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Rock CA, Chen YI, Wang R, Philip AL, Keil B, Weiner RB, Elmariah S, Mekkaoui C, Nguyen CT, Sosnovik DE. Diffusion Tensor Phenomapping of the Healthy and Pressure-Overloaded Human Heart. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.03.24306781. [PMID: 38746173 PMCID: PMC11092740 DOI: 10.1101/2024.05.03.24306781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Current techniques to image the microstructure of the heart with diffusion tensor MRI (DTI) are highly under-resolved. We present a technique to improve the spatial resolution of cardiac DTI by almost 10-fold and leverage this to measure local gradients in cardiomyocyte alignment or helix angle (HA). We further introduce a phenomapping approach based on voxel-wise hierarchical clustering of these gradients to identify distinct microstructural microenvironments in the heart. Initial development was performed in healthy volunteers (n=8). Thereader, subjects with severe but well-compensated aortic stenosis (AS, n=10) were compared to age-matched controls (CTL, n=10). Radial HA gradient was significantly reduced in AS (8.0±0.8°/mm vs. 10.2±1.8°/mm, p=0.001) but the other HA gradients did not change significantly. Four distinct microstructural clusters could be idenJfied in both the CTL and AS subjects and did not differ significantly in their properties or distribution. Despite marked hypertrophy, our data suggest that the myocardium in well-compensated AS can maintain its microstructural coherence. The described phenomapping approach can be used to characterize microstructural plasticity and perturbation in any organ system and disease.
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Teh I, Shelley D, Boyle JH, Zhou F, Poenar A, Sharrack N, Foster RJ, Yuldasheva NY, Parker GJM, Dall'Armellina E, Plein S, Schneider JE, Szczepankiewicz F. Cardiac q-space trajectory imaging by motion-compensated tensor-valued diffusion encoding in human heart in vivo. Magn Reson Med 2023; 90:150-165. [PMID: 36941736 PMCID: PMC10952623 DOI: 10.1002/mrm.29637] [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: 09/26/2022] [Revised: 01/25/2023] [Accepted: 02/23/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Tensor-valued diffusion encoding can probe more specific features of tissue microstructure than what is available by conventional diffusion weighting. In this work, we investigate the technical feasibility of tensor-valued diffusion encoding at high b-values with q-space trajectory imaging (QTI) analysis, in the human heart in vivo. METHODS Ten healthy volunteers were scanned on a 3T scanner. We designed time-optimal gradient waveforms for tensor-valued diffusion encoding (linear and planar) with second-order motion compensation. Data were analyzed with QTI. Normal values and repeatability were investigated for the mean diffusivity (MD), fractional anisotropy (FA), microscopic FA (μFA), isotropic, anisotropic and total mean kurtosis (MKi, MKa, and MKt), and orientation coherence (Cc ). A phantom, consisting of two fiber blocks at adjustable angles, was used to evaluate sensitivity of parameters to orientation dispersion and diffusion time. RESULTS QTI data in the left ventricular myocardium were MD = 1.62 ± 0.07 μm2 /ms, FA = 0.31 ± 0.03, μFA = 0.43 ± 0.07, MKa = 0.20 ± 0.07, MKi = 0.13 ± 0.03, MKt = 0.33 ± 0.09, and Cc = 0.56 ± 0.22 (mean ± SD across subjects). Phantom experiments showed that FA depends on orientation dispersion, whereas μFA was insensitive to this effect. CONCLUSION We demonstrated the first tensor-valued diffusion encoding and QTI analysis in the heart in vivo, along with first measurements of myocardial μFA, MKi, MKa, and Cc . The methodology is technically feasible and provides promising novel biomarkers for myocardial tissue characterization.
