Maria Carr

Three-dimensional hemodynamics in intracranial aneurysms: Influence of size and morphology

To use four‐dimensional (4D)‐flow MRI for the comprehensive in vivo analysis of hemodynamics and its relationship to size and morphology of different intracranial aneurysms (IA). We hypothesize that different IA groups, defined by size and morphology, exhibit different velocity fields, wall shear stress, and vorticity.

3D Hemodynamics in Intracranial Aneurysms: Influence of Size and Morphology

To use four‐dimensional (4D)‐flow MRI for the comprehensive in vivo analysis of hemodynamics and its relationship to size and morphology of different intracranial aneurysms (IA). We hypothesize that different IA groups, defined by size and morphology, exhibit different velocity fields, wall shear stress, and vorticity.

Thoracic Aorta 3D Hemodynamics in Pediatric and Young Adult Patients With Bicuspid Aortic Valve

To evaluate the 3D hemodynamics in the thoracic aorta of pediatric and young adult bicuspid aortic valve (BAV) patients.

Left Atrial 4-Dimensional Flow Magnetic Resonance Imaging: Stasis and Velocity Mapping in Patients With Atrial Fibrillation.

ObjectivesLeft atrial (LA) 4-dimensional flow magnetic resonance imaging (MRI) was used to derive anatomic maps of LA stasis, peak velocity, and time-to-peak (TTP) velocity in patients with atrial fibrillation (AF) and to identify relationships between LA flow with LA volume and patient characteristics. Materials and MethodsFour-dimensional flow MRI for the in vivo assessment of time-resolved 3-dimensional LA blood flow velocities was performed in 111 subjects: 42 patients with a history of AF and in sinus rhythm (AF-sinus), 39 patients with persistent AF (AF-afib), 10 young healthy volunteers (HVs), and 20 age-appropriate controls (CTRL). Data analysis included the 3-dimensional segmentation of the LA and the calculation of LA stasis, peak velocity, and TTP maps. Regional LA flow dynamics were quantified by calculating mean stasis, peak velocity, and TTP in the LA center region and the region adjacent to the LA wall. ResultsA sensitivity analysis identified thresholds for global LA stasis (<0.1 m/s) and peak velocity (top 5% LA velocities), which detected significant differences between AF patients and controls for global LA stasis (HV, 25% ± 5%; CTRL, 29% ± 10%; AF-sinus, 41% ± 13%; AF-afib, 52% ± 17%) and peak velocity (HV, 0.43 ± 0.02 m/s; CTRL, 0.37 ± 0.04 m/s; AF-sinus, 0.33 ± 0.05 m/s; AF-afib, 0.30 ± 0.05 m/s). Regional analysis revealed significantly increased stasis at both LA center and wall for AF patients compared with age-appropriate controls (29%–84% difference, P < 0.006) and for AF-afib versus AF-sinus patients (22%–30% difference, P < 0.004). In addition, stasis close to the LA wall was significantly elevated (P < 0.001) compared with the LA center for all subject groups. Multiple regressions revealed significant (R2Adj = 0.45–0.50, P < 0.001) relationships between impaired global LA flow (reduced velocity and increased stasis) with age (|&bgr;| = 0.27–0.50, P < 0.002) and LA volume (|&bgr;| = 0.26–0.50, P < 0.003). ConclusionsAtrial 4-dimensional flow MRI detected changes in global and regional LA flow dynamics associated with AF, age, and LA volume. Longitudinal studies are needed to test the diagnostic value of LA flow metrics as potential risk factors for thromboembolic events.

Left Atrial and Left Atrial Appendage 4D Blood Flow Dynamics in Atrial Fibrillation

Background—Atrial 4D flow magnetic resonance imaging was used for the characterization of left atrial (LA) and left atrial appendage (LAA) flow dynamics in patients with atrial fibrillation (AF). Methods and Results—4D flow magnetic resonance imaging measured in vivo 3D blood flow velocities in 60 AF patients and 15 controls. Anatomic maps of LA and LAA stasis and velocity were calculated to quantify atrial peak velocity, mean velocity, and stasis (velocities <0.1 m/s). In a substudy with 30 AF patients, 4D flow metrics were compared with Doppler transesophageal echocardiography. For all 15 controls, LAA mean and peak velocities were consistently lower (by 21%/12%; P<0.001) while LAA stasis was higher (by 58%; P<0.001) compared with the LA. In contrast, lower LAA velocity and increased LAA stasis were only found in a fraction (38 of 60) of AF patients. In AF patients, increased CHA2DS2-VASc score was associated with significantly (P<0.043) reduced LA velocities and elevated stasis. There was a heterogeneous expression of atrial flow dynamics, and 25% to 68% of AF patients demonstrated flow in the normal range: 25%/68% for LA/LAA stasis and 38%/60% for LA/LAA peak velocities. Transesophageal echocardiography velocities modestly but significantly (P<0.05) correlated with 4D flow–based LA velocities (r=0.41) and stasis (r=−0.39). Conclusions—AF resulted in overall impaired but individually variable flow dynamics in both the LA and LAA. AF patients demonstrated atrial flow in the normal range, despite elevated CHA2DS2-VASc score.

