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Purpose: To develop and evaluate a phase unwrapping method for cine phase contrast MRI based on graph cuts. Methods: A proposed Iterative Graph Cuts method was evaluated in 10 cardiac patients with two‐dimensional flow quantification which was repeated at low venc settings to provoke wrapping. The images were also unwrapped by a path‐following method (ROMEO), and a Laplacian‐based method (LP). Net flow was quantified using semi‐automatic vessel segmentation. High venc images were also wrapped retrospectively to asses the residual amount of wrapped voxels. Results: The absolute net flow error after unwrapping at venc = 100 cm/s was 1.8 mL, which was 0.83 mL smaller than for LP. The repeatability error at high venc without unwrapping was 2.5 mL. The error at venc = 50 cm/s was 7.5 mL, which was 8.2 mL smaller than for ROMEO and 5.7 mL smaller than for LP. For retrospectively wrapped images with synthetic venc of 100/50/25 cm/s, the residual amount of wrapped voxels was 0.00/0.12/0.79%, which was 0.09/0.26/8.0 percentage points smaller than for LP. With synthetic venc of 25 cm/s, omitting magnitude information resulted in 3.2 percentage points more wrapped voxels, and only spatial/temporal unwrapping resulted in 4.6/21 percentage points more wrapped voxels compared to spatiotemporal unwrapping. Conclusion: Iterative Graph Cuts enables unwrapping of cine phase contrast MRI with very small errors, except for at extreme blood velocities, with equal or better performance compared to ROMEO and LP. The use of magnitude information and spatiotemporal unwrapping is recommended. [ABSTRACT FROM AUTHOR]

Purposeof Review: Cardiac sarcoidosis is an inflammatory condition that has been associated with deleterious cardiac manifestations. The diagnosis of cardiac sarcoidosis is challenging and can be guided by advanced cardiac imaging. Recent Findings: Endomyocardial biopsy lacks sensitivity in confirming a diagnosis of cardiac sarcoidosis. Studies have shown that the use of cardiac magnetic resonance imaging (MRI) and cardiac Positron Emission Testing (PET) are associated with increased sensitivity and specificity in the diagnosis of cardiac sarcoidosis. Summary: Cardiac MRI and cardiac PET CT, although distinct entities, are complimentary in the diagnosis, prognostication of major cardiac events, and aid in the treatment algorithm in patients with cardiac sarcoidosis. [ABSTRACT FROM AUTHOR]

Background Infective endocarditis (IE) is a rare disease associated with high mortality rates. Clinical presentation is highly variable with a time interval between first onset of symptoms and diagnosis > 1 month in 25% of patients. We present a case of aortic valve endocarditis with aortic root abscess (ARA) with chest pain and ischaemic changes on the electrocardiogram (ECG). Case summary A 59-year-old Caucasian male with a known bicuspid aortic valve presented at our emergency department with a 2-week history of malaise, subfebrile temperatures, and chest pain episodes. The ECG exhibited ischaemic changes, and laboratory workup showed elevated inflammatory markers and troponin levels. Coronary angiography revealed a one-vessel coronary artery disease with a borderline significant stenosis of the left circumflex artery. Cardiac magnetic resonance imaging showed a large aortic valve vegetation with an ARA expanding intramyocardially, which was not seen on bedside echocardiography. The patient was set on intravenous (i.v.) antibiotics and urgently referred for surgery. The patient received surgical aortic root and valve replacements, reconstruction of the anterior mitral leaflet, and a venous bypass. After successful surgical management followed by 6 weeks of i.v. antibiotics, the patient completely recovered. Discussion Diagnosing IE in atypical cases, such as those with ischaemic ECG changes, remains challenging. Infective endocarditis should be considered as an early differential diagnosis in individuals with prosthetic or native valve disease. Infective endocarditis poses a significant risk for perivalvular and ARA formation with high mortality. Aortic root abscess may present with unspecific symptoms or unusual ECG changes and might be missed in standard transthoracic echocardiography in up to 30% of cases. Multimodal imaging can help in establishing a prompt and accurate diagnosis, aid in timely treatment and mitigating the risk of complications of IE. [ABSTRACT FROM AUTHOR]

