Ravi T. Seethamraju

Myocardial blood flow quantification with MRI by model-independent deconvolution

Magnetic resonance (MR) imaging during the first pass of an injected contrast agent has been used to assess myocardial perfusion, but the quantification of blood flow has been generally judged as too complex for its clinical application. This study demonstrates the feasibility of applying model-independent deconvolution to the measured tissue residue curves to quantify myocardial perfusion. Model-independent approaches only require minimal user interaction or expertise in modeling. Monte Carlo simulations were performed with contrast-to-noise ratios typical of MR myocardial perfusion studies to determine the accuracy of the resulting blood flow estimates. With a B-spline representation of the tissue impulse response and Tikhonov regularization, the bias of blood flow estimates obtained by model-independent deconvolution was less than 1% in all cases for peak contrast to noise ratios in the range from 15:1 to 20:1. The relative dispersion of blood flow estimates in Monte Carlo simulations was less than 7%. Comparison of MR blood flow estimates against measurements with radio-isotope labeled microspheres indicated excellent linear correlation (R2 = 0.995, slope: 0.96, intercept: 0.06). It can be concluded from these studies that the application of myocardial blood flow quantification with MRI can be performed with model-independent methods, and this should support a more widespread use of blood flow quantification in the clinical environment.

Analysis of myocardial perfusion MRI

Rapid MR imaging (MRI) during the first pass of an injected tracer is used to assess myocardial perfusion with a spatial resolution of 2–3 mm, and to detect any regional impairments of myocardial blood flow (MBF) that may lead to ischemia. The spatial resolution is sufficient to detect flow reductions that are limited to the subendocardial layer. The capacity of the coronary system to increase MBF severalfold in response to vasodilation can be quantified by analysis of the myocardial contrast enhancement. The myocardial perfusion reserve (MPR) is a useful concept for quantifying the vasodilator response. The perfusion reserve can be estimated from the ratio of MBFs during vasodilation and at baseline, in units identical to those used for invasive measurements with labeled microspheres, or from dimensionless flow indices normalized by their value for autoregulated flow at rest. The perfusion reserve can be reduced as a result of a blunted hyperemic response and/or an abnormal resting blood flow. The absolute quantification of MBF removes uncertainties in the evaluation of the vasodilator response, and can be achieved without the use of complex tracer kinetic models; therefore, its application to clinical studies is feasible. J. Magn. Reson. Imaging 2004;19:758–770.

Magnetic Resonance Image-Guided Transcatheter Closure of Atrial Septal Defects

Background—Recent developments in cardiac MRI have extended the potential spectrum of diagnostic and interventional applications. The purpose of this study was to test the ability of MRI to perform transcatheter closures of secundum type atrial septal defects (ASD) and to assess ASD size and changes in right cardiac chamber volumes in the same investigation. Methods and Results—In 7 domestic swine (body weight, 38±13 kg), an ASD (Qp:Qs=1.7±0.2) was created percutaneously by balloon dilation of the fossa ovalis. The ASD was imaged and sized by both conventional radiography and MRI. High-resolution MRI of the ASD diameters correlated well with postmortem examination (r =0.97). Under real-time MR fluoroscopy, the introducer sheath was tracked toward the left atrium with the use of novel miniature MR guide wires. The defect was then closed with an Amplatzer Septal Occluder. In all animals, it was possible to track and interactively control the position of the guide wire within the vessels and the heart, including the successful deployment of the Amplatzer Septal Occluder. Right atrial and ventricular volumes were calculated before and after the intervention by using cine-MRI. Both volumes were found to be significantly reduced after ASD closure (P <0.005). Conclusions—These in vivo studies demonstrate that catheter tracking and ASD device closure can be performed under real-time MRI guidance with the use of intravascular antenna guide wires. High-resolution imaging allows accurate determination of ASD size before the intervention, and immediate treatment effects such as changes in right cardiac volumes can also be measured.

Quantitative Magnetic Resonance First-Pass Perfusion Analysis: Inter- and Intraobserver Agreement

Magnetic resonance first-pass (MRFP) imaging awaits longitudinal clinical trials for quantification of myocardial perfusion. The purpose of this study was to assess inter- and intraobserver agreement of this method. Seventeen MRFP studies (14 rest and 3 under adenosine-induced hyperemia) from 14 patients were acquired. Two observers visually graded study quality. Each study was subdivided into eight regions. Both observers analyzed all 17 studies (8 x 17 = 136 regions) for interobserver agreement. Each observer then analyzed 10 of the 17 studies a second time (2 x 8 x 10 = 160 regions) for intraobserver agreement. Signal intensity curves were obtained with Argus software (Siemens, Iselin, NJ). The maximum amplitude of the impulse response function (Rmax) and the change of signal intensity (deltaSImax) of the contrast bolus were determined. Intraclass correlation coefficient was used to determine intra- and interobserver agreement. The quality was good or excellent in 14 studies. Intraobserver agreement of Rmax and deltaSImax were good (0.85 and 0.80, n = 160). Interobserver agreement of Rmax was fair (0.55, n = 136) but improved after exclusion of poor-quality studies (0.88, n = 112). Interobserver agreement of deltaSImax was good (0.73) and improved less than Rmax with study quality (0.83). Interobserver agreement for Rmax in individual myocardial regions before and after exclusion of studies with poor quality changed most markedly in lateral and posterior regions (0.69 and 0.65 vs. 0.97 and 0.94), where signal-to-noise ratios were reduced compared with anteroseptal regions (p < 0.01). Analysis of MRFP images provides good intraobserver agreement. Interobserver agreement of the quantitative perfusion analysis is good under the premise of good image quality.

