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Contijoch F, Rasche V, Seiberlich N, Peters DC. The future of CMR: All-in-one vs. real-time CMR (Part 2). J Cardiovasc Magn Reson 2024; 26:100998. [PMID: 38237901 DOI: 10.1016/j.jocmr.2024.100998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 02/20/2024] Open
Abstract
Cardiac Magnetic Resonance (CMR) protocols can be lengthy and complex, which has driven the research community to develop new technologies to make these protocols more efficient and patient-friendly. Two different approaches to improving CMR have been proposed, specifically "all-in-one" CMR, where several contrasts and/or motion states are acquired simultaneously, and "real-time" CMR, in which the examination is accelerated to avoid the need for breathholding and/or cardiac gating. The goal of this two-part manuscript is to describe these two different types of emerging rapid CMR protocols. To this end, the vision of all-in-one and real-time imaging are described, along with techniques which have been devised and tested along the pathway of clinical implementation. The pros and cons of the different methods are presented, and the remaining open needs of each are detailed. Part 1 tackles the "All-in-One" approaches, and Part 2 focuses on the "Real-Time" approaches along with an overall summary of these emerging methods.
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Affiliation(s)
| | - Volker Rasche
- Ulm University Medical Center, Department of Internal Medicine II, Ulm, Germany
| | - Nicole Seiberlich
- Michigan Institute for Imaging Technology and Translation, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Mayer J, Blaszczyk E, Cipriani A, Ferrazzi G, Schulz-Menger J, Schaeffter T, Kolbitsch C. Cardio-respiratory motion-corrected 3D cardiac water-fat MRI using model-based image reconstruction. Magn Reson Med 2022; 88:1561-1574. [PMID: 35775790 DOI: 10.1002/mrm.29284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/04/2022] [Accepted: 04/13/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Myocardial fat infiltrations are associated with a range of cardiomyopathies. The purpose of this study was to perform cardio-respiratory motion-correction for model-based water-fat separation to image fatty infiltrations of the heart in a free-breathing, non-cardiac-triggered high-resolution 3D MRI acquisition. METHODS Data were acquired in nine patients using a free-breathing, non-cardiac-triggered high-resolution 3D Dixon gradient-echo sequence and radial phase encoding trajectory. Motion correction was combined with a model-based water-fat reconstruction approach. Respiratory and cardiac motion models were estimated using a dual-mode registration algorithm incorporating both motion-resolved water and fat information. Qualitative comparisons of fat structures were made between 2D clinical routine reference scans and reformatted 3D motion-corrected images. To evaluate the effect of motion correction the local sharpness of epicardial fat structures was analyzed for motion-averaged and motion-corrected fat images. RESULTS The reformatted 3D motion-corrected reconstructions yielded qualitatively comparable fat structures and fat structure sharpness in the heart as the standard 2D breath-hold. Respiratory motion correction improved the local sharpness on average by 32% ± 24% with maximum improvements of 81% and cardiac motion correction increased the sharpness further by another 15% ± 11% with maximum increases of 31%. One patient showed a fat infiltration in the myocardium and cardio-respiratory motion correction was able to improve its visualization in 3D. CONCLUSION The 3D water-fat separated cardiac images were acquired during free-breathing and in a clinically feasible and predictable scan time. Compared to a motion-averaged reconstruction an increase in sharpness of fat structures by 51% ± 27% using the presented motion correction approach was observed for nine patients.