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Affiliation(s)
- Irvin Teh
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - David Shelley
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
- Leeds Teaching Hospitals TrustLeedsUK
| | - Jordan H. Boyle
- Faculty of Industrial Design EngineeringDelft University of TechnologyDelftNetherlands
| | - Fenglei Zhou
- Center for Medical Image Computing, Department of Medical Physics & Biomedical Engineering and Department of NeuroinflammationUniversity College LondonLondonUK
- Astrea BioseparationCombertonUK
| | - Ana‐Maria Poenar
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Noor Sharrack
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Richard J. Foster
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Nadira Y. Yuldasheva
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Geoff J. M. Parker
- Center for Medical Image Computing, Department of Medical Physics & Biomedical Engineering and Department of NeuroinflammationUniversity College LondonLondonUK
- Bioxydyn LimitedManchesterUK
| | - Erica Dall'Armellina
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Jürgen E. Schneider
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
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Pathophysiology of LV Remodeling Following STEMI: A Longitudinal Diffusion Tensor CMR Study. JACC Cardiovasc Imaging 2023; 16:159-171. [PMID: 36412993 PMCID: PMC9902278 DOI: 10.1016/j.jcmg.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/28/2022] [Accepted: 04/07/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adverse LV remodeling post-ST-segment elevation myocardial infarction (STEMI) is associated with a poor prognosis, but the underlying mechanisms are not fully understood. Diffusion tensor (DT)-cardiac magnetic resonance (CMR) allows in vivo characterization of myocardial architecture and provides unique mechanistic insight into pathophysiologic changes following myocardial infarction. OBJECTIVES This study evaluated the potential associations between DT-CMR performed soon after STEMI and long-term adverse left ventricular (LV) remodeling following STEMI. METHODS A total of 100 patients with STEMI underwent CMR at 5 days and 12 months post-reperfusion. The protocol included DT-CMR for assessing fractional anisotropy (FA), secondary eigenvector angle (E2A) and helix angle (HA), cine imaging for assessing LV volumes, and late gadolinium enhancement for calculating infarct and microvascular obstruction size. Adverse remodeling was defined as a 20% increase in LV end-diastolic volume at 12 months. RESULTS A total of 32 patients experienced adverse remodeling at 12 months. Compared with patients without adverse remodeling, they had lower FA (0.23 ± 0.03 vs 0.27 ± 0.04; P < 0.001), lower E2A (37 ± 6° vs 51 ± 7°; P < 0.001), and, on HA maps, a lower proportion of myocytes with right-handed orientation (RHM) (8% ± 5% vs 17% ± 9%; P < 0.001) in their acutely infarcted myocardium. On multivariable logistic regression analysis, infarct FA (odds ratio [OR]: <0.01; P = 0.014) and E2A (OR: 0.77; P = 0.001) were independent predictors of adverse LV remodeling after adjusting for left ventricular ejection fraction (LVEF) and infarct size. There were no significant changes in infarct FA, E2A, or RHM between the 2 scans. CONCLUSIONS Extensive cardiomyocyte disorganization (evidenced by low FA), acute loss of sheetlet angularity (evidenced by low E2A), and a greater loss of organization among cardiomyocytes with RHM, corresponding to the subendocardium, can be detected within 5 days post-STEMI. These changes persist post-injury, and low FA and E2A are independently associated with long-term adverse remodeling.
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Computational analysis of ventricular mechanics in hypertrophic cardiomyopathy patients. Sci Rep 2023; 13:958. [PMID: 36653468 PMCID: PMC9849405 DOI: 10.1038/s41598-023-28037-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic heart disease that is associated with many pathological features, such as a reduction in global longitudinal strain (GLS), myofiber disarray and hypertrophy. The effects of these features on left ventricle (LV) function are, however, not clear in two phenotypes of HCM, namely, obstructive and non-obstructive. To address this issue, we developed patient-specific computational models of the LV using clinical measurements from 2 female HCM patients and a control subject. Left ventricular mechanics was described using an active stress formulation and myofiber disarray was described using a structural tensor in the constitutive models. Unloaded LV configuration for each subject was first determined from their respective end-diastole LV geometries segmented from the cardiac magnetic resonance images, and an empirical single-beat estimation of the end-diastolic pressure volume relationship. The LV was then connected to a closed-loop circulatory model and calibrated using the clinically measured LV pressure and volume waveforms, peak GLS and blood pressure. Without consideration of myofiber disarray, peak myofiber tension was found to be lowest in the obstructive HCM subject (60 kPa), followed by the non-obstructive subject (242 kPa) and the control subject (375 kPa). With increasing myofiber disarray, we found that peak tension has to increase in the HCM models to match the clinical measurements. In the obstructive HCM patient, however, peak tension was still depressed (cf. normal subject) at the largest degree of myofiber disarray found in the clinic. The computational modeling workflow proposed here can be used in future studies with more HCM patient data.
