[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: -Fast, noninvasive identification of ischemic territories at rest (prior to tissue-specific changes) and assessment of functional status can be valuable in the management of severe coronary artery disease. This study investigated the utility of cardiac phase-resolved Blood-Oxygen-Level-Dependent (CP-BOLD) CMR in detecting myocardial ischemia at rest secondary to severe coronary artery stenosis. METHODS AND RESULTS: -CP-BOLD, standard-cine, and T(2)-weighted images were acquired in canines (n=11) at baseline and within 20 minutes of ischemia induction (severe LAD stenosis) at rest. Following 3-hours of ischemia, LAD stenosis was removed and T(2)-weighted and late-gadolinium-enhancement (LGE) images were acquired. From standard-cine and CP-BOLD images, End-Systolic (ES) and End-Diastolic (ED) myocardium were segmented. Affected and remote sections of the myocardium were identified from post-reperfusion LGE images. S/D, quotient of mean ES and ED signal intensities (on CP-BOLD and standard-cine), was computed for affected and remote segments at baseline and ischemia. Ejection fraction (EF) and segmental wall-thickening (sWT) were derived from CP-BOLD images at baseline and ischemia. On CP-BOLD images: S/D was greater than 1 (remote and affected territories) at baseline; S/D was diminished only in affected territories during ischemia and the findings were statistically significant (ANOVA, post-hoc p<0.01). The dependence of S/D on ischemia was not observed in standard-cine images. Computer simulations confirmed the experimental findings. ROC analysis showed that S/D identifies affected regions with similar performance (AUC:0.87) as EF (AUC:0.89) and sWT (AUC:0.75). CONCLUSIONS: -Preclinical studies and computer simulations showed that CP-BOLD CMR could be useful in detecting myocardial ischemia at rest. Patient studies are needed for clinical translation.
[Show abstract][Hide abstract] ABSTRACT: To investigate whether a statistical analysis of myocardial blood-oxygen-level-dependent (mBOLD) signal intensities can lead to the identification and quantification of the ischemic area supplied by the culprit artery.
Cardiac BOLD images were acquired in a canine model (n = 9) with controllable LCX stenosis at rest and during adenosine infusion on a 1.5T clinical scanner. Statistical distributions of myocardial pixel-intensities derived from BOLD images were used to compute an area metric (ischemic extent, IE). True myocardial perfusion was estimated from microsphere analysis. IE was compared against a standard metric (segment-intensity-response, SIR). Additional animals (n = 3) were used to investigate the feasibility of the approach for identifying ischemic territories due to LAD stenosis from mBOLD images.
Regression analyses showed that IE and myocardial flow ratio between rest and adenosine infusion (MFR) were exponentially related (R(2) > 0.70, P < 0.001, for end-systole and end-diastole), while SIR and MFR were linearly related to end-systole (R(2) = 0.51, P < 0.04) and unrelated to end-diastole (R(2) ≈ 0, P = 0.91). Receiver-operating-characteristic analysis that IE was superior to SIR for detecting critical stenosis (MFR ≤ 2) in end-systole and end-diastole. Feasibility studies on LAD narrowing demonstrated that the proposed approach could also identify oxygenation changes in the LAD territories.
The proposed evaluation of cardiac BOLD magnetic resonance imaging (MRI) offers marked improvement in sensitivity and specificity for detecting critical coronary stenosis at 1.5T compared to the mean segmental intensity approach. Patient studies are now warranted to determine its clinical utility.
