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Sanguineti F, Duhamel S, Garot P, Garot J. [The role of Cardiovascular Magnetic Resonance in Interventional Cardiology]. Ann Cardiol Angeiol (Paris) 2022; 71:362-367. [PMID: 36229237 DOI: 10.1016/j.ancard.2022.09.013] [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] [Indexed: 06/16/2023]
Abstract
Cardiovascular magnetic resonance has emerged as a very helpful tool for the interventional cardiologists not only in the assessment and treatment of coronary artery disease, but also in the evaluation of various structural cardiac diseases. The main pulse sequences are standardised, acquired during short breath-holds, and include steady-state free precession cines, dynamic myocardial first-pass perfusion imaging during contrast injection, and late enhancement imaging for the identification of myocardial substrates. Less than 30-minute CMR studies are now available for the most common clinical indications. More recently, T1 and T2 parametric myocardial maps are promising for detailed myocardial tissue characterisation (edema, replacement fibrosis, diffuse interstitial fibrosis). Technical aspects will not be addressed with particular emphasis on clinical applications.
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Affiliation(s)
- Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, IRM Cardiovasculaire, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France; Institut Cardiovasculaire Paris Sud, Cardiologie Interventionnelle, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300, Massy, France
| | - Suzanne Duhamel
- Institut Cardiovasculaire Paris Sud, IRM Cardiovasculaire, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, IRM Cardiovasculaire, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France; Institut Cardiovasculaire Paris Sud, Cardiologie Interventionnelle, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300, Massy, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, IRM Cardiovasculaire, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France.
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Blanken CPS, Schrauben EM, Peper ES, Gottwald LM, Coolen BF, van Wijk DF, Piek JJ, Strijkers GJ, Planken RN, van Ooij P, Nederveen AJ. Coronary Flow Assessment Using Accelerated 4D Flow MRI With Respiratory Motion Correction. Front Bioeng Biotechnol 2021; 9:725833. [PMID: 34869250 PMCID: PMC8634777 DOI: 10.3389/fbioe.2021.725833] [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] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022] Open
Abstract
Magnetic resonance imaging (MRI) can potentially be used for non-invasive screening of patients with stable angina pectoris to identify probable obstructive coronary artery disease. MRI-based coronary blood flow quantification has to date only been performed in a 2D fashion, limiting its clinical applicability. In this study, we propose a framework for coronary blood flow quantification using accelerated 4D flow MRI with respiratory motion correction and compressed sensing image reconstruction. We investigate its feasibility and repeatability in healthy subjects at rest. Fourteen healthy subjects received 8 times-accelerated 4D flow MRI covering the left coronary artery (LCA) with an isotropic spatial resolution of 1.0 mm3. Respiratory motion correction was performed based on 1) lung-liver navigator signal, 2) real-time monitoring of foot-head motion of the liver and LCA by a separate acquisition, and 3) rigid image registration to correct for anterior-posterior motion. Time-averaged diastolic LCA flow was determined, as well as time-averaged diastolic maximal velocity (VMAX) and diastolic peak velocity (VPEAK). 2D flow MRI scans of the LCA were acquired for reference. Scan-rescan repeatability and agreement between 4D flow MRI and 2D flow MRI were assessed in terms of concordance correlation coefficient (CCC) and coefficient of variation (CV). The protocol resulted in good visibility of the LCA in 11 out of 14 subjects (six female, five male, aged 28 ± 4 years). The other 3 subjects were excluded from analysis. Time-averaged diastolic LCA flow measured by 4D flow MRI was 1.30 ± 0.39 ml/s and demonstrated good scan-rescan repeatability (CCC/CV = 0.79/20.4%). Time-averaged diastolic VMAX (17.2 ± 3.0 cm/s) and diastolic VPEAK (24.4 ± 6.5 cm/s) demonstrated moderate repeatability (CCC/CV = 0.52/19.0% and 0.68/23.0%, respectively). 4D flow- and 2D flow-based diastolic LCA flow agreed well (CCC/CV = 0.75/20.1%). Agreement between 4D flow MRI and 2D flow MRI was moderate for both diastolic VMAX and VPEAK (CCC/CV = 0.68/20.3% and 0.53/27.0%, respectively). In conclusion, the proposed framework of accelerated 4D flow MRI equipped with respiratory motion correction and compressed sensing image reconstruction enables repeatable diastolic LCA flow quantification that agrees well with 2D flow MRI.
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Affiliation(s)
- Carmen P S Blanken
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Eric M Schrauben
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Eva S Peper
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Lukas M Gottwald
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Bram F Coolen
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | - Jan J Piek
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - R Nils Planken
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
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The impact of helical flow on coronary atherosclerotic plaque development. Atherosclerosis 2020; 300:39-46. [PMID: 32085872 DOI: 10.1016/j.atherosclerosis.2020.01.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/18/2019] [Accepted: 01/29/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Atherosclerosis has been associated with near-wall hemodynamics and wall shear stress (WSS). However, the role of coronary intravascular hemodynamics, in particular of the helical flow (HF) patterns that physiologically develop in those arteries, is rarely considered. The purpose of this study was to assess how HF affects coronary plaque initiation and progression, definitively demonstrating its atheroprotective nature. METHODS The three main coronary arteries of five adult hypercholesterolemic mini-pigs on a high fat diet were imaged by computed coronary tomography angiography (CCTA) and intravascular ultrasound (IVUS) at 3 (T1, baseline) and 9.4 ± 1.9 (T2) months follow-up. The baseline geometries of imaged coronary arteries (n = 15) were reconstructed, and combined with pig-specific boundary conditions (based on in vivo Doppler blood flow measurements) to perform computational fluid dynamic simulations. Local wall thickness (WT) was measured on IVUS images at T1 and T2, and its temporal changes were assessed. Descriptors of HF and WSS nature were computed for each model, and statistically compared to WT data. RESULTS HF intensity was strongly positively associated with WSS magnitude (p < 0.001). Overall, coronary segments exposed to high baseline levels of HF intensity exhibited a significantly lower WT growth (p < 0.05), compared to regions with either mid or low HF intensity. CONCLUSIONS This study confirms the physiological significance of HF in coronary arteries, revealing its protective role against atherosclerotic WT growth and its potential in predicting regions undergoing WT development. These findings support future in vivo measurement of coronary HF as atherosclerotic risk marker, overcoming current limitations of in vivo WSS assessment.
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Masoud-Ansari S, Ormiston J, Webster M, Pontre B, Cowan B, Beier S. Towards validating stent induced micro flow patterns in left main coronary artery bifurcations. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:5749-5752. [PMID: 31947158 DOI: 10.1109/embc.2019.8856419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We investigated if blood flow changes induced through the presence of a stent could be detected using in vitro dynamically scaled 4D Phase-Contrast Magnetic Resonance Imaging (PC-MRI). Using idealized and patient-specific left main coronary artery bifurcations, we 3D-printed the dynamically large scaled geometries and incorporated them into a flow circuit for non-invasive acquisition with a higher effective spatial resolution. We tested the effects of using non-Newtonian and Newtonian fluids for the experiment. We also numerically simulated the same geometries in true scale for comparison using computational fluid dynamics (CFD). We found that the experimental setup increased the effective spatial resolution enough to reveal stent induced blood flow changes close to the vessel wall. Non-Newtonian fluid replicated all of the flow field well with a strong agreement with the computed flow field (R2 > 0.9). Fine flow structures were not as prominent for the Newtonian compared to non-Newtonian fluid consideration. In the patient-specific geometry, arterial non-planarity increased the difficulty to capture the near wall slow velocity changes. Findings demonstrate the potential to dynamically scale in vitro 4D MRI flow acquisition for micro blood flow considerations.
