Niranjan Balu

University of Washington Seattle, Seattle, Washington, United States

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Publications (38)114.71 Total impact

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    ABSTRACT: Objective: Effective prevention and management strategies of intraplaque hemorrhage (IPH) remain elusive because of our limited knowledge regarding its pathogenesis and contributing factors. This hypothesis-generating study aimed to investigate associations between cardiovascular risk factors and IPH for improved understanding of the pathogenesis of IPH. Approach and results: Asymptomatic subjects with 16% to 79% stenosis on ultrasound underwent carotid magnetic resonance imaging using a large-coverage, 3-dimensional magnetic resonance imaging protocol. Individual plaques (maximum thickness >1.5 mm) in bilateral carotid arteries were identified, and presence of IPH was determined. From 80 subjects, 176 de novo plaques were measured, of which 38 (21.6%) contained IPH. Blood pressure (BP), primarily low diastolic BP, was associated with IPH in multivariate analysis adjusted for age, sex, and plaque size (odds ratio with 95% confidence interval per 10-mm Hg increase: 0.51 [0.30-0.88]), which was little changed after adjusting for antihypertensive use and systemic atherosclerosis. Antiplatelet use was associated with IPH in age and sex-adjusted models (P=0.018), for which a trend remained after considering plaque size and past medical history (odds ratio for aspirin alone versus none: 3.1 [0.66-14.8]; odds ratio for clopidogrel or dual therapy versus none: 5.3 [0.80-35.0]; P=0.083). Conclusions: Low diastolic BP was independently associated with IPH, which was unlikely because of treatment difference or BP changes from systemic atherosclerosis. Hemodynamic changes from lowering diastolic BP may be the pathophysiological link. Prospective serial studies are needed to assess whether BP and antiplatelet use are associated with the development of new or repeated IPH.
    No preview · Article · Feb 2016 · Arteriosclerosis Thrombosis and Vascular Biology
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    Zechen Zhou · Rui Li · Xihai Zhao · Le He · Xiaole Wang · Jinnan Wang · Niranjan Balu · Chun Yuan
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    ABSTRACT: Multi-contrast vessel wall cardiovascular magnetic resonance (CMR) has demonstrated its capability for atherosclerotic plaque morphology measurement and component characterization in different vasculatures. However, limited coverage and partial volume effect with conventional two-dimensional (2D) techniques might cause lesion underestimation. The aim of this work is to evaluate the performance in a) blood suppression and b) vessel wall delineation of three-dimensional (3D) multi-contrast joint intra- and extracranial vessel wall imaging at 3T. Three multi-contrast 3D black blood (BB) sequences with T1, T2 and heavy T1 weighting and a custom designed 36-channel neurovascular coil covering the entire intra- and extracranial vasculature have been used and investigated in this study. Two healthy subjects were recruited for sequence parameter optimization and twenty-five patients were consecutively scanned for image quality and blood suppression assessment. Qualitative image scores of vessel wall delineation as well as quantitative Signal-to-Noise Ratio (SNR) and Contrast-to-Noise Ratio (CNR) were evaluated at five typical locations ranging from common carotid arteries to middle cerebral arteries. The 3D multi-contrast images acquired within 15mins allowed the vessel wall visualization with 0.8 mm isotropic spatial resolution covering intra- and extracranial segments. Quantitative wall and lumen SNR measurements for each sequence showed effective blood suppression at all selected locations (P < 0.0001). Although the wall-lumen CNR varied across measured locations, each sequence provided good or adequate image quality in both intra- and extracranial segments. The proposed 3D multi-contrast vessel wall technique provides isotropic resolution and time efficient solution for joint intra- and extracranial vessel wall CMR.
