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Székely A, Steding-Ehrenborg K, Ryd D, Hedeer F, Valind K, Akil S, Hindorf C, Hedström E, Erlinge D, Arheden H, Engblom H. Quantitative myocardial perfusion should be interpreted in the light of sex and comorbidities in patients with suspected chronic coronary syndrome: A cardiac positron emission tomography study. Clin Physiol Funct Imaging 2024; 44:89-99. [PMID: 37642142 DOI: 10.1111/cpf.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/13/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
Diagnosis and treatment of patients with suspected chronic coronary syndrome (CCS) currently relies on the degree of coronary artery stenosis and its significance for myocardial perfusion. However, myocardial perfusion can be affected by factors other than coronary stenosis. The aim of this study was to investigate to what extent sex, age, diabetes, hypertension and smoking affect quantitative myocardial perfusion, beyond the degree of coronary artery stenosis, in patients with suspected or established CCS. Eighty-six patients [median age 69 (range 46-86) years, 24 females] planned for elective coronary angiography due to suspected or established CCS were included. All patients underwent cardiac 13 N-NH3 positron emission tomography to quantify myocardial perfusion at rest and stress. Lowest myocardial perfusion (perfusionmin ) at stress and rest and lowest myocardial perfusion reserve (MPRmin ) for all vessel territories was used as dependent variables in a linear mixed model. Independent variables were vessel territory, degree of coronary artery stenosis (as a continuous variable of 0%-100% stenosis), sex, age, diabetes, hypertension and smoking habits. Degree of coronary artery stenosis (p < 0.001), male sex (1.8 ± 0.6 vs. 2.3 ± 0.6 mL/min/g, p < 0.001), increasing age (p = 0.025), diabetes (1.6 ± 0.5 vs. 2.0 ± 0.6 mL/min/g, p = 0.023) and smoking (1.9 ± 0.6 vs. 2.1 ± 0.6 mL/min/g, p = 0.052) were independently associated with myocardial perfusionmin at stress. Degree of coronary artery stenosis (p < 0.001), age (p = 0.040), diabetes (1.8 ± 0.6 vs. 2.3 ± 0.7, p = 0.046) and hypertension (2.2 ± 0.7 vs. 2.5 ± 0.6, p = 0.033) were independently associated with MPRmin . Sex, increasing age, diabetes, hypertension and smoking affect myocardial perfusion independent of coronary artery stenosis in patients with suspected or established CCS. Thus, these factors need to be considered when assessing the significance of reduced quantitative myocardial perfusion of patients with suspected or established CCS.
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Affiliation(s)
- Anna Székely
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Fredrik Hedeer
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Kristian Valind
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Shahnaz Akil
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Cecilia Hindorf
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - David Erlinge
- Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Henrik Engblom
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Fricke K, Ryd D, Weismann CG, Hanséus K, Hedström E, Liuba P. Fetal cardiac magnetic resonance imaging of the descending aorta in suspected left-sided cardiac obstructions. Front Cardiovasc Med 2023; 10:1285391. [PMID: 38107261 PMCID: PMC10725198 DOI: 10.3389/fcvm.2023.1285391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
Background Severe left-sided cardiac obstructions are associated with high morbidity and mortality if not detected in time. The correct prenatal diagnosis of coarctation of the aorta (CoA) is difficult. Fetal cardiac magnetic resonance imaging (CMR) may improve the prenatal diagnosis of complex congenital heart defects. Flow measurements in the ascending aorta could aid in predicting postnatal CoA, but its accurate visualization is challenging. Objectives To compare the flow in the descending aorta (DAo) and umbilical vein (UV) in fetuses with suspected left-sided cardiac obstructions with and without the need for postnatal intervention and healthy controls by fetal phase-contrast CMR flow. A second objective was to determine if adding fetal CMR to echocardiography (echo) improves the fetal CoA diagnosis. Methods Prospective fetal CMR phase-contrast flow in the DAo and UV and echo studies were conducted between 2017 and 2022. Results A total of 46 fetuses with suspected left-sided cardiac obstructions [11 hypoplastic left heart syndrome (HLHS), five critical aortic stenosis (cAS), and 30 CoA] and five controls were included. Neonatal interventions for left-sided cardiac obstructions (n = 23) or comfort care (n = 1 with HLHS) were pursued in all 16 fetuses with suspected HLHS or cAS and in eight (27%) fetuses with true CoA. DAo or UV flow was not different in fetuses with and without need of intervention. However, DAo and UV flows were lower in fetuses with either retrograde isthmic systolic flow [DAo flow 253 (72) vs. 261 (97) ml/kg/min, p = 0.035; UV flow 113 (75) vs. 161 (81) ml/kg/min, p = 0.04] or with suspected CoA and restrictive atrial septum [DAo flow 200 (71) vs. 268 (94) ml/kg/min, p = 0.04; UV flow 89 vs. 159 (76) ml/kg/min, p = 0.04] as well as in those without these changes. Adding fetal CMR to fetal echo predictors for postnatal CoA did not improve the diagnosis of CoA. Conclusion Fetal CMR-derived DAo and UV flow measurements do not improve the prenatal diagnosis of left-sided cardiac obstructions, but they could be important in identifying fetuses with a more severe decrease in blood flow across the left side of the heart. The physiological explanation may be a markedly decreased left ventricular cardiac output with subsequent retrograde systolic isthmic flow and decreased total DAo flow.
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Affiliation(s)
- Katrin Fricke
- Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
- Pediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
| | - Constance G. Weismann
- Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
- Pediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilian University, Munich, Germany
| | - Katarina Hanséus
- Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Diagnostic Radiology, Skåne University Hospital, Lund, Sweden
| | - Petru Liuba
- Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
- Pediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Hedström E, Piek M, Bidhult-Johansson S, Ryd D, Testud F, Töger J, Aletras AH. Factors affecting performance of fetal blood T 2 measurements for noninvasive estimation of oxygen saturation. Magn Reson Med 2023; 90:2472-2485. [PMID: 37582228 DOI: 10.1002/mrm.29821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/19/2023] [Accepted: 07/18/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE To ultimately make accurate and precise fetal noninvasive oxygen saturation (sO2 ) measurements by T2 -prepared bSSFP more widely available by systematically assessing error sources in order to potentially reduce perinatal mortality in cardiovascular malformations and fetal growth restriction. METHODS T2 -prepared bSSFP data were acquired in phantoms; in flowing blood in adults in the superior sagittal sinus, ascending and descending aorta, and main pulmonary artery; and in the fetal descending aorta and umbilical vein. T2 was assessed in relation to T2 two- or three-parameter curve-fitting techniques, SSFP readout, refocusing time delay (τ), constant and pulsatile blood flow, and impact of T1 recovery. Further, fetal T2 and sO2 variability were quantified in the descending aorta and umbilical vein in healthy fetuses and fetuses with cardiovascular malformation (gestational weeks 32-38). RESULTS In phantoms, three-parameter fitting was accurate irrespective of phase FOV (<4 ms; i.e., <2%), and T2 was overestimated (up to 23 ms/10%; p = 0.001) beyond ±30 Hz off-resonance. In the adult aorta, T2 was underestimated during higher blood flow velocities and pulsatility for τ = 16 ms (-41 ms/-17%; p = 0.008). In fetuses, two-parameter fitting overestimated T2 compared with three-parameter fitting (+33 ms/+18%; p = 0.03). T2 variability was 18 ms/15% in the fetal descending aorta and 28 ms/14% in the umbilical vein. The resulting estimated sO2 variability was ∼10% (15% of sO2 value) in the fetal descending aorta. CONCLUSIONS Errors due to T2 -fitting techniques, off-resonance, flow velocity, and insufficient T1 recovery between image acquisitions could be mitigated by using three-parameter fitting with included saturation-prepared images approximating infinite T2 -preparation time, adequate shimming covering the fetus and placenta, and by modifying acquisition parameters. Variability in fetal blood T2 and sO2 , however, indicate that it is currently not feasible to use these methods for prediction of disease.
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Affiliation(s)
- Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
- Department of Radiology, Skåne University Hospital, Lund, Sweden
| | - Marjolein Piek
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
| | | | - Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
| | | | - Johannes Töger
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anthony H Aletras
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Frieberg P, Sjöberg P, Hedström E, Carlsson M, Liuba P. In vivo hepatic flow distribution by computational fluid dynamics can predict pulmonary flow distribution in patients with Fontan circulation. Sci Rep 2023; 13:18206. [PMID: 37875552 PMCID: PMC10598063 DOI: 10.1038/s41598-023-45396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023] Open
Abstract
In Fontan patients, a lung deprived of hepatic blood may develop pulmonary arterio-venous malformations (PAVMs) resulting in shunting, reduced pulmonary vascular resistance (PVR) and decreased oxygenation. To provide guidance for corrective invasive interventions, we aimed to non-invasively determine how the hepatic to pulmonary blood flow balance correlates with pulmonary flow, PVR, and with oxygen saturation. Magnetic resonance imaging (MRI) data from eighteen Fontan patients (eight females, age 3-14 years) was used to construct patient-specific computational fluid dynamics (CFD) models to calculate the hepatic to pulmonary blood flow. This was correlated with pulmonary vein flow, simulated PVR and oxygen saturation. Clinical applicability of the findings was demonstrated with an interventional patient case. The hepatic to pulmonary blood flow balance correlated with right/left pulmonary vein flow (R2 = 0.50), left/right simulated PVR (R2 = 0.47), and oxygen saturation at rest (R2 = 0.56). In the interventional patient, CFD predictions agreed with post-interventional MRI measurements and with regressions in the cohort. The balance of hepatic blood to the lungs has a continuous effect on PVR and oxygen saturation, even without PAVM diagnosis. MRI combined with CFD may help in planning of surgical and interventional designs affecting the hepatic to pulmonary blood flow balance in Fontan patients.
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Affiliation(s)
- Petter Frieberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
| | - Pia Sjöberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Petru Liuba
- Department of Clinical Sciences Lund, Pediatric Heart Center, Lund University, Skåne University Hospital, Lund, Sweden
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Liefke J, Sepúlveda-Martinez A, Shakya S, Ehrenborg KS, Arheden H, Morsing E, Ley D, Heiberg E, Hedström E. Early-Onset Fetal Growth Restriction Increases Left Ventricular Sphericity in Adolescents Born Very Preterm. Pediatr Cardiol 2023:10.1007/s00246-023-03265-z. [PMID: 37596421 DOI: 10.1007/s00246-023-03265-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/04/2023] [Indexed: 08/20/2023]
Abstract
Left ventricular shape alterations predict cardiovascular outcomes and have been observed in children born preterm and after fetal growth restriction (FGR). The aim was to investigate whether left ventricular shape is altered in adolescents born very preterm and if FGR has an additive effect. Adolescents born very preterm due to verified early-onset FGR and two control groups with birthweight appropriate for gestational age (AGA), born at similar gestational age and at term, respectively, underwent cardiac MRI. Principal component analysis was applied to find the modes of variation best explaining shape variability for end-diastole, end-systole, and for the combination of both, the latter indicative of function. Seventy adolescents were included (13-16 years; 49% males). Sphericity was increased for preterm FGR versus term AGA for end-diastole (36[0-60] vs - 42[- 82-8]; p = 0.01) and the combined analysis (27[- 23-94] vs - 51[- 119-11]; p = 0.01), as well as for preterm AGA versus term AGA for end-diastole (30[- 56-115] vs - 42[- 82-8]; p = 0.04), for end-systole (57[- 29-89] vs - 30[- 79-34]; p = 0.03), and the combined analysis (44[- 50-145] vs - 51[- 119-11]; p = 0.02). No group differences were observed for left ventricular mass or ejection fraction (all p ≥ 0.33). Sphericity was increased after very preterm birth and exacerbated by early-onset FGR, indicating an additive effect to that of very preterm birth on left ventricular remodeling. Increased sphericity may be a prognostic biomarker of future cardiovascular disease in this cohort that as of yet shows no signs of cardiac dysfunction using standard clinical measurements.
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Affiliation(s)
- Jonas Liefke
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Alvaro Sepúlveda-Martinez
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Clínico de La Universidad de Chile, Santiago de Chile, Chile
| | - Snehlata Shakya
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Eva Morsing
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | - David Ley
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden.
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Radiology, Skåne University Hospital, Lund, Sweden.