Background: The impact of left ventricular mechanical dyssynchrony (LVMD) on the long‐term prognosis of ST‐segment elevation myocardial infarction (STEMI) is unclear. Hypothesis: MR uniformity ratio estimates (URE) can detect LVMD and assess STEMI prognosis. Study Type: Retrospective analysis of a prospective multicenter registry (EARLY‐MYO trial, NCT 03768453). Population: Overall, 450 patients (50 females) with first‐time STEMI were analyzed, as well as 40 participants without cardiovascular disease as controls. Field Strength/Sequence: 3.0‐T, balanced steady‐state free precession cine and late gadolinium enhancement imaging. Assessment: MRI data were acquired within 1 week of symptom onset. Major adverse cardiovascular events (MACEs), including cardiovascular death, nonfatal re‐infarction, hospitalization for heart failure, and stroke, were the primary clinical outcomes. LVMD was represented by circumferential URE (CURE) and radial URE (RURE) calculated using strain measurements. The patients were grouped according to clinical outcomes or URE values. Patients' clinical characteristics and MR indicators were compared. Statistical Tests: The Student's t‐test, Mann–Whitney U test, chi‐square test, Fisher's exact test, receiver operating characteristic curve analysis with area under the curve, Kaplan–Meier analysis, Cox regression, logistic regression, intraclass correlation coefficient, c‐index, and integrated discrimination improvement were used. P < 0.05 was considered statistically significant. Results: CURE and RURE were significantly lower in patients with STEMI than in controls. The median follow‐up was 60.5 months. Patients with both lower CURE and RURE values experienced a significantly higher incidence of MACEs by 3.525‐fold. Both CURE and RURE were independent risk factors for MACEs. The addition of UREs improved diagnostic efficacy and risk stratification based on infarct size and left ventricular ejection fraction (LVEF). The indicators associated with LVMD included male sex, serum biomarkers (peak creatine phosphokinase and cardiac troponin I), infarct size, and LVEF. Data Conclusion: CURE and RURE may be useful to evaluate long‐term prognosis after STEMI. Evidence Level: 4 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

The aim of the current study was to develop a novel approach for 2D breath‐hold cardiac cine imaging from a single heartbeat, by combining cardiac motion‐corrected reconstructions and nonrigidly aligned patch‐based regularization. Conventional cardiac cine imaging is obtained via motion‐resolved reconstructions of data acquired over multiple heartbeats. Here, we achieve single‐heartbeat cine imaging by incorporating nonrigid cardiac motion correction into the reconstruction of each cardiac phase, in conjunction with a motion‐aligned patch‐based regularization. The proposed Motion‐Corrected CINE (MC‐CINE) incorporates all acquired data into the reconstruction of each (motion‐corrected) cardiac phase, resulting in a better posed problem than motion‐resolved approaches. MC‐CINE was compared with iterative sensitivity encoding (itSENSE) and Extra‐Dimensional Golden Angle Radial Sparse Parallel (XD‐GRASP) in 14 healthy subjects in terms of image sharpness, reader scoring (range: 1–5) and reader ranking (range: 1–9) of image quality, and single‐slice left ventricular assessment. MC‐CINE was significantly superior to both itSENSE and XD‐GRASP using 20 heartbeats, two heartbeats, and one heartbeat. Iterative SENSE, XD‐GRASP, and MC‐CINE achieved a sharpness of 74%, 74%, and 82% using 20 heartbeats, and 53%, 66%, and 82% with one heartbeat, respectively. The corresponding results for reader scoring were 4.0, 4.7, and 4.9 with 20 heartbeats, and 1.1, 3.0, and 3.9 with one heartbeat. The corresponding results for reader ranking were 5.3, 7.3, and 8.6 with 20 heartbeats, and 1.0, 3.2, and 5.4 with one heartbeat. MC‐CINE using a single heartbeat presented nonsignificant differences in image quality to itSENSE with 20 heartbeats. MC‐CINE and XD‐GRASP at one heartbeat both presented a nonsignificant negative bias of less than 2% in ejection fraction relative to the reference itSENSE. It was concluded that the proposed MC‐CINE significantly improves image quality relative to itSENSE and XD‐GRASP, enabling 2D cine from a single heartbeat. [ABSTRACT FROM AUTHOR]

