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ObjectivesTo determine the intra-individual flow variation in serially acquired studies, and the influence of this variation on subsequent hemodynamic simulations using the inlet flow as a boundary condition. Author: Kindly check and confirm whether the corresponding authors are correctly identified.Confirmed.Materials and methodsThis prospective study included 51 patients (37 females and 14 males) with unruptured intracranial aneurysms who have received more than three times follow-up of 2D phase-contrast MR. The flow and velocity parameters were extracted to calculate the reproducibility and variation. Patient-specific computational fluid dynamics simulations were performed using the measured flows.ResultsIntraclass correlation coefficients for mean and maximum velocity and flow parameters ranged from 0.77 to 0.90. A 10% CV of mean flow was identified. Variations of 10% in inlet flow resulted in hemodynamic changes including 41.41% of peak systolic wall shear stress; 39.13% of end-diastolic wall shear stress; 2.79% of low shear area at peak systole; 2.12% of low shear area at end diastole: 47.57% of time-averaged wall shear stress; and 0.17% of oscillatory shear index.ConclusionThis study identified 10% of intra-individual mean flow variation on phase-contrast MR. Intra-individual flow variation resulted in a non-negligible variation in wall shear stress, but relatively small variation in low shear area in hemodynamic calculations.

Purpose Pulsatile tinnitus (PT) is a debilitating condition that can be caused by abnormal blood flow in venous vasculature near the cochlea1. Often times PT is very difficult to diagnose reliably with diagnosis rates typically hovering around 50% and requiring multiple advanced imaging procedures including diagnostic cerebral angiography2. A tool that could objectively mimic a PT patient’s hearing experience would allow physicians to reliably diagnose the cause of this difficult symptom. Materials and Methods We developed a prototype of the ‘Phonocatheter’, a 6 Fr catheter that can measure and record PT sounds as well as replay them in real time. The Phonocatheter consists of an embedded microphone at its distal end to record intravascular sounds and relay them to a microcontroller (Arduino Mega 2560 Rev3) based custom data acquisition interface. Two benchtop PT flow models3 that represent a PT patient’s transverse sinus (TS) anatomy before and after lumbar puncture (LP) were created and used to test the Phonocatheter. Glycerol-water mixture was pumped through these models to mimic blood flow at a mean flow rate of 7.4 cc/s. The Phonocatheter was inserted through a 9 Fr access port and was navigated into the TS stenosis region (figure 1A). A handsfree Bluetooth compatible electronic stethoscope was placed externally over the same TS region to record PT transluminally and validate the sound measurements recorded by Phonocatheter (n=10). The sound measurements acquired by Phonocatheter and stethoscope were saved in .wav file format and were exported to MATLAB for comparative analysis. Variation in peak-to-rms sound amplitude values from the TS in pre-LP and post-LP models was calculated. Wilcoxon rank sum test was used to statistically determine the differences in sound measurements between the two patient-specific models for each sensor. Results Both the Phonocatheter and stethoscope were able to record transluminal and intravascular sounds generated from stenosis respectively. The Phonocather was in good agreement with the stethoscope demonstrating that the peak-to-rms (mean ± standard deviation) sound amplitude was significantly louder (p Conclusion We have developed a prototype of microphone enabled catheter that can measure sound in patient-specific PT flow models, and potentially measure sounds quantitively in PT patients. Disclosures M. Amans: 1; C; NIH R01 HL149124-01A1. K. Valluru: None. S. Kondapavulur: None. B. Kilbride: None. H. Haraldsson: None. W. Smith: None. K. Meisel: None. D. Saloner: None.

Purpose Idiopathic Intracranial Hypertension (IIH) is a pathologic elevation of the intracranial pressure (ICP) with normal CSF composition which mostly affects younger women who are obese. IIH is most commonly presented along with focal stenosis of venous transverse sinus (TS). Venous sinus stenting (VSS) is an effective procedure that can resolve PT in patients with IIH and TS stenosis but has significant relapse rates. A benchtop phantom that can reliably mimic IIH pathophysiology and induce TS stenosis would allow evaluation of factors causing restenosis. Materials and Methods Our benchtop phantom constitutes an interchangeable 3D printed TS flow model submerged in a rigid water-filled chamber akin to dura mater. The phantom is equipped with an underwater pressure sensor connected to a microcontroller and capable of continuously relaying the ICP values to a computer in real time. Two calibrated needle gauges connected externally on either side of the TS flow model monitor IVP gradient across the stenosis (figure 1A). ICP is manipulated by infusing additional water analogous to increasing CSF, through the inlet provided on top of the phantom. To better approximate the compliance of the TS in vivo, we tested seven thin-walled flow models of same size made of four different materials with a range of shore hardness factors (27A – 60A). With glycerol-water mixture pumped through the model, the ICP was increased in the phantom from 0 – 60 cmH2O in 5 cmH2O increments and IVP gradient was recorded across the stenosis (n=3 trials per flow model). Measurements were obtained with the phantom positioned to resemble TS in both upright and supine positions respectively. Results Among all the flow models tested, the model 3D printed with Agilus 30A was found to be a good surrogate for TS when the phantom was oriented in supine position. It produced a stenosis with a mean IVP gradient of 7.84 mmHg at a mean ICP of 25.5 cmH2O, agreeing with typical lumbar puncture opening pressure values (>25 cmH2O) seen in most IIH patients (figure 1B). Conclusion We developed a benchtop phantom that can mimic the pathophysiology of IIH and can reliably induce TS stenosis by increasing the ICP to the levels typically observed in patients. We anticipate that our phantom will facilitate evaluating anatomical and physiological parameters that induce restenosis and will eventually allow testing of new devices that could minimize VSS relapse rate in IIH patients. Disclosures K. Valluru: None. T. Shen: None. K. O’Reilly: None. H. Haraldsson: None. E. Kao: None. J. Leach: None. A. Wright: None. M. Ballweber: None. K. Meisel: None. D. Saloner: None. M. Amans: 1; C; NIH R01 HL149124-01A1.

BACKGROUND AND PURPOSE: Case reports demonstrate that coiling of a sigmoid sinus diverticulum can treat pulsatile tinnitus. We hypothesized that MR imaging 4D flow and computational fluid dynamics would reveal distinct blood flow patterns in the venous outflow tract in these patients. MATERIALS AND METHODS: Patients with pulsatile tinnitus of suspected venous etiology underwent MR imaging at 3T, using venous phase contrast-enhanced MR angiography, 4D flow, and 2D phase contrast. The contrast-enhanced MRA contours were evaluated to determine the presence and extent of a sigmoid sinus diverticulum. Computational fluid dynamics analysis was performed using the 4D flow inlet flow and the luminal contours from contrast-enhanced MRA as boundary conditions. In addition, computational fluid dynamics was performed for the expected post treatment conditions by smoothing the venous geometry to exclude the sigmoid sinus diverticulum from the anatomic boundary conditions. Streamlines were generated from the 4D flow and computational fluid dynamics velocity maps, and flow patterns were examined for the presence of rotational components. RESULTS: Twenty-five patients with pulsatile tinnitus of suspected venous etiology and 10 control subjects were enrolled. Five (20%) of the symptomatic subjects had sigmoid sinus diverticula, all associated with an upstream stenosis. In each of these patients, but none of the controls, a stenosis-related flow jet was directed toward the opening of the sigmoid sinus diverticulum with rotational flow patterns in the sigmoid sinus diverticulum and parent sigmoid sinus on both 4D flow and computational fluid dynamics. CONCLUSIONs: Consistent patterns of blood flow can be visualized in a sigmoid sinus diverticulum and the parent sinus using 4D flow and computational fluid dynamics. Strong components of rotational blood flow were seen in subjects with sigmoid sinus diverticula that were absent in controls.

