Ascending-descending aortic bypass surgery in aortic arch coarctation: four-dimensional magnetic resonance flow analysis.
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Aorta↗
Biomedical subjects
Michael Markl
Publications and source records attributed to Michael Markl.
Accelerated time-resolved 3D contrast-enhanced MR angiography at 3T: clinical experience in 31 patients.
PURPOSE: To evaluate whether time-resolved 3D MR-angiography at 3T with a net acceleration factor of eight is applicable in clinical routine and to evaluate whether good image quality and a low artifact level can be achieved with a temporal update rate that allows for additional information on pathologies. MATERIALS AND METHODS: Thirty-one consecutive patients underwent time-resolved 3D contrast-enhanced MR-angiography on a 3T system. Imaging consisted of accelerated 3D gradient echo sequences combining parallel imaging with an acceleration factor of four, partial Fourier acquisition along phase and slice encoding direction, and twofold temporal acceleration using view sharing. Data volumes representing the arterial and venous contrast phases were independently evaluated by two experienced radiologists by grading of image quality and artifact level on a 0-3 scale. RESULTS: Time-resolved MR-angiography was successfully performed in all subjects without the need for contrast agent bolus timing. Excellent arterial (average score = 2.65 +/- 0.32) and good venous (average score = 2.56 +/- 0.28) diagnostic image quality and little image degrading due to artifacts (average score = 2.20 +/- 0.16) were confirmed by both independent readers (agreement in 65.2% of all evaluations). In 14 patients vascular pathologies were identified in the arterial phases. In eight examinations temporal resolution and depiction of contrast agent dynamics provided additional information about pathology. DISCUSSION: Without the necessity for additional bolus timing, time-resolved 3D contrast-enhanced MR-angiography with imaging acceleration along both the spatial encoding direction and temporal domain revealed excellent diagnostic image quality in neurovascular and thoracic imaging. Despite the limited spatial resolution as compared to high-resolution imaging of the carotid artery bifurcation, the results demonstrate the applicability of contrast-enhanced MR-angiography in thoracic and abdominal MRA as well as cervical imaging with a temporal update rate allowing for additional information on pathologies. Future studies may include an evaluation of optimal trade-offs between spatial and temporal resolution, different acceleration factors and a comparison to the gold-standard for accuracy.
Adolescent↗
MRI myocardial motion and fiber tracking: a confirmation of knowledge from different imaging modalities.
OBJECTIVE: A helical configuration underlies the anatomy of cardiac structure, and a structure/function relationship is needed to determine if the ventricular myocardial band model defines this spatial relationship. This report explores how studies of velocity-encoded phase contrast magnetic resonance imaging (MRI) for myocardial motion and fiber tracking algorithms that imply fiber orientations can (a) quantify regional myocardial wall motion of the entire heart, (b) determine if these motion of implied fiber orientation link with the helical heart model, and (c) reveal if this new knowledge correlates with imaging information from other different imaging modalities. METHODS: Accumulated left ventricular motion patterns that accurately differentiate radial (i.e. contraction and expansion), rotational (i.e. twisting and untwisting), and longitudinal (i.e. lengthening and shortening) motion components are correlated with structure/function data achieved by sonomicrometer crystals, echocardiography, corrosion casts, and MUGA recordings. RESULTS: Acceleration fiber tracking to determine fiber orientation and cardiac motion during the ejection and rapid filling phases of the cardiac cycle corresponded to maximal force displayed by ultrasonic crystals placed into the angulation of the presumed functional units of the descending and ascending segments of the apical loop of the helical ventricular myocardial band, and motion by echocardiographic recordings. These integrated findings imply a favourable interaction of MRI with the myocyte orientation of the helical ventricular myocardial band. CONCLUSIONS: These composite findings indicate that phase contrast MRI techniques for high temporal resolution velocity mapping during cardiac motion and myocardial fiber tracking confirm other technologies, and centralize the capacity of MRI to link other imaging methods together relative to a single helical structural model. The close agreement amongst a spectrum of imaging studies provide a very powerful integration that transcends a single look; the same thing is observed by each component of global technology, thereby implying that the helical ventricular band is the structural basis for these functional changes.
Echocardiography↗
Visualization of tissue velocity data from cardiac wall motion measurements with myocardial fiber tracking: principles and implications for cardiac fiber structures.
