74 results on '"Piechnik, Stefan K."'
Search Results
2. Global extracellular volume (ECVglobal) in HCM - the 'next generation' test for risk in hypertrophic cardiomyopathy?
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Sado Daniel, Maestrini Viviana, White Steven K, Piechnik Stefan K, Robson Matthew D, Flett Andrew, Tome Esteban Maria T, Pantazis Antonios, McKenna William J, Neubauer Stefan, Elliott Perry, and Moon James
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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3. Native T1 lowering in iron overload and Anderson Fabry disease; a novel and early marker of disease
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Sado Daniel, White Steven K, Piechnik Stefan K, Banypersad Sanjay M, Treibel Thomas A, Fontana Marianna, Captur Gaby, Maestrini Viviana, Lachmann Robin, Hughes Derralyn, Murphy Elaine, Porter John, Mehta Atul, Elliott Perry, and Moon James
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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4. T1 mapping for myocardial extracellular volume measurement by cardiovascular magnetic resonance: bolus only vs primed infusion technique
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White Steven K, Sado Daniel, Fontana Marianna, Banypersad Sanjay M, Maestrini Viviana, Piechnik Stefan K, Robson Matthew D, Hausenloy Derek J, Sheikh Amir M, Hawkins Philip N, and Moon James
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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5. Impaired myocardial perfusion in moderate asymptomatic aortic stenosis relates to longitudinal strain but not non-contrast T1 values
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Bull Sacha, Loudon Margaret, Ntusi Ntobeko, Joseph Jubin P, Francis Jane M, Ferreira Vanessa, Piechnik Stefan K, Karamitsos Theodoros, Neubauer Stefan, and Myerson Saul
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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6. Comprehensive cardiac magnetic resonance imaging and spectroscopy reveals a high burden of myocardial disease in HIV infection
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Holloway Cameron, Ntusi Ntobeko, Suttie Joseph, Mahmod Masliza, Wainwright Emma, Clutton Genevieve, Hancock Gemma, Beak Philip, Tajar Abdelouahid, Piechnik Stefan K, Schneider Jurgen E, Clarke Kieran, Dorrell Lucy, and Neubauer Stefan
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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7. Pre-contrast ShMOLLI T1 mapping in cardiac AL amyloidosis
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Karamitsos Theodoros, Banypersad Sanjay M, Sado Daniel, Maestrini Viviana, Ferreira Vanessa, Piechnik Stefan K, Robson Matthew D, Hawkins Philip N, Neubauer Stefan, and Moon James
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2012
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8. Pre-contrast T1 mapping for detection of myocardial fibrosis in asymptomatic and symptomatic aortic stenosis
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Bull Sacha, White Steven K, Piechnik Stefan K, Flett Andrew, Ferreira Vanessa, Loudon Margaret, Francis Jane M, Neubauer Stefan, Moon James, and Myerson Saul
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2012
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9. Histological validation of ShMOLLI equilibrium contrast CMR for the measurement of diffuse myocardial fibrosis
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White Steven K, Piechnik Stefan K, Neubauer Stefan, Robson Matthew D, and Moon James
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2012
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10. Age and gender dependence of pre-contrast T1-relaxation times in normal human myocardium at 1.5T using ShMOLLI
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Piechnik Stefan K, Ferreira Vanessa, Lewandowski Adam J, Ntusi Ntobeko, Sado Daniel, Maestrini Viviana, White Steven K, Lazdam Merzaka, Banerjee Rajarshi, Hofman Mark B, Moon James, Neubauer Stefan, Leeson Paul, and Robson Matthew D
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2012
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11. Characterization of acute myocardial infarction by pre-contrast T1 mapping
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Dall'Armellina Erica, Piechnik Stefan K, Ferreira Vanessa, Francis Jane M, Robson Matthew D, Cuculi Florim, Kharbanda Rajesh, Banning Adrian P, Choudhury Robin P, Karamitsos Theodoros, and Neubauer Stefan
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2012
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12. T1-mapping accurately detects acute myocardial edema: a comparison to T2-weighted cardiovascular magnetic resonance imaging
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Ferreira Vanessa, Piechnik Stefan K, Dall'Armellina Erica, Karamitsos Theodoros, Francis Jane M, Choudhury Robin P, Friedrich Matthias G, Robson Matthew D, and Neubauer Stefan
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2012
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13. Non-contrast T1 mapping characterizes the myocardium beyond that achieved by late gadolinium enhancement in both hypertrophic and dilated cardiomyopathy
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Dass Sairia, Suttie Joseph, Piechnik Stefan K, Ferreira Vanessa, Holloway Cameron, Robson Matthew D, Watkins Hugh, Karamitsos Theodoros, and Neubauer Stefan
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2012
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14. The diagnostic performance of non-contrast T1-mapping in patients with acute myocarditis on cardiovascular magnetic resonance imaging
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Ferreira Vanessa, Piechnik Stefan K, Dall'Armellina Erica, Karamitsos Theodoros, Francis Jane M, Choudhury Robin P, Kardos Attila, Friedrich Matthias G, Robson Matthew D, and Neubauer Stefan
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2012
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15. Quantification of acute myocardial injury in STEMI patients post revascularization at 3Tesla. Comparison of T1-mapping, late gadolinium and edema imaging
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Robson Matthew D, Francis Jane M, Karamitsos Theodoros D, Ferreira Vanessa M, Piechnik Stefan K, Erica Dall'Armellina, Choudhury Robin P, and Neubauer Stefan
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2011
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16. Quantification of acute myocardial injury by ShMOLLI T1-Mapping, T2-weighted and late gadolinium imaging in patients presenting with chest pain, positive troponins and non-obstructive coronary arteries
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Robson Matthew D, Friedrich Matthias G, Francis Jane M, Karamitsos Theodoros D, Dall'Armellina Erica, Piechnik Stefan K, Ferreira Vanessa M, and Neubauer Stefan
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2011
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17. Gaussian modelling for operator-independent and threshold-free volumetric segmentation of phase sensitive inversion recovery late gadolinium enhanced images
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Ferreira Vanessa M, Dall'Armellina Erica, Piechnik Stefan K, and Robson Matthew D
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2011
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18. Validation of the shortened modified look locker inversion recovery (Sh-MOLLI) sequence for cardiac gated T1 mapping
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Robson Matthew D, Neubauer Stefan, Dall'Armellina E, Ferreira Vanessa M, and Piechnik Stefan K
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2010
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19. Differentiation of acutely infarcted myocardium by quantitative differences in T1 relaxation times using Shortened Modified Look-Locker Inversion Recovery (ShMOLLI) in 3T
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Neubauer Stefan, Ferreira Vanessa M, Piechnik Stefan K, Dall'Armellina Erica, and Robson Matthew D
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2010
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20. Adenosine Stress and Rest T1 Mapping Can Differentiate Between Ischemic, Infarcted, Remote, and Normal Myocardium Without the Need for Gadolinium Contrast Agents
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Liu, Alexander, Wijesurendra, Rohan S., Francis, Jane M., Robson, Matthew D., Neubauer, Stefan, Piechnik, Stefan K., and Ferreira, Vanessa M.
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Adult ,Male ,Adenosine ,T1 mapping ,Vasodilator Agents ,ROI, region of interest ,Myocardial Infarction ,Myocardial Ischemia ,Contrast Media ,MBF, myocardial blood flow ,Magnetic Resonance Imaging, Cine ,ischemia ,CAD, chronic coronary artery disease ,Ventricular Function, Left ,cardiac magnetic resonance ,Diagnosis, Differential ,MBV, myocardial blood volume ,Young Adult ,Meglumine ,Predictive Value of Tests ,CMR, cardiac magnetic resonance ,Coronary Circulation ,Organometallic Compounds ,Humans ,cardiovascular diseases ,LV, left ventricular ,Aged ,Original Research ,LGE, late gadolinium enhancement ,Myocardium ,Myocardial Perfusion Imaging ,Middle Aged ,Magnetic Resonance Imaging ,Radiology Nuclear Medicine and imaging ,Case-Control Studies ,adenosine stress ,cardiovascular system ,ShMOLLI, Shortened Modified Look-Locker Inversion recovery ,ShMOLLI ,Female ,Cardiology and Cardiovascular Medicine - Abstract
Objectives The aim of this study was to evaluate the potential of T1 mapping at rest and during adenosine stress as a novel method for ischemia detection without the use of gadolinium contrast. Background In chronic coronary artery disease (CAD), accurate detection of ischemia is important because targeted revascularization improves clinical outcomes. Myocardial blood volume (MBV) may be a more comprehensive marker of ischemia than myocardial bloodflow. T1 mapping using cardiac magnetic resonance (CMR) is highly sensitive to changes in myocardial water content, including MBV. We propose that T1 mapping at rest and during adenosine vasodilatory stress can detect MBV changes in normal and diseased myocardium in CAD. Methods Twenty normal controls (10 at 1.5-T; 10 at 3.0-T) and 10 CAD patients (1.5-T) underwent conventional CMR to assess for left ventricular function (cine), infarction (late gadolinium enhancement [LGE]) and ischemia (myocardial perfusion reserve index [MPRI] onfirst-pass perfusion imaging during adenosine stress). These were compared to novel pre-contrast stress/rest T1 mapping using the Shortened Modified Look-Locker Inversion recovery technique, which is heart rate independent. T1 values were derived for normal myocardium in controls and for infarcted, ischemic, and remote myocardium in CAD patients. Results Normal myocardium in controls (normal wall motion, MPRI, no LGE) showed normal resting T1 (954±19 ms at 1.5-T; 1,189±34 ms at 3.0-T) and significant positive T1 reactivity during adenosine stress compared to baseline (6.2±0.5% at 1.5-T; 6.3±1.1% at 3.0-T; all p Conclusions T1 mapping at rest and during adenosine stress can differentiate between normal, infarcted, ischemic, and remote myocardium with distinctive T1 profiles. Stress/rest T1 mapping holds promisefor ischemia detection without the need for gadolinium contrast.