Both noncontrast and contrast-enhanced approaches to gated thoracic magnetic resonance angiography (MRA) for aortic root evaluation have been reported at 3T. We compare qualitative and quantitative image quality measures for the two approaches, and assess the reproducibility of standard aortic measurements. Respiratory and cardiac gated MRA of the chest was performed at 3T in 45 patients: 23 after administration of iron-based blood pool contrast, and 22 without contrast. Image quality was assessed with a 5-point Likert scale, vessel lumen-to-muscle contrast ratios, and vessel wall sharpness. Two reviewers measured the ascending aorta diameter and valve annulus area. Interrater agreement was assessed using Bland-Altman plots and coefficient of variation (CV). Qualitative image quality was better with blood pool contrast in all principal vessels of the chest (mean Likert of 4.20 ± 0.79 vs. 2.60 ± 0.77, p

The decrease in contractility in myocardium adjacent (border zone; BZ) to a myocardial infarction (MI) is correlated with an increase in reactive oxygen species (ROS). We hypothesized that injection of a thermoresponsive hydrogel, with ROS scavenging properties, into the MI would decrease ROS and improve BZ function. Fourteen sheep underwent antero-apical MI. Seven sheep had a comb-like copolymer synthesized from N-isopropyl acrylamide (NIPAAm) and 1500 MW methoxy poly(ethylene glycol) methacrylate, (NIPAAm-PEG1500), injected (20 × 0.5 mL) into the MI zone 40 min after MI (MI + NIPAAm-PEG1500) and seven sheep were MI controls. Cardiac MRI was performed 2 weeks before and 6 weeks after MI + NIPAAm-PEG1500. BZ wall thickness at end systole was significantly higher for MI + NIPAAm-PEG1500 (12.32 ± 0.51 mm/m2 MI + NIPAAm-PEG1500 vs. 9.88 ± 0.30 MI; p = .023). Demembranated muscle force development for BZ myocardium 6 weeks after MI was significantly higher for MI + NIPAAm-PEG1500 (67.67 ± 2.61 mN/m2 MI + NIPAAm-PEG1500 vs. 40.53 ± 1.04 MI; p < .0001) but not significantly different from remote myocardium or BZ or non-operated controls. Levels of ROS in BZ tissue were significantly lower in the MI + NIPAAm-PEG1500 treatment group (hydroxyl p = .0031; superoxide p = .0182). We conclude that infarct injection of the NIPAAm-PEG1500 hydrogel with ROS scavenging properties decreased ROS and improved contractile protein function in the border zone 6 weeks after MI.

The left ventricular (LV) end-systolic (ES) pressure volume relationship (ESPVR) is the cornerstone of systolic LV function analysis. We describe a 2D real-time (RT) MRI-based method (RTPVR) with separate software tools for 1) semi-automatic level set-based shape prior method (LSSPM) of the LV, 2) generation of synchronized pressure area loops and 3) calculation of the ESPVR. We used the RTPVR method to measure ventricular geometry, ES pressure area relationship (ESPAR) and ESPVR during vena cava occlusion (VCO) in normal sheep. 14 adult sheep were anesthetized and underwent measurement of LV systolic function. Ten of the 14 sheep underwent RTMRI and eight of the 14 underwent measurement with conductance catheter; 4 had both RTMRI and conductance measurements. 2D cross sectional RTMRI were performed at apex, mid-ventricle and base levels during separate VCOs. The Dice similarity coefficient was used to compare LSSPM and manual image segmentation and thus determine LSSPM accuracy. LV cross-sectional area, major and minor axis length, axis ratio, major axis orientation angle and ESPAR were measured at each LV level. ESPVR was calculated with a trapezoidal rule. The Dice similarity coefficient between LSSPM and manual segmentation by two readers was 87.31±2.51% and 88.13±3.43%. All cross sections became more elliptical during VCO. The major axis orientation shifted during VCO but remained in the septo-lateral direction. LV chamber obliteration at the apical level occurred during VCO in 7 of 10 sheep that underwent RTMRI. ESPAR was non-linear at all levels. Finally, ESPVR was non-linear because of apical collapse. ESPVR measured by conductance catheter (EES,Index = 2.23±0.66 mmHg/ml/m2) and RT (EES,Index = 2.31±0.31 mmHg/ml/m2) was not significantly different. LSSPM segmentation of 2D RT MRI images is accurate and allows calculation of LV geometry, ESPAR and ESPVR during VCO. In the future, RTPVR will facilitate determination of regional systolic material parameters underlying ESPVR.

HYPOTHESIS: We hypothesize patient-specific flow models to be an adequate in vitro surrogate to allow for characterization of Pulsatile Tinnitus that affects 3–5 million Americans. BACKGROUND: Pulsatile tinnitus (PT), rhythmic sounds without an extracorporeal source that patients appreciate, can be caused by aberrant blood flow in large cerebral veins near the cochlea. In order to investigate the sound production mechanism, we created 3D printed flow models based on patient-specific cerebral venous anatomies. METHODS: Magnetic resonance angiography datasets from two patients with PT were used to generate patient-specific 3D printed flow models. A flow circuit connecting the patient-specific models to a pulsatile, continuous flow pump simulating cardiac cycle was created. Sound recordings were made along the surface of the models using an electronic stethoscope. Peak-to-rms amplitude, and area under the power spectral density (PSD) curve values were computed to evaluate the sound measurements. Wilcoxon rank sum test was used to statistically determine the differences in measurements between the patient-specific models. RESULTS: In patient-1, the recordings (peak-to-rms) from the internal jugular vein stenosis of baseline model (4.29±1.26 for 146 samples) were significantly louder (p

OBJECTIVES: This study aims to evaluate the reproducibility of measures of plaque morphology in serially acquired black-blood MRI of untreated atherosclerotic femoral arteries. MATERIALS AND METHODS: MR studies was obtained from 42 timepoints, on 12 patients with known femoral artery atherosclerosis. Images with a 3D isotropic FLASH with DANTE-prepared black blood contrast (DASH) at a 3-T scanner were acquired at baseline, within 1 week, and at 1 month. Six of the patients were scanned additionally at 6 months. Inter-scan and inter-observer variations of arterial area/volume measurements were evaluated. RESULTS: Measurement of vessel area, lumen area, wall area and wall volume showed inter-scan intraclass correlation coefficients (ICC) ranging from 0.92 to 0.97 for 3 scans, 0.91–0.97 for 4 scans, and inter-observer ICCs of 0.89–0.96. Among 3 scans, the coefficients of variance (CV) for the vessel area, lumen area, wall area and wall volume were 4.1%, 6.5%, 7.5%, and 4.4%. CVs among 4 scans ranged from 4.4% to 7.9%, and interobserver CVs ranged from 6.1% to 11.8% for the different area/volume measurements. CONCLUSION: DASH MRI is useful for quantifying atherosclerotic vessel area and volume of femoral arteries with low variability among serial repeated scans and between observers.

BACKGROUND AND PURPOSE: Idiopathic intracranial hypertension is commonly associated with transverse sinus stenosis, a venous cause of pulsatile tinnitus. In patients with idiopathic intracranial hypertension, CSF drainage via lumbar puncture decreases intracranial pressure, which relieves the stenosis, and may provide at least temporary cessation of pulsatile tinnitus. The objective of this study was to evaluate changes in venous blood flow caused by lowered intracranial pressure in patients with pulsatile tinnitus to help identify the cause of pulsatile tinnitus. MATERIALS AND METHODS: Ten patients with suspected transverse sinus stenosis as a venous etiology for pulsatile tinnitus symptoms underwent MR imaging before and after lumbar puncture in the same session. The protocol included flow assessment and rating of pulsatile tinnitus intensity before and after lumbar puncture and MR venography before lumbar puncture. Post-lumbar puncture MR venography was performed in 1 subject. RESULTS: There was a lumbar puncture–induced reduction in venous peak velocity that correlated with the opening pressure ( r = −0.72, P = .019) without a concomitant reduction in flow rate. Patients with flow jets had their peak velocity reduced by 0.30 ± 0.18 m/s ( P = .002), correlating with a reduction in CSF pressure ( r = 0.82, P = .024) and the reduction in subjectively scored pulsatile tinnitus intensity ( r = 0.78, P = .023). The post-lumbar puncture MR venography demonstrated alleviation of the stenosis. CONCLUSIONS: Our results show a lumbar puncture–induced reduction in venous peak velocity without a concomitant reduction in flow rate. We hypothesize that the reduction is caused by the expansion of the stenosis after lumbar puncture. Our results further show a correlation between the peak velocity and pulsatile tinnitus intensity, suggesting the flow jet to be instrumental in the development of sound.

