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Dietrich T, Bujak ST, Keller T, Schnackenburg B, Bourayou R, Gebker R, Graf K, Fleck E. In Vivo Fluorine Imaging Using 1.5 Tesla MRI for Depiction of Experimental Myocarditis in a Rodent Animal Model. Int J Biomed Imaging 2023; 2023:4659041. [PMID: 37484527 PMCID: PMC10361831 DOI: 10.1155/2023/4659041] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 02/13/2023] [Accepted: 06/04/2023] [Indexed: 07/25/2023] Open
Abstract
The usefulness of perfluorocarbon nanoemulsions for the imaging of experimental myocarditis has been demonstrated in a high-field 9.4 Tesla MRI scanner. Our proof-of-concept study investigated the imaging capacity of PFC-based 19F/1H MRI in an animal myocarditis model using a clinical field strength of 1.5 Tesla. To induce experimental myocarditis, five male rats (weight ~300 g, age ~50 days) were treated with one application per week of doxorubicin (2 mg/kg BW) over a period of six weeks. Three control animals received the identical volume of sodium chloride 0.9% instead. Following week six, all animals received a single 4 ml injection of an 20% oil-in-water perfluorooctylbromide nanoemulsion 24 hours prior to in vivo1H/19F imaging on a 1.5 Tesla MRI. After euthanasia, cardiac histology and immunohistochemistry using CD68/ED1 macrophage antibodies were performed, measuring the inflamed myocardium in μm2 for further statistical analysis to compare the extent of the inflammation with the 19F-MRI signal intensity. All animals treated with doxorubicin showed a specific signal in the myocardium, while no myocardial signal could be detected in the control group. Additionally, the doxorubicin group showed a significantly higher SNR for 19F and a stronger CD68/ED1 immunhistoreactivity compared to the control group. This proof-of-concept study demonstrates that perfluorocarbon nanoemulsions could be detected in an in vivo experimental myocarditis model at a currently clinically relevant field strength.
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Affiliation(s)
- Thore Dietrich
- Department of Cardiology, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
| | - Stephan Theodor Bujak
- Department of Cardiology, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
- Department of Geriatrics, Krankenhaus Hedwigshöhe, Alexianer St. Hedwig Kliniken Berlin GmbH, Berlin 12526, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
| | - Thorsten Keller
- Department of Cardiology, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
- B. Braun Melsungen AG, Melsungen 34212, Germany
| | | | - Riad Bourayou
- Department of Cardiology, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
| | - Rolf Gebker
- Department of Cardiology, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
| | - Kristof Graf
- Department of Cardiology, Jüdisches Krankenhaus Berlin, Berlin 13347, Germany
| | - Eckart Fleck
- Department of Cardiology, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
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Weiss KJ, Nasser SB, Bigvava T, Doltra A, Schnackenburg B, Berger A, Anker MS, Stehning C, Doeblin P, Abdelmeguid M, Talat M, Gebker R, E-Naggar W, Pieske B, Kelle S. Long-term prognostic value of vasodilator stress cardiac magnetic resonance in patients with atrial fibrillation. ESC Heart Fail 2021; 9:110-121. [PMID: 34866358 PMCID: PMC8787987 DOI: 10.1002/ehf2.13736] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/04/2021] [Accepted: 11/11/2021] [Indexed: 11/09/2022] Open
Abstract
AIMS Although the prevalence of coronary artery disease (CAD) is high among patients with atrial fibrillation (AF), studies on stress perfusion cardiac magnetic resonance (CMR) imaging frequently exclude patients with AF, and its prognostic and diagnostic value in high-risk patients with suspected or known CAD remains unclear. METHODS AND RESULTS In this longitudinal cohort study, we included 164 consecutive patients with AF during vasodilator perfusion CMR. Diagnostic value was evaluated regarding invasive coronary angiography in a subset of patients. We targeted a follow-up of >5 years and used CMR results as stratification, and the primary outcome was major adverse cardiac events [MACE, cardiovascular (CV) death and myocardial infarction (MI)]. Secondary outcomes included late coronary revascularization or stroke and the components of the primary outcome. Of the whole cohort (73.8% male, mean age 72.2 years ± 7.8 SD), 99.4% were successfully scanned (163/164 patients). Median CHA2DS2-VASc score was 4 [interquartile range (IQR) 3-5], and median 10-year risk for CV events based on SMART risk score was high (24%, IQR 16-32%). Thirty-two patients (19.6%) presented with ischaemia and 52 patients (31.9%) with late gadolinium enhancement (LGE). A combination of LGE and inducible ischaemia was present in 20 patients (12.3%). Diagnostic accuracy was 86.2% [confidence interval (CI) 68.3-96.1%]. The median follow-up was 6.6 years (IQR 3.6-7.8). Ischaemia in vasodilator perfusion CMR was significantly associated with the occurrence of MACE [P < 0.01; hazard ratio (HR) 2.65, CI 1.39-5.08], as well as LGE (P = 0.03; 1.74, CI 1.07-3.64) and the combination of both (P < 0.01; HR 2.67, CI 1.59-5.62). After adjustment by age, left ventricular ejection fraction, and the presence of diabetes, ischaemia in vasodilator perfusion CMR remained significantly associated with the occurrence of MACE (2.10, CI 1.08-4.10; P = 0.03). In secondary endpoint analysis, there was a significant association of ischaemia in CMR with CV death (P < 0.05; HR 1.93, CI 0.95-3.9) and MI (P < 0.01; HR 13, CI 1.35-125.4), while no significant association was found regarding the occurrence of revascularization (P = 0.45; HR 1.43, CI 0.57-3.58) or stroke (P = 0.99; HR 0.99, CI 0.21-2.59). CONCLUSIONS Vasodilator stress perfusion CMR demonstrated an excellent diagnostic and significant prognostic value at long-term follow-up in high-risk patients with persistent AF and suspected or known CAD.
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Affiliation(s)
- Karl J Weiss
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Augustenburgerplatz 1, Berlin, 13533, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Sarah B Nasser
- Department of Cardiovascular Medicine, Dar Al Fouad Hospital, Cairo, Egypt.,Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | - Tamar Bigvava
- Department of Cardiovascular Medicine, Tbilisi Heart and Vascular Clinic, Tbilisi, Georgia
| | - Adelina Doltra
- Cardiac Imaging Section, Cardiovascular Institute, Hospital Clinic De Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Alexander Berger
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Augustenburgerplatz 1, Berlin, 13533, Germany
| | - Markus S Anker
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Cardiology (CBF), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
| | | | - Patrick Doeblin
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Augustenburgerplatz 1, Berlin, 13533, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Mohamed Abdelmeguid
- Department of Cardiovascular Medicine, Dar Al Fouad Hospital, Cairo, Egypt.,Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Talat
- Department of Radiology, Cairo University, Cairo, Egypt
| | - Rolf Gebker
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Augustenburgerplatz 1, Berlin, 13533, Germany
| | - Wael E-Naggar
- Department of Cardiovascular Medicine, Dar Al Fouad Hospital, Cairo, Egypt.,Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Augustenburgerplatz 1, Berlin, 13533, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Augustenburgerplatz 1, Berlin, 13533, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
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3
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Faragli A, Alogna A, Lee CB, Zhu M, Ghorbani N, Lo Muzio FP, Schnackenburg B, Stehning C, Kuehne T, Post H, Goubergrits L, Nagel E, Pieske B, Kelle S, Kelm M. Non-invasive CMR-Based Quantification of Myocardial Power and Efficiency Under Stress and Ischemic Conditions in Landrace Pigs. Front Cardiovasc Med 2021; 8:689255. [PMID: 34381823 PMCID: PMC8352437 DOI: 10.3389/fcvm.2021.689255] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Myocardial efficiency should be maintained stable under light-to-moderate stress conditions, but ischemia puts the myocardium at risk for impaired functionality. Additionally, the measurement of such efficiency typically requires invasive heart catheterization and exposure to ionizing radiation. In this work, we aimed to non-invasively assess myocardial power and the resulting efficiency during pharmacological stress testing and ischemia induction. Methods: In a cohort of n = 10 healthy Landrace pigs, dobutamine stress testing was performed, followed by verapamil-induced ischemia alongside cardiac magnetic resonance (CMR) imaging. External myocardial power, internal myocardial power, and myocardial efficiency were assessed non-invasively using geometrical and functional parameters from CMR volumetric as well as blood flow and pressure measurements. Results: External myocardial power significantly increased under dobutamine stress [2.3 (1.6-3.1) W/m2 vs. 1.3 (1.1-1.6) W/m2, p = 0.005] and significantly decreased under verapamil-induced ischemia [0.8 (0.5-0.9) W/m2, p = 0.005]. Internal myocardial power [baseline: 5.9 (4.6-8.5) W/m2] was not affected by dobutamine [7.5 (6.9-9.0) W/m2, p = 0.241] nor verapamil [5.8 (4.7-8.8) W/m2, p = 0.878]. Myocardial efficiency did not change from baseline to dobutamine [21% (15-27) vs. 31% (20-44), p = 0.059] but decreased significantly during verapamil-induced ischemia [10% (8-13), p = 0.005]. Conclusion: In healthy Landrace pigs, dobutamine stress increased external myocardial power, whereas myocardial efficiency was maintained stable. On the contrary, verapamil-induced ischemia substantially decreased external myocardial power and myocardial efficiency. Non-invasive CMR was able to quantify these efficiency losses and might be useful for future clinical studies evaluating the effects of therapeutic interventions on myocardial energetics.
