Journal of Cardiovascular Magnetic Resonance

Published by BioMed Central
Online ISSN: 1532-429X
Print ISSN: 1097-6647
Cardiovascular magnetic resonance (CMR) yields important clinical information which often cannot be obtained from other imaging modalities. Cardiac pacemakers have conventionally been considered a contraindication to CMR, and relatively few data exist on CMR in such patients. We present 5 patients who underwent 6 CMR scans in a 0.5 Tesla scanner. The patients were non-pacemaker dependent, and the pacemakers were reprogrammed prior to scanning to have sub-threshold output. Spin echo, gradient echo and real-time sequences were used with specific absorption rates of up to 0.1 W/kg. A cardiologist was present during each scan, and the patient had continuous electrocardiographic and non-invasive monitoring of vital signs. Five of the scans were carried out without incident providing useful diagnostic information, which was not compromised by obvious artifact from the pacemaker box. In one case, the pacemaker began pacing at maximum voltage at a fixed rate of 100. This patient was removed from the magnet, and there were no clinical sequelae. The mean pre-and post-scan ventricular lead voltage threshold was the same (2.28 V vs 2.28 V). Our experience is that CMR at 0.5T in non-pacemaker dependent patents can be performed in closely supervised circumstances where the benefit-risk assessment is considered positive.
The safety of most available implantable intracoronary stents during magnetic resonance imaging (MRI) has not been sufficiently tested. Minor, but possibly clinically significant, increases in temperature have not been excluded. We measured temperature changes of 14 different stents clinically in use or currently tested for release on the world market. Stents were examined in 1.0- and 1.5-T MR scanners with multiple sequences used in routine cardiac and thoracic MRI examinations ("clinical worst case") and after implantation of the stents into the coronary arteries of excised pig hearts (1.5-T scanner only). We used a highly sensitive infrared camera with a thermal resolution of 10 mK and did not see significant heating of any stent during the examinations. We conclude that MRI is safe in patients with the currently available intracoronary stents.
Background: T1 mapping allows direct in-vivo quantitation of microscopic changes in the myocardium, providing new diagnostic insights into cardiac disease. Existing methods require long breath holds that are demanding for many cardiac patients. In this work we propose and validate a novel, clinically applicable, pulse sequence for myocardial T1-mapping that is compatible with typical limits for end-expiration breath-holding in patients. Materials and methods: The Shortened MOdified Look-Locker Inversion recovery (ShMOLLI) method uses sequential inversion recovery measurements within a single short breath-hold. Full recovery of the longitudinal magnetisation between sequential inversion pulses is not achieved, but conditional interpretation of samples for reconstruction of T1-maps is used to yield accurate measurements, and this algorithm is implemented directly on the scanner. We performed computer simulations for 100 ms<T1 < 2.7 s and heart rates 40-100 bpm followed by phantom validation at 1.5T and 3T. In-vivo myocardial T1-mapping using this method and the previous gold-standard (MOLLI) was performed in 10 healthy volunteers at 1.5T and 3T, 4 volunteers with contrast injection at 1.5T, and 4 patients with recent myocardial infarction (MI) at 3T. Results: We found good agreement between the average ShMOLLI and MOLLI estimates for T1 < 1200 ms. In contrast to the original method, ShMOLLI showed no dependence on heart rates for long T1 values, with estimates characterized by a constant 4% underestimation for T1 = 800-2700 ms. In-vivo, ShMOLLI measurements required 9.0 ± 1.1 s (MOLLI = 17.6 ± 2.9 s). Average healthy myocardial T1 s by ShMOLLI at 1.5T were 966 ± 48 ms (mean ± SD) and 1166 ± 60 ms at 3T. In MI patients, the T1 in unaffected myocardium (1216 ± 42 ms) was similar to controls at 3T. Ischemically injured myocardium showed increased T1 = 1432 ± 33 ms (p < 0.001). The difference between MI and remote myocardium was estimated 15% larger by ShMOLLI than MOLLI (p < 0.04) which suffers from heart rate dependencies for long T1. The in-vivo variability within ShMOLLI T1-maps was only 14% (1.5T) or 18% (3T) higher than the MOLLI maps, but the MOLLI acquisitions were twice longer than ShMOLLI acquisitions. Conclusion: ShMOLLI is an efficient method that generates immediate, high-resolution myocardial T1-maps in a short breath-hold with high precision. This technique provides a valuable clinically applicable tool for myocardial tissue characterisation.
The purpose of this study was to determine the magnetic resonance (MR) safety aspects and artifacts for three different heart valve prostheses and two different annuloplasty rings that have not been evaluated previously in association with the 1.5-T MR environment. Ex vivo testing was performed using previously described techniques for the evaluation of magnetic field interactions (deflection angle and torque), heating (gel-filled phantom and fluoroptic thermometry; 15 min of MR imaging at a whole body-averaged specific absorption rate of 1.2 W/kg), and artifacts (using T1-weighted, spin echo, and gradient echo pulse sequences). One heart valve prosthesis and one annuloplasty ring showed no magnetic field interactions. Two heart valve prostheses and one annuloplasty ring displayed relatively minor magnetic field interactions (i.e., deflection angle < or = 6 degrees, torque, +1). Heating was < or = 0.7 degrees C for the five different implants. Artifacts varied depending on the amount and type of metal used to make the implants. For the three heart valve prostheses and two annuloplasty rings, the lack of substantial magnetic field interactions and relatively minor hearing indicated that MR procedures may be conducted safetly in patients with these implants using MR systems operating with static magneticfields of 1.5 T or less. Notably, these findings essentially apply to 54 different heart valve prostheses and 37 different annuloplasty rings (i.e., based on the various models and sizes available for these implants).
MR coronary angiography (MRCA) has been demonstrated successfully at 3 Tesla (T). However, the advantages remain unclear. No systematic comparison of MRCA between 1.5 T and 3 T has been performed. Therefore, anatomic coverage, image quality, signal-to-noise ratio (SNR), contrast-to-noise ration (CNR), and susceptibility artifacts were compared in 23 subjects. Identical real-time (RT) and high-resolution (HR) sequences were implemented on the GE 1.5 T (Signa Twinspeed) and 3.0 T (Signa VH/i) whole body systems (GE, Milwaukee, WI). Both scanners were equipped with high-performance gradient systems capable of 40 mT/m peak amplitude and 150 mT/m/ms slew rate. Real-time localization of the coronary arteries was followed by a cardiac-gated, breath-hold HR sequence. Twenty-three subjects were recruited consecutively and underwent both 3 T and 1.5 T MRCA within one week. Coronary coverage based on the number of coronary segments visualized, image quality using a grading scale, SNR, CNR, and presence of susceptibility artifacts were analyzed. A significant improvement in SNR (47%), CNR (30%), and image quality were seen in 3 T. However, a significant increase in susceptibility artifacts was also noted. MRCA at 3 T significantly improves SNR, CNR, and image quality at the expense of susceptibility artifacts. Further optimization of the imaging parameters at 3 T may facilitate clinical implementation of MRCA.
Typical T1 maps from a single healthy subject. Basal (A), mid-ventricular (B) and apical (C) short-axis slices. Thin dashed lines denote manually contoured endo- and epi-cardial outlines. Thick coloured outlines mark the left (dark green) and right (yellow) ventricular blood pool, placed within the left- and right-ventricular cavity, respectively, avoiding papillary muscle.
The effect of partial volume on A) average myocardial T1 and B) average segmental pixel variability. Notes: Myocardial ROI thickness is calculated as distance between endo- and epi-cardial contours. Filled large symbols represent the T1 derived from myocardial contours drawn manually by the operator (original) compared to systematic erosion or dilatation in 1-pixel increments. P values refer to comparisons between subsequent inflation/erosion steps.
Intra- and inter-centre reproducibility of myocardial T1 measurements. Repetition accuracy within the Oxford centre and amongst the three test centres.
Age- and gender-dependence of myocardial and blood T1. A) Measured myocardial T1 within manually drawn myocardial contours demonstrated a small elevation of T1 in young females. B) Myocardial midwall T1 (see partial volume section), indicated a similar persistent gender difference, albeit at a slightly lower T1 likely due to reduction of blood partial volume. C) Left Ventricle blood T1. D) Right Ventricle blood T1. Note: Unpaired student T-test p-values are marked above each bar for age-groups when Bonferroni-corrected significance threshold is achieved for gender difference.
