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Pype LL, Domenech-Ximenos B, Paelinck BP, Sturkenboom N, Van De Heyning CM. Assessment of Tricuspid Regurgitation by Cardiac Magnetic Resonance Imaging: Current Role and Future Applications. J Clin Med 2024; 13:4481. [PMID: 39124748 PMCID: PMC11312898 DOI: 10.3390/jcm13154481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Tricuspid regurgitation (TR) is a prevalent valvular disease with a significant mortality rate. The evaluation of TR severity and associated right heart remodeling and dysfunction is crucial to determine the optimal therapeutic strategy and to improve prognosis. While echocardiography remains the first-line imaging technique to evaluate TR, it has many limitations, both operator- and patient-related. Cardiovascular magnetic resonance imaging (CMR) has emerged as an innovative and comprehensive non-invasive cardiac imaging technique with additional value beyond routine echocardiographic assessment. Besides its established role as the gold standard for the evaluation of cardiac volumes, CMR can add important insights with regard to valvular anatomy and function. Accurate quantification of TR severity, including calculation of regurgitant volume and fraction, can be performed using either the well-known indirect volumetric method or novel 4D flow imaging. In addition, CMR can be used to assess the impact on the right heart, including right heart remodeling, function and tissue characterization. Several CMR-derived parameters have been associated with outcome, highlighting the importance of multi-modality imaging in patients with TR. The aim of this review is to provide an overview of the current role of CMR in the assessment and management of patients with TR and its future applications.
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Affiliation(s)
- Lobke L. Pype
- Department of Cardiology, University Hospital Antwerp, 2650 Edegem, Belgium; (L.L.P.)
- GENCOR Research Group, University of Antwerp, 2000 Antwerp, Belgium
| | - Blanca Domenech-Ximenos
- Department of Radiology, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK
| | - Bernard P. Paelinck
- GENCOR Research Group, University of Antwerp, 2000 Antwerp, Belgium
- Department of Cardiac Surgery, University Hospital Antwerp, 2650 Edegem, Belgium
| | - Nicole Sturkenboom
- Department of Cardiology, University Hospital Antwerp, 2650 Edegem, Belgium; (L.L.P.)
- GENCOR Research Group, University of Antwerp, 2000 Antwerp, Belgium
| | - Caroline M. Van De Heyning
- Department of Cardiology, University Hospital Antwerp, 2650 Edegem, Belgium; (L.L.P.)
- GENCOR Research Group, University of Antwerp, 2000 Antwerp, Belgium
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK
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Bijvoet GP, Hermans BJM, Linz D, Luermans JGLM, Maesen B, Nijveldt R, Mihl C, Vernooy K, Wildberger JE, Holtackers RJ, Schotten U, Chaldoupi SM. Optimal Threshold and Interpatient Variability in Left Atrial Ablation Scar Assessment by Dark-Blood LGE CMR. JACC Clin Electrophysiol 2024:S2405-500X(24)00377-3. [PMID: 39001763 DOI: 10.1016/j.jacep.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Dark-blood late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) has better correlation with bipolar voltage (BiV) to define ablation scar in the left atrium (LA) compared to conventional bright-blood LGE CMR. OBJECTIVES This study sought to determine the optimal signal intensity threshold of dark-blood LGE CMR to identify LA ablation scar. METHODS In 54 patients scheduled for atrial fibrillation ablation, image intensity ratios (IIRs) were derived from preprocedural dark-blood LGE CMR. In 26 patients without previous ablation, the upper limit of normal was derived from the 95th and 98th percentiles of pooled IIR values. In 28 patients with previous atrial fibrillation ablation, BiV was compared with the corresponding IIR. Receiver-operating characteristics analyses were employed to determine the optimal IIR threshold (ie, the point with the smallest distance to the upper left corner of the receiver-operating characteristics) for LA ablation scar (BiV ≤0.15 mV). RESULTS Upper limit of normal corresponded to IIR values 1.16 and 1.21, yielding low sensitivities of 0.32 and 0.09 to detect LA ablation scar. Receiver-operating characteristics analysis of IIR and BiV comparison achieved a median area under the curve of 0.77. Median optimal IIR threshold for LA ablation scar was 1.09, with an average sensitivity of 0.73, specificity of 0.75, and accuracy of 0.71. Median IIR thresholds of 1.00 and 1.10 corresponded to 80% sensitivity and 80% specificity, respectively. There was considerable interpatient variability: optimal IIR thresholds per patient ranged from 1.01 to 1.22. CONCLUSIONS The optimal IIR threshold to identify LA ablation scar by dark-blood LGE CMR is 1.09. Because of interpatient variability, the investigators recommend using a lower (1.00) and upper (1.10) threshold to prevent over- or underestimation of ablation scar.
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Affiliation(s)
- Geertruida Petronella Bijvoet
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands.
| | - Ben J M Hermans
- Department of Physiology, CARIM, Maastricht University, Maastricht, the Netherlands
| | - Dominik Linz
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Justin G L M Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, CARIM, MUMC+, Maastricht, the Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Casper Mihl
- Department of Radiology and Nuclear Medicine, CARIM, MUMC+, Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, CARIM, MUMC+, Maastricht, the Netherlands
| | - Rob J Holtackers
- Department of Radiology and Nuclear Medicine, CARIM, MUMC+, Maastricht, the Netherlands
| | - Ulrich Schotten
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands; Department of Physiology, CARIM, Maastricht University, Maastricht, the Netherlands
| | - Sevasti-Maria Chaldoupi
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands.
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Darwish A, Bersali A, Saeed M, Dhore A, Maragiannis D, El-Tallawi KC, Shah DJ. Assessing Regurgitation Severity, Adverse Remodeling, and Fibrosis with CMR in Primary Mitral Regurgitation. Curr Cardiol Rep 2024; 26:705-715. [PMID: 38748329 DOI: 10.1007/s11886-024-02069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE OF REVIEW This review offers an evidence-based analysis of established and emerging cardiovascular magnetic resonance (CMR) techniques used to assess the severity of primary mitral regurgitation (MR), identify adverse cardiac remodeling and its prognostic effect. The aim is to provide different insights regarding clinical decision-making and enhance the clinical outcomes of patients with MR. RECENT FINDINGS Cardiac remodeling and myocardial replacement fibrosis are observed frequently in the presence of substantial LV volume overload, particularly in cases with severe primary MR. CMR serves as a useful diagnostic imaging modality in assessing mitral regurgitation severity, early detection of cardiac remodeling, myocardial dysfunction, and myocardial fibrosis, enabling timely intervention before irreversible damage ensues. Incorporating myocardial remodeling in terms of left ventricular (LV) dilatation and myocardial fibrosis with quantitative MR severity assessment by CMR may assist in defining optimal timing of intervention.
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Affiliation(s)
- Amr Darwish
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin, suite 1801, Houston, TX, 77030, USA
| | - Akila Bersali
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin, suite 1801, Houston, TX, 77030, USA
| | - Mujtaba Saeed
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin, suite 1801, Houston, TX, 77030, USA
| | - Aneesh Dhore
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin, suite 1801, Houston, TX, 77030, USA
| | - Dimitrios Maragiannis
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin, suite 1801, Houston, TX, 77030, USA
| | - K Carlos El-Tallawi
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin, suite 1801, Houston, TX, 77030, USA
| | - Dipan J Shah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin, suite 1801, Houston, TX, 77030, USA.
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Li S, Wang Z, Fu W, Li F, Gu H, Cui N, Lin Y, Xie M, Yang Y. Left Ventricular Papillary Muscle: Anatomy, Pathophysiology, and Multimodal Evaluation. Diagnostics (Basel) 2024; 14:1270. [PMID: 38928685 PMCID: PMC11202998 DOI: 10.3390/diagnostics14121270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/04/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
As an integral part of the mitral valve apparatus, the left ventricle papillary muscle (PM) controls mitral valve closure during systole and participates in the ejection process during left ventricular systole. Mitral regurgitation (MR) is the most immediate and predominant result when the PM is structurally or functionally abnormal. However, dysfunction of the PM is easily underestimated or overlooked in clinical interventions for MR-related diseases. Therefore, adequate recognition of PM dysfunction and PM-derived MR is critical. In this review, we systematically describe the normal anatomical variations in the PM and the pathophysiology of PM dysfunction-related diseases and summarize the commonly used parameters and the advantages and disadvantages of various noninvasive imaging modalities for the structural and functional assessment of the PM.
