Phase-sensitive Inversion Recovery Sequence Research Articles

Incremental prognostic value of cardiovascular magnetic resonance imaging in patients with severe LV dysfunction undergoing coronary artery bypass grafting.

Coronary artery disease (CAD) remains a significant global health issue, particularly when complicated by left ventricular ejection fraction (LVEF) < 35%. Although coronary artery bypass grafting (CABG) is recommended for such cases, the unclear prognosis necessitates further investigation. This retrospective study aimed to determine whether cardiovascular magnetic resonance (CMR) imaging provides additional prognostic value in guiding effective clinical management. The study included patients with CAD and LVEF < 35% who underwent CABG surgery after enhanced CMR between March 2016 and March 2023. CMR was performed using a 3.0T scanner with steady-state free precession and phase-sensitive inversion recovery sequences. Prognostic analysis of clinical and CMR data was conducted, with the endpoint defined as cardiovascular death, revascularization, hospitalization for heart failure, or stroke. Statistical analysis included Student's t-test, chi-squared test, univariate and multivariate Cox regression analysis, receiver operating characteristic analysis, Harrell C statistical analysis, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) analysis. The study included 152 patients (mean age 58.6 ± 9.7 years; 138 men). During a mean follow-up of 2.0 years, 8 patients experienced cardiovascular death, while 1 case had revascularization, 13 had hospitalization for heart failure, and 11 had a stroke. Left atrial diameter index (LADi) (hazard ratio [HR], 1.08 [95% confidence interval (CI): 1.02-1.15]; P = 0.04) and late gadolinium enhancement (LGE) mass (HR, 1.03 [95% CI: 1.01-1.06]; P < 0.001) were associated with the endpoint, even after adjusting for multiple clinical variables. Adding LADi and LGE mass improved risk prediction for adverse events, as indicated by the C-index (0.738, p < 0.01), IDI (0.36), and NRI (0.13). Left atrial diameter index (LADi) and scar burden are valuable prognostic indicators in patients with LVEF < 35% undergoing CABG. They offer enhanced risk stratification beyond traditional clinical factors, highlighting their importance in guiding clinical management.

Patterns of cerebral damage in multiple sclerosis and aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders-major differences revealed by non-conventional imaging.

Multiple sclerosis and aquaporin-4 antibody neuromyelitis optica spectrum disorders are distinct autoimmune CNS disorders with overlapping clinical features but differing pathology. Multiple sclerosis is primarily a demyelinating disease with the presence of widespread axonal damage, while neuromyelitis optica spectrum disorders is characterized by astrocyte injury with secondary demyelination. Diagnosis is typically based on lesion characteristics observed on standard MRI imaging and antibody testing but can be challenging in patients with in-between clinical presentations. Non-conventional MRI techniques can provide valuable diagnostic information by measuring disease processes at the microstructural level. We used non-conventional MRI to measure markers of axonal loss in specific white matter tracts in multiple sclerosis and neuromyelitis optica spectrum disorders, depending on their relationship with focal lesions. Patients with relapsing-remitting multiple sclerosis (n = 20), aquaporin-4 antibody-associated neuromyelitis optica spectrum disorders (n = 20) and healthy controls (n = 20) underwent a 3T brain MRI, including T1-, T2- and diffusion-weighted sequences, quantitative susceptibility mapping and phase-sensitive inversion recovery sequence. Tractometry was used to differentiate tract fibres traversing through white matter lesions from those that did not. Neurite density index was assessed using neurite orientation dispersion and density imaging model. Cortical damage was evaluated using T1 relaxation rates. Cortical lesions and paramagnetic rim lesions were identified using phase-sensitive inversion recovery and quantitative susceptibility mapping. In tracts traversing lesions, only one out of 50 tracts showed a decreased neurite density index in multiple sclerosis compared with neuromyelitis optica spectrum disorders. Among 50 tracts not traversing lesions, six showed reduced neurite density in multiple sclerosis (including three in the cerebellum and brainstem) compared to neuromyelitis optica spectrum disorders. In multiple sclerosis, reduced neurite density was found in the majority of fibres traversing (40/50) and not traversing (37/50) white matter lesions when compared to healthy controls. A negative correlation between neurite density in lesion-free fibres and cortical lesions, but not paramagnetic rim lesions, was observed in multiple sclerosis (39/50 tracts). In neuromyelitis optica spectrum disorders compared to healthy controls, decreased neurite density was observed in a subset of fibres traversing white matter lesions, but not in lesion-free fibres. In conclusion, we identified significant differences between multiple sclerosis and neuromyelitis optica spectrum disorders corresponding to their distinct pathologies. Specifically, in multiple sclerosis, neurite density reduction was widespread across fibres, regardless of their relationship to white matter lesions, while in neuromyelitis optica spectrum disorders, this reduction was limited to fibres passing through white matter lesions. Further studies are needed to evaluate the discriminatory potential of neurite density measures in white matter tracts for differentiating multiple sclerosis from neuromyelitis optica spectrum disorders.

Biventricular Impairment and Ventricular Interdependence in Patients With Alcoholic Cardiomyopathy: Insights Through Cardiac Magnetic Resonance Imaging.

