Influence of bolus volume and dose of gadolinium chelate for first-pass myocardial perfusion MR imaging studies

In-vitro gadolinium retro-microdialysis in agarose gel-a human brain phantom study

Rationale and objectives

Cerebral microdialysis is a technique that enables monitoring of the neurochemistry of patients with significant acquired brain injury, such as traumatic brain injury (TBI) and subarachnoid haemorrhage (SAH). Cerebral microdialysis can also be used to characterise the neuro-pharmacokinetics of small-molecule study substrates using retrodialysis/retromicrodialysis. However, challenges remain: (i) lack of a simple, stable, and inexpensive brain tissue model for the study of drug neuropharmacology; and (ii) it is unclear how far small study-molecules administered via retrodialysis diffuse within the human brain.

Materials and methods

Here, we studied the radial diffusion distance of small-molecule gadolinium-DTPA from microdialysis catheters in a newly developed, simple, stable, inexpensive brain tissue model as a precursor for in-vivo studies. Brain tissue models consisting of 0.65% weight/volume agarose gel in two kinds of buffers were created. The distribution of a paramagnetic contrast agent gadolinium-DTPA (Gd-DTPA) perfusion from microdialysis catheters using magnetic resonance imaging (MRI) was characterized as a surrogate for other small-molecule study substrates.

Results

We found the mean radial diffusion distance of Gd-DTPA to be 18.5 mm after 24 h (p < 0.0001).

Conclusion

Our brain tissue model provides avenues for further tests and research into infusion studies using cerebral microdialysis, and consequently effective focal drug delivery for patients with TBI and other brain disorders.

Evaluation of Maximum and Minimum Signal Intensity and the Linear Relationship between Concentration and Signal Intensity in Saturation Recovery T1-weighted Images by use of a Turbo Fast Low-Angle Shot Sequence

ABSTRACTBACKGROUND

The relationship between the concentration of contrast agents and signal intensity (SI) are affected by some image parameters, phase-encoding scheme, magnetic field strength, image sequences, and iron oxide nanoparticles used and Gd-DTPA as MRI contrast agents.

OBJECTIVE

In this article, the effect of saturation times (TSs) on the maximum and minimum SI, and also the linear relationship between the concentration of the contrast agent and SI are evaluated. Additionally, we evaluated the concentration of contrast agent that results the minimum SI using a saturation recovery TurboFLASH sequence.

MATERIAL AND METHODS

In this experimental study, a phantom was designed to hold vials with different concentrations of Gd-DTPA (0-19.77mmol/L). The mean SI was acquired from the nine central pixels of every vial at various TSs.

RESULTS

This study shows that the maximum SI in an image is dependent on short TSs (up to 400ms) and independent of long TSs (400-1000ms). The result also shows that the concentration at which a maximum linear relationship between concentration and SI is maintained that gave an R² equal to 0.95 and 0.99 dependent on the TS. Moreover, the outcome demonstrates that as TS increases, the concentration of the contrast agent decreases. This causes SI to be minimized.

CONCLUSION

This study demonstrated that the TS is a key parameter for measuring the maximum and minimum SI and also TS plays the role in determining the maximum linear relationship between the MRI contrast agent concentration and SI in an in vivo perfusion study.

Gd and Eu Co-Doped Nanoscale Metal-Organic Framework as a T1-T2 Dual-Modal Contrast Agent for Magnetic Resonance Imaging

Recently, a growing interest has been seen in the development of T1-T2 dual-mode probes that can simultaneously enhance contrast on T1- and T2-weighted images. A common strategy is to integrate T1 and T2 components in a decoupled manner into a nanoscale particle. This approach, however, often requires a multi-step synthesis and delicate nanoengineering, which may potentially affect the production and wide application of the probes. We herein report the facile synthesis of a 50-nm nanoscale metal-organic framework (NMOF) comprising gadolinium (Gd3+) and europium (Eu3+) as metallic nodes. These nanoparticles can be prepared in large quantities and can be easily coated with a layer of silica. The yielded Eu,Gd-NMOF@SiO2 nanoparticles are less toxic, highly fluorescent, and afford high longitudinal (38 mM-1s-1) and transversal (222 mM-1s-1) relaxivities on a 7 T magnet. The nanoparticles were conjugated with c(RGDyK), a tumor-targeting peptide sequence, which has a high binding affinity toward integrin αvβ3. Eu,Gd-NMOF@SiO2 nanoparticles, when intratumorally or intravenously injected, induce simultaneous signal enhancement and signal attenuation on T1-and T2-weighted images, respectively. These results suggest great potential of the NMOFs as a novel T1-T2 dual-mode contrast agent.

Analysis of pharmacokinetics of Gd-DTPA for dynamic contrast-enhanced magnetic resonance imaging

The pharmacokinetics (PK) of the contrast agent Gd-DTPA administered intravenously (i.v.) for contrast-enhanced MR imaging (DCE-MRI) is an important factor for quantitative data acquisition. We studied the effect of various initial bolus doses on the PK of Gd-DTPA and analyzed population PK of a lower dose for intra-subject variations in DCE-MRI. First, fifteen subjects (23-85years, M/F) were randomly divided into four groups for DCE-MRI with different Gd-DTPA dose: group-I, 0.1mmol/kg, n=4; group-II, 0.05mmol/kg, n=4; group-III, 0.025mmol/kg, n=4; and group-IV, 0.0125mmol/kg, n=3. Sequential fast T1 mapping sequence, after a bolus i.v. Gd-DTPA administered, and a linear T1-[Gd-DTPA] relationship were used to estimate the PK of Gd-DTPA. Secondly, MR-acquired PKs of Gd-DTPA from 58 subjects (28-80years, M/F) were collected retrospectively, from an ongoing study of the brain using DCE-MRI with Gd-DTPA at 0.025mmol/kg, to statistically analyze population PK of Gd-DTPA. We found that the PK of Gd-DTPA (i.v. 0.025mmol/kg) had a half-life of 37.3±6.6min, and was a better fit into a linear T1-[Gd-DTPA] relationship than higher doses (up to 0.1mmol/kg). The area under the curve (AUC) for 0.025mmol/kg was 3.37±0.46, which was a quarter of AUC of 0.1mmol/kg. In population analysis, a dose of 0.025mmol/kg of Gd-DTPA provided less than 5% subject-dependent variation in the PK of Gd-DTPA. Administration of 0.025mmol/kg Gd-DTPA enabled us to estimate [Gd-DTPA] from T1 by using a linear relationship that has a lower estimation error compared to a non-linear relationship. DCE-MRI with a quarter dose of Gd-DTPA is more sensitive to detect changes in [Gd-DTPA].

