Diagnosing and mapping pulmonary emphysema on X-ray projection images

To assess whether grating-based X-ray dark-field imaging can increase the sensitivity of X-ray projection images in the diagnosis of pulmonary emphysema and allow for a more accurate assessment of emphysema distribution. Lungs from three mice with pulmonary emphysema and three healthy mice were imaged ex vivo using a laser-driven compact synchrotron X-ray source. Median signal intensities of transmission (T), dark-field (V) and a combined parameter (normalized scatter) were compared between emphysema and control group. To determine the diagnostic value of each parameter in differentiating between healthy and emphysematous lung tissue, a receiver-operating-characteristic (ROC) curve analysis was performed both on a per-pixel and a per-individual basis. Parametric maps of emphysema distribution were generated using transmission, dark-field and normalized scatter signal and correlated with histopathology. Transmission values relative to water were higher for emphysematous lungs than for control lungs (1.11 vs. 1.06, p<0.001). There was no difference in median dark-field signal intensities between both groups (0.66 vs. 0.66). Median normalized scatter was significantly lower in the emphysematous lungs compared to controls (4.9 vs. 10.8, p<0.001), and was the best parameter for differentiation of healthy vs. emphysematous lung tissue. In a per-pixel analysis, the area under the ROC curve (AUC) for the normalized scatter value was significantly higher than for transmission (0.86 vs. 0.78, p<0.001) and dark-field value (0.86 vs. 0.52, p<0.001) alone. Normalized scatter showed very high sensitivity for a wide range of specificity values (94% sensitivity at 75% specificity). Using the normalized scatter signal to display the regional distribution of emphysema provides color-coded parametric maps, which show the best correlation with histopathology. In a murine model, the complementary information provided by X-ray transmission and dark-field images adds incremental diagnostic value in detecting pulmonary emphysema and visualizing its regional distribution as compared to conventional X-ray projections

Free Breathing Real-Time Cardiac Cine Imaging With Improved Spatial Resolution at 3 T

Objectives: The aim of this study was to evaluate free-breathing single-shot real-time cine imaging for functional cardiac imaging at 3 +/- with increased spatial resolution. Special emphasis of this study was placed on the influence of parallel imaging techniques. Materials and Methods: Gradient echo phantom images were acquired with GRAPPA and modified SENSE reconstruction using both integrated and separate reference scans as well as TGRAPPA and TSENSE. In vivo measurements were performed for GRAPPA reconstruction with an integrated and a separate reference scan, as well as TGRAPPA using balanced steady-state free precession protocols. Three clinical protocols, rtLRInt (T-res = 51.3 milliseconds; voxel, 2.5 x 5.0 x 10 mm(3)), rtMRSep (T-res = 48.8 milliseconds; voxel, 1.9 x 3.1 x 10 mm(3)), and rtHRSep ((Tres) = 48.3 milliseconds; voxel, 1.6 x 2.6 x 10 mm(3)), were investigated on 20 volunteers using GRAPPA reconstruction with internal as well as separate reference scans. End-diastolic volume, end-systolic volume, ejection fraction, peak ejection rate, peak filling rate, and myocardial mass were evaluated for the left ventricle and compared with an electrocardiogram-triggered segmented readout cine protocol used as standard of reference. All studies were performed at 3 T. Results: Phantom and in vivo data demonstrate that the combination of GRAPPA reconstruction with a separate reference scan provides an optimal compromise of image quality as well as spatial and temporal resolution. Functional values (P values) for the standard of reference, rtLRInt, rtMRSep, and rtHRSep end-diastolic volume were 141 +/- 24 mL, 138 +/- 21 mL, 138 +/- 19 mL, and 128 +/- 33 mL, respectively (P = 0.7, 0.7, 0.4); end-systolic volume, 55 +/- 15 mL, 61 +/- 14 mL, 58 +/- 12 mL, and 55 +/- 20 mL, respectively (P = 0.23, 0.43, 0.62); ejection fraction, 61% +/- 5%, 57% +/- 5%, 58% +/- 4%, and 56% +/- 8%, respectively (P = 0.01, 0.11, 0.06); peak ejection rate, 481 +/- 73 mL/s, 425 +/- 62 mL/s, 434 +/- 67 mL/s, and 381 +/- 86 mL/s, respectively (P = 0.03, 0.04, 0.01); peak filling rate, 555 +/- 80 mL/s, 480 +/- 70 mL/s, 500 +/- 70 mL/s, and 438 +/- 108 mL/s, respectively (P = 0.007, 0.05, 0.004); and myocardial mass, 137 +/- 26 g, 141 T 25 g, 141 +/- 23 g, and 130 +/- 31 g, respectively (P = 0.62, 0.54, 0.99). Conclusions: Using a separate reference scan and high acceleration factors up to R = 6, single-shot real-time cardiac imaging offers adequate temporal and spatial resolution for accurate assessment of global left ventricular function in free breathing with short examination times