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Affiliation(s)
- Johannes Mayer
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Berlin, Germany
| | - Edyta Blaszczyk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany. HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Alberto Cipriani
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany. HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Jeanette Schulz-Menger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany. HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Tobias Schaeffter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Berlin, Germany
- Department of Medical Engineering, Technical University of Berlin, Berlin, Germany
| | - Christoph Kolbitsch
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Berlin, Germany
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Yu Y, Chen Y, Zhao S, Ge M, Yang S, Yun H, Bi X, Fu C, Zeng M, Jin H. Role of free-breathing motion-corrected late gadolinium enhancement technique for image quality assessment and LGE quantification. Eur J Radiol 2020; 135:109510. [PMID: 33401112 DOI: 10.1016/j.ejrad.2020.109510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 12/19/2020] [Accepted: 12/28/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the image quality and late gadolinium enhancement (LGE) quantification between free-breathing motion-corrected and conventional breath-hold LGE method in a variety of cardiovascular diseases. MATERIALS AND METHODS 149 consecutive patients underwent contrast-enhanced cardiac magnetic resonance examination employing both free-breathing motion-corrected LGE and conventional breath-hold LGE method. Scan time, contrast-to-noise ratio, overall image quality score and LGE mass were measured and analyzed statistically. RESULTS Free-breathing motion-corrected LGE method had a shorter scan time and higher overall image quality score in comparison with conventional breath-hold LGE method (p < 0.001). Univariate/multivariate logistic regression analysis showed that breath-holding difficulty, high heart rate and arrhythmia could be predictive factors possibly for an inferior image quality score (p < 0.05 for all). The contrast-to-noise ratios of free-breathing motion-corrected LGE images were higher than those of conventional breath-hold LGE images (p < 0.001). In the cases with subepicardial and/or transmural myocardial enhancement, the measured LGE masses were larger on free-breathing motion-corrected LGE images in comparison with those on conventional breath-hold LGE images (p < 0.05). CONCLUSION Free-breathing motion-corrected LGE could be a better choice for patients who need contrast-enhanced cardiac MRI and have one or more of the risk factors for an inferior image quality score, including breath-holding difficulty, high heart rate and arrhythmia. However, an overestimation of LGE mass on free-breathing motion-corrected LGE image should be taken into consideration when LGE pattern involves subepicardial and/or transmural myocardium.
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Affiliation(s)
- Yunfei Yu
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yinyin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Shihai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Meiying Ge
- Department of Radiology, The 5th People's Hospital of Shanghai, Fudan University, Shanghai, China.
| | - Shan Yang
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Hong Yun
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Xiaoming Bi
- MR Research and Development, Siemens Healthcare, Los Angeles, CA, 90048, USA
| | - Caixia Fu
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, 518057, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China.
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Henningsson M, Carlhäll CJ. Inflow artifact reduction using an adaptive flip-angle navigator restore pulse for late gadolinium enhancement of the left atrium. Magn Reson Med 2020; 84:3308-3315. [PMID: 32459007 DOI: 10.1002/mrm.28334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE Late gadolinium enhancement (LGE) of the left atrium is susceptible to artifacts arising from the right pulmonary veins, caused by inflowing blood tagged by the navigator restore pulse. The purpose of this study was to evaluate a new method to reduce the inflow artifact using an adaptive flip-angle restore pulse. METHODS A low-restore angle reduces the inflow artifact but may lead to a poor navigator SNR. The proposed approach aims to determine the patient-specific restore angle, which optimizes the trade-off between inflow artifacts and navigator SNR. Three-dimensional LGE with adaptive navigator restore (3D LGEA ) was implemented by incrementing the flip angle of the restore pulse from a starting value of 0°, based on the navigator normalized cross-correlation. Magnetic resonance imaging experiments were performed on a 1.5T scanner. The value of 3D LGEA was compared with 3D LGE with a constant 180° restore pulse (3D LGE180 ) in 22 patients with heart diseases. The values of 3D LGEA and 3D LGE180 were compared in terms of pulmonary vein blood signal relative to reference blood in the descending aorta (PVrel ) and visual scoring to determine level of motion artifacts using a 4-point scale (1 = severe artifacts; 4 = no artifacts). RESULTS The value of PVrel was significantly lower for 3D LGEA than for 3D LGE180 (1.16 ± 0.23 vs. 1.59 ± 0.29, P < .001). Furthermore, visual scoring of the motion artifacts yielded no difference (P = .78). CONCLUSION Adaptively adjusting the navigator restore flip angle based on the navigator normalized cross-correlation reduces the 3D LGE inflow artifact without affecting image quality or the scan time.
