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ABSTRACT: We have evaluated the use of deconvolution using an exponential approximation basis for the quantification of myocardial blood flow from perfusion cardiovascular magnetic resonance. Our experiments, based on simulated signal intensity curves, phantom acquisitions, and clinical image data, indicate that exponential deconvolution allows for accurate quantification of myocardial blood flow. Together with automated respiratory motion correction myocardial contour delineation, the exponential deconvolution enables efficient and reproducible quantification of myocardial blood flow in clinical routine.
IEEE transactions on bio-medical engineering 05/2012; 59(7):2060-7. · 2.15 Impact Factor
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C H P Jansen,
D Perera,
M R Makowski,
A J Wiethoff,
A Phinikaridou,
R M Razavi,
M S Marber,
G F Greil, E Nagel,
D Maintz,
S Redwood,
R M Botnar
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ABSTRACT: Persistent intracoronary thrombus after plaque rupture is associated with an increased risk of subsequent myocardial infarction and mortality. Coronary thrombus is usually visualized invasively by x-ray coronary angiography. Non-contrast-enhanced T1-weighted magnetic resonance (MR) imaging has been useful for direct imaging of carotid thrombus and intraplaque hemorrhage by taking advantage of the short T1 of methemoglobin present in acute thrombus and intraplaque hemorrhage. The aim of this study was to investigate the use of non-contrast-enhanced MR for direct thrombus imaging (MRDTI) in patients with acute myocardial infarction.
Eighteen patients (14 men; age, 61±9 years) underwent MRDTI within 24 to 72 hours of presenting with an acute coronary syndrome before invasive x-ray coronary angiography; MRDTI was performed with a T1-weighted, 3-dimensional, inversion-recovery black-blood gradient-echo sequence without contrast administration. Ten patients were found to have intracoronary thrombus on x-ray coronary angiography (left anterior descending, 4; left circumflex, 2; right coronary artery, 4; and right coronary artery-posterior descending artery, 1), and 8 had no visible thrombus. We found that MRDTI correctly identified thrombus in 9 of 10 patients (sensitivity, 91%; posterior descending artery thrombus not detected) and correctly classified the control group in 7 of 8 patients without thrombus formation (specificity, 88%). The contrast-to-noise ratio was significantly greater in coronary segments containing thrombus (n=10) compared with those without visible thrombus (n=131; mean contrast-to-noise ratio, 15.9 versus 2.6; P<0.001).
Use of MRDTI allows selective visualization of coronary thrombus in a patient population with a high probability of intracoronary thrombosis.
Circulation 07/2011; 124(4):416-24. · 14.74 Impact Factor
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ABSTRACT: Conventional quantitative assessments of myocardial perfusion analyze the temporal relation between the arterial input function and the myocardial signal intensity curves, thereby neglecting the important spatial relation between the myocardial signal intensity curves. The new method presented in this article enables characterization of sub-endocardial to sub-epicardial gradients in myocardial perfusion based on a two dimensional, "gradientogram" representation, which displays the evolution of the transmural gradient in myocardial contrast uptake over time in all circumferential positions of the acquired images. Moreover, based on segmentation in these gradientograms, several new measurements that characterize transmural myocardial perfusion distribution over time are defined. In application to clinical image data, the new two-dimensional representations, as well as the newly defined measurements revealed a clear distinction between normal perfusion and inducible ischaemia. Thus, the new measurements may serve as diagnostic markers for the detection and characterization of epicardial coronary and microvascular disease.
Magnetic Resonance in Medicine 05/2011; 66(5):1477-87. · 2.96 Impact Factor
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Current Cardiovascular Imaging Reports 01/2009; 2(2):83-84.
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W Y Kim,
P G Danias,
M Stuber,
S D Flamm,
S Plein, E Nagel,
S E Langerak,
O M Weber,
E M Pedersen,
M Schmidt,
R M Botnar,
W J Manning
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ABSTRACT: An accurate, noninvasive technique for the diagnosis of coronary disease would be an important advance. We investigated the accuracy of coronary magnetic resonance angiography among patients with suspected coronary disease in a prospective, multicenter study.
Coronary magnetic resonance angiography was performed during free breathing in 109 patients before elective x-ray coronary angiography, and the results of the two diagnostic procedures were compared.
