Smita Sampath

Imaging longitudinal cardiac strain on short-axis images using strain-encoded MRI.

This article presents a new method for measuring longitudinal strain in a short‐axis section of the heart using harmonic phase magnetic resonance imaging (HARP‐MRI). The heart is tagged using 1‐1 SPAMM at end‐diastole with tag surfaces parallel to a short‐axis imaging plane. Two or more images are acquired such that the images have different phase encodings in a direction orthogonal to the image plane. A dense map of the longitudinal strain can be computed from these images using a simple, fast computation. Simulations are conducted to study the effect of noise and the choice of out‐of‐plane phase encoding values. Longitudinal strains acquired from a normal human male are shown. Magn Reson Med 46:324‐334, 20001.

Quantitative Ischemia Detection During Cardiac Magnetic Resonance Stress Testing by Use of FastHARP

Background—Because ECG alterations caused by ischemia cannot be reliably detected in the high-field MRI environment, detection of wall motion abnormalities is often used to ensure patient safety during stress testing. However, an experienced observer is needed to detect these abnormalities. In this study, we investigate the use of fast harmonic phase (FastHARP) MRI for the quantitative, operator-independent detection of the onset of ischemia during acute coronary occlusion. Methods and Results—Eight mongrel dogs underwent an acute 2-minute closed-chest coronary artery occlusion while continuous FastHARP images were acquired. Full regional wall strain was determined every other heartbeat in a single short-axis imaging slice. After 5 minutes of reperfusion, a second 2-minute ischemic episode was induced during the acquisition of conventional cine wall-motion images. The time at which ECG alterations were observed during the first ischemic period was recorded. The time from occlusion to the detection of ischemia, based on a consensus of 2 blinded observers, was determined for MRI. No significant ischemia was present in 2 animals. In the remaining animals, the onset of ischemia was detected significantly earlier by FastHARP than by cine MRI (9.5±5 versus 33±14 seconds, P <0.01). HARP ischemia detection preceded ECG changes, on average, by 54 seconds. Conclusions—The rapid acquisition and detection of induced ischemia with FastHARP MRI shows promise as a nonsubjective method to diagnose significant coronary lesions during MR stress testing.

Real‐time imaging of two‐dimensional cardiac strain using a harmonic phase magnetic resonance imaging (HARP‐MRI) pulse sequence

The harmonic phase (HARP) method provides automatic and rapid analysis of tagged magnetic resonance (MR) images for quantification and visualization of myocardial strain. In this article, the development and implementation of a pulse sequence that acquires HARP images in real time are described. In this pulse sequence, a CINE sequence of images with 1‐1 spatial modulation of magnetization (SPAMM) tags are acquired during each cardiac cycle, alternating between vertical and horizontal tags in successive heartbeats. An incrementing train of imaging RF flip angles is used to compensate for the decay of the harmonic peaks due to both T1 relaxation and the applied imaging pulses. The magnitude images displaying coarse anatomy are automatically reconstructed and displayed in real time after each heartbeat. HARP strain images are generated offline at a rate of four images per second; real‐time processing should be possible with faster algorithms or computers. A comparison of myocardial contractility in non‐breath‐hold and breath‐hold experiments in normal humans is presented. Magn Reson Med 50:154–163, 2003.

Real-Time Magnetic Resonance Imaging–Guided Endovascular Recanalization of Chronic Total Arterial Occlusion in a Swine Model

Background— Endovascular recanalization (guidewire traversal) of peripheral artery chronic total occlusion (CTO) can be challenging. X-ray angiography resolves CTO poorly. Virtually “blind” device advancement during x-ray–guided interventions can lead to procedure failure, perforation, and hemorrhage. Alternatively, MRI may delineate the artery within the occluded segment to enhance procedural safety and success. We hypothesized that real-time MRI (rtMRI)–guided CTO recanalization can be accomplished in an animal model. Methods and Results— Carotid artery CTO was created by balloon injury in 19 lipid-overfed swine. After 6 to 8 weeks, 2 underwent direct necropsy analysis for histology, 3 underwent primary x-ray–guided CTO recanalization attempts, and the remaining 14 underwent rtMRI-guided recanalization attempts in a 1.5-T interventional MRI system. Real-time MRI intervention used custom CTO catheters and guidewires that incorporated MRI receiver antennae to enhance device visibility. The mean length of the occluded segments was 13.3±1.6 cm. The rtMRI-guided CTO recanalization was successful in 11 of 14 swine and in only 1 of 3 swine with the use of x-ray alone. After unsuccessful rtMRI (n=3), x-ray–guided attempts were also unsuccessful. Conclusions— Recanalization of long CTO is entirely feasible with the use of rtMRI guidance. Low-profile clinical-grade devices will be required to translate this experience to humans.

Unsupervised estimation of myocardial displacement from tagged MR sequences using nonrigid registration

We propose a fully automatic cardiac motion estimation technique that uses nonrigid registration between temporally adjacent images to compute the myocardial displacement field from tagged MR sequences using as inputs (sources) both horizontally and vertically tagged images. We present a new multisource nonrigid registration algorithm employing a semilocal deformation model that provides controlled smoothness. The method requires no segmentation. We apply a multiresolution optimization strategy for better speed and robustness. The accuracy of the algorithm is assessed on experimental data (animal model) and healthy volunteer data by calculating the root mean square (RMS) difference in position between the estimated tag trajectories and manual tracings outlined by an expert. For the ∼20000 tag lines analyzed (45 slices over 20–40 time frames), the RMS difference between the automatic tag trajectories and the manually segmented tag trajectories was 0.51 pixels (0.25 mm) for the animal data and 0.49 pixels (0.49 mm) for the human volunteer data. The RMS difference in the separation between adjacent tag lines (RMS_TS) was also assessed, resulting in an RMS_TS of 0.40 pixels (0.19 mm) in the experimental data and 0.52 pixels (0.56 mm) in the volunteer data. These results confirm the subpixel accuracy achieved using the proposed methodology. Magn Reson Med 2007.