OBJECTIVE: The spatial arrangement of myocardial fiber structure affects the mechanical and electrical properties of the heart. Therefore, information on the structure and dynamics of the orientation of the muscle fibers in the human heart might provide significant insight into principles of the mechanics of normal ventricular contraction and electrical propagation and may subsequently aid pre- and postsurgical evaluation of patients. Fiber orientation is inherently linked to cardiac wall motion, which can be measured with phase contrast magnetic resonance imaging (MRI), also termed tissue phase mapping (TPM). METHODS: This study provides initial results of the visualization of velocity data with fiber tracking algorithms and discusses implications for the fiber orientations. In order to generate datasets with sufficient volume coverage and resolution TPM measurements with three-dimensional (3D) velocity encoding were executed during breath-hold periods and free breathing. Subsequent postprocessing evaluation with a tracking algorithm for acceleration fields derived from the velocity data was performed. RESULTS: Myocardial acceleration tracking illustrated the dynamics of fiber structure during four different phases of left ventricular performance, that include isovolumetric contraction (IVC), mid-systole, isovolumetric relaxation (IVR), and mid-diastole. Exact reconstruction of the myocardial fiber structure from velocity data requires mathematical modeling of spatiotemporal evolution of the velocity fields. CONCLUSIONS: 'Acceleration fibers' were reconstructed at these four phases during the cardiac cycle, and these findings may become (a) surrogate parameters in the normal ventricle, (b) baseline markers for subsequent clinical studies of abnormal hearts with altered architecture, and (c) may help to explain and illustrate functional features of cardiac performance in structural models like the helical ventricular myocardial band.
Algorithms↗
Investigating myocardial motion by MRI using tissue phase mapping.
OBJECTIVE: Velocity-encoded phase contrast magnetic resonance imaging (MRI) provides a tool to quantify regional myocardial wall motion of the entire heart. It allows the acquisition of three-directional velocity vector fields with high spatial resolution that reflect the temporal evolution of myocardial velocities over the cardiac cycle. In contrast to other imaging modalities such as echocardiography left ventricular performance can be assessed without limited anatomical or functional coverage. METHODS: Compared to other techniques that quantify local myocardial contractility (e.g. implanted ultrasonic crystals) by means of regional displacement, phase contrast MRI provides information about local and global left ventricular velocities (i.e. motion) by utilizing the intrinsic motion sensitivity of MRI. The resultant motion components of contraction, expansion, rotation, lengthening, and shortening of the left ventricle are described in high spatial and temporal detail. Phase contrast measurements were performed in 12 healthy volunteers with a respiratory-gated technique in order to achieve a high temporal resolution of 13.8ms to demonstrate the detailed assessment of global and regional myocardial motion. RESULTS: Data revealed details in left ventricular motion patterns that were previously not seen in phase contrast measurements and are only known from echocardiography. For all volunteers, characteristic myocardial motion patterns and locally different radial (i.e. contraction and expansion), rotational (i.e. twisting and untwisting) and longitudinal (i.e. lengthening and shortening) motion components could be detected with high accuracy. CONCLUSIONS: The phase contrast MRI technique for high temporal resolution velocity mapping is therefore very promising for the investigation and better understanding of the myocardial motion in normal subjects and patients with disturbed left ventricular performance and may validate further testing of different models of cardiac structure.
Heart↗
Images in cardiovascular medicine. Time-resolved 3-dimensional magnetic resonance velocity mapping at 3 T reveals drastic changes in flow patterns in a partially thrombosed aortic arch.
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Adult↗
High resolution 3T MRI for the assessment of cervical and superficial cranial arteries in giant cell arteritis.
A new high-resolution MR protocol for the combined assessment of neurovascular arterial anatomy and subsequent evaluation of inflammatory disease in cranial vessels walls has been investigated. First-pass contrast-enhanced MR angiography (CE-MRA) in combination with parallel imaging at high field permits the depiction of the neurovascular geometry with large coverage, including the aortic arch, supraaortic vessels, and almost the entire head, with high, submillimeter detail. Utilizing the remaining contrast agent, postcontrast T(1)-weighted turbo spin-echo (TSE) imaging was used to generate late enhancement images of the vessel walls to assess the morphology and potential inflammatory changes in cranial arteries with high in-plane (195 x 260 microm(2)) spatial resolution. As a result, a combined analysis of neurovascular arterial anatomy as well as cranial vessel wall inflammations could be achieved in less than 45 minutes in all studies. The feasibility and clinical value for the diagnosis of rheumatologic diseases and simultaneous arteriosclerotic involvement was demonstrated in seven patients with suspected giant cell arteritis (GCA). Excellent CE-MRA image quality could be achieved and even vascular geometry of small superficial cranial arteries could be successfully visualized using single dose (0.1 mmol/kg) contrast agent administration and a dedicated phased-array head and neck coil at 3T.