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Johansson M, Binka E, Barnes B, Gaur L, Hedström E, Kutty S, Carlsson M. Correction: Right ventricular longitudinal function is linked to left ventricular filling pressure in patients with repaired tetralogy of Fallot. Int J Cardiovasc Imaging 2023; 39:1615-1616. [PMID: 37211581 PMCID: PMC10427521 DOI: 10.1007/s10554-023-02854-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Martin Johansson
- Department of Pediatrics, Blalock-Taussig-Thomas Heart Center, Johns Hopkins Hospital, Baltimore, MD USA
| | - Edem Binka
- Department of Pediatrics, Blalock-Taussig-Thomas Heart Center, Johns Hopkins Hospital, Baltimore, MD USA
| | - Benjamin Barnes
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Lasya Gaur
- Department of Pediatrics, Blalock-Taussig-Thomas Heart Center, Johns Hopkins Hospital, Baltimore, MD USA
| | - Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Shelby Kutty
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Pediatric Anesthesia and Intensive Care, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Division of Pediatric Cardiology, Johns Hopkins Hospital, Baltimore, MD USA
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Piek M, Ryd D, Töger J, Testud F, Hedström E, Aletras AH. Fetal 3D cardiovascular cine image acquisition using radial sampling and compressed sensing. Magn Reson Med 2023; 89:594-604. [PMID: 36156292 PMCID: PMC10087603 DOI: 10.1002/mrm.29467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/09/2022] [Accepted: 09/04/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To explore a fetal 3D cardiovascular cine acquisition using a radial image acquisition and compressed-sensing reconstruction and compare image quality and scan time with conventional multislice 2D imaging. METHODS Volumetric fetal cardiac data were acquired in 26 volunteers using a radial 3D balanced SSFP pulse sequence. Cardiac gating was performed using a Doppler ultrasound device. Images were reconstructed using a parallel-imaging and compressed-sensing algorithm. Multiplanar reformatting to standard cardiac views was performed before image analysis. Clinical 2D images were used for comparison. Qualitative and quantitative image evaluation were performed by two experienced observers (scale: 1-4). Volumes, mass, and function were assessed. RESULTS Average scan time for the 3D imaging was 6 min, including one localizer. A 2D imaging stack covering the entire heart including localizer sequences took at least 6.5 min, depending on planning complexity. The 3D acquisition was successful in 7 of 26 subjects (27%). Overall image contrast and perceived resolution were lower in the 3D images. Nonetheless, the 3D images had, on average, a moderate cardiac diagnostic quality (median [range]: 3 [1-4]). Standard clinical 2D acquisitions had a high cardiac diagnostic quality (median [range]: 4 [3, 4]). Cardiac measurements were not different between 2D and 3D images (all p > 0.16). CONCLUSION The presented free-breathing whole-heart fetal 3D radial cine MRI acquisition and reconstruction method enables retrospective visualization of all cardiac views while keeping examination times short. This proof-of-concept work produced images with diagnostic quality, while at the same time reducing the planning complexity to a single localizer.
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Affiliation(s)
- Marjolein Piek
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Johannes Töger
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.,Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anthony H Aletras
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.,Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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8
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Johansson M, Binka E, Barnes B, Gaur L, Hedström E, Kutty S, Carlsson M. Right ventricular longitudinal function is linked to left ventricular filling pressure in patients with repaired tetralogy of fallot. Int J Cardiovasc Imaging 2023; 39:401-409. [PMID: 36115891 PMCID: PMC9870964 DOI: 10.1007/s10554-022-02728-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/05/2022] [Indexed: 01/27/2023]
Abstract
Experimental data on pulmonary regurgitation has linked right ventricular longitudinal function to left ventricular filling pressure in animals with induced and treated pulmonary regurgitation but this relationship has not been investigated in patients with repaired Tetralogy of Fallot (rToF). The aim of this study was to determine if right ventricular longitudinal function assessed using cardiovascular magnetic resonance (CMR) is associated with left ventricular filling pressure in patients with rToF. A second objective of this study was to determine if direction of septal movement is related to right ventricular pressure load in rToF. Eighteen patients with rToF undergoing CMR and heart catheterization prior to pulmonary valve replacement were retrospectively included and catheter-based pressure measurements were compared with CMR-derived RV regional function. Left ventricular filling pressure was measured as precapillary wedge pressure (PCWP). Longitudinal contribution to RV stroke volume correlated with PCWP (r = 0.48; p = 0.046) but not with RV EF or pulmonary regurgitation. Neither RV longitudinal strain nor TAPSE showed correlation with PCWP. Longitudinal contribution to stroke volume was lower for the RV compared to the LV (49 vs 54%; p = 0.039). Direction of septal movement did not show a correlation with RV end-systolic pressure. Right ventricular longitudinal pumping is associated with left ventricular filling pressure in rToF-patients and this inter-ventricular coupling may explain LV underfilling in patients with pulmonary regurgitation and rToF and may be of value to determine right ventricular dysfunction. RV systolic pressure, however, cannot be assessed from the direction of septal movement, in these patients.
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Affiliation(s)
- Martin Johansson
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden ,Department of Clinical Sciences Lund, Pediatric Anesthesia and Intensive Care, Lund University, Skåne University Hospital, Lund, Sweden
| | - Edem Binka
- Division of Pediatric Cardiology, Johns Hopkins Hospital, Baltimore, MD USA
| | - Benjamin Barnes
- Department of Pediatrics, Blalock-Taussig-Thomas Heart Center, Johns Hopkins Hospital, Baltimore, MD USA
| | - Lasya Gaur
- Department of Pediatrics, Blalock-Taussig-Thomas Heart Center, Johns Hopkins Hospital, Baltimore, MD USA
| | - Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden ,Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Shelby Kutty
- Department of Pediatrics, Blalock-Taussig-Thomas Heart Center, Johns Hopkins Hospital, Baltimore, MD USA
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden ,National Heart, Lung, and Blood Institute, NIH*, Maryland, USA
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9
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Sjöberg P, Hedström E, Fricke K, Frieberg P, Weismann CG, Liuba P, Carlsson M, Töger J. Comparison of 2D and 4D Flow MRI in Neonates Without General Anesthesia. J Magn Reson Imaging 2023; 57:71-82. [PMID: 35726779 PMCID: PMC10084310 DOI: 10.1002/jmri.28303] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Neonates with critical congenital heart disease require early intervention. Four-dimensional (4D) flow may facilitate surgical planning and improve outcome, but accuracy and precision in neonates are unknown. PURPOSE To 1) validate two-dimensional (2D) and 4D flow MRI in a phantom and investigate the effect of spatial and temporal resolution; 2) investigate accuracy and precision of 4D flow and internal consistency of 2D and 4D flow in neonates; and 3) compare scan time of 4D flow to multiple 2D flows. STUDY TYPE Phantom and prospective patients. POPULATION A total of 17 neonates with surgically corrected aortic coarctation (age 18 days [IQR 11-20]) and a three-dimensional printed neonatal aorta phantom. FIELD STRENGTH/SEQUENCE 1.5T, 2D flow and 4D flow. ASSESSMENT In the phantom, 2D and 4D flow volumes (ascending and descending aorta, and aortic arch vessels) with different resolutions were compared to high-resolution reference 2D flow. In neonates, 4D flow was compared to 2D flow volumes at each vessel. Internal consistency was computed as the flow volume in the ascending aorta minus the sum of flow volumes in the aortic arch vessels and descending aorta, divided by ascending aortic flow. STATISTICAL TESTS Bland-Altman plots, Pearson correlation coefficient (r), and Student's t-tests. RESULTS In the phantom, 2D flow differed by 0.01 ± 0.02 liter/min with 1.5 mm spatial resolution and -0.01 ± 0.02 liter/min with 0.8 mm resolution; 4D flow differed by -0.05 ± 0.02 liter/min with 2.4 mm spatial and 42 msec temporal resolution, -0.01 ± 0.02 liter/min with 1.5 mm, 42 msec resolution and -0.01 ± 0.02 liter/min with 1.5 mm, 21 msec resolution. In patients, 4D flow and 2D flow differed by -0.06 ± 0.08 liter/min. Internal consistency in patients was -11% ± 17% for 2D flow and 5% ± 13% for 4D flow. Scan time was 17.1 minutes [IQR 15.5-18.5] for 2D flow and 6.2 minutes [IQR 5.3-6.9] for 4D flow, P < 0.0001. DATA CONCLUSION Neonatal 4D flow MRI is time efficient and can be acquired with good internal consistency without contrast agents or general anesthesia, thus potentially expanding 4D flow use to the youngest and smallest patients. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Pia Sjöberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund.,Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katrin Fricke
- Pediatric Heart Center, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Petter Frieberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund
| | - Constance G Weismann
- Pediatric Heart Center, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Petru Liuba
- Pediatric Heart Center, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund
| | - Johannes Töger
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund
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10
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Liefke J, Steding-Ehrenborg K, Sjöberg P, Ryd D, Morsing E, Arheden H, Ley D, Hedström E. Higher blood pressure in adolescent boys after very preterm birth and fetal growth restriction. Pediatr Res 2022:10.1038/s41390-022-02367-3. [PMID: 36344695 DOI: 10.1038/s41390-022-02367-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although preterm birth predisposes for cardiovascular disease, recent studies in children indicate normal blood pressure and arterial stiffness. This prospective cohort study therefore assessed blood pressure and arterial stiffness in adolescents born very preterm due to verified fetal growth restriction (FGR). METHODS Adolescents (14 (13-17) years; 52% girls) born very preterm with FGR (preterm FGR; n = 24) and two control groups born with appropriate birth weight (AGA), one in similar gestation (preterm AGA; n = 27) and one at term (term AGA; n = 28) were included. 24-hour ambulatory blood pressure and aortic pulse wave velocity (PWV) and distensibility by magnetic resonance imaging were acquired. RESULTS There were no group differences in prevalence of hypertension or in arterial stiffness (all p ≥ 0.1). In boys, diastolic and mean arterial blood pressures increased from term AGA to preterm AGA to preterm FGR with higher daytime and 24-hour mean arterial blood pressures in the preterm FGR as compared to the term AGA group. In girls, no group differences were observed (all p ≥ 0.1). CONCLUSIONS Very preterm birth due to FGR is associated with higher, yet normal blood pressure in adolescent boys, suggesting an existing but limited impact of very preterm birth on cardiovascular risk in adolescence, enhanced by male sex and FGR. IMPACT Very preterm birth due to fetal growth restriction was associated with higher, yet normal blood pressure in adolescent boys. In adolescence, very preterm birth due to fetal growth restriction was not associated with increased thoracic aortic stiffness. In adolescence, very preterm birth in itself showed an existing but limited effect on blood pressure and thoracic aortic stiffness. Male sex and fetal growth restriction enhanced the effect of preterm birth on blood pressure in adolescence. Male sex and fetal growth restriction should be considered as additional risk factors to that of preterm birth in cardiovascular risk stratification.
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Affiliation(s)
- Jonas Liefke
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Pia Sjöberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Eva Morsing
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - David Ley
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden. .,Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
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11
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Ryd D, Nilsson A, Heiberg E, Hedström E. Automatic Segmentation of the Fetus in 3D Magnetic Resonance Images Using Deep Learning: Accurate and Fast Fetal Volume Quantification for Clinical Use. Pediatr Cardiol 2022:10.1007/s00246-022-03038-0. [PMID: 36334112 DOI: 10.1007/s00246-022-03038-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Magnetic resonance imaging (MRI) provides images for estimating fetal volume and weight, but manual delineations are time consuming. The aims were to (1) validate an algorithm to automatically quantify fetal volume by MRI; (2) compare fetal weight by Hadlock's formulas to that of MRI; and (3) quantify fetal blood flow and index flow to fetal weight by MRI. Forty-two fetuses at 36 (29-39) weeks gestation underwent MRI. A neural network was trained to segment the fetus, with 20 datasets for training and validation, and 22 for testing. Hadlock's formulas 1-4 with biometric parameters from MRI were compared with weight by MRI. Blood flow was measured using phase-contrast MRI and indexed to fetal weight. Bland-Altman analysis assessed the agreement between automatic and manual fetal segmentation and the agreement between Hadlock's formulas and fetal segmentation for fetal weight. Bias and 95% limits of agreement were for automatic versus manual measurements 4.5 ± 351 ml (0.01% ± 11%), and for Hadlock 1-4 vs MRI 108 ± 435 g (3% ± 14%), 211 ± 468 g (7% ± 15%), 106 ± 425 g (4% ± 14%), and 179 ± 472 g (6% ± 15%), respectively. Umbilical venous flow was 406 (range 151-650) ml/min (indexed 162 (range 52-220) ml/min/kg), and descending aortic flow was 763 (range 481-1160) ml/min (indexed 276 (range 189-386) ml/min/kg). The automatic method showed good agreement with manual measurements and saves considerable analysis time. Hadlock 1-4 generally agree with MRI. This study also illustrates the confounding effects of fetal weight on absolute blood flow, and emphasizes the benefit of indexed measurements for physiological assessment.
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Affiliation(s)
- Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Amanda Nilsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden. .,Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.
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12
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Lundström S, Liefke J, Heiberg E, Hedström E. Pulse Wave Velocity Measurements by Magnetic Resonance Imaging in Neonates and Adolescents: Methodological Aspects and Their Clinical Implications. Pediatr Cardiol 2022; 43:1631-1644. [PMID: 35396945 PMCID: PMC9489561 DOI: 10.1007/s00246-022-02894-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
Abstract
Pulse wave velocity (PWV) by cardiovascular magnetic resonance (CMR) lacks standardization. The aim of this study was to investigate methodological aspects of PWV measurements by CMR in neonates and adolescents. A computer phantom was created to validate the temporal resolution required for accurate PWV. Fifteen neonates and 71 adolescents underwent CMR with reference standard 3D angiography and phase-contrast flow acquisitions, and in a subset coronal overview images. Velocity and flow curves, transit time methods (time-to-foot (TTF), maximum upslope, and time-to-peak (TTP)), and baseline correction methods (no correction, automatic and manual) were investigated. In neonates, required timeframes per cardiac cycle for accurate PWV was 42 for the aortic arch and 41 for the thoracic aorta. In adolescents, corresponding values were 39 and 32. Aortic length differences by overview images and 3D angiography in adolescents were - 16-18 mm (aortic arch) and - 25-30 mm (thoracic aorta). Agreement in PWV between automatic and manual baseline correction was - 0.2 ± 0.3 m/s in neonates and 0.0 ± 0.1 m/s in adolescents. Velocity and flow-derived PWV measurements did not differ in either group (all p > 0.08). In neonates, transit time methods did not differ (all p > 0.19) but in adolescents PWV was higher for TTF (3.8 ± 0.5 m/s) and maximum upslope (3.7 ± 0.6 m/s) compared to TTP (2.7 ± 1.0 m/s; p < 0.0001). This study is a step toward standardization of PWV in neonates and adolescents using CMR. It provides required temporal resolution for phase-contrast flow acquisitions for typical heartrates in neonates and adolescents, and supports 3D angiography and time-to-foot with automatic baseline correction for accurate PWV measurements.
