Beat phenomena of oscillating readouts.

PURPOSE: To demonstrate slowly varying, erroneous magnetic field gradients for oscillating readouts due to the mechanically resonant behavior of gradient systems. METHODS: Projections of a static phantom were acquired using a one-dimensional (1D) EPI sequence with varying EPI frequencies ranging from 1121 to 1580 Hz on clinical 3T systems (30 mT/m, 200 T/m/s). Phase due to static B0 inhomogeneities was eliminated by a complex division of two separate scans with different polarities of the EPI readout. The temporal evolution of phase was evaluated and related to the mechanical resonances of the gradient systems derived from the gradient modulation transfer function. Additionally, the impact of temporally varying mechanical resonance effects on EPI was evaluated using an echo-planar spectroscopic imaging sequence. RESULTS: A beat phenomenon resulting in a slowly varying phase was observed. Its temporal frequency was given by the difference between the EPI frequency and the mechanical resonance frequency of the activated gradient axis. The maximum erroneous, oscillating phase during phase encoding was ±0.5 rad for an EPI frequency of 1281 Hz. Echo-planar spectroscopic imaging images showed the resulting time-dependent stretching/compression of the FOV. CONCLUSION: Oscillating readouts such as those used in EPI can result in low-frequency, erroneous phase contributions, which are explained by the beat phenomenon. Therefore, EPI phase-correction approaches may need to include beat effects for accurate image reconstruction.

CMRsim-A python package for cardiovascular MR simulations incorporating complex motion and flow.

PURPOSE: To present an open-source MR simulation framework that facilitates the incorporation of complex motion and flow for studying cardiovascular MR (CMR) acquisition and reconstruction. METHODS: CMRsim is a Python package that allows simulation of CMR images using dynamic digital phantoms with complex motion as input. Two simulation paradigms are available, namely, numerical and analytical solutions to the Bloch equations, using a common motion representation. Competitive simulation speeds are achieved using TensorFlow for GPU acceleration. To demonstrate the capability of the package, one introductory and two advanced CMR simulation experiments are presented. The latter showcase phase-contrast imaging of turbulent flow downstream of a stenotic section and cardiac diffusion tensor imaging on a contracting left ventricle. Additionally, extensive documentation and example resources are provided. RESULTS: The Bloch simulation with turbulent flow using approximately 1.5 million particles and a sequence duration of 710 ms for each of the seven different velocity encodings took a total of 29 min on a NVIDIA Titan RTX GPU. The results show characteristic phase contrast and magnitude modulation present in real data. The analytical simulation of cardiac diffusion tensor imaging with bulk-motion phase sensitivity took approximately 10 s per diffusion-weighted image, including preparation and loading steps. The results exhibit the expected alteration of diffusion metrics due to strain. CONCLUSION: CMRsim is the first simulation framework that allows one to feasibly incorporate complex motion, including turbulent flow, to systematically study advanced CMR acquisition and reconstruction approaches. The open-source package features modularity and transparency, facilitating maintainability and extensibility in support of reproducible research.

Impact of late gadolinium enhancement image acquisition resolution on neural network based automatic scar segmentation.

BACKGROUND: Automatic myocardial scar segmentation from late gadolinium enhancement (LGE) images using neural networks promises an alternative to time-consuming and observer-dependent semi-automatic approaches. However, alterations in data acquisition, reconstruction as well as post-processing may compromise network performance. The objective of the present work was to systematically assess network performance degradation due to a mismatch of point-spread function between training and testing data. METHODS: Thirty-six high-resolution (0.7×0.7×2.0 mm3) LGE k-space datasets were acquired post-mortem in porcine models of myocardial infarction. The in-plane point-spread function and hence in-plane resolution Δx was retrospectively degraded using k-space lowpass filtering, while field-of-view and matrix size were kept constant. Manual segmentation of the left ventricle (LV) and healthy remote myocardium was performed to quantify location and area (% of myocardium) of scar by thresholding (≥ SD5 above remote). Three standard U-Nets were trained on training resolutions Δxtrain = 0.7, 1.2 and 1.7 mm to predict endo- and epicardial borders of LV myocardium and scar. The scar prediction of the three networks for varying test resolutions (Δxtest = 0.7 to 1.7 mm) was compared against the reference SD5 thresholding at 0.7 mm. Finally, a fourth network trained on a combination of resolutions (Δxtrain = 0.7 to 1.7 mm) was tested. RESULTS: The prediction of relative scar areas showed the highest precision when the resolution of the test data was identical to or close to the resolution used during training. The median fractional scar errors and precisions (IQR) from networks trained and tested on the same resolution were 0.0 percentage points (p.p.) (1.24 - 1.45), and - 0.5 - 0.0 p.p. (2.00 - 3.25) for networks trained and tested on the most differing resolutions, respectively. Deploying the network trained on multiple resolutions resulted in reduced resolution dependency with median scar errors and IQRs of 0.0 p.p. (1.24 - 1.69) for all investigated test resolutions. CONCLUSION: A mismatch of the imaging point-spread function between training and test data can lead to degradation of scar segmentation when using current U-Net architectures as demonstrated on LGE porcine myocardial infarction data. Training networks on multi-resolution data can alleviate the resolution dependency.