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Affiliation(s)
- Markus Henningsson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Carl-Johan Carlhäll
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Fan H, Li S, Lu M, Yin G, Yang X, Lan T, Dai L, Chen X, Li J, Zhang Y, Sirajuddin A, Kellman P, Arai AE, Zhao S. Myocardial late gadolinium enhancement: a head-to-head comparison of motion-corrected balanced steady-state free precession with segmented turbo fast low angle shot. Clin Radiol 2018; 73:593.e1-593.e9. [PMID: 29548551 DOI: 10.1016/j.crad.2018.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 02/08/2018] [Indexed: 02/08/2023]
Abstract
AIM To evaluate the image quality and diagnostic agreement with a head-to-head comparison of late gadolinium enhancement (LGE) images acquired by the motion-corrected (MOCO) balanced steady-state free precession (bSSFP) phase sensitivity inversion recovery (PSIR) and conventional segmented fast low angle shot (FLASH) PSIR methods15,16 in a patient cohort with a wide spectrum of cardiovascular disease. MATERIALS AND METHODS In 59 consecutive patients, signal-to-noise ratios (SNRs), contrast-to-noise ratios (CNRs) of the normal myocardium (NM), LGE, and blood pool (BP) were pair-wise compared between the two different sequences. A further semi-qualitative score system (graded 1 -4) was used to compare the overall image quality (OIQ). The diagnostic agreement of the two techniques were evaluated by both transmural severity and absolutely quantitative size of LGE. RESULTS The SNRs of the NM, LGE, and BP of MOCO bSSFP were 4.8±3.4, 53.6±35.6 and 43.2±29.3, compared with 3.9±3.6 (p=0.126), 27.7±18.5 (p<0.001) and 24.3±13.4 (p<0.001) of FLASH LGE, respectively. The CNRs of LGE to NM, LGE to BP, and BP to NM were 48.3±33.1 versus 23.8±16.7 (p<0.001), 6.5±21.6 versus 3.8±10.8 (p<0.001), and 38.3±27.2 versus 20.3±10.7 (p=0.448), respectively. The OIQ of MOCO bSSFP was higher than that of segmented FLASH (median 4 versus median 3, p<0.001). For quantification of LGE size, there is good agreement and high correlation (r=0.992, p<0.001) between the two methods. CONCLUSIONS MOCO bSSFP is a feasible, robust sequence for LGE imaging, especially for patients with arrhythmia and those incapable of breath-holding due to severe heart failure.
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Affiliation(s)
- H Fan
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, Air Force General Hospital, People's Liberation Army, Beijing, China
| | - S Li
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - M Lu
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA.
| | - G Yin
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - X Yang
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - T Lan
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - L Dai
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - X Chen
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - J Li
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Y Zhang
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - A Sirajuddin
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - P Kellman
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, USA
| | - A E Arai
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - S Zhao
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Keegan J, Jhooti P, Babu-Narayan SV, Drivas P, Ernst S, Firmin DN. Improved respiratory efficiency of 3D late gadolinium enhancement imaging using the continuously adaptive windowing strategy (CLAWS). Magn Reson Med 2015; 71:1064-74. [PMID: 23605998 DOI: 10.1002/mrm.24758] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Acquisition durations of navigator-gated high-resolution three-dimensional late gadolinium enhancement studies may typically be up to 10 min, depending on the respiratory efficiency and heart rate. Implementation of the continuously adaptive windowing strategy (CLAWS) could increase respiratory efficiency, but the resulting non-smooth k-space acquisition order during gadolinium wash-out could result in increased artifact. METHODS Navigator-gated three-dimensional late gadolinium enhancement acquisitions were performed in 18 patients using tracking end-expiratory accept/reject (EE-ARA) and CLAWS algorithms in random order. RESULTS Retrospective analysis of the stored navigator data shows that CLAWS scan times are very close to (within 1%) or equal to the fastest achievable scan times while EE-ARA significantly extends the acquisition duration (P < 0.0001). EE-ARA acquisitions are 26% longer than CLAWS acquisitions (378 ± 104 s compared to 301 ± 85 s, P = 0.002). Image quality scores for CLAWS and EE-ARA acquisitions are not significantly different (4.1 ± 0.6 compared to 4.3 ± 0.6, P = ns). Numerical phantom simulations show that the non-uniform k-space ordering introduced by CLAWS results in slight, but not statistically significant, reductions in both blood signal-to-noise ratio (10%) and blood-myocardium contrast-to-noise ratio (12%). CONCLUSIONS CLAWS results in markedly reduced acquisition durations compared to EE-ARA without significant detriment to the image quality.
