Cardiac Imaging Methods Research Articles

Localized constrictive pericarditis after Gore-Tex pericardial substitution

A 65-year-old patient presented with recurrent cardiac decompensation 12 years after aortic prosthesis replacement and expanded polytetrafluoroethylene (ePTFE) membrane pericardial substitution. Diagnosis of pericardial constriction was difficult. Only one cardiac imaging method, radionuclide ventriculography, was helpful. Upon re-operation, an epicardial fibrous strap which restricted right ventricle (RV) diastolic expansion was found between the anterior free wall and diaphragmatic portion of the RV. Clinical status dramatically improved after surgical removal of this bridle, as did ventricular filling curves in radionuclide imaging. This case shows that delayed cardiac constriction is possible after ePTFE pericardial substitution, especially if the membrane is applied to both anterior and diaphragmatic aspects of the heart.

Respiratory and cardiac self‐gated free‐breathing cardiac CINE imaging with multiecho 3D hybrid radial SSFP acquisition

A respiratory and cardiac self-gated free-breathing three-dimensional cine steady-state free precession imaging method using multiecho hybrid radial sampling is presented. Cartesian mapping of the k-space center along the slice encoding direction provides intensity-weighted position information, from which both respiratory and cardiac motions are derived. With in plan radial sampling acquired at every pulse repetition time, no extra scan time is required for sampling the k-space center. Temporal filtering based on density compensation is used for radial reconstruction to achieve high signal-to-noise ratio and contrast-to-noise ratio. High correlation between the self-gating signals and external gating signals is demonstrated. This respiratory and cardiac self-gated, free-breathing, three-dimensional, radial cardiac cine imaging technique provides image quality comparable to that acquired with the multiple breath-hold two-dimensional Cartesian steady-state free precession technique in short-axis, four-chamber, and two-chamber orientations. Functional measurements from the three-dimensional cardiac short axis cine images are found to be comparable to those obtained using the standard two-dimensional technique.

Tracing Cardiac Metabolism In Vivo: One Substrate at a Time

In the myocardial cell, a series of enzyme-catalyzed reactions results in the efficient transfer of chemical energy into mechanical energy. The goals of this article are to emphasize the ability of noninvasive imaging techniques using isotopic tracers to detect the metabolic footprints of heart disease and to propose that cardiac metabolic imaging is more than a useful adjunct to current myocardial perfusion imaging studies. A strength of metabolic imaging is in the assessment of regional myocardial differences in metabolic activity, probing for 1 substrate at a time. We hope that new and developing methods of cardiac imaging will lead to the earlier detection of heart disease and improve the management and quality of life for patients afflicted with ischemic and nonischemic heart muscle disorders.

Imaging the pericardium: appearances on ECG-gated 64-detector row cardiac computed tomography

Multidetector row computed tomography (MDCT) with its high spatial and temporal resolution has now become an established and complementary method for cardiac imaging. It can now be used reliably to exclude significant coronary artery disease and delineate complex coronary artery anomalies, and has become a valuable problem-solving tool. Our experience with MDCT imaging suggests that it is clinically useful for imaging the pericardium. It is important to be aware of the normal anatomy of the pericardium and not mistake normal variations for pathology. The pericardial recesses are visible in up to 44% of non-electrocardiogram (ECG)-gated MDCT images. Abnormalities of the pericardium can now be identified with increasing certainty on 64-detector row CT; they may be the key to diagnosis and therefore must not be overlooked. This educational review of the pericardium will cover different imaging techniques, with a significant emphasis on MDCT. We have a large research and clinical experience of ECG-gated cardiac CT and will demonstrate examples of pericardial recesses, their variations and a wide variety of pericardial abnormalities and systemic conditions affecting the pericardium. We give a brief relevant background of the conditions and reinforce the key imaging features. We aim to provide a pictorial demonstration of the wide variety of abnormalities of the pericardium and the pitfalls in the diagnosis of pericardial disease.