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Higashikawa T, Ichikawa Y, Ishida M, Kitagawa K, Hirano T, Sakuma H. Assessment of coronary flow velocity reserve with phase-contrast cine magnetic resonance imaging in patients with heavy coronary calcification. Int J Cardiovasc Imaging 2019; 35:897-905. [PMID: 30805755 DOI: 10.1007/s10554-019-01531-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
Coronary flow velocity reserve (CFVR) can be noninvasively measured by phase-contrast cine magnetic resonance imaging (PC-MRI). Heavy coronary calcification degrades the diagnostic accuracy for the detection of coronary arterial stenosis on computed tomography (CT). The aim of this study was to evaluate the value of CFVR measurement with PC-MRI for detecting significant coronary stenoses in patients with heavy coronary calcification. Sixteen patients (71 ± 8 years) with coronary calcium score above 400 who had suspected moderate coronary stenosis (50-69% diameter stenosis) on CT angiography were prospectively studied. The CFVR values, calculated as the ratio of peak flow velocity during hyperemia to the peak flow velocity at rest, were measured using breath-hold PC-MRI with 3 T system, and were compared with the results of quantitative coronary angiography (QCA). The mean coronary calcium score was 985 ± 378. CFVR was successfully determined with PC-MRI in 17/18 (94%) vessels. Using a threshold of 1.4 for CFVR, the sensitivity, specificity, and positive and negative predictive value for detecting ≥ 50% stenosis on QCA was 88% (7/8), 89% (8/9), 88% (7/8), 89% (8/9), respectively. When MRI CFVR measurements was added to CT angiography for the evaluation of coronary stenosis, the positive predictive value was 88% (7/8), while the positive predictive value of CT angiography alone was 44% (8/18). PC-MRI can provide noninvasive detection of altered CFVR caused by significant stenosis in patient. CFVR measurement by PC-MRI is useful for diagnosing physiologically significant coronary stenosis in patients with high calcium score on CT.
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Affiliation(s)
- Takatoshi Higashikawa
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Yasutaka Ichikawa
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Tadanori Hirano
- Department of Radiology, Matsusaka Central Hospital, 102 Kobou, Kawai, Matsusaka, Mie, 515-8566, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Agujetas R, González-Fernández MR, Nogales-Asensio JM, Montanero JM. Numerical analysis of the pressure drop across highly-eccentric coronary stenoses: application to the calculation of the fractional flow reserve. Biomed Eng Online 2018; 17:67. [PMID: 29848333 PMCID: PMC5977766 DOI: 10.1186/s12938-018-0503-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/23/2018] [Indexed: 11/29/2022] Open
Abstract
Background Fractional flow reverse (FFR) is the gold standard assessment of the hemodynamic significance of coronary stenoses. However, it requires the catheterization of the coronary artery to determine the pressure waveforms proximal and distal to the stenosis. On the contrary, computational fluid dynamics enables the calculation of the FFR value from relatively non-invasive computed tomography angiography (CTA). Methods We analyze the flow across idealized highly-eccentric coronary stenoses by solving the Navier–Stokes equations. We examine the influence of several aspects (approximations) of the simulation method on the calculation of the FFR value. We study the effects on the FFR value of errors made in the segmentation of clinical images. For this purpose, we compare the FFR value for the nominal geometry with that calculated for other shapes that slightly deviate from that geometry. This analysis is conducted for a range of stenosis severities and different inlet velocity and pressure waveforms. Results and conclusions The errors made in assuming a uniform velocity profile in front of the stenosis, as well as those due to the Newtonian and laminar approximations, are negligible for stenosis severities leading to FFR values around the threshold 0.8. The limited resolution of the stenosis geometry reconstruction is the major source of error when predicting the FFR value. Both systematic errors in the contour detection of just 1-pixel size in the CTA images and a low-quality representation of the stenosis surface (coarse faceted geometry) may yield wrong outcomes of the FFR assessment for an important set of eccentric stenoses. On the contrary, the spatial resolution of images acquired with optical coherence tomography may be sufficient to ensure accurate predictions for the FFR value.
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Affiliation(s)
- R Agujetas
- Depto. de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, Avda. de Elvas s/n, 06006, Badajoz, Spain
| | - M R González-Fernández
- Servicio de Cardiología, Hospital Infanta Cristina, Avda. de Elvas s/n, 06006, Badajoz, Spain
| | - J M Nogales-Asensio
- Servicio de Cardiología, Hospital Infanta Cristina, Avda. de Elvas s/n, 06006, Badajoz, Spain
| | - J M Montanero
- Depto. de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, Avda. de Elvas s/n, 06006, Badajoz, Spain.
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7
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Advanced flow MRI: emerging techniques and applications. Clin Radiol 2016; 71:779-95. [PMID: 26944696 DOI: 10.1016/j.crad.2016.01.011] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/10/2015] [Accepted: 01/10/2016] [Indexed: 12/12/2022]
Abstract
Magnetic resonance imaging (MRI) techniques provide non-invasive and non-ionising methods for the highly accurate anatomical depiction of the heart and vessels throughout the cardiac cycle. In addition, the intrinsic sensitivity of MRI to motion offers the unique ability to acquire spatially registered blood flow simultaneously with the morphological data, within a single measurement. In clinical routine, flow MRI is typically accomplished using methods that resolve two spatial dimensions in individual planes and encode the time-resolved velocity in one principal direction, typically oriented perpendicular to the two-dimensional (2D) section. This review describes recently developed advanced MRI flow techniques, which allow for more comprehensive evaluation of blood flow characteristics, such as real-time flow imaging, 2D multiple-venc phase contrast MRI, four-dimensional (4D) flow MRI, quantification of complex haemodynamic properties, and highly accelerated flow imaging. Emerging techniques and novel applications are explored. In addition, applications of these new techniques for the improved evaluation of cardiovascular (aorta, pulmonary arteries, congenital heart disease, atrial fibrillation, coronary arteries) as well as cerebrovascular disease (intra-cranial arteries and veins) are presented.
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Nayak KS, Nielsen JF, Bernstein MA, Markl M, D Gatehouse P, M Botnar R, Saloner D, Lorenz C, Wen H, S Hu B, Epstein FH, N Oshinski J, Raman SV. Cardiovascular magnetic resonance phase contrast imaging. J Cardiovasc Magn Reson 2015; 17:71. [PMID: 26254979 PMCID: PMC4529988 DOI: 10.1186/s12968-015-0172-7] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/16/2015] [Indexed: 11/10/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) phase contrast imaging has undergone a wide range of changes with the development and availability of improved calibration procedures, visualization tools, and analysis methods. This article provides a comprehensive review of the current state-of-the-art in CMR phase contrast imaging methodology, clinical applications including summaries of past clinical performance, and emerging research and clinical applications that utilize today's latest technology.