Free Breathing Real-Time Cardiac Cine Imaging With Improved Spatial Resolution at 3 T

Objectives: The aim of this study was to evaluate free-breathing single-shot real-time cine imaging for functional cardiac imaging at 3 +/- with increased spatial resolution. Special emphasis of this study was placed on the influence of parallel imaging techniques. Materials and Methods: Gradient echo phantom images were acquired with GRAPPA and modified SENSE reconstruction using both integrated and separate reference scans as well as TGRAPPA and TSENSE. In vivo measurements were performed for GRAPPA reconstruction with an integrated and a separate reference scan, as well as TGRAPPA using balanced steady-state free precession protocols. Three clinical protocols, rtLRInt (T-res = 51.3 milliseconds; voxel, 2.5 x 5.0 x 10 mm(3)), rtMRSep (T-res = 48.8 milliseconds; voxel, 1.9 x 3.1 x 10 mm(3)), and rtHRSep ((Tres) = 48.3 milliseconds; voxel, 1.6 x 2.6 x 10 mm(3)), were investigated on 20 volunteers using GRAPPA reconstruction with internal as well as separate reference scans. End-diastolic volume, end-systolic volume, ejection fraction, peak ejection rate, peak filling rate, and myocardial mass were evaluated for the left ventricle and compared with an electrocardiogram-triggered segmented readout cine protocol used as standard of reference. All studies were performed at 3 T. Results: Phantom and in vivo data demonstrate that the combination of GRAPPA reconstruction with a separate reference scan provides an optimal compromise of image quality as well as spatial and temporal resolution. Functional values (P values) for the standard of reference, rtLRInt, rtMRSep, and rtHRSep end-diastolic volume were 141 +/- 24 mL, 138 +/- 21 mL, 138 +/- 19 mL, and 128 +/- 33 mL, respectively (P = 0.7, 0.7, 0.4); end-systolic volume, 55 +/- 15 mL, 61 +/- 14 mL, 58 +/- 12 mL, and 55 +/- 20 mL, respectively (P = 0.23, 0.43, 0.62); ejection fraction, 61% +/- 5%, 57% +/- 5%, 58% +/- 4%, and 56% +/- 8%, respectively (P = 0.01, 0.11, 0.06); peak ejection rate, 481 +/- 73 mL/s, 425 +/- 62 mL/s, 434 +/- 67 mL/s, and 381 +/- 86 mL/s, respectively (P = 0.03, 0.04, 0.01); peak filling rate, 555 +/- 80 mL/s, 480 +/- 70 mL/s, 500 +/- 70 mL/s, and 438 +/- 108 mL/s, respectively (P = 0.007, 0.05, 0.004); and myocardial mass, 137 +/- 26 g, 141 T 25 g, 141 +/- 23 g, and 130 +/- 31 g, respectively (P = 0.62, 0.54, 0.99). Conclusions: Using a separate reference scan and high acceleration factors up to R = 6, single-shot real-time cardiac imaging offers adequate temporal and spatial resolution for accurate assessment of global left ventricular function in free breathing with short examination times

Comparison of symptomatic and asymptomatic atherosclerotic carotid plaques using parallel imaging and 3 T black-blood in vivo CMR