Noncardiac findings on cardiac CT. Part II: Spectrum of imaging findings

Cardiac computed tomography (CT) has evolved into an effective imaging technique for the evaluation of coronary artery disease in selected patients. Two distinct advantages over other noninvasive cardiac imaging methods include its ability to directly evaluate the coronary arteries and to provide a unique opportunity to evaluate for alternative diagnoses by assessing the extracardiac structures, such as the lungs and mediastinum, particularly in patients presenting with the chief symptom of acute chest pain. Some centers reconstruct a small field of view (FOV) cropped around the heart but a full FOV (from skin to skin in the area irradiated) is obtainable in the raw data of every scan so that clinically relevant noncardiac findings are identifiable. Debate in the scientific community has centered on the necessity for this large FOV. A review of noncardiac structures provides the opportunity to make alternative diagnoses that may account for the patient's presentation or to detect important but clinically silent problems such as lung cancer. Critics argue that the yield of biopsy-proven cancers is low and that the follow-up of incidental noncardiac findings is expensive, resulting in increased radiation exposure and possibly unnecessary further testing. In this 2-part review we outline the issues surrounding the concept of the noncardiac read, looking for noncardiac findings on cardiac CT. Part I focused on the pros and cons for and against the practice of identifying noncardiac findings on cardiac CT. Part II illustrates the imaging spectrum of cardiac CT appearances of benign and malignant noncardiac pathology.

System and method for cardiac imaging

Ultrasound systems and methods are described to measure changes in cardiac chamber volumes and organ wall areas, thicknesses, volumes and masses between the cardiac chambers using computer readable media employing image processing algorithms applied to 3D data sets acquired at systole and diastole. The systems for cardiac imaging includes an ultrasound transceiver configured to sense the mitral valve of a heart by Doppler ultrasound, an electrocardiograph connected with a patient and synchronized with the transceiver to acquire ultrasound-based 3D data sets during systole and diastole at a transceiver location determined by Doppler ultrasound affected by the mitral valve, and a computer readable medium configurable to process ultrasound imaging information from the 3D data sets communicated from the transceiver.

Method and apparatus of CT cardiac diagnostic imaging using motion a priori information from 3D ultrasound and ECG gating

ECG and ultrasound data of the heart are acquired in real-time during a scan. A data acquisition module is controlled during the scan to prospectively gate acquisition of CT data as a function of the real-time ECG data and the real-time ultrasound data. An image is reconstructed from the acquired CT data.

Key Issues in the Developing Synergism between Cardiovascular Imaging and Biomarkers

Sophisticated methods of cardiac imaging have the potential to revolutionize the care of patients with cardiovascular disease. The benefits of these state-of-the art imaging techniques can be enhanced by their use in combination with new cardiac biomarkers. This review addresses potentially useful interactions between imaging and biomarkers. Areas were defined in which the combined use of novel imaging techniques and biomarkers would be most beneficial. This review addresses multiple cardiovascular conditions for which the useful aspects of imaging and biomarkers are likely to be positively synergistic, including acute and chronic ischemic heart disease, heart failure, myocarditis, hypertension, and atherosclerosis. The synergistic use of imaging techniques and biomarkers will enhance the investigation of many key issues and questions and will be an important resource in the future.

Analysis of microvascularity after reperfused acute myocardial infarction using the maximum slope method of contrast-enhanced magnetic resonance imaging

The aim of this study was to analyze microvas-cularity after reperfused acute myocardial infarction (AMI) using the maximum slope method of contrastenhanced cardiac magnetic resonance imaging (CMR). CMR and resting (201)T1 single photon emission computed tomography (SPECT) images were obtained in 30 consecutive patients after reperfused AMI and 10 controls. After bolus injection of gadolinium diethylenetriamine pentaacetic acid, first-pass CMR images were obtained using the True-FISP sequence. Time-intensity curves were generated by measuring the signal intensity in the myocardium and left ventricle. The arterial input function was obtained from the left ventricular time-intensity curve. On the basis of the maximum slope method, the microvascular index (MVI) was calculated by dividing the maximum initial upslope of the myocardium by the initial upslope of the left ventricle. The MVI was significantly lower in the segments related to the occluded coronary artery. MVIs in segments with (201)Tl uptake of 50%-59% of peak were significantly lower than in those with (201)Tl uptake of 60%-69%. MVIs in segments with (201)Tl uptake of <50% of peak were significantly lower than in those with (201)Tl uptake of 50%-59%. This study presents a method that directly assesses microvascularity after reperfused AMI.

