Myocardial tagging by Cardiovascular Magnetic Resonance: evolution of techniques--pulse sequences, analysis algorithms, and applications

Cardiovascular magnetic resonance (CMR) tagging has been established as an essential technique for measuring regional myocardial function. It allows quantification of local intramyocardial motion measures, e.g. strain and strain rate. The invention of CMR tagging came in the late eighties, where the technique allowed for the first time for visualizing transmural myocardial movement without having to implant physical markers. This new idea opened the door for a series of developments and improvements that continue up to the present time. Different tagging techniques are currently available that are more extensive, improved, and sophisticated than they were twenty years ago. Each of these techniques has different versions for improved resolution, signal-to-noise ratio (SNR), scan time, anatomical coverage, three-dimensional capability, and image quality. The tagging techniques covered in this article can be broadly divided into two main categories: 1) Basic techniques, which include magnetization saturation, spatial modulation of magnetization (SPAMM), delay alternating with nutations for tailored excitation (DANTE), and complementary SPAMM (CSPAMM); and 2) Advanced techniques, which include harmonic phase (HARP), displacement encoding with stimulated echoes (DENSE), and strain encoding (SENC). Although most of these techniques were developed by separate groups and evolved from different backgrounds, they are in fact closely related to each other, and they can be interpreted from more than one perspective. Some of these techniques even followed parallel paths of developments, as illustrated in the article. As each technique has its own advantages, some efforts have been made to combine different techniques together for improved image quality or composite information acquisition. In this review, different developments in pulse sequences and related image processing techniques are described along with the necessities that led to their invention, which makes this article easy to read and the covered techniques easy to follow. Major studies that applied CMR tagging for studying myocardial mechanics are also summarized. Finally, the current article includes a plethora of ideas and techniques with over 300 references that motivate the reader to think about the future of CMR tagging

Reduced Jet Velocity in Venous Flow after CSF Drainage: Assessing Hemodynamic Causes of Pulsatile Tinnitus.

Background and purposeIdiopathic intracranial hypertension is commonly associated with transverse sinus stenosis, a venous cause of pulsatile tinnitus. In patients with idiopathic intracranial hypertension, CSF drainage via lumbar puncture decreases intracranial pressure, which relieves the stenosis, and may provide at least temporary cessation of pulsatile tinnitus. The objective of this study was to evaluate changes in venous blood flow caused by lowered intracranial pressure in patients with pulsatile tinnitus to help identify the cause of pulsatile tinnitus.Materials and methodsTen patients with suspected transverse sinus stenosis as a venous etiology for pulsatile tinnitus symptoms underwent MR imaging before and after lumbar puncture in the same session. The protocol included flow assessment and rating of pulsatile tinnitus intensity before and after lumbar puncture and MR venography before lumbar puncture. Post-lumbar puncture MR venography was performed in 1 subject.ResultsThere was a lumbar puncture-induced reduction in venous peak velocity that correlated with the opening pressure (r = -0.72, P = .019) without a concomitant reduction in flow rate. Patients with flow jets had their peak velocity reduced by 0.30 ± 0.18 m/s (P = .002), correlating with a reduction in CSF pressure (r = 0.82, P = .024) and the reduction in subjectively scored pulsatile tinnitus intensity (r = 0.78, P = .023). The post-lumbar puncture MR venography demonstrated alleviation of the stenosis.ConclusionsOur results show a lumbar puncture-induced reduction in venous peak velocity without a concomitant reduction in flow rate. We hypothesize that the reduction is caused by the expansion of the stenosis after lumbar puncture. Our results further show a correlation between the peak velocity and pulsatile tinnitus intensity, suggesting the flow jet to be instrumental in the development of sound

Evaluation of the biocompatibility of S-phase layers on medical grade austenitic stainless steels

S-phase surface layers were formed in AISI 316LVM (ASTM F138) and High-N (ASTM F1586) medical grade austenitic stainless steels by plasma surface alloying with nitrogen (at 430°C), carbon (at 500°C) and both carbon and nitrogen (at 430°C). The presence of the S-phase was confirmed by microscopy, hardness testing, depth-profile analysis of chemical composition and X-ray Diffraction. Attachment and proliferation of mouse osteoblast MC3T3-E1 cells were tested on S-phase and untreated controls and the results demonstrated that all the S-phase layers formed were biocompatible under the conditions used. Cells adhered equally well to all samples but proliferation was enhanced on the treated materials

Who Really Needs a Rhinoplasty?

ven if the indication for rhinoplasty is to do with nasal function, the patient undergoing rhinoplasty usually still considers cosmetic aspects. Why patients agree to put themselves in discomfort, accept the risk, and shoulder the cost of a procedure, the main aim of which is an improvement in physical appearance, remains poorly understood. In the majority of cases, there is no direct correlation between the willingness to have the procedure and objective measures of nasal deformity. Likewise, psychometric measurements bear little relationship to how deformed the patient's appearance really is. For those cases where cosmetic considerations predominate, the degree of distress is greater than in those having the procedure solely to improve nasal function. Patients' satisfaction after rhinoplasty undertaken to address both functional and cosmetic needs depends more on aesthetic result than on improvement in function. Since patients undergoing rhinoplasty are often preoccupied with deformities that others would neither notice nor be concerned about, it shows clearly that this group has already undergone alterations in the way they think. Candidates for rhinoplasty are unhappy with their looks than those contemplating other cosmetic procedures, and each time they look in the mirror, they recall their dissatisfaction, a situation which has generally already begun at the age of puberty. In 80% of cases, the motivating factor is a wish for an alteration in facial appearance or the experience of seeing someone else benefit from rhinoplasty

Corrosion properties of S-phase layers formed on medical grade austenitic stainless steel

The corrosion properties of S-phase surface layers formed in AISI 316LVM (ASTM F138) and High-N (ASTM F1586) medical grade austenitic stainless steels by plasma surface alloying with nitrogen (at 430°C), carbon (at 500°C) and both carbon and nitrogen (at 430°C) has been investigated. The corrosion behaviour of the S-phase layers in Ringer's solutions was evaluated using potentiodynamic and immersion corrosion tests. The corrosion damage was evaluated using microscopy, hardness testing, inductive coupled plasma mass spectroscopy and X-ray diffraction. The experimental results have demonstrated that low-temperature nitriding, carburising and carbonitriding can improve the localised corrosion resistance of both industrial and medical grade austenitic stainless steels as long as the threshold sensitisation temperature is not reached. Carburising at 500°C has proved to be the best hardening treatment with the least effect on the corrosion resistance of the parent alloy