Tagged cine magnetic resonance imaging to quantify regional mechanical changes after acute myocardial infarction

PurposeThe conventional volumetric approaches of measuring cardiac function are load-dependent, and are not able to discriminate functional changes in the infarct, transition and remote myocardium. We examined phase-dependent regional mechanical changes in the infarct, transition and remote regions after acute myocardial infarction (MI) in a preclinical mouse model using cardiovascular magnetic resonance imaging (CMR).MethodsWe induced acute MI in six mice with left anterior descending coronary artery ligation. We then examined cardiac (infarct, transition and remote-zone) morphology and function utilizing 9.4 T high field CMR before and 2 weeks after the induction of acute MI. Myocardial scar tissue was evaluated by using CMR with late gadolinium enhancement (LGE). After determining global function through volumetric analysis, regional wall motion was evaluated by measuring wall thickening and radial velocities. Strain rate imaging was performed to assess circumferential contraction and relaxation at the myocardium, endocardium, and epicardium.ResultsThere was abnormal LGE in the anterior walls after acute MI suggesting a successful MI procedure. The transition zone consisted of a mixed signal intensity, while the remote zone contained viable myocardium. As expected, the infarct zone had demonstrated severely decreased myocardial velocities and strain rates, suggesting reduced contraction and relaxation function. Compared to pre-infarct baseline, systolic and diastolic velocities (v_S and v_D) were significantly reduced at the transition zone (v_S: −1.86 ± 0.16 cm/s vs −0.68 ± 0.13 cm/s, P < 0.001; v_D: 1.86 ± 0.17 cm/s vs 0.53 ± 0.06 cm/s, P < 0.001) and remote zone (v_S: −1.86 ± 0.16 cm/s vs −0.65 ± 0.12 cm/s, P < 0.001; v_D: 1.86 ± 0.16 cm/s vs 0.51 ± 0.04 cm/s, P < 0.001). Myocardial peak systolic and diastolic strain rates (SR_S and SR_D) were significantly lower in the transition zone (SR_S: −4.2 ± 0.3 s⁻¹ vs −1.3 ± 0.2 s⁻¹, P < 0.001; SR_D: 3.9 ± 0.3 s⁻¹ vs 1.3 ± 0.2 s⁻¹, P < 0.001) and remote zone (SR_S: −3.8 ± 0.3 s⁻¹ vs −1.4 ± 0.3 s⁻¹, P < 0.001; SR_D: 3.5 ± 0.2 s⁻¹ vs 1.5 ± 0.4 s⁻¹, P = 0.006). Endocardial and epicardial SR_S and SR_D were similarly reduced in the transition and remote zones compared to baseline.ConclusionsThis study, for the first time, utilized state-of-the art high-field CMR algorithms in a preclinical mouse model for a comprehensive and controlled evaluation of the regional mechanical changes in the transition and remote zones, after acute MI. Our data demonstrate that CMR can quantitatively monitor dynamic post-MI remodeling in the transition and remote zones, thereby serving as a gold standard tool for therapeutic surveillance.     

Left ventricular aneurysmectomy after myocardial infarction following detection of left ventricular thrombosis by magnetic resonance imaging

A 54-year-old man with a history of myocardial infarction presented with recurrent transient ischemic attacks 7 yr after the acute event. The emboli originated from a left ventricular thrombus despite adequate oral anticoagulant therapy. The thrombus was best detected with magnetic resonance imaging and had to be removed by surgery.     

