Metabolite-cycled echo-planar spectroscopic imaging of the human heart

Purpose Spectroscopic imaging could provide insights into regional cardiac triglyceride variations, but is hampered by relatively long scan times. It is proposed to synergistically combine echo-planar spectroscopic imaging (EPSI) with motion-adapted gating, weighted acquisition and metabolite cycling to reduce scan times to less than 10 min while preserving spatial-spectral quality. The method is compared to single-voxel measurements and to metabolite-cycled EPSI with conventional acquisition for assessing triglyceride-to-water (TG/W) ratios in the human heart. Methods Measurements were performed on 10 healthy volunteers using a clinical 1.5T system. EPSI data was acquired both without and with motion-adapted gating in combination with weighted acquisition to assess TG/W ratios and relative Cramér-Rao lower bounds (CRLB) of TG. For comparison, single-voxel (PRESS) spectra were acquired in the interventricular septum. Results Bland–Altman analyses did not show a significant bias in TG/W when comparing both metabolite-cycled EPSI methods to PRESS for any of the cardiac segments. Scan time was 8.05 ± 2.06 min and 17.91 ± 3.93 min for metabolite-cycled EPSI with and without motion-adapted gating and weighted acquisition, respectively, while relative CRLB of TG did not differ significantly between the two methods for any of the cardiac segments. Conclusions Metabolite-cycled EPSI with motion-adapted gating and weighted acquisition allows detecting TG/W ratios in different regions of the in vivo human heart. Scan time is reduced by more than 2-fold to less than 10 min as compared to conventional acquisition, while keeping the quality of TG fitting constant.ISSN:0740-3194ISSN:1522-259

Beat phenomena of oscillating readouts

PurposeTo demonstrate slowly varying, erroneous magnetic field gradients for oscillating readouts due to the mechanically resonant behavior of gradient systems.MethodsProjections of a static phantom were acquired using a one-dimensional (1D) EPI sequence with varying EPI frequencies ranging from 1121 to 1580 Hz on clinical 3T systems (30 mT/m, 200 T/m/s). Phase due to static B0 inhomogeneities was eliminated by a complex division of two separate scans with different polarities of the EPI readout. The temporal evolution of phase was evaluated and related to the mechanical resonances of the gradient systems derived from the gradient modulation transfer function. Additionally, the impact of temporally varying mechanical resonance effects on EPI was evaluated using an echo-planar spectroscopic imaging sequence.ResultsA beat phenomenon resulting in a slowly varying phase was observed. Its temporal frequency was given by the difference between the EPI frequency and the mechanical resonance frequency of the activated gradient axis. The maximum erroneous, oscillating phase during phase encoding was +/- 0.5 rad for an EPI frequency of 1281 Hz. Echo-planar spectroscopic imaging images showed the resulting time-dependent stretching/compression of the FOV.ConclusionOscillating readouts such as those used in EPI can result in low-frequency, erroneous phase contributions, which are explained by the beat phenomenon. Therefore, EPI phase-correction approaches may need to include beat effects for accurate image reconstruction.ISSN:0740-3194ISSN:1522-259

Preliminary experience of cardiac proton spectroscopy at 0.75 T

Recent work on high-performance lower-field MR systems has renewed the interest in assessing relative advantages and disadvantages of magnetic fields less than 1 T. The objective of the present work was to investigate signal-to-noise ratio (SNR) scaling of point-resolved spectroscopy as a function of field strength and to test the feasibility of proton MRS of triglycerides (TGs) in human in vivo myocardium at 0.75 T relative to 1.5 T and 3 T. Measurements at 0.75 T were obtained by temporarily ramping down a clinical 3 T MR scanner. System configurations at 0.75, 1.5 and 3 T featured identical hard- and software, except for differences in transmit/receive coil geometries and receive channel count, which were accounted for in SNR comparisons. Proton MRS was performed at 0.75 T, 1.5 T and 3 T in ex vivo tissue and in vivo calf muscle to measure T-1 and T-2 values as a function of field strength, which in turn served as input to simulations of SNR scaling and field-dependent TG fit errors. Preliminary in vivo spectra of myocardium were acquired at 0.75 T, 1.5 T and 3 T in healthy subjects. Measurements of both ex vivo tissue and in vivo muscle tissue at 0.75 T versus 1.5 T and 3 T confirmed decreasing T-1 and increasing T-2* for decreasing field strengths. Using measured T-1, T-2 and T-2* as input and using field-dependent echo time and bandwidth scaling, simulated Cramer-Rao lower bounds of TG amplitudes at 0.75 T were 2.3 and 4.5 times larger with respect to 1.5 T and 3 T, respectively. In vivo measurements demonstrate that human proton spectroscopy of TGs in cardiac muscle is feasible at 0.75 T, supporting the potential practical value of lower-field high-performance MR systems.ISSN:0952-3480ISSN:1099-149