The effects of common physiological parameters on the myocardial midwall T1 and blood T1 after correcting for age and gender differences. (A) Blood hematocrit is the principle driving force of blood T1s, but not myocardial T1, variation. (B) Increase in heart rate is associated with an increase in myocardial T1 and a decrease in blood T1s. (C) There is no relation between myocardial thickness and myocardial T1, but blood T1s change in opposite direction. (D) Increased body size does not influence myocardial T1, but decreases blood T1s. Note: statistical significance of marked correlations reaches Bonferroni-corrected significance of p < 0.002 (p < 0.05/18 comparisons including height and weight not shown here) for r2 > 0.15 (n = 62, A) and r2 > 0.026 (n = 374, B-D).
Background Quantitative T1-mapping is rapidly becoming a clinical tool in cardiovascular magnetic resonance (CMR) to objectively distinguish normal from diseased myocardium. The usefulness of any quantitative technique to identify disease lies in its ability to detect significant differences from an established range of normal values. We aimed to assess the variability of myocardial T1 relaxation times in the normal human population estimated with recently proposed Shortened Modified Look-Locker Inversion recovery (ShMOLLI) T1 mapping technique. Methods A large cohort of healthy volunteers (n = 342, 50% females, age 11–69 years) from 3 clinical centres across two countries underwent CMR at 1.5T. Each examination provided a single average myocardial ShMOLLI T1 estimate using manually drawn myocardial contours on typically 3 short axis slices (average 3.4 ± 1.4), taking care not to include any blood pool in the myocardial contours. We established the normal reference range of myocardial and blood T1 values, and assessed the effect of potential confounding factors, including artefacts, partial volume, repeated measurements, age, gender, body size, hematocrit and heart rate. Results Native myocardial ShMOLLI T1 was 962 ± 25 ms. We identify the partial volume as primary source of potential error in the analysis of respective T1 maps and use 1 pixel erosion to represent “midwall myocardial” T1, resulting in a 0.9% decrease to 953 ± 23 ms. Midwall myocardial ShMOLLI T1 was reproducible with an intra-individual, intra- and inter-scanner variability of ≤2%. The principle biological parameter influencing myocardial ShMOLLI T1 was the female gender, with female T1 longer by 24 ms up to the age of 45 years, after which there was no significant difference from males. After correction for age and gender dependencies, heart rate was the only other physiologic factor with a small effect on myocardial ShMOLLI T1 (6ms/10bpm). Left and right ventricular blood ShMOLLI T1 correlated strongly with each other and also with myocardial T1 with the slope of 0.1 that is justifiable by the resting partition of blood volume in myocardial tissue. Overall, the effect of all variables on myocardial ShMOLLI T1 was within 2% of relative changes from the average. Conclusion Native T1-mapping using ShMOLLI generates reproducible and consistent results in normal individuals within 2% of relative changes from the average, well below the effects of most acute forms of myocardial disease. The main potential confounder is the partial volume effect arising from over-inclusion of neighbouring tissue at the manual stages of image analysis. In the study of cardiac conditions such as diffuse fibrosis or small focal changes, the use of “myocardial midwall” T1, age and gender matching, and compensation for heart rate differences may all help to improve the method sensitivity in detecting subtle changes. As the accuracy of current T1 measurement methods remains to be established, this study does not claim to report an accurate measure of T1, but that ShMOLLI is a stable and reproducible method for T1-mapping.
Three-dimensional time-resolved (4D) phase-contrast (PC) CMR can visualize and quantify cardiovascular flow but is hampered by long acquisition times. Acceleration with SENSE or k-t BLAST are two possibilities but results on validation are lacking, especially at 3 T. The aim of this study was therefore to validate quantitative in vivo cardiac 4D-acquisitions accelerated with parallel imaging and k-t BLAST at 1.5 T and 3 T with 2D-flow as the reference and to investigate if field strengths and type of acceleration have major effects on intracardiac flow visualization. The local ethical committee approved the study. 13 healthy volunteers were scanned at both 1.5 T and 3 T in random order with 2D-flow of the aorta and main pulmonary artery and two 4D-flow sequences of the heart accelerated with SENSE and k-t BLAST respectively. 2D-image planes were reconstructed at the aortic and pulmonary outflow. Flow curves were calculated and peak flows and stroke volumes (SV) compared to the results from 2D-flow acquisitions. Intra-cardiac flow was visualized using particle tracing and image quality based on the flow patterns of the particles was graded using a four-point scale. Good accuracy of SV quantification was found using 3 T 4D-SENSE (r2 = 0.86, -0.7 ± 7.6%) and although a larger bias was found on 1.5 T (r2 = 0.71, -3.6 ± 14.8%), the difference was not significant (p = 0.46). Accuracy of 4D k-t BLAST for SV was lower (p < 0.01) on 1.5 T (r2 = 0.65, -15.6 ± 13.7%) compared to 3 T (r2 = 0.64, -4.6 ± 10.0%). Peak flow was lower with 4D-SENSE at both 3 T and 1.5 T compared to 2D-flow (p < 0.01) and even lower with 4D k-t BLAST at both scanners (p < 0.01). Intracardiac flow visualization did not differ between 1.5 T and 3 T (p = 0.09) or between 4D-SENSE or 4D k-t BLAST (p = 0.85). The present study showed that quantitative 4D flow accelerated with SENSE has good accuracy at 3 T and compares favourably to 1.5 T. 4D flow accelerated with k-t BLAST underestimate flow velocities and thereby yield too high bias for intra-cardiac quantitative in vivo use at the present time. For intra-cardiac 4D-flow visualization, however, 1.5 T and 3 T as well as SENSE or k-t BLAST can be used with similar quality.
The magnetic resonance technique of arterial spin labeling (ASL) allows myocardial perfusion to be quantified without the use of a contrast agent. This study aimed to use a modified ASL technique and T1 regression algorithm, previously validated in canine models, to calculate myocardial blood flow (MBF) in normal human subjects and to compare the accuracy and repeatability of this calculation at 1.5 T and 3.0 T. A computer simulation was performed and compared with experimental findings. Eight subjects were imaged, with scans at 3.0 T showing significantly higher T1 values (P < 0.001) and signal-to-noise ratios (SNR) (P < 0.002) than scans at 1.5 T. The average MBF was found to be 0.990 +/- 0.302 mL/g/min at 1.5 T and 1.058 +/- 0.187 mL/g/min at 3.0 T. The repeatability at 3.0 T was improved 43% over that at 1.5 T, although no statistically significant difference was found between the two field strengths. In the simulation, the accuracy and the repeatability of the MBF calculations were 61% and 38% higher, respectively, at 3.0 T than at 1.5 T, but no statistically significant differences were observed. There were no significant differences between the myocardial perfusion data sets obtained from the two independent observers. Additionally, there was a trend toward less variation in the perfusion data from the two observers at 3.0 T as compared to 1.5 T. This suggests that this ASL technique can be used, preferably at 3.0 T, to quantify myocardial perfusion in humans and with further development could be useful in the clinical setting as an alternative method of perfusion analysis.
Haemodynamic response to an incremental stress using incremental dobutamine doses: 0, 2.5, 5 and 10 μg/min/kg (*: p < 0.05 vs 0; †: p < 0.05 vs 2.5; ‡:p < 0.05 vs 5 μg/min/kg).
Representative example of tagged and cine CMR at rest (first row) and stress under 5 μg/min/kg of dobutamine (2nd row) in diastolic and systolic phases obtained in normal heart. The effect of both the increase of wall thickening and the decrease of the LV end-systolic volume are clearly seen on the CMR images.
Wall thickening and circumferential strain at endocardial, midwall and epicardial levels measurements. All measurements under dobutamine stress are significantly different from the values obtained at rest, except for circumferential strain at epicardial at 2.5 μg/min/kg. (*: p < 0.05 vs 0; †: p < 0.05 vs 2.5; ‡:p < 0.05 vs 5 μg/min/kg).
The curves show the circumferential strain (CS) at midwall level as a function of cardiac cycle phase under rest and stress (10 μg/min/kg) obtained with tagged images. The observed strain increase under stress in tag measurement is consistent with the increase of wall thickening measured in cine images between rest and stress. No difference in the systolic and diastolic strain (dCS/dt) rate was induced by the dobutamine.
