[Magnetic resonance imaging and active cardiac implants]. / Magnetresonanztomographie und aktive kardiale Implantate.

The combination of magnetic resonance imaging (MRI) and active cardiac implants, such as pacemakers and implantable cardioverter defibrillators (ICD) has been a challenge for electrophysiologists and imaging for many years. Diagnostic and therapeutic possibilities on the one hand and technical hazards on the other hand highlight the need for improvements and algorithms that enable a safe approach to these challenges. The advent of so-called MRI conditional implants provides safe procedures for at least some of the patients with an implant and the need for MRI. Recently published data encourage clinicians not to completely excluded an imaging modality as promising as MRI in clinically urgent cases in the presence of conventional implants. The interdisciplinary consensus paper of the German Society of Cardiology and the German Society of Radiology provides recommendations for these situations. This review article discusses these recommendations and provides an overview of the most recent publications with a focus on the long-term course of device parameters.

The influence of spatial patterns of capillary networks on transverse relaxation.

Tissue-inherent relaxation parameters offer valuable information about the arrangement of capillaries: in an external field, capillaries act as magnetic perturbers to generate local inhomogeneous fields due to the susceptibility difference of deoxygenated blood and the surrounding tissue. These field inhomogeneities influence the free induction decay in a characteristic way, and, conversely, the above tissue parameters can be recovered by multi-parametric fits of adequate theoretical models to experimentally sampled free induction decays. In this work we study the influence of different spatial patterns of capillary positions on the free induction decay. Starting from the standard single capillary approximation (Krogh cylinder) for a symmetric array of capillaries, the free induction decay is analyzed for increasingly random capillary positions, using a previously described Gibbs point field model. The effects of diffusion are implemented with a flexible and fast random walk simulation. We find that the asymmetric form of the obtained frequency distribution is more robust against variations of capillary radii than against shifts of capillary positions, and further that, for an inclusion of diffusion effects, the single capillary approximation models the uniform alignment of capillaries in the hexagonal lattice to great accuracy. An increase in randomization of capillary positions then leads to a significant change in relaxation times. This effect, however, is found less pronounced than that of changes in the off-resonance field strengths which are controlled by the oxygen extraction fraction, thus indicating that observed changes in BOLD imaging are more likely to be attributed to changes in oxygenation than to capillary alignment.

Case series evidence for changed interhemispheric relationships in cortical structure in some amputees.

Limb amputation and related changes in body feelings are associated with cortical functional reorganization that is reflected by increased interhemispheric asymmetry of body maps in the postcentral somatosensory cortex (PCS). As a pilot test to determine if limb amputation affects interhemispheric symmetry in PCS structure, we used MRI and computational morphometry to examine interhemispheric relationships of PCS thicknesses in a case series of eight lower limb amputees compared with 11 control subjects. As a further control, the same relationships were compared in the lateral occipital visual cortex (LOV) which, by nature of its visual connectivity, would be expected to be less related to amputation. The PCS thicknesses in the left and right hemispheres were positively related in control subjects, but not in amputees. The range of the PCS interhemispheric thickness differences (ID) in amputees was larger than the range in control subjects, and four of eight amputees had PCS ID that were at or above the maximal control subject ID. In contrast, LOV thicknesses in the two hemispheres were positively related and LOV ID ranges were similar in both amputees and control subjects. The results from this case series suggest the hypothesis that amputation alters PCS interhemispheric thickness relationships in some amputees. Further tests of this hypothesis would be useful to determine whether changes in structural symmetry contribute to known post-amputation alterations in PCS functional map symmetry and body feeling.

Spin dephasing in a magnetic dipole field.

Transverse relaxation by dephasing in an inhomogeneous field is a general mechanism in physics, for example, in semiconductor physics, muon spectroscopy, or nuclear magnetic resonance. In magnetic resonance imaging the transverse relaxation provides information on the properties of several biological tissues. Since the dipole field is the most important part of the multipole expansion of the local inhomogeneous field, dephasing in a dipole field is highly important in relaxation theory. However, there have been no analytical solutions which describe the dephasing in a magnetic dipole field. In this work we give a complete analytical solution for the dephasing in a magnetic dipole field which is valid over the whole dynamic range.

MR safety: fast T1 thermometry of the RF-induced heating of medical devices.