    Full-text · Article · Dec 2015 · Journal of Cardiovascular Magnetic Resonance
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    ABSTRACT: Automatic in vivo segmentation of multicontrast (multisequence) carotid magnetic resonance for plaque composition has been proposed as a substitute for manual review to save time and reduce inter-reader variability in large-scale or multicenter studies. Using serial images from a prospective longitudinal study, we sought to compare a semi-automatic approach versus expert human reading in analyzing carotid atherosclerosis progression. Baseline and 6-month follow-up multicontrast carotid images from 59 asymptomatic subjects with 16-79 % carotid stenosis were reviewed by both trained radiologists with 2-4 years of specialized experience in carotid plaque characterization with MRI and a previously reported automatic atherosclerotic plaque segmentation algorithm, referred to as morphology-enhanced probabilistic plaque segmentation (MEPPS). Agreement on measurements from individual time points, as well as on compositional changes, was assessed using the intraclass correlation coefficient (ICC). There was good agreement between manual and MEPPS reviews on individual time points for calcification (CA) (area: ICC; 0.85-0.91; volume: ICC; 0.92-0.95) and lipid-rich necrotic core (LRNC) (area: ICC; 0.78-0.82; volume: ICC; 0.84-0.86). For compositional changes, agreement was good for CA volume change (ICC; 0.78) and moderate for LRNC volume change (ICC; 0.49). Factors associated with LRNC progression as detected by MEPPS review included intraplaque hemorrhage (positive association) and reduction in low-density lipoprotein cholesterol (negative association), which were consistent with previous findings from manual review. Automatic classifier for plaque composition produced results similar to expert manual review in a prospective serial MRI study of carotid atherosclerosis progression. Such automatic classification tools may be beneficial in large-scale multicenter studies by reducing image analysis time and avoiding bias between human reviewers.
    No preview · Article · Jul 2015 · The international journal of cardiovascular imaging
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    ABSTRACT: Although studies have attempted to differentiate intracranial vascular disease using vessel wall magnetic resonance imaging (VWI), none have incorporated multicontrast imaging. This study uses T1- and T2-weighted VWI to differentiate intracranial vasculopathies. We retrospectively reviewed patients with clinically defined intracranial vasculopathies causing luminal stenosis/irregularity who underwent VWI studies. Two blinded experts evaluated T1 precontrast and postcontrast and T2-weighted VWI characteristics, including the pattern of wall thickening; presence, pattern, and intensity of postcontrast enhancement; and T2 signal characteristics. Twenty-one cases of atherosclerosis (intracranial atherosclerotic disease [ICAD]), 4 of reversible cerebral vasoconstriction syndrome, and 4 of vasculitis were identified, with a total of 118 stenotic lesions (81 ICAD, 22 reversible cerebral vasoconstriction syndrome, and 15 vasculitic lesions). There was substantial to excellent inter-reader agreement for the assessment of lesional T2 hyperintensity (κ=0.80), pattern of wall thickening (κ=0.87), presence (κ=0.90), pattern (κ=0.73), and intensity (κ=0.77) of enhancement. ICAD lesions were significantly more likely to have eccentric wall involvement (90.1%) than reversible cerebral vasoconstriction syndrome (8.2%; P<0.001) and vasculitic lesions (6.7%; P<0.001) and were also more likely to have T2 hyperintensity present than the other 2 vasculopathies (79% versus 0%; P<0.001). There were also significant differences in the presence, intensity, and pattern of enhancement between all lesion types. Combining T1 and T2 VWI increased the sensitivity of VWI in differentiating ICAD from other vasculopathies from 90.1% to 96.3%. Multicontrast VWI can be a complementary tool for intracranial vasculopathy differentiation, which often leads to more invasive workups when reversible cerebral vasoconstriction syndrome and vasculitis are in the differential diagnosis. © 2015 American Heart Association, Inc.