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Affiliation(s)
- Alessandro Faragli
- Department of Internal Medicine and Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Alessio Alogna
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Chong Bin Lee
- Department of Internal Medicine and Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Miry Zhu
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Niky Ghorbani
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Francesco Paolo Lo Muzio
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Titus Kuehne
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Heiner Post
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiology, Contilia Heart and Vessel Centre, St. Marien-Hospital Mülheim, Mülheim, Germany
| | - Leonid Goubergrits
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Einstein Center Digital Future, Berlin, Germany
| | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Marcus Kelm
- Berlin Institute of Health, Berlin, Germany.,Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
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4
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Faragli A, Tanacli R, Kolp C, Abawi D, Lapinskas T, Stehning C, Schnackenburg B, Lo Muzio FP, Fassina L, Pieske B, Nagel E, Post H, Kelle S, Alogna A. Cardiovascular magnetic resonance-derived left ventricular mechanics-strain, cardiac power and end-systolic elastance under various inotropic states in swine. J Cardiovasc Magn Reson 2020; 22:79. [PMID: 33256761 PMCID: PMC7708216 DOI: 10.1186/s12968-020-00679-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/17/2019] [Accepted: 10/06/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) strain imaging is an established technique to quantify myocardial deformation. However, to what extent left ventricular (LV) systolic strain, and therefore LV mechanics, reflects classical hemodynamic parameters under various inotropic states is still not completely clear. Therefore, the aim of this study was to investigate the correlation of LV global strain parameters measured via CMR feature tracking (CMR-FT, based on conventional cine balanced steady state free precession (bSSFP) images) with hemodynamic parameters such as cardiac index (CI), cardiac power output (CPO) and end-systolic elastance (Ees) under various inotropic states. METHODS Ten anaesthetized, healthy Landrace swine were acutely instrumented closed-chest and transported to the CMR facility for measurements. After baseline measurements, two steps were performed: (1) dobutamine-stress (Dobutamine) and (2) verapamil-induced cardiovascular depression (Verapamil). During each protocol, CMR images were acquired in the short axisand apical 2Ch, 3Ch and 4Ch views. MEDIS software was utilized to analyze global longitudinal (GLS), global circumferential (GCS), and global radial strain (GRS). RESULTS Dobutamine significantly increased heart rate, CI, CPO and Ees, while Verapamil decreased them. Absolute values of GLS, GCS and GRS accordingly increased during Dobutamine infusion, while GLS and GCS decreased during Verapamil. Linear regression analysis showed a moderate correlation between GLS, GCS and LV hemodynamic parameters, while GRS correlated poorly. Indexing global strain parameters for indirect measures of afterload, such as mean aortic pressure or wall stress, significantly improved these correlations, with GLS indexed for wall stress reflecting LV contractility as the clinically widespread LV ejection fraction. CONCLUSION GLS and GCS correlate accordingly with LV hemodynamics under various inotropic states in swine. Indexing strain parameters for indirect measures of afterload substantially improves this correlation, with GLS being as good as LV ejection fraction in reflecting LV contractility. CMR-FT-strain imaging may be a quick and promising tool to characterize LV hemodynamics in patients with varying degrees of LV dysfunction.
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Affiliation(s)
- A Faragli
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - R Tanacli
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C Kolp
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - D Abawi
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - T Lapinskas
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu Street 2, 50161, Kaunas, Lithuania
| | - C Stehning
- Clinical Science, Philips Healthcare, Röntgenstr. 24, 22335, Hamburg, Germany
| | - B Schnackenburg
- Clinical Science, Philips Healthcare, Röntgenstr. 24, 22335, Hamburg, Germany
| | - F P Lo Muzio
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Via S. Francesco 22, 37129, Verona, Italy
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - L Fassina
- Department of Electrical, Computer and Biomedical Engineering (DIII), Centre for Health Technologies (CHT), University of Pavia, Via Ferrata 5, 27100, Pavia, Italy
| | - B Pieske
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - E Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - H Post
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany
- Department of Cardiology, Contilia Heart and Vessel Centre, St. Marien-Hospital Mülheim, 45468, Mülheim, Germany
| | - S Kelle
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Alogna
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany.
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5
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Nasser SB, Doeblin P, Doltra A, Schnackenburg B, Wassilew K, Berger A, Gebker R, Bigvava T, Hennig F, Pieske B, Kelle S. Cardiac Myxomas Show Elevated Native T1, T2 Relaxation Time and ECV on Parametric CMR. Front Cardiovasc Med 2020; 7:602137. [PMID: 33330663 PMCID: PMC7710854 DOI: 10.3389/fcvm.2020.602137] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: While cardiac tumors are rare, their identification and differentiation has wide clinical implications. Recent cardiac magnetic resonance (CMR) parametric mapping techniques allow for quantitative tissue characterization. Our aim was to examine the range of values encountered in cardiac myxomas in correlation to histological measurements. Methods and Results: Nine patients with histologically proven cardiac myxomas were included. CMR (1.5 Tesla, Philips) including parametric mapping was performed in all patients pre-operatively. All data are reported as mean ± standard deviation. Compared to myocardium, cardiac myxomas demonstrated higher native T1 relaxation times (1,554 ± 192 ms vs. 1,017 ± 58 ms, p < 0.001), ECV (46.9 ± 13.0% vs. 27.1 ± 2.6%, p = 0.001), and T2 relaxation times (209 ± 120 ms vs. 52 ± 3 ms, p = 0.008). Areas with LGE showed higher ECV than areas without (54.3 ± 17.8% vs. 32.7 ± 18.6%, p = 0.042), with differences in native T1 relaxation times (1,644 ± 217 ms vs. 1,482 ± 351 ms, p = 0.291) and T2 relaxation times (356 ± 236 ms vs. 129 ± 68 ms, p = 0.155) not reaching statistical significance. Conclusions: Parametric CMR showed elevated native T1 and T2 relaxation times and ECV values in cardiac myxomas compared to normal myocardium, reflecting an increased interstitial space and fluid content. This might help in the differentiation of cardiac myxomas from other tumor entities.
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Affiliation(s)
- Sarah B Nasser
- Department of Cardiology, Dar Al Fouad Hospital, Cairo, Egypt
| | - Patrick Doeblin
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Adelina Doltra
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Katharina Wassilew
- Department of Pathology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Alexander Berger
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Rolf Gebker
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Felix Hennig
- Department of Cardiothoracic Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany
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6
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Weiss KJ, Eggers H, Stehning C, Kouwenhoven M, Nassar M, Pieske B, Stawowy P, Schnackenburg B, Kelle S. Feasibility and Robustness of 3T Magnetic Resonance Angiography Using Modified Dixon Fat Suppression in Patients With Known or Suspected Peripheral Artery Disease. Front Cardiovasc Med 2020; 7:549392. [PMID: 33195449 PMCID: PMC7661693 DOI: 10.3389/fcvm.2020.549392] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/24/2020] [Indexed: 11/18/2022] Open
Abstract
Objective: Contrast-enhanced magnetic resonance angiography (CE-MRA) is a well-established non-invasive imaging technique for the assessment of peripheral artery disease (PAD). A subtractionless method using modified Dixon (mDixon) fat suppression showed superior image quality at 1.5T over the common subtraction method, using a three-positions stepping table approach with a single dose of contrast agent. The aim of this study was to investigate the feasibility of subtractionless first-pass peripheral MRA at 3T in patients with known or suspected PAD and to compare the performance in terms of vessel-to-background contrast (VBC), signal-to-noise ratio (SNR), and subjective image quality to conventional subtraction MRA. Methods: Ten patients [mean age 69 years ± 12 standard deviation (SD)] with known or suspected PAD were examined on a clinical 3T scanner (Ingenia, Philips Healthcare, Best, Netherlands) at three table positions using subtractionless and subtraction first-pass peripheral MRA. Two readers rated image quality on a four- point scale. Interobserver agreement was expressed in quadratic weighted κ values. VBC was assessed with a semi-automated process and SNR was compared in a healthy volunteer. Results: Subjective image quality was significantly better with the subtractionless method overall (mean image quality for mDixon imaging: 2.88 ± 0.32 SD vs. for subtraction imaging: 2.57 ± 0.48 SD; P < 0.001) and per table position (abdominal position: 2.88 ± 0.32 vs. 2.57 ± 0.48 SD; P < 0.001); upper leg position: (2.97 ± 0.15 SD vs. 2.68 ± 0.37 SD; P < 0.001; lower leg position: 2.60 ± 0.50 SD vs. 2.13 ± 0.60 SD; P < 0.001). Vessel-to-background contrast increased by 22% with the subtractionless method overall (mean VBC for mDixon imaging: 23.16 ± 8.4 SD vs. for subtraction imaging: 19.00 ± 8.1 SD; factor 1.22, P < 0.001). SNR was 82% higher with the subtractionless method (overall SNR gain 1.82; P < 0.001). Conclusion: This study demonstrated the feasibility and robustness of subtractionless first-pass peripheral MRA at 3T in patients with known or suspected PAD using a three- positions stepping table approach with a single dose of contrast agent. It showed increased image quality compared to the conventional subtraction method and superior performance in terms of SNR and vessel-to-background contrast.
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Affiliation(s)
- Karl Jakob Weiss
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | | | | | | | - Mithal Nassar
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Virchow Klinikum, Berlin, Germany
| | - Philipp Stawowy
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | | | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Virchow Klinikum, Berlin, Germany
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7
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Gastl M, Lachmann V, Christidi A, Janzarik N, Veulemans V, Haberkorn S, Holzbach L, Jacoby C, Schnackenburg B, Berrisch-Rahmel S, Zeus T, Kelm M, Bönner F. Cardiac magnetic resonance T2 mapping and feature tracking in athlete's heart and HCM. Eur Radiol 2020; 31:2768-2777. [PMID: 33063183 PMCID: PMC8043946 DOI: 10.1007/s00330-020-07289-4] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/17/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022]
Abstract
Objectives Distinguishing hypertrophic cardiomyopathy (HCM) from left ventricular hypertrophy (LVH) due to systematic training (athlete’s heart, AH) from morphologic assessment remains challenging. The purpose of this study was to examine the role of T2 mapping and deformation imaging obtained by cardiovascular magnetic resonance (CMR) to discriminate AH from HCM with (HOCM) or without outflow tract obstruction (HNCM). Methods Thirty-three patients with HOCM, 9 with HNCM, 13 strength-trained athletes as well as individual age- and gender-matched controls received CMR. For T2 mapping, GRASE-derived multi-echo images were obtained and analyzed using dedicated software. Besides T2 mapping analyses, left ventricular (LV) dimensional and functional parameters were obtained including LV mass per body surface area (LVMi), interventricular septum thickness (IVS), and global longitudinal strain (GLS). Results While LVMi was not significantly different, IVS was thickened in HOCM patients compared to athlete’s. Absolute values of GLS were significantly increased in patients with HOCM/HNCM compared to AH. Median T2 values were elevated compared to controls except in athlete’s heart. ROC analysis revealed T2 values (AUC 0.78) and GLS (AUC 0.91) as good parameters to discriminate AH from overall HNCM/HOCM. Conclusion Discrimination of pathologic from non-pathologic LVH has implications for risk assessment of competitive sports in athletes. Multiparametric CMR with parametric T2 mapping and deformation imaging may add information to distinguish AH from LVH due to HCM. Key Points • Structural analyses using T2 mapping cardiovascular magnetic resonance imaging (CMR) may help to further distinguish myocardial diseases. • To differentiate pathologic from non-pathologic left ventricular hypertrophy, CMR including T2 mapping was obtained in patients with hypertrophic obstructive/non-obstructive cardiomyopathy (HOCM/HNCM) as well as in strength-trained athletes. • Elevated median T2 values in HOCM/HNCM compared with athlete’s may add information to distinguish athlete’s heart from pathologic left ventricular hypertrophy.