Navigator‐free metabolite‐cycled proton spectroscopy of the heart

Purpose Respiratory gating in cardiac water‐suppressed (WS) proton spectroscopy leads to long and unpredictable scan times. Metabolite cycling allows to perform frequency and phase correction on the water signal and, hence, offers an approach to navigator‐free cardiac spectroscopy with fixed scan time. The objective of the present study was to develop and implement navigator‐free metabolite‐cycled cardiac proton spectroscopy (MC nonav) and compare it with standard navigator‐gated WS (WS nav) and navigator‐free WS (WS nonav) measurements for the assessment of triglyceride‐to‐water ratios (TG/W) and creatine‐to‐water ratios (CR/W) in the intraventricular septum of the in vivo heart. Methods Navigator‐free metabolite‐cycled spectroscopy was implemented on a clinical 1.5T system. In vivo measurements were performed on 10 young and 5 older healthy volunteers to assess signal‐to‐noise ratio efficiency as well as TG/W and CR/W and the relative Cramér‐Rao lower bounds for CR. The performance of the metabolite‐cycled sequence was verified using simulations. Results On average, scan times of MC nonav were 3.4 times shorter compared with WS nav, while no significant bias for TG/W was observed (coefficient of variation = 14.0%). signal‐to‐noise ratio efficiency of both TG and CR increased for MC nonav compared with WS nav. Relative Cramér‐Rao lower bounds of CR decreased for MC nonav. Overall spectral quality was found comparable between MC nonav and WS nav, while it was inferior for WS nonav. Conclusion Navigator‐free metabolite‐cycled cardiac proton spectroscopy offers 3.4‐fold accelerated assessment of TG/W and CR/W in the heart with preserved spectral quality when compared with navigator‐gated WS scans

Retrospective phase-based gating for cardiac proton spectroscopy with fixed scan time

BACKGROUND Respiratory motion is a major limiting factor for spectral quality and duration of in vivo proton MR spectroscopy of the heart. Prospective navigator gating is frequently applied to minimize the effects of respiratory motion, but scan durations are subject-dependent and hence difficult to predict. PURPOSE To implement cardiac proton MRS with fixed scan time by employing retrospective phase-based gating and to compare the proposed method to conventional navigator-gated MRS. STUDY TYPE Prospective. SUBJECTS Eighteen healthy volunteers (29.7 ± 7.8 years). FIELD STRENGTH/SEQUENCE 1.5, navigator-gated (16 averages without, 96 with water suppression [WS]) data acquisition as reference and navigator-free data acquisition with a fixed scan time (48 without WS, 304 with WS), cardiac-triggered point-resolved spectroscopy (PRESS). ASSESSMENT Navigator-free data acquisition with retrospective phase-based gating was compared with prospective navigator-gating. Navigator-free acquisition was repeated in 10 subjects to assess reproducibility. Scan time was assessed for prospective and retrospective gating. Retrospective phase-based gating was performed using a threshold based on the standard deviation (SD) of individual water (W) and triglyceride (TG) phases. STATISTICAL TESTS T-tests and Bland-Altman analysis. RESULTS The duration of the prospective navigator-gated scans ranged from 6:09 minutes to 21:50 minutes (mean 10:05 ± 3:46 min, gating efficiency 40.4 ± 10.5%), while data acquisition for retrospective phase-based gating had a fixed scan time of 11:44 minutes. Retrospective phase-based gating using a threshold of 1 × SD yielded a gating efficiency of 72.7 ± 4.3% and a coefficient of variation (CoV) of triglyceride-to-water ratios of 9.8% compared with the navigated reference. The intrasubject reproducibility of retrospective gating revealed a CoV of 9.5%. DATA CONCLUSION Cardiac proton MRS employing retrospective phase-based gating is feasible and provides reproducible assessment of TG/W in a fixed scan time. Since scan time is independent of respiratory motion, retrospective phase-based gating offers an approach to motion compensation with predictable exam time for proton MRS of the heart. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1973-1981