Alcoholic cardiomyopathy (ACM) can lead to progressive cardiac dysfunction and heart failure, but little is known about biventricular impairment and ventricular interdependence (VI) in ACM patients. To use cardiac MRI to investigate biventricular impairment and VI in ACM patients. Retrospective. Forty-one male patients with ACM and 45 sex- and age-matched controls. 3.0 T/balanced steady-state free precession sequence, inversion recovery prepared echo-planar imaging sequence and phase-sensitive inversion recovery sequence. Biventricular structure, function, and global strain (encompassing peak strain [PS], peak systolic, and diastolic strain rate), PS of interventricular septal (IVS), microvascular perfusion (including upslope and time to maximum signal intensity [TTM]), late gadolinium enhancement (LGE), and baseline characteristics were compared between the controls and ACM patients. Student's t-test, Mann-Whitney U test, Pearson's correlation, and multivariable linear regression models with a stepwise selection procedure. A two-tailed P value <0.05 was deemed as statistically significant. Compared to control subjects, ACM patients showed significantly biventricular adverse remodeling, reduced left ventricle (LV) global upslope and prolonged global TTM, and the presence of LGE. ACM patients were characterized by a significant decline in all global strain within the LV, right ventricle (RV), and IVS compared with the controls. RV global PS was significantly associated with LV global PS and IVS PS in radial, circumferential, and longitudinal directions. Multivariable analyses demonstrated the longitudinal PS of IVS was significantly correlated with RV global radial PS (β = 0.614) and circumferential PS (β = 0.545). Additionally, RV global longitudinal PS (GLPS) was significantly associated with radial PS of IVS (β = -0.631) and LV GLPS (β = 1.096). ACM patients exhibited biventricular adverse structural alterations and impaired systolic and diastolic function. This cohort also showed reduced LV microvascular perfusion, the presence of LGE, and unfavorable VI. 3 TECHNICAL EFFICACY: Stage 3.

Association of Pulmonary Transit Time and Pulmonary Blood Volume From First-Pass Perfusion Cardiac MRI With Diastolic Dysfunction and Left Ventricle Deformation in Restrictive Cardiomyopathy.

Patients with restrictive cardiomyopathy (RCM) have impaired diastolic filling and hemodynamic congestion. Pulmonary transit time (PTT) and pulmonary blood volume index (PBVi) reflect the hemodynamic status, but the relationship with left ventricle (LV) dysfunction remains unclear. To evaluate the PTT and PBVi in RCM patients, the association with diastolic dysfunction and LV deformation, and the effects on the occurrence of major adverse cardiac events (MACE) in RCM patients. Retrospective. 137 RCM patients (88 men, age 58.80 ± 10.83 years) and 68 age- and sex-matched controls (46 men, age 57.00 ± 8.59 years). 3.0T/Balanced steady-state free precession sequence, recovery prepared echo-planar imaging sequence, and phase-sensitive inversion recovery sequence. The LV function and peak strain (PS) parameters were measured. The PTT was calculated and corrected by heart rate (PTTc). The PBVi was calculated as the product of PTTc and RV stroke volume index. Chi-squared test, student's t-test, Mann-Whitney U test, Pearson's or Spearman's correlation, multivariate linear regression, Kaplan-Meier survival analysis, and Cox regression models analysis. A P-value <0.05 was considered statistically significant. The PTTc showed a significant correlation with the E/A ratio (r = 0.282), and PBVi showed a significant correlation with the E/e' ratio, E/A ratio, and diastolic dysfunction stage (r = 0.222, 0.320, and 0.270). PTTc showed an independent association with LVEF, LV circumferential PS, and LV longitudinal PS (β = 0.472, 0.299, and 0.328). In Kaplan-Meier analysis, higher PTTc and PBVi were significantly associated with MACE. In multivariable Cox regression analysis, PTTc was a significantly independent predictor of the MACE in combination with both cardiac MRI functional and tissue parameters (hazard ratio: 1.23/1.32, 95% confidence interval: 1.10-1.42/1.20-1.46). PTTc and PBVi are associated with diastolic dysfunction and deteriorated LV deformation, and PTTc independently predicts MACE in patients with RCM. 3 TECHNICAL EFFICACY: Stage 2.

Automated assessment of cardiac pathologies on cardiac MRI using T1-mapping and late gadolinium phase sensitive inversion recovery sequences with deep learning

BackgroundA deep learning (DL) model that automatically detects cardiac pathologies on cardiac MRI may help streamline the diagnostic workflow. To develop a DL model to detect cardiac pathologies on cardiac MRI T1-mapping and late gadolinium phase sensitive inversion recovery (PSIR) sequences were used.MethodsSubjects in this study were either diagnosed with cardiac pathology (n = 137) including acute and chronic myocardial infarction, myocarditis, dilated cardiomyopathy, and hypertrophic cardiomyopathy or classified as normal (n = 63). Cardiac MR imaging included T1-mapping and PSIR sequences. Subjects were split 65/15/20% for training, validation, and hold-out testing. The DL models were based on an ImageNet pretrained DenseNet-161 and implemented using PyTorch and fastai. Data augmentation with random rotation and mixup was applied. Categorical cross entropy was used as the loss function with a cyclic learning rate (1e-3). DL models for both sequences were developed separately using similar training parameters. The final model was chosen based on its performance on the validation set. Gradient-weighted class activation maps (Grad-CAMs) visualized the decision-making process of the DL model.ResultsThe DL model achieved a sensitivity, specificity, and accuracy of 100%, 38%, and 88% on PSIR images and 78%, 54%, and 70% on T1-mapping images. Grad-CAMs demonstrated that the DL model focused its attention on myocardium and cardiac pathology when evaluating MR images.ConclusionsThe developed DL models were able to reliably detect cardiac pathologies on cardiac MR images. The diagnostic performance of T1 mapping alone is particularly of note since it does not require a contrast agent and can be acquired quickly.