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Affiliation(s)
- Mareike Gastl
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany.
| | - Vera Lachmann
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Aikaterini Christidi
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Nico Janzarik
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Verena Veulemans
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Sebastian Haberkorn
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Leonie Holzbach
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Christoph Jacoby
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | | | - Susanne Berrisch-Rahmel
- KardioPro, Praxis für Innere Medizin, Kardiologie, Sport Medizin und Sportkardiologie, Düsseldorf, Germany
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany.,CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Florian Bönner
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
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8
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Faragli A, Tanacli R, Kolp C, Lapinskas T, Stehning C, Schnackenburg B, Lo Muzio FP, Perna S, Pieske B, Nagel E, Post H, Kelle S, Alogna A. Cardiovascular magnetic resonance feature tracking in pigs: a reproducibility and sample size calculation study. Int J Cardiovasc Imaging 2020; 36:703-712. [PMID: 31950298 PMCID: PMC7125242 DOI: 10.1007/s10554-020-01767-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/02/2020] [Indexed: 12/18/2022]
Abstract
Cardiovascular magnetic resonance feature tracking (CMR-FT) is a novel technique for non-invasive assessment of myocardial motion and deformation. Although CMR-FT is standardized in humans, literature on comparative analysis from animal models is scarce. In this study, we measured the reproducibility of global strain under various inotropic states and the sample size needed to test its relative changes in pigs. Ten anesthetized healthy Landrace pigs were investigated. After baseline (BL), two further steps were performed: (I) dobutamine-induced hyper-contractility (Dob) and (II) verapamil-induced hypocontractility (Ver). Global longitudinal (GLS), circumferential (GCS) and radial strain (GRS) were assessed. This study shows a good to excellent inter- and intra-observer reproducibility of CMR-FT in pigs under various inotropic states. The highest inter-observer reproducibility was observed for GLS at both BL (ICC 0.88) and Ver (ICC 0.79). According to the sample size calculation for GLS, a small number of animals could be used for future trials.
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Affiliation(s)
- A Faragli
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany
| | - R Tanacli
- Department of Internal Medicine / Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C Kolp
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - T Lapinskas
- Department of Internal Medicine / Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu Street 2, 50161, Kaunas, Lithuania
| | - C Stehning
- Clinical Science, Philips Healthcare, Röntgenstr. 24, 22335, Hamburg, Germany
| | - B Schnackenburg
- Clinical Science, Philips Healthcare, Röntgenstr. 24, 22335, Hamburg, Germany
| | - F P Lo Muzio
- Department of Surgery, Dentistry, Paedriatics and Gynaecology, University of Verona, Via S. Francesco 22, 37129, Verona, Italy.,Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - S Perna
- Department of Biology, College of Science, University of Bahrain, Sakhir Campus, P.O. Box 32038, Zallaq, Bahrain
| | - B Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany.,Department of Internal Medicine / Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - E Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - H Post
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany.,Department of Cardiology, Contilia Heart and Vessel Centre, St. Marien-Hospital Mülheim, Kaiserstraße 50, 45468, Mülheim, Germany
| | - S Kelle
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany
| | - A Alogna
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany.
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9
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Lapinskas T, Zieschang V, Erley J, Stoiber L, Schnackenburg B, Stehning C, Gebker R, Patel AR, Kawaji K, Steen H, Zaliunas R, Backhaus SJ, Schuster A, Makowski M, Giusca S, Korosoglou G, Pieske B, Kelle S. Strain-encoded cardiac magnetic resonance imaging: a new approach for fast estimation of left ventricular function. BMC Cardiovasc Disord 2019; 19:52. [PMID: 30836942 PMCID: PMC6402124 DOI: 10.1186/s12872-019-1031-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 08/12/2018] [Accepted: 02/21/2019] [Indexed: 11/29/2022] Open
Abstract
Background Recently introduced fast strain-encoded (SENC) cardiac magnetic resonance (CMR) imaging (fast-SENC) provides real-time acquisition of myocardial performance in a single heartbeat. We aimed to test the ability and accuracy of real-time strain-encoded CMR imaging to estimate left ventricular volumes, ejection fraction and mass. Methods Thirty-five subjects (12 healthy volunteers and 23 patients with known or suspected coronary artery disease) were investigated. All study participants were imaged at 1.5 Tesla MRI scanner (Achieva, Philips) using an advanced CMR study protocol which included conventional cine and fast-SENC imaging. A newly developed real-time free-breathing SENC imaging technique based on the acquisition of two images with different frequency modulation was employed. Results All parameters were successfully derived from fast-SENC images with total study time of 105 s (a 15 s scan time and a 90 s post-processing time). There was no significant difference between fast-SENC and cine imaging in the estimation of LV volumes and EF, whereas fast-SENC underestimated LV end-diastolic mass by 7%. Conclusion The single heartbeat fast-SENC technique can be used as a good alternative to cine imaging for the precise calculation of LV volumes and ejection fraction while the technique significantly underestimates LV end-diastolic mass.
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Affiliation(s)
- Tomas Lapinskas
- Department of Internal Medicine / Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. .,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
| | - Victoria Zieschang
- Department of Internal Medicine / Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jennifer Erley
- Department of Internal Medicine / Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Lukas Stoiber
- Department of Internal Medicine / Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | | | - Rolf Gebker
- Department of Internal Medicine / Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Amit R Patel
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Keigo Kawaji
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Henning Steen
- Department of Internal Medicine / Cardiology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | - Remigijus Zaliunas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center, Georg-August University, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center, Georg-August University, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany.,Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, Australia
| | - Marcus Makowski
- Department of Radiology, Charité Campus Virchow Clinic, Berlin, Germany
| | - Sorin Giusca
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Grigorious Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Burkert Pieske
- Department of Internal Medicine / Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine / Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Department of Internal Medicine / Cardiology, Charité Campus Virchow Clinic, Berlin, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
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10
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Giusca S, Korosoglou G, Zieschang V, Stoiber L, Schnackenburg B, Stehning C, Gebker R, Pieske B, Schuster A, Backhaus S, Pieske-Kraigher E, Patel A, Kawaji K, Steen H, Lapinskas T, Kelle S. Reproducibility study on myocardial strain assessment using fast-SENC cardiac magnetic resonance imaging. Sci Rep 2018; 8:14100. [PMID: 30237411 PMCID: PMC6147889 DOI: 10.1038/s41598-018-32226-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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: 04/04/2018] [Accepted: 09/04/2018] [Indexed: 12/26/2022] Open
Abstract
Myocardial strain is a well validated parameter for estimating left ventricular (LV) performance. The aim of our study was to evaluate the inter-study as well as intra- and interobserver reproducibility of fast-SENC derived myocardial strain. Eighteen subjects (11 healthy individuals and 7 patients with heart failure) underwent a cardiac MRI examination including fast-SENC acquisition for evaluating left ventricular global longitudinal (GLS) and circumferential strain (GCS) as well as left ventricular ejection fraction (LVEF). The examination was repeated after 63 [range 49‒87] days and analyzed by two experienced observers. Ten datasets were repeatedly assessed after 1 month by the same observer to test intraobserver variability. The reproducibility was measured using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Patients with heart failure demonstrated reduced GLS and GCS compared to healthy controls (−15.7 ± 3.7 vs. −20.1 ± 1.4; p = 0.002 for GLS and −15.3 ± 3.7 vs. −21.4 ± 1.1; p = 0.001 for GCS). The test-retest analysis showed excellent ICC for LVEF (0.92), GLS (0.94) and GCS (0.95). GLS exhibited excellent ICC (0.99) in both intra- and interobserver variability analysis with very narrow limits of agreement (−0.6 to 0.5 for intraobserver and −1.3 to 0.96 for interobserver agreement). Similarly, GCS showed excellent ICC (0.99) in both variability analyses with narrow limits of agreement (−1.1 to 1.2 for intraobserver and −1.7 to 1.3 for interobserver agreement), whereas LVEF showed larger limits of agreement (−14.4 to 10.1). The analysis of fast-SENC derived myocardial strain using cardiac MRI provides a highly reproducible method for assessing LV functional performance.
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Affiliation(s)
- Sorin Giusca
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Grigorios Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Victoria Zieschang
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Lukas Stoiber
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | | | | | - Rolf Gebker
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center, Georg-August University, Göttingen, Germany.,Department of Cardiology, Royal North Shore Hospital, the Kolling Institute, Northern Clinical School, University of Sydney, Sydney, Australia
| | - Sören Backhaus
- Department of Cardiology and Pneumology, University Medical Center, Georg-August University, Göttingen, Germany
| | | | - Amit Patel
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Keigo Kawaji
- Department of Medicine, University of Chicago, Chicago, Illinois, USA.,Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Henning Steen
- Department of Internal Medicine/Cardiology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | - Tomas Lapinskas
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany. .,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany.
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11
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Gastl M, Behm P, Haberkorn S, Holzbach L, Veulemans V, Jacoby C, Schnackenburg B, Zeus T, Kelm M, Bönner F. Role of T2 mapping in left ventricular reverse remodeling after TAVR. Int J Cardiol 2018; 266:262-268. [DOI: 10.1016/j.ijcard.2018.02.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/01/2018] [Accepted: 02/08/2018] [Indexed: 10/14/2022]
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12
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Bohnen S, Radunski UK, Lund GK, Ojeda F, Looft Y, Senel M, Radziwolek L, Avanesov M, Tahir E, Stehning C, Schnackenburg B, Adam G, Blankenberg S, Muellerleile K. Tissue characterization by T1 and T2 mapping cardiovascular magnetic resonance imaging to monitor myocardial inflammation in healing myocarditis. Eur Heart J Cardiovasc Imaging 2018; 18:744-751. [PMID: 28329275 DOI: 10.1093/ehjci/jex007] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [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: 07/26/2016] [Accepted: 01/16/2017] [Indexed: 12/18/2022] Open
Abstract
Aims Monitoring disease activity in myocarditis is important for tailored therapeutic strategies. This study evaluated the ability of T1 and T2 mapping cardiovascular magnetic resonance (CMR) to monitor the course of myocardial inflammation in healing myocarditis. Methods and Results Forty-eight patients with strictly defined acute myocarditis underwent CMR at 1.5 T in the acute stage, at 3-months (n = 39), and at 12-months follow-up (FU) (n = 21). Normal values were obtained in a control group of 27 healthy subjects. The CMR protocol included standard ('Lake-Louise') sequences as well as T1 (modified Look-Locker inversion recovery sequence, MOLLI) and T2 (gradient- and spin-echo sequence, GraSE) mapping. T1, T2, and extracellular volume (ECV) maps were generated using an OsiriX plug-in. Native myocardial T1, T2, and ECV values were increased in the acute stage, but declined with healing of myocarditis. The performances of global native T1 and T2 to differentiate acute from healed myocarditis stages were significantly better compared with all other global CMR parameters with AUCs of 0.85 (95% CI, 0.76-0.94) and 0.83 (95% CI, 0.73-0.93). Furthermore, regional native T1 and T2 in myocarditis lesions provided AUCs of 0.97 (95% CI, 0.93-1.02) and 0.93 (95% CI, 0.85-1.01), which were significantly superior to any other global or regional CMR parameter. Conclusion Healing of myocarditis can be monitored by native myocardial T1 and T2 measurements without the need for contrast media. Both native myocardial T1 and T2 provide an excellent performance for assessing the stage of myocarditis by CMR.