Relaxation enhancement by microwave irradiation may limit dynamic nuclear polarization.

Dynamic nuclear polarization enables the hyperpolarization of nuclear spins beyond the thermal-equilibrium Boltzmann distribution. However, it is often unclear why the experimentally measured hyperpolarization is below the theoretically achievable maximum polarization. We report a (near-) resonant relaxation enhancement by microwave (MW) irradiation, leading to a significant increase in the nuclear polarization decay compared to measurements without MW irradiation. For example, the increased nuclear relaxation limits the achievable polarization levels to around 35% instead of hypothetical 60%, measured in the DNP material TEMPO in 1H glassy matrices at 3.3 K and 7 T. Applying rate-equation models to published build-up and decay data indicates that such relaxation enhancement is a common issue in many samples when using different radicals at low sample temperatures and high Boltzmann polarizations of the electrons. Accordingly, quantification and a better understanding of the relaxation processes under MW irradiation might help to design samples and processes towards achieving higher nuclear hyperpolarization levels.

AI Cardiac MRI Scar Analysis Aids Prediction of Major Arrhythmic Events in the Multicenter DERIVATE Registry.

Background Scar burden with late gadolinium enhancement (LGE) cardiac MRI (CMR) predicts arrhythmic events in patients with postinfarction in single-center studies. However, LGE analysis requires experienced human observers, is time consuming, and introduces variability. Purpose To test whether postinfarct scar with LGE CMR can be quantified fully automatically by machines and to compare the ability of LGE CMR scar analyzed by humans and machines to predict arrhythmic events. Materials and Methods This study is a retrospective analysis of the multicenter, multivendor CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy (DERIVATE) registry. Patients with chronic heart failure, echocardiographic left ventricular ejection fraction (LVEF) of less than 50%, and LGE CMR were recruited (from January 2015 through December 2020). In the current study, only patients with ischemic cardiomyopathy were included. Quantification of total, dense, and nondense scars was carried out by two experienced readers or a Ternaus network, trained and tested with LGE images of 515 and 246 patients, respectively. Univariable and multivariable Cox analyses were used to assess patient and cardiac characteristics associated with a major adverse cardiac event (MACE). Area under the receiver operating characteristic curve (AUC) was used to compare model performances. Results In 761 patients (mean age, 65 years ± 11, 671 men), 83 MACEs occurred. With use of the testing group, univariable Cox-analysis found New York Heart Association class, left ventricle volume and/or function parameters (by echocardiography or CMR), guideline criterion (LVEF of ≤35% and New York Heart Association class II or III), and LGE scar analyzed by humans or the machine-learning algorithm as predictors of MACE. Machine-based dense or total scar conferred incremental value over the guideline criterion for the association with MACE (AUC: 0.68 vs 0.63, P = .02 and AUC: 0.67 vs 0.63, P = .01, respectively). Modeling with competing risks yielded for dense and total scar (AUC: 0.67 vs 0.61, P = .01 and AUC: 0.66 vs 0.61, P = .005, respectively). Conclusion In this analysis of the multicenter CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy (DERIVATE) registry, fully automatic machine learning-based late gadolinium enhancement analysis reliably quantifies myocardial scar mass and improves the current prediction model that uses guideline-based risk criteria for implantable cardioverter defibrillator implantation. ClinicalTrials.gov registration no.: NCT03352648 Published under a CC BY 4.0 license. Supplemental material is available for this article.