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Affiliation(s)
- Krishna S Nayak
- Ming Hsieh Department of Electrical Engineering, University of Southern California, 3740 McClintock Ave, EEB 406, Los Angeles, California, 90089-2564, USA.
| | - Jon-Fredrik Nielsen
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | | | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, IL, USA.
| | - Peter D Gatehouse
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Rene M Botnar
- Cardiovascular Imaging, Imaging Sciences Division, Kings's College London, London, UK.
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - Christine Lorenz
- Center for Applied Medical Imaging, Siemens Corporation, Baltimore, MD, USA.
| | - Han Wen
- Imaging Physics Laboratory, National Heart Lung and Blood Institute, Bethesda, MD, USA.
| | - Bob S Hu
- Palo Alto Medical Foundation, Palo Alto, CA, USA.
| | - Frederick H Epstein
- Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
| | - John N Oshinski
- Departments of Radiology and Biomedical Engineering, Emory University School of Medicine, Atlanta, GA, USA.
| | - Subha V Raman
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
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Jahnke C, Manka R, Kozerke S, Schnackenburg B, Gebker R, Marx N, Paetsch I. Cardiovascular magnetic resonance profiling of coronary atherosclerosis: vessel wall remodelling and related myocardial blood flow alterations. Eur Heart J Cardiovasc Imaging 2014; 15:1400-10. [PMID: 25104810 DOI: 10.1093/ehjci/jeu148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To determine the association between coronary vessel wall morphology and haemodynamic consequences to the myocardium using a combined cardiovascular magnetic resonance (CMR) imaging protocol. Non-invasive CMR profiling of coronary atherosclerotic wall changes and related myocardial blood flow impairment has not been established yet. METHODS AND RESULTS Sixty-three patients (45 men, 61.5 ± 10.7 years) with suspected or known coronary artery disease underwent 3.0 Tesla CMR imaging. The combined CMR protocol consisted of the following imaging modules at rest: 3D vessel wall imaging and flow measurement of the proximal right coronary artery (RCA), myocardial T2*, and first-pass perfusion imaging. During adenosine stress coronary flow, T2* and first-pass perfusion imaging were repeated. Coronary X-ray angiography classified patient groups: (i) all-smooth (n = 19); (ii) luminal irregular (diameter reduction < 30%; n = 35); and (iii) stenosed RCA (diameter reduction ≥ 50%; n = 9). The ratio of CMR-derived vessel wall area-to-lumen area significantly increased stepwise for the comparison of all-smooth vs. luminal irregular vs. stenosed RCA (1.9 ± 0.6 vs. 2.6 ± 0.6 vs. 3.6 ± 0.9, P < 0.01). Epicardial coronary flow reserve exhibited a stepwise significant decrease (3.4 ± 0.5 vs. 2.9 ± 0.7 vs. 1.7 ± 0.3, P < 0.01). On the myocardial level, stress-induced percentage gain of T2* values (ΔT2*) was significantly decreased between groups (29.2 ± 10.6 vs. 9.0 ± 9.8 vs. 2.2 ± 11.8%, P < 0.01) while perfusion reserve index decreased in the presence of stenosed RCA only (2.2 ± 0.6 vs. 2.0 ± 0.4 vs. 1.3 ± 0.3, P = ns and P < 0.01, respectively). CONCLUSION The proposed comprehensive CMR imaging protocol provided a non-invasive approach for direct assessment of coronary vessel wall remodelling and resultant pathophysiological consequences on the level of epicardial coronary and myocardial blood flow in patients.
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Affiliation(s)
- Cosima Jahnke
- Department of Cardiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Robert Manka
- Department of Cardiology, German Heart Institute Berlin, Berlin, Germany Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | | | - Rolf Gebker
- Department of Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Nikolaus Marx
- Department of Cardiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Ingo Paetsch
- Department of Cardiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
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Poon EKW, Barlis P, Moore S, Pan WH, Liu Y, Ye Y, Xue Y, Zhu SJ, Ooi ASH. Numerical investigations of the haemodynamic changes associated with stent malapposition in an idealised coronary artery. J Biomech 2014; 47:2843-51. [PMID: 25132633 DOI: 10.1016/j.jbiomech.2014.07.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/10/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
The deployment of a coronary stent near complex lesions can sometimes lead to incomplete stent apposition (ISA), an undesirable side effect of coronary stent implantation. Three-dimensional computational fluid dynamics (CFD) calculations are performed on simplified stent models (with either square or circular cross-section struts) inside an idealised coronary artery to analyse the effect of different levels of ISA to the change in haemodynamics inside the artery. The clinical significance of ISA is reported using haemodynamic metrics like wall shear stress (WSS) and wall shear stress gradient (WSSG). A coronary stent with square cross-sectional strut shows different levels of reverse flow for malapposition distance (MD) between 0mm and 0.12 mm. Chaotic blood flow is usually observed at late diastole and early systole for MD=0mm and 0.12 mm but are suppressed for MD=0.06 mm. The struts with circular cross section delay the flow chaotic process as compared to square cross-sectional struts at the same MD and also reduce the level of fluctuations found in the flow field. However, further increase in MD can lead to chaotic flow not only at late diastole and early systole, but it also leads to chaotic flow at the end of systole. In all cases, WSS increases above the threshold value (0.5 Pa) as MD increases due to the diminishing reverse flow near the artery wall. Increasing MD also results in an elevated WSSG as flow becomes more chaotic, except for square struts at MD=0.06 mm.
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Affiliation(s)
- Eric K W Poon
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia.
| | - Peter Barlis
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia; North West Academic Centre, Melbourne Medical School, The University of Melbourne, Victoria 3010, Australia
| | - Stephen Moore
- IBM Research Collaboratory for Life Sciences-Melbourne, Victoria Life Sciences Computation Initiative, The University of Melbourne, Victoria 3010, Australia
| | - Wei-Han Pan
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Yun Liu
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Yufei Ye
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Yuan Xue
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Shuang J Zhu
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Andrew S H Ooi
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
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Coelho-Filho OR, Rickers C, Kwong RY, Jerosch-Herold M. MR myocardial perfusion imaging. Radiology 2013; 266:701-15. [PMID: 23431226 DOI: 10.1148/radiol.12110918] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Contrast material-enhanced myocardial perfusion imaging by using cardiac magnetic resonance (MR) imaging has, during the past decade, evolved into an accurate technique for diagnosing coronary artery disease, with excellent prognostic value. Advantages such as high spatial resolution; absence of ionizing radiation; and the ease of routine integration with an assessment of viability, wall motion, and cardiac anatomy are readily recognized. The need for training and technical expertise and the regulatory hurdles, which might prevent vendors from marketing cardiac MR perfusion imaging, may have hampered its progress. The current review considers both the technical developments and the clinical experience with cardiac MR perfusion imaging, which hopefully demonstrates that it has long passed the stage of a research technique. In fact, cardiac MR perfusion imaging is moving beyond traditional indications such as diagnosis of coronary disease to novel applications such as in congenital heart disease, where the imperatives of avoidance of ionizing radiation and achievement of high spatial resolution are of high priority. More wide use of cardiac MR perfusion imaging, and novel applications thereof, are aided by the progress in parallel imaging, high-field-strength cardiac MR imaging, and other technical advances discussed in this review.
