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Journal of Cardiovascular Magnetic Resonance

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Open Access 01-12-2014 | Research

In vivo contrast free chronic myocardial infarction characterization using diffusion-weighted cardiovascular magnetic resonance

Authors: Christopher Nguyen, Zhaoyang Fan, Yibin Xie, James Dawkins, Eleni Tseliou, Xiaoming Bi, Behzad Sharif, Rohan Dharmakumar, Eduardo Marbán, Debiao Li

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2014

Abstract

Background

Despite the established role of late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) in characterizing chronic myocardial infarction (MI), a significant portion of chronic MI patients are contraindicative for the use of contrast agents. One promising alternative contrast free technique is diffusion weighted CMR (dwCMR), which has been shown ex vivo to be sensitive to myocardial fibrosis. We used a recently developed in vivo dwCMR in chronic MI pigs to compare apparent diffusion coefficient (ADC) maps with LGE imaging for infarct characterization.

Methods

In eleven mini pigs, chronic MI was induced by complete occlusion of the left anterior descending artery for 150 minutes. LGE, cine, and dwCMR imaging was performed 8 weeks post MI. ADC maps were derived from three orthogonal diffusion directions (b = 400 s/mm²) and one non-diffusion weighted image. Two semi-automatic infarct classification methods, threshold and full width half max (FWHM), were performed in both LGE and ADC maps. Regional wall motion (RWM) analysis was performed and compared to ADC maps to determine if any observed ADC change was significantly influenced by bulk motion.

Results

ADC of chronic MI territories was significantly increased (threshold: 2.4 ± 0.3 μm²/ms, FWHM: 2.4 ± 0.2 μm²/ms) compared to remote myocardium (1.4 ± 0.3 μm²/ms). RWM was significantly reduced (threshold: 1.0 ± 0.4 mm, FWHM: 0.9 ± 0.4 mm) in infarcted regions delineated by ADC compared to remote myocardium (8.3 ± 0.1 mm). ADC-derived infarct volume and location had excellent agreement with LGE. Both LGE and ADC were in complete agreement when identifying transmural infarcts. Additionally, ADC was able to detect LGE-delineated infarcted segments with high sensitivity, specificity, PPV, and NPV. (threshold: 0.88, 0.93, 0.87, and 0.94, FWHM: 0.98, 0.97, 0.93, and 0.99, respectively).

Conclusions

In vivo diffusion weighted CMR has potential as a contrast free alternative for LGE in characterizing chronic MI.

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Kelle S, Roes SD, Klein C, Kokocinski T, de Roos A, Fleck E, Bax JJ, Nagel E: Prognostic value of myocardial infarct size and contractile reserve using magnetic resonance imaging. J Am Coll Cardiol. 2009, 54: 1770-1777. 10.1016/j.jacc.2009.07.027.CrossRefPubMed

Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM: The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000, 343: 1445-1453. 10.1056/NEJM200011163432003.CrossRefPubMed

Kim HW, Farzaneh-Far A, Kim RJ: Cardiovascular magnetic resonance in patients with myocardial infarction: current and emerging applications. J Am Coll Cardiol. 2009, 55: 1-16. 10.1016/j.jacc.2009.06.059.CrossRefPubMed

Fox CS, Muntner P, Chen AY, Alexander KP, Roe MT, Cannon CP, Saucedo JF, Kontos MC, Wiviott SD: Use of evidence-based therapies in short-term outcomes of ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in patients with chronic kidney disease: a report from the national cardiovascular data acute coronary treatment and intervention outcomes network registry. Circulation. 2010, 121: 357-365. 10.1161/CIRCULATIONAHA.109.865352.PubMedCentralCrossRefPubMed

Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, Jafar TH, Heerspink HJL, Mann JF, Matsushita K, Wen CP: Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet. 2013, 382: 339-352. 10.1016/S0140-6736(13)60595-4.CrossRefPubMed

Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, McCullough PA, Kasiske BL, Kelepouris E, Klag MJ, Parfrey P, Pfeffer M, Raij L, Spinosa DJ, Wilson PW: Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American heart association councils on kidney in cardiovascular disease, high blood pressure research, clinical cardiology, and epidemiology and prevention. Circulation. 2003, 108: 2154-2169. 10.1161/01.CIR.0000095676.90936.80.CrossRefPubMed

Witschey WRT, Zsido GA, Koomalsingh K, Kondo N, Minakawa M, Shuto T, McGarvey JR, Levack MM, Contijoch F, Pilla JJ, Gorman JH, Gorman RC:In vivo chronic myocardial infarction characterization by spin locked cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2012, 14: 37-10.1186/1532-429X-14-37.PubMedCentralCrossRefPubMed