Aged↗
Detailed analysis of myocardial motion in volunteers and patients using high-temporal-resolution MR tissue phase mapping.
PURPOSE: To detect and investigate details in left ventricular (LV) motion patterns with a temporal resolution comparable to that of echocardiography. MATERIAL AND METHODS: To assess global and regional myocardial motion in high temporal detail, respiratory-gated MR phase-contrast measurements with three-directional velocity encoding (venc) were performed in 12 healthy volunteers and two patients with LV hypertrophy in basal, midventricular, and apical locations of the LV with a temporal resolution of 13.8 msec. RESULTS: The volunteer data revealed details in LV motion patterns that were known only from echocardiography. For all volunteers, characteristic myocardial motion patterns, such as triphasic global diastolic expansion, could be detected with high accuracy. One volunteer underwent an additional echocardiographic measurement in order to corroborate the complex motion features as measured by MRI. Patient examinations revealed substantial changes in diastolic function compared to motion patterns in healthy volunteers. CONCLUSION: The proposed high-temporal-resolution velocity-mapping technique provides previously undetectable information on LV performance, and is highly promising for the detection of local and global motion abnormalities in patients with disturbed LV performance, such as diastolic dysfunction.
Adult↗
Navigator gated high temporal resolution tissue phase mapping of myocardial motion.
Data acquisition for phase contrast velocity mapping of myocardial motion is typically based on multiple breath-held 2D measurements with limited acquisition duration and consequently relatively poor temporal resolution. In order to overcome the limitations of breath-hold acquisitions, an improved navigator-guided technique was implemented based on 2 navigator signals within each cardiac cycle in combination with paired acceptance and rejection criteria of successive navigator signals. Respiratory gated phase contrast measurements with 3-directional velocity encoding were performed in 12 healthy volunteers in basal, midventricular, and apical locations of the left ventricle during free breathing with a temporal resolution of 13.8 ms. Results were compared to standard breath-hold measurements with a temporal resolution of 69 ms. Data from the high temporal resolution study revealed details in left ventricular motion patterns that were previously not seen in phase contrast measurements and are only known from echocardiography. The proposed navigator gated technique for high temporal resolution velocity mapping is, therefore, highly promising for the detection of local and global motion abnormalities in patients with disturbed left ventricular performance, such as diastolic dysfunction.
Adult↗
T2-weighted balanced SSFP imaging (T2-TIDE) using variable flip angles.
A new technique for acquiring T2-weighted, balanced steady-state free precession (b-SSFP) images is presented. Based on the recently proposed transition into driven equilibrium (TIDE) method, T2-TIDE uses a special flip angle scheme to achieve T2-weighted signal decay during the transient phase. In combination with half-Fourier image acquisition, T2-weighted images can be obtained using T2-TIDE. Numerical simulations were performed to analyze the signal behavior of T2-TIDE in comparison with TSE and b-SSFP. The results indicate identical signal evolution of T2-TIDE and TSE during the transient phase. T2-TIDE was used in phantom experiments, and quantitative ROI analysis shows a linear relationship between TSE and T2-TIDE SNR values. T2-TIDE was also applied to abdominal and head imaging on healthy volunteers. The resulting images were analyzed quantitatively and compared with standard T2-weighted and standard b-SSFP methods. T2-TIDE images clearly revealed T2 contrast and less blurring compared to T2-HASTE images. In combination with a magnetization preparation technique, STIR-weighted images were obtained. T2-TIDE is a robust technique for acquiring T2-weighted images while exploiting the advantages of b-SSFP imaging, such as high signal-to-noise ratio (SNR) and short TRs.
Brain↗
Rapid vessel prototyping: vascular modeling using 3t magnetic resonance angiography and rapid prototyping technology.
OBJECT: Conversion of thoracic aortic vasculature as measured by Magnetic Resonance Imaging into a real physical replica. MATERIALS AND METHODS: Several procedural steps including data acquisition with contrast enhanced MR Angiography at 3T, data visualization and 3D computer model generation, as well as rapid prototyping were used to construct an in-vitro model of the vessel geometry. RESULTS: A rapid vessel prototyping process was implemented and used to convert complex vascular geometry of the entire thoracic aorta and major branching arteries into a real physical replica with large anatomical coverage and high spatial resolution. CONCLUSION: Rapid vessel prototyping permits the creation of a concrete solid replica of a patient's vascular anatomy.