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Affiliation(s)
- Otavio R Coelho-Filho
- Division of Cardiology and Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
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12
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Ehara S, Nakamura Y, Matsumoto K, Hasegawa T, Shimada K, Takagi M, Hanatani A, Izumi Y, Terashima M, Yoshiyama M. Effects of intravenous atrial natriuretic peptide and nitroglycerin on coronary vasodilation and flow velocity determined using 3 T magnetic resonance imaging in patients with nonischemic heart failure. Heart Vessels 2012; 28:596-605. [PMID: 23014927 DOI: 10.1007/s00380-012-0292-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 09/07/2012] [Indexed: 01/06/2023]
Abstract
Although atrial natriuretic peptide (ANP) is widely used in patients with congestive heart failure (CHF), little is known about its effect on epicardial coronary arteries. Magnetic resonance imaging (MRI) enables precise measurement of coronary vasodilation and flow velocity. In this study, we examined the changes in epicardial coronary artery size and flow velocity in response to intravenous infusion of ANP or nitroglycerin (NTG) by using 3 T MRI in patients with CHF. The study cohort contained a total of 14 subjects: 8 patients with CHF and 6 healthy volunteers as controls, randomly divided into two groups: the ANP group (0.03 μg/kg/min) and the NTG group (0.3 μg/kg/min). Cross-sectional MR angiography and phase-contrast flow velocity of the right coronary artery in the same in-plane slice were obtained at the baseline, during drug infusion, and at two subsequent time points after stopping drug infusion. A significant increase was observed in the coronary cross-sectional area at 15 min after drug infusion in both groups compared with that at baseline; however, a late peak was observed at 15 min after stopping infusion in the ANP group. No significant differences were detected in the flow velocity in both groups. Furthermore, although NTG increased the heart rate, this change was not found in the ANP group. Coronary vasodilation and flow velocity can be measured simultaneously using 3 T MRI. Using this method, we showed that the effects of ANP on the coronary artery vasodilation and flow velocity were not inferior to those of NTG, with no significant alteration in heart rate.
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Affiliation(s)
- Shoichi Ehara
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan,
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BIERBACH BENJAMIN, SCHEEWE JENS, DERFUSS THOMAS, KRUG ALFONS, SCHRAMM RENÉ, DAHM MANFRED, KUROCZYNSKI WLODZIMIERZ, KEMPSKI OLIVER, HORSTICK GEORG. Continuous Regional Myocardial Blood Flow Measurement: Validation of a Near-Infrared Laser Doppler Device in a Porcine Model. Microcirculation 2012; 19:485-93. [DOI: 10.1111/j.1549-8719.2012.00173.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Bunck AC, Jüttner A, Kröger JR, Burg MC, Kugel H, Niederstadt T, Tiemann K, Schnackenburg B, Crelier GR, Heindel W, Maintz D. 4D phase contrast flow imaging for in-stent flow visualization and assessment of stent patency in peripheral vascular stents--a phantom study. Eur J Radiol 2012; 81:e929-37. [PMID: 22770579 DOI: 10.1016/j.ejrad.2012.05.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 04/26/2012] [Accepted: 05/04/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE 4D phase contrast flow imaging is increasingly used to study the hemodynamics in various vascular territories and pathologies. The aim of this study was to assess the feasibility and validity of MRI based 4D phase contrast flow imaging for the evaluation of in-stent blood flow in 17 commonly used peripheral stents. MATERIALS AND METHODS 17 different peripheral stents were implanted into a MR compatible flow phantom. In-stent visibility, maximal velocity and flow visualization were assessed and estimates of in-stent patency obtained from 4D phase contrast flow data sets were compared to a conventional 3D contrast-enhanced magnetic resonance angiography (CE-MRA) as well as 2D PC flow measurements. RESULTS In all but 3 of the tested stents time-resolved 3D particle traces could be visualized inside the stent lumen. Quality of 4D flow visualization and CE-MRA images depended on stent type and stent orientation relative to the magnetic field. Compared to the visible lumen area determined by 3D CE-MRA, estimates of lumen patency derived from 4D flow measurements were significantly higher and less dependent on stent type. A higher number of stents could be assessed for in-stent patency by 4D phase contrast flow imaging (n=14) than by 2D phase contrast flow imaging (n=10). CONCLUSIONS 4D phase contrast flow imaging in peripheral vascular stents is feasible and appears advantageous over conventional 3D contrast-enhanced MR angiography and 2D phase contrast flow imaging. It allows for in-stent flow visualization and flow quantification with varying quality depending on stent type.
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Affiliation(s)
- Alexander C Bunck
- Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany.
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Golshani B, Lazzaro MA, Raslau F, Darkhabani Z, Baruah D, Eastwood D, Fitzsimmons BF, Zaidat OO. Surveillance imaging after intracranial stent implantation: non-invasive imaging compared with digital subtraction angiography. J Neurointerv Surg 2012; 5:361-5. [DOI: 10.1136/neurintsurg-2012-010341] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Achenbach S, Barkhausen J, Beer M, Beerbaum P, Dill T, Eichhorn J, Fratz S, Gutberlet M, Hoffmann M, Huber A, Hunold P, Klein C, Krombach G, Kreitner KF, Kühne T, Lotz J, Maintz D, Marholdt H, Merkle N, Messroghli D, Miller S, Paetsch I, Radke P, Steen H, Thiele H, Sarikouch S, Fischbach R. Konsensusempfehlungen der DRG/DGK/DGPK zum Einsatz der Herzbildgebung mit Computertomographie und Magnetresonanztomographie. KARDIOLOGE 2012. [DOI: 10.1007/s12181-012-0417-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Accurate measurement of pulsatile flow velocity in a small tube phantom: comparison of phase-contrast cine magnetic resonance imaging and intraluminal Doppler guidewire. Jpn J Radiol 2010; 28:571-7. [DOI: 10.1007/s11604-010-0472-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 06/01/2010] [Indexed: 10/18/2022]
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18
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Spatial factors for quantifying constant flow velocity in a small tube phantom: comparison of phase-contrast cine-magnetic resonance imaging and the intraluminal Doppler guidewire method. Jpn J Radiol 2009; 27:335-41. [DOI: 10.1007/s11604-009-0349-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Accepted: 07/06/2009] [Indexed: 10/19/2022]
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The gold standard for noninvasive imaging in coronary heart disease: magnetic resonance imaging. Curr Opin Cardiol 2009; 24:567-79. [DOI: 10.1097/hco.0b013e3283315553] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Coronary MR imaging is a promising noninvasive technique for the combined assessment of coronary artery anatomy and function. Anomalous coronary arteries and aneurysms can reliably be assessed in clinical practice using coronary MR imaging and the presence of significant left main or proximal multivessel coronary artery disease detected. Technical challenges that need to be addressed are further improvements in motion suppression and abbreviated scanning times aimed at improving spatial resolution and patient comfort. The development of new and specific contrast agents, high-field MR imaging with improved spatial resolution, and continued progress in MR imaging methods development will undoubtedly lead to further progress toward the noninvasive and comprehensive assessment of coronary atherosclerotic disease.