Haris M, Singh A, Cai K, Kogan F, McGarvey J, Debrosse C, Zsido GA, Witschey WRT, Koomalsingh K, Pilla JJ, Chirinos JA, Ferrari VA, Gorman JH, Hariharan H, Gorman RC, Reddy R: A technique for in vivo mapping of myocardial creatine kinase metabolism. Nat Med. 2014, 20: 209-214. 10.1038/nm.3436.PubMedCentralCrossRefPubMed

Messroghli DR, Walters K, Plein S, Sparrow P, Friedrich MG, Ridgway JP, Sivananthan MU: Myocardial T1 mapping: application to patients with acute and chronic myocardial infarction. Magn Reson Med. 2007, 58: 34-40. 10.1002/mrm.21272.CrossRefPubMed

10.

Bauner KU, Biffar A, Theisen D, Greiser A, Zech CJ, Nguyen ET, Reiser MF, Wintersperger BJ: Extracellular volume fractions in chronic myocardial infarction. Invest Radiol. 2012, 47: 538-545. 10.1097/RLI.0b013e3182631c37.CrossRefPubMed

11.

Kali A, Cokic I, Tang RLQ, Yang HJ, Sharif B, Marban E, Li D, Berman D, Dharmakumar R. Determination of location, size and transmurality of chronic myocardial infarction without exogenous contrast media using cardiac magnetic resonance imaging at 3T.Cardiovascular Imaging. 2014; CIRCIMAGING.113.001541.,

12.

Wu EX, Wu Y, Nicholls JM, Wang J, Liao S, Zhu S, Lau C-P, Tse H-F: MR diffusion tensor imaging study of postinfarct myocardium structural remodeling in a porcine model. Magn Reson Med. 2007, 58: 687-695. 10.1002/mrm.21350.CrossRefPubMed

13.

Pop M, Ghugre NR, Ramanan V, Morikawa L, Stanisz G, Dick AJ, Wright GA: Quantification of fibrosis in infarcted swine hearts by ex vivo late gadolinium-enhancement and diffusion-weighted MRI methods. Phys Med Biol. 2013, 58: 5009-5028. 10.1088/0031-9155/58/15/5009.CrossRefPubMed

14.

Nielles-Vallespin S, Mekkaoui C, Gatehouse P, Reese TG, Keegan J, Ferreira PF, Collins S, Speier P, Feiweier T, de Silva R, Jackowski MP, Pennell DJ, Sosnovik DE, Firmin D:In vivo diffusion tensor MRI of the human heart: reproducibility of breath-hold and navigator-based approaches. MRM. 2013, 70: 454-465. 10.1002/mrm.24488.CrossRefPubMed

15.

Lau AZ, Tunnicliffe EM, Frost R, Koopmans PJ, Tyler DJ, Robson MD. Accelerated human cardiac diffusion tensor imaging using simultaneous multislice imaging.MRM. 2014; DOI: 10.1002/mrm.25200.,

16.

Nguyen C, Fan Z, Sharif B, He Y, Dharmakumar R, Berman DS, Li D. In vivothree-dimensional high resolution cardiac diffusion-weighted MRI: a motion compensated diffusion-prepared balanced steady-state free precession approach.MRM. 2013; DOI: 10.1002/mrm.25038.,

17.

Gamper U, Boesiger P, Kozerke S: Diffusion imaging of the in vivo heart using spin echoes–considerations on bulk motion sensitivity. Magn Reson Med. 2007, 57: 331-337. 10.1002/mrm.21127.CrossRefPubMed

18.

Sosnovik DE, Mekkaoui C, Huang S, Chen HH, Dai G, Stoeck CT, Ngoy S, Guan J, Wang R, Kostis WJ, Jackowski MP, Wedeen VJ, Kozerke S, Liao R. Microstructural impact of ischemia and bone marrow-derived cell therapy revealed with diffusion tensor MRI tractography of the heartIn vivo.Circulation. 2014; CIRCULATIONAHA.113.005841.,

19.

Rapacchi S, Wen H, Viallon M, Grenier D, Kellman P, Croisille P, Pai VM: Low b-value diffusion-weighted cardiac magnetic resonance imaging: initial results in humans using an optimal time-window imaging approach. Invest Radiol. 2011, 46: 751-758. 10.1097/RLI.0b013e31822438e8.PubMedCentralCrossRefPubMed

20.

Malliaras K, Smith RR, Kanazawa H, Yee K, Seinfeld J, Tseliou E, Dawkins JF, Kreke M, Cheng K, Luthringer D, Ho C-S, Blusztajn A, Valle I, Chowdhury S, Makkar RR, Dharmakumar R, Li D, Marbán L, Marbán E: Validation of contrast-enhanced magnetic resonance imaging to monitor regenerative efficacy after cell therapy in a porcine model of convalescent myocardial infarction. Circulation. 2013, 128: 2764-2775. 10.1161/CIRCULATIONAHA.113.002863.PubMedCentralCrossRefPubMed

21.