Time delay for arrival of MR contrast agent in collateral-dependent myocardium

An analysis of the kinetics of myocardial contrast enhancement is an important component of myocardial perfusion studies. The contrast enhancement can be modeled by a linear time-invariant system, and the myocardial impulse response, calculated by deconvolution of the measured tissue response with an arterial input, gives a direct estimate of myocardial blood flow. In this paper, we analyze the effects of delays in the contrast enhancement, that occur in collateral-dependent myocardium, where the tracer reaches the tissue region only through branches from other coronary arteries that form natural bypass vessels. We investigate how the delayed arrival of tracer alters the myocardial impulse response. Model-independent deconvolution is applied to determine the lag between arterial input and tissue enhancement. Experimental data in a porcine model of collateral development indicate that the delayed arrival of an injected tracer, measured at rest, is a useful marker to identify collateral-dependent myocardium, and predict its flow capacitance.

Faster dynamic imaging of speech with field inhomogeneity corrected spiral fast low angle shot (FLASH) at 3 T

To evaluate the impact of magnetic field inhomogeneity correction on achievable imaging speeds for magnetic resonance imaging (MRI) of articulating oropharyngeal structures during speech and to determine if sufficient acquisition speed is available for visualizing speech structures with real‐time MRI.

Myocardial Tissue Remodeling in Adolescent Obesity

Background Childhood obesity is a significant risk factor for cardiovascular disease in adulthood. Although ventricular remodeling has been reported in obese youth, early tissue‐level markers within the myocardium that precede organ‐level alterations have not been described. Methods and Results We studied 21 obese adolescents (mean age, 17.7±2.6 years; mean body mass index [BMI], 41.9±9.5 kg/m2, including 11 patients with type 2 diabetes [T2D]) and 12 healthy volunteers (age, 15.1±4.5 years; BMI, 20.1±3.5 kg/m2) using biomarkers of cardiometabolic risk and cardiac magnetic resonance imaging (CMR) to phenotype cardiac structure, function, and interstitial matrix remodeling by standard techniques. Although left ventricular ejection fraction and left atrial volumes were similar in healthy volunteers and obese patients (and within normal body size‐adjusted limits), interstitial matrix expansion by CMR extracellular volume fraction (ECV) was significantly different between healthy volunteers (median, 0.264; interquartile range [IQR], 0.253 to 0.271), obese adolescents without T2D (median, 0.328; IQR, 0.278 to 0.345), and obese adolescents with T2D (median, 0.376; IQR, 0.336 to 0.407; P=0.0001). ECV was associated with BMI for the entire population (r=0.58, P<0.001) and with high‐sensitivity C‐reactive protein (r=0.47, P<0.05), serum triglycerides (r=0.51, P<0.05), and hemoglobin A1c (r=0.76, P<0.0001) in the obese stratum. Conclusions Obese adolescents (particularly those with T2D) have subclinical alterations in myocardial tissue architecture associated with inflammation and insulin resistance. These alterations precede significant left ventricular hypertrophy or decreased cardiac function.

Feedback‐assisted three‐dimensional reconstruction of the left ventricle with MRI

To develop and test a new technique for rapid, accurate three‐dimensional (3D) reconstruction of the left ventricle (LV) and calculation of its volume parameters, with images from multiple orientations and interactive feedback.

An approach to the three-dimensional display of left ventricular function and viability using MRI

Cardiac MRI was performed in human volunteers to determine the magnitude of the misregistration (MSR) of cardiac landmarks due to variability in the diaphragm position for repeated breath-holds. Seven normal volunteers underwent MR imaging of the left ventricle (LV) to evaluate the magnitude of the endocardial centroid MSR. The MSR for a mid-ventricle short-axis image was 3.01 ± 1.68 mm through-plane and 4.16 ± 1.62 mm in-plane. A second order polynomial fit through the LV centroid coordinates minimized the in-plane component of the MSR error. Short-axis cine images, corrected for MSR, provided high-resolution 2D data from which an accurate anatomical model of the LV was generated. Anatomical landmarks were used to register parametric maps of myocardial perfusion and viability to the three-dimensional (3D) model, with the corresponding parameters displayed as color-encoded values on the endo- and epicardial surfaces of the LV. Registration of regional wall motion, perfusion and viability to the 3D model was performed for three patients with a history of cardiovascular disease. The proposed 3D reconstruction technique allows visualization in 3D of the LV anatomy, in combination with parametric mapping of its functional status.

Cardiac MRI in mice at 9.4 Tesla with a transmit-receive surface coil and a cardiac-tailored intensity-correction algorithm

To evaluate the use of a transmit‐receive surface (TRS) coil and a cardiac‐tailored intensity‐correction algorithm for cardiac MRI in mice at 9.4 Tesla (9.4T).