Temporally Targeted Imaging Method Applied to ECG-Gated Computed Tomography: Preliminary Phantom and In Vivo Experience

Existing cardiac imaging methods do not allow for improved temporal resolution when considering a targeted region of interest (ROI). The imaging method presented here enables improved temporal resolution for ROI imaging (namely, a reconstruction volume smaller than the complete field of view). Clinically, temporally targeted reconstruction would not change the primary means of reconstructing and evaluating images, but rather would enable the adjunct technique of ROI imaging, with improved temporal resolution compared with standard reconstruction ( approximately 20% smaller temporal scan window). In gated cardiac computed tomography (CT) scans improved temporal resolution directly translates into a reduction in motion artifacts for rapidly moving objects such as the coronary arteries. Retrospectively electrocardiogram gated coronary angiography data from a 64-slice CT system were used. A motion phantom simulating the motion profile of a coronary artery was constructed and scanned. Additionally, an in vivo study was performed using a porcine model. Comparisons between the new reconstruction technique and the standard reconstruction are given for an ROI centered on the right coronary artery, and a pulmonary ROI. In both a well-controlled motion model and a porcine model results show a decrease in motion induced artifacts including motion blur and streak artifacts from contrast enhanced vessels within the targeted ROIs, as assessed through both qualitative and quantitative observations. Temporally targeted reconstruction techniques demonstrate the potential to reduce motion artifacts in coronary CT. Further study is warranted to demonstrate the conditions under which this technique will offer direct clinical utility. Improvement in temporal resolution for gated cardiac scans has implications for improving: contrast enhanced CT angiography, calcium scoring, and assessment of the pulmonary anatomy.

Establishing a Cardiac Imaging Rotation in Radiology Residency

The advent of new technologies for cardiac imaging such as magnetic resonance imaging (MRI) and cardiac computed tomography (CT) have added new tools in the armamentarium of noninvasive methods for predicting cardiac disease. However, training in cardiac anatomy and physiology is critical if radiology is to meet the demands of this service. We designed a core rotation in cardiac imaging at the Beth Israel Deaconess Medical Center, Harvard Medical School, to train residents in noninvasive cardiac imaging methods, such as cardiac echocardiography, nuclear cardiac imaging, cardiac MRI, and with special emphasis on cardiac CT. This 1-month block includes cardiac imaging conferences and a lecture series, hands-on training in the use of imaging software, introduction to cardiac catheterization, and clinical cardiology. Residents are provided with a set of research and review articles along with textbooks on coronary imaging to serve as references for this rotation. We believe that this educational exercise will establish a core of young, knowledgeable, and capable physicians who will be able to meet the clinical demand for noninvasive cardiac imaging and maintain a major role in this emerging specialty.

Cardiotrophin: its importance as a pathogenetic factor and as a measure of left ventricular hypertrophy

Cardiotrophin: its importance as a pathogenetic factor and as a measure of left ventricular hypertrophy

Improved cardiac sodium MR imaging by density‐weighted phase‐encoding

To show that density-weighted (DW) k-space sampling improves the quality of human cardiac sodium imaging, a novel method was implemented that combines the high signal-to-noise efficiency of three-dimensional phase-encoding with the advantageous localization performance of nonuniform sampling. A simulation demonstrates substantially reduced blood contamination in the myocardium. At 2.0 T, DW cardiac "fast" sodium images with a voxel size of 844 microL in seven minutes and "high-resolution" scans in 30 minutes with a voxel size of 570 microL were acquired. For comparison, conventional gradient-echo imaging was also performed. In the DW images, a myocardial signal-to-noise ratio (SNR) of 16.0 in the left ventricle and 8.5 in the septum (N = 4) was measured. With longer experimental duration (about 30 minutes; N = 3), the image quality and the SNR could be further improved (voxel size: 570 microL; SNR: blood 16.1, septum 10.6). Compared to the gradient-echo images, the image quality was substantially improved. This new method for human cardiac sodium imaging provides high image quality combined with optimal sensitivity and thus may improve the clinical applicability of 23Na cardiac MRI.