Magnetic resonance and confocal imaging of solute penetration into the lens reveals a zone of restricted extracellular space diffusion

It has been proposed that in the absence of blood supply, the ocular lens operates an internal microcirculation system that delivers nutrients to internalized fiber cells faster and more efficiently than would occur by passive diffusion alone. To visualize the extracellular space solute fluxes potentially generated by this system, bovine lenses were organ cultured in artificial aqueous humor (AAH) for 4 h in the presence or absence of two gadolinium-based contrast agents, ionic Gd3+, or a chelated form of Gd3+, Gd-diethylenetriamine penta-acetic acid (Gd-DTPA; mol mass = 590 Da). Contrast reagent penetration into the lens core was monitored in real time using inversion recovery-spin echo (IR-SE) magnetic resonance imaging (MRI), while steady-state accumulation of [Gd-DTPA]−2 was also determined by calculating T1 values. After incubation, lenses were fixed and cryosectioned, and sections were labeled with the membrane marker wheat germ agglutinin (WGA). Sections were imaged by confocal microscopy using standard and reflectance imaging modalities to visualize the fluorescent WGA label and gadolinium reagents, respectively. Real-time IR-SE MRI showed rapid penetration of Gd3+ into the outer cortex of the lens and a subsequent bloom of signal in the core. These two areas of signal were separated by an area in the inner cortex that limited entry of Gd3+. Similar results were obtained for Gd-DTPA, but the penetration of the larger negatively charged molecule into the core could only be detected by calculating T1 values. The presence of Gd-DTPA in the extracellular space of the outer cortex and core, but its apparent absence from the inner cortex was confirmed using reflectance imaging of equatorial sections. In axial sections, Gd-DTPA was associated with the sutures, suggesting these structures provide a pathway from the surface, across the inner cortex barrier to the lens core. Our studies have revealed inner and outer boundaries of a zone within which a narrowing of the extracellular space restricts solute diffusion and acts to direct fluxes into the lens core via the sutures.

An improved coverage and spatial resolution--using dual injection dynamic contrast-enhanced (ICE-DICE) MRI: a novel dynamic contrast-enhanced technique for cerebral tumors

A new dual temporal resolution-based, high spatial resolution, pharmacokinetic parametric mapping method is described--improved coverage and spatial resolution using dual injection dynamic contrast-enhanced (ICE-DICE) MRI. In a dual-bolus dynamic contrast-enhanced-MRI acquisition protocol, a high temporal resolution prebolus is followed by a high spatial resolution main bolus to allow high spatial resolution parametric mapping for cerebral tumors. The measured plasma concentration curves from the dual-bolus data were used to reconstruct a high temporal resolution arterial input function. The new method reduces errors resulting from uncertainty in the temporal alignment of the arterial input function, tissue response function, and sampling grid. The technique provides high spatial resolution 3D pharmacokinetic maps (voxel size 1.0 × 1.0 × 2.0 mm(3)) with whole brain coverage and greater parameter accuracy than that was possible with the conventional single temporal resolution methods. High spatial resolution imaging of brain lesions is highly desirable for small lesions and to support investigation of heterogeneity within pathological tissue and peripheral invasion at the interface between diseased and normal brain. The new method has the potential to be used to improve dynamic contrast-enhanced-MRI techniques in general.

Constrained estimation of the arterial input function for myocardial perfusion cardiovascular magnetic resonance

Accurate quantification of myocardial perfusion remains challenging due to saturation of the arterial input function at high contrast concentrations. A method for estimating the arterial input function directly from tissue curves in the myocardium that avoids these difficulties is presented. In this constrained alternating minimization with model (CAMM) algorithm, a portion of the left ventricular blood pool signal is also used to constrain the estimation process. Extensive computer simulations assessing the accuracy of kinetic parameter estimation were performed. In 5000 noise realizations, the use of the AIF given by the estimation method returned kinetic parameters with mean Ktrans error of -2% and mean kep error of 0.4%. Twenty in vivo resting perfusion datasets were also processed with this method, and pharmacokinetic parameter values derived from the blind AIF were compared with those derived from a dual-bolus measured AIF. For 17 of the 20 datasets, there were no statistically significant differences in Ktrans estimates, and in aggregate the kinetic parameters were not significantly different from the dual-bolus method. The cardiac constrained alternating minimization with model method presented here provides a promising approach to quantifying perfusion of myocardial tissue with a single injection of contrast agent and without a special pulse sequence though further work is needed to validate the approach in a clinical setting.

Assessment of tumor blood flow in breast tumors with T1-dynamic contrast-enhanced MR imaging: impact of dose reduction and the use of a prebolus technique on diagnostic efficacy

PURPOSE

To prospectively evaluate whether dose reduction and the application of a prebolus technique can effectively alleviate signal saturation effects in T1 dynamic contrast enhanced (T1-DCE) magnetic resonance imaging (MRI) data in breast tumors and lead to increased diagnostic efficacy of the regional tumor blood flow (TBF) values obtained with deconvolution of T1-DCE MRI data.

MATERIALS AND METHODS

After obtaining informed consent, 23 women (32-80 years) with histologically proven breast tumors underwent MR mammography that included a whole-breast T1 DCE sequence. In the slice where the tumor enhanced maximally, a prebolus protocol was applied. One mL of Gd-DTPA solution at 2 mL/s was injected at the beginning of a dynamic axial single slice inversion-prepared turbo field echo acquisition. At the 400th dynamic, a high dose of either 20 mL (15 patients) or 10 mL (8 patients) of contrast agent was injected at 2 mL/s and a further 400 dynamics were acquired. From the aortic prebolus curve an arterial input function (AIF) was reconstructed by time-shifting and adding the prebolus data. The relative enhancement time course from the tumor region of interest was deconvolved with the reconstructed AIF to generate the impulse response function, the maximum of which yielded the TBF. The institutional ethical committee approved the study.

RESULTS

Reducing the contrast dose by a factor of 2 led to an increase in diagnostic contrast for the TBF values of malignant and benign tumors by a factor of slightly more than 2. Addition of the prebolus technique improved this further by 45%. receiver operating characteristic analysis showed a significant increase of diagnostic yield related to the combined use of a prebolus and minimal dose.

CONCLUSION

Using a prebolus approach provides an estimate of the unsaturated AIF, while reduction of the high-dose bolus minimizes possible saturation effects in the tumor time course.

