ISMRM 24th Annual Meeting & Exhibition • 07-13 May 2016 • Singapore

Scientific Session: Myocardial Viability & Clinical Studies

Monday, May 9, 2016
Room 334-336
14:15 - 16:15
Moderators: Vincent Ho, Taehoon Shin

Fully Automatic Left Atrium and Pulmonary Veins Segmentation for Late Gadolinium Enhanced MRI Combining Contrast Enhanced MRA
Qian Tao1, Esra Gucuk Ipek2, Rahil Shahzad1, Floris F. Berendsen1, Saman Nazarian2, and Rob J. van der Geest1
1Department of Radiology, Leiden University Medical Center, Leiden, Netherlands, 2Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
The extent and distribution of left atrial (LA) scar, visualized by LGE MR, can provide important information for treatment of atrial fibrillation (AF) patients. However, in current practice, to extract such information requires substantial manual effort and expertise. In this study, a fully automatic method was developed to segment LA and PV’s in LGE-MRI, combining robust multi-atlas segmentation and flexible level-set based segmentation optimization. The method demonstrated comparable accuracy to manual segmentation, with improved 3D continuity. The method enables automated generation of patient-specific LA and PV geometry models, and potentially objective LA scar assessment for individual AF patients.

Dark Blood Late Gadolinium Enhanced Imaging of Myocardial Scar using First-Moment-Nulled Motion Sensitized Driven Equilibrium (m2MSDE)
Gregory J Wilson1, Niranjan Balu1, Jinnan Wang1,2, Chun Yuan1, and Jeffrey H Maki1
1University of Washington, Seattle, WA, United States, 2Bayer Healthcare, Whippany, NJ, United States
A novel black-blood pre-pulse is described that darkens intraventricular blood pool signal in late gadolinium enhanced (LGE) imaging of myocardial scar. The pre-pulse is m1-nulled motion-sensitized driven equilibrium (m2MSDE) with user-specified motion-sensitizing direction. The pre-pulse nulls blood signal while maintaining good myocardial image quality. Preliminary results are described.

Visual quality assessment of 3D High Resolution Late Gadolinium Enhancement with Compressed-Sensing in a Clinical Setting: the impact of patient factors
Charlene Liew1,2, Tamer Basha1, Mehmet Akcakaya1, Connie Tsao1, Francesca Delling1, Kraig Kissinger1, Beth Goddu1, Sophie Berg1, Warren Manning1,3, and Reza Nezafat1
1Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States, 2Department of Radiology, Changi General Hospital, Singapore, Singapore, 3Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, United States
Compressed sensing can be used to reduce 3D LGE scan time by factor of 5 with isotropic spatial resolution. However, clinical feasibility and overall image quality of 3D LGE with compressed sensing is still unknown. In this study, we sought to assess the image quality of 3D LGE with isotropic spatial resolution of 1-1.5 mm3 in 268 consecutive patients with known or suspected cardiovascular disease and investigate the impact of patient characteristics on overall image quality. 

Detection of myocardial infarcts without contrast agent injection: Comparison of spin-lock with magnetization transfer MR imaging
Joep van Oorschot1, Martijn Froeling1, Thijs van den Broek2, Frebus van Slochteren2, Steven Chamuleau2, Peter Luijten1, Tim Leiner1, and Jaco Zwanenburg1
1Radiology, University Medical Center Utrecht, Utrecht, Netherlands, 2Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
Two promising techniques for endogenous myocardial infarct detection are Magnetization Transfer  and T1ρ-MRI. Goal of the study was to compare the ability to detect and quantify myocardial scar tissue in a chronic infarct model using MT and T1ρ mapping. In vivo MRI was performed on a clinical 1.5 MR scanner in 3 anesthetized pigs, 4 weeks after 90 minutes occlusion of the LAD. The MTR was significantly lower in the infarcted region (0.27±0.01 ms), compared to remote myocardium (0.38±0.01 ms).The T1ρ relaxation time was significantly higher in the infarcted region (87.0±1 ms), compared to healthy remote myocardium (56.4± 1 ms).

Free-breathing 3D late gadolinium enhancement cardiovascular magnetic resonance using outer volume suppressed projection navigators: Development and clinical validation
Rajiv G Menon1, G Wilson Miller2, Jean Jeudy1, Sanjay Rajagopalan3, and Taehoon Shin1
1Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Baltimore, MD, United States, 2Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States, 3Division of Cardiovascular Medicine, University of Maryland, Baltimore, Baltimore, MD, United States
We developed a free-breathing, 3D late gadolinium enhancement (FB 3D-LGE) cardiovascular magnetic resonance  technique based on outer volume suppressed 1D-projection navigators and a stack-of-spirals acquisition. The free-breathing 3D-LGE and conventional breath-hold 2D-LGE scans were performed on 29 cardiac patients. 2D and 3D techniques showed no significant differences in overall image quality scores and image artifact scores (P  >  0.1). There was a significant correlation in the average difference in fractional scar volume (r=0.96). The FB 3D-LGE is a viable option for patients, particularly in acute settings or in patients who are unable to comply with breath-hold instructions.