    Full-text · Article · May 2015 · Stroke
  • Zechen Zhou · Jinnan Wang · Niranjan Balu · Rui Li · Chun Yuan
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    ABSTRACT: A new subspace-based iterative reconstruction method, termed Self-supporting Tailored k-space Estimation for Parallel imaging reconstruction (STEP), is presented and evaluated in comparison to the existing autocalibrating method SPIRiT and calibrationless method SAKE. In STEP, two tailored schemes including k-space partition and basis selection are proposed to promote spatially variant signal subspace and incorporated into a self-supporting structured low rank model to enforce properties of locality, sparsity, and rank deficiency, which can be formulated into a constrained optimization problem and solved by an iterative algorithm. Simulated and in vivo datasets were used to investigate the performance of STEP in terms of overall image quality and detail structure preservation. The advantage of STEP on image quality is demonstrated by retrospectively undersampled multichannel Cartesian data with various patterns. Compared with SPIRiT and SAKE, STEP can provide more accurate reconstruction images with less residual aliasing artifacts and reduced noise amplification in simulation and in vivo experiments. In addition, STEP has the capability of combining compressed sensing with arbitrary sampling trajectory. Using k-space partition and basis selection can further improve the performance of parallel imaging reconstruction with or without calibration signals. Magn Reson Med, 2015. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    No preview · Article · Mar 2015 · Magnetic Resonance in Medicine
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    ABSTRACT: This study sought to determine the multicenter reproducibility of magnetic resonance imaging (MRI) and the compatibility of different scanner platforms in assessing carotid plaque morphology and composition. A standardized multi-contrast MRI protocol was implemented at 16 imaging sites (GE: 8; Philips: 8). Sixty-eight subjects (61 ± 8 years; 52 males) were dispersedly recruited and scanned twice within 2 weeks on the same magnet. Images were reviewed centrally using a streamlined semiautomatic approach. Quantitative volumetric measurements on plaque morphology (lumen, wall, and outer wall) and plaque tissue composition [lipid-rich necrotic core (LRNC), calcification, and fibrous tissue] were obtained. Inter-scan reproducibility was summarized using the within-subject standard deviation, coefficient of variation (CV) and intraclass correlation coefficient (ICC). Good to excellent reproducibility was observed for both morphological (ICC range 0.98-0.99) and compositional (ICC range 0.88-0.96) measurements. Measurement precision was related to the size of structures (CV range 2.5-4.9 % for morphology, 36-44 % for LRNC and calcification). Comparable measurement variability was found between the two platforms on both plaque morphology and tissue composition. In conclusion, good to excellent inter-scan reproducibility of carotid MRI can be achieved in multicenter settings with comparable measurement precision between platforms, which may facilitate future multicenter endeavors that use serial MRI to monitor atherosclerotic plaque progression.
    No preview · Article · Sep 2014 · The International Journal of Cardiovascular Imaging
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    ABSTRACT: Association between clinical factors and high-risk plaque features, such as, thin or ruptured cap, intraplaque hemorrhage, presence of lipid-rich necrotic core (LRNC), and increased LRNC volume as assessed by magnetic resonance imaging (MRI), was examined in patients with established vascular disease in the Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides (AIM-HIGH) trial. A total of 214 subjects underwent carotid MRI and had acceptable image quality for assessment of plaque burden, tissue contents, and MRI-modified American Heart Association lesion type by a core laboratory. We found that 77% of subjects had carotid plaques, 52% had lipid-containing plaques, and 11% had advanced American Heart Association type-VI lesions with possible surface defect, intraplaque hemorrhage, or mural thrombus. Type-VI lesions were associated with older age (odds ratio [OR] = 2.6 per 5 years increase, p <0.001). After adjusting for age, these lesions were associated with history of cerebrovascular disease (OR = 4.1, p = 0.01), higher levels of lipoprotein(a) (OR = 2.0 per 1 SD increase, p = 0.02), and larger percent wall volume (PWV [OR = 4.6 per 1 SD increase, p <0.001]) but, were negatively associated with metabolic syndrome (OR = 0.2, p = 0.02). Presence of LRNC was associated with the male gender (OR = 3.2, p = 0.02) and PWV (OR = 3.8 per 1 SD, p <0.001); however, it was negatively associated with diabetes (OR = 0.4, p = 0.02) and high-density lipoprotein cholesterol levels (OR = 0.7 per 1 SD, p = 0.02). Increased percent LRNC was associated with PWV (regression coefficient = 0.36, p <0.001) and negatively associated with ApoA1 levels (regression coefficient = -0.20, p = 0.03). In conclusion, older age, male gender, history of cerebrovascular disease, larger plaque burden, higher lipoprotein(a), and lower high-density lipoprotein cholesterol or ApoA1 level have statistically significant associations with high-risk plaque features. Metabolic syndrome and diabetes showed negative associations in this population.
