Tagged Cine Magnetic Resonance Imaging Research Articles

Analysis of three-chamber view conventional and tagged cine MRI in patients with suspected hypertrophic cardiomyopathy.

To investigate the potential value of adding a tagged three-chamber (3Ch) cine to clinical hypertrophic cardiomyopathy (HCM) magnetic resonance imaging (MRI) protocols, including to help distinguish HCM patients with regionally impaired cardiac function. Forty-eight HCM patients, five patients with "septal knuckle" (SK), and 20 healthy volunteers underwent MRI at 1.5T; a tagged 3Ch cine was added to the protocol. Regional strain, myocardial wall thickness, and mitral valve leaflet lengths were measured in the 3Ch view. In HCM, we found a reduced tangential strain with decreased diastolic relaxation in both hypertrophied (p = 0.003) and remote segments (p = 0.035). Strain in the basal septum correlated with the length of the coaptation zone + residual leaflet (r = 0.48, p < 0.001). In the basal free wall, patients with SK had faster relaxation compared to HCM patients with septal hypertrophy. The 3Ch tagged MRI sequence provides useful information for the examination of suspected HCM patients, with minimal additional time cost. Local wall function is closely associated with morphological changes of the mitral apparatus measured in the same plane and may provide insights into mechanisms of obstruction. The additional strain information may be helpful when analyzing local myocardial wall motion patterns in the presence of SK.

Tagged cine magnetic resonance imaging to quantify regional mechanical changes after acute myocardial infarction

PurposeThe conventional volumetric approaches of measuring cardiac function are load-dependent, and are not able to discriminate functional changes in the infarct, transition and remote myocardium. We examined phase-dependent regional mechanical changes in the infarct, transition and remote regions after acute myocardial infarction (MI) in a preclinical mouse model using cardiovascular magnetic resonance imaging (CMR). MethodsWe induced acute MI in six mice with left anterior descending coronary artery ligation. We then examined cardiac (infarct, transition and remote-zone) morphology and function utilizing 9.4 T high field CMR before and 2 weeks after the induction of acute MI. Myocardial scar tissue was evaluated by using CMR with late gadolinium enhancement (LGE). After determining global function through volumetric analysis, regional wall motion was evaluated by measuring wall thickening and radial velocities. Strain rate imaging was performed to assess circumferential contraction and relaxation at the myocardium, endocardium, and epicardium. ResultsThere was abnormal LGE in the anterior walls after acute MI suggesting a successful MI procedure. The transition zone consisted of a mixed signal intensity, while the remote zone contained viable myocardium. As expected, the infarct zone had demonstrated severely decreased myocardial velocities and strain rates, suggesting reduced contraction and relaxation function. Compared to pre-infarct baseline, systolic and diastolic velocities (vS and vD) were significantly reduced at the transition zone (vS: −1.86 ± 0.16 cm/s vs −0.68 ± 0.13 cm/s, P < 0.001; vD: 1.86 ± 0.17 cm/s vs 0.53 ± 0.06 cm/s, P < 0.001) and remote zone (vS: −1.86 ± 0.16 cm/s vs −0.65 ± 0.12 cm/s, P < 0.001; vD: 1.86 ± 0.16 cm/s vs 0.51 ± 0.04 cm/s, P < 0.001). Myocardial peak systolic and diastolic strain rates (SRS and SRD) were significantly lower in the transition zone (SRS: −4.2 ± 0.3 s−1 vs −1.3 ± 0.2 s−1, P < 0.001; SRD: 3.9 ± 0.3 s−1 vs 1.3 ± 0.2 s−1, P < 0.001) and remote zone (SRS: −3.8 ± 0.3 s−1 vs −1.4 ± 0.3 s−1, P < 0.001; SRD: 3.5 ± 0.2 s−1 vs 1.5 ± 0.4 s−1, P = 0.006). Endocardial and epicardial SRS and SRD were similarly reduced in the transition and remote zones compared to baseline. ConclusionsThis study, for the first time, utilized state-of-the art high-field CMR algorithms in a preclinical mouse model for a comprehensive and controlled evaluation of the regional mechanical changes in the transition and remote zones, after acute MI. Our data demonstrate that CMR can quantitatively monitor dynamic post-MI remodeling in the transition and remote zones, thereby serving as a gold standard tool for therapeutic surveillance.

Myocardial motion analysis based on an optical flow method using tagged MR images.