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Bakogiannis C, Mouselimis D, Tsarouchas A, Papatheodorou E, Vassilikos VP, Androulakis E. Hypertrophic cardiomyopathy or athlete's heart? A systematic review of novel cardiovascular magnetic resonance imaging parameters. Eur J Sport Sci 2023; 23:143-154. [PMID: 34720041 DOI: 10.1080/17461391.2021.2001576] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is a common cause of sudden cardiac death in athletes. Cardiac Magnetic Resonance (CMR) imaging is considered an excellent tool to differentiate between HCM and athlete's heart. The aim of this systematic review was to highlight the novel CMR-derived parameters with significant discriminative capacity between the two conditions. A systematic search in the MEDLINE, EMBASE and Cochrane Reviews databases was performed. Eligible studies were considered the ones comparing novel CMR-derived parameters on athletes and HCM patients. Therefore, studies that only examined Cine-derived volumetric parameters were excluded. Particular attention was given to binary classification results from multi-variate regression models and ROC curve analyses. Bias assessment was performed with the Quality Assessment on Diagnostic Accuracy Studies. Five (5) studies were included in the systematic review, with a total of 284 athletes and 373 HCM patients. Several novel indices displayed discriminatory potential, such as native T1 mapping and T2 values, LV global longitudinal strain, late gadolinium enhancement and whole-LV fractal dimension. Diffusion tensor imaging enabled quantification of the secondary eigenvalue angle and fractional anisotropy in one study, which also proved capable of reliably detecting HCM in a mixed athlete/patient sample. Several novel CMR-derived parameters, most of which are currently under development, show promising results in discerning between athlete's heart and HCM. Prospective studies examining the discriminatory capacity of all promising modalities side-by-side will yield definitive answers on their relative importance; diagnostic models can incorporate the best performing variables for optimal results.
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Affiliation(s)
- Constantinos Bakogiannis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Mouselimis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Cardiovascular Prevention and Digital Cardiology Lab, Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Vassilios P Vassilikos
- Cardiovascular Prevention and Digital Cardiology Lab, Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Eder RA, van den Boomen M, Yurista SR, Rodriguez-Aviles YG, Islam MR, Chen YCI, Trager L, Coll-Font J, Cheng L, Li H, Rosenzweig A, Wrann CD, Nguyen CT. Exercise-induced CITED4 expression is necessary for regional remodeling of cardiac microstructural tissue helicity. Commun Biol 2022; 5:656. [PMID: 35787681 PMCID: PMC9253017 DOI: 10.1038/s42003-022-03635-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Both exercise-induced molecular mechanisms and physiological cardiac remodeling have been previously studied on a whole heart level. However, the regional microstructural tissue effects of these molecular mechanisms in the heart have yet to be spatially linked and further elucidated. We show in exercised mice that the expression of CITED4, a transcriptional co-regulator necessary for cardioprotection, is regionally heterogenous in the heart with preferential significant increases in the lateral wall compared with sedentary mice. Concordantly in this same region, the heart’s local microstructural tissue helicity is also selectively increased in exercised mice. Quantification of CITED4 expression and microstructural tissue helicity reveals a significant correlation across both sedentary and exercise mouse cohorts. Furthermore, genetic deletion of CITED4 in the heart prohibits regional exercise-induced microstructural helicity remodeling. Taken together, CITED4 expression is necessary for exercise-induced regional remodeling of the heart’s microstructural helicity revealing how a key molecular regulator of cardiac remodeling manifests into downstream local tissue-level changes. Expression of transcription factor CITED4 is necessary for exercise-induced regional remodeling of the heart’s microstructural helicity, revealing how a key molecular regulator of cardiac remodeling mediates local tissue-level changes.
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Affiliation(s)
- Robert A Eder
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Maaike van den Boomen
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,Harvard Medical School, Boston, MA, 02129, USA
| | - Salva R Yurista
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Medical School, Boston, MA, 02129, USA
| | - Yaiel G Rodriguez-Aviles
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Ponce Health Sciences University, School of Medicine, Ponce, PR, 00716, USA
| | - Mohammad Rashedul Islam
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Medical School, Boston, MA, 02129, USA
| | - Yin-Ching Iris Chen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Medical School, Boston, MA, 02129, USA
| | - Lena Trager
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Jaume Coll-Font
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Medical School, Boston, MA, 02129, USA
| | - Leo Cheng
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Medical School, Boston, MA, 02129, USA
| | - Haobo Li
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Medical School, Boston, MA, 02129, USA
| | - Anthony Rosenzweig
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Medical School, Boston, MA, 02129, USA.,Massachusetts General Hospital, Cardiology Division and Corrigan Minehan Heart Center, Boston, MA, 02114, USA
| | - Christiane D Wrann
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, 02129, USA. .,Harvard Medical School, Boston, MA, 02129, USA. .,McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Christopher T Nguyen
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, 02129, USA. .,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA. .,Harvard Medical School, Boston, MA, 02129, USA. .,Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, MA, 02139, USA. .,Cardiovascular Innovation Research Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, 44195, USA.