An 18-year male with no significant past medical history presented with features of right-sided heart failure. Haematological investigations revealed raised erythrocyte sedimentation rate (23 mm/h). Transthoracic echocardiography (TTE) demonstrated biventricular systolic dysfunction with thickened free wall of right ventricle (RV). Whole-body fluorodeoxyglucose (FDG) - positron emission tomography (PET) computed tomography (FDG-PET-CT) showed intensely increased FDG uptake in the thickened RV wall and an FDG avid lesion in the left medial temporal lobe. Cardiac magnetic resonance imaging (CMR) characterized thickening and suggested an infiltrative disease (isointense on TI, hyperintense on myocardial oedema sensitive sequence with transmural enhancement on late gadolinium sequence). Magnetic resonance imaging (MRI) brain showed a thick rim enhancing ring lesion in the body of hippocampus. Endomyocardial biopsy revealed moderately dense lymphomononuclear inflammation with the formation of granulomas. Since tuberculosis is endemic in our country and considering all laboratory, imaging and biopsy findings a working diagnosis of tuberculosis was considered, and standard anti-tubercular treatment was started. There was an improvement in clinical status and follow-up imaging (TTE, CMR, brain MRI and FDG-PET-CT) showed improvement in biventricular function with regression in myocardial thickening and resolution of brain lesion, confirming the diagnosis of tuberculosis. [ABSTRACT FROM AUTHOR]

Purpose: Develop a novel approach for accelerated 2D free‐breathing myocardial perfusion via low‐rank motion‐corrected (LRMC) reconstructions. Methods: Myocardial perfusion imaging requires high spatial and temporal resolution, despite scan time constraints. Here, we incorporate LRMC models into the reconstruction‐encoding operator, together with high‐dimensionality patch‐based regularization, to produce high quality, motion‐corrected myocardial perfusion series from free‐breathing acquisitions. The proposed framework estimates beat‐to‐beat nonrigid respiratory (and any other incidental) motion and the dynamic contrast subspace from the actual acquired data, which are then incorporated into the proposed LRMC reconstruction. LRMC was compared with iterative SENSitivity Encoding (SENSE) (itSENSE) and low‐rank plus sparse (LpS) reconstruction in 10 patients based on image‐quality scoring and ranking by two clinical expert readers. Results: LRMC achieved significantly improved results relative to itSENSE and LpS in terms of image sharpness, temporal coefficient of variation, and expert reader evaluation. Left ventricle image sharpness was approximately 75%, 79%, and 86% for itSENSE, LpS and LRMC, respectively, indicating improved image sharpness for the proposed approach. Corresponding temporal coefficient of variation results were 23%, 11% and 7%, demonstrating improved temporal fidelity of the perfusion signal with the proposed LRMC. Corresponding clinical expert reader scores (1–5, from poor to excellent image quality) were 3.3, 3.9 and 4.9, demonstrating improved image quality with the proposed LRMC, in agreement with the automated metrics. Conclusion: LRMC produces motion‐corrected myocardial perfusion in free‐breathing acquisitions with substantially improved image quality when compared with iterative SENSE and LpS reconstructions. [ABSTRACT FROM AUTHOR]

A 38-year-old woman with sinus venosus atrial septal defect and partial anomalous return of the right upper pulmonary vein underwent a Warden procedure but experienced a large residual defect after patch dehiscence. Image-derived 3D modeling informed novel device closure with a Gore Cardioform atrial septal occluder. (Level of Difficulty: Advanced.)

Abstract Aims Sepsis‐induced cardiomyopathy is a major complication of septic shock and contributes to its high mortality. This pilot study investigated myocardial tissue differentiation in critically ill, sedated, and ventilated patients with septic shock using cardiovascular magnetic resonance (MR). Methods and results Fifteen patients with septic shock were prospectively recruited from the intensive care unit. Individuals received a cardiac MR scan (1.5 T) within 48 h after initial catecholamine peak and a transthoracic echocardiography at 48 and 96 h after cardiac MR. Left ventricular ejection fraction was assessed using both imaging modalities. During cardiac MR imaging, balanced steady‐state free precession imaging was performed for evaluation of cardiac anatomy and function in long‐axis and short‐axis views. Native T1 maps (modified Look–Locker inversion recovery 5 s(3 s)3 s), T2 maps, and extracellular volume maps were acquired in mid‐ventricular short axis and assessed for average plane values. Patients were given 0.2 mmol/kg of gadoteridol for extracellular volume quantification and late gadolinium enhancement imaging. Critical care physicians monitored sedated and ventilated patients during the scan with continuous invasive monitoring and realized breathholds through manual ventilation breaks. Laboratory analysis included high‐sensitive troponine T and N terminal pro brain natriuretic peptide levels. Twelve individuals with complete datasets were available for analysis (age 59.5 ± 16.9 years; 6 female). Nine patients had impaired systolic function with left ventricular ejection fraction (LVEF)