High resolution MRI of the intracranial vessel wall provides important insights in the assessment of intracranial vascular disease. This study aims to refine high resolution 3D MRI techniques for intracranial vessel wall imaging at both 3 and 7 T using customized flip angle train design, and to explore their comparative abilities. 11 patients with intracranial artery disease (four atherosclerotic plaques, six aneurysms and one reversible cerebral vasoconstriction syndrome) were imaged at 3 and 7 T with a 3D T 1-weighted fast-spin-echo sequence (SPACE) both pre and post Gd contrast injection. Wall to lumen contrast ratio (CRwall-lumen), contrast enhancement ratio (ER) and the sharpness of the vessel wall were quantified. Two experienced radiologists evaluated the image quality on a 0–5 scale. Both 3 and 7 T achieved good image quality with high resolution (nominal 0.5 mm isotropic) and whole brain coverage. The CRwall-lumen and the ER measurements were comparable (p > 0.05). The 7 T images were significantly sharper (sharpness: 2.69 ± 0.50 vs. 1.88 ± 0.53 mm−1, p

Non-contrast 3D black blood MRI is a promising tool for abdominal aortic aneurysm (AAA) surveillance, permitting accurate aneurysm diameter measurements needed for patient management.To evaluate whether automated AAA volume and diameter measurements obtained from computer-aided segmentation of non-contrast 3D black blood MRI are accurate, and whether they can supplant reference standard manual measurements from contrast-enhanced CT angiography (CTA).Thirty AAA patients (mean age, 71.9 ± 7.9 years) were recruited between 2014 and 2017. Participants underwent both non-contrast black blood MRI and CTA within 3 months of each other. Semi-automatic (computer-aided) MRI and CTA segmentations utilizing deformable registration methods were compared against manual segmentations of the same modality using the Dice similarity coefficient (DSC). AAA lumen and total aneurysm volumes and AAA maximum diameter, quantified automatically from these segmentations, were compared against manual measurements using Pearson correlation and Bland-Altman analyses. Finally, automated measurements from non-contrast 3D black blood MRI were evaluated against manual CTA measurements using the Wilcoxon test, Pearson correlation and Bland-Altman analyses.Semi-automatic segmentations had excellent agreement with manual segmentations (lumen DSC: 0.91 ± 0.03 and 0.94 ± 0.03; total aneurysm DSC: 0.92 ± 0.02 and 0.94 ± 0.03, for black blood MRI and CTA, respectively). Automated volume and maximum diameter measurements also had excellent correlation to their manual counterparts for both black blood MRI (volume: r = 0.99, P0.001; diameter: r = 0.97, P0.001) and CTA (volume: r = 0.99, P0.001; diameter: r = 0.97, P0.001). Compared to manual CTA measurements, bias and limits of agreement (LOA) for automated MRI measurements (lumen volume: 1.49, [-4.19 7.17] cmSemi-automatic segmentation of non-contrast 3D black blood MRI efficiently provides reproducible morphologic AAA assessment yielding accurate AAA diameters and volumes with no clinically relevant differences compared to either automatic or manual measurements based on CTA.

The left ventricular (LV) end-systolic pressure volume relationship (ES; ESPVR) is the cornerstone of systolic LV function analysis. Recently, it became possible to measure 2D LV chamber shape during vena cava occlusion (VCO) with MRI. We used an improved level-set semi-automatic segmentation method (LSSM) to determine the effect of VCO on LV geometry, ES pressure area (PA) and ESPVR.10 healthy adult sheep were anesthetized. LV pressure transducer and inferior vena cava (IVC) balloon catheter were percutaneously inserted. Ferumoxytol (0.125 ml/kg iv; AMAG Pharmaceuticals, Waltham, MA) was given to enhance blood pool contrast. LV pressure and 2D retrospectively-gated cine MRI of LV cross sections 25 (Apex), 50 (Mid) and 75% (Base) of the distance from the apex to the base of the LV were obtained during separate IVC balloon inflations (VCO). LV pressure was digitally filtered and LV chamber segmented with the LSSM. Cross sectional area, major and minor axes, major axis orientation, ESPAR and ESPVR were calculated.The LSSM had excellent reliability. All cross sections became more elliptical during VCO. The orientation (angle) of each major axis relative to the anterior RV insertion shifted during VCO. However, the orientation remained toward the septum. There was chamber collapse (LV area < 0.25 cm2) at the apical level during VCO (7 cases). ESPAR was non-linear at all levels. ESPVR was non-linear because of apical collapse.In conclusion, MRI-based measurement of LV geometry, ESPAR and ESPVR during VCO is a valuable method that may lead to improved understanding of systolic LV function.New and NoteworthyReal-time MRI was used to continuously measure the LV PA relationship as loading conditions were transiently varied in anesthetized sheep. All three examined cross-sections became more elliptical during VCO. The ESPAR were non-linear at all three cross-sections. Chamber collapse at the apical level during VCO resulted in a non-linear ESPVR. The heart contracted in a non-concentric manner during VCO which could inform modeling studies and elucidate mechanisms underlying LV adaptations to sudden load changes.

This study reports on the development and evaluation of a novel segmentation method for extracting the internal jugular vein and the adjacent carotid artery from magnetic resonance (MR) images of patients with pulsatile tinnitus. A narrow band level set method with combined shape and appearance constraints was developed and applied to high-resolution MR images from 17 pulsatile tinnitus patients (age 52 ± 23 years, 10 females). The proposed method was validated by comparing with the manual segmentation as well as by identifying the jugular vein and carotid artery based on 4D flow MRI in which the two types of vessels have opposing flow. Our study showed that the vein and artery are in contact with each other on 30.2% of all the slices. Dice value, Peak signal-to-noise ratio (PSNR), Hausdorff distance and mean sum of square distance (MSSD) between automatic and manual segmentation were 89.13 ± 2.84%, 27.36 ± 2.39%, 17.2 ± 6.9 mm, 7.4 ± 5.5 mm, demonstrating good segmentation accuracy. The average Dice similarity coefficient and the coefficient of variation compared with 4D flow MRI was 91.42 ± 1.63% and 89.28 ± 4.54% for the internal jugular vein and the carotid artery. The present pipeline for automatic internal jugular vein quantification holds promise for efficient image interpretation in large-scale cohort studies.

