From Compressed-Sensing to Deep Learning MR: Comparative Biventricular Cardiac Function Analysis in a Patient Cohort.

BACKGROUND: Conventional segmented, retrospectively gated cine (Conv-cine) is challenged in patients with breath-hold difficulties. Compressed sensing (CS) has shown values in cine imaging but generally requires long reconstruction time. Recent artificial intelligence (AI) has demonstrated potential in fast cine imaging. PURPOSE: To compare CS-cine and AI-cine with Conv-cine in quantitative biventricular functions, image quality, and reconstruction time. STUDY TYPE: Prospective human studies. SUBJECTS: 70 patients (age, 39 ± 15 years, 54.3% male). FIELD STRENGTH/SEQUENCE: 3T; balanced steady state free precession gradient echo sequences. ASSESSMENT: Biventricular functional parameters of CS-, AI-, and Conv-cine were measured by two radiologists independently and compared. The scan and reconstruction time were recorded. Subjective scores of image quality were compared by three radiologists. STATISTICAL TESTS: Paired t-test and two related-samples Wilcoxon sign test were used to compare biventricular functional parameters between CS-, AI-, and Conv-cine. Intraclass correlation coefficient (ICC), Bland-Altman analysis, and Kendall's W method were applied to evaluate agreement of biventricular functional parameters and image quality of these three sequences. A P-value <0.05 was considered statistically significant, and standardized mean difference (SMD) < 0. 100 was considered no significant difference. RESULTS: Compared to Conv-cine, no statistically significant differences were identified in CS- and AI-cine function results (all P > 0.05), except for very small differences in left ventricle end-diastole volumes of 2.5 mL (SMD = 0.082) and 4.1 mL (SMD = 0.096), respectively. Bland-Altman scatter plots revealed that biventricular function results were mostly distributed within the 95% confidence interval. All parameters had acceptable to excellent interobserver agreements (ICC: 0.748-0.989). Compared with Conv-cine (84 ± 13 sec), both CS (14 ± 2 sec) and AI (15 ± 2 sec) techniques reduced scan time. Compared with CS-cine (304 ± 17 sec), AI-cine (24 ± 4 sec) reduced reconstruction time. CS-cine demonstrated significantly lower quality scores than Conv-cine, while AI-cine demonstrated similar scores (P = 0.634). CONCLUSION: CS- and AI-cine can achieve whole-heart cardiac cine imaging in a single breath-hold. Both CS- and AI-cine have the potential to supplement the gold standard Conv-cine in studying biventricular functions and benefit patients having difficulties with breath-holds. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 1.

Myocardial First-Pass Perfusion With Increased Anatomic Coverage at 3 T Using Autocalibrated Multiband Imaging.

BACKGROUND: Myocardial first-pass perfusion (FPP) imaging is a useful cardiac MRI method for the diagnosis of coronary artery disease. However, conventional 2D multislice FPP acquisitions usually have gaps between myocardium slices, which limits the overall assessment of myocardial ischemia. PURPOSE: To increase the anatomic coverage of myocardial FPP imaging at 3 T by implementing both autocalibrated multiband (MB) acquisition and k-t space acceleration with compress sensing (CS) reconstruction, without the need for additional reference scans. STUDY TYPE: Phantom and prospective human studies. PHANTOM/SUBJECTS: A T1MES (T1 Mapping and ECV Standardization in cardiovascular magnetic resonance) phantom and 20 subjects (12 healthy subjects and 8 patients, 10 males, age 42 ± 16 years). FIELD STRENGTH/SEQUENCE: A 3 T/saturation recovery prepared gradient echo sequence with contrast administration. ASSESSMENT: Phantom experiments were performed to compare the performance of autocalibrated MB-FPP with k-t acceleration using slice-GRAPPA and CS reconstructions. In vivo experiments were performed to compare the performance of conventional FPP (2.5× acceleration) with autocalibrated MB + CS-FPP (6× acceleration). In phantom experiments, the error maps were calculated. In in vivo experiments, the contrast ratio (CR) and blurring were quantitatively measured, while image quality, perceived signal-to-noise ratio (SNR), and artifact level were qualitatively graded by three cardiologists on a 4-point scale. STATISTICAL TESTS: Wilcoxon signed-rank test, paired t-test. A P value <0.05 was considered statistically significant. RESULTS: In phantom experiments, residual artifact was reduced using the MB + CS-FPP reconstruction method compared with using the MB + slice-GRAPPA reconstruction method. In in vivo experiments, the proposed autocalibrated MB + CS-FPP method demonstrated significantly higher CR (3.52 ± 0.78 vs 2.91 ± 0.81) and had significantly better perceived SNR (2.69 ± 0.29 vs 2.48 ± 0.31) compared to the conventional sequence. Compared with conventional FPP, MB + CS-FPP doubled the spatial coverage (MB + CS-FPP vs conventional FPP) without compromising the image quality (2.69 ± 0.26 vs 2.60 ± 0.30) or increasing the artifact level (2.60 ± 0.26 vs 2.52 ± 0.31). CONCLUSION: Autocalibrated MB + CS-FPP improved the myocardial coverage and achieved comparable image quality with the same spatial resolution and scan time as conventional FPP and is a promising technique for clinical myocardial perfusion imaging. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 3.