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Affiliation(s)
- S Bohnen
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - U K Radunski
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - G K Lund
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg
| | - F Ojeda
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - Y Looft
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - M Senel
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - L Radziwolek
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - M Avanesov
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg
| | - E Tahir
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg
| | - C Stehning
- Philips GmbH Market DACH, Roentgenstr. 22, 22335 Hamburg
| | | | - G Adam
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg
| | - S Blankenberg
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - K Muellerleile
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
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13
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Stoiber L, Schnackenburg B, Gebker R, Hireche-Chikaoui H, Pieske B, Kelle S. CMR stress testing in a patient with morbid obesity (BMI 58 kg/m 2) and suspected coronary artery disease. BMC Cardiovasc Disord 2018; 18:47. [PMID: 29506495 PMCID: PMC5838924 DOI: 10.1186/s12872-018-0779-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 02/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background Severe obesity is asscociated with an increased risk of coronary artery disease (CAD) but non-invasive cardiac imaging modalities have important technical limits. Case presentation We report a case of a 58-year old patient with suspected CAD and severely elevated BMI of 58 kg/m2. Conclusions Stress-CMR was able to non-invasively stratify risk with good imaging quality despite the body dimensions of the patient.
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Affiliation(s)
- Lukas Stoiber
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.
| | | | - Rolf Gebker
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | | | - Burkert Pieske
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.,Charité Campus Virchow Klinikum, Department of Internal Medicine/Cardiology, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.,Charité Campus Virchow Klinikum, Department of Internal Medicine/Cardiology, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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14
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Spieker M, Katsianos E, Gastl M, Behm P, Horn P, Jacoby C, Schnackenburg B, Reinecke P, Kelm M, Westenfeld R, Bönner F. T2 mapping cardiovascular magnetic resonance identifies the presence of myocardial inflammation in patients with dilated cardiomyopathy as compared to endomyocardial biopsy. Eur Heart J Cardiovasc Imaging 2017; 19:574-582. [DOI: 10.1093/ehjci/jex230] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 01/30/2017] [Accepted: 09/07/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Spieker
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstraße 5, Duesseldorf 40221, Germany
| | - E Katsianos
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstraße 5, Duesseldorf 40221, Germany
| | - M Gastl
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstraße 5, Duesseldorf 40221, Germany
| | - P Behm
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstraße 5, Duesseldorf 40221, Germany
| | - P Horn
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstraße 5, Duesseldorf 40221, Germany
| | - C Jacoby
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstraße 5, Duesseldorf 40221, Germany
| | - B Schnackenburg
- Philips Healthcare, Röntgenstraße 24, Hamburg 22335, Germany
| | - P Reinecke
- Insitute of Pathology, Heinrich-Heine University, Moorenstraße 5, Duesseldorf 40221, Germany
| | - M Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstraße 5, Duesseldorf 40221, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), Moorenstraße 5, Duesseldorf 40221, Germany
| | - R Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstraße 5, Duesseldorf 40221, Germany
| | - F Bönner
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstraße 5, Duesseldorf 40221, Germany
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15
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Tahir E, Sinn M, Bohnen S, Avanesov M, Säring D, Stehning C, Schnackenburg B, Eulenburg C, Wien J, Radunski UK, Blankenberg S, Adam G, Higgins CB, Saeed M, Muellerleile K, Lund GK. Acute versus Chronic Myocardial Infarction: Diagnostic Accuracy of Quantitative Native T1 and T2 Mapping versus Assessment of Edema on Standard T2-weighted Cardiovascular MR Images for Differentiation. Radiology 2017; 285:83-91. [DOI: 10.1148/radiol.2017162338] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Enver Tahir
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Martin Sinn
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Sebastian Bohnen
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Maxim Avanesov
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Dennis Säring
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Christian Stehning
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Bernhard Schnackenburg
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Christine Eulenburg
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Joshua Wien
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Ulf K. Radunski
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Stefan Blankenberg
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Gerhard Adam
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Charles B. Higgins
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Maythem Saeed
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Kai Muellerleile
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
| | - Gunnar K. Lund
- From the Department of Diagnostic and Interventional Radiology (E.T., M. Sinn, M.A., J.W., G.A., G.K.L.), University Heart Center, Department of General and Interventional Cardiology (S. Bohnen, U.K.R., S. Blankenberg, K.M.), and Department for Medical Biometry and Epidemiology (C.E.), University Hospital Eppendorf, Martinistr 52, 20246 Hamburg, Germany; Department of Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany (D.S.); Philips Research Hamburg, Hamburg,
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16
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Bönner F, Haberkorn S, Behm P, Schnackenburg B, Krüger S, Weiss S, Meyer C, Kelm M, Neizel-Wittke M. Magnetic resonance guided renal denervation using active tracking: first in vivo experience in Swine. Int J Cardiovasc Imaging 2017; 34:431-439. [DOI: 10.1007/s10554-017-1244-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
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Baeßler B, Treutlein M, Schaarschmidt F, Stehning C, Schnackenburg B, Michels G, Maintz D, Bunck AC. A novel multiparametric imaging approach to acute myocarditis using T2-mapping and CMR feature tracking. J Cardiovasc Magn Reson 2017; 19:71. [PMID: 28931401 PMCID: PMC5607501 DOI: 10.1186/s12968-017-0387-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 09/12/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the diagnostic potential of a novel cardiovascular magnetic resonance (CMR) based multiparametric imaging approach in suspected myocarditis and to compare it to traditional Lake Louise criteria (LLC). METHODS CMR data from 67 patients with suspected acute myocarditis were retrospectively analyzed. Seventeen age- and gender-matched healthy subjects served as control. T2-mapping data were acquired using a Gradient-Spin-Echo T2-mapping sequence in short-axis orientation. T2-maps were segmented according to the 16-segments AHA-model and segmental T2 values and pixel-standard deviation (SD) were recorded. Afterwards, the parameters maxT2 (the highest segmental T2 value) and madSD (the mean absolute deviation (MAD) of the pixel-SDs) were calculated for each subject. Cine sequences in three long axes and a stack of short-axis views covering the left and right ventricle were analyzed using a dedicated feature tracking algorithm. RESULTS A multiparametric imaging model containing madSD and LV global circumferential strain (GCSLV) resulted in the highest diagnostic performance in receiver operating curve analyses (area under the curve [AUC] 0.84) when compared to any model containing a single imaging parameter or to LLC (AUC 0.79). Adding late gadolinium enhancement (LGE) to the model resulted in a further increased diagnostic performance (AUC 0.93) and yielded the highest diagnostic sensitivity of 97% and specificity of 77%. CONCLUSIONS A multiparametric CMR imaging model including the novel T2-mapping derived parameter madSD, the feature tracking derived strain parameter GCSLV and LGE yields superior diagnostic sensitivity in suspected acute myocarditis when compared to any imaging parameter alone and to LLC.
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Affiliation(s)
- Bettina Baeßler
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Melanie Treutlein
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Frank Schaarschmidt
- Institute of Biostatistics, Faculty of Natural Sciences, Leibniz Universität Hannover, Hannover, Germany
| | | | | | - Guido Michels
- Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Cologne, Germany
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Alexander C. Bunck
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
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18
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Fischbach K, Kosiek O, Friebe B, Wybranski C, Schnackenburg B, Schmeisser A, Smid J, Ricke J, Pech M. Cardiac Magnetic Resonance Imaging Using an Open 1.0T MR Platform: A Comparative Study with a 1.5T Tunnel System. Pol J Radiol 2017; 82:498-505. [PMID: 29662579 PMCID: PMC5894020 DOI: 10.12659/pjr.899822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 05/31/2016] [Accepted: 12/06/2016] [Indexed: 11/09/2022] Open
Abstract
Background Cardiac magnetic resonance imaging (cMRI) has become the non-invasive reference standard for the evaluation of cardiac function and viability. The introduction of open, high-field, 1.0T (HFO) MR scanners offers advantages for examinations of obese, claustrophobic and paediatric patients.The aim of our study was to compare standard cMRI sequences from an HFO scanner and those from a cylindrical, 1.5T MR system. Material/Method Fifteen volunteers underwent cMRI both in an open HFO and in a cylindrical MR system. The protocol consisted of cine and unenhanced tissue sequences. The signal-to-noise ratio (SNR) for each sequence and blood-myocardium contrast for the cine sequences were assessed. Image quality and artefacts were rated. The location and number of non-diagnostic segments was determined. Volunteers' tolerance to examinations in both scanners was investigated. Results SNR was significantly lower in the HFO scanner (all p<0.001). However, the contrast of the cine sequence was significantly higher in the HFO platform compared to the 1.5T MR scanner (0.685±0.41 vs. 0.611±0.54; p<0.001). Image quality was comparable for all sequences (all p>0.05). Overall, only few non-diagnostic myocardial segments were recorded: 6/960 (0.6%) by the HFO and 17/960 (1.8%) segments by the cylindrical system. The volunteers expressed a preference for the open MR system (p<0.01). Conclusions Standard cardiac MRI sequences in an HFO platform offer a high image quality that is comparable to the quality of images acquired in a cylindrical 1.5T MR scanner. An open scanner design may potentially improve tolerance of cardiac MRI and therefore allow to examine an even broader patient spectrum.
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Affiliation(s)
- Katharina Fischbach
- Department of Radiology and Nuclear Medicine, University Clinic Magdeburg, Magdeburg, Germany
| | - Otrud Kosiek
- Department of Radiology and Nuclear Medicine, University Clinic Magdeburg, Magdeburg, Germany
| | - Björn Friebe
- Department of Radiology and Nuclear Medicine, University Clinic Magdeburg, Magdeburg, Germany
| | - Christian Wybranski
- Department of Radiology and Nuclear Medicine, University Clinic Magdeburg, Magdeburg, Germany
| | | | | | - Jan Smid
- Department of Cardiology, University Clinic, Magdeburg, Germany
| | - Jens Ricke
- Department of Radiology and Nuclear Medicine, University Clinic Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University Clinic Magdeburg, Magdeburg, Germany
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19
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Gastl M, Lachmann V, Janzarik N, Veulemans V, Haberkorn S, Holzbach L, Behm P, Jacoby C, Schnackenburg B, Zeus T, Kelm M, Boenner F. P3333CMR feature tracking and T2 mapping provide additional information to distinguish athlete's heart from pathologic left ventricular hypertrophy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3333] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Behm P, Gastl M, Jahn A, Rohde A, Krueger S, Weiss S, Schnackenburg B, Sager M, Duering K, Clogenson H, Horn P, Westenfeld R, Kelm M, Neizel-Wittke M, Boenner F. P1076MR-guided endomyocardial biopsy in a preclinical in vivo model. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1076] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Lapinskas T, Schnackenburg B, Kouwenhoven M, Gebker R, Berger A, Zaliunas R, Pieske B, Kelle S. Fatty metaplasia quantification and impact on regional myocardial function as assessed by advanced cardiac MR imaging. MAGMA 2017. [PMID: 28620752 PMCID: PMC5813049 DOI: 10.1007/s10334-017-0639-7] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective This study aimed to investigate the advantages of recently developed cardiac imaging techniques of fat–water separation and feature tracking to characterize better individuals with chronic myocardial infarction (MI). Materials and methods Twenty patients who had a previous MI underwent CMR imaging. The study protocol included routine cine and late gadolinium enhancement (LGE) technique. In addition, mDixon LGE imaging was performed in every patient. Left ventricular (LV) circumferential (EccLV) and radial (ErrLV) strain were calculated using dedicated software (CMR42, Circle, Calgary, Canada). The extent of global scar was measured in LGE and fat–water separated images to compare conventional and recent CMR imaging techniques. Results The infarct size derived from conventional LGE and fat–water separated images was similar. However, detection of lipomatous metaplasia was only possible with mDixon imaging. Subjects with fat deposition demonstrated a significantly smaller percentage of fibrosis than those without fat (10.68 ± 5.07% vs. 13.83 ± 6.30%; p = 0.005). There was no significant difference in EccLV or ErrLV between myocardial segments containing fibrosis only and fibrosis with fat. However, EccLV and ErrLV values were significantly higher in myocardial segments adjacent to fibrosis with fat deposition than in those adjacent to LGE only. Conclusions Advanced CMR imaging ensures more detailed tissue characterization in patients with chronic MI without a relevant increase in imaging and post-processing time. Fatty metaplasia may influence regional myocardial deformation especially in the myocardial segments adjacent to scar tissue. A simplified and shortened myocardial viability CMR protocol might be useful to better characterize and stratify patients with chronic MI.
