Faculty Bibliography

PURPOSE: To assess liver stiffness using magnetization-tagged magnetic resonance imaging (MRI) to measure the cardiac-induced motion in the liver of cirrhosis patients with known Child-Pugh scores. MATERIALS AND METHODS: Tagged MRI was performed using a 3T MR scanner on 52 cirrhosis patients classified into two groups: liver cirrhosis with Child-Pugh A (LCA; n = 39) and liver cirrhosis with Child-Pugh B or C (LCBC; n = 13). We also included 19 healthy controls. Tagged images were acquired encompassing both the liver and the heart. The corresponding displacement and strains were calculated using a Gabor filter bank. The maximum displacement (MaxDisp) was found over the cardiac cycle, as well as the local maximum P1 (MaxP1) and minimum P2 strains (MinP2). Group comparisons were made without and with adjustment for age and gender. RESULTS: In control, LCA, and LCBC groups, the MaxDisp was 3.98 +/- 0.88 mm, 2.52 +/- 0.73 mm, and 1.86 +/- 0.77 mm; the MaxP1 was 0.10 +/- 0.02, 0.04 +/- 0.01, and 0.02 +/- 0.01; and the MinP2 was -0.08 +/- 0.01, -0.05 +/- 0.02, and -0.03 +/- 0.01, respectively. Statistically significant differences were found between groups (P < 0.05 for all). CONCLUSION: This method measures cardiac-induced liver motion and deformation to assess liver stiffness. Significant differences were found in our stiffness measures between control, LCA, and LCBC groups, with more severe disease being associated with greater stiffness. J. Magn. Reson. Imaging 2014;39:1301-1307. (c) 2013 Wiley Periodicals, Inc.

Background: For patients with impaired breath-hold capacity or arrhythmias, free breathing real-time cine MRI is preferred at the expense of compromised spatiotemporal resolution. Compressed sensing (CS) has been used to achieve higher spatiotemporal resolutions in real-time cine MRI, but the superposition of respiratory and cardiac motion limits temporal sparsity. In this work, we propose a novel approach that sorts out cardiac and respiratory motion into separated but synchronized dimensions and performs a joint multicoil CS reconstruction with different sparsity constraints on cardiac and respiratory dimensions. Golden-angle radial sampling was employed for flexible data sorting. In arrhythmias cases, data are also sorted according to cardiac cycles with different length to reconstruct both "normal" and "ectopic" cycles. Methods: Cardiac imaging was performed on one volunteer (male age = 27) and one patient (female age = 49) with Mobitz I arrhythmia during free breathing without external gating on a 1.5T MRI scanner (Avanto, Siemens). Data were continuously acquired for 15 s in a short axis plane using a 2D golden-angle radial b-SSFP sequence. Imaging parameters were: spatial resolution = 2 x 2 mm², TR/TE = 2.8/1.4 ms, FA = 70degree and slice thickness = 8 mm. Temporal evolution of the central k-space positions (green dots, Figure 1a) was used to estimate cardiac contraction and respiration from coil-elements close to the heart and diaphragm respectively (Figure 1b). Raw data were then sorted into an expanded dataset of images containing two dynamic dimensions, one for cardiac and the other for respiratory motion. As shown in Figure 1b, each colored rectangular block represents an individual cardiac phase from a short "snapshot" period (e.g. 13 adjacent spokes). Data were sorted first into a higher dimensional matrix using the cardiac motion signal (Figure 1c left) followed by a second sorting along the respiratory dimension from expiration to inspiration using the respiratory mot!

Background: Evaluation of myocardial function with MRI is challenging on patients with impaired breath-hold (BH) capabilities or arrhythmias due to the difficulty of respiratory motion suspension and synchronization of cardiac cycles. Compressed sensing (CS) enables free breathing (FB) real-time cine imaging with improved spatiotemporal resolution, but conventional temporal sparsifying transforms do not account for respiratory motion, which limits its performance. In this work, we propose to acquire data continuously in FB using a golden-angle radial sampling scheme and reconstruct images with separated but synchronized cardiac and respiratory motion dimensions using self-detected motion signals. For patients with arrhythmias, both "normal" and "ectopic" cycles are reconstructed by sorting out cardiac cycles with different lengths. The performance of the proposed method was compared to Cartesian BH approach using retrospective ECG-gating in 9 patients. Methods: Both BH and FB cine sequences (b-SSFP) were implemented on a 1.5T MRI scanner (Avanto, Siemens). Imaging parameters for BH cine were: spatial resolution = 1.8 x 1.8 mm², slice thickness = 8 mm, TR/TE = 2.5/1.25 ms, FA = 55degree. Imaging parameters for FB cine were: spatial resolution = 2 x 2 mm², slice thickness = 8 mm, TR/TE2.8/1.4 ms, FA = 70degree. Both sequences achieved temporal resolution ~30-40 ms. Cardiac imaging was performed on 9 patients (mean age = 56; 4 had normal sinus rhythm, 4 had arrhythmias including bigeminy PVCs, atrial fibrillation and Mobitz I, 1 was incapable of prolonged BH). One short axis and one 4 chamber cine image set were acquired on each patient at ~12-15s per slice. In FB cine imaging, central k-space positions (green dots, Figure 1a) were used to extract cardiac and respiratory signals from coils near the heart and diaphragm respectively (Figure 1b). Data were sorted and synchronized to separately reconstruct cardiac cycles of different lengths at different respiratory states. A mul!