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Affiliation(s)
- Simon Lundström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jonas Liefke
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
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13
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Kalapotharakos G, Ryd D, Steding-Ehrenborg K, Andersson MEV, Arheden H, Hansson SR, Hedström E. Corrigendum to "Cardiovascular effects of severe late-onset preeclampsia are reversed within six months postpartum" [Preg. Hypertens. 19 (2020) 18-24]. Pregnancy Hypertens 2022; 30:95. [PMID: 36113247 DOI: 10.1016/j.preghy.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Grigorios Kalapotharakos
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Obstetrics and Gynaecology, Lund, Sweden
| | - Daniel Ryd
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden; Lund University, Skåne University Hospital, Department of Health Sciences, Physiotherapy, Lund, Sweden
| | - Maria E V Andersson
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Obstetrics and Gynaecology, Lund, Sweden
| | - Håkan Arheden
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden
| | - Stefan R Hansson
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Obstetrics and Gynaecology, Lund, Sweden
| | - Erik Hedström
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Diagnostic Radiology, Lund, Sweden.
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14
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Ryd D, Sun L, Steding-Ehrenborg K, Bidhult S, Kording F, Ruprecht C, Macgowan CK, Seed M, Aletras AH, Arheden H, Hedström E. Correction to: Quantification of blood flow in the fetus with cardiovascular magnetic resonance imaging using Doppler ultrasound gating: validation against metric optimized gating. J Cardiovasc Magn Reson 2022; 24:22. [PMID: 35365154 PMCID: PMC8973891 DOI: 10.1186/s12968-022-00850-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Liqun Sun
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Sebastian Bidhult
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Fabian Kording
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Ruprecht
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher K Macgowan
- Department of Medical Biophysics, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Michael Seed
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
- Department of Diagnostic Imaging, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada
| | - Anthony H Aletras
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- School of Medicine, Laboratory of Computing, Medical Informatics and Biomedical, Imaging Technologies, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.
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15
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Hedström E, Ishida M, Sepúlveda-Martínez A, Ryd D, Sperling J, Engblom H, Nagel E. Correction to: The effect of initial teaching on evaluation of left ventricular volumes by cardiovascular magnetic resonance imaging: comparison between complete and intermediate beginners and experienced observers. BMC Med Imaging 2022; 22:41. [PMID: 35272612 PMCID: PMC8915522 DOI: 10.1186/s12880-022-00771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Erik Hedström
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK. .,BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trusts and King's College London, London, UK. .,Skane University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Lund, Sweden. .,Skane University Hospital, Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden.
| | - Masaki Ishida
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trusts and King's College London, London, UK
| | - Alvaro Sepúlveda-Martínez
- Skane University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Lund, Sweden.,Fetal I + D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, and Centre for Biomedical Research On Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Daniel Ryd
- Skane University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Lund, Sweden
| | - Johannes Sperling
- Skane University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Lund, Sweden
| | - Henrik Engblom
- Skane University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Lund, Sweden
| | - Eike Nagel
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trusts and King's College London, London, UK.,Institute for Experimental and Translational Cardiovascular Imaging, Goethe University, Frankfurt/Main and DZHK (German Centre for Cardiovascular Research, Standort RheinMain), Frankfurt, Germany
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16
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Liefke J, Steding-Ehrenborg K, Asgeirsson D, Nordlund D, Kopic S, Morsing E, Hedström E. Non-contrast-enhanced magnetic resonance imaging can be used to assess renal cortical and medullary volumes—A validation study. Acta Radiol Open 2022; 11:20584601211072281. [PMID: 35096415 PMCID: PMC8796087 DOI: 10.1177/20584601211072281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) biomarkers can diagnose and prognosticate kidney disease. Renal volume validation studies are however scarce, and measurements are limited by use of contrast agent or advanced post-processing. Purpose To validate a widely available non-contrast-enhanced MRI method for quantification of renal cortical and medullary volumes in pigs; investigate observer variability of cortical and medullary volumes in humans; and present reference values for renal cortical and medullary volumes in adolescents. Materials and Methods Cortical and medullary volumes were quantified from transaxial in-vivo water-excited MR images in six pigs and 15 healthy adolescents (13–16years). Pig kidneys were excised, and renal cortex and medulla were separately quantified by the water displacement method. Both limits of agreement by the Bland-Altman method and reference ranges are presented as 2.5–97.5 percentiles. Results Agreement between MRI and ex-vivo quantification were -7 mL (-10–0 mL) for total parenchyma, -4 mL (-9–3 mL) for cortex, and -2 mL (-7–2 mL) for medulla. Intraobserver variability for pig and human kidneys were <5% for total parenchyma, cortex, and medulla. Interobserver variability for both pig and human kidneys were ≤4% for total parenchyma and cortex, and 6% and 12% for medulla. Reference ranges indexed for body surface area and sex were 54–103 mL/m2 (boys) and 56–103 mL/m2 (girls) for total parenchyma, 39–62 mL/m2 and 36–68 mL/m2 for cortex, and 16–45 mL/m2 and 17–42 mL/m2 for medulla. Conclusion The proposed widely available non-contrast-enhanced MRI method can quantify cortical and medullary renal volumes and can be directly implemented clinically.
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Affiliation(s)
- Jonas Liefke
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | | | - David Nordlund
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Sascha Kopic
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Eva Morsing
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Erik Hedström
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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17
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Berggren K, Ryd D, Heiberg E, Aletras AH, Hedström E. Super-Resolution Cine Image Enhancement for Fetal Cardiac Magnetic Resonance Imaging. J Magn Reson Imaging 2021; 56:223-231. [PMID: 34652860 DOI: 10.1002/jmri.27956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Fetal cardiac magnetic resonance imaging (MRI) improves the diagnosis of congenital heart defects, but is sensitive to fetal motion due to long image acquisition time. This may be overcome with faster image acquisition with low resolution, followed by image enhancement to provide clinically useful images. PURPOSE To combine phase-encoding undersampling with super-resolution neural networks to achieve high-resolution fetal cine cardiac MR images with short acquisition time. STUDY TYPE Prospective. SUBJECTS Twenty-eight fetuses (gestational week 36 [interquartile range 33-38 weeks]). FIELD STRENGTH/SEQUENCE 1.5 T, balanced steady-state free precession (bSSFP) cine sequence. ASSESSMENT Images were acquired using fully sampled Doppler ultrasound-gated clinical bSSFP cine as reference, with equivalent cine sequences with decreased phase-encoding resolution (25%, 33%, and 50% of clinical standard). Two super-resolution methods based on convolutional neural networks were proposed and evaluated (phasrGAN and phasrresnet). Data were partitioned into training (36 cine slices), validation (3 cine slices), and test sets (67 cine slices) without overlap. Conventional reconstruction methods using bicubic interpolation and k-space zeropadding were used for comparison. Three blinded observers scored image quality between 1 and 10. STATISTICAL TESTS Image scores are reported as median [interquartile range] and were compared using Mann-Whitney's nonparametric test with P < 0.05 showing statistically significant differences. RESULTS Both proposed methods showed no significant difference in image quality compared to clinical images (8 [7-8.5]) down to 33% (phasrGAN 8 [6.5-8]; phasrresnet 8 [7-8], all P ≥ 0.19) phase-encoding resolution, i.e., up to three times faster image acquisition, whereas bicubic interpolation and k-space zeropadding showed significantly lower quality for 33% phase-encoding resolution (both 7 [6-8]). DATA CONCLUSION Super-resolution enhancement can be used for fetal cine cardiac MRI to reduce image acquisition time while maintaining image quality. This may lead to an improved success rate for fetal cine MR imaging, as the impact of fetal motion is lessened by shortened acquisitions. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Klas Berggren
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.,Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Anthony H Aletras
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.,Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.,Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
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18
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Abstract
OBJECTIVES Previous studies have investigated the association between socioeconomic characteristics and fractures among children, producing different results. In a population-based study, we previously found an increased risk of fractures among children living in an urban municipality compared with rural municipalities. This study aimed to evaluate the importance of socioeconomic variables for the incidence of fractures among 0-17 year olds. SETTING, DESIGN AND OUTCOME MEASURE We present a longitudinal, observational study of a population 0-17 years of age. Data from an injury database were linked with additional socioeconomic data for the population at risk. These were 55 758 individuals residing within the primary catchment area of a regional hospital in northern Sweden. Using the number of fractures as the outcome, we fitted a generalised linear mixed model for a Poisson response with socioeconomic variables at the family level as independent variables while controlling for age, sex and place of residence. RESULTS We found a significant association between higher levels of family income and the risk of fracture, rate ratio 1.40 (1.28-1.52) p<0.001 when comparing the highest income quintile to the lowest as well as the number of siblings and the risk of fracture. Children with one or two siblings had a rate ratio of 1.28 (1.19-1.38) p<0.001 when compared with children with no siblings. Parents' educational level and having a single parent showed no significant association with fractures. The previously observed association between municipalities and fracture risk was less pronounced when taking family-level socioeconomic variables into account. CONCLUSION Our results indicate that children from families with higher income and with siblings are at greater risk of sustaining fractures.
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Affiliation(s)
- Erik Hedström
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Antonia Kullström
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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19
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Steding-Ehrenborg K, Hedström E, Carlsson M, Maksuti E, Broomé M, Ugander M, Magnusson M, Smith JG, Arheden H. Hydraulic force is a novel mechanism of diastolic function that may contribute to decreased diastolic filling in HFpEF and facilitate filling in HFrEF. J Appl Physiol (1985) 2021; 130:993-1000. [PMID: 33539261 DOI: 10.1152/japplphysiol.00890.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A hydraulic force generated by blood moving the atrioventricular plane is a novel mechanism of diastolic function. The direction and magnitude of the force is dependent on the geometrical relationship between the left atrium and ventricle and is measured as the short-axis atrioventricular area difference (AVAD). In short, the net hydraulic force acts from a larger area toward a smaller one. It is currently unknown how cardiac remodeling affects this mechanism. The aim of the study was therefore to investigate this diastolic mechanism in patients with pathological or physiological remodeling. Seventy subjects [n = 11 heart failure with preserved ejection fraction (HFpEF), n = 10 heart failure with reduced ejection fraction (HFrEF), n = 7 signs of isolated diastolic dysfunction, n = 10 hypertrophic cardiomyopathy, n = 10 cardiac amyloidosis, n = 18 triathletes, and n = 14 controls] were included. Subjects underwent cardiac MR, and short-axis images of the left atrium and ventricle were delineated. AVAD was calculated as ventricular area minus atrial area and used as an indicator of net hydraulic force. At the onset of diastole, AVAD in HFpEF was -9.2 cm2 (median) versus -4.4 cm2 in controls, P = 0.02. The net hydraulic force was directed toward the ventricle for both but was larger in HFpEF. HFrEF was the only group with a positive median value (11.6 cm2), and net hydraulic force was throughout diastole directed toward the atrium. The net hydraulic force may impede cardiac filling throughout diastole in HFpEF, worsening diastolic dysfunction. In contrast, it may work favorably in patients with dilated ventricles and aid ventricular filling.NEW & NOTEWORTHY It is a previously unrecognized physiological mechanism of the heart that diastolic filling occurs with the help of hydraulics. In patients with heart failure with preserved ejection fraction, atrial dilatation may cause the net hydraulic force to work against cardiac filling, thus further augmenting diastolic dysfunction. In contrast, it may work favorably in patients with dilated ventricles, as in heart failure with reduced ejection fraction.
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Affiliation(s)
- Katarina Steding-Ehrenborg
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden.,Department of Radiology, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Elira Maksuti
- Department of Physiology and Pharmacology, Anaesthesiology and Intensive Care, Karolinska Institute, Stockholm, Sweden
| | - Michael Broomé
- Department of Physiology and Pharmacology, Anaesthesiology and Intensive Care, Karolinska Institute, Stockholm, Sweden
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institute, Stockholm, Sweden.,Kolling Institute, Royal North Shore Hospital, and Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Martin Magnusson
- Department of Clinical Sciences Malmö, Cardiology, Lund University, Lund, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - J Gustav Smith
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Department of Clinical Sciences Lund, Cardiology, Lund University and Skåne University Hospital, Lund, Sweden.,Lund University Diabetes Center, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
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20
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Salehi D, Fricke K, Bhat M, Arheden H, Liuba P, Hedström E. Utility of Fetal Cardiovascular Magnetic Resonance for Prenatal Diagnosis of Complex Congenital Heart Defects. JAMA Netw Open 2021; 4:e213538. [PMID: 33779747 PMCID: PMC8008290 DOI: 10.1001/jamanetworkopen.2021.3538] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/06/2021] [Indexed: 12/17/2022] Open
Abstract
Importance Prenatal diagnosis of complex congenital heart defects reduces mortality and morbidity in affected infants. However, fetal echocardiography can be limited by poor acoustic windows, and there is a need for improved diagnostic methods. Objective To assess the clinical utility of fetal cardiovascular magnetic resonance imaging in cases in which fetal echocardiography could not visualize all relevant anatomy. Design, Setting, and Participants This cohort study was conducted between January 20, 2017, and June 29, 2020, at Skåne University Hospital (Lund, Sweden), a tertiary center for pediatric cardiology and thoracic surgery. Participants were fetuses referred for fetal cardiovascular magnetic resonance examination by a pediatric cardiologist after an inconclusive echocardiograph. Exposures Fetal cardiovascular magnetic resonance examination requested by the patient's pediatric cardiologist. Main Outcomes and Measures Any change in patient management because of diagnostic information gained from fetal cardiovascular magnetic resonance imaging. Results A total of 31 fetuses underwent cardiovascular magnetic resonance examination at a median gestational age of 36 weeks (range, 31-39 weeks). Overall, fetal cardiovascular magnetic resonance imaging had clinical utility, affecting patient management and/or parental counseling in 26 cases (84%). For aortic arch anatomy including signs of coarctation (20 fetuses), fetal cardiovascular magnetic resonance imaging added diagnostic information in 16 cases (80%). For assessment of univentricular vs biventricular outcome in borderline left ventricle, unbalanced atrioventricular septal defect, and pulmonary atresia with intact ventricular septum (15 fetuses), fetal cardiovascular magnetic resonance imaging visualized intracardiac anatomy and ventricular function, allowing assessment of outcome in 13 cases (87%). In 4 fetuses with hypoplastic left heart syndrome, fetal cardiovascular magnetic resonance imaging helped delivery planning in 3 cases (75%). Finally, fetal cardiovascular magnetic resonance imaging provided valuable information for parental counseling in 21 cases (68%). Conclusions and Relevance In this cohort study, fetal cardiovascular magnetic resonance imaging added clinically useful information to what was available from echocardiography. These findings suggest that fetal CMR has the potential to affect clinical decision-making in challenging cases of congenital heart defects with inconclusive data from echocardiography. Fetal cardiovascular magnetic resonance imaging showed an association with clinical decision-making, including mode of delivery and early postnatal care, as well as with parental counseling.