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Affiliation(s)
- Sebastian Kelle
- Division of Cardiology, Department of Medicine, German Heart Institute, Berlin, Germany; Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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Camici PG, Rimoldi OE. The Clinical Value of Myocardial Blood Flow Measurement. J Nucl Med 2009; 50:1076-87. [DOI: 10.2967/jnumed.108.054478] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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22
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Bloch KM, Carlsson M, Arheden H, Ståhlberg F. Quantifying coronary sinus flow and global LV perfusion at 3T. BMC Med Imaging 2009; 9:9. [PMID: 19519892 PMCID: PMC2702273 DOI: 10.1186/1471-2342-9-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 06/11/2009] [Indexed: 11/30/2022] Open
Abstract
Background Despite the large availability of 3T MR scanners and the potential of high field imaging, this technical platform has yet to prove its usefulness in the cardiac MR setting, where 1.5T remains the established standard. Global perfusion of the left ventricle, as well as the coronary flow reserve (CFR), can provide relevant diagnostic information, and MR measurements of these parameters may benefit from increased field strength. Quantitative flow measurements in the coronary sinus (CS) provide one method to investigate these parameters. However, the ability of newly developed faster MR sequences to measure coronary flow during a breath-hold at 3T has not been evaluated. Methods The aim of this work was to measure CS flow using segmented phase contrast MR (PC MR) on a clinical 3T MR scanner. Parallel imaging was employed to reduce the total acquisition time. Global LV perfusion was calculated by dividing CS flow with left ventricular (LV) mass. The repeatability of the method was investigated by measuring the flow three times in each of the twelve volunteers. Phantom experiments were performed to investigate potential error sources. Results The average CS flow was determined to 88 ± 33 ml/min and the deduced LV perfusion was 0.60 ± 0.22 ml/min·g, in agreement with published values. The repeatability (1-error) of the three repeated measurements in each subject was on average 84%. Conclusion This work demonstrates that the combination of high field strength (3T), parallel imaging and segmented gradient echo sequences allow for quantification of the CS flow and global perfusion within a breath-hold.
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Eichhorn JG, Long FR, Jourdan C, Heverhagen JT, Hill SL, Raman SV, Cheatham JP. Usefulness of multidetector CT imaging to assess vascular stents in children with congenital heart disease: An in vivo and in vitro study. Catheter Cardiovasc Interv 2008; 72:544-51. [DOI: 10.1002/ccd.21680] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bluemke DA, Achenbach S, Budoff M, Gerber TC, Gersh B, Hillis LD, Hundley WG, Manning WJ, Printz BF, Stuber M, Woodard PK. Noninvasive coronary artery imaging: magnetic resonance angiography and multidetector computed tomography angiography: a scientific statement from the american heart association committee on cardiovascular imaging and intervention of the council on cardiovascular radiology and intervention, and the councils on clinical cardiology and cardiovascular disease in the young. Circulation 2008; 118:586-606. [PMID: 18586979 DOI: 10.1161/circulationaha.108.189695] [Citation(s) in RCA: 351] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Park JK, Rhee TK, Cashen TA, Shin W, Resnick SA, Gehl JA, Schirf BE, Wang D, Larson AC, Carroll TJ, Omary RA. MR Imaging Assessment of Changes in Renal Function with Renal Artery Stent Placement in Swine. J Vasc Interv Radiol 2007; 18:1409-16. [DOI: 10.1016/j.jvir.2007.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abstract
Coronary magnetic resonance angiography (MRA) is a powerful noninvasive technique with high soft-tissue contrast for the visualization of the coronary anatomy without X-ray exposure. Due to the small dimensions and tortuous nature of the coronary arteries, a high spatial resolution and sufficient volumetric coverage have to be obtained. However, this necessitates scanning times that are typically much longer than one cardiac cycle. By collecting image data during multiple RR intervals, one can successfully acquire coronary MR angiograms. However, constant cardiac contraction and relaxation, as well as respiratory motion, adversely affect image quality. Therefore, sophisticated motion-compensation strategies are needed. Furthermore, a high contrast between the coronary arteries and the surrounding tissue is mandatory. In the present article, challenges and solutions of coronary imaging are discussed, and results obtained in both healthy and diseased states are reviewed. This includes preliminary data obtained with state-of-the-art techniques such as steady-state free precession (SSFP), whole-heart imaging, intravascular contrast agents, coronary vessel wall imaging, and high-field imaging. Simultaneously, the utility of electron beam computed tomography (EBCT) and multidetector computed tomography (MDCT) for the visualization of the coronary arteries is discussed.
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Affiliation(s)
- Matthias Stuber
- Department of Radiology, Division of Magnetic Resonance Research, Johns Hopkins University, Baltimore, Maryland, USA.
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Dall'Armellina E, Hamilton CA, Hundley WG. Assessment of blood flow and valvular heart disease using phase-contrast cardiovascular magnetic resonance. Echocardiography 2007; 24:207-16. [PMID: 17313556 DOI: 10.1111/j.1540-8175.2007.00377.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Measurement of blood flow is important for assessing the severity of disease processes involving the cardiovascular system. Phase-contrast cardiovascular magnetic resonance (PC-CMR) can be used to measure blood flow noninvasively without ionizing radiation or limitations imposed by body habitus. This review describes the performance of PC-CMR and its clinical utility in assessing patients with cardiovascular or valvular heart disease.
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Affiliation(s)
- Erica Dall'Armellina
- Cardiopulmonary Sciences Department, S. Maria della Misericordia Hospital, Udine, Italy
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Abstract
Cardiac MRI has long been recognized as an accurate and reliable means of evaluating cardiac anatomy and ventricular function. Considerable progress has been made in the field of cardiac MRI, and cardiac MRI can provide accurate evaluation of myocardial ischemia and infarction (MI). Late gadolinium (Gd)-enhanced MRI can clearly delineate subendocardial infarction, and the assessment of transmural extent of infarction on late enhanced MRI has been shown to be useful in predicting functional recovery of dysfunctional myocardium in patients after MI. Stress first-pass contrast-enhanced (CE) myocardial perfusion MRI can be used to detect subendocardial ischemia, and recent studies have demonstrated the high diagnostic accuracy of stress myocardial perfusion MRI for detecting significant coronary artery disease (CAD). Free-breathing, whole-heart coronary MR angiography (MRA) was recently introduced as a method that can provide visualization of all three major coronary arteries within a single three-dimensional (3D) acquisition. With further improvements in MRI techniques and the establishment of a standardized study protocol, cardiac MRI will play a pivotal role in managing patients with ischemic heart disease.
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Affiliation(s)
- Hajime Sakuma
- Department of Diagnostic Radiology, Mie University Hospital, Mie, Japan.