The purpose of this study was to measure regional contractile function in the normal rat using cardiac cine and tagged cardiovascular magnetic resonance (CMR) during incremental low doses of dobutamine and at rest. Five rats were investigated for invasive left ventricle pressure measurements and five additional rats were imaged on a clinical 1.5 T MR system using a cine sequence (11-20 phases per cycle, 0.28/0.28/2 mm) and a C-SPAMM tag sequence (18-25 phases per cycle, 0.63/1.79/3 mm, tag spacing 1.25 mm). For each slice, wall thickening (WT) and circumferential strains (CS) were calculated at rest and at stress (2.5, 5 and 10 microg/min/kg of dobutamine). Good cine and tagged images were obtained in all the rats even at higher heart rate (300-440 bpm). Ejection fraction and left ventricular (LV) end-systolic volume showed significant changes after each dobutamine perfusion dose (p < 0.001). Tagged CMR had the capacity to resolve the CS transmural gradient and showed a significant increase of both WT and CS at stress compared to rest. Intra and interobserver study showed less variability for the tagged technique. In rats in which a LV catheter was placed, dobutamine produced a significant increase of heart rate, LV dP/dtmax and LV pressure significantly already at the lowest infusion dose. Robust cardiac cine and tagging CMR measurements can be obtained in the rat under incremental dobutamine stress using a clinical 1.5 T MR scanner.
To evaluate the effect of Magnetic Resonance Imaging (MRI) performed at 1.5-Tesla on current generation pacemakers and ICDs to identify safe parameters for MRI examinations. Pacemakers (Identity ADx XL DR+ 5386 and Identity ADx DR + 5380 generators; 1688T/52-cm atrial and ventricular leads) and ICDs (Atlas + V-243, Epic + V-236, and Epic + HF V-350 generators; Riata 1581/65-cm and QuickSite 1056K/75-cm leads; St. Jude Medical, Sylmar, California, USA) were evaluated for magnetic field interactions. MRI-related heating was assessed using various levels of RF power (SARs) and conditions that included scans on different body regions. Functional aspects of the devices were evaluated immediately before and after MRI procedures utilizing nine different pulse sequences. Induced currents were measured using a custom built system. Magnetic field interactions will not create a hazard for these pacemakers and ICDs. All scans of the "head" and "lumbar" regions resulted in temperature changes < or =0.5 degrees C at SARs ranging from 2.0 to 3.0-W/kg. For the "chest" area, temperature increases ranged from 0.4 degrees C to 3.6 degrees C at an SAR of 2.0-W/kg. No memory corruption, hardware changes, or changes in device parameters were seen. Magnetic field gradients have a low likelihood of inducing currents that would stimulate the heart. No hazardous magnetic field interactions or physiologically significant heating occurred for certain conditions. There was no permanent effect on device function. By following specific conditions, these pacemakers and ICDs may be safe for patients scanned at 1.5-Tesla.
SSFP and FLASH left atrial images at 1.5 and 3 T in a male healthy volunteer showing the endocardial border contours. 
Horizontal long axis (HLA) in ventricular end-diastole (A) and end-systole (B), vertical long axis (VLA) in end-diastole (C) and end- systole (D) using SSFP images at 3 T illustrating the contours for the biplane are-length method for left atrial volumes and ejection fraction. The upper panel demonstrates the minimal left atrial volume and the lower panel shows the maximal volume. The left atrial appendage was included in the atrial volume, but the pulmonary veins were excluded. 
Bland-Altman plot between the biplane area-length method and short-axis method for left atrial maximal volume in 10 healthy volunteers using SSFP and FLASH at 3 T. Solid lines represent the mean (bias) and dotted lines represent the limits of agreement (95% limits of agreement). 
Reproducibility of measurements for left trial ejection fraction
To investigate left atrial volumes and function and their variability in healthy volunteers using steady state free precession (SSFP) and fast low angle shot (FLASH) sequences at both 1.5 and 3 T using both the short-axis and biplane area-length methods. Ten healthy volunteers underwent CMR at both 1.5 and 3 Tesla. The biplane area-length method utilized volumes from the horizontal and vertical long axis images. There were no significant differences between left atrial short-axis volumes or function between 1.5 and 3 T assessed using either FLASH or SSFP sequences. The biplane area-length method underestimated maximal left atrial volume using FLASH by 12 mL at 3 T (18%) and by 10 mL (14%) at 1.5 T (p = 0.003 and p = 0.05 respectively). Variability was larger for left atrial measurements using the biplane area-length method. Field strength had no effect on left atrial volume and function assessment using either FLASH or SSFP. The use of the short-axis method for the acquisition of left atrial parameters is more reproducible than the biplane area-length for serial measurements.
We report a case of aortocaval fistula demonstrated with gadolinium-enhanced magnetic resonance (MR) angiography. Specific radiographic features of this rare complication, such as early and intense enhancement of the inferior vena cava, are underlined with MR imaging. The exact location of the fistula can also be assessed with this noninvasive imaging technique. Moreover, the absence of iodinated contrast media makes it particularly suited for stable patients with renal insufficiency. A complete preoperative assessment of abdominal aortic aneurysm can be performed with MR imaging.
Cardiac pacemakers, ICDs, and insertable loop recorder assessed for translational attraction using conventional ("long-bore") and "short-bore" 3.0-Tesla MR systems. a 
To evaluate magnet-related translational attraction for cardiac pacemakers, ICDs, and an insertable loop recorder in association with exposure to "long-bore" and "short-bore" 1.5- and 3.0-Tesla MR systems. Fourteen cardiac pacemakers, four ICDs, and one insertable loop recorder were evaluated for translational attraction using deflection angle tests performed at the points of the highest spatial gradients for long-bore and short-bore 1.5- and 3.0-Tesla MR systems according to ASTM guidelines. Deflection angles ranged from 9-90 degrees for the long-bore and from 11-90 degrees for the short-bore 1.5-T MR system. Deflection angles ranged from 23-90 degrees for the long-bore and from 34-90 degrees for the short-bore 3.0-T MR system. Three of the cardiovascular implants exhibited deflection angles > or = 45 degrees (i.e., indicating that they are potentially unsafe for patients) on the long-bore and short-bore 1.5-T MR systems. Eight implants exhibited deflection angles > or = 45 degrees on the long-bore 3.0-T MR system, while 14 exhibited deflection angles > or = 45 degrees on the short-bore 3.0-T MR system. In general, deflection angles for these cardiovascular implants were significantly (p < 0.01) higher on 1.5- and 3.0-Tesla short-bore compared to the long-bore MR systems. Several of the cardiovascular implants that underwent evaluation may be problematic for patients undergoing MR procedures using 1.5- and 3.0-T MR systems because of risks associated with magnet-related movements. Obviously, additional MR safety issues must also be considered for these implants.
Background To predict the type and extent of CMR artifacts caused by commonly used pediatric trans-catheter devices at 1.5 T and 3 T as an aid to clinical planning and patient screening. Methods Eleven commonly used interventional, catheter-based devices including stents, septal occluders, vascular plugs and embolization coils made from either stainless steel or nitinol were evaluated ex-vivo at both 1.5T and 3T. Pulse sequences and protocols commonly used for cardiovascular magnetic resonance (CMR) were evaluated, including 3D high-resolution MR angiography (MRA), time-resolved MRA, 2D balanced-SSFP cine and 2D phase-contrast gradient echo imaging (GRE). We defined the signal void amplification factor (F) as the ratio of signal void dimension to true device dimension. F1 and F2 were measured in the long axis and short axes respectively of the device. We defined F3 as the maximum extent of the off-resonance dark band artifact on SSFP measured in the B0direction. The effects of field strength, sequence type, orientation, flip angle and phase encode direction were tested. Clinical CMR images in 3 patients with various indwelling devices were reviewed for correlation with the in-vitro findings. Results F1 and F2 were higher (p<0.05) at 3T than at 1.5T for all sequences except 3D-MRA. Stainless steel devices produced greater off-resonance artifact on SSFP compared to nitinol devices (p<0.05). Artifacts were most severe with the stainless steel Flipper detachable embolization coil (Cook Medical, Bloomington, IN), with F1 and F2 10 times greater than with stainless steel stents. The orientation of stents changed the size of off-resonance artifacts by up to two fold. Sequence type did influence the size of signal void or off-resonance artifact (p<0.05). Varying the flip angle and phase encode direction did not affect image artifact. Conclusion Stainless steel embolization coils render large zones of anatomy uninterpretable, consistent with predictions based on ex-vivo testing. Most other commonly used devices produce only mild artifact ex-vivo and are compatible with diagnostic quality in-vivo studies. Knowledge of ex-vivo device behavior can help predict the technical success or failure of CMR scans and may preempt the performance of costly, futile studies.
