BOLD cardiovascular magnetic resonance at 3.0 tesla in myocardial ischemia

Background: The purpose of this study was to determine the ability of Blood Oxygen Level Dependent (BOLD) cardiovascular magnetic resonance (CMR) to detect stress-inducible myocardial ischemic reactions in the presence of angiographically significant coronary artery disease (CAD). Methods: Forty-six patients (34 men; age 65 ± 9 years,) with suspected or known coronary artery disease underwent CMR at 3Tesla prior to clinically indicated invasive coronary angiography. BOLD CMR was performed in 3 short axis slices of the heart at rest and during adenosine stress (140 μg/kg/min) followed by late gadolinium enhancement (LGE) imaging. In all 16 standard myocardial segments, T2* values were derived at rest and under adenosine stress. Quantitative coronary angiography served as the standard of reference and defined normal myocardial segments (i.e. all 16 segments in patients without any CAD), ischemic segments (i.e. supplied by a coronary artery with ≥50% luminal narrowing) and non-ischemic segments (i.e. supplied by a non-significantly stenosed coronary artery in patients with significant CAD). Results: Coronary angiography demonstrated significant CAD in 23 patients. BOLD CMR at rest revealed significantly lower T2* values for ischemic segments (26.7 ± 11.6 ms) compared to normal (31.9 ± 11.9 ms; p < 0.0001) and non-ischemic segments (31.2 ± 12.2 ms; p = 0.0003). Under adenosine stress T2* values increased significantly in normal segments only (37.2 ± 14.7 ms; p < 0.0001). Conclusions: Rest and stress BOLD CMR at 3Tesla proved feasible and differentiated between ischemic, non-ischemic, and normal myocardial segments in a clinical patient population. BOLD CMR during vasodilator stress identified patients with significant CAD

Visualization of Chronic Myocardial Infarction Using the Intravascular Contrast Agent MS-325 (Gadofosveset) in Patients

Aims. The aim of this study was to evaluate the potential of visualizing chronic myocardial infarction in patients using the intravascular CA MS-325 (gadofosveset, EPIX Pharmaceuticals, Mass, USA). Methods. Nine patients were enrolled in a clinical phase II multicenter trial for MRCA and perfusion imaging using MS-325. They had objective evidence of chronic myocardial infarction as visualized by previously performed late gadolinium (Gd) enhancement imaging (LGE) with a conventional extracellular Gd-DTPA CA (Magnevist, Bayer Healthcare, Germany, 0.2 mmol/kg/body weight) serving as reference standard. A prepulse-optimized LGE study was performed immediately and at several time points after injection of MS-325 (0.05 mmol/kg/body weight). The number and localization of segments demonstrating LGE with MS-325 as well as signal intensities were compared with the reference standard (Gd-DTPA). Results. Using MS-325, LGE could be detected at every time point in all 9 patients. The accuracy of LGE with MS-325 as compared to LGE with Gd-DTPA was highest 54 ± 4 minutes after contrast injection, resulting in a sensitivity of 84% with a specificity of 98%. Conclusion. The intravascular CA MS-325 has the potential to visualize chronic myocardial infarction. However, in comparison with Gd-DTPA, the transmural extent and the number of segments are smaller

A reference dataset for verifying numerical electrophysiological heart models

<p>Abstract</p> <p>Background</p> <p>The evaluation, verification and comparison of different numerical heart models are difficult without a commonly available database that could be utilized as a reference. Our aim was to compile an exemplary dataset.</p> <p>Methods</p> <p>The following methods were employed: Magnetic Resonance Imaging (MRI) of heart and torso, Body Surface Potential Maps (BSPM) and MagnetoCardioGraphy (MCG) maps. The latter were recorded simultaneously from the same individuals a few hours after the MRI sessions.</p> <p>Results</p> <p>A training dataset is made publicly available; datasets for blind testing will remain undisclosed.</p> <p>Conclusions</p> <p>While the MRI data may provide a common input that can be applied to different numerical heart models, the verification and comparison of different models can be performed by comparing the measured biosignals with forward calculated signals from the models.</p

Reproducibility of three different cardiac T2-mapping sequences at 1.5T and impact of cofactors on T2-relaxation times