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Affiliation(s)
- Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu Street 2, 50161, Kaunas, Lithuania. .,Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany.
| | | | - Marc Kouwenhoven
- Philips Healthcare, Veenpluis 4-6, 5684 PC, Best, The Netherlands
| | - Rolf Gebker
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Alexander Berger
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Remigijus Zaliunas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu Street 2, 50161, Kaunas, Lithuania
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
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22
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Hilbert S, Weber A, Nehrke K, Börnert P, Schnackenburg B, Oebel S, Spampinato R, Rogge C, Richter S, Hindricks G, Paetsch I, Jahnke C. Artefact-free late gadolinium enhancement imaging in patients with implanted cardiac devices using a modified broadband sequence: current strategies and results from a real-world patient cohort. Europace 2017; 20:801-807. [DOI: 10.1093/europace/eux016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 01/17/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sebastian Hilbert
- Department of Electrophysiology, HELIOS Heart Center Leipzig, Leipzig, Germany
| | - Alexander Weber
- Department of Electrophysiology, HELIOS Heart Center Leipzig, Leipzig, Germany
| | - Kay Nehrke
- Philips Research Laboratories, Hamburg, Germany
| | | | | | - Sabrina Oebel
- Department of Electrophysiology, HELIOS Heart Center Leipzig, Leipzig, Germany
| | - Ricardo Spampinato
- Department of Cardiac Surgery, HELIOS Heart Center Leipzig, Leipzig, Germany
| | - Cathleen Rogge
- Department of Electrophysiology, HELIOS Heart Center Leipzig, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, HELIOS Heart Center Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, HELIOS Heart Center Leipzig, Leipzig, Germany
| | - Ingo Paetsch
- Department of Electrophysiology, HELIOS Heart Center Leipzig, Leipzig, Germany
| | - Cosima Jahnke
- Department of Electrophysiology, HELIOS Heart Center Leipzig, Leipzig, Germany
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23
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Spieker M, Haberkorn S, Gastl M, Behm P, Katsianos S, Horn P, Jacoby C, Schnackenburg B, Reinecke P, Kelm M, Westenfeld R, Bönner F. Abnormal T2 mapping cardiovascular magnetic resonance correlates with adverse clinical outcome in patients with suspected acute myocarditis. J Cardiovasc Magn Reson 2017; 19:38. [PMID: 28351402 PMCID: PMC5370450 DOI: 10.1186/s12968-017-0350-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [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: 01/29/2017] [Accepted: 03/01/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND While most patients recover from suspected acute myocarditis (sAMC) some develop progressive disease with 5-year mortality up to 20%. Recently, parametric Cardiovascular Magnetic Resonance (CMR) approaches, quantifying native T1 and T2 relaxation time, have demonstrated the ability to increase diagnostic accuracy. However, prognostic implications of T2 values in this cohort are unknown. The purpose of the study was to investigate the prognostic relevance of elevated CMR T2 values in patients with sAMC. METHODS AND RESULTS We carried out a prospective study in 46 patients with sAMC defined by current ESC recommendations. A combined endpoint was defined by the occurrence of at least one major adverse cardiac event (MACE) and hospitalisation for heart failure. Event rate was 24% (n = 11) for 1-year-MACE and hospitalisation. A follow-up after 11 ± 7 months was performed in 98% of the patients. Global T2 values were significantly increased at acute stage of disease compared to controls and decreased over time. During acute disease, elevated global T2 time (odds ratio 6.3, p < 0.02) as well as myocardial fraction with T2 time >80 ms (odds ratio 4.9, p < 0.04) predicted occurrence of the combined endpoint. Patients with clinical recovery revealed significantly decreased T2 relaxation times at follow-up examinations; however, T2 values were still elevated compared to healthy controls. CONCLUSION Assessment of myocardial T2 relaxation times at initial presentation facilitates CMR-based risk stratification in patients with acute myocarditis. T2 Mapping may emerge as a new tool to monitor inflammatory myocardial injuries during the course of disease.
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Affiliation(s)
- Maximilian Spieker
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Sebastian Haberkorn
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Mareike Gastl
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Patrick Behm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Stratis Katsianos
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Christoph Jacoby
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | | | - Petra Reinecke
- Institute of Pathology, Heinrich Heine University, Duesseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
- CARID, Cardiovascular Research Institute Düsseldorf, Duesseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Florian Bönner
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
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24
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Tahir E, Sinn M, Avanesov M, Bohnen S, Müllerleile K, Radunksi U, Stehning C, Säring D, Starekova J, Schnackenburg B, Adam G, Lund G. Quantitatives T1- und T2-Mapping CMR zur Differenzierung von akutem und chronischem Myokardinfarkt. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600256] [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: 10/19/2022]
Affiliation(s)
- E Tahir
- Universitätsklinikum Eppendorf-Hamburg, Diagnostische und Interventionelle Radiologie, Hamburg
| | - M Sinn
- Universitätsklinikum Eppendorf-Hamburg, Diagnostische und Interventionelle Radiologie, Hamburg
| | - M Avanesov
- Universitätsklinikum Eppendorf-Hamburg, Diagnostische und Interventionelle Radiologie, Hamburg
| | - S Bohnen
- Universitäres Herzzentrum Hamburg, Allgemeine und Interventionelle Kardiologie, Hamburg
| | - K Müllerleile
- Universitäres Herzzentrum Hamburg, Allgemeine und Interventionelle Kardiologie, Hamburg
| | - U Radunksi
- Universitäres Herzzentrum Hamburg, Allgemeine und Interventionelle Kardiologie, Hamburg
| | | | - D Säring
- FH Wedel, Medizinische und Industrielle Bildverarbeitung, Wedel
| | - J Starekova
- Universitätsklinikum Eppendorf-Hamburg, Diagnostische und Interventionelle Radiologie, Hamburg
| | | | - G Adam
- Universitätsklinikum Eppendorf-Hamburg, Diagnostische und Interventionelle Radiologie, Hamburg
| | - G Lund
- Universitätsklinikum Eppendorf-Hamburg, Diagnostische und Interventionelle Radiologie, Hamburg
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Paetsch I, Jahnke C, Hilbert S, Krueger S, Weiss S, Smink J, Schnackenburg B, Lloyd T, Hindricks G, Sommer P. Cardiovascular Magnetic Resonance-Guided Electrophysiological Interventions: Radiofrequency Ablation of Typical Atrial Flutter. Circ Cardiovasc Imaging 2016; 10:CIRCIMAGING.116.005780. [PMID: 28028014 DOI: 10.1161/circimaging.116.005780] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ingo Paetsch
- From the Department of Electrophysiology, HELIOS Heart Center Leipzig, Germany (I.P., C.J., S.H., G.H., P.S.); Philips Research Laboratories, Best, The Netherlands, and Hamburg, Germany (S.K., S.W., J.S., B.S.); and Imricor Medical Systems, Burnsville, MN (T.L.).
| | - Cosima Jahnke
- From the Department of Electrophysiology, HELIOS Heart Center Leipzig, Germany (I.P., C.J., S.H., G.H., P.S.); Philips Research Laboratories, Best, The Netherlands, and Hamburg, Germany (S.K., S.W., J.S., B.S.); and Imricor Medical Systems, Burnsville, MN (T.L.)
| | - Sebastian Hilbert
- From the Department of Electrophysiology, HELIOS Heart Center Leipzig, Germany (I.P., C.J., S.H., G.H., P.S.); Philips Research Laboratories, Best, The Netherlands, and Hamburg, Germany (S.K., S.W., J.S., B.S.); and Imricor Medical Systems, Burnsville, MN (T.L.)
| | - Sascha Krueger
- From the Department of Electrophysiology, HELIOS Heart Center Leipzig, Germany (I.P., C.J., S.H., G.H., P.S.); Philips Research Laboratories, Best, The Netherlands, and Hamburg, Germany (S.K., S.W., J.S., B.S.); and Imricor Medical Systems, Burnsville, MN (T.L.)
| | - Steffen Weiss
- From the Department of Electrophysiology, HELIOS Heart Center Leipzig, Germany (I.P., C.J., S.H., G.H., P.S.); Philips Research Laboratories, Best, The Netherlands, and Hamburg, Germany (S.K., S.W., J.S., B.S.); and Imricor Medical Systems, Burnsville, MN (T.L.)
| | - Jouke Smink
- From the Department of Electrophysiology, HELIOS Heart Center Leipzig, Germany (I.P., C.J., S.H., G.H., P.S.); Philips Research Laboratories, Best, The Netherlands, and Hamburg, Germany (S.K., S.W., J.S., B.S.); and Imricor Medical Systems, Burnsville, MN (T.L.)
| | - Bernhard Schnackenburg
- From the Department of Electrophysiology, HELIOS Heart Center Leipzig, Germany (I.P., C.J., S.H., G.H., P.S.); Philips Research Laboratories, Best, The Netherlands, and Hamburg, Germany (S.K., S.W., J.S., B.S.); and Imricor Medical Systems, Burnsville, MN (T.L.)
| | - Tom Lloyd
- From the Department of Electrophysiology, HELIOS Heart Center Leipzig, Germany (I.P., C.J., S.H., G.H., P.S.); Philips Research Laboratories, Best, The Netherlands, and Hamburg, Germany (S.K., S.W., J.S., B.S.); and Imricor Medical Systems, Burnsville, MN (T.L.)
| | - Gerhard Hindricks
- From the Department of Electrophysiology, HELIOS Heart Center Leipzig, Germany (I.P., C.J., S.H., G.H., P.S.); Philips Research Laboratories, Best, The Netherlands, and Hamburg, Germany (S.K., S.W., J.S., B.S.); and Imricor Medical Systems, Burnsville, MN (T.L.)
| | - Philipp Sommer
- From the Department of Electrophysiology, HELIOS Heart Center Leipzig, Germany (I.P., C.J., S.H., G.H., P.S.); Philips Research Laboratories, Best, The Netherlands, and Hamburg, Germany (S.K., S.W., J.S., B.S.); and Imricor Medical Systems, Burnsville, MN (T.L.)