Analysis of temporal encoding efficiency of MR fingerprinting sequences.

PURPOSE: MR Fingerprinting (MRF) relies on highly-undersampled images to simultaneously estimate multiple tissue parameters of interest. While a good understanding of the encoding principle behind MRF exists, we want to shed light on the question of when parameters are encoded during an MRF acquisition. THEORY AND METHODS: We analyze the importance of each time point by leaving it out during matching (leave-one-out, LOO) assuming linear reconstruction is applied and study its influence on the reconstructed parameter map. To accelerate the analysis, we treat LOO as a small perturbation (LOOP) to the full matching problem and derive an analytical formula by leveraging Stolk and Sbrizzi's analysis on the interplay of k-space sampling and transient state dynamics. To study the influence of geometry and parameter distribution, we deploy LOOP on randomly sliced 3D brain geometries with randomized T1/T2 values to identify primary encoding regions independent of geometry. RESULTS: LOOP can be evaluated orders of magnitude faster than conventional matching and visualizes temporal encoding efficiency. We use the findings to accelerate an MRF sequence by truncation as well as to remove undersampling artifacts through an iterative omission scheme in an ill-working MRF sequence in both in-silico and in-vivo experiments. CONCLUSION: LOOP is an analytical approach to quantify and visualize parameter encoding in MRF.

Considerations for hyperpolarized 13 C MR at reduced field: Comparing 1.5T versus 3T.

PURPOSE: In contrast to conventional MR, signal-to-noise ratio (SNR) is not linearly dependent on field strength in hyperpolarized MR, as polarization is generated outside the MR system. Moreover, field inhomogeneity-induced artifacts and other practical limitations associated with field strengths ≥ $$ \ge $$ 3T are alleviated at lower fields. The potential of hyperpolarized 13 $$ {}^{13} $$ C spectroscopy and imaging at 1.5T versus 3T is demonstrated in silico, in vitro, and in vivo for applications on clinical MR systems. THEORY AND METHODS: Theoretical noise and SNR behavior at different field strengths are investigated based on simulations. A thorough field comparison between 1.5T and 3T is performed using thermal and hyperpolarized 13 $$ {}^{13} $$ C spectroscopy and imaging. Cardiac in vivo data is obtained in pigs using hyperpolarized [1- 13 $$ {}^{13} $$ C]pyruvate spectroscopy and imaging at 1.5T and 3T. RESULTS: Based on theoretical considerations and simulations, the SNR of hyperpolarized MR at identical acquisition bandwidths is independent of the field strength for typical coil setups, while adaptively changing the acquisition bandwidth proportional to the static magnetic field allows for net SNR gains of up to 40% at 1.5T compared to 3T. In vitro 13 $$ {}^{13} $$ C data verified these considerations with less than 7% deviation. In vivo feasibility of hyperpolarized [1- 13 $$ {}^{13} $$ C]pyruvate dynamic metabolic spectroscopy and imaging at 1.5T is demonstrated in the pig heart with comparable SNR between 1.5T and 3T while B 0 $$ {}_0 $$ artifacts are noticeably reduced at 1.5T. CONCLUSION: Hyperpolarized 13 $$ {}^{13} $$ C MR at lower field strengths is favorable in terms of SNR and off-resonance effects, which makes 1.5T a promising alternative to 3T, especially for clinical cardiac metabolic imaging.

Preliminary experience of cardiac proton spectroscopy at 0.75 T.