Effects of inversion and saturation times on relationships between contrast agent concentrations and signal intensities of T1-weighted magnetic resonance images

The present study was an attempt to investigate the effect of variation of inversion time (T (I)) and saturation time (T (S)) on the linear relationship between contrast agent concentration and signal intensity (SI) on Turbo Fast Low Angle Shot (TurboFLASH) T (1)-weighted images in MRI. For this purpose, inversion recovery (IR) and saturation recovery (SR) sequences (Center out Phase-Encoding acquisition) were used. A phantom was designed to hold 25 vials which contained either different (between 0 and 19.77 mmol/L) or constant (1.20 mmol/L) concentrations of contrast agent. The vials of constant concentration were used for the measurement of coil non-uniformity, which was normalized to give a correction factor. The vials of different concentrations were used to measure the SI by using different sequences and different T (I) and T (S) values. To calculate the corrected SI for different concentrations, we multiplied the SI of each vial by its correction factor. The relationships between the corrected SI and the concentration [were evaluated], where the threshold of (R (2) = 0.95 and 0.99) was maintained. This study shows that different sequences and different T (I) and T (S) values can have an effect on the correlation between the SI and concentration. Regardless of the values of T (I), T (S), and the different IR and SR sequences chosen, the linear relationship between the SI and concentration was about twice that previously reported (i.e., 0.8 mmol/L, R (2) = 0.95).

Comparison of different contrast agents and doses for quantitative MR myocardial perfusion imaging

PURPOSE

To investigate three different contrast agents at different injection volumes for repetitive quantitative multislice myocardial perfusion imaging using the prebolus technique.

MATERIALS AND METHODS

Two consecutive prebolus perfusion measurements were performed on a 1.5 T scanner using identical injection volumes for the first and second examination to test the reproducibility for possible rest and stress examination in normal volunteers. Either 1-8 mL, 1-12 mL Gd-DTPA, 1-4 mL, 1-6 mL, 1-9 mL Gd-BOPTA, or 1-4 mL, 1-6 mL gadobutrol were applied.

RESULTS

In cases where injection volumes were sufficiently small, there was no indication of significant differences in quantitative perfusion values with respect to the different contrast agents. Increasing the bolus volume improved the contrast-to-noise ratio (CNR) but led to saturation effects and underestimation of the true perfusion. The highest CNR was measured for gadobutrol (6 mL, p < 0.0005 compared to 8 mL Gd-DTPA). The smallest difference of perfusion values between the first and the second prebolus examination was found for Gd-BOPTA (p < or = 0.006 compared Gd-DTPA).

CONCLUSION

Prebolus examinations for quantitative myocardial perfusion imaging are possible with all three contrast agents for sufficient small injection volumes. Gd-BOPTA was found to be advantageous for a combined quantitative rest and stress examination.

Influence of the k-space trajectory on the dynamic T1-weighted signal in quantitative first-pass cardiac perfusion MRI at 3T

The dynamic T(1)-weighted signal in first-pass myocardial perfusion MRI can vary as a function of k-space trajectory. The purpose of this study, therefore, was to compare the relative T(1)-weighted signal produced by the linear, centric, and reverse centric k-space trajectories at 3T. The centric k-space trajectory yielded higher arterial input function (AIF) than the linear and reverse centric k-space trajectories (6.21 +/- 0.84 vs. 4.75 +/- 0.75 vs. 4.39 +/- 0.85 mM, respectively; N = 9; P < 0.01), and the reverse centric k-space trajectory yielded higher myocardial signal contrast (as a fraction of equilibrium magnetization) than the linear and centric k-space trajectories (0.17 +/- 0.02 vs. 0.12 +/- 0.02 vs. 0.05 +/- 0.01, respectively; N = 9; P < 0.001). Compared to the linear k-space trajectory, the centric k-space trajectory is relatively optimal for the quantification of AIF, whereas the reverse centric k-space trajectory is relatively optimal for high contrast of myocardial wall enhancement.

Myocardial First Pass Perfusion Imaging With Gadobutrol

OBJECTIVE

To implement parallel imaging algorithms in fast gradient recalled echo sequences for myocardial perfusion imaging and evaluate image quality, signal-to-noise ratio (SNR), contrast-enhancement ratio (CER), and semiquantitative perfusion parameters.

MATERIALS AND METHODS

In 20 volunteers, myocardial perfusion imaging with gadobutrol was performed at rest using an accelerated TurboFLASH sequence (TR 2.3 milliseconds, TE 0.93 milliseconds, flip angle [FA] 15 degrees) with GRAPPA, R=2. A nonaccelerated TurboFLASH sequence with similar scan parameters served as standard of reference. Artifacts were assessed qualitatively. SNR, CER, and CNR were calculated and semiquantitative perfusion parameters were determined from fitted SI-time curves.

RESULTS

Phantom measurements yielded significant higher SNR for nonaccelerated images (P<0.001). CER was equal; differences in CNR were statistically nonsignificant. The evaluation of semiquantitative perfusion parameters yielded significantly higher peak signal intensities in nonaccelerated images (P<0.001). Differences in maximum upslope were statistically nonsignificant. A qualitative examination of all images for artifacts by 2 board-certified radiologists yielded a significant reduction in dark rim artifacts with GRAPPA, R=2 (P<0.001).

CONCLUSIONS

The application of GRAPPA with an acceleration factor of R=2 leads to a significant reduction of dark rim artifacts in fast gradient recalled echo sequences.

Absolute quantification of myocardial perfusion under adenosine stress

The prebolus technique allows one to quantify perfusion in the human heart with a low variability by means of MRI. In this study the prebolus technique was used to determine quantitative perfusion values in the human heart under adenosine stress and to measure the myocardial perfusion reserve (MPR). Twelve healthy volunteers were examined using the multislice prebolus technique with 1/4 cc Gd-BOPTA. Signal intensity (SI) time courses were evaluated in 288 manually segmented sectors at rest and stress. Myocardial perfusion was determined by deconvolution of the SI time courses with the arterial input function (AIF) from the prebolus scan. The mean stress perfusion value was 1.78 +/- 0.53 cc/g/min, and the mean rest perfusion was 0.52 +/- 0.11 cc/g/min, resulting in a mean MPR of 3.59 +/- 1.26. The measured values correlate well with data from animal models and human positron emission tomography (PET) studies.

Contrast–dose relation in first-pass myocardial MR perfusion imaging

PURPOSE

To determine the regime of linear contrast enhancement in human first-pass perfusion cardiovascular magnetic resonance (CMR) imaging to improve accuracy in myocardial perfusion quantification.

MATERIALS AND METHODS

A total of 10 healthy subjects were studied on a clinical 1.5T MR scanner. Seven doses of Gd-DTPA ranging from 0.00125 to 0.1 mmol/kg of body weight (b.w.) were administered as equal volumes by rapid bolus injection (6 mL/second). Resting periods of 15 minutes were introduced after delivery of Gd doses >0.01 mmol/kg b.w. For each subject, two series of rest perfusion scans were performed using two different multislice saturation-recovery perfusion sequences. Maximum contrast enhancement and maximum upslope were obtained in the blood pool of the left ventricular (LV) cavity and in the myocardium. The range of linear contrast-dose relation was determined by linear regression analysis.

RESULTS

MR signal intensity increased linearly for contrast agent concentrations up to 0.01 mmol/kg b.w. in the LV blood pool and up to 0.05 mmol/kg b.w. in the myocardium. For Gd concentrations exceeding these thresholds the signal intensity response was not linear with respect to the contrast agent dose.

