Three-dimensional assessment of image distortion induced by active cardiac implants in 3.0T CMR.

CMR at 3.0T in the presence of active cardiac implants remains a challenge due to susceptibility artifacts. Beyond a signal void that cancels image information, magnetic field inhomogeneities may cause distorted appearances of anatomical structures. Understanding influencing factors and the extent of distortion are a first step towards optimizing the image quality of CMR with active implants at 3.0T. All measurements were obtained at a clinical 3.0T scanner. An in-house designed phantom with a 3D cartesian grid of water filled spheres was used to analyze the distortion caused by four representative active cardiac devices (cardiac loop recorder, pacemaker, 2 ICDs). For imaging a gradient echo (3D-TFE) sequence and a turbo spin echo (2D-TSE) sequence were used. The work defines metrics to quantify the different features of distortion such as changes in size, location and signal intensity. It introduces a specialized segmentation technique based on a reaction-diffusion-equation. The distortion features are dependent on the amount of magnetic material in the active implants and showed a significant increase when measured with the 3D TFE compared to the 2D TSE. This work presents a quantitative approach for the evaluation of image distortion at 3.0T caused by active cardiac implants and serves as foundation for both further optimization of sequences and devices but also for planning of imaging procedures.

Device-based impedance measurement is a useful and accurate tool for direct assessment of intrathoracic fluid accumulation in heart failure.

AIMS: Heart failure patients are often equipped with implanted devices and are frequently hospitalized due to volume overload. Reliable prediction of imminent fluid congestion has the potential to provide early detection of cardiac decompensation and therefore might be capable of enhancing therapy management. We investigated whether implant-based impedance (Z) measurement is closely correlated with directly assessed extravascular lung water and might thus be useful for patient monitoring. METHODS AND RESULTS: In sheep, pulmonary fluid congestion was induced. Continuous haemodynamic monitoring was performed and extravascular lung water index (EVLWI) assessed. An implanted device with a right ventricular lead measured Z using different electrode configurations. All animals developed gradual pulmonary fluid accumulation leading to inclining lung oedema: EVLWI did increase from 9.5 +/- 1 to 21.1 +/- 5.1 mL/kg (+127%). A concomitant decrease of Z by up to 23%, depending on the electrode configuration, was observed and regression analysis between Z and EVLWI yielded a significant inverse correlation. CONCLUSION: Changes of Z show a strong inverse correlation with changes of directly measured EVLWI. This allows the application of Z as a measure of intrathoracic fluid status and has the potential to optimize patient care, especially in the context of evolving telemedicine concepts.

Assessment of cardiovascular apoptosis in the isolated rat heart by magnetic resonance molecular imaging.

Apoptosis, an active process of cell self-destruction, is associated with myocardial ischemia. The redistribution of phosphatidylserine (PS) from the inner to the outer leaflet of the cell membrane is an early event in apoptosis. Annexin V, a protein with high specificity and tight binding to PS, was used to identify and localize apoptosis in the ischemic heart.Fluorescein-labeled annexin V has been used routinely for the assessment of apoptosis in vitro. For the detection of apoptosis in vivo, positron emission tomography and single-photon emission computed tomography have been shown to be suitable tools. In view of the relatively low spatial resolution of nuclear imaging techniques, we developed a high-resolution contrast-enhanced magnetic resonance imaging (MRI) method that allows rapid and noninvasive monitoring of apoptosis in intact organs. Instead of employing superparamagnetic iron oxide particles linked to annexin V, a new T1 contrast agent was used. To this effect, annexin V was linked to gadolinium diethylenetriamine pentaacetate (Gd-DTPA)-coated liposomes. The left coronary artery of perfused isolated rat hearts was ligated for 30 min followed by reperfusion. T(1) and T(2)* images were acquired by using an 11.7-T magnet before and after intracoronary injection of Gd-DTP-labeled annexin V to visualize apoptotic cells. A significant increase in signal intensity was visible in those regions containing cardiomyocytes in the early stage of apoptosis. Because labeling of early apoptotic cell death in intact organs by histological and immunohistochemical methods remains challenging, the use of Gd-DTPA-labeled annexin V in MRI is clearly an improvement in rapid targeting of apoptotic cells in the ischemic and reperfused myocardium.

In vivo assessment of absolute perfusion and intracapillary blood volume in the murine myocardium by spin labeling magnetic resonance imaging.