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Affiliation(s)
- Shiying Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Zhen Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenpei Fu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Fangya Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Hui Gu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Nan Cui
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yixia Lin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yali Yang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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de Villedon de Naide V, Maes JD, Villegas-Martinez M, Ribal I, Maillot A, Ozenne V, Montier G, Boullé T, Sridi S, Gut P, Küstner T, Stuber M, Cochet H, Bustin A. Fully automated contrast selection of joint bright- and black-blood late gadolinium enhancement imaging for robust myocardial scar assessment. Magn Reson Imaging 2024; 109:256-263. [PMID: 38522623 PMCID: PMC11116338 DOI: 10.1016/j.mri.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/14/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Joint bright- and black-blood MRI techniques provide improved scar localization and contrast. Black-blood contrast is obtained after the visual selection of an optimal inversion time (TI) which often results in uncertainties, inter- and intra-observer variability and increased workload. In this work, we propose an artificial intelligence-based algorithm to enable fully automated TI selection and simplify myocardial scar imaging. METHODS The proposed algorithm first localizes the left ventricle using a U-Net architecture. The localized left cavity centroid is extracted and a squared region of interest ("focus box") is created around the resulting pixel. The focus box is then propagated on each image and the sum of the pixel intensity inside is computed. The smallest sum corresponds to the image with the lowest intensity signal within the blood pool and healthy myocardium, which will provide an ideal scar-to-blood contrast. The image's corresponding TI is considered optimal. The U-Net was trained to segment the epicardium in 177 patients with binary cross-entropy loss. The algorithm was validated retrospectively in 152 patients, and the agreement between the algorithm and two magnetic resonance (MR) operators' prediction of TI values was calculated using the Fleiss' kappa coefficient. Thirty focus box sizes, ranging from 2.3mm2 to 20.3cm2, were tested. Processing times were measured. RESULTS The U-Net's Dice score was 93.0 ± 0.1%. The proposed algorithm extracted TI values in 2.7 ± 0.1 s per patient (vs. 16.0 ± 8.5 s for the operator). An agreement between the algorithm's prediction and the MR operators' prediction was found in 137/152 patients (κ= 0.89), for an optimal focus box of size 2.3cm2. CONCLUSION The proposed fully-automated algorithm has potential of reducing uncertainties, variability, and workload inherent to manual approaches with promise for future clinical implementation for joint bright- and black-blood MRI.
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Affiliation(s)
| | - Jean-David Maes
- CHU de Bordeaux, Department of Cardiovascular Imaging, INSERM, U 1045, F-33000 Bordeaux, France
| | | | - Indra Ribal
- Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, F-33000 Bordeaux, France
| | - Aurélien Maillot
- Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, F-33000 Bordeaux, France
| | - Valéry Ozenne
- Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, F-33000 Bordeaux, France
| | - Géraldine Montier
- CHU de Bordeaux, Department of Cardiovascular Imaging, INSERM, U 1045, F-33000 Bordeaux, France
| | - Thibaut Boullé
- CHU de Bordeaux, Department of Cardiovascular Imaging, INSERM, U 1045, F-33000 Bordeaux, France
| | - Soumaya Sridi
- CHU de Bordeaux, Department of Cardiovascular Imaging, INSERM, U 1045, F-33000 Bordeaux, France
| | - Pauline Gut
- Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, F-33000 Bordeaux, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Küstner
- Medical Image and Data Analysis (MIDAS.lab), Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, 72076 Tübingen, Germany
| | - Matthias Stuber
- Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, F-33000 Bordeaux, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Hubert Cochet
- Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, F-33000 Bordeaux, France; CHU de Bordeaux, Department of Cardiovascular Imaging, INSERM, U 1045, F-33000 Bordeaux, France
| | - Aurélien Bustin
- Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, F-33000 Bordeaux, France; CHU de Bordeaux, Department of Cardiovascular Imaging, INSERM, U 1045, F-33000 Bordeaux, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Jaspers TJM, Martens B, Crawley R, Jada L, Amirrajab S, Breeuwer M, Holtackers RJ, Chiribiri A, Scannell CM. Deep Learning Synthesis of White-Blood From Dark-Blood Late Gadolinium Enhancement Cardiac Magnetic Resonance. Invest Radiol 2024:00004424-990000000-00213. [PMID: 38687025 DOI: 10.1097/rli.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVES Dark-blood late gadolinium enhancement (DB-LGE) cardiac magnetic resonance has been proposed as an alternative to standard white-blood LGE (WB-LGE) imaging protocols to enhance scar-to-blood contrast without compromising scar-to-myocardium contrast. In practice, both DB and WB contrasts may have clinical utility, but acquiring both has the drawback of additional acquisition time. The aim of this study was to develop and evaluate a deep learning method to generate synthetic WB-LGE images from DB-LGE, allowing the assessment of both contrasts without additional scan time. MATERIALS AND METHODS DB-LGE and WB-LGE data from 215 patients were used to train 2 types of unpaired image-to-image translation deep learning models, cycle-consistent generative adversarial network (CycleGAN) and contrastive unpaired translation, with 5 different loss function hyperparameter settings each. Initially, the best hyperparameter setting was determined for each model type based on the Fréchet inception distance and the visual assessment of expert readers. Then, the CycleGAN and contrastive unpaired translation models with the optimal hyperparameters were directly compared. Finally, with the best model chosen, the quantification of scar based on the synthetic WB-LGE images was compared with the truly acquired WB-LGE. RESULTS The CycleGAN architecture for unpaired image-to-image translation was found to provide the most realistic synthetic WB-LGE images from DB-LGE images. The results showed that it was difficult for visual readers to distinguish if an image was true or synthetic (55% correctly classified). In addition, scar burden quantification with the synthetic data was highly correlated with the analysis of the truly acquired images. Bland-Altman analysis found a mean bias in percentage scar burden between the quantification of the real WB and synthetic white-blood images of 0.44% with limits of agreement from -10.85% to 11.74%. The mean image quality of the real WB images (3.53/5) was scored higher than the synthetic white-blood images (3.03), P = 0.009. CONCLUSIONS This study proposed a CycleGAN model to generate synthetic WB-LGE from DB-LGE images to allow assessment of both image contrasts without additional scan time. This work represents a clinically focused assessment of synthetic medical images generated by artificial intelligence, a topic with significant potential for a multitude of applications. However, further evaluation is warranted before clinical adoption.
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Affiliation(s)
- Tim J M Jaspers
- From the Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (T.J.M.J., S.A., M.B., C.M.S.); School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (T.J.M.J., R.C., L.J., R.J.H., A.C., C.M.S.); Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (T.J.M.J.); Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands (B.M., R.J.H.); and Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (B.M., R.J.H.)
