Novel strategies for mouse cardiac MRI : better, faster, stronger

Mouse models of cardiac disease are an important tool to gain understanding of the pathophysiological processes related to the heart, as well as for the development of new treatment strategies. In this respect, Magnetic Resonance Imaging (MRI) has become the gold standard imaging modality, because it combines high spatial resolution imaging with a large variety of soft tissue contrast weightings that can be related to the presence of diseased tissue. In addition, (targeted) MRI contrast agents can be employed to visualize different processes on the molecular level, for example in relation to myocardial infarction and the subsequent cardiac remodeling process. The specificity to discriminate healthy from diseased tissue as well as the sensitivity for detection of MR contrast agents is strongly affected by the specific MRI protocol design. Moreover, the challenging physiology of the mouse heart, especially with respect to its small size and high heart rate, often limits the direct translation of imaging protocols already available from clinical studies. Finally, the growing knowledge on cardiac pathology continuously pushes the development of sophisticated mouse cardiac MRI protocols that allow more detailed measurements of a variety of physiologically relevant cardiac parameters. The overall goal of this thesis was therefore to design and investigate novel imaging strategies in the field of mouse cardiac MRI and their application in models of cardiac disease. Chapter 2 of this thesis contains an extensive overview of currently available protocols for mouse cardiac MRI and more specifically those related to contrast enhanced imaging of myocardial infarction. The remainder of the thesis contains the experimental chapters describing all details on our newly developed mouse cardiac MRI techniques. This chapter shortly summarizes the aims and results with respect to each of these techniques, categorized based on the parameter of interest for which each measurement was specifically designed. Diastolic function Measurement of murine diastolic function requires Cine imaging with an extremely high frame rate ¿ more than 60 frames within a cardiac cycle of 100-120 ms ¿ to be able to discriminate between the two separate filling phases of the heart. In chapter 3, it was shown that using a retrospectively triggered MRI sequence, reconstruction of 80 Cine images was feasible, corresponding to a temporal resolution of around 1.5 ms. This was achieved without using any form of data interpolation. With retrospective triggering, the MRI measurements are not synchronized with the ECG, thereby in theory sampling an infinite number of time points during the cardiac cycle. Correct assignment of each k-line to a specific cardiac frame could be done retrospectively by measuring an additional navigator signal prior to image acquisition, whose signal amplitude varies with cardiac as well as respiratory movements. Because in this case, filling of k-space for each cardiac frame is a stochastic process, simulations were performed to investigate the efficiency of the method with respect to signal averaging, which was found to be almost equal compared to regular prospective triggering. Diabetic cardiomyopathy has a high prevalence in type 2 diabetes patients and is characterized by diastolic dysfunction. With the current technique, we were indeed able to measure a subtle reduction is several diastolic function parameters, which are the E/A-ratio and the E-contribution to total left ventricular filling. Therefore, this technique is a promising tool in experimental studies of diabetic cardiomyopathy and for evaluation of emerging treatment strategies for diastolic dysfunction. Myocardial perfusion Chapter 4 describes the application of first-pass perfusion measurements in a mouse model of myocardial infarction to allow the assessment of the myocardial perfusion status. A first-pass perfusion measurement is performed by venous injection of an MRI contrast agent and monitoring its passage through the left ventricle and myocardial wall. From the signal intensity changes upon passage of the contrast agent, myocardial perfusion values can be determined. The application of this technique in mice requires ultra-fast MRI sequences that can sample the signal intensity-time curves with sufficient temporal resolution. Because this concerns imaging of non-periodic signal changes this is a much different problem compared to the diastolic function experiments described in chapter 3. We showed that using a saturation recovery MRI sequence with segmented k-space read-out in combination with parallel imaging acceleration techniques, a time-series of images could be acquired with a temporal resolution of 1 image for each 3 heart beats. The use of parallel imaging was crucial, since this requires less k-lines for image reconstruction compared to conventional imaging. Furthermore, the use of saturation pulses enhanced the contrast between contrast-enhanced and non-enhanced blood and myocardium. Using this technique, semi-quantitative perfusion values could be determined based on the upslope of the signal intensity-time curves. Experiments in mice with permanent occlusion of the LAD showed a significant decrease of perfusion values in the