Cardiac 31P MRS in breast cancer patients undergoing chemotherapy
Gillian Macnaught1,2, Christopher Rodgers3, Martin Denvir4, Olga Oikonomidou5,6, Annette Cooper1, William Clarke3, Heather McVicars6, Larry Hayward6, Saeed Mirsadraee1, and Scott Semple1,4
1Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, United Kingdom, 2the MRC Centre for inflammation Research, University of Edinburgh, Edinburgh, United Kingdom, 3RDM Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom, 4BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom, 5Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom, 6Edinburgh Cancer Centre, NHS Lothian, Edinburgh, United Kingdom
Anthracyclines are chemotherapy agents widely used to treat cancer but that can also induce cardiotoxicity. Techniques are required to provide an earlier warning of cardiotoxicity before irreversible myocardial damage. 9 subjects were recruited to this on-going 31P MRS study to detect changes in cardiac energetics of breast cancer patients undergoing chemotherapy. Between pre- and mid-chemotherapy four subjects experienced a greater than 20% decrease in their cardiac PCr/ATP ratio, 1 subject experienced a 13.8% decrease in left ventricular ejection fraction (LVEF) and all had increased troponin levels. Ultimately this study aims to determine whether changes in PCr/ATP precede changes in LVEF.

Significant improvement of survival by T2* MRI in thalassemia major
Antonella Meloni1, Caterina Borgna-Pignatti2, Giovanni Carlo Del Vecchio3, Maria Antonietta Romeo4, Maria Rita Gamberini5, Federico Bonetti6, Maria Giovanna Neri1, Elisabetta Chiodi7, Vincenzo Positano1, and Alessia Pepe1
1Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy, 2Università di Ferrara, Ferrara, Italy, 3Uiversity of Bari, Bari, Italy, 4University of Catania, Catania, Italy, 5Arcispedale "S.Anna", Ferrara, Italy,6Policlinic Foundation San Matteo IRCCS, Pavia, Italy, 7Arcispedale “S. Anna”, Ferrara, Italy
The introduction of T2* CMR for the reproducible and non-invasive assessment of myocardial iron overload reduced the likelihood of developing decompensated cardiac failure, allowing the reduction of cardiac mortality in chronically transfused TM patients

Elevated Hemoglobin A1c(HbA1c) Is Independently Associated with Large Lipid-Rich Necrotic Cores in Hypertensive Patients with Symptomatic Carotid Atherosclerosis: A 3.0T MRI Study
Huilin Zhao1, Beibei Sun1, Xiaosheng Liu1, Xihai Zhao2, Yongming Dai3, Chun Yuan4, and Jianrong Xu1
1Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, People's Republic of, 2Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China, People's Republic of, 3Philips Healthcare, Shanghai, China, People's Republic of, 4Radiology, University of Washington, Seattle, WA, United States
Further understanding of the association of hemoglobin A1c(HbA1c) levels with symptomatic carotid plaque characteristics will be helpful for stroke risk stratification and treatment strategy modification. This study sought to investigate the associations of HbA1c levels with MR-identified carotid plaque characteristics in hypertensive patients with acute stroke. Our key findings are that elevated HbA1c was associated with carotid plaque presence, higher HbA1c level tended to exhibit an increased plaque burden and larger lipid-rich necrotic core, independent of other cardiovascular risk factors. Our findings indicate that elevated HbA1c may contribute to the development of advanced carotid plaques in stroke patients with hypertension.

Cardiac Magnetic Resonance detects an association between aortic stiffness and epicardial fat volume in patients with increased cardiovascular risk - Permission Withheld
Rami Homsi1, Alois Martin Sprinkart1, Jürgen Gieseke1,2, Julian Luetkens1, Michael Meier-Schroers1, Darius Dabir1, Daniel Kuetting1, Christian Marx1, Hans Schild1, and Daniel Thomas1
1Radiology, University Hospital Bonn, Bonn, Germany, 2Philips Healthcare, Hamburg, Germany
In a Cardiac Magnetic Resonance based approach the study reveals a relationship between epicardial fat and aortic stiffness which are both associated with cardiovascular risk and disease.

Intradialytic MRI for the assessment of Cardiovascular Function
Charlotte E Buchanan1,2, Azharuddin Mohammed2, Eleanor F Cox1, Maarten W Taal2, Nicholas M Selby2, Susan T Francis1, and Christopher W McIntyre3
1Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom, 2Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, United Kingdom, 3Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
We perform the first study of intradialytic MRI to assess cardiovascular stress during dialysis. A significant reduction in cardiac output (CO), stroke volume (SV) and IVC flux was seen during dialysis. Myocardial strain measures revealed significant stunned segments in the long axis in all individuals. No significant change in coronary artery flow was evident, and both myocardial perfusion and T1 measures in a single short axis slice showed no significant change. The change in CO and SV was negatively correlated with dialysis ultrafiltration volume. This work demonstrates MRI can be used to assess cardiac stress during dialysis.

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