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7
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Teh I, Romero R. WA, Boyle J, Coll‐Font J, Dall'Armellina E, Ennis DB, Ferreira PF, Kalra P, Kolipaka A, Kozerke S, Lohr D, Mongeon F, Moulin K, Nguyen C, Nielles‐Vallespin S, Raterman B, Schreiber LM, Scott AD, Sosnovik DE, Stoeck CT, Tous C, Tunnicliffe EM, Weng AM, Croisille P, Viallon M, Schneider JE. Validation of cardiac diffusion tensor imaging sequences: A multicentre test-retest phantom study. NMR IN BIOMEDICINE 2022; 35:e4685. [PMID: 34967060 PMCID: PMC9285553 DOI: 10.1002/nbm.4685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/19/2021] [Accepted: 12/24/2021] [Indexed: 05/23/2023]
Abstract
Cardiac diffusion tensor imaging (DTI) is an emerging technique for the in vivo characterisation of myocardial microstructure, and there is a growing need for its validation and standardisation. We sought to establish the accuracy, precision, repeatability and reproducibility of state-of-the-art pulse sequences for cardiac DTI among 10 centres internationally. Phantoms comprising 0%-20% polyvinylpyrrolidone (PVP) were scanned with DTI using a product pulsed gradient spin echo (PGSE; N = 10 sites) sequence, and a custom motion-compensated spin echo (SE; N = 5) or stimulated echo acquisition mode (STEAM; N = 5) sequence suitable for cardiac DTI in vivo. A second identical scan was performed 1-9 days later, and the data were analysed centrally. The average mean diffusivities (MDs) in 0% PVP were (1.124, 1.130, 1.113) x 10-3 mm2 /s for PGSE, SE and STEAM, respectively, and accurate to within 1.5% of reference data from the literature. The coefficients of variation in MDs across sites were 2.6%, 3.1% and 2.1% for PGSE, SE and STEAM, respectively, and were similar to previous studies using only PGSE. Reproducibility in MD was excellent, with mean differences in PGSE, SE and STEAM of (0.3 ± 2.3, 0.24 ± 0.95, 0.52 ± 0.58) x 10-5 mm2 /s (mean ± 1.96 SD). We show that custom sequences for cardiac DTI provide accurate, precise, repeatable and reproducible measurements. Further work in anisotropic and/or deforming phantoms is warranted.
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Affiliation(s)
- Irvin Teh
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - William A. Romero R.
- Univ Lyon, INSA‐Lyon, Université Claude Bernard Lyon 1UJM‐Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, F‐42023Saint EtienneFrance
| | - Jordan Boyle
- School of Mechanical EngineeringUniversity of LeedsLeedsUK
| | - Jaume Coll‐Font
- Cardiovascular Research Center and A. A. Martinos Center for Biomedical ImagingMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Erica Dall'Armellina
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Daniel B. Ennis
- Division of RadiologyVA Palo Alto Health Care SystemPalo AltoCaliforniaUSA
- Department of RadiologyStanford UniversityStanfordCaliforniaUSA
| | - Pedro F. Ferreira
- Cardiovascular Magnetic Resonance UnitThe Royal Brompton and Harefield NHS Foundation TrustLondonUK
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Prateek Kalra
- Department of RadiologyThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Arunark Kolipaka
- Department of RadiologyThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Sebastian Kozerke
- Institute for Biomedical EngineeringUniversity and ETH ZurichZurichSwitzerland
| | - David Lohr
- Department of Cardiovascular ImagingComprehensive Heart Failure CenterWürzburgGermany
| | | | - Kévin Moulin
- Department of RadiologyStanford UniversityStanfordCaliforniaUSA
| | - Christopher Nguyen
- Cardiovascular Research Center and A. A. Martinos Center for Biomedical ImagingMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Sonia Nielles‐Vallespin
- Cardiovascular Magnetic Resonance UnitThe Royal Brompton and Harefield NHS Foundation TrustLondonUK
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Brian Raterman
- Department of RadiologyThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Laura M. Schreiber
- Department of Cardiovascular ImagingComprehensive Heart Failure CenterWürzburgGermany
| | - Andrew D. Scott
- Cardiovascular Magnetic Resonance UnitThe Royal Brompton and Harefield NHS Foundation TrustLondonUK
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - David E. Sosnovik
- Cardiovascular Research Center and A. A. Martinos Center for Biomedical ImagingMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Christian T. Stoeck
- Institute for Biomedical EngineeringUniversity and ETH ZurichZurichSwitzerland
| | - Cyril Tous
- Department of Radiology, Radiation‐Oncology and Nuclear Medicine and Institute of Biomedical EngineeringUniversité de MontréalMontréalCanada