infarcted myocardium as compared to remote myocardium. In future experiments, this technique will be extended to provide quantitative perfusion values (in mg/l/min), requiring determination of the true arterial input function from a pre-bolus measurement with a smaller contrast agent bolus volume. T1 and T2 relaxation times Pathology is often accompanied by a change in the magnetic properties of the tissue, in particular the T1 and T2 relaxation times. This directly affects the signal intensity on the MR image. Diseased and healthy tissue can therefore be discriminated on MR images, which is one of the main applications of MRI in clinical diagnostics. However, there is much interest in quantitative assesment of T1 and T2 relaxation times, as this improves repeatibility of results in longitudinal studies and reproducibility between research groups. In this thesis, we aimed at developing protocols for both T1 and T2 mapping of the complete mouse heart for application in mouse models of myocardial infarction. Whole-heart coverage is important considering that a priori, the extent of the infarct is unknown. Currently available protocols for T1 mapping are relatvively time-consuming. In chapter 5, a 3D T1 mapping sequence is presented which allows myocardial T1 quantification of the mouse heart within 20 minutes. The retrospective triggering sequence used in chapter 3 proved also useful in this study, because it allows steady-state acqusition with very short repetition times, enabling whole heart coverage. T1 values were derived from measuring a variable flip angle data set and using available MRI signal models. Variable flip angle data showed excellent agreement in cardiac anatomy, allowing pixel-wise determination of T1. In healthy mice, no substantial differences in T1 were found for different heart regions in the 3D volume. Coefficents of repeatibility were determined from measurements at different days, which varied as function of the number of flip angles used in data analysis. In contrast to T1, T2 values could not be acquired using 3D acquisitons or retrospective triggering. Alternatively, chapter 6 describes a multi-slice T2 mapping protocol for the mouse heart based on a ECG-triggered T2 magnetization preparation module with variable TE. Because the preparation module consisted of many consecutive RF pulses, the effect of these pulses on T2 relxation had to be taken into account. Additionally, simulations were used to calculate the effect of T1 relaxation on T2 estimation, which was small as long as the repetition time was kept sufficiently long. Homogeneous T2 maps of healthy mouse heart were obtained, with no substantial differences between different heart regions or slices. In a ischemia/reperfusion model, elevated T2 values were found in the infarcted area, probably as result of edema formation. The extent of the infarction was also measured using late gadolinium enhanced imaging. The degree of correlation of T2 and LGE enhanced regions strongly depended on the signal intensity thresholds derived from remote tissue. Contrast agent accumulation Another application of quantitative T1 and T2¬ mapping is the assessment of the concentration of a contrast agent, which has been targeted to a specific disease site. This is especially valuable in molecular imaging applications where contrast agents report on the presence of specific disease markers related to various cardiac remodeling processes after myocardial infarction. Chapter 7 describes the application of the T1 mapping protocol from chapter 5 to quantify the accumulation of a Gd-based liposomal contrast agent in a model of myocardial infarction. Functional imaging and assessment of wall thickening values were used to determine which regions could be identified as being infarcted. Statistical analysis showed that before contrast agent administration, T¬1¬ values were already elevated in the infarcted regions as compared to remote myocardium, however, a more pronounced change in T1 values was found 24h post-contrast, with significantly lower T1 values in the infarcted areas. Pre-contrast T1 values in control mice were very similar to the study described in chapter 5, proving good reproducibility of T1 quantification using our methods. After the MRI measurement, the hearts were cut into slices, from which the Gd-content was determined in different sections of the heart using inductively coupled plasma mass spectrometry. T1 changes measured using in vivo MRI correlated well with ex vivo measurements of Gd concentration. These are promising results for quantification of contrast agent concentrations in contrast-enhanced MRI of mouse models of cardiac disease. More research has to be performed with regard to changes in contrast agent efficiency as a result of different cellular environments. Our results already indicate that the relaxivity values of liposomal contrast agents are significantly lower in vivo as compared to values obtained from measurements in phantom solutions. Conclusion This thesis has shown that mouse cardiac MRI is capable of assessing a large variety of parameters related to cardiac physiology in the in vivo mouse heart in a non-invasive way. This makes this technique an attractive platform for experimental studies on cardiac disease, as well as developing new treatment strategies