Background Few studies directed at assessing the visualization of the walls of unruptured aneurysms have used higher-resolution 3D MRI vessel wall imaging. Prospective longitudinal studies are also needed to screen vessel wall changes in unruptured aneurysms. Purpose To compare the aneurysm wall visualization on pre- and post-3D isotropic T1 -weighted Sampling Perfection with Application-optimized Contrasts by using different flip angle Evolutions (SPACE) images and to explore whether there is a change in wall enhancement at follow up. Study type Prospective. Population Twenty-nine patients with a total of 35 unruptured intracranial aneurysms. Sequence 3D T1 -weighted pre- and postcontrast SPACE (0.5 mm isotropic) at 3.0T. Assessment The aneurysm wall visibility (0-5 scale) between pre- and postcontrast images as well as the wall enhancement (0-5 scale) between follow-up and baseline studies (6-30 months, average 12.7 months) were compared. Differences in wall visibility and enhancement were also investigated as a function of aneurysm diameter and location. Statistical test The Wilcoxon signed rank paired test was used to compare the wall visibility score between pre- and postcontrast SPACE images, as well as wall enhancement between follow-up and baseline. The Mann-Whitney and Kruskal-Wallis tests were used to investigate the enhancement difference between different diameters and locations. Results Postcontrast images had significantly higher wall visibility (P = 0.01). A wall enhancement score ≥2 was found in 71% of the aneurysms. Changes in levels of wall enhancement were found in 17% of the aneurysms at follow-up studies, but those changes were small. Wall visibility and enhancement scores of large aneurysms were significantly higher than small ones (P Data conclusion 3D T1 -weighted higher resolution SPACE can be used to assess changes in enhancement at follow-up studies. Contrast SPACE image provides better aneurysm wall visibility and improves visualization of the aneurysm wall. Level of evidence 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:193-200.

ObjectiveGuidelines for repair of bicuspid aortic valve-associated ascending thoracic aortic aneurysms have been changing, most recently to the same criteria as tricuspid aortic valve-ascending thoracic aortic aneurysms. Rupture/dissection occurs when wall stress exceeds wall strength. Recent studies suggest similar strength of bicuspid aortic valve versus tricuspid aortic valve-ascending thoracic aortic aneurysms; thus, comparative wall stress may better predict dissection in bicuspid aortic valve versus tricuspid aortic valve-ascending thoracic aortic aneurysms. Our aim was to determine whether bicuspid aortic valve-ascending thoracic aortic aneurysms had higher wall stresses than their tricuspid aortic valve counterparts.MethodsPatients with bicuspid aortic valve- and tricuspid aortic valve-ascending thoracic aortic aneurysms (bicuspid aortic valve=17, tricuspid aortic valve=19) greater than 4.5cm underwent electrocardiogram-gated computed tomography angiography. Patient-specific 3-dimensional geometry was reconstructed and loaded to systemic pressure after accounting for prestress geometry. Finite element analyses were performed using the LS-DYNA solver (LSTC Inc, Livermore, Calif) with user-defined fiber-embedded material model to determine ascending thoracic aortic aneurysm wall stress.ResultsBicuspid aortic valve-ascending thoracic aortic aneurysms 99th-percentile longitudinal stresses were 280kPa versus 242kPa(P=.028) for tricuspid aortic valve-ascending thoracic aortic aneurysms in systole. These stresses did not correlate to diameter for bicuspid aortic valve-ascending thoracic aortic aneurysms (r=-0.004) but had better correlation to tricuspid aortic valve-ascending thoracic aortic aneurysms diameter (r=0.677). Longitudinal stresses on sinotubular junction were significantly higher in bicuspid aortic valve-ascending thoracic aortic aneurysms than in tricuspid aortic valve-ascending thoracic aortic aneurysms (405 vs 329kPa, P=.023). Bicuspid aortic valve-ascending thoracic aortic aneurysm 99th-percentile circumferential stresses were 548kPa versus 462kPa(P=.033) for tricuspid aortic valve-ascending thoracic aortic aneurysms, which also did not correlate to bicuspid aortic valve-ascending thoracic aortic aneurysm diameter (r=0.007).ConclusionsCircumferential and longitudinal stresses were greater in bicuspid aortic valve- than tricuspid aortic valve-ascending thoracic aortic aneurysms and were more pronounced in the sinotubular junction. Peak wall stress did not correlate with bicuspid aortic valve-ascending thoracic aortic aneurysm diameter, suggesting diameter alone in this population may be a poor predictor of dissection risk. Our results highlight the need for patient-specific aneurysm wall stress analysis for accurate dissection risk prediction.

PurposeTo measure the Reynolds stress tensor using 4D flow MRI, and to evaluate its contribution to computed pressure maps. MethodsA method to assess both velocity and Reynolds stress using 4D flow MRI is presented and evaluated. The Reynolds stress is compared by cross-sectional integrals of the Reynolds stress invariants. Pressure maps are computed using the pressure Poisson equationboth including and neglecting the Reynolds stress. ResultGood agreement is seen for Reynolds stress between computational fluid dynamics, simulated MRI, and MRI experiment. The Reynolds stress can significantly influence the computed pressure loss for simulated (eg, -0.52% vs -15.34% error; Pamp;lt;0.001) and experimental (eg, 30611 vs 203 +/- 6 Pa; Pamp;lt;0.001) data. A 54% greater pressure loss is seen at the highest experimental flow rate when accounting for Reynolds stress (Pamp;lt;0.001). Conclusion4D flow MRI with extended motion-encoding enables quantification of both the velocity and the Reynolds stress tensor. The additional information provided by this method improves the assessment of pressure gradients across a stenosis in the presence of turbulence. Unlike conventional methods, which are only valid if the flow is laminar, the proposed method is valid for both laminar and disturbed flow, a common presentation in diseased vessels. Magn Reson Med 79:1962-1971, 2018. (c) 2017 International Society for Magnetic Resonance in Medicine. Funding Agencies|European Union [310612]; National Institutes of Health [HL114118, NS059944]

OBJECTIVE. Ferumoxytol is increasingly reported as an alternative to gadolinium-based contrast agents for MR angiography (MRA), particularly for patients with renal failure. This article summarizes more than 3 years of clinical experience with ferumoxytol-enhanced MRA for a range of indications and anatomic regions. CONCLUSION. Ferumoxytol-enhanced MRA has many advantages including that it is safe for patients with renal failure and provides a lengthy plateau of vascular signal as a blood pool agent that allows longer navigated MRA sequences.

Magnetic resonance assessment of regional myocardial function is a novel potentially important tool for early identification of cardiac pathology. Many cardiac magnetic resonance techniques have been developed for detection and quantification of regional strain abnormalities including steady-state free-precession CINE, tagging, displacement encoding with stimulated echoes, strain encoding imaging, and feature tracking. Potential clinical applications of magnetic resonance strain imaging include early detection of systolic dysfunction in heart failure patients with both ischemic and nonischemic etiologies.

The quality of the medical imaging is a key component for accurate disease diagnosis. Optimizing image quality while maintaining scan time efficiency and patient comfort is important for routine clinical MRIs. In this article, we review both practical and advanced techniques for achieving high image quality, especially focusing on optimizing the trade-offs between the image quality (such as signal-to-noise and spatial resolution) and acquisition time. We provide practical examples for optimizing the image quality and scan time.

To evaluate an accelerated 4D flow MRI method that provides high temporal resolution in a clinically feasible acquisition time for intracranial velocity imaging. Accelerated 4D flow MRI was developed by using a pseudo-random variable-density Cartesian undersampling strategy (CIRCUS) with the combination of k-t, parallel imaging and compressed sensing image reconstruction techniques (k-t SPARSE-SENSE). Four-dimensional flow data were acquired on five healthy volunteers and eight patients with intracranial aneurysms using CIRCUS (acceleration factor of R = 4, termed CIRCUS4) and GRAPPA (R = 2, termed GRAPPA2) as the reference method. Images with three times higher temporal resolution (R = 12, CIRCUS12) were also reconstructed from the same acquisition as CIRCUS4. Qualitative and quantitative image assessment was performed on the images acquired with different methods, and complex flow patterns in the aneurysms were identified and compared. Four-dimensional flow MRI with CIRCUS was achieved in 5 min and allowed further improved temporal resolution of

Ventricular wall stress is believed to be responsible for many physical mechanisms taking place in the human heart, including ventricular remodeling, which is frequently associated with heart failure. Therefore, normalization of ventricular wall stress is the cornerstone of many existing and new treatments for heart failure. In this paper, we sought to construct reference maps of normal ventricular wall stress in humans that could be used as a target for in silico optimization studies of existing and potential new treatments for heart failure. To do so, we constructed personalized computational models of the left ventricles of five normal human subjects using magnetic resonance images and the finite-element method. These models were calibrated using left ventricular volume data extracted from magnetic resonance imaging (MRI) and validated through comparison with strain measurements from tagged MRI (950 ± 170 strain comparisons/subject). The calibrated passive material parameter values were C0 = 0.115 ± 0.008 kPa and B0 = 14.4 ± 3.18; the active material parameter value was Tmax = 143 ± 11.1 kPa. These values could serve as a reference for future construction of normal human left ventricular computational models. The differences between the predicted and the measured circumferential and longitudinal strains in each subject were 3.4 ± 6.3 and 0.5 ± 5.9%, respectively. The predicted end-diastolic and end-systolic myofiber stress fields for the five subjects were 2.21 ± 0.58 and 16.54 ± 4.73 kPa, respectively. Thus these stresses could serve as targets for in silico design of heart failure treatments.