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Pan X, Yu H, Shi X, Korzh V, Wohland T. Characterization of flow direction in microchannels and zebrafish blood vessels by scanning fluorescence correlation spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2007; 12:014034. [PMID: 17343509 DOI: 10.1117/1.2435173] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The investigation of flow profiles in microstructures and tissues by fluorescence correlation spectroscopy (FCS) has been a challenging topic in the past decade. Due to its inherent optical configuration, a circular focused laser beam, FCS is unable to resolve microfluidic flow directions. Earlier schemes reported the use of two laser beams or the use of nonsymmetrical laser foci to break the symmetry of the measurement system. This, however, is difficult to combine with confocal systems since it would require modifications that interfere with the imaging capabilities. We propose a method called line-scan FCS to measure different flow angles in microchannels and tissues. This method is implemented on a combined laser scanning confocal microscopy (LSCM) and FCS system that enables uncompromised imaging and spectroscopy measurements. We demonstrate that by scanning the laser beam with a defined speed and direction we can measure flow direction with the current system at an optimal resolution of at least 3 microm. The combination system is assessed by measuring flow profiles in a microchannel with and without obstruction. To extend the technique to live tissue measurements we demonstrate that line-scan FCS can determine the flow direction in zebrafish small blood vessels in a label-free approach.
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Affiliation(s)
- Xiaotao Pan
- National University of Singapore, NUS Graduate Program in Bioengineering, 28 Medical Drive, Singapore 117456, Singapore
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30
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Magnetic Resonance Imaging of the Myocardium. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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31
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Schwizer W, Steingoetter A, Fox M. Magnetic resonance imaging for the assessment of gastrointestinal function. Scand J Gastroenterol 2006; 41:1245-60. [PMID: 17060117 DOI: 10.1080/00365520600827188] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Werner Schwizer
- Clinic of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland.
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32
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Dall'Armellina E, Baugh MB, Morgan TM, Hamilton CA, Tan P, Herrington DM, Link KM, Hundley WG. Cardiovascular Magnetic Resonance Measurement of Coronary Arterial Blood Flow at Rest and After Submaximal Exercise. J Comput Assist Tomogr 2006; 30:421-5. [PMID: 16778616 DOI: 10.1097/00004728-200605000-00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Because most daily activities are conducted at submaximal exercise level, treatments are implemented to improve submaximal coronary artery blood flow (CABF). We sought to validate the reproducibility of cardiovascular magnetic resonance imaging measurements of submaximal CABF. METHODS We measured CABF in the left anterior descending artery in 11 healthy postmenopausal women at rest and after submaximal bike exercise on 2 occasions 8 to 16 weeks apart. RESULTS After exercise, CABF increased by 42% and 47% on the first and second examination, respectively. These changes in CABF in the 2 examinations were highly correlated (r=0.86). CONCLUSIONS These data indicate that cardiovascular magnetic resonance assessments of CABF before and after submaximal exercise are feasible, reproducible, and consistent with those obtained invasively. In future studies, 24 patients would be needed per group to detect a 20% change of submaximal exercise blood flow at 80% power.
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Affiliation(s)
- Erica Dall'Armellina
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1045, USA
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Eichhorn JG, Long FR, Hill SL, O'Donovan J, Chisolm JL, Fernandez SA, Cheatham JP. Assessment of in-stent stenosis in small children with congenital heart disease using multi-detector computed tomography: A validation study. Catheter Cardiovasc Interv 2006; 68:11-20. [PMID: 16764005 DOI: 10.1002/ccd.20760] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Our purpose was to investigate the diagnostic reliability of multi-detector computed tomography (MDCT) in assessing in-stent stenosis compared to digital angiography (DA) in small children. BACKGROUND Little is known about the feasibility of using MDCT to assess stents placed to treat children with congenital heart disease (CHD). METHODS Twenty-two children (median age [range], 2(3/4) [(1/2) to 12] years) with 42 transcatheter placed stents (median diameter: 7.2 [3.4-16.3] mm) in the pulmonary arteries (n = 36), aorta (2), PDA (1), and SVC (3) underwent both MDCT and DA due to suspected hemodynamic problems. RESULTS Independent "blinded" observers were able to measure stent and minimal luminal diameters in 115 out of 124 (93%) stent segments on MDCT and DA. The interobserver variability was low (mean difference: 0.5, SD 0.8 mm) with high correlation (r = 0.97; P < .0001). The percent stenosis by MDCT correlated well with DA (r = 0.89, P < .0001; mean error 2.7, SD 10.4%). For all grades of stenosis, the sensitivity and specificity for MDCT were 58% and 97%, respectively. At a threshold of approximately > or =20% stenosis sensitivity became >98%. All stent associated complications [fracture (4), vascular narrowings (11)] were diagnosed by MDCT. As the stent diameter increased, there was significantly reduced variability between MDCT and DA for in-stent stenosis (P < .0001). CONCLUSION In small children, MDCT is a feasible and promising method for assessing stent associated complications in the treatment of CHD. Cardiac surgeons and interventional cardiologists might rely on this imaging modality to plan specific interventions more precisely and to assess the results upon follow up.
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Affiliation(s)
- Joachim G Eichhorn
- Department of Radiology, Ohio State University College of Medicine, Columbus, USA.
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Abstract
With cardiovascular magnetic resonance imaging (CMR), the necessity of invasive coronary angiography may be increasingly avoided. CMR provides information about the anatomy of the coronaries themselves (e.g. anomalies, aneurysm), functional information on myocardial blood flow (dobutamine-stress-MR, perfusion measurement) and detailed information on cell-mediated alterations (e.g. fibrosis, necrosis). However, visualization of distal coronary vessels and the small side branches is not yet adequate, so that complete replacement of invasive coronary angiography by CMR is not possible.
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Affiliation(s)
- S Kelle
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin
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Pujadas S, Reddy GP, Weber O, Tan C, Moore P, Higgins CB. Phase contrast MR imaging to measure changes in collateral blood flow after stenting of recurrent aortic coarctation: Initial experience. J Magn Reson Imaging 2006; 24:72-6. [PMID: 16755530 DOI: 10.1002/jmri.20613] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess the feasibility of using phase contrast magnetic resonance (PC-MR) imaging to measure the change in collateral blood flow early after stenting of aortic coarctation. MATERIALS AND METHODS A total of 10 consecutive patients with coarctation of the aorta underwent MR imaging, X-ray angiography, and stent placement. PC-MR at two sites in the descending aorta was performed before and early after stenting in order to estimate collateral inflow to the descending thoracic aorta. The collateral flow and collateral flow percentage before and after stent placement were compared. RESULTS Before stenting, the mean proximal aortic flow = 43.9 +/- 14.6 mL/second; mean distal flow = 54.2 +/- 10 mL/second; collateral flow = 10.2 +/- 6.8 mL/second; and collateral flow percentage = 30.1 +/- 27.9%. After stenting, the mean proximal aortic flow = 62.1 +/- 17.9 mL/second; mean distal flow = 60 +/- 19 mL/second; collateral flow = -1.9 +/- 3.7 mL/second; and collateral flow percentage = -3.3 +/- 6.8%. CONCLUSION PC-MR can be used to measure changes in collateral circulation after stent treatment of coarctation of the aorta.