CONCLUSION

Quantitative evaluation of cardiac MR perfusion data needs to account for signal saturation in both the LV blood pool and the myocardium.

Contrast agents and cardiac MR imaging of myocardial ischemia: from bench to bedside

This review paper presents, in the first part, the different classes of contrast media that are already used or are in development for cardiac magnetic resonance imaging. A classification of the different types of contrast media is proposed based on the distribution of the compounds in the body, their type of relaxivity and their potential affinity to particular molecules. In the second part, the different uses of the extracellular type of T1-enhancing contrast agent for myocardial imaging is covered from the detection of stable coronary artery disease to the detection and characterization of chronic infarction. A particular emphasis is placed on the clinical use of gadolinium-chelates, which are the universally used type of MRI contrast agent in the clinical routine. Both approaches, first-pass magnetic resonance imaging (FP-MRI) as well as delayed-enhanced magnetic resonance imaging (DE-MRI), are covered in the different situations of acute and chronic myocardial infarction.

Multislice, dual-imaging sequence for increasing the dynamic range of the contrast-enhanced blood signal and CNR of myocardial enhancement at 3T

PURPOSE

To develop a multislice, first-pass perfusion imaging sequence for increasing the effective dynamic range of the contrast-enhanced blood signal and the contrast-to-noise ratio (CNR) of myocardial wall enhancement.

MATERIALS AND METHODS

A hybrid echo-planar imaging (EPI) pulse sequence was modified to acquire data for both the arterial input function (AIF) and the myocardium, using two different saturation-recovery time delays (TDs) and spatial resolutions, after a single saturation pulse. Five healthy subjects were scanned at 3T in three short-axis levels of the heart per heartbeat during passage of a high-dose bolus of contrast agent. The T(1)-weighted signal-time curve of the blood was converted to AIF using empirical conversion tables derived from phantom experiments.

RESULTS

In all subjects the calculated AIF was consistently less distorted and higher for the short-TD protocol than for the long-TD protocol (peak concentration: 5.0 +/- 1.0 mM vs. 3.0 +/- 0.6 mM; P < 0.01). A combination of EPI, long TD, high-dose bolus of contrast agent, and 3T imaging yielded relatively strong peak enhancement in the myocardium (CNR = 11.9 +/- 3.3).

CONCLUSION

Our dual-imaging approach at 3T seems promising for acquiring both a relatively accurate AIF and a high CNR of myocardial wall enhancement in multiple slices per heartbeat.

Myocardial first pass perfusion: steady-state free precession versus spoiled gradient echo and segmented echo planar imaging

The imaging sequences used in first pass (FP) perfusion to date have important limitations in contrast-to-noise ratio (CNR), temporal and spatial resolution, and myocardial coverage. As a result, controversy exists about optimal imaging strategies for FP myocardial perfusion. Since imaging performance varies from subject to subject, it is difficult to form conclusions without direct comparison of different sequences in the same subject. The purpose of this study was to directly compare the saturation recovery SSFP technique to other more commonly used myocardial first pass perfusion techniques, namely spoiled GRE and segmented EPI. Differences in signal-to-noise ratio (SNR), CNR, relative maximal upslope (RMU) of signal amplitude, and artifacts at comparable temporal and spatial resolution among the three sequences were investigated in computer simulation, contrast agent doped phantoms, and 16 volunteers. The results demonstrate that SSFP perfusion images exhibit an improvement of approximately 77% in SNR and 23% in CNR over spoiled GRE and 85% SNR and 50% CNR over segmented EPI. Mean RMU was similar between SSFP and spoiled GRE, but there was a 58% increase in RMU with SSFP versus segmented EPI.

Optimization of the arterial input function for myocardial perfusion cardiovascular magnetic resonance

PURPOSE

To determine how injection rate, cardiac function, and breathhold influence the arterial input function (AIF), in order to optimize the AIF in the clinical setting for quantitative myocardial perfusion cardiovascular magnetic resonance (CMR).

MATERIALS AND METHODS

Gd (0.1 mmol/kg) bolus was injected at 3, 5, or 7 mL/second in 35 patients. In each cardiac cycle during the first-pass, a series of saturation recovery (SR) fast low-angle shot (FLASH) low resolution images with exponentially increasing SR delay times were acquired. Signal intensity (SI) time measurements were made from a region of interest (ROI) drawn in the ascending aorta (AA). The calculation of short T1s and thus peak Gd concentration [Gd] was performed by fitting the mean ROI SI against SR delay times.

RESULTS

The mean peak [Gd] in the AA increased as injection rate increased from 3 mL/second (5.0 mM), to 5 mL/second (7.1 mM), to 7 mL/second (4 mM) (P < 0.0001). The peak [Gd] increased as the left ventricular stroke volume (LV SV) increased (P = 0.01). Breath holding was not found to influence peak [Gd].

CONCLUSION

In this study, we found that a high injection rate has advantages over lower injection speeds, although the duration of the AIF was apparently not significantly shortened by faster injection. The choice of expiration or inspiration as breathhold did not have a significant influence upon the AIF. Poor cardiac function was associated with a lower peak [Gd], indicating that first pass perfusion measurements in these patients will be suboptimal.

Multislice MR first-pass myocardial perfusion imaging: impact of the receiver coil array

PURPOSE

To compare a new 12-element body phased-array coil with a conventional four-element surface receiver coil array to provide increased signal-to-noise ratios (SNRs) for cardiac steady state free precession (SSFP) perfusion imaging.

MATERIALS AND METHODS

Thirteen consecutive patients were included in the study. Patients were examined both with a four-element surface coil array and a 12-element body coil array. First-pass myocardial perfusion imaging using saturation recovery SSFP was acquired during antecubital injection of Gd-DTPA. Imaging parameters: TR 2.8 msec/TE 1.3 msec, flip angle 50 degrees , bandwidth 960 Hz/pixel and half-Fourier acquisition. SNR was calculated using six regions of interest (ROI) for the myocardial perfusion scans. Calculations of corresponding ROIs using the two different coil setups were compared using analysis of variance (ANOVA). Semiquantitative perfusion parameters were calculated for both groups.

RESULTS

The mean SNR in myocardial perfusion imaging increased by 21% using the 12-element coil setup (P < 0.001) when compared to the four-element coil. ROI comparisons revealed an increased signal inhomogeneity with the 12-element coil when compared to four-element coil experiments. Absolute normal range values of semiquantitative perfusion parameters were consistently higher using the 12-element coil setup (P < 0.001).

CONCLUSION

The 12-element coil array provides higher SNR, but these improvements come with trade-offs in image homogeneity. Increased SNR translates into higher semiquantitative perfusion values and offers the potential for improved detection of perfusion defects.

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.

