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Purpose: In the past, dictionary learning (DL) and sparse coding (SC) have been proposed for the regularization of image reconstruction problems. The regularization is given by a sparse approximation of all image patches using a learned dictionary, that is, an overcomplete set of basis functions learned from data. Despite its competitiveness, DL and SC require the tuning of two essential hyperparameters: the sparsity level S — the number of basis functions of the dictionary, called atoms, which are used to approximate each patch, and K — the overall number of such atoms in the dictionary. These two hyperparameters usually have to be chosen a priori and are determined by repetitive and computationally expensive experiments. Furthermore, the final reported values vary depending on the specific situation. As a result, the clinical application of the method is limited, as standardized reconstruction protocols have to be used. Methods: In this work, we use adaptive DL and propose a novel adaptive sparse coding algorithm for two‐dimensional (2D) radial cine MR image reconstruction. Using adaptive DL and adaptive SC, the optimal dictionary size K as well as the optimal sparsity level S are chosen dependent on the considered data. Results: Our three main results are the following: First, adaptive DL and adaptive SC deliver results which are comparable or better than the most widely used nonadaptive version of DL and SC. Second, the time needed for the regularization is accelerated due to the fact that the sparsity level S is never overestimated. Finally, the a priori choice of S and K is no longer needed but is optimally chosen dependent on the data under consideration. Conclusions: Adaptive DL and adaptive SC can highly facilitate the application of DL‐ and SC‐based regularization methods. While in this work we focused on 2D radial cine MR image reconstruction, we expect the method to be applicable to different imaging modalities as well. [ABSTRACT FROM AUTHOR]

Background: Unrolled neural networks (NNs) have been extensively applied to different image reconstruction problems across all imaging modalities. A key component of the latter is that they allow for physics‐informed learning of the regularization method, which is parametrized by the NN. However, due to the lack of understanding of deep NNs from a theoretical point of view, unrolled NNs are still black‐boxes when the regularizers are given by deep NNs, for example, U‐Nets. Purpose: Dictionarylearning (DL) is a well‐established regularization method, which is based on learning a transform to sparsely approximate the signals of interest. Typically, DL‐based image reconstruction either employs a dictionary, which was pretrained on a set of patches which were extracted from ground‐truth images or a dictionary which is jointly trained during the reconstruction. However, in both cases, the used DL‐algorithms are not designed to take into account the reconstruction problem or the underlying physical model, which describes the imaging process. In this work, we propose a DL‐algorithm based on unrolled NNs to overcome these limitations. Methods: We construct an unrolled NN, which corresponds to an unrolled DL‐based reconstruction algorithm and train the unrolled NN to optimize its weights, that is, the atoms of the dictionary, by back‐propagation in a supervised manner. Further, we propose a new way to employ a 2D dictionary in the spatio‐temporal domain. We tested and evaluated the method on an accelerated cardiac cine MR image reconstruction problem using 216/36/36 dynamic images for training, validation, and testing and compared it to two well‐known state‐of‐the‐art approaches for cardiac cine MRI based on deep iterative CNNs. Further, we analyze the obtained dictionaries in terms of dictionary‐coherence and structure of the atoms. Last, we compare the reported methods in terms of stability by applying them to an entirely different dataset consisting of 49 different test images. Results: The investigated physics‐informed DL‐approach yields significantly more accurate reconstructions compared to the DL‐method, which uses dictionaries obtained by decoupled pretraining, thereby providing an improvement of up to 4.90 dB in terms of PSNR and 5% in terms of SSIM. Further, the proposed spatio‐temporal 2D dictionary outperforms the 1D and 3D dictionaries by preventing smoothing of image details while still accurately removing undersampling artifacts and noise resulting in an increase of up to 1.10 dB in terms of PSNR and 4% in terms of SSIM. Although being surpassed by the CNNs on the first dataset, the proposed NNs‐based DL method is more stable compared to the latter approach and yields comparable results on the second dataset. Last, it has the advantage of being entirely interpretable in each component. Conclusions: The presented physics‐informed NN can be used as training algorithm for a classical and interpretable data‐driven regularization method based on a learned dictionary, which can then not only be linked to the considered data but also to the reconstruction method that the NN defines. [ABSTRACT FROM AUTHOR]

Abstract: Non-rigid image registration techniques are commonly used to estimate complex tissue deformations in medical imaging. A range of non-rigid registration algorithms have been proposed, but they typically have high computational complexity. To reduce this complexity, combinations of multiple less complex deformations have been proposed such as hierarchical techniques which successively split the non-rigid registration problem into multiple locally rigid or affine components. However, to date the splitting has been regular and the underlying image content has not been considered in the splitting process. This can lead to errors and artefacts in the resulting motion fields. In this paper, we propose three novel adaptive splitting techniques, an image-based, a similarity-based, and a motion-based technique within a hierarchical framework which attempt to process regions of similar motion and/or image structure in single registration components. We evaluate our technique on free-breathing whole-chest 3D MRI data from 10 volunteers and two publicly available CT datasets. We demonstrate a reduction in registration error of up to 49.1% over a non-adaptive technique and compare our results with a commonly used free-form registration algorithm. [Copyright &y& Elsevier]

We present a fast parallel algorithm to compute the nonequispaced fast Fourier transform on commodity graphics hardware (the GPU). We focus particularly on a novel implementation of the convolution step in the transform as it was previously its most time consuming part. We describe the performance for two common sample distributions in medical imaging (radial and spiral trajectories), and for different convolution kernels as these parameters all influence the speed of the algorithm. The GPU-accelerated convolution is up to 85 times faster as our reference, the open source NFFT library on a state-of-the-art 64 bit CPU. The accuracy of the proposed GPU implementation was quantitatively evaluated at the various settings. To illustrate the applicability of the transform in medical imaging, in which it is also known as gridding, we look specifically at non-Cartesian magnetic resonance imaging and reconstruct both a numerical phantom and an in vivo cardiac image. [ABSTRACT FROM AUTHOR]

In dynamic magnetic resonance imaging (MRI) studies, the motion kinetics or the contrast variability are often hard to predict, hampering an appropriate choice of the image update rate or the temporal resolution. A constant azimuthal profile spacing (111.246°), based on the Golden Ratio, is investigated as optimal for image reconstruction from an arbitrary number of profiles in radial MRI. The profile order is evaluated and compared with a uniform profile distribution in terms of signal-to-noise ratio (SNR) and artifact level. The favorable characteristics of such a profile order are exemplified in two applications on healthy volunteers. First, an advanced sliding window reconstruction scheme is applied to dynamic cardiac imaging, with a reconstruction window that can be flexibly adjusted according to the extent of cardiac motion that is acceptable. Second, a contrast-enhancing k-space filter is presented that permits reconstructing an arbitrary number of images at arbitrary time points from one raw data set. The filter was utilized to depict the T1-relaxation in the brain after a single inversion prepulse. While a uniform profile distribution with a constant angle increment is optimal for a fixed and predetermined number of profiles, a profile distribution based on the Golden Ratio proved to be an appropriate solution for an arbitrary number of profiles. [ABSTRACT FROM AUTHOR]

The steady-state free precessing (SSFP) sequences, widely used in MRI today, acquire data only during a short fraction of the repetition time (TR). Thus, they exhibit a poor scan efficiency. In this paper, a novel approach to extending the acquisition window for a given TR without considerably modifying the basic sequence is explored for radial SSFF sequences. The additional data are primarily employed to increase the signal-to-noise ratio, rather than to improve the temporal resolution of the imaging. The approach is analyzed regarding its effect on the image SNR (signal to noise ratio) and the reconstruction algorithm. Results are presented for phantom experiments and cardiac functions studies. The gain in SNR is most notable in rapid imaging, since SNR enhancement for a constant repetition time may be used to compensate for the increase in noise resulting from angular undersampling. [ABSTRACT FROM AUTHOR]

An abstract of the conference paper "A dual-slice k-t approach for highly accelerated flow MRI," by Daniel Giese and colleagues is presented.

