A black-blood ultra-short echo time (UTE) sequence for 3D isotropic resolution imaging of the lungs.

PURPOSE: Ultra-short echo time MRI is a promising alternative to chest CT for cystic fibrosis patients. Black-blood imaging in particular could help discern small-sized anomalies, such as mucoid plugging, which may otherwise be confused with neighboring blood vessels, particularly when contrast agent is not used. We, therefore, implemented and tested an ultra-short echo time sequence with black-blood preparation. Additionally, this sequence may also be used to generate bright-blood angiograms. METHODS: Using this sequence, data was acquired during free breathing in 10 healthy volunteers to obtain respiratory-motion-resolved 3D volumes covering the entire thorax with an isotropic resolution of (1 mm)3 . The magnitude of signal suppression relative to a bright-blood reference acquisition was quantified and compared with that obtained with a turbo-spin echo (TSE) acquisition. Bright-blood angiograms were also generated by subtraction. Finally, an initial feasibility assessment was performed in 2 cystic fibrosis patients, and images were visually compared with contrast-enhanced images and with CT data. RESULTS: Black-blood preparation significantly decreased the average normalized signal intensity in the vessel lumen (-66%; P < 0.001). Similarly, blood signal was significantly lowered (-60%; P = 0.001) compared with the TSE acquisition. In patients, mucoid plugging could be emphasized in the black-blood datasets. An intercostal artery could also be visualized in the subtraction angiograms. CONCLUSION: Black-blood free-breathing ultra-short echo time imaging was successfully implemented and motion-resolved full volumetric coverage of the lungs with high spatial resolution was achieved, while obtaining an angiogram without contrast agent injection. Encouraging initial results in patients prompt further investigations in a larger cohort.

Accelerated and high-resolution cardiac T2 mapping through peripheral k-space sharing.

PURPOSE: To develop high-spatial-resolution cardiac T2 mapping that allows for a reduced acquisition time while maintaining its precision. We implemented and optimized a new golden-angle radial T2 mapping technique named SKRATCH (Shared k-space Radial T2 Characterization of the Heart) that shares k-space peripheries of T2 -weighted images while preserving their contrasts. METHODS: Six SKRATCH variants (gradient-recalled echo and balanced SSFP, free-breathing and breath-held, with and without a saturation preparation) were implemented, and their precision was compared with a navigator-gated reference technique in phantoms and 22 healthy volunteers at 3 T. The optimal breath-held SKRATCH technique was applied in a small cohort of patients with subacute myocardial infarction. RESULTS: The faster free-breathing SKRATCH technique reduced the acquisition time by 52.4%, while maintaining the precision and spatial resolution of the reference technique. Similarly, the most precise and robust breath-held SKRATCH technique demonstrated homogenous T2 values that did not significantly differ from the navigator-gated reference (T2 = 39.9 ± 3.4 ms versus 39.5 ± 3.4 ms, P > .20, respectively). All infarct patients demonstrated a large T2 elevation in the ischemic regions of the myocardium. CONCLUSION: The optimized SKRATCH technique enabled the accelerated acquisition of high-spatial-resolution T2 maps, was validated in healthy adult volunteers, and was successfully applied to a small initial group of patients.

On the accuracy and precision of cardiac magnetic resonance T2 mapping: A high-resolution radial study using adiabatic T2 preparation at 3 T.