Semiquantitative assessment of myocardial perfusion using magnetic resonance imaging: evaluation of appropriate thresholds and segmentation models

RATIONALE AND OBJECTIVES

The aim of the study was to determine optimal thresholds for semiquantitative perfusion parameters and to evaluate the influence of different segmentation models in detecting malperfused regions.

MATERIAL AND METHODS

In 6 healthy subjects and 13 patients with coronary artery disease, contrast-enhanced first-pass perfusion imaging was performed using a SR-TrueFISP-sequence. Thresholds for semiquantitative parameters were established, and different segmentation models of the left ventricular myocardium were tested. The standard of reference for patient studies was single photon emission computed tomography.

RESULTS

Optimal thresholds were determined in healthy subjects for the perfusion parameters upslope, AUC, and peak SI of mv-0.5*std, mv-1.5*std, and mv-1.0*std, respectively. Using the optimal threshold for each parameter/segmentation combination sensitivities and specificities of stress studies were between 66% and 93% and 77% and 92%, respectively. Subdivision of radial segments into subendo/subepicardial segments increased sensitivities for perfusion deficits.

CONCLUSIONS

Subdivision of radial myocardial segments is essential in analysis of magnetic resonance first-pass perfusion series. Semiquantitative perfusion parameters possess different sensitivities for the detection of perfusion deficits.

Assessment of skeletal muscle perfusion by contrast medium first-pass magnetic resonance imaging: technical feasibility and preliminary experience in healthy volunteers

PURPOSE

To probe the potential and pitfalls of contrast medium first-pass skeletal muscle perfusion imaging under reproducible stress conditions.

MATERIALS AND METHODS

Magnetic resonance (MR) signal dynamics in calf muscle and lower-leg arteries of 20 healthy volunteers were analyzed under postarterial occlusion reactive hyperemia and concurrent contrast medium first pass, using a saturation recovery spoiled gradient-echo type sequence without heartbeat synchronization. The signal vs. time curves were analyzed descriptively and by two-compartment deconvolution analysis.

RESULTS

Highly significant changes in calf muscle signal dynamics in the hyperemic leg vs. those in the contralateral leg at rest were found in phenomenological and deconvolution analysis. Although a distortion of the arterial signal derived input function by inflow effects was found to cause large variations of the deconvolution results, the magnitude of the observed effects suggested a potential for immediate visual detection of areas with reduced tissue perfusion.

CONCLUSION

The first-pass approach appeared promising for visual evaluation. However, a disentanglement of inflow and contrast medium-induced effects on arterial signal intensity was deemed a prerequisite for input function-based numerical assessment.

Multislice first-pass myocardial perfusion imaging: Comparison of saturation recovery (SR)-TrueFISP-two-dimensional (2D) and SR-TurboFLASH-2D pulse sequences

PURPOSE

To compare signal-to-noise ratio (SNR), contrast-to-noise (CNR) ratio, and diagnostic accuracy of a newly developed saturation recovery (SR)-TrueFISP-two-dimensional (2D) sequence with an SR-TurboFLASH-2D sequence.

MATERIALS AND METHODS

In seven healthy subjects and nine patients with coronary artery disease (CAD), contrast-enhanced perfusion imaging (with Gd-DTPA) was performed with SR-TrueFISP and SR-TurboFLASH sequences. Hypoperfused areas were assessed qualitatively (scale = 0-4). Furthermore, SNR and CNR were calculated and semiquantitative perfusion parameters were determined from signal intensity (SI) time curves. Standard of reference for patient studies was single-photon emission computer tomography (SPECT) and angiography.

RESULTS

The perception of perfusion deficits was superior in TrueFISP images (2.6 +/- 1.0) than in TurboFLASH (1.4 +/- 0.6) (P < 0.001). Phantom measurements yielded increased SNR (143 +/- 34%) and CNR (158 +/- 64%) values for TrueFISP. In patient/volunteer studies SNR was 61% to 100% higher and signal enhancement was 110% to 115% higher with TrueFISP than with TurboFLASH. Qualitative and semiquantitative assessment of perfusion defects yielded higher sensitivities for detection of perfusion defects with TrueFISP (68% to 78%) than with TurboFLASH (44% to 59%).

CONCLUSION

SR-TrueFISP-2D perfusion imaging provides superior SNR and CNR than TurboFLASH imaging. Moreover, the dynamic range of SIs was found to be higher with TrueFISP, resulting in an increased sensitivity for detection of perfusion defects.

Prebolus quantitative MR heart perfusion imaging

The purpose of this study was to present the prebolus technique for quantitative multislice myocardial perfusion imaging. In quantitative MR perfusion studies the maximum contrast agent dose is limited by the requirement to determine the arterial input function (AIF). The prebolus technique consists of two consecutive contrast agent administrations. The AIF is determined from a first low-dose bolus, while a second, high-dose bolus allows the measurement of the myocardium with improved signal increase. The results of the prebolus technique using a multislice saturation recovery trueFISP sequence in healthy volunteers are presented. In comparison to a standard dose of 3 ml Gd-DTPA, perfusion values are maintained while the signal increase in the concentration time courses was considerably improved, accompanied by reduced standard deviations of the obtained perfusion values (0.72 +/- 0.13 ml/g/min for 1 ml/8 ml and 0.67 +/- 0.10 ml/g/min for 1 ml/12 ml Gd-DTPA, respectively).

Single-vessel coronary artery stenosis: myocardial perfusion imaging with Gadomer-17 first-pass MR imaging in a swine model of comparison with gadopentetate dimeglumine

PURPOSE

To evaluate the ability of Gadomer-17 to depict perfusion defects in a closed-chest swine model of single-vessel coronary artery disease.

MATERIALS AND METHODS

Twelve pigs underwent closed-chest placement of a flow reducer for 70%-90% luminal stenosis in the proximal left anterior coronary artery. Magnetic resonance (MR) perfusion imaging with Gadomer-17 and gadopentetate dimeglumine, microsphere blood flow (MBF) testing, and technetium 99m ((99m)Tc) 2 methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) were performed during dipyridamole vasodilation. Comparisons of percentage signal intensity (SI) increase (PSIC) in remote and ischemic myocardium were made with repeated measurements analysis of variance after injection of both tracers.