Gauging effective spatial resolution in multirow helical cardiac computed tomography with a dynamic phantom.

To devise a numerical indicator of image quality for multirow helical cardiac computed tomography (CT) and its relation to temporal resolution. A pulsatile cardiac assist device was used to simulate cardiac wall motion by mechanically transmitting the device dynamics to a piece of tungsten wire. Wire motion induced by different device rates was captured with an 8-row subsecond helical CT scanner operating with various scanning parameters. Image artifacts were visually assessed and compared with the image point spread function (PSF) using the full width at half maximum (FWHM) area as a numerical estimate of spatial accuracy. At rest, the FWHM area was determined as 1.3 mm2. At a device rate of 60 bpm, the FWHM area ranged from 1.51 mm2 to 21.62 mm2, depending on the time of image reconstruction. Mean reproducibility of the FWHM area measurements was determined as 0.05, whereas visual estimates of motion artifact were highly variable between different readers (kappa = 0.19). Visually determined image quality correlated closely with the FWHM area metric (Spearman's rank correlation, P = 0.0001, rho = 0.841). At a device rate of 100 bpm, the minimum FWHM area was 2.00 mm2 using a single-sector algorithm, 1.41 mm2 using a 2-segment algorithm, and 1.37 mm2 using a 4-segment algorithm. Use of a pulsatile cardiac assist device could serve as an in vitro test bed for cardiac CT imaging methods. Area FWHM of the PSF correlates well with visually determined image quality of a dynamic phantom, but provides better reproducibility than visual analysis.

The biometrical comparison of cardiac imaging methods

Objectives: Biometrical comparison procedures for cardiac imaging methods with continuous outcome are reviewed mainly concentrating on assessment and design adequate comparison of accuracy and precision. Univariate graphical and numerical representation of corresponding deviations is outlined to derive a ‘check list’ of minimum information necessary to compare the measurement methods. Data: The methods reviewed here are illustrated by the comparison of standard 2DE bidimensional cardial volumetry versus assessment using TDE colour imaging in 28 normal probands. Sources: The paired t-test and the corresponding confidence interval approach are used to assess deviations in location of two imaging methods; the test procedures of Maloney and Rastogi Hahn and Nelson and Grubbs are surveyed as proposals for the comparison of precisions in paired data. The Krippendorff coefficient and the Bradley/Blackwood test are illustrated as surrogate measures for method concordance. Conclusions: Since these methods can be performed by simple modification of standard options available in most statistics software packages, this review intends to enable cardiologists to choose appropriate methods for statistical data analysis and representation on their own.

Cardiac imaging with rapid, retrospective ECG synchronized multilevel spiral CT

In this paper a method for cardiac imaging with fast multi-slice CT and retrospectively ECG-gated spiral acquisition is presented. A fast multi-slice CT system with 4 simultaneously acquired slices and 0.5 s rotation time is used (Siemens Somatom VolumeZoom). Continuous spiral data of the entire heart volume is acquired together with the patient's ECG and reconstructed with dedicated spiral algorithms providing 250 ms temporal resolution. Three-dimensional image data sets are built up from overlapping slices that are reconstructed in an arbitrary, user-defined phase of the heart cycle (e.g. diastolic phase). To evaluate the capability of the method for functional imaging complete three-dimensional image volumes are reconstructed from the same spiral data set in different phases of the heart cycle. A spiral data set of the entire heart volume may be acquired within a single breath-hold. Typical scan times for standard examinations with 3 mm slice width are 10-15 s, and for high-resolution CT angiographies of the coronary arteries with 1.25 mm slice width about 30-35 s. Motion-free reconstruction of the heart and coronary arteries with high spatial resolution is possible in the diastolic phase of the heart cycle. Multi-phase reconstructions from the same spiral scan data set are possible, however, motion artifacts in heart phases with fast cardiac motion may not be completely avoided. Fast multi-slice spiral CT with retrospectively ECG-gated spiral reconstruction is well suited for three-dimensional and functional imaging of the heart, especially for high-resolution imaging of calcified coronary plaques and CT-angiography of the coronary arteries.