Background: Cardiac PET has recently found novel applications in coronary atherosclerosis imaging using [18F]NaF as a radiotracer, highlighting vulnerable plaques. However, the resulting uptakes are relatively small, and cardiac motion and respiration-induced movement of the heart can impair the reconstructed images due to motion blurring and attenuation correction mismatches. This study aimed to apply an MR-based motion compensation framework to [18F]NaF data yielding high-resolution motion-compensated PET and MR images. Methods: Free-breathing 3-dimensional Dixon MR data were acquired, retrospectively binned into multiple respiratory and cardiac motion states, and split into fat and water fraction using a model-based reconstruction framework. From the dynamic MR reconstructions, both a non-rigid cardiorespiratory motion model and a motion-resolved attenuation map were generated and applied to the PET data to improve image quality. The approach was tested in 10 patients and focal tracer hotspots were evaluated concerning their target-to-background ratio, contrast-to-background ratio, and their diameter. Results: MR-based motion models were successfully applied to compensate for physiological motion in both PET and MR. Target-to-background ratios of identified plaques improved by 7 ± 7%, contrast-to-background ratios by 26 ± 38%, and the plaque diameter decreased by −22 ± 18%. MR-based dynamic attenuation correction strongly reduced attenuation correction artefacts and was not affected by stent-related signal voids in the underlying MR reconstructions. Conclusions: The MR-based motion correction framework presented here can improve the target-to-background, contrast-to-background, and width of focal tracer hotspots in the coronary system. The dynamic attenuation correction could effectively mitigate the risk of attenuation correction artefacts in the coronaries at the lung-soft tissue boundary. In combination, this could enable a more reproducible and reliable plaque localisation. [ABSTRACT FROM AUTHOR]

Purpose: Iterative convolutional neural networks (CNNs) which resemble unrolled learned iterative schemes have shown to consistently deliver state‐of‐the‐art results for image reconstruction problems across different imaging modalities. However, because these methods include the forward model in the architecture, their applicability is often restricted to either relatively small reconstruction problems or to problems with operators which are computationally cheap to compute. As a consequence, they have not been applied to dynamic non‐Cartesian multi‐coil reconstruction problems so far. Methods: In this work, we propose a CNN architecture for image reconstruction of accelerated 2D radial cine MRI with multiple receiver coils. The network is based on a computationally light CNN component and a subsequent conjugate gradient (CG) method which can be jointly trained end‐to‐end using an efficient training strategy. We investigate the proposed training strategy and compare our method with other well‐known reconstruction techniques with learned and non‐learned regularization methods. Results: Our proposed method outperforms all other methods based on non‐learned regularization. Further, it performs similar or better than a CNN‐based method employing a 3D U‐Net and a method using adaptive dictionary learning. In addition, we empirically demonstrate that even by training the network with only iteration, it is possible to increase the length of the network at test time and further improve the results. Conclusions: End‐to‐end training allows to highly reduce the number of trainable parameters of and stabilize the reconstruction network. Further, because it is possible to change the length of the network at the test time, the need to find a compromise between the complexity of the CNN‐block and the number of iterations in each CG‐block becomes irrelevant. [ABSTRACT FROM AUTHOR]

Background: Cardiac MRI has become the gold‐standard imaging technique for assessing cardiovascular morphology and function. In spite of this, its slow data acquisition process presents imaging challenges due to the motion from heartbeats, respiration, and blood flow. In recent studies, deep learning (DL) algorithms have shown promising results for the task of image reconstruction. However, there have been instances where they have introduced artifacts that may be misinterpreted as pathologies or may obscure the detection of pathologies. Therefore, it is important to obtain a metric, such as the uncertainty of the network output, that identifies such artifacts. However, this can be quite challenging for large‐scale image reconstruction problems such as dynamic multi‐coil non‐Cartesian MRI. Purpose: To efficiently quantify uncertainties of a physics‐informed DL‐based image reconstruction method for a large‐scale accelerated 2D multi‐coil dynamic radial MRI reconstruction problem, and demonstrate the benefits of physics‐informed DL over model‐agnostic DL in reducing uncertainties while at the same time improving image quality. Methods: We extended a recently proposed physics‐informed 2D U‐Net that learns spatio‐temporal slices (named XT‐YT U‐Net), and employed it for the task of uncertainty quantification (UQ) by using Monte Carlo dropout and a Gaussian negative log‐likelihood loss function. Our data comprised 2D dynamic MR images acquired with a radial balanced steady‐state free precession sequence. The XT‐YT U‐Net, which allows for training with a limited amount of data, was trained and validated on a dataset of 15 healthy volunteers, and further tested on data from four patients. An extensive comparison between physics‐informed and model‐agnostic neural networks (NNs) concerning the obtained image quality and uncertainty estimates was performed. Further, we employed calibration plots to assess the quality of the UQ. Results: The inclusion of the MR‐physics model of data acquisition as a building block in the NN architecture led to higher image quality (NRMSE: −33±8.2%$-33 \pm 8.2 \%$, PSNR: 6.3±1.3%$6.3 \pm 1.3 \%$, and SSIM: 1.9±0.96%$1.9 \pm 0.96 \%$), lower uncertainties (−46±8.7%$-46 \pm 8.7 \%$), and, based on the calibration plots, an improved UQ compared to its model‐agnostic counterpart. Furthermore, the UQ information can be used to differentiate between anatomical structures (e.g., coronary arteries, ventricle boundaries) and artifacts. Conclusions: Using an XT‐YT U‐Net, we were able to quantify uncertainties of a physics‐informed NN for a high‐dimensional and computationally demanding 2D multi‐coil dynamic MR imaging problem. In addition to improving the image quality, embedding the acquisition model in the network architecture decreased the reconstruction uncertainties as well as quantitatively improved the UQ. The UQ provides additional information to assess the performance of different network approaches. [ABSTRACT FROM AUTHOR]

Objective: According to the European Reference Organization for Quality Assured Breast Cancer Screening and Diagnostic Services (EUREF) image quality in mammography is assessed by recording and analyzing a set of images of the CDMAM phantom. The EUREF procedure applies an automated analysis combining image registration, signal detection and nonlinear fitting. We present a proof of concept for an end-to-end deep learning framework that assesses image quality on the basis of single images as an alternative. Methods: Virtual mammography is used to generate a database with known ground truth for training a regression convolutional neural net (CNN). Training is carried out by continuously extending the training data and applying transfer learning. Results: The trained net is shown to correctly predict the image quality of simulated and real images. Specifically, image quality predictions on the basis of single images are of similar quality as those obtained by applying the EUREF procedure with 16 images. Our results suggest that the trained CNN generalizes well. Conclusion: Mammography image quality assessment can benefit from the proposed deep learning approach. Significance: Deep learning avoids cumbersome pre-processing and allows mammography image quality to be estimated reliably using single images. [ABSTRACT FROM AUTHOR]

In this work we reduce undersampling artefacts in two-dimensional (2D) golden-angle radial cine cardiac MRI by applying a modified version of the U-net. The network is trained on 2D spatio-temporal slices which are previously extracted from the image sequences. We compare our approach to two 2D and a 3D deep learning-based post processing methods, three iterative reconstruction methods and two recently proposed methods for dynamic cardiac MRI based on 2D and 3D cascaded networks. Our method outperforms the 2D spatially trained U-net and the 2D spatio-temporal U-net. Compared to the 3D spatio-temporal U-net, our method delivers comparable results, but requiring shorter training times and less training data. Compared to the compressed sensing-based methods kt-FOCUSS and a total variation regularized reconstruction approach, our method improves image quality with respect to all reported metrics. Further, it achieves competitive results when compared to the iterative reconstruction method based on adaptive regularization with dictionary learning and total variation and when compared to the methods based on cascaded networks, while only requiring a small fraction of the computational and training time. A persistent homology analysis demonstrates that the data manifold of the spatio-temporal domain has a lower complexity than the one of the spatial domain and therefore, the learning of a projection-like mapping is facilitated. Even when trained on only one single subject without data-augmentation, our approach yields results which are similar to the ones obtained on a large training dataset. This makes the method particularly suitable for training a network on limited training data. Finally, in contrast to the spatial 2D U-net, our proposed method is shown to be naturally robust with respect to image rotation in image space and almost achieves rotation-equivariance where neither data-augmentation nor a particular network design are required. [ABSTRACT FROM AUTHOR]

An abstract of the conference paper "Real time phase encoded MR for assessment of acute variability of central pulse wave velocity," by Nicholas Gaddum and colleagues is presented.