Association Between Myocardial Oxygenation and Fibrosis in Duchenne Muscular Dystrophy: Analysis by Rest Oxygenation-Sensitive Magnetic Resonance Imaging.

Myocardial hypoxia has been demonstrated in many cardiomyopathies and is related to development of myocardial fibrosis. However, myocardial hypoxia and its association with myocardial fibrosis are understudied in Duchenne muscular dystrophy (DMD)-associated cardiomyopathy. To evaluate myocardial hypoxia by oxygenation-sensitive (OS) cardiac magnetic resonance imaging, and further explore its association with fibrosis. Prospective. Ninety-one DMD boys (8.78 ± 2.32) and 30 healthy boys (9.07 ± 2.30). 3 T, Balanced steady-state free procession, Modified Look-Locker inversion recovery sequence and Single-shot phase-sensitive inversion recovery sequence. Cardiac MRI data, including left ventricular functional, segmental native T1, and oxygenation signal-intensity (SI) according to AHA 17-segment model, were acquired. Patients were divided into LGE+ and LGE- groups. In patients with LGE, all segments were further classified as positive or negative segments by segmentally presence/absence of LGE. Variables were compared using Student's t, Wilcoxon, Kruskal-Wallis test and one-way analysis of variance. Bivariate Pearson or Spearman correlation were calculated to determine association between oxygenation SI and native T1. Variables with P < 0.10 in the univariable analysis were included in multivariable model. Receiver operating characteristic analysis was used to assess the performance of OS in diagnosing myocardial hypoxia. The myocardial oxygenation SI of DMD was significantly decreased in all segments compared with normal controls, and more obvious in the LGE+ segments (0.46 ± 0.03 vs. 0.52 ± 0.03). For patients with and without LGE, myocardial oxygenation SI were significantly negatively correlated with native T1 in all segments (r = -0.23 to -0.42). The inferolateral oxygenation SI was a significant independent associator of LGE presence (adjusted OR = 0.900). Myocardial hypoxia evaluated by the OS-Cardiac-MRI indeed occurs in DMD and associate with myocardial fibrosis, which might be used as a biomarker in assessing myocardial damage in DMD. 1 TECHNICAL EFFICACY: Stage 1.

Diagnostic Contribution of Additional Sequences to the Evaluation of Cord Lesions in Patients with Cervical Spinal Multiple Sclerosis in Turkey: A Retrospective Study.

Multiple Sclerosis (MS) is the most common cause of non-traumatic disability in young adults. Spinal cord involvement is observed in 55-75% of patients with MS. To identify the strengths and shortcomings of sagittal phase-sensitive inversion recovery (PSIR), sagittal proton density/T2-weighted (PD/T2W), and axial turbo inversion recovery magnitude (TIRM) sequences in the detection of cervical MS plaques by comparing with routine sequences (axial and sagittal T2W, sagittal T1W, sagittal TIRM, fat-suppressed contrast T1W) and therefore determine their diagnostic contributions. A total of 48 patients in whom additional magnetic resonance imaging (MRI) sequences were obtained for the diagnosis of cervical MS were retrospectively identified and included in the study. A total of 111 MS plaques were analyzed in terms of visibility, number, size, border sharpness, and intensity ratio based on the routine and additional MRI sequences. The evaluation of the images was independently undertaken by two radiologists. The highest visibility was provided by sagittal PSIR, sagittal TIRM, and axial TIRM sequences (P < 0.05 for all additional sequences). Seven lesions in PD/T2W and four lesions in axial T2W sequences were unable to be detected. Lesions seen in sagittal and axial TIRM sequences were larger than the others. The sharpest borders were determined in the axial TIRM sequence, and the most diffuse borders in the PD/T2W sequence. In intensity ratio, the sagittal PSIR sequence revealed the most significant contrast difference. The sagittal PSIR sequence may improve the detection of cervical MS plaques due to the improved visibility and intensity ratios. The axial TIRM sequence may be more useful than routine axial T2W in the evaluation of visibility, border sharpness, and size measurement of MS plaques.

Detection of Spinal Cord Multiple Sclerosis Lesions Using a 3D-PSIR Sequence at 1.5 T.