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Affiliation(s)
- Jennifer Keegan
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
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Advances in cardiac magnetic resonance imaging of congenital heart disease. Pediatr Radiol 2015; 45:5-19. [PMID: 25552386 DOI: 10.1007/s00247-014-3067-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/21/2014] [Indexed: 01/09/2023]
Abstract
Due to advances in cardiac surgery, survival of patients with congenital heart disease has increased considerably during the past decades. Many of these patients require repeated cardiovascular magnetic resonance imaging to assess cardiac anatomy and function. In the past decade, technological advances have enabled faster and more robust cardiovascular magnetic resonance with improved image quality and spatial as well as temporal resolution. This review aims to provide an overview of advances in cardiovascular magnetic resonance hardware and acquisition techniques relevant to both pediatric and adult patients with congenital heart disease and discusses the techniques used to assess function, anatomy, flow and tissue characterization.
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Current state of the art cardiovascular MR imaging techniques for assessment of ischemic heart disease. Radiol Clin North Am 2014; 53:335-44. [PMID: 25726998 DOI: 10.1016/j.rcl.2014.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cardiac magnetic resonance (CMR) imaging is increasingly being used to evaluate patients with known or suspected ischemic heart disease, because of its ability to acquire images in any orientation and the wide variety of sequences available to characterize normal and abnormal structure and function. Substantial improvements have been made in the hardware and software used to perform CMR, resulting in better and more consistent image quality. There has been a greater emphasis recently in developing and validating quantitative CMR techniques. This article reviews advances in CMR techniques for assessing cardiac function, myocardial perfusion, late gadolinium enhancement, and tissue characterization with T1 and T2 mapping sequences.
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Pierce IT, Keegan J, Drivas P, Gatehouse PD, Firmin DN. Free-breathing 3D late gadolinium enhancement imaging of the left ventricle using a stack of spirals at 3T. J Magn Reson Imaging 2014; 41:1030-7. [PMID: 24796700 PMCID: PMC4377106 DOI: 10.1002/jmri.24643] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/08/2014] [Indexed: 12/31/2022] Open
Abstract
Purpose To develop navigator-gated free-breathing 3D spiral late gadolinium enhancement (LGE) imaging of the left ventricle at 3T and compare it with conventional breath-hold 2D Cartesian imaging. Materials and Methods Equivalent slices from 3D spiral and multislice 2D Cartesian acquisitions were compared in 15 subjects in terms of image quality (1, nondiagnostic to 5, excellent), sharpness (1–3), and presence of artifacts (0–2). Blood signal-to-noise ratio (SNR), blood/myocardium contrast-to-noise ratio (CNR), and quantitative sharpness were also compared. Results All 3D spiral scans were completed faster than an equivalent 2D Cartesian short-axis stack (85 vs. 230 sec, P < 0.001). Image quality was significantly higher for 2D Cartesian images than 3D spiral images (3.7 ± 0.87 vs. 3.4 ± 1.05, P = 0.03) but not for mid or apical slices specifically. There were no significant differences in qualitative and quantitative sharpness (95% confidence interval [CI]: 1.91 ± 0.67 vs. 1.93 ± 0.69, P = 0.83 and 95% CI: 0.41 ± 0.07 vs. 0.40 ± 0.09, P = 0.25, respectively), artifact scores (95% CI: 0.16 ± 0.37 vs. 0.40 ± 0.58, P = 0.16), SNR (95% CI: 121.5 ± 55.3 vs. 136.4 ± 77.9, P = 0.13), and CNR (95% CI: 101.6 ± 48.4 vs. 102.7 ± 61.8, P = 0.98). Similar enhancement ratios (0.65 vs. 0.62) and volumes (13.8 vs. 14.1cm3) were measured from scar regions of three patients. Conclusio Navigator-gated 3D spiral LGE imaging can be performed in significantly and substantially shorter acquisition durations, although with some reduced image quality, than multiple breath-hold 2D Cartesian imaging while providing higher resolution and contiguous coverage..