Recent work on high-performance lower-field MR systems has renewed the interest in assessing relative advantages and disadvantages of magnetic fields less than 1 T. The objective of the present work was to investigate signal-to-noise ratio (SNR) scaling of point-resolved spectroscopy as a function of field strength and to test the feasibility of proton MRS of triglycerides (TGs) in human in vivo myocardium at 0.75 T relative to 1.5 T and 3 T. Measurements at 0.75 T were obtained by temporarily ramping down a clinical 3 T MR scanner. System configurations at 0.75, 1.5 and 3 T featured identical hard- and software, except for differences in transmit/receive coil geometries and receive channel count, which were accounted for in SNR comparisons. Proton MRS was performed at 0.75 T, 1.5 T and 3 T in ex vivo tissue and in vivo calf muscle to measure T1 and T2 values as a function of field strength, which in turn served as input to simulations of SNR scaling and field-dependent TG fit errors. Preliminary in vivo spectra of myocardium were acquired at 0.75 T, 1.5 T and 3 T in healthy subjects. Measurements of both ex vivo tissue and in vivo muscle tissue at 0.75 T versus 1.5 T and 3 T confirmed decreasing T1 and increasing T2 * for decreasing field strengths. Using measured T1 , T2 and T2 * as input and using field-dependent echo time and bandwidth scaling, simulated Cramér-Rao lower bounds of TG amplitudes at 0.75 T were 2.3 and 4.5 times larger with respect to 1.5 T and 3 T, respectively. In vivo measurements demonstrate that human proton spectroscopy of TGs in cardiac muscle is feasible at 0.75 T, supporting the potential practical value of lower-field high-performance MR systems.

Diagnostic performance of 3D cardiac magnetic resonance perfusion in elderly patients for the detection of coronary artery disease as compared to fractional flow reserve.

OBJECTIVES: In patients of advanced age, the feasibility of myocardial ischemia testing might be limited by age-related comorbidities and falling compliance abilities. Therefore, we aimed to test the accuracy of 3D cardiac magnetic resonance (CMR) stress perfusion in the elderly population as compared to reference standard fractional flow reserve (FFR). METHODS: Fifty-six patients at age 75 years or older (mean age 79 ± 4 years, 35 male) underwent 3D CMR perfusion imaging and invasive coronary angiography with FFR in 5 centers using the same study protocol. The diagnostic accuracy of CMR was compared to a control group of 360 patients aged below 75 years (mean age 61 ± 9 years, 262 male). The percentage of myocardial ischemic burden (MIB) relative to myocardial scar burden was further analyzed using semi-automated software. RESULTS: Sensitivity, specificity, and positive and negative predictive values of 3D perfusion CMR deemed similar for both age groups in the detection of hemodynamically relevant (FFR < 0.8) stenosis (≥ 75 years: 86%, 83%, 92%, and 75%; < 75 years: 87%, 80%, 82%, and 85%; p > 0.05 all). While MIB was larger in the elderly patients (15% ± 17% vs. 9% ± 13%), the diagnostic accuracy of 3D CMR perfusion was high in both elderly and non-elderly populations to predict pathological FFR (AUC: 0.906 and 0.866). CONCLUSIONS: 3D CMR perfusion has excellent diagnostic accuracy for the detection of hemodynamically relevant coronary stenosis, independent of patient age. KEY POINTS: • The increasing prevalence of coronary artery disease in elderly populations is accompanied with a larger ischemic burden of the myocardium as compared to younger individuals. • 3D cardiac magnetic resonance perfusion imaging predicts pathological fractional flow reserve in elderly patients aged ≥ 75 years with high diagnostic accuracy. • Ischemia testing with 3D CMR perfusion imaging has similarly high accuracy in the elderly as in younger patients and it might be particularly useful when other non-invasive techniques are limited by aging-related comorbidities and falling compliance abilities.

MRXCAT2.0: Synthesis of realistic numerical phantoms by combining left-ventricular shape learning, biophysical simulations and tissue texture generation.