Multiple sclerosis (MS) is aprevalent autoimmune inflammatory disease. Besides cerebral manifestations, an affection of the spinal cord is typical; however, imaging of the spinal cord is difficult due to its anatomy. The aim of this study was to assess the diagnostic value of a3D PSIR pulse sequencing at a1.5 T magnetic field strength for both the cervical and thoracic spinal cord. Phase sensitive inversion recovery (PSIR), short tau inversion recovery (STIR) and T2-weighted (T2-w)images of the spinal cord of 50patients were separately evaluated by three radiologists concerning the number and location of MS lesions. Furthermore, lesion to cord contrast ratios were determined for the cervical and thoracic spinal cord. Of the lesions 54.81% were located in the cervical spinal cord, 42.26% in the thoracic spinal cord and 2.93% in the conus medullaris. The PSIR images showed ahigher sensitivity for lesion detection in the cervical and thoracic spinal cord (77.10% and 72.61%, respectively) compared to the STIR images (58.63% and 59.10%, respectively) and the T2-w images (59.95% and 59.52%, respectively). The average lesion to cord contrast ratio was significantly higher in the PSIR images compared to the STIR images (p < 0.001) and the T2-w images (p < 0.001). Evaluation of the spinal cord with a3D PSIR sequence at amagnetic field strength of 1.5 T is feasible with ahigh sensitivity for the detection of spinal MS lesions for the cervical as well as the thoracic segments. In combination with other pulse sequences it might become avaluable addition in an advanced imaging protocol.

Associations between cortical lesions, optic nerve damage, and disability at the onset of multiple sclerosis: insights into neurodegenerative processes.

BackgroundMultiple sclerosis cortical lesions are areas of demyelination and neuroaxonal loss. Retinal layer thickness, measured with optical coherence tomography (OCT), is an emerging biomarker of neuroaxonal loss. Studies have reported correlations between cortical lesions and retinal layer thinning in established multiple sclerosis, suggesting a shared pathophysiological process. Here, we assessed the correlation between cortical lesions and OCT metrics at the onset of multiple sclerosis, examining, for the first time, associations with physical or cognitive disability. ObjectiveTo examine the relationship between cortical lesions, optic nerve and retinal layer thicknesses, and physical and cognitive disability at the first demyelinating event. MethodsThirty-nine patients and 22 controls underwent 3T-MRI, optical coherence tomography, and clinical tests. We identified cortical lesions on phase-sensitive inversion recovery sequences, including occipital cortex lesions. We measured the estimated total intracranial volume and the white matter lesion volume. OCT metrics included peripapillary retinal nerve fibre layer (pRNFL), ganglion cell and inner plexiform layer (GCIPL) and inner nuclear layer (INL) thicknesses. ResultsHigher total cortical and leukocortical lesion volumes correlated with thinner pRNFL (B = -0.0005, 95 % CI -0.0008 to -0.0001, p = 0.01; B = -0.0005, 95 % CI -0.0008 to -0.0001, p = 0.01, respectively). Leukocortical lesion number correlated with colour vision deficits (B = 0.58, 95 %CI 0.039 to 1,11, p = 0.036). Thinner GCIPL correlated with a higher Expanded Disability Status Scale (B = -0.06, 95 % CI -1.1 to -0.008, p = 0.026). MS diagnosis (n = 18) correlated with higher cortical and leukocortical lesion numbers (p = 0.004 and p = 0.003), thinner GCIPL (p = 0.029) and INL (p = 0.041). ConclusionThe association between cortical lesions and axonal damage in the optic nerve reinforces the role of neurodegenerative processes in MS pathogenesis at onset.

3D phase-sensitive inversion recovery sequence for intracranial vertebrobasilar artery dissection

BackgroundT1-weighted 3D turbo spin echo (T1W-3D-TSE) sequences with variable refocusing flip angle are commonly used to diagnose intracranial vertebrobasilar artery dissection (iVAD). However, magnetic susceptibility artifacts of the cavernous sinus may cause loss of the basilar and vertebral arteries. This study investigated the effectiveness of a 3D phase-sensitive inversion recovery (3D-PSIR) sequence in reducing magnetic susceptibility artifacts in the cavernous sinus, and its imaging findings for iVAD. MethodsTwelve volunteers and eleven patients with iVAD were included. Magnetic resonance imaging (MRI) was performed using a 3.0-T MRI system. 3D-PSIR and T1W-3D-TSE sequences were used. Vessel wall defects and contrast-to-noise ratio (CNR) were evaluated. The MRI findings were visually evaluated. ResultsIn the 3D-PSIR images, one volunteer (8 %) had vessel wall defects, and five (42 %) had vessel wall defects (p = 0.046) in the T1W-3D-TSE images. CNR was higher in 3D-PSIR images for vessel wall-to-lumen, whereas it was higher in T1W-3D-TSE images for vessel wall-to-CSF (p < 0.001). Visual evaluation revealed similar MRI findings between the two sequences. ConclusionsThe 3D-PSIR sequence may be able to improve the vessel wall defects and achieve MRI findings comparable to those of the T1W-3D-TSE sequence in iVAD. The 3D-PSIR sequence can be a useful tool for the imaging-based diagnosis of iVAD.

Feasibility of gray-blood late gadolinium enhancement evaluation in young patients with congenital and acquired heart disease.

