Ming-Ting Wu

VGHKS Kaohsiung Veterans General Hospital, Kaohsiung, Kaohsiung, Taiwan

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Publications (52)211.36 Total impact

  • Article: Inflow-weighted pulmonary perfusion: Comparison between dynamic contrast-enhanced MRI versus perfusion scintigraphy in complex pulmonary circulation.
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    ABSTRACT: BACKGROUND: Due to the different properties of the contrast agents, the lung perfusion maps as measured by 99mTc-labeled macroaggregated albumin perfusion scintigraphy (PS) are not uncommonly discrepant from those measured by dynamic contrast-enhanced MRI (DCE-MRI) using indicator-dilution analysis in complex pulmonary circulation. Since PS offers the pre-capillary perfusion of the first-pass transit, we hypothesized that an inflow-weighted perfusion model of DCE-MRI could simulate the result by PS. METHODS: 22 patients underwent DCE-MRI at 1.5T and also PS. Relative perfusion contributed by the left lung was calculated by PS (PSL%), by DCE-MRI using conventional indicator dilution theory for pulmonary blood volume (PVLL%) and pulmonary blood flow (PVFL%) and using our proposed inflow-weighted pulmonary blood volume (PBViwL%). For PBViwL%, the optimal upper bound of the inflow-weighted integration range was determined by correlation coefficient analysis. RESULTS: The time-to-peak of the normal lung parenchyma was the optimal upper bound in the inflow-weighted perfusion model. Using PSL% as a reference, PBVL% showed error of 49.24% to -40.37% (intraclass correlation coefficient RI = 0.55) and PBFL% had error of 34.87% to -27.76% (RI = 0.80). With the inflow-weighted model, PBViwL% had much less error of 12.28% to -11.20% (RI = 0.98) from PSL%. CONCLUSIONS: The inflow-weighted DCE-MRI provides relative perfusion maps similar to that by PS. The discrepancy between conventional indicator-dilution and inflow-weighted analysis represents a mixed-flow component in which pathological flow such as shunting or collaterals might have participated.
    Journal of Cardiovascular Magnetic Resonance 02/2013; 15(1):21. · 3.72 Impact Factor
  • Article: Diffusion tensor imaging study of white matter fiber tracts in adolescent attention-deficit/hyperactivity disorder.
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    ABSTRACT: A diffusion tensor imaging (DTI) study was conducted in 12 adolescents with attention deficit/hyperactivity disorder and 14 age- and IQ-matched healthy controls. Inter-subject comparison of fractional anisotropy (FA) of the whole brain between the groups was obtained using the tract-based spatial statistics method. Results revealed significantly lower FA in widespread white matter tracts in cases relative to controls. Also, the FA measure of identified regions was associated with cognitive performance.
    Psychiatry research. 02/2013; 211(2):186-7.
  • Article: Reliable categorisation of visual scoring of coronary artery calcification on low-dose CT for lung cancer screening: validation with the standard Agatston score.
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    ABSTRACT: OBJECTIVES: To validate the reliability of the visual coronary artery calcification score (VCACS) on low-dose CT (LDCT) for concurrent screening of CAC and lung cancer. METHODS: We enrolled 401 subjects receiving LDCT for lung cancer screening and ECG-gated CT for the Agatston score (AS). LDCT was reconstructed with 3- and 5-mm slice thickness (LDCT-3mm and LDCT-5mm respectively) for VCACS to obtain VCACS-3mm and VCACS-5mm respectively. After a training session comprising 32 cases, two observers performed four-scale VCACS (absent, mild, moderate, severe) of 369 data sets independently, the results were compared with four-scale AS (0, 1-100, 101-400, >400). RESULTS: CACs were present in 39.6 % (146/369) of subjects. The sensitivity of VCACS-3mm was higher than for VCACS-5mm (83.6 % versus 74.0 %). The median of AS of the 24 false-negative cases in VCACS-3mm was 2.3 (range 1.1-21.1). The false-negative rate for detecting AS ≥ 10 on LDCT-3mm was 1.9 %. VCACS-3mm had higher concordance with AS than VCACS-5mm (k = 0.813 versus k = 0.685). An extended test of VCACS-3mm for four junior observers showed high inter-observer reliability (intra-class correlation = 0.90) and good concordance with AS (k = 0.662-0.747). CONCLUSIONS: This study validated the reliability of VCACS on LDCT for lung cancer screening and showed that LDCT-3mm was more feasible than LDCT-5mm for CAD risk stratification. KEY POINTS : • Low-dose computed tomography (LDCT) rarely misses significant coronary artery calcification (CAC). • Visual scoring of CAC on LDCT is highly concordant with Agatston scoring. • LDCT-3mm is more feasible than LDCT-5mm for CAD risk stratification. • CAC assessment enriched the screening information for LDCT lung cancer screening.