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Affiliation(s)
- Iain T Pierce
- Cardiovascular BRU, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
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Keegan J, Drivas P, Firmin DN. Navigator artifact reduction in three-dimensional late gadolinium enhancement imaging of the atria. Magn Reson Med 2013; 72:779-85. [PMID: 24151231 DOI: 10.1002/mrm.24967] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 11/08/2022]
Abstract
PURPOSE Navigator-gated three-dimensional (3D) late gadolinium enhancement (LGE) imaging demonstrates scarring following ablation of atrial fibrillation. An artifact originating from the slice-selective navigator-restore pulse is frequently present in the right pulmonary veins (PVs), obscuring the walls and making quantification of enhancement difficult. We describe a simple sequence modification to greatly reduce or remove this artifact. METHODS A navigator-gated inversion-prepared gradient echo sequence was modified so that the slice-selective navigator-restore pulse was delayed in time from the nonselective preparation (NAV-restore-delayed). Both NAV-restore-delayed and conventional 3D LGE acquisitions were performed in 11 patients and the results compared. RESULTS One patient was excluded due to severe respiratory motion artifact in both NAV-restore-delayed and conventional acquisitions. Moderate to severe artifact was present in 9 of the remaining 10 patients using the conventional sequence and was considerably reduced when using the NAV-restore-delayed sequence (ostial PV to blood pool ratio, 1.7 ± 0.5 versus 1.1 ± 0.2, respectively [P < 0.0001]; qualitative artifact scores, 2.8 ± 1.1 versus 1.2 ± 0.4, respectively [P < 0.001]). While navigator signal-to-noise ratio was reduced with the NAV-restore-delayed sequence, respiratory motion compensation was unaffected. CONCLUSIONS Shifting the navigator-restore pulse significantly reduces or eliminates navigator artifact. This simple modification improves the quality of 3D LGE imaging and potentially aids late enhancement quantification in the atria.
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Affiliation(s)
- Jennifer Keegan
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
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Roujol S, Basha TA, Akçakaya M, Foppa M, Chan RH, Kissinger KV, Goddu B, Berg S, Manning WJ, Nezafat R. 3D late gadolinium enhancement in a single prolonged breath-hold using supplemental oxygenation and hyperventilation. Magn Reson Med 2013; 72:850-7. [PMID: 24186772 DOI: 10.1002/mrm.24969] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 08/28/2013] [Accepted: 09/04/2013] [Indexed: 11/07/2022]
Abstract
PURPOSE To evaluate the feasibility of three-dimensional (3D) single breath-hold late gadolinium enhancement (LGE) of the left ventricle (LV) using supplemental oxygen and hyperventilation and compressed-sensing acceleration. METHODS Breath-hold metrics [breath-hold duration, diaphragmatic/LV position drift, and maximum variation of R wave to R wave (RR) interval] without and with supplemental oxygen and hyperventilation were assessed in healthy adult subjects using a real-time single shot acquisition. Ten healthy subjects and 13 patients then underwent assessment of the proposed 3D breath-hold LGE acquisition (field of view = 320 × 320 × 100 mm(3) , resolution = 1.6 × 1.6 × 5.0 mm(3) , acceleration rate of 4) and a free-breathing acquisition with right hemidiaphragm navigator (NAV) respiratory gating. Semiquantitative grading of overall image quality, motion artifact, myocardial nulling, and diagnostic value was performed by consensus of two blinded observers. RESULTS Supplemental oxygenation and hyperventilation increased the breath-hold duration (35 ± 11 s to 58 ± 21 s; P < 0.0125) without significant impact on diaphragmatic/LV position drift or maximum variation of RR interval (both P > 0.01). LGE images were of similar quality when compared with free-breathing acquisitions, but with reduced total scan time (85 ± 22 s to 35 ± 6 s; P < 0.001). CONCLUSIONS Supplemental oxygenation and hyperventilation allow for prolonged breath-holding and enable single breath-hold 3D accelerated LGE with similar image quality as free breathing with NAV.