Late gadolinium enhancement (LGE) sequences have become common in pediatric cardiovascular magnetic resonance (CMR) to assess for myocardial fibrosis. Bright-blood late gadolinium enhancement (BB-LGE) by conventional phase-sensitive inversion recovery (PSIR) is commonly utilized, but similar inversion time (TI) value of fibrosis and left ventricular (LV) blood pool can make subendocardial areas difficult to assess. A gray-blood LGE (GB-LGE) technique has been described, targeting nulling of the LV blood pool and demonstrating improvement in ischemic scar detection over BB-LGE in adult patients. We sought to evaluate the feasibility of the GB-LGE technique in a young population with congenital and acquired heart disease and compare its ability to detect subendocardial scar to conventional BB-LGE. Seventy-six consecutive patients referred for clinical CMR underwent both BB-LGE and GB-LGE on 1.5 T and 3 T scanners. Conventional PSIR sequences were obtained with TI to null the myocardium (BB-LGE) in short-axis and horizontal long-axis stacks. Same PSIR stacks were immediately repeated with TI to null the blood pool (GB-LGE). Both sequences were reviewed separately a week apart by two readers, blinded to the initial clinical interpretation. Studies were analyzed for overall image quality, confidence in scar detection, confidence in detection of LGE, LGE class, inter- and intra-observer agreement for the presence of scar, and intraclass correlation coefficient (ICC) for total scar burden. Overall confidence in myocardial scar detection by BB-LGE or GB-LGE as well as grading of image quality were not statistically different [(p = 1 and p = 1) and (p = 0.53, p = 0.18), respectively]. There was very good inter-observer agreement for the presence of scar on BB-LGE (K = 0.88, 95% CI 0.77-0.99) and GB-LGE (K = 0.84, 95% CI 0.7-0.96), as well as excellent intra-observer agreement for both readers (K = 0.93, 95% CI 0.87-0.99; and K = 0.81, 95% CI 0.69-0.95). Interclass correlation coefficient for total scar burden was excellent for BB-LGE (ICC = 0.98, 95% CI 0.96-0.99) and GB-LGE (ICC = 0.94, 95% CI 0.91-0.97). The GB-LGE technique is feasible in the pediatric population with congenital and acquired heart disease. It can detect subendocardial/ischemic scar similar to conventional bright-blood PSIR sequences in the pediatric population.

Feasibility and image quality of bright-blood and black-blood phase-sensitive inversion recovery (BOOST) sequence in clinical practice using for left atrial visualization in patients with atrial fibrillation

ObjectivesVisualizing left atrial anatomy including the pulmonary veins (PVs) is important for planning the procedure of pulmonary vein isolation with ablation in patients with atrial fibrillation (AF). The aims of our study are to investigate the feasibility of the 3D whole-heart bright-blood and black-blood phase-sensitive (BOOST) inversion recovery sequence in patients with AF scheduled for ablation or electro-cardioversion, and to analyze the correlation between image quality and heart rate and rhythm of patients.MethodsBOOST was performed for assessing PVs both with T2 preparation pre-pulse (T2prep) and magnetization transfer preparation (MTC) in 45 patients with paroxysmal or permanent AF scheduled for ablation or electro-cardioversion. Image quality analyses were performed by two independent observers. Qualitative assessment was made using the Likert scale; for quantitative analysis, signal to noise ratios (SNR) and contrast to noise ratios (CNR) were calculated for each PV. Heart rate and rhythm were analyzed based on standard 12-lead ECGs.ResultsAll MTC-BOOST acquisitions achieved diagnostic quality in the PVs, while a significant proportion of T2prep-BOOST images were not suitable for assessing PVs. SNR and CNR values of the MTC-BOOST bright-blood images were higher if patients had sinus rhythm. We found a significant or nearly significant negative correlation between heart rate and the SNR and CNR values of MTC-BOOST bright-blood images.Conclusion3D whole-heart MTC-BOOST bright-blood imaging is suitable for visualizing the PVs in patients with AF, producing diagnostic image quality in 100% of cases. However, image quality was influenced by heart rate and rhythm.Clinical relevance statementThe novel 3D whole-heart BOOST CMR sequence needs no contrast administration and is performed during free-breathing; therefore, it is easy to use for a wide range of patients and is suitable for visualizing the PVs in patients with AF.Key Points• The applicability of the novel 3D whole-heart bright-blood and black-blood phase-sensitive sequence to pulmonary vein imaging in clinical practice is unknown.• Magnetization transfer-bright-blood and black-blood phase-sensitive imaging is suitable for visualizing the pulmonary veins in patients with atrial fibrillation with excellent or good image quality.• Bright-blood and black-blood phase-sensitive cardiac magnetic resonance sequence is easy to use for a wide range of patients as it needs no contrast administration and is performed during free-breathing.