A total of 636 of 759 proximal and middle segments of coronary arteries (84 percent) were interpretable on magnetic resonance angiography. In these segments, 78 (83 percent) of 94 clinically significant lesions (those with a > or = 50 percent reduction in diameter on x-ray angiography) were also detected by magnetic resonance angiography. Overall, coronary magnetic resonance angiography had an accuracy of 72 percent (95 percent confidence interval, 63 to 81 percent) in diagnosing coronary artery disease. The sensitivity, specificity, and accuracy for patients with disease of the left main coronary artery or three-vessel disease were 100 percent (95 percent confidence interval, 97 to 100 percent), 85 percent (95 percent confidence interval, 78 to 92 percent), and 87 percent (95 percent confidence interval, 81 to 93 percent), respectively. The negative predictive values for any coronary artery disease and for left main artery or three-vessel disease were 81 percent (95 percent confidence interval, 73 to 89 percent) and 100 percent (95 percent confidence interval, 97 to 100 percent), respectively.
Among patients referred for their first x-ray coronary angiogram, three-dimensional coronary magnetic resonance angiography allows for the accurate detection of coronary artery disease of the proximal and middle segments. This noninvasive approach reliably identifies (or rules out) left main coronary artery or three-vessel disease.
New England Journal of Medicine 12/2001; 345(26):1863-9. · 53.30 Impact Factor
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ABSTRACT: Diastolic dysfunction with delayed relaxation and abnormal passive elastic properties has been described in patients with severe pressure overload hypertrophy. The purpose of this study was to evaluate the time course of rotational motion of the left ventricle in patients with aortic valve stenosis using myocardial tagging.
Myocardial tagging is a non-invasive method based on magnetic resonance which makes it possible to label ('tag') specific myocardial regions. From the motion of the tag's cardiac rotation, radial displacement and translational motion can be determined. In 12 controls and 13 patients with severe aortic valve stenosis systolic and diastolic wall motion was assessed in an apical and basal short axis plane.
The normal left ventricle performs a systolic wringing motion around the ventricular long axis with clockwise rotation at the base (-4.4+/-1.6 degrees) and counter-clockwise rotation at the apex (+6.8+/-2.5 degrees) when viewed from the apex. During early diastole an untwisting motion can be observed which precedes diastolic filling. In patients with aortic valve stenosis systolic rotation is reduced at the base (-2.4+/-2.0 degrees; P<0.01) but increased at the apex (+12.0+/-6.0 degrees; P<0.05). Diastolic untwisting is delayed and prolonged with a decrease in normalized rotation velocity (-6.9+/-1.1 s(-1)) when compared to controls (-10.7+/-2.2 s(-1); P<0.001). Maximal systolic torsion is 8.0+/-2.1 degrees in controls and 14.1+/-6.4 degrees (P<0.01) in patients with aortic valve stenosis.
Left ventricular pressure overload hypertrophy is associated with a reduction in basal and an increase in apical rotation resulting in increased torsion of the ventricle. Diastolic untwisting is delayed and prolonged. This may explain the occurrence of diastolic dysfunction in patients with severe pressure overload hypertrophy.
European Heart Journal 04/2000; 21(7):582-9. · 10.48 Impact Factor
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ABSTRACT: Magnetic resonance (MRI) velocity mapping was used to evaluate non-invasively the flow profiles of the ascending aorta in normal volunteers and in patients with an aortic (mechanical) valve prosthesis.
In patients with artificial aortic valves the flow profile in the ascending aorta is severely altered. These changes have been associated with an increased risk of thrombus formation and mechanical hemolysis.
Velocity profiles were determined 30 mm distal to the aortic valve in six healthy volunteers and seven patients with aortic valve replacement (replacement within the last 2 years) using ECG triggered phase contrast MRI. Peak flow, mean flow and mean reverse flow were measured in intervals of 25 ms during the entire heart cycle. Systolic reverse flow, end-systolic closing and diastolic leakage volume were calculated for all subjects.
Peak flow velocity during mid-systole was significantly higher in patients with valvular prosthesis than in normals (mean + SD, 1.9 +/- 0.4 m/s vs. 1.2 +/- 0.03 m/s, P < 0.001) with a double peak and a zone of reversed flow close to the inner (left lateral) wall of the ascending aorta of the patients. Closing volume was significantly larger in patients than in controls (-3.3 +/- 1.2 ml/beat vs. -0.9 +/- 0.5 ml/beat; P < 0.001). There was reverse flow during systole in valvular patients amounting to 15.7 +/- 6.7% of total cardiac output compared to 2.3 +/- 1.2% in controls (P < 0.001). Diastolic mean flow was negative in patients after valve replacement but not in controls (-11.0 +/- 15.2 ml/beat vs. 6.8 +/- 3.2 ml/beat; P < 0.01).