Background: Cardiac catheterization is a common procedure in patients with congenital heart disease (CHD). Although cardiovascular magnetic resonance imaging (CMR) represents a promising alternative approach to fluoroscopy guidance, simultaneous high contrast visualization of catheter, soft tissue and the blood pool remains challenging. In this study, a novel passive tracking technique is proposed for enhanced positive contrast visualization of gadolinium-filled balloon catheters using partial saturation (pSAT) magnetization preparation. Methods: The proposed pSAT sequence uses a single shot acquisition with balanced steady-state free precession (bSSFP) readout preceded by a partial saturation pre-pulse. This technique was initially evaluated in five healthy subjects. The pSAT sequence was compared to conventional bSSFP images acquired with (SAT) and without (Non-SAT) saturation pre-pulse. Signal-to-noise ratio (SNR) of the catheter balloon, blood and myocardium and the corresponding contrast-to-noise ratio (CNR) are reported. Subjective assessment of image suitability for CMR-guidance and ideal pSAT angle was performed by three cardiologists. The feasibility of the pSAT sequence is demonstrated in two adult patients undergoing CMR-guided cardiac catheterization. Results: The proposed pSAT approach provided better catheter balloon/blood contrast and catheter balloon/ myocardium contrast than conventional Non-SAT sequences. It also resulted in better blood and myocardium SNR than SAT sequences. When averaged over all volunteers, images acquired with a pSAT angle of 20° to 40° enabled simultaneous visualization of the catheter balloon and the cardiovascular anatomy (blood and myocardium) and were found suitable for CMR-guidance in >93% of cases. The pSAT sequence was successfully used in two patients undergoing CMR-guided diagnostic cardiac catheterization. Conclusions: The proposed pSAT sequence offers real-time, simultaneous, enhanced contrast visualization of the catheter balloon, soft tissues and blood. This technique provides improved passive tracking capabilities during CMR-guided catheterization in patients. [ABSTRACT FROM AUTHOR]

Abstract: In vivo imaging of cardiac 3D fibre architecture is still a practical and methodological challenge. However it potentially provides important clinical insights, for example leading to a better understanding of the pathophysiology and the follow up of ventricular remodelling after therapy. Recently, the acquisition of 2D multi-slice Diffusion Tensor Images (DTI) of the in vivo human heart has become feasible, yielding a limited number of slices with relatively poor signal-to-noise ratios. In this article, we present a method to analyse the fibre architecture of the left ventricle (LV) using shape-based transformation into a normalised Prolate Spheroidal coordinate frame. Secondly, a dense approximation scheme of the complete 3D cardiac fibre architecture of the LV from a limited number of DTI slices is proposed and validated using ex vivo data. Those two methods are applied in vivo to a group of healthy volunteers, on which 2D DTI slices of the LV were acquired using a free-breathing motion compensated protocol. Results demonstrate the advantages of using curvilinear coordinates both for the anaylsis and the interpolation of cardiac DTI information. Resulting in vivo fibre architecture was found to agree with data from previous studies on ex vivo hearts. [Copyright &y& Elsevier]

An abstract of the conference paper "Velocity spectrum imaging using radial k-t SPIRiT," by Claudio Santelli and colleagues is presented.

This paper presents a novel, magnetic resonance imaging (MRI)-compatible, force sensor suitable for cardiac catheterization procedures. The miniature, fiber-optic sensor is integrated with the tip of a catheter to allow the detection of interaction forces with the cardiac walls. The optical fiber light intensity is modulated when a force acting at the catheter tip deforms an elastic element, which, in turn, varies the distance between a reflector and the optical fiber. The tip sensor has an external diameter of 9 Fr (3 mm) and can be used during cardiac catheterization procedures. The sensor is able to measure forces in the range of 0–0.85 N, with relatively small hysteresis.  A nonlinear method for calibration is used and real-time MRI in vivo experiments are carried out, to prove the feasibility of this low-cost sensor, enabling the detection of catheter-tip contact forces under dynamic conditions. [ABSTRACT FROM PUBLISHER]

The case of an 8-year-old girl with atrial septal defect and associated anomalous pulmonary venous return is presented to illustrate the advantages of four dimensional flow (4D flow) over the current two dimensional flow (2D flow) in terms of time efficiency, easy planning, accurate and individual quantification of the blood sources contributing to the left-to-right shunting from one single acquisition, internal validation of flow measurement accuracy, possibility of reanalysis without rescanning in case of unexpected findings during the postprocessing, and comprehensive understanding of flow insight by use of particle tracing visualization. [ABSTRACT FROM AUTHOR]

A barrier to the adoption of non-Cartesian parallel magnetic resonance imaging for real-time applications has been the times required for the image reconstructions. These times have exceeded the underlying acquisition time thus preventing real-time display of the acquired images. We present a reconstruction algorithm for commodity graphics hardware (GPUs) to enable real time reconstruction of sensitivity encoded radial imaging (radial SENSE). We demonstrate that a radial profile order based on the golden ratio facilitates reconstruction from an arbitrary number of profiles. This allows the temporal resolution to be adjusted on the fly. A user adaptable regularization term is also included and, particularly for highly undersampled data, used to interactively improve the reconstruction quality. Each reconstruction is fully self-contained from the profile stream, i.e., the required coil sensitivity profiles, sampling density compensation weights, regularization terms, and noise estimates are computed in real-time from the acquisition data itself. The reconstruction implementation is verified using a steady state free precession (SSFP) pulse sequence and quantitatively evaluated. Three applications are demonstrated; real-time imaging with real-time SENSE 1) or k-t SENSE 2) reconstructions, and 3) offline reconstruction with interactive adjustment of reconstruction settings. [ABSTRACT FROM AUTHOR]

Simultaneous positron-emission tomography (PET)-magnetic resonance (MR) imaging is a hybrid technique in oncological hepatic imaging combining soft-tissue and functional contrast of dynamic contrast enhanced MR (DCE-MR) with metabolic information from PET. In this context, respiratory motion represents a major challenge by introducing blurring, artifacts and misregistration in the liver. In this work, we propose a free-breathing 3D non-rigid respiratory motion correction framework for simultaneously acquired DCE-MR and PET data, which makes use of higher spatial resolution MR data to derive motion information used directly during image reconstruction to minimize image blurring and motion artifacts. The main aim was to increase contrast of hepatic metastases to improve their detection and characterization. DCE-MR data were acquired at 3T through a golden radial phase encoding scheme, enabling derivation of motion fields. These were used in the motion compensated image reconstruction of DCE-MR time-series (48 time-points, 6 s temporal resolution, 1.5 mm isotropic spatial resolution) and 3D PET activity map, which was subsequently interpolated to the DCE-MR resolution. The extended Tofts model was fitted to DCE-MR data, obtaining functional parametric maps related to perfusion such as the endothelial permeability (). Fifty-seven hepatic metastases were identified and analyzed. Quantitative evaluations of motion correction in PET images demonstrated average percentage increases of 16% ± 5% (mean ± SD) in Contrast (C), 18% ± 6% in SUVmean and 14% ± 2% in SUVmax, while DCE-MR and scored contrast-to-noise-ratio increases of 64% ± 3% and 90% ± 6%, respectively. Motion-corrected data visually showed improved image contrast of hepatic metastases and effectively reduced blurring and motion artefacts. Scatter plots of SUVmean versus suggested that the proposed framework improved differentiation of measurements. The presented motion correction framework for simultaneously acquired PET-DCE-MR data provides accurately aligned images with increased contrast of hepatic lesions allowing for improved detection and characterization. [ABSTRACT FROM AUTHOR]

Clinical evidence suggests a link between fibrosis in the left atrium (LA) and atrial fibrillation (AF), the most common sustained arrhythmia. Image-derived fibrosis is increasingly used for patient stratification and therapy guidance. However, locations of re-entrant drivers (RDs) sustaining AF are unknown and therapy success rates remain suboptimal. This study used image-derived LA models to explore the dynamics of RD stabilization in fibrotic regions and generate maps of RD locations. LA models with patient-specific geometry and fibrosis distribution were derived from late gadolinium enhanced magnetic resonance imaging of 6 AF patients. In each model, RDs were initiated at multiple locations, and their trajectories were tracked and overlaid on the LA fibrosis distributions to identify the most likely regions where the RDs stabilized. The simulations showed that the RD dynamics were strongly influenced by the amount and spatial distribution of fibrosis. In patients with fibrosis burden greater than 25%, RDs anchored to specific locations near large fibrotic patches. In patients with fibrosis burden below 25%, RDs either moved near small fibrotic patches or anchored to anatomical features. The patient-specific maps of RD locations showed that areas that harboured the RDs were much smaller than the entire fibrotic areas, indicating potential targets for ablation therapy. Ablating the predicted locations and connecting them to the existing pulmonary vein ablation lesions was the most effective in-silico ablation strategy. Author summary: Atrial fibrillation (AF) is the most common cardiac arrhythmia and a huge healthcare problem, but its mechanisms are incompletely understood, and clinical therapies such as catheter ablation (CA) have poor long-term outcomes. This is due to the empirical nature of the procedure and lack of mechanistic knowledge of optimal ablation sites and strategies in patients whose atria is altered by AF-induced structural remodelling. In this study, we developed 3D atrial models with patient-specific geometry and distribution of fibrosis obtained from AF patient imaging and applied the models to explore the mechanisms of re-entrant drivers (RD) sustaining AF. Moreover, we used the novel mechanistic knowledge to simulate CA based on the model predictions and compared its success with existing clinical CA strategies. We discovered that the RD dynamics were strongly influenced by the spatial distribution of fibrosis, and RDs typically anchored to specific locations near large fibrotic patches. Virtual ablations of such anchoring locations by connecting them with linear lesions to the nearest pulmonary veins (PV) had superior efficacy compared to clinically used strategies such as the PV isolation. After incorporating further patient-specific information and careful validation, the proposed in-silico approach can help evaluate and potentially guide CA therapy in the clinic. [ABSTRACT FROM AUTHOR]