Aorta, Thoracic↗
Cardiac CINE imaging with IDEAL water-fat separation and steady-state free precession.
PURPOSE: To decompose multicoil CINE steady-state free precession (SSFP) cardiac images acquired at short echo time (TE) increments into separate water and fat images, using an iterative least-squares "Dixon" (IDEAL) method. MATERIALS AND METHODS: Multicoil CINE IDEAL-SSFP cardiac imaging was performed in three volunteers and 15 patients at 1.5 T. RESULTS: Measurements of signal-to-noise ratio (SNR) matched theoretical expectations and were used to optimize acquisition parameters. TE increments of 0.9-1.0 msec permitted the use of repetition times (TRs) of 5 msec or less, and provided good SNR performance of the water-fat decomposition, while maintaining good image quality with a minimum of banding artifacts. Images from all studies were evaluated for fat separation and image quality by two experienced radiologists. Uniform fat separation and diagnostic image quality was achieved in all images from all studies. Examples from volunteers and patients are shown. CONCLUSION: Multicoil IDEAL-SSFP imaging can produce high quality CINE cardiac images with uniform water-fat separation, insensitive to Bo inhomogeneities. This approach provides a new method for reliable fat-suppression in cardiac imaging.
Adult↗
Time-resolved three-dimensional magnetic resonance velocity mapping of aortic flow in healthy volunteers and patients after valve-sparing aortic root replacement.
OBJECTIVE: To provide more complete characterization of ascending aortic blood flow, including vortex formation behind the valve cusps, in healthy subjects and patients after valve-sparing aortic root replacement (David reimplantation). METHODS: Time-resolved 3-dimensional magnetic resonance imaging velocity mapping was performed to analyze pulsatile blood flow by using encoded 3-directional vector fields in the thoracic aortas of 10 volunteers and 12 patients after David reimplantation using a cylindrical tube graft (T. David I) and two versions of neosinus recreation (T. David-V and T. David-V-S mod ). Aortic flow was evaluated by using 3-dimensional time-resolved particle traces and velocity vector fields reformatted onto 2-dimensional planes. Semiquantitative data were derived by using a blinded grading system (0-3: 0, none; 1, minimal; 2, medium; 3, prominent) to analyze the systolic vortex formation behind the cusps, as well as retrograde and helical flow in the ascending aorta. RESULTS: Systolic vortices were seen in both coronary sinuses of all volunteers (greater in the left sinus [2.5 +/- 0.5] than the right [1.8 +/- 0.8]) but in only 4 of 10 noncoronary sinuses (0.7 +/- 0.9). Comparable coronary vortices were detected in all operated patients. Vorticity was minimal in the noncoronary cusp in T. David-I repairs (0.7 +/- 0.7) but was prominent in T. David-V noncoronary graft pseudosinuses (1.5 +/- 0.6; P = .035). Retrograde flow (P = .001) and helicity (P = .028) were found in all patients but were not distinguishable from normal values in the T. David-V-S mod patients. CONCLUSIONS: Coronary cusp vorticity was preserved after David reimplantation, regardless of neosinus creation. Increased retrograde flow and helicity were more prominent in T. David-V patients. These novel magnetic resonance imaging methods can assess the clinical implications of altered aortic flow dynamics in patients undergoing various types of valve-sparing aortic root replacement.
Adult↗
Images in cardiovascular medicine. Four-dimensional magnetic resonance velocity mapping in a healthy volunteer with pseudocoarctation of the thoracic aorta.
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Animals↗
On flow effects in balanced steady-state free precession imaging: pictorial description, parameter dependence, and clinical implications.