Journal of Magnetic Resonance Imaging 06/2012; 35(6):1338-48. DOI:10.1002/jmri.23577 · 2.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The biophysical mechanisms influencing balanced steady-state free precession (bSSFP) based edema imaging in the setting of acute myocardial infarction are not well understood. To assess the various mechanisms that enable the detection of myocardial edema on bSSFP-based imaging approaches (cine bSSFP and T(2)-prepared bSSFP), experiments were conducted in canine models subjected to ischemia-reperfusion injury. Results showed that in addition to relaxation effects, the alteration in thermal equilibrium (M(0)) (including magnetization transfer) has a significant contribution to the image contrast between edematous and healthy myocardium. The relative signal-intensity ratios between edematous and healthy myocardium were: 1.51 ± 0.18 (cine bSSFP) and 1.58 ± 0.20 (T(2)-prepared bSSFP); the theoretically estimated relative relaxation and M(0) effects were: 1.17 ± 0.09 and 1.30 ± 0.19, respectively (cine bSSFP), and 1.49 ± 0.23 and 1.06 ± 0.07, respectively (T(2)-prepared bSSFP). There were no significant difference between cine bSSFP and T(2)-prep bSSFP relative signal-intensity ratios. However, the relative relaxation effect in cine bSSFP was significantly lower than in T(2)-prep bSSFP (P < 0.05), and the M(0) effect in cine bSSFP was significantly higher than in T(2)-prep bSSFP (P < 0.05). Hence the acquisition strategies that wish to maximize myocardial edema contrast in cine bSSFP imaging should take both relaxation and M(0) effects into account.
Magnetic Resonance in Medicine 07/2011; 66(1):187-91. DOI:10.1002/mrm.22794 · 3.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Flow-sensitive dephasing (FSD) magnetization preparation has been developed for black-blood vessel wall MRI and noncontrast MR angiography. The first-order gradient moment, m(1) , is a measure of the flow-sensitization imparted by an FSD preparative module. Determination of the optimal m(1) for each individual is highly desirable for FSD-prepared MR angiography. This work developed a 2D m(1)-scouting method that evaluates a range of m(1) values for their effectiveness in blood signal suppression in a single scan. The feasibility of using the 2D method to predict blood signal suppression in 3D FSD-prepared imaging was validated on a flow phantom and the popliteal arteries of 5 healthy volunteers. Excellent correlation of the blood signal measurements between the 2D scouting and 3D FSD imaging was obtained. Therefore, the optimal m(1) determined from the 2D m(1)-scouting scan may be directly translated to 3D FSD-prepared imaging. In vivo studies of additional 10 healthy volunteers and 2 patients have demonstrated the proposed method can help significantly improve the signal performance of FSD MR angiography, indicating its potential to enhance diagnostic confidence. Further systematic studies in patients are warranted to evaluate its clinical value.
Magnetic Resonance in Medicine 04/2011; 65(4):964-72. DOI:10.1002/mrm.22847 · 3.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the contribution of proton density (PD) in T(2) -STIR based edema imaging in the setting of acute myocardial infarction (AMI).
Canines (n = 5), subjected to full occlusion of the left anterior descending artery for 3 hours, underwent serial magnetic resonance imaging (MRI) studies 2 hours postreperfusion (day 0) and on day 2. During each study, T(1) and T(2) maps, STIR (TE = 7.1 msec and 64 msec) and late gadolinium enhancement (LGE) images were acquired. Using T(1) and T(2) maps, relaxation and PD contributions to myocardial edema contrast (EC) in STIR images at both TEs were calculated.
Edematous territories showed significant increase in PD (20.3 ± 14.3%, P < 0.05) relative to healthy territories. The contributions of T(1) changes and T(2) or PD changes toward EC were in opposite directions. One-tailed t-test confirmed that the mean T(2) and PD-based EC at both TEs were greater than zero. EC from STIR images at TE = 7.1 msec was dominated by PD than T(2) effects (94.3 ± 11.3% vs. 17.6 ± 2.5%, P < 0.05), while at TE = 64 msec, T(2) effects were significantly greater than PD effects (90.8 ± 20.3% vs. 12.5 ± 11.9%, P < 0.05). The contribution from PD in standard STIR acquisitions (TE = 64 msec) was significantly higher than 0 (P < 0.05).
In addition to T(2) -weighting, edema detection in the setting of AMI with T(2) -weighted STIR imaging has a substantial contribution from PD changes, likely stemming from increased free-water content within the affected tissue. This suggests that imaging approaches that take advantage of both PD as well as T(2) effects may provide the optimal sensitivity for detecting myocardial edema.
Journal of Magnetic Resonance Imaging 04/2011; 33(4):962-7. DOI:10.1002/jmri.22456 · 2.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate whether dynamic alterations in high-energy phosphate (HEP) occur in postischemic "stunned" myocardium (SM) in canine model and to investigate the correlation between HEP and cardiac function, using cine magnetic resonance imaging (cine-MRI) and phosphorus-31 magnetic resonance spectroscopy (31P-MRS).