Garwood M, Ke Y: Symmetric pulses to induce arbitrary flip angles with compensation for RF inhomogeneity and resonance offsets. J Magn Reson. 1991, 94: 511-525.

22.

Turkbey EB, Nacif MS, Noureldin RA, Sibley CT, Liu S, Lima JAC, Bluemke DA: Differentiation of myocardial scar from potential pitfalls and artefacts in delayed enhancement MRI. Br J Radiol. 2012, 85: e1145-e1154. 10.1259/bjr/25893477.PubMedCentralCrossRefPubMed

23.

Amado LC, Gerber BL, Gupta SN, Rettmann DW, Szarf G, Schock R, Nasir K, Kraitchman DL, Lima JAC: Accurate and objective infarct sizing by contrast-enhanced magnetic resonance imaging in a canine myocardial infarction model. J Am Coll Cardiol. 2004, 44: 2383-2389. 10.1016/j.jacc.2004.09.020.CrossRefPubMed

24.

Rueckert D, Sonoda LI, Hayes C, Hill DL, Leach MO, Hawkes DJ: Nonrigid registration using free-form deformations: application to breast MR images. IEEE Trans Med Imaging. 1999, 18: 712-721. 10.1109/42.796284.CrossRefPubMed

25.

Kwong RY, Schussheim AE, Rekhraj S, Aletras AH: Detecting acute coronary syndrome in the emergency department with cardiac magnetic resonance imaging. Circulation. 2003, 107: 531-537. 10.1161/01.CIR.0000047527.11221.29.CrossRefPubMed

26.

Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986, 1: 307-310. 10.1016/S0140-6736(86)90837-8.CrossRefPubMed

27.

Rousson V, Gasser T, Seifert B: Assessing intrarater, interrater and test-retest reliability of continuous measurements. Stat Med. 2002, 21: 3431-3446. 10.1002/sim.1253.CrossRefPubMed

28.

Cohen J: A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960, 20: 37-46. 10.1177/001316446002000104.CrossRef

29.

Kundel HL, Polansky M: Measurement of observer agreement. Radiology. 2003, 228: 303-308. 10.1148/radiol.2282011860.CrossRefPubMed

30.

Kellman P, Aletras AH, Mancini C, McVeigh ER, Arai AE: T2-prepared SSFP improves diagnostic confidence in edema imaging in acute myocardial infarction compared to turbo spin echo. Magn Reson Med. 2007, 57: 891-897. 10.1002/mrm.21215.PubMedCentralCrossRefPubMed

31.

Shepherd TM, Thelwall PE, Stanisz GJ, Blackband SJ: Aldehyde fixative solutions alter the water relaxation and diffusion properties of nervous tissue. Magn Reson Med. 2009, 62: 26-34. 10.1002/mrm.21977.PubMedCentralCrossRefPubMed

32.

Wu M-T, Su M-YM, Huang Y-L, Chiou K-R, Yang P, Pan H-B, Reese TG, Wedeen VJ, Tseng W-YI: Sequential changes of myocardial microstructure in patients postmyocardial infarction by diffusion-tensor cardiac MR: correlation with left ventricular structure and function. Circulation Cardiovascular Imaging. 2009, 2: 32-40– 6. 10.1161/CIRCIMAGING.108.778902. following 40CrossRefPubMed

33.

Buckberg GD, Mahajan A, Jung B, Markl M, Hennig J, Ballester-Rodes M: MRI myocardial motion and fiber tracking: a confirmation of knowledge from different imaging modalities. Eur J Cardiothorac Surg. 2006, 29 (Suppl 1): S165-S177. 10.1016/j.ejcts.2006.02.064.CrossRefPubMed

34.

Pang J, Sharif B, Arsanjani R, Bi X, Fan Z, Yang Q, Li K, Berman DS, Li D. Accelerated whole-heart coronary MRA using motion-corrected sensitivity encoding with three-dimensional projection reconstruction.MRM. 2014; DOI: 10.1002/mrm.25097.,

Title: In vivo contrast free chronic myocardial infarction characterization using diffusion-weighted cardiovascular magnetic resonance
Authors: Christopher Nguyen
Zhaoyang Fan
Yibin Xie
James Dawkins
Eleni Tseliou
Xiaoming Bi
Behzad Sharif
Rohan Dharmakumar
Eduardo Marbán
Debiao Li
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2014
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-014-0068-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

In vivo contrast free chronic myocardial infarction characterization using diffusion-weighted cardiovascular magnetic resonance

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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