BACKGROUND: Standardised performance assessment of image acquisition, reconstruction and processing methods is limited by the absence of images paired with ground truth reference values. To this end, we propose MRXCAT2.0 to generate synthetic data, covering healthy and pathological function, using a biophysical model. We exemplify the approach by generating cardiovascular magnetic resonance (CMR) images of healthy, infarcted, dilated and hypertrophic left-ventricular (LV) function. METHOD: In MRXCAT2.0, the XCAT torso phantom is coupled with a statistical shape model, describing population (patho)physiological variability, and a biophysical model, providing known and detailed functional ground truth of LV morphology and function. CMR balanced steady-state free precession images are generated using MRXCAT2.0 while realistic image appearance is ensured by assigning texturized tissue properties to the phantom labels. FINDING: Paired CMR image and ground truth data of LV function were generated with a range of LV masses (85-140 g), ejection fractions (34-51%) and peak radial and circumferential strains (0.45 to 0.95 and - 0.18 to - 0.13, respectively). These ranges cover healthy and pathological cases, including infarction, dilated and hypertrophic cardiomyopathy. The generation of the anatomy takes a few seconds and it improves on current state-of-the-art models where the pathological representation is not explicitly addressed. For the full simulation framework, the biophysical models require approximately two hours, while image generation requires a few minutes per slice. CONCLUSION: MRXCAT2.0 offers synthesis of realistic images embedding population-based anatomical and functional variability and associated ground truth parameters to facilitate a standardized assessment of CMR acquisition, reconstruction and processing methods.

4D Flow cardiovascular magnetic resonance consensus statement: 2023 update.

Hemodynamic assessment is an integral part of the diagnosis and management of cardiovascular disease. Four-dimensional cardiovascular magnetic resonance flow imaging (4D Flow CMR) allows comprehensive and accurate assessment of flow in a single acquisition. This consensus paper is an update from the 2015 '4D Flow CMR Consensus Statement'. We elaborate on 4D Flow CMR sequence options and imaging considerations. The document aims to assist centers starting out with 4D Flow CMR of the heart and great vessels with advice on acquisition parameters, post-processing workflows and integration into clinical practice. Furthermore, we define minimum quality assurance and validation standards for clinical centers. We also address the challenges faced in quality assurance and validation in the research setting. We also include a checklist for recommended publication standards, specifically for 4D Flow CMR. Finally, we discuss the current limitations and the future of 4D Flow CMR. This updated consensus paper will further facilitate widespread adoption of 4D Flow CMR in the clinical workflow across the globe and aid consistently high-quality publication standards.

Ramping down a clinical 3 T scanner: a journey into MRI and MRS at 0.75 T.

OBJECT: Lower-field MR is reemerging as a viable, potentially cost-effective alternative to high-field MR, thanks to advances in hardware, sequence design, and reconstruction over the past decades. Evaluation of lower field strengths, however, is limited by the availability of lower-field systems on the market and their considerable procurement costs. In this work, we demonstrate a low-cost, temporary alternative to purchasing a dedicated lower-field MR system. MATERIALS AND METHODS: By ramping down an existing clinical 3 T MRI system to 0.75 T, proton signals can be acquired using repurposed 13C transmit/receive hardware and the multi-nuclei spectrometer interface. We describe the ramp-down procedure and necessary software and hardware changes to the system. RESULTS: Apart from presenting system characterization results, we show in vivo examples of cardiac cine imaging, abdominal two- and three-point Dixon-type water/fat separation, water/fat-separated MR Fingerprinting, and point-resolved spectroscopy. In addition, the ramp-down approach allows unique comparisons of, e.g., gradient fidelity of the same MR system operated at different field strengths using the same receive chain, gradient coils, and amplifiers. DISCUSSION: Ramping down an existing MR system may be seen as a viable alternative for lower-field MR research in groups that already own multi-nuclei hardware and can also serve as a testing platform for custom-made multi-nuclei transmit/receive coils.

Metabolite-cycled echo-planar spectroscopic imaging of the human heart.

PURPOSE: Spectroscopic imaging could provide insights into regional cardiac triglyceride variations, but is hampered by relatively long scan times. It is proposed to synergistically combine echo-planar spectroscopic imaging (EPSI) with motion-adapted gating, weighted acquisition and metabolite cycling to reduce scan times to less than 10 min while preserving spatial-spectral quality. The method is compared to single-voxel measurements and to metabolite-cycled EPSI with conventional acquisition for assessing triglyceride-to-water (TG/W) ratios in the human heart. METHODS: Measurements were performed on 10 healthy volunteers using a clinical 1.5T system. EPSI data was acquired both without and with motion-adapted gating in combination with weighted acquisition to assess TG/W ratios and relative Cramér-Rao lower bounds (CRLB) of TG. For comparison, single-voxel (PRESS) spectra were acquired in the interventricular septum. RESULTS: Bland-Altman analyses did not show a significant bias in TG/W when comparing both metabolite-cycled EPSI methods to PRESS for any of the cardiac segments. Scan time was 8.05 ± 2.06 min and 17.91 ± 3.93 min for metabolite-cycled EPSI with and without motion-adapted gating and weighted acquisition, respectively, while relative CRLB of TG did not differ significantly between the two methods for any of the cardiac segments. CONCLUSIONS: Metabolite-cycled EPSI with motion-adapted gating and weighted acquisition allows detecting TG/W ratios in different regions of the in vivo human heart. Scan time is reduced by more than 2-fold to less than 10 min as compared to conventional acquisition, while keeping the quality of TG fitting constant.