Keyhole method for high-speed human cardiac cine MR imaging.

Although electrocardiographic (ECG)-gated magnetic resonance (MR) imaging is widely used for cardiac imaging, it has several disadvantages, such as long imaging time, respiratory artifacts, and motion artifacts induced by arrhythmia. An MR image can be acquired within about 0.3 seconds by using a fast gradient-echo imaging method. When this method is continuously applied, only two to three images can be obtained during a single cardiac cycle. The goal of this study is to obtain cine MR images in a single cardiac cycle using fast gradient-echo imaging combined with the "keyhole" method. The optimal conditions for the keyhole method for cardiac cine imaging were obtained by computer simulation based on a simplified cardiac model. When the read-out direction was set parallel to the cardiac short axis, left ventricular motion was almost correctly reproduced by the keyhole method with acquisition time reduced to one-fourth. J. Magn. Reson. Imaging 1999;10:778-783.

Keyhole method for high‐speed human cardiac cine MR imaging

Although electrocardiographic (ECG)-gated magnetic resonance (MR) imaging is widely used for cardiac imaging, it has several disadvantages, such as long imaging time, respiratory artifacts, and motion artifacts induced by arrhythmia. An MR image can be acquired within about 0.3 seconds by using a fast gradient-echo imaging method. When this method is continuously applied, only two to three images can be obtained during a single cardiac cycle. The goal of this study is to obtain cine MR images in a single cardiac cycle using fast gradient-echo imaging combined with the “keyhole” method. The optimal conditions for the keyhole method for cardiac cine imaging were obtained by computer simulation based on a simplified cardiac model. When the read-out direction was set parallel to the cardiac short axis, left ventricular motion was almost correctly reproduced by the keyhole method with acquisition time reduced to one-fourth. J. Magn. Reson. Imaging 1999;10:778–783. © 1999 Wiley-Liss, Inc.

A multiresolution restoration method for cardiac SPECT imaging

In this study we present a multiresolution based method for restoring cardiac SPECT projections. Original projections were decomposed into a set of sub-band frequency images by using analyzing functions localized in both the space and frequency domain. This representation allows a simple denoising and restoration procedure by discarding high-frequency channels and performing inversion only in low frequencies. The method was evaluated in bull's eye reconstructions of a realistic cardiac chest phantom with a custom-made liver insert and 99mTc liver-to-heart activity ratios (LHAR) of 0:1, 1.5:1, 2.5:1, and 3.5:1. The cardiac phantom in free air was used as the reference standard. Reconstructions were performed by filtered backprojection using (1) no correction; (2) restoration without attenuation correction; (3) attenuation correction without restoration; and (4) restoration and attenuation correction. The attenuation correction was carried out with the Chang's method for one iteration. Results were compared with those obtained using an optimized prereconstruction Metz filter. Quantitative analysis was performed by calculating the normalized chi-square measure and mean +/- s.d. of bull's eye counts. In reconstructions with high liver activity (LHAR > 2), attenuation correction without restoration severely distorted the polar maps due to the spill-over of liver activity into the inferior myocardial wall. Both restoration methods when combined with an attenuation correction compensated this artifact and yielded uniform polar maps similar to that of the standard reference. There was no visual or quantitative difference between the performance of Metz filtering and multiresolution restoration. However, the main advantage of the multiresolution method is that it states a more concise and straightforward approach to the restoration problem. Multiresolution based methods does not require information about the object image or optimization processes, such as in conventional nuclear medicine restoration filters. In addition, the method is easy to implement using DFT techniques and potentially can be extended to noniterative spatially shift-invariant restorations in SPECT.

Magnetic resonance—its current and future role in paediatric cardiac radiology

Cardiac magnetic resonance (MR) has developed rapidly providing a method of both imaging congenital heart disease and assessing function using a variety of techniques. The aim of this review is to identify indications for MR and its relative strengths and weaknesses in comparison to other methods of cardiac imaging. A potential future role for MR is also discussed.