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- 2016
21. Comparison of T1 mapping techniques for ECV quantification. Histological validation and reproducibility of ShMOLLI versus multibreath-hold T1 quantification equilibrium contrast CMR
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Fontana Marianna, White Steve K, Banypersad Sanjay M, Sado Daniel M, Maestrini Viviana, Flett Andrew S, Piechnik Stefan K, Neubauer Stefan, Roberts Neil, and Moon James C
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Interstitial space ,Fibrosis ,CMR ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Myocardial extracellular volume (ECV) is elevated in fibrosis or infiltration and can be quantified by measuring the haematocrit with pre and post contrast T1 at sufficient contrast equilibrium. Equilibrium CMR (EQ-CMR), using a bolus-infusion protocol, has been shown to provide robust measurements of ECV using a multibreath-hold T1 pulse sequence. Newer, faster sequences for T1 mapping promise whole heart coverage and improved clinical utility, but have not been validated. Methods Multibreathhold T1 quantification with heart rate correction and single breath-hold T1 mapping using Shortened Modified Look-Locker Inversion recovery (ShMOLLI) were used in equilibrium contrast CMR to generate ECV values and compared in 3 ways. Firstly, both techniques were compared in a spectrum of disease with variable ECV expansion (n=100, 50 healthy volunteers, 12 patients with hypertrophic cardiomyopathy, 18 with severe aortic stenosis, 20 with amyloid). Secondly, both techniques were correlated to human histological collagen volume fraction (CVF%, n=18, severe aortic stenosis biopsies). Thirdly, an assessment of test:retest reproducibility of the 2 CMR techniques was performed 1 week apart in individuals with widely different ECVs (n=10 healthy volunteers, n=7 amyloid patients). Results More patients were able to perform ShMOLLI than the multibreath-hold technique (6% unable to breath-hold). ECV calculated by multibreath-hold T1 and ShMOLLI showed strong correlation (r2=0.892), little bias (bias -2.2%, 95%CI -8.9% to 4.6%) and good agreement (ICC 0.922, range 0.802 to 0.961, p2= 0.589) but better by ShMOLLI ECV (r2= 0.685). Inter-study reproducibility demonstrated that ShMOLLI ECV trended towards greater reproducibility than the multibreath-hold ECV, although this did not reach statistical significance (95%CI -4.9% to 5.4% versus 95%CI -6.4% to 7.3% respectively, p=0.21). Conclusions ECV quantification by single breath-hold ShMOLLI T1 mapping can measure ECV by EQ-CMR across the spectrum of interstitial expansion. It is procedurally better tolerated, slightly more reproducible and better correlates with histology compared to the older multibreath-hold FLASH techniques.
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- 2012
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22. Non-contrast T1-mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to T2-weighted cardiovascular magnetic resonance
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Ferreira Vanessa M, Piechnik Stefan K, Dall’Armellina Erica, Karamitsos Theodoros D, Francis Jane M, Choudhury Robin P, Friedrich Matthias G, Robson Matthew D, and Neubauer Stefan
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T1-mapping ,ShMOLLI ,Myocardial edema ,Cardiovascular magnetic resonance ,T2-weighted MRI ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background T2w-CMR is used widely to assess myocardial edema. Quantitative T1-mapping is also sensitive to changes in free water content. We hypothesized that T1-mapping would have a higher diagnostic performance in detecting acute edema than dark-blood and bright-blood T2w-CMR. Methods We investigated 21 controls (55 ± 13 years) and 21 patients (61 ± 10 years) with Takotsubo cardiomyopathy or acute regional myocardial edema without infarction. CMR performed within 7 days included cine, T1-mapping using ShMOLLI, dark-blood T2-STIR, bright-blood ACUT2E and LGE imaging. We analyzed wall motion, myocardial T1 values and T2 signal intensity (SI) ratio relative to both skeletal muscle and remote myocardium. Results All patients had acute cardiac symptoms, increased Troponin I (0.15-36.80 ug/L) and acute wall motion abnormalities but no LGE. T1 was increased in patient segments with abnormal and normal wall motion compared to controls (1113 ± 94 ms, 1029 ± 59 ms and 944 ± 17 ms, respectively; p Conclusions Non-contrast T1-mapping using ShMOLLI is a novel method for objectively detecting myocardial edema with a high diagnostic performance. T1-mapping may serve as a complementary technique to T2-weighted imaging for assessing myocardial edema in ischemic and non-ischemic heart disease, such as quantifying area-at-risk and diagnosing myocarditis.
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- 2012
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23. Cardiovascular magnetic resonance by non contrast T1-mapping allows assessment of severity of injury in acute myocardial infarction
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Dall'Armellina Erica, Piechnik Stefan K, Ferreira Vanessa M, Si Quang Le, Robson Matthew D, Francis Jane M, Cuculi Florim, Kharbanda Rajesh K, Banning Adrian P, Choudhury Robin P, Karamitsos Theodoros D, and Neubauer Stefan
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Current cardiovascular magnetic resonance (CMR) methods, such as late gadolinium enhancement (LGE) and oedema imaging (T2W) used to depict myocardial ischemia, have limitations. Novel quantitative T1-mapping techniques have the potential to further characterize the components of ischemic injury. In patients with myocardial infarction (MI) we sought to investigate whether state-of the art pre-contrast T1-mapping (1) detects acute myocardial injury, (2) allows for quantification of the severity of damage when compared to standard techniques such as LGE and T2W, and (3) has the ability to predict long term functional recovery. Methods 3T CMR including T2W, T1-mapping and LGE was performed in 41 patients [of these, 78% were ST elevation MI (STEMI)] with acute MI at 12-48 hour after chest pain onset and at 6 months (6M). Patients with STEMI underwent primary PCI prior to CMR. Assessment of acute regional wall motion abnormalities, acute segmental damaged fraction by T2W and LGE and mean segmental T1 values was performed on matching short axis slices. LGE and improvement in regional wall motion at 6M were also obtained. Results We found that the variability of T1 measurements was significantly lower compared to T2W and that, while the diagnostic performance of acute T1-mapping for detecting myocardial injury was at least as good as that of T2W-CMR in STEMI patients, it was superior to T2W imaging in NSTEMI. There was a significant relationship between the segmental damaged fraction assessed by either by LGE or T2W, and mean segmental T1 values (P < 0.01). The index of salvaged myocardium derived by acute T1-mapping and 6M LGE was not different to the one derived from T2W (P = 0.88). Furthermore, the likelihood of improvement of segmental function at 6M decreased progressively as acute T1 values increased (P < 0.0004). Conclusions In acute MI, pre-contrast T1-mapping allows assessment of the extent of myocardial damage. T1-mapping might become an important complementary technique to LGE and T2W for identification of reversible myocardial injury and prediction of functional recovery in acute MI.
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- 2012
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24. Shortened Modified Look-Locker Inversion recovery (ShMOLLI) for clinical myocardial T1-mapping at 1.5 and 3 T within a 9 heartbeat breathhold
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Greiser Andreas, Cochlin Lowri E, Dall'Armellina Erica, Ferreira Vanessa M, Piechnik Stefan K, Neubauer Stefan, and Robson Matthew D
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background T1 mapping allows direct in-vivo quantitation of microscopic changes in the myocardium, providing new diagnostic insights into cardiac disease. Existing methods require long breath holds that are demanding for many cardiac patients. In this work we propose and validate a novel, clinically applicable, pulse sequence for myocardial T1-mapping that is compatible with typical limits for end-expiration breath-holding in patients. Materials and methods The Shortened MOdified Look-Locker Inversion recovery (ShMOLLI) method uses sequential inversion recovery measurements within a single short breath-hold. Full recovery of the longitudinal magnetisation between sequential inversion pulses is not achieved, but conditional interpretation of samples for reconstruction of T1-maps is used to yield accurate measurements, and this algorithm is implemented directly on the scanner. We performed computer simulations for 100 msIn-vivo myocardial T1-mapping using this method and the previous gold-standard (MOLLI) was performed in 10 healthy volunteers at 1.5T and 3T, 4 volunteers with contrast injection at 1.5T, and 4 patients with recent myocardial infarction (MI) at 3T. Results We found good agreement between the average ShMOLLI and MOLLI estimates for T1 < 1200 ms. In contrast to the original method, ShMOLLI showed no dependence on heart rates for long T1 values, with estimates characterized by a constant 4% underestimation for T1 = 800-2700 ms. In-vivo, ShMOLLI measurements required 9.0 ± 1.1 s (MOLLI = 17.6 ± 2.9 s). Average healthy myocardial T1 s by ShMOLLI at 1.5T were 966 ± 48 ms (mean ± SD) and 1166 ± 60 ms at 3T. In MI patients, the T1 in unaffected myocardium (1216 ± 42 ms) was similar to controls at 3T. Ischemically injured myocardium showed increased T1 = 1432 ± 33 ms (p < 0.001). The difference between MI and remote myocardium was estimated 15% larger by ShMOLLI than MOLLI (p < 0.04) which suffers from heart rate dependencies for long T1. The in-vivo variability within ShMOLLI T1-maps was only 14% (1.5T) or 18% (3T) higher than the MOLLI maps, but the MOLLI acquisitions were twice longer than ShMOLLI acquisitions. Conclusion ShMOLLI is an efficient method that generates immediate, high-resolution myocardial T1-maps in a short breath-hold with high precision. This technique provides a valuable clinically applicable tool for myocardial tissue characterisation.