This paper presents a simulation framework for dynamic PET-MR. The main focus of this framework is to provide motion-resolved MR and PET data and ground truth motion information. This can be used in the optimisation and quantitative evaluation of image registration and in assessing the error propagation due to inaccuracies in motion estimation in complex motion-compensated reconstruction algorithms. Contrast and tracer kinetics can also be simulated and are available as ground truth information. To closely emulate medical examination, input and output of the simulation are files in standardised open-source raw data formats. This enables the use of existing raw data as a template input and ensures seamless integration of the output into existing reconstruction pipelines. The proposed framework was validated in PET-MR and image registration applications. It was used to simulate a FDG-PET-MR scan with cardiac and respiratory motion. Ground truth motion information could be utilised to optimise parameters for PET and synergistic PET-MR image registration. In addition, a free-breathing dynamic contrast enhancement (DCE) abdominal scan of a patient with hepatic lesions was simulated. In order to correct for breathing motion, a motion-corrected image reconstruction scheme was used and a Toft's model was fit to the DCE data to obtain quantitative DCE-MRI parameters. Utilising the ground truth motion information, the dependency of quantitative DCE-MR images on the accuracy of the motion estimation was evaluated. We demonstrated that respiratory motion had to be available with an average accuracy of at least the spatial resolution of the DCE-MR images in order to ensure an improvement in lesions visualisation and quantification compared to no motion correction. The proposed framework provides a valuable tool with a wide range of scientific PET and MR applications and will be available as part of the open-source project Synergistic Image Reconstruction Framework (SIRF). [ABSTRACT FROM AUTHOR]

Magnetic particle imaging (MPI) is a non-invasive, non-ionizing imaging technique for the visualization and quantification of magnetic nanoparticles (MNPs). The technique is especially suitable for cell imaging as it offers zero background contribution from the surrounding tissue, high sensitivity, and good spatial and temporal resolutions. Previous studies have demonstrated that the dynamic magnetic behaviour of MNPs changes during cellular binding and internalization. In this study, we demonstrate how this information is encoded in the MPI imaging signal. Through MPI imaging we are able to discriminate between free and cell-bound MNPs in reconstructed images. This technique was used to image and quantify the changes that occur in-vitro when free MNPs come into contact with cells and undergo cellular-uptake over time. The quantitative MPI results were verified by colorimetric measurements of the iron content. The results showed a mean relative difference between the MPI results and the reference method of 23.8% for the quantification of cell-bound MNPs. With this technique, the uptake of MNPs in cells can be imaged and quantified directly from the first MNP cell contact, providing information on the dynamics of cellular uptake. [ABSTRACT FROM AUTHOR]

Introduction: Multiple cardiac magnetic resonance (CMR)‐derived indices of atrial fibrillation (AF) substrate have been shown in isolation to predict long‐term outcome following catheter ablation. Left atrial (LA) fibrosis, LA volume, LA ejection fraction (EF), left ventricular ejection fraction (LVEF), LA shape (sphericity) and pulmonary vein anatomy have all been shown to correlate with late AF recurrence. This study aimed to validate and assess the relative contribution of multiple indices in a long‐term single‐center study. Methods and Results: Eighty‐nine patients (53% paroxysmal AF, 73% male) underwent comprehensive CMR study before first‐time AF ablation (median follow‐up 726 days [IQR: 418‐1010 days]). The 3D late gadolinium‐enhanced acquisition (1.5T, 1.3 × 1.3 × 2 mm) was quantified for fibrosis; LA volume and sphericity were assessed on manual segmentation at atrial diastole; LAEF and LVEF were quantified on multislice cine imaging. AF recurred in 43 patients (48%) overall (31 at 1 year). In the recurrence group, LA fibrosis was higher (42% vs 29%; hazard ratio [HR]: 1.032; P = .002), left atrial ejection fraction (LAEF) lower (25% vs 34%; HR: 0.063; P = .016) and LVEF lower (57% vs 63%; HR: 0.011; P = .008). LA volume (135 vs 124 mL) and sphericity (0.819 vs 0.822) were similar. Multivariate Cox regression analysis was adjusted for age and sex (Model 1), additionally AF type (Model 2) and combined (Model 3). In Models 1 and 2, LA fibrosis, LAEF, and LVEF were independently associated with outcome, but only LA fibrosis was independent in Model 3 (HR: 1.021; P = .022). Conclusions: LAEF, LVEF, and LA fibrosis differed significantly in the AF recurrence cohort. However, on combined multivariate analysis only LA fibrosis remained independently associated with outcome. [ABSTRACT FROM AUTHOR]

Abstract Quantification and imaging of magnetic nanoparticles is of vital importance for various novel biomedical applications, like cell tracking, drug targeting or hyperthermia treatments. In this work we studied the performance of magnetic resonance imaging (MRI) and magnetic particle imaging (MPI) for quantitative imaging of magnetic nanoparticles (MNP). This was done by measurements of serial dilutions of MNP (Ferucarbotran) in two different media (water and CuSO 4 solution). The concentration range in which quantification was possible was determined for each technique, and the influence of the environment was analyzed and discussed. This revealed a significantly stronger influence of the surrounding medium on MRI performance as compared to MPI. All results were validated by measurements using their respective zero-dimensional (spectroscopic) techniques nuclear magnetic resonance and magnetic particle spectroscopy, showing similar behavior compared to the imaging modalities. Physical explanations of all observed effects are given, and a concentration range is determined in which the advantages of both imaging techniques can be utilized. [ABSTRACT FROM AUTHOR]

Magnetic Particle Imaging (MPI) is a quantitative imaging modality with promising features for several biomedical applications. Here, we study quantitatively the raw data obtained during MPI measurements. We present a method for the calibration of the MPI scanner output using measurements from a magnetic particle spectrometer (MPS) to yield data in units of magnetic moments. The calibration technique is validated in a simplified MPI mode with a 1D excitation field. Using the calibrated results from MPS and MPI, we determine and compare the detection limits for each system. The detection limits were found to be 5·10-12 Am2 for MPS and 3.6·10-10 Am2 for MPI. Finally, the quantitative information contained in a standard MPI measurement with a 3D excitation is analyzed and compared to the previous results, showing a decrease in signal amplitudes of the odd harmonics related to the case of 1D excitation. We propose physical explanations for all acquired results; and discuss the possible benefits for the improvement of MPI technology. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular magnetic resonance (CMR) imaging has been used to visualise post-ablation atrial scar (PAAS), generally employing a three-dimensional (3D) late gadolinium enhancement (LGE) technique. However the reproducibility of PAAS imaging has not been determined. This cross-over study is the first to investigate the reproducibility of the technique, crucial for both future research design and clinical implementation. Methods: Forty subjects undergoing first time ablation for atrial fibrillation (AF) had detailed CMR assessment of PAAS. Following baseline pre-ablation scan, two scans (separated by 48 h) were performed at three months post-ablation. Each scan session included 3D LGE acquisition at 10, 20 and 30 min post administration of gadolinium-based contrast agent (GBCA). Subjects were allocated at second scan post-ablation to identical imaging parameters (‘Repro’, n = 10), 3 T scanner (‘3 T’, n = 10), half-slice thickness (‘Half-slice’, n = 10) or half GBCA dose (‘Half-gad’, n = 10). PAAS was compared to baseline scar and then reproducibility was assessed for two measures of thresholded scar (% left atrial (LA) occupied by PAAS (%LA PAAS) and Pulmonary Vein Encirclement (PVE)), and then four measures of non-thresholded scar (point-by-point assessment of PAAS, four normalisation methods). Thresholded measures of PAAS were evaluated against procedural outcome (AF recurrence). Results: A total of 271 3D acquisitions (out of maximum 280, 96.7%) were acquired. At 20 and 30 min, inter-scan reproducibility was good to excellent (coefficient of variation at 20 min and 30 min: %LA PAAS 0.41 and 0.20; PVE 0.13 and 0.04 respectively for ‘Repro’ group). Changes in imaging parameters, especially reduced GBCA dose, reduced interscan reproducibility, but for most measures remained good to excellent (ICC for %LA PAAS 0.454–0.825, PVE 0.618–0.809 at 30 min). For non-thresholded scar, highest reproducibility was observed using blood pool z-score normalisation technique: inter-scan ICC 0.759 (absolute agreement, ‘Repro’ group). There was no significant relationship between indices of PAAS and AF recurrence. Conclusion: PAAS imaging is a reproducible finding. Imaging should be performed at least 20 min post-GBCA injection, and a blood pool z-score should be considered for normalisation of signal intensities. The clinical implications of these findings remain to be established in the absence of a simple correlation with arrhythmia outcome. [ABSTRACT FROM AUTHOR]