Since the first description of coronary magnetic angiography (MRA) in the early of 1990, this method seems to be shaped us a promising noninvasive modality to view the coronary arteries. Since several years dedicated high-field MR systems up to 4T are available for human use. The aim of the study was the evaluation of an in vitro vessel model with defined stenoses on 1.5T and 3T. For imaging at 3T, we used a 3d gradient-echo-sequence (fast SPGR). Furthermore, we examined the influence of the flow velocity and the contrast medium concentration on the spatial resolution. The accurate detection of in vitro stenoses was possible in segments up to 0.6 mm at 3T, the best results were obtained at a flow velocity of 40 ml/min and a contrast medium concentration of 0.2 mmol/l. The influence of the contrast medium concentration was statistically not significant. These results show that the spatial resolution can be increased by the use of a high-field MR scanner. Further in vivo studies are necessary to eliminate the method's limitation in visualizing small distal vessel segments.
( A–F ) Selected images from a series of dynamic 19 F images of undiluted crown ether nanoparticles flowing through plastic tubing. The time of acquisition after the injection started is labeled on the images in seconds. G, A 1 H single slice image of the tubing lying on top of a saline IV bag. H, False color overlay of image F onto image G showing the colocalization of the 19 F signal with the tubing. 
( A–F ) Dynamic 19 F images of undiluted crown ether (CE) nanoparticles injected into the left anterior descending (LAD) coronary artery 
( A–F ) Dynamic 19 F images of crown ether (CE) nanoparticles injected via a catheter into the left carotid artery of a live rabbit. Panel 
Correlation between the dose of fluorine administered to rabbits and the resulting blood concentration used for the steady- state imaging experiment. The concentration of fluorine in the blood was determined by measuring the concentration of gadolinium and using the known ratio of gadolinium to crown ether in the emulsion to calculate fluorine concentration. Note that rabbit 2 exhibited a smaller increase in blood concentration as a function of dose at the higher doses. The dotted line indicates the concentration at which adequate signal was generated for imaging. 
( A–C ) 19 F coronal projections of the rabbit neck acquired after each systemic injection of the fluorinated contrast agent. D, A 19 F 
While the current gold standard for coronary imaging is X-ray angiography, evidence is accumulating that it may not be the most sensitive technique for detecting unstable plaque. Other imaging modalities, such as cardiovascular magnetic resonance (CMR), can be used for plaque characterization, but suffer from long scan and reconstruction times for determining regions of stenosis. We have developed an intravascular fluorinated contrast agent that can be used for angiography with cardiovascular magnetic resosnace at clinical field strengths (1.5 T). This liquid perfluorocarbon nanoparticle contains a high concentration of fluorine atoms that can be used to generate contrast on 19F MR images without any competing background signal from surrounding tissues. By using a perfluorocarbon with 20 equivalent fluorine molecules, custom-built RF coils, a modified clinical scanner, and an efficient steady-state free procession sequence, we demonstrate the use of this agent for angiography of small vessels in vitro, ex vivo, and in vivo. The surprisingly high signal generated with very short scan times and low doses of perfluorocarbon indicates that this technique may be useful in clinical settings when coupled with advanced imaging strategies.
Image quality scores for real-time and cine SSFP CMR of patients Anatomical views Number of views # Real-time CMR Cine CMR
Evaluations of real-time and cine SSFP CMR (19 patients)
Real-time SSFP CMR. Short-axis and three-chamber views of two healthy subjects at (left) diastole and (right) systole. The images refer to selected frames of real-time CMR movies acquired with the use of (a) CMR system I at 41 ms resolution (TR/TE = 2.72/1.36 ms, 15 spokes) and (b) CMR system II at 40 ms resolution (TR/TE = 3.08/1.54 ms, 13 spokes). For other details see Table 1.
Arrhythmias. Real-time SSFP CMR of a patient with supraventricular arrhythmias at 40 ms resolution (for details see Table 1). (Left) Selected diastolic frame of a three-chamber movie and (right) corresponding “1D arrhythmia plot” depicting the temporal profile of the indicated reference line. The diagram covers 10 normal contractions and identifies two atrial extrasystoles (285 images = 11.4 s). See also Additional files 1 and 2 for real-time CMR movies of the same patient in a short-axis and four-chamber view.
Abnormal wall motion. Real-time SSFP CMR of a patient with abnormal motion of the left-ventricular myocardial wall at 40 ms resolution (for details see Table 1). (Left) Selected diastolic and (right) systolic frames of three short-axis movies from (top) base to (bottom) apex visualize the reduced thickening and contraction of the myocardial wall (arrows). See also Additional files 3 and 4 for real-time CMR movies of the same patient in a short-axis and three-chamber view.
While cardiovascular magnetic resonance (CMR) commonly employs ECG-synchronized cine acquisitions with balanced steady-state free precession (SSFP) contrast at 1.5 T, recent developments at 3 T demonstrate significant potential for T1-weighted real-time imaging at high spatiotemporal resolution using undersampled radial FLASH. The purpose of this work was to combine both ideas and to evaluate a corresponding real-time CMR method at 1.5 T with SSFP contrast. Radial gradient-echo sequences with fully balanced gradients and at least 15-fold undersampling were implemented on two CMR systems with different gradient performance. Image reconstruction by regularized nonlinear inversion (NLINV) was performed offline and resulted in real-time SSFP CMR images at a nominal resolution of 1.8 mm and with acquisition times of 40 ms. Studies of healthy subjects demonstrated technical feasibility in terms of robustness and general image quality. Clinical applicability with access to quantitative evaluations (e.g., ejection fraction) was confirmed by preliminary applications to 27 patients with typical indications for CMR including arrhythmias and abnormal wall motion. Real-time image quality was slightly lower than for cine SSFP recordings, but considered diagnostic in all cases. Extending conventional cine approaches, real-time radial SSFP CMR with NLINV reconstruction provides access to individual cardiac cycles and allows for studies of patients with irregular heartbeat.
Coronal contrast-enhanced MR angiographic maximum intensity projection images of 67-year-old man presenting with bilateral claudication: (A) 1.5T and (B) 3T contrast-enhanced MR angiography show significant stenosis in the left external iliac artery (short arrow) and an occlusion in the right superficial femoral artery (long arrow). There is an excellent correlation between MR angiography and digital subtraction angiography (C). 
Diagnostic performance for stenosis detection at 3T versus 1.5T contrast-enhanced MRA
Summary Standardized single-injection 3-station moving-table 3T contrast-enhanced MR angiography (CE-MRA) is reliable for stenosis detection and classification in peripheral arterial occlusive disease with equivalent diagnostic performance as 1.5T CE-MRA, while contrast-to-noise ratio significantly increased at 3T for identical contrast dosage. Background Contrast-enhanced MR angiography (CE-MRA) has evolved into a reliable imaging technique for peripheral arterial occlusive disease (PAOD). Recent advances in MRI technology offer large homogeneous magnetic fields with comparable Field-of-Views at 3T and 1.5T, allowing visualization of the complete runoff vascular tree by single-injection 3-station (pelvic/thigh/calf) moving-table CE-MRA. Diagnostic performance of 3T versus 1.5T CE-MRA has not yet been described. The purpose of this study was to compare diagnostic accuracy of 3T CE-MRA in POAD in an equivalence trial with 1.5T CE-MRA, with conventional digital subtraction angiography (DSA) as the standard of reference. Methods In nineteen patients (13 men; mean age 69 years), DSA and standardized single-injection 3-station moving-table CE-MRA with equivalent acquisition protocols and contrast dosage were performed at 3T and 1.5T MRI (Philips, Best, the Netherlands). For CE-MRA, 0.2 mmol/kg body weight gadoterate meglumine was injected, with the first half of the bolus at 2 mL/s and second half at 0.6 mL/s. At 1.5T, a quadrature body coil (QBC) was used for imaging pelvic and thigh stations and a 4-element phased array coil for calf station. At 3T, a QBC was used in all three stations. DSA was performed using iomeprol injection at variable volumes and flow rates depending on the arterial segment. The arterial tree in each patient was divided into 27 segments, infrarenal aorta, common and external iliac arteries, common and superficial femoral arteries, popliteal arteries in thigh and calf station, tibiofibular trunk, proximal and distal halves of the anterior and posterior tibial arteries and peroneal arteries. Visual stenosis classification was performed in consensus by two radiologists in blinded manner using the following categories: class 1 (0%-stenosis), 2 (1-50%), 3 (51-75%), 4 (76-99%) and 5 (100%). Quantitative analysis of contrast-to-noise ratio (CNR) was performed for the external iliac artery and the superficial femoral artery. Results
Gender and age dependence of T1±SD relaxation times in human myocardium at 1.5 Tesla. Note: Case numbers of females ♀ and males ♂ in the overlapping age groups are shown above the respective bars. (*)Unpaired Student T-test p-values for gender differences are marked when Bonferroni-significant. 