T2STIR preparation for single-shot cardiovascular magnetic resonance myocardial edema imaging.

BACKGROUND: Myocardial edema in acute myocardial infarction (AMI) is commonly imaged using dark-blood short tau inversion recovery turbo spin echo (STIR-TSE) cardiovascular magnetic resonance (CMR). The technique is sensitive to cardiac motion and coil sensitivity variation, leading to myocardial signal nonuniformity and impeding reliable depiction of edematous tissues. T2-prepared balanced steady state free precession (T2p-bSSFP) imaging has been proposed, but its contrast is low, and averaging is commonly needed. T2 mapping is useful but requires a long scan time and breathholding. We propose here a single-shot magnetization prepared sequence that increases the contrast between edema and normal myocardium and apply it to myocardial edema imaging. METHODS: A magnetization preparation module (T2STIR) is designed to exploit the simultaneous elevation of T1 and T2 in edema to improve the depiction of edematous myocardium. The module tips magnetization down to the -z axis after T2 preparation. Transverse magnetization is sampled at the fat null point using bSSFP readout and allows for single-shot myocardial edema imaging. The sequence (T2STIR-bSSFP) was studied for its contrast behavior using simulation and phantoms. It was then evaluated on 7 healthy subjects and 7 AMI patients by comparing it to T2p-bSSFP and T2 mapping using the contrast-to-noise ratio (CNR) and the contrast ratio as performance indices. RESULTS: In simulation and phantom studies, T2STIR-bSSFP had improved contrast between edema and normal myocardium compared with the other two edema imaging techniques. In patients, the CNR of T2STIR-bSSFP was higher than T2p-bSSFP (5.9 ± 2.6 vs. 2.8 ± 2.0, P < 0.05) but had no significant difference compared with that of the T2 map (T2 map: 6.6 ± 3.3 vs. 5.9 ± 2.6, P = 0.62). The contrast ratio of T2STIR-bSSFP (2.4 ± 0.8) was higher than that of the T2 map (1.3 ± 0.1, P < 0.01) and T2p-bSSFP (1.4 ± 0.5, P < 0.05). CONCLUSION: T2STIR-bSSFP has improved contrast between edematous and normal myocardium compared with commonly used bSSFP-based edema imaging techniques. T2STIR-bSSFP also differentiates between fat that was robustly suppressed and fluids around the heart. The technique is useful for single-shot edema imaging in AMI patients.

Dark blood T2-weighted imaging of the human heart with AI-assisted compressed sensing: a patient cohort study.

Background: Dark blood T2-weighted (DB-T2W) imaging is widely used to evaluate myocardial edema in myocarditis and inflammatory cardiomyopathy. However, this technique is sensitive to arrhythmia, tachycardia, and cardiac and respiratory motion due to the long scan time with multiple breath-holds. The application of artificial intelligence (AI)-assisted compressed sensing (ACS) has facilitated significant progress in accelerating medical imaging. However, the effect of DB-T2W imaging on ACS has not been elucidated. This study aimed to examine the effects of ACS on the image quality of single-shot and multi-shot DB-T2W imaging of edema. Methods: Thirty-three patients were included in this study and received DB-T2W imaging with ACS, including single-shot acquisition (SS-ACS) and multi-shot acquisition (MS-ACS). The resulting images were compared with those of the conventional multi-shot DB-T2W imaging with parallel imaging (MS-PI). Quantitative assessments of the signal-to-noise ratio (SNR), tissue contrast ratio (CR), and contrast-to-noise ratio (CNR) were performed. Three radiologists independently evaluated the overall image quality, blood nulling, free wall of the left ventricle, free wall of the right ventricle, and interventricular septum using a 5-point Likert scale. Results: The total scan time of the DB-T2W imaging with ACS was significantly reduced compared to the conventional parallel imaging [number of heartbeats (SS-ACS:MS-ACS:MS-PI) =19:63:99; P<0.001]. The SNRmyocardium and CNRblood-myocardium of MS-ACS and SS-ACS were higher than those of MS-PI (all P values <0.01). Furthermore, the CRblood-myocardium of SS-ACS was also higher than that of MS-PI (P<0.01). There were significant differences in overall image quality, blood nulling, left ventricle free wall visibility, and septum visibility between the MS-PI, MS-ACS, and SS-ACS protocols (all P values <0.05). Moreover, blood in the heart was better nulled using SS-ACS (P<0.01). Conclusions: The ACS method shortens the scan time of DB-T2W imaging and achieves comparable or even better image quality compared to the PI method. Moreover, DB-T2W imaging using the ACS method can reduce the number of breath-holds to 1 with single-shot acquisition.