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7
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Jada L, Holtackers RJ, Martens B, Nies HMJM, Van De Heyning CM, Botnar RM, Wildberger JE, Ismail TF, Razavi R, Chiribiri A. Quantification of myocardial scar of different etiology using dark- and bright-blood late gadolinium enhancement cardiovascular magnetic resonance. Sci Rep 2024; 14:5395. [PMID: 38443457 PMCID: PMC10914833 DOI: 10.1038/s41598-024-52058-8] [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: 05/19/2023] [Accepted: 01/12/2024] [Indexed: 03/07/2024] Open
Abstract
Dark-blood late gadolinium enhancement (LGE) has been shown to improve the visualization and quantification of areas of ischemic scar compared to standard bright-blood LGE. Recently, the performance of various semi-automated quantification methods has been evaluated for the assessment of infarct size using both dark-blood LGE and conventional bright-blood LGE with histopathology as a reference standard. However, the impact of this sequence on different quantification strategies in vivo remains uncertain. In this study, various semi-automated scar quantification methods were evaluated for a range of different ischemic and non-ischemic pathologies encountered in clinical practice. A total of 62 patients referred for clinical cardiovascular magnetic resonance (CMR) were retrospectively included. All patients had a confirmed diagnosis of either ischemic heart disease (IHD; n = 21), dilated/non-ischemic cardiomyopathy (NICM; n = 21), or hypertrophic cardiomyopathy (HCM; n = 20) and underwent CMR on a 1.5 T scanner including both bright- and dark-blood LGE using a standard PSIR sequence. Both methods used identical sequence settings as per clinical protocol, apart from the inversion time parameter, which was set differently. All short-axis LGE images with scar were manually segmented for epicardial and endocardial borders. The extent of LGE was then measured visually by manual signal thresholding, and semi-automatically by signal thresholding using the standard deviation (SD) and the full width at half maximum (FWHM) methods. For all quantification methods in the IHD group, except the 6 SD method, dark-blood LGE detected significantly more enhancement compared to bright-blood LGE (p < 0.05 for all methods). For both bright-blood and dark-blood LGE, the 6 SD method correlated best with manual thresholding (16.9% vs. 17.1% and 20.1% vs. 20.4%, respectively). For the NICM group, no significant differences between LGE methods were found. For bright-blood LGE, the 5 SD method agreed best with manual thresholding (9.3% vs. 11.0%), while for dark-blood LGE the 4 SD method agreed best (12.6% vs. 11.5%). Similarly, for the HCM group no significant differences between LGE methods were found. For bright-blood LGE, the 6 SD method agreed best with manual thresholding (10.9% vs. 12.2%), while for dark-blood LGE the 5 SD method agreed best (13.2% vs. 11.5%). Semi-automated LGE quantification using dark-blood LGE images is feasible in both patients with ischemic and non-ischemic scar patterns. Given the advantage in detecting scar in patients with ischemic heart disease and no disadvantage in patients with non-ischemic scar, dark-blood LGE can be readily and widely adopted into clinical practice without compromising on quantification.
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Affiliation(s)
- Lamis Jada
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
- King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Robert J Holtackers
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Bibi Martens
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hedwig M J M Nies
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Caroline M Van De Heyning
- GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Rene M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
- Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tevfik F Ismail
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
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Cavus E, Schneider JN, di Carluccio E, Ziegler A, Haack A, Ojeda F, Chevalier C, Jahnke C, Riedl KA, Radunski UK, Twerenbold R, Kirchhof P, Blankenberg S, Adam G, Tahir E, Lund GK, Muellerleile K. Unrecognized myocardial scar by late-gadolinium-enhancement cardiovascular magnetic resonance: Insights from the population-based Hamburg City Health Study. J Cardiovasc Magn Reson 2024; 26:101008. [PMID: 38341145 PMCID: PMC10944257 DOI: 10.1016/j.jocmr.2024.101008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/19/2023] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The presence of myocardial scar is associated with poor prognosis in several underlying diseases. Late-gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging reveals clinically silent "unrecognized myocardial scar" (UMS), but the etiology of UMS often remains unclear. This population-based CMR study evaluated prevalence, localization, patterns, and risk factors of UMS. METHODS The study population consisted of 1064 consecutive Hamburg City Health Study participants without a history of coronary heart disease or myocarditis. UMS was assessed by standard-phase-sensitive-inversion-recovery LGE CMR. RESULTS Median age was 66 [quartiles 59, 71] years and 37% (388/1064) were females. UMS was detected in 244 (23%) participants. Twenty-five participants (10%) had ischemic, and 217 participants (89%) had non-ischemic scar patterns, predominantly involving the basal inferolateral left-ventricular (LV) myocardium (75%). Two participants (1%) had coincident ischemic and non-ischemic scar. The presence of any UMS was independently associated with LV ejection fraction (odds ratios (OR) per standard deviation (SD) 0.77 (confidence interval (CI) 0.65-0.90), p = 0.002) and LV mass (OR per SD 1.54 (CI 1.31-1.82), p < 0.001). Ischemic UMS was independently associated with LV ejection fraction (OR per SD 0.58 (CI 0.39-0.86), p = 0.007), LV mass (OR per SD 1.74 (CI 1.25-2.45), p = 0.001), and diabetes (OR 4.91 (CI 1.66-13.03), p = 0.002). Non-ischemic UMS was only independently associated with LV mass (OR per SD 1.44 (CI 1.24-1.69), p < 0.001). CONCLUSION UMS, in particular with a non-ischemic pattern, is frequent in individuals without known cardiac disease and predominantly involves the basal inferolateral LV myocardium. Presence of UMS is independently associated with a lower LVEF, a higher LV mass, and a history of diabetes.
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Affiliation(s)
- Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany.
| | - Jan N Schneider
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Eleonora di Carluccio
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Cardio-Care, Medizincampus Davos, Davos, Switzerland
| | - Andreas Ziegler
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Cardio-Care, Medizincampus Davos, Davos, Switzerland; School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Alena Haack
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Francisco Ojeda
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Celeste Chevalier
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Charlotte Jahnke
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Katharina A Riedl
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Ulf K Radunski
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany; University Center of Cardiovascular Science, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Kai Muellerleile
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
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9
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Campbell-Washburn AE, Varghese J, Nayak KS, Ramasawmy R, Simonetti OP. Cardiac MRI at Low Field Strengths. J Magn Reson Imaging 2024; 59:412-430. [PMID: 37530545 PMCID: PMC10834858 DOI: 10.1002/jmri.28890] [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: 03/17/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 08/03/2023] Open
Abstract
Cardiac MR imaging is well established for assessment of cardiovascular structure and function, myocardial scar, quantitative flow, parametric mapping, and myocardial perfusion. Despite the clear evidence supporting the use of cardiac MRI for a wide range of indications, it is underutilized clinically. Recent developments in low-field MRI technology, including modern data acquisition and image reconstruction methods, are enabling high-quality low-field imaging that may improve the cost-benefit ratio for cardiac MRI. Studies to-date confirm that low-field MRI offers high measurement concordance and consistent interpretation with clinical imaging for several routine sequences. Moreover, low-field MRI may enable specific new clinical opportunities for cardiac imaging such as imaging near metal implants, MRI-guided interventions, combined cardiopulmonary assessment, and imaging of patients with severe obesity. In this review, we discuss the recent progress in low-field cardiac MRI with a focus on technical developments and early clinical validation studies. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Adrienne E Campbell-Washburn
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Juliet Varghese
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
- Alfred Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
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10
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Gertz RJ, Wagner A, Sokolowski M, Lennartz S, Gietzen C, Grunz JP, Goertz L, Kaya K, ten Freyhaus H, Persigehl T, Bunck AC, Doerner J, Naehle CP, Maintz D, Weiss K, Katemann C, Pennig L. Compressed SENSE accelerated 3D single-breath-hold late gadolinium enhancement cardiovascular magnetic resonance with isotropic resolution: clinical evaluation. Front Cardiovasc Med 2023; 10:1305649. [PMID: 38099228 PMCID: PMC10720442 DOI: 10.3389/fcvm.2023.1305649] [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: 10/02/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Aim The purpose of this study was to investigate the clinical application of Compressed SENSE accelerated single-breath-hold LGE with 3D isotropic resolution compared to conventional LGE imaging acquired in multiple breath-holds. Material & Methods This was a retrospective, single-center study including 105 examinations of 101 patients (48.2 ± 16.8 years, 47 females). All patients underwent conventional breath-hold and 3D single-breath-hold (0.96 × 0.96 × 1.1 mm3 reconstructed voxel size, Compressed SENSE factor 6.5) LGE sequences at 1.5 T in clinical routine for the evaluation of ischemic or non-ischemic cardiomyopathies. Two radiologists independently evaluated the left ventricle (LV) for the presence of hyperenhancing lesions in each sequence, including localization and transmural extent, while assessing their scar edge sharpness (SES). Confidence of LGE assessment, image quality (IQ), and artifacts were also rated. The impact of LV ejection fraction (LVEF), heart rate, body mass index (BMI), and gender as possible confounders on IQ, artifacts, and confidence of LGE assessment was evaluated employing ordinal logistic regression analysis. Results Using 3D single-breath-hold LGE readers detected more hyperenhancing lesions compared to conventional breath-hold LGE (n = 246 vs. n = 216 of 1,785 analyzed segments, 13.8% vs. 12.1%; p < 0.0001), pronounced at subendocardial, midmyocardial, and subepicardial localizations and for 1%-50% of transmural extent. SES was rated superior in 3D single-breath-hold LGE (4.1 ± 0.8 vs. 3.3 ± 0.8; p < 0.001). 3D single-breath-hold LGE yielded more artifacts (3.8 ± 1.0 vs. 4.0 ± 3.8; p = 0.002) whereas IQ (4.1 ± 1.0 vs. 4.2 ± 0.9; p = 0.122) and confidence of LGE assessment (4.3 ± 0.9 vs. 4.3 ± 0.8; p = 0.374) were comparable between both techniques. Female gender negatively influenced artifacts in 3D single-breath-hold LGE (p = 0.0028) while increased heart rate led to decreased IQ in conventional breath-hold LGE (p = 0.0029). Conclusions In clinical routine, Compressed SENSE accelerated 3D single-breath-hold LGE yields image quality and confidence of LGE assessment comparable to conventional breath-hold LGE while providing improved delineation of smaller LGE lesions with superior scar edge sharpness. Given the fast acquisition of 3D single-breath-hold LGE, the technique holds potential to drastically reduce the examination time of CMR.