Myocardial edema at CMR imaging end evolution of ventricular function following COVID-19 myocarditis - insights from the CARDIOCOV study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The CARDIOCOV project - Prototype for personalized assessment of cardiovascular risk and post-Covid myocarditis based on artificial intelligence, advanced medical imaging and cloud computing - financed by UEFISCDI PN-III-P2-2.1-PTE-2021-0450 (Contract Number 108PTE/2022). Background Myocarditis following SARS-COV-2 infection has recently become a subject of concern, being detected in a significant number of post-COVID-19 patients who undergo cardiac magnetic resonance(CMR) examination. While the role of CMR in detecting presence of viral myocarditis has been well established, the CMR features associated with significant alteration of ventricular function in post-COVID patients are not clearly identified yet. Purpose The aim of the study was to investigate the role of myocardial edema (ME) at CMR for predicting the evolution of ventricular function in patients with COVID myocarditis. Methods In total, 55 patients with CMR signs of viral myocarditis following COVID-19 infection (52.72% males, mean age 36.85+/-16.29) were enrolled in the study. The delayed gadolinium enhancement phase-sensitive inversion recovery sequences were used for characterization of the myocardial tissue, and inversion recovery images showing high signal intensity were considered suggestive of edematous changes. Patients were divided into 2 study groups, according to the presence of myocardial edema at the moment of CMR evaluation: group 1 (n=18, 32.72%) - patients without ME, and group 2 (n=37, 67.27%)-patients with ME identified by CMR. In all patients, end-distolic and end-systolic volume indexes (EDVI and ESVI), ejection fraction (EF) and stroke volume (SV) were calculated. Results Compared to patients without ME, those with ME present at CMR were older n (42.9+/-14.8 vs. 36.7+/-16.6, p = 0.145) and more frequently males(59.4% vs. 38.8%). At the same time, EF was significantly lower in patients with ME(50.9+/-14.5% in group 2 vs. 58.4+/-10.2% in group 1, p = 0.03). Patients from group 2 also exhibited a more pronounced dilatation of ventricular cavities, as reflected by a significant increase of ventricular volumes and especially of the ESVI(109.8+/-125.9 versus 80.1+/-14.2, p = 0.5 for EDVI, and 65.2+/-109.1 vs. 30.0+/-11.4, p = 0.02 for ESVI). Compared to the group without ME, those with ME presented a significantly lower stroke volume index: 44.2+/-17.3 in group 1 vs. 47.7+/-7.5, p = 0.03 in group 2. Conclusions In patients with COVID-19 myocarditis, presence of ME at CMR imaging is associated with a worse evolution of the left ventricular function, as reflected by increased ventricular dilatation and decreased cardiac output in the post-COVID period.

Three-dimensional High-Resolution Dark-Blood Late Gadolinium Enhancement Imaging for Improved Atrial Scar Evaluation.

Background Radiofrequency ablation (RFA) is a widely used treatment for atrial fibrillation, reducing the risk of cardiac arrhythmia. Detailed visualization and quantification of atrial scarring has the potential to improve preprocedural decision-making and postprocedural prognosis. Conventional bright-blood late gadolinium enhancement (LGE) MRI can help detect atrial scars; however, its suboptimal myocardium to blood contrast inhibits accurate scar estimation. Purpose To develop and test a free-breathing LGE cardiac MRI approach that simultaneously provides high-spatial-resolution dark-blood and bright-blood images for improved atrial scar detection and quantification. Materials and Methods A free-breathing, independent navigator-gated, dark-blood phase-sensitive inversion recovery (PSIR) sequence with whole-heart coverage was developed. Two coregistered high-spatial-resolution (1.25 × 1.25 × 3 mm3) three-dimensional (3D) volumes were acquired in an interleaved manner. The first volume combined inversion recovery and T2 preparation to achieve dark-blood imaging. The second volume functioned as the reference for phase-sensitive reconstruction with built-in T2 preparation for improved bright-blood contrast. The proposed sequence was tested in prospectively enrolled participants who had undergone RFA for atrial fibrillation (mean time since RFA, 89 days ± 26 [SD]) from October 2019 to October 2021. Image contrast was compared with conventional 3D bright-blood PSIR images using the relative signal intensity difference. Furthermore, native scar area quantification obtained from both imaging approaches was compared with measurements obtained with electroanatomic mapping (EAM) as the reference standard. Results A total of 20 participants (mean age, 62 years ± 9; 16 male) who underwent RFA for atrial fibrillation were included. The proposed PSIR sequence successfully acquired 3D high-spatial-resolution volumes in all participants, with a mean scan time of 8.3 minutes ± 2.4. The developed PSIR sequence improved scar to blood contrast compared with conventional PSIR sequence (mean contrast, 0.60 arbitrary units [au] ± 0.18 vs 0.20 au ± 0.19, respectively; P < .01) and correlated with EAM regarding scar area quantification (r = 0.66 [P < .01] vs r = 0.13 [P = .63]). Conclusion In participants who had undergone RFA for atrial fibrillation, an independent navigator-gated dark-blood PSIR sequence produced high-spatial-resolution dark-blood and bright-blood images with improved image contrast and native scar quantification compared with conventional bright-blood images. © RSNA, 2023 Supplemental material is available for this article.

Assessment of Myocardial Viability and Risk Stratification in Coronary Chronic Total Occlusion: A Qualitative and Quantitative Stress Cardiac MRI Study.