The absolute perfusion and the intracapillary or regional blood volume (RBV) in murine myocardium were assessed in vivo by spin labeling magnetic resonance imaging. Pixel-based perfusion and RBV maps were calculated at a pixel resolution of 469 x 469 mum and a slice thickness of 2 mm. The T(1) imaging module was a segmented inversion recovery snapshot fast low angle shot sequence with velocity compensation in all three gradient directions. The group average myocardial perfusion at baseline was determined to be 701 +/- 53 mL (100 g . min)(-1) for anesthesia with isoflurane (N = 11) at a mean heart rate (HR) of 455 +/- 10 beats per minute (bpm). This value is in good agreement with perfusion values determined by invasive microspheres examinations. For i.v. administration of the anesthetic Propofol, the baseline perfusion decreased to 383 +/- 40 mL (100 g . min)(-1) (N = 17, P < 0.05 versus. isoflurane) at a mean heart rate of 261 +/- 13 bpm (P < 0.05 versus isoflurane). In addition, six mice with myocardial infarction were studied under isoflurane anesthesia (HR 397 +/- 7 bpm). The perfusion maps showed a clear decrease of the perfusion in the infarcted area. The perfusion in the remote myocardium decreased significantly to 476 +/- 81 mL (100 g . min)(-1) (P < 0.05 versus sham). Regarding the regional blood volume, a mean value of 11.8 +/- 0.8 vol % was determined for healthy murine myocardium under anesthesia with Propofol (N = 4, HR 233 +/- 17 bpm). In total, the presented techniques provide noninvasive in vivo assessment of the perfusion and the regional blood volume in the murine myocardium for the first time and seem to be promising tools for the characterization of mouse models in cardiovascular research.

Quantitative assessment of myocardial perfusion with a spin-labeling technique: preliminary results in patients with coronary artery disease.

PURPOSE: To determine perfusion and coronary reserve in human myocardium without contrast agent using a spin labeling technique. MATERIALS AND METHODS: Assessment of myocardial perfusion is based on T1 measurements after global and slice-selective spin preparation. This magnetic resonance imaging (MRI) technique was applied to 12 healthy volunteers and 16 patients with suspected coronary artery disease under resting conditions and adenosine-induced vasodilatation. RESULTS: In volunteers, quantitative perfusion was calculated as 2.4 +/- 1.2 mL/g/minute (rest) and 3.9 +/- 1.3 mL/g/minute (adenosine), respectively. Perfusion reserve was 2.1 +/- 0.6. In patients, when comparing perfusion reserve in the anterior and posterior myocardium, reduced values according to a stenotic supplying vessel could be seen in seven of 11 patients who underwent stress testing. In these patients, the relative difference of coronary reserve was 44% +/- 18%. Two patients without stenosis of coronary arteries showed no differences in coronary reserve (with a relative change of 2 +/- 2%). CONCLUSION: In patients with single-vessel coronary artery disease, differences in coronary reserve were clearly detectable when comparing anterior and posterior myocardium. The spin labeling method is noninvasive and easily repeatable, and it could therefore become an important tool to study changes in myocardial perfusion.

In vivo assessment of absolute perfusion in the murine skeletal muscle with spin labeling MRI. Magnetic resonance imaging.

PURPOSE: To assess absolute perfusion in the skeletal muscle of mice in vivo with spin labeling magnetic resonance imaging (MRI) under normal and stress conditions. MATERIALS AND METHODS: Absolute perfusion in the skeletal muscle of 27 C57BL/6 mice was assessed in vivo non-invasively by spin labeling MRI at 7.05 T. This technique was based on the acquisition of T1 maps with global and slice-selective spin inversion in separate acquisitions. T1 mapping was performed by inversion recovery snapshot fast low angle shot imaging. To guarantee proper spin inversion within the whole mouse, a dedicated radiofrequency (RF) coil combination was constructed. A birdcage resonator was used for transmission, while detection of the MRI signal was achieved by a surface coil. RESULTS: Basal perfusion in the hindlimbs was determined to be 94 +/- 10 mL (100 g x minute)(-1) (mean +/- standard error of the mean [SEM], N = 27). This value is in good agreement with perfusion values determined by invasive techniques such as microspheres. A subgroup of six animals received a constant dose of 4 mg (kg x minute)(-1) of the vasodilator adenosine by an intraperitoneal catheter. In this case, perfusion was significantly increased to 179 +/- 56 mL (100 g x minute)(-1) (mean +/- SEM, N = 6, P < 0.02). Mean basal perfusion in this subgroup was 96 +/- 26 mL (100 g x minute)(-1). CONCLUSION: Spin labeling MRI is a well-suited technique for the in vivo assessment of absolute perfusion in the murine skeletal muscle.