RESULTS

Perfusion defects and reduced PSIC in the anterior ischemic versus the inferior remote myocardium could be identified after injection of both Gadomer-17 (PSIC, 66% +/- 30 [mean +/- SD] vs 100% +/- 32, respectively; P <.001) and gadopentetate dimeglumine (PSIC, 49% +/- 31 vs 81% +/- 43, respectively; P <.005). The size of perfusion defect depicted with both tracers was highly correlated with defect size at (99m)Tc MIBI SPECT (r = 0.69, P <.05 for Gadomer-17 and r = 0.60, P =.05 for gadopentetate dimeglumine) and with areas of reduced MBF (r = 0.70, P <.05 for Gadomer-17 and r = 0.80, P <.05 for gadopentetate dimeglumine). PSIC also correlated with MBF (r = 0.89, P <.001 for Gadomer-17 and r = 0.75, P <.001 for gadopentetate dimeglumine). Gadomer-17 allowed differentiation of ischemic from nonischemic myocardium, as demonstrated by reduced PSIC (PSIC, 48% +/- 38 vs 72% +/- 31, respectively; P <.001) until 20 minutes after contrast material injection. In contrast, differentiation of ischemic from nonischemic myocardium was possible only until 55 seconds after injection of gadopentetate dimeglumine (PSIC, 36% +/- 24 vs 56% +/- 27, respectively; P <.005) but not at any time point thereafter.

CONCLUSION

With the study conditions, Gadomer-17 provided more prolonged differentiation of ischemic from remote myocardium than that with gadopentetate dimeglumine.

Multislice first-pass cardiac perfusion MRI: validation in a model of myocardial infarction

The purpose of this study was to validate a first-pass MRI method for imaging myocardial perfusion with multislice coverage and relatively small analyzable regions of interest (ROIs). A fast gradient-echo (FGRE) sequence with an echo-train (ET) readout was used to achieve multislice coverage, and a high dose of a contrast agent (CA) was used to achieve a high signal-to-noise ratio (SNR). Dogs (N = 6) were studied 1 day after reperfused myocardial infarction, and fluorescent microspheres were used as a standard for perfusion. First-pass MRI correlated well vs. microsphere flow, achieving mean R values of 0.87 (range = 0.82-0.93), 0.71 (range = 0.46-0.85), and 0.72 (range = 0.49-0.95) for subendocardial ROIs, transmural ROIs, and the endocardial-epicardial ratio, respectively. Additionally, analysis of myocardial time-intensity curves (TICs) indicated that 15.8 +/- 6 sectors, corresponding to 260 microl of endocardium, can be analyzed (R(2) > 0.95).

MRI detection of myocardial perfusion defects due to coronary artery stenosis with MS-325

PURPOSE

To assess the value of an intravascular, albumin-targeted contrast agent, MS-325, in visualizing myocardial ischemia with magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Left anterior descending coronary artery (LAD) stenosis was created in 19 pigs using a closed-chest modified angioplasty technique. Myocardial ischemia was detected by first-pass, contrast-enhanced MRI at peak dipyridamole stress and was compared to Technetium-99m (Tc-99m) sestamibi single photon emission computed tomography (SPECT). Regional coronary blood flow was determined using microspheres.

RESULTS

Inducible myocardial ischemia with >40% reduction in stress myocardial blood flow was created in eight animals. An MRI defect, classified as > or=75% reduction in peak myocardial signal intensity in the affected territory, was detected in 92.3% of these animals. In the presence of mild coronary stenosis, there was uniform enhancement with MRI and tracer uptake by SPECT. Concordance of MRI and SPECT for detecting perfusion defects was 85%.

CONCLUSION

The pattern of prolonged and persistent MR hypoenhancement of the ischemic myocardial bed using MS-325, which is retained primarily in the vascular bed due to its albumin-binding properties, facilitates the detection of myocardial perfusion defects.

Factor analysis of medical image sequences improves evaluation of first-pass MR imaging acquisitions for myocardial perfusion

RATIONALE AND OBJECTIVES

Factor analysis of medical image sequences (FAMIS) applied to gadolinium chelate-enhanced subsecond magnetic resonance (MR) imaging was evaluated as a postprocessing method for assessing myocardial perfusion in coronary artery disease (CAD).

MATERIALS AND METHODS

To assess the accuracy of motion correction, five normal volunteers underwent MR imaging at rest. Thirteen patients with well-documented CAD and no myocardial infarction underwent MR imaging at rest and after dipyridamole administration. After motion correction, a single myocardial tissue factor (FAMISt) image was obtained with FAMIS for each raw MR imaging series acquisition. To evaluate how FAMIS could improve the analysis of these acquisitions, five readers visually assessed myocardial perfusion with FAMISt and raw MR images, and a multicase, multireader receiver operating characteristic analysis was performed.

RESULTS

FAMISt images significantly improved detection of the perfusion defects when compared with raw MR images (P = .002). Areas under the receiver operating characteristic curves ranged from 0.84 to 0.93 with FAMISt images and from 0.48 to 0.85 with raw MR images.

CONCLUSION

FAMIS applied to first-pass MR imaging series provided myocardial perfusion images that improve the objective assessment of myocardial perfusion in patients with CAD.

FAST sequences optimization for contrast media pharmacokinetic quantification in tissue

The purpose of this study was to investigate the influence of the fast gradient-recalled echo (GRE) sequence parameters on the contrast dynamic range and signal sensitivity, to optimize the magnetic resonance (MR) sequence for contrast media pharmacokinetic assessment. Effects of the fast low-angle shot (FLASH), Fast acquisition at steady rate (FAST), and radiofrequency-spoiled (RF)-FAST sequence parameters were studied in vitro. The FAST sequence had the highest sensitivity in low gadolinium (Gd) concentration. The FLASH and RF-FAST sequences had a larger contrast dynamic range, but the FLASH images contained side band artifacts. Increasing the flip angle to 90 degrees raised the sensitivity of the FAST sequence and the contrast dynamic range of the RF-FAST sequence. The shortest possible TE was optimal for both contrast dynamics and imaging time. TI had an influence on the sensitivity of the FAST sequence only for small acquisition matrices. This study indicates the optimal parameters for contrast dynamics (RF-FAST, 90 degrees flip angle, shortest possible TE) and sensitivity (FAST, 90 degrees flip angle, long TI(eff)).

Perfusion MRI of infarcted and noninfarcted brain tissue in stroke: a comparison of conventional hemodynamic imaging and factor analysis of dynamic studies

RATIONALE AND OBJECTIVES

To investigate the hemodynamics of infarcted and noninfarcted regions of the brain in patients with stroke secondary to a complete middle cerebral artery occlusion. Also, to compare factor analysis, a novel method of analyzing perfusion-weighted images, with more conventional techniques.

METHODS

Twenty-two patients with complete unilateral occlusion of the middle cerebral artery were examined by T1-weighted, contrast-enhanced, perfusion-weighted imaging, diffusion-weighted imaging, and magnetic resonance angiography. Quantitative cerebral blood volume (CBV), cerebral blood flow (CBF), and time-to-peak-intensity (TTP) images were generated. Factor analysis of dynamic studies (FADS) was used to generate "early" and "late" images. The hemodynamic parameters for the infarcted and noninfarcted regions of the occluded territory were compared with those for the brain territory on the nonoccluded side.