Myocardial perfusion MRI shows impaired perfusion of the mouse hypertrophic left ventricle

There is growing consensus that myocardial perfusion deficits play a pivotal role in the transition from compensated to overt decompensated hypertrophy. The purpose of this study was to systematically study myocardial perfusion deficits in the highly relevant model of pressure overload induced hypertrophy and heart failur

A 3-slice cardiac quantitative native and post-contrast T1 and T2 MRI protocol requiring only four BHs using a 72-channel receive array coil

Introduction: Current practice to obtain left ventricular (LV) native and post-contrast T1 and T2 comprises single-slice readouts with multiple breath-holds (BHs). We propose a multi-slice parallel-imaging approach with a 72-channel receive-array to reduce BHs and demonstrate this in healthy subjects and hypertrophic cardiomyopathy (HCM) patients.Methods: A T1/T2 phantom was scanned at 3 T using a 16-channel and a novel 72-channel coil to assess the impact of different coils and acceleration factors on relaxation times. 16-18 healthy participants (8 female, age 28.4 +/- 5.1 years) and 3 HCM patients (3 male, age 55.3 +/- 4.2 years) underwent cardiac-MRI with the 72-channel coil, using a Modified Look-Locker scan with a shared inversion pulse across 3 slices and a Gradient-Spin-Echo scan. Acceleration was done by sensitivity encoding (SENSE) with accelerations 2, 4, and 6. LV T1 and T2 values were analyzed globally, per slice, and in 16 segments, with SENSE = 2 as the reference.Results: The phantom scans revealed no bias between coils and acceleration factors for T1 or T2, except for T2 with SENSE = 2, which resulted in a bias of 8.0 +/- 6.7 ms (p < 0.001) between coils. SENSE = 4 and 6 enabled T1 mapping of three slices in a single BH, and T2 mapping of three slices within two BHs. In healthy subjects, T1 and T2 values varied. We found an average overestimation of T1 in 3 slices of 25 +/- 87 ms for SENSE = 4 and 30 +/- 103 ms using SENSE = 6, as compared to SENSE = 2. Acceleration resulted in decreased signal-to-noise; however, visually insignificant and without increased incidence of SENSE-artifacts. T2 was overestimated by 2.1 +/- 5.0 ms for SENSE = 4 and 6.4 +/- 9.7 ms using SENSE = 6, as compared to SENSE = 2. Native and post-contrast T1 measurements with SENSE = 4 and ECV quantification in HCM patients was successful.Conclusion: The 72-channel receiver-array coil with SENSE = 4 and 6, enabled LV-tissue characterization in three slices. Pre- and post-contrast T1 maps were obtained in a single BH, while T2 required two BHs.Radiolog

Impairment of cerebrovascular hemodynamics in patients with severe and milder forms of sickle cell disease

In patients with sickle cell disease (SCD), cerebral blood flow (CBF) is elevated to counteract anemia and maintain oxygen supply to the brain. This may exhaust the vasodilating capacity of the vessels, possibly increasing the risk of silent cerebral infarctions (SCI). To further investigate cerebrovascular hemodynamics in SCD patients, we assessed CBF, arterial transit time (ATT), cerebrovascular reactivity of CBF and ATT (CVRCBF and CVRATT) and oxygen delivery in patients with different forms of SCD and matched healthy controls. We analyzed data of 52 patients with severe SCD (HbSS and HbS beta(0)-thal), 20 patients with mild SCD (HbSC and HbS beta(+)-thal) and 10 healthy matched controls (HbAA and HbAS). Time-encoded arterial spin labeling (ASL) scans were performed before and after a vasodilatory challenge using acetazolamide (ACZ). To identify predictors of CBF and ATT after vasodilation, regression analyses were performed. Oxygen delivery was calculated and associated with hemoglobin and fetal hemoglobin (HbF) levels. At baseline, severe SCD patients showed significantly higher CBF and lower ATT compared to both the mild SCD patients and healthy controls. As CBFpostACZ was linearly related to CBFpreACZ, CVRCBF decreased with disease severity. CVRATT was also significantly affected in severe SCD patients compared to mild SCD patients and healthy controls. Considering all groups, women showed higher CBFpostACZ than men (p < 0.01) independent of baseline CBF. Subsequently, post ACZ oxygen delivery was also higher in women (p < 0.05). Baseline, but not post ACZ, GM oxygen delivery increased with HbF levels. Our data showed that baseline CBF and ATT and CVRCBF and CVRATT are most affected in severe SCD patients and to a lesser extent in patients with milder forms of SCD compared to healthy controls. Cerebrovascular vasoreactivity was mainly determined by baseline CBF, sex and HbF levels. The higher vascular reactivity observed in women could be related to their lower SCI prevalence, which remains an area of future work. Beneficial effects of HbF on oxygen delivery reflect changes in oxygen dissociation affinity from hemoglobin and were limited to baseline conditions suggesting that high HbF levels do not protect the brain upon a hemodynamic challenge, despite its positive effect on hemolysis.Neuro Imaging Researc

On the use of steady-state signal equations for 2D TrueFISP imaging

To explain the signal behavior in 2D-TrueFISP imaging, a slice excitation profile should be considered that describes a variation of effective flip angles and magnetization phases after excitation. These parameters can be incorporated into steady-state equations to predict the final signal within a pixel. The use of steady-state equations assumes that excitation occurs instantaneously, although in reality this is a nonlinear process. In addition, often the flip angle variation within the slice excitation profile is solely considered when using steady-state equations, while TrueFISP is especially known for its sensitivity to phase variations. The purpose of this study was therefore to evaluate the precision of steady-state equations in calculating signal intensities in 2D TrueFISP imaging. To that end, steady-state slice profiles and corresponding signal intensities were calculated as function of flip angle, RF phase advance and pulse shape. More complex Bloch simulations were considered as a gold standard, which described every excitation within the sequence until steady state was reached. They were used to analyze two different methods based on steady-state equations. In addition, measurements on phantoms were done with corresponding imaging parameters. Although the Bloch simulations described the steady-state slice profile formation better than methods based on steady-state equations, the latter performed well in predicting the steady-state signal resulting from it. In certain cases the phase variation within the slice excitation profile did not even have to be taken into account. © 2009 Elsevier Inc. All rights reserved

