ISMRM 25th Annual Meeting & Exhibition • 22-27 April 2017 • Honolulu, HI, USA

Scientific Session: Myocardial Viability & Perfusion


Tuesday, 25 April 2017
Room 320  13:45 - 15:45 Moderators:  Ganesh Adluru, Leon Axel

Slack Channel: #s_cv
Session Number: O19


3D Whole-Heart Phase Sensitive Inversion Recovery (PSIR) for Simultaneous Bright Blood Coronary Angiography and Black Blood Late Gadolinium Enhancement (LGE)
Giulia Ginami, Radhouene Neji, Tevfik Ismail, Amedeo Chiribiri, Rene Botnar, Claudia Prieto
This study introduces a free-breathing 3D whole-heart sequence with image-based navigation for post-contrast phase sensitive inversion recovery (PSIR) allowing for simultaneous bright-blood coronary angiography and black-blood late gadolinium enhancement (LGE) imaging. Such approach was successfully tested in a cohort of 10 patients with cardiovascular disease. Data acquisition was performed in free-breathing with 100% scan efficiency, thus allowing for predictable scan time. The proposed sequence allowed for LGE visualization with high volumetric coverage and improved contrast (black-blood dataset) while simultaneously providing sharp visualization of the coronary arteries and heart anatomy (bright-blood dataset).

Magnetization Transfer-weighted Cardiac MRI in End Stage Renal Disease Quantifies Fibrosis and Identifies Biochemical Markers of Fibrosis without Gadolinium
Tori Stromp, Rebecca Kidney, Tyler Spear, Kristin Andres, Joshua Kaine, Steve Leung, Moriel Vandsburger
Cardiac fibrosis is prevalent in end stage renal disease (ESRD). Contraindication to late gadolinium enhancement (LGE) cardiac MRI (CMR) obstructs diagnosis, treatment selection, and potential therapeutic target identification. Currently, ventricular hypertrophy and function are used as surrogate measures of fibrosis and correlates of biomarkers. We used magnetization transfer (MT) weighted CMR to quantify fibrosis, comparing to structure, function, and blood biomarkers. We recapitulated prevalent fibrosis found previously by LGE. Results suggest hypertrophy or strains may be inappropriate fibrosis measures in ESRD. Extracellular matrix turnover markers, e.g. TIMPs, may represent more specific biomarkers of fibrosis and molecular targets for therapeutics development.

Free-breathing 3D whole-heart stress myocardial perfusion using compressed sensing
Merlin Fair, Eliana Reyes, Peter Gatehouse, Ganesh Adluru, Jason Mendes, Ricardo Wage, Edward DiBella, David Firmin
A consistent, reliable, 3D myocardial first-pass perfusion sequence is developed using a stack-of-stars design and tested at both stress and rest during free-breathing. A compressed sensing algorithm is used to compensate for the high undersampling rates, including a modified form with temporal pixel reordering designed to better cope with respiratory motion. Reconstructions were successful, despite large respiratory motion, in all cases. An example of a perfusion defect in a coronary artery disease patient is presented, with confirmation from recent SPECT myocardial perfusion scintigraphy.

Clinical Evaluation of Whole-Heart Quantitative Adenosine Stress CMR with Motion-compensated L1-SPIRIT
Michael Salerno, Yang Yang, Stephen McHugh, Eric Holland, Jonathan Pan, Craig Meyer, Angela Taylor, Christopher Kramer
Adenosine stress CMR has potential advantages over competing modalities for diagnosing coronary artery disease (CAD) including the ability to quantify myocardial perfusion, however current CMR techniques have limited spatial coverage.  We perform a clinical assessment of the diagnostic performance of whole-heart spiral perfusion imaging using motion compensated compressed sensing for detection of CAD and demonstrate good image quality, minimal motion artifacts, and high diagnostic accuracy for both visual and quantitative evaluation.

Coronary Relaxation Mapping for Multi-fold Amplification in Myocardial BOLD Sensitivity
Hsin-Jung yang, Damini Dey, Behzad Sharif, Jane Sykes, John Butler, Ivan Cokic, Sotirios Tsaftaris, Piotr Slomka, Frank Prato, Rohan Dharmakumar
Over the past two decades cardiac BOLD MRI has seen major technical advances. However, its reliability for detecting ischemic heart disease remains poor. We hypothesized that the reliability of cardiac BOLD MRI can be improved by repeatedly acquiring BOLD images following regadenoson injection. We found that repeatedly acquired myocardial BOLD imaging following regadenoson administration can be used to significantly amplify the BOLD sensitivity and improve the reliability of myocardial BOLD MRI in health and disease.