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Nasser SB, Doltra A, Schnackenburg B, Wassilew K, Messroghli D, Bigvava T, Pieske B, Falk V, Gebker R, Kelle S. Quantitative tissue characterization of cardiac myxomas by CMR-Mapping techniques validated by histology. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032453 DOI: 10.1186/1532-429x-18-s1-p110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Baessler B, Schaarschmidt F, Schnackenburg B, Stehning C, Treutlein M, Dick A, Michels G, Maintz D, Bunck A. A novel analytical approach to quantitative myocardial edema imaging in acute myocarditis using T2-mapping. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032090 DOI: 10.1186/1532-429x-18-s1-w9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Suttmeyer B, Teichgräber U, Rathke H, Albrecht L, Güttler F, Schnackenburg B, Hamm B, de Bucourt M. Initial experience with imaging of the lower extremity arteries in an open 1.0 Tesla MRI system using the triggered angiography non-contrast-enhanced sequence (TRANCE) compared to digital subtraction angiography (DSA). ACTA ACUST UNITED AC 2016; 61:383-92. [DOI: 10.1515/bmt-2014-0181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 11/09/2015] [Indexed: 11/15/2022]
Abstract
Abstract
Purpose:
The aim of this study was to evaluate the feasibility and validity of arterial lower limb imaging with triggered angiography non-contrast enhanced (TRANCE) in an open MRI at 1.0 Tesla (T) compared to digital subtraction angiography (DSA).
Material and methods:
ECG-gated, non-contrast-enhanced magnetic resonance angiography (MRA) was performed in a 1.0-T high-field open magnetic resonance imaging (MRI) system which generates a vertical magnetic field. Three acquisition levels were defined (abdominal and pelvic level, arterial segments above the knee and segments below the knee) and a total of 1782 vessel diameter measurements were taken on a total of 11 patients with suspected peripheral arterial occlusive disease (PAOD) (8 men, 3 women; average age 66 years). In each patient, 162 vessel segments (81 each with TRANCE and DSA) were defined and measured. Pearson correlation coefficients were calculated.
Results:
At the abdominal/pelvic level, all mean values measured with DSA exceeded the mean values obtained with TRANCE. Above the knee, mean vessel diameters were measured smaller in DSA in six, equal in three, and larger in two vessel segments. Below the knee, all measured averages, except for the tibiofibular tract (TFT) measurements, were larger in TRANCE. In total, two small (≤0.3), two moderate (>0.3), 11 good (>0.5), 10 high (>0.7) and 13 very high (>0.8) correlations were obtained.
Conclusions:
Non-contrast-enhanced imaging of the lower limb arteries using a TRANCE-sequence in a 1.0 T open MRI system is feasible with the protocol presented; however, TRANCE tends to underestimate larger vessels and overestimate smaller vessels compared to DSA.
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Radunski UK, Lund GK, Säring D, Bohnen S, Stehning C, Schnackenburg B, Avanesov M, Tahir E, Adam G, Blankenberg S, Muellerleile K. T1 and T2 mapping cardiovascular magnetic resonance imaging techniques reveal unapparent myocardial injury in patients with myocarditis. Clin Res Cardiol 2016; 106:10-17. [DOI: 10.1007/s00392-016-1018-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/30/2016] [Indexed: 12/20/2022]
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Bönner F, Spieker M, Haberkorn S, Jacoby C, Flögel U, Schnackenburg B, Horn P, Reinecke P, Neizel-Wittke M, Kelm M, Westenfeld R. Myocardial T2 Mapping Increases Noninvasive Diagnostic Accuracy for Biopsy-Proven Myocarditis. JACC Cardiovasc Imaging 2016; 9:1467-1469. [PMID: 27085445 DOI: 10.1016/j.jcmg.2015.11.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 12/21/2022]
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Baeßler B, Schaarschmidt F, Stehning C, Schnackenburg B, Giolda A, Maintz D, Bunck AC. Reproducibility of three different cardiac T 2 -mapping sequences at 1.5T. J Magn Reson Imaging 2016; 44:1168-1178. [PMID: 27043352 DOI: 10.1002/jmri.25258] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/15/2016] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To elucidate the impact of technical and intraindividual reproducibility on the overall variability of myocardial T2 relaxation times. MATERIALS AND METHODS Thirty healthy volunteers were examined three times (day 1 morning/evening, evening after 2-3 weeks) at 1.5T. During each examination three different T2 -mapping sequences were acquired twice at three slices in short axis view: multi-echo-spin-echo (MESE), T2 -prepared balanced steady-state free precession (SSFP) (T2 prep), and gradient-spin-echo with and without fat saturation (GraSE/GraSEFS ). Repeated measurements were performed for T2 prep and GraSE. Segmented T2 -maps were generated for each slice according to the American Heart Association (AHA) 16-segment model. RESULTS The coefficients of variation and intraclass correlation coefficients for intraobserver variability were: 1.3% and 0.89 for T2 prep, 1.5% and 0.93 for GraSE, 3.1% and 0.83 for MESE; and for interobserver variability: 3.3% and 0.66 for T2 prep, 2.0% and 0.83 for GraSE, 3.6% and 0.77 for MESE. No systematic difference of T2 times was observed due to diurnal effects and on long-term analysis using one-way analysis of variance (ANOVA) with Tukey-type multiple comparisons (morning vs. evening scan for T2 prep: 52.5 ± 2.4 vs. 51.7 ± 2.7 msec, P = 0.119; for GraSE: 58.6 ± 4.0 vs. 58.5 ± 3.8 msec, P = 0.984; for GraSEFS 57.1 ± 3.2 vs. 57.2 ± 3.9 msec, P = 0.998, and for MESE: 53.8 ± 2.7 vs. 53.3 ± 3.3 msec, P = 0.541; scans between weeks for T2 prep: 51.7 ± 2.7 vs. 51.4 ± 2.4 msec, P = 0.873; for GraSE: 58.5 ± 3.8 vs. 58.1 ± 3.4 msec, P = 0.736; for GraSEFS : 57.2 ± 3.9 vs. 57.0 ± 4.6 msec, P = 0.964, and for MESE: 53.3 ± 3.3 vs. 53.4 ± 2.4 msec, P = 0.970). ANOVA components, however, demonstrated a greater variance of T2 times over multiple timepoints than for repeated measurements within the same scan (variance components of the model fit for intraday variance vs. repeated measurements: T2 prep 2.22 vs. 1.36, GraSE 3.76 vs. 2.09, GraSEFS 3.96 vs. 1.58, MESE 1.86; and for interweeks variance vs. repeated measurements: T2 prep 2.21 vs. 0.80, GraSE 3.20 vs. 2.10, GraSEFS 8.82 vs. 1.18, and MESE 4.49). CONCLUSION Technical reproducibility and intra- and interobserver agreement of myocardial T2 relaxation times are excellent and intraindividual variation over time is small. Therefore, we consider subject-related factors to explain most of the interindividual variability of myocardial T2 times reported in previous studies. The acknowledgment of this subject-related, biological variability may be important for the future diagnostic value of T2 -mapping. J. Magn. Reson. Imaging 2016;44:1168-1178.
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Affiliation(s)
- Bettina Baeßler
- Department of Radiology, University Hospital of Cologne, Germany.
| | - Frank Schaarschmidt
- Institute of Biostatistics, Faculty of Natural Sciences, Leibniz Universität Hannover, Germany
| | | | | | - Agathe Giolda
- Department of Radiology, University Hospital of Cologne, Germany
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Germany
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Baeßler B, Schaarschmidt F, Schnackenburg B, Stehning C, Dick A, Maintz D, Bunck A. Ein neuer multiparametrischer Ansatz in der MRT-basierten Diagnostik der Myokarditis: Kombination von T2-Mapping mit Feature Tracking basierter Strain-Analyse. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581380] [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: 10/22/2022]
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Bigvava T, Nasser SB, Doltra A, Schnackenburg B, Berger A, Klein C, Pieske B, Gebker R, Kelle S. Prognostic value of cardiovascular magnetic resonance stress perfusion imaging in patients with atrial fibrillation. Journal of Cardiovascular Magnetic Resonance 2016. [PMCID: PMC5032761 DOI: 10.1186/1532-429x-18-s1-p76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Radunski UK, Bohnen S, Lund G, Wilmink LM, Looft Y, Senel M, Stehning C, Schnackenburg B, Adam G, Blankenberg S, Muellerleile K. T1 and T2 mapping cardiovascular magnetic resonance to monitor the course of myocarditis. Journal of Cardiovascular Magnetic Resonance 2016. [PMCID: PMC5032721 DOI: 10.1186/1532-429x-18-s1-o99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Bigvava T, Schnackenburg B, Nasser SB, Gebker R, Berger A, Pieske B, Kelle S. Liquefaction necrosis of mitral annulus calcification. Int J Cardiol 2016; 202:59-61. [PMID: 26386922 DOI: 10.1016/j.ijcard.2015.08.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 08/21/2015] [Indexed: 01/03/2023]
Affiliation(s)
| | | | - Sarah B Nasser
- Dar Al Fouad Hospital, Department of Cardiology, Cairo, Egypt
| | - Rolf Gebker
- Deutsches Herzzentrum Berlin, Department of Internal Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin
| | - Alexander Berger
- Deutsches Herzzentrum Berlin, Department of Internal Medicine, Berlin, Germany
| | - Burkert Pieske
- Deutsches Herzzentrum Berlin, Department of Internal Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin
| | - Sebastian Kelle
- Deutsches Herzzentrum Berlin, Department of Internal Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin.
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Baeßler B, Schaarschmidt F, Dick A, Stehning C, Schnackenburg B, Michels G, Maintz D, Bunck AC. Mapping tissue inhomogeneity in acute myocarditis: a novel analytical approach to quantitative myocardial edema imaging by T2-mapping. J Cardiovasc Magn Reson 2015; 17:115. [PMID: 26700020 PMCID: PMC4690253 DOI: 10.1186/s12968-015-0217-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/09/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of the present study was to investigate the diagnostic value of T2-mapping in acute myocarditis (ACM) and to define cut-off values for edema detection. METHODS Cardiovascular magnetic resonance (CMR) data of 31 patients with ACM were retrospectively analyzed. 30 healthy volunteers (HV) served as a control. Additionally to the routine CMR protocol, T2-mapping data were acquired at 1.5 T using a breathhold Gradient-Spin-Echo T2-mapping sequence in six short axis slices. T2-maps were segmented according to the 16-segments AHA-model and segmental T2 values as well as the segmental pixel-standard deviation (SD) were analyzed. RESULTS Mean differences of global myocardial T2 or pixel-SD between HV and ACM patients were only small, lying in the normal range of HV. In contrast, variation of segmental T2 values and pixel-SD was much larger in ACM patients compared to HV. In random forests and multiple logistic regression analyses, the combination of the highest segmental T2 value within each patient (maxT2) and the mean absolute deviation (MAD) of log-transformed pixel-SD (madSD) over all 16 segments within each patient proved to be the best discriminators between HV and ACM patients with an AUC of 0.85 in ROC-analysis. In classification trees, a combined cut-off of 0.22 for madSD and of 68 ms for maxT2 resulted in 83% specificity and 81% sensitivity for detection of ACM. CONCLUSIONS The proposed cut-off values for maxT2 and madSD in the setting of ACM allow edema detection with high sensitivity and specificity and therefore have the potential to overcome the hurdles of T2-mapping for its integration into clinical routine.