Direct comparison of gradient Fidelity and acoustic noise of the same MRI system at 3 T and 0.75 T.

PURPOSE: To analyze the difference between gradient fidelity and acoustic noise of the same MRI scanner operated at product field strength (3 T) and lower field strength (0.75 T). METHODS: Gradient modulation transfer functions (GMTFs) were measured using a four-slice 2D phase-encoded chirp-based sequence on the same scanner operated at 3 T and, following ramp-down, at 0.75 T with identical gradient specifications (40 mT/m, 200 T/m/s). Calibrated audio measurements were performed at both field strengths to correlate audio spectra with GMTFs. RESULTS: While eddy currents were independent of field strength, mechanical resonances were substantially decreased at lower field, resulting in a reduction of GMTF distortions by up to 95% (88% on average) at the mechanical resonances of the gradient system. Audio spectra amplitudes were reduced by up to 87% when comparing 0.75 T versus 3 T. CONCLUSION: Lower static fields lead to reduced Lorentz forces on the gradient coil and, in turn, to reduced mechanical resonances, thereby improving gradient fidelity. Simultaneously, the reduction of acoustic noise may help to improve patient comfort.

Fundamentals of turbulent flow spectrum imaging.

PURPOSE: To introduce a mathematical framework and in-silico validation of turbulent flow spectrum imaging (TFSI) of stenotic flow using phase-contrast MRI, evaluate systematic errors in quantitative turbulence parameter estimation, and propose a novel method for probing the Lagrangian velocity spectra of turbulent flows. THEORY AND METHODS: The spectral response of velocity-encoding gradients is derived theoretically and linked to turbulence parameter estimation including the velocity autocorrelation function spectrum. Using a phase-contrast MRI simulation framework, the encoding properties of bipolar gradient waveforms with identical first gradient moments but different duration are investigated on turbulent flow data of defined characteristics as derived from computational fluid dynamics. Based on theoretical insights, an approach using velocity-compensated gradient waveforms is proposed to specifically probe desired ranges of the velocity autocorrelation function spectrum with increased accuracy. RESULTS: Practical velocity-encoding gradients exhibit limited encoding power of typical turbulent flow spectra, resulting in up to 50% systematic underestimation of intravoxel SD values. Depending on the turbulence level in fluids, the error due to a single encoding gradient spectral response can vary by 20%. When using tailored velocity-compensated gradients, improved quantification of the Lagrangian velocity spectrum on a voxel-by-voxel basis is achieved and used for quantitative correction of intravoxel SD values estimated with velocity-encoding gradients. CONCLUSION: To address systematic underestimation of turbulence parameters using bipolar velocity-encoding gradients in phase-contrast MRI of stenotic flows with short correlation times, tailored velocity-compensated gradients are proposed to improve quantitative mapping of turbulent blood flow characteristics.

Free-breathing motion-informed locally low-rank quantitative 3D myocardial perfusion imaging.