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Affiliation(s)
- Roman Johannes Gertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anton Wagner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute for Diagnostic and Interventional Radiology, Krankenhaus der Augustinerinnen, Cologne, Germany
| | - Marcel Sokolowski
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carsten Gietzen
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Lukas Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kenan Kaya
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Henrik ten Freyhaus
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alexander Christian Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jonas Doerner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Kontraste Radiologie-Praxis Köln West, Cologne, Germany
| | - Claas Philip Naehle
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Radiologische Allianz Hamburg, Hamburg, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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11
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Nies HM, Martens B, Gommers S, Bijvoet GP, Wildberger JE, ter Bekke RM, Holtackers RJ, Mihl C. Myocardial Scar Detection Using High-Resolution Free-Breathing 3D Dark-Blood and Standard Breath-Holding 2D Bright-Blood Late Gadolinium Enhancement MRI: A Comparison of Observer Confidence. Top Magn Reson Imaging 2023; 32:27-32. [PMID: 37058709 PMCID: PMC10510822 DOI: 10.1097/rmr.0000000000000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/14/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE To compare observer confidence for myocardial scar detection using 3 different late gadolinium enhancement (LGE) data sets by 2 observers with different levels of experience. MATERIALS AND METHODS Forty-one consecutive patients, who were referred for 3D dark-blood LGE MRI before implantable cardioverter-defibrillator implantation or ablation therapy and who underwent 2D bright-blood LGE MRI within a time frame of 3 months, were prospectively included. From all 3D dark-blood LGE data sets, a stack of 2D short-axis slices was reconstructed. All acquired LGE data sets were anonymized and randomized and evaluated by 2 independent observers with different levels of experience in cardiovascular imaging (beginner and expert). Confidence in detection of ischemic scar, nonischemic scar, papillary muscle scar, and right ventricular scar for each LGE data set was scored using a using a 3-point Likert scale (1 = low, 2 = medium, or 3 = high). Observer confidence scores were compared using the Friedman omnibus test and Wilcoxon signed-rank post hoc test. RESULTS For the beginner observer, a significant difference in confidence regarding ischemic scar detection was observed in favor of reconstructed 2D dark-blood LGE compared with standard 2D bright-blood LGE (p = 0.030) while for the expert observer, no significant difference was found (p = 0.166). Similarly, for right ventricular scar detection, a significant difference in confidence was observed in favor of reconstructed 2D dark-blood LGE compared with standard 2D bright-blood LGE (p = 0.006) while for the expert observer, no significant difference was found (p = 0.662). Although not significantly different for other areas of interest, 3D dark-blood LGE and its derived 2D dark-blood LGE data set showed a tendency to score higher for all areas of interest at both experience levels. CONCLUSIONS The combination of dark-blood LGE contrast and high isotropic voxels may contribute to increased observer confidence in myocardial scar detection, independent of observer's experience level but in particular for beginner observers.
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Affiliation(s)
- Hedwig M.J.M. Nies
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bibi Martens
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Suzanne Gommers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Geertruida P. Bijvoet
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Joachim E. Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Rachel M.A. ter Bekke
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Robert J. Holtackers
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Casper Mihl
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
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12
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Brendel JM, Holtackers RJ, Geisel JN, Kübler J, Hagen F, Gawaz M, Nikolaou K, Greulich S, Krumm P. Dark-Blood Late Gadolinium Enhancement MRI Is Noninferior to Bright-Blood LGE in Non-Ischemic Cardiomyopathies. Diagnostics (Basel) 2023; 13:1634. [PMID: 37175026 PMCID: PMC10178168 DOI: 10.3390/diagnostics13091634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/29/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background and Objectives: Dark-blood late gadolinium enhancement has been shown to be a reliable cardiac magnetic resonance (CMR) method for assessing viability and depicting myocardial scarring in ischemic cardiomyopathy. The aim of this study was to evaluate dark-blood LGE imaging compared with conventional bright-blood LGE for the detection of myocardial scarring in non-ischemic cardiomyopathies. (2) Materials and Methods: Patients with suspected non-ischemic cardiomyopathy were prospectively enrolled in this single-centre study from January 2020 to March 2023. All patients underwent 1.5 T CMR with both dark-blood and conventional bright-blood LGE imaging. Corresponding short-axis stacks of both techniques were analysed for the presence, distribution, pattern, and localisation of LGE, as well as the quantitative scar size (%). (3) Results: 343 patients (age 44 ± 17 years; 124 women) with suspected non-ischemic cardiomyopathy were examined. LGE was detected in 123 of 343 cases (36%) with excellent inter-reader agreement (κ 0.97-0.99) for both LGE techniques. Dark-blood LGE showed a sensitivity of 99% (CI 98-100), specificity of 99% (CI 98-100), and an accuracy of 99% (CI 99-100) for the detection of non-ischemic scarring. No significant difference in total scar size (%) was observed. Dark-blood imaging with mean 5.35 ± 4.32% enhanced volume of total myocardial volume, bright-blood with 5.24 ± 4.28%, p = 0.84. (4) Conclusions: Dark-blood LGE imaging is non-inferior to conventional bright-blood LGE imaging in detecting non-ischemic scarring. Therefore, dark-blood LGE imaging may become an equivalent method for the detection of both ischemic and non-ischemic scars.
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Affiliation(s)
- Jan M. Brendel
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Robert J. Holtackers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Jan N. Geisel
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Jens Kübler
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Florian Hagen
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Meinrad Gawaz
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Simon Greulich
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
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13
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Allen JJ, Keegan J, Mathew G, Conway M, Jenkins S, Pennell DJ, Nielles-Vallespin S, Gatehouse P, Babu-Narayan SV. Fully-modelled blood-focused variable inversion times for 3D late gadolinium-enhanced imaging. Magn Reson Imaging 2023; 98:44-54. [PMID: 36581215 DOI: 10.1016/j.mri.2022.12.014] [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: 02/01/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Variable heart rate during single-cycle inversion-recovery Late Gadolinium-Enhanced (LGE) scanning degrades image quality, which can be mitigated using Variable Inversion Times (VTIs) in real-time response to R-R interval changes. We investigate in vivo and in simulations an extension of a single-cycle VTI method previously applied in 3D LGE imaging, that now fully models the longitudinal magnetisation (fmVTI). METHODS The VTI and fmVTI methods were used to perform 3D LGE scans for 28 3D LGE patients, with qualitative image quality scores assigned for left atrial wall clarity and total ghosting. Accompanying simulations of numerical phantom images were assessed in terms of ghosting of normal myocardium, blood, and myocardial scar. RESULTS The numerical simulations for fmVTI showed a significant decrease in blood ghosting (VTI: 410 ± 710, fmVTI: 68 ± 40, p < 0.0005) and scar ghosting (VTI: 830 ± 1300, fmVTI: 510 ± 730, p < 0.02). Despite this, there was no significant change in qualitative image quality scores, either for left atrial wall clarity (VTI: 2.0 ± 1.0, fmVTI: 1.8 ± 1.0, p > 0.1) or for total ghosting (VTI: 1.9 ± 1.0, fmVTI: 2.0 ± 1.0, p > 0.7). CONCLUSIONS Simulations indicated reduced ghosting with the fmVTI method, due to reduced Mz variability in the blood signal. However, other sources of phase-encode ghosting and blurring appeared to dominate and obscure this finding in the patient studies available.