Magnetic resonance imaging (MRI) is a versatile modality that can generate high‐resolution images with a variety of tissue contrasts. However, MRI is a slow technique and requires long acquisition times, which increase with higher temporal and spatial resolution and/or when multiple contrasts and large volumetric coverage is required. In order to speedup MR data acquisition, several approaches have been introduced in the literature. Most of these techniques acquire less data than required and exploit intrinsic redundancies in the MR images to recover the information that was not sampled. This article presents a review of MR acquisition and reconstruction methods that have exploited redundancies in the temporal, spatial, and contrast/parametric dimensions to accelerate image data acquisition, focusing on cardiac and abdominal MR imaging applications. The review describes how each of these dimensions has been separately exploited for speeding up MR acquisition to then discuss more advanced techniques where multiple dimensions are exploited together for further reducing scan times. Finally, future directions for multidimensional image acceleration and remaining technical challenges are discussed. Evidence Level: 5 Technical Efficacy: 1 [ABSTRACT FROM AUTHOR]

Competing Interests: Conflict of interest None.

Cardiac MRI modality with excellent contrast plays an important role for both anatomical and functional evaluation of the heart. The localization of the right ventricle is quite a critical process due to the complex shape of the organ and its fuzzy borders than surrounding tissues. In this paper we present our work with two approaches, first one is clustering based and second is deep learning based. The experimentation is performed on short axis cardiac MR images available as heart database by A2SI LABs. The performance of algorithms is evaluated using two statistical parameters Dice metric and Haussdorff distance parameters and ejection fraction. is the quantitative parameter. The Dice metric and Haussdorff distance achieved using both approaches is 87%, 96% and 3.50mm, 2.65mm respectively. The result shows that deep learning approach gives promising results over clustering based method. [ABSTRACT FROM AUTHOR]

Purpose: To develop a compact MR‐compatible ergometer for exercise stress and to initially evaluate the reproducibility of myocardial native T1 and myocardial blood flow (MBF) measurements during exercise stress performed on this ergometer. Methods: The compact ergometer consists of exercise, workload, and data processing components. The exercise stress can be achieved by pedaling on a pair of cylinders at a predefined frequency with adjustable resistances. Ten healthy subjects were recruited to perform cardiac MRI scans twice in a 3.0T MR scanner, at different days to assess reproducibility. Myocardial native T1 and MBF were acquired at rest and during a moderate exercise. The reproducibility of the two tests was determined by the intra‐group correlation coefficient (ICC) and coefficient of variation (CoV). Results: The mean exercise intensity in this pilot study was 45 Watts (W), with an exercise duration of 5 min. Stress induced a significant increase in systolic blood pressure (from 113 ± 11 mmHg to 141 ± 12, P < 0.05) and maximal increase in heart rate by 74 ± 19%. The rate pressure product increased two‐fold (P < 0.001). Excellent reproducibility was demonstrated in native T1 during the exercise (CoV = 3.0%), whereas the reproducibility of MBF and myocardial perfusion reserve during the exercise was also good (CoV = 10.7% and 8.8%, respectively). Conclusion: This pilot study demonstrated that it is possible to acquire reproducible measurements of myocardial native T1 and MBF during the exercise stress in healthy volunteers using our new compact ergometer. [ABSTRACT FROM AUTHOR]