Dogs (n = 13) underwent cine MRI and 31P-MRS at 60 minutes, 8 days after 10 minutes full left anterior descending occlusion followed by reperfusion. The same MRI/MRS experiments were repeated on 5 reference animals (dogs without ischemic reperfusion) at the same time points to serve as internal reference myocardium (RM). After MR data acquisitions, the SM dogs (n = 3 at 60 minutes; n = 10 at 60 minutes and day 8) and RM dogs (n = 5) were euthanized and myocardial tissues were sampled for histologic study by triphenyltetrazolium chloride staining, hematoxylin and eosin staining, and electron microscopic examination.
The myocardial stunning at 60 minutes was confirmed by electron microscopy examinations from the 3 randomly chosen animals with SM. The phosphocreatine (PCr)/β- adenosine triphosphate (ATP) ratio of SM was significantly lower at 60 minutes than that at day 8 (1.07 ± 0.20 vs. 1.97 ± 0.28, P < 0.05). However, no significant difference was found between 60 minutes and day 8 in RM group (1.91 ± 0.14 at 60 minutes vs. 1.89 ± 0.16 at day 8, P > 0.05). At 60 minutes, the PCr/β-ATP ratio has significant difference between SM and RM groups; while at day 8, the ratio shows no significant difference between the 2 groups. The same results were obtained for left ventricle ejection fraction (LVEF). In SM group, LVEF has good correlation with myocardial PCr/β-ATP ratios at 60 minutes (R2 = 0.71, P < 0.05) and at day 8 (R2 = 0.73, P < 0.05), respectively.
The HEP alterations were confirmed by 31P-MRS in SM and there is a good correlation between PCr/β-ATP ratio and LVEF for SM at 60 minutes and recovered myocardium at day 8. The combined MRS/MRI method offers the potential to systematically assess the cardiac function, morphology, and metabolism of SM. These MRS/MRI biomarker datasets could be used to dynamically monitor therapeutic efficiency and predict cardiac events.
[Show abstract][Hide abstract] ABSTRACT: Previous studies investigated the effect of successful coronary artery bypass grafting (CABG) upon left ventricular function. The relationship between myocardial metabolism and heart function after CABG remains unclear. We investigated the relationship between high-energy phosphate (HEP) and cardiac function following CABG using cine magnetic resonance imaging (cine-MRI) and phosphorus-31 magnetic resonance spectroscopy (31P-MRS). A retrospective study was approved by the institutional review board. MRI and 31P-MRS examinations were reviewed of 37 patients with multivessel disease who underwent CABG. 13 of these patients selected for the retrospective analysis had ≥70% stenosis in the proximal left anterior descending artery (LAD) and left ventricular ejection fraction (LVEF) <40%. LVEF was evaluated using cine-MRI. HEP such as phosphocreatine (PCr) and adenosine triphosphate (β-ATP) was measured using 31P-MRS to calculate PCr/β-ATP ratio. Cine-MRI and 31P-MRS measurements were performed before and after CABG, respectively. Ten normal healthy volunteers served as controls. 31P-MRS in 13 patients showed that post-CABG PCr/β-ATP ratio was significantly higher than that of pre-CABG (pre-CABG vs. post-CABG, 1.43±0.24 vs. 1.71±0.29, P<.05), but both ratios were significantly lower than control group (2.13±0.21, P<.05). With the change of the ratio, the left ventricle function was significantly improved (LVEF: pre-CABG vs. post-CABG: 35.7±12.9 vs. 45.6±17.2, P<.05). The ability of 31P-MRS and cine-MRI to non-invasively assess changes of metabolism and function in myocardium may prove important for patient-specific optimization of treatment strategies.