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Affiliation(s)
- Daniel Salehi
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katrin Fricke
- Pediatric Cardiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Misha Bhat
- Pediatric Cardiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Petru Liuba
- Pediatric Cardiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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21
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Sepúlveda-Martínez A, Steding-Ehrenborg K, Rodríguez-López M, Ostenfeld E, Valenzuela-Alcaráz B, Heiberg E, Gratacós E, Prat-González S, Crispi F, Hedström E. Atrioventricular plane displacement versus mitral and tricuspid annular plane systolic excursion: A comparison between cardiac magnetic resonance and M-mode echocardiography. Clin Physiol Funct Imaging 2021; 41:262-270. [PMID: 33550709 DOI: 10.1111/cpf.12693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 01/17/2021] [Accepted: 02/02/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Both echocardiography and CMR imaging are used to quantify longitudinal function. Inter-method variability for mitral (MAPSE) and tricuspid (TAPSE) annular plane systolic excursion, and variability between directly measured MAPSE and TAPSE and as based on atrioventricular plane displacement (AVPD) analysis by CMR, are, however, not known. This study, therefore, assessed inter-method variability and variability between annular plane systolic excursion and AVPD-based values in a healthy adult population. METHODS Echocardiography and CMR were performed in 111 adults (35 [32-38] years). Method comparisons were assessed with Deming regression, Bland-Altman analysis and coefficient of variation. Observer reproducibility was assessed by the concordance correlation coefficient. RESULTS Echocardiography and semi-automatic CMR agreed on MAPSE (17 ± 2 mm vs. 17 ± 2 mm, p = 0.1) and TAPSE (25 ± 3 mm vs. 25 ± 3 mm, p = 0.5), correlated highly between methods (fitted-slope 1.22 [95% CI 1.07-1.38] and 1.12 [95% CI 0.95-1.29]) and showed low bias (0.42 [95% CI - 2.05 to 2.88] and - 0.18 [95% CI - 4.78 to 4.43]). Intra-/inter-observer reproducibility was high for both methods for both MAPSE (echocardiography 0.96/0.86; CMR 0.87/0.85) and TAPSE (echocardiography 0.96/0.95; CMR 0.97/0.96). MAPSE (16 ± 2 mm vs. 17 ± 2 mm; p < 0.001) and TAPSE (24 ± 3 vs. 25 ± 3 mm; p < 0.001) based on AVPD were similar but statistically different compared with semi-automatic CMR. CONCLUSIONS Echocardiography and semi-automatic CMR have low variability and provide similar values for MAPSE and TAPSE and are thus interchangeable for follow-up studies. Lateral values based on tracked data from AVPD analysis are not clinically significantly different and could be used as a representation of annular displacement.
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Affiliation(s)
- Alvaro Sepúlveda-Martínez
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile.,Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.,Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Mérida Rodríguez-López
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Pontificia Universidad Javeriana Cali, Cali, Colombia.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Ellen Ostenfeld
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Brenda Valenzuela-Alcaráz
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Eduard Gratacós
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Susanna Prat-González
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS, Barcelona, Spain
| | - Fátima Crispi
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.,Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
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22
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Hedström E, Bredfelt A, Rådegran G, Arheden H, Ostenfeld E. Risk assessment in PAH using quantitative CMR tricuspid regurgitation: relation to heart catheterization. ESC Heart Fail 2020; 7:1653-1663. [PMID: 32372555 PMCID: PMC7373895 DOI: 10.1002/ehf2.12720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/07/2020] [Accepted: 03/31/2020] [Indexed: 11/12/2022] Open
Abstract
Aims Improved risk stratification is of value for decision making in pulmonary arterial hypertension (PAH). Right heart catheterization combined with quantitative tricuspid regurgitation (TR) by cardiovascular magnetic resonance (CMR) may provide this. The aims were to study: (i) to what extent quantitative TR is associated with event‐free survival; (ii) how quantitative TR is related to known prognostic markers in PAH; and (iii) to what extent quantitative TR and right atrial pressure determine right atrial dilation. Methods and results Fifty patients (63 ± 17 years) with PAH referred for CMR were included. Volumes and pulmonary artery flow by CMR and pressure and vascular resistance by right heart catheterization were obtained. Composite outcome was lung transplantation or death. Four transplantations and 27 deaths occurred over a median of 2.7 years. A trend towards higher hazard ratio was shown for TR volume (TRV; 2.1, 95% CI 1.0–4.4) and TR fraction (TR%; 1.6, 95% CI 0.8–3.3) above median. TRV and TR% correlated with right ventricular (RV) end‐diastolic (TRV r = 0.50; TR% r = 0.39) and end‐systolic (TRV r = 0.35; TR% r = 0.30) volumes, pulmonary vascular resistance (TRV r = 0.28; TR% r = 0.43), N terminal pro brain natriuretic peptide (TRV r = 0.65; TR% r = 0.68), cardiac index (TRV r = −0.32; TR% r = −0.54), pulmonary artery stroke volume (TRV r = −0.32; TR% r = −0.58) and effective RV ejection fraction by pulmonary artery quantitative flow (TRV r = −0.56; TR% r = −0.69), but not RVEF. Both TR% and right atrial pressure determined right atrial volumes (r2 = 0.38; r2 = 0.48). Conclusions A clear trend towards worse outcome with larger TRV or TR% was shown; however, the number of events was insufficient for significant outcome differences. Prognostic value of quantitative TR should be investigated in a larger multicentre cohort. Effective RV ejection fraction may be considered an improved measure of RV function in PAH.
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Affiliation(s)
- Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anna Bredfelt
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Göran Rådegran
- Department of Clinical Sciences Lund, Cardiology, Lund University, The Hemodynamic Lab, VO Heart and Lung Medicine, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
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23
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Kalapotharakos G, Salehi D, Steding-Ehrenborg K, Andersson MEV, Arheden H, Hansson SR, Hedström E. Cardiovascular effects of severe late-onset preeclampsia are reversed within six months postpartum. Pregnancy Hypertens 2020; 19:18-24. [PMID: 31864208 DOI: 10.1016/j.preghy.2019.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Preeclampsia (PE) is a common pregnancy-related disorder associated with cardiovascular long-term disease. Eighty percent are late-onset PE, occurring after 34 gestational weeks, and can present with severe symptoms. Magnitude and reversibility rate of maternal cardiovascular changes after severe late-onset PE have not been characterized. This study therefore evaluated longitudinal dynamics of maternal cardiovascular changes after severe late-onset PE. STUDY DESIGN Six previously normotensive women with severe late-onset PE and eight pregnant controls were included. Severe PE was defined as systolic blood pressure (SBP) ≥ 160 mmHg or diastolic blood pressure (DBP) ≥ 110 mmHg and proteinuria with/without evidence of end-organ dysfunction, or SBP ≥ 140 mmHg or DBP ≥ 90 mmHg with/without proteinuria and with evidence of end-organ dysfunction. Cardiovascular function was assessed by magnetic resonance imaging at 1-3 days, one week and six months postpartum. RESULTS Left ventricular mass at 1-3 days postpartum was higher after severe late-onset PE (57 g/m2) compared to after normal pregnancy (48 g/m2; p = 0.01). Pulse wave velocity (PWV) decreased between 1 and 3 days and six months postpartum after PE (6.1 to 5.0 m/s; p = 0.028). There was no difference in PWV 1-3 days postpartum after severe PE compared after normal pregnancy (6.1 versus 5.6 m/s; p = 0.175). Blood pressure normalized within six months in all but one patient. CONCLUSIONS Cardiac effects after severe late-onset PE were small and transient. This indicates that left ventricular hypertrophy after severe late-onset PE may be a secondary physiologic response to increased peripheral resistance in PE. Vascular mechanisms rather than persistent cardiac hypertrophy postpartum may be the culprit for increased long-term cardiovascular risk after PE.
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Affiliation(s)
- Grigorios Kalapotharakos
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Obstetrics and Gynaecology, Lund, Sweden
| | - Daniel Salehi
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden; Lund University, Skåne University Hospital, Department of Health Sciences, Physiotherapy, Lund, Sweden
| | - Maria E V Andersson
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Obstetrics and Gynaecology, Lund, Sweden
| | - Håkan Arheden
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden
| | - Stefan R Hansson
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Obstetrics and Gynaecology, Lund, Sweden
| | - Erik Hedström
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Diagnostic Radiology, Lund, Sweden.
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24
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Sjöberg P, Ostenfeld E, Hedström E, Arheden H, Gustafsson R, Nozohoor S, Carlsson M. Changes in left and right ventricular longitudinal function after pulmonary valve replacement in patients with Tetralogy of Fallot. Am J Physiol Heart Circ Physiol 2020; 318:H345-H353. [PMID: 31886724 DOI: 10.1152/ajpheart.00417.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Timing and indication for pulmonary valve replacement (PVR) in patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) are uncertain. To improve understanding of pumping mechanics, we investigated atrioventricular coupling before and after surgical PVR. Cardiovascular magnetic resonance was performed in patients (n = 12) with rToF and PR > 35% before and after PVR and in healthy controls (n = 15). Atrioventricular plane displacement (AVPD), global longitudinal peak systolic strain (GLS), atrial and ventricular volumes, and caval blood flows were analyzed. Right ventricular (RV) AVPD and RV free wall GLS were lower in patients before PVR compared with controls (P < 0.0001; P < 0.01) and decreased after PVR (P < 0.0001 for both). Left ventricular AVPD was lower in patients before PVR compared with controls (P < 0.05) and decreased after PVR (P < 0.01). Left ventricular GLS did not differ between patients and controls (P > 0.05). Right atrial reservoir volume and RV stroke volume generated by AVPD correlated in controls (r = 0.93; P < 0.0001) and patients before PVR (r = 0.88; P < 0.001) but not after PVR. In conclusion, there is a clear atrioventricular coupling in patients before PVR that is lost after PVR, possibly because of loss of pericardial integrity. Impaired atrioventricular coupling complicates assessment of ventricular function after surgery using measurements of longitudinal function. Changes in atrioventricular coupling seen in patients with rToF may be energetically unfavorable, and long-term effects of surgery on atrioventricular coupling is therefore of interest. Also, AVPD and GLS cannot be used interchangeably to assess longitudinal function in rToF.NEW & NOTEWORTHY There is a clear atrioventricular coupling in patients with Tetralogy of Fallot (ToF) and pulmonary regurgitation before surgical pulmonary valve replacement (PVR) that is lost after operation, possibly because of loss of pericardial integrity. The impaired atrioventricular coupling complicates assessment of ventricular function after surgery when using measurements of longitudinal function. Left ventricular atrioventricular plane displacement (AVPD) found differences between patients and controls and changes after PVR that longitudinal strain could not detect. This indicates that AVPD and strain cannot be used interchangeably to assess longitudinal function in repaired ToF.
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Affiliation(s)
- Pia Sjöberg
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ellen Ostenfeld
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.,Diagnostic Radiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ronny Gustafsson
- Cardiothoracic Surgery, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Shahab Nozohoor
- Cardiothoracic Surgery, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
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25
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Ryd D, Sun L, Steding-Ehrenborg K, Bidhult S, Kording F, Ruprecht C, Macgowan CK, Seed M, Aletras AH, Arheden H, Hedström E. Quantification of blood flow in the fetus with cardiovascular magnetic resonance imaging using Doppler ultrasound gating: validation against metric optimized gating. J Cardiovasc Magn Reson 2019; 21:74. [PMID: 31783877 PMCID: PMC6883707 DOI: 10.1186/s12968-019-0586-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/25/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Fetal cardiovascular magnetic resonance (CMR) imaging is used clinically and for research, but has been previously limited due to lack of direct gating methods. A CMR-compatible Doppler ultrasound (DUS) gating device has resolved this. However, the DUS-gating method is not validated against the current reference method for fetal phase-contrast blood flow measurements, metric optimized gating (MOG). Further, we investigated how different methods for vessel delineation affect flow volumes and observer variability in fetal flow acquisitions. AIMS To 1) validate DUS gating versus MOG for quantifying fetal blood flow; 2) assess repeatability of DUS gating; 3) assess impact of region of interest (ROI) size on flow volume; and 4) compare time-resolved and static delineations for flow volume and observer variability. METHODS Phase-contrast CMR was acquired in the fetal descending aorta (DAo) and umbilical vein by DUS gating and MOG in 22 women with singleton pregnancy in gestational week 360 (265-400) with repeated scans in six fetuses. Impact of ROI size on measured flow was assessed for ROI:s 50-150% of the vessel diameter. Four observers from two centers provided time-resolved and static delineations. Bland-Altman analysis was used to determine agreement between both observers and methods. RESULTS DAo flow was 726 (348-1130) ml/min and umbilical vein flow 366 (150-782) ml/min by DUS gating. Bias±SD for DUS-gating versus MOG were - 45 ± 122 ml/min (-6 ± 15%) for DAo and 19 ± 136 ml/min (2 ± 24%) for umbilical vein flow. Repeated flow measurements in the same fetus showed similar volumes (median CoV = 11% (DAo) and 23% (umbilical vein)). Region of interest 50-150% of vessel diameter yielded flow 35-120%. Bias±SD for time-resolved versus static DUS-gated flow was 33 ± 39 ml/min (4 ± 6%) for DAo and 11 ± 84 ml/min (2 ± 15%) for umbilical vein flow. CONCLUSIONS Quantification of blood flow in the fetal DAo and umbilical vein using DUS-gated phase-contrast CMR is feasible and agrees with the current reference method. Repeatability was generally high for CMR fetal blood flow assessment. An ROI similar to the vessel area or slightly larger is recommended. A static ROI is sufficient for fetal flow quantification using currently available CMR sequences.