Indicators for assessing myocardial viability and risk stratification in patients with coronary chronic total occlusion (CTO) are still in the research stage. To use stress-MRI to assess myocardial function, blood perfusion, and viability and to explore their relationship with collateral circulation. Prospective. Fifty-one patients with CTO in at least one major artery confirmed by X-ray coronary angiography (male: 46; age 55.2 ± 10.8 years). 3.0T; TurboFlash, balanced steady-state free precession cine, and phase-sensitive inversion recovery sequences. Stress-MRI was used to obtain qualitative and quantitative parameters of segmental myocardium. Myocardial segments supplied by CTO target vessels were grouped according to the degree of collateral circulation assessed by radiographic coronary angiography (no/mild, moderate, or good). Depending on qualitative stress perfusion assessment and late gadolinium enhancement (LGE) extent, segments were also categorized as negative, viable, or trans-infarcted. Independent sample Student's t-test, one-way analysis of variance (ANOVA) test, Mann-Whitney U test, Kruskal-Wallis test, Spearman correlation coefficient (r). P < 0.05 was considered statistically significant. A total of 334 segments were supplied by CTO target vessels. The radial strain (RS), circumferential strain (CS), longitudinal strain (LS) of the negative, viable, and trans-infarcted regions showed a significant and stepwise impairment. Myocardial blood flow at rest was positively correlated with RS, CS, and LS (r = 0.42, 0.43, 0.38, respectively). Among the different collateral circulation, there were no significant differences in RS, CS, LS, and LGE volume (P = 0.788, 0.562, 0.122, 0.170, respectively), and there were also no statistically significant differences in the proportions of negative, viable, and trans-infarcted regions (P = 0.372). Myocardial perfusion obtained by stress-MRI combined with strain and LGE may comprehensively evaluate myocardial function and viability, and has potential to facilitate risk stratification of CTO. 2 TECHNICAL EFFICACY: Stage 1.

Association of Epicardial Adipose Tissue With Left Ventricular Strain and MR Myocardial Perfusion in Patients With Known Coronary Artery Disease.

Epicardial adipose tissue (EAT) may have a paracrine effect on coronary microcirculation and myocardium. However, it is unclear whether EAT is linked to cardiac function and perfusion. To investigate the association of EAT with left ventricular (LV) strain and myocardial perfusion in patients with coronary artery disease (CAD). Retrospective. A total of 78 patients with CAD and 20 healthy controls. The patients were further divided into high (n=39) and low EAT volume (n=39) groups according to median EAT volume. A 1.5 T, balanced steady-state free precession, inversion recovery prepared echo-planar, and segmented-turbo fast low-angle shot (FLASH) phase-sensitive inversion recovery (PSIR) sequences. EAT volume was measured by manually tracing the epicardial border and the visceral layer of pericardium on the short-axis cine stacks. LV strain parameters included global radial (GRS), circumferential (GCS), and longitudinal peak strain (GLS). Perfusion indices included upslope, perfusion index, time-to-maximum signal intensity (TTM), and maximum signal intensity (MaxSI). One-way analysis of variance or Kruskal-Wallis rank tests, Chi-squared or Fisher exact tests. Multivariate linear regression analyses. A P value < 0.05 was considered statistically significant. The parameters of GRS GCS, GLS, upslope, perfusion index, and MaxSI were significantly lower in the patients when compared to the controls. Moreover, the high EAT volume group presented significantly longer TTM values and lower GRS, GCS, GLS, upslope, perfusion index, and MaxSI than the low EAT volume group. Multivariate linear regression analyses demonstrated that EAT was independently associated with GRS, GCS, GLS, upslope, perfusion index, TTM, and MaxSI in patients. EAT and upslope were independently associated with GRS, while EAT and perfusion index were both independently associated with GCS and GLS. EAT was associated with parameters of LV function and perfusion, and myocardial perfusion was independently associated with LV strain in patients with CAD. 3. Stage 3.

Interrater reliability for the detection of cortical lesions on phase-sensitive inversion recovery magnetic resonance imaging in patients with multiple sclerosis.

To assess the reliability of phase-sensitive inversion recovery (PSIR) magnetic resonance imaging (MRI) and its accuracy for determining the topography of demyelinating cortical lesions in patients with multiple sclerosis (MS). This was a cross-sectional study conducted at a tertiary referral center for MS and other demyelinating disorders. We assessed the agreement among three raters for the detection and topographic classification of cortical lesions on fluid-attenuated inversion recovery (FLAIR) and PSIR sequences in patients with MS. We recruited 71 patients with MS. The PSIR sequences detected 50% more lesions than did the FLAIR sequences. For detecting cortical lesions, the level of interrater agreement was satisfactory, with a mean free-response kappa (κFR) coefficient of 0.60, whereas the mean κFR for the topographic reclassification of the lesions was 0.57. On PSIR sequences, the raters reclassified 366 lesions (20% of the lesions detected on FLAIR sequences), with excellent interrater agreement. There was a significant correlation between the total number of lesions detected on PSIR sequences and the Expanded Disability Status Scale score (ρ = 0.35; p < 0.001). It seems that PSIR sequences perform better than do FLAIR sequences, with clinically satisfactory interrater agreement, for the detection and topographic classification of cortical lesions. In our sample of patients with MS, the PSIR MRI findings were significantly associated with the disability status, which could influence decisions regarding the treatment of such patients.