| | - Elizabeth M. Tunnicliffe
- Radcliffe Department of MedicineUniversity of OxfordOxfordUK
- Oxford NIHR Biomedical Research CentreOxfordUK
| | - Andreas M. Weng
- Department of Diagnostic and Interventional RadiologyUniversity Hospital WürzburgWürzburgGermany
| | - Pierre Croisille
- Univ Lyon, INSA‐Lyon, Université Claude Bernard Lyon 1UJM‐Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, F‐42023Saint EtienneFrance
| | - Magalie Viallon
- Univ Lyon, INSA‐Lyon, Université Claude Bernard Lyon 1UJM‐Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, F‐42023Saint EtienneFrance
| | - Jürgen E. Schneider
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
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8
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Weine J, van Gorkum RJH, Stoeck CT, Vishnevskiy V, Kozerke S. Synthetically Trained Convolutional Neural Networks for Improved Tensor Estimation from Free-Breathing Cardiac DTI. Comput Med Imaging Graph 2022; 99:102075. [DOI: 10.1016/j.compmedimag.2022.102075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/15/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
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Das A, Kelly C, Teh I, Sharrack N, Stoeck CT, Kozerke S, Schneider JE, Plein S, Dall'Armellina E. Detection of Intramyocardial Iron in Patients Following ST-Elevation Myocardial Infarction Using Cardiac Diffusion Tensor Imaging. J Magn Reson Imaging 2022; 56:1171-1181. [PMID: 35019174 PMCID: PMC9544509 DOI: 10.1002/jmri.28063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 12/20/2022] Open
Abstract
Background Intramyocardial hemorrhage (IMH) following ST‐elevation myocardial infarction (STEMI) is associated with poor prognosis. In cardiac magnetic resonance (MR), T2* mapping is the reference standard for detecting IMH while cardiac diffusion tensor imaging (cDTI) can characterize myocardial architecture via fractional anisotropy (FA) and mean diffusivity (MD) of water molecules. The value of cDTI in the detection of IMH is not currently known. Hypothesis cDTI can detect IMH post‐STEMI. Study Type Prospective. Subjects A total of 50 patients (20% female) scanned at 1‐week (V1) and 3‐month (V2) post‐STEMI. Field Strength/Sequence A 3.0 T; inversion‐recovery T1‐weighted‐imaging, multigradient‐echo T2* mapping, spin‐echo cDTI. Assessment T2* maps were analyzed to detect IMH (defined as areas with T2* < 20 msec within areas of infarction). cDTI images were co‐registered to produce averaged diffusion‐weighted‐images (DWIs), MD, and FA maps; hypointense areas were manually planimetered for IMH quantification. Statistics On averaged DWI, the presence of hypointense signal in areas matching IMH on T2* maps constituted to true‐positive detection of iron. Independent samples t‐tests were used to compare regional cDTI values. Results were considered statistically significant at P ≤ 0.05. Results At V1, 24 patients had IMH on T2*. On averaged DWI, all 24 patients had hypointense signal in matching areas. IMH size derived using averaged‐DWI was nonsignificantly greater than from T2* (2.0 ± 1.0 cm2 vs 1.89 ± 0.96 cm2, P = 0.69). Compared to surrounding infarcted myocardium, MD was significantly reduced (1.29 ± 0.20 × 10−3 mm2/sec vs 1.75 ± 0.16 × 10−3 mm2/sec) and FA was significantly increased (0.40 ± 0.07 vs 0.23 ± 0.03) within areas of IMH. By V2, all 24 patients with acute IMH continued to have hypointense signals on averaged‐DWI in the affected area. T2* detected IMH in 96% of these patients. Overall, averaged‐DWI had 100% sensitivity and 96% specificity for the detection of IMH. Data Conclusion This study demonstrates that the parameters MD and FA are susceptible to the paramagnetic properties of iron, enabling cDTI to detect IMH. Evidence Level 1 Technical Efficacy Stage 2
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Affiliation(s)
- Arka Das
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Christopher Kelly
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Irvin Teh
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Noor Sharrack
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Christian T Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Jürgen E Schneider
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sven Plein
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Erica Dall'Armellina
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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10