RESULTS

Three regions were shown: (1) Normal tissue on the unaffected side; (2) an infarcted region, which was characterized by reduced CBV, CBF, and early FADS values with increased TTP values; and (3) a noninfarcted region with reduced early FADS and increased late FADS and TTP values compared with the normal region. Cerebral blood volume and CBF values were not reduced significantly in the noninfarcted region.

CONCLUSIONS

The differences in parameters such as TTP, CBV, and CBF are significant, and it is necessary to use more than one parameter when interpreting magnetic resonance imaging perfusion data. Factor analysis of dynamic studies provides additional information to conventional methods of analyzing perfusion data.

Extracting parametric images from dynamic contrast-enhanced MRI studies of the brain using factor analysis

Factor analysis of dynamic studies (FADS) is a technique that allows structures with different temporal characteristics to be extracted from dynamic contrast enhanced studies without making any a priori assumptions about physiology. These dynamic structures may correspond to different tissue types or different organs or they may simply be a useful way of characterising the data. This paper describes a method of automatically extracting factor images and curves from contrast enhanced MRI studies of the brain. This method has been applied to 107 studies carried out on patients with acute stroke. The results show that FADS is able to extract factor curves correlated to arterial and venous signal intensity curves and that the corresponding factor images allow a distinction to be made between areas of the brain with normal and abnormal perfusion. The method is robust and can be applied routinely to dynamic studies of the brain. The constraints described are sufficiently general to be applicable to other dynamic MRI contrast enhanced studies where an increase in contrast concentration produces an increase in signal intensity.

Myocardial flow reserve parametric map, assessed by first-pass MRI compartmental analysis at the chronic stage of infarction

Regional myocardial flow and flow reserve (MFR) were assessed by compartmental analysis of Gd-enhanced MRI first-pass data in 7 patients with atypical chest pain, and in 15 patients with previous transmural myocardial infarction. The FE product (Flow x Extraction coefficient), derived from the modified Kety equation, was measured in regions corresponding to the Tetrofosmine-SPECT fixed defect and in remote normal regions. The FE product at rest and hyperemic FE product were similar in healed revascularized tissues (70.5 +/- 15.6 and 112.5 +/- 19.5 ml/mn/100 g, respectively) and in normal myocardium (76.2 +/- 18.3 and 142.2 +/- 33.0, respectively). In contrast, the FE index (48.8 +/- 15.2 and 60.7 +/- 18.0, respectively, P < 0.01 versus the two previous groups) and the MFR (1.27 +/- 0.20 vs. 1.91 +/- 0.29 in normal regions) were reduced in healed fibrotic tissues when the infarct-related artery remained occluded. Myocardial flow reserve maps allowed correct identification of regions corresponding to an occluded infarct-related artery.

Multimodality MR imaging assessment of myocardial viability: combination of first-pass and late contrast enhancement to wall motion dynamics and comparison with FDG PET-initial experience

PURPOSE

To combine three magnetic resonance (MR) imaging modalities-dobutamine stress cine, first pass, and late contrast material-enhanced T1-weighted imaging-and to compare the results with 2-[fluorine 18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in the assessment of unviable myocardium in coronary artery disease.

MATERIALS AND METHODS

Ten patients with multivessel coronary artery disease underwent MR imaging before and 6 months after bypass surgery. Left ventricular cine MR imaging was performed at rest and during dobutamine infusion. Inversion-recovery gradient-echo images were obtained to study myocardial contrast enhancement at first pass and 5 minutes later. FDG PET was performed with orally administered acipimox before surgery.

RESULTS

With dobutamine cine MR imaging, unviable myocardium was detected with a sensitivity of 79% and a specificity of 93%; postoperative wall thickening was the standard. First-pass analysis increased these values to 97% and 96%; analysis of late enhancement with T1-weighted imaging, to 62% and 98%. FDG PET had a sensitivity of 81% and a specificity of 86%.

CONCLUSION

The combination of first-pass enhancement analysis and wall motion assessment with stress significantly increases the specificity of MR imaging in the detection of unviable sectors.

Contrast-reduced imaging of tissue concentration and arterial level (CRITICAL) for assessment of cerebral hemodynamics in acute stroke by magnetic resonance

RATIONALE AND OBJECTIVES

To compare cerebral perfusion data obtained by using a low-dose, T1-weighted MRI technique with radionuclide (single positron emission computed tomography [SPECT]) brain imaging and to assess the reproducibility of parametric MRI data (cerebral blood flow [CBF], cerebral blood volume [CBV], and time to peak [TTP]) by applying a previously described nuclear medicine technique to derive quantitative perfusion data.

METHODS

Single-slice brain and neck images were rapidly acquired during the passage of a small (1/10th of normal dose) bolus of contrast. Parametric images were constructed from the MR data by extracting the bolus transit curve for the brain and the peak arterial input curve from the carotid vessels in the neck. These were compared with SPECT perfusion imaging. Twenty-four patients with acute stroke were studied with both techniques; 13 underwent repeated scanning to assess data reproducibility.

RESULTS

Relative CBF data were comparable to SPECT data (r = 0.584, P = 0.01). Results were reproducible for relative CBF, CBV, and TTP. The arterial input function was significantly different on the second injection with an average difference of 73.5, suggesting that the signal-concentration relationship had lost linearity with increased contrast load. Absolute quantitative MRI data produced values in the expected range (CBF = 42.6 mL x 100 g(-1) x min(-1)).

CONCLUSIONS

This technique allows estimation of CBF in the setting of acute stroke with quantitative values in the expected range. Repeated measurements in the same patients showed that this technique provides a reproducible measure of relative CBF, CBV, and TTP.

Magnetic resonance perfusion imaging in ischemic heart disease

This review explores the present status of contrast media available for myocardial perfusion studies, the magnetic resonance (MR) sequences adapted to multi-slice first-pass acquisitions, and the issue of myocardial perfusion quantification. To date, only low molecular weight paramagnetic gadolinium chelates have been used in clinical protocols for myocardial perfusion. With the availability of fast MR acquisition techniques to follow the first-pass distribution of the contrast agent in the myocardium, the bolus tracking technique represents the more widely used protocol in MR perfusion studies. On T1-weighted imaging, the ischemic zone appears with a delayed and lower signal enhancement compared with normally perfused myocardium. Visual analysis of the image series can be greatly improved by image post-processing to obtain relative myocardial perfusion maps. With an intravascular tracer, myocardial kinetics are in theory easier to analyze in terms of perfusion. In experimental studies, different intravascular or blood pool MR contrast agents have been tested to measure quantitative perfusion parameters. If a simple flow-limited kinetic model is developed with MR contrast agents, one important clinical application will be the evaluation of the functional consequence of coronary stenoses, ie, non-invasive evaluation of the coronary reserve.

Pitfalls in myocardial perfusion assessment with dynamic MR imaging after administration of a contrast material bolus in dogs

RATIONALE AND OBJECTIVES

The authors evaluated the artifacts observed on myocardial perfusion curves derived from an inversion-prepared fast gradient-echo (GRE) imaging sequence in dogs after injection of a gadolinium-based contrast agent.