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Affiliation(s)
- Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Liqun Sun
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Sebastian Bidhult
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Fabian Kording
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Ruprecht
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher K. Macgowan
- Department of Medical Biophysics, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
| | - Michael Seed
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
- Department of Diagnostic Imaging, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
| | - Anthony H. Aletras
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- School of Medicine, Laboratory of Computing, Medical Informatics and Biomedical, Imaging Technologies, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
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26
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Haris K, Hedström E, Kording F, Bidhult S, Steding-Ehrenborg K, Ruprecht C, Heiberg E, Arheden H, Aletras AH. Free-breathing fetal cardiac MRI with doppler ultrasound gating, compressed sensing, and motion compensation. J Magn Reson Imaging 2019; 51:260-272. [PMID: 31228302 PMCID: PMC6916642 DOI: 10.1002/jmri.26842] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/04/2019] [Indexed: 12/23/2022] Open
Abstract
Background Fetal cardiovascular MRI complements ultrasound to assess fetal cardiovascular pathophysiology. Purpose To develop a free‐breathing method for retrospective fetal cine MRI using Doppler ultrasound (DUS) cardiac gating and tiny golden angle radial sampling (tyGRASP) for accelerated acquisition capable of detecting fetal movements for motion compensation. Study Type Feasibility study. Subjects Nine volunteers (gestational week 34–40). Short‐axis and four‐chamber views were acquired during maternal free‐breathing and breath‐hold. Field Strength/Sequence 1.5T cine balanced steady‐state free precession. Assessment A self‐gated reconstruction method was improved for clinical application by using 1) retrospective DUS gating, and 2) motion detection and rejection/correction algorithms for compensating for fetal motion. The free‐breathing reconstructions were qualitatively and quantitatively assessed, and DUS‐gating was compared with self‐gating in breath‐hold reconstructions. A scoring of 1–4 for overall image quality, cardiac, and extracardiac diagnostic quality was used. Statistical Tests Friedman's test was used to assess differences in qualitative scoring between observers. A Wilcoxon matched‐pairs signed rank test was used to assess differences between breath‐hold and free‐breathing acquisitions and between observers' quantitative measurements. Results In all cases, 111 free‐breathing and 145 breath‐hold acquisitions, the automatically calculated DUS‐based cardiac gating signal provided reconstructions of diagnostic quality (median score 4, range 1–4). Free‐breathing did not affect the DUS‐based cardiac gated retrospective radial reconstruction with respect to image or diagnostic quality (all P > 0.06). Motion detection with rejection/correction in k‐space produced high‐quality free‐breathing DUS‐based reconstructions [median 3, range (2–4)], whereas free‐breathing self‐gated methods failed in 80 out of 88 cases to produce a stable gating signal. Data Conclusion Free‐breathing fetal cine cardiac MRI based on DUS gating and tyGRASP with motion compensation yields diagnostic images. This simplifies acquisition for the pregnant woman and thus could help increase fetal cardiac MRI acceptance in the clinic. Level of Evidence: 2 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2020;51:260–272.
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Affiliation(s)
- Kostas Haris
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Fabian Kording
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Bidhult
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Christian Ruprecht
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Einar Heiberg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anthony H Aletras
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
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27
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Erlandsson L, Ducat A, Castille J, Zia I, Kalapotharakos G, Hedström E, Vilotte JL, Vaiman D, Hansson SR. Alpha-1 microglobulin as a potential therapeutic candidate for treatment of hypertension and oxidative stress in the STOX1 preeclampsia mouse model. Sci Rep 2019; 9:8561. [PMID: 31189914 PMCID: PMC6561956 DOI: 10.1038/s41598-019-44639-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 05/21/2019] [Indexed: 01/22/2023] Open
Abstract
Preeclampsia is a human placental disorder affecting 2–8% of pregnancies worldwide annually, with hypertension and proteinuria appearing after 20 weeks of gestation. The underlying cause is believed to be incomplete trophoblast invasion of the maternal spiral arteries during placentation in the first trimester, resulting in oxidative and nitrative stress as well as maternal inflammation and organ alterations. In the Storkhead box 1 (STOX1) preeclampsia mouse model, pregnant females develop severe and early onset manifestations as seen in human preeclampsia e.g. gestational hypertension, proteinuria, and organ alterations. Here we aimed to evaluate the therapeutic potential of human recombinant alpha-1 microglobulin (rA1M) to alleviate the manifestations observed. Human rA1M significantly reduced the hypertension during gestation and significantly reduced the level of hypoxia and nitrative stress in the placenta. In addition, rA1M treatment reduced cellular damage in both placenta and kidneys, thereby protecting the tissue and improving their function. This study confirms that rA1M has the potential as a therapeutic drug in preeclampsia, and likely also in other pathological conditions associated with oxidative stress, by preserving normal organ function.
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Affiliation(s)
- Lena Erlandsson
- Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Aurélien Ducat
- INSERM U1016, CNRS UMR8104, Faculté de Médecine, Institut Cochin, Paris, France
| | - Johann Castille
- INRA-AgroParisTech, UMR1313 Génétique Animale et Biologie Intégrative, Institut National de la Recherche Agronomique, Jouy-en-Josas, France
| | - Isac Zia
- Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jean-Luc Vilotte
- INRA-AgroParisTech, UMR1313 Génétique Animale et Biologie Intégrative, Institut National de la Recherche Agronomique, Jouy-en-Josas, France
| | - Daniel Vaiman
- INSERM U1016, CNRS UMR8104, Faculté de Médecine, Institut Cochin, Paris, France
| | - Stefan R Hansson
- Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Bidhult S, Hedström E, Carlsson M, Töger J, Steding-Ehrenborg K, Arheden H, Aletras AH, Heiberg E. A new vessel segmentation algorithm for robust blood flow quantification from two-dimensional phase-contrast magnetic resonance images. Clin Physiol Funct Imaging 2019; 39:327-338. [PMID: 31102479 PMCID: PMC6852024 DOI: 10.1111/cpf.12582] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/10/2019] [Indexed: 11/29/2022]
Abstract
Blood flow measurements in the ascending aorta and pulmonary artery from phase-contrast magnetic resonance images require accurate time-resolved vessel segmentation over the cardiac cycle. Current semi-automatic segmentation methods often involve time-consuming manual correction, relying on user experience for accurate results. The purpose of this study was to develop a semi-automatic vessel segmentation algorithm with shape constraints based on manual vessel delineations for robust segmentation of the ascending aorta and pulmonary artery, to evaluate the proposed method in healthy volunteers and patients with heart failure and congenital heart disease, to validate the method in a pulsatile flow phantom experiment, and to make the method freely available for research purposes. Algorithm shape constraints were extracted from manual reference delineations of the ascending aorta (n = 20) and pulmonary artery (n = 20) and were included in a semi-automatic segmentation method only requiring manual delineation in one image. Bias and variability (bias ± SD) for flow volume of the proposed algorithm versus manual reference delineations were 0·0 ± 1·9 ml in the ascending aorta (n = 151; seven healthy volunteers; 144 heart failure patients) and -1·7 ± 2·9 ml in the pulmonary artery (n = 40; 25 healthy volunteers; 15 patients with atrial septal defect). Interobserver bias and variability were lower (P = 0·008) for the proposed semi-automatic method (-0·1 ± 0·9 ml) compared to manual reference delineations (1·5 ± 5·1 ml). Phantom validation showed good agreement between the proposed method and timer-and-beaker flow volumes (0·4 ± 2·7 ml). In conclusion, the proposed semi-automatic vessel segmentation algorithm can be used for efficient analysis of flow and shunt volumes in the aorta and pulmonary artery.
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Affiliation(s)
- Sebastian Bidhult
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.,Department of Clinical Sciences Lund, Diagnostic Radiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Johannes Töger
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.,Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Anthony H Aletras
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.,Laboratory of Computing, Medical Informatics and Biomedical - Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Einar Heiberg
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
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Bhat M, Haris K, Bidhult S, Liuba P, Aletras AH, Hedström E. Fetal iGRASP cine CMR assisting in prenatal diagnosis of complicated cardiac malformation with impact on delivery planning. Clin Physiol Funct Imaging 2019; 39:231-235. [PMID: 30785656 PMCID: PMC6850003 DOI: 10.1111/cpf.12566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/17/2019] [Indexed: 12/18/2022]
Abstract
Limited visualization of the fetal heart and vessels by fetal ultrasound due to suboptimal fetal position, patient habitus and skeletal calcification may lead to missed diagnosis, overdiagnosis and parental uncertainty. Counselling and delivery planning may in those cases also be tentative. The recent fetal cardiac magnetic resonance (CMR) reconstruction method utilizing tiny golden‐angle iGRASP (iterative Golden‐angle RAdial Sparse Parallel MRI) allows for cine imaging of the fetal heart for use in clinical practice. This case describes an unbalanced common atrioventricular canal where limited ultrasound image quality and visibility of the aortic arch precluded confirming or ruling out presence of a ventricular septal defect. Need of prostaglandins or neonatal intervention was thus uncertain. Cardiovascular magnetic resonance imaging confirmed ultrasound findings and added value by ruling out a significant ventricular septal defect and diagnosing arch hypoplasia. This confirmed the need of patient relocation for delivery at a paediatric cardiothoracic surgery centre and prostaglandins could be initiated before the standard postnatal ultrasound. The applied CMR method can thus improve diagnosis of complicated fetal cardiac malformation and has direct clinical impact.
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Affiliation(s)
- Misha Bhat
- Pediatric Cardiac Center, Skåne University Hospital and Lund University, Lund, Sweden
| | - Kostas Haris
- Laboratory of Computing, Medical Informatics and Biomedical - Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, and Lund University, Lund, Sweden
| | - Sebastian Bidhult
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, and Lund University, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Petru Liuba
- Pediatric Cardiac Center, Skåne University Hospital and Lund University, Lund, Sweden
| | - Anthony H Aletras
- Laboratory of Computing, Medical Informatics and Biomedical - Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, and Lund University, Lund, Sweden
| | - Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, and Lund University, Lund, Sweden.,Department of Clinical Sciences Lund, Diagnostic Radiology, Skåne University Hospital and Lund University, Lund, Sweden
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Bidhult S, Töger J, Heiberg E, Carlsson M, Arheden H, Aletras AH, Hedström E. Independent validation of metric optimized gating for fetal cardiovascular phase-contrast flow imaging. Magn Reson Med 2019; 81:495-503. [PMID: 30159933 PMCID: PMC6282515 DOI: 10.1002/mrm.27392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To validate metric optimized gating phase-contrast MR (MOG PC-MR) flow measurements for a range of fetal flow velocities in phantom experiments. 2) To investigate intra- and interobserver variability for fetal flow measurements at an imaging center other than the original site. METHODS MOG PC-MR was compared to timer/beaker measurements in a pulsatile flow phantom using a heart rate (∼145 bpm), nozzle diameter (∼6 mm), and flow range (∼130-700 mL/min) similar to fetal imaging. Fifteen healthy fetuses were included for intra- and interobserver variability in the fetal descending aorta and umbilical vein. RESULTS Phantom MOG PC-MR flow bias and variability was 2% ± 23%. Accuracy of MOG PC-MR was degraded for flow profiles with low velocity-to-noise ratio. Intra- and interobserver coefficients of variation were 6% and 19%, respectively, for fetal descending aorta; and 10% and 17%, respectively, for the umbilical vein. CONCLUSION Phantom validation showed good agreement between MOG and conventionally gated PC-MR, except for cases with low velocity-to-noise ratio, which resulted in MOG misgating and underestimated peak velocities and warranted optimization of sequence parameters to individual fetal vessels. Inter- and intraobserver variability for fetal MOG PC-MR imaging were comparable to previously reported values.