PURPOSE: To propose respiratory motion-informed locally low-rank reconstruction (MI-LLR) for robust free-breathing single-bolus quantitative 3D myocardial perfusion CMR imaging. Simulation and in-vivo results are compared to locally low-rank (LLR) and compressed sensing reconstructions (CS) for reference. METHODS: Data were acquired using a 3D Cartesian pseudo-spiral in-out k-t undersampling scheme (R = 10) and reconstructed using MI-LLR, which encompasses two stages. In the first stage, approximate displacement fields are derived from an initial LLR reconstruction to feed a motion-compensated reference system to a second reconstruction stage, which reduces the rank of the inverse problem. For comparison, data were also reconstructed with LLR and frame-by-frame CS using wavelets as sparsifying transform ( ℓ1$$ {\ell}_1 $$ -wavelet). Reconstruction accuracy relative to ground truth was assessed using synthetic data for realistic ranges of breathing motion, heart rates, and SNRs. In-vivo experiments were conducted in healthy subjects at rest and during adenosine stress. Myocardial blood flow (MBF) maps were derived using a Fermi model. RESULTS: Improved uniformity of MBF maps with reduced local variations was achieved with MI-LLR. For rest and stress, intra-volunteer variation of absolute and relative MBF was lower in MI-LLR (±0.17 mL/g/min [26%] and ±1.07 mL/g/min [33%]) versus LLR (±0.19 mL/g/min [28%] and ±1.22 mL/g/min [36%]) and versus ℓ1$$ {\ell}_1 $$ -wavelet (±1.17 mL/g/min [113%] and ±6.87 mL/g/min [115%]). At rest, intra-subject MBF variation was reduced significantly with MI-LLR. CONCLUSION: The combination of pseudo-spiral Cartesian undersampling and dual-stage MI-LLR reconstruction improves free-breathing quantitative 3D myocardial perfusion CMR imaging under rest and stress condition.

Characterization and correction of diffusion gradient-induced eddy currents in second-order motion-compensated echo-planar and spiral cardiac DTI.

PURPOSE: Very high gradient amplitudes played out over extended time intervals as required for second-order motion-compensated cardiac DTI may violate the assumption of a linear time-invariant gradient system model. The aim of this work was to characterize diffusion gradient-related system nonlinearity and propose a correction approach for echo-planar and spiral spin-echo motion-compensated cardiac DTI. METHODS: Diffusion gradient-induced eddy currents of 9 diffusion directions were characterized at b values of 150 s/mm2 and 450 s/mm2 for a 1.5 Tesla system and used to correct phantom, ex vivo, and in vivo motion-compensated cardiac DTI data acquired with echo-planar and spiral trajectories. Predicted trajectories were calculated using gradient impulse response function and diffusion gradient strength- and direction-dependent zeroth- and first-order eddy current responses. A reconstruction method was implemented using the predicted k $$ k $$ -space trajectories to additionally include off-resonances and concomitant fields. Resulting images were compared to a reference reconstruction omitting diffusion gradient-induced eddy current correction. RESULTS: Diffusion gradient-induced eddy currents exhibited nonlinear effects when scaling up the gradient amplitude and could not be described by a 3D basis alone. This indicates that a gradient impulse response function does not suffice to describe diffusion gradient-induced eddy currents. Zeroth- and first-order diffusion gradient-induced eddy current effects of up to -1.7 rad and -16 to +12 rad/m, respectively, were identified. Zeroth- and first-order diffusion gradient-induced eddy current correction yielded improved image quality upon image reconstruction. CONCLUSION: The proposed approach offers correction of diffusion gradient-induced zeroth- and first-order eddy currents, reducing image distortions to promote improvements of second-order motion-compensated spin-echo cardiac DTI.

Comparison of interpolation methods of predominant cardiomyocyte orientation from in vivo and ex vivo cardiac diffusion tensor imaging data.

Cardiac electrophysiology and cardiac mechanics both depend on the average cardiomyocyte long-axis orientation. In the realm of personalized medicine, knowledge of the patient-specific changes in cardiac microstructure plays a crucial role. Patient-specific computational modelling has emerged as a tool to better understand disease progression. In vivo cardiac diffusion tensor imaging (cDTI) is a vital tool to non-destructively measure the average cardiomyocyte long-axis orientation in the heart. However, cDTI suffers from long scan times, rendering volumetric, high-resolution acquisitions challenging. Consequently, interpolation techniques are needed to populate bio-mechanical models with patient-specific average cardiomyocyte long-axis orientations. In this work, we compare five interpolation techniques applied to in vivo and ex vivo porcine input data. We compare two tensor interpolation approaches, one rule-based approximation, and two data-driven, low-rank models. We demonstrate the advantage of tensor interpolation techniques, resulting in lower interpolation errors than do low-rank models and rule-based methods adapted to cDTI data. In an ex vivo comparison, we study the influence of three imaging parameters that can be traded off against acquisition time: in-plane resolution, signal to noise ratio, and number of acquired short-axis imaging slices.