MATERIALS AND METHODS

Six mongrel dogs were divided into three groups. In groups 1 and 2, anesthesia was maintained with pentobarbital. Group 2 also received an intravenous injection of atropine (0.03 mg/kg). In group 3, anesthesia was maintained with isoflurane (1.0%). Imaging was performed on a 1.5-T magnetic resonance (MR) imaging unit (one section per heart beat, a 30 x 15-cm field of view, 10-mm section thickness, and 64-kHz bandwidth). Region-of-interest (ROI) markers were placed on the blood pool of the left intraventricular cavity, anterior wall of the left ventricle, and anterior to the chest wall to track respiratory motion.

RESULTS

In group 1, the signal intensity (SI) periodically increased during each inspiration due to respiratory sinus arrhythmia. The relation between the SI increase and the variation of the delay between images was demonstrated in vitro and by computer simulations. No periodic increase of the SI was observed when regular cardiac rhythm was maintained by pharmacologic inhibition of the vagal-mediated chronotropic response with either the addition of atropine to pentobarbital or the use of isoflurane as the anesthetic agent.

CONCLUSION

In an inversion-prepared fast GRE sequence, respiratory sinus arrhythmia can induce periodic SI increase by varying the respiratory rate interval and delay between images.

Quantification of gadolinium-DTPA concentrations for different inversion times using an IR-turbo flash pulse sequence: a study on optimizing multislice perfusion imaging

The purpose of this study was to optimize an inversion-recovery (IR) turbo fast low-angle shot (FLASH) for multislice imaging by evaluating the accuracy of calculated the relaxation-rate (R1) for different inversion times (TI). This is important for tracer kinetic modeling because it requires a system responding linearly to input. R1 are linearly related to changes in the concentration of gadolinium (Gd)-diethylenetriaminepentaacetic acid (DTPA), and R1 is a parameter that can be derived from the magnetic resonance (MR) signal. The accuracy of calculated R1 using an IR turbo fast low-angle shot was evaluated in phantoms and for increasing TIs using spectroscopically measured R1 values as reference. Signal curves, obtained in vivo after a bolus injection of Gd-DTPA, were used in an analytical computer program to study the effect of different TI-values on accurate calculation of R1. Results show that TIeff should be <200 ms to measure the bolus-passage of Gd-DTPA in blood accurately, whereas the myocardial response can be measured correctly for TIeff < 870 ms at 1.5 T. The initial slope of the myocardial signal enhancement curve becomes steeper for larger TI values, whereas the calculated R1 curves were similar, indicating that these curves, rather than signal curves, are more suitable even for qualitative perfusion evaluation. It is concluded that the results can be incorporated in a multislice IR turbo fast low-angle shot using the first slice (with a short TI) for assessment of both the arterial input function and the tissue response and the second slice in another position for assessment of the tissue response alone.

Integrated MRI assessment of regional function and perfusion in canine myocardial infarction

A single integrated examination using regional measurements of perfusion from contrast-enhanced MRI and three-dimensional (3D) strain from tissue-tagged MRI was developed to differentiate infarcted myocardium from adjacent tissue with functional abnormalities. Ten dogs were studied at baseline and 10 days after a 2-hour occlusion of the left anterior descending coronary artery (LAD). Strain was determined using a 3D finite element model. Two-dimensional measurements of hypoenhancing regions were highly correlated with myocardial viability (r = 0.96). Signal intensity versus time curves obtained from contrast-enhanced MRI were used for quantitative perfusion analysis. The remote and adjacent noninfarcted tissue of the dogs with LAD occlusion, as well as the infarcted tissue, exhibited abnormal deformation patterns as compared to normal dogs (positive predictive value (PPV) of strain determination of infarction = 66%). Integration of contrast-enhanced MRI results with 3D strain analysis enabled the delineation of the myocardial infarction (PPV = 100%) from functionally compromised myocardium. This integrated cardiac examination shows promise for noninvasive serial assessment of potentially jeopardized noninfarcted myocardium to study the process of infarct remodeling and expansion.

MRI quantitative myocardial perfusion with compartmental analysis: a rest and stress study

K1 (first-order transfer constant from arterial plasma to myocardium for Gd-DTPA) and Vd (distribution volume of Gd-DTPA in myocardium) were measured in vivo in a canine model (n = 5) using MRI-derived myocardial perfusion curves and a compartmental model. Perfusion curves were obtained after a bolus injection of Gd-DTPA (0.04 mM/kg) with an inversion-prepared fast gradient echo sequence. Myocardium and blood signal intensity were converted to a concentration of Gd-DTPA, according to a model appropriate for short (<1 s) interimage intervals characteristic of cardiac-triggered acquisitions. Before dipyridamole-induced stress, K1 and Vd, obtained from the fit of the MRI-derived perfusion curves, were 6.2 +/- 1.4 (mHz) and 17.5 +/- 4.2%, respectively. After dipyridamole infusion, a K1 increase of a factor of 2.82 +/- 0.72 was measured (P = 0.003). No change was observed in Vd (P = 0.98). These results suggest that the K1 increase after dipyridamole reflects a flow-related effect that can be useful to quantify the MRI-derived perfusion curves.

MRI for the evaluation of regional myocardial perfusion in an experimental animal model

Myocardial perfusion was assessed in nine pigs using ultrafast gradient-echo MRI (.5 T, 15-mT/m gradients) at different levels of myocardial blood flow (range, .005-1.84 ml/min/g), generated either by adenosine infusion or by a mechanical occluder, and measured independently using radiolabeled microspheres. Sixty-four consecutive, ECG-triggered, diastolic, short axis images of the left ventricle were obtained during intravenous bolus injections (n = 30) of .05 mmol/kg of gadopentetate dimeglumine. Relative changes in peak intensity, time to peak intensity, washin slope, correlation coefficient, and cross-correlation coefficient were computed from the time-intensity curves obtained from four regions of interest, namely septal, anterior, lateral, and inferior walls. The values from the inferior wall acted as reference for evaluating relative changes in the other three regions. The cross-correlation coefficient (P < .001, rho = .60) and the peak intensity (P < .001, r = .72) showed the best correlation with myocardial blood flow. The washin slope showed a weak positive trend (P < .05), but the low value of r (r = .28) indicated that the use of this parameter to predict flow was invalid; the correlation coefficient and time to peak intensity were not correlated (P = ns). In conclusion, this study shows that it is possible to evaluate relative myocardial perfusion after the first pass of a an intravenously injected bolus of gadopentetate dimeglumine, using dynamic MRI on a conventional medium field MRI system. The cross-correlation coefficient and the peak intensity resulted in more efficient parameters to evaluate relative inhomogeneity of regional myocardial perfusion.