Summary Robust pre-contrast reference T1 values using ShMOLLI in 231 normal human controls aged 11 to 81 years demonstrate little dependence on gender, age or heart rates. Background Quantitative T1-mapping is rapidly becoming a clinical Cardiovascular Magnetic Resonance (CMR) imaging tool that can distinguish normal from diseased myocardium. The usefulness of any quantitative measurement to identify disease lies in its ability to detect significant differences from an established normal range of values. In this study we aim to establish a large database for the normal range of T1 values in healthy human myocardium and to examine any differences based on age and gender.
Dedicated UK Biobank imaging centre layout.
Previously developed prospective population studies with CMR imaging (including at least 1000 participants)
Representation of participant flow with complex buffered process for groups of 3 participants.
Dedicated UK Biobank imaging centre layout.
Representation of participant flow with complex buffered process for groups of 3 participants.
UK Biobank is a prospective cohort study with 500,000 participants aged 40 to 69. Recently an enhanced imaging study received funding. Cardiovascular magnetic resonance (CMR) will be part of a multi-organ, multi-modality imaging visit in 3--4 dedicated UK Biobank imaging centres that will acquire and store imaging data from 100,000 participants (subject to successful piloting). In each of UK Biobank's dedicated bespoke imaging centres, it is proposed that 15--20 participants will undergo a 2 to 3 hour visit per day, seven days a week over a period of 5--6 years. The imaging modalities will include brain MRI at 3 Tesla, CMR and abdominal MRI at 1.5 Tesla, carotid ultrasound and DEXA scans using carefully selected protocols. We reviewed the rationale, challenges and proposed approaches for concise phenotyping using CMR on such a large scale. Here, we discuss the benefits of this imaging study and review existing and planned population based cardiovascular imaging in prospective cohort studies. We will evaluate the CMR protocol, feasibility, process optimisation and costs. Procedures for incidental findings, quality control and data processing and analysis are also presented. As is the case for all other data in the UK Biobank resource, this database of images and related information will be made available through UK Biobank's Access Procedures to researchers (irrespective of their country of origin and whether they are academic or commercial) for health-related research that is in the public interest.
MR imaging is uniquely placed to non-invasively study rodent cardiac structure and function. High-field MR scanners commonly have a vertical bore, and the purpose of this work was to demonstrate CINE-MR imaging in normal and infarcted rat hearts after determining hemodynamic stability when positioned vertically for imaging. Optimisation of imaging parameters was carried out prior to assessment of cardiac function in a group of normal and infarcted rat hearts. Rat hemodynamics were unaltered when vertical for 90 minutes, compared with horizontal measurements and rat cardiac parameters were measured accurately and reproducibly with our optimized CINE-MR protocol. A flip angle of 17.5 degrees was shown to provide optimal contrast for the assessment of structure and function, and, in contrast to our findings in mice, respiratory gating was not found to be essential. Hence, we conclude that vertical bore MR systems can be used to measure in vivo cardiac function in normal and infarcted rat hearts.
Phase contrast cardiovascular magnetic resonance (CMR) is able to measure all three directional components of the velocities of blood flow relative to the three spatial dimensions and the time course of the heart cycle. In this article, methods used for the acquisition, visualization, and quantification of such datasets are reviewed and illustrated. Currently, the acquisition of 3D cine (4D) phase contrast velocity data, synchronized relative to both cardiac and respiratory movements takes about ten minutes or more, even when using parallel imaging and optimized pulse sequence design. The large resulting datasets need appropriate post processing for the visualization of multidirectional flow, for example as vector fields, pathlines or streamlines, or for retrospective volumetric quantification. Multidirectional velocity acquisitions have provided 3D visualization of large scale flow features of the healthy heart and great vessels, and have shown altered patterns of flow in abnormal chambers and vessels. Clinically relevant examples include retrograde streams in atheromatous descending aortas as potential thrombo-embolic pathways in patients with cryptogenic stroke and marked variations of flow visualized in common aortic pathologies. Compared to standard clinical tools, 4D velocity mapping offers the potential for retrospective quantification of flow and other hemodynamic parameters. Multidirectional, 3D cine velocity acquisitions are contributing to the understanding of normal and pathologically altered blood flow features. Although more rapid and user-friendly strategies for acquisition and analysis may be needed before 4D velocity acquisitions come to be adopted in routine clinical CMR, their capacity to measure multidirectional flows throughout a study volume has contributed novel insights into cardiovascular fluid dynamics in health and disease.
Image analysis procedure: myocardium segmentation (A), resulting metabolite polar map (B), AHA reference model (C). 
Segmental mismatch between basal and occlusion condition for lactate and bicarbonate. Gray blocks indicate statistically significant difference between the two conditions. 
An image analysis method was developed to obtain a 3D map of the pyruvate metabolites distribution in the LV in hyperpolarised 13C MRI. The obtained polar maps follow the standardized LV AHA segmentation, allowing reproducible and standardized LV segmental analysis.
Correction to McGill LA, Ismail T, Nielles-Vallespin S, Ferreira P, Scott AD, Roughton M, Kilner PJ, Ho SY, McCarthy KP, Gatehouse PD, de Silva R, Speier P, Feiweier T, Mekkaoui C, Sosnovik DE, Prasad SK, Firmin DN, Pennell DJ. Reproducibility of in-vivo diffusion tensor cardiovascular magnetic resonance in hypertrophic cardiomyopathy. Journal of Cardiovascular Magnetic Resonance 2012, 14:86.
The 16th Annual Scientific Sessions of the Society for Cardiovascular Magnetic Resonance (SCMR) took place in San Francisco, USA at the end of January 2013. With a faculty of experts from across the world, this congress provided a wealth of insight into cutting-edge research and technological development. This review article intends to provide a highlight of what represented the most significant advances in the field of cardiovascular magnetic resonance (CMR) during this year's meeting.
Transgenic mouse models are increasingly used to study the pathophysiology of human cardiovascular diseases. The aortic pulse wave velocity (PWV) is an indirect measure for vascular stiffness and a marker for cardiovascular risk. This study presents a cardiovascular magnetic resonance (CMR) transit time (TT) method that allows the determination of the PWV in the descending murine aorta by analyzing blood flow waveforms. Systolic flow pulses were recorded with a temporal resolution of 1 ms applying phase velocity encoding. In a first step, the CMR method was validated by pressure waveform measurements on a pulsatile elastic vessel phantom. In a second step, the CMR method was applied to measure PWVs in a group of five eight-month-old apolipoprotein E deficient (ApoE(-/-)) mice and an age matched group of four C57Bl/6J mice. The ApoE(-/-) group had a higher mean PWV (PWV = 3.0 ± 0.6 m/s) than the C57Bl/6J group (PWV = 2.4 ± 0.4 m/s). The difference was statistically significant (p = 0.014). The findings of this study demonstrate that high field CMR is applicable to non-invasively determine and distinguish PWVs in the arterial system of healthy and diseased groups of mice.
Several large epidemiological outcome studies did not demonstrate a benefit of combined estrogen-progestin replacement treatment (HRT) on cardiovascular events in elderly postmenopausal women. Whether progestin antagonism is responsible for these negative results or the natural estrogen 17ss-estradial (E2) itself is not effective in the coronary circulation is unknown. To assess the effect of 3 months of E2 treatment on the coronary circulation, i.e., on coronary flow reserve (CFR), in postmenopausal women without established coronary artery disease (CAD). In a double-blind placebo-controlled cross-over design postmenopausal women (60 +/- 5 years, n = 14) were randomized to either start with placebo or E2 (Estrofem, Novo Nordisk, Copenhagen, Denmark) 2 mg/d given orally over 3 months and to switch thereafter for another 3 months of therapy. At baseline, a stress echocardiography was performed to exclude CAD. CFR was determined by coronary sinus CMR flow measurements (with motion-adapted gating and interactive acquisition window control; spatial/temporal resolution of 0.8 x 0.9 mm2/25-30 ms) which were performed at rest and during vasodilation (dipyridamole 0.56 mg/kg over 4 minutes IV) at baseline, and after 3 and 6 months of therapy, respectively. Hemodynamics such as heart rate and systolic and diastolic blood pressure were not different for the control and E2 group. For CFR and for resting and hyperemic coronary sinus blood flow, no differences between the placebo and E2 group were found (2-way ANOVA for repeated measurements). Reproducibility of phase-contrast CMR measurements of CFR was -1.1 +/- 4.9%. In elderly postmenopausal women without significant CAD, oral administration of E2 over 3 months without a progestin co-administration does not improve CFR. This finding yields partly explanation for some large epidemiological trials which could not demonstrate a clinical cardiovascular benefit of HRT in elderly women.