    European Radiology 12/2012; · 3.22 Impact Factor
  • Article: Fast dynamic contrast-enhanced lung MR imaging using k-t BLAST: a spatiotemporal perspective.
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    ABSTRACT: Dynamic contrast-enhanced MR imaging has long been an attractive alternative to measure pulmonary perfusion as it offers simultaneous acquisition of high-resolution anatomical images and various functional information without exposing to ionizing radiation. As higher temporal resolution in addition to simultaneous acquisition of more slices from different positions favors more precise diagnosis, rapid acquisition of multiple images during bolus contrast administration remains essential to pulmonary perfusion imaging. Nevertheless, the branching morphology together with asynchronization of contrast-enhanced pulmonary perfusion scattered among distinct blood vessels imposes difficulties to faster imaging. This work demonstrates that k-t broad-use linear acquisition speed-up technique (k-t BLAST), having substantial performance on accelerating cardiac cine imaging, can be applied to accelerate dynamic contrast-enhanced lung imaging up to a factor of 5 with errors less than 6% on five healthy subjects and less than 10% on 13 patients, respectively, in the overall signal intensity. Perfusion parameter estimates show somewhat less errors than those in overall signal intensity. Results from healthy subjects and two groups of patients with various diseases show high consistency between fully sampled datasets and their accelerated counterparts. These suggest feasibility of accelerated contrast-enhanced lung images in clinical examinations and potential of extending k-t BLAST into related applications.
    Magnetic Resonance in Medicine 03/2012; 67(3):786-92. · 2.96 Impact Factor
  • Article: CT of coronary heart disease: Part 2, Dual-phase MDCT evaluates late symptom recurrence in ST-segment elevation myocardial infarction patients after revascularization.
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    ABSTRACT: The purpose of the study was to investigate dual-phase MDCT for assessing obstructive lesions and the extent and severity of the subtending myocardium at risk in patients presenting with chest pain syndromes 9 or more months after having undergone revascularization for the treatment of ST-segment elevation myocardial infarction (STEMI). Dual-phase 64-MDCT was performed on 135 patients with recurring chest symptoms 9 months or more after revascularization (mean ± SD, 23 ± 11 months after index invasive angiogram for treatment of STEMI). Obstructive lesions (≥ 50% stenosis) were detected by MDCT angiography and the extent of myocardium at risk was detected by delayed phase 3D myocardium maps. A myocardium at-risk score based on MDCT findings was defined as the extent of myocardium at risk governed by the coronary lesion and weighted by lesion severity. Results were compared with stress-redistribution (201)Tl-SPECT and invasive angiography. In restenotic, new, progressive, and previously obstructive lesions that are not currently progressive, analysis of assessable segments (1966/2025, 97.1%) obtained true-positive detection rates of 88.1%, 88.6%, 82.9%, and 100%, respectively; false-negative detection rates were 5.3%, 1.6%, 2.9%, and 8.8%. In 124 patients (91.9%) in whom all segments were assessable, the MDCT-based myocardium at-risk score correlated with the SPECT-based summed difference score (SDS) (r = 0.841, p < 0.001). For detecting SPECT-based SDS ≥ 1 and SDS > 3, areas under the receiver operating characteristic curve for the MDCT-based myocardium at-risk score were 0.874 (95% CI, 0.805-0.942) and 0.938 (95% CI, 0.895-0.981), with optimal cutoff values of 2.68 and 5.01, respectively. Dual-phase MDCT is useful in detecting different patterns of obstructive lesions and the extent of myocardium at risk as an alternative for therapeutic planning in patients presenting with late symptoms after treatment for acute myocardial infarction.