    No preview · Article · Aug 2014 · The American Journal of Cardiology
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    ABSTRACT: Background The aim of this study is to investigate the inter-scan reproducibility of kinetic parameters in atherosclerotic plaque using dynamic contrast-enhanced (DCE) cardiovascular magnetic resonance (CMR) in a multi-center setting at 3T.Methods Carotid arteries of 51 subjects from 15 sites were scanned twice within two weeks on 3T scanners using a previously described DCE-CMR protocol. Imaging data with protocol compliance and sufficient image quality were analyzed to generate kinetic parameters of vessel wall, expressed as transfer constant (K trans ) and plasma volume (v p ). The inter-scan reproducibility was evaluated using intra-class correlation coefficient (ICC) and coefficient of variation (CV). Power analysis was carried out to provide sample size estimations for future prospective study.ResultsTen (19.6%) subjects were found to suffer from protocol violation, and another 6 (11.8%) had poor image quality (n¿=¿6) in at least one scan. In the 35 (68.6%) subjects with complete data, the ICCs of K trans and v p were 0.65 and 0.28, respectively. The CVs were 25% and 62%, respectively. The ICC and CV for v p improved to 0.73 and 28% in larger lesions with analyzed area larger than 25 mm2. Power analysis based on the measured CV showed that 50 subjects per arm are sufficient to detect a 20% difference in change of K trans over time between treatment arms with 80% power without consideration of the dropout rate.Conclusion The result of this study indicates that quantitative measurement from DCE-CMR is feasible to detect changes with a relatively modest sample size in a prospective multi-center study despite the limitations. The relative high dropout rate suggested the critical needs for intensive operator training, optimized imaging protocol, and strict quality control in future studies.
    Full-text · Article · Aug 2014 · Journal of Cardiovascular Magnetic Resonance
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    ABSTRACT: The main objective of cell therapy is regeneration of damaged tissues. To distinguish graft from host tissue by magnetic resonance imaging (MRI), a paramagnetic label must be introduced to cells prior to transplantation. The paramagnetic label can be either exogenous iron oxide nanoparticles or a genetic overexpression of ferritin, an endogenous iron storage protein. The purpose of this work was to compare efficacy of these 2 methods for MRI evaluation of engrafted cell survival in the infarcted mouse heart. Mouse skeletal myoblasts were labeled either by cocultivation with iron oxide particles or by engineering them to overexpress ferritin. Along with live cell transplantation, 2 other groups of mice were injected with dead-labeled cells. Both particle-labeled and ferritin-tagged grafts were detected as areas of MRI signal hypointensity in the left ventricle of the mouse heart using T2*-weighted sequences, although the signal attenuation decreased with ferritin tagging. Importantly, live cells could not be distinguished from dead cells when labeled with iron oxide particles, whereas the ferritin tagging was detected only in live grafts, thereby allowing identification of viable grafts using MRI. Thus, iron oxide particles can provide information about initial cell injection success but cannot assess graft viability. On the other hand, genetically based cell tagging, such as ferritin overexpression, despite having lower signal intensity in comparison with iron oxide particles, is able to identify live transplanted cells.
    No preview · Article · Mar 2014 · Journal of Cardiovascular Pharmacology and Therapeutics
  • Jie Sun · Niranjan Balu · Chun Yuan
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    ABSTRACT: Growing interest in the in vivo characterization of plaque pathology has furthered the development of vessel wall imaging approaches beyond traditional techniques of luminal imaging. By leveraging histopathological information from carotid endarterectomy specimens, magnetic resonance imaging has been proven capable of providing qualitative and quantitative information on a number of morphological and pathological features of carotid atherosclerosis, including fibrous cap and necrotic core, intraplaque hemorrhage, plaque neovascularization, and inflammation. These technical advancements present new opportunities to expand the understanding of the pathophysiology of ischemic stroke and devise more efficient diagnostic and prognostic tools to address contemporary clinical problems in the management of carotid atherosclerosis. From a clinical perspective, this article introduces the various magnetic resonance techniques for carotid atherosclerosis imaging. The background and pathological basis of direct plaque imaging in carotid arteries are discussed, followed by available solutions and key technical considerations, as well as promising applications that have arisen from these techniques.