Aims: Sepsis‐induced cardiomyopathy is a major complication of septic shock and contributes to its high mortality. This pilot study investigated myocardial tissue differentiation in critically ill, sedated, and ventilated patients with septic shock using cardiovascular magnetic resonance (MR). Methods and results: Fifteen patients with septic shock were prospectively recruited from the intensive care unit. Individuals received a cardiac MR scan (1.5 T) within 48 h after initial catecholamine peak and a transthoracic echocardiography at 48 and 96 h after cardiac MR. Left ventricular ejection fraction was assessed using both imaging modalities. During cardiac MR imaging, balanced steady‐state free precession imaging was performed for evaluation of cardiac anatomy and function in long‐axis and short‐axis views. Native T1 maps (modified Look–Locker inversion recovery 5 s(3 s)3 s), T2 maps, and extracellular volume maps were acquired in mid‐ventricular short axis and assessed for average plane values. Patients were given 0.2 mmol/kg of gadoteridol for extracellular volume quantification and late gadolinium enhancement imaging. Critical care physicians monitored sedated and ventilated patients during the scan with continuous invasive monitoring and realized breathholds through manual ventilation breaks. Laboratory analysis included high‐sensitive troponine T and N terminal pro brain natriuretic peptide levels. Twelve individuals with complete datasets were available for analysis (age 59.5 ± 16.9 years; 6 female). Nine patients had impaired systolic function with left ventricular ejection fraction (LVEF) < 50% (39.8 ± 5.7%), and three individuals had preserved LVEF (66.9 ± 6.7%). Global longitudinal strain was impaired in both subgroups (LVEF impaired: 11.0 ± 1.8%; LVEF preserved: 16.0 ± 5.8%; P = 0.1). All patients with initially preserved LVEF died during hospital stay; in‐hospital mortality with initially impaired LVEF was 11%. Upon echocardiographic follow‐up, LVEF improved in all previously impaired patients at 48 (52.3 ± 9.0%, P = 0.06) and 96 h (54.9 ± 7.0%, P = 0.02). Patients with impaired systolic function had increased T2 times as compared with patients with preserved LVEF (60.8 ± 5.6 ms vs. 52.2 ± 2.8 ms; P = 0.02). Left ventricular GLS was decreased in all study individuals with impaired LVEF (11.0 ± 1.8%) and less impaired with preserved LVEF (16.0 ± 5.8%; P = 0.01). T1 mapping showed increased T1 times in patients with LVEF impairment as compared with patients with preserved LVEF (1093.9 ± 86.6 ms vs. 987.7 ± 69.3 ms; P = 0.03). Extracellular volume values were elevated in patients with LVEF impairment (27.9 ± 2.1%) as compared with patients with preserved LVEF (22.7 ± 1.9%; P < 0.01). Conclusions: Septic cardiomyopathy with impaired LVEF reflects inflammatory cardiomyopathy. Takotsubo‐like contractility patterns occur in some cases. Cardiac MR is safely feasible in critically ill, sedated, and ventilated patients using extensive monitoring and experienced staff. Trial Registration: retrospectively registered (ISRCTN85297773) [ABSTRACT FROM AUTHOR]

BackgroundCardiovascular magnetic resonance (CMR) imaging at ultra-high fields (UHF) such as 7T has encountered many challenges such as faster T2* relaxation, stronger B0 and B1+ field inhomogeneities and additional safety concerns due to increased specific absorption rate (SAR) and peripheral nervous stimulation (PNS). Recently, a new line of 5T whole body MRI system has become available, and this study aims at evaluating the performance and benefits of this new UHF system for CMR imaging.MethodsGradient echo (GRE) CINE imaging was performed on healthy volunteers at both 5 and 3T, and was compared to balanced steady-state-free-procession (bSSFP) CINE imaging at 3T as reference. Higher spatial resolution GRE CINE scans were additionally performed at 5T. All scans at both fields were performed with ECG-gating and breath-holding. Image quality was blindly evaluated by two radiologists, and the cardiac functional parameters (e.g., EDV/ESV/mass/EF) of the left and right ventricles were measured for statistical analyses using the Wilcoxon signed-rank test and Bland-Altman analysis.ResultsCompared to 3T GRE CINE imaging, 5T GRE CINE imaging achieved comparable or improved image quality with significantly superior SNR and CNR, and it has also demonstrated excellent capability for high resolution (1.0 × 1.0 × 6.0 mm3) imaging. Functional assessments from 5T GRE CINE images were highly similar with the 3T bSSFP CINE reference.ConclusionsThis pilot study has presented the initial evaluation of CMR CINE imaging at 5T UHF, which yielded superior image quality and accurate functional quantification when compared to 3T counterparts. Along with reliable ECG gating, the new 5T UHF system has the potential to achieve well-balanced performance for CMR applications.