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Affiliation(s)
- Bettina Baeßler
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany.
| | - Frank Schaarschmidt
- Institute of Biostatistics, Faculty of Natural Sciences, Leibniz Universität Hannover, Hannover, Germany.
| | - Anastasia Dick
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany.
| | | | | | - Guido Michels
- Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Cologne, Germany.
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany.
| | - Alexander C Bunck
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany.
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Tahir E, Sinn MR, Radunski UK, Säring D, Stehning C, Muellerleile K, Schnackenburg B, Adam G, Lund G. Serial native T1- and T2-mapping to quantitatively monitor resorption of myocardial edema following acute myocardial infarction. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328946 DOI: 10.1186/1532-429x-17-s1-p101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Doltra A, Hartmann A, Goubergrits L, Kuehne T, Stawowy P, Gebker R, Schneeweis C, Dreysse S, Schnackenburg B, Fleck E, Kelle S. Assessment of wall-shear stress pre and post renal sympathetic nerve denervation in patients with resistant hypertension. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328865 DOI: 10.1186/1532-429x-17-s1-q60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Baessler B, Schaarschmidt F, Schnackenburg B, Stehning C, Giolda AD, Maintz D, Bunck A. Reproducibility of three different cardiac T2-mapping sequences at 1.5T and impact of cofactors on T2-relaxation times. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328289 DOI: 10.1186/1532-429x-17-s1-w12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Doltra A, Nasser SB, Messroghli D, Gebker R, Schnackenburg B, Pieske B, Kelle S. T1 Mapping for the Study of Cardiac Hypertrophy. Curr Cardiovasc Imaging Rep 2015. [DOI: 10.1007/s12410-015-9362-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Doltra A, Messroghli D, Stawowy P, Hassel JH, Gebker R, Leppänen O, Gräfe M, Schneeweis C, Schnackenburg B, Fleck E, Kelle S. Potential reduction of interstitial myocardial fibrosis with renal denervation. J Am Heart Assoc 2015; 3:e001353. [PMID: 25516438 PMCID: PMC4338728 DOI: 10.1161/jaha.114.001353] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hypertensive cardiomyopathy is characterized by myocyte hypertrophy and interstitial fibrosis. The effects of renal denervation (RD) on the heart are poorly understood. New magnetic resonance imaging techniques (extracellular volume fraction) permit the quantitative assessment of myocardial fibrosis. Our aim was to study the effects of RD on myocardial fibrosis. METHODS AND RESULTS Twenty‐three patients with resistant hypertension undergoing RD and 5 resistant hypertensive controls were prospectively included. Cardiac magnetic resonance imaging at 1.5 T was performed before RD and at 6‐month follow‐up. Indexed left ventricular mass, septal extracellular volume fraction, and indexed absolute extracellular volume (a quantitative measure of extracellular matrix) were quantified. All data are reported as mean±SD deviation (median). Decreases in systolic (161.96±19.09 [160] versus 144.78±16.48 [143] mm Hg, P<0.0001) and diastolic (85.61±12.88 [83] versus 80.39±11.93 [81] mm Hg, P=0.018) blood pressures and in indexed left ventricular mass (41.83±10.20 [41.59] versus 37.72±7.44 [38.49] g/m1.7, P=0.001) were observed at follow‐up only in RD patients. No significant differences in extracellular volume were found (26.24±3.92% [26.06%] versus 25.74±4.53% [25.63%], P=0.605). A significant decrease in absolute extracellular volume was observed after 6 months in RD patients exclusively (10.36±2.25 [10.79] versus 9.25±2.38 [9.79] mL/m1.7, P=0.031). This effect was observed independently of blood pressure reduction. CONCLUSIONS RD significantly decreases left ventricular mass, while extracellular volume remains stable. Our results suggest that the observed left ventricular mass decrease was due not exclusively to a reversion of myocyte hypertrophy but also to an additional reduction in collagen content, indicating interstitial myocardial fibrosis.
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Affiliation(s)
- Adelina Doltra
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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Hilbert S, Sommer P, Gutberlet M, Gaspar T, Foldyna B, Piorkowski C, Weiss S, Lloyd T, Schnackenburg B, Krueger S, Fleiter C, Paetsch I, Jahnke C, Hindricks G, Grothoff M. Real-time magnetic resonance-guided ablation of typical right atrial flutter using a combination of active catheter tracking and passive catheter visualization in man: initial results from a consecutive patient series. Europace 2015; 18:572-7. [DOI: 10.1093/europace/euv249] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 06/15/2015] [Indexed: 11/13/2022] Open
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Baeßler B, Schaarschmidt F, Stehning C, Schnackenburg B, Maintz D, Bunck AC. A systematic evaluation of three different cardiac T2-mapping sequences at 1.5 and 3T in healthy volunteers. Eur J Radiol 2015; 84:2161-70. [PMID: 26276731 DOI: 10.1016/j.ejrad.2015.08.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [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: 04/27/2015] [Revised: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Previous studies showed that myocardial T2 relaxation times measured by cardiac T2-mapping vary significantly depending on sequence and field strength. Therefore, a systematic comparison of different T2-mapping sequences and the establishment of dedicated T2 reference values is mandatory for diagnostic decision-making. METHODS Phantom experiments using gel probes with a range of different T1 and T2 times were performed on a clinical 1.5T and 3T scanner. In addition, 30 healthy volunteers were examined at 1.5 and 3T in immediate succession. In each examination, three different T2-mapping sequences were performed at three short-axis slices: Multi Echo Spin Echo (MESE), T2-prepared balanced SSFP (T2prep), and Gradient Spin Echo with and without fat saturation (GraSEFS/GraSE). Segmented T2-Maps were generated according to the AHA 16-segment model and statistical analysis was performed. RESULTS Significant intra-individual differences between mean T2 times were observed for all sequences. In general, T2prep resulted in lowest and GraSE in highest T2 times. A significant variation with field strength was observed for mean T2 in phantom as well as in vivo, with higher T2 values at 1.5T compared to 3T, regardless of the sequence used. Segmental T2 values for each sequence at 1.5 and 3T are presented. CONCLUSIONS Despite a careful selection of sequence parameters and volunteers, significant variations of the measured T2 values were observed between field strengths, MR sequences and myocardial segments. Therefore, we present segmental T2 values for each sequence at 1.5 and 3T with the inherent potential to serve as reference values for future studies.
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Affiliation(s)
- Bettina Baeßler
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Frank Schaarschmidt
- Institute of Biostatistics, Faculty of Natural Sciences, Leibniz Universität Hannover, Herrenhaeuser Str.2, 30419 Hannover, Germany.
| | | | | | - David Maintz
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Alexander C Bunck
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
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Baeßler B, Schaarschmidt F, Stehning C, Schnackenburg B, Maintz D, Bunck AC. Cardiac T2-mapping using a fast gradient echo spin echo sequence - first in vitro and in vivo experience. J Cardiovasc Magn Reson 2015; 17:67. [PMID: 26231927 PMCID: PMC4522069 DOI: 10.1186/s12968-015-0177-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/24/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The aim of this study was the evaluation of a fast Gradient Spin Echo Technique (GraSE) for cardiac T2-mapping, combining a robust estimation of T2 relaxation times with short acquisition times. The sequence was compared against two previously introduced T2-mapping techniques in a phantom and in vivo. METHODS Phantom experiments were performed at 1.5 T using a commercially available cylindrical gel phantom. Three different T2-mapping techniques were compared: a Multi Echo Spin Echo (MESE; serving as a reference), a T2-prepared balanced Steady State Free Precession (T2prep) and a Gradient Spin Echo sequence. For the subsequent in vivo study, 12 healthy volunteers were examined on a clinical 1.5 T scanner. The three T2-mapping sequences were performed at three short-axis slices. Global myocardial T2 relaxation times were calculated and statistical analysis was performed. For assessment of pixel-by-pixel homogeneity, the number of segments showing an inhomogeneous T2 value distribution, as defined by a pixel SD exceeding 20 % of the corresponding observed T2 time, was counted. RESULTS Phantom experiments showed a greater difference of measured T2 values between T2prep and MESE than between GraSE and MESE, especially for species with low T1 values. Both, GraSE and T2prep resulted in an overestimation of T2 times compared to MESE. In vivo, significant differences between mean T2 times were observed. In general, T2prep resulted in lowest (52.4 ± 2.8 ms) and GraSE in highest T2 estimates (59.3 ± 4.0 ms). Analysis of pixel-by-pixel homogeneity revealed the least number of segments with inhomogeneous T2 distribution for GraSE-derived T2 maps. CONCLUSIONS The GraSE sequence is a fast and robust sequence, combining advantages of both MESE and T2prep techniques, which promises to enable improved clinical applicability of T2-mapping in the future. Our study revealed significant differences of derived mean T2 values when applying different sequence designs. Therefore, a systematic comparison of different cardiac T2-mapping sequences and the establishment of dedicated reference values should be the goal of future studies.
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Affiliation(s)
- Bettina Baeßler
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany.
| | - Frank Schaarschmidt
- Institute of Biostatistics, Faculty of Natural Sciences, Leibniz Universität Hannover, Hannover, Germany.
| | | | | | - David Maintz
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany.
| | - Alexander C Bunck
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937, Cologne, Germany.
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Bohnen S, Radunski UK, Lund GK, Kandolf R, Stehning C, Schnackenburg B, Adam G, Blankenberg S, Muellerleile K. Performance of t1 and t2 mapping cardiovascular magnetic resonance to detect active myocarditis in patients with recent-onset heart failure. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.003073. [PMID: 26015267 DOI: 10.1161/circimaging.114.003073] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study evaluated the performance of novel quantitative T1 and T2 mapping cardiovascular magnetic resonance (CMR) techniques to identify active myocarditis in patients with recent-onset heart failure. METHODS AND RESULTS Thirty-one consecutive patients with recent-onset heart failure, reduced left ventricular function and clinically suspected myocarditis underwent endomyocardial biopsy and CMR at 1.5 Tesla. The CMR protocol included standard Lake-Louise parameters as well as T1 mapping using a modified Look-Locker inversion recovery sequence and T2 mapping using a hybrid gradient and spin-echo sequence. Short-axis maps were generated using an OsiriX plug-in to calculate global myocardial T1, T2, and extracellular volume fraction. Active myocarditis was defined by ongoing inflammation on endomyocardial biopsy. Endomyocardial biopsy revealed active myocarditis in 16 (52%) of 31 patients. Neither clinical characteristics, standard Lake-Louise CMR parameters, global myocardial T1 nor extracellular volume fraction differed significantly between patients with and without active myocarditis. However, median global myocardial T2 was significantly higher in patients with active myocarditis (65 ms [Q1-Q3, 61-70 ms]) than in patients without active myocarditis (59 ms [Q1-Q3, 55-64 ms]; P<0.01). A cutoff value for global myocardial T2 of ≥60 ms provided a sensitivity, specificity, accuracy, negative and positive predictive value of 94% (70%-100%), 60% (32%-84%), 77% (60%-89%), 90% (56%-100%), and 71% (48%-89%) for active myocarditis, respectively. CONCLUSIONS T2 mapping seems to be superior when compared with standard CMR parameters, global myocardial T1, and extracellular volume fraction values for assessing the activity of myocarditis in patients with recent-onset heart failure and reduced left ventricular function.