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Affiliation(s)
- Jack J Allen
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Royal Brompton Hospital. Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jennifer Keegan
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Royal Brompton Hospital. Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - George Mathew
- Royal Brompton Hospital. Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Miriam Conway
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Royal Brompton Hospital. Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sophie Jenkins
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Royal Brompton Hospital. Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Dudley J Pennell
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Royal Brompton Hospital. Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sonia Nielles-Vallespin
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Royal Brompton Hospital. Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Peter Gatehouse
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Royal Brompton Hospital. Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Sonya V Babu-Narayan
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Royal Brompton Hospital. Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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14
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Yin X, Yin X, Pan X, Zhang J, Fan X, Li J, Zhai X, Jiang L, Hao P, Wang J, Chen Y. Post-myocardial infarction fibrosis: Pathophysiology, examination, and intervention. Front Pharmacol 2023; 14:1070973. [PMID: 37056987 PMCID: PMC10086160 DOI: 10.3389/fphar.2023.1070973] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Cardiac fibrosis plays an indispensable role in cardiac tissue homeostasis and repair after myocardial infarction (MI). The cardiac fibroblast-to-myofibroblast differentiation and extracellular matrix collagen deposition are the hallmarks of cardiac fibrosis, which are modulated by multiple signaling pathways and various types of cells in time-dependent manners. Our understanding of the development of cardiac fibrosis after MI has evolved in basic and clinical researches, and the regulation of fibrotic remodeling may facilitate novel diagnostic and therapeutic strategies, and finally improve outcomes. Here, we aim to elaborate pathophysiology, examination and intervention of cardiac fibrosis after MI.
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Affiliation(s)
- Xiaoying Yin
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Xinxin Yin
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Xin Pan
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Jingyu Zhang
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Xinhui Fan
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Jiaxin Li
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaoxuan Zhai
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Lijun Jiang
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Panpan Hao
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Jiali Wang
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Yuguo Chen
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
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15
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Jenista ER, Wendell DC, Azevedo CF, Klem I, Judd RM, Kim RJ, Kim HW. Revisiting how we perform late gadolinium enhancement CMR: insights gleaned over 25 years of clinical practice. J Cardiovasc Magn Reson 2023; 25:18. [PMID: 36922844 PMCID: PMC10018965 DOI: 10.1186/s12968-023-00925-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Affiliation(s)
- Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, DUMC-3934, Durham, NC, 27710, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - David C Wendell
- Duke Cardiovascular Magnetic Resonance Center, DUMC-3934, Durham, NC, 27710, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Clerio F Azevedo
- Duke Cardiovascular Magnetic Resonance Center, DUMC-3934, Durham, NC, 27710, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, DUMC-3934, Durham, NC, 27710, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Robert M Judd
- Duke Cardiovascular Magnetic Resonance Center, DUMC-3934, Durham, NC, 27710, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, DUMC-3934, Durham, NC, 27710, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, DUMC-3934, Durham, NC, 27710, USA.
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA.
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16
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Dieterlen MT, Klaeske K, Spampinato R, Marin-Cuartas M, Wiesner K, Morningstar J, Norris RA, Melnitchouk S, Levine RA, van Kampen A, Borger MA. Histopathological insights into mitral valve prolapse-induced fibrosis. Front Cardiovasc Med 2023; 10:1057986. [PMID: 36960475 PMCID: PMC10028262 DOI: 10.3389/fcvm.2023.1057986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/16/2023] [Indexed: 03/09/2023] Open
Abstract
Mitral valve prolapse (MVP) is a cardiac valve disease that not only affects the mitral valve (MV), provoking mitral regurgitation, but also leads to maladaptive structural changes in the heart. Such structural changes include the formation of left ventricular (LV) regionalized fibrosis, especially affecting the papillary muscles and inferobasal LV wall. The occurrence of regional fibrosis in MVP patients is hypothesized to be a consequence of increased mechanical stress on the papillary muscles and surrounding myocardium during systole and altered mitral annular motion. These mechanisms appear to induce fibrosis in valve-linked regions, independent of volume-overload remodeling effects of mitral regurgitation. In clinical practice, quantification of myocardial fibrosis is performed with cardiovascular magnetic resonance (CMR) imaging, even though CMR has sensitivity limitations in detecting myocardial fibrosis, especially in detecting interstitial fibrosis. Regional LV fibrosis is clinically relevant because even in the absence of mitral regurgitation, it has been associated with ventricular arrhythmias and sudden cardiac death in MVP patients. Myocardial fibrosis may also be associated with LV dysfunction following MV surgery. The current article provides an overview of current histopathological studies investigating LV fibrosis and remodeling in MVP patients. In addition, we elucidate the ability of histopathological studies to quantify fibrotic remodeling in MVP and gain deeper understanding of the pathophysiological processes. Furthermore, molecular changes such as alterations in collagen expression in MVP patients are reviewed.
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Affiliation(s)
- Maja-Theresa Dieterlen
- University Department of Cardiac Surgery, Heart Center Leipzig, HELIOS Clinic, Leipzig, Germany
| | - Kristin Klaeske
- University Department of Cardiac Surgery, Heart Center Leipzig, HELIOS Clinic, Leipzig, Germany
| | - Ricardo Spampinato
- University Department of Cardiac Surgery, Heart Center Leipzig, HELIOS Clinic, Leipzig, Germany
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Heart Center Leipzig, HELIOS Clinic, Leipzig, Germany
| | - Karoline Wiesner
- University Department of Cardiac Surgery, Heart Center Leipzig, HELIOS Clinic, Leipzig, Germany
| | - Jordan Morningstar
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, United States
| | - Russell A. Norris
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, United States
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Robert A. Levine
- Cardiac Ultrasound Laboratory, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Antonia van Kampen
- University Department of Cardiac Surgery, Heart Center Leipzig, HELIOS Clinic, Leipzig, Germany
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Michael A. Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, HELIOS Clinic, Leipzig, Germany
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17
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Saprungruang A, Aguet J, Gill N, Tassos VP, Amirabadi A, Seed M, Yoo SJ, Lam CZ. Myocardial late gadolinium enhancement using delayed 3D IR-FLASH in the pediatric population: feasibility and diagnostic performance compared to single-shot PSIR-bSSFP. J Cardiovasc Magn Reson 2023; 25:2. [PMID: 36683053 PMCID: PMC9869523 DOI: 10.1186/s12968-023-00917-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND This study compares three-dimensional (3D) high-resolution (HR) late gadolinium enhancement (LGE; 3D HR-LGE) imaging using a respiratory navigated, electrocardiographically-gated inversion recovery gradient echo sequence with conventional LGE imaging using a single-shot phase-sensitive inversion recovery (PSIR) balanced steady-state free precession (bSSFP; PSIR-bSSFP) sequence for routine clinical use in the pediatric population. METHODS Pediatric patients (0-18 years) who underwent clinical cardiovascular magnetic resonance (CMR) with both 3D HR-LGE and single-shot PSIR-bSSFP LGE between January 2018 and June 2020 were included. Image quality (0-4) and detection of LGE in the left ventricle (LV) (per 17 segments), in the right ventricle (RV) (per 3 segments), as endocardial fibroelastosis (EFE), at the hinge points, and at the papillary muscles was analyzed by two blinded readers for each sequence. Ratios of the mean signal intensity of LGE to normal myocardium (LGE:Myo) and to LV blood pool (LGE:Blood) were recorded. Data is presented as median (1st-3rd quartiles). Wilcoxon signed rank test and chi-square analyses were used as appropriate. Inter-rater agreement was analyzed using weighted κ-statistics. RESULTS 102 patients were included with median age at CMR of 8 (1-13) years-old and 44% of exams performed under general anesthesia. LGE was detected in 55% of cases. 3D HR LGE compared to single-shot PSIR-bSSFP had longer scan time [4:30 (3:35-5:34) vs 1:11 (0:47-1:32) minutes, p < 0.001], higher image quality ratings [3 (3-4) vs 2 (2-3), p < 0.001], higher LGE:Myo [23.7 (16.9-31.2) vs 5.0 (2.9-9.0), p < 0.001], detected more segments of LGE in both the LV [4 (2-8) vs 3 (1-7), p = 0.045] and RV [1 (1-1) vs 1 (0-1), p < 0.001], and also detected more cases of LGE with 13/56 (23%) of patients with LGE only detectable by 3D HR LGE (p < 0.001). 3D HR LGE specifically detected a greater proportion of RV LGE (27/27 vs 17/27, p < 0.001), EFE (11/11 vs 5/11, p = 0.004), and papillary muscle LGE (14/15 vs 4/15, p < 0.001). Inter-rater agreement for the recorded variables ranged from 0.42 to 1.00. CONCLUSIONS 3D HR LGE achieves greater image quality and detects more LGE than conventional single-shot PSIR-bSSFP LGE imaging, and should be considered an alternative to conventional LGE sequences for routine clinical use in the pediatric population.