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Affiliation(s)
- Sebastian Bidhult
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Clinical PhysiologyLundSweden
- Lund UniversityDepartment of Biomedical Engineering, Faculty of EngineeringLundSweden
| | - Johannes Töger
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Clinical PhysiologyLundSweden
| | - Einar Heiberg
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Clinical PhysiologyLundSweden
- Lund UniversityDepartment of Biomedical Engineering, Faculty of EngineeringLundSweden
| | - Marcus Carlsson
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Clinical PhysiologyLundSweden
| | - Håkan Arheden
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Clinical PhysiologyLundSweden
| | - Anthony H. Aletras
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Clinical PhysiologyLundSweden
- Laboratory of Computing, Medical Informatics and Biomedical–Imaging Technologies, School of MedicineAristotle University of ThessalonikiGreece
| | - Erik Hedström
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Clinical PhysiologyLundSweden
- Lund University, Skane University HospitalDepartment of Clinical Sciences Lund, Diagnostic RadiologyLundSweden
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Sjöberg P, Töger J, Hedström E, Arvidsson P, Heiberg E, Arheden H, Gustafsson R, Nozohoor S, Carlsson M. Altered biventricular hemodynamic forces in patients with repaired tetralogy of Fallot and right ventricular volume overload because of pulmonary regurgitation. Am J Physiol Heart Circ Physiol 2018; 315:H1691-H1702. [PMID: 30265559 DOI: 10.1152/ajpheart.00330.2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in patients with repaired tetralogy of Fallot (rToF) to further understand the pathophysiological mechanisms as this could be a potential marker for pulmonary valve replacement (PVR) in these patients. Patients with rToF and pulmonary regurgitation (PR) > 20% ( n = 18) and healthy control subjects ( n = 15) underwent MRI, including four-dimensional flow. A subset of patients ( n = 8) underwent PVR and MRI after surgery. Time-resolved hemodynamic forces were quantified using 4D-flow data and indexed to ventricular volume. Patients had higher systolic and diastolic left ventricular (LV) hemodynamic forces compared with control subjects in the lateral-septal/LV outflow tract ( P = 0.011 and P = 0.0031) and inferior-anterior ( P < 0.0001 and P < 0.0001) directions, which are forces not aligned with blood flow. Forces did not change after PVR. Patients had higher RV diastolic forces compared with control subjects in the diaphragm-right ventricular (RV) outflow tract (RVOT; P < 0.001) and apical-basal ( P = 0.0017) directions. After PVR, RV systolic forces in the diaphragm-RVOT direction decreased ( P = 0.039) to lower levels than in control subjects ( P = 0.0064). RV diastolic forces decreased in all directions ( P = 0.0078, P = 0.0078, and P = 0.039) but were still higher than in control subjects in the diaphragm-RVOT direction ( P = 0.046). In conclusion, patients with rToF and PR had LV hemodynamic forces less aligned with intraventricular blood flow compared with control subjects and higher diastolic RV forces along the regurgitant flow direction in the RVOT and that of tricuspid inflow. Remaining force differences in the LV and RV after PVR suggest that biventricular pumping does not normalize after surgery. NEW & NOTEWORTHY Biventricular hemodynamic forces in patients with repaired tetralogy of Fallot and pulmonary regurgitation were quantified for the first time. Left ventricular hemodynamic forces were less aligned to the main blood flow direction in patients compared with control subjects. Higher right ventricular forces were seen along the pulmonary regurgitant and tricuspid inflow directions. Differences in forces versus control subjects remain after pulmonary valve replacement, suggesting that altered biventricular pumping does not normalize after surgery.
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Affiliation(s)
- Pia Sjöberg
- Lund University, Department of Clinical Sciences, Lund, Clinical Physiology, Skåne University Hospital , Sweden
| | - Johannes Töger
- Lund University, Department of Clinical Sciences, Lund, Clinical Physiology, Skåne University Hospital , Sweden.,Lund University, Department of Biomedical Engineering, Faculty of Engineering , Sweden
| | - Erik Hedström
- Lund University, Department of Clinical Sciences, Lund, Clinical Physiology, Skåne University Hospital , Sweden.,Lund University, Department of Clinical Sciences, Lund, Diagnostic Radiology, Skåne University Hospital , Sweden
| | - Per Arvidsson
- Lund University, Department of Clinical Sciences, Lund, Clinical Physiology, Skåne University Hospital , Sweden
| | - Einar Heiberg
- Lund University, Department of Clinical Sciences, Lund, Clinical Physiology, Skåne University Hospital , Sweden.,Lund University, Department of Biomedical Engineering, Faculty of Engineering , Sweden
| | - Håkan Arheden
- Lund University, Department of Clinical Sciences, Lund, Clinical Physiology, Skåne University Hospital , Sweden
| | - Ronny Gustafsson
- Lund University, Department of Clinical Sciences, Lund, Cardiothoracic Surgery, Skåne University Hospital , Sweden
| | - Shahab Nozohoor
- Lund University, Department of Clinical Sciences, Lund, Cardiothoracic Surgery, Skåne University Hospital , Sweden
| | - Marcus Carlsson
- Lund University, Department of Clinical Sciences, Lund, Clinical Physiology, Skåne University Hospital , Sweden
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Engblom H, Hedström E, Götestam S, Drake M, Bengtsson J, Kahn A, Carlsson M. [Not Available]. Lakartidningen 2018; 115:E4TC. [PMID: 29664540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Kording F, Yamamura J, de Sousa MT, Ruprecht C, Hedström E, Aletras AH, Ellen Grant P, Powell AJ, Fehrs K, Adam G, Kooijman H, Schoennagel BP. Dynamic fetal cardiovascular magnetic resonance imaging using Doppler ultrasound gating. J Cardiovasc Magn Reson 2018; 20:17. [PMID: 29530064 PMCID: PMC5846256 DOI: 10.1186/s12968-018-0440-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 02/26/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Fetal cardiovascular magnetic resonance (CMR) imaging may provide a valuable adjunct to fetal echocardiography in the evaluation of congenital cardiovascular pathologies. However, dynamic fetal CMR is difficult due to the lack of direct in-utero cardiac gating. The aim of this study was to investigate the effectiveness of a newly developed Doppler ultrasound (DUS) device in humans for fetal CMR gating. METHODS Fifteen fetuses (gestational age 30-39 weeks) were examined using 1.5 T CMR scanners at three different imaging sites. A newly developed CMR-compatible DUS device was used to generate gating signals from fetal cardiac motion. Gated dynamic balanced steady-state free precession images were acquired in 4-chamber and short-axis cardiac views. Gating signals during data acquisition were analyzed with respect to trigger variability and sensitivity. Image quality was assessed by measuring endocardial blurring (EB) and by image evaluation using a 4-point scale. Left ventricular (LV) volumetry was performed using the single-plane ellipsoid model. RESULTS Gating signals from the fetal heart were detected with a variability of 26 ± 22 ms and a sensitivity of trigger detection of 96 ± 4%. EB was 2.9 ± 0.6 pixels (4-chamber) and 2.5 ± 0.1 pixels (short axis). Image quality scores were 3.6 ± 0.6 (overall), 3.4 ± 0.7 (mitral valve), 3.4 ± 0.7 (foramen ovale), 3.6 ± 0.7 (atrial septum), 3.7 ± 0.5 (papillary muscles), 3.8 ± 0.4 (differentiation myocardium/lumen), 3.7 ± 0.5 (differentiation myocardium/lung), and 3.9 ± 0.4 (systolic myocardial thickening). Inter-observer agreement for the scores was moderate to very good (kappa 0.57-0.84) for all structures. LV volumetry revealed mean values of 2.8 ± 1.2 ml (end-diastolic volume), 0.9 ± 0.4 ml (end systolic volume), 1.9 ± 0.8 ml (stroke volume), and 69.1 ± 8.4% (ejection fraction). CONCLUSION High-quality dynamic fetal CMR was successfully performed using a newly developed DUS device for direct fetal cardiac gating. This technique has the potential to improve the utility of fetal CMR in the evaluation of congenital pathologies.
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Affiliation(s)
- Fabian Kording
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Manuela Tavares de Sousa
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Christian Ruprecht
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Anthony H. Aletras
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - P. Ellen Grant
- Departments of Radiology and Medicine, Boston Children’s Hospital, and Harvard Medical School, Boston, MA USA
| | - Andrew J. Powell
- Department of Cardiology and Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Kai Fehrs
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | | | - Bjoern P. Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Asgeirsson D, Hedström E, Jögi J, Pahlm U, Steding-Ehrenborg K, Engblom H, Arheden H, Carlsson M. Longitudinal shortening remains the principal component of left ventricular pumping in patients with chronic myocardial infarction even when the absolute atrioventricular plane displacement is decreased. BMC Cardiovasc Disord 2017; 17:208. [PMID: 28754098 PMCID: PMC5534092 DOI: 10.1186/s12872-017-0641-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/21/2017] [Indexed: 11/21/2022] Open
Abstract
Background The majority (60%) of left ventricular (LV) stroke volume (SV) is generated by longitudinal shortening causing apical atrioventricular plane displacement (AVPD) in systole. The remaining SV is caused by radial inward motion of the epicardium both in the septal and the lateral wall. We aimed to determine if these longitudinal, septal and lateral contributions to LVSV are changed in patients with chronic myocardial infarction (MI). Methods Patients with a chronic (>3 months) ST-elevation MI in the left anterior descending (LAD, n = 20) or right coronary artery (RCA, n = 16) and healthy controls (n = 20) were examined with cardiovascular magnetic resonance (CMR). AVPD was quantified in long axis cine CMR images and LV volumes and dimensions in short axis cine images. Results AVPD was decreased both in patients with LAD-MI (11 ± 1 mm, p < 0.001) and RCA-MI (13 ± 1 mm, p < 0.05) compared to controls (15 ± 0 mm). However, the longitudinal contribution to SV was unchanged for both LAD-MI (58 ± 3%, p = 0.08) and RCA-MI (59 ± 3%, p = 0.09) compared to controls (64 ± 2%). The preserved longitudinal contribution despite decreased absolute AVPD was a results of increased epicardial dimensions (p < 0.01 for LAD-MI and p = 0.06 for RCA-MI). In LAD-MI the septal contribution to LVSV was decreased (5 ± 1%) compared to both controls (10 ± 1%, p < 0.01) and patients with RCA-MIs (10 ± 1%, p < 0.01). The lateral contribution was increased in LAD-MI patients (44 ± 3%) compared to both RCA-MI (35 ± 2%, p < 0.05) and controls (29 ± 2%, p < 0.001). Conclusion Longitudinal shortening remains the principal component of left ventricular pumping in patients with chronic MI even when the absolute AVPD is decreased.
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Affiliation(s)
- Daniel Asgeirsson
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Jonas Jögi
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Ulrika Pahlm
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.
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Hedström E, Ishida M, Sepúlveda-Martínez A, Salehi D, Sperling J, Engblom H, Nagel E. The effect of initial teaching on evaluation of left ventricular volumes by cardiovascular magnetic resonance imaging: comparison between complete and intermediate beginners and experienced observers. BMC Med Imaging 2017; 17:33. [PMID: 28514940 PMCID: PMC5436456 DOI: 10.1186/s12880-017-0197-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background High reproducibility and low intra- and interobserver variability are important strengths of cardiac magnetic resonance (CMR). In clinical practice a significant learning curve may however be observed. Basic CMR courses offer an average of 1.4 h dedicated to lecturing and demonstrating left ventricular (LV) function analysis. The purpose of this study was to evaluate the effect of initial teaching on complete and intermediate beginners’ quantitative measurements of LV volumes and function by CMR. Methods Standard clinical cine CMR sequences were acquired in 15 patients. Five observers (two complete beginners, one intermediate, two experienced) measured LV volumes. Before initial evaluation beginners read the SCMR guidelines on CMR analysis. After initial evaluation, beginners participated in a two-hour teaching session including cases and hands-on training, representative for most basic CMR courses, after which it is uncertain to what extent different centres provide continued teaching and feedback in-house. Dice Similarity Coefficient (DSC) assessed delineations. Agreement, accuracy, precision, repeatability and reliability were assessed by Bland-Altman, coefficient of variation, and intraclass correlation coefficient methods. Results Endocardial DSC improved after teaching (+0.14 ± 0.17;p < 0.001) for complete beginners. Low intraobserver variability was found before and after teaching, however with wide limits of agreement. Beginners underestimated volumes by up to 44 ml (EDV), 27 ml (ESV) and overestimated LVM by up to 53 g before teaching, improving to an underestimation of up to 9 ml (EDV), 7 ml (ESV) and an overestimation of up to 30 g (LVM) after teaching. For the intermediate beginner, however, accuracy was quite high already before teaching. Conclusions Initial teaching to complete beginners increases accuracy for assessment of LV volumes, however with high bias and low precision even after standardised teaching as offered in most basic CMR courses. Even though the intermediate beginner showed quite high accuracy already before teaching, precision did generally not improve after standardised teaching. To maintain CMR as a technique known for high accuracy and reproducibility and low intra- and inter-observer variability for quantitative measurements, internationally standardised training should be encouraged including high-quality feedback mechanisms. Objective measurements of training methods, training duration and, above all, quality of assessments are required.