Magnetic resonance imaging in patients with unstable angina: comparison with acute myocardial infarction and normals

The role of magnetic resonance imaging in characterizing normal, ischemic and infarcted segments of myocardium was examined in 8 patients with unstable angina, 11 patients with acute myocardial infarction, and 7 patients with stable angina. Eleven normal volunteers were imaged for comparison. Myocardial segments in short axis magnetic resonance images were classified as normal or abnormal on the basis of perfusion changes observed in thallium-201 images in 22 patients and according to the electrocariographic localization of infarction in 4 patients. T2 relaxation time was measured in 57 myocardial segments with abnormal perfusion (24 with reversible and 33 with irreversible perfusion changes) and in 25 normally perfused segments. T2 measurements in normally perfused segments of patients with acute myocardial infarction, unstable angina and stable angina were within normal range derived from T2 measurements in 48 myocardial segments of 11 normal volunteers (42 +/- 10 ms). T2 in abnormal myocardial segments of patients with stable angina also was not significantly different from normal. T2 of abnormal segments in patients with unstable angina (64 +/- 14 in reversibly ischemic and 67 +/- 21 in the irreversibly ischemic segments) was prolonged when compared to normal (p less than 0.0001) and was not significantly different from T2 in abnormal segments of patients with acute myocardial infarction (62 +/- 18 for reversibly and 66 +/- 11 for irreversibly ischemic segments). The data indicate that T2 prolongation is not specific for acute myocardial infarction and may be observed in abnormally perfused segments of patients with unstable angina.(ABSTRACT TRUNCATED AT 250 WORDS)     

Assessment of acute myocardial infarction in man with magnetic resonance imaging and the use of a new paramagnetic contrast agent gadolinium-bopta

To assess the feasibility of and characterize the new paramagnetic contrast agent gadolinium-BOPTA/dimeglumine (Gd-BOPTA) to detect acute myocardial infarctions with MR imaging, 24 patients (53.3 ± 8.3 yr) were examined 9.3 ± 3.6 days after a first myocardial infarction. Short-axis T₁-weighted and T₂-weighted MR imaging was performed at three slice levels. T₁-weighted images were obtained before, immediately after, 15, 30, and 45 min after injection. Patients received either 0.05 or 0.1 mmol/kg body weight Gd-BOPTA. Images were qualitatively and quantitatively analyzed. Two patients showed no signs of infarction on T₂-weighted images as opposed to contrast-enhanced T₁-weighted images. Contrast-to-noise ratio was not affected by the dosage level. Signal intensity (SI) of normal to infarcted myocardium was significantly improved by both dosages (p < .0005) but a dosage of 0.05 mmol/kg produced significantly higher SI inf/norm (1.42 ± 0.07 vs. 1.34 ± 0.06, respectively, p = .015). SI of normal and infarcted myocardium enhanced immediately after administration of 0.05 mmol/kg (29.3 ± 5.1% and 53.8 ± 9.6% respectively), which decreased thereafter to 5.3 ± 4.8% and 40.2 ± 8.5% respectively, at 45 min (p < .002 for normal myocardium). SI enhancement immediately after 0.1 mmol/kg Gd-BOPTA showed no decrease within the first 45 min. Gd-BOPTA enables the detection of myocardial infarction. Optimal infarct delineation is achieved from 15 to 45 min after administration of 0.05 mmol/kg body weight Gd-BOPTA. Gd-BOPTA at 0.05 mmol/kg does improve image quality as measured by contrast-to-noise ratio and SI enhancement as compared to 0.10 mmol/kg.     

Motion dependence of myocardial transverse relaxation time in magnetic resonance imaging

We discuss the effects of motion on the computation of the myocardial transverse relaxation time by use of magnetic resonance imaging. Equations describing its behavior are derived and illustrated graphically under different conditions. It is shown that the myocardial transverse relaxation time calculated from magnetic resonance images depends on the actual myocardial transverse relaxation time ex vivo (T2) as well as the phase of the cardiac cycle in which it is computed, heart rate, cardiac wall velocity, choice of spin-echoes used in the calculation, and the spin-echo times employed. In particular, the error in T2 decreases when both the first and third echoes are employed in the calculation, rather than only the first two echoes. However, the myocardial transverse relaxation time is more strongly dependent on heart rate in the former case rather than in the latter. Furthermore, the error in T2, when both the first and second spin echoes are used in the calculation, is seen to increase as the spin-echo time shortens. On the other hand, the error in T2 decreases for shorter spin-echo times when both the first and third spin echoes are used instead. The results are relevant to the noninvasive assessment of ischemia, cardiac transplantation rejection, and other myocardial disorders.     