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Das A, Kelly C, Teh I, Nguyen C, Brown LAE, Chowdhary A, Jex N, Thirunavukarasu S, Sharrack N, Gorecka M, Swoboda PP, Greenwood JP, Kellman P, Moon JC, Davies RH, Lopes LR, Joy G, Plein S, Schneider JE, Dall'Armellina E. Phenotyping hypertrophic cardiomyopathy using cardiac diffusion magnetic resonance imaging: the relationship between microvascular dysfunction and microstructural changes. Eur Heart J Cardiovasc Imaging 2021; 23:352-362. [PMID: 34694365 PMCID: PMC8863073 DOI: 10.1093/ehjci/jeab210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/16/2021] [Indexed: 01/05/2023] Open
Abstract
Aims Microvascular dysfunction in hypertrophic cardiomyopathy (HCM) is predictive of clinical decline, however underlying mechanisms remain unclear. Cardiac diffusion tensor imaging (cDTI) allows in vivo characterization of myocardial microstructure by quantifying mean diffusivity (MD), fractional anisotropy (FA) of diffusion, and secondary eigenvector angle (E2A). In this cardiac magnetic resonance (CMR) study, we examine associations between perfusion and cDTI parameters to understand the sequence of pathophysiology and the interrelation between vascular function and underlying microstructure. Methods and results Twenty HCM patients underwent 3.0T CMR which included: spin-echo cDTI, adenosine stress and rest perfusion mapping, cine-imaging, and late gadolinium enhancement (LGE). Ten controls underwent cDTI. Myocardial perfusion reserve (MPR), MD, FA, E2A, and wall thickness were calculated per segment and further divided into subendocardial (inner 50%) and subepicardial (outer 50%) regions. Segments with wall thickness ≤11 mm, MPR ≥2.2, and no visual LGE were classified as ‘normal’. Compared to controls, ‘normal’ HCM segments had increased MD (1.61 ± 0.09 vs. 1.46 ± 0.07 × 10−3 mm2/s, P = 0.02), increased E2A (60 ± 9° vs. 38 ± 12°, P < 0.001), and decreased FA (0.29 ± 0.04 vs. 0.35 ± 0.02, P = 0.002). Across all HCM segments, subendocardial regions had higher MD and lower MPR than subepicardial (MDendo 1.61 ± 0.08 × 10−3 mm2/s vs. MDepi 1.56 ± 0.18 × 10−3 mm2/s, P = 0.003, MPRendo 1.85 ± 0.83, MPRepi 2.28 ± 0.87, P < 0.0001). Conclusion In HCM patients, even in segments with normal wall thickness, normal perfusion, and no scar, diffusion is more isotropic than in controls, suggesting the presence of underlying cardiomyocyte disarray. Increased E2A suggests the myocardial sheetlets adopt hypercontracted angulation in systole. Increased MD, most notably in the subendocardium, is suggestive of regional remodelling which may explain the reduced subendocardial blood flow.
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Affiliation(s)
- Arka Das
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK
| | - Christopher Kelly
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK
| | - Irvin Teh
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK
| | - Christopher Nguyen
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, 55 Fruit St, Boston, MA 02114, USA.,A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, 55 Fruit St, Boston, MA 02114, USA.,Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.,Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, 116 N Robertson Blvd, Los Angeles, CA 90048, USA
| | - Louise A E Brown
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK
| | - Amrit Chowdhary
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK
| | - Nicholas Jex
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK
| | - Sharmaine Thirunavukarasu
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK
| | - Noor Sharrack
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK
| | - Miroslawa Gorecka
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK
| | - Peter P Swoboda
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK
| | - John P Greenwood
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 31 Center Dr, Bethesda, MD 20892, USA
| | - James C Moon
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Rhodri H Davies
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Luis R Lopes
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.,Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK
| | - George Joy
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Sven Plein
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK
| | - Jürgen E Schneider
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK
| | - Erica Dall'Armellina
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK
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Chen J. Editorial for "Insight Into Myocardial Microstructure of Athletes and Hypertrophic Cardiomyopathy Patients Using Diffusion Tensor Imaging". J Magn Reson Imaging 2020; 53:83-84. [PMID: 32812283 DOI: 10.1002/jmri.27293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Junjie Chen
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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