Background: To determine if black-blood 3 T cardiovascular magnetic resonance (bb-CMR) can depict differences between symptomatic and asymptomatic carotid atherosclerotic plaques in acute ischemic stroke patients. Methods: In this prospective monocentric observational study 34 patients (24 males; 70 +/- 9.3 years) with symptomatic carotid disease defined as ischemic brain lesions in one internal carotid artery territory on diffusion weighted images underwent a carotid bb-CMR at 3 T with fat-saturated pre- and post-contrast T1w-, PDw-, T2w- and TOF images using surface coils and Parallel Imaging techniques (PAT factor = 2) within 10 days after symptom onset. All patients underwent extensive clinical workup (lab, brain MR, duplex sonography, 24-hour ECG, transesophageal echocardiography) to exclude other causes of ischemic stroke. Prevalence of American Heart Association lesion type VI (AHA-LT6), status of the fibrous cap, presence of hemorrhage/thrombus and area measurements of calcification, necrotic core and hemorrhage were determined in both carotid arteries in consensus by two reviewers who were blinded to clinical information. McNemar and Wilcoxon's signed rank tests were use for statistical comparison. A p-value <0.05 was considered statistically significant. Results: Symptomatic plaques showed a higher prevalence of AHA-LT6 (67.7% vs. 11.8%; p < 0.001; odds ratio = 12.5), ruptured fibrous caps (44.1% vs. 2.9%; p < 0.001; odds ratio = 15.0), juxtaluminal thrombus (26.5 vs. 0%; < 0.01; odds ratio = 7.3) and intraplaque hemorrhage (58.6% vs. 11.8%; p = 0.01; odds ratio = 3.8). Necrotic core and hemorrhage areas were greater in symptomatic plaques (14.1 mm(2) vs. 5.5 mm(2) and 13.6 mm(2) vs. 5.3 mm(2); p < 0.01, respectively). Conclusion: 3 T bb-CMR is able to differentiate between symptomatic and asymptomatic carotid plaques, demonstrating the potential of bb-CMR to differentiate between stable and vulnerable lesions and ultimately to identify patients with low versus high risk for cardiovascular complications. Best predictors of the symptomatic side were a ruptured fibrous cap, AHA-LT 6, juxtaluminal hemorrhage/thrombus, and intraplaque hemorrhage

Assessing Pulmonary Perfusion in Emphysema Automated Quantification of Perfused Blood Volume in Dual-Energy CTPA

Objectives: The objective of this study was to determine whether automated quantification of lung perfused blood volume (PBV) in dual-energy computed tomographic pulmonary angiography (DE-CTPA) can be used to assess the severity and regional distribution of pulmonary hypoperfusion in emphysema. Materials and Methods: We retrospectively analyzed 40 consecutive patients (mean age, 67 13] years) with pulmonary emphysema, who have no cardiopulmonary comorbidities, and a DE-CTPA negative for pulmonary embolism. Automated quantification of global and regional pulmonary PBV was performed using the syngo Dual Energy application (Siemens Healthcare). Similarly, the global and regional degrees of parenchymal hypodensity were assessed automatically as the percentage of voxels with a computed tomographic density less than -900 Hounsfield unit. Emphysema severity was rated visually, and pulmonary function tests were obtained by chart review, if available. Results: Global PBV generated by automated quantification of pulmonary PBV in the DE-CTPA data sets showed a moderately strong but highly significant negative correlation with residual volume in percentage of the predicted residual volume (r = -0.62; P = 0.002; n = 23) and a positive correlation with forced expiratory volume in 1 second in percentage of the predicted forced expiratory volume in 1 second (r = 0.67; P < 0.001; n = 23). Global PBV values strongly correlated with diffusing lung capacity for carbon monoxide (r = 0.80; P < 0.001; n = 15). Pulmonary PBV values decreased with visual emphysema severity (r = -0.46, P = 0.003, n = 40). Moderate negative correlations were found between global PBV values and parenchymal hypodensity both in a per-patient (r = -0.63; P G 0.001; n = 40) and per-region analyses (r = -0.62; P < 0.001; n = 40). Conclusions: Dual-energy computed tomographic pulmonary angiography allows simultaneous assessment of lung morphology, parenchymal density, and pulmonary PBV. In patients with pulmonary emphysema, automated quantification of pulmonary PBV in DE-CTPA can be used for a quick, reader-independent estimation of global and regional pulmonary perfusion, which correlates with several lung function parameters