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- 2010
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25. Automatic measurement of the myocardial interstitium synthetic extracellular volume quantification without hematocrit sampling
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Treibel, Thomas A., Fontana, Marianna, Maestrini, Viviana, Castelletti, Silvia, Rosmini, Stefania, Simpson, Joanne, Nasis, Arthur, Bhuva, Anish N., Bulluck, Heerajnarain, Abdel Gadir, Amna, White, Steven K., Manisty, Charlotte, Spottiswoode, Bruce S., Wong, Timothy C., Piechnik, Stefan K., Kellman, Peter, Robson, Matthew D., Schelbert, Erik B., and Moon, James C.
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collagen ,hematocrit ,nuclear medicine and imaging ,london ,male ,left ,middle aged ,myocardium ,magnetic resonance imaging ,humans ,automation ,pennsylvania ,heart diseases ,ECV ,mortality ,myocardial fibrosis ,adult ,aged ,biomarkers ,case-control studies ,extracellular space ,female ,image interpretation, computer-assisted ,linear models ,predictive value of tests ,prognosis ,reproducibility of results ,stroke volume ,ventricular function, left ,young adult ,radiology, nuclear medicine and imaging ,cardiology and cardiovascular medicine ,image interpretation ,radiology ,computer-assisted ,ventricular function - Published
- 2016
26. Clinical Significance of Myocardial Injury in Patients Hospitalized for COVID-19: A Prospective, Multicenter, Cohort Study.
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Shiwani H, Artico J, Moon JC, Gorecka M, McCann GP, Roditi G, Morrow A, Mangion K, Lukaschuk E, Shanmuganathan M, Miller CA, Chiribiri A, Alzahir M, Ramirez S, Lin A, Swoboda PP, McDiarmid AK, Sykes R, Singh T, Bucciarelli-Ducci C, Dawson D, Fontana M, Manisty C, Treibel TA, Levelt E, Arnold R, Young R, McConnachie A, Neubauer S, Piechnik SK, Davies RH, Ferreira VM, Dweck MR, Berry C, and Greenwood JP
- Abstract
Background: Hospitalized COVID-19 patients with troponin elevation have a higher prevalence of cardiac abnormalities than control individuals. However, the progression and impact of myocardial injury on COVID-19 survivors remain unclear., Objectives: This study sought to evaluate myocardial injury in COVID-19 survivors with troponin elevation with baseline and follow-up imaging and to assess medium-term outcomes., Methods: This was a prospective, longitudinal cohort study in 25 United Kingdom centers (June 2020 to March 2021). Hospitalized COVID-19 patients with myocardial injury underwent cardiac magnetic resonance (CMR) scans within 28 days and 6 months postdischarge. Outcomes were tracked for 12 months, with quality of life surveys (EuroQol-5 Dimension and 36-Item Short Form surveys) taken at discharge and 6 months., Results: Of 342 participants (median age: 61.3 years; 71.1% male) with baseline CMR, 338 had a 12-month follow-up, 235 had a 6-month CMR, and 215 has baseline and follow-up quality of life surveys. Of 338 participants, within 12 months, 1.2% died; 1.8% had new myocardial infarction, acute coronary syndrome, or coronary revascularization; 0.8% had new myopericarditis; and 3.3% had other cardiovascular events requiring hospitalization. At 6 months, there was a minor improvement in left ventricular ejection fraction (1.8% ± 1.0%; P < 0.001), stable right ventricular ejection fraction (0.4% ± 0.8%; P = 0.50), no change in myocardial scar pattern or volume (P = 0.26), and no imaging evidence of continued myocardial inflammation. All pericardial effusions (26 of 26) resolved, and most pneumonitis resolved (95 of 101). EuroQol-5 Dimension scores indicated an overall improvement in quality of life (P < 0.001)., Conclusions: Myocardial injury in severe hospitalized COVID-19 survivors is nonprogressive. Medium-term outcomes show a low incidence of major adverse cardiovascular events and improved quality of life. (COVID-19 Effects on the Heart; ISRCTN58667920)., Competing Interests: Funding Support and Author Disclosures This work was supported by NIHR (National Institute for Health and Care Research) and UK Research and Innovation (COV0254). West Yorkshire and Humber Clinical Research Network (CV070) funded the patient information leaflet translation. Dr Berry has received British Heart Foundation support (RE/18/6134217). Dr Artico received funding from the European Association of Cardiovascular Imaging (EACVI Research Grant App000073878). Dr McCann is funded by a NIHR Research Professorship (RP-2017-08-ST2-007). Dr Manisty is funded by a NIHR Clinician Scientist Award (CS-2015-15-003). Drs Ferreira, Piechnik, and Neubauer acknowledge the NIHR Oxford BRC for support of this study. Dr Bucciarelli-Ducci is in part supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS (National Health Service) Foundation Trust and the University of Bristol. Additional support was provided by the NIHR Leicester Biomedical Research Centre and the NIHR Leeds Clinical Research Facility. Dr Dweck is supported by the British Heart Foundation (FS/SCRF/21/32010). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. Dr Moon has served on Advisory Boards for Sanofi and Genzyme. Dr Miller has served on Advisory Boards for Novartis, Boehringer Ingelheim and Lilly Alliance, and AstraZeneca; serves as an advisor for HAYA Therapeutics and PureTech Health; and has received research support from Amicus Therapeutics, Guerbet Laboratories Limited, Roche, and Univar Solutions B.V. Dr Bucciarelli-Ducci is the chief executive officer (part-time) of the Society for Magnetic Resonance. Dr Berry is employed by the University of Glasgow, which holds research and/or consultancy agreements with AstraZeneca, Abbott Vascular, Boehringer Ingelheim, GlaxoSmithKline, HeartFlow, Opsens, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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27. The Role of Coronary Blood Flow and Myocardial Edema in the Pathophysiology of Takotsubo Syndrome.
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Couch LS, Thomas KE, Marin F, Terentes-Printzios D, Kotronias RA, Chai J, Lukaschuk E, Shanmuganathan M, Kellman P, Langrish JP, Channon KM, Neubauer S, Piechnik SK, Ferreira VM, De Maria GL, and Banning AP
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- Humans, Myocardium pathology, Predictive Value of Tests, Ventricular Function, Left, Coronary Angiography, Prognosis, Takotsubo Cardiomyopathy physiopathology, Takotsubo Cardiomyopathy diagnostic imaging, Coronary Circulation, Edema, Cardiac physiopathology, Edema, Cardiac diagnostic imaging, Edema, Cardiac etiology
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- 2024
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28. Cardiovascular Magnetic Resonance Before Invasive Coronary Angiography in Suspected Non-ST-Segment Elevation Myocardial Infarction.
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Shanmuganathan M, Nikolaidou C, Burrage MK, Borlotti A, Kotronias R, Scarsini R, Banerjee A, Terentes-Printzios D, Pitcher A, Gara E, Langrish J, Lucking A, Choudhury R, De Maria GL, Banning A, Piechnik SK, Channon KM, and Ferreira VM
- Abstract
Background: In suspected non-ST-segment elevation myocardial infarction (NSTEMI), this presumed diagnosis may not hold true in all cases, particularly in patients with nonobstructive coronary arteries (NOCA). Additionally, in multivessel coronary artery disease, the presumed infarct-related artery may be incorrect., Objectives: This study sought to assess the diagnostic utility of cardiac magnetic resonance (CMR) before invasive coronary angiogram (ICA) in suspected NSTEMI., Methods: A total of 100 consecutive stable patients with suspected acute NSTEMI (70% male, age 62 ± 11 years) prospectively underwent CMR pre-ICA to assess cardiac function (cine), edema (T
2 -weighted imaging, T1 mapping), and necrosis/scar (late gadolinium enhancement). CMR images were interpreted blinded to ICA findings. The clinical care and ICA teams were blinded to CMR findings until post-ICA., Results: Early CMR (median 33 hours postadmission and 4 hours pre-ICA) confirmed only 52% (52 of 100) of patients had subendocardial infarction, 15% transmural infarction, 18% nonischemic pathologies (myocarditis, Takotsubo and other forms of cardiomyopathies), and 11% normal CMR; 4% were nondiagnostic. Subanalyses according to ICA findings showed that, in patients with obstructive coronary artery disease (73 of 100), CMR confirmed only 84% (61 of 73) had MI, 10% (7 of 73) nonischemic pathologies, and 5% (4 of 73) normal. In patients with NOCA (27 of 100), CMR found MI in only 22% (6 of 27 true MI with NOCA), and reclassified the presumed diagnosis of NSTEMI in 67% (18 of 27: 11 nonischemic pathologies, 7 normal). In patients with CMR-MI and obstructive coronary artery disease (61 of 100), CMR identified a different infarct-related artery in 11% (7 of 61)., Conclusions: In patients presenting with suspected NSTEMI, a CMR-first strategy identified MI in 67%, nonischemic pathologies in 18%, and normal findings in 11%. Accordingly, CMR has the potential to affect at least 50% of all patients by reclassifying their diagnosis or altering their potential management., Competing Interests: Funding Support and Author Disclosures The OxAMI study is supported by a British Heart Foundation (BHF) Centre of Research Excellence (CRE) Oxford (RE/13/1/30181), and the National Institute for Health Research Oxford Biomedical Research Centre. Dr Shanmuganathan has received funding from the Alison Brading Memorial Graduate Scholarship in Medical Science, Lady Margaret Hall, University of Oxford. Dr Burrage has received support from a British Heart Foundation Clinical Research Training Fellowship (FS/19/65/34692). Dr Gara has received a European Society of Cardiology, EACVI Research grant. Dr Piechnik has received support from the BHF CRE Oxford (RE/18/3/34214); and has patent authorship rights for U.S. patent 9285446 B2 (systems and methods for Shortened Look Locker Inversion Recovery [Sh-MOLLI] cardiac gated mapping of T1), granted March 15, 2016; intellectual properties are owned and managed by Oxford University Innovations. Dr Channon has received funding from a BHF Chair award (CH/16/1/32013). Dr Ferreira has received funding from the BHF, BHF CRE Oxford, and National Institute for Health Research Oxford Biomedical Research Center. The funders were not involved in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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29. Concurrent Left Ventricular Myocardial Diffuse Fibrosis and Left Atrial Dysfunction Strongly Predict Incident Heart Failure.
