluer à partir des mesures locales. Quelques exemples de calcul de dose engagée sont donnés en considérant des périodes spécifiques du composé. La transposition de la dose au risque local est simple pour ce qui concerne le risque non stochastique. Il n'en va pas de même pour le risque d'inflammation chronique ou de cancer. Cette dernière question ne peut être résolue que par le retour d'expérience fondé sur l'analyse des cas réels observés jusqu'à présent, en sachant toutefois que les données disponibles ne sont en général pas facilement exploitables pour établir une corrélation dose – effet indiscutable. Une question importante reste ouverte quant à l'utilisation de ces doses pour la comparaison aux limites réglementaires et pour les décisions en cas de dépassement. L'impact réel d'une irradiation, par des particules alpha notamment, n'est pas lié d'une manière directe et simple à la dose locale calculée. Ce sujet mériterait une réflexion et peut être un guide sur la conduite à tenir. Les conséquences anatomiques (séquelles chirurgicales), psychologiques et professionnelles doivent peser largement face aux doses, hormis bien sûr les cas de contaminations indiscutablement importantes

A double echo ultra short echo time (UTE) acquisition for respiratory motion-suppressed high resolution imaging of the lung.

Magnetic resonance imaging is a promising alternative to computed tomography for lung imaging. However, organ motion and poor signal-to-noise ratio, arising from short T2*, impair image quality. To alleviate these issues, a new retrospective gating method was implemented and tested with an ultra-short echo time sequence. A 3D double-echo ultra-short echo time sequence was used to acquire data during free breathing in ten healthy adult subjects. A self-gating method was used to reconstruct respiratory motion suppressed expiratory and inspiratory images. These images were objectively compared to uncorrected data sets using quantitative end-points (pulmonary vessel sharpness, lung-liver interface definition, signal-to-noise ratio). The method was preliminarily tested in two cystic fibrosis patients who underwent computed tomography. Vessel sharpness in expiratory ultra-short echo time data sets with second echo motion detection was significantly higher (13% relative increase) than in uncorrected images while the opposite was observed in inspiratory images. The method was successfully applied in patients and some findings (e.g., hypointense areas) were similar to those from computed tomography. Free breathing ultra-short echo time was successfully implemented, allowing flexible image reconstruction of two different respiratory states. Objective improvements in image quality were obtained with the new method and initial feasibility in a clinical setting was demonstrated. Magn Reson Med 79:2297-2305, 2018. © 2017 International Society for Magnetic Resonance in Medicine

A phantom study to determine the theoretical accuracy and precision of radial MRI to measure cross-sectional area differences for the application of coronary endothelial function assessment.

MRI has been used to noninvasively assess coronary endothelial function by measuring the vasoreactivity in response to handgrip exercise. However, the spatial resolution of MRI is limited relative to the expected vasodilation response of healthy coronary arteries (10%-20%), and the sensitivity of MRI to detect such small cross-sectional area differences has yet to be quantitatively examined. Holes of different diameters were drilled in a phantom to simulate a range of physiological responses of coronary arteries to stress. Radial cine MR images with different spatial resolutions were acquired under moving conditions, and different noise levels were simulated. Cross-sectional areas were automatically measured and statistically analyzed to quantify the smallest detectable area difference. Statistical analyses suggest that radial MRI is capable of distinguishing area differences of 0.2 to 0.3 mm2 for high signal-to-noise ratio images, which correspond to a percentage coronary area difference of 3% to 4% for a 3-mm baseline diameter. Furthermore, the smallest detectable area difference was largely independent of the pixel size for the sequence and range of diameters investigated in this study. Radial MRI is capable of reliably detecting small differences in cross-sectional areas that are well within the expected physiological range of stress-induced area changes in of healthy coronary arteries. Magn Reson Med 79:108-120, 2018. © 2017 International Society for Magnetic Resonance in Medicine

Respiratory optimized data selection for more resilient self-navigated whole-heart coronary MR angiography.

Our objective was to test a data-exclusion strategy for respiratory motion suppression by retrospectively eliminating data acquired at extreme respiratory positions for improved coronary vessel sharpness (VS) of 1-D self-navigated 3-D radial whole-heart coronary angiography acquisitions. 3-D radial self-navigated acquisitions were performed on a 1.5T scanner in volunteers during free-breathing (n = 8), in coached volunteers (n = 13) who were asked to breathe in a controlled manner to mimic cardiovascular patients presenting with Cheyne-Stokes breathing, and in free-breathing patients (n = 20). Data collected during large respiratory excursions were gradually excluded retrospectively from the reconstruction yielding 14 data sets per subject on average. The impact on VS, blood and myocardium signal-to-noise and contrast-to-noise was measured. From these results, two retrospective gating strategies were defined for the k-line elimination procedure and tested in all groups. Maximum right coronary artery VS improvement was +7.4 and +2.7% in coached volunteers and patients (P < 0.0001 for both), respectively, and 1.6% for the free-breathing volunteers (P = 0.13). The first gating strategy was defined as a fixed undersampling factor of 5 compared to a fully sampled 3-D radial acquisition, yielding significant VS improvement in coached volunteers and patients while myocardial signal-to-noise decreased in these. The second strategy was defined as a fixed gating window of 5.7 mm, leading to similar improvements. The presented strategies improve image quality of self-navigated acquisitions by retrospectively excluding data collected during end-inspiration

Improved border sharpness of post-infarct scar by a novel self-navigated free-breathing high-resolution 3D whole-heart inversion recovery magnetic resonance approach.