Regional cardiac motion scoring aims to classify the motion status of each myocardium segment into one of the four categories (normal, hypokinetic, akinetic, and dyskinetic) from multiple short-axis MR sequences. It is essential for prognosis and early diagnosis for various cardiac diseases. However, the complex motion procedure of the myocardium and the invisible pattern differences pose great challenges, leading to low performance for automatic methods. Most existing works mitigate the task by differentiating the normal motion patterns from the abnormal ones, without fine-grained motion scoring. We propose an effective method for the task of cardiac motion scoring by connecting a bottom-up and another top-down branch with a novel motion-based spatial attention module in multi-scale space. Specifically, we use the convolution blocks for low-level feature extraction that acts as a bottom-up mechanism, and the task of optical flow for explicit motion extraction that acts as a top-down mechanism for high-level allocation of spatial attention. To this end, a newly designed Multi-scale Motion-based Spatial Attention (MMSA) module is used as the pivot connecting the bottom-up part and the top-down part, and adaptively weight the low-level features according to the motion information. Experimental results on a newly constructed dataset of 1440 myocardium segments from 90 subjects demonstrate that the proposed MMSA can accurately analyze the regional myocardium motion, with accuracies of 79.3% for 4-way motion scoring, 89.0% for abnormality detection, and correlation of 0.943 for estimation of motion score index. This work has great potential for practical assessmentof cardiac motion function. [ABSTRACT FROM AUTHOR]

Purpose: Develop a novel 2D cardiac MR fingerprinting (MRF) approach to enable simultaneous T1, T2, T2*, and fat fraction (FF) myocardial tissue characterization in a single breath‐hold scan. Methods: Simultaneous, co‐registered, multi‐parametric mapping of T1, T2, and FF has been recently achieved with cardiac MRF. Here, we further incorporate T2* quantification within this approach, enabling simultaneous T1, T2, T2*, and FF myocardial tissue characterization in a single breath‐hold scan. T2* quantification is achieved with an eight‐echo readout that requires a long cardiac acquisition window. A novel low‐rank motion‐corrected (LRMC) reconstruction is exploited to correct for cardiac motion within the long acquisition window. The proposed T1/T2/T2*/FF cardiac MRF was evaluated in phantom and in 10 healthy subjects in comparison to conventional mapping techniques. Results: The proposed approach achieved high quality parametric mapping of T1, T2, T2*, and FF with corresponding normalized RMS error (RMSE) T1 = 5.9%, T2 = 9.6% (T2 values <100 ms), T2* = 3.3% (T2* values <100 ms), and FF = 0.8% observed in phantom scans. In vivo, the proposed approach produced higher left‐ventricular myocardial T1 values than MOLLI (1148 vs 1056 ms), lower T2 values than T2‐GraSE (42.8 vs 50.6 ms), lower T2* values than eight‐echo gradient echo (GRE) (35.0 vs 39.4 ms), and higher FF values than six‐echo GRE (0.8 vs 0.3 %) reference techniques. The proposed approach achieved considerable reduction in motion artifacts compared to cardiac MRF without motion correction, improved spatial uniformity, and statistically higher apparent precision relative to conventional mapping for all parameters. Conclusion: The proposed cardiac MRF approach enables simultaneous, co‐registered mapping of T1, T2, T2*, and FF in a single breath‐hold for comprehensive myocardial tissue characterization, achieving higher apparent precision than conventional methods. [ABSTRACT FROM AUTHOR]

Purpose: To develop and validate a three‐parameter model for improved precision multiparametric SAturation‐recovery single‐SHot Acquisition (mSASHA) cardiac T1 and T2 mapping with high accuracy in a single breath‐hold. Methods: The mSASHA acquisition consists of nine images of variable saturation recovery and T2 preparation in 11 heartbeats with T1 and T2 values calculated using a three‐parameter model. It was validated in simulations and phantoms at 3 T with comparison to a four‐parameter joint T1‐T2 technique. The mSASHA acquisition was compared with MOLLI, SASHA, and T2‐prepared balanced SSFP in 10 volunteers. Results: The mSASHA technique had high accuracy in phantoms compared to spin echo, with −0.2 ± 0.3% T1 error and −2.4 ± 1.3% T2 error. The mSASHA coefficient of variation in phantoms for T1 was similar to MOLLI (0.7 ± 0.2% for both) and T2‐prepared balanced SSFP for T2 (1.3 ± 0.7% vs 1.4 ± 0.3%, adjusted p >.05 for both). In simulations, three‐parameter mSASHA had higher precision than four‐parameter joint T1‐T2 for both T1 and T2 (46% and 11% reductions in T1 and T2 interquartile range for native myocardium). In vivo myocardial mSASHA T1 was similar to SASHA (1523 ± 18 ms vs 1520 ± 18 ms) with similar coefficient of variation to both MOLLI and SASHA (3.3 ± 0.6% vs 3.1 ± 0.6% and 3.3 ± 0.5% respectively, adjusted p >.05 for all). Myocardial mSASHA T2 was 37.1 ± 1.1 ms with similar precision to T2‐prepared balanced SSFP (6.7 ± 1.7% vs 6.0 ± 1.6%, adjusted p >.05). Conclusion: Three‐parameter mSASHA provides high‐accuracy cardiac T1 and T2 quantification in a single breath‐hold with similar precision to MOLLI and T2‐prepared balanced SSFP. Further study is required to both establish normative values and demonstrate clinical utility in patient populations. [ABSTRACT FROM AUTHOR]

