Cardiac MR elastography for quantitative assessment of elevated myocardial stiffness in cardiac amyloidosis.

PURPOSE: To evaluate if cardiac magnetic resonance elastography (MRE) can measure increased stiffness in patients with cardiac amyloidosis. Myocardial tissue stiffness plays an important role in cardiac function. A noninvasive quantitative imaging technique capable of measuring myocardial stiffness could aid in disease diagnosis, therapy monitoring, and disease prognostic strategies. We recently developed a high-frequency cardiac MRE technique capable of making noninvasive stiffness measurements. MATERIALS AND METHODS: In all, 16 volunteers and 22 patients with cardiac amyloidosis were enrolled in this study after Institutional Review Board approval and obtaining formal written consent. All subjects were imaged head-first in the supine position in a 1.5T closed-bore MR imager. 3D MRE was performed using 5 mm isotropic resolution oblique short-axis slices and a vibration frequency of 140 Hz to obtain global quantitative in vivo left ventricular stiffness measurements. The median stiffness was compared between the two cohorts. An octahedral shear strain signal-to-noise ratio (OSS-SNR) threshold of 1.17 was used to exclude exams with insufficient motion amplitude. RESULTS: Five volunteers and six patients had to be excluded from the study because they fell below the 1.17 OSS-SNR threshold. The myocardial stiffness of cardiac amyloid patients (median: 11.4 kPa, min: 9.2, max: 15.7) was significantly higher (P = 0.0008) than normal controls (median: 8.2 kPa, min: 7.2, max: 11.8). CONCLUSION: This study demonstrates the feasibility of 3D high-frequency cardiac MRE as a contrast-agent-free diagnostic imaging technique for cardiac amyloidosis. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1361-1367.

Sex Differences in Aging-related Myocardial Stiffening Quantitatively Measured with MR Elastography.

Purpose To investigate the feasibility of using quantitative MR elastography (MRE) to characterize the influence of aging and sex on left ventricular (LV) shear stiffness. Materials and Methods In this prospective study, LV myocardial shear stiffness was measured in 109 healthy volunteers (age range: 18-84 years; mean age, 40 years ± 18 [SD]; 57 women, 52 men) enrolled between November 2018 and September 2019, using a 5-minute MRE acquisition added to a clinical MRI protocol. Linear regression models were used to estimate the association of cardiac MRI and MRE characteristics with age and sex; models were also fit to assess potential age-sex interaction. Results Myocardial shear stiffness significantly increased with age in female (age slope = 0.03 kPa/year ± 0.01, P = .009) but not male (age slope = 0.008 kPa/year ± 0.009, P = .38) volunteers. LV ejection fraction (LVEF) increased significantly with age in female volunteers (0.23% ± 0.08 per year, P = .005). LV end-systolic volume (LVESV) decreased with age in female volunteers (-0.20 mL/m2 ± 0.07, P = .003). MRI parameters, including T1, strain, and LV mass, did not demonstrate this interaction (P > .05). Myocardial shear stiffness was not significantly correlated with LVEF, LV stroke volume, body mass index, or any MRI strain metrics (P > .05) but showed significant correlations with LV end-diastolic volume/body surface area (BSA) (slope = -3 kPa/mL/m2 ± 1, P = .004, r2 = 0.08) and LVESV/BSA (-1.6 kPa/mL/m2 ± 0.5, P = .003, r2 = 0.08). Conclusion This study demonstrates that female, but not male, individuals experience disproportionate LV stiffening with natural aging, and these changes can be noninvasively measured with MRE. Keywords: Cardiac, Elastography, Biological Effects, Experimental Investigations, Sexual Dimorphisms, MR Elastography, Myocardial Shear Stiffness, Quantitative Stiffness Imaging, Aging Heart, Myocardial Biomechanics, Cardiac MRE Supplemental material is available for this article. Published under a CC BY 4.0 license.

Development of a training phantom for compression breast elastography-comparison of various elastography systems and numerical simulations.