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Wong MYZ, Vargas JD, Naderi H, Sanghvi MM, Raisi-Estabragh Z, Suinesiaputra A, Bonazzola R, Attar R, Ravikumar N, Hann E, Neubauer S, Piechnik SK, Frangi AF, Petersen SE, and Aung N
- Subjects
- Humans, Male, Female, Risk Factors, Aged, Middle Aged, Ventricular Dysfunction, Left physiopathology, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left etiology, Incidence, Risk Assessment, Time Factors, Prognosis, Heart Atria physiopathology, Heart Atria diagnostic imaging, Cardiomyopathies physiopathology, Cardiomyopathies diagnostic imaging, Cardiomyopathies etiology, Fibrosis, Heart Failure physiopathology, Heart Failure diagnostic imaging, Heart Failure etiology, Atrial Function, Left, Ventricular Function, Left, Myocardium pathology, Predictive Value of Tests
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- 2024
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30. Editorial Expression of Concern: Splenic T1-mapping: a novel quantitative method for assessing adenosine stress adequacy for cardiovascular magnetic resonance.
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Liu A, Wijesurendra RS, Ariga R, Mahmod M, Levelt E, Greiser A, Petrou M, Krasopoulos G, Forfar JC, Kharbanda RK, Channon KM, Neubauer S, Piechnik SK, and Ferreira VM
- Published
- 2023
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31. Acute Response in the Noninfarcted Myocardium Predicts Long-Term Major Adverse Cardiac Events After STEMI.
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Shanmuganathan M, Masi A, Burrage MK, Kotronias RA, Borlotti A, Scarsini R, Banerjee A, Terentes-Printzios D, Zhang Q, Hann E, Tunnicliffe E, Lucking A, Langrish J, Kharbanda R, De Maria GL, Banning AP, Choudhury RP, Channon KM, Piechnik SK, and Ferreira VM
- Subjects
- Humans, Stroke Volume, Ventricular Function, Left, Magnetic Resonance Imaging, Cine methods, Contrast Media, Predictive Value of Tests, Gadolinium, Myocardium pathology, Prognosis, ST Elevation Myocardial Infarction diagnostic imaging, ST Elevation Myocardial Infarction therapy, ST Elevation Myocardial Infarction complications, Anterior Wall Myocardial Infarction complications, Percutaneous Coronary Intervention adverse effects
- Abstract
Background: Acute ST-segment elevation myocardial infarction (STEMI) has effects on the myocardium beyond the immediate infarcted territory. However, pathophysiologic changes in the noninfarcted myocardium and their prognostic implications remain unclear., Objectives: The purpose of this study was to evaluate the long-term prognostic value of acute changes in both infarcted and noninfarcted myocardium post-STEMI., Methods: Patients with acute STEMI undergoing primary percutaneous coronary intervention underwent evaluation with blood biomarkers and cardiac magnetic resonance (CMR) at 2 days and 6 months, with long-term follow-up for major adverse cardiac events (MACE). A comprehensive CMR protocol included cine, T2-weighted, T2∗, T1-mapping, and late gadolinium enhancement (LGE) imaging. Areas without LGE were defined as noninfarcted myocardium. MACE was a composite of cardiac death, sustained ventricular arrhythmia, and new-onset heart failure., Results: Twenty-two of 219 patients (10%) experienced an MACE at a median of 4 years (IQR: 2.5-6.0 years); 152 patients returned for the 6-month visit. High T1 (>1250 ms) in the noninfarcted myocardium was associated with lower left ventricular ejection fraction (LVEF) (51% ± 8% vs 55% ± 9%; P = 0.002) and higher NT-pro-BNP levels (290 pg/L [IQR: 103-523 pg/L] vs 170 pg/L [IQR: 61-312 pg/L]; P = 0.008) at 6 months and a 2.5-fold (IQR: 1.03-6.20) increased risk of MACE (2.53 [IQR: 1.03-6.22]), compared with patients with normal T1 in the noninfarcted myocardium (P = 0.042). A lower T1 (<1,300 ms) in the infarcted myocardium was associated with increased MACE (3.11 [IQR: 1.19-8.13]; P = 0.020). Both noninfarct and infarct T1 were independent predictors of MACE (both P = 0.001) and significantly improved risk prediction beyond LVEF, infarct size, and microvascular obstruction (C-statistic: 0.67 ± 0.07 vs 0.76 ± 0.06, net-reclassification index: 40% [IQR: 12%-64%]; P = 0.007)., Conclusions: The acute responses post-STEMI in both infarcted and noninfarcted myocardium are independent incremental predictors of long-term MACE. These insights may provide new opportunities for treatment and risk stratification in STEMI., Competing Interests: Funding Support and Author Disclosures The OxAMI study is supported by the British Heart Foundation (BHF) Centre of Research Excellence (CRE) Oxford (RE/13/1/30181), and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. Dr Shanmuganathan is supported by the Alison Brading Memorial Graduate Scholarship in Medical Science, Lady Margaret Hall, University of Oxford. Dr Burrage was supported by a BHF Clinical Research Training Fellowship (FS/19/65/34692). Prof Channon is funded by a BHF Chair award (CH/16/1/32013). Prof Ferreira has received support from the BHF, BHF CRE Oxford, and NIHR Oxford BRC. Prof Piechnik and Dr Zhang have received support from the BHF CRE Oxford (RE/18/3/34214). Prof Piechnik has patent authorship rights for U.S. patent 9285446 B2 (systems and methods for Shortened Look-Locker Inversion Recovery [Sh-MOLLI] cardiac gated mapping of T1), granted March 15, 2016; all rights transferred to Siemens Medical. The funders were not involved in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the paper. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023. Published by Elsevier Inc.)
- Published
- 2023
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32. Mitral Annular Disjunction Assessed Using CMR Imaging: Insights From the UK Biobank Population Study.
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Zugwitz D, Fung K, Aung N, Rauseo E, McCracken C, Cooper J, El Messaoudi S, Anderson RH, Piechnik SK, Neubauer S, Petersen SE, and Nijveldt R
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- Humans, Biological Specimen Banks, Predictive Value of Tests, Prolapse, United Kingdom epidemiology, Mitral Valve, Mitral Valve Prolapse diagnostic imaging, Mitral Valve Prolapse epidemiology
- Abstract
Background: Mitral annular disjunction is the atrial displacement of the mural mitral valve leaflet hinge point within the atrioventricular junction. Said to be associated with malignant ventricular arrhythmias and sudden death, its prevalence in the general population is not known., Objectives: The purpose of this study was to assess the frequency of occurrence and extent of mitral annular disjunction in a large population cohort., Methods: The authors assessed the cardiac magnetic resonance (CMR) images in 2,646 Caucasian subjects enrolled in the UK Biobank imaging study, measuring the length of disjunction at 4 points around the mitral annulus, assessing for presence of prolapse or billowing of the leaflets, and for curling motion of the inferolateral left ventricular wall., Results: From 2,607 included participants, the authors found disjunction in 1,990 (76%) cases, most commonly at the anterior and inferior ventricular wall. The authors found inferolateral disjunction, reported as clinically important, in 134 (5%) cases. Prolapse was more frequent in subjects with disjunction (odds ratio [OR]: 2.5; P = 0.02), with positive associations found between systolic curling and disjunction at any site (OR: 3.6; P < 0.01), and systolic curling and prolapse (OR: 71.9; P < 0.01)., Conclusions: This large-scale study shows that disjunction is a common finding when using CMR. Disjunction at the inferolateral ventricular wall, however, was rare. The authors found associations between disjunction and both prolapse and billowing of the mural mitral valve leaflet. These findings support the notion that only extensive inferolateral disjunction, when found, warrants consideration of further investigation, but disjunction elsewhere in the annulus should be considered a normal finding., Competing Interests: Funding Support and Author Disclosures This work was partly funded by the European Union’s Horizon 2020 research and innovation program under grant agreement number 825903 (euCanSHare project, Dr Petersen). Dr Petersen acknowledges support from the National Institute for Health Research (NIHR) Biomedical Research Centre at Barts, London, United Kingdom. Drs Petersen, Neubauer, and Piechnik acknowledge the British Heart Foundation, London, United Kingdom, for funding the manual analysis to create a cardiovascular magnetic resonance imaging reference standard for the UK Biobank imaging resource in 5000 CMR scans (PG/14/89/31194). This project was enabled through access to the Medical Research Council eMedLab Medical Bioinformatics infrastructure, supported by the Medical Research Council (MR/L016311/1). Dr Zugwitz acknowledges funding received from the European Society of Cardiology, Sophia Antipolis Cedex, France, in the form of an European Society of Cardiology Training Grant. Dr Neubauer acknowledges support from the Oxford NIHR Biomedical Research Centre and the Oxford British Heart Foundation Centre of Research Excellence. Dr Aung recognizes the NIHR Integrated Academic Training program, which supports his Academic Clinical Lectureship post. Drs McCracken and Neubauer are supported by the Oxford NIHR Biomedical Research Centre. Drs Petersen and Rauseo acknowledge support by the London Medical Imaging and Artificial Intelligence Centre for Value Based Healthcare (AI4VBH), which is funded from the Data to Early Diagnosis and Precision Medicine strand of the government’s Industrial Strategy Challenge Fund, managed and delivered by Innovate UK on behalf of United Kingdom Research and Innovation (UKRI). Dr Nijveldt has received research grants from Philips Volcano and Biotronik. Dr Petersen provides consultancy to Circle Cardiovascular Imaging, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
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33. Shape registration with learned deformations for 3D shape reconstruction from sparse and incomplete point clouds.