PURPOSE: The goal of this study was to characterize the accuracy and precision of cardiac T2 mapping as a function of different factors including low signal-to-noise ratio (SNR), imaging in systole, and off-resonance frequencies. METHODS: Bloch equation and Monte Carlo simulations were used to determine the influence of SNR and the choice of T2 preparation echo time (TET2prep ) increments on the accuracy and precision of high-resolution radial cardiac T2 mapping at 3.0 T. Healthy volunteers were scanned to establish the difference in precision and inter- and intraobserver variability between T2 mapping in diastole and systole, as well as the effect of SNR and off-resonance frequencies on the accuracy of T2 maps. RESULTS: The simulations demonstrated that a TET2prep increment of ∼0.75 times the T2 value of interest optimally increases the precision of the T2 fit. Systolic T2 maps were found to have a higher precision (P = 0.002), but similar inter- and intraobserver variability compared with diastolic T2 maps, whereas off-resonance frequencies beyond ± 100 Hz cause a significant decrease in both accuracy and precision (P < 0.05). CONCLUSION: This evaluation of the accuracy and precision of cardiac T2 mapping characterizes the major vulnerabilities of the technique and will help guide protocol definition of studies that include T2 mapping. Magn Reson Med 77:159-169, 2017. © 2016 Wiley Periodicals, Inc.

Adrenergic Receptor Polymorphism and Maximal Exercise Capacity after Orthotopic Heart Transplantation.

BACKGROUND: Maximal exercise capacity after heart transplantion (HTx) is reduced to the 50-70% level of healthy controls when assessed by cardiopulmonary exercise testing (CPET) despite of normal left ventricular function of the donor heart. This study investigates the role of donor heart ß1 and ß2- adrenergic receptor (AR) polymorphisms for maximal exercise capacity after orthotopic HTx. METHODS: CPET measured peak VO2 as outcome parameter for maximal exercise in HTx recipients ≥9 months and ≤4 years post-transplant (n = 41; mean peak VO2: 57±15% of predicted value). Donor hearts were genotyped for polymorphisms of the ß1-AR (Ser49Gly, Arg389Gly) and the ß2-AR (Arg16Gly, Gln27Glu). Circumferential shortening of the left ventricle was measured using magnetic resonance based CSPAMM tagging. RESULTS: Peak VO2 was higher in donor hearts expressing the ß1-Ser49Ser alleles when compared with ß1-Gly49 carriers (60±15% vs. 47±10% of the predicted value; p = 0.015), and by trend in cardiac allografts with the ß1-AR Gly389Gly vs. ß1-Arg389 (61±15% vs. 54±14%, p = 0.093). Peak VO2 was highest for the haplotype Ser49Ser-Gly389, and decreased progressively for Ser49Ser-Arg389Arg > 49Gly-389Gly > 49Gly-Arg389Arg (adjusted R2 = 0.56, p = 0.003). Peak VO2 was not different for the tested ß2-AR polymorphisms. Independent predictors of peak VO2 (adjusted R2 = 0.55) were ß1-AR Ser49Gly SNP (p = 0.005), heart rate increase (p = 0.016), and peak systolic blood pressure (p = 0.031). Left ventricular (LV) motion kinetics as measured by cardiac MRI CSPAMM tagging at rest was not different between carriers and non-carriers of the ß1-AR Gly49allele. CONCLUSION: Similar LV cardiac motion kinetics at rest in donor hearts carrying either ß1-AR Gly49 or ß1-Ser49Ser variant suggests exercise-induced desensitization and down-regulation of the ß1-AR Gly49 variant as relevant pathomechanism for reduced peak VO2 in ß1-AR Gly49 carriers.

Free-running 4D whole-heart self-navigated golden angle MRI: Initial results.

PURPOSE: To test the hypothesis that both coronary anatomy and ventricular function can be assessed simultaneously using a single four-dimensional (4D) acquisition. METHODS: A free-running 4D whole-heart self-navigated acquisition incorporating a golden angle radial trajectory was implemented and tested in vivo in nine healthy adult human subjects. Coronary magnetic resonance angiography (MRA) datasets with retrospective selection of acquisition window width and position were extracted and quantitatively compared with baseline self-navigated electrocardiography (ECG) -triggered coronary MRA. From the 4D datasets, the left-ventricular end-systolic, end-diastolic volumes (ESV & EDV) and ejection fraction (EF) were computed and compared with values obtained from conventional 2D cine images. RESULTS: The 4D datasets enabled dynamic assessment of the whole heart with isotropic spatial resolution of 1.15 mm(3). Coronary artery image quality was very similar to that of the ECG-triggered baseline scan despite some SNR penalty. A good agreement between 4D and 2D cine imaging was found for EDV, ESV, and EF. CONCLUSION: The hypothesis that both coronary anatomy and ventricular function can be assessed simultaneously in vivo has been tested positive. Retrospective and flexible acquisition window selection allows to best visualize each coronary segment at its individual time point of quiescence.

