Virtual tagging: numerical considerations and phantom validation

Assessment of left sided filling dynamics in diastolic dysfunction using cardiac computed tomography

BACKGROUND

Left ventricular (LV) diastolic dysfunction (DD) often accompanies coronary artery disease but is difficult to assess since it involves a complex interaction between LV filling and left atrial (LA) emptying.

OBJECTIVE

To characterize simultaneous changes in LA and LV volumes using cardiac computed tomography (CT) in a group of patients with various grades of DD based on echocardiography.

METHODS

We identified 35 patients with DD by echocardiography, who had also undergone cardiac CT, and 35 age-matched normal controls. LV and LA volumes were measured every 10% of the RR interval, using semi-automatic software. From these, - systolic, early-diastolic and late-diastolic volume changes were calculated, and additional parameters of diastolic filling derived. Conduit volume was defined as the difference between the LV and LA early-diastolic volume change.

RESULTS

Patients with DD had significantly larger LV mass, and LA volumes, reduced early emptying volumes and increased conduit volume as percent of early LV filling (All p<0.001). LA function, manifesting as total emptying fraction (LATEF), decreased proportionately with worsening grades of DD (p<0.001). LA contractile function was maintained until advanced grade-3 DD. By receiver operating characteristic analysis, LATEF had an AUC of 0.88 to separate between normals and DD. At a threshold of <42.5%, LATEF has 97% sensitivity and 69% specificity to detect DD.

CONCLUSIONS

DD is characterized by reduced LA function and an alteration in the relative contributions of the atrial emptying and conduit volume components of early LV filling. In patients undergoing cardiac CT, it is possible to identify the presence and severity of DD.

Novel insight into the detailed myocardial motion and deformation of the rodent heart using high-resolution phase contrast cardiovascular magnetic resonance

BACKGROUND

Phase contrast velocimetry cardiovascular magnetic resonance (PC-CMR) is a powerful and versatile tool allowing assessment of in vivo motion of the myocardium. However, PC-CMR is sensitive to motion related artifacts causing errors that are geometrically systematic, rendering regional analysis of myocardial function challenging. The objective of this study was to establish an optimized PC-CMR method able to provide novel insight in the complex regional motion and strain of the rodent myocardium, and provide a proof-of-concept in normal and diseased rat hearts with higher temporal and spatial resolution than previously reported.

METHODS

A PC-CMR protocol optimized for assessing the motion and deformation of the myocardium in rats with high spatiotemporal resolution was established, and ten animals with different degree of cardiac dysfunction underwent examination and served as proof-of-concept. Global and regional myocardial velocities and circumferential strain were calculated, and the results were compared to five control animals. Furthermore, the global strain measurements were validated against speckle-tracking echocardiography, and inter- and intrastudy variability of the protocol were evaluated.

RESULTS

The presented method allows assessment of regional myocardial function in rats with high level of detail; temporal resolution was 3.2 ms, and analysis was done using 32 circumferential segments. In the dysfunctional hearts, global and regional function were distinctly altered, including reduced global peak values, increased regional heterogeneity and increased index of dyssynchrony. Strain derived from the PC-CMR data was in excellent agreement with echocardiography (r = 0.95, p < 0.001; limits-of-agreement -0.02 ± 3.92%strain), and intra- and interstudy variability were low for both velocity and strain (limits-of-agreement, radial motion: 0.01 ± 0.32 cm/s and -0.06 ± 0.75 cm/s; circumferential strain: -0.16 ± 0.89%strain and -0.71 ± 1.67%strain, for intra- and interstudy, respectively).

CONCLUSION

We demonstrate, for the first time, that PC-CMR enables high-resolution evaluation of in vivo circumferential strain in addition to myocardial motion of the rat heart. In combination with the superior geometric robustness of CMR, this ultimately provides a tool for longitudinal studies of regional function in rodents with high level of detail.

Cardiac motion and deformation recovery from MRI: a review

Magnetic resonance imaging (MRI) is a highly advanced and sophisticated imaging modality for cardiac motion tracking and analysis, capable of providing 3D analysis of global and regional cardiac function with great accuracy and reproducibility. In the past few years, numerous efforts have been devoted to cardiac motion recovery and deformation analysis from MR image sequences. Many approaches have been proposed for tracking cardiac motion and for computing deformation parameters and mechanical properties of the heart from a variety of cardiac MR imaging techniques. In this paper, an updated and critical review of cardiac motion tracking methods including major references and those proposed in the past ten years is provided. The MR imaging and analysis techniques surveyed are based on cine MRI, tagged MRI, phase contrast MRI, DENSE, and SENC. This paper can serve as a tutorial for new researchers entering the field.

Development of an accuracy assessment phantom for surgical navigators

The objective of this study was to design a calibration phantom for a surgical navigator used in a hospital environment. It addresses two major issues: the design of an accuracy phantom and the accuracy analysis of the surgical navigator in a hospital setting. The designed phantom was used to assess the accuracy of the optical tracking modality of the surgical navigator used at Oulu University Hospital, Oulu, Finland. The phantom functioned according to the design criteria, it was easy to use and it had enough calibration points that were localized by the navigator according to the accuracy assessment protocol to assess the accuracy error. The distances measured from a fixed origin with the surgical navigator were compared to the known phantom calibration point coordinates. The mean error was within the manufacturer specifications of 1.00 mm. The analysis done using the designed phantom and accuracy assessment protocol showed that the error increased with the distance from the center of the phantom. The accuracy assessment protocol using the present phantom proved to be a suitable method for accuracy analysis of a surgical navigator in a hospital setting.

