Improved contrast agent bolus tracking using T1 FARM

Improved quantification of myocardial blood flow using highly constrained back projection reconstruction

PURPOSE

To improve quantification of myocardial blood flow using a fast T1 mapping technique using highly constrained back projection reconstruction (HYPR)-accelerated acquisition.

METHODS

A major source of error in the measurement of myocardial blood flow (MBF) using MRI is the nonlinear relationship between image signal intensity and contrast agent (CA) concentration. HYPR-accelerated radial acquisition was used to generate pixel-wise T1 maps with a temporal resolution of one heartbeat. HYPR produces images with a temporal footprint of 40 ms and four images within 188 ms. T1 values were converted into CA concentrations by the known linear relationship between CA concentration and T1 . The T1 mapping technique was used to quantify MBF in 10 healthy subjects and compared with MBF found using image signal intensity as well as MBF reported in the literature.

RESULTS

The MBF measured using the proposed method was more consistent with that previously reported in the literature and was significantly lower (P = 0.002) than that calculated using image signal intensity (1.11 ± 0.27 mL/min/g versus 1.88 ± 0.45 mL/min/g, respectively).

CONCLUSION

We developed a fast T1 mapping method for MBF quantification using radial sampling and HYPR. Further validation is required to determine its clinical value in assessing myocardial perfusion deficit in coronary artery disease.

A novel estimation method for physiological parameters in dynamic contrast-enhanced MRI: application of a distributed parameter model using Fourier-domain calculations

Dynamic contrast-enhanced magnetic resonance imaging (MRI) is a promising tool in the evaluation of tumor physiology. From rapidly acquired images and a model for contrast agent pharmacokinetics, physiological parameters are derived. One pharmacokinetic model, the tissue homogeneity model, enables estimation of both blood flow and vessel permeability together with parameters that describe blood volume and extracellular extravascular volume fraction. However, studies have shown that parameter estimation with this model is unstable. Therefore, several initial guesses are needed for accurate estimates, which makes the estimation slow. In this study a new estimation algorithm for the tissue homogeneity model, based on Fourier domain calculations, was derived and implemented as a Matlab program. The algorithm was tested with Monte-Carlo simulations and the results were compared to an existing method that uses the adiabatic approximation. The algorithm was also tested on data from a metastasis in the brain. The comparison showed that the new algorithm gave more accurate results on the 2.5th and 97.5th percentile levels, for instance the error in blood volume was reduced by 21%. In addition, the time needed for the computations was reduced with a factor 25. It was concluded that the new algorithm can be used to speed up parameter estimation while accuracy can be gained at the same time.

Beneficial effects of eplerenone versus hydrochlorothiazide on coronary circulatory function in patients with diabetes mellitus

CONTEXT

Impaired coronary circulatory function predicts cardiovascular events, the leading cause of death in patients with diabetes mellitus. Aldosterone causes cardiovascular injury and is not suppressed by chronic angiotensin converting enzyme (ACE) inhibitor therapy.

OBJECTIVE

Our objective was to assess whether mineralocorticoid receptor activation contributes to coronary circulatory dysfunction in patients with diabetes who are already receiving ACE inhibitor therapy.

DESIGN AND SETTING

A randomized, double-blind, crossover study with an intervening washout period of at least 4 wk was conducted with ambulatory patients from the community.

PATIENTS

Patients included 16 subjects (11 men, eight Caucasians; mean age, 53 yr; mean body mass index, 38.0 kg/m2) with diabetes and albuminuria but without clinical cardiovascular disease.

INTERVENTIONS

ACE inhibitors were switched to enalapril 20 mg daily, and other antihypertensives were discontinued. Amlodipine 5-10 mg daily was added to achieve blood pressures less than 130/80 mm Hg. Subjects then received, in random order, 6 wk of the mineralocorticoid receptor antagonist eplerenone 50 mg (with placebo pill) daily and 6 wk of another diuretic, hydrochlorothiazide 12.5 mg (with potassium 10 mEq) daily.

MAIN OUTCOME MEASURES

Before and after each 6-wk treatment period, we measured coronary circulatory function (adenosine-stimulated myocardial perfusion reserve) and endothelial function (brachial artery reactivity and peripheral arterial tonometry).

