Real-time Assessment of Right and Left Ventricular Volumes and Function in Children Using High Spatiotemporal Resolution Spiral bSSFP with Compressed Sensing

Background: Real-time (RT) assessment of ventricular volumes and function enables data acquisition during free-breathing. However, in children the requirement for high spatiotemporal resolution requires accelerated imaging techniques. In this study, we implemented a novel RT bSSFP spiral sequence reconstructed using Compressed Sensing (CS) and validated it against the breath-hold (BH) reference standard for assessment of ventricular volumes in children with heart disease. Methods: Data was acquired in 60 children. Qualitative image scoring and evaluation of ventricular volumes was performed by 3 clinical cardiac MR specialists. 30 cases were reassessed for intra-observer variability, and the other 30 cases for inter-observer variability. Results: Spiral RT images were of good quality, however qualitative scores reflected more residual artefact than standard BH images and slightly lower edge definition. Quantification of Left Ventricular (LV) and Right Ventricular (RV) metrics showed excellent correlation between the techniques with narrow limits of agreement. However, we observed small but statistically significant overestimation of LV end-diastolic volume, underestimation of LV end-systolic volume, as well as a small overestimation of RV stroke volume and ejection fraction using the RT imaging technique. No difference in inter-observer or intra-observer variability were observed between the BH and RT sequences. Conclusions: Real-time bSSFP imaging using spiral trajectories combined with a compressed sensing reconstruction is feasible. The main benefit is that it can be acquired during free breathing. However, another important secondary benefit is that a whole ventricular stack can be acquired in ~20 seconds, as opposed to ~6 minutes for standard BH imaging. Thus, this technique holds the potential to significantly shorten MR scan times in children

Free breathing contrast-enhanced time-resolved magnetic resonance angiography in pediatric and adult congenital heart disease

Contrast enhanced magnetic resonance angiography (MRA) is generally performed during a long breath-hold (BH), limiting its utility in infants and small children. This study proposes a free-breathing (FB) time resolved MRA (TRA) technique for use in pediatric and adult congenital heart disease (CHD)

Adiposity is associated with blunted cardiovascular, neuroendocrine and cognitive responses to acute mental stress

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited - Copyright @ 2012 Jones et al.Obesity and mental stress are potent risk factors for cardiovascular disease but their relationship with each other is unclear. Resilience to stress may differ according to adiposity. Early studies that addressed this are difficult to interpret due to conflicting findings and limited methods. Recent advances in assessment of cardiovascular stress responses and of fat distribution allow accurate assessment of associations between adiposity and stress responsiveness. We measured responses to the Montreal Imaging Stress Task in healthy men (N=43) and women (N=45) with a wide range of BMIs. Heart rate (HR) and blood pressure (BP) measures were used with novel magnetic resonance measures of stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR) and arterial compliance to assess cardiovascular responses. Salivary cortisol and the number and speed of answers to mathematics problems in the task were used to assess neuroendocrine and cognitive responses, respectively. Visceral and subcutaneous fat was measured using T2*-IDEAL. Greater BMI was associated with generalised blunting of cardiovascular (HR:β=−0.50 bpm.unit−1, P=0.009; SV:β=−0.33 mL.unit−1, P=0.01; CO:β=−61 mL.min−1.unit−1, P=0.002; systolic BP:β=−0.41 mmHg.unit−1, P=0.01; TPR:β=0.11 WU.unit−1, P=0.02), cognitive (correct answers: r=−0.28, P=0.01; time to answer: r=0.26, P=0.02) and endocrine responses (cortisol: r=−0.25, P=0.04) to stress. These associations were largely determined by visceral adiposity except for those related to cognitive performance, which were determined by both visceral and subcutaneous adiposity. Our findings suggest that adiposity is associated with centrally reduced stress responsiveness. Although this may mitigate some long-term health risks of stress responsiveness, reduced performance under stress may be a more immediate negative consequence.This work is funded by the UK National Institute of Health Research (NIHR), Siemens Medical Systems, British Heart Foundation (BHF), NIHR Senior Research Fellowship & The Fondation Leducq, BHF Intermediate Fellowship

Perturbed spiral real-time phase-contrast MR with compressive sensing reconstruction for assessment of flow in children