We developed a method of velocimetry based on an optical flow method using quantitative analyses of tagged magnetic resonance (MR) images (tagged MR-optical flow velocimetry, tMR-O velocimetry). The purpose of our study was to examine the accuracy of measurement of the proposed tMR-O velocimetry. We performed retrospective pseudo-electrocardiogram (ECG) gating tagged cine MR imaging on a rotating phantom. We optimized imaging parameters for tagged MR imaging, and validated the accuracy of tMR-O velocimetry. Our results indicated that the difference between the reference velocities and the computed velocities measured using optimal imaging parameters was less than 1%. In addition, we performed tMR-O velocimetry and echocardiography on 10 healthy volunteers, for four sections of the heart (apical, midventricular, and basal sections aligned with the short-axis, and a four-chamber section aligned with the long-axis), and obtained radial and longitudinal myocardial velocities in these sections. We compared the myocardial velocities obtained using tMR-O velocimetry with those obtained using echocardiography. Our results showed good agreement between tMR-O velocimetry and echocardiography in the radial myocardial velocities in three short-axial sections and longitudinal myocardial velocities on the midventricular portion of the four-chamber section in the long-axis. In the study conducted on the rotating phantom, tMR-O velocimetry showed high accuracy; moreover, in the healthy volunteers, the myocardial velocities obtained using tMR-O velocimetry were relatively similar to those obtained using echocardiography. In conclusion, tMR-O velocimetry is a potentially feasible method for analyzing myocardial motion in the human heart.

Tagged cine magnetic resonance imaging with a finite element model can predict the severity of retrosternal adhesions prior to redo cardiac surgery

Reoperative median sternotomy entails a risk of damaging the heart or great vessels. If the severity of retrosternal adhesion is accurately assessed before sternal re-entry, resternotomy-related complications can be prevented. The purpose of this investigation was to evaluate whether the severity of retrosternal adhesions can be accurately predicted by tagged cine magnetic resonance imaging. Thirteen patients who were scheduled to undergo cardiac reoperation were investigated by electrocardiography-gated tagged cine magnetic resonance imaging before sternal re-entry. With the imaging data, the severity of retrosternal adhesion was scored visually on the basis of abnormality in regional myocardial motion and discordance in the tagged signals of the sternum and the myocardium. Also, with the aid of a finite element model, strain at the surface of the right ventricle was calculated on the basis of displacement of the tags on the heart over the cardiac cycle. For comparison, the adhesion severity was scored visually at the time of redo surgery by surgeons who were blinded to the preoperative assessment. The preoperative adhesion severity score, as determined visually by tagged cine magnetic resonance imaging, was correlated with the intraoperative severity score (correlation coefficient: r = 0.76, P < .01). Mean strain at the surface of the heart, as calculated preoperatively by finite element model analysis, was inversely correlated with the intraoperative adhesion severity score (r = -0.78, P < .01). Tagged cine magnetic resonance imaging with a finite element model can provide an accurate quantitative assessment of retrosternal adhesions before redo cardiac surgery.

Left Ventricular Postmyocardial Infarction Remodeling Studied by Combining MR-Tagging With Delayed MR Contrast Enhancement

We sought to monitor the evolution of noninfarcted and infarcted myocardium function in the process of left ventricular (LV) remodeling after a reperfused myocardial infarction. Pigs (n = 8) were subjected to reperfused infarction. Magnetic resonance imaging (MRI) was performed at 3 days and 8 weeks after infarction. Regional circumferential shortening (Ecc) and principal strain L1 in the infarcted, peri-infarcted, and remote myocardium were evaluated by tagged cine MRI combined with matched late enhancement data (Gadolinium-DOTA-enhanced IR-GRE) Global LV function was evaluated by cine MRI. Animals were euthanized after the second imaging session and tissue samples from the different myocardial regions were obtained for histopathologic study. There was a significant deterioration in Ecc between the 3-day and 8-week studies in the peri-infarcted myocardium at apex (-9.9% +/- 4.5% to -6.5 +/- 3.9; P = 0.046) whereas it remained stable for all other regions at all levels. A trend toward improvement in Ecc existed in the infarcted myocardium when infarction transmurality was less than 50% of the LV wall (-7.5% +/- 0.8% to -12.2% +/- 2.9% P = 0.06). Ecc in infarcted myocardium was significantly inferior (P < 0.002) to that in remote and peri-infarcted myocardium at the apical level (2.7% +/- 2.6% vs. -14.4% +/- 3.3% and -9.9% +/- 4.5%, respectively). Global LV function substantially deteriorated after infarction and was associated with a significant LV dilation. These results confirm the hypothesis that scarred myocardium imposes additional functional burden to the peri-infarcted myocardium.

