Gilion Hautvast

Correlation of Trabeculae and Papillary Muscles With Clinical and Cardiac Characteristics and Impact on CMR Measures of LV Anatomy and Function

OBJECTIVES The goal of this study was to assess the relationship of left ventricular (LV) trabeculae and papillary muscles (TPM) with clinical characteristics in a community-based, free-living adult cohort and to determine the effect of TPM on quantitative measures of LV volume, mass, and ejection fraction (EF). BACKGROUND Hypertrabeculation has been associated with adverse cardiovascular events, but the distribution and clinical correlates of the volume and mass of the TPM in a normal left ventricle have not been well characterized. METHODS Short-axis cine cardiac magnetic resonance images, obtained using a steady-state free precession sequence from 1,494 members of the Framingham Heart Study Offspring cohort, were analyzed with software that automatically segments TPM. Absolute TPM volume, TPM as a fraction of end-diastolic volume (EDV) (TPM/EDV), and TPM mass as a fraction of LV mass were determined in all offspring and in a referent group of offspring free of clinical cardiovascular disease and hypertension. RESULTS In the referent group (mean age 61 ± 9 years; 262 men and 423 women), mean TPM was 23 ± 3% of LV EDV in both sexes (p = 0.9). TPM/EDV decreased with age (p < 0.02) but was not associated with body mass index. TPM mass as a fraction of LV mass was inversely correlated with age (p < 0.0001), body mass index (p < 0.018), and systolic blood pressure (p < 0.0001). Among all 1,494 participants (699 men), LV volumes decreased 23%, LV mass increased 28%, and EF increased by 7.5 EF units (p < 0.0001) when TPM were considered myocardial mass rather than part of the LV blood pool. CONCLUSIONS Global cardiac magnetic resonance LV parameters were significantly affected by whether TPM was considered as part of the LV blood pool or as part of LV mass. Our cross-sectional data from a healthy referent group of adults free of clinical cardiovascular disease demonstrated that TPM/EDV decreases with increasing age in both sexes but is not related to hypertension or obesity.

Automatic myocardium segmentation in late-enhancement MRI

We propose a novel automatic method to segment the myocardium on late-enhancement cardiac MR (LE CMR) images with a multi-step approach. First, in each slice of the LE CMR volume, a geometrical template is deformed so that its borders fit the myocardial contours. The second step consists in introducing a shape prior of the left ventricle. To do so, we use the cine MR sequence that is acquired along with the LE CMR volume. As the myocardial contours can be more easily automatically obtained on this data, they are used to build a 3D mesh representing the left ventricle geometry and the underlying myocardium thickness. This mesh is registered towards the contours obtained with the geometrical template, then locally adjusted to guarantee that scars are included inside the final segmentation. The quantitative evaluation on 27 volumes (272 slices) shows robust and accurate results.

Assessment of Coronary Artery Stenosis Severity and Location : Quantitative Analysis of Transmural Perfusion Gradients by High-Resolution MRI Versus FFR

OBJECTIVES This study sought to test the hypothesis that transmural perfusion gradients (TPG) on adenosine stress myocardial perfusion cardiac magnetic resonance (CMR) predict hemodynamically significant coronary artery disease (CAD) as defined by fractional flow reserve (FFR). BACKGROUND Myocardial ischemia affects the subendocardial layers of the left ventricular myocardium earlier and more severely than the outer layers, and the identification of TPG should be sensitive and specific for the diagnosis of CAD. Previous studies have shown that high spatial resolution myocardial perfusion CMR allows quantitation of TPG between the subendocardium and the subepicardium. METHODS Sixty-seven patients (53 men, age 61 ± 9 years) underwent coronary angiography and high-resolution (1.2 × 1.2-mm in-plane) adenosine stress perfusion CMR at 3.0-T. TPG was calculated for 3 coronary territories. Visual analysis was performed to identify myocardial ischemia. FFR was measured in all vessels with ≥50% severity stenosis. FFR <0.8 was considered hemodynamically significant. In a training group of 30 patients, the optimal threshold of TPG to detect significant CAD was determined (Group 1). This threshold was then tested prospectively in the remaining 37 patients (Group 2). RESULTS In Group 1, a 20% TPG provided the best diagnostic threshold on both per-segment and per-patient analysis. Applied to Group 2, this threshold yielded a sensitivity of 0.78, specificity of 0.94, and area under the curve of 0.86 for the detection of CAD in a per-segment analysis and of 0.89, 0.83, and 0.86 in a per-patient analysis, respectively. TPG had a similar diagnostic accuracy to visual assessment. Linear regression analysis showed a relationship between TPG and FFR values, with r = 0.63 (p < 0.001). CONCLUSIONS The quantitative analysis of transmural perfusion gradients on high-resolution myocardial perfusion CMR accurately predicts hemodynamically significant CAD as defined by FFR. A TPG diagnostic threshold of 20% is as accurate as visual assessment.

