Review of Journal of Cardiovascular Magnetic Resonance 2015.

There were 116 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2015, which is a 14 % increase on the 102 articles published in 2014. The quality of the submissions continues to increase. The 2015 JCMR Impact Factor (which is published in June 2016) rose to 5.75 from 4.72 for 2014 (as published in June 2015), which is the highest impact factor ever recorded for JCMR. The 2015 impact factor means that the JCMR papers that were published in 2013 and 2014 were cited on average 5.75 times in 2015. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is <25 % and has been falling because the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality papers to JCMR for publication.

Relationship between cardiac diffusion tensor imaging parameters and anthropometrics in healthy volunteers.

BACKGROUND: In vivo cardiac diffusion tensor imaging (cDTI) is uniquely capable of interrogating laminar myocardial dynamics non-invasively. A comprehensive dataset of quantative parameters and comparison with subject anthropometrics is required. METHODS: cDTI was performed at 3T with a diffusion weighted STEAM sequence. Data was acquired from the mid left ventricle in 43 subjects during the systolic and diastolic pauses. Global and regional values were determined for fractional anisotropy (FA), mean diffusivity (MD), helix angle gradient (HAg, degrees/%depth) and the secondary eigenvector angulation (E2A). Regression analysis was performed between global values and subject anthropometrics. RESULTS: All cDTI parameters displayed regional heterogeneity. The RR interval had a significant, but clinically small effect on systolic values for FA, HAg and E2A. Male sex and increasing left ventricular end diastolic volume were associated with increased systolic HAg. Diastolic HAg and systolic E2A were both directly related to left ventricular mass and body surface area. There was an inverse relationship between E2A mobility and both age and ejection fraction. CONCLUSIONS: Future interpretations of quantitative cDTI data should take into account anthropometric variations observed with patient age, body surface area and left ventricular measurements. Further work determining the impact of technical factors such as strain and SNR is required.

Review of Journal of Cardiovascular Magnetic Resonance 2014.

There were 102 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2014, which is a 6% decrease on the 109 articles published in 2013. The quality of the submissions continues to increase. The 2013 JCMR Impact Factor (which is published in June 2014) fell to 4.72 from 5.11 for 2012 (as published in June 2013). The 2013 impact factor means that the JCMR papers that were published in 2011 and 2012 were cited on average 4.72 times in 2013. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is <25% and has been falling because the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality papers to JCMR for publication.

A fully automatic and highly efficient navigator gating technique for high-resolution free-breathing acquisitions: Continuously adaptive windowing strategy.

A fully automatic and highly efficient free-breathing navigator gated technique, continuously adaptive windowing strategy (CLAWS), is presented. Using a novel and dynamic acquisition strategy that ensures all potential navigator acceptance windows are possible, CLAWS acquires an image with the highest possible efficiency regardless of variations in the respiratory pattern. Unnecessary prolongation of scan durations due to respiratory drift or navigator acceptance window adjustments are avoided. As CLAWS requires no setting of the acceptance window, nor monitoring of the navigator traces during the scan, operator dependence is minimized and ease of use improved. CLAWS was compared against a standard accept/reject algorithm (ARA) and an end-expiratory following ARA (EE-ARA) in 20 healthy subjects and 10 patients (ARA only). The respiratory efficiency was compared against the retrospectively determined best possible respiratory efficiency for each acquisition. On average, the difference between CLAWS scan times and best possible scan times was 0.6% (± 1.3%). For the ARA and EE-ARA techniques, mean differences were 14.4% (± 20.9%) and 32.6 ± 10.9%, respectively. Had the CLAWS algorithm been used with the ARA and EE-ARA traces, mean differences would have been 0.2% (± 1.1%) and 0.5% (± 1.7%), respectively. Image quality was the same for all techniques: respiratory gating, motion artifacts, navigator, and coronary artery imaging.

Review of Journal of Cardiovascular Magnetic Resonance 2009.

There were 56 articles published in the Journal of Cardiovascular Magnetic Resonance in 2009. The editors were impressed with the high quality of the submissions, of which our acceptance rate was about 40%. In accordance with open-access publishing, the articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. We have therefore chosen to briefly summarise the papers in this article for quick reference for our readers in broad areas of interest, which we feel will be useful to practitioners of cardiovascular magnetic resonance (CMR). In some cases where it is considered useful, the articles are also put into the wider context with a short narrative and recent CMR references. It has been a privilege to serve as the Editor of the JCMR this past year. I hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.

Eczematous dermatosis and thrombocytosis induced by efalizumab: two new side effects.