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Affiliation(s)
- Ankavipar Saprungruang
- Division of Cardiology, Department of Pediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Julien Aguet
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Navjot Gill
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Vivian P Tassos
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Afsaneh Amirabadi
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Mike Seed
- Division of Cardiology, Department of Pediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Shi-Joon Yoo
- Division of Cardiology, Department of Pediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Christopher Z Lam
- Division of Cardiology, Department of Pediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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18
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Manning WJ. 2021-2022 state of our JCMR. J Cardiovasc Magn Reson 2022; 24:75. [PMID: 36587219 PMCID: PMC9804242 DOI: 10.1186/s12968-022-00909-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 01/01/2023] Open
Abstract
In 2021, there were 136 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR), including 122 original research papers, six reviews, four technical notes, one Society for Cardiovascular Magnetic Resonance (SCMR) guideline, one SCMR position paper, one study protocol, and one obituary (Nathaniel Reichek). The volume was up 53% from 2020 (n = 89) with a corresponding 21% decrease in manuscript submissions from 435 to 345. This led to an increase in the acceptance rate from 24 to 32%. The quality of the submissions continues to be high. The 2021 JCMR Impact Factor (which is released in June 2022) markedly increased from 5.41 to 6.90 placing us in the top quartile of Society and cardiac imaging journals. Our 5 year impact factor similarly increased from 6.52 to 7.25. Fifteen years ago, the JCMR was at the forefront of medical and medical society journal migration to the Open-Access format. The Open-Access system has dramatically increased the availability and JCMR citation. Full-text article requests in 2021 approached 1.5 M!. As I have mentioned, it takes a village to run a journal. JCMR is very fortunate to have a group of very dedicated Associate Editors, Guest Editors, Journal Club Editors, and Reviewers. I thank each of them for their efforts to ensure that the review process occurs in a timely and responsible manner. These efforts have allowed the JCMR to continue as the premier journal of our field. My role, and the entire editorial process would not be possible without the ongoing high dedication and efforts of our managing editor, Jennifer Rodriguez. Her premier organizational skills have allowed for streamlining of the review process and marked improvement in our time-to-decision (see later). As I conclude my 6th and final year as your editor-in-chief, I thank you for entrusting me with the JCMR editorship and appreciate the time I have had at the helm. I am very confident that our Journal will reach new heights under the stewardship of Dr. Tim Leiner, currently at the Mayo Clinic with a seamless transition occurring as I write this in late November. I hope that you will continue to send your very best, high quality CMR manuscripts to JCMR, and that our readers will continue to look to JCMR for the very best/state-of-the-art CMR publications.
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Affiliation(s)
- Warren J Manning
- Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School and JCMR Editorial Office, Boston, MA, 02215, USA.
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19
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Wendell D, Jenista E, Kim HW, Chen EL, Azevedo CF, Kaolawanich Y, Alenezi F, Rehwald W, Darty S, Parker M, Kim RJ. Assessment of Papillary Muscle Infarction with Dark-Blood Delayed Enhancement Cardiac MRI in Canines and Humans. Radiology 2022; 305:329-338. [PMID: 35880980 PMCID: PMC9619201 DOI: 10.1148/radiol.220251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/19/2022] [Accepted: 06/02/2022] [Indexed: 11/11/2022]
Abstract
Background The relationship between papillary muscle infarction (papMI) and the culprit coronary lesion has not been fully investigated. Delayed enhancement cardiac MRI may detect papMI, yet its accuracy is unknown. Flow-independent dark-blood delayed enhancement (FIDDLE) cardiac MRI has been shown to improve the detection of myocardial infarction adjacent to blood pool. Purpose To assess the diagnostic performance of delayed enhancement and FIDDLE cardiac MRI for the detection of papMI, and to investigate the prevalence of papMI and its relationship to the location of the culprit coronary lesion. Materials and Methods A prospective canine study was used to determine the accuracy of conventional delayed enhancement imaging and FIDDLE imaging for detection of papMI, with pathology-based findings as the reference standard. Participants with first-time myocardial infarction with a clear culprit lesion at coronary angiography were prospectively enrolled at a single hospital from 2015 to 2018 and compared against control participants with low Framingham risk scores. In canines, diagnostic accuracy was calculated for delayed enhancement and FIDDLE imaging. Results In canines (n = 27), FIDDLE imaging was more sensitive (100% [23 of 23] vs 57% [13 of 23], P < .001) and accurate (100% [54 of 54] vs 80% [43 of 54], P = .01) than delayed enhancement imaging for detection of papMI. In 43 participants with myocardial infarction (mean age, 56 years ± 16 [SD]; 28 men), the infarct-related artery was the left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), and right coronary artery in 47% (20 of 43), 26% (11 of 43), and 28% (12 of 43), respectively. The prevalence of anterior papMI was lower than posterior papMI (37% [16 of 43 participants] vs 44% [19 of 43 participants]) despite more LAD culprit lesions. Culprits leading to papMI were restricted to a smaller "at-risk" portion of the coronary tree for anterior papMI (subtended first diagonal branch of the LAD or first marginal branch of the LCX) compared with posterior (subtended posterior descending artery or third obtuse marginal branch of the LCX). Culprits within these at-risk portions were predictive of papMI at a similar rate (anterior, 83% [15 of 18 participants] vs posterior, 86% [18 of 21 participants]). Conclusion Flow-independent dark-blood delayed enhancement cardiac MRI, unlike conventional delayed enhancement cardiac MRI, was highly accurate in the detection of papillary muscle infarction (papMI). Anterior papMI was less prevalent than posterior papMI, most likely due to culprit lesions being restricted to a smaller portion of the coronary tree rather than because of redundant, dual vascular supply. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Kawel-Boehm and Bremerich in this issue.
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Affiliation(s)
- David Wendell
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Elizabeth Jenista
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Han W. Kim
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Enn-Ling Chen
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Clerio F. Azevedo
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | | | - Fawaz Alenezi
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Wolfgang Rehwald
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Stephen Darty
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Michele Parker
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
| | - Raymond J. Kim
- From the Duke Cardiovascular Magnetic Resonance Center (D.W., E.J.,
H.W.K., E.L.C., C.F.A., Y.K., F.A., S.D., M.P., R.J.K.), Division of Cardiology
(D.W., E.J., H.W.K., E.L.C., C.F.A., F.A., S.D., M.P., R.J.K.), and Department
of Radiology (R.J.K.), Duke University Medical Center, DUMC-3934, Durham, NC
27710; and Siemens Healthineers, Malvern, Pa (W.R.)