Quantitative assessment of regional systolic and diastolic functions and temporal heterogeneity of myocardial contraction in patients with myocardial infarction using cine magnetic resonance imaging and Fourier fitting

Purpose

The objective of this study is to determine regional left ventricle (LV) function and temporal heterogeneity of LV wall contraction by analyzing regional time–volume curve (TVC) after Fourier fitting and to assess altered systolic and diastolic functions and temporal indices of myocardial contraction in infarcted segments in comparison with noninfarcted myocardium in patients with myocardial infarction (MI).

Methods

Steady-state cine magnetic resonance (MR) and late gadolinium-enhanced (LGE) MR images were acquired using a 1.5-T MR system in 60 patients with MI. Regional LV function was determined by analyzing regional TVC in 16 segments. The fitted regional TVC was generated by Fourier curve fitting with five harmonics. Regional LV ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR), time to end-systole and time to peak filling (TPF) were determined from TVC and the first derivative curve.

Results

On LGE MR imaging (MRI), MI was observed in 307 of 960 segments (32.0%). Regional EF and PER averaged in LGE segments were 49.3±14.5% and 2.83±0.65 end-diastolic volume (EDV)/s, significantly lower than those in normal segments (66.7±11.9% and 3.63±0.60 EDV/s, P<.001 and P<.01, respectively). In addition, regional PFR, an index of diastolic function, was significantly reduced in LGE segments (1.94±0.54 vs. 2.86±0.68 EDV/s, P<.01). Time to end-systole and TPF were significantly greater in LGE segments (380.2±57.6 and 169.3±45.4 ms) than in normal segments (300.9±55.1 and 132.3±43.0 ms, P<.01 and P<.01, respectively).

Conclusions

Analysis of regional TVC on cine MRI after Fourier fitting allows quantitative assessment of regional systolic and diastolic LV functions and temporal heterogeneity of LV wall contraction in patients with MI.     

Ultra-low-field magnetic resonance imaging of acute cruciate ligament tears

Ultra-low-field (0.04 T) magnetic resonance imaging (MRI) was evaluated in 15 patients with acute trauma to the knee and clinically suspected injuries of the cruciate ligaments. Subsequent arthroscopy was performed within 14 days (mean: 3 days) in 14 patients and after 3 mo in one patient. At arthroscopy/arthrotomy tears of the anterior cruciate ligament (ACL) were verified in 13 patients (11 complete, 2 partial tears). An additional tear of the posterior cruciate ligament (PCL) was found in one patient. All the tears could be demonstrated by MRI. There was one false positive MR diagnosis of ACL tear. It is possible with low-field MRI to diagnose injuries of the cruciate ligaments with good accuracy.     

Intraventricular dispersion and temporal delay of early left ventricular filling after acute myocardial infarction. Assessment by magnetic resonance velocity mapping

This article aims to describe early left ventricular diastolic inflow using magnetic resonance velocity mapping in patients with recent acute myocardial infarction and in normal volunteers. Magnetic resonance velocity mapping was performed in a long axis plane through the hearts of 46 patients with recent, first time acute myocardial infarction and 43 age-matched normal volunteers. The peak velocities at six levels of the early diastolic inflow stream were recorded. A velocity index was calculated as the peak velocity in each position relative to the peak velocity at the mitral leaflet tips. Also, the temporal delay of velocity propagation was computed. Velocity index 4 cm downstream of mitral leaflet tips was lower in the acute myocardial infarction group (0.42 (0.17)) (mean (SD)) compared to controls (0.59 (0.25)) (p < 0.001). Temporal delay in the same position was longer in the acute myocardial infarction group (62 (67) ms) than in controls (32 (39) ms) (p < 0.02). Blood flow patterns in patients after acute myocardial infarction were characterized by increased dispersion of velocities and increased temporal delay of velocity propagation, probably reflecting impaired active left ventricular relaxation. Intraventricular flow measurements constitute a promising new technique for non-invasive assessment of left ventricular diastolic function.     