RESULTS

The eplerenone and hydrochlorothiazide groups had similar blood pressures, serum potassium, glycemia, and endothelial function. Although pretreatment myocardial perfusion reserve did not differ between groups, myocardial perfusion reserve was significantly higher after eplerenone than after hydrochlorothiazide (median 1.57 vs. 1.30; P = 0.03).

CONCLUSIONS

Mineralocorticoid receptor blockade improves coronary circulatory function compared with hydrochlorothiazide in patients with diabetes already receiving ACE inhibitor therapy.

Contrast agents for functional and cellular MRI of the kidney

Low-molecular-weight gadolinium (Gd) chelates are glomerular tracers but their role in evaluation of renal function with magnetic resonance (MR) imaging is still marginal. Because of their small size, they diffuse freely into the interstitium and the relationship between measured signal intensity and concentration is complex. New categories of contrast agents, such as large Gd-chelates or iron oxide particules, with different pharmacokinetic and magnetic properties have been developed. These large molecules could be useful for both functional (quantification of perfusion, quantification of glomerular filtration rate, estimation of tubular function) and cellular imaging (intrarenal phagocytosis in inflammatory renal diseases). Continuous development of new contrast agents remains worthwhile to get the best adequacy between the physiological phenomenon of interest and the pharmacokinetic of the agent.

T1 measurement using a short acquisition period for quantitative cardiac applications

Myocardial signal intensity curves for myocardial perfusion studies may be made quantitative by the use of T1 measurements made after the first-pass of contrast agent. A short data acquisition method for T1 mapping is presented in which all data for each T1 map are acquired in a short breath hold, and the slice geometry and timing in the cardiac cycle exactly match that of the dynamic first-pass perfusion sequence. This allows accurate image registration of the T1 map with the first-pass series of images. The T1 method is based on varying the preparation-pulse delay time of a saturation recovery sequence, and in this implementation employs an ECG-triggered, single-shot, spoiled gradient echo technique with SENSE reconstruction. The method allows T1 estimates of three slices to be made in fifteen heartbeats. For a range of samples with T1 values equivalent to those found in the myocardium during the first-pass of contrast agent, T1 estimates were accurate to within 6%, and the variation between slices was 2% or less.

Application of the keyhole technique to T1? relaxation mapping

PURPOSE

To demonstrate the feasibility of using the keyhole technique to minimize error in a least squares regression estimation of T(1rho) from magnetic resonance (MR) image data.

MATERIALS AND METHODS

The keyhole method of partial k-space acquisition was simulated using data from a virtual phantom and MR images of ex vivo bovine and in vivo human cartilage. T(1rho) maps were reconstructed from partial k-space (keyhole) image data using linear regression, and error was measured with relation to T(1rho) maps created from the full k-space images. An error model was created based on statistical theory and fitted to the error measurements.

RESULTS

T(1rho) maps created from keyhole images of a human knee produced levels of error on the order of 1% while reducing standard image acquisition time approximately by half. The resultant errors were strongly correlated with expectations derived from statistical theory.

CONCLUSION

The error model can be used to analytically optimize the keyhole method in order to minimize the overall error in the estimation of the relaxation parameter of interest. The keyhole method can be generalized to significantly expedite all forms of relaxation mapping.

The use of Gd-DTPA as a marker of myocardial viability in reperfused acute myocardial infarction

At present, accurate assessment of the extent of myocardial viability after acute myocardial infarction is limited due to the spatial resolution of currently available imaging modalities. MR cardiac imaging, with its superior spatial resolution, would be used if viable and infarcted tissue could be separated based on signal intensity. In infarcted tissue, cell membrane breakdown allows the entry of the MR contrast agent Gd-DTPA which is normally extracellular. The increased space for Gd-DTPA distribution (partition coefficient, lambda) in this infarcted tissue results in increased Gd-DTPA concentration and hence increased signal intensity on T1-weighted MR images. In a canine model of ischemia/reperfusion injury, the partition coefficient in infarcted tissue increased as early as 1 min post reperfusion. lambda in infarcted tissue stayed increased over that in normal tissue for at least 8 weeks. The accuracy of contrast-enhanced MRI was confirmed by results of 201Tl SPECT and a cine MRI dobutamine wall motion study in a patient 1 week after an acute myocardial infarction. Thus, contrast-enhanced MRI shows great promise for the non-invasive determination of myocardial viability after acute myocardial infarction.