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20
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Nies HMJM, Gommers S, Bijvoet GP, Heckman LIB, Prinzen FW, Vogel G, Van De Heyning CM, Chiribiri A, Wildberger JE, Mihl C, Holtackers RJ. Histopathological validation of semi-automated myocardial scar quantification techniques for dark-blood late gadolinium enhancement magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2022; 24:364-372. [PMID: 35723673 PMCID: PMC9936958 DOI: 10.1093/ehjci/jeac107] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS To evaluate the performance of various semi-automated techniques for quantification of myocardial infarct size on both conventional bright-blood and novel dark-blood late gadolinium enhancement (LGE) images using histopathology as reference standard. METHODS AND RESULTS In 13 Yorkshire pigs, reperfused myocardial infarction was experimentally induced. At 7 weeks post-infarction, both bright-blood and dark-blood LGE imaging were performed on a 1.5 T magnetic resonance scanner. Following magnetic resonance imaging (MRI), the animals were sacrificed, and histopathology was obtained. The percentage of infarcted myocardium was assessed per slice using various semi-automated scar quantification techniques, including the signal threshold vs. reference mean (STRM, using 3 to 8 SDs as threshold) and full-width at half-maximum (FWHM) methods, as well as manual contouring, for both LGE methods. Infarct size obtained by histopathology was used as reference. In total, 24 paired LGE MRI slices and histopathology samples were available for analysis. For both bright-blood and dark-blood LGE, the STRM method with a threshold of 5 SDs led to the best agreement to histopathology without significant bias (-0.23%, 95% CI [-2.99, 2.52%], P = 0.862 and -0.20%, 95% CI [-2.12, 1.72%], P = 0.831, respectively). Manual contouring significantly underestimated infarct size on bright-blood LGE (-1.57%, 95% CI [-2.96, -0.18%], P = 0.029), while manual contouring on dark-blood LGE outperformed semi-automated quantification and demonstrated the most accurate quantification in this study (-0.03%, 95% CI [-0.22, 0.16%], P = 0.760). CONCLUSION The signal threshold vs. reference mean method with a threshold of 5 SDs demonstrated the most accurate semi-automated quantification of infarcted myocardium, without significant bias compared to histopathology, for both conventional bright-blood and novel dark-blood LGE.
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Affiliation(s)
| | - Suzanne Gommers
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
| | - Geertruida P Bijvoet
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Luuk I B Heckman
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Frits W Prinzen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Gaston Vogel
- Pie Medical Imaging, Maastricht, The Netherlands
| | - Caroline M Van De Heyning
- Department of Cardiology, Antwerp University Hospital and GENCOR, University of Antwerp, Antwerp, Belgium
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
| | - Casper Mihl
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
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21
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Noninvasive Cardiac Imaging in Formerly Preeclamptic Women for Early Detection of Subclinical Myocardial Abnormalities: A 2022 Update. Biomolecules 2022; 12:biom12030415. [PMID: 35327607 PMCID: PMC8946283 DOI: 10.3390/biom12030415] [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: 02/01/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023] Open
Abstract
Preeclampsia is a maternal hypertensive disease, complicating 2–8% of all pregnancies. It has been linked to a 2–7-fold increased risk for the development of cardiovascular disease, including heart failure, later in life. A total of 40% of formerly preeclamptic women develop preclinical heart failure, which may further deteriorate into clinical heart failure. Noninvasive cardiac imaging could assist in the early detection of myocardial abnormalities, especially in the preclinical stage, when these changes are likely to be reversible. Moreover, imaging studies can improve our insights into the relationship between preeclampsia and heart failure and can be used for monitoring. Cardiac ultrasound is used to assess quantitative changes, including the left ventricular cavity volume and wall thickness, myocardial mass, systolic and diastolic function, and strain. Cardiac magnetic resonance imaging may be of additional diagnostic value to assess diffuse and focal fibrosis and perfusion. After preeclampsia, sustained elevated myocardial mass along with reduced myocardial circumferential and longitudinal strain and decreased diastolic function is reported. These findings are consistent with the early phases of heart failure, referred to as preclinical (asymptomatic) or B-stage heart failure. In this review, we will provide an up-to-date overview of the potential of cardiac magnetic resonance imaging and echocardiography in identifying formerly preeclamptic women who are at high risk for developing heart failure. The potential contribution to early cardiac screening of women with a history of preeclampsia and the pros and cons of these imaging modalities are outlined. Finally, recommendations for future research are presented.
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22
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Holtackers RJ, Emrich T, Botnar RM, Kooi ME, Wildberger JE, Kreitner KF. Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging: From Basic Concepts to Emerging Methods. ROFO-FORTSCHR RONTG 2022; 194:491-504. [PMID: 35196714 DOI: 10.1055/a-1718-4355] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) is a widely used cardiac magnetic resonance imaging (MRI) technique to diagnose a broad range of ischemic and non-ischemic cardiomyopathies. Since its development and validation against histology already more than two decades ago, the clinical utility of LGE and its span of applications have increased considerably. METHODS In this review we will present the basic concepts of LGE imaging and its diagnostic and prognostic value, elaborate on recent developments and emerging methods, and finally discuss future prospects. RESULTS Continuous developments in 3 D imaging methods, motion correction techniques, water/fat-separated imaging, dark-blood methods, and scar quantification improved the performance and further expanded the clinical utility of LGE imaging. CONCLUSION LGE imaging is the current noninvasive reference standard for the assessment of myocardial viability. Improvements in spatial resolution, scar-to-blood contrast, and water/fat-separated imaging further strengthened its position. KEY POINTS · LGE MRI is the reference standard for the noninvasive assessment of myocardial viability. · LGE MRI is used to diagnose a broad range of non-ischemic cardiomyopathies in everyday clinical practice.. · Improvements in spatial resolution and scar-to-blood contrast further strengthened its position. · Continuous developments improve its performance and further expand its clinical utility. CITATION FORMAT · Holtackers RJ, Emrich T, Botnar RM et al. Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging: From Basic Concepts to Emerging Methods. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1718-4355.
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Affiliation(s)
- Robert J Holtackers
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands.,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, the Netherlands.,School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.,Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - René M Botnar
- School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom.,Pontificia Universidad Católica de Chile, Escuela de Ingeniería, Santiago, Chile
| | - M Eline Kooi
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands.,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, the Netherlands
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands.,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, the Netherlands
| | - K-F Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Germany
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23
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Krittayaphong R, Zhang S, Tanapibunpon P, Kaolawanich Y, Nakyen S. Dark-blood late gadolinium-enhancement cardiac magnetic resonance imaging for myocardial scar detection based on simplified timing scheme: single-center experience in patients with suspected coronary artery disease. Quant Imaging Med Surg 2022; 12:1037-1050. [PMID: 35111603 DOI: 10.21037/qims-21-704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022]
Abstract
Background This study aims to examine scar detectability using dark-blood late gadolinium enhancement (LGE) with simplified timing scheme and fixed parameters comparing to two conventional bright-blood approaches in patients with known or suspected coronary artery disease. Methods Three LGE techniques were performed in all patients with known or suspected coronary artery disease at 3 T: dark blood two-dimensional (2D) phase-sensitive inversion recovery (PSIR) preceded with a T2-preparation pulse (DB-LGE), conventional three-dimensional (3D) gradient-echo inversion recovery (3D-IR) and conventional 2D PSIR. Timing parameters in DB-LGE were tested in five clinically confirmed coronary artery disease patients with scars and fixed for the rest of the study. Two independent readers evaluated images at both patient and segment levels. Image quality and contrast ratio between scar and adjacent tissues were assessed. Concordance between the three techniques and detection rate based on expert consensus were reported. Results Forty-six patients were recruited in the study (average age 66.8 years, 69.6% male). DB-LGE demonstrated superior image quality (P=0.001 vs. 3D-IR) and scar-to-blood contrast ratio (P<0.001 vs. 3D-IR and PSIR). Among 41 patients with suspected coronary artery disease, myocardial scar was present in 30 patients (73.2%), all detected by DB-LGE, yielding a detection rate of 100% compared to 93.3% and 96.7% for bright-blood 3D-IR and PSIR. For subendocardial scar detection among 656 segments, DB-LGE had a detection rate of 99.4% compared to 57.8% for 3D-IR and 61.0% for PSIR (both P<0.001). Conclusions DB-LGE improves detection of myocardial scar compared with conventional bright-blood LGE techniques, particularly of subendocardial scar.