    American Journal of Roentgenology 03/2012; 198(3):548-62. · 2.78 Impact Factor
  • Article: Diffuse tensor cardiac MRI evaluation of fiber architecture of athlete hypertrophic heart in vivo.
    Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:P170. · 3.72 Impact Factor
  • Article: Numerical study for blood flow in pulmonary arteries after repair of tetralogy of fallot.
    Ming-Jyh Chern, Ming-Ting Wu, Sheau-Wei Her
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    ABSTRACT: Pulmonary regurgitation (PR) is a common phenomenon in pulmonary arteries in patients after repair of tetralogy of Fallot (TOF). The regurgitation fraction of left pulmonary artery (LPA) is usually greater than right pulmonary artery (RPA) according to clinic data. It may be related to blood flow in pulmonary arteries. Therefore, understanding hemodynamics in pulmonary arteries helps to comprehend the reason. The aim of this study is to use 3D reconstructed pulmonary artery models from magnetic resonance imaging (MRI) and to use numerical approaches for simulation of flow variations in pulmonary arteries after repair of TOF. From the numerical results, the blood flow is influenced by the bifurcation angles and geometry of pulmonary artery. The regurgitation happens first in LPA after repair of TOF due to the small angle between LPA and main pulmonary artery (MPA). The recirculation region which obstructs forward blood flow to the left lung is found in LPA during acceleration of systole. We also analyze the pressure distribution; the extreme pressure variations are in dilation area of MPA. Numerical data including regurgitation in MPA, LPA, and RPA are compared with phase contrast MR measured data. Good agreements are found between numerical results and measured data.
    Computational and Mathematical Methods in Medicine 01/2012; 2012:198108. · 0.68 Impact Factor
  • Article: Validation of ordinal scoring of coronary artery calcification on low-dose CT images.
    Ming-Ting Wu, Yi-Luan Huang
    Radiology 05/2011; 259(2):610; author reply 610. · 5.73 Impact Factor
  • Article: Intramural blood pools accompanying aortic intramural hematoma: CT appearance and natural course.
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    ABSTRACT: To evaluate multidetector computed tomographic (CT) images to investigate the prevalence, morphology, natural course, and prognostic effect of intramural blood pools (IBPs) in patients with acute intramural hematoma (IMH). Institutional review board approval and written informed consent were obtained. Sixty-five patients (41 men; mean age, 65.9 years ± 11.3 [standard deviation]) with acute IMH undergoing three or more multidetector CT examinations during follow-up for 12 months or longer (median = 18 months), except for those undergoing surgery (n = 16), were enrolled. Associated factors of developing and resorption of IBP in IMH were analyzed by using logistic regression. There were 40 IBPs in 10 patients at initial multidetector CT, and 15 new IBPs developed in 11 patients during follow-up. IBPs occurred most in the descending thoracic (55% [31 of 56]) and abdominal (41% [23 of 56]) aorta in 28% (18 of 65) of patients. During 33.8 months (range, 2.8-50 months) of follow-up in these 18 patients, 57% (32 of 56) of IBPs showed complete resorption in 15 patients, 29% (16 of 56) of IBPs showed incomplete resorption in eight patients, and 14% (eight of 56) of IBPs had interrupted follow-up because of surgery or death in three patients. Logistic regression showed that age younger than 70 years (odds ratio [OR], 8.74; 95% confidence interval [CI]: 1.03, 76.9) and IMH wall thickness greater than 10 mm (OR, 4.93; 95% CI: 1.04, 23.0) were associated with developing IBP at initial multidetector CT, while IBP with larger transmural diameter (OR, 1.16; 95% CI: 1.02, 1.31) and multidetector CT-demonstrated connection with intercostal or lumbar artery (63% [35 of 56]) (OR, 5.44; 95% CI: 1.43, 20.9) were associated with incomplete resorption. IBPs are frequently observed at multidetector CT in patients with IMH. They may resolve over time or appear during follow-up. These findings are not associated with a poor prognosis, and IBPs should be distinguished from ulcerlike projections.