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Affiliation(s)
- Erik Hedström
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK. .,BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trusts and King's College London, London, UK. .,Skane University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Lund, Sweden. .,Skane University Hospital, Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden.
| | - Masaki Ishida
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trusts and King's College London, London, UK
| | - Alvaro Sepúlveda-Martínez
- Skane University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Lund, Sweden.,Fetal i + D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Daniel Salehi
- Skane University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Lund, Sweden
| | - Johannes Sperling
- Skane University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Lund, Sweden
| | - Henrik Engblom
- Skane University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Lund, Sweden
| | - Eike Nagel
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trusts and King's College London, London, UK.,Institute for Experimental and Translational Cardiovascular Imaging, Goethe University, Frankfurt/Main and DZHK (German Centre for Cardiovascular Research, Standort RheinMain), Frankfurt, Germany
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36
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Haris K, Hedström E, Bidhult S, Testud F, Maglaveras N, Heiberg E, Hansson SR, Arheden H, Aletras AH. Self-gated fetal cardiac MRI with tiny golden angle iGRASP: A feasibility study. J Magn Reson Imaging 2017; 46:207-217. [PMID: 28152243 DOI: 10.1002/jmri.25599] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 12/05/2016] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To develop and assess a technique for self-gated fetal cardiac cine magnetic resonance imaging (MRI) using tiny golden angle radial sampling combined with iGRASP (iterative Golden-angle RAdial Sparse Parallel) for accelerated acquisition based on parallel imaging and compressed sensing. MATERIALS AND METHODS Fetal cardiac data were acquired from five volunteers in gestational week 29-37 at 1.5T using tiny golden angles for eddy currents reduction. The acquired multicoil radial projections were input to a principal component analysis-based compression stage. The cardiac self-gating (CSG) signal for cardiac gating was extracted from the acquired radial projections and the iGRASP reconstruction procedure was applied. In all acquisitions, a total of 4000 radial spokes were acquired within a breath-hold of less than 15 seconds using a balanced steady-state free precession pulse sequence. The images were qualitatively compared by two independent observers (on a scale of 1-4) to a single midventricular cine image from metric optimized gating (MOG) and real-time acquisitions. RESULTS For iGRASP and MOG images, good overall image quality (2.8 ± 0.4 and 2.6 ± 1.3, respectively, for observer 1; 3.6 ± 0.5 and 3.4 ± 0.9, respectively, for observer 2) and cardiac diagnostic quality (3.8 ± 0.4 and 3.4 ± 0.9, respectively, for observer 1; 3.6 ± 0.5 and 3.6 ± 0.9, respectively, for observer 2) were obtained, with visualized myocardial thickening over the cardiac cycle and well-defined myocardial borders to ventricular lumen and liver/lung tissue. For iGRASP, MOG, and real time, left ventricular lumen diameter (14.1 ± 2.2 mm, 14.2 ± 1.9 mm, 14.7 ± 1.1 mm, respectively) and wall thickness (2.7 ± 0.3 mm, 2.6 ± 0.3 mm, 3.0 ± 0.4, respectively) showed agreement and no statistically significant difference was found (all P > 0.05). Images with iGRASP tended to have higher overall image quality scores compared with MOG and particularly real-time images, albeit not statistically significant in this feasibility study (P > 0.99 and P = 0.12, respectively). CONCLUSION Fetal cardiac cine MRI can be performed with iGRASP using tiny golden angles and CSG. Comparison with other fetal cardiac cine MRI methods showed that the proposed method produces high-quality fetal cardiac reconstructions. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:207-217.
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Affiliation(s)
- Kostas Haris
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Greece.,Lund Cardiac MR Group, Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Erik Hedström
- Lund Cardiac MR Group, Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Lund, Sweden.,Department of Diagnostic Radiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sebastian Bidhult
- Lund Cardiac MR Group, Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | | | - Nicos Maglaveras
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Einar Heiberg
- Lund Cardiac MR Group, Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Stefan R Hansson
- Department of Obstetrics and Gynecology, Skåne University Hospital,Lund University, Lund, Sweden
| | - Håkan Arheden
- Lund Cardiac MR Group, Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anthony H Aletras
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Greece.,Lund Cardiac MR Group, Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Lund, Sweden
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Bidhult S, Kantasis G, Aletras AH, Arheden H, Heiberg E, Hedström E. Validation of T1 and T2 algorithms for quantitative MRI: performance by a vendor-independent software. BMC Med Imaging 2016; 16:46. [PMID: 27501697 PMCID: PMC4977731 DOI: 10.1186/s12880-016-0148-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 07/28/2016] [Indexed: 11/26/2022] Open
Abstract
Background Determination of the relaxation time constants T1 and T2 with quantitative magnetic resonance imaging is increasingly used for both research and clinical practice. Recently, groups have been formed within the Society of Cardiovascular Magnetic Resonance to address issues with relaxometry. However, so far they have avoided specific recommendations on methodology due to lack of consensus and current evolving research. Standardised widely available software may simplify this process. The purpose of the current study was to develop and validate vendor-independent T1 and T2 mapping modules and implement those in the versatile and widespread software Segment, freely available for research and FDA approved for clinical applications. Results The T1 and T2 mapping modules were developed and validated in phantoms at 1.5 T and 3 T with reference standard values calculated from reference pulse sequences using the Nelder-Mead Simplex optimisation method. The proposed modules support current commonly available MRI pulse sequences and both 2- and 3-parameter curve fitting. Images acquired in patients using three major vendors showed vendor-independence. Bias and variability showed high agreement with T1 and T2 reference standards for T1 (range 214–1752 ms) and T2 (range 45–338 ms), respectively. Conclusions The developed and validated T1 and T2 mapping and quantification modules generated relaxation maps from current commonly used MRI sequences and multiple signal models. Patient applications showed usability for three major vendors.
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Affiliation(s)
- Sebastian Bidhult
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - George Kantasis
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Laboratory of Medical Informatics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anthony H Aletras
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Laboratory of Medical Informatics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden. .,Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Skane University Hospital, Lund, Sweden.
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Vavoulas A, Vaiopoulos N, Hedström E, Xanthis CG, Sandalidis HG, Aletras AH. Using a modified 3D-printer for mapping the magnetic field of RF coils designed for fetal and neonatal imaging. J Magn Reson 2016; 269:146-151. [PMID: 27310429 DOI: 10.1016/j.jmr.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Abstract
An experimental setup for characterizing the magnetic field of MRI RF coils was proposed and tested. The setup consisted of a specially configured 3D-printer, a network analyzer and a mid-performance desktop PC. The setup was tested on a single loop RF coil, part of a phased array for fetal imaging. Then, the setup was used for determining the magnetic field characteristics of a high-pass birdcage coil used for neonatal MR imaging with a vertical static field. The scattering parameter S21, converted into power ratio, was used for mapping the B1 magnetic field. The experimental measurements from the loop coil were close to the theoretical results (R=0.924). A high degree of homogeneity was measured for the neonatal birdcage RF coil. The development of MR RF coils is time consuming and resource intensive. The proposed experimental setup provides an alternative method for magnetic field characterization of RF coils used in MRI.
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Affiliation(s)
- Alexander Vavoulas
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Papassiopoulou 2-4, GR 35131 Lamia, Greece.
| | - Nicholas Vaiopoulos
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Papassiopoulou 2-4, GR 35131 Lamia, Greece.
| | - Erik Hedström
- Cardiac MR Group, Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Getingevagen 4, Lund SE 22185, Sweden; Department of Diagnostic Radiology, Skåne University Hospital, Lund University, Getingevagen 4, Lund SE 22185, Sweden.
| | - Christos G Xanthis
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Papassiopoulou 2-4, GR 35131 Lamia, Greece; Cardiac MR Group, Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Getingevagen 4, Lund SE 22185, Sweden.
| | - Harilaos G Sandalidis
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Papassiopoulou 2-4, GR 35131 Lamia, Greece.
| | - Anthony H Aletras
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Papassiopoulou 2-4, GR 35131 Lamia, Greece; Laboratory of Computing and Medical Informatics, School of Medicine, Aristotle University of Thessaloniki, Box 323, Thessaloniki GR 54124, Greece.
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Dorniak K, Heiberg E, Hellmann M, Rawicz-Zegrzda D, Wesierska M, Galaska R, Sabisz A, Szurowska E, Dudziak M, Hedström E. Required temporal resolution for accurate thoracic aortic pulse wave velocity measurements by phase-contrast magnetic resonance imaging and comparison with clinical standard applanation tonometry. BMC Cardiovasc Disord 2016; 16:110. [PMID: 27387199 PMCID: PMC4937588 DOI: 10.1186/s12872-016-0292-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/19/2016] [Indexed: 11/24/2022] Open
Abstract
Background Pulse wave velocity (PWV) is a biomarker for arterial stiffness, clinically assessed by applanation tonometry (AT). Increased use of phase-contrast cardiac magnetic resonance (CMR) imaging allows for PWV assessment with minor routine protocol additions. The aims were to investigate the acquired temporal resolution needed for accurate and precise measurements of CMR-PWV, and develop a tool for CMR-PWV measurements. Methods Computer phantoms were generated for PWV = 2–20 m/s based on human CMR-PWV data. The PWV measurements were performed in 13 healthy young subjects and 13 patients at risk for cardiovascular disease. The CMR-PWV was measured by through-plane phase-contrast CMR in the ascending aorta and at the diaphragm level. Centre-line aortic distance was determined between flow planes. The AT-PWV was assessed within 2 h after CMR. Three observers (CMR experience: 15, 4, and <1 year) determined CMR-PWV. The developed tool was based on the flow-curve foot transit time for PWV quantification. Results Computer phantoms showed bias 0.27 ± 0.32 m/s for a temporal resolution of at least 30 ms. Intraobserver variability for CMR-PWV were: 0 ± 0.03 m/s (15 years), -0.04 ± 0.33 m/s (4 years), and -0.02 ± 0.30 m/s (<1 year). Interobserver variability for CMR-PWV was below 0.02 ± 0.38 m/s. The AT-PWV overestimated CMR-PWV by 1.1 ± 0.7 m/s in healthy young subjects and 1.6 ± 2.7 m/s in patients. Conclusions An acquired temporal resolution of at least 30 ms should be used to obtain accurate and precise thoracic aortic phase-contrast CMR-PWV. A new freely available research tool was used to measure PWV in healthy young subjects and in patients, showing low intra- and interobserver variability also for less experienced CMR observers.
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Affiliation(s)
- Karolina Dorniak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland
| | - Einar Heiberg
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Marcin Hellmann
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland
| | - Dorota Rawicz-Zegrzda
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland
| | - Maria Wesierska
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland
| | - Rafal Galaska
- 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Sabisz
- 2nd Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Edyta Szurowska
- 2nd Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Maria Dudziak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland
| | - Erik Hedström
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden. .,Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Diagnostic Radiology, Lund, Sweden.
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Hedström E, Voigt T, Greil G, Schaeffter T, Nagel E. Automatic T2* determination for quantification of iron load in heart and liver: a comparison between automatic inline Maximum Likelihood Estimate and the truncation and offset methods. Clin Physiol Funct Imaging 2015; 37:299-304. [PMID: 26475530 DOI: 10.1111/cpf.12303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To validate ironload T2* by automatic inline Maximum Likelihood Estimate (MLE) with k-space Rician noise correction, against the manual and automated truncation, as well as offset methods, in phantoms and in heart and liver in patients. METHODS Twenty-five patients and an iron-oxide phantom were scanned at 1.5T using 2 multi-echo gradient-echo sequences. All parameters were identical (voxel 2-3 × 2-3 × 10 mm3 , 10 echoes, TR = 26 ms, FA = 20°, BW = 833 Hz, SENSE = 2) except for TE (cardiac: TE1 = 2·5 ms, ΔTE = 2·5 ms; liver: TE1 = 1·2 ms, ΔTE = 1·5 ms). Phantoms were scanned at 1 and 32 signal averages (NSA), with NSA32 representing low-noise reference. RESULTS Phantoms: MLE showed low variability between NSA1 and NSA32 (0·02 ± 0·29 ms, CI ±0·21 ms). Between methods, no difference was shown (MLE versus all: <0·31 ms, CI < ±0·35 ms). PATIENTS No differences were found between methods in heart (MLE versus all: <-0·22 ms, CI < ±0·75 ms) or liver (MLE versus all: <0·12 ms, CI < ±0·26 ms). CONCLUSIONS The automatic inline MLE method is comparable to the general reference standards for determining cardiac and liver T2* for ironload in man. An automatic inline method may simplify ironload assessment, particularly in centres seeing fewer cases.
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Affiliation(s)
- Erik Hedström
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,BHF Centre of Research Excellence, NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trusts, King's College London, London, UK
| | - Tobias Voigt
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,BHF Centre of Research Excellence, NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trusts, King's College London, London, UK.,Philips Research, London, UK
| | - Gerald Greil
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,BHF Centre of Research Excellence, NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trusts, King's College London, London, UK
| | - Tobias Schaeffter
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,BHF Centre of Research Excellence, NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trusts, King's College London, London, UK
| | - Eike Nagel
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,BHF Centre of Research Excellence, NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trusts, King's College London, London, UK.,Division of Cardiovascular Imaging, Goethe University, Frankfurt am Main, Germany
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Wiiala J, Hedström E, Kraen M, Magnusson M, Arheden H, Engblom H. Diagnostic performance of the Selvester QRS scoring system in relation to clinical ECG assessment of patients with lateral myocardial infarction using cardiac magnetic resonance as reference standard. J Electrocardiol 2015; 48:750-7. [PMID: 26277444 DOI: 10.1016/j.jelectrocard.2015.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Selvester QRS scoring system has previously been shown to enable estimation of myocardial infarct (MI) size by quantitative evaluation of the 12-lead ECG. The aim of this study was to assess the system's ability to detect and quantify lateral MI, using cardiac magnetic resonance (CMR) as reference standard. METHODS In 23 patients with isolated lateral infarctions MI size was assessed by CMR and estimated by QRS scoring. The ECGs were also evaluated by two cardiologists according to clinical routine. RESULTS The MI size estimated by QRS scoring correlated with MI size assessed by CMR (r=0.55, p=0.006). The sensitivity for lateral MI detection was 78% for QRS scoring and 39% for clinical routine ECG evaluation, respectively. CONCLUSION Selvester QRS scoring can be used to estimate size of isolated lateral MI and has a higher sensitivity for infarct detection compared to clinical routine evaluation of ECGs in these patients.
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Affiliation(s)
- Jonathan Wiiala
- Department of Clinical Physiology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Erik Hedström
- Department of Clinical Physiology, Lund University and Skåne University Hospital, Lund, Sweden; Department of Diagnostic Radiology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Morten Kraen
- Department of Clinical Physiology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Martin Magnusson
- Department of Heart Failure and Valvular Disease, Lund University and Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology, Lund University and Skåne University Hospital, Lund, Sweden.