Gd-DTPA bolus tracking in the myocardium using T1 fast acquisition relaxation mapping (T1 FARM)

MRI methods currently used for bolus tracking in the myocardium, such as saturation recovery turbo-fast low-angle shot (FLASH) (srTFL), are limited by signal intensity (SI) saturation at high contrast agent (CA) concentrations. By using T1 fast acquisition relaxation mapping (T1 FARM), a Gd-DTPA bolus (0.075 vs. 0.025 mmol/kg) may be injected without causing saturation. This study tested the feasibility of in vivo T1 FARM bolus tracking under rest/stress conditions in seven beagles with multiple permanently occluded branches of the left anterior descending (LAD) coronary artery. Although it underestimated the myocardial perfusion reserve (MPR) measured ex vivo using radioactive microspheres (mean +/- SEM; 3.60 +/- 0.26), the MPR determined upon application of the modified Kety model (1.86 +/- 0.10) enabled distinction between normal and infarcted tissue. The partition coefficient (lambda) estimated at rest and stress using the modified Kety model underestimated ex vivo radioactive measurements in infarcted tissue (0.25 +/- 0.01 vs. 0.26 +/- 0.01 vs. 0.79 +/- 0.08 ml/g, P < 0.0001) yet was accurate in normal tissue (0.28 +/- 0.01 vs. 0.30 +/- 0.01 vs. 0.33 +/- 0.01 ml/g, P = NS). Thus, although unsuitable for myocardial viability assessment, T1 FARM bolus tracking shows potential for assessment of myocardial perfusion.

Methodology of brain perfusion imaging

Numerous techniques have been proposed in the last 15 years to measure various perfusion-related parameters in the brain. In particular, two approaches have proven extremely successful: injection of paramagnetic contrast agents for measuring cerebral blood volumes (CBV) and arterial spin labeling (ASL) for measuring cerebral blood flows (CBF). This review presents the methodology of the different magnetic resonance imaging (MRI) techniques in use for CBV and CBF measurements and briefly discusses their limitations and potentials.

Modeling tissue contrast agent concentration: a solution to the tissue homogeneity model using a simulated arterial input function

The tissue homogeneity model, which describes tissue in terms of two compartments, one intravascular (iv) and one extravascular (ev), is solved by Laplace transformation of two coupled differential equations. By assuming a functional form for the arterial input function (AIF), or by fitting to an experimentally determined AIF, this function is introduced into the solution as a boundary condition describing the time dependent input to the capillary. The solution to the tissue homogeneity model equations in Laplace space are numerically inverted to obtain the concentration of tracer in the ev space as a function of time and in the iv space as a function of both position and time. Magn Reson Med 45:42-45, 2001.

Captopril MR renography in a swine model: toward a comprehensive evaluation of renal arterial stenosis

PURPOSE

To test the feasibility of captopril magnetic resonance (MR) renography and to validate the technique in an animal model of renal arterial stenosis.

MATERIALS AND METHODS

Seven pigs with induced renal arterial stenosis were studied. MR renography was performed with a T1-weighted approach by using three-dimensional fast imaging with steady-state precession, or FISP, sequences after administration of a bolus of 0.1 mmol of gadopentetate dimeglumine per kilogram of body weight. Captopril was administered to improve the specificity.

RESULTS

The results demonstrate that differences in renographic curves and indices are observed only if an anatomically substantial stenosis, typically a diameter reduction of more than 70%, is present and captopril is administered.

CONCLUSION

In this preliminary experience in an animal model, captopril MR renography provided data consistent with expectations based on conventional renographic results.