Background: The high interindividual variability of myocardial T2 relaxation times appears to be one of the main challenges for the clinical application of cardiac T2-mapping. This study therefore aimed to evaluate potential underlying causes for this variability, analyzing the reproducibility of three different cardiac T2-mapping sequences and evaluating the influence of cofactors on T2 relaxation times. Methods: 30 healthy volunteers were examined three times on a clinical 1.5T scanner (scan 1: in the morning; scan 2: in the evening of the same day; scan 3: in the evening 2-3 weeks later). In each examination three different T2-mapping sequences were acquired at three slices in short axis view: Multi Echo Spin Echo (MESE), T2-prepared balanced Steady State Free Precession (T2prep; [1]) and Gradient Spin Echo (GraSE). Repeated measurements were performed for T2prep and GraSE. Segmented T2-maps were generated for each slice according to the AHA 17-segment model. Intra- and inter-observer reproducibility was tested in a subgroup of 10 randomly selected subjects, where manual ROIs were drawn independently to measure T2 values of each segment blinded to the other results. Results: Overall, we observed no systematic difference of T2 times due to diurnal effects and on long-term analysis. Differentiated analysis of variance components for all sequences, however, revealed a greater variance of T2 times over multiple time points than for repeated measurements within the same scan. Our study revealed a low intra-observer and inter-observer variability of manual ROI-definition and the acquired T2 times for each sequence. The coefficients of variation and intraclass correlation coefficients for intra-observer variability were: 1.3% and 0.89 for T2prep, 1.5% and 0.93 for GraSE, 3.1% and 0.83 for MESE; and for inter-observer variability: 3.3% and 0.66 for T2prep, 2.0% and 0.83 for GraSE, 3.6% and 0.77 for MESE. With respect to the influence of potential cofactors on T2 times, we observed a negative effect of the cofactor heart rate on mean T2 values, yet this effect proved to be not significant. Conversely, we found significant and positive relation between mean T2 times and the cofactors age, weight and height (p < 0.005, p < 0.05 and p < 0.05) in single linear regression models. Using multiple regression models, we observed significant relations between mean T2 times and age (p < 0.005), gender (p < 0.01), and either weight or height (p < 0.005), for given values of the remaining cofactors. Conclusions: Intra- and inter-observer reproducibility of all tested T2-mapping sequnces is high, thereby confirming previous studies. According to our study, the high interindividual variability of myocardial T2 relaxation times is most likely due to proband-related effects such as age, gender, weight and height and other cofactors intraindividually varying with time

A novel multiparametric imaging approach to acute myocarditis using T2-mapping and CMR feature tracking

Background: The aim of this study was to evaluate the diagnostic potential of a novel cardiovascular magnetic resonance (CMR) based multiparametric imaging approach in suspected myocarditis and to compare it to traditional Lake Louise criteria (LLC). Methods: CMR data from 67 patients with suspected acute myocarditis were retrospectively analyzed. Seventeen age- and gender-matched healthy subjects served as control. T2-mapping data were acquired using a Gradient-Spin-Echo T2-mapping sequence in short-axis orientation. T2-maps were segmented according to the 16-segments AHA-model and segmental T2 values and pixel-standard deviation (SD) were recorded. Afterwards, the parameters maxT2 (the highest segmental T2 value) and madSD (the mean absolute deviation (MAD) of the pixel-SDs) were calculated for each subject. Cine sequences in three long axes and a stack of short-axis views covering the left and right ventricle were analyzed using a dedicated feature tracking algorithm. Results: A multiparametric imaging model containing madSD and LV global circumferential strain (GCSLV) resulted in the highest diagnostic performance in receiver operating curve analyses (area under the curve [AUC] 0.84) when compared to any model containing a single imaging parameter or to LLC (AUC 0.79). Adding late gadolinium enhancement (LGE) to the model resulted in a further increased diagnostic performance (AUC 0.93) and yielded the highest diagnostic sensitivity of 97% and specificity of 77%. Conclusions: A multiparametric CMR imaging model including the novel T2-mapping derived parameter madSD, the feature tracking derived strain parameter GCSLV and LGE yields superior diagnostic sensitivity in suspected acute myocarditis when compared to any imaging parameter alone and to LLC. © 2017 The Author(s)