Freddy Odille

Electroanatomic Characterization of Post-Infarct Scars Comparison With 3-Dimensional Myocardial Scar Reconstruction Based on Magnetic Resonance Imaging

OBJECTIVES This study was designed to compare electroanatomic mapping (EAM) and magnetic resonance imaging (MRI) with delayed contrast enhancement (DCE) data for delineation of post-infarct scars. BACKGROUND Electroanatomic substrate mapping is an important step in the post-infarct ventricular tachycardia (VT) ablation strategy, but this technique has not yet been compared with a gold-standard noninvasive tool informing on the topography and transmural extent of myocardial scars in humans. METHODS Ten patients (9 men, age 71 +/- 10 years) admitted for post-infarct VT ablation underwent both a left ventricle DCE MRI and a sinus-rhythm 3-dimensional (3D) (CARTO) EAM (Biosense Webster, Johnson & Johnson, Diamond Bar, California). A 3D color-coded MRI-reconstructed left ventricular endocardial shell was generated to display scar data (intramural location and transmural extent). A matching process allocated any CARTO point to its corresponding position on the MRI map. Electrogram (EGM) characteristics were then evaluated in relation to scar data. RESULTS A spiky EGM morphology, a reduced unipolar or bipolar EGM voltage amplitude (<6.52 and <1.54 mV, respectively), as well as a longer bipolar EGM duration (>56 ms) independently correlated with the presence of scar whatever its intramural position. Endocardial scars had a larger degree of signal reduction than intramural or epicardial scars. None of the parameters was correlated with transmural scar depth. A clear mismatch in infarct surface between CARTO and MRI maps was observed in one-third of infarct zones. CONCLUSIONS Sinus-rhythm EAM helps identify the limits of post-infarct scars. However, the accuracy of EAM for precise scar delineation is limited. This limit might be circumvented using anatomical information provided by 3D MRI data.

Generalized Reconstruction by Inversion of Coupled Systems (GRICS) applied to free-breathing MRI

A reconstruction strategy is proposed for physiological motion correction, which overcomes many limitations of existing techniques. The method is based on a general framework allowing correction for arbitrary motion–nonrigid or affine, making it suitable for cardiac or abdominal imaging, in the context of multiple coil, arbitrarily sampled acquisition. A model is required to predict motion in the field of view at each sample time point, based on prior knowledge provided by external sensors. A theoretical study is carried out to analyze the influence of motion prediction errors. Small errors are shown to propagate linearly in that reconstruction algorithm, and thus induce a reconstruction residue that is bounded (stability). Furthermore, optimization of the motion model is proposed in order to minimize this residue. This leads to reformulating reconstruction as two inverse problems which are coupled: motion‐compensated reconstruction (known motion) and model optimization (known image). A fixed‐point multiresolution scheme is described for inverting these two coupled systems. This framework is shown to allow fully autocalibrated reconstructions, as coil sensitivities and motion model coefficients are determined directly from the corrupted raw data. The theory is validated with real cardiac and abdominal data from healthy volunteers, acquired in free‐breathing. Magn Reson Med 60:146–157, 2008.

Quantified terminal ileal motility during MR enterography as a potential biomarker of Crohn’s disease activity: a preliminary study

AbstractObjectiveTo compare quantified terminal ileal (TI) motility during MR enterography (MRE) with histopathological severity of acute inflammation in Crohn’s disease.MethodsA total of 28 Crohn’s patients underwent MRE and endoscopic TI biopsy. Axial and coronal TrueFISP, HASTE and post-gadolinium VIBE images were supplemented by multiple coronal TrueFISP cine motility sequences through the small bowel volume. TI motility index (MI) was quantified using validated software; an acute inflammation score (eAIS; 0–6) was assigned to the biopsy. Two observers qualitatively scored mural thickness, T2 signal, contrast enhancement and perimural oedema (0–3) to produce an activity score (aMRIs) based on anatomical MRI. The association among the MI, eAIS and aMRIs was tested using Spearman’s rank correlation. Wilcoxon rank sum test compared motility in subjects with and without histopathological inflammation.ResultsMean MI and mean eAIS were 0.27 (range 0.06–0.55) and 1.5 (range 0–5), respectively. There was a significant difference in MI between non-inflamed (mean 0.37, range 0.13–0.55) and inflamed (mean 0.19, range 0.06–0.44) TI, P = 0.002, and a significant negative correlation between MI and both eAIS (Rho = −0.52, P = 0.005) and aMRIs (R = −0.7, P < 0.001).ConclusionQuantified TI motility negatively correlates with histopathological measures of disease activity and existing anatomical MRI activity biomarkers.Key Points• Magnetic resonance imaging is increasingly used to assess Crohn’s disease. • MRI measurements can provide a quantitative assessment of small bowel motility. • MR enterography can grade Crohn’s disease. • Small bowel motility can be used as a marker of inflammatory activity.