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Chen X, Ravikumar N, Xia Y, Attar R, Diaz-Pinto A, Piechnik SK, Neubauer S, Petersen SE, and Frangi AF
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- Heart, Humans, Magnetic Resonance Imaging, Algorithms, Imaging, Three-Dimensional
- Abstract
Shape reconstruction from sparse point clouds/images is a challenging and relevant task required for a variety of applications in computer vision and medical image analysis (e.g. surgical navigation, cardiac motion analysis, augmented/virtual reality systems). A subset of such methods, viz. 3D shape reconstruction from 2D contours, is especially relevant for computer-aided diagnosis and intervention applications involving meshes derived from multiple 2D image slices, views or projections. We propose a deep learning architecture, coined Mesh Reconstruction Network (MR-Net), which tackles this problem. MR-Net enables accurate 3D mesh reconstruction in real-time despite missing data and with sparse annotations. Using 3D cardiac shape reconstruction from 2D contours defined on short-axis cardiac magnetic resonance image slices as an exemplar, we demonstrate that our approach consistently outperforms state-of-the-art techniques for shape reconstruction from unstructured point clouds. Our approach can reconstruct 3D cardiac meshes to within 2.5-mm point-to-point error, concerning the ground-truth data (the original image spatial resolution is ∼1.8×1.8×10mm
3 ). We further evaluate the robustness of the proposed approach to incomplete data, and contours estimated using an automatic segmentation algorithm. MR-Net is generic and could reconstruct shapes of other organs, making it compelling as a tool for various applications in medical image analysis., Competing Interests: Declaration of Competing Interest SEP provides consultancy to and is shareholder of Circle Cardiovascular Imaging, Inc., Calgary, Alberta, Canada., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)- Published
- 2021
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34. Deep neural network ensemble for on-the-fly quality control-driven segmentation of cardiac MRI T1 mapping.
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Hann E, Popescu IA, Zhang Q, Gonzales RA, Barutçu A, Neubauer S, Ferreira VM, and Piechnik SK
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- Humans, Image Processing, Computer-Assisted, Neural Networks, Computer, Quality Control, Reproducibility of Results, Artificial Intelligence, Magnetic Resonance Imaging
- Abstract
Recent developments in artificial intelligence have generated increasing interest to deploy automated image analysis for diagnostic imaging and large-scale clinical applications. However, inaccuracy from automated methods could lead to incorrect conclusions, diagnoses or even harm to patients. Manual inspection for potential inaccuracies is labor-intensive and time-consuming, hampering progress towards fast and accurate clinical reporting in high volumes. To promote reliable fully-automated image analysis, we propose a quality control-driven (QCD) segmentation framework. It is an ensemble of neural networks that integrate image analysis and quality control. The novelty of this framework is the selection of the most optimal segmentation based on predicted segmentation accuracy, on-the-fly. Additionally, this framework visualizes segmentation agreement to provide traceability of the quality control process. In this work, we demonstrated the utility of the framework in cardiovascular magnetic resonance T1-mapping - a quantitative technique for myocardial tissue characterization. The framework achieved near-perfect agreement with expert image analysts in estimating myocardial T1 value (r=0.987,p<.0005; mean absolute error (MAE)=11.3ms), with accurate segmentation quality prediction (Dice coefficient prediction MAE=0.0339) and classification (accuracy=0.99), and a fast average processing time of 0.39 second/image. In summary, the QCD framework can generate high-throughput automated image analysis with speed and accuracy that is highly desirable for large-scale clinical applications., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Authors declare that a patent is filed for the methods used in this submitted work., (Copyright © 2021. Published by Elsevier B.V.)
- Published
- 2021
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35. Cardiovascular magnetic resonance stress and rest T1-mapping using regadenoson for detection of ischemic heart disease compared to healthy controls.
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Burrage MK, Shanmuganathan M, Masi A, Hann E, Zhang Q, Popescu IA, Soundarajan R, Leal Pelado J, Chow K, Neubauer S, Piechnik SK, and Ferreira VM
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- Contrast Media, Coronary Circulation, Humans, Magnetic Resonance Imaging, Magnetic Resonance Imaging, Cine, Magnetic Resonance Spectroscopy, Myocardium, Predictive Value of Tests, Purines, Pyrazoles, Myocardial Ischemia diagnostic imaging, Myocardial Perfusion Imaging
- Abstract
Background: Adenosine stress T1-mapping on cardiovascular magnetic resonance (CMR) can differentiate between normal, ischemic, infarcted, and remote myocardial tissue classes without the need for contrast agents. Regadenoson, a selective coronary vasodilator, is often used in stress perfusion imaging when adenosine is contra-indicated, and has advantages in ease of administration, safety profile, and clinical workflow. We aimed to characterize the regadenoson stress T1-mapping response in healthy individuals, and to investigate its ability to differentiate between myocardial tissue classes in patients with coronary artery disease (CAD)., Methods: Eleven healthy controls and 25 patients with CAD underwent regadenoson stress perfusion CMR, as well as rest and stress ShMOLLI T1-mapping. Native T1 values and stress T1 reactivity were derived for normal myocardium in healthy controls and for different myocardial tissue classes in patients with CAD., Results: Healthy controls had normal myocardial native T1 values at rest (931 ± 22 ms) with significant global regadenoson stress T1 reactivity (δT1 = 8.2 ± 0.8% relative to baseline; p < 0.0001). Infarcted myocardium had significantly higher resting T1 (1215 ± 115 ms) than ischemic, remote, and normal myocardium (all p < 0.0001) with an abolished stress T1 response (δT1 = -0.8% [IQR: -1.9-0.5]). Ischemic myocardium had elevated resting T1 compared to normal (964 ± 57 ms; p < 0.01) with an abolished stress T1 response (δT1 = 0.5 ± 1.6%). Remote myocardium in patients had comparable resting T1 to normal (949 ms [IQR: 915-973]; p = 0.06) with blunted stress reactivity (δT1 = 4.3% [IQR: 3.1-6.3]; p < 0.0001)., Conclusions: Healthy controls demonstrate significant stress T1 reactivity during regadenoson stress. Regadenoson stress and rest T1-mapping is a viable alternative to adenosine and exercise for the assessment of CAD and can distinguish between normal, ischemic, infarcted, and remote myocardium., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2021
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36. Quality assurance of quantitative cardiac T1-mapping in multicenter clinical trials - A T1 phantom program from the hypertrophic cardiomyopathy registry (HCMR) study.
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Zhang Q, Werys K, Popescu IA, Biasiolli L, Ntusi NAB, Desai M, Zimmerman SL, Shah DJ, Autry K, Kim B, Kim HW, Jenista ER, Huber S, White JA, McCann GP, Mohiddin SA, Boubertakh R, Chiribiri A, Newby D, Prasad S, Radjenovic A, Dawson D, Schulz-Menger J, Mahrholdt H, Carbone I, Rimoldi O, Colagrande S, Calistri L, Michels M, Hofman MBM, Anderson L, Broberg C, Andrew F, Sanz J, Bucciarelli-Ducci C, Chow K, Higgins D, Broadbent DA, Semple S, Hafyane T, Wormleighton J, Salerno M, He T, Plein S, Kwong RY, Jerosch-Herold M, Kramer CM, Neubauer S, Ferreira VM, and Piechnik SK
- Subjects
- Humans, Phantoms, Imaging, Registries, Reproducibility of Results, Cardiomyopathy, Hypertrophic diagnostic imaging, Magnetic Resonance Imaging
- Abstract
Background: Quantitative cardiovascular magnetic resonance T1-mapping is increasingly used for myocardial tissue characterization. However, the lack of standardization limits direct comparability between centers and wider roll-out for clinical use or trials., Purpose: To develop a quality assurance (QA) program assuring standardized T1 measurements for clinical use., Methods: MR phantoms manufactured in 2013 were distributed, including ShMOLLI T1-mapping and reference T1 and T2 protocols. We first studied the T1 and T2 dependency on temperature and phantom aging using phantom datasets from a single site over 4 years. Based on this, we developed a multiparametric QA model, which was then applied to 78 scans from 28 other multi-national sites., Results: T1 temperature sensitivity followed a second-order polynomial to baseline T1 values (R
2 > 0.996). Some phantoms showed aging effects, where T1 drifted up to 49% over 40 months. The correlation model based on reference T1 and T2, developed on 1004 dedicated phantom scans, predicted ShMOLLI-T1 with high consistency (coefficient of variation 1.54%), and was robust to temperature variations and phantom aging. Using the 95% confidence interval of the correlation model residuals as the tolerance range, we analyzed 390 ShMOLLI T1-maps and confirmed accurate sequence deployment in 90%(70/78) of QA scans across 28 multiple centers, and categorized the rest with specific remedial actions., Conclusions: The proposed phantom QA for T1-mapping can assure correct method implementation and protocol adherence, and is robust to temperature variation and phantom aging. This QA program circumvents the need of frequent phantom replacements, and can be readily deployed in multicenter trials., Competing Interests: Declaration of Competing Interest SKP has patent authorship rights for U.S. patent US20120078084A1. Systems and methods for shortened Look Locker inversion recovery (Sh-MOLLI) cardiac gated mapping of T1. Granted March 15, 2016. IP is managed by Oxford University Innovations; the license exclusively transferred to Siemens Healthcare. QZ, SKP, KW, IAP, VMF have authorship rights for pending patent PCT/GB2020/051189. A method for identity validation and quality assurance of quantitative magnetic resonance imaging protocols. Filed May 15, 2020. IP is owned and managed by Oxford University Innovations., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)- Published
- 2021
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37. Standardization of T1-mapping in cardiovascular magnetic resonance using clustered structuring for benchmarking normal ranges.