Management of patients with chronic chest pain in the setting of high probability of coronary artery disease (CAD) relies heavily on imaging for determining or excluding presence and severity of myocardial ischemia, hibernation, scarring, and/or the presence, site, and severity of obstructive coronary lesions, as well as course of management and long-term prognosis. In patients with no known ischemic heart disease, imaging is valuable in determining and documenting the presence, extent, and severity of obstructive coronary narrowing and presence of myocardial ischemia. In patients with known ischemic heart disease, imaging findings are important in determining the management of patients with chronic myocardial ischemia and can serve as a decision-making tool for medical therapy, angioplasty, stenting, or surgery. This document summarizes the recent growing body of evidence on various imaging tests and makes recommendations for imaging based on the available data and expert opinion. This document is focused on epicardial CAD and does not discuss the microvascular disease as the cause for CAD. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Abstract Background There are some limitations using the different sequences of clinical cardiac magnetic resonance (cardiac MR) in detection of edema in patients presenting with acute myocardial injury. The purpose of this study is to evaluate the myocardial segmental agreement between the different edema sequences: T2 mapping and turbo inversion recovery magnitude (TIRM) in detection of acute myocardial edema. Results Thirty-seven patients presented with acute infarction were sent to cardiac MR to assess myocardial edema. All cardiac MR studies were scanned using cine, TIRM, and late gadolinium enhancement (LGE) in short axis views (SAX). Position of the T2 mapping slices were copied from the TIRM. The left ventricle (LV) was divided into apical, mid, and basal segments per visualization of the papillary muscles. Edema mass was assessed separately in each segment as well as the total edema mass in both the TIRM and T2 mapping. Twenty-four patients of whom 12.5% had multi-territorial coronary lesions and edema were assessed. Myocardial edema was not assessed in thirteen patients (35%) due to significant intra myocardial hemorrhage (T2 mapping

A 47-year-old female with cardiac dysfunction and lymphadenopathy underwent 18FDG PET/CT and 68Ga-FAPI-04 imaging for tumor screening. Mild uptake in the left ventricular wall was detected on the oncology 18FDG PET/CT. True myocardiac-involvement could not be distinguished with physiological uptake. The following 68Ga-FAPI-04 showed intense heterogeneous uptake in the left ventricular wall, particularly in the septum and apex area, corresponding with the late gadolinium enhancement regions shown by cardiac MR. Intense uptake was also noted in the mediastinal and bilateral hilar lymph nodes. Endomyocardial biopsy demonstrated sarcoidosis. [ABSTRACT FROM AUTHOR]

A 47-year-old female with cardiac dysfunction and lymphadenopathy underwent 18FDG PET/CT and 68Ga-FAPI-04 imaging for tumor screening. Mild uptake in the left ventricular wall was detected on the oncology 18FDG PET/CT. True myocardiac-involvement could not be distinguished with physiological uptake. The following 68Ga-FAPI-04 showed intense heterogeneous uptake in the left ventricular wall, particularly in the septum and apex area, corresponding with the late gadolinium enhancement regions shown by cardiac MR. Intense uptake was also noted in the mediastinal and bilateral hilar lymph nodes. Endomyocardial biopsy demonstrated sarcoidosis.