19F spectra of valves – Representative CE spectra of valve leaflets from (A) a rabbit treated with targeted nanoparticles and (B) a rabbit treated with control untargeted nanoparticles. The PFOB peaks correspond to the reference standard included for quantitative comparison. Notice the much stronger signal from the valve of the rabbit treated with targeted particles (CE/PFOB = 4.6) than from the valve of the rabbit treated with nontargeted particles (CE/PFOB = 2.2).
Quantitative comparison of spectra – Comparison of CE spectra from the four study groups. All values are nanoliters of emulsion present in the valve, as calculated from the 19F MR signal. Note that the valves treated with targeted particles have ~3× the signal of control valves and ~2× the signal of valves from the competitive inhibition group. Minimal nanoparticle deposition occurs in non-atherosclerotic animals treated with targeted nanoparticles, where no angiogenesis (and hence no binding ligands) are present in the valve.
19F imaging of the aortic valve – Coregistered proton (left) and fluorine (center) images of an aortic valve at 11.7T. At far right, the fluorine image is false-colored and overlaid on the proton image, showing strong signal at the base of the valve leaflets, as well as signal from the body of the leaflets.
Histological comparison of diseased and normal aortic valve leaflets – All scale bars are 50 μm in length. (A, B): Hematoxylin & Eosin shows thickening and foam cell accumulation in diseased valve leaflets compared to normal valve leaflet (C). (B) shows bone formation at the base of a diseased aortic valve leaflet. The diseased valve leaflet contains extensive macrophage infiltration (D) and smooth muscle actin-positive myofibroblasts (E). Endothelial staining (PECAM) shows microvasculature within diseased valve leaflet (F). Macrophage, smooth muscle actin, and PECAM stains were negative in normal aortic valve (data not shown). ανβ3 integrin stain shows angiogenesis in diseased valve leaflet with highly upregulated expression of ανβ3 (G), while there is minimal expression in the healthy valve leaflet (H).
Angiogenesis is a critical early feature of atherosclerotic plaque development and may also feature prominently in the pathogenesis of aortic valve stenosis. It has been shown that MRI can detect and quantify specific molecules of interest expressed in cardiovascular disease and cancer by measuring the unique fluorine signature of appropriately targeted perfluorocarbon (PFC) nanoparticles. In this study, we demonstrated specific binding of alphanubeta3 integrin targeted nanoparticles to neovasculature in a rabbit model of aortic valve disease. We also showed that fluorine MRI could be used to detect and quantify the development of neovasculature in the excised aortic valve leaflets. New Zealand White rabbits consumed a cholesterol diet for ~180 days and developed aortic valve thickening, inflammation, and angiogenesis mimicking early human aortic valve disease. Rabbits (n = 7) were treated with alphanubeta3 integrin targeted PFC nanoparticles or control untargeted PFC nanoparticles (n = 6). Competitive inhibition in vivo of nanoparticle binding (n = 4) was tested by pretreatment with targeted nonfluorinated nanoparticles followed 2 hours later by targeted PFC nanoparticles. 2 hours after treatment, aortic valves were excised and 19F MRS was performed at 11.7T. Integrated 19F spectral peaks were compared using a one-way ANOVA and Hsu's MCB (multiple comparisons with the best) post hoc t test. In 3 additional rabbits treated with alphanubeta3 integrin targeted PFC nanoparticles, 19F spectroscopy was performed on a 3.0T clinical scanner. The presence of angiogenesis was confirmed by immunohistochemistry. Valves of rabbits treated with targeted PFC nanoparticles had 220% more fluorine signal than valves of rabbits treated with untargeted PFC nanoparticles (p < 0.001). Pretreatment of rabbits with targeted oil-based nonsignaling nanoparticles reduced the fluorine signal by 42% due to competitive inhibition, to a level not significantly different from control animals. Nanoparticles were successfully detected in all samples scanned at 3.0T. PECAM endothelial staining and alphanubeta3 integrin staining revealed the presence of neovasculature within the valve leaflets. Integrin-targeted PFC nanoparticles specifically detect early angiogenesis in sclerotic aortic valves of cholesterol fed rabbits. These techniques may be useful for assessing atherosclerotic components of preclinical aortic valve disease in patients and could assist in defining efficacy of medical therapies.
Decreases in the −(CH 2 ) n − content of perfused diabetic rat hearts under the four groups of experimental conditions. Diabetes was induced in rats and their hearts were isolated and perfused as per Methods. 1 H-MRS spectra were acquired as per Methods. Hearts were perfused with KH containing either (i) 10 mM glucose (G, n = 5), (ii) 10 mM glucose and 7.5 mM Na + acetate (, n = 5), (iii) 10 mM glucose and 5 mM methylamine (, n = 5), or (iv) were pre-treated with 0.04 mM DNPP and then perfused with 10 mM glucose (, n = 5) during the experimental period. Values are the mean ± the S.E.M. of the percent decrease in heart content of (CH 2 ) n compared to the initial content of (CH 2 ) n in that heart.
Triacylglycerol (TAG) lipolysis increases in diabetic hearts. However, it is not known which pathway for lipolysis catalyzes this process. Thus, using 1H-magnetic resonance spectroscopy (MRS), we determined whether TAG lipolysis in diabetic rat hearts requires acid lipase or neutral lipase activity. Rats were given IP injections of 110 mg streptozotocin (STZ)/kg. Forty-eight to 72 h after this treatment, all rats exhibited ketotic diabetes. The hearts of these ketotic rats were isolated, perfused isovolumically, and analyzed using 1H-MRS. The content of methylene protons (CH2)n--and otherfatty acid protons, measured using 1H-MRS, increased in hearts isolatedfrom STZ-treated compared to untreated rats. This increase in heart--(CH2)n--was directly related to the chemical content of heart TAGs. If isolated diabetic hearts were perfused with either glucose or glucose plus the acid lipase inhibitor methylamine, then heart content of TAG, measured as (CH2)n, decreased at rates of approximately 130 nmol TAG/gdw/min throughout a 55-min perfusion. If diabetic hearts were pretreated with the neutral lipase inhibitor diethyl-p-nitro-phenylphosphate (DNPP) and perfused with glucose, then heart TAG content, measured as (CH2)n, did not change during perfusion. 1H-MRS can detect the TAG and the net lipolysis of TAG in diabetic rat hearts. Net TAG lipolysis in diabetic rat hearts requires neutral lipase.
Conventional transaxial 1 H magnetic resonance images demonstrating how the region of interest (ROI) was placed into the left ventricle [2 Â (6 to 8) Â 12.5 cm]. The MR spectra were spatially selected in the sagittal direction (A), and one-dimensional chemical shift imaging was performed (B). Key: ATP, adenosine triphosphate; PCr, phosphocreatine.
(A) 1 H MR spectra acquired from 2 Â 2 Â 2-cm voxel localized in the intraventricular septum by the PRESS method in a normal volunteer. (B) This spectrum was acquired without water suppression for the water resonance. (C) This spectrum was acquired with water suppression and was shown with the same vertical scale as (B). (D) This spectrum was acquired with water suppression for the creatine resonance and was shown with vertical gain increased by $ 30-fold.
The 1 H MR spectra of typical patients in the four groups. The patients in the WHH and WAH groups have reduced creatine peaks (3.0 ppm) compared with patients in the WNH and CNH groups. Key: WNH, normokinetic left ventricular wall motion group; WHH, hypokinetic wall motion group; WAH, a-or dyskinetic wall motion group; CNH, normal control group.
To assess quantitatively phosphocreatine (PCr), adenosine triphosphate (ATP) and total creatine (CR) in asynergic regions of ischemic human myocardium using phosphorus (31P) and proton magnetic resonance spectroscopy (1H MRS). Patients were divided into two groups: 31P MRS and 1H MRS. In each group, patients were subdivided into three groups using echocardiography: a normokinetic [WN(P) (n = 6) in 31P MRS, WN(H) (n = 10) in 1H MRS], a hypokinetic [WH(P) (n = 13), WH(H) (n = 7)], and a- or dyskinetic wall motion groups [WA(P) (n = 14), WA(H) (n =6)]. They were compared with normal subjects of each group [CNP (n = 10), CN(H) (n = 10)]. 31P MRS spectra were obtained from the anterior and apical regions of the left ventricle by slice-selected 1D CSI. 1H MRS spectra were obtained from the 2 x 2 x 2-cm voxel set in the left ventricular wall by the PRESS method. In the 31P MRS group, myocardial PCr was significantly lower in the WH(P) and WA(P) groups than in the CN(P) group, but myocardial PCr in the WN(P) group did not differ from that in CN(P). A difference in ATP could not be detected among the four groups. In the 1H MRS group, myocardial CR was significantly lower in the WH(H) and WA(H) groups than in the CN(H) group. Myocardial CR in the WNH group did not differ from that in the CN(H). The noninvasive 31P and 1H MRS approach is useful in the assessment of metabolite reduction associated with wall motion abnormality.