    Radiology 03/2011; 258(3):705-13. · 5.73 Impact Factor
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    Article: Congenital left ventricular diverticulum in a patient with coronary artery disease.
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    ABSTRACT: Congenital ventricular diverticulum is rare. We present the case of a 76-year-old man who underwent cardiac multidetector computed tomography (MDCT) for recent intermittent chest pain. Obstructive single-vessel coronary artery disease was diagnosed. A left ventricular diverticulum of about 10 x 9 mm was found incidentally. Conventional angiography confirmed both diagnoses. Ventricular diverticulum may be more frequently found in the era of cardiac MDCT and should be differentiated from postinfarct (pseudo)-aneurysm.
    Journal of the Chinese Medical Association 08/2010; 73(8):441-3. · 0.79 Impact Factor
  • Article: Role of multi-slice and three-dimensional computed tomography in delineating extracardiac vascular abnormalities in neonates.
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    ABSTRACT: Recent advances in multi-slice computed tomography (MSCT) and three-dimensional computed tomography (3D CT) provide good-resolution images and short scan time for complete diagnosis of congenital heart disease (CHD). In the present study, we found that MSCT rapidly provides clinically relevant information for diagnosing extracardiac vascular anatomy in neonates with CHD. It is less invasive, necessitating only minimum or no sedation and a relatively small amount of contrast material. These advantages are crucial, especially for critically ill neonates. Between January 2007 and December 2008, MSCT scans were conducted on 41 neonates who were admitted to our neonatal intensive care unit. All the neonates were suspected to have complex CHD after an initial echocardiography examination. The scans were focused on detecting extracardiac vascular anatomy and abnormalities. All the image data sets were sent to image processing workstations for multiplanar interactive viewing and 3D reconstruction. High-resolution MSCT scan images were obtained from 41 patients. Reported indications and findings of extracardiac abnormalities and related structural anatomy pertaining to congenital heart disease from MSCT and 3D CT findings were confirmed by clinical and surgical findings by a team of multidisciplinary congenital heart disease specialists. Based on clinical and surgical confirmation of the MSCT scan results from a multidisciplinary congenital heart disease specialist team, we concluded that adequate information on CHD, specifically that regarding extracardiac abnormalities of the anatomy, can be obtained and MSCT can be used to replace cardiac catheterization.
    Pediatrics & Neonatology 08/2010; 51(4):227-34. · 0.75 Impact Factor
  • Article: Stimulated echo induced misestimates on diffusion tensor indices and its remedy.
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    ABSTRACT: To report possible erroneous estimates of diffusion parameters in the twice-refocused spin-echo (TRSE) technique, proposed to eliminate eddy-current-induced geometric distortions in diffusion-weighted echo-planar imaging, when stimulated echo signals are inappropriately included. Eleven subjects were included for imaging experiments on two 1.5 Tesla systems using the TRSE sequence. Three versions, two with unbalanced crusher gradients inserted to dephase the stimulated echo from the b = 0 images and one with balanced crusher gradients, were implemented. The apparent diffusion coefficients (ADC) and fractional anisotropy (FA) were derived and compared. The ADCs obtained with unbalanced crusher gradients were closer to values reported in the literature. Stimulated echo led to ADC over-estimations by 34.2%, 50.4%, 54.0%, 51.5%, 24.0%, and 41.9% in the genu of corpus callosum, splenium of corpus callosum, bilateral corona radiata, internal capsule, mediofrontal gyrus, and the cuneus, respectively (P < 0.01), with concomitant reduction in FA in highly anisotropic regions. Over-estimations of diffusion coefficients were found to be roughly equal along all directions. Formation of stimulated echo in the TRSE technique can lead to erroneous estimations of the diffusion parameters, even if no prominent morphological artifacts are seen.
    Journal of Magnetic Resonance Imaging 06/2010; 31(6):1522-9. · 2.70 Impact Factor
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    Article: Short-TE proton magnetic resonance spectroscopy investigation in adolescents with attention-deficit hyperactivity disorder.