Self-navigated isotropic three-dimensional cardiac T2 mapping.

PURPOSE: To implement and characterize an isotropic three-dimensional cardiac T2 mapping technique. METHODS: A self-navigated three-dimensional radial segmented balanced steady-state free precession pulse sequence with an isotropic 1.7-mm spatial resolution was implemented at 3T with a variable T2 preparation module. Bloch equation and Monte Carlo simulations were performed to determine the influence of the heart rate, B1 inhomogeneity and noise on the T2 fitting accuracy. In a phantom study, the accuracy of the pulse sequence was studied through comparison with a gold-standard spin-echo T2 mapping method. The robustness and homogeneity of the technique were ascertained in a study of 10 healthy adult human volunteers, while first results obtained in patients are reported. RESULTS: The numerical simulations demonstrated that the heart rate and B1 inhomogeneity cause only minor deviations in the T2 fitting, whereas the phantom study showed good agreement of the technique with the gold standard. The volunteer study demonstrated an average myocardial T2 of 40.5 ± 3.3 ms and a <15% T2 gradient in the base-apex and anterior-inferior direction. In three patients, elevated T2 values were measured in regions with expected edema. CONCLUSION: This respiratory self-navigated isotropic three-dimensional technique allows for accurate and robust in vitro and in vivo T2 quantification.

Free-breathing 3 T magnetic resonance T2-mapping of the heart.

OBJECTIVES: This study sought to establish an accurate and reproducible T(2)-mapping cardiac magnetic resonance (CMR) methodology at 3 T and to evaluate it in healthy volunteers and patients with myocardial infarct. BACKGROUND: Myocardial edema affects the T(2) relaxation time on CMR. Therefore, T(2)-mapping has been established to characterize edema at 1.5 T. A 3 T implementation designed for longitudinal studies and aimed at guiding and monitoring therapy remains to be implemented, thoroughly characterized, and evaluated in vivo. METHODS: A free-breathing navigator-gated radial CMR pulse sequence with an adiabatic T(2) preparation module and an empirical fitting equation for T(2) quantification was optimized using numerical simulations and was validated at 3 T in a phantom study. Its reproducibility for myocardial T(2) quantification was then ascertained in healthy volunteers and improved using an external reference phantom with known T(2). In a small cohort of patients with established myocardial infarction, the local T(2) value and extent of the edematous region were determined and compared with conventional T(2)-weighted CMR and x-ray coronary angiography, where available. RESULTS: The numerical simulations and phantom study demonstrated that the empirical fitting equation is significantly more accurate for T(2) quantification than that for the more conventional exponential decay. The volunteer study consistently demonstrated a reproducibility error as low as 2 ± 1% using the external reference phantom and an average myocardial T(2) of 38.5 ± 4.5 ms. Intraobserver and interobserver variability in the volunteers were -0.04 ± 0.89 ms (p = 0.86) and -0.23 ± 0.91 ms (p = 0.87), respectively. In the infarction patients, the T(2) in edema was 62.4 ± 9.2 ms and was consistent with the x-ray angiographic findings. Simultaneously, the extent of the edematous region by T(2)-mapping correlated well with that from the T(2)-weighted images (r = 0.91). CONCLUSIONS: The new, well-characterized 3 T methodology enables robust and accurate cardiac T(2)-mapping at 3 T with high spatial resolution, while the addition of a reference phantom improves reproducibility. This technique may be well suited for longitudinal studies in patients with suspected or established heart disease.