Ex Vivo Assessment of Coronary Atherosclerotic Plaque by Grating-Based Phase-Contrast Computed Tomography Correlation With Optical Coherence Tomography

Objectives: The aim of this study was to determine the diagnostic accuracy of grating-based phase-contrast computed tomography (gb-PCCT) to classify and quantify coronary vessel characteristics in comparison with optical coherence tomography (OCT) and histopathology in an ex vivo setting. Materials and Methods: After excision from 5 heart specimens, 15 human coronary arteries underwent gb-PCCT examination using an experimental imaging setup consisting of a rotating molybdenum anode x-ray tube, a Talbot-Lau grating interferometer, and a single photon counting detector. Subsequently, all vessels were imaged by OCT and histopathologically processed. Optical coherence tomography, gb-PCCT, and histopathology images were manually matched using anatomical landmarks. Optical coherence tomography and gb-PCCT were reviewed by 2 independent observers blinded to histopathology. Vessel, lumen, and plaque area were measured, and plaque characteristics (lipid rich, calcified, and fibrous) were determined for each section. Measures of diagnostic accuracy were derived, applying histopathology as the standard of reference. Results: Of a total of 286 assessed cross sections, 241 corresponding sections were included in the statistical analysis. Quantitative measures derived from gb-PCCT were significantly higher than from OCT (P = 0.85 for gb-PCCT and >= 0.61 for OCT, respectively). Results of Bland-Altman analysis demonstrated smaller mean differences between OCT and histopathology than for gb-PCCT and histopathology. Limits of agreement were narrower for gb-PCCT with regard to lumen area, for OCT with regard to plaque area, and were comparable with regard to vessel area. Based on histopathology, 228/241 (94.6%) sections were classified as fibrous, calcified, or lipid rich. The diagnostic accuracy of gb-PCCT was excellent for the detection of all plaque components (sensitivity, >= 0.95;specificity, >= 0.94), whereas the results for OCT showed sensitivities of >= 0.73 and specificities of >= 0.66. Conclusions: In this ex vivo setting, gb-PCCT provides excellent results in the assessment of coronary atherosclerotic plaque characteristics and vessel dimensions in comparison to OCT and histopathology. Thus, the technique may serve as adjunct nondestructive modality for advanced plaque characterization in an experimental setting

Association of smoking and physical inactivity with MRI derived changes in cardiac function and structure in cardiovascular healthy subjects

We aimed to investigate the association of smoking and physical exercise on ventricular function and structure, determined by cardiac magnetic resonance imaging (CMR), in subjects without known cardiovascular diseases. A total of 381 participants (median age 57 years) of the Cooperative Health Research in the Region of Augsburg (KORA) FF4 cohort underwent CMR. The participants' smoking and sporting habits were measured by a questionnaire. Physical inactivity was associated with a reduction of left ventricular ejection fraction (LV-EF), stroke volume, early diastolic peak filling rate and peak ejection rate of the left ventricle as well as right ventricular stroke volume. LV-EF was reduced in subjects with almost no physical activity compared to subjects with regular physical activity (68.4%, 95%CI 66.8-70.1% vs. 70.8%, 95%CI 69.2-72.3%, p < 0,05). Smokers had lower right ventricular end-diastolic volumes (80.6 ml/m(2), 95%CI 76.7-84.5 ml/m(2);never-smokers: 85.5 ml/m(2), 95%CI 82.6-88.3 ml/m(2);p < 0.05) but higher extracellular volume fractions (ECV) and fibrosis volumes (34.3 ml, 95%CI 32.5-36.0 ml, vs. 31.0 ml, 95%CI 29.6-32.3 ml, p < 0.01). We conclude that asymptomatic individuals without known cardiovascular diseases show differences in cardiac function and structure depending on their physical activity and smoking habits. This underlines the importance of prevention and health education