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    ABSTRACT: In this study, short echo time (1)H-magnetic resonance spectroscopy (MRS) was applied for quantification of neurometabolites using the LC Model algorithm in Taiwanese adolescents with attention-deficit hyperactivity disorder (ADHD). Proton magnetic resonance spectra were acquired bilaterally on the prefrontal area (part of the anterior cingulate gyrus and part of the medial frontal gyrus) in 15 adolescents with ADHD (average age of 13.88years) and 22 controls (average age of 14.85years). Absolute metabolite levels and ratios relative to creatine plus phosphocreatine (Cr+PCr) were obtained to be compared between groups. Results showed that adolescents with ADHD had significantly lower mean right prefrontal levels of Cr+PCr as compared with the controls. No significant differences between groups were noted in the remainder of the prefrontal metabolites. As for the group comparison of relative ratios, the N-acetylaspartate/Cr+PCr ratio was significantly higher in the right prefrontal regions of ADHD adolescents. This finding provides evidence of a right prefrontal neurochemical alteration in ADHD adolescents, which is consistent with current ADHD theory of prefrontal neuropathology with developmental mechanism. In addition, it highlights the importance of the method in interpretation of MRS findings in the context of ADHD.
    Psychiatry Research 02/2010; 181(3):199-203. · 2.52 Impact Factor
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    Article: Dissection of arteria lusoria by transradial coronary catheterization: a rare complication evaluated by multidetector CT.
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    ABSTRACT: An aberrant right subclavian artery (arteria lusoria) arising from the descending thoracic aorta is an uncommon congenital variant that occurs in about 0.2-1.7% of the population. In such cases, the angular course of the arteria lusoria to the ascending aorta imposes difficulty in passing a guide wire to the ascending aorta during right transradial catheterization. Here, we present the first report of an iatrogenic dissection of arteria lusoria during transradial coronary angiography evaluated by multidetector computed tomography. Computed tomography is useful for assessing the severity and extension of the dissection to guide the clinical management of this complication.
    Journal of the Chinese Medical Association 08/2009; 72(7):379-81. · 0.79 Impact Factor
  • Article: Dual-phase multi-detector computed tomography assesses jeopardised and infarcted myocardium subtending infarct-related artery early after acute myocardial infarction.
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    ABSTRACT: To investigate dual-phase multi-detector computed tomography (MDCT) for assessing extent and severity of jeopardised and infarcted myocardium subtended by infarct-related artery (IRA), and its indication for revascularisation after acute myocardial infarction (AMI). Designs, setting and Prospective, single-centre study included 107 patients with uncomplicated post-AMI 3-7 days, who met criteria and underwent dual-phase 64-slice MDCT. IRA, culprit lesion and extent of jeopardised/infarcted myocardium were assessed by three-dimensional (3D) volume-rendered images with myocardium maps and computed tomography angiography (CTA), compared with stress-redistribution thallium-201 single-photon emission computed tomography (SPECT) plus conventional coronary angiography (CCA). MDCT-jeopardised score (severity of jeopardised myocardium) was defined as extent of jeopardised myocardium multiplied by the weighted factor dependent on culprit lesion severity compared with SPECT-SRS (summation of segmental reversible score). The IRA indication for revascularisation was evaluated by MDCT-jeopardised score plus CTA. SPECT-SRS > or =2 plus CCA-culprit lesion > or =50% was the standard reference. The presence of MDCT-delayed enhancement was found in 101 (94.4%) patients. The IRA and culprit lesion were identified in 99 (92.5%) patients by MDCT-myocardium maps plus CTA. The concordance between MDCT and SPECT for detecting infarcted myocardium was good (kappa = 0.702). The correlation between MDCT-jeopardised score and SPECT-SRS was 0.741. The correlation between CTA and CCA for culprit lesion severity was 0.85. The sensitivity, specificity, negative and positive predictive values of MDCT-jeopardised score > or =2.5 plus CTA for indicating revascularisation were 90.2%, 80.4%, 86.0% and 85.9%, respectively. Dual-phase MDCT has good accuracy for identifying IRA, and assessing infarcted and jeopardised myocardium for clinical relevance. It provides an alternative for triage and therapeutic planning in post-AMI.
    Heart (British Cardiac Society) 07/2009; 95(18):1495-501. · 4.22 Impact Factor
  • Article: Absence of gender effect on children with attention-deficit/hyperactivity disorder as assessed by optimized voxel-based morphometry.