Radial Basis Functions for Combining Shape and Speckle Tracking in 4D Echocardiography

Quantitative analysis of left ventricular deformation can provide valuable information about the extent of disease as well as the efficacy of treatment. In this work, we develop an adaptive multi-level compactly supported radial basis approach for deformation analysis in 3D+time echocardiography. Our method combines displacement information from shape tracking of myocardial boundaries (derived from B-mode data) with mid-wall displacements from radio-frequency-based ultrasound speckle tracking. We evaluate our methods on open-chest canines (N=8) and show that our combined approach is better correlated to magnetic resonance tagging-derived strains than either individual method. We also are able to identify regions of myocardial infarction (confirmed by postmortem analysis) using radial strain values obtained with our approach.

Multimodality Imaging Approach for Serial Assessment of Regional Changes in Lower Extremity Arteriogenesis and Tissue Perfusion in a Porcine Model of Peripheral Arterial Disease

Background—A standard quantitative imaging approach to evaluate peripheral arterial disease does not exist. Quantitative tools for evaluating arteriogenesis in vivo are not readily available, and the feasibility of monitoring serial regional changes in lower extremity perfusion has not been examined. Methods and Results—Serial changes in lower extremity arteriogenesis and muscle perfusion were evaluated after femoral artery occlusion in a porcine model using single photon emission tomography (SPECT)/CT imaging with postmortem validation of in vivo findings using gamma counting, postmortem imaging, and histological analysis. Hybrid 201Tl SPECT/CT imaging was performed in pigs (n=8) at baseline, immediately postocclusion, and at 1 and 4 weeks postocclusion. CT imaging was used to identify muscle regions of interest in the ischemic and nonischemic hindlimbs for quantification of regional changes in CT-defined arteriogenesis and quantification of 201Tl perfusion. Four weeks postocclusion, postmortem tissue 201Tl activity was measured by gamma counting, and immunohistochemistry was performed to assess capillary density. Relative 201Tl retention (ischemic/nonischemic) was reduced immediately postocclusion in distal and proximal muscles and remained lower in calf and gluteus muscles 4 weeks later. Analysis of CT angiography revealed collateralization at 4 weeks within proximal muscles (P<0.05). SPECT perfusion correlated with tissue gamma counting at 4 weeks (P=0.01). Increased capillary density was seen within the ischemic calf at 4 weeks (P=0.004). Conclusions—201Tl SPECT/CT imaging permits serial, regional quantification of arteriogenesis and resting tissue perfusion after limb ischemia. This approach may be effective for detection of disease and monitoring therapy in peripheral arterial disease.

A combined harmonic phase and strain-encoded pulse sequence for measuring three-dimensional strain

Measurement of myocardial strain provides direct information about heart function that can be correlated with disease. We present an MRI pulse sequence that acquires in just six heartbeats both harmonic phase (HARP) and strain-encoded (SENC) images and provides dense measurements of radial, circumferential and longitudinal strains within a single short-axis slice. Normal volunteer data confirm the feasibility of this pulse sequence, and acquired data demonstrate the strain measurement reliability.

Real-Time Monitoring of Cardiac Regional Function Using FastHARP MRI and Region-of-Interest Reconstruction

Cardiovascular stress test imaging assists in the diagnosis and monitoring of cardiovascular disease. The procedure can be carried out in a magnetic resonance (MR) scanner using pharmacological agents that mimic the effects of natural exercise. In order to provide real time indication of ischemia, thereby assisting in diagnosis and helping to assure patient safety, it is desirable to have real time monitoring of the myocardial regional function. This paper presents an algorithm for the real time myocardium region-of-interest reconstruction and myocardial strain computation using data acquired from a real time pulse sequence that has been previously reported. The chirp Fourier transform is used for efficient computation, enabling a real-time continuous strain map at a rate of 25 frames/s. Coupled with a real time data path from the scanner to a laptop computer, this algorithm enables real time continuous monitoring of cardiac strain and is targeted for use in the early detection and quantification of ischemia during MR stress tests.

High-Resolution 3D Arteriography of Chronic Total Peripheral Occlusions Using a T1-W Turbo Spin-Echo Sequence With Inner-Volume Imaging

Percutaneous revascularization of peripheral artery chronic total occlusion (CTO) is challenging under X‐ray guidance without direct image feedback, due to poor visualization of the obstructed segment and underappreciation of vessel tortuosity. Operators are required to steer interventional devices relatively “blindly,” and therefore procedural failure or perforation may occur. Alternatively, MRI may allow complete visualization of both patent and occluded arterial segments. We designed and implemented a 3D high‐resolution, T1‐weighted (T1‐W) turbo spin‐echo (TSE) MRI sequence with inner‐volume (IV) imaging to enable detailed peripheral artery CTO imaging. Using this sequence, high‐resolution volumes of interest (VOIs) around the vessel were achieved within 5−10 min. This imaging approach may be used for rapid pre‐ and postprocedural evaluations, and as a 3D roadmap that can be overlaid during real‐time X‐, MR‐, or XMR‐guided catheterization. Experiments were successfully performed on a carotid CTO model in swine ex vivo, and in peripheral arteries in normal volunteers and patients in vivo. Delineation of the vascular architecture, including contrast differences between the patent and occluded artery segments, and lesion morphology heterogeneity were visualized. Magn Reson Med 57:40–49, 2007. Published 2006 Wiley‐Liss, Inc.