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Affiliation(s)
- Sebastian Bohnen
- From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.)
| | - Ulf K Radunski
- From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.)
| | - Gunnar K Lund
- From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.)
| | - Reinhard Kandolf
- From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.)
| | - Christian Stehning
- From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.)
| | - Bernhard Schnackenburg
- From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.)
| | - Gerhard Adam
- From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.)
| | - Stefan Blankenberg
- From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.)
| | - Kai Muellerleile
- From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.).
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Lossnitzer D, Seitz SA, Krautz B, Schnackenburg B, André F, Korosoglou G, Katus HA, Steen H. Feasibility of real-time magnetic resonance imaging-guided endomyocardial biopsies: An in-vitro study. World J Cardiol 2015; 7:415-422. [PMID: 26225203 PMCID: PMC4513494 DOI: 10.4330/wjc.v7.i7.415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/04/2015] [Accepted: 06/19/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate if magnetic resonance (MR)-guided biopsy can improve the performance and safety of such procedures.
METHODS: A novel MR-compatible bioptome was evaluated in a series of in-vitro experiments in a 1.5T magnetic resonance imaging (MRI) system. The bioptome was inserted into explanted porcine and bovine hearts under real-time MR-guidance employing a steady state free precession sequence. The artifact produced by the metal element at the tip and the signal voids caused by the bioptome were visually tracked for navigation and allowed its constant and precise localization.
RESULTS: Cardiac structural elements and the target regions for the biopsy were clearly visible. Our method allowed a significantly better spatial visualization of the bioptoms tip compared to conventional X-ray guidance. The specific device design of the bioptome avoided inducible currents and therefore subsequent heating. The novel MR-compatible bioptome provided a superior cardiovascular magnetic resonance (imaging) soft-tissue visualization for MR-guided myocardial biopsies. Not at least the use of MRI guidance for endomyocardial biopsies completely avoided radiation exposure for both patients and interventionalists.
CONCLUSION: MRI-guided endomyocardial biopsies provide a better than conventional X-ray guided navigation and could therefore improve the specificity and reproducibility of cardiac biopsies in future studies.
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Manka R, Wissmann L, Gebker R, Jogiya R, Motwani M, Frick M, Reinartz S, Schnackenburg B, Niemann M, Gotschy A, Kuhl C, Nagel E, Fleck E, Marx N, Luescher TF, Plein S, Kozerke S. Multicenter evaluation of dynamic three-dimensional magnetic resonance myocardial perfusion imaging for the detection of coronary artery disease defined by fractional flow reserve. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.003061. [PMID: 25901043 DOI: 10.1161/circimaging.114.003061] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [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: 12/13/2022]
Abstract
BACKGROUND First-pass myocardial perfusion cardiovascular magnetic resonance (CMR) imaging yields high diagnostic accuracy for the detection of coronary artery disease (CAD). However, standard 2D multislice CMR perfusion techniques provide only limited cardiac coverage, and hence considerable assumptions are required to assess myocardial ischemic burden. The aim of this prospective study was to assess the diagnostic performance of 3D myocardial perfusion CMR to detect functionally relevant CAD with fractional flow reserve (FFR) as a reference standard in a multicenter setting. METHODS AND RESULTS A total of 155 patients with suspected CAD listed for coronary angiography with FFR were prospectively enrolled from 5 European centers. 3D perfusion CMR was acquired on 3T MR systems from a single vendor under adenosine stress and at rest. All CMR perfusion analyses were performed in a central laboratory and blinded to all clinical data. One hundred fifty patients were successfully examined (mean age 62.9±10 years, 45 female). The prevalence of CAD defined by FFR (<0.8) was 56.7% (85 of 150 patients). The sensitivity and specificity of 3D perfusion CMR were 84.7% and 90.8% relative to the FFR reference. Comparison to quantitative coronary angiography (≥50%) yielded a prevalence of 65.3%, sensitivity and specificity of 76.5% and 94.2%, respectively. CONCLUSIONS In this multicenter study, 3D myocardial perfusion CMR proved highly diagnostic for the detection of significant CAD as defined by FFR.
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Affiliation(s)
- Robert Manka
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Lukas Wissmann
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Rolf Gebker
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Roy Jogiya
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Manish Motwani
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Michael Frick
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Sebastian Reinartz
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Bernhard Schnackenburg
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Markus Niemann
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Alexander Gotschy
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Christiane Kuhl
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Eike Nagel
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Eckart Fleck
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Nikolaus Marx
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Thomas F Luescher
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Sven Plein
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Sebastian Kozerke
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.).
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Berger A, Schnackenburg B, Schneeweis C, Kelle S, Klein C, Kouwenhoven M, Fleck E, Gebker R. High-dose dobutamine stress steady-state free precession (SSFP) cine MRI at 3T with patient adaptive local radiofrequency (RF) shimming using dual-source RF transmission. J Magn Reson Imaging 2015; 42:746-53. [PMID: 25683284 DOI: 10.1002/jmri.24867] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 11/21/2014] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To prospectively assess the feasibility, image quality, and diagnostic accuracy of high-dose dobutamine stress magnetic resonance imaging (DSMR) using steady-state free precession (SSFP) cine imaging at 3T applying a dual-source radiofrequency (RF) excitation magnetic resonance imaging (MRI) system with parallel transmission and patient adaptive local RF shimming. MATERIALS AND METHODS DSMR using SSFP cine imaging was performed in 44 patients at 3T scheduled for a clinically indicated coronary angiography. The effect of conventional versus dual-source RF transmission was assessed regarding homogeneity of the B1 field, contrast-to-noise ratios (CNRs) at rest, image quality, and diagnostic accuracy of DSMR using long and short axis. RESULTS The mean percentage of the intended flip angle within the heart increased from 88 ± 9.1% with single-source to 103 ± 5.6% (P < 0.001) dual-source RF transmission. CNR increased for dual-source particularly at the apex (63.4 ± 24.2 vs. 36.5 ± 16.5, P < 0.001) but also at the base of the left ventricle (LV) (50.1 ± 14.8 vs. 39.3 ± 15.8, P < 0.001). Image quality of dual-source was higher both at rest (2.8 ± 0.5 vs. 2.6 ± 0.7, P < 0.001) and stress (2.5 ± 0.7 vs. 2.0 ± 1.0, P < 0.001). The number of segments with severe artifacts or nondiagnostic image quality at stress was lower with dual-source RF transmission (8% vs. 27%, P < 0.001). The diagnostic accuracy of DSMR in coronary territories using dual-source RF transmission was significantly higher (77% vs. 65%, P = 0.04). CONCLUSION Patient adaptive local RF shimming using dual-source RF transmission provided significantly improved image quality and higher diagnostic accuracy of SSFP during DSMR at 3T compared to conventional RF transmission.
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Sprinkart AM, Luetkens JA, Träber F, Doerner J, Gieseke J, Schnackenburg B, Schmitz G, Thomas D, Homsi R, Block W, Schild H, Naehle CP. Gradient Spin Echo (GraSE) imaging for fast myocardial T2 mapping. J Cardiovasc Magn Reson 2015; 17:12. [PMID: 25885268 PMCID: PMC4326516 DOI: 10.1186/s12968-015-0127-z] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/26/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Quantitative Cardiovascular Magnetic Resonance (CMR) techniques have gained high interest in CMR research. Myocardial T2 mapping is thought to be helpful in diagnosis of acute myocardial conditions associated with myocardial edema. In this study we aimed to establish a technique for myocardial T2 mapping based on gradient-spin-echo (GraSE) imaging. METHODS The local ethics committee approved this prospective study. Written informed consent was obtained from all subjects prior to CMR. A modified GraSE sequence allowing for myocardial T2 mapping in a single breath-hold per slice using ECG-triggered acquisition of a black blood multi-echo series was developed at 1.5 Tesla. Myocardial T2 relaxation time (T2-RT) was determined by maximum likelihood estimation from magnitude phased-array multi-echo data. Four GraSE sequence variants with varying number of acquired echoes and resolution were evaluated in-vitro and in 20 healthy volunteers. Inter-study reproducibility was assessed in a subset of five volunteers. The sequence with the best overall performance was further evaluated by assessment of intra- and inter-observer agreement in all volunteers, and then implemented into the clinical CMR protocol of five patients with acute myocardial injury (myocarditis, takotsubo cardiomyopathy and myocardial infarction). RESULTS In-vitro studies revealed the need for well defined sequence settings to obtain accurate T2-RT measurements with GraSE. An optimized 6-echo GraSE sequence yielded an excellent agreement with the gold standard Carr-Purcell-Meiboom-Gill sequence. Global myocardial T2 relaxation times in healthy volunteers was 52.2 ± 2.0 ms (mean ± standard deviation). Mean difference between repeated examinations (n = 5) was -0.02 ms with 95% limits of agreement (LoA) of [-4.7; 4.7] ms. Intra-reader and inter-reader agreement was excellent with mean differences of -0.1 ms, 95% LoA = [-1.3; 1.2] ms and 0.1 ms, 95% LoA = [-1.5; 1.6] ms, respectively (n = 20). In patients with acute myocardial injury global myocardial T2-RTs were prolonged (mean: 61.3 ± 6.7 ms). CONCLUSION Using an optimized GraSE sequence CMR allows for robust, reliable, fast myocardial T2 mapping and quantitative tissue characterization. Clinically, the GraSE-based T2-mapping has the potential to complement qualitative CMR in patients with acute myocardial injuries.
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Affiliation(s)
- Alois M Sprinkart
- Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
- Institute of Medical Engineering, Ruhr-University Bochum, Universitätsstraße, Bochum, Germany.
| | - Julian A Luetkens
- Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Frank Träber
- Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Jonas Doerner
- Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Jürgen Gieseke
- Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
- Philips Healthcare Germany, Lübeckertordamm, Hamburg, Germany.
| | | | - Georg Schmitz
- Institute of Medical Engineering, Ruhr-University Bochum, Universitätsstraße, Bochum, Germany.
| | - Daniel Thomas
- Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Rami Homsi
- Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Wolfgang Block
- Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Hans Schild
- Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Claas P Naehle
- Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
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