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Popescu IA, Werys K, Zhang Q, Puchta H, Hann E, Lukaschuk E, Ferreira VM, and Piechnik SK
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- Humans, Magnetic Resonance Spectroscopy, Predictive Value of Tests, Reference Standards, Reference Values, Reproducibility of Results, Benchmarking, Magnetic Resonance Imaging
- Abstract
Background: Cardiovascular magnetic resonance T1-mapping is increasingly used for tissue characterization, commonly based on Modified Look-Locker Inversion recovery (MOLLI). However, there are numerous MOLLI variants with differing normal ranges. This lack of standardization presents confusion and difficulty in inter-center comparisons, hindering widespread adoption of T1-mapping., Methods: To address this, we performed a structured literature search for native left ventricular myocardial T1-mapping in healthy humans measured using MOLLI variants at 1.5 and 3 Tesla, across scanner vendors. We then used k-means clustering to structure normal MOLLI-T1 values according to magnetic field strength, and investigated correlations between common imaging parameters: repetition time (TR), echo time (TE), flip angle (FA)., Results: We analyzed data from 2207 healthy controls in 76 independent reports. Normal MOLLI-T1 standard deviations varied by 11-fold, and dependencies on TE, TR, and FA differed between 1.5 T and 3 T, thwarting meaningful T1 standardization even within a single field strength, including the use of Z-score. However, divergent MOLLI-T1 norms may be structured using data clustering. For 1.5 T, two clusters emerged: Cluster1
1.5T : T1 = 958 ± 16 ms (n = 1280); Cluster21.5T : T1 = 1027 ± 19 ms (n = 386). For 3 T, three clusters emerged: Cluster13T : T1 = 1160 ± 21 ms (n = 330); Cluster23T : T1 = 1067 ± 18 ms (n = 178); Cluster33T : T1 = 1227 ± 19 ms (n = 41). We then propose the concept of an online calculator for assigning local norms to a known MOLLI-T1 cluster, allowing benchmarking against published norms., Conclusion: Clustered structuring allows T1 standardization of widely-divergent MOLLI variants, benchmarking local norms (usually based on smaller samples) against published norms (larger samples). This may increase confidence and quality control in method implementation, facilitating wider clinical adoption of T1-mapping., Competing Interests: Declaration of Competing Interest SKP has patent authorship rights for U.S. patent US20120078084A1. Systems and methods for shortened Look Locker inversion recovery (Sh-MOLLI) cardiac gated mapping of T1. Granted March 15, 2016. IP is managed by Oxford University Innovations; the license exclusively transferred to Siemens Healthcare. All other authors have no industry relationships relevant to the contents of this paper to disclose., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)- Published
- 2021
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38. Recovering from missing data in population imaging - Cardiac MR image imputation via conditional generative adversarial nets.
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Xia Y, Zhang L, Ravikumar N, Attar R, Piechnik SK, Neubauer S, Petersen SE, and Frangi AF
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- Artifacts, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging
- Abstract
Accurate ventricular volume measurements are the primary indicators of normal/abnor- mal cardiac function and are dependent on the Cardiac Magnetic Resonance (CMR) volumes being complete. However, missing or unusable slices owing to the presence of image artefacts such as respiratory or motion ghosting, aliasing, ringing and signal loss in CMR sequences, significantly hinder accuracy of anatomical and functional cardiac quantification, and recovering from those is insufficiently addressed in population imaging. In this work, we propose a new robust approach, coined Image Imputation Generative Adversarial Network (I2-GAN), to learn key features of cardiac short axis (SAX) slices near missing information, and use them as conditional variables to infer missing slices in the query volumes. In I2-GAN, the slices are first mapped to latent vectors with position features through a regression net. The latent vector corresponding to the desired position is then projected onto the slice manifold, conditioned on intensity features through a generator net. The generator comprises residual blocks with normalisation layers that are modulated with auxiliary slice information, enabling propagation of fine details through the network. In addition, a multi-scale discriminator was implemented, along with a discriminator-based feature matching loss, to further enhance performance and encourage the synthesis of visually realistic slices. Experimental results show that our method achieves significant improvements over the state-of-the-art, in missing slice imputation for CMR, with an average SSIM of 0.872. Linear regression analysis yields good agreement between reference and imputed CMR images for all cardiac measurements, with correlation coefficients of 0.991 for left ventricular volume, 0.977 for left ventricular mass and 0.961 for right ventricular volume., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier B.V.)
- Published
- 2021
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39. Cardiovascular magnetic resonance reference values of mitral and tricuspid annular dimensions: the UK Biobank cohort.
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Ricci F, Aung N, Gallina S, Zemrak F, Fung K, Bisaccia G, Paiva JM, Khanji MY, Mantini C, Palermi S, Lee AM, Piechnik SK, Neubauer S, and Petersen SE
- Subjects
- Age Factors, Aged, Cross-Sectional Studies, Female, Healthy Volunteers, Humans, Male, Middle Aged, Observer Variation, Predictive Value of Tests, Reference Values, Reproducibility of Results, Sex Factors, United Kingdom, White People, Magnetic Resonance Imaging, Cine, Mitral Valve diagnostic imaging, Tricuspid Valve diagnostic imaging
- Abstract
Background: Mitral valve (MV) and tricuspid valve (TV) apparatus geometry are essential to define mechanisms and etiologies of regurgitation and to inform surgical or transcatheter interventions. Given the increasing use of cardiovascular magnetic resonance (CMR) for the evaluation of valvular heart disease, we aimed to establish CMR-derived age- and sex-specific reference values for mitral annular (MA) and tricuspid annular (TA) dimensions and tethering indices derived from truly healthy Caucasian adults., Methods: 5065 consecutive UK Biobank participants underwent CMR using cine balanced steady-state free precession imaging at 1.5 T. Participants with non-Caucasian ethnicity, prevalent cardiovascular disease and other conditions known to affect cardiac chamber size and function were excluded. Absolute and indexed reference ranges for MA and TA diameters and tethering indices were stratified by gender and age (45-54, 55-64, 65-74 years)., Results: Overall, 721 (14.2%) truly healthy participants aged 45-74 years (54% women) formed the reference cohort. Absolute MA and TA diameters, MV tenting length and MV tenting area, were significantly larger in men. Mean ± standard deviation (SD) end-diastolic and end-systolic MA diameters in the 3-chamber view (anteroposterior diameter) were 2.9 ± 0.4 cm (1.5 ± 0.2 cm/m
2 ) and 3.3 ± 0.4 cm (1.7 ± 0.2 cm/m2 ) in men, and 2.6 ± 0.4 cm (1.6 ± 0.2 cm/m2 ) and 3.0 ± 0.4 cm (1.8 ± 0.2 cm/m2 ) in women, respectively. Mean ± SD end-diastolic and end-systolic TA diameters in the 4-chamber view were 3.2 ± 0.5 cm (1.6 ± 0.3 cm/m2 ) and 3.2 ± 0.5 cm (1.7 ± 0.3 cm/m2 ) in men, and 2.9 ± 0.4 cm (1.7 ± 0.2 cm/m2 ) and 2.8 ± 0.4 cm (1.7 ± 0.3 cm/m2 ) in women, respectively. With advancing age, end-diastolic TA diameter became larger and posterior MV leaflet angle smaller in both sexes. Reproducibility of measurements was good to excellent with an inter-rater intraclass correlation coefficient (ICC) between 0.92 and 0.98 and an intra-rater ICC between 0.90 and 0.97., Conclusions: We described age- and sex-specific reference ranges of MA and TA dimensions and tethering indices in the largest validated healthy Caucasian population. Reference ranges presented in this study may help to improve the distinction between normal and pathological states, prompting the identification of subjects that may benefit from advanced cardiac imaging for annular sizing and planning of valvular interventions.- Published
- 2020
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40. Improving cardiac MRI convolutional neural network segmentation on small training datasets and dataset shift: A continuous kernel cut approach.