Efalizumab was authorized to be put on the market in France starting July 21, 2005. Its efficacy and tolerance profile in plaque psoriasis at a dose of 1 mg kg(-1) weekly in a subcutaneous injection have been studied in phase III trials. At the current moment, more than 3,500 patients have been included in clinical trials. Flu-like symptoms (fever, chills, headaches, nausea, vomiting, myalgia) are the most frequent adverse events. On the skin, a localized papular rash or the aggravation of the psoriasis in an edematous or even pustular form are the two most regularly observed complications. At the biological level, hyperlymphocytosis and a temporary increase in alkaline phosphatases without clinical consequences are the most frequent anomalies. We report 2 adverse events under efalizumab that to our knowledge have never been described: a case of an eczematous rash and a case of thrombocytosis.

Subject-specific computational simulation of left ventricular flow based on magnetic resonance imaging.

A detailed investigation of left ventricle (LV) flow patterns could improve our understanding of the function of the heart and provide further insight into the mechanisms of heart failure. This study presents patient-specific modelling with magnetic resonance imaging (MRI) to investigate LV blood flow patterns in normal subjects. In the study, the prescribed LV wall movements based on the MRI measurements drove the blood flow in and out of the LV in computational fluid dynamics simulation. For the six subjects studied, the simulated LV flow swirls towards the aortic valve and is ejected into the ascending aorta with a vertical flow pattern that follows the left-hand rule. In diastole, the inflow adopts a reasonably straight route (with no significant secondary flow) towards the apex in the rapid filling phase with slight variations in the jet direction between different cases. When the jet reaches about two thirds of the distance from the inflow plane to the apex, the blood flow starts to change direction and swirls towards the apex. In the more slowly filling phase, a centrally located jet is evident with vortices located on both sides of the jet on an anterior-posterior plane that passes through the mitral and aortic valves. In the inferior-superior plane, a main vortex appears for most of the cases in which an anticlockwise vortex appears for three cases and a clockwise vortex occurs for one case. The simulated flow patterns agree well qualitatively with MRI-measured flow fields.

[Leukaemia cutis during acute aleukaemic myeloid leukaemia in a two-month-old infant]. / Leucémie cutanée révélatrice d'une leucémie aiguë myéloïde sans blastes circulants chez un nourrisson de deux mois.

BACKGROUND: Congenital cutaneous leukaemia is rare. PATIENTS AND METHODS: A two-month-old girl presented bluish cutaneous macules of the trunk, histological examination of which suggested acute myeloid leukaemia (LAM B 5). The blood picture was negative for circulating tumour cells and the outcome under chemotherapy was favourable at one year of follow-up. DISCUSSION: The prognosis of congenital leukaemia is serious. Aleukaemic congenital leukaemia is seen occasionally but is rare. The existence of multiple cutaneous tumours in newborn infants raises the possibility of TORCH infection and of other malignant tumours such as nephroblastoma or neuroblastoma.

Numerical simulations of phase contrast velocity mapping of complex flows in an anatomically realistic bypass graft geometry.

Combined in vitro experiments and numerical simulations were performed to study flow artifacts in phase contrast (PC) velocity mapping of steady flow through an anatomically realistic aortocoronary bypass graft model. The geometry was obtained through imaging and computational reconstruction of a left anterior descending (LAD) coronary artery of a porcine heart. Simulated images of through-plane velocity were obtained at selected slices of the geometry. These were then compared and contrasted with velocity images of corresponding sites that were obtained from in vitro experiments. The shift and distortion of the measured velocity profile was well predicted by the simulation, while trajectories obtained from particle tracking were shown to be useful in understanding the origins of the flow artifacts that were observed.

Inter-study reproducibility of 3D volume selective fast spin echo sequence for quantifying carotid artery wall volume in asymptomatic subjects.

PURPOSE: To determine, in asymptomatic subjects, the inter-study reproducibility of a three-dimensional (3D) volume selective fast spin echo (FSE) cardiovascular magnetic resonance sequence for the assessment of carotid artery wall volume as a measure of atheroma burden. METHODS: Inter-study reproducibility was evaluated in 16 asymptomatic volunteers (10 male, 6 female). Both carotid arteries were scanned twice with a median inter-scan time of 5 days. The images were acquired in cross-section, and the total carotid arterial wall volume (TWV) was calculated by subtraction of the total carotid lumen volume from the total outer carotid vessel volume. RESULTS: The mean carotid T1-weighted TWV for the first and second scans was 828 and 821 mm(3), respectively (mean difference 7 mm(3), p=0.45). The standard deviation (S.D.) of the differences between the measurements was 38 mm(3) yielding an inter-study coefficient of variation of 4.6%. The time for each study was approximately 30 min. For the longitudinal evaluation of carotid atheroma burden with pharmacological intervention versus placebo, 32 subjects would enable a difference of 38 mm(3) to be detected with a significance level of 5% with 80% power. CONCLUSION: Volumetric analysis with carotid CMR in asymptomatic subjects using a 3D volume-selective FSE is time-efficient with good inter-study reproducibility, and is well suited for longitudinal studies of carotid atheroma with reasonable sample sizes.