Background and purpose: The purpose of this work is to summarize cardiovascular magnetic resonance (CMR) research trends and highlights presented at the annual Society for Cardiovascular Magnetic Resonance (SCMR) scientific sessions over the past 20 years. Methods: Scientific programs from all SCMR Annual Scientific Sessions from 1998 to 2017 were obtained. SCMR Headquarters also provided data for the number and the country of origin of attendees and the number of accepted abstracts according to type. Data analysis included text analysis (key word extraction) and visualization by 'word clouds' representing the most frequently used words in session titles for 5-year intervals. In addition, session titles were sorted into 17 major subject categories to further evaluate research and clinical CMR trends over time. Results: Analysis of SCMR annual scientific sessions locations, attendance, and number of accepted abstracts demonstrated substantial growth of CMR research and clinical applications. As an international field of study, significant growth of CMR was documented by a strong increase in SCMR scientific session attendance (> 500%, 270 to 1406 from 1998 to 2017, number of accepted abstracts (> 700%, 98 to 701 from 1998 to 2018) and number of international participants (42-415% increase for participants from Asia, Central and South America, Middle East and Africa in 2004-2017). 'Word clouds' based evaluation of research trends illustrated a shift from early focus on 'MRI technique feasibility' to new established techniques (e.g. late gadolinium enhancement) and their clinical applications and translation (key words 'patient', 'disease') andmore recently novel techniques and quantitative CMR imaging (key words 'mapping', 'T1', 'flow', 'function'). Nearly every topic category demonstrated an increase in the number of sessions over the 20-year period with 'Clinical Practice' leading all categories. Our analysis identified three growth areas 'Congenital', 'Clinical Practice', and 'Structure/function/flow'. Conclusion: The analysis of the SCMR historical archives demonstrates a healthy and internationally active field of study which continues to undergo substantial growth and expansion into new and emerging CMR topics and clinical application areas. [ABSTRACT FROM AUTHOR]

Background and purpose: The purpose of this work is to summarize cardiovascular magnetic resonance (CMR) research trends and highlights presented at the annual Society for Cardiovascular Magnetic Resonance (SCMR) scientific sessions over the past 20 years. Methods: Scientific programs from all SCMR Annual Scientific Sessions from 1998 to 2017 were obtained. SCMR Headquarters also provided data for the number and the country of origin of attendees and the number of accepted abstracts according to type. Data analysis included text analysis (key word extraction) and visualization by 'word clouds' representing the most frequently used words in session titles for 5-year intervals. In addition, session titles were sorted into 17 major subject categories to further evaluate research and clinical CMR trends over time. Results: Analysis of SCMR annual scientific sessions locations, attendance, and number of accepted abstracts demonstrated substantial growth of CMR research and clinical applications. As an international field of study, significant growth of CMR was documented by a strong increase in SCMR scientific session attendance (> 500%, 270 to 1406 from 1998 to 2017, number of accepted abstracts (> 700%, 98 to 701 from 1998 to 2018) and number of international participants (42-415% increase for participants from Asia, Central and South America, Middle East and Africa in 2004-2017). 'Word clouds' based evaluation of research trends illustrated a shift from early focus on 'MRI technique feasibility' to new established techniques (e.g. late gadolinium enhancement) and their clinical applications and translation (key words 'patient', 'disease') and more recently novel techniques and quantitative CMR imaging (key words 'mapping', 'T1', 'flow', 'function'). Nearly every topic category demonstrated an increase in the number of sessions over the 20-year period with 'Clinical Practice' leading all categories. Our analysis identified three growth areas 'Congenital', 'Clinical Practice',and 'Structure/function/flow'. Conclusion: The analysis of the SCMR historical archives demonstrates a healthy and internationally active field of study which continues to undergo substantial growth and expansion into new and emerging CMR topics and clinical application areas. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the impact of BMI on late gadolinium enhancement (LGE) of the coronary artery wall in identical monozygous twins discordant for BMI. Coronary LGE represents a useful parameter for the detection and quantification of atherosclerotic coronary vessel wall disease.Methods: Thirteen monozygote female twin pairs (n = 26) with significantly different BMIs (>1.6 kg/m2) were recruited out of >10,000 twin pairs (TwinsUK Registry). A coronary 3D-T2prep-TFE MR angiogram and 3D-IR-TFE vessel wall scan were performed prior to and following the administration of 0.2 mmol/kg of Gd-DTPA on a 1.5 T MR scanner. The number of enhancing coronary segments and contrast to noise ratios (CNRs) of the coronary wall were quantified.Results: An increase in BMI was associated with an increased number of enhancing coronary segments (5.3 ± 1.5 vs. 3.5 ± 1.6, p < 0.0001) and increased coronary wall enhancement (6.1 ± 1.1 vs. 4.8 ± 0.9, p = 0.0027) compared to matched twins with lower BMI.Conclusions: This study in monozygous twins indicates that acquired factors predisposing to obesity, including lifestyle and environmental factors, result in increased LGE of the coronary arteries, potentially reflecting an increase in coronary atherosclerosis in this female study population.Key Points: • BMI-discordant twins allow the investigation of the influence of lifestyle factors independent from genetic confounders. • Only thirteen obesity-discordant twins were identified underlining the strong genetic component of BMI. • In female twins, a BMI increase is associated with increased coronary late gadolinium enhancement. • Increased late gadolinium enhancement in the coronary vessel wall potentially reflects increased atherosclerosis. [ABSTRACT FROM AUTHOR]

Arterial pressure is an important diagnostic parameter for cardiovascular disease. However, relative contributions of individual ventricular and arterial parameters in generating and augmenting pressure are not understood. Using a novel experimental arterial model, our aim was to characterize individual parameter contributions to arterial pressure and its amplification. A piston-driven ventricle provided programmable stroke profiles into various silicone arterial trees and a bovine aorta. Inotropy was varied in the ventricle, and arterial parameters modulated included wall thickness, taper and diameter, the presence of bifurcation, and a native aorta (bovine) versus silicone. Wave reflection at bifurcations was measured and compared with theory, varying parent-to-child tube diameter ratios, and branch angles. Intravascular pressure-tip wires and ultrasonic flow probes measured pressure and flow. Increasing ventricular inotropy independently augmented pressure amplification from 17% to 61% between the lower and higher systolic gradient stroke profiles in the silicone arterial network and from 10% to 32% in the bovine aorta. Amplification increased with presence of a bifurcation, decreasing wall thickness and vessel taper. Pulse pressure increased with increasing wall thickness (stiffness) and taper angle and decreasing diameter. Theoretical predictions of wave transmission through bifurcations werre similar to measurements (correlation: 0.91, R² = 0.94) but underestimated wave reflection (correlation: 0.75, R² = 0.94), indicating energy losses during mechanical wave reflection. This study offers the first comprehensive investigation of contributors to hypertensive pressure and its propagation throughout the arterial tree. Importantly, ventricular inotropy plays a crucial role in the amplification of peripheral pressure wave, which offers opportunity for noninvasive assessment of ventricular health. NEW & NOTEWORTHY The present study distinguishes contributions from cardiac and arterial parameters to elevated blood pressure and pressure amplification. Most importantly, it offers the first evidence that ventricular inotropy, an indicator of ventricular function, is an independent determinant of pressure amplification and could be measured with such established devices such as the SphygmoCor. [ABSTRACT FROM AUTHOR]

Knowledge of atrial wall thickness (AWT) has the potential to provide important information for patient stratification and the planning of interventions in atrial arrhythmias. To date, information about AWT has only been acquired in post-mortem or poor-contrast computed tomography (CT) studies, providing limited coverage and highly variable estimates of AWT. We present a novel contrast agent-free MRI sequence for imaging AWT and use it to create personalized AWT maps and a biatrial atlas. A novel black-blood phase-sensitive inversion recovery protocol was used to image ten volunteers and, as proof of concept, two atrial fibrillation patients. Both atria were manually segmented to create subject-specific AWT maps using an average of nearest neighbors approach. These were then registered non-linearly to generate an AWT atlas. AWT was 2.4 ± 0.7 and 2.7 ± 0.7 mm in the left and right atria, respectively, in good agreement with post-mortem and CT data, where available. AWT was 2.6 ± 0.7 mm in the left atrium of a patient without structural heart disease, similar to that of volunteers. In a patient with structural heart disease, the AWT was increased to 3.1 ± 1.3 mm. We successfully designed an MRI protocol to non-invasively measure AWT and create the first whole-atria AWT atlas. The atlas can be used as a reference to study alterations in thickness caused by atrial pathology. The protocol can be used to acquire personalized AWT maps in a clinical setting and assist in the treatment of atrial arrhythmias. [ABSTRACT FROM PUBLISHER]