    No preview · Chapter · Jan 2014
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    ABSTRACT: Molecular imaging of atherosclerotic biomarkers is critical for non-invasive detection and diagnosis of atherosclerotic plaques and therapeutic management. Fibrin and fibronectin accumulate at elevated levels in atherosclerotic plaques and are associated with atherogenesis and disease progression. Molecular imaging of these biomarkers has the potential to non-invasively characterize plaque burden. In this work, we investigated the effectiveness of a peptide-targeted macrocyclic Gd(III) chelate, CLT1-dL-(DOTA-Gd)4, specific to fibrin-fibronectin complexes for molecular MRI of atherosclerosis. Atherosclerotic plaques were induced in Apolipoprotein E-knockout (ApoE(-/-)) mice by feeding with high fat and cholesterol-enriched diet (HFD) for up to 30 weeks. MRI of the vessel wall in the arch aorta was performed at 10, 20 and 30 weeks after the onset of HFD. High spatial-resolution MRI was performed prior and up to 35 minutes after i.v. injection of CLT1-dL-(DOTA-Gd)4 or a nonspecific control agent at a dose of 0.1 mmol-Gd/kg. CLT1-dL-(DOTA-Gd)4 produced stronger enhancement in the atherosclerotic lesions of the aortic wall than the control at all time points in the mice. Cross sectional MR images of the aortic arch revealed progressive thickening of the atherosclerotic vessel wall in the mice on HFD for up to 30 weeks. This progression correlated well to histological staining, as well as fibrin and fibronectin immunochemical stained images. Molecular MRI with CLT1-dL-(DOTA-Gd)4 has a potential for detecting atherosclerosis and non-invasive monitoring of the progression of the plaques.
    Full-text · Article · Oct 2013 · American Journal of Nuclear Medicine and Molecular Imaging
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    ABSTRACT: Purpose: To use magnetic resonance (MR) imaging to examine the short-term (6 months) natural history of the lipid-rich necrotic core (LRNC) in carotid artery plaques by examining the placebo group of a multicenter clinical trial. Materials and methods: Study procedures and consent forms were approved by the institutional review board for this HIPAA-compliant study. Written informed consent was obtained for all enrolled subjects. Subjects in the placebo group of a multicenter clinical trial who showed LRNC at screening MR imaging had a follow-up MR imaging examination after 6 months. Lumen and wall volumes and LRNC volume and percentage were measured on images from both examinations by readers who were blinded to the time sequence. Plaque progression was calculated as annualized change in common coverage by using the carotid artery bifurcation as a landmark. Associations of clinical and imaging variables with LRNC progression were examined by using linear regression analysis. Results: Fifty-nine of 73 (81%) subjects completed the study, with a mean interval ± standard deviation of 6.9 months ± 1.0. The mean progression rates per year ± standard deviation of LRNC volume and percentage were -5.2 mm(3) ± 34.3 (P = .249) and -1.74% ± 6.27% (P = .038), respectively. Of the clinical and imaging variables examined, presence of intraplaque hemorrhage (IPH) was significantly associated with LRNC progression (P = .001). Plaques with IPH had increased LRNC volume per year (62.9 mm(3) ± 46.2 vs -8.8 mm(3) ± 29.9, P < .001) and percentage per year (3.67% ± 1.85% vs -2.03% ± 6.30%, P = .126) compared with those without IPH. Spearman correlation analysis showed that change in LRNC positively correlated with change in wall volume (ρ = 0.60, P < .001), but not with change in lumen volume (ρ = -0.17, P = .201). Conclusion: Serial MR imaging of the carotid artery allowed observation of changes in LRNC over a short follow-up period and demonstrated the complexity of plaque progression patterns related to tissue composition. LRNC progression may be influenced not only by clinical characteristics, but also and to a large extent by plaque characteristics such as IPH.
    Preview · Article · Mar 2013 · Radiology
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    ABSTRACT: A simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) MR imaging technique is proposed to detect both luminal stenosis and hemorrhage in atherosclerosis patients in a single scan. Thirteen patients with diagnosed carotid atherosclerotic plaque were admitted after informed consent. All scans were performed on a 3T MR imaging system with SNAP, 2D time-of-flight and magnetization-prepared 3D rapid acquisition gradient echo sequences. The SNAP sequence utilized a phase sensitive acquisition, and was designed to provide positive signals corresponding to intraplaque hemorrhage and negative signals corresponding to lumen. SNAP images were compared to time-of-flight images to evaluate lumen size measurements using linear mixed models and the intraclass correlation coefficient. Intraplaque hemorrhage identification accuracy was evaluated by comparing to magnetization-prepared 3D rapid acquisition gradient echo images using Cohen's Kappa. Diagnostic quality SNAP images were generated from all subjects. Quantitatively, the lumen size measurements by SNAP were strongly correlated (intraclass correlation coefficient = 0.96, P < 0.001) with those measured by time-of-flight. For intraplaque hemorrhage detection, strong agreement (κ = 0.82, P < 0.001) was also identified between SNAP and magnetization-prepared 3D rapid acquisition gradient echo images. In conclusion, a SNAP imaging technique was proposed and shows great promise for imaging both lumen size and carotid intraplaque hemorrhage with a single scan. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.