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Affiliation(s)
- Sébastien Roujol
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Schmidt EJ, Fung MM, Ciris PA, Song T, Shankaranarayanan A, Holmvang G, Gupta SN, Chaput M, Levine RA, Ruskin J, Reddy VY, D'avila A, Aletras AH, Danik SB. Navigated DENSE strain imaging for post-radiofrequency ablation lesion assessment in the swine left atria. Europace 2013; 16:133-41. [PMID: 24014803 DOI: 10.1093/europace/eut229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIMS Prior work has demonstrated that magnetic resonance imaging (MRI) strain can separate necrotic/stunned myocardium from healthy myocardium in the left ventricle (LV). We surmised that high-resolution MRI strain, using navigator-echo-triggered DENSE, could differentiate radiofrequency ablated tissue around the pulmonary vein (PV) from tissue that had not been damaged by radiofrequency energy, similarly to navigated 3D myocardial delayed enhancement (3D-MDE). METHODS AND RESULTS A respiratory-navigated 2D-DENSE sequence was developed, providing strain encoding in two spatial directions with 1.2 × 1.0 × 4 mm(3) resolution. It was tested in the LV of infarcted sheep. In four swine, incomplete circumferential lesions were created around the right superior pulmonary vein (RSPV) using ablation catheters, recorded with electro-anatomic mapping, and imaged 1 h later using atrial-diastolic DENSE and 3D-MDE at the left atrium/RSPV junction. DENSE detected ablation gaps (regions with >12% strain) in similar positions to 3D-MDE (2D cross-correlation 0.89 ± 0.05). Low-strain (<8%) areas were, on average, 33% larger than equivalent MDE regions, so they include both injured and necrotic regions. Optimal DENSE orientation was perpendicular to the PV trunk, with high shear strain in adjacent viable tissue appearing as a sensitive marker of ablation lesions. CONCLUSIONS Magnetic resonance imaging strain may be a non-contrast alternative to 3D-MDE in intra-procedural monitoring of atrial ablation lesions.
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Affiliation(s)
- Ehud J Schmidt
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
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Kellman P, Arai AE. Cardiac imaging techniques for physicians: late enhancement. J Magn Reson Imaging 2013; 36:529-42. [PMID: 22903654 DOI: 10.1002/jmri.23605] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Late enhancement imaging is used to diagnose and characterize a wide range of ischemic and nonischemic cardiomyopathies, and its use has become ubiquitous in the cardiac MR exam. As the use of late enhancement imaging has matured and the span of applications has widened, the demands on image quality have grown. The characterization of subendocardial MI now includes the accurate quantification of scar size, shape, and characterization of borders which have been shown to have prognostic significance. More diverse patterns of late enhancement including patchy, mid-wall, subepicardial, or diffuse enhancement are of interest in diagnosing nonischemic cardiomyopathies. As clinicians are examining late enhancement images for more subtle indication of fibrosis, the demand for lower artifacts has increased. A range of new techniques have emerged to improve the speed and quality of late enhancement imaging including: methods for acquisition during free breathing, and fat water separated imaging for characterizing fibrofatty infiltration and reduction of artifacts related to the presence of fat. Methods for quantification of T1 and extracellular volume fraction are emerging to tackle the issue of discriminating globally diffuse fibrosis from normal healthy tissue which is challenging using conventional late enhancement methods. The aim of this review will be to describe the current state of the art and to provide a guide to various clinical protocols that are commonly used.