There were 56 articles published in the Journal of Cardiovascular Magnetic Resonance in 2009. The editors were impressed with the high quality of the submissions, of which our acceptance rate was about 40%. In accordance with open-access publishing, the articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. We have therefore chosen to briefly summarise the papers in this article for quick reference for our readers in broad areas of interest, which we feel will be useful to practitioners of cardiovascular magnetic resonance (CMR). In some cases where it is considered useful, the articles are also put into the wider context with a short narrative and recent CMR references. It has been a privilege to serve as the Editor of the JCMR this past year. I hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.
Patient's characteristics. 
A 14-segments model used for analyses of Tl-201 SPECT and cine MR images. Segments 1-3, 7-9, 13, and 14 corresponded to the anteroseptal wall and apex, and segments 4-6 and 10-12 corresponded to the inferior and posterolateral walls.
Diagnostic performances and 95% confidence intervals of Tl-201 SPECT and dobutamine stress cine MRI for predicting preserved systolic wall thickening in chronic phase assessed in all segments. 
Scatter plots of %Tl-201 uptake in normal and dysfunctional segments on the second follow-up cine MRI. Significant differences were observed between the percentage of Tl-201 in 226 segments with normal myocardial contraction and that in 54 segments with impaired myocardial contraction. Error bars represent standard deviation.  
Diagnostic performances and 95% confidence intervals of Tl-201 SPECT and dobutamine stress cine MRI for predicting preserved systolic wall thickening in chronic phase assessed in the anteroseptal wall and apex, or the inferior wall and posterlateral wall.
The purpose of this study was to compare the diagnostic performances of Tl-201 single photon emission computed tomography (SPECT) and dobutamine stress cine magnetic resonance imaging (MRI) for predicting functional recovery of regional myocardial contraction in patients after myocardial infarction. Twenty patients underwent Tl-201 SPECT and MRI 3-4 weeks after onset of myocardial infarction. Cine MR images were acquired in the resting state and during dobutamine stress. Tl-201 uptake and systolic wall thickening (SWT) on cine MRI were analyzed on short-axis images by using a 14-segment model. Follow-up cine MR images were obtained 187.1+/-33.5 days after onset. The averaged Tl-201 uptake in 54 segments with impaired SWT was 47%+/-20%, being significantly lower than that in 226 segments with preserved SWT (75%+/-18%; p<0.0001). The sensitivity, specificity, and accuracy of dobutamine MRI and Tl-201 SPECT for predicting preserved SWT after 6 months were 89% vs. 80%, not significant (NS); 89% vs. 72%, p<0.01; and 89% vs. 79%, NS, respectively. In the anterior wall and apex, the sensitivity and specificity of SPECT were not significantly different from those of MRI. In the inferior wall and posterolateral wall, however, the specificity of SPECT was substantially lower than that of MRI (53% vs. 88%, p<0.001), resulting in significantly lower accuracy (75% vs. 90%, p<0.01). Both SPECT and dobutamine MRI showed excellent sensitivity for predicting myocardial viability in all left ventricular segments. Decreased specificity of SPECT in the inferior and posterolateral segments resulted in lower overall specificity in comparison with dobutamine MRI.
There were 75 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2010, which is a 34% increase in the number of articles since 2009. The quality of the submissions continues to increase, and the editors were delighted with the recent announcement of the JCMR Impact Factor of 4.33 which showed a 90% increase since last year. Our acceptance rate is approximately 30%, but has been falling as the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. Last year for the first time, the Editors summarized the papers for the readership into broad areas of interest or theme, which we felt would be useful to practitioners of cardiovascular magnetic resonance (CMR) so that you could review areas of interest from the previous year in a single article in relation to each other and other recent JCMR articles 1 . This experiment proved very popular with a very high rate of downloading, and therefore we intend to continue this review annually. The papers are presented in themes and comparison is drawn with previously published JCMR papers to identify the continuity of thought and publication in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.
Contrast and chasing bolus doses and injection rates 
This document is an update to the 2008 publication of the Society for Cardiovascular Magnetic Resonance (SCMR) Board of Trustees Task Force on Standardized Protocols. Since the time of the original publication, 3 additional task forces (Reporting, Post-Processing, and Congenital Heart Disease) have published documents that should be referred to in conjunction with the present document. The section on general principles and techniques has been expanded as more of the techniques common to CMR have been standardized. There is still a great deal of development in the area of tissue characterization/mapping, so these protocols have been in general left as optional. The authors hope that this document continues to standardize and simplify the patient-based approach to clinical CMR. It will be updated at regular intervals as the field of CMR advances.
There were 83 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2011, which is an 11% increase in the number of articles since 2010. The quality of the submissions continues to increase. The editors had been delighted with the 2010 JCMR Impact Factor of 4.33, although this fell modestly to 3.72 for 2011. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, we remain very pleased with the progress of the journal's impact over the last 5 years. Our acceptance rate is approximately 25%, and has been falling as the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors feel it is useful to summarize the papers for the readership into broad areas of interest or theme, which we feel would be useful, so that areas of interest from the previous year can be reviewed in a single article in relation to each other and other recent JCMR articles [1]. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.
CMR findings of patient population (n = 10)
Short axis phase sensitive reconstructed IR-TrueFISP image through the mid-ventricle demonstrates subepicardial linear late gadolinium enhancement (arrow) in the lateral wall of a patient who had received Trastuzumab.
Trastuzumab (Herceptin), an antagonist to the human epidermal growth factor 2 (HER2) receptor significantly decreases the rates of breast cancer recurrence and mortality by 50%. Despite therapeutic benefits, the risk of cardiotoxicity with trastuzumab ranges from 10-15% when administered sequentially following anthraycline chemotherapy. Little is known about the utility of cardiac magnetic resonance (CMR) in the assessment of trastuzumab mediated cardiomyopathy. Between 2005-2006 inclusive, 160 breast cancer patients were identified at a single tertiary care oncology centre. Of the total population, 10 patients (mean age 40 +/- 8 years) were identified with trastuzumab induced cardiomyopathy, based on a LVEF less than 40% on serial MUGA or echocardiography. CMR was performed in all patients to determine LV volumes, systolic function and evidence of late gadolinium enhancement (LGE). At the time of diagnosis of trastuzumab induced cardiomyopathy, the mean LVEF was 29 +/- 4%. Subepicardial linear LGE was present in the lateral portion of the left ventricles in all 10 patients. LGE-CMR is a novel way of detecting early changes in the myocardium due to trastuzumab induced cardiotoxicity.
Diagram of the time course of the coronary MR exami- nation. LCA = indicates left coronary artery; RCA = right coronary artery; IR = inversion recovery. 
Representative examples of the right coronary artery of three patients (group A: 0.050 mmol/kg; group B: 0.075 mmol/kg; group C: 0.100 mmol/kg). Multiplanar reformatted MR coronary angiograms of the precontrast T2 preparation scan, the postcontrast B-22956 enhanced inversion recovery scan and the corresponding x-ray coronary angiography are provided. For all three dose groups, the overall improvement in visible vessel length and vessel sharpness as well as the increased visibility of coronary side branches can be appreciated. 
Detection of coronary stenoses. Patient 1: In the precontrast T2prep scan, there are signal irregularities within the coronary artery lumen and the visibility of the distal RCA is limited. The postcontrast scan allows the diagnosis of a coronary stenosis in the proximal RCA and depicts the vessel course beyond the crux. Patient 2: In the precontrast T2prep scan, the decrease in signal intensity in the mid-portion of the LAD is suggestive of a coronary stenosis, though reader confidence might be low. The postcontrast scan with its improved depiction of the distal LAD allows the definite diagnosis of a focal and high grade mid LAD stenosis. Patient 3: In the precontrast T2prep scan, the distal RCA lumen appears blurred. The postcontrast scan with its flow-independent and thus, clear depiction of the distal RCA lumen provides the diagnosis of a long distance stenosis before the crux. White arrows show coronary stenosis. 
Imaging of the right and left coronary artery system of a patient (group B, 0.075 mmol/kg). The multiplanar reformatted precontrast T2 prep scan, the postcontrast B-22956 enhanced scan (left: multiplanar reformatted image; right: surface rendered image) and corresponding x-ray angiography are shown. Upper row: The precontrast scan does not visualize the distal LAD and side branches. The postcontrast scan shows a normal left coronary artery system. Bottom row: On the preconstrast scan, the lumen of the mid RCA appears normal while the postcontrast scan gives clear evidence of obstructive coronary disease in this segment. 