Segmentation of the geometric morphology of abdominal aortic aneurysm is important for interventional planning. However, the segmentation of both the lumen and the outer wall of aneurysm in magnetic resonance (MR) image remains challenging. This study proposes a registration based segmentation methodology for efficiently segmenting MR images of abdominal aortic aneurysms. The proposed methodology first registers the contrast enhanced MR angiography (CE-MRA) and black-blood MR images, and then uses the Hough transform and geometric active contours to extract the vessel lumen by delineating the inner vessel wall directly from the CE-MRA. The proposed registration based geometric active contour is applied to black-blood MR images to generate the outer wall contour. The inner and outer vessel wall are then fused presenting the complete vessel lumen and wall segmentation. The results obtained from 19 cases showed that the proposed registration based geometric active contour model was efficient and comparable to manual segmentation and provided a high segmentation accuracy with an average Dice value reaching 89.79%.

The ability to measure and quantify myocardial motion and deformation provides a useful tool to assist in the diagnosis, prognosis and management of heart disease. Myocardial motion can be measured by means of several different types of data acquisition. The earliest myocardial motion tracking technique was invasive, based on implanting radiopaque markers into the myocardium around the left ventricle, and recording the marker positions during the cardiac cycle by biplane cineradiography. Until recently, this was the only method with high enough spatial resolution of three-dimensional (3D) myocardial displacements to resolve transmural behaviors. However, the recent development of magnetic resonance imaging techniques, such as displacement encoding with stimulated echoes (DENSE), make detailed non-invasive 3D transmural kinematic analyses of human myocardium possible in the clinic and for research purposes.Diastolic left ventricular filling is a highly dynamic process with early and late transmitral inflows and it is determined by a complex sequence of many interrelated events and parameters. Extensive research has been performed to describe myocardial kinematics during the systolic phase of the cardiac cycle, but not by far the same amount of research has been accomplished during diastole. Measures of global and regional left ventricular kinematics during diastole are important when attempting to understand left ventricular filling characteristics in health and disease.This thesis presents methods for invasive and non-invasive quantification of cardiac kinematics, with focus on diastole. The project started by quantification of changes in global left ventricular kinematics during diastolic filling. The helical myocardial fiber architecture of the left ventricle produces both long- and short-axis motion as well as torsional deformation. The longitudinal excursion of the mitral annular plane is an important component of left ventricular filling and ejection. This was studied by analyzing the contribution of mitral annular dynamics to left ventricular filling volume in the ovine heart.In order to quantify strains for a specific body undergoing deformation, displacements for a set of internal points at a deformed configuration relative to a reference configuration are needed. A new method for strain quantification from measured myocardial displacements is presented in this thesis. The method is accurate and robust and delivers analytical expressions of the strain components. The developed strain quantification method is simple in nature which aids to bridge a possible gap in understanding between different disciplines and is well suited for sparse arrays of displacement data.Analyses of myocardial kinematics at the level of myocardial fibers require knowledge of cardiac tissue architecture. Temporal changes in myofiber directions during the cardiac cycle have been analyzed in the ovine heart by combining histological measurements of transmural myocardial architecture and local transmural strains.Rapid early diastolic filling is an essential component of the left ventricular function. Such filling requires a highly compliant chamber immediately after systole, allowing inflow at low driving pressures. Failure of this process can lead to exercise intolerance and ultimately to heart failure. A thorough analysis of the relation between global left ventricular kinematics and local myocardial strain at the level of myocardial fibers during early diastole in the ovine heart was performed by applying the method for strain quantification and the technique for computing temporal changes in myocardial architecture on measures of myocardial displacements and tissue architecture in the ovine heart.As data acquisition technologies develop, quantification methods for cardiac kinematics need to be adapted and validated on the new types of data. Recent improvements of DENSE magnetic resonance imaging enable non-invasive transmural strain analyses in the human heart. The strain quantification method was first tailored to displacement data from a surgically implanted bead array but has been extended to applications on non-invasive DENSE data measured in two and three dimensions. Validation against an analytical standard reveals accurate results and in vivo strains agree with values for normal human hearts from other studies.The method has in this thesis been used with displacement data from invasive marker technology and non-invasive DENSE magnetic resonance imaging, but can equally well be applied on any type of displacement data provided that the spatial resolution is high enough to resolve local strain variations.

Quantitative assessment of myocardial function is a valuable tool for clinical applications and physiological studies. This assessment can be acquired using phase based motion sensitive magnetic resonance imaging (MRI) techniques. In this thesis, the accuracy of these phase based motion sensitive MRI techniques is investigated, and modifications in acquisition and post-processing are proposed. The strain rate of the myocardium can be used to evaluate the myocardial function. However, the estimation of strain rate from the velocity data acquired with phase-contrast MRI (PC-MRI) is sensitive to noise. Estimation using normalized convolution showed, however, to reduce this sensitivity to noise and to minimize the influence of non-myocardial tissue which could impair the result. Strain of the myocardium is another measure to assess myocardial function. Strain can be estimated from the myocardial displacement acquired with displacement encoding with stimulated echo (DENSE). DENSE acquisition can be realized with several different encoding strategies. The choice of encoding scheme may make the acquisition more or less sensitive to different sources of error. Two potential sources of errors in DENSE acquisition are the influence of the FID and of the off-resonance effects. Their influence on DENSE were investigated to determine suitable encoding strategies to reduce their influence and thereby improve the measurement accuracy acquired. The quality of the DENSE measurement is not only dependent on the accuracy, but also the precision of the measurement. The precision is affected by the SNR and thereby depends on flip angle strategies, magnetic field strength and spatial variation of the receiver coil sensitivity. A mutual comparison of their influence on SNR in DENSE was therefore performed and could serve as a guideline to optimize parameters for specific applications. The acquisition time is often an important factor, especially in clinical applications where it affects potential patient discomfort and patient through-put. A multiple-slice DENSE acquisition was therefore presented, which allows the acquisition of strain values according to the 16-segment cardiac model within a single breath-hold, instead of the conventional three breath-holds. The DENSE technique can also be adapted toward comprehensive evaluation of the heart in the form of full three-dimensional three-directional acquisition of the displacement. To estimate the full strain tensor from these data, a novel post-processing technique using a polynomial was investigated. The method yielded accurate results on an analytical model and \textit{in-vivo} strains obtained agreed with previously reported myocardial strains in normal volunteers.