Purpose To validate ironload T2* by automatic inline Maximum Likelihood Estimate ( MLE) with k-space Rician noise correction, against the manual and automated truncation, as well as offset methods, in phantoms and in heart and liver in patients. Methods Twenty-five patients and an iron-oxide phantom were scanned at 1.5T using 2 multi-echo gradient-echo sequences. All parameters were identical (voxel 2-3 × 2-3 × 10 mm3, 10 echoes, TR = 26 ms, FA = 20°, BW = 833 Hz, SENSE = 2) except for TE (cardiac: TE1 = 2·5 ms, Δ TE = 2·5 ms; liver: TE1 = 1·2 ms, Δ TE = 1·5 ms). Phantoms were scanned at 1 and 32 signal averages ( NSA), with NSA32 representing low-noise reference. Results Phantoms: MLE showed low variability between NSA1 and NSA32 (0·02 ± 0·29 ms, CI ±0·21 ms). Between methods, no difference was shown ( MLE versus all: <0·31 ms, CI < ±0·35 ms). Patients: No differences were found between methods in heart ( MLE versus all: <−0·22 ms, CI < ±0·75 ms) or liver ( MLE versus all: <0·12 ms, CI < ±0·26 ms). Conclusions The automatic inline MLE method is comparable to the general reference standards for determining cardiac and liver T2* for ironload in man. An automatic inline method may simplify ironload assessment, particularly in centres seeing fewer cases. [ABSTRACT FROM AUTHOR]

Objectives: To compare a standard sequential 2D Planning Method (2D-PM) with a 3D offline Planning Method (3D-PM) based on 3D contrast-enhanced magnetic resonance angiography (CE-MRA) in children with congenital heart disease (CHD). Design: In 14 children with complex CHD (mean: 2.6 years, range: 3 months to 7.6 years), axial and coronal cuts were obtained with single slice spin echo sequences to get the final double oblique longitudinal cut of the targeted anatomical structure (2D-PM, n=31). On a separate workstation, similar maximal intensity projection (MIP) images were generated offline from a 3DCE-MRA. MIP images were localizers for repeated targeted imaging using the previous spin echo sequence (3D-PM). Finally, image coverage, spatial orientation and acquisition time were compared for 2D-PM and 3D-PM. Main outcome measures: 2D-PM and 3D-PM images were similar: both perfectly covered the selected anatomic regions and no spatial differences were found (p>0.05). The mean time for creation of the final imaging plane was 241±31 s (2D-PM) compared to 71±18 s (3D-PM) (p<0.05). Conclusions: 3D-PM shows similar results compared to 2D-PM, but allows faster and offline planning thereby reducing the scan time significantly. As newly developed high-resolution 3D datasets can also be used further improvement of this technology is expected. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The Norwood procedure for hypoplastic left heart syndrome (HLHS) is performed either via a right ventricle-to-pulmonary artery (RVPA) conduit or a modified Blalock-Taussig (MBT) shunt. Cardiac magnetic resonance (CMR) data was used to assess the effects of the RVPA conduit on ventricular shape and function through a computational analysis of anatomy and assessment of indices of strain. METHODS: A retrospective analysis of 93 CMR scans of subjects with HLHS was performed (59 with MBT shunt, 34 with RVPA conduit), incorporating data at varying stages of surgery from two congenital centres. Longitudinal and short-axis cine images were used to create a computational cardiac atlas and assess global strain. RESULTS: Those receiving an RVPA conduit had significant differences (P < 0.0001) in the shape of the RV corresponding to increased ventricular dilatation (P = 0.001) and increased sphericity (P = 0.006). Differences were evident only following completion of stage II surgery. Despite preserved ejection fraction in both groups, functional strain in the RVPA conduit group compared with that in the MBT shunt group was reduced across multiple ventricular axes, including a reduced systolic longitudinal strain rate (P < 0.0001), reduced diastolic longitudinal strain rate (P = 0.0001) and reduced midventricular systolic circumferential strain (P < 0.0001). CONCLUSIONS: Computational modelling analysis reveals differences in ventricular remodelling in patients with HLHS undergoing an RVPA conduit insertion with focal scarring and volume loading leading to decreased functional markers of strain. The need for continued surveillance is warranted, as deleterious effects may not become apparent until later years. [ABSTRACT FROM AUTHOR]

This paper presents a novel MR-compatible 3-DOF cardiac catheter steering mechanism. The catheter's steerable structure is tendon driven and consists of miniature deflectable, helical segments created by a precise rapid prototyping technique. The created catheter prototype has an outer diameter of 9 Fr (3 mm) and a steerable distal end that can be deflected in a 3-D space via four braided high-tensile Spectra fiber tendons. Any longitudinal twist commonly observed in helical structures is compensated for by employing clockwise (CW) and counter clockwise (CCW) helical segments in an alternating fashion. A 280 μm flexible carbon fiber rod is used as a backbone in a central channel to improve the structure's steering and positioning repeatability. In addition to the backbone, a carbon fiber tube can be inserted into the structure to a varying amount capable of changing the structure's forcibility and, thus, providing a means to change the curvature and to modify the deflectable length of the catheter leading to an extension of reachable points in the catheter-tip workspace. A unique feature of this helical segment structure is that the stiffness can be further adjusted by appropriately tensioning tendons simultaneously. An experimental study has been conducted examining the catheter-tip trajectory in a 3-D space and its positioning repeatability using a 5-DOF magnetic coil tracking system. Furthermore, MRI experiments in a 1.5-T scanner confirmed the MR-compatibility of the catheter prototype. The study shows that the proposed concept for catheter steering has great potential to be employed for robotically steered and MR-guided cardiac catheterization. [ABSTRACT FROM PUBLISHER]

Studies have demonstrated the feasibility of late Gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging for guiding the management of patients with sequelae to myocardial infarction, such as ventricular tachycardia and heart failure. Clinical implementation of these developments necessitates a reproducible and reliable segmentation of the infarcted regions. It is challenging to compare new algorithms for infarct segmentation in the left ventricle (LV) with existing algorithms. Benchmarking datasets with evaluation strategies are much needed to facilitate comparison. This manuscript presents a benchmarking evaluation framework for future algorithms that segment infarct from LGE CMR of the LV. The image database consists of 30 LGE CMR images of both humans and pigs that were acquired from two separate imaging centres. A consensus ground truth was obtained for all data using maximum likelihood estimation. Six widely-used fixed-thresholding methods and five recently developed algorithms are tested on the benchmarking framework. Results demonstrate that the algorithms have better overlap with the consensus ground truth than most of the n -SD fixed-thresholding methods, with the exception of the Full-Width-at-Half-Maximum (FWHM) fixed-thresholding method. Some of the pitfalls of fixed thresholding methods are demonstrated in this work. The benchmarking evaluation framework, which is a contribution of this work, can be used to test and benchmark future algorithms that detect and quantify infarct in LGE CMR images of the LV. The datasets, ground truth and evaluation code have been made publicly available through the website: https://www.cardiacatlas.org/web/guest/challenges . [ABSTRACT FROM AUTHOR]

Aging has important deleterious effects on the cardiovascular system. We sought to compare intraventricular kinetic energy (KE) in healthy subjects of varying ages with subjects with ventricular dysfunction to understand if changes in energetic momentum may predispose individuals to heart failure. Four-dimensional flow MRI was acquired in 35 healthy subjects (age: 1-67 yr) and 10 patients with left ventricular (LV) dysfunction (age: 28-79 yr). Healthy subjects were divided into age quartiles (1st quartile: <16 yr, 2nd quartile: 17-32 yr, 3rd quartile: 33-48 yr, and 4th quartile: 49-64 yr). KE was measured in the LV throughout the cardiac cycle and indexed to ventricular volume. In healthy subjects, two large peaks corresponding to systole and early diastole occurred during the cardiac cycle. A third smaller peak was seen during late diastole in eight adults. Systolic KE (P = 0.182) and ejection fraction (P = 0.921) were preserved through all age groups. Older adults showed a lower early peak diastolic KE compared with children (P < 0.0001) and young adults (P = 0.025). Subjects with LV dysfunction had reduced ejection fraction (P < 0.001) and compared with older healthy adults exhibited a similar early peak diastolic KE (P = 0.142) but with the addition of an elevated KE in diastasis (P = 0.029). In healthy individuals, peak diastolic KE progressively decreases with age, whereas systolic peaks remain constant. Peak diastolic KE in the oldest subjects is comparable to those with LV dysfunction. Unique age-related changes in ventricular diastolic energetics might be physiological or herald subclinical pathology. [ABSTRACT FROM AUTHOR]