To determine the diagnostic value of the intravascular contrast agent gadocoletic acid (B-22956) in three-dimensional, free breathing coronary magnetic resonance angiography (MRA) for stenosis detection in patients with suspected or known coronary artery disease. Eighteen patients underwent three-dimensional, free breathing coronary MRA of the left and right coronary system before and after intravenous application of a single dose of gadocoletic acid (B-22956) using three different dose regimens (group A 0.050 mmol/kg; group B 0.075 mmol/kg; group C 0.100 mmol/kg). Precontrast scanning followed a coronary MRA standard non-contrast T2 preparation/turbo-gradient echo sequence (T2Prep); for postcontrast scanning an inversion-recovery gradient echo sequence was used (real-time navigator correction for both scans). In pre- and postcontrast scans quantitative analysis of coronary MRA data was performed to determine the number of visible side branches, vessel length and vessel sharpness of each of the three coronary arteries (LAD, LCX, RCA). The number of assessable coronary artery segments was determined to calculate sensitivity and specificity for detection of stenosis > or = 50% on a segment-to-segment basis (16-segment-model) in pre- and postcontrast scans with x-ray coronary angiography as the standard of reference. Dose group B (0.075 mmol/kg) was preferable with regard to improvement of MR angiographic parameters: in postcontrast scans all MR angiographic parameters increased significantly except for the number of visible side branches of the left circumflex artery. In addition, assessability of coronary artery segments significantly improved postcontrast in this dose group (67 versus 88%, p < 0.01). Diagnostic performance (sensitivity, specificity, accuracy) was 83, 77 and 78% for precontrast and 86, 95 and 94% for postcontrast scans. The use of gadocoletic acid (B-22956) results in an improvement of MR angiographic parameters, asssessability of coronary segments and detection of coronary stenoses > or = 50%.
Phenotypic features
Pathogenic mutations in the 16 patients
LGE Findings in LGMD. Late post-gadolinium enhancement imaging in LGMD patients typically demonstrated focal epicardial (A) or midwall (B) enhancement; one patient with LGMD2I and advanced dilated cardiomyopathy had extensive myocardial injury/fibrosis (C). Control subjects showed no myocardial enhancement on LGE imaging (D).
Limb girdle muscular dystrophies (LGMD) are inclusive of 7 autosomal dominant and 14 autosomal recessive disorders featuring progressive muscle weakness and atrophy. Studies of cardiac function have not yet been well-defined in deficiencies of dysferlin (LGMD2B) and fukutin related protein (LGMD2I). In this study of patients with these two forms of limb girdle muscular dystrophy, cardiovascular magnetic resonance (CMR) was used to more specifically define markers of cardiomyopathy including systolic dysfunction, myocardial fibrosis, and diastolic dysfunction. Consecutive patients with genetically-proven LGMD types 2I (n = 7) and 2B (n = 9) and 8 control subjects were enrolled. All subjects underwent cardiac magnetic resonance (CMR) on a standard 1.5 Tesla clinical scanner with cine imaging for left ventricular (LV) volume and ejection fraction (EF) measurement, vector velocity analysis of cine data to calculate myocardial strain, and late post-gadolinium enhancement imaging (LGE) to assess for myocardial fibrosis. Sixteen LGMD patients (7 LGMD2I, 9 LGMD2B), and 8 control subjects completed CMR. All but one patient had normal LV size and systolic function; one (type 2I) had severe dilated cardiomyopathy. Of 15 LGMD patients with normal systolic function, LGE imaging revealed focal myocardial fibrosis in 7 (47%). Peak systolic circumferential strain rates were similar in patients vs. controls: εendo was -23.8 ± 8.5vs. -23.9 ± 4.2%, εepi was -11.5 ± 1.7% vs. -10.1 ± 4.2% (p = NS for all). Five of 7 LGE-positive patients had grade I diastolic dysfunction [2I (n = 2), 2B (n = 3)]. that was not present in any LGE-negative patients or controls. LGMD2I and LGMD2B generally result in mild structural and functional cardiac abnormalities, though severe dilated cardiomyopathy may occur. Long-term studies are warranted to evaluate the prognostic significance of subclinical fibrosis detected by CMR in these patients.
Two- and three-compartment models. Compartment 1: Blood; Compartment 2: Extracellular space with communication with blood (free compartment); Compartment 3: Extracellular Space without communication with blood (trapping compartment). Note that compartment three may not be a physical compartment. Inputs to the model are the blood Gd concentration (Cb) and the myocardial tissue Gd-concentration (Ct). Calculated model parameters are the transfer constant between compartments (k) and fractional volumes (v).
Gd concentration curves showed significantly different shapes of infarcted and viable myocardium. There was a significantly better fit for infarcted myocardial tissue with the three-compartment model (B) when compared to the two-compartment model (A). Viable myocardium was equally well fit with both models.
Summary We observed significantly different curve shapes in healed chronic myocardial infarction when compared with normal myocardium and found that gadolinium kinetics was more accurately modeled (greater R2) with a 3C model rather than a 2C model. 2C Modeling of fibrotic and normal myocardium showed both a significant difference between the transport into the tissue and extracellular volumes while 3C modeling showed only a significant difference between the extracellular volumes of fibrotic and normal myocardium as well as the functional existence of a third compartment in fibrotic and not in normal myocardium. Background
Displacement Encoding with Stimulated Echoes (DENSE) encodes displacement into the phase of the magnetic resonance signal. Due to the stimulated echo, the signal is inherently low and fades through the cardiac cycle. To compensate, a spiral acquisition has been used at 1.5T. This spiral sequence has not been validated at 3T, where the increased signal would be valuable, but field inhomogeneities may result in measurement errors. We hypothesized that spiral cine DENSE is valid at 3T and tested this hypothesis by measuring displacement errors at both 1.5T and 3T in vivo. Two-dimensional spiral cine DENSE and tagged imaging of the left ventricle were performed on ten healthy subjects at 3T and six healthy subjects at 1.5T. Intersection points were identified on tagged images near end-systole. Displacements from the DENSE images were used to project those points back to their origins. The deviation from a perfect grid was used as a measure of accuracy and quantified as root-mean-squared error. This measure was compared between 3T and 1.5T with the Wilcoxon rank sum test. Inter-observer variability of strains and torsion quantified by DENSE and agreement between DENSE and harmonic phase (HARP) were assessed by Bland-Altman analyses. The signal to noise ratio (SNR) at each cardiac phase was compared between 3T and 1.5T with the Wilcoxon rank sum test. The displacement accuracy of spiral cine DENSE was not different between 3T and 1.5T (1.2 ± 0.3 mm and 1.2 ± 0.4 mm, respectively). Both values were lower than the DENSE pixel spacing of 2.8 mm. There were no substantial differences in inter-observer variability of DENSE or agreement of DENSE and HARP between 3T and 1.5T. Relative to 1.5T, the SNR at 3T was greater by a factor of 1.4 ± 0.3. The spiral cine DENSE acquisition that has been used at 1.5T to measure cardiac displacements can be applied at 3T with equivalent accuracy. The inter-observer variability and agreement of DENSE-derived peak strains and torsion with HARP is also comparable at both field strengths. Future studies with spiral cine DENSE may take advantage of the additional SNR at 3T.
To compare left ventricular (LV) torsion represented as the circumferential-longitudinal (CL) shear angle between 2D and 3D quantification, using cardiovascular magnetic resonance (CMR). CMR tagging was performed in six healthy volunteers. From this, LV torsion was calculated using a 2D and a 3D method. The cross-correlation between both methods was evaluated and comparisons were made using Bland-Altman analysis. The cross-correlation between the curves was r2 = 0.97 +/- 0.02. No significant time-delay was observed between the curves. Bland-Altman analysis revealed a significant positive linear relationship between the difference and the average value of both analysis methods, with the 2D results showing larger values than the 3D. The difference between both methods can be explained by the definition of the 2D method. LV torsion represented as CL shear quantified by the 2D and 3D analysis methods are strongly related. Therefore, it is suggested to use the faster 2D method for torsion calculation.
Top-cited authors
Eike Nagel
  • Goethe-Universität Frankfurt am Main
Peter Kellman
  • Hearts Content Homestead
Matthias G. Friedrich
  • McGill University Health Centre
James C Moon
  • University College London
David Bluemke
  • University of Wisconsin–Madison