High-Quality MR Fingerprinting Reconstruction Using Structured Low-Rank Matrix Completion and Subspace Projection.

Due to the capability of fast multiparametric quantitative imaging, magnetic resonance fingerprinting (MRF) is becoming a promising quantitative magnetic resonance imaging approach. However, the artifacts caused by the highly undersampled data acquisition lead to inaccurate estimation of the tissue parameter maps. Based on the assumption that the 3-D MRF data can be modeled as a piecewise smooth signal, with the discontinuities localized to the zero sets of a bandlimited function, we exploit the low-rank property of the structured Toeplitz matrix constructed from the Fourier measurements. In addition, we adopt the subspace projection scheme to improve the accuracy of parameter estimation. In order to efficiently solve the regularized problem, we propose an iterative two-stage algorithm, which alternately updates the k -space data and projects the space-time matrix into the dictionary space. Numerical experiments demonstrate that the proposed algorithm shows significant improvement in MRF time-series images reconstruction and can provide more accurate parameter maps over the state-of-the-art algorithms.

MHD signal derived Auto Variable Velocity Encoding for 2D Flow Imaging in 3T Cardiac Magnetic Resonance Imaging.

To develop a novel technique to set variable velocity-encoding (VENC) values according to magnetohydrodynamic (MHD) voltage/signal for 2D flow imaging in 3 Tesla MR system. MHD signal is calculated using the electrocardiogram signals measured outside and inside the static magnetic bore during the patient preparation process. Then, VENC values are assigned in terms of the MHD signal in each cardiac phase. A volunteer was scanned to evaluate the feasibility of the proposed method. Specifically, velocity and velocity to noise ratio (VNR) using the proposed method were measured and compared with conventional constant VENC value methods at 3T. MHD signal is measured during the patient preparation, thus no additional breath-holds are required and the VENC values can be calculated for each cardiac phase before the acquisition.

Quantitative MR relaxation using MR fingerprinting with fractional-order signal evolution.

The fractional-order Bloch equations have been shown to describe a wider range of experimental situations involving heterogeneous, porous, or composite materials. This paper introduces a novel dictionary of quantitative MR fingerprinting generated by signal evolution model with fractional-order Bloch equations to describe magnetic resonance (MR) relaxation. Here, the fractional-order relaxation models are implemented into Bloch equations through phase transitions using EPG simulation. In the phantom experiments, the fractional-order analysis showed smaller root mean squared error (T1: RMSE = 5.21%, T2: RMSE=3.75%) using the proposed method compared to using conventional method. Among the in vivo experiments of human brains, the estimated T1 and T2 values (mean ± SD) were 843 ± 46.3 ms and 70 ± 4.7 ms in white matter, 1323 ± 28.5 ms and 95 ± 3.8 ms in gray matter. So the proposed method can provide well extensions of current MR fingerprinting and has shown potential to apply into the phantom experiments and the in vivo applications to approach the standard methods for quantitative imaging.

Three Dimensional Positive Contrast Susceptibility Fast Spin Echo MR Imaging with Variable Excitation Pulses and PD Algorithm.

A susceptibility-based positive contrast MR technique is applied to image the MR compatible metallic devices by solving a regularized ℓ1 minimization problem. However, the previous SE/FSE sequence is used for the data acquisition which can result in high SAR and low sampling efficiency in 3D imaging. Therefore, a 3D single slab 3D FSE sequence with slab selective and variable excitation pulse is proposed to implement 3D positive contrast MR imaging for low SAR and acquiring high-resolution 3D images within a shorter timeframe. Furthermore, in order to achieve faster reconstruction and better imaging quality of the 3D positive contrast MRI, the primal-dual iteration algorithm is also used to solve the regularized ℓ1 minimization problem. The visualization of the positive contrast and convergence behaviour of the proposed reconstruction framework base on the first-order PD algorithm were tested and validated on phantom experiments, compared with the previous nonlinear conjugate gradient (NLCG), fast iterative soft thresholding (FISTA) and alternating direction method of multipliers (ADMM) algorithms.