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Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Shuo Zhang
- Philips Healthcare, Singapore.,Philips Healthcare, Hamburg, Germany
| | - Prajak Tanapibunpon
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yodying Kaolawanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaporn Nakyen
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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24
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Pype LL, Holtackers RJ, Paelinck BP, Bekelaar T, Heidbuchel H, Van De Heyning CM. Persistent microvascular obstruction-like lesion after ventricular tachycardia ablation detected by novel dark-blood late gadolinium enhancement. BJR Case Rep 2022; 8:20210124. [PMID: 36101728 PMCID: PMC9461736 DOI: 10.1259/bjrcr.20210124] [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: 06/25/2021] [Revised: 12/22/2021] [Accepted: 01/15/2022] [Indexed: 12/02/2022] Open
Abstract
Microvascular obstruction is a transient phenomenon of “no reflow” after myocardial infarction or radiofrequency ablation, diagnosed using late gadolinium enhancement cardiac MRI. We present a patient with a persistent microvascular obstruction-like lesion following radiofrequency ventricular tachycardia ablation post-myocardial infarction, which was best characterized by a novel dark-blood late gadolinium enhancement technique.
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Affiliation(s)
- Lobke L Pype
- Department of Cardiology, Antwerp University Hospital Drie Eikenstraat, Antwerp (Edegem), Belgium
- Research group Cardiovascular Diseases, GENCOR, Antwerp University Universiteitsplein, Antwerp, Belgium
| | - Robert J Holtackers
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre P. Debyelaan, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Duboisdomein, Maastricht, the Netherlands
| | - Bernard P Paelinck
- Research group Cardiovascular Diseases, GENCOR, Antwerp University Universiteitsplein, Antwerp, Belgium
- Department of Cardiac Surgery, Antwerp University Hospital, Drie Eikenstraat, Antwerp (Edegem), Belgium
| | - Thalia Bekelaar
- Department of Cardiology, Antwerp University Hospital Drie Eikenstraat, Antwerp (Edegem), Belgium
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital Drie Eikenstraat, Antwerp (Edegem), Belgium
- Research group Cardiovascular Diseases, GENCOR, Antwerp University Universiteitsplein, Antwerp, Belgium
| | - Caroline M Van De Heyning
- Department of Cardiology, Antwerp University Hospital Drie Eikenstraat, Antwerp (Edegem), Belgium
- Research group Cardiovascular Diseases, GENCOR, Antwerp University Universiteitsplein, Antwerp, Belgium
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25
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Van De Heyning CM, Holtackers RJ, Nazir MS, Grapsa J, Demetrescu C, Pype L, Chiribiri A. Dark-blood late gadolinium enhancement CMR improves detection of papillary muscle fibrosis in patients with mitral valve prolapse. Eur J Radiol 2021; 147:110118. [PMID: 34972057 DOI: 10.1016/j.ejrad.2021.110118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Papillary muscle fibrosis may act as an arrhythmogenic substrate in patients with mitral valve prolapse (MVP). Previous studies used conventional bright-blood late gadolinium enhancement cardiovascular magnetic resonance (LGE CMR) imaging to assess papillary muscle fibrosis, although this technique suffers from poor scar-to-blood contrast which may limit its sensitivity, in contrast to dark-blood LGE. This study sought to compare bright-blood and dark-blood LGE for the detection of papillary muscle fibrosis in patients with MVP. METHOD 60 patients with known isolated MVP referred for CMR were prospectively recruited. A routine CMR protocol was used to obtain cine imaging, dark-blood LGE and bright-blood LGE in three long-axis views and a stack of short-axis views. Flow mapping of the proximal aorta was performed to calculate mitral regurgitant volume. Images were analysed for cardiac volumes, ejection fraction, mitral regurgitation severity, MVP characteristics (mitral annular disjunction, prolapse volume) and presence of LGE at the papillary muscles and myocardium. RESULTS Dark-blood LGE detected significantly more subjects with LGE at the papillary muscles than bright-blood LGE (35% vs 15%, p = 0.002). There was no difference between LGE techniques regarding myocardial (non-papillary muscle) fibrosis (present in 25% each). No statistical differences were observed between patients with or without LGE at the papillary muscles regarding demographics, clinical data (including ventricular arrhythmia) and MVP characteristics. Furthermore, no association was found between LGE at the papillary muscles and at the myocardium. CONCLUSIONS Compared to bright-blood LGE, dark-blood LGE CMR improves the detection of LGE at the papillary muscles in patients with MVP.
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Affiliation(s)
- Caroline M Van De Heyning
- Cardiovascular Diseases Research Group, GENCOR, University of Antwerp, and Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium; Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Robert J Holtackers
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, and Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Muhummad Sohaib Nazir
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Julia Grapsa
- Department of Cardiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Camelia Demetrescu
- Department of Cardiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Lobke Pype
- Cardiovascular Diseases Research Group, GENCOR, University of Antwerp, and Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Amedeo Chiribiri
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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26
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Holtackers RJ, Gommers S, Heckman LIB, Van De Heyning CM, Chiribiri A, Prinzen FW. Histopathological Validation of Dark-Blood Late Gadolinium Enhancement MRI Without Additional Magnetization Preparation. J Magn Reson Imaging 2021; 55:190-197. [PMID: 34169603 PMCID: PMC9290659 DOI: 10.1002/jmri.27805] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 12/18/2022] Open
Abstract
Background Conventional bright‐blood late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (MRI) often suffers from poor scar‐to‐blood contrast due to the bright blood pool adjacent to the enhanced scar tissue. Recently, a dark‐blood LGE method was developed which increases scar‐to‐blood contrast without using additional magnetization preparation. Purpose We aim to histopathologically validate this dark‐blood LGE method in a porcine animal model with induced myocardial infarction (MI). Study Type Prospective. Animal Model Thirteen female Yorkshire pigs. Field Strength/Sequence 1.5 T, two‐dimensional phase‐sensitive inversion‐recovery radiofrequency‐spoiled turbo field‐echo. Assessment MI was experimentally induced by transient coronary artery occlusion. At 1‐week and 7‐week post‐infarction, in‐vivo cardiac MRI was performed including conventional bright‐blood and novel dark‐blood LGE. Following the second MRI examination, the animals were sacrificed, and histopathology was obtained. Matching LGE slices and histopathology samples were selected based on anatomical landmarks. Independent observers, while blinded to other data, manually delineated the endocardial, epicardial, and infarct borders on either LGE images or histopathology samples. The percentage of infarcted left‐ventricular myocardium was calculated for both LGE methods on a per‐slice basis, and compared with histopathology as reference standard. Contrast‐to‐noise ratios were calculated for both LGE methods at 1‐week and 7‐week post‐infarction. Statistical Tests Pearson's correlation coefficient and paired‐sample t‐tests were used. Significance was set at P < 0.05. Results A combined total of 24 matched LGE and histopathology slices were available for histopathological validation. Dark‐blood LGE demonstrated a high level of agreement compared to histopathology with no significant bias (−0.03%, P = 0.75). In contrast, bright‐blood LGE showed a significant bias of −1.57% (P = 0.03) with larger 95% limits of agreement than dark‐blood LGE. Image analysis demonstrated significantly higher scar‐to‐blood contrast for dark‐blood LGE compared to bright‐blood LGE, at both 1‐week and 7‐weeks post‐infarction. Data Conclusion Dark‐blood LGE without additional magnetization preparation provides superior visualization and quantification of ischemic scar compared to the current in vivo reference standard. Level of Evidence 1 Technical Efficacy Stage 2
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Affiliation(s)
- Robert J Holtackers
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Suzanne Gommers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Luuk I B Heckman
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | | | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Frits W Prinzen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Physiology, Maastricht University, Maastricht, The Netherlands
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