Inotropic "A" ring substituted sulmazole and isomazole analogues.

A series of "A" ring substituted sulmazole and isomazole analogues have been prepared and evaluated as inotropic agents. pKA's, protonation sites, and log P values were measured for selected compounds and their electronic properties were calculated. No simple correlation between inotropic activity and pKA, protonation site, or log P value was observed. However, in vitro inotropism did correlate with the calculated charge density of the "B" ring imidazo nitrogen atom. The 6-position of sulmazole appeared to be the most tolerant toward substituents, the 6-amino derivative 7 being a more potent inotrope than sulmazole itself. 4-Methoxyisomazole 13 had comparable in vivo inotropic properties to those of isomazole.

Comparison of magnetic resonance imaging with echocardiography and radionuclide angiography in assessing cardiac function and anatomy following Mustard's operation for transposition of the great arteries.

The Mustard operation in infancy and childhood has successfully palliated many patients with transposition of the great arteries who have now survived to adulthood. Right ventricular dysfunction and tricuspid regurgitation are important determinants of late morbidity and mortality. The value of noninvasive magnetic resonance imaging (MRI) in the assessment of cardiac function and anatomy 9 to 20 years after this procedure has been investigated, and compared with findings on echocardiography, radionuclide ventriculography and angiography in 17 adult patients. Ejection fractions measured by MRI were higher compared with radionuclide ventriculography. The correlation for the left ventricle was closer (r = 0.75) than for the right ventricle (r = 0.49). Tricuspid regurgitation was assessed by Doppler echocardiography and by MRI using the right/left ventricular stroke volume ratio. The mean stroke volume ratio in those with Doppler evidence of tricuspid regurgitation was 1.6:1 compared to 1.1:1 in those without, and this difference reached significance (p less than 0.01). The anatomy of the great arteries was clearly visible in all patients. Five patients had a residual ventricular septal defect which, with the exception of 1 small defect, was easily visualized. The intraatrial baffle was best seen in transverse slices, and the systemic venous connection showed as a relatively narrow channel lying in the posterior part of the cavity. In general, baffle anatomy was easier to assess on 2-dimensional echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Magnetic resonance characterization of pulmonary arterial blood flow after single lung transplantation.

Magnetic resonance imaging has been used to study pulmonary arterial anatomy and to measure pulmonary arterial blood flow in patients with single lung transplantation. Nine patients and nine control subjects matched for age and sex were studied. The anatomy of the main pulmonary artery and its main branches, as well as the site of arterial anastomoses, was identified and measurements of their diameters were taken. There were no significant differences in diameters of these vessels between the patients and the control subjects. Arterial blood flows to the transplanted lung were 2.07 +/- 0.45 L/min/m2 in the group with right lung transplantation and 2.43 +/- 0.60 L/min/m2 in those with left lung transplantation compared with 1.22 +/- 0.22 L/min/m2 and 1.27 +/- 0.41 L/min/m2 in the control group, respectively. The ratio of blood flow in the transplanted and the native lungs in all patients studied was 2.8 +/- 0.83:1. The flow profile in the artery of the transplanted lung showed a wide forward flow during systole and most of diastole, whereas that of the native lung showed a narrow early systolic peak and a reverse flow in most of diastole. These differences in the volume and pattern of flow in the transplanted lung are most likely related to the relative resistance in the native and the transplanted lung and could constitute an additional index for monitoring the condition of patients with lung transplantation and help in the understanding of the physiology of the denervated pulmonary vascular bed.

Magnetic resonance velocity vector mapping of blood flow in thoracic aortic aneurysms and grafts.