    Preview · Article · Feb 2013 · Magnetic Resonance in Medicine
  • J Chi · B Chiu · Y Cao · X Liu · J Wang · N Balu · C Yuan · J Xu
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    ABSTRACT: Aim: To assess whether the three-dimensional (3D) black-blood motion-sensitized driven equilibrium (MSDE) prepared rapid gradient-echo sequence (3D MERGE) magnetic resonance imaging (MRI) sequence is sensitive enough to detect differences in atherosclerotic plaque size and morphology occurring in the adductor canal and the proximal bifurcation segment. Materials and methods: Fifty pairs of adductor canal and bifurcation segments from 25 patients with intermittent claudication were examined using 3D MERGE. The two-dimensional (2D) transverse section showing the largest plaque burden in each segment was chosen for comparison. Wall and lumen boundaries were segmented from each 2D section and quantified using six metrics: wall area (WA), lumen area (LA), normalized wall index (NWI), maximum wall thickness (MaxWT), minimum wall thickness (MinWT), and eccentricity. Results: The mean LA in the adductor region was significantly lower than that in the bifurcation segment (p < 0.0001). Mean NWI, MaxWT, and eccentricity in the adductor region were significantly higher than those at bifurcation (p < 0.0001, p < 0.0021, and p < 0.0045, respectively). Mean WA and MinWT of the two segments did not show a statistically significant difference. WA in both regions was positively correlated with eccentricity (p < 0.0049 and p < 0.0049, respectively). LA was negatively correlated with eccentricity (p < 0.0017), and NWI was positively correlated with eccentricity only in the adductor region (p < 0.0004). Conclusion: The results suggest that compensatory enlargement was limited in the adductor canal when compared to the proximal bifurcation segment. 3D MERGE, as a fast and non-invasive sequence, may assist the evaluation of femoral atherosclerosis by assessing the size and morphology of plaques, knowledge of which can guide clinical treatment.
    No preview · Article · Jan 2013 · Clinical Radiology
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    ABSTRACT: To determine the potential for accelerated 3D carotid magnetic resonance imaging (MRI) using wavelet based compressed sensing (CS) with a hidden Markov tree (HMT) model. We retrospectively applied HMT model-based CS and conventional CS to 3D carotid MRI data with 0.7 mm isotropic resolution from six subjects with known carotid stenosis (12 carotids). We applied a wavelet-tree model learned from a training database of carotid images to improve CS reconstruction. Quantitative endpoints such as lumen area, wall area, mean and maximum wall thickness, plaque calcification, and necrotic core area were measured and compared using Bland-Altman analysis along with image quality. Rate-4.5 acceleration with HMT model-based CS provided image quality comparable to that of rate-3 acceleration with conventional CS and fully sampled reference reconstructions. Morphological measurements made on rate-4.5 HMT model-based CS reconstructions were in good agreement with measurements made on fully sampled reference images. There was no significant bias or correlation between mean and difference of measurements when comparing rate 4.5 HMT model-based CS with fully sampled reference images. HMT model-based CS can potentially be used to accelerate clinical carotid MRI by a factor of 4.5 without impacting diagnostic quality or quantitative endpoints. J. Magn. Reson. Imaging 2012;36:1194-1202. © 2012 Wiley Periodicals, Inc.