Motion corrected compressed sensing for free-breathing dynamic cardiac MRI

Compressed sensing (CS) has been demonstrated to accelerate MRI acquisitions by reconstructing sparse images of good quality from highly undersampled data. Motion during MR scans can cause inconsistencies in k‐space data, resulting in strong motion artifacts in the reconstructed images. For CS to be useful in these applications, motion correction techniques need to be combined with the undersampled reconstruction. Recently, joint motion correction and CS approaches have been proposed to partially correct for effects of motion. However, the main limitation of these approaches is that they can only correct for affine deformations. In this work, we propose a novel motion corrected CS framework for free‐breathing dynamic cardiac MRI that incorporates a general motion correction formulation directly into the CS reconstruction. This framework can correct for arbitrary affine or nonrigid motion in the CS reconstructed cardiac images, while simultaneously benefiting from highly accelerated MR acquisition. The application of this approach is demonstrated both in simulations and in vivo data for 2D respiratory self‐gated free‐breathing cardiac CINE MRI, using a golden angle radial acquisition. Results show that this approach allows for the reconstruction of respiratory motion corrected cardiac CINE images with similar quality to breath‐held acquisitions. Magn Reson Med 70:504–516, 2013.

Noise Cancellation Signal Processing Method and Computer System for Improved Real-Time Electrocardiogram Artifact Correction During MRI Data Acquisition

A system was developed for real-time electrocardiogram (ECG) analysis and artifact correction during magnetic resonance (MR) scanning, to improve patient monitoring and triggering of MR data acquisitions. Based on the assumption that artifact production by magnetic field gradient switching represents a linear time invariant process, a noise cancellation (NC) method is applied to ECG artifact linear prediction. This linear prediction is performed using a digital finite impulse response (FIR) matrix, that is computed employing ECG and gradient waveforms recorded during a training scan. The FIR filters are used during further scanning to predict artifacts by convolution of the gradient waveforms. Subtracting the artifacts from the raw ECG signal produces the correction with minimal delay. Validation of the system was performed both off-line, using prerecorded signals, and under actual examination conditions. The method is implemented using a specially designed Signal Analyzer and Event Controller (SAEC) computer and electronics. Real-time operation was demonstrated at 1 kHz with a delay of only 1 ms introduced by the processing. The system opens the possibility of automatic monitoring algorithms for electrophysiological signals in the MR environment

Suppression of MR gradient artefacts on electrophysiological signals based on an adaptive real-time filter with LMS coefficient updates

Electrocardiogram (ECG) acquisition is still a challenge as gradient artefacts superimposed on the electrophysiological signal can only be partially removed. The signal shape of theses artefacts can be similar to the QRS-complex, causing possible misinterpretation during patient monitoring and false triggering/gating of the MRI. For their real-time suppression, an adaptive filter is proposed. The adaptive filter is based on the noise-canceller configuration with LMS coefficient updates. The references of the noise canceller are the three gradient signals that are acquired simultaneously with the noisy ECG. Tests were done on patients, on volunteers and using an MR-safe ECG simulator. The noise canceller’s performance was measured offline, simulating real-time processing by point-by-point operations. To create worst-case scenarios, clinical sequences with strong- and fast-switching gradients have been chosen. The noise-cancelling filter reduces the gradient artefacts’ peak amplitudes by 80–99% after adaptation, without changing the desired ECG signal shape. The estimated reduction of total average power of the MR gradient artefacts is 62–98%. The proposed filter is capable of reducing artefacts due to strong- and fast-switching gradients in real-time applications and worst-case situations. The quality of the ECG is sufficiently high that a standard one-lead QRS-detector can be used for gating/triggering the MRI. For permanent patient monitoring, further improvements are needed.