Magnetic resonance imaging with multidirectional cine velocity mapping was used to study relationships between aortic blood flow patterns and the geometry of thoracic aortic aneurysms and grafts. Ten patients with 13 thoracic aortic aneurysms, single or multiple, or grafts (4) participated in the study. The causes of disease were atherosclerosis (4), Marfan's syndrome (2), trauma (1), and unknown (1), and there were two dissections. Spin-echo imaging and cine velocity mapping in 10 mm thick slices with vertical and horizontal velocity encoding were done. Maps of the two velocity components were processed into multiple computer-generated streaks whose orientation and length corresponded to velocity vectors in the chosen plane. The dynamic arrow maps were compared with previously reported aortic arrow maps from normal subjects. The forward flow occupied the entire lumen in the normal aorta in systole and small vortices were only present in the sinuses of Valsalva. Atherosclerotic aneurysms in the ascending aorta were located at the anterior right and had oblique, eccentric jet flows that created a large secondary vortex in the aneurysm. Patients with Marfan's syndrome had a central jet and two large vortices, one on each side. All other aneurysms, dissections, and grafts had irregular flows and vortices not seen in normal subjects. Magnetic resonance imaging with multidirectional velocity mapping is a powerful noninvasive tool to assess morphologic features and disturbed blood flow in aortic aneurysms and grafts. Recognizably altered flow patterns were found to be associated with altered vessel geometry. The significance of this requires further investigation.

Age-related changes of human aortic flow wave velocity measured noninvasively by magnetic resonance imaging.

We have used magnetic resonance imaging with cine velocity mapping to measure flow wave velocity in the thoracic aorta of 20 healthy volunteers of different ages. We have also studied the relationship between propagation of flow wave velocity and regional aortic compliance. Aortic flow velocity increased linearly with age (r = 0.87), and there was a significant difference between the youngest decade [age 10-19, mean velocity 4.3 +/- 0.7 (SD) m/s] and the oldest decade studied (age 50-59, mean velocity 7.2 +/- 0.2 m/s). Flow wave velocity (m/s) was negatively correlated with ascending aortic compliance (microliter/mmHg) (r = -0.75). Magnetic resonance imaging is a noninvasive method for measurement of aortic flow wave velocity that is an important parameter in assessing arterial wall mechanics and blood flow dynamic.

Assessment of coronary artery stenosis by magnetic resonance imaging.

OBJECTIVE: The findings of magnetic resonance and x-ray angiography were compared for assessment of coronary artery stenosis in this validation study. BACKGROUND: Magnetic resonance angiography of the coronary arteries has recently been described, but there has been no comparison with x-ray angiography of localisation or assessment of important characteristics of coronary stenosis. METHODS: A breath hold, segmented k-space, 2D gradient echo imaging technique incorporating fat suppression was used in 39 patients (55 coronary stenoses) with known coronary artery disease. RESULTS: Overall, 47 stenoses (85%) were assessed by magnetic resonance (29 of 33 stenoses in the left anterior descending artery, one of one in the left main stem, 14 of 17 in the right coronary artery, and three of four in the left circumflex artery were detected). There was close agreement between magnetic resonance and x-ray angiography for the distance of the stenosis from the arterial origin (magnetic resonance mean (SD) 27 (16) mm versus x-ray angiography 27 (16) mm, P = NS, mean difference -0.2 mm). The distance to 39 stenoses (83%) agreed to within 5 mm, with increased scatter for more distal stenoses. The severity of magnetic resonance signal loss, assessed visually at the site of stenosis, varied significantly according to the percentage diameter stenosis (F = 30, P < 0.0001); stenosis severity with severe signal loss was 89 (7)%, with partial signal was 70 (16)%, and with irregular wall only 37 (11)%, with significant differences among the three groups (P < 0.001). A significant correlation was found between the proportional magnetic resonance signal loss at the stenosis and the percentage diameter stenosis severity (r = -0.67, P < 0.0001). The length of stenosis measured by magnetic resonance (6 (3) mm) was greater than by x-ray angiography (5 (2) mm, P < 0.006, mean difference +1.1 mm). Spearman's rank test showed that there was significant overestimation of stenosis length by magnetic resonance as stenosis severity increased (rs = 0.34, P < 0.02). CONCLUSIONS: Accurate localisation of coronary stenosis and a qualitative assessment of stenosis severity are possible by magnetic resonance, but stenosis length is overestimated as severity increases, probably because of disturbed patterns of flow with turbulence distal to severe stenoses. Reasonable results for the detection of coronary artery stenosis by magnetic resonance were achieved in this highly selected population, but further progress in imaging techniques is necessary before moving towards appreciable clinical application.

Carotid geometry reconstruction: a comparison between MRI and ultrasound.

