Paul J Finn

Nephrogenic systemic fibrosis versus contrast‐induced nephropathy: Risks and benefits of contrast‐enhanced MR and CT in renally impaired patients

Magnetic resonance imaging (MRI) and computed tomography (CT) have become essential to diagnostic evaluation of many, or most, important medically and surgically treated diseases. It is important to consider comprehensively the implications in making decisions when choosing one or the other cross‐sectional imaging modality. Factors to consider include the relative risks of the contrast agent. Other factors include the relative procedural risks, including radiation risks and the relative expected diagnostic yield of the examination technique ( 1 , 2 ). In this review we describe both nephrogenic systemic fibrosis and contrast‐induced nephropathy to compare the implications with regard to relative risks and benefits of contrast‐enhanced MRI or CT in patients with impaired renal function. J. Magn. Reson. Imaging 2009;30:1350–1356.

Accuracy of T1 measurements at high temporal resolution: feasibility of dynamic measurement of blood T1 after contrast administration.

The purpose of this work was to optimize a technique to measure blood T1 dynamically after contrast agent administration with a high temporal resolution. This technique uses a 90° prepared gradient‐echo sequence and has a temporal resolution of one T1 measurement per cardiac cycle. The non‐ideal excitation slice profiles on the estimation of T1 were evaluated by theoretical simulations and used to obtain corrected blood T1 values. The technique was validated on phantom and in vivo pig studies, which demonstrated significant improvement on the accuracy of the dynamic T1 measurement method after slice profile correction. This technique may find important applications in studying the dynamic blood T1 after injection of various contrast agents. J. Magn. Reson. Imaging 1999;10:576–581.

Preoperative evaluation of potential living related kidney donors with high-spatial-resolution magnetic resonance (MR) angiography at 3 tesla comparison with intraoperative findings

Purpose:The purpose of this prospective study was to determine the feasibility and accuracy of high-spatial-resolution MR imaging at 3 Tesla (T) in the preoperative evaluation of potential living related kidney donors. Materials and Methods:Eighteen potential donors (8 men, 10 women; mean age, 50.1 ± 14.2 years) for renal transplantation were evaluated with 3 T MR imaging. A high-spatial-resolution 3-dimensional (3D) gradient-echo MR angiography (repetition time/echo time, 3.0/1.14 ms; flip, 19–23°; matrix, 512; slice thickness, 1.0 mm) using parallel acquisition technique (GRAPPA) with an acceleration factor of 3 was performed on a whole body scanner. Images were evaluated in a prospective and blinded fashion by 2 MR radiologists. The number of renal arteries, presence of early branches (defined as a branch arising within 2 cm of the main renal ostium), and renal artery stenosis were analyzed. The renal parenchyma, collecting system and ureters, were evaluated on the MR urograms. Interpretation of MR images were compared with surgical findings. Results:Based on MR angiography data sets, a total of 36 main and 9 accessory renal arteries was found. There were 5 renal arteries presenting an early branching (≤2 cm). The correct venous anatomy was identified in 13 of 14 patients (93%), including a single left renal vein anterior to the aorta (n = 3), retroaortic left renal vein (n = 2), and single right renal vein (n = 9). A single collecting system in all harvested kidneys was identified correctly with MR imaging. Overall, the sensitivity and positive predictive value of MRI in correctly determining the vascular and parenchymal anatomy in the harvested kidney was 85% and 93%, respectively. Conclusions:High-spatial-resolution contrast-enhanced MR angiography at 3 T can predict successful donor nephrectomy in potential living related kidney donors.

EFFICACY OF ENDOTHELIN BLOCKADE IN ADULTS WITH FONTAN PHYSIOLOGY

OBJECTIVE Phosphodiesterase-5 inhibitors have shown to improve cardiac output and functional capacity in Fontan patients. We sought to test the efficacy and safety of endothelin blockade with bosentan in adult patients with Fontan physiology. DESIGN Ten patients were enrolled and seven patients completed this single-center open-label clinical trial. Patients were treated with bosentan for 4 months. Cardiac magnetic resonance imaging (MRI), 6-minute walking distance (6MWD), brain natriuretic peptide, and New York Heart Association functional class were compared before and after treatment using paired t-test. RESULTS The 6MWD improved by 73 m, from a mean of 435 m (standard deviation [SD] = 92, standard error [SE] = 35) to 508 m (SD = 93, SE = 35) (P = .03). MRI resting aortic flow increased from 3.3 L/minute (SD = 1.27, SE = 0.73) to 4.4 L/minute (SD = 0.9, SE = 0.54) (P = .03). New York Heart Association class was unchanged in three patients, improved in three patients and worsened in one patient. Brain natriuretic peptide, aspartate aminotransferase, and alanine aminotransferase did not change significantly. Of the three patients with elevated baseline bilirubin, two normalized at the completion of the study, while the other was unchanged. Mean duration of therapy was 4.1 ± 0.51 months. Three adverse advents occurred. One patient complained of fatigue and chest pain after 87 days and withdrew from the study. After extensive workup, it was determined that her symptoms were not related to treatment. The second patient suffered palpitations and fatigue after 75 days; no concerning arrhythmias were identified and symptoms improved with increased antiarrhythmic dose. The third patient developed fatigue on therapy and decided to stop therapy; fatigue improved following drug discontinuation. There were no deaths or hospitalizations. CONCLUSIONS In this cohort of adult patients with Fontan physiology, endothelin blockade with bosentan resulted in improved 6MWD and MRI-derived resting cardiac output, suggesting a positive effect on pulmonary vascular resistance and pulmonary blood flow. Bosentan was well tolerated and hepatic function was not adversely affected.