Background: Observation of the kinetics of tissue enhancement after the injection of a bolus of tracer has been used for the analysis of perfusion and related variables. In general, a gradient of concentration in the exchanging vascular compartment between the arterial and venous ends is represented in models via focus on maintaining the detailed balance between the advective and diffusive exchange processes. Conventionally, this is by considering the exchange in an Eulerian framework, based on considering the exchange within each compartment as a separate unit (e.g., tissue homogeneity (TH) model [1]). Herein, we present a Lagrangian approach to the exchange modeling, such that the blood flowing between compartments is considered as the primary unit, and, thereby, allowing for coarser discretization and more efficient calculations (Figure 1a). Methods: Eight patients (age 63 + 12 years) underwent first-pass perfusion (FPP) rest and regadenoson stress cardiac MRI (CMR) (3T scanner, Tim Trio, Siemens), followed by invasive coronary angiography. Images were obtained at 4 slice locations (the aortic root for the arterial input function (AIF) and 3 short-axis slices of the left ventricle for the wall) using a TurboFLASH readout with centric k-space reordering [2]. A proton density-weighted image was acquired for normalization [3]. Myocardial blood flow (MBF) (mL/g/min) and perfusion reserve index (MPRI) were calculated in endocardial and epicardial areas (total 32 segments) using our method by an expert in the field of MRI blinded to coronary angiography results. Results: The results of a representative patient (66 year old man) with history of hypertension, hyperlipidemia, Diabetes Mellitus and known coronary artery disease with prior stents on maximal medical therapy are shown in Figure 1b-f. Coronary angiography was performed via the right femoral artery and demonstrated severe triple-vessel disease with left to right collaterals (Figure 1b). First-pass CMR perfusion imaging demonstrates a delay!

In this study, we propose a novel scheme for real time dynamic magnetic resonance imaging (dMRI) reconstruction. Different from previous methods, the reconstructions of the second frame to the last frame are independent in our scheme, which only require the first frame as the reference. Therefore, this scheme can be naturally implemented in parallel. After the first frame is reconstructed, all the later frames can be processed as soon as the k-space data is acquired. As an extension of the convention total variation, a new online model called dynamic total variation is used to exploit the sparsity on both spatial and temporal domains. In addition, we design an accelerated reweighted least squares algorithm to solve the challenging reconstruction problem. This algorithm is motivated by the special structure of partial Fourier transform in sparse MRI. The proposed method is compared with 4 state-of-the-art online and offline methods on in-vivo cardiac dMRI datasets. The results show that our method significantly outperforms previous online methods, and is comparable to the offline methods in terms of reconstruction accuracy.

PURPOSE: To develop an arrhythmia-insensitive rapid (AIR) cardiac T1 mapping pulse sequence for quantification of diffuse fibrosis. METHODS: An arrhythmia-insensitive cardiac T1 mapping pulse sequence was developed based on saturation recovery T1 weighting, which is inherently insensitive to heart rate and rhythm, and two single-shot balanced steady-state free precession image acquisitions with centric k-space ordering, where T1 calculation is inherently insensitive to T2 effects. Its performance against conventional cardiac T1 mapping based on inversion recovery (i.e., MOLLI) is compared. Phantom experiments (T1 ranging from 535 to 2123 ms) were performed with heart rate and rhythm simulated at 60 and 120 beats per minute (bpm) and arrhythmia using an external triggering device. Ten human subjects and 17 large animals were scanned precontrast and 5, 10, and 15 min after contrast agent administration. RESULTS: Compared with the reference T1 mapping, AIR yielded lower normalized root-mean-square error than MOLLI (8% vs. 3%, respectively, at 60 bpm, 28% vs. 3%, respectively, at 120 bpm, and 22% vs. 3%, respectively, at arrhythmia). In vivo studies showed that T1 measurements made by MOLLI and AIR were strongly correlated (r = 0.99) but in poor agreement (mean difference = 161.8 ms, upper and lower 95% limits of agreements = 347.5 ms and -24.0 ms). CONCLUSION: Our AIR pulse sequence may be clinically useful for assessment of diffuse myocardial fibrosis in patients. Magn Reson Med 70:1274-1282, 2013. (c) 2012 Wiley Periodicals, Inc.

Cardiac anatomic variants, vascular abnormalities and non-neoplastic mass lesions may be misinterpreted as tumours, potentially leading to inappropriate intervention. This article discusses the complementary role of multi-detector computed tomography and magnetic resonance imaging in the work-up of suspected masses. The cross-sectional imaging appearance of common or distinctive anatomic variants and pseudotumours, including 'don't touch' lesions, are reviewed.