Focal But Not Diffuse Fibrosis Burden Predicts CRT Remodeling Response Introduction Many heart failure patients with dyssynchrony do not reverse remodel (RR) in response to cardiac resynchronization therapy (CRT). The presence of focal and diffuse interstitial myocardial fibrosis may explain this high nonresponse rate. T1 mapping is a new cardiac magnetic resonance imaging (CMR) technique that overcomes the limitations of conventional contrast CMR and provides reliable quantitative assessment of diffuse myocardial fibrosis. The study tested the hypothesis that focal and diffuse fibrosis quantification would correlate with a lack of left ventricular (LV) RR to CRT. Methods and Results In a prospective study of 48 consecutive patients (27 ischemic cardiomyopathy, 21 dilated cardiomyopathy) LV scar burdens were quantified (scar core and gray zone using late gadolinium enhancement LGE CMR; interstitial fibrosis using T1 mapping) before CRT implant. LV RR was defined by a ≥ 15% reduction in LV end-systolic volume 6 months postimplant. Twenty-seven (56%) patients were responders with RR. Association between scar quantification and LV RR was assessed using the Poisson regression model. Univariate analysis showed that QRS duration/morphology, scar core, and gray zone volumes expressed as % of LV mass and extracellular volume index (ECV) (a measure of interstitial fibrosis from T1 mapping) to be significant predictors of LV RR. Multivariable-adjusted analyses demonstrated scar core quantification (≥13.7% LV mass) to be the only independent predictor of LV RR (prevalence ratio 0.40, P = 0.038). Conclusions Focal scar burden detected by LGE CMR is associated with a poor response to CRT. Diffuse interstitial fibrosis assessment by T1 mapping, however, is not independently predictive of CRT response. [ABSTRACT FROM AUTHOR]

We demonstrate a new method to recover 4D blood flow over the entire ventricle from partial blood velocity measurements using multiple 3D+t colour Doppler images and ventricular wall motion estimated using 3D+t BMode images. We apply our approach to realistic simulated data to ascertain the ability of the method to deal with incomplete data, as typically happens in clinical practice. Experiments using synthetic data show that the use of wall motion improves velocity reconstruction, shows more accurate flow patterns and improves mean accuracy particularly when coverage of the ventricle is poor. The method was applied to patient data from 6 congenital cases, producing results consistent with the simulations. The use of wall motion produced more plausible flow patterns and reduced the reconstruction error in all patients. [ABSTRACT FROM AUTHOR]

We have carried out a PET performance evaluation a silicon photo-multiplier (SiPM) based PET scanner designed for fully simultaneous pre-clinical PET/MR studies. The PET scanner has an inner diameter of 20 cm with an LYSO crystal size of 1.3 by 1.3 by 10 mm. The axial PET field of view (FOV) is 30.2 mm. The PET detector modules, which incorporate SiPMs, have been designed to be MR-compatible allowing them to be located directly within a Philips Achieva 3T MR scanner. The spatial resolution of the system measured using a point source in a non-active background, is just under 2.3 mm full width at half maximum (FWHM) in the transaxial direction when single slice rebinning (SSRB) and 2D filtered back-projection (FBP) is used for reconstruction, and 1.3 mm FWHM when resolution modeling is employed. The system sensitivity is 0.6% for a point source at the center of the FOV. The true coincidence count rate shows no sign of saturating at 30 MBq, at which point the randoms fraction is 8.2%, and the scatter fraction for a rat sized object is approximately 23%. Artifact-free images of phantoms have been obtained using FBP and iterative reconstructions. The performance is currently limited because only one of three axial ring positions is populated with detectors, and due to limitations of the first-generation detector readout ASIC used in the system. The performance of the system as described is sufficient for simultaneous PET-MR imaging of rat-sized animals and large organs within the mouse. This is demonstrated with dynamic PET and MR data acquired simultaneously from a mouse injected with a dual-labeled PET/MR probe. [ABSTRACT FROM PUBLISHER]

Background: Selection of patients with congenital heart disease for surgical septation in biventricular repair or surgical palliation in functionally single ventricles requires low pulmonary vascular resistance (PVR). Where there is uncertainty, PVR can be assessed using hybrid cardiovascular magnetic resonance (CMR) and fluoroscopic (X-Ray) guided cardiac catheterizations (XMR). CMR/XMR catheterization is a validated technique for accurate assessment of pulmonary vascular resistance. However, data concerning its application in clinical practice is lacking. Methods: PVR assessments were performed in 167 studies in 149 congenital heart disease patients by CMR/XMR catheterization. Data was collated on patient demographics, procedural data, complications and outcomes. Institutional ethics approval was obtained. Results: Median age was 3.6 years (6 days - 67 years) and weight 13.8 kg (2.3 -122 kg). One hundred and eight studies were in biventricular circulations and 59 in functionally single ventricles. Median radiation dose was 0.72 mSv. A baseline Qp:Qs ≤2.75 in biventricular circulations with left-to-right shunts predicted a PVR ≥6 WU.m2 with 100% sensitivity and 48% specificity. Median follow up until death or last review was 4.2 years (4 days - 11 years). Eighty-four patients had a surgical or catheter intervention based on CMR/XMR catheterization findings at a median of 94 days after the study. This included successful biventricular repair at resting PVR values ≤6 WU.m2 and Fontan completion at ≤4 WU.m2. Conclusion: PVR measured by CMR/XMR catheterization allows accurate stratification for intervention in patients with congenital heart disease in both, biventricular and univentricular circulations. [ABSTRACT FROM AUTHOR]

Background: Selection of patients with congenital heart disease for surgical septation in biventricular repair or surgical palliation in functionally single ventricles requires low pulmonary vascular resistance (PVR). Where there is uncertainty, PVR can be assessed using hybrid cardiovascular magnetic resonance (CMR) and fluoroscopic (X-Ray) guided cardiac catheterizations (XMR). CMR/XMR catheterization is a validated technique for accurate assessment of pulmonary vascular resistance. However, data concerning its application in clinical practice is lacking. Methods: PVR assessments were performed in 167 studies in 149 congenital heart disease patients by CMR/XMR catheterization. Data was collated on patient demographics, procedural data, complications and outcomes. Institutional ethics approval was obtained. Results: Median age was 3.6 years (6 days - 67 years) and weight 13.8 kg (2.3 -122 kg). One hundred and eight studies were in biventricular circulations and 59 in functionally single ventricles. Median radiation dose was 0.72 mSv. A baseline Qp:Qs ≤2.75 in biventricular circulations with left-to-right shunts predicted a PVR ≥6 WU.m2 with 100% sensitivity and 48% specificity. Median follow up until death or last review was 4.2 years (4 days - 11 years). Eighty-four patients had a surgical or catheter intervention based on CMR/XMR catheterization findings at a median of 94 days after the study. This included successful biventricular repair at resting PVR values ≤6 WU.m #178; and Fontan completion at ≤4 WU.m². Conclusion: PVR measured by CMR/XMR catheterization allows accurate stratification for intervention in patients with congenital heart disease in both, biventricular and univentricular circulations. [ABSTRACT FROM AUTHOR]

Purpose: Positron emission tomography (PET) is a highly sensitive medical imaging technique commonly used to detect and assess tumor lesions. Magnetic resonance imaging (MRI) provides high resolution anatomical images with different contrasts and a range of additional information important for cancer diagnosis. Recently, simultaneous PET-MR systems have been released with the promise to provide complementary information from both modalities in a single examination. Due to long scan times, subject nonrigid bulk motion, i.e., changes of the patient's position on the scanner table leading to nonrigid changes of the patient's anatomy, during data acquisition can negatively impair image quality and tracer uptake quantification. A 3D MR-acquisition scheme is proposed to detect and correct for nonrigid bulk motion in simultaneously acquired PET-MR data. Methods: A respiratory navigated three dimensional (3D) MR-acquisition with Radial Phase Encoding (RPE) is used to obtain T1- and T2-weighted data with an isotropic resolution of 1.5 mm. Healthy volunteers are asked to move the abdomen two to three times during data acquisition resulting in overall 19 movements at arbitrary time points. The acquisition scheme is used to retrospectively reconstruct dynamic 3D MR images with different temporal resolutions. Nonrigid bulk motion is detected and corrected in this image data. A simultaneous PET acquisition is simulated and the effect of motion correction is assessed on image quality and standardized uptake values (SUV) for lesions with different diameters. Results: Six respiratory gated 3D data sets with T1- and T2-weighted contrast have been obtained in healthy volunteers. All bulk motion shifts have successfully been detected and motion fields describing the transformation between the different motion states could be obtained with an accuracy of 1.71 ± 0.29 mm. The PET simulation showed errors of up to 67% in measured SUV due to bulk motion which could be reduced to less than 10% with the proposed motion compensation approach. Conclusions: A MR acquisition scheme which yields both high resolution 3D anatomical data and highly accurate nonrigid motion information without an increase in scan time is presented. The proposed method leads to a strong improvement in both MR and PET image quality and ensures an accurate assessment of tracer uptake. [ABSTRACT FROM AUTHOR]