Idiopathic massive myocardial calcification: a case report and review of the literature.

We report a rare case of massive myocardial calcification in a 42-year-old male who presented with symptoms of congestive heart failure and arrhythmia. Myocardial calcification is most commonly associated with myocardial infarction or, less commonly, hypercalcemia. This case is particularly unusual due to the lack of any known predisposing risk factors, including normal coronary arteries, normal renal function, and normal serum calcium levels. Alternative etiologies are discussed accompanied by a review of the literature.

Scar voltage threshold determination using ex vivo magnetic resonance imaging integration in a porcine infarct model: Influence of interelectrode distances and three-dimensional spatial effects of scar

BACKGROUND Studies analyzing optimal voltage thresholds for scar detection with electroanatomic mapping frequently lack a gold standard for comparison. OBJECTIVE The purpose of this study was to use a porcine infarct model with ex vivo magnetic resonance imaging (MRI) integration to characterize the relationship between interelectrode spacing and bipolar voltage thresholds and examine the influence of 3-dimensional scar on unipolar voltages. METHODS Thirty-two combined endocardial-epicardial electroanatomic maps were created in 8 postinfarct porcine subjects (bipolar 2-mm, 5-mm, and 8-mm interelectrode spacing and unipolar) for comparison with ex vivo MRI. Two thresholds were compared: (1) 95% normal distribution and (2) best fit to MRI. Direct electrogram analysis was performed in regions across from MRI-defined scar and adjacent to scar border zone. RESULTS A linear increase in optimal thresholds was observed with wider bipole spacing. The 95% thresholds for scar were lower than MRI-matched thresholds with moderate sensitivity for nontransmural scar (54% endo, 63% epi). Unipolar endocardial scar area exceeded MRI-defined scar, resulting in mismatched false scar in 5 of 8 (63%). Endocardial and epicardial unipolar voltages were lower than normal in regions adjacent and across from scar. CONCLUSION Variations in interelectrode spacing necessitate tailored bipolar voltage thresholds to optimize scar detection. Statistical 95% thresholds appear to be conservative and not fully sensitive for the detection of scar defined by high-resolution ex vivo MRI. In the presence of endocardial scar, unipolar mapping to quantitatively characterize epicardial scar may be overly sensitive due to 3-dimensional spatial averaging.

The cardiac atlas project: rationale, design and preliminary results

Author(s): Medrano-Gracia, Pau; Backhaus, Michael; Bluemke, David A; Chung, Jae; Cowan, Brett R; Finn, Paul J; Fonseca, Carissa G; Hunter, Peter J; Kadish, Alan H; Lee, Daniel C; Lima, Joao AC; Shivkumar, Kalyanam; Tao, Wenchao; Young, Alistair A

Quantitative magnetic resonance imaging phantoms: A review and the need for a system phantom

The MRI community is using quantitative mapping techniques to complement qualitative imaging. For quantitative imaging to reach its full potential, it is necessary to analyze measurements across systems and longitudinally. Clinical use of quantitative imaging can be facilitated through adoption and use of a standard system phantom, a calibration/standard reference object, to assess the performance of an MRI machine. The International Society of Magnetic Resonance in Medicine AdHoc Committee on Standards for Quantitative Magnetic Resonance was established in February 2007 to facilitate the expansion of MRI as a mainstream modality for multi‐institutional measurements, including, among other things, multicenter trials. The goal of the Standards for Quantitative Magnetic Resonance committee was to provide a framework to ensure that quantitative measures derived from MR data are comparable over time, between subjects, between sites, and between vendors. This paper, written by members of the Standards for Quantitative Magnetic Resonance committee, reviews standardization attempts and then details the need, requirements, and implementation plan for a standard system phantom for quantitative MRI. In addition, application‐specific phantoms and implementation of quantitative MRI are reviewed. Magn Reson Med 79:48–61, 2018.

Modified wideband 3D late gadolinium enhancement (LGE) MRI for patients with implantable cardiac devices

Background Late gadolinium enhancement (LGE) cardiac MRI is the clinical gold standard for non-invasive assessment of myocardial viability and plays an important role in guiding catheter ablation of ventricular tachycardia (VT). The majority of VT patients have implanted cardiac devices such as implantable cardioverter defibrillators (ICDs). The presence of ICDs gives rise to strong off-resonance within the myocardium. This produces hyper-intensity (HI) artifacts in LGE, which can mask scar tissue, compromising the diagnostic value of LGE. Recent studies show that HI artifacts can be eliminated by using a wideband inversion recovery (IR) pulse in the LGE sequence. However, the current wideband LGE is a 2D sequence, which limits spatial resolution, especially slice thickness (8 mm). This is problematic for using LGE to guide catheter ablation of VT. High resolution LGE is feasible using a 3D LGE sequence. However, no prior studies have explored 3D LGE under the influence of strong off-resonance imposed by ICDs.

Segmented golden ratio radial reordering for dynamic cardiac MRI with variable temporal resolution

Background Golden angle radial reordering (GA) has been applied in many abdominal and neurological imaging applications to allow for retrospective choice of temporal resolution by providing a near-uniform k-space sampling within any image reconstruction time window [1]. However, its application in cardiac imaging is limited because the ECG-gated acquisition, which is required in most cases, breaks a single reconstruction window into several temporally isolated k-space data so that the k-space coverage may not be as uniform as GA without ECG gating (Fig. 1a) [2]. Therefore, we sought to investigate the image artifacts caused by applying GA to ECG-gated cardiac imaging and propose a segmented GA method to address this issue.