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Bidhult S, Xanthis CG, Liljekvist LL, Greil G, Nagel E, Aletras AH, Heiberg E, Hedström E. Validation of a new T2* algorithm and its uncertainty value for cardiac and liver iron load determination from MRI magnitude images. Magn Reson Med 2015; 75:1717-29. [PMID: 26010550 PMCID: PMC4791092 DOI: 10.1002/mrm.25767] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 03/26/2015] [Accepted: 04/16/2015] [Indexed: 12/24/2022]
Abstract
Purpose To validate an automatic algorithm for offline T2* measurements, providing robust, vendor‐independent T2*, and uncertainty estimates for iron load quantification in the heart and liver using clinically available imaging sequences. Methods A T2* region of interest (ROI)‐based algorithm was developed for robustness in an offline setting. Phantom imaging was performed on a 1.5 Tesla system, with clinically available multiecho gradient‐recalled‐echo (GRE) sequences for cardiac and liver imaging. A T2* single‐echo GRE sequence was used as reference. Simulations were performed to assess accuracy and precision from 2000 measurements. Inter‐ and intraobserver variability was obtained in a patient study (n = 23). Results Simulations: Accuracy, in terms of the mean differences between the proposed method and true T2* ranged from 0–0.73 ms. Precision, in terms of confidence intervals of repeated measurements, was 0.06–4.74 ms showing agreement between the proposed uncertainty estimate and simulations. Phantom study: Bias and variability were 0.26 ± 4.23 ms (cardiac sequence) and −0.23 ± 1.69 ms (liver sequence). Patient study: Intraobserver variability was similar for experienced and inexperienced observers (0.03 ± 1.44 ms versus 0.16 ± 2.33 ms). Interobserver variability was 1.0 ± 3.77 ms for the heart and −0.52 ± 2.75 ms for the liver. Conclusion The proposed algorithm was shown to provide robust T2* measurements and uncertainty estimates over the range of clinically relevant T2* values. Magn Reson Med, 2015. © 2015 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Magn Reson Med 75:1717–1729, 2016. © 2015 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance.
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Affiliation(s)
- Sebastian Bidhult
- Lund Cardiac MR Group, Department of Clinical Physiology, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Sweden
| | - Christos G Xanthis
- Lund Cardiac MR Group, Department of Clinical Physiology, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Love Lindau Liljekvist
- Lund Cardiac MR Group, Department of Clinical Physiology, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Gerald Greil
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trusts and King's College London, London, United Kingdom
| | - Eike Nagel
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trusts and King's College London, London, United Kingdom
| | - Anthony H Aletras
- Lund Cardiac MR Group, Department of Clinical Physiology, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.,Laboratory of Medical Informatics, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Einar Heiberg
- Lund Cardiac MR Group, Department of Clinical Physiology, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Sweden
| | - Erik Hedström
- Lund Cardiac MR Group, Department of Clinical Physiology, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,BHF Centre of Research Excellence and NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trusts and King's College London, London, United Kingdom.,Department of Diagnostic Radiology, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Tufvesson J, Hedström E, Steding-Ehrenborg K, Carlsson M, Arheden H, Heiberg E. Validation and development of a new automatic algorithm for time resolved segmentation of the left ventricle in magnetic resonance imaging. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328296 DOI: 10.1186/1532-429x-17-s1-p68] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Xu J, Eriksson SE, Cebula M, Sandalova T, Hedström E, Pader I, Cheng Q, Myers CR, Antholine WE, Nagy P, Hellman U, Selivanova G, Lindqvist Y, Arnér ESJ. The conserved Trp114 residue of thioredoxin reductase 1 has a redox sensor-like function triggering oligomerization and crosslinking upon oxidative stress related to cell death. Cell Death Dis 2015; 6:e1616. [PMID: 25611390 PMCID: PMC4669772 DOI: 10.1038/cddis.2014.574] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/19/2014] [Accepted: 12/03/2014] [Indexed: 12/19/2022]
Abstract
The selenoprotein thioredoxin reductase 1 (TrxR1) has several key roles in cellular redox systems and reductive pathways. Here we discovered that an evolutionarily conserved and surface-exposed tryptophan residue of the enzyme (Trp114) is excessively reactive to oxidation and exerts regulatory functions. The results indicate that it serves as an electron relay communicating with the FAD moiety of the enzyme, and, when oxidized, it facilitates oligomerization of TrxR1 into tetramers and higher multimers of dimers. A covalent link can also be formed between two oxidized Trp114 residues of two subunits from two separate TrxR1 dimers, as found both in cell extracts and in a crystal structure of tetrameric TrxR1. Formation of covalently linked TrxR1 subunits became exaggerated in cells on treatment with the pro-oxidant p53-reactivating anticancer compound RITA, in direct correlation with triggering of a cell death that could be prevented by antioxidant treatment. These results collectively suggest that Trp114 of TrxR1 serves a function reminiscent of an irreversible sensor for excessive oxidation, thereby presenting a previously unrecognized level of regulation of TrxR1 function in relation to cellular redox state and cell death induction.
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Affiliation(s)
- J Xu
- Division of Biochemistry, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - S E Eriksson
- Division of Biochemistry, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - M Cebula
- Division of Biochemistry, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - T Sandalova
- Division of Molecular Structural Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - E Hedström
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - I Pader
- Division of Biochemistry, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Q Cheng
- Division of Biochemistry, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - C R Myers
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - W E Antholine
- Department of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - P Nagy
- Department of Molecular Immunology and Toxicology, National Institute of Oncology, Rath György ut 7-91, 1122, Budapest, Hungary
| | - U Hellman
- Ludwig Institutet for Cancer Research Ltd., Uppsala University BMC, SE-75 124 Uppsala, Sweden
| | - G Selivanova
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Y Lindqvist
- Division of Molecular Structural Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - E S J Arnér
- Division of Biochemistry, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-17177 Stockholm, Sweden
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Shi Y, Nikulenkov F, Zawacka-Pankau J, Li H, Gabdoulline R, Xu J, Eriksson S, Hedström E, Issaeva N, Kel A, Arnér ESJ, Selivanova G. ROS-dependent activation of JNK converts p53 into an efficient inhibitor of oncogenes leading to robust apoptosis. Cell Death Differ 2014; 21:612-23. [PMID: 24413150 PMCID: PMC3950324 DOI: 10.1038/cdd.2013.186] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 10/04/2013] [Accepted: 11/20/2013] [Indexed: 01/10/2023] Open
Abstract
Rescue of the p53 tumor suppressor is an attractive cancer therapy approach. However, pharmacologically activated p53 can induce diverse responses ranging from cell death to growth arrest and DNA repair, which limits the efficient application of p53-reactivating drugs in clinic. Elucidation of the molecular mechanisms defining the biological outcome upon p53 activation remains a grand challenge in the p53 field. Here, we report that concurrent pharmacological activation of p53 and inhibition of thioredoxin reductase followed by generation of reactive oxygen species (ROS), result in the synthetic lethality in cancer cells. ROS promote the activation of c-Jun N-terminal kinase (JNK) and DNA damage response, which establishes a positive feedback loop with p53. This converts the p53-induced growth arrest/senescence to apoptosis. We identified several survival oncogenes inhibited by p53 in JNK-dependent manner, including Mcl1, PI3K, eIF4E, as well as p53 inhibitors Wip1 and MdmX. Further, we show that Wip1 is one of the crucial executors downstream of JNK whose ablation confers the enhanced and sustained p53 transcriptional response contributing to cell death. Our study provides novel insights for manipulating p53 response in a controlled way. Further, our results may enable new pharmacological strategy to exploit abnormally high ROS level, often linked with higher aggressiveness in cancer, to selectively kill cancer cells upon pharmacological reactivation of p53.
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Affiliation(s)
- Y Shi
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet 17177, Stockholm, Sweden
| | - F Nikulenkov
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet 17177, Stockholm, Sweden
| | - J Zawacka-Pankau
- 1] Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet 17177, Stockholm, Sweden [2] Department of Biotechnology, Intercollegiate Faculty of Biotechnology, UG-MUG 80-822, Gdansk, Poland
| | - H Li
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet 17177, Stockholm, Sweden
| | | | - J Xu
- Division of Biochemistry, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - S Eriksson
- Division of Biochemistry, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - E Hedström
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet 17177, Stockholm, Sweden
| | - N Issaeva
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet 17177, Stockholm, Sweden
| | - A Kel
- geneXplain GmbH D-38302, Wolfenbüttel, Germany
| | - E S J Arnér
- Division of Biochemistry, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - G Selivanova
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet 17177, Stockholm, Sweden
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Morton G, Chiribiri A, Ishida M, Hussain ST, Schuster A, Indermuehle A, Perera D, Knuuti J, Baker S, Hedström E, Schleyer P, O'Doherty M, Barrington S, Nagel E. Quantification of absolute myocardial perfusion in patients with coronary artery disease: comparison between cardiovascular magnetic resonance and positron emission tomography. J Am Coll Cardiol 2012; 60:1546-55. [PMID: 22999722 DOI: 10.1016/j.jacc.2012.05.052] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 04/25/2012] [Accepted: 05/11/2012] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to compare fully quantitative cardiovascular magnetic resonance (CMR) and positron emission tomography (PET) myocardial perfusion and myocardial perfusion reserve (MPR) measurements in patients with coronary artery disease (CAD). BACKGROUND Absolute quantification of myocardial perfusion and MPR with PET have proven diagnostic and prognostic roles in patients with CAD. Quantitative CMR perfusion imaging has been established more recently and has been validated against PET in normal hearts. However, there are no studies comparing fully quantitative CMR against PET perfusion imaging in patients with CAD. METHODS Forty-one patients with known or suspected CAD prospectively underwent quantitative (13)N-ammonia PET and CMR perfusion imaging before coronary angiography. RESULTS The CMR-derived MPR (MPR(CMR)) correlated well with PET-derived measurements (MPR(PET)) (r = 0.75, p < 0.0001). MPR(CMR) and MPR(PET) for the 2 lowest scoring segments in each coronary territory also correlated strongly (r = 0.79, p < 0.0001). Absolute CMR perfusion values correlated significantly, but weakly, with PET values both at rest (r = 0.32; p = 0.002) and during stress (r = 0.37; p < 0.0001). Area under the receiver-operating characteristic curve for MPR(PET) to detect significant CAD was 0.83 (95% confidence interval: 0.73 to 0.94) and for MPR(CMR) was 0.83 (95% confidence interval: 0.74 to 0.92). An MPR(PET) ≤1.44 predicted significant CAD with 82% sensitivity and 87% specificity, and MPR(CMR) ≤1.45 predicted significant CAD with 82% sensitivity and 81% specificity. CONCLUSIONS There is good correlation between MPR(CMR) and MPR(PET.) For the detection of significant CAD, MPR(PET) and MPR(CMR) seem comparable and very accurate. However, absolute perfusion values from PET and CMR are only weakly correlated; therefore, although quantitative CMR is clinically useful, further refinements are still required.
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Affiliation(s)
- Geraint Morton
- King's College London British Heart Foundation Centre of Excellence, National Institute of Health Research Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, Wellcome Trust and Engineering and Physical Sciences Research Council Medical Engineering Centre, Division of Imaging Sciences, The Rayne Institute, St. Thomas' Hospital, London, United Kingdom
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Farnebo M, Hedström E, Edgren M, Henriksson S. 13 Proffered Paper: The Cajal Body Protein WRAP53β - a Novel Player in the Early DNA Damage Response. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schuster A, Hedström E, Blauth C, Marber MS, Nagel E, Carr-White G. Ruptured aneurysm of the sinus of valsalva insights from magnetic resonance first-pass myocardial perfusion imaging. J Am Coll Cardiol 2012; 59:538. [PMID: 22281256 DOI: 10.1016/j.jacc.2011.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 04/13/2011] [Indexed: 10/14/2022]
Affiliation(s)
- Andreas Schuster
- Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom
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Borgquist O, Anesäter E, Hedström E, Lee CK, Ingemansson R, Malmsjö M. Measurements of wound edge microvascular blood flow during negative pressure wound therapy using thermodiffusion and transcutaneous and invasive laser Doppler velocimetry. Wound Repair Regen 2011; 19:727-33. [DOI: 10.1111/j.1524-475x.2011.00741.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 09/08/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Ola Borgquist
- Department of Anesthesiology and Intensive Care and Department of Ophthalmology; Lund University and Skåne University Hospital; Lund; Sweden
| | - Erik Anesäter
- Department of Ophthalmology; Lund University and Skåne University Hospital; Lund; Sweden
| | - Erik Hedström
- Department of Clinical Physiology; Lund University and Skåne University Hospital; Lund; Sweden
| | - Charles K. Lee
- Division of Plastic & Reconstructive Surgery; University of California, San Francisco (UCSF); San Francisco; California
| | - Richard Ingemansson
- Department of Cardiothoracic Surgery; Lund University and Skåne University Hospital; Lund; Sweden
| | - Malin Malmsjö
- Department of Ophthalmology; Lund University and Skåne University Hospital; Lund; Sweden
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Engblom H, Strauss DG, Heden B, Hedström E, Jovinge S, Götberg M, Erlinge D, Wagner GS, Arheden H. The evaluation of an electrocardiographic myocardial ischemia acuteness score to predict the amount of myocardial salvage achieved by early percutaneous coronary intervention. J Electrocardiol 2011; 44:525-32. [DOI: 10.1016/j.jelectrocard.2011.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Indexed: 10/18/2022]
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