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    ABSTRACT: Brain abnormalities, as determined by structural magnetic resonance imaging (MRI), have been reported in patients with attention-deficit hyperactivity disorder (ADHD); however, female subjects have been underrepresented in previous reports. In this study, we used optimized voxel-based morphometry to compare the total and regional gray matter volumes between groups of 7- to 17-year-old ADHD and healthy children (total 114 subjects). Fifty-seven children with ADHD (n=57, 35 males and 22 females) and healthy children (n=57) received MRI scans. Segmented brain MRI images were normalized into standardized stereotactic space, modulated to allow volumetric analysis, smoothed and compared at the voxel level with statistical parametric mapping. Global volumetric comparisons between groups revealed that the total brain volumes of ADHD children were smaller than those of the control children. As for the regional brain analysis, the brain volumes of ADHD children were found to be bilaterally smaller in the following regions as compared with normal control values: the caudate nucleus and the cerebellum. There were two clusters of regional decrease in the female brain, left posterior cingulum and right precuneus, as compared with the male brain. Brain regions showing the interaction effect of diagnosis and gender were negligible. These results were consistent with the hypothesized dysfunctional systems in ADHD, and they also suggested that neuroanatomical abnormalities in ADHD were not influenced by gender.
    Psychiatry Research 01/2009; 164(3):245-53. · 2.52 Impact Factor
  • Article: Sequential changes of myocardial microstructure in patients postmyocardial infarction by diffusion-tensor cardiac MR: correlation with left ventricular structure and function.
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    ABSTRACT: We used diffusion-tensor cardiac MR to investigate myocardial microstructure changes, including tissue integrity (mean diffusivity [MD], fractional anisotropy) and fiber architecture (helix angles) in patients with recent myocardial infarction (MI). This study aimed to investigate the sequential changes of myocardial microstructure and its relationships with changes of macrostructure and function of the left ventricle post-MI. Seventeen patients (age, 55.1+/-11.5 years; all men) participated in the follow-up study. Diffusion-tensor cardiac MR, cine gradient echo for left ventricle function, and late gadolinium enhancement for viability were measured from recent to chronic MI (median interval, 191 days). When compared with the remote zone, the infarct-adjacent zone showed overall increase of MD (2-way MANOVA, F(1,16)=36.3; P<0.001), decrease of fractional anisotropy (F(1,16)=5.8; P=0.029), and decrease of mean helix angles (F(1,16)=62.0; P<0.001). From recent to chronic MI, there was overall sequential decrease of MD (F(1,16)=22.6; P<0.001) and increase of fractional anisotropy (F(1,16)=7.8; P=0.013). Multiple linear regression showed that the improvement of wall thickening in the infarct-adjacent zone correlated with sequential decrease of MD in the infarct-adjacent zone (r=-0.70; P=0.002) and increase of mean helix angles (ie, more right-handed helical myofiber reorientation, predominantly subendocardial location) in the remote zone (r=0.60; P=0.011). Likewise, wall thickening in the remote zone correlated with MD in the remote zone (r=-0.72; P=0.001) and mean helix angles in the infarct-adjacent zone (r=0.72; P=0.001). Diffusion-tensor cardiac MR suggests that sequential zonal improvement of tissue integrity and fiber architecture remodeling both associate with sequential recovery of zonal wall thickening of the left ventricle from recent to chronic MI.
    Circulation Cardiovascular Imaging 01/2009; 2(1):32-40, 6 p following 40. · 5.94 Impact Factor
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    Article: Effects of interpolation methods in spatial normalization of diffusion tensor imaging data on group comparison of fractional anisotropy.