Right ventricular assessment at cardiac MRI: initial clinical experience utilizing an IS-SENSE reconstruction

Cardiac MR is considered the gold standard in assessing RV function. The purpose of this study is to evaluate the clinical utility of an investigational iterative reconstruction algorithm in the quantitative assessment of RV function. This technique has the potential to improve the clinical utility of CMR in the evaluation of RV pathologies, particularly in patients with dyspnea, by shortening acquisition times without adversely influencing imaging performance. Segmented cine images were acquired on 9 healthy volunteers and 29 patients without documented RV pathologies using conventional GRAPPA acquisition with factor 2 acceleration (GRAPPA 2), a spatio-temporal TSENSE acquisition with factor 4 acceleration (TSENSE 4), and iteratively reconstructed Sparse SENSE acquisition with factor 4 acceleration (IS-SENSE 4). 14 subjects were re-analyzed and intraclass correlation coefficients (ICC) were calculated and Bland–Altman plots generated to assess agreement. Two independent reviewers qualitatively scored images. Comparison of acquisition techniques was performed using univariate analysis of variance (ANOVA). Differences in RV EF, BSA-indexed ESV (ESVi), BSA-indexed EDV (EDVi), and BSA-indexed SV (SVi) were shown to be statistically insignificant via ANOVA testing. R2 values for linear regression of TSENSE 4 and IS-SENSE 4 versus GRAPPA 2 were 0.34 and 0.72 for RV-EF, and 0.61 and 0.76 for RV-EDVi. ICC values for intraobserver and interobserver quantification yielded excellent agreement, and Bland–Altman plots assessing agreement were generated as well. Qualitative review yielded small, but statistically significant differences in image quality and noise between TSENSE 4 and IS-SENSE 4. All three techniques were rated nearly artifact free. Segmented imaging acquisitions with IS-SENSE reconstruction and an acceleration factor of 4 accurately and reliably quantitates RV systolic function parameters, while maintaining image quality. TSENSE-4 accelerated acquisitions showed poorer correlation to standard imaging, and inferior interobserver and intraobserver agreement. IS-SENSE has the potential to shorten cine acquisition times by 50 %, improving imaging options in patients with intermittent arrhythmias or difficulties with breath holding.

Measurement of extracellular volume fraction by cardiac magnetic resonance imaging detects diffuse myocardial fibrosis in systemic sclerosis

Summary We measured extracellular volume fraction (Ve) from pre- and post-contrast T1 maps of the left ventricle in 13 patients with systemic sclerosis (SSc) and 13 agematched controls. SSc patients and controls were similar with regard to LV and RV mass, volumes, and function. However, Ve was significantly higher in SSc patients than in controls, even when patients with visible late gadolinium enhancement were excluded. Ve correlated with SSc severity as measured by the modified Rodnan Skin Score. Ve may be valuable for detection of myocardial involvement in SSc, even when conventional CMR appears normal. Background Primary cardiac involvement is common in systemic sclerosis (SSc) and responsible for 25% of deaths. Myocardial extracellular volume fraction (Ve), derived from cardiac magnetic resonance (CMR) T1 mapping of the myocardium, has been shown to quantify diffuse myocardial fibrosis (DMF) - but its utility in SSc has not been studied. We hypothesized that subjects with SSc have a higher Ve compared to controls and that patients with worse SSc severity have higher Ve. Methods CMR was performed in 13 SSc patients (5 diffuse and 8 limited cutaneous) and 13 age-matched controls. Cine, pre- and post- contrast T1 mapping, and late gadolinium enhanced (LGE) imaging was performed. LV mass index (LVMi), LV end-diastolic volume index (LVEDVi), LV ejection fraction (EF), RV mass index (RVMi), RV

Accelerated real-time cardiac MRI using iterative sparse SENSE reconstruction: comparing performance in patients with sinus rhythm and atrial fibrillation