On the use of steady-state signal equations for 2D TrueFISP imaging

To explain the signal behavior in 2D-TrueFISP imaging, a slice excitation profile should be considered that describes a variation of effective flip angles and magnetization phases after excitation. These parameters can be incorporated into steady-state equations to predict the final signal within a pixel. The use of steady-state equations assumes that excitation occurs instantaneously, although in reality this is a nonlinear process. In addition, often the flip angle variation within the slice excitation profile is solely considered when using steady-state equations, while TrueFISP is especially known for its sensitivity to phase variations. The purpose of this study was therefore to evaluate the precision of steady-state equations in calculating signal intensities in 2D TrueFISP imaging. To that end, steady-state slice profiles and corresponding signal intensities were calculated as function of flip angle, RF phase advance and pulse shape. More complex Bloch simulations were considered as a gold standard, which described every excitation within the sequence until steady state was reached. They were used to analyze two different methods based on steady-state equations. In addition, measurements on phantoms were done with corresponding imaging parameters. Although the Bloch simulations described the steady-state slice profile formation better than methods based on steady-state equations, the latter performed well in predicting the steady-state signal resulting from it. In certain cases the phase variation within the slice excitation profile did not even have to be taken into account. © 2009 Elsevier Inc. All rights reserved

Diffusion-prepared stimulated-echo turbo spin echo (DPsti-TSE):An eddy current-insensitive sequence for three-dimensional high-resolution and undistorted diffusion-weighted imaging

In this study, we present a new three-dimensional (3D), diffusion-prepared turbo spin echo sequence based on a stimulated-echo read-out (DPsti-TSE) enabling high-resolution and undistorted diffusion-weighted imaging (DWI). A dephasing gradient in the diffusion preparation module and rephasing gradients in the turbo spin echo module create stimulated echoes, which prevent signal loss caused by eddy currents. Near to perfect agreement of apparent diffusion coefficient (ADC) values between DPsti-TSE and diffusion-weighted echo planar imaging (DW-EPI) was demonstrated in both phantom transient signal experiments and phantom imaging experiments. High-resolution and undistorted DPsti-TSE was demonstrated in vivo in prostate and carotid vessel wall. 3D whole-prostate DWI was achieved with four b values in only 6 min. Undistorted ADC maps of the prostate peripheral zone were obtained at low and high imaging resolutions with no change in mean ADC values [(1.60 ± 0.10) × 10−3 versus (1.60 ± 0.02) × 10−3 mm2/s]. High-resolution 3D DWI of the carotid vessel wall was achieved in 12 min, with consistent ADC values [(1.40 ± 0.23) × 10−3 mm2/s] across different subjects, as well as slice locations through the imaging volume. This study shows that DPsti-TSE can serve as a robust 3D diffusion-weighted sequence and is an attractive alternative to the traditional two-dimensional DW-EPI approaches.</p

Diffusion-prepared stimulated-echo turbo spin echo (DPsti-TSE): An eddy current-insensitive sequence for three-dimensional high-resolution and undistorted diffusion-weighted imaging

In this study, we present a new three-dimensional (3D), diffusion-prepared turbo spin echo sequence based on a stimulated-echo read-out (DPsti-TSE) enabling high-resolution and undistorted diffusion-weighted imaging (DWI). A dephasing gradient in the diffusion preparation module and rephasing gradients in the turbo spin echo module create stimulated echoes, which prevent signal loss caused by eddy currents. Near to perfect agreement of apparent diffusion coefficient (ADC) values between DPsti-TSE and diffusion-weighted echo planar imaging (DW-EPI) was demonstrated in both phantom transient signal experiments and phantom imaging experiments. High-resolution and undistorted DPsti-TSE was demonstrated in vivo in prostate and carotid vessel wall. 3D whole-prostate DWI was achieved with four b values in only 6 min. Undistorted ADC maps of the prostate peripheral zone were obtained at low and high imaging resolutions with no change in mean ADC values [(1.60 ± 0.10) × 10−3 versus (1.60 ± 0.02) × 10−3 mm2/s]. High-resolution 3D DWI of the carotid vessel wall was achieved in 12 min, with consistent ADC values [(1.40 ± 0.23) × 10−3 mm2/s] across different subjects, as well as slice locations through the imaging volume. This study shows that DPsti-TSE can serve as a robust 3D diffusion-weighted sequence and is an attractive alternative to the traditional two-dimensional DW-EPI approaches