Generalized MRI reconstruction including elastic physiological motion and coil sensitivity encoding

This article describes a general framework for multiple coil MRI reconstruction in the presence of elastic physiological motion. On the assumption that motion is known or can be predicted, it is shown that the reconstruction problem is equivalent to solving an integral equation—known in the literature as a Fredholm equation of the first kind—with a generalized kernel comprising Fourier and coil sensitivity encoding, modified by physiological motion information. Numerical solutions are found using an iterative linear system solver. The different steps in the numerical resolution are discussed, in particular it is shown how over‐determination can be used to improve the conditioning of the generalized encoding operator. Practical implementation requires prior knowledge of displacement fields, so a model of patient motion is described which allows elastic displacements to be predicted from various input signals (e.g., respiratory belts, ECG, navigator echoes), after a free‐breathing calibration scan. Practical implementation was demonstrated with a moving phantom setup and in two free‐breathing healthy subjects, with images from the thoracic‐abdominal region. Results show that the method effectively suppresses the motion blurring/ghosting artifacts, and that scan repetitions can be used as a source of over‐determination to improve the reconstruction. Magn Reson Med, 2008.

Global Small Bowel Motility: Assessment with Dynamic MR Imaging

PURPOSE To assess the repeatability in human volunteers of software-quantified small bowel motility captured with magnetic resonance (MR) imaging and to test the ability to detect changes in motility induced by pharmacologic agents. MATERIALS AND METHODS The study was approved by the Royal Free Research Ethics Committee, and all subjects gave full written informed consent. Twenty-one healthy volunteers (14 men, seven women; mean age, 28 years) underwent cine MR imaging with a three-dimensional balanced turbo field-echo sequence to capture small bowel motility. Volume blocks (15 cm thick) were acquired every second during a 20-second breath hold. A randomized, blinded, placebo-controlled crossover study of either 0.5 mg neostigmine or saline (n = 11) or 20 mg intravenous butylscopolamine or saline (n = 10) was performed with motility MR imaging at baseline and repeated at a mean of 4 weeks (range, 2-7 weeks). Two readers independently drew regions of interest around the small bowel, and motility was quantified by using a registration algorithm that provided a global motility metric in arbitrary units. Repeatability of the motility measurements at baseline was assessed by using Bland-Altman and within-subject coefficient of variation measures. Changes in mean motility measurements after drug administration were compared with those after placebo administration by using paired t testing. RESULTS The repeatability between baseline measurements of motility was high; the Bland-Altman mean difference was -0.0025 (range, 0.28-0.4), the 95% limit of agreement was ±0.044 arbitrary units (au), and the within-subject coefficient of variation was 4.9%. Measured motility with neostigmine (mean, 0.39 au) was significantly higher than that with placebo (mean, 0.34 au; P < .001), whereas that with butylscopolamine (mean, 0.13 au) was significantly lower than that with placebo (mean, 0.30 au; P < .001). CONCLUSION Quantification of small bowel motility with use of MR imaging in healthy volunteers is repeatable and sensitive to changes induced by means of pharmacologic manipulation. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13130151/-/DC1.

Automatic segmentation propagation of the aorta in real-time phase contrast MRI using nonrigid registration.

To assess the use of a nonrigid registration technique for semi‐automatic segmentation of the aorta from real‐time velocity mapping MRI.

Model-based reconstruction for cardiac cine MRI without ECG or breath holding.

This paper describes an acquisition and reconstruction strategy for cardiac cine MRI that does not require the use of electrocardiogram or breath holding. The method has similarities with self‐gated techniques as information about cardiac and respiratory motion is derived from the imaging sequence itself; here, by acquiring the center k‐space line at the beginning of each segment of a balanced steady‐state free precession sequence. However, the reconstruction step is fundamentally different: a generalized reconstruction by inversion of coupled systems is used instead of conventional gating. By correcting for nonrigid cardiac and respiratory motion, generalized reconstruction by inversion of coupled systems (GRICS) uses all acquired data, whereas gating rejects data acquired in certain motion states. The method relies on the processing and analysis of the k‐space central line data: local information from a 32‐channel cardiac coil is used in order to automatically extract eigenmodes of both cardiac and respiratory motion. In the GRICS framework, these eigenmodes are used as driving signals of a motion model. The motion model is defined piecewise, so that each cardiac phase is reconstructed independently. Results from six healthy volunteers, with various slice orientations, show improved image quality compared to combined respiratory and cardiac gating. Magn Reson Med 63:1247–1257, 2010.