The elastic properties of tissue are related to tissue composition and pathological changes. It has been observed that many pathological processes increase the elastic modulus of soft tissue compared to normal. Ultrasound compression elastography is a method of characterization of elastic properties that has been the focus of many research efforts in the last two decades. In medical radiology, compression elastography is provided as an additional tool with ultrasound B-mode in the existing scanners, and the combined features of elastography and echography act as a promising diagnostic method in breast cancer detection. However, the full capability of the ultrasound elastography technique together with B-mode has not been utilized by novice radiologists due to the nonavailability of suitable, appropriately designed tissue-mimicking phantoms. Since different commercially available ultrasound elastographic scanners follow their own unique protocols, training novice radiologists is becoming cumbersome. The main focus of this work is to develop a tissue-like agar-based phantom, which mimics breast tissue with common abnormal lesions like fibroadenoma and invasive ductal carcinoma in a clinically perceived way and compares the sonographic and elastographic appearances using different commercially available systems. In addition, the developed phantoms are simulated using the finite-element method, and ideal strain images are generated. Strain images from experiment and simulation are compared based on image contrast parameters, namely contrast transfer efficiency (CTE) and observed strain, and they are in good agreement. The strain image contrast of malignant inclusions is significantly improved compared to benign inclusions, and the trend of CTE is similar for all elastographic scanners under investigation.

Characterization of biomechanical properties of agar based tissue mimicking phantoms for ultrasound stiffness imaging techniques.

Pathological changes of the body have been observed to change the mechanical properties of soft tissue types which can be imaged by ultrasound elastography. Though initial clinical results using ultrasound elastography in detection of tumors are promising, quantification of signal to noise ratio, resolution and strain image patterns are the best achieved under a controlled study using phantoms with similar biomechanical properties of normal and abnormal tissues. The purpose of this work is to characterize the biomechanical properties of agar based tissue mimicking phantoms by varying the agar concentration from 1.7 to 6.6% by weight and identify the optimum property to be used in classification of cancerous tissues. We performed quasi-static uniaxial compression test under a strain rate of 0.5mm/min up to 15% strain and measured Young's modulus of phantom samples which are from 50kPa to 450kPa. Phantoms show nonlinear stress-strain characteristics at finite strain which were characterized using hyperelastic parameters by fitting Neo-Hookean, Mooney Rivlin, Ogden and Veronda Westmann models. We also investigated viscoelastic parameters of the samples by conducting oscillatory shear rheometry at various precompression levels (2-5%). Loss modulus values are always less than storage modulus which represents the behavior of soft tissues. The increase in agar concentration increases the shear modulus of the samples as well as decreases the linear viscoelastic region. The results suggest that dynamic shear modul are more promising than linear and nonlinear elastic modul in differentiation of various classes of abnormal tissues.

Study of ultrasound stiffness imaging methods using tissue mimicking phantoms.

A pilot study was carried out to investigate the performance of ultrasound stiffness imaging methods namely Ultrasound Elastography Imaging (UEI) and Acoustic Radiation Force Impulse (ARFI) Imaging. Specifically their potential for characterizing different classes of solid mass lesions was analyzed using agar based tissue mimicking phantoms. Composite tissue mimicking phantom was prepared with embedded inclusions of varying stiffness from 50 kPa to 450 kPa to represent different stages of cancer. Acoustic properties such as sound speed, attenuation coefficient and acoustic impedance were characterized by pulse echo ultrasound test at 5 MHz frequency and they are ranged from (1564 ± 88 to 1671 ± 124 m/s), (0.6915 ± 0.123 to 0.8268 ± 0.755 db cm(-1)MHz(-1)) and (1.61 × 10(6) ± 0.127 to 1.76 × 10(6) ± 0.045 kg m(-2)s(-1)) respectively. The elastic property Young's Modulus of the prepared samples was measured by conducting quasi static uni axial compression test under a strain rate of 0.5mm/min upto 10 % strain, and the values are from 50 kPa to 450 kPa for a variation of agar concentration from 1.7% to 6.6% by weight. The composite phantoms were imaged by Siemens Acuson S2000 (Siemens, Erlangen, Germany) machine using linear array transducer 9L4 at 8 MHz frequency; strain and displacement images were collected by UEI and ARFI. Shear wave velocity 4.43 ± 0.35 m/s was also measured for high modulus contrast (18 dB) inclusion and X.XX m/s was found for all other inclusions. The images were pre processed and parameters such as Contrast Transfer Efficiency and lateral image profile were computed and reported. The results indicate that both ARFI and UEI represent the abnormalities better than conventional US B mode imaging whereas UEI enhances the underlying modulus contrast into improved strain contrast. The results are corroborated with literature and also with clinical patient images.