Background The clinical applicability of time-resolved 3D flow cardiovascular magnetic resonance (CMR) remains compromised by the long scan times associated with phase-contrast imaging. The present work demonstrates the applicability of 8-fold acceleration of Cartesian time- resolved 3D flow CMR in 10 volunteers and in 9 patients with different congenital heart diseases (CHD). It is demonstrated that accelerated 3D flow CMR data acquisition and image reconstruction using k-t PCA (principal component analysis) can be implemented into clinical workflow and results are sufficiently accurate relative to conventional 2D flow CMR to permit for comprehensive flow quantification in CHD patients. Methods The fidelity of k-t PCA was first investigated on retrospectively undersampled data for different acceleration factors and compared to k-t SENSE and fully sampled reference data. Subsequently, k-t PCA with 8-fold nominal undersampling was applied on 10 healthy volunteers and 9 CHD patients on a clinical 1.5 T MR scanner. Quantitative flow validation was performed in vessels of interest on the 3D flow datasets and compared to 2D through-plane flow acquisitions. Particle trace analysis was used to qualitatively visualise flow patterns in patients. Results Accelerated time-resolved 3D flow data were successfully acquired in all subjects with 8-fold nominal scan acceleration. Nominal scan times excluding navigator efficiency were on the order of 6 min and 7 min in patients and volunteers. Mean differences in stroke volume in selected vessels of interest were 2.5 ± 8.4 ml and 1.63 ± 4.8 ml in volunteers and patients, respectively. Qualitative flow pattern analysis in the time-resolved 3D dataset revealed valuable insights into hemodynamics including circular and helical patterns as well as flow distributions and origin in the Fontan circulation. Conclusion Highly accelerated time-resolved 3D flow using k-t PCA is readily applicable in clinical routine protocols of CHD patients. Nominal scan times of 6 min are well tolerated and allow for quantitative and qualitative flow assessment in all great vessels. [ABSTRACT FROM AUTHOR]

Accurate measurement of blood pressure is important because it is a biomarker for cardiovascular disease. Diagnostic catheterization is routinely used for pressure acquisition in vessels despite being subject to significant measurement errors. To investigate these errors, this study compares pressure measurement using two different techniques in vitro and numerical simulations. Pressure was acquired in a pulsatile flow phantom using a 6F fluid-filled catheter and a 0.014′′ pressure wire, which is considered the current gold standard. Numerical simulations of the experimental set-up with and without a catheter were also performed. Despite the low catheter-to-vessel radius ratio, the catheter traces showed a 24% peak systolic pressure overestimation compared to the wire. The numerical models replicated this difference and indicated the cause for overestimation was the increased flow resistance due to the presence of the catheter. Further, the higher frequency pressure oscillations observed in the wire and numerical data were absent in the catheter, resulting in an overestimation of the pulse wave velocity with the latter modality. These results show that catheter geometry produces significant measurement bias in both the peak pressure and the waveform shape even with radius ratios considered acceptable in clinical practice. The wire allows for more accurate pressure quantification, in agreement with the numerical model without a catheter. [ABSTRACT FROM PUBLISHER]

Left Atrial Scar Formation After Contact Force-Guided AF Ablation Background Catheter contact force (CF) is an important determinant of radiofrequency (RF) lesion quality during pulmonary vein isolation (PVI). Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) allows good visualization of ablation lesions. Objective This study describes a new technique to examine the relationship between CF during RF delivery and LGE signal intensity (SI) following PVI. Methods Six patients underwent PVI for paroxysmal AF using a CF-sensing catheter and following preprocedural MRI. During ablation, CF-time integral (FTI) and position was documented for each RF application. All patients underwent repeat LGE MRI 3 months later. The LGE SIs were projected onto a MRI-derived 3-dimensional left atrial (LA) shell and a CF map was generated on the same shell. The entire LA surface was divided into 5 mm2 segments. Force and LGE maps were fused and compared for each 5 mm2 zone. An effective lesion was defined when MRI-defined scar occupied >90% of a 5 mm2 analysis zone. Results Acute PVI was achieved in 100%. Two hundred sixty-eight RF lesions were tagged on the LA shells and given a lesion-specific FTI. Increasing FTI correlated with increased LGE SI, which was greater when the FTI was > 1,200 gs. Below an FTI of 1,200 gs, an increment in the FTI resulted in only a small increment in scar, whereas above 1,200 gs an increment in the FTI resulted in a large change of scar. Conclusion There is a correlation between FTI and LGE SI in MRI following AF ablation. Real-time FTI maps are feasible and may prevent inadequate lesion formation. [ABSTRACT FROM AUTHOR]

Motion occurring during magnetic resonance imaging acquisition is a major factor of image quality degradation. Self-navigation can help reduce artefacts by estimating motion from the acquired data to enable motion correction. Popular self-navigation techniques rely on the availability of a fully-sampled motion-free reference to register the motion corrupted data with. In the proposed technique, rigid motion parameters are derived using the inherent correlation between radial segments in k-space. The registration is performed exclusively in k-space using the Phase Correlation Method, a popular registration technique in computer vision. Robust and accurate registration has been carried out from radial segments composed of as few as 32 profiles. Successful self-navigation has been performed on 2-D dynamic brain scans corrupted with continuous motion for six volunteers. Retrospective motion correction using the derived self-navigation parameters resulted in significant improvement of image quality compared to the conventional sliding window. This work also demonstrates the benefits of using a bit-reversed ordering scheme to limit undesirable effects specific to retrospective motion correction on radial trajectories. This method provides a fast and efficient mean of measuring rigid motion directly in k-space from dynamic radial data under continuous motion. [ABSTRACT FROM AUTHOR]

Background: The magnetic resonance longitudinal relaxation time (T1) changes with thrombus age in humans. In this study, we investigate the possible mechanisms that give rise to the T1 signal in venous thrombi and whether changes in T1 relaxation time are informative of the susceptibility to lysis.Methods and Results: Venous thrombosis was induced in the vena cava of BALB/C mice, and temporal changes in T1 relaxation time correlated with thrombus composition. The mean T1 relaxation time of thrombus was shortest at 7 days following thrombus induction and returned to that of blood as the thrombus resolved. T1 relaxation time was related to thrombus methemoglobin formation and further processing. Studies in inducible nitric oxide synthase (iNOS(-/-))-deficient mice revealed that inducible nitric oxide synthase mediates oxidation of erythrocyte lysis-derived iron to paramagnetic Fe3+, which causes thrombus T1 relaxation time shortening. Studies using chemokine receptor-2-deficient mice (Ccr2(-/-)) revealed that the return of the T1 signal to that of blood is regulated by removal of Fe3+ by macrophages that accumulate in the thrombus during its resolution. Quantification of T1 relaxation time was a good predictor of successful thrombolysis with a cutoff point of <747 ms having a sensitivity and specificity to predict successful lysis of 83% and 94%, respectively.Conclusions: The source of the T1 signal in the thrombus results from the oxidation of iron (released from the lysis of trapped erythrocytes in the thrombus) to its paramagnetic Fe3+ form. Quantification of T1 relaxation time appears to be a good predictor of the success of thrombolysis. [ABSTRACT FROM AUTHOR]

Background--The magnetic resonance longitudinal relaxation time (T1) changes with thrombus age in humans. In this study, we investigate the possible mechanisms that give rise to the T1 signal in venous thrombi and whether changes in T1 relaxation time are informative of the susceptibility to lysis. Methods and Results--Venous thrombosis was induced in the vena cava of BALB/C mice, and temporal changes in T1 relaxation time correlated with thrombus composition. The mean T1 relaxation time of thrombus was shortest at 7days following thrombus induction and returned to that of blood as the thrombus resolved. T1 relaxation time was related to thrombus methemoglobin formation and further processing. Studies in inducible nitric oxide synthase (iNOS-/-)-deficient mice revealed that inducible nitric oxide synthase mediates oxidation of erythrocyte lysis-derived iron to paramagnetic Fe3+ which causes thrombus T1 relaxation time shortening. Studies using chemokine receptor-2-deficient mice (Ccr2-/- revealed that the return of the T1 signal to that of blood is regulated by removal of Fe3+ by macrophages that accumulate in the thrombus during its resolution. Quantification of T1 relaxation time was a good predictor of successful thrombolysis with a cutoff point of <747 ms having a sensitivity and specificity to predict successful lysis of 83% and 94%, respectively. Conclusions--The source of the T1 signal in the thrombus results from the oxidation of iron (released from the lysis of trapped erythrocytes in the thrombus) to its paramagnetic Fe3+ form. Quantification of T1 relaxation time appears to be a good predictor of the success of thrombolysis [ABSTRACT FROM AUTHOR]