ObjectivesTo compare accelerated real-time cardiac MRI (CMR) using sparse spatial and temporal undersampling and non-linear iterative SENSE reconstruction (RT IS SENSE) with real-time CMR (RT) and segmented CMR (SEG) in a cohort that included atrial fibrillation (AF) patients.MethodsWe evaluated 27 subjects, including 11 AF patients, by acquiring steady-state free precession cine images covering the left ventricle (LV) at 1.5 T with SEG (acceleration factor 2, TR 42 ms, 1.8 × 1.8 × 6 mm3), RT (acceleration factor 3, TR 62 ms, 3.0 × 3.0 × 7 mm3), and RT IS SENSE (acceleration factor 9.9-12, TR 42 ms, 2.0 × 2.0 × 7 mm3). We performed quantitative LV functional analysis in sinus rhythm (SR) patients and qualitatively scored image quality, noise and artefact using a 5-point Likert scale in the complete cohort and AF and SR subgroups.ResultsThere was no difference between LV functional parameters between acquisitions in SR patients. RT IS SENSE short-axis image quality was superior to SEG (4.5 ± 0.6 vs. 3.9 ± 1.1, p = 0.007) and RT (3.8 ± 0.4, p = 0.003). There was reduced artefact in RT IS SENSE compared to SEG (4.4 ± 0.6 vs. 3.8 ± 1.2, p = 0.04), driven by arrhythmia performance. RT IS SENSE short-axis image quality was superior to SEG (4.6 ± 0.5 vs. 3.1 ± 1.0, p < 0.001) in the AF subgroup.ConclusionAccelerated real-time CMR with iterative sparse SENSE provides excellent clinical performance, especially in patients with AF.Key Points• Iterative sparse SENSE significantly accelerates real-time cardiovascular MRI acquisitions.• It provides excellent qualitative and quantitative performance in sinus rhythm patients.• It outperforms standard segmented acquisitions in patients with atrial fibrillation.• It improves the trade-off between temporal and spatial resolution in real-time imaging.

Clinical evaluation of accelerated cardiac cine imaging using iterative k-t-sparse SENSE

Methods IRB approval was obtained. Twenty patients (age: 54.8 ± 14 years, M:F = 15:5) undergoing non-emergent CMR assessment for myocardial pathology were consecutively recruited. Nine healthy volunteers (age: 44.3 ± 14 years, M:F = 6:3) were also imaged. CMR was performed at 1.5T (MAGNETOM Aera, Siemens Healthcare, Erlangen, Germany). The examination included acquisition of standard segmented SSFP (iPAT2) (GRAPPA accel factor 2, TR 40 msec, 2.1 × 2.1 × 10 mm) cine and two accelerated segmented SSFP acquisitions (TPAT accel factor 4, TR 37.7 msec, 2.1 × 2.1 × 6 mm), one with an investigational prototype inline iterative k-t-sparse SENSE reconstruction with L1 regularization along one spatial and temporal dimension (TPAT4i) (1)and the other with conventional SENSE reconstruction (TPAT4). Each technique was used to acquire a three(3Ch), four-chamber (4Ch), and short axis (SA) series in identical slice positions (Figure 1), with SA coverage of the entire left ventricle (LV) with 10 mm interslice gaps. Individual slice scan times were recorded. Quantitative LV functional analysis was performed. A reviewer blinded to acquisition type scored images for overall image quality, noise, and artifacts using a 5-point Likert scale. Continuous variables were compared between groups using a paired t-test, and ordinal variables were compared using a Wilcoxon signed-rank test.

Biventricular strain analysis at 1.5T cardiac MR imaging: preliminary results in volunteers using an iterative SENSE reconstruction with L1 regularization

Background Changes in myocardial strain have been shown to precede onset of systolic dysfunction in patients with cardiomyopathy. Traditionally performed with echocardiography, acoustic windows can limit strain evaluation. Preliminary work has shown good agreement between myocardial strain derived from deformation field analysis at balanced steady-state free-precession (bSSFP) cine MRI and speckle tracking echocardiography. The application of a novel prototype iterative SENSE reconstruction with L1 regularization (IRSENSE) to highly accelerated segmented bSSFP cine acquisitions can maintain or improve the effective temporal resolution with a shorter breath-hold. The purpose of this study is to evaluate left- and right-ventricular stain analysis from bSSFP cine acquisitions using conventional GRAPPA and highly accelerated T-PAT with IR-SENSE. We hypothesize that myocardial strain parameters derived from accelerated T-PAT cine acquisitions with IR-SENSE are similar to those obtained using conventional segmented bSSFP with comparable effective temporal resolutions.