Bayesian motion recovery framework for myocardial phase-contrast velocity MRI

Detailed assessment of myocardial motion provides a key indicator of ventricular function, enabling the early detection and assessment of a range of cardiac abnormalities. Existing techniques for myocardial contractility analysis are complicated by a combination of factors including resolution, acquisition time, and consistency of quantification results. Phase-contrast velocity MRI is a technique that provides instantaneous, in vivo measurement of tissue velocity on a per-voxel basis. It allows for the direct derivation of contractile indices with minimal post-processing. For this method to be clinically useful, SNR and image artifacts need to be addressed. The purpose of this paper is to present a Maximum a posteriori (MAP) restoration technique for high quality myocardial motion recovery. It employs an accurate noise modeling scheme and a generalized Gaussian Markov random field prior tailored for the myocardial morphology. The quality of the proposed method is evaluated with both simulated myocardial velocity data with known ground truth and in vivo phase-contrast MR velocity acquisitions from a group of normal subjects.

Spline-based cardiac motion tracking using velocity-encoded magnetic resonance imaging

This paper deals with the problem of tracking cardiac motion and deformation using velocity-encoded magnetic resonance imaging. We expand upon an earlier described method and fit a spatiotemporal motion model to measured velocity data. We investigate several different spatial elements both qualitatively and quantitatively using phantom measurements and data from human subjects. In addition, we also use optical flow estimation by the Horn-Schunk method as complementary data in regions where the velocity measurements are noisy. Our results show that it is possible to obtain good motion tracking accuracy in phantoms with relatively few spatial elements, if the type of element is properly chosen. The use of optical flow can correct some measurement artifacts but may give an underestimation of the magnitude of the deformation. In human subjects the different spatial elements perform quantitatively in a similar way but qualitative differences exists, as shown by a semiquantitative visual scoring of the different methods.

Predictive K-PLSR myocardial contractility modeling with phase contrast MR velocity mapping

With the increasing versatility of CMR, further understanding of intrinsic contractility of the myocardium can be achieved by performing subject-specific modeling by integrating structural and functional information available. The recent introduction of the virtual tagging framework allows for visualization of the localized deformation of the myocardium based on phase contrast myocardial velocity mapping. The purpose of this study is to examine the use of a non-linear, Kernel-Partial Least Squares Regression (K-PLSR) predictive motion modeling scheme for the virtual tagging framework. The method allows for the derivation of a compact non-linear deformation model such that the entire deformation field can be predicted by a limited number of control points. When applied to virtual tagging, the technique can be used to predictively guide the mesh refinement based on the motion of the coarse grid, thus greatly reducing the search space and increasing the convergence speed of the algorithm. The effectiveness and numerical accuracy of the proposed technique are assessed with both numerically simulated data sets and in vivo phase contrast CMR velocity mapping from a group of 7 subjects. The technique presented has a distinct advantage over the conventional mesh refinement scheme and brings CMR myocardial contractility analysis closer to routine clinical practice.

Contractile analysis with kriging based on MR myocardial velocity imaging

Diagnosis and treatment of coronary artery disease requires a full understanding of the intrinsic contractile mechanics of the heart. MR myocardial velocity imaging is a promising technique for revealing intramural cardiac motion but its ability to depict 3D strain tensor distribution is constrained by anisotropic voxel coverage of velocity imaging due to limited imaging slices and the achievable SNR in patient studies. This paper introduces a novel Kriging estimator for simultaneously improving the tracking and dense inter-slice estimation of the myocardial velocity data. A harmonic embedding technique is employed to determine point correspondence between left ventricle models between subjects, allowing for a statistical shape model to be reconstructed. The use of different semivariograms is investigated for optimal deformation reconstruction. Results from in vivo data demonstrate a marked improvement in tracking myocardial deformation, thus enhancing the potential clinical value of MR myocardial velocity imaging.

A fast and highly automated approach to myocardial motion analysis using phase contrast magnetic resonance imaging

PURPOSE

To develop a fast and highly automated method for calculating two-dimensional myocardial motion and deformation using velocity encoded magnetic resonance imaging.

MATERIALS AND METHODS

Two-dimensional phase contrast magnetic resonance imaging was used to acquire time resolved velocity maps of the myocardium. Cardiac motion was calculated by an iterative integration-regularization scheme of low computational cost. Image segmentation was performed using active appearance models.

RESULTS

Validation of motion tracking was performed in N = 47 subjects using saturation grid-tagging and closely followed "tag-lines." Image segmentation was validated vs. manual delineation.

CONCLUSION

The speed and limited user interaction gives the method good potential for use in clinical practice.

Applications of phase-contrast flow and velocity imaging in cardiovascular MRI

A review of cardiovascular clinical and research applications of MRI phase-contrast velocity imaging, also known as velocity mapping or flow imaging. Phase-contrast basic principles, advantages, limitations, common pitfalls and artefacts are described. It can measure many different aspects of the complicated blood flow in the heart and vessels: volume flow (cardiac output, shunt, valve regurgitation), peak blood velocity (for stenosis), patterns and timings of velocity waveforms and flow distributions within heart chambers (abnormal ventricular function) and vessels (pulse-wave velocity, vessel wall disease). The review includes phase-contrast applications in cardiac function, heart valves, congenital heart diseases, major blood vessels, coronary arteries and myocardial wall velocity.