    No preview · Article · Nov 2012 · Journal of Magnetic Resonance Imaging
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    ABSTRACT: The noninvasive detection of transplanted cells in damaged organs and the longitudinal follow-up of cell fate and graft size are important for the evaluation of cell therapy. We have shown previously that the overexpression of the natural iron storage protein, ferritin, permits the detection of engrafted cells in mouse heart by MRI, but further imaging optimization is required. Here, we report a systematic evaluation of ferritin-based stem cell imaging in infarcted mouse hearts in vivo using three cardiac-gated pulse sequences in a 3-T scanner: black-blood proton-density-weighted turbo spin echo (PD TSE BB), bright-blood T(2) *-weighted gradient echo (GRE) and black-blood T(2) *-weighted GRE with improved motion-sensitized-driven equilibrium (iMSDE) preparation. Transgenic C2C12 myoblast grafts overexpressing ferritin did not change MRI contrast in the PD TSE BB images, but showed a 20% reduction in signal intensity ratio in black-blood T(2) *-weighted iMSDE (p < 0.05) and a 30% reduction in bright-blood T(2) *-weighted GRE (p < 0.0001). Graft size measurements by T(2) * iMSDE and T(2) * GRE were highly correlated with histological assessments (r = 0.79 and r = 0.89, respectively). Unlabeled wild-type C2C12 cells transplanted to mouse heart did not change the MRI signal intensity, although endogenous hemosiderin was seen in some infarcts. These data support the use of ferritin to track the survival, growth and migration of stem cells transplanted into the injured heart. Copyright © 2012 John Wiley & Sons, Ltd.
    No preview · Article · Oct 2012 · NMR in Biomedicine
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    Chun Yuan · Jinnan Wang · Niranjan Balu
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    ABSTRACT: Manifestations of atherosclerotic plaque in different arterial beds range from perfusion deficits to overt ischemia such as stroke and myocardial infarction. Atherosclerotic plaque composition is associated with its propensity to rupture and cause vascular events. Magnetic resonance (MR) imaging of atherosclerotic plaque using clinical 1.5 T scanners can detect plaque composition. Plaque MR imaging at higher field strengths offers both opportunities and challenges to improving the high spatial resolution and contrast required for this type of imaging. This article summarizes the technological requirements required for high-field plaque MR imaging and its application in detecting plaque components.
    Preview · Article · May 2012 · Neuroimaging Clinics of North America
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    ABSTRACT: To evaluate the performance of automatic segmentation of atherosclerotic plaque components using solely multicontrast 3D gradient echo (GRE) magnetic resonance imaging (MRI). A total of 15 patients with a history of recent transient ischemic attacks or stroke underwent carotid vessel wall imaging bilaterally with a combination of 2D turbo spin echo (TSE) sequences and 3D GRE sequences. The TSE sequences included T1-weighted, T2-weighted, and contrast-enhanced T1-weighted scans. The 3D GRE sequences included time-of-flight (TOF), magnetization-prepared rapid gradient echo (MP-RAGE), and motion-sensitized driven equilibrium prepared rapid gradient echo (MERGE) scans. From these images, the previously developed morphology-enhanced probabilistic plaque segmentation (MEPPS) algorithm was retrained based solely on the 3D GRE sequences to segment necrotic core (NC), calcification (CA), and loose matrix (LM). Segmentation performance was assessed using a leave-one-out cross-validation approach via comparing the new 3D-MEPPS algorithm to the original MEPPS algorithm that was based on the traditional multicontrast protocol including 2D TSE and TOF sequences. Twenty arteries of 15 subjects were found to exhibit significant plaques within the coverage of all imaging sequences. For these arteries, between new and original MEPPS algorithms, the areas per slice exhibited correlation coefficients of 0.86 for NC, 0.99 for CA, and 0.80 for LM; no significant area bias was observed. The combination of 3D imaging sequences (TOF, MP-RAGE, and MERGE) can provide sufficient contrast to distinguish NC, CA, and LM. Automatic segmentation using 3D sequences and traditional multicontrast protocol produced highly similar results.
    Full-text · Article · Apr 2012 · Journal of Magnetic Resonance Imaging
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    Jinnan Wang · Peter Koken · Niranjan Balu · Chun Yuan · Peter Boernert

    Preview · Article · Feb 2012 · Journal of Cardiovascular Magnetic Resonance
  • Rui Li · Niranjan Balu · Chun Yuan
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    ABSTRACT: Atherosclerosis-related cardiovascular disease is the leading cause of morbidity and mortality all over the world. Atherosclerosis can occur in the aorta, carotid, and coronary arteries causing stroke, myocardial infarction, and sudden death without prior symptoms. The culprit lesions are mainly caused from the rupture of the plaque surface which then triggers thrombotic complications. Thus, a challenge for imaging is to identify vulnerable plaques that are likely to rupture. Extensive pathological studies link plaque morphology and tissue composition as major contributors to plaque instability. Thus, raises the need for vessel wall imaging.
    No preview · Chapter · Jan 2012