Quantification of Perfusion in Hypertrophic Cardiomyopathy using 3D Contrast Agent Flow Simulation
Leili Riazy, Marc Olbrich, Tobias Schaeffter, Simone Fritschi, Thoralf Niendorf, Jeanette Schulz-Menger
Hypertrophic Cardiomyopathy (HCM) is a common cause of sudden heart death in young adults. MRI is a powerful tool for the diagnosis and surveillance of this myocardial morphology as well as tissue injury. In clinical routine the assessment is mainly based on visual assessment or semi-quantification is increasingly used.  Quantification of perfusion defect should be nowadays assessed with computational tools. We aim at quantifying differences in perfusion with a computational flow model that incorporates the vascular, as well as extracellular compartment, using the Damk÷hler Number $$$Da$$$. Areas of different perfusion in N=5 patients with HCM were fitted in $$$Da$$$ with model-derived curves with an overall error of 10.48%.

Intravoxel Incoherent Motion Model in the Heart of Patients under Adenosine Induced Stress
Georg Spinner, Constantin von Deuster, Sabrina Oebel, Christian Stoeck, Robert Manka, Sebastian Kozerke
Intravoxel Incoherent Motion Imaging (IVIM) in the in vivo human heart has the potential of measuring myocardial perfusion without the need for contrast agents. In order to validate previous IVIM animal studies, patients where measured both during rest and under adenosine induced stress using a slice following second-order motion compensated diffusion weighted imaging sequence. The IVIM perfusion fraction is found to significantly increase during stress, which shows that IVIM imaging allows measuring a perfusion surrogate. This can hence be used for example to assess perfusion deficits in patients with ischemia.

Combined Late Gadolinium Enhancement (LGE) and 18F-fluorodeoxyglucose (18F-FDG) Uptake in a Hybrid PET/MR System to Diagnose Active Cardiac Sarcoidosis
Philip Robson, Maria Giovanna Trivieri, Ronan Abgral, Marc Dweck, Nicolas Karakatsanis, Venkatesh Mani, Maria Padilla, Marc Miller, Anarahda Lala, Javier Sanz, Jagat Narula, Valentin Fuster, Johanna Contreras, Jason Kovacic, Zahi Fayad
Recent advances in hybrid Positron Emission Tomography (PET) Magnetic Resonance (MR) technology have enabled simultaneous imaging with both modalities.  Sarcoidosis is a granulomatous disease that, when involving the heart has a poor prognosis.  However, cardiac sarcoidosis has been shown to respond to immunosuppressive therapy.  Currently, both late gadolinium enhancement (LGE)-MR and 18F-fluorodeoxyglucose (18F-FDG)-PET are used separately to evaluate the disease yet a clear diagnosis is not easily achieved.  In this work, we investigate the potential improvement in evaluation with combined 18F-FDG-PET/MR imaging.

Microvascular tissue characterization with cardiac PET/MRI: Quantitative comparison of myocardial DCE-MRI perfusion flow with 18F-FDG viability PET and coronary angiography
Karl Kunze, Teresa Vitadello, Christoph Rischpler, Markus Schwaiger, Stephan Nekolla
This cardiac multimodality study combines the use of metabolic 18F-FDG PET imaging with coronary angiography as well as DCE-MR perfusion imaging to investigate the relationship of myocardial metabolism and perfusion in chronic ischemia. A patient group with chronic total occlusion received exams pre- (PET/MRI+Angiography) as well as post- (MRI+Angiography) coronary intervention. Results showed a range of subtle to heavy resting perfusion deficits, with variable intra-patient relationships to metabolic deficits as indicated by 18F-FDG PET. Comparison of coronary angiography results with the corresponding quantitative perfusion analysis pre- and post-intervention suggest that resting perfusion is more sensitive to micro- than macrovascular coronary integrity.

Correlations and differences of myocardial blood flow with simultaneous measurements of MRI and PET
Masoud Edalati, David Muccigrosso, Richard Laforest, Pamela Woodard, Jie Zheng
The presented study explores correlations and differences of myocardial blood flow measured with MRI and PET. We employed a post-processing method to estimate the arterial input function using gamma variate model. Rest/stress quantitative PET/MRI cardiac perfusion study were simultaneously performed on sixteen patients with myocardial ischemia. The results demonstrated the feasibility of the new AIF estimation method for the quantification of MBF by MRI without using special sequences or dual bolus injections of contrast media. Statistical analysis between PET and MRI data demonstrated good correlation with a linear trend and error ranges comparable to those previously reported in the literature.

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