Quantitative assessment of myocardial function is a valuable tool for clinical applications and physiological studies. This assessment can be acquired using phase based motion sensitive magnetic resonance imaging (MRI) techniques. In this thesis, the accuracy of these phase based motion sensitive MRI techniques is investigated, and modifications in acquisition and post-processing are proposed. The strain rate of the myocardium can be used to evaluate the myocardial function. However, the estimation of strain rate from the velocity data acquired with phase-contrast MRI (PC-MRI) is sensitive to noise. Estimation using normalized convolution showed, however, to reduce this sensitivity to noise and to minimize the influence of non-myocardial tissue which could impair the result. Strain of the myocardium is another measure to assess myocardial function. Strain can be estimated from the myocardial displacement acquired with displacement encoding with stimulated echo (DENSE). DENSE acquisition can be realized with several different encoding strategies. The choice of encoding scheme may make the acquisition more or less sensitive to different sources of error. Two potential sources of errors in DENSE acquisition are the influence of the FID and of the off-resonance effects. Their influence on DENSE were investigated to determine suitable encoding strategies to reduce their influence and thereby improve the measurement accuracy acquired. The quality of the DENSE measurement is not only dependent on the accuracy, but also the precision of the measurement. The precision is affected by the SNR and thereby depends on flip angle strategies, magnetic field strength and spatial variation of the receiver coil sensitivity. A mutual comparison of their influence on SNR in DENSE was therefore performed and could serve as a guideline to optimize parameters for specific applications. The acquisition time is often an important factor, especially in clinical applications where it affects potential patient discomfort and patient through-put. A multiple-slice DENSE acquisition was therefore presented, which allows the acquisition of strain values according to the 16-segment cardiac model within a single breath-hold, instead of the conventional three breath-holds. The DENSE technique can also be adapted toward comprehensive evaluation of the heart in the form of full three-dimensional three-directional acquisition of the displacement. To estimate the full strain tensor from these data, a novel post-processing technique using a polynomial was investigated. The method yielded accurate results on an analytical model and \textit{in-vivo} strains obtained agreed with previously reported myocardial strains in normal volunteers.

Flow-induced blood damage plays an important role in determining the hemodynamic impact of abnormal blood flow, but quantifying of these effects, which are dominated by shear stresses in highly fluctuating turbulent flow, has not been feasible. This study evaluated the novel application of turbulence tensor measurements using simulated 4D Flow MRI data with six-directional velocity encoding for assessing hemodynamic stresses and corresponding blood damage index (BDI) in stenotic turbulent blood flow. The results showed that 4D Flow MRI underestimates the maximum principal shear stress of laminar viscous stress (PLVS), and overestimates the maximum principal shear stress of Reynolds stress (PRSS) with increasing voxel size. PLVS and PRSS were also overestimated by about 1.2 and 4.6 times at medium signal to noise ratio (SNR) = 20. In contrast, the square sum of the turbulent viscous shear stress (TVSS), which is used for blood damage index (BDI) estimation, was not severely affected by SNR and voxel size. The square sum of TVSS and the BDI at SNR amp;gt;20 were underestimated by less than 1% and 10%, respectively. In conclusion, this study demonstrated the feasibility of 4D Flow MRI based quantification of TVSS and BDI which are closely linked to blood damage. Funding Agencies|European Research Council [310612]; Swedish Research Council [2013-6077, 2014-6191]; National Research Foundation of Korea (NRF) - Ministry of Education [2016R1A6A3A03006337]

IntroductionThe aortic wall and intraluminal thrombus (ILT) have been increasingly studied as potential markers of progressive disease with abdominal aortic aneurysms (AAAs). Our goal was to develop a high resolution, 3D black blood MR technique for AAA wall and ILT imaging within a clinically acceptable scan time.MethodsTwenty two patients with AAAs (maximal diameter 4.3±1.0cm), along with five healthy volunteers, were imaged at 3T with a 3D T1-weighted fast-spin-echo sequence using variable flip angle trains (SPACE) with a preparation pulse (DANTE) for suppressing blood signal. Volunteers and ten patients were also scanned with SPACE alone for comparison purposes. The signal to noise ratio (SNR) and the aortic wall/ILT to lumen contrast to noise ratio (CNR) were measured. Qualitative image scores (1-4 scale) assessing the inner lumen and outer wall boundaries of AAA were performed by two blinded reviewers. In patients with ILT, the ratio of ILT signal intensity (ILTSI) over psoas muscle SI (MuscleSI) was calculated, and the signal heterogeneity of ILT was quantified as standard deviation (SD) over the mean.ResultsAll subjects were imaged successfully with an average scan time of 7.8±0.7minutes. The DANTE preparation pulse for blood suppression substantially reduced flow artifacts in SPACE with lower lumen SNR (8.8 vs. 21.4, p0.05). ILT was present in ten patients, with relatively high signal and a wide SD (average ILTSI/MuscleSI 1.42±0.48 (range 0.75-2.11)) and with SD/mean of 27.7%±6.6% (range 19.6%-39.4%).ConclusionHigh resolution, 3D black blood MRI of AAAs can be achieved in a clinical accepted scan time with reduction of flow artifacts using the DANTE preparation pulse. Signal characteristics of ILT can be quantified and may be used for improved patient-specific risk stratification.

© 2015 Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US. OBJECTIVES Rupture/dissection of ascending thoracic aortic aneurysms (aTAAs) carries high mortality and occurs in many patients who did not meet size criteria for elective surgery. Elevated wall stress may better predict adverse events, but cannot be directly measured in vivo, rather determined from finite element (FE) simulations. Current computational models make assumptions that limit accuracy, most commonly using in vivo imaging geometry to represent zero-pressure state. Accurate patient-specific wall stress requires models with zero-pressure three-dimensional geometry, material properties, wall thickness and residual stress. We hypothesized that wall stress calculated from in vivo imaging geometry at systemic pressure underestimates that using zero-pressure geometry. We developed a novel method to derive zero-pressure geometry from in vivo imaging at systemic pressure. The purpose of this study was to develop the first patient-specific aTAA models using magnetic resonance imaging (MRI) to assess material properties and zero-pressure geometry. Wall stress results from FE models using systemic pressure were compared with those from models using zero-pressure correction. METHODS Patients with aTAAs

© 2015 Wolters Kluwer Health, Inc. All rights reserved. We have used a multimodality imaging approach to assess the inflammatory component of a growing iliac artery aneurysm in a 53-year-old man who presented with related ureteral obstruction. Research suggests that episodic and heterogeneous inflammatory processes are important for the progression of aneurysms. The combined PET and MRI evaluation of inflammation that we present here is a novel approach to vascular imaging that is well suited for emerging hybrid PET/MRI systems.

Background We hypothesised that myocardial deformation determined with magnetic resonance imaging (MRI) will detect myocardial scar. Methods Displacement Encoding with Stimulated Echoes (DENSE) was used to calculate left ventricular strain in 125 patients (29 women and 96 men) with suspected coronary artery disease. The patients also underwent cine imaging and late gadolinium enhancement. 57 patients had a scar area >1 % in at least one segment, 23 were considered free from coronary artery disease (control group) and 45 had pathological findings but no scar (mixed group). Peak strain was calculated in eight combinations: radial and circumferential strain in transmural, subendocardial and epicardial layers derived from short axis acquisition, and transmural longitudinal and radial strain derived from long axis acquisitions. In addition, the difference between strain in affected segments and reference segments, “differential strain”, from the control group was analysed. Results In receiver-operator-characteristic analysis for the detection of 50 % transmurality, circumferential strain performed best with area-under-curve (AUC) of 0.94. Using a cut-off value of -17 %, sensitivity was 95 % at a specificity of 80 %. AUC did not further improve with differential strain. There were significant differences between the control group and global strain circumferential direction (-17 % versus -12 %) and in the longitudinal direction (-13 % versus -10 %). Interobserver and scan-rescan reproducibility was high with an intraclass correlation coefficient (ICC) >0.93. Conclusions DENSE-derived circumferential strain may be used for the detection of myocardial segments with >50 % scar area. The repeatability of strain is satisfactory. DENSE-derived global strain agrees with other global measures of left ventricular ejection fraction.