Quantitative Analysis of Transmural Gradients in Myocardial Perfusion Magnetic Resonance Images

Conventional quantitative assessments of myocardial perfusion analyze the temporal relation between the arterial input function and the myocardial signal intensity curves, thereby neglecting the important spatial relation between the myocardial signal intensity curves. The new method presented in this article enables characterization of sub‐endocardial to sub‐epicardial gradients in myocardial perfusion based on a two dimensional, “gradientogram” representation, which displays the evolution of the transmural gradient in myocardial contrast uptake over time in all circumferential positions of the acquired images. Moreover, based on segmentation in these gradientograms, several new measurements that characterize transmural myocardial perfusion distribution over time are defined. In application to clinical image data, the new two‐dimensional representations, as well as the newly defined measurements revealed a clear distinction between normal perfusion and inducible ischaemia. Thus, the new measurements may serve as diagnostic markers for the detection and characterization of epicardial coronary and microvascular disease. Magn Reson Med, 2011.

Perfusion phantom : an efficient and reproducible method to simulate myocardial first-pass perfusion measurements with cardiovascular magnetic resonance

The aim of this article is to describe a novel hardware perfusion phantom that simulates myocardial first‐pass perfusion allowing comparisons between different MR techniques and validation of the results against a true gold standard. MR perfusion images were acquired at different myocardial perfusion rates and variable doses of gadolinium and cardiac output. The system proved to be sensitive to controlled variations of myocardial perfusion rate, contrast agent dose, and cardiac output. It produced distinct signal intensity curves for perfusion rates ranging from 1 to 10 mL/mL/min. Quantification of myocardial blood flow by signal deconvolution techniques provided accurate measurements of perfusion. The phantom also proved to be very reproducible between different sessions and different operators. This novel hardware perfusion phantom system allows reliable, reproducible, and efficient simulation of myocardial first‐pass MR perfusion. Direct comparison between the results of image‐based quantification and reference values of flow and myocardial perfusion will allow development and validation of accurate quantification methods. Magn Reson Med, 2013.

Comprehensive Segmentation of Cine Cardiac MR Images

A typical Cardiac Magnetic Resonance (CMR) examination includes acquisition of a sequence of short-axis (SA) and long-axis (LA) images covering the cardiac cycle. Quantitative analysis of the heart function requires segmentation of the left ventricle (LV) SA images, while segmented LA views allow more accurate estimation of the basal slice and can be used for slice registration. Since manual segmentation of CMR images is very tedious and time-consuming, its automation is highly required. In this paper, we propose a fully automatic 2D method for segmenting LV consecutively in LA and SA images. The approach was validated on 35 patients giving mean segmentation error smaller than one pixel, both for LA and SA, and accurate LV volume measurements.

Voxel‐wise quantification of myocardial perfusion by cardiac magnetic resonance. Feasibility and methods comparison

The purpose of this study is to enable high spatial resolution voxel‐wise quantitative analysis of myocardial perfusion in dynamic contrast‐enhanced cardiovascular MR, in particular by finding the most favorable quantification algorithm in this context. Four deconvolution algorithms—Fermi function modeling, deconvolution using B‐spline basis, deconvolution using exponential basis, and autoregressive moving average modeling —were tested to calculate voxel‐wise perfusion estimates. The algorithms were developed on synthetic data and validated against a true gold‐standard using a hardware perfusion phantom. The accuracy of each method was assessed for different levels of spatial averaging and perfusion rate. Finally, voxel‐wise analysis was used to generate high resolution perfusion maps on real data acquired from five patients with suspected coronary artery disease and two healthy volunteers. On both synthetic and perfusion phantom data, the B‐spline method had the highest error in estimation of myocardial blood flow. The autoregressive moving average modeling and exponential methods gave accurate estimates of myocardial blood flow. The Fermi model was the most robust method to noise. Both simulations and maps in the patients and hardware phantom showed that voxel‐wise quantification of myocardium perfusion is feasible and can be used to detect abnormal regions. Magn Reson Med, 2012.

Impact of left ventricular trabeculations and papillary muscles on measures of cavity volume and ejection fraction

Left ventricular (LV) trabeculations are typically considered LV cavity volume (i.e. ignored) when analyzing cardiac magnetic resonance (CMR) images as they are difficult to manually segment, but they are not actually part of the LV bloodpool. The treatment of papillary muscles is more variable, but they too have often been considered bloodpool.

CMR reference values for left ventricular volumes, mass, and ejection fraction using computer‐aided analysis: The Framingham Heart Study

To determine sex‐specific reference values for left ventricular (LV) volumes, mass, and ejection fraction (EF) in healthy adults using computer‐aided analysis and to examine the effect of age on LV parameters.

Myocardial Blood Flow Quantification From MRI by Deconvolution Using an Exponential Approximation Basis

We have evaluated the use of deconvolution using an exponential approximation basis for the quantification of myocardial blood flow from perfusion cardiovascular magnetic resonance. Our experiments, based on simulated signal intensity curves, phantom acquisitions, and clinical image data, indicate that exponential deconvolution allows for accurate quantification of myocardial blood flow. Together with automated respiratory motion correction myocardial contour delineation, the exponential deconvolution enables efficient and reproducible quantification of myocardial blood flow in clinical routine.