Simultaneous MRI measurement of blood flow, blood volume, and capillary permeability in mammary tumors using two different contrast agents

A technique for the simultaneous measurement of three vascular parameters: blood flow (Frho), blood volume (v(b)), and the capillary permeability-surface area product (PSrho) in breast tumors using dynamic contrast-enhanced magnetic resonance imaging (MRI) is presented. Features of the technique include measurement of precontrast tumor T(1), rapid temporal sampling, measurement of the arterial input function, and use of a distributed parameter tracer kinetic model. Parameter measurements are compared that were determined using two contrast agents of different molecular weights, gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA; 0.6 kDa) and Gadomer-17 (17 kDa), in 18 spontaneous canine mammary tumors. Measurements of Frho and v(b) corresponded well with literature values, and the mean PSrho measured using Gd-DTPA was a factor of 15 higher than that measured using Gadomer-17. J. Magn. Reson. Imaging 2000;12:991-1003.

Clinical assessment of myocardial viability using MRI during a constant infusion of Gd-DTPA

This study assessed the accuracy and feasibility of magnetic resonance imaging (MRI) during a constant infusion of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) for the determination of myocardial viability in patients with recent acute myocardial infarction (AMI). Nine patients were studied within 10 days of AMI. Rest-redistribution 201Thallium (201Tl) single photon emission computed tomography (SPECT) was used as a gold standard for viability. Using MRI, regional perfusion was assessed using dynamic imaging during a bolus injection of Gd-DTPA and viability was assessed during a continuous infusion. Finally, cine MR images were acquired at baseline, during low-dose dobutamine infusion and after recovery. To assess viability, the left ventricle was divided into 16 segments and signal intensity in corresponding MRI and redistribution SPECT segments were compared. Wall thickening index (WTI) was determined at each step during the dobutamine study. The results revealed that in five patients, reduced perfusion in infarcted regions was observed qualitatively during dynamic first pass imaging. There was a significant inverse correlation between 201Tl uptake and MRI signal intensity, i.e. infarcted tissue (low 201Tl uptake) had increased MR signal intensity. Segments were separated into normal (201Tl uptake > 90%) and infarcted (< 601%). lnfarcted MRI segments had greater signal intensity than normal segments (179 +/- 50 vs. 102 +/- 14%; P < 0.0001). WTI in normal segments increased by 18 +/- 8.5% (P < 0.0001) from baseline to 10 microg/kg per min of dobutamine while infarcted tissue WTI decreased 2.8 +/- 7.2% (P = 0.17). Thus regions of myocardium that were infarcted as defined by reduced 201Tl uptake and absent contractile reserve showed greatly increased MRI signal intensity during a constant infusion of Gd-DTPA. The use of MRI during a constant infusion of Gd-DTPA is accurate and feasible for the determination of myocardial necrosis in a clinical setting.

T(1) fast acquisition relaxation mapping (T(1)-FARM): optimized data acquisition

A theoretical procedure for estimating the precision of the T(1) Fast Acquisition Relaxation Mapping sequence as a function of a number of acquisition parameters has been validated by both simulations and experimental results. These results have clarified the selection of sequence parameters to give optimal accuracy and precision in the R(1)* measurements. There is excellent agreement between theory, simulation, and experiment except for flip angles greater than 9 degrees, at which point slice profile imperfections significantly degrade the precision of the technique. The experimental results indicate that over a range of T(1)s that would be seen in a bolus tracking experiment (25-1200 ms), T(1) Fast Acquisition Relaxation Mapping can be used to obtain 64 x 128 R(1)* maps at a rate of 1 map/s, with a precision of 10% or better.

Assessment of myocardial viability using MRI during a constant infusion of Gd-DTPA: further studies at early and late periods of reperfusion

It was previously shown in a canine model of ischemia/reperfusion injury that the partition coefficient of gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) (lambda) increases in infarcted tissue. That previous study used a non-magnetic resonance imaging (MRI) method to measure lambda and only investigated reperfusion times from 2 hr to 3 weeks. This study presents evidence suggesting that lambda starts to increase as early as 1 min after reperfusion of a 2 hr occlusion and continues to rise for up to 2 hr or more; lambda stays increased as late as 8 weeks, reaching peak values at 1-11 days and subsequently decreasing. It was also demonstrated that lambda can be accurately measured in vivo using a saturation recovery turbo fast low-angle shot (FLASH) sequence. The results of this study show that MRI during a constant infusion of Gd-DTPA has great potential for the non-invasive determination of myocardial viability as early as 1 min to as late as 8 weeks following reperfusion of acute myocardial infarction.