Background Acute pericarditis as a sign of mediastinal mass is rare and aetiological diagnosis can be challenging without adequate imaging. Case summary An 18-year-old woman came to our attention describing acute sharp chest pain radiated to the left arm, exacerbated with supine positioning and attenuated while sitting or leaning forward. The electrocardiogram showed diffuse ST elevation and PR depression, with sinus tachycardia. Cardiac biomarkers and D-dimer were negative; echocardiography showed no abnormalities and the absence of pericardial effusion. Her blood work revealed no sign of inflammation or bacterial infection (PCR and procalcitonin were normal); thyroid-stimulating hormone plasma levels were suppressed, showing decompensated thyrotoxicosis. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Epstein–Barr virus, human immunodeficiency virus, hepatitis C virus, Enterovirus, Parvovirus B19, and Adenovirus tests were normal. Her past medical history was silent, apart from Grave's disease on treatment with methimazole. Chest computed tomography (CT) was performed and showed the presence of slightly increased density pericardial effusion, with a maximum thickness of 15 mm in the upper mediastinum. Finally, cardiac magnetic resonance (MR) identified a mass of 73 × 51 mm located in the upper mediastinum. The mass was subsequently biopsed with video-assisted thoracoscopic surgery and the histological analysis showed thymic hyperplasia. Discussion This case shows the importance of an adequate clinical suspicion of thymic hyperplasia in the context of acute pericarditis symptoms and known Graves' disease. In this case, a negative chest CT finding may not be sufficient to rule out the diagnosis and cardiac MR imaging is necessary. [ABSTRACT FROM AUTHOR]

Background: Cardiac magnetic resonance (MR) images are often collected with different imaging parameters, which may impact the calculated values of myocardial radiomic features. Purpose: To investigate the sensitivity of myocardial radiomic features to changes in imaging parameters in cardiac MR images. Study Type: Prospective. Population: A total of 11 healthy participants/five patients. Field Strength/ Sequence: A 3 T/cine balanced steady‐state free‐precession, T1‐weighted spoiled gradient‐echo, T2‐weighted turbo spin‐echo, and quantitative T1 and T2 mapping. For each sequence, the flip angle, in‐plane resolution, slice thickness, and parallel imaging technique were varied to study the sensitivity of radiomic features to alterations in imaging parameters. Assessment: Myocardial contours were manually delineated by experienced readers, and a total of 1023 radiomic features were extracted using PyRadiomics with 11 image filters and six feature families. Statistical Tests: Sensitivity was defined as the standardized mean difference (D effect size), and the robust features were defined at sensitivity < 0.2. Sensitivity analysis was performed on predefined sets of reproducible features. The analysis was performed using the entire cohort of 16 subejcts. Results: 64% of radiomic features were robust (sensitivity < 0.2) to changes in any imaging parameter. In qualitative sequences, radiomic features were most sensitive to changes in in‐plane spatial resolution (spatial resolution: 0.6 vs. flip angle: 0.19, parallel imaging: 0.18, slice thickness: 0.07; P < 0.01 for all); in quantitative sequences, radiomic features were least sensitive to changes in spatial resolution (spatial resolution: 0.07 vs. slice thickness: 0.16, flip angle: 0.24; P < 0.01 for all). In an individual feature level, no singular feature family/image filter was identified as robust (sensitivity < 0.2) across sequences; however, highly sensitive features were predominantly associated with high‐frequency wavelet filters across all sequences (32/50 features). Data Conclusion: In cardiac MR, a considerable number of radiomic features are sensitive to changes in sequence parameters. Evidence Level: 1 Technical Efficacy: Stage 1 [ABSTRACT FROM AUTHOR]

Background: Coronavirus 2019 (COVID‐19) causes morbidity and mortality in an increasing number of people worldwide. Although it mainly affects the respiratory system, it influences all organs, including the heart. It is associated with a broad spectrum of widespread cardiovascular problems ranging from mild myocardial injury to fulminant myocarditis. We aimed to evaluate the presence and prevalence of cardiac involvement in asymptomatic or symptomatic patients after they recovered from COVID 19 infection. Methods: A total of 100 consecutive patients with COVID‐19 proven by reverse transcription polymerase chain reaction (RT‐PCR), under 40 years of age and without any known additional chronic diseases were analyzed retrospectively for cardiac magnetic resonance (CMR) results and symptoms. Results: Cardiac involvement was detected in 49 out of 100 patients on CMR imaging. In the cardiac involvement group, the number of patients with chest pain and/or dyspnea was 41 (84%), which was statistically significant (p = 0.001). Twenty‐four patients (47%) in the without cardiac involvement group were asymptomatic and this was also statistically significant (p = 0.001). LV ejection fraction was statistically significantly lower in the group with cardiac involvement (61% vs 66%, p = 0.001). LV stroke volume and tricuspid annular plane systolic excursion (TAPSE) were statistically significantly lower in patients with cardiac involvement (p = 0.028 and p = 0.019, respectively). Conclusion: Based on single center experience, myocardial involvement is common in symptomatic patients after COVID‐19. More studies are needed for long‐term side effects and clinical results in these patients. [ABSTRACT FROM AUTHOR]