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    ABSTRACT: This study investigated the effects on the measurement of fractional anisotropy (FA) during interpolation of diffusion tensor images in spatial normalization, which is required for voxel-based statistics. Diffusion tensor imaging data were obtained from nine male patients with attention deficit/hyperactivity disorder and nine age-matched control subjects. Regions of interest were selected from the genu of corpus callosum (GCC) and the right anterior corona radiata (RACR), with FA values measured before and after spatial normalization using two interpolation algorithms: linear and rotationally linear. Computer simulations were performed to verify the experimental findings. Between-group difference in FA was observed in the GCC and RACR before spatial normalization (P<.00001). Interpolation reduced the measured FA values significantly (P<.00001 for both algorithms) but did not affect the group difference in the GCC. For the RACR, the between-group difference vanished (P=.968) after linear interpolation but was relatively unaffected by using rotationally linear interpolation (P=.00001). FA histogram analysis and computer simulations confirmed these findings. This work suggests that caution should be exercised in voxel-based group comparisons as spatial normalization may affect the FA value in nonnegligible degrees, particularly in brain areas with predominantly crossing fibers.
    Magnetic Resonance Imaging 12/2008; 27(5):681-90. · 1.99 Impact Factor
  • Article: Comparing culprit lesions in ST-segment elevation and non-ST-segment elevation acute coronary syndrome with 64-slice multidetector computed tomography.
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    ABSTRACT: Classifying acute coronary syndrome (ACS) as ST elevation ACS (STE-ACS) or non-ST elevation ACS (NSTE-ACS) is critical for clinical prognosis and therapeutic decision-making. Assessing the differences in composition and configuration of culprit lesions between STE-ACS and NSTE-ACS can clarify their pathophysiologic differences. This study focused on evaluating the ability of 64-slice multidetector computed tomography (MDCT) to investigate these differences in culprit lesions in patients with STE-ACS and NSTE-ACS. Of 161 ACS cases admitted, 120 who fit study criteria underwent MDCT and conventional coronary angiography. The following MDCT data were analyzed: calcium volume, Agatston calcium scores, plaque area, plaque burden, remodeling index, and plaque density. The MDCT angiography had a good correlation with conventional coronary angiography regarding the stenotic severity of culprit lesions (r=0.86, p<0.001). The STE-ACS culprit lesions (n=54) had significantly higher luminal area stenosis (78.6+/-21.2% vs. 66.7+/-23.9%, p=0.006), larger plaque burden (0.91+/-0.10 vs. 0.84+/-0.12, p=0.007) and remodeling index (1.28+/-0.34 vs. 1.16+/-0.22, p=0.021) than those with NSTE-ACS (n=66). The percentage of expanding remodeling index (remodeling index >1.05) was significantly higher in the STE-ACS group (81.5% vs. 63.6%, p=0.031). The patients with STE-ACS had significantly lower MDCT density of culprit lesions than patients with NSTE-ACS (25.8+/-13.9HU vs. 43.5+/-19.1HU, p<0.001). Sixty-four-slice MDCT can accurately evaluate the stenotic severity and composition of culprit lesions in selected patients with either STE-ACS or NSTE-ACS. Culprit lesions in NSTE-ACS patients had significantly lower luminal area stenosis, plaque burden, remodeling index and higher MDCT density, which possibly reflect differences in the composition of vulnerable culprit plaques and thrombi.
    European journal of radiology 11/2008; 73(1):74-81. · 2.65 Impact Factor
  • Article: Numerical investigation of regurgitation phenomena in pulmonary arteries of Tetralogy of Fallot patients after repair.
    Ming-Jyh Chern, Ming-Ting Wu, Hong-Lin Wang
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    ABSTRACT: Pulmonary regurgitation is a very common phenomenon in pulmonary arteries after repair of patients of Tetralogy of Fallot (TOF) which is the most common complex congenital heart diseases. The aim of this study is to use numerical approaches to simulate flow variations in pulmonary artery after repair of patients of TOF. We analyze the flow patterns in an in-vitro bifurcation pulmonary artery and consider effects of various regurgitation fractions (RF or b/f) in left pulmonary artery (LPA) and right pulmonary artery (RPA). We not only observe the variation of flow patterns, but also analyze the results of b/f and net volumetric flow rates in LPA and RPA. In general, the b/f of LPA is higher than RPA in the measured data provided by phase-contrast magnetic resonance imaging (PC-MRI). We validate the result using numerical approaches to analyze the flow patterns in pulmonary artery in this study. The results will be useful for medical doctors when they perform operations for TOF patients.
    Journal of Biomechanics 10/2008; 41(14):3002-9. · 2.43 Impact Factor