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Affiliation(s)
- Sandra Pujadas
- Department of Radiology, University of California, San Francisco, San Francisco, California, USA.
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da Luz PL, Bertini PJ, Favarato D. Noninvasive detection of coronary artery disease -- challenges for prevention of disease and clinical events. Clinics (Sao Paulo) 2005; 60:415-28. [PMID: 16254679 DOI: 10.1590/s1807-59322005000500011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Atherosclerosis is a chronic inflammatory disease that affects essentially all arterial beds including the aorta, coronaries, carotids, and peripheral arteries. It is the main cause of death in the western hemisphere, due to cardiovascular syndromes such as myocardial infarction, heart failure, and cerebrovascular accidents. Very substantial economic and human resources have been used on treatments of its complications, including imaging studies, coronary bypass surgery, catheter interventions, pacemakers, and medical treatments. Treating complications, however, are remedial actions. A better alternative is to prevent the development of atherosclerosis, or at least to identify patients who are at risk of acute events and intervene before they occur. The aims of this review are to discuss the predictive value of traditional and emerging risk factors, as well as the role of noninvasive diagnostic methods for coronary atherosclerosis, including exercise stress test, echo stress test, duplex ultrasound, computed tomography, and magnetic resonance. A combination of serum biomarkers and noninvasive approaches is of practical utility for identifying early disease. It is to be expected that future developments will soon perfect our ability to identify the vulnerable patient and allow a more individualized approach.
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Affiliation(s)
- Protásio Lemos da Luz
- Heart Institute (INCOR), Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil.
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Spuentrup E, Ruebben A, Mahnken A, Stuber M, Kölker C, Nguyen TH, Günther RW, Buecker A. Artifact-free coronary magnetic resonance angiography and coronary vessel wall imaging in the presence of a new, metallic, coronary magnetic resonance imaging stent. Circulation 2005; 111:1019-26. [PMID: 15723984 DOI: 10.1161/01.cir.0000156462.97532.8f] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary in-stent restenosis cannot be directly assessed by magnetic resonance angiography (MRA) because of the local signal void of currently used stainless steel stents. The aim of this study was to investigate the potential of a new, dedicated, coronary MR imaging (MRI) stent for artifact-free, coronary MRA and in-stent lumen and vessel wall visualization. METHODS AND RESULTS Fifteen prototype stents were deployed in coronary arteries of 15 healthy swine and investigated with a double-oblique, navigator-gated, free-breathing, T2-prepared, 3D cartesian gradient-echo sequence; a T2-prepared, 3D spiral gradient-echo sequence; and a T2-prepared, 3D steady-state, free-precession coronary MRA sequence. Furthermore, black-blood vessel wall imaging by a dual-inversion-recovery, turbo spin-echo sequence was performed. Artifacts of the stented vessel segment and signal intensities of the coronary vessel lumen inside and outside the stent were assessed. With all investigated sequences, the vessel lumen and wall could be visualized without artifacts, including the stented vessel segment. No signal intensity alterations inside the stent when compared with the vessel lumen outside the stent were found. CONCLUSIONS The new, coronary MRI stent allows for completely artifact-free coronary MRA and vessel wall imaging.
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Affiliation(s)
- Elmar Spuentrup
- Department of Diagnostic Radiology, Technical University of Aachen, Aachen, Germany
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Terashima M, Meyer CH, Keeffe BG, Putz EJ, de la Pena-Almaguer E, Yang PC, Hu BS, Nishimura DG, McConnell MV. Noninvasive assessment of coronary vasodilation using magnetic resonance angiography. J Am Coll Cardiol 2005; 45:104-10. [PMID: 15629383 DOI: 10.1016/j.jacc.2004.09.057] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Revised: 09/16/2004] [Accepted: 09/21/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the use of coronary magnetic resonance angiography (MRA) for assessing human epicardial coronary artery vasodilation. BACKGROUND Coronary vasodilation plays a vital role in the human coronary circulation. Previous studies of epicardial coronary vasodilation have used invasive coronary angiography. Coronary MRA may provide an alternative noninvasive method to directly assess changes in coronary size. METHODS Thirty-two subjects were studied: 12 patients (age 55 +/- 18 years) and 20 healthy subjects (age 34 +/- 4 years). High-resolution multi-slice spiral coronary MRA (in-plane resolution of 0.52 to 0.75 mm) was performed before and after sublingual nitroglycerin (NTG). Quantitative analysis of coronary vasodilation was performed on cross-sectional images of the right coronary artery (RCA). A time-course analysis of coronary vasodilation was performed in a subset of eight subjects for 30 min after NTG. Signal-to-noise ratio was also measured on the in-plane RCA images. RESULTS Coronary MRA demonstrated a 23% increase in cross-sectional area after NTG (16.9 +/- 7.8 mm2 to 20.8 +/- 8.9 mm2, p <0.0001), with significant vasodilation between 3 and 15 min after NTG on time-course analysis. The MRA measurements had low interobserver variability (< or =5%) and good correlation with X-ray angiography (r=0.98). The magnitude of vasodilation correlated with baseline cross-sectional area (r=0.52, p=0.03) and age (r=0.40, p=0.019). Post-NTG images also demonstrated a 31% improvement in coronary signal-to-noise ratio (p = 0.002). CONCLUSIONS Nitroglycerin-enhanced coronary MRA can noninvasively measure coronary artery vasodilation and is a promising noninvasive technique to study coronary vasomotor function.
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Affiliation(s)
- Masahiro Terashima
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA 94305, USA
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Salm LP, Bax JJ, Vliegen HW, Langerak SE, Dibbets P, Jukema JW, Lamb HJ, Pauwels EKJ, de Roos A, van der Wall EE. Functional significance of stenoses in coronary artery bypass grafts. Evaluation by single-photon emission computed tomography perfusion imaging, cardiovascular magnetic resonance, and angiography. J Am Coll Cardiol 2005; 44:1877-82. [PMID: 15519022 DOI: 10.1016/j.jacc.2004.07.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Revised: 07/16/2004] [Accepted: 07/29/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study was designed to perform a head-to-head comparison between single-photon emission computed tomography (SPECT) and cardiovascular magnetic resonance (CMR) to evaluate hemodynamic significance of angiographic findings in bypass grafts. BACKGROUND The hemodynamic significance of a bypass graft stenosis may not always accurately be determined from the coronary angiogram. A variety of diagnostic tests (invasive or noninvasive) can further characterize the hemodynamic consequence of a lesion. METHODS Fifty-seven arterial and vein grafts in 25 patients were evaluated by angiography, SPECT perfusion imaging, and coronary flow velocity reserve determination by CMR. Based on angiography and SPECT, four different groups could be identified: 1) no significant stenosis (<50%), normal perfusion; 2) significant stenosis (>/=50%), abnormal perfusion; 3) significant stenosis, normal perfusion (no hemodynamic significance); and 4) no significant stenosis, abnormal perfusion (suggesting microvascular disease). RESULTS A complete evaluation was obtained in 46 grafts. Single-photon emission computed tomography and CMR provided similar information in 37 of 46 grafts (80%), illustrating good agreement (kappa = 0.61, p < 0.001). Eight grafts perfused a territory with scar tissue. When agreement between SPECT and CMR was restricted to grafts without scar tissue, it improved to 84% (kappa = 0.68). Integration of angiography with SPECT categorized 14 lesions in group 1, 23 in group 2, 6 in group 3, and 3 in group 4. Single-photon emission computed tomography and CMR agreement per group was 86%, 78%, 100%, and 33%, respectively. CONCLUSIONS Head-to-head comparison showed good agreement between SPECT and CMR for functional evaluation of bypass grafts. Cardiovascular magnetic resonance may offer an alternative method to SPECT for functional characterization of angiographic lesions.