Image-based Computational Fluid Dynamics (CFD) has become a popular tool for the prediction of in vivo flow profiles and hemodynamic wall parameters. Currently, Magnetic Resonance Imaging (MRI) is most widely used for in vivo geometry acquisition. For superficial arteries such as the carotids and the femoral artery, three-dimensional (3-D) extravascular ultrasound (3-DUS) could be a cost-effective alternative to MRI. In this study, nine healthy subjects were scanned both with MRI and 3-DUS. The reconstructed carotid artery geometries for each subject were compared by evaluating cross-sectional areas, centerlines, and carotid nonplanarity. Lumen areas agreed very well between the two different acquisition techniques, whereas centerlines and nonplanarity parameters showed measurable disagreement, possibly due to the different neck and head positions adopted for 3-DUS versus MRI. With the current level of agreement achieved, 3-DUS has the potential to become an inexpensive and fast alternative to MRI for image-based CFD modeling of superficial arteries.

Magnetic resonance imaging: a method for the assessment of changes in vascular structure and function.

A brief review is made of the history of nuclear magnetic resonance (NMR) and magnetic resonance imaging (MRI). The advantages and disadvantages of MRI are discussed with particular reference to methods of studying the vascular system. Techniques developed to study separately sclerosis and atherosis, the two components of atherosclerotic disease, are discussed in more detail. Finally, in vitro and in vivo results are presented to demonstrate the great wealth of information already available from the NMR signal and hence its considerable potential for the study of vascular disease in the future.

Magnetic resonance coronary angiography in heart transplant recipients.

BACKGROUND: Magnetic resonance angiography (MRA) using segmented k-space fast low-angle shot imaging has recently been used to demonstrate the proximal coronary arteries in healthy subjects and in patients with coronary artery disease. We assessed the sensitivity and specificity of coronary MRA in heart transplant recipients and investigated the feasibility of coronary MRA in patients with metallic sutures and clips in the chest. MATERIALS AND METHODS: Sixteen cardiac transplant patients aged 57.2 +/- 7.9 years (mean +/- SD) were recruited. Forty-eight arterial segments were evaluated, including the left main artery (LMA), left anterior descending artery (LADA) and right coronary artery (RCA). We excluded the left circumflex artery which could not be imaged accurately. The average time between heart transplant operation and MRA was 6 years, whereas that between MRA and X-ray angiography was 4 months. The coronary MRA was interpreted by two experienced investigators who were blinded to the coronary X-ray angiography results. Similarly, the coronary X-ray angiography results were interpreted by two experienced investigators blinded to the MRA results. The coronary arterial segments were classified by MRA as being normal or as having an amount of disease that was significant (> 50% lesion) or insignificant (< 50% lesion). RESULTS: There were 28 true-negative, five true-positive, four false-negative and six false-positive results. Of the 28 true-negative cases, 13 were in the LMA, six in the LADA and nine in the RCA. There was one false-positive LMA, two false-positive LADA and three false-positive RCA stenoses. There were four false-negative results in the LADA and one in the RCA. Clips precluded evaluation in one LMA, one LADA and one RCA. One LMA and one LADA were not evaluated as a result of poor images. One false-positive RCA stenosis was caused by a metallic clip. Three of the false-negative LADA stenoses had lesions in the distal third of the artery. The sensitivity, specificity, negative and positive predictive values were generally poor for the left coronary artery. The best results were for the RCA (sensitivity 100%, specificity 75%, positive predictive value 50% and negative predictive value 100%). The specificity in the left coronary arteries (LMA and LADA) was 86%, but the other indicators were all poorer. For the RCA, LMA and LADA combined, the overall sensitivity was 56%, specificity 82%, predictive accuracy 45% and negative predictive value 88%. In three patients, < 50% RCA lesions were seen in the MRA data, which were all confirmed by angiography. No < 50% lesions were seen in the LMA or in the LADA by MRA or by X-ray angiography. CONCLUSION: Coronary MRA using the segmented fast low-angle shot technique is feasible in heart transplant recipients but the sensitivity and specificity of this method are limited. Further developments in coil design, rapid imaging techniques and respiratory monitoring methods are necessary to improve the accuracy of coronary MRA.

Motion and deformation tracking for short-axis echo-planar myocardial perfusion imaging.

The assessment of regional myocardial perfusion during the first-pass of a contrast agent bolus requires tracking of the signal time course for each myocardial segment so that a detailed perfusion map can be derived. To obtain such a map in practice, however, is not trivial because deformation of the shape of the myocardium and respiratory-induced motion render a major difficulty in this process. This study describes an automated approach for motion and deformation tracking of functional myocardial perfusion images. The effectiveness of the described method has been evaluated using a numerical phantom and results are compared with those from existing techniques which use deformable models. Preliminary results from applying our approach to 20 patients are discussed and compared with those from SPECT studies.