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Affiliation(s)
- Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Feasibility of free-breathing late gadolinium-enhanced cardiovascular MRI for assessment of myocardial infarction: navigator-gated versus single-shot imaging. Int J Cardiol 2012; 168:94-9. [PMID: 23040999 DOI: 10.1016/j.ijcard.2012.09.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 05/25/2012] [Accepted: 09/14/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the feasibility of two free-breathing late gadolinium-enhanced cardiovascular magnetic resonance (LGE-CMR) techniques (two-dimensional segmented navigator-gated [NAV-LGE] and single-shot [SS-LGE]) by comparing with breath-hold LGE-CMR (BH-LGE) as reference. METHODS A total of 200 consecutive patients underwent the three LGE-CMR imaging techniques. BH patterns were assessed with dynamic navigator MR imaging. Image quality was graded on a 5-point scale (4=optimal; 0=not assessable). In patients with sufficient BH capability (diaphragmatic movement with a deviation of <3mm), hyperenhancement was scored with a 5-point scale, and global infarct size (%left ventricle) was quantified. RESULTS Compared to free-breathing LGE-CMR, BH-LGE had higher image quality grade in patients with sufficient BH capability (P<0.01 [vs. NAV-LGE]; P<0.001 [vs. SS-LGE]) but poorer image quality in patients with insufficient BH capability (P<0.001 [vs. NAV-LGE]; P<0.01 [vs. SS-LGE]). NAV-LGE had higher sensitivity for infarct detection than SS-LGE (97.1% vs. 88.4%, P<0.05), but specificity was not significantly different (97.3% vs. 94.7%, P=0.37). By Bland-Altman analysis, the average differences in global infarct size were 0.4% and 1.2%, and the limits of agreement were ± 4.0% and ± 5.9% for NAV- and SS-LGE, respectively. CONCLUSIONS Although both NAV- and SS-LGE improve the image quality in patients with insufficient BH capability, NAV-LGE is superior to SS-LGE in infarct detection and infarct size measurement. NAV-LGE can be a possible first-line technique for patients with inability to perform sufficient BH.
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Kadbi M, Kotys M, Alshaher M, Fischer S, Amini AA. An improved real-time cine Late Gadolinium Enhancement (LGE) imaging method at 3T. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:531-4. [PMID: 22254365 DOI: 10.1109/iembs.2011.6090097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A real-time Late Gadolinium Enhancement (LGE) MRI technique (free breathing and non-gated) is presented for detection of myocardial scars. Conventional LGE imaging methods currently in use are applied in conjunction with breath-hold and, thus, are difficult to use in patients with cardiac disease and may lead to motion artifacts. Additionally, conventional techniques involve ECG gating, which is problematic in patients with arrhythmias requiring multiple breath holds and use of arrhythmia rejection techniques. Finally, conventional LGE techniques require accurate estimates for the inversion time in order to null the normal myocardium, revealing the location of the scar with high contrast. Real-time LGE imaging obviates these difficulties and can, in principle, acquire cine images to assess wall motion over several heart phases as part of the same scan. To date, the main limitation of real-time LGE imaging has been long acquisition window and low temporal resolution. These limitations lead to temporal blurring of wall motion and possible overestimation of infarct size. The goal of this study was to increase the temporal resolution of real-time, cine LGE imaging, providing the possibility for better visualization of the wall motion and more accurate assessment of myocardial viability.
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Affiliation(s)
- Mo Kadbi
- Medical Imaging Lab, Electrical and Computer Engineering Department, University of Louisville, Louisville, KY, United States.
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Ferrari VA, Witschey WR, Zhou R. Cardiac Magnetic Resonance Assessment of Myocardial Fibrosis. Circ Cardiovasc Imaging 2011; 4:604-6. [DOI: 10.1161/circimaging.111.969204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Victor A. Ferrari
- From the Cardiovascular Magnetic Resonance Program, Penn Cardiovascular Institute, and the Noninvasive Imaging Laboratory, Hospital of the University of Pennsylvania, University of Pennsylvania Medical Center, Philadelphia, PA (V.A.F.); Center for Magnetic Resonance and Optical Imaging, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (W.R.T.W.); and Molecular Imaging Laboratories, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia,
| | - Walter R.T. Witschey
- From the Cardiovascular Magnetic Resonance Program, Penn Cardiovascular Institute, and the Noninvasive Imaging Laboratory, Hospital of the University of Pennsylvania, University of Pennsylvania Medical Center, Philadelphia, PA (V.A.F.); Center for Magnetic Resonance and Optical Imaging, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (W.R.T.W.); and Molecular Imaging Laboratories, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia,