Magnetic resonance assessment of regional myocardial function is a novel potentially important tool for early identification of cardiac pathology. Many cardiac magnetic resonance techniques have been developed for detection and quantification of regional strain abnormalities including steady-state free-precession CINE, tagging, displacement encoding with stimulated echoes, strain encoding imaging, and feature tracking. Potential clinical applications of magnetic resonance strain imaging include early detection of systolic dysfunction in heart failure patients with both ischemic and nonischemic etiologies.

BACKGROUND: Quantification of the longitudinal- and transverse relaxation time in the myocardium has shown to provide important information in cardiac diagnostics. Methods for cardiac relaxation time mapping generally demand a long breath hold to measure either T1 or T2 in a single 2D slice. In this paper we present and evaluate a novel method for 3D interleaved T1 and T2 mapping of the whole left ventricular myocardium within a single breath hold of 15 heartbeats. METHODS: The 3D-QALAS (3D-quantification using an interleaved Look-Locker acquisition sequence with T2 preparation pulse) is based on a 3D spoiled Turbo Field Echo sequence using inversion recovery with interleaved T2 preparation. Quantification of both T1 and T2 in a volume of 13 slices with a resolution of 2.0x2.0x6.0 mm is obtained from five measurements by using simulations of the longitudinal magnetizations Mz. This acquisition scheme is repeated three times to sample k-space. The method was evaluated both in-vitro (validated against Inversion Recovery and Multi Echo) and in-vivo (validated against MOLLI and Dual Echo). RESULTS: In-vitro, a strong relation was found between 3D-QALAS and Inversion Recovery (R = 0.998; N = 10; p < 0.01) and between 3D-QALAS and Multi Echo (R = 0.996; N = 10; p < 0.01). The 3D-QALAS method showed no dependence on e.g. heart rate in the interval of 40-120 bpm. In healthy myocardium, the mean T1 value was 1083 ± 43 ms (mean ± SD) for 3D-QALAS and 1089 ± 54 ms for MOLLI, while the mean T2 value was 50.4 ± 3.6 ms 3D-QALAS and 50.3 ± 3.5 ms for Dual Echo. No significant difference in in-vivo relaxation times was found between 3D-QALAS and MOLLI (N = 10; p = 0.65) respectively 3D-QALAS and Dual Echo (N = 10; p = 0.925) for the ten healthy volunteers. CONCLUSIONS: The 3D-QALAS method has demonstrated good accuracy and intra-scan variability both in-vitro and in-vivo. It allows rapid acquisition and provides quantitative information of both T1 and T2 relaxation times in the same scan with full coverage of the left ventricle, enabling clinical application in a broader spectrum of cardiac disorders.

Background Mechanical properties of the aortic wall have been used to diagnose and characterize cardiovascular disease. Aortic stiffness correlates with aortic disease and disease progression. Mechanical regulation from strain and wall shear stress is hypothesized to influence remodeling in the cardiovascular system. Current non-invasive techniques for assessing aortic deformation are based on diameter changes, and are sensitive to through-plane motion of the aorta. Conventional methods for assessing strain, such as tagging, have limited resolution. We propose a new MRI approach that measures the regional stretch of the aortic wall itself using displacement encoding with stimulated echoes (DENSE). Methods Six subjects were studied with standard CINE and DENSE imaging of the tubular portion of the ascending aorta. DENSE was performed at the point of max dilation according to the cine images. The aorta was segmented in the DENSE images and the stretch of the aortic wall was calculated. Results Two young volunteers (26 years old) had an aortic stretch of 12%, two older patients (48 years old) with cardiovascular risk factors had stretch of 5%, and two older patients (60 years old) with dilated aortas had stretch of 1%. Figure 1 shows the circumferential stretch of 10±7% in a young volunteer (a), 5±6% in an older patient with aortic valve disease (b), and 0.4±0.4% in an older patient with a dilated aorta (c). Regional differences in stretch are noted with higher stretch seen on the right for the volunteer and the patient with valvular disease. Conclusions This novel application of DENSE imaging allows for direct assessment of regional stretch in the ascending

Introduction/purpose Pulsatile tinnitus (PT) has been linked to multiple anatomical variants of the venous outflow tract including sigmoid sinus diverticulum (SSD). We hypothesize that turbulence generated by the SSD, which is normally preceded by a transverse sinus stenosis (TSS), can explain the source of sound. Turbulent flow has a known association to vasculogenic bruit. Advanced magnetic resonance velocimetry (MRV) was performed in cerebral venous sinuses and internal jugular veins (IJV) to obtain both volumetric velocity and turbulence maps. Materials and methods A series of MRI protocols was performed at 3 T for patients with suspected venous PT including contrast-enhanced MRA (CE-MRA) to delineate the anatomy and identify SSD, 4 D-flow MR to acquire time-resolved phase (velocity) and flow-encoded magnitudes in all three directions, as well as 2 D flow to obtain flow waveforms. Flow turbulence was quantified based on turbulence kinetic energy (TKE). Five SSD patients were evaluated, four of which had an associated TSS upstream from the SSD. Results The TSS resulted in a jet of flow, the direction of which seemed to determine the position of the SSD downstream. The streamline visualization of the flow patterns revealed recirculation in the diverticulum. A helical flow pattern was also found adjacent to the jet flow opposite and downstream of the SSD (Figure 1). TKE mapping revealed a highly localized region of elevated TKE downstream from the stenosis extending to the opening of the diverticulum with a maximum value of 80 J/m 3 (Figure 2). Discussion and Conclusion The unique flow patterns and the presence of turbulence introduced by the TSS and SSD may help explain PT in these patients. Treatment of TSS with PTA and stent implantation, or treatment of the SSD with coil embolization can potentially alter the TKE level and pattern. Disclosures S. Kefayati: None. E. Kao: None. J. Liu: None. H. Haraldsson: None. F. Faraji: None. M. Ballweber: None. K. Meisel: None. V. Halbach: None. D. Saloner: None. M. Amans: None.

Background The ability to measure and quantify myocardial motion and deformation provides a useful tool to assist in the diagnosis, prognosis and management of heart disease. The recent development of magnetic resonance imaging methods, such as harmonic phase analysis of tagging and displacement encoding with stimulated echoes (DENSE), make detailed non-invasive 3D kinematic analyses of human myocardium possible in the clinic and for research purposes. A robust analysis method is required, however. Methods We propose to estimate strain using a polynomial function which produces local models of the displacement field obtained with DENSE. Given a specific polynomial order, the model is obtained as the least squares fit of the acquired displacement field. These local models are subsequently used to produce estimates of the full strain tensor. Results The proposed method is evaluated on a numerical phantom as well as in vivo on a healthy human heart. The evaluation showed that the proposed method produced accurate results and showed low sensitivity to noise in the numerical phantom. The method was also demonstrated in vivo by assessment of the full strain tensor and to resolve transmural strain variations. Conclusions Strain estimation within a 3D myocardial volume based on polynomial functions yields accurate and robust results when validated on an analytical model. The polynomial field is capable of resolving the measured material positions from the in vivo data, and the obtained in vivo strains values agree with previously reported myocardial strains in normal human hearts.

A quantitative analysis of myocardial mechanics is fundamental to the understanding of cardiac function, diagnosis of heart disease and assessment of therapeutic intervention. In clinical practice, most cardiac imaging analyses are performed in 2D because of the limited scan time available. However, the obtained information from a 2D measurement is limited. This study presents a method to obtain temporal evolutions of transmural 3D Lagrangian strains from two intersecting 2D planes of slice-followed cine displacement encoding with stimulated echoes (DENSE) data using a bilinear-cubic polynomial element to resolve strain from the displaced myocardial positions. The method was validated against an analytical standard and has been applied to in vivo data acquired on a 3 T magnetic resonance system from a healthy volunteer to quantify systolic strains at the anterior-basal region of left ventricular myocardium. The method demonstrates accurate results when validated in the analytical model, and the in vivo results agree within experimental accuracy with values reported in the literature. Even with a short scan time, this method provides the full 3D Lagrangian strain tensor from two 2D DENSE measurements.