Bayesian image processing in magnetic resonance imaging.

In the past several years, image processing techniques based on Bayesian models have received considerable attention. In our earlier work, we developed a novel Bayesian approach which was primarily aimed at the processing and reconstruction of images in positron emission tomography. In this paper, we describe how the technique has been adopted to process magnetic resonance images in order to reduce noise and artifacts, thereby improving image quality. In this framework, the image is assumed to be a statistical variable whose posterior probability density conditional on the observed image is modeled by the product of the likelihood function of the observed data with a prior density based our prior knowledge. A Gibbs random field incorporating local continuity information and with edge-detection capability is used as the prior model. Based on the formalism of the posterior density, we can compute an estimate of the image using an iterative technique. We have implemented this technique and applied it to phantom and clinical images. Our results indicate that the approach works reasonably well for reducing noise, enhancing edges, and removing ringing artifact.     

Study of myocardial fiber pathway using magnetic resonance diffusion tensor imaging

The purpose of this study was to investigate myocardial fiber pathway distribution in order to provide supplemental information on myocardial fiber architecture and cardiac mechanics. Diffusion tensor imaging (DTI) with medium diffusion resolution (15 directions) was performed on normal canine heart samples (N=6) fixed in formalin. With the use of diffusion tensor fiber tracking, left ventricle (LV) myocardial fiber pathways and helix angles were computed pixel by pixel at short-axis slices from base to apex. Distribution of DTI-tracked fiber pathway length and number was analyzed quantitatively as a function of fiber helix angle in step of 9 degrees . The long fiber pathways were found to have small helix angles. They are mostly distributed in the middle myocardium and run circumferentially. Fiber pathways tracked at the middle and upper LV are generally longer than those near the apex. Majority of fiber pathways have small helix angles between -20 degrees and 20 degrees , dominating the fiber architecture in myocardium. Likely, such myocardial fiber pathway measurement by DTI may reflect the spatial connectiveness or connectivity of elastic myofiber bundles along their preferential pathway of electromechanical activation. The dominance of the long and circumferentially running fiber pathways found in the study may explain the circumferential predominance in left ventricular contraction.     

Serial magnetic resonance imaging in a non-traumatic rabbit osteonecrosis model: an experimental longitudinal study

We investigated the time-dependent natural course of experimental osteonecrosis (ON), including initial changes in ON and the reparative process, using in vivo serial repetitive magnetic resonance imaging (MRI) in a non-traumatic rabbit serum sickness ON model. Some necrotic lesions were detected at 1 week (3 of 16 femora with necrotic lesions) and some in the metaphysis were detected by 12 weeks (2 of 6 femora with lesions) on T(1)-weighted, T(2)-weighted, and fat suppression T(1)-weighted images. On contrast-enhanced MRI, extravasation of the erythrocytes was detected at 72 h (7 of 26 femora with lesions) as a small, focal enhanced area. Necrotic lesions were detected in all abnormal femora by 6 weeks (16 of 16 femora with lesions) as focal, homogeneously or inhomogeneously enhanced areas. Reparative tissue replaced with new vascular and trabecular formation in necrotic areas was detected as an extended marginal enhanced area at 12 weeks. These results suggest that the enhancement patterns on contrast-enhanced MRI may provide helpful information about the developmental and reparative process of clinical ON.     