T1rho Fractional-order Relaxation of Human Articular Cartilage.

T1rho imaging is a promising non-invasive diagnostic tool for early detection of articular cartilage degeneration. A mono-exponential model is normally used to describe the T1rho relaxation process. However, mono-exponentials may not adequately to describe NMR relaxation in complex, heterogeneous, and anisotropic materials, such as articular cartilage. Fractional-order models have been used successfully to describe complex relaxation phenomena in the laboratory frame in cartilage matrix components. In this paper, we develop a time-fractional order (T-FACT) model for T1rho fitting in human articular cartilage. Representative results demonstrate that the proposed method is able to fit the experimental data with smaller root mean squared error than the one from conventional mono-exponential relaxation model in human articular cartilage.

Accelerating MR Imaging via Deep Chambolle-Pock Network.

Compressed sensing (CS) has been introduced to accelerate data acquisition in MR Imaging. However, CS-MRI methods suffer from detail loss with large acceleration and complicated parameter selection. To address the limitations of existing CS-MRI methods, a model-driven MR reconstruction is proposed that trains a deep network, named CP-net, which is derived from the Chambolle-Pock algorithm to reconstruct the in vivo MR images of human brains from highly undersampled complex k-space data acquired on different types of MR scanners. The proposed deep network can learn the proximal operator and parameters among the Chambolle-Pock algorithm. All of the experiments show that the proposed CP-net achieves more accurate MR reconstruction results, outperforming state-of-the-art methods across various quantitative metrics.

Research on the relation of EEG signal chaos characteristics with high-level intelligence activity of human brain.

Using phase space reconstruct technique from one-dimensional and multi-dimensional time series and the quantitative criterion rule of system chaos, and combining the neural network; analyses, computations and sort are conducted on electroencephalogram (EEG) signals of five kinds of human consciousness activities (relaxation, mental arithmetic of multiplication, mental composition of a letter, visualizing a 3-dimensional object being revolved about an axis, and visualizing numbers being written or erased on a blackboard). Through comparative studies on the determinacy, the phase graph, the power spectra, the approximate entropy, the correlation dimension and the Lyapunov exponent of EEG signals of 5 kinds of consciousness activities, the following conclusions are shown: (1) The statistic results of the deterministic computation indicate that chaos characteristic may lie in human consciousness activities, and central tendency measure (CTM) is consistent with phase graph, so it can be used as a division way of EEG attractor. (2) The analyses of power spectra show that ideology of single subject is almost identical but the frequency channels of different consciousness activities have slight difference. (3) The approximate entropy between different subjects exist discrepancy. Under the same conditions, the larger the approximate entropy of subject is, the better the subject's innovation is. (4) The results of the correlation dimension and the Lyapunov exponent indicate that activities of human brain exist in attractors with fractional dimensions. (5) Nonlinear quantitative criterion rule, which unites the neural network, can classify different kinds of consciousness activities well. In this paper, the results of classification indicate that the consciousness activity of arithmetic has better differentiation degree than that of abstract.

Biochemical and histological assessment of alkali therapy during high animal protein intake in the rat.

The Westernized diet is acidogenic due to the high content of sulfur-containing amino acids and relative deficiency of potassium organic anions. Chronic acid loads result in hypercalciuria and negative calcium balance often associated with loss of bone mineral. Alkali therapy tends to reverse the hypercalciuria but little is known regarding its effect on bone as assessed by bone histomorphometry. The present study utilized dynamic bone histomorphometry to evaluate the effects of alkali therapy on acid-induced changes in bone turnover. Serum and urine analyses and bone histomorphometry were assessed in adult rats after 2 months of either a low casein (LC) or high casein (HC) diet supplemented with either potassium chloride (KCl) or potassium citrate (KCit). Compared to animals on LC-KCl diet, HC-KCl diet delivered a substantial acid load as shown by significant increases in urinary sulfate, ammonium, and net acid excretion, and a lower urinary pH and citrate excretion without detectable changes in serum parameters. The acid load also resulted in hypercalciuria. Dynamic and static bone histomorphometry disclosed a significant reduction in cancellous bone volume and trabecular number associated with a 2.5-fold increase in eroded and a 3.5-fold increase in osteoclastic surfaces. There was also a near 2-fold increase in bone formation rate in rats on the HC-KCl diet. When animals on the HC diet were given KCit instead of KCl, all of the aforementioned changes in urine biochemistry and bone turnover were significantly attenuated or entirely prevented. These findings underscore the deleterious effects of high animal protein intake in promoting hypercalciuria and increasing bone turnover. Co-administration of potassium alkali attenuates or prevents these changes. In this animal model of high dietary animal protein intake, the major skeletal effect of alkali therapy is to reduce bone resorption, with little or no effect on bone formation.