[Show abstract][Hide abstract] ABSTRACT: Previous studies investigated the effect of successful coronary artery bypass grafting (CABG) upon left ventricular function. The relationship between myocardial metabolism and heart function after CABG remains unclear. We investigated the relationship between high-energy phosphate (HEP) and cardiac function following CABG using cine magnetic resonance imaging (cine-MRI) and phosphorus-31 magnetic resonance spectroscopy ((31)P-MRS). A retrospective study was approved by the institutional review board. MRI and (31)P-MRS examinations were reviewed of 37 patients with multivessel disease who underwent CABG. 13 of these patients selected for the retrospective analysis had >or=70% stenosis in the proximal left anterior descending artery (LAD) and left ventricular ejection fraction (LVEF) <40%. LVEF was evaluated using cine-MRI. HEP such as phosphocreatine (PCr) and adenosine triphosphate (beta-ATP) was measured using (31)P-MRS to calculate PCr/beta-ATP ratio. Cine-MRI and (31)P-MRS measurements were performed before and after CABG, respectively. Ten normal healthy volunteers served as controls. (31)P-MRS in 13 patients showed that post-CABG PCr/beta-ATP ratio was significantly higher than that of pre-CABG (pre-CABG vs. post-CABG, 1.43+/-0.24 vs. 1.71+/-0.29, P<.05), but both ratios were significantly lower than control group (2.13+/-0.21, P<.05). With the change of the ratio, the left ventricle function was significantly improved (LVEF: pre-CABG vs. post-CABG: 35.7+/-12.9 vs. 45.6+/-17.2, P<.05). The ability of (31)P-MRS and cine-MRI to non-invasively assess changes of metabolism and function in myocardium may prove important for patient-specific optimization of treatment strategies.
Magnetic Resonance Imaging 05/2010; 28(7):936-42. DOI:10.1016/j.mri.2010.03.040 · 2.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To minimize image artifacts in long TR cardiac phase-resolved steady state free precession (SSFP) based blood-oxygen-level-dependent (BOLD) imaging.
Nine healthy dogs (four male, five female, 20-25 kg) were studied in a clinical 1.5 Tesla MRI scanner to investigate the effect of temporal resolution, readout bandwidth, and motion compensation on long repetition time (TR) SSFP images. Breath-held 2D SSFP cine sequences with various temporal resolutions (10-204 ms), bandwidths (239-930 Hz/pixel), with and without first-order motion compensation were prescribed in the basal, mid-ventricular, and apical along the short axis. Preliminary myocardial BOLD studies in dogs with controllable coronary stenosis were performed to assess the benefits of artifact-reduction strategies.
Shortening the readout time by means of increasing readout bandwidth had no observable reduction in image artifacts. However, increasing the temporal resolution in the presence of first-order motion compensation led to significant reduction in image artifacts. Preliminary studies demonstrated that BOLD signal changes can be reliably detected throughout the cardiac cycle.
Artifact-reduction methods used in this study provide significant improvement in image quality compared with conventional long TR SSFP BOLD MRI. It is envisioned that the methods proposed here may enable reliable detection of myocardial oxygenation changes throughout the cardiac cycle with long TR SSFP-based myocardial BOLD MRI.
Journal of Magnetic Resonance Imaging 04/2010; 31(4):863-71. DOI:10.1002/jmri.22116 · 2.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Myocardial blood oxygen level dependent, balanced steady-state free precession (bSSFP) imaging is a relatively new technique for evaluating myocardial oxygenation changes in the presence of coronary artery stenosis. However, the dependence of myocardial bSSFP blood oxygen level dependent signal on imaging parameters has not been well studied. In this work, modeling capillaries as cylinders that act as magnetic perturbers, the Monte Carlo method was used to simulate spin relaxation via diffusion in a field variation inside and outside blood vessels. bSSFP signal changes at various levels of capillary blood oxygen saturation, for a range of pulse repetition times, flip angle, capillary blood volume fraction, vessel wall permeability, water diffusion coefficient, vessel angle to static magnetic field, and the impact of bulk frequency shifts were studied. The theoretical dependence of bSSFP blood oxygen level dependent contrast on pulse repetition times and flip angle was confirmed by experiments in an animal model with controllable coronary stenosis. Results showed that, with the standard bSSFP acquisition, optimum bSSFP blood oxygen level dependent contrast could be obtained at pulse repetition times = 6.0 ms and flip angle = 70 degrees . Additional technical improvements that preserve the image quality may be necessary to further increase the myocardial bSSFP blood oxygen level dependent sensitivity at 1.5 T through even longer pulse repetition times.
Magnetic Resonance in Medicine 02/2010; 63(2):484-93. DOI:10.1002/mrm.22240 · 3.40 Impact Factor