Left Ventricular Deformation Recovery From Cine MRI Using an Incompressible Model

This paper presents a method for 3-D deformation recovery of the left ventricular (LV) wall from anatomical cine magnetic resonance imaging (MRI). The method is based on a deformable model that is incompressible, a desired property since the myocardium has been shown to be nearly incompressible. The LV wall needs to be segmented in an initial frame after which the method automatically determines the deformation everywhere in the LV wall throughout the cardiac cycle. Two studies were conducted to validate the method. In the first study, the deformation recovered from a 3-D anatomical cine MRI of a healthy volunteer was compared against the manual segmentation of the LV wall and against the corresponding 3-D tagged cine MRI. The average volume agreement between the model and the manual segmentation had a false positive rate of 3%, false negative rate of 3%, and true positive rate of 93%. The average distance between the model and manually determined intersections of perpendicular tag planes was 1.6 mm (1.1 pixel). Another set of 3-D anatomical and tagged MRI scans was taken of the same volunteer four months later. The method was applied to the second set and the recovered deformation was very similar to the one obtained from the first set. In the second study, the method was applied to 3-D anatomical cine MRI scans of three patients with ventricular dyssynchrony and three age-matched healthy volunteers. The LV wall deformations recovered for the three normals agreed well and the recovered strains were similar to those reported by other researchers for normal subjects. Strains and displacements of the three patients were clearly smaller than those of the three normals indicating reduced cardiac function. The deformation recovered for the three normals and the three patients was validated against manual segmentation and corresponding tag cine MRI scans and the agreement was similar to that of the first validation study.

Constrictive Pericarditis Diagnosed by Cardiac Magnetic Resonance Imaging in a Pacemaker Patient

A 71-year-old male was referred for evaluation of 6 months of progressively worsening dyspnea on exertion and peripheral edema, mainly of the legs. During the symptomatic period, he had undergone 3 thoracentesis procedures, each draining more than 1500 mL of transudative fluid. His functional impairment was so severe that he contemplated suicide. His cardiac history was significant for syncope attributable to sinus node dysfunction 19 years earlier, requiring implantation of an atrioventricular pacing system. Because of atrial lead fracture, a second atrial lead had been placed 1 month before the onset of the dyspnea and leg edema. Physical examination revealed diminished breath sounds over both lung fields and moderate (2+) edema of both lower extremities to the level of the knee. The 12-lead ECG demonstrated normal sinus rhythm at 79 bpm with low-voltage and diffuse ST and T-wave abnormalities (Figure 1). A chest x-ray revealed a dual-chamber permanent cardiac pacemaker, 2 retained leads, and bilateral pleural effusions (Figure 2). Transthoracic and transesophageal echocardiography and …

Delineation of normal human left ventricular twist throughout systole by tagged cine magnetic resonance imaging.

Myofibril shortening and the oblique fiber orientation of the left ventricular myocardium results in a twisting motion of the left ventricle. Advances in cardiac magnetic resonance imaging (MRI) have made it possible to label the myocardium noninvasively and track this motion (twist) through the cardiac cycle, but little data exist on its complete systolic time course. The purpose of this study was to delineate the normal human systolic time course of ventricular twist using tagged cine-MRI. Tagged cine-MRI was performed in 10 healthy subjects. The mean systolic twist angle relative to the short axis centroid for the 10 volunteers was calculated. Interstudy and intra- and interobserver variability were assessed. During isovolumic contraction, all ventricular twist was counterclockwise. Later in systole, the basal segments changed direction and rotated in a clockwise direction, whereas the apical segments continued counterclockwise rotation. The midpoint for rotation was 45+/-8% of ventricular length. The mean short axis net ventricular twist (apex-base) at 80% systole was 12.6+/-1.5 degrees. The four wall segments showed heterogeneity in twist (lateral wall, 20.6+/-1.7 degrees; anterior wall, 17.5+/-5.1 degrees; inferior wall, 8.8+/-4.9 degrees; septum, 3.5+/-2.4 degrees). The anterior and lateral walls demonstrated significantly higher twist than the other walls (p < 0.01). Torsion increased steadily throughout systole after isovolumic contraction, whereas twist displayed rate changes. The mean interstudy and intra- and interobserver differences were less than 2.1 degrees. The close similarity in twist between subjects and the low interstudy and inter/intraobserver variation indicates that twist is a robust parameter of myocardial function. Torsion varies smoothly during systole, which may play a role in minimizing oxygen consumption. These data can serve as a baseline from which to compare alterations in regional myocardial function in disease.

Regional Left Ventricnlar Motion during Early Filling Phase in Patients with Right Ventricular Pressure Overload.

Global left ventricular (LV) diastolic function has been reported to be disturbed under conditions of right ventricular pressure overload (RVPO). However, from the standpoint of regional wall motion, only a little information related to the mechanism of LV diastolic dysfunction is available. Eight patients with RVPO and 7 healthy volunteers were investigated using tagged cine magnetic resonance imaging. Regional diastolic fraction (RDF) was determined in 4 segments (anterior, lateral, inferior, and septal) in the mid-ventricular short axis section and in 2 segments (septal and lateral) in the 4-chamber section. A heterogeneity index was obtained from the RDFs of the short axis section. In the RVPO group, in both short axis and 4-chamber sections, the RDF of the septal segment was depressed, and it showed an inverse correlation with the right-to-left ventricular systolic pressure (RV/LV) ratio (r = -0.74, p < 0.05) in the short axis section. In the 4-chamber section, the RDF was lower in the septal segment than in the lateral segment (p < 0.05). The heterogeneity index in the RVPO group was greater than that in the control group (p < 0.01). The index correlated positively with the RV/LV ratio (r = 0.77, p < 0.05). The altered regional diastolic motion results in increased heterogeneity in regional diastolic motion.