The border zone of post-infarction myocardial scar as identified by late gadolinium enhancement (LGE) has been identified as a substrate for arrhythmias and consequently, high-resolution 3D scar information is potentially useful for planning of electrophysiological interventions. This study evaluates the performance of a novel high-resolution 3D self-navigated free-breathing inversion recovery magnetic resonance pulse sequence (3D-SN-LGE) vs. conventional 2D breath-hold LGE (2D-LGE) with regard to sharpness of borders (SBorder) of post-infarction scar. Patients with post-infarction scar underwent two magnetic resonance examinations for conventional 2D-LGE and high-resolution 3D-SN-LGE acquisitions (both 15 min after 0.2 mmol/kg Gadobutrol IV) at 1.5T. In the prototype 3D-SN-LGE sequence, each ECG-triggered radial steady-state-free-precession read-out segment is preceded by a non-slice-selective inversion pulse. Scar volume and SBorder were assessed on 2D-LGE and matching reconstructed high-resolution 3D-SN-LGE short-axis slices. In 16 patients (four females, 58 ± 10y) all scars visualized by 2D-LGE could be identified on 3D-SN-LGE (time between 2D-LGE and 3D-SN-LGE 48 ± 53 days). A good agreement of scar volume by 3D-SN-LGE vs. 2D-LGE was found (Bland-Altman: -3.7 ± 3.4 ml, correlation: r = 0.987, p < 0.001) with a small difference in scar volume (20.5 (15.8, 35.2) ml vs. 24.5 (20.0, 41.9)) ml, respectively, p = 0.002] and a good intra- and interobserver variability (1.1 ± 4.1 and -1.1 ± 11.9 ml, respectively). SBorder of border "scar to non-infarcted myocardium" was superior on 3D-SN-LGE vs. 2D-LGE: 0.180 ± 0.044 vs. 0.083 ± 0.038, p < 0.001. Detection and quantification of myocardial scar by 3D-SN-LGE is feasible and accurate in comparison to 2D-LGE. The high spatial resolution of the 3D sequence improves delineation of scar borders

Accelerated and high-resolution cardiac T₂ mapping through peripheral k-space sharing.

To develop high-spatial-resolution cardiac T <sub>2</sub> mapping that allows for a reduced acquisition time while maintaining its precision. We implemented and optimized a new golden-angle radial T <sub>2</sub> mapping technique named SKRATCH (Shared k-space Radial T <sub>2</sub> Characterization of the Heart) that shares k-space peripheries of T <sub>2</sub> -weighted images while preserving their contrasts. Six SKRATCH variants (gradient-recalled echo and balanced SSFP, free-breathing and breath-held, with and without a saturation preparation) were implemented, and their precision was compared with a navigator-gated reference technique in phantoms and 22 healthy volunteers at 3 T. The optimal breath-held SKRATCH technique was applied in a small cohort of patients with subacute myocardial infarction. The faster free-breathing SKRATCH technique reduced the acquisition time by 52.4%, while maintaining the precision and spatial resolution of the reference technique. Similarly, the most precise and robust breath-held SKRATCH technique demonstrated homogenous T <sub>2</sub> values that did not significantly differ from the navigator-gated reference (T <sub>2</sub> = 39.9 ± 3.4 ms versus 39.5 ± 3.4 ms, P > .20, respectively). All infarct patients demonstrated a large T <sub>2</sub> elevation in the ischemic regions of the myocardium. The optimized SKRATCH technique enabled the accelerated acquisition of high-spatial-resolution T <sub>2</sub> maps, was validated in healthy adult volunteers, and was successfully applied to a small initial group of patients

Free-running 4D whole-heart self-navigated golden angle MRI: Initial results.

PURPOSE: To test the hypothesis that both coronary anatomy and ventricular function can be assessed simultaneously using a single four-dimensional (4D) acquisition. METHODS: A free-running 4D whole-heart self-navigated acquisition incorporating a golden angle radial trajectory was implemented and tested in vivo in nine healthy adult human subjects. Coronary magnetic resonance angiography (MRA) datasets with retrospective selection of acquisition window width and position were extracted and quantitatively compared with baseline self-navigated electrocardiography (ECG) -triggered coronary MRA. From the 4D datasets, the left-ventricular end-systolic, end-diastolic volumes (ESV & EDV) and ejection fraction (EF) were computed and compared with values obtained from conventional 2D cine images. RESULTS: The 4D datasets enabled dynamic assessment of the whole heart with isotropic spatial resolution of 1.15 mm(3). Coronary artery image quality was very similar to that of the ECG-triggered baseline scan despite some SNR penalty. A good agreement between 4D and 2D cine imaging was found for EDV, ESV, and EF. CONCLUSION: The hypothesis that both coronary anatomy and ventricular function can be assessed simultaneously in vivo has been tested positive. Retrospective and flexible acquisition window selection allows to best visualize each coronary segment at its individual time point of quiescence

Author Correction: Fetal cardiac cine magnetic resonance imaging in utero.

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