PURPOSE: we implemented a golden‐angle spiral phase contrast sequence. A commonly used uniform density spiral and a new ‘perturbed’ spiral that produces more incoherent aliases were assessed. The aim was to ascertain whether greater incoherence enabled more accurate Compressive Sensing reconstruction and superior measurement of flow and velocity. METHODS: A range of ‘perturbed’ spiral trajectories based on a uniform spiral trajectory were formulated. The trajectory that produced the most noise‐like aliases was selected for further testing. For in‐silico and in‐vivo experiments, data was reconstructed using total Variation L1 regularisation in the spatial and temporal domains. In‐silico, the reconstruction accuracy of the ‘perturbed’ golden spiral was compared to uniform density golden‐angle spiral. For the in‐vivo experiment, stroke volume and peak mean velocity were measured in 20 children using ‘perturbed’ and uniform density golden‐angle spiral sequences. These were compared to a reference standard gated Cartesian sequence. RESULTS: In‐silico, the perturbed spiral acquisition produced more accurate reconstructions with less temporal blurring (NRMSE ranging from 0.03 to 0.05) than the uniform density acquisition (NRMSE ranging from 0.06 to 0.12). This translated in more accurate results in‐vivo with no significant bias in the peak mean velocity (bias: −0.1, limits: −4.4 to 4.1 cm/s; P = 0.98) or stroke volume (bias: −1.8, limits: −9.4 to 5.8 ml, P = 0.19). CONCLUSION: We showed that a ‘perturbed’ golden‐angle spiral approach is better suited to Compressive Sensing reconstruction due to more incoherent aliases. This enabled accurate real‐time measurement of flow and peak velocity in children

Reducing Contrast Agent Dose in Cardiovascular MR Angiography with Deep Learning

BACKGROUND: Contrast-enhanced magnetic resonance angiography (MRA) is used to assess various cardiovascular conditions. However, gadolinium-based contrast agents (GBCAs) carry a risk of dose-related adverse effects. PURPOSE: To develop a deep learning method to reduce GBCA dose by 80%. STUDY TYPE: Retrospective and prospective. POPULATION: A total of 1157 retrospective and 40 prospective congenital heart disease patients for training/validation and testing, respectively. FIELD STRENGTH/SEQUENCE: A 1.5 T, T1-weighted three-dimensional (3D) gradient echo. ASSESSMENT: A neural network was trained to enhance low-dose (LD) 3D MRA using retrospective synthetic data and tested with prospective LD data. Image quality for LD (LD-MRA), enhanced LD (ELD-MRA), and high-dose (HD-MRA) was assessed in terms of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and a quantitative measure of edge sharpness and scored for perceptual sharpness and contrast on a 1-5 scale. Diagnostic confidence was assessed on a 1-3 scale. LD- and ELD-MRA were assessed against HD-MRA for sensitivity/specificity and agreement of vessel diameter measurements (aorta and pulmonary arteries). STATISTICAL TESTS: SNR, CNR, edge sharpness, and vessel diameters were compared between LD-, ELD-, and HD-MRA using one-way repeated measures analysis of variance with post-hoc t-tests. Perceptual quality and diagnostic confidence were compared using Friedman's test with post-hoc Wilcoxon signed-rank tests. Sensitivity/specificity was compared using McNemar's test. Agreement of vessel diameters was assessed using Bland-Altman analysis. RESULTS: SNR, CNR, edge sharpness, perceptual sharpness, and perceptual contrast were lower (P < 0.05) for LD-MRA compared to ELD-MRA and HD-MRA. SNR, CNR, edge sharpness, and perceptual contrast were comparable between ELD and HD-MRA, but perceptual sharpness was significantly lower. Sensitivity/specificity was 0.824/0.921 for LD-MRA and 0.882/0.960 for ELD-MRA. Diagnostic confidence was 2.72, 2.85, and 2.92 for LD, ELD, and HD-MRA, respectively (PLD-ELD , PLD-HD < 0.05). Vessel diameter measurements were comparable, with biases of 0.238 (LD-MRA) and 0.278 mm (ELD-MRA). DATA CONCLUSION: Deep learning can improve contrast in LD cardiovascular MRA. LEVEL OF EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2