Autonomous magnetic resonance imaging

Access to Magnetic Resonance Imaging (MRI) across developing countries ranges from being prohibitive to scarcely available. For example, eleven countries in Africa have no scanners. One critical limitation is the absence of skilled manpower required for MRI usage. Some of these challenges can be mitigated using autonomous MRI (AMRI) operation. In this work, we demonstrate AMRI to simplify MRI workflow by separating the required intelligence and user interaction from the acquisition hardware. AMRI consists of three components: user node, cloud and scanner. The user node voice interacts with the user and presents the image reconstructions at the end of the AMRI exam. The cloud generates pulse sequences and performs image reconstructions while the scanner acquires the raw data. An AMRI exam is a custom brain screen protocol comprising of one T₁-, T₂- and T₂*-weighted exams. A neural network is trained to incorporate Intelligent Slice Planning (ISP) at the start of the AMRI exam. A Look Up Table was designed to perform intelligent protocolling by optimizing for contrast value while satisfying signal to noise ratio and acquisition time constraints. Data were acquired from four healthy volunteers for three experiments with different acquisition time constraints to demonstrate standard and self-administered AMRI. The source code is available online. AMRI achieved an average SNR of 22.86 ± 0.89 dB across all experiments with similar contrast. Experiment #3 (33.66% shorter table time than experiment #1) yielded a SNR of 21.84 ± 6.36 dB compared to 23.48 ± 7.95 dB for experiment #1. AMRI can potentially enable multiple scenarios to facilitate rapid prototyping and research and streamline radiological workflow. We believe we have demonstrated the first Autonomous MRI of the brain.     

Effect of hyperosmotic mannitol on magnetic resonance relaxation parameters in reperfused canine myocardial infarction

To determine how administration of a hyperosmotic agent alters regional nuclear magnetic resonance (NMR) relaxation parameters and imaging characteristics in ischemic-reperfused myocardium, 7 dogs were infused with mannitol for 15 minutes before and after the release of a 3 hour left anterior descending coronary artery (LAD) occlusion. Nine control animals received normal saline during the 3 hour occlusion and 1 hour reperfusion periods. Normal posterior left ventricular (LV) wall and the ischemic anterior LV wall (risk area) myocardium was sampled for calculation of segmental microsphere myocardial blood flow, % tissue water content, NMR relaxation times (T1, T2) and myocyte ultrastructure using electron microscopy. Mean infarct T1 values were 14% greater than normal segments in saline-treated controls, but only 5% greater after mannitol. The difference in tissue water content between infarcted and normal segments was 4% in saline-treated (83 vs. 79%) compared to 2% in mannitol-treated dogs (79 vs. 77%). T1, T2 and % water content of control infarct segments were greater than treated infarcts (p less than 0.01). T1 and T2 rose as occlusion flow fell below 0.5 ml/min/g in control hearts but did not rise until flows were reduced to 0.1 ml/min/g in mannitol-treated hearts. Areas of increased signal in T1 and T2 NMR images correlated well with histochemical infarct volume (r = 0.98, SEE = 1.1 cc) in mannitol-treated dogs, but infarct borders were qualitatively less well-defined than in controls. We concluded that mannitol (1) diminishes tissue edema and reduces NMR relaxation parameters (T1, T2) in infarcted myocardium; and (2) attenuates the rise in T1 and T2 and ultrastructural myocyte injury in ischemic-reperfused myocardium.     

磁共振成象新进展

磁共振成象(MRI)已经成为生命科学研究和医疗诊断的有力手段，因此荣获2003年诺贝尔生理学或医学奖．文章概述了磁共振成象的新近进展，包括医疗成象、脑功能成象、显微成象、活体磁共振波谱等方面．     

Fast field-cycling magnetic resonance imaging

Magnetic resonance imaging (MRI) and fast field-cycling (FFC) NMR are both well-developed methods. The combination of these techniques, namely fast field-cycling magnetic resonance imaging (FFC-MRI) is much less well-known. Nevertheless, FFC-MRI has a number of significant applications and advantages over conventional techniques, and is being pursued in a number of laboratories. This article reviews the progress in FFC-MRI over the last two decades, particularly in the areas of Earth's field and pre-polarised MRI, as well as free radical imaging using field-cycling Overhauser MRI. Different approaches to magnet design for FFC-MRI are also described. The paper then goes on to discuss recent techniques and applications of FFC-MRI, including protein measurement via quadrupolar cross-relaxation, contrast agent studies, localised relaxometry and FFC-MRI with magnetisation-transfer contrast.