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Guo F, Ng M, Goubran M, Petersen SE, Piechnik SK, Neubauer S, and Wright G
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- Datasets as Topic, Humans, Reproducibility of Results, Cardiovascular Diseases diagnostic imaging, Image Interpretation, Computer-Assisted methods, Magnetic Resonance Imaging, Neural Networks, Computer
- Abstract
Cardiac magnetic resonance imaging (MRI) provides a wealth of imaging biomarkers for cardiovascular disease care and segmentation of cardiac structures is required as a first step in enumerating these biomarkers. Deep convolutional neural networks (CNNs) have demonstrated remarkable success in image segmentation but typically require large training datasets and provide suboptimal results that require further improvements. Here, we developed a way to enhance cardiac MRI multi-class segmentation by combining the strengths of CNN and interpretable machine learning algorithms. We developed a continuous kernel cut segmentation algorithm by integrating normalized cuts and continuous regularization in a unified framework. The high-order formulation was solved through upper bound relaxation and a continuous max-flow algorithm in an iterative manner using CNN predictions as inputs. We applied our approach to two representative cardiac MRI datasets across a wide range of cardiovascular pathologies. We comprehensively evaluated the performance of our approach for two CNNs trained with various small numbers of training cases, tested on the same and different datasets. Experimental results showed that our approach improved baseline CNN segmentation by a large margin, reduced CNN segmentation variability substantially, and achieved excellent segmentation accuracy with minimal extra computational cost. These results suggest that our approach provides a way to enhance the applicability of CNN by enabling the use of smaller training datasets and improving the segmentation accuracy and reproducibility for cardiac MRI segmentation in research and clinical patient care., Competing Interests: Declaration of Competing Interest No conflicts of interest, financial or otherwise, are declared by F Guo, M Ng, M Goubran, SK Piechnik, S Neubauer, and G Wright. SEP acts as a paid consultant to Circle Cardiovascular Imaging Inc., Calgary, Canada and Servier., (Copyright © 2020. Published by Elsevier B.V.)
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- 2020
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41. Association Between Recreational Cannabis Use and Cardiac Structure and Function.
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Khanji MY, Jensen MT, Kenawy AA, Raisi-Estabragh Z, Paiva JM, Aung N, Fung K, Lukaschuk E, Zemrak F, Lee AM, Barutcu A, Maclean E, Cooper J, Piechnik SK, Neubauer S, and Petersen SE
- Subjects
- Aged, Female, Heart Diseases diagnostic imaging, Heart Diseases physiopathology, Humans, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Risk Factors, Heart Diseases etiology, Marijuana Abuse complications, Marijuana Smoking adverse effects, Myocardial Contraction, Ventricular Function, Left
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- 2020
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42. Standardized image post-processing of cardiovascular magnetic resonance T1-mapping reduces variability and improves accuracy and consistency in myocardial tissue characterization.
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Carapella V, Puchta H, Lukaschuk E, Marini C, Werys K, Neubauer S, Ferreira VM, and Piechnik SK
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- Databases, Factual standards, Humans, Reproducibility of Results, Stroke Volume physiology, Cardiovascular Diseases diagnostic imaging, Clinical Competence standards, Magnetic Resonance Imaging, Cine methods, Magnetic Resonance Imaging, Cine standards, Myocardium pathology
- Abstract
Background: Myocardial T1-mapping is increasingly used in multicentre studies and trials. Inconsistent image analysis introduces variability, hinders differentiation of diseases, and results in larger sample sizes. We present a systematic approach to standardize T1-map analysis by human operators to improve accuracy and consistency., Methods: We developed a multi-step training program for T1-map post-processing. The training dataset contained 42 left ventricular (LV) short-axis T1-maps (normal and diseases; 1.5 and 3 Tesla). Contours drawn by two experienced human operators served as reference for myocardial T1 and wall thickness (WT). Trainees (n = 26) underwent training and were evaluated by: (a) qualitative review of contours; (b) quantitative comparison with reference T1 and WT., Results: The mean absolute difference between reference operators was 8.4 ± 6.3 ms (T1) and 1.2 ± 0.7 pixels (WT). Trainees' mean discrepancy from reference in T1 improved significantly post-training (from 8.1 ± 2.4 to 6.7 ± 1.4 ms; p < 0.001), with a 43% reduction in standard deviation (SD) (p = 0.035). WT also improved significantly post-training (from 0.9 ± 0.4 to 0.7 ± 0.2 pixels, p = 0.036), with 47% reduction in SD (p = 0.04). These experimentally-derived thresholds served to guide the training process: T1 (±8 ms) and WT (±1 pixel) from reference., Conclusion: A standardized approach to CMR T1-map image post-processing leads to significant improvements in the accuracy and consistency of LV myocardial T1 values and wall thickness. Improving consistency between operators can translate into 33-72% reduction in clinical trial sample-sizes. This work may: (a) serve as a basis for re-certification for core-lab operators; (b) translate to sample-size reductions for clinical studies; (c) produce better-quality training datasets for machine learning., (Copyright © 2019. Published by Elsevier B.V.)
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- 2020
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43. The Effect of Blood Composition on T1 Mapping.
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Rosmini S, Bulluck H, Abdel-Gadir A, Treibel TA, Culotta V, Thompson R, Piechnik SK, Kellman P, Manisty C, and Moon JC
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- Adult, Aged, Biomarkers blood, Blood Chemical Analysis, Female, Healthy Volunteers, Hematocrit, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Young Adult, Cholesterol, HDL blood, Hemoglobins analysis, Iron blood, Magnetic Resonance Imaging
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- 2019
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44. T1 or ECV?: Depends on the Methods.
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Ferreira VM and Piechnik SK
- Subjects
- Humans, Myocardium, Cardiomyopathy, Dilated, Heart Failure
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- 2019
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45. Quantitative CMR population imaging on 20,000 subjects of the UK Biobank imaging study: LV/RV quantification pipeline and its evaluation.
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Attar R, Pereañez M, Gooya A, Albà X, Zhang L, de Vila MH, Lee AM, Aung N, Lukaschuk E, Sanghvi MM, Fung K, Paiva JM, Piechnik SK, Neubauer S, Petersen SE, and Frangi AF
- Subjects
- Biological Specimen Banks, Female, Humans, Imaging, Three-Dimensional, Male, Pattern Recognition, Automated, United Kingdom, Heart Ventricles diagnostic imaging, Image Interpretation, Computer-Assisted methods, Magnetic Resonance Imaging, Cine methods, Models, Statistical, Neural Networks, Computer
- Abstract
Population imaging studies generate data for developing and implementing personalised health strategies to prevent, or more effectively treat disease. Large prospective epidemiological studies acquire imaging for pre-symptomatic populations. These studies enable the early discovery of alterations due to impending disease, and enable early identification of individuals at risk. Such studies pose new challenges requiring automatic image analysis. To date, few large-scale population-level cardiac imaging studies have been conducted. One such study stands out for its sheer size, careful implementation, and availability of top quality expert annotation; the UK Biobank (UKB). The resulting massive imaging datasets (targeting ca. 100,000 subjects) has put published approaches for cardiac image quantification to the test. In this paper, we present and evaluate a cardiac magnetic resonance (CMR) image analysis pipeline that properly scales up and can provide a fully automatic analysis of the UKB CMR study. Without manual user interactions, our pipeline performs end-to-end image analytics from multi-view cine CMR images all the way to anatomical and functional bi-ventricular quantification. All this, while maintaining relevant quality controls of the CMR input images, and resulting image segmentations. To the best of our knowledge, this is the first published attempt to fully automate the extraction of global and regional reference ranges of all key functional cardiovascular indexes, from both left and right cardiac ventricles, for a population of 20,000 subjects imaged at 50 time frames per subject, for a total of one million CMR volumes. In addition, our pipeline provides 3D anatomical bi-ventricular models of the heart. These models enable the extraction of detailed information of the morphodynamics of the two ventricles for subsequent association to genetic, omics, lifestyle habits, exposure information, and other information provided in population imaging studies. We validated our proposed CMR analytics pipeline against manual expert readings on a reference cohort of 4620 subjects with contour delineations and corresponding clinical indexes. Our results show broad significant agreement between the manually obtained reference indexes, and those automatically computed via our framework. 80.67% of subjects were processed with mean contour distance of less than 1 pixel, and 17.50% with mean contour distance between 1 and 2 pixels. Finally, we compare our pipeline with a recently published approach reporting on UKB data, and based on deep learning. Our comparison shows similar performance in terms of segmentation accuracy with respect to human experts., (Crown Copyright © 2019. Published by Elsevier B.V. All rights reserved.)
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- 2019
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46. Right ventricular shape and function: cardiovascular magnetic resonance reference morphology and biventricular risk factor morphometrics in UK Biobank.
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Mauger C, Gilbert K, Lee AM, Sanghvi MM, Aung N, Fung K, Carapella V, Piechnik SK, Neubauer S, Petersen SE, Suinesiaputra A, and Young AA
- Subjects
- Aged, Anatomic Landmarks, Cardiovascular Diseases epidemiology, Cardiovascular Diseases physiopathology, Female, Heart Ventricles physiopathology, Humans, Image Interpretation, Computer-Assisted, Male, Middle Aged, Predictive Value of Tests, Reference Values, Reproducibility of Results, Risk Factors, United Kingdom epidemiology, Cardiovascular Diseases diagnostic imaging, Heart Ventricles diagnostic imaging, Magnetic Resonance Imaging, Cine standards, Ventricular Function, Left, Ventricular Function, Right, Ventricular Remodeling
- Abstract
Background: The associations between cardiovascular disease (CVD) risk factors and the biventricular geometry of the right ventricle (RV) and left ventricle (LV) have been difficult to assess, due to subtle and complex shape changes. We sought to quantify reference RV morphology as well as biventricular variations associated with common cardiovascular risk factors., Methods: A biventricular shape atlas was automatically constructed using contours and landmarks from 4329 UK Biobank cardiovascular magnetic resonance (CMR) studies. A subdivision surface geometric mesh was customized to the contours using a diffeomorphic registration algorithm, with automatic correction of slice shifts due to differences in breath-hold position. A reference sub-cohort was identified consisting of 630 participants with no CVD risk factors. Morphometric scores were computed using linear regression to quantify shape variations associated with four risk factors (high cholesterol, high blood pressure, obesity and smoking) and three disease factors (diabetes, previous myocardial infarction and angina)., Results: The atlas construction led to an accurate representation of 3D shapes at end-diastole and end-systole, with acceptable fitting errors between surfaces and contours (average error less than 1.5 mm). Atlas shape features had stronger associations than traditional mass and volume measures for all factors (p < 0.005 for each). High blood pressure was associated with outward displacement of the LV free walls, but inward displacement of the RV free wall and thickening of the septum. Smoking was associated with a rounder RV with inward displacement of the RV free wall and increased relative wall thickness., Conclusion: Morphometric relationships between biventricular shape and cardiovascular risk factors in a large cohort show complex interactions between RV and LV morphology. These can be quantified by z-scores, which can be used to study the morphological correlates of disease.