Summary The aim of this study is to investigate if the use of individual, per segment reference values for cardiac strain allows for improved discrimination of pathological deformation. In a cohort of patients with a high likelihood of ischemic heart disease, preliminary results within the subgroup of patients without pathological findings on cardiac MRI suggest a spatial dependency of strain. Background In addition to perfusion and viability, systolic myocardial function constitutes one of the cornerstones in the evaluation of ischemic patients. Technical achievements have improved the accuracy of the quantitative assessment of myocardial function, allowing for better discrimination between healthy and diseased myocardium. These advances cannot be fully exploited without knowledge of the spatial dependency and individual variance of deformation in health and disease. Methods In an ongoing study, a large cohort of patients with moderate chest pain and a high likelihood of coronary artery disease undergo cardiac MRI including cine loops for wall motion, perfusion at rest and during adenosine stress, acquisition of myocardial deformation with displacement encoding with stimulated echo (DENSE), and late gadolinium enhancement to demonstrate scar tissue. In this preliminary study, patient demonstrating maintained perfusion, normal wall motion, and no signs of scar at late gadolinium enhancement were selected for further evaluation. Regional deformation acquired with DENSE was evaluated in terms of radial and circumferential strains. All measurements were reported according to the seventeen segment model of the AHA. The apical cap was excluded from the quantification of regional deformation. Results Preliminary results for radia la nd circumferential strain for the 11 patients without pathological findings are presented in the Figure 1. The figure demonstrates the mean and standard deviation of the strain for the individual myocardial segments. Strain in the basal segments appears to be more spatially dependent than strain in the mid-cavity segments. The strain in the apical segments showed a larger variation between the subjects. Conclusions

Aim: The influences on the SNR of DENSE MRI of field strength, receiver coil sensitivity and choice of flip angle strategy have been previously investigated individually. In this study, all of these parameters have been investigated in the same setting, and a mutual comparison of their impact on SNR is presented. Materials and methods: Ten healthy volunteers were imaged in a 1.5T and a 3T MRI system, using standard 5 or 6 channel cardiac coils as well as 32 channel coils, with four different excitation patterns. Variation of spatial coil sensitivity was assessed by regional SNR analysis. Results: SNR ranging from 2.8 to 30.5 was found depending on the combination of excitation patterns, coil sensitivity and field strength. The SNR at 3T was 53 ± 26% higher than at 1.5T (pOriginal Publication: Andreas Sigfridsson, Henrik Haraldsson, Tino Ebbers, Hans Knutsson and Hajime Sakuma, In-vivo SNR in DENSE MRI: temporal and regional effects of field strength, receiver coil sensitivity, and flip angle strategies, 2011, Magnetic Resonance Imaging, (29), 2, 202-208. http://dx.doi.org/10.1016/j.mri.2010.08.016 Copyright: Elsevier Science B.V., Amsterdam. http://www.elsevier.com/

Accurate functional measurement in cardiovascular diseases is important as inaccuracy may compromise diagnostic decisions. Cardiac function can be assessed using displacement encoding with stimulated echoes, resulting in three signal components. The free induction decay (FID), arising from spins undergoing T(1) -relaxation, is not displacement encoded and impairs the displacement acquired. Techniques for suppressing the FID exist; however, a residual will remain. The effect of the residual is difficult to distinguish and investigate in vitro and in vivo. In this work, the influence of the FID as well as of off-resonance effects is evaluated by altering the phase of the FID in relation to the stimulated echo. The results show that the FID and off-resonance effects can impair the accuracy of the displacement measurement acquired. The influence of the FID can be avoided by using an encoded reference. We therefore recommend the assessment of this influence of the FID for each displacement encoding with stimulated echoes protocol.

We use artificial neural networks (ANNs) to detect signs of acute myocardial infarction (AMI) in ECGs. The 12-lead ECG is decomposed into Hermite basis functions, and the resulting coefficients are used as inputs to the ANNs. Furthermore, we present a case-based method that qualitatively explains the operation of the ANNs, by showing regions of each ECG critical for ANN response. Key ingredients in this method are: (i) a cost function used to find local ECG perturbations leading to the largest possible change in ANN output and (ii) a minimization scheme for this cost function using mean field annealing. Our approach was tested on 2238 ECGs recorded at an emergency department. The obtained ROC areas for ANNs trained with the Hermite representation and standard ECG measurements were 83.4 and 84.3% (P=0.4), respectively. We believe that the proposed method has potential as a decision support system that can provide good advice for diagnosis, as well as providing the physician with insight into the reason underlying the advice.

Artificial neural networks have successfully been applied for automated interpretation of myocardial perfusion images. So far the networks have used data from the myocardial perfusion images only. The purpose of this study was to investigate whether the automated interpretation of myocardial perfusion images with the use of artificial neural networks was improved if clinical data were assessed in addition to the perfusion images.A population of 229 patients who had undergone both rest-stress myocardial perfusion scintigraphy in conjunction with an exercise test and coronary angiography, with no more than 3 months elapsing between the 2 examinations, were studied. The networks were trained to detect coronary artery disease or myocardial ischemia with the use of 2 different gold standards. The first was based on coronary angiography, and the second was based on all data available (including perfusion scintigrams, coronary angiography, exercise test, resting electrocardiography, patient history, etc). The performance of the neural networks was quantified as areas under the receiver operating characteristic curves. The results showed that the neural networks trained with perfusion images performed better than those trained with exercise data (0.78 vs 0.55, P.0001), with coronary angiography used as the gold standard. Furthermore, the networks did not improve when data from the exercise test were used as input in addition to the perfusion images (0.78 vs 0.77, P =.6).The results show that the clinically important information in combined exercise test and myocardial scintigraphy could be found in the perfusion images. Exercise test information did not improve upon the accuracy of automated neural network interpretation of myocardial perfusion images in a receiver operator characteristic analysis of test accuracy.

Background In clinical practice, perfusion, viability and systolic myocardial function are fundamental to the evaluation of ischemic patients. Deformation of muscle expresses active contraction and can be represented by strain in various directions. Improvements to the “DENSE” technique, “Displacement Encoding with Stimulated Echoes”, have shown high accuracy warranting its application to clinical patients. The purpose of this study was to explore potential differences in myocardial deformation determined in patients with various extent of myocardial scar as well as in the corresponding segments of coronary patients without scar.

Summary The purpose of this study was to explore the differences in myocardial deformation by DENSE determined in healthy myocardium and in segments variously affected by myocardial infarction. There was a significant difference in both radial and circumferential strain between normal and infarcted myocardium. Background The purpose of this study was to explore the differences in myocardial deformation by DENSE determined in healthy myocardium and in segments variously affected by myocardial infarction. There was a significant difference in both radial and circumferential strain between normal and infarcted myocardium. Methods By using a 1.5T scanner have 68 patients with a high likelihood of coronary artery disease been included. The following MRI protocol was used: cine SSFP, single slice multiphase Displacement ENcoding with Stimulated Echoes (DENSE) during breath holding, perfusion during adenosine stress and at rest and late gadolinium enhancement. Ejection fraction was calculated from the short axis cine and wall motion was assessed in terms of normal, hypokinetic, akinetic and dyskinetic according to guidelines. Perfusion was assessed as normal or reduced in parts of the thickness of the wall. Late gadolinium enhancement was also graded in terms of transmurality (scar percentage of the wall thickness). All measurements were applied to segments of the AHA seventeen segment model, excluding the apical cap. DENSE post processing was performed with an in-house developed software calculating radial strain and circumferential strain. Healthy myocardium was determined if scar was absent and, wall motion and perfusion were normal (n=11). Significant myocardial infarction was defined as positive gadolinium enhancement in excess of fifty percent wall thickness (n=27). Segments were aggregated according to the coronary perfusion territories. Results Data are shown for healthy/scared areas (p