The following three major quantitative observations have been made in the present study: (1) Mechanical valve prostheses have an increased peak flow velocity with a systolic reverse flow at the inner (left lateral) wall of the ascending aorta. (2) A double peak flow velocity pattern can be observed in patients with bileaflet (mechanical) prosthesis. (3) The blood volume required for leaflet closure and the diastolic leakage blood volume are significantly higher for the examined bileaflet valve than for native heart valves.
MAGMA Magnetic Resonance Materials in Physics Biology and Medicine 02/2000; 10(1):18-26. · 1.88 Impact Factor
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ABSTRACT: MR tissue tagging allows the noninvasive assessment of the locally and temporally resolved motion pattern of the left ventricle. Alterations in cardiac torsion and diastolic relaxation of the left ventricle were studied in patients with aortic stenosis and were compared with those of healthy control subjects and championship rowers with physiological volume-overload hypertrophy.
Twelve aortic stenosis patients, 11 healthy control subjects with normal left ventricular function, and 11 world-championship rowers were investigated for systolic and diastolic heart wall motion on a basal and an apical level of the myocardium. Systolic torsion and untwisting during diastole were examined by use of a novel tagging technique (CSPAMM) that provides access to systolic and diastolic motion data. In the healthy heart, the left ventricle performs a systolic wringing motion, with a counterclockwise rotation at the apex and a clockwise rotation at the base. Apical untwisting precedes diastolic filling. In the athlete's heart, torsion and untwisting remain unchanged compared with those of the control subjects. In aortic stenosis patients, torsion is significantly increased and diastolic apical untwisting is prolonged compared with those of control subjects or athletes.
Torsional behavior as observed in pressure- and volume-overloaded hearts is consistent with current theoretical findings. A delayed diastolic untwisting in the pressure-overloaded hearts of the patients may contribute to a tendency toward diastolic dysfunction.
Circulation 08/1999; 100(4):361-8. · 14.74 Impact Factor
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ABSTRACT: Changes of the left ventricle after myocardial infarction are characterized by geometric, structural, and vascular alterations, which have been summarized under the term "remodeling". This process takes place in the infarct region as well as in the surviving myocardium. Depending on to the size of infarction and the degree of neurohumoral activation, the left ventricle demonstrates diastolic dysfunction which may finally lead to systolic failure. The residual myocardium develops progressive myocyte hypertrophy and interstitial fibrosis. These structural alterations are due to changes in loading conditions and stimulation of the neurohumoral system with an activation of local paracrine and autocrine factors. Myocardial function can be assessed by different non-invasive (echocardiography, radionuclide ventriculography, magnetic resonance imaging, etc.) or invasive methods (e.g., simultaneous pressure-volume measurements). "Myocardial tagging" based on magnetic resonance imaging allows the assessment of 3D-motion of the left ventricle by labelling specific myocardial regions with a rectangular grid. A systolic "wringing" motion with clock-wise rotation at the base and counter-clockwise rotation at the apex has been described in normal subjects. In the ischemic myocardium, delayed relaxation with a prolonged back-rotation (untwisting) has been reported during early diastole, whereas decreased systolic contraction with delayed diastolic rotation has been observed in non-Q-wave infarction. In patients with anterolateral aneurysms, a complete loss of systolic rotation has been demonstrated. The prognostic significance of LV "remodeling" has been emphasized by several authors: The size of infarction, LV volume, LV ejection fraction, as well as the degree of neurohumoral activation have been identified as being associated with an unfavorable clinical outcome. Yearly mortality rates have been reported to range between 15 and 17% in patients with large infarcts and marked LV dilatation and between 3 and 7% in patients with small to medium-sized infarcts.