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- 2019
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47. Automated quality control in image segmentation: application to the UK Biobank cardiovascular magnetic resonance imaging study.
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Robinson R, Valindria VV, Bai W, Oktay O, Kainz B, Suzuki H, Sanghvi MM, Aung N, Paiva JM, Zemrak F, Fung K, Lukaschuk E, Lee AM, Carapella V, Kim YJ, Piechnik SK, Neubauer S, Petersen SE, Page C, Matthews PM, Rueckert D, and Glocker B
- Subjects
- Automation, Humans, Predictive Value of Tests, Quality Control, Reproducibility of Results, United Kingdom, Heart diagnostic imaging, Image Interpretation, Computer-Assisted standards, Magnetic Resonance Imaging standards
- Abstract
Background: The trend towards large-scale studies including population imaging poses new challenges in terms of quality control (QC). This is a particular issue when automatic processing tools such as image segmentation methods are employed to derive quantitative measures or biomarkers for further analyses. Manual inspection and visual QC of each segmentation result is not feasible at large scale. However, it is important to be able to automatically detect when a segmentation method fails in order to avoid inclusion of wrong measurements into subsequent analyses which could otherwise lead to incorrect conclusions., Methods: To overcome this challenge, we explore an approach for predicting segmentation quality based on Reverse Classification Accuracy, which enables us to discriminate between successful and failed segmentations on a per-cases basis. We validate this approach on a new, large-scale manually-annotated set of 4800 cardiovascular magnetic resonance (CMR) scans. We then apply our method to a large cohort of 7250 CMR on which we have performed manual QC., Results: We report results used for predicting segmentation quality metrics including Dice Similarity Coefficient (DSC) and surface-distance measures. As initial validation, we present data for 400 scans demonstrating 99% accuracy for classifying low and high quality segmentations using the predicted DSC scores. As further validation we show high correlation between real and predicted scores and 95% classification accuracy on 4800 scans for which manual segmentations were available. We mimic real-world application of the method on 7250 CMR where we show good agreement between predicted quality metrics and manual visual QC scores., Conclusions: We show that Reverse classification accuracy has the potential for accurate and fully automatic segmentation QC on a per-case basis in the context of large-scale population imaging as in the UK Biobank Imaging Study.
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- 2019
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48. Anti-TNF modulation reduces myocardial inflammation and improves cardiovascular function in systemic rheumatic diseases.
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Ntusi NAB, Francis JM, Sever E, Liu A, Piechnik SK, Ferreira VM, Matthews PM, Robson MD, Wordsworth PB, Neubauer S, and Karamitsos TD
- Subjects
- Adult, Anti-Inflammatory Agents, Non-Steroidal pharmacology, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Antirheumatic Agents pharmacology, Antirheumatic Agents therapeutic use, Cohort Studies, Electrocardiography methods, Female, Humans, Male, Middle Aged, Prospective Studies, Myocarditis diagnostic imaging, Myocarditis drug therapy, Rheumatic Heart Disease diagnostic imaging, Rheumatic Heart Disease drug therapy, Tumor Necrosis Factor-alpha antagonists & inhibitors
- Abstract
Background: Rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are common disorders associated with increased rates of cardiovascular disease (CVD), but the contribution of cytokine-induced inflammation to impaired cardiovascular function in these conditions remains poorly understood., Objectives: We assessed the effect of anti-TNF therapy on myocardial and vascular function, myocardial tissue characteristics and perfusion in inflammatory arthropathy and systemic rheumatic disease (IASRD) patients, using cardiovascular magnetic resonance (CMR)., Methods: 20 RA patients, 7 AS patients, 5 PsA patients without previously known CVD scheduled to commence anti-TNF therapy and 8 RA patients on standard disease modifying antirheumatic drugs underwent CMR at 1.5 T, including cine, tagging, pulse wave velocity (PWV), T2-weighted, native and postcontrast T1 mapping, ECV quantification, rest and stress perfusion and late gadolinium enhancement (LGE) imaging., Results: Following anti-TNF therapy, there was significant reversal of baseline subclinical cardiovascular dysfunction, as evidenced by improvement in peak systolic circumferential strain (p < 0.001), peak diastolic circumferential strain rate (p < 0.001), and total aortic PWV, (p < 0.001). This was accompanied by a reduction in myocardial inflammation, as assessed by T2-weighted imaging (p = 0.005), native T1 mapping (p = 0.009) and ECV quantification (p = 0.001), as well as in serum inflammatory markers like CRP (p < 0.001) and ESR (p < 0.001), and clinical measures of disease activity (DAS28-CRP, p = 0.001; BASDAI, p < 0.001). A trend towards improvement in myocardial perfusion was observed (p = 0.07). Focal myocardial fibrosis, as detected by LGE CMR was not altered by anti-TNF therapy (p = 0.92)., Conclusions: Anti-TNF therapy reduces subclinical myocardial inflammation and improves cardiovascular function in RA, AS and PsA. CMR may be used to track disease progression and response to therapy. Future CMR-based studies to demonstrate effect of anti-TNF therapy modulation of vascular structure and function on hard clinical events and outcomes would be useful., (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Published
- 2018
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49. Automated cardiovascular magnetic resonance image analysis with fully convolutional networks.
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Bai W, Sinclair M, Tarroni G, Oktay O, Rajchl M, Vaillant G, Lee AM, Aung N, Lukaschuk E, Sanghvi MM, Zemrak F, Fung K, Paiva JM, Carapella V, Kim YJ, Suzuki H, Kainz B, Matthews PM, Petersen SE, Piechnik SK, Neubauer S, Glocker B, and Rueckert D
- Subjects
- Aged, Automation, Databases, Factual, Deep Learning, Female, Heart Diseases physiopathology, Humans, Male, Middle Aged, Observer Variation, Predictive Value of Tests, Reproducibility of Results, Heart Diseases diagnostic imaging, Image Interpretation, Computer-Assisted methods, Magnetic Resonance Imaging, Cine methods, Myocardial Contraction, Neural Networks, Computer, Stroke Volume, Ventricular Function, Left, Ventricular Function, Right
- Abstract
Background: Cardiovascular resonance (CMR) imaging is a standard imaging modality for assessing cardiovascular diseases (CVDs), the leading cause of death globally. CMR enables accurate quantification of the cardiac chamber volume, ejection fraction and myocardial mass, providing information for diagnosis and monitoring of CVDs. However, for years, clinicians have been relying on manual approaches for CMR image analysis, which is time consuming and prone to subjective errors. It is a major clinical challenge to automatically derive quantitative and clinically relevant information from CMR images., Methods: Deep neural networks have shown a great potential in image pattern recognition and segmentation for a variety of tasks. Here we demonstrate an automated analysis method for CMR images, which is based on a fully convolutional network (FCN). The network is trained and evaluated on a large-scale dataset from the UK Biobank, consisting of 4,875 subjects with 93,500 pixelwise annotated images. The performance of the method has been evaluated using a number of technical metrics, including the Dice metric, mean contour distance and Hausdorff distance, as well as clinically relevant measures, including left ventricle (LV) end-diastolic volume (LVEDV) and end-systolic volume (LVESV), LV mass (LVM); right ventricle (RV) end-diastolic volume (RVEDV) and end-systolic volume (RVESV)., Results: By combining FCN with a large-scale annotated dataset, the proposed automated method achieves a high performance in segmenting the LV and RV on short-axis CMR images and the left atrium (LA) and right atrium (RA) on long-axis CMR images. On a short-axis image test set of 600 subjects, it achieves an average Dice metric of 0.94 for the LV cavity, 0.88 for the LV myocardium and 0.90 for the RV cavity. The mean absolute difference between automated measurement and manual measurement is 6.1 mL for LVEDV, 5.3 mL for LVESV, 6.9 gram for LVM, 8.5 mL for RVEDV and 7.2 mL for RVESV. On long-axis image test sets, the average Dice metric is 0.93 for the LA cavity (2-chamber view), 0.95 for the LA cavity (4-chamber view) and 0.96 for the RA cavity (4-chamber view). The performance is comparable to human inter-observer variability., Conclusions: We show that an automated method achieves a performance on par with human experts in analysing CMR images and deriving clinically relevant measures.
- Published
- 2018
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50. Correction to: Adenosine stress CMR T1-mapping detects early microvascular dysfunction in patients with type 2 diabetes mellitus without obstructive coronary artery disease.
- Author
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Levelt E, Piechnik SK, Liu A, Wijesurendra RS, Mahmod M, Ariga R, Francis JM, Greiser A, Clarke K, Neubauer S, Ferreira VM, and Karamitsos TD
- Abstract
In the original publication of this article [1] Fig. 1 was incorrect due to the use of a colour bar with wrong range in error.
- Published
- 2017
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