Left ventricular regional systolic motion in patients with right ventricular pressure overload

Left ventricular regional systolic motion was investigated in patients with right ventricular pressure overload and 10 controls using tagged cine magnetic resonance imaging. The regional shortening fraction was determined in four segments (septal, lateral, inferior, and anterior) on the short-axis image. An asynchrony index, nonhomogeneity of regional shortening, was calculated. Septal shortening in these patients was depressed, and showed an inverse correlation with the right-to-left ventricular peak pressure ratio ( r=−0.80, P<0.01). Lateral shortening was greater in the patients than in the controls ( P<0.01). The asynchrony index was significantly greater in the patients than in the controls ( P<0.01), and correlated with the right-to-left systolic pressure ratio ( r=0.64, P=0.02) and the left ventricular end-diastolic pressure ( r=0.79, P<0.01). The altered distribution of regional circumferential shortening results in an increased heterogeneity of regional systolic motion. These findings may have important implications for the assessment of ventricular function in patients with right ventricular pressure overload.

Regional ventricular systolic abnormalities caused by a rudimentary chamber in patients with univentricular hearts

Previous studies have demonstrated that regional wall motion abnormalities are common in univentricular hearts; however, the mechanism of this abnormality and its relation to hemodynamics remain unclear. The aim of this study was to document and analyze the etiology of regional wall motion abnormality and its relation to hemodynamics in univentricular hearts. Sixteen patients (age 11 ± 6 years) were examined. A tagged cine magnetic resonance imaging method that superimposes “tags” on myocardium was used to assess regional systolic motion. The tags were traced from end-diastole to end-systole, and the percent regional shortening fraction was calculated as the shortening ratio. The tags were positioned on 6 segments. Normal ranges for wall motion were established from 10 normal volunteers. An asynchrony index was calculated as the SD divided by the mean regional shortening fraction to quantify asynchronous regional motion. Hemodynamic parameters were also obtained by cardiac catheterization. In patients, regional shortening fraction was significantly lower in segments adjacent to the rudimentary chamber compared with normal values in both circumferential and longitudinal directions (p <0.05 and p <0.01, respectively). The asynchrony index was much greater in patients than in controls (62 ± 25 vs 27 ± 10, p <0.01). The index correlated with rudimentary chamber volume and the rudimentary/main chamber volume ratio (r = 0.58, r = 0.79, respectively). Furthermore, the index correlated with end-diastolic pressure (r = 0.82). The rudimentary chamber may play an important role in causing asynchronous regional motion, and this motion may contribute to ventricular diastolic dysfunction.

Breath-Hold Dobutamine Magnetic Resonance Myocardial Tagging: Normal Left Ventricular Response

Analysis of the changes in myocardial deformation produced by adrenergic stress has been limited by the imaging techniques used. We used rapid magnetic resonance imaging (MRI) myocardial tagging to map the dose-dependent response to incremental dobutamine in the normal human left ventricle. Thirteen volunteers underwent breath-hold tagged cine MRI during dobutamine infusion. Images were acquired throughout systole to a peak dose of 20 μg/kg/min. End-systolic percent circumferential shortening (%S) was measured at 3 transmural locations and 4 circumferential locations at 3 long-axis positions. Mean circumferential shortening velocity (CSV) was also calculated at each location and dose. Mean %S reached a maximum of 26 ± 3% at 10 μg/kg/min compared with 21 ± 4% at baseline (p <0.003). Peak %S was reached by 10 μg/kg/min before a significant increase in heart rate or blood pressure and was unchanged at higher doses. In contrast, CSV increased linearly with dobutamine dose from 4.4 ± 0.9 mm/s at baseline to 9.8 ± 1.4 mm/s at 20 μg/kg/min (p <0.0001). Breath-hold tagged dobutamine MRI is safe and effective in detecting regional and transmural changes in function during incremental dobutamine. CSV increased continuously across the dobutamine dose range. At low dose (≤10 μg/kg/min) %S increased without any change in blood pressure or heart rate. Maintenance of peak %S beyond 10 μg/kg/min in the presence of decreasing systolic intervals resulted from a continued increase in CSV. Thus, CSV may be the preferred measure of contractile function during dobutamine stimulation in human myocardium.