| | - Rong Zhou
- From the Cardiovascular Magnetic Resonance Program, Penn Cardiovascular Institute, and the Noninvasive Imaging Laboratory, Hospital of the University of Pennsylvania, University of Pennsylvania Medical Center, Philadelphia, PA (V.A.F.); Center for Magnetic Resonance and Optical Imaging, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (W.R.T.W.); and Molecular Imaging Laboratories, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia,
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Amano Y, Matsumura Y, Kumita S. Free-breathing high-spatial-resolution delayed contrast-enhanced three-dimensional viability MR imaging of the myocardium at 3.0 T: a feasibility study. J Magn Reson Imaging 2009; 28:1361-7. [PMID: 19025943 DOI: 10.1002/jmri.21595] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To assess the feasibility of free-breathing high-spatial-resolution delayed contrast-enhanced three-dimensional (3D) viability magnetic resonance imaging (MRI) at 3.0 T for the detection of myocardial damages. MATERIALS AND METHODS Twenty-five patients with myocardial diseases, including myocardial infarction and cardiomyopathies, were enrolled after informed consent was given. Free-breathing 3D viability MRI with high spatial resolution (1.5 x 1.25 x 2.5 mm) at 3.0 T, for which cardiac and navigator gating techniques were employed, was compared with breath-hold two-dimensional (2D) viability imaging (1.77 x 1.18 x 10 mm) for assessment of contrast-to-noise ratio (CNR) and myocardial damage. RESULTS Free-breathing 3D viability imaging was achieved successfully in 21 of the 25 patients. This imaging technique depicted 84.6% of hyperenhancing myocardium with a higher CNR between hyperenhancing myocardium and blood and with excellent agreement for the transmural extension of myocardial damage (k = 0.91). In particular, the 3D viability images delineated the myocardial infarction and linear hyperenhancing myocardium, comparable to the 2D viability images. CONCLUSION Free-breathing high-spatial-resolution delayed contrast-enhanced 3D viability MRI using 3.0 T was feasible for the evaluation of hyperenhancing myocardium, as seen with myocardial infarction and cardiomyopathies.
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Affiliation(s)
- Yasuo Amano
- Department of Radiology, Nippon Medical School, Tokyo, Japan.
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Detsky JS, Graham JJ, Vijayaraghavan R, Biswas L, Stainsby JA, Guttman MA, Wright GA, Dick AJ. Free-breathing, nongated real-time delayed enhancement MRI of myocardial infarcts: A comparison with conventional delayed enhancement. J Magn Reson Imaging 2008; 28:621-5. [DOI: 10.1002/jmri.21505] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Nguyen TD, Spincemaille P, Weinsaft JW, Ho BY, Cham MD, Prince MR, Wang Y. A fast navigator-gated 3D sequence for delayed enhancement MRI of the myocardium: Comparison with breathhold 2D imaging. J Magn Reson Imaging 2008; 27:802-8. [PMID: 18302233 DOI: 10.1002/jmri.21296] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Thanh D Nguyen
- Department of Radiology, Weill Medical College of Cornell University, New York, New York 10022, USA.
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Goldfarb JW, Arnold S, Han J. Recent myocardial infarction: assessment with unenhanced T1-weighted MR imaging. Radiology 2007; 245:245-50. [PMID: 17885192 DOI: 10.1148/radiol.2451061590] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of the study was to prospectively evaluate a T1-weighted technique for detection of myocardial edema resulting from recent myocardial infarction (MI) or intervention. This study was HIPAA compliant and institutional review board approved. Fifteen men and one woman (mean age, 57.8 years+/-11.5 [standard deviation]) were examined with T1-weighted magnetic resonance (MR) imaging and inversion-recovery cine pulse sequence in two groups, recent MI and chronic MI, and gave informed consent. T1 relaxation times of MI and adjacent myocardium were compared (Student t test and correlation analysis). In patients with recent MI, areas of myocardial edema were well depicted with T1-weighted MR imaging. T1 relaxation times of recent infarcts were longer than those of older MIs (925 msec+/-169 vs 551 msec+/-107, P<.001). From local edema, T1 relaxation time of infarcted myocardium is increased, may remain elevated for 2 months, and enables imaging with T1-weighted techniques.
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Affiliation(s)
- James W Goldfarb
- Department of Research and Education, DeMatteis MRI, St Francis Hospital, 100 Port Washington Blvd, Roslyn, NY 11576, and Program in Biomedical Engineering, SUNY Stony Brook, NY, USA.
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