Cardiac- versus diaphragm-based respiratory navigation for proton spectroscopy of the heart

OBJECTIVES To study inter-individual differences of the relation between diaphragm and heart motion, the objective of the present study was to implement respiratory navigation on the heart and compare it against the established method of navigator gating on the diaphragm for single-voxel cardiac H-MRS. MATERIALS AND METHODS H-MRS was performed on a 1.5T system in 19 healthy volunteers of mixed age (range 24-75 years). Spectra were recorded in a 6-8 ml voxel in the ventricular septum using a PRESS (point-resolved spectroscopy) sequence and ECG gating. Water-unsuppressed data acquired with pencil beam navigation on the heart were compared to data with navigation on the diaphragm. Water-suppressed data were obtained to assess triglyceride-to-water ratios. RESULTS Water phase and amplitude fluctuations for cardiac versus diaphragm navigation did not reveal significant differences. Both navigator positions provided comparable triglyceride-to-water ratios and gating efficiencies (coefficient of variation (CoV) 7.0%). The cardiac navigator showed a good reproducibility (CoV 5.2%). DISCUSSION Respiratory navigation on the heart does not convey an advantage over diaphragm-based navigator gating for cardiac H-MRS, but also no disadvantage. Consequently, cardiac and diaphragm respiratory navigation may be used interchangeably

Hyperpolarized C-13 urea myocardial first-pass perfusion imaging using velocity-selective excitation

Background A velocity-selective binomial excitation scheme for myocardial first-pass perfusion measurements with hyperpolarized 13C substrates, which preserves bolus magnetization inside the blood pool, is presented. The proposed method is evaluated against gadolinium-enhanced 1H measurements in-vivo. Methods The proposed excitation with an echo-planar imaging readout was implemented on a clinical CMR system. Dynamic myocardial stress perfusion images were acquired in six healthy pigs after bolus injection of hyperpolarized 13C urea with the velocity-selective vs. conventional excitation, as well as standard 1H gadolinium-enhanced images. Signal-to-noise, contrast-to-noise (CNR) and homogeneity of semi-quantitative perfusion measures were compared between methods based on first-pass signal-intensity time curves extracted from a mid-ventricular slice. Diagnostic feasibility is demonstrated in a case of septal infarction. Results Velocity-selective excitation provides over three-fold reduction in blood pool signal with a two-fold increase in myocardial CNR. Extracted first-pass perfusion curves reveal a significantly reduced variability of semi-quantitative first-pass perfusion measures (12–20%) for velocity-selective excitation compared to conventional excitation (28–93%), comparable to that of reference 1H gadolinium data (9–15%). Overall image quality appears comparable between the velocity-selective hyperpolarized and gadolinium-enhanced imaging. Conclusion The feasibility of hyperpolarized 13C first-pass perfusion CMR has been demonstrated in swine. Comparison with reference 1H gadolinium data revealed sufficient data quality and indicates the potential of hyperpolarized perfusion imaging for human applications.ISSN:1097-6647ISSN:1532-429

Quantitative myocardial first-pass cardiovascular magnetic resonance perfusion imaging using hyperpolarized [1-13C] pyruvate