PURPOSE: To present a pictorial description of the origin of flow effects in balanced steady-state free precession (SSFP) imaging that can result in considerable frequency offset-dependent signal changes originating from outflow of spins that can still contribute to the total SSFP signal (out-of-slice contributions), to analyze the parameter dependence and slice broadening associated with outflow effects, and to illustrate clinical implications such as frequency offset-dependent flow artifacts and spatial misencoding. MATERIALS AND METHODS: Computer simulations were used to create a pictorial description of flow effects that illustrates the origin and parameter dependence of the observed signal changes and links their frequency dependency to the phase distribution of spins flowing in and out of the imaging slice. Slice broadening associated with out-of-slice contributions and flow-related signal enhancement was characterized by an effective slice thickness, which depends on flow rate, the T2* decay of signal magnitude from spins that have left the imaging slice, and the ratio of the net out-of-slice magnetization relative to the thickness of the imaging slice. RESULTS: Both simulated SSFP signal intensities and effective slice broadening vary with flip angle and demonstrate a nonlinear dependence on inflow. Simulations with bloodlike T1 and T2 show that the effective slice thickness can be as large as 15 times the prescribed slice thickness. These effects can have significant clinical implications such as large frequency offset-dependent signal enhancement, pulsatile flow artifacts, and spatial misrepresentation of blood signal that has already left the imaging slice. CONCLUSION: Flow-related signal changes in SSFP imaging exhibit highly complex parameter dependence, which predominantly has to be associated with frequency offset-dependent outflow effects and a resulting broadening of the slice thickness.
Artifacts↗
Multicoil Dixon chemical species separation with an iterative least-squares estimation method.
This work describes a new approach to multipoint Dixon fat-water separation that is amenable to pulse sequences that require short echo time (TE) increments, such as steady-state free precession (SSFP) and fast spin-echo (FSE) imaging. Using an iterative linear least-squares method that decomposes water and fat images from source images acquired at short TE increments, images with a high signal-to-noise ratio (SNR) and uniform separation of water and fat are obtained. This algorithm extends to multicoil reconstruction with minimal additional complexity. Examples of single- and multicoil fat-water decompositions are shown from source images acquired at both 1.5T and 3.0T. Examples in the knee, ankle, pelvis, abdomen, and heart are shown, using FSE, SSFP, and spoiled gradient-echo (SPGR) pulse sequences. The algorithm was applied to systems with multiple chemical species, and an example of water-fat-silicone separation is shown. An analysis of the noise performance of this method is described, and methods to improve noise performance through multicoil acquisition and field map smoothing are discussed.
Adipose Tissue↗
Quantification of vessel wall motion and cyclic strain using cine phase contrast MRI: in vivo validation in the porcine aorta.
Artery wall motion and strain play important roles in vascular remodeling and may be important in the pathogenesis of vascular disease. In vivo observations of circumferentially nonuniform wall motion in the human aorta suggest that nonuniform strain may contribute to the localization of vascular pathology. A velocity-based method to investigate circumferential strain variations was previously developed and validated in vitro; the current study was undertaken to determine whether accurate displacement and strain fields can be calculated from velocity data acquired in vivo. Wall velocities in the porcine thoracic aorta were quantified with PC-MRI and an implanted coil and were then time-integrated to compute wall displacement trajectories and cyclic strain. Displacement trajectories were consistent with observed aortic wall motion and with the displacements of markers in the aortic wall. The mean difference between velocity-based and marker-based trajectory points was 0.1 mm, relative to an average pixel size of 0.4 mm. Propagation of error analyses based on the precision of the computed displacements were used to demonstrate that 10% strain results in a standard deviation of 3.6%. This study demonstrates that it is feasible to accurately quantify strain from low wall velocities in vivo and that the porcine thoracic aorta does not deform uniformly.
Algorithms↗
Measurement of left ventricular velocities: phase contrast MRI velocity mapping versus tissue-doppler-ultrasound in healthy volunteers.
The aim of this study was the comparison of phase contrast magnetic resonance imaging (PCMRI) measurements of left ventricular velocities in a physiological in vivo setting with tissue-Doppler-ultrasound (tissue Doppler imaging: TDI) data in healthy volunteers. Images were acquired in short axis view using a flow compensated black blood k-space segmented gradient echo sequence. Velocity encoding was performed by adding a bipolar gradient after each rf-pulse to the otherwise identical pulse sequences. Full in-plane velocity information of the moving heart was obtained in 16 heartbeats within one breath-hold measurement. Twenty-nine healthy volunteers (mean age=25 years) were examined with both imaging modalities. Both PCMRI and TDI demonstrate a biphasic profile of radial velocities over the cardiac cycle. Intraindividual comparison of left ventricular velocity data acquired using PCMRI and TDI show a very good correspondence with r-values of 0.97. The in vivo study in 29 healthy volunteers demonstrates a high validity of time-resolved phase contrast measurements for the analysis of left ventricular myocardial velocities.
Adult↗