Validation of cardiac diffusion tensor imaging sequences: A multicentre test-retest phantom study.

Cardiac diffusion tensor imaging (DTI) is an emerging technique for the in vivo characterisation of myocardial microstructure, and there is a growing need for its validation and standardisation. We sought to establish the accuracy, precision, repeatability and reproducibility of state-of-the-art pulse sequences for cardiac DTI among 10 centres internationally. Phantoms comprising 0%-20% polyvinylpyrrolidone (PVP) were scanned with DTI using a product pulsed gradient spin echo (PGSE; N = 10 sites) sequence, and a custom motion-compensated spin echo (SE; N = 5) or stimulated echo acquisition mode (STEAM; N = 5) sequence suitable for cardiac DTI in vivo. A second identical scan was performed 1-9 days later, and the data were analysed centrally. The average mean diffusivities (MDs) in 0% PVP were (1.124, 1.130, 1.113) x 10-3  mm2 /s for PGSE, SE and STEAM, respectively, and accurate to within 1.5% of reference data from the literature. The coefficients of variation in MDs across sites were 2.6%, 3.1% and 2.1% for PGSE, SE and STEAM, respectively, and were similar to previous studies using only PGSE. Reproducibility in MD was excellent, with mean differences in PGSE, SE and STEAM of (0.3 ± 2.3, 0.24 ± 0.95, 0.52 ± 0.58) x 10-5  mm2 /s (mean ± 1.96 SD). We show that custom sequences for cardiac DTI provide accurate, precise, repeatable and reproducible measurements. Further work in anisotropic and/or deforming phantoms is warranted.

Role of sex hormones in modulating myocardial perfusion and coronary flow reserve.

BACKGROUND: A growing body of evidence highlights sex differences in the diagnostic accuracy of cardiovascular imaging modalities. Nonetheless, the role of sex hormones in modulating myocardial perfusion and coronary flow reserve (CFR) is currently unclear. The aim of our study was to assess the impact of female and male sex hormones on myocardial perfusion and CFR. METHODS: Rest and stress myocardial perfusion imaging (MPI) was conducted by small animal positron emission tomography (PET) with [18F]flurpiridaz in a total of 56 mice (7-8 months old) including gonadectomized (Gx) and sham-operated males and females, respectively. Myocardial [18F]flurpiridaz uptake (% injected dose per mL, % ID/mL) was used as a surrogate for myocardial perfusion at rest and following intravenous regadenoson injection, as previously reported. Apparent coronary flow reserve (CFRApp) was calculated as the ratio of stress and rest myocardial perfusion. Left ventricular (LV) morphology and function were assessed by cardiac magnetic resonance (CMR) imaging. RESULTS: Orchiectomy resulted in a significant decrease of resting myocardial perfusion (Gx vs. sham, 19.4 ± 1.0 vs. 22.2 ± 0.7 % ID/mL, p = 0.034), while myocardial perfusion at stress remained unchanged (Gx vs. sham, 27.5 ± 1.2 vs. 27.3 ± 1.2 % ID/mL, p = 0.896). Accordingly, CFRApp was substantially higher in orchiectomized males (Gx vs. sham, 1.43 ± 0.04 vs. 1.23 ± 0.05, p = 0.004), and low serum testosterone levels were linked to a blunted resting myocardial perfusion (r = 0.438, p = 0.020) as well as an enhanced CFRApp (r = -0.500, p = 0.007). In contrast, oophorectomy did not affect myocardial perfusion in females. Of note, orchiectomized males showed a reduced LV mass, stroke volume, and left ventricular ejection fraction (LVEF) on CMR, while no such effects were observed in oophorectomized females. CONCLUSION: Our experimental data in mice indicate that sex differences in myocardial perfusion are primarily driven by testosterone. Given the diagnostic importance of PET-MPI in clinical routine, further studies are warranted to determine whether testosterone levels affect the interpretation of myocardial perfusion findings in patients.