BACKGROUND: The feasibility of absolute myocardial blood flow quantification and suitability of hyperpolarized [1-13C] pyruvate as contrast agent for first-pass cardiovascular magnetic resonance (CMR) perfusion measurements are investigated with simulations and demonstrated in vivo in a swine model. METHODS: A versatile simulation framework for hyperpolarized CMR subject to physical, physiological and technical constraints was developed and applied to investigate experimental conditions for accurate perfusion CMR with hyperpolarized [1-13C] pyruvate. Absolute and semi-quantitative perfusion indices were analyzed with respect to experimental parameter variations and different signal-to-noise ratio (SNR) levels. Absolute myocardial blood flow quantification was implemented with an iterative deconvolution approach based on Fermi functions. To demonstrate in vivo feasibility, velocity-selective excitation with an echo-planar imaging readout was used to acquire dynamic myocardial stress perfusion images in four healthy swine. Arterial input functions were extracted from an additional image slice with conventional excitation that was acquired within the same heartbeat. RESULTS: Simulations suggest that obtainable SNR and B0 inhomogeneity in vivo are sufficient for the determination of absolute and semi-quantitative perfusion with ≤25% error. It is shown that for expected metabolic conversion rates, metabolic conversion of pyruvate can be neglected over the short duration of acquisition in first-pass perfusion CMR. In vivo measurements suggest that absolute myocardial blood flow quantification using hyperpolarized [1-13C] pyruvate is feasible with an intra-myocardial variability comparable to semi-quantitative perfusion indices. CONCLUSION: The feasibility of quantitative hyperpolarized first-pass perfusion CMR using [1-13C] pyruvate has been investigated in simulations and demonstrated in swine. Using an approved and metabolically active compound is envisioned to increase the value of hyperpolarized perfusion CMR in patients

Myocardial triglycerides in cardiac amyloidosis assessed by proton cardiovascular magnetic resonance spectroscopy

Abstract Background Cardiac involvement of amyloidosis leads to left-ventricular (LV) wall thickening with progressive heart failure requiring rehospitalization. Cardiovascular magnetic resonance (CMR) is a valuable tool to non-invasively assess myocardial thickening as well as structural changes. Proton CMR spectroscopy (1H-CMRS) additionally allows assessing metabolites including triglycerides (TG) and total creatine (CR). However, opposing results exist regarding utilization of these metabolites in LV hypertrophy or thickening. Therefore, the aim of this study was to measure metabolic alterations using 1H-CMRS in a group of patients with thickened myocardium caused by cardiac amyloidosis. Methods 1H-CMRS was performed on a 1.5 T system (Achieva, Philips Healthcare, Best, The Netherlands) using a 5-channel receive coil in 11 patients with cardiac amyloidosis (60.5 ± 11.4 years, 8 males) and 11 age- and gender-matched controls (63.2 ± 8.9 years, 8 males). After cardiac morphology and function assessment, proton spectra from the interventricular septum (IVS) were acquired using a double-triggered PRESS sequence. Post-processing was performed using a customized reconstruction pipeline based on ReconFrame (GyroTools LLC, Zurich, Switzerland). Spectra were fitted in jMRUI/AMARES and the ratios of triglyceride-to-water (TG/W) and total creatine-to-water (CR/W) were calculated. Results Besides an increased LV mass and a thickened IVS concomitant to the disease characteristics, patients with cardiac amyloidosis presented with decreased global longitudinal (GLS) and circumferential (GCS) strain. LV ejection fraction was preserved relative to controls (60.0 ± 13.2 vs. 66.1 ± 4.3%, p = 0.17). Myocardial TG/W ratios were significantly decreased compared to controls (0.53 ± 0.23 vs. 0.80 ± 0.26%, p = 0.015). CR/W ratios did not show a difference between both groups, but a higher standard deviation in patients with cardiac amyloidosis was observed. Pearson correlation revealed a negative association between elevated LV mass and TG/W (R = − 0.59, p = 0.004) as well as GCS (R = − 0.48, p = 0.025). Conclusions A decrease in myocardial TG/W can be detected in patients with cardiac amyloidosis alongside impaired cardiac function with an association to the degree of myocardial thickening. Accordingly, 1H-CMRS may provide an additional diagnostic tool to gauge progression of cardiac amyloidosis along with standard imaging sequences. Trial registration EK 2013–0132