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Affiliation(s)
- Liesbeth P Salm
- Department of Cardiology, Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
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Ischemic Heart Disease. Hypertension 2005. [DOI: 10.1016/b978-0-7216-0258-5.50144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Holton AD, Walsh EG, Brott BC, Venugopalan R, Hershey B, Ito Y, Shih A, Koomullil R, Anayiotos AS. Evaluation of in-stent stenosis by magnetic resonance phase-velocity mapping in nickel-titanium stents. J Magn Reson Imaging 2005; 22:248-57. [PMID: 16028256 DOI: 10.1002/jmri.20380] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate different grades of in-stent stenosis in a nickel-titanium stent with MRI. MATERIALS AND METHODS Magnetic resonance phase velocity mapping (MR-PVM) was used to measure flow velocity through a 9-mm NiTi stent with three different degrees of stenosis in a phantom study. The tested stenotic geometries were 1) axisymmetric 75%, 2) axisymmetric 90%, and 3) asymmetric 50%. The MR-PVM data were subsequently compared with the velocities from computational fluid dynamic (CFD) simulations of identical conditions. RESULTS Good quantitative agreement in velocity distribution for the 50% and 75% stenoses was observed. The agreement was poor for the 90% stenosis, most likely due to turbulence and the high-velocity gradients found in the small luminal area relative to the pixel resolution in our imaging settings. CONCLUSION The accuracy of the MRI velocities inside the stented area renders MRI a modality that may be used to assess moderate to severe in-stent restenosis (ISR) in medium-sized vascular stents in peripheral vessels, such as the iliac, carotid, and femoral arteries. Advances in MR instrumentation may provide sufficient resolution to obtain adequate velocity information from smaller vessels, such as the coronary arteries, and allow MRI to substitute for invasive and expensive catheterization procedures currently in clinical use.
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Affiliation(s)
- Andrea D Holton
- Department of Biomedical Engineering, University of Alabama at Birmingham, 1075 13th Street South, Birmingham, AL 35294-4440, USA
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Moreno PR, Fuster V. The year in atherothrombosis. J Am Coll Cardiol 2004; 44:2099-110. [PMID: 15582305 DOI: 10.1016/j.jacc.2004.06.077] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2004] [Revised: 06/23/2004] [Accepted: 06/23/2004] [Indexed: 01/15/2023]
Affiliation(s)
- Pedro R Moreno
- Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York, USA
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Abstract
PURPOSE OF REVIEW MRI is a novel strategy to assess myocardial ischemia. It provides information on myocardial perfusion, viability, and potentially the extent of coronary artery disease. This technology may replace many of the current noninvasive and, perhaps, invasive techniques in the diagnosis and management of patients with coronary artery disease. This review aims to cover the major advances in cardiac MRI related to both diagnosis and therapy of myocardial ischemia. RECENT FINDINGS Although improved image acquisition techniques have made it possible to obtain excellent image quality in most patients, powerful processing software has permitted the quantification of accurate and reproducible functional information regarding perfusion, wall motion, and viability. Stem cell delivery and gene therapy to the myocardium using cardiac MRI has been shown to be feasible. The use of 3-T systems for cardiac imaging and the imaging of atherosclerosis with MRI are currently being studied. SUMMARY MRI is a highly accurate method of characterizing both reversible and irreversible myocardial injury and of obtaining information on myocardial viability. It has the ability to prognostic patients by evaluating ejection fraction and contractility. Robust and uncomplicated methodologies for coronary MR angiography are almost on the horizon. Quantification of several parameters used to diagnose, prognosticate, and follow patients with ischemic heart disease should be much easier in the future. It may, with the recent advances in imaging such as 3-T systems, provide major noninvasive diagnostic capability. Cardiac MRI, with its improved imaging, and its ability to treat and monitor various forms of invasive and noninvasive therapy, may attain its potential as a "one-stop shop" in the near future.
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Affiliation(s)
- Sanjaya Viswamitra
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
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Walsh EG, Holton AD, Brott BC, Venugopalan R, Anayiotos AS. Magnetic resonance phase velocity mapping through NiTi stents in a flow phantom model. J Magn Reson Imaging 2004; 21:59-65. [PMID: 15611949 DOI: 10.1002/jmri.20238] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess constant and pulsatile flow velocity within the lumen of a peripheral NiTi stent using phase velocity mapping for comparison with independent assessments of flow velocity in a phantom model. MATERIALS AND METHODS A 9 x 20-mm stent installed in flexible tubing was placed in a phantom filled with stationary fluid. Constant and pulsatile flow (produced by a pump programmed to produce a simulation of the carotid artery flow) was assessed using phase velocity mapping at 4.1 T (for constant flow) and at 1.5 T (for pulsatile flow). In all cases 256 x 256 gradient echo phase velocity maps were acquired. For the pulsatile flow condition, cine images with acquisition gated to the pump cycle were acquired with 40 msec temporal resolution across the simulated cardiac cycle. Computed flow volume rates were compared with fluid volume collection for the constant flow model, and with ultrasonic Doppler flow meter measurements for the pulsatile model. RESULTS The data showed that volume flow rate assessments by phase velocity mapping agreed with independent measurements within 10% to 15%. CONCLUSION Phase velocity mapping of the lumen of peripheral size NiTi stents is possible in an in vitro model.
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Affiliation(s)
- Edward G Walsh
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Aude YW, Garza L. How to prevent unnecessary coronary interventions: identifying lesions responsible for ischemia in the cath lab. Curr Opin Cardiol 2003; 18:394-9. [PMID: 12960473 DOI: 10.1097/00001573-200309000-00012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Coronary angiography is limited by the inability to identify intermediate coronary lesions responsible for ischemia. In the catheterization laboratory three techniques can be used for the evaluation of the physiologic significance of intermediate or borderline significant coronary stenoses: (1) pressure wire-derived coronary fractional flow reserve (FFR), (2) Doppler wire-derived measurement of coronary flow reserve (CFR), and (3) intravascular ultrasound (IVUS). RECENT FINDINGS All of these techniques have been validated for assessing the functional significance of intermediate stenoses, but also have inherent limitations. SUMMARY Overall, measurement of FFR appears to be the best method for interrogating intermediate coronary lesions. This review discusses the strengths and limitations of each of these techniques.
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Affiliation(s)
- Y Wady Aude
- Department of Internal Medicine, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock 72205-7199, USA.
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