Zeitschrift für Kardiologie 10/1997; 86(9):684-90. · 0.97 Impact Factor
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ABSTRACT: The importance of the right ventricle as a determinant of clinical symptoms, exercise capacity, peri-operative survival and postoperative outcome has been underestimated for a long time. Right ventricular ejection fraction has been used as a measure of right ventricular function but has been found to be dependent on loading conditions, ventricular interaction as well as on myocardial structure. Altered left ventricular function in patients with valvular disease influences right ventricular performance mainly by changes in afterload but also by ventricular interaction. Right ventricular function and regional wall motion can be determined with right ventricular angiography, radionuclide ventriculography, two-dimensional echocardiography or magnetic resonance imaging. However, the complex structure of the right ventricle and its pronounced translational movements render quantification difficult. True regional wall motion analysis is, however, possible with myocardial tagging based on magnetic resonance techniques. With this technique a baso-apical shear motion of the right ventricle was observed which was enhanced in patients with aortic stenosis.
European Heart Journal 07/1996; 17(6):829-36. · 10.48 Impact Factor
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ABSTRACT: Heart failure has been divided into several different forms depending on etiology, clinical course and pathophysiology of left ventricular (LV) dysfunction. Systolic and diastolic dysfunction are characterized by a reduced cardiac output with normal (= diastolic dysfunction) or depressed (= systolic dysfunction) LV pump function. New diagnostic techniques such as magnetic resonance imaging (MRI) allow to determine noninvasively LV 3D motion by labelling specific myocardial regions (= myocardial "tagging") with a rectangular or radial grid. From the deformation of this grid rotational and translational motion of the heart can be derived. A "wringing" motion of the left ventricle has been described during systole which includes a clockwise rotation at the base and a counterclockwise rotation at the apex. During diastole, an "untwisting" motion has been demonstrated. In the normal heart, diastolic "untwisting" occurs primarily during isovolumic relaxation, analogous to the systolic "wringing" which takes place mainly during isovolumic contraction. A prolongation of the "untwisting" motion was found in the hypertrophied (aortic stenosis) and hibernating myocardium. Thus, heart failure is associated with profound alterations in the mechanical function of the heart which are manifested by changes in systolic "wringing" and diastolic "untwisting" motion.
Archiv für Kreislaufforschung 02/1996; 91 Suppl 2:23-8. · 7.35 Impact Factor
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ABSTRACT: Sophisticated magnetic resonance tagging techniques provide powerful tools for the non-invasive assessment of the local heartwall motion towards a deeper fundamental understanding of local heart function. For the extraction of motion data from the time series of magnetic resonance tagged images and for the visualization of the local heartwall motion a new image analysis procedure has been developed. New parameters have been derived which allows quantification of the motion patterns and are highly sensitive to any changes in these patterns. The new procedure has been applied for heart motion analysis in healthy volunteers and in patient collectives with different heart diseases. The achieved results are summarized and discussed.
Computerized Medical Imaging and Graphics 22(3):217-28. · 1.47 Impact Factor
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ABSTRACT: Background Diastolic dysfunction with delayed relaxation and abnormal passive elastic properties has been described in patients with severe pressure overload hypertrophy. The purpose of this study was to evaluate the time course of rotational motion of the left ventricle in patients with aortic valve stenosis using myocardial tagging. Methods Myocardial tagging is a non-invasive method based on magnetic resonance which makes it possible to label (‘tag’) specific myocardial regions. From the motion of the tag’s cardiac rotation, radial displacement and translational motion can be determined. In 12 controls and 13 patients with severe aortic valve stenosis systolic and diastolic wall motion was assessed in an apical and basal short axis plane. Results The normal left ventricle performs a systolic wringing motion around the ventricular long axis with clockwise rotation at the base (−4·4±1·6°) and counterclockwise rotation at the apex (+6·8±2·5°) when viewed from the apex. During early diastole an untwisting motion can be observed which precedes diastolic filling. In patients with aortic valve stenosis systolic rotation is reduced at the base (−2·4±2·0°; P <0·01) but increased at the apex (+12·0±6·0°; P <0·05). Diastolic untwisting is delayed and prolonged with a decrease in normalized rotation velocity (−6·9±1·1s−1) when compared to controls (−10·7±2·2s−1; P <0·001). Maximal systolic torsion is 8·0±2·1° in controls and 14·1±6·4° ( P <0·01) in patients with aortic valve stenosis. Conclusions Left ventricular pressure overload hypertrophy is associated with a reduction in basal and an increase in apical rotation resulting in increased torsion of the ventricle. Diastolic untwisting is delayed and prolonged. This may explain the occurrence of diastolic dysfunction in patients with severe pressure overload hypertrophy.