Quantitative evaluation of functional liver reserve using the liver-to-spleen ΔR1 ratio based on gadoxetic acid-enhanced MRI: corrected for the effect of gadoxetic acid dose.

The liver T1 reduction rate can be used to assess liver function. However, higher doses of gadoxetic acid may shorten the liver T1 value in the hepatobiliary phase and increase the T1 reduction rate in patients with severe liver dysfunction, potentially overestimating liver function. To verify the relationship between the gadoxetic acid dose and the liver T1 reduction rate and ΔR1 of the liver and spleen, and to clarify whether the ΔR1 of hepatocytes, corrected for the effect of gadoxetic acid dose, could be used as an index of functional liver reserve. We enrolled 13 patients with normal liver function (NLF); and 18, 8, and 3 patients with Child-Pugh classes A (CPA), B (CPB), and C (CPC) who underwent gadoxetic acid-enhanced magnetic resonance imaging. Phase-sensitive inversion recovery sequence was performed before and at 15 min after injection and T1 maps were calculated. Liver and spleen ΔR1, liver T1 reduction rate, and the liver-to-spleen ΔR1 ratio were calculated. Only the liver-to-spleen ΔR1 ratio showed no correlation with gadoxetic acid dose in any group. The T1 reduction rate was not significantly different between the CPA and CPB + CPC groups. The liver-to-spleen ΔR1 ratio significantly differed between all groups. The liver and spleen ΔR1 was dependent on the dose of gadoxetic acid in severe liver dysfunction. The liver-to-spleen ΔR1 ratio improves the delineation of the CPA and CPB + CPC groups.

The Impact of Hypertension on Left Ventricular Function and Remodeling in Non-Ischemic Dilated Cardiomyopathy Patients: A 3.0 T MRI Study.

Hypertension (HTN) is highly prevalent in non-ischemic dilated cardiomyopathy (NIDCM) patients, but little is known about its impact on left ventricular (LV) function and remodeling. To evaluate the effect of hypertension on LV function and remodeling in NIDCM patients. Retrospective. Two-hundred and twelve NIDCM (HTN-) patients, 91 NIDCM (HTN+) patients, and 74 normal controls. 3.0 T/bSSFP and phase-sensitive inversion recovery sequence. The LV geometry, myocardial strain, remodeling index (calculated as LVM/LVEDV), and LGE were measured and compared between groups. Determinants of LV strain and remodeling in NIDCM were investigated. Student's t-test, Mann-Whitney U test, one-way analysis of variance, Kruskal-Wallis test, univariable and multivariable linear regression. A P value <0.05 was considered statistically significant. Compared with normal controls, NIDCM patients had significantly higher LVEDV and significantly impaired LV strains, including LV global peak strain (PS) and peak systolic and diastolic strain rates in the radial, circumferential, and longitudinal directions. The NIDCM (HTN+) group had significantly decreased LV global longitudinal PS and peak diastolic strain rate (PDSR), and significantly increased LV mass index and remodeling index compared to the NIDCM (HTN-) group, despite there being no significant difference in ejection fraction (P=0.241). The prevalence of LV LGE was significantly higher in the NIDCM (HTN+) group than in the NIDCM (HTN-) group. In multivariable regression models adjusted for potential confounders, hypertension was independently associated with LV global longitudinal PS and PDSR. Male sex, resting heart rate, and log(NT-proBNP) level were independent determinants of LV strains. Moreover, male sex, systolic and diastolic blood pressure, and presence of LGE were independent determinants of LV remodeling index. These findings suggest that coexistence of hypertension may further exacerbate the reduction in LV global strain and the aggravation of LV remodeling in NIDCM patients. 3 TECHNICAL EFFICACY: Stage 3.

Comparison of Phase-Sensitive Inversion Recovery and Conventional Magnetic Resonance Imaging for Detection of Cortical Plaques in MS Patients

Background: Precise detection and classification of intracortical (IC) lesions in multiple sclerosis (MS) patients are very important for understanding their role in disease progression and determining their effects on the clinical presentations of the disease. Objectives: This study aimed to evaluate the efficacy of phase-sensitive inversion recovery (PSIR) in delineation of cortical lesions in MS patients. Patients and Methods: This cross-sectional, single-center study was performed among 38 patients with the mean age of 31 years, who were recruited from December 2018 to August 2020. All MS patients underwent magnetic resonance imaging (MRI), using a 1.5-Tesla scanner. Two expert neuroradiologists interpreted the fluid-attenuated inversion recovery (FLAIR), T2-weighted turbo spin echo (T2W-TSE), and PSIR images. The lesions were classified as purely IC, mixed gray/white matter (WM) [leukocortical (LC)], and juxtacortical (JC). The number of lesions in each region was compared between the FLAIR, T2W-TSE, and PSIR sequences. Results: The number of cortical lesions (IC and LC) was significantly higher in PSIR compared to T2W-TSE and Fluid attenuated inversion recovery (FLAIR) (P &lt; 0.001), while the number of JC lesions was lower; in other words, the mean number of plaques was higher in T2W-TSE and FLAIR as compared to PSIR. Conclusion: The PSIR sequence significantly improved the delineation of cortical lesions and could be useful in monitoring cortical injuries and disease progression in MS patients.