Cholestatic jaundice and IgA nephropathy induced by OTC muscle building agent superdrol.

Over the counter (OTC) medicines are commonly used in the United States despite a lack of scientific evidence for clinical utility and toxicity associated with their use. A case of jaundice and IgA nephropathy as a consequence of use of a muscle enhancing OTC supplement that was advertised as innocuous with no hormonal activity is described. IgA nephropathy has not been described previously in association with the use of testosterone. The case highlights that, besides adulteration, the misrepresentation of chemicals present in OTC medications and supplements can create confusion and a false sense of security with their use.

Glucocorticoids acutely increase cell surface Na+/H+ exchanger-3 (NHE3) by activation of NHE3 exocytosis.

Glucocorticoids have important effects on renal function, including the modulation of renal acidification by the major proximal tubular Na(+)/H(+) exchanger, NHE3. While the chronic effect of glucocorticoids is considered to be primarily at the transcriptional level, with increases in NHE3 mRNA and protein expression driving increased transport activity, the mechanisms by which glucocorticoids activate NHE3 in an acute setting have not been investigated. Previous studies have shown that a glucocorticoid-stimulated increase in NHE3 activity can occur before any detectable change in NHE3 mRNA. The present study examines the acute effects of glucocorticoids on NHE3 using opossum kidney (OKP) cells as a cell model. In OKP cells, total NHE3 protein abundance was not changed by 3 h of treatment with dexamethasone (10(-6) M). However, the biotin-accessible fraction representing NHE3 at the apical membrane as well as Na(+)/H(+) exchange activity measured fluorimetrically using the pH-sensitive dye BCECF-AM were significantly increased. These effects were not prevented by the protein synthesis inhibitor cycloheximide. NHE3 insertion (biotinylatable NHE3 after sulfo-NHS-acetate blockade) was stimulated by dexamethasone incubation, with or without cycloheximide. The rate of NHE3 endocytic retrieval, assessed either by the avidin protection assay (early endocytosis) or by the sodium 2-mercaptoethane sulfonate (MesNa) cleavage assay (early and late endocytosis), was not affected by dexamethasone. These findings suggest that trafficking plays a key role in the acute stimulation of NHE3 by glucocorticoids, with exocytosis being the major contributor to the glucocorticoid-induced rapid increase in cell surface NHE3 protein abundance and Na(+)/H(+) exchange activity.

Dopamine acutely decreases apical membrane Na/H exchanger NHE3 protein in mouse renal proximal tubule.

BACKGROUND: Dopamine is a principal natriuretic hormone in mammalian Na+ homeostasis. Dopamine acutely alters glomerular filtration rate (GFR) and decreases Na+ absorption in both the proximal and distal nephron. Proximal tubule natriuresis is effected through inhibition of the apical membrane Na/H exchanger NHE3. METHODS: We examined whether dopamine directly and acutely decreases apical membrane NHE3 protein using renal tissue in two in vitro systems: renal cortical slices and in vitro perfused single tubules. After incubation with dopamine, NHE3 activity was measured by 22Na flux and NHE3 antigen was measured by immunoblot in apical membrane and total cellular membranes. RESULTS: Direct application of dopamine to either cortical slices or microperfused tubules acutely decreases NHE3 activity and antigen at the apical membrane of the proximal tubule. No change in total cellular NHE3 was detected. CONCLUSION: One mechanism by which dopamine causes natriuresis is via direct and acute reduction of NHE3 protein at the apical membrane via changes in NHE3 protein trafficking.

Unraveling the Mystery of Goldblatt Hypertension.

In hypertension caused by unilateral renal artery stenosis, the nonstenotic kidney becomes renin depleted but fails to prevent hypertension. The nonstenotic kidney mysteriously develops elevated intrarenal angiotensin II (ANG II) content. Rats chronically infused with ANG II exhibit a similar hypertensive process. The augmentation of intrarenal ANG II is due to receptor-mediated internalization and continued ANG II formation, which provide a hypertensinogenic stimulus.