Determining the MR compatibility of medical implants and devices is becoming increasingly relevant. In most cases, the heating of conductive implants due to radiefrequency (RF) excitation pulses is measured by fluoroptic temperature sensors in relevant tests for approval. Another common method to determine these heating effects is MR thermometry using the proton resonance frequency. This method gives good results in homogeneous phantoms. However in many cases, technical shortcomings such as susceptibility artifacts prohibit exact proton resonance frequency thermometry near medical implants. Therefore, this work aimed at developing a fast T1-based method which allows controlled MR-related heating of a medical implant while simultaneously quantifying the spatial and temporal temperature distribution. To this end, an inversion recovery snapshot Fast Low-Angle Shot (FLASH) sequence was modified with additional off-resonant heating pulses. With an accelerated imaging method and a sliding-window technique, every 7.6 s a new temperature map could be generated with a spatial in-plane resolution of 2 mm. The temperature deviation from calculated temperature values to reference fluoroptic probe was found to be smaller than 1 K.

Application of compressed sensing to in vivo 3D ¹9F CSI.

This study shows how applying compressed sensing (CS) to (19)F chemical shift imaging (CSI) makes highly accurate and reproducible reconstructions from undersampled datasets possible. The missing background signal in (19)F CSI provides the required sparsity needed for application of CS. Simulations were performed to test the influence of different CS-related parameters on reconstruction quality. To test the proposed method on a realistic signal distribution, the simulation results were validated by ex vivo experiments. Additionally, undersampled in vivo 3D CSI mouse datasets were successfully reconstructed using CS. The study results suggest that CS can be used to accurately and reproducibly reconstruct undersampled (19)F spectroscopic datasets. Thus, the scanning time of in vivo(19)F CSI experiments can be significantly reduced while preserving the ability to distinguish between different (19)F markers. The gain in scan time provides high flexibility in adjusting measurement parameters. These features make this technique a useful tool for multiple biological and medical applications.

Diffusion effects on the CPMG relaxation rate in a dipolar field.

The diffusion in the magnetic dipolar field around a sphere is considered. The diffusion is restricted to the space between two concentric spheres, where the inner sphere is the source of the magnetic dipolar field. Analytical expressions for the CPMG transverse relaxation rate as well as the free induction decay and the spin echo time evolution are given in the Gaussian approximation. The influence of the inter-echo time is analyzed. The limiting cases of small and large inter-echo times as well as the short and long time behavior are evaluated.

Spin dephasing in the dipole field around capillaries and cells: numerical solution.

We numerically solve the Bloch-Torrey equation by discretizing the differential operators in real space using finite differences. The differential equation is either solved directly in time domain as initial-value problem or in frequency domain as boundary-value problem. Especially the solution in time domain is highly efficient and suitable for arbitrary domains and dimensions. As examples, we calculate the average magnetization and the frequency distribution for capillaries and cells which are idealized as cylinders and spheres, respectively. The solution is compared with the commonly used Gaussian approximation and the strong-collision approximation. While these approximations become exact in limiting cases (small or large diffusion coefficient), they strongly deviate from the numerical solution for intermediate values of the diffusion coefficient.

Measurement of apparent cell radii using a multiple wave vector diffusion experiment.

It had been previously shown that an idealized version of the two-wave-vector extension of the NMR pulsed-field-gradient spin echo diffusion experiment can be used to determine the apparent radius of geometries with restricted diffusion. In the present work, the feasibility of the experiment was demonstrated in an NMR imaging experiment, in which the apparent radius of axons in white matter tissue was determined. Moreover, numerical simulations have been carried out to determine the reliability of the results. For small diffusion times, the radius is systematically underestimated. Larger gradient area, finite length gradient pulses, and a statistical distribution of radii within a voxel all have a minor influence on the estimated radius.

Frequency autocorrelation function of stochastically fluctuating fields caused by specific magnetic field inhomogeneities.

Signal formation in NMR is due to incoherent dephasing of nuclear spins. Of particular practical importance is the situation of nuclear spins undergoing independent stochastic motion in inhomogeneous local magnetic fields, e.g., created by magnetized objects. Since it was demonstrated recently that the frequency correlation function of nuclear spins can be measured directly, a theoretical analysis of such functions is of interest. Here, we provide a numerically exact analysis of that correlation function for the inhomogeneous fields around two particular geometries: cylinders and spheres. The functional form exhibits three regimes: after an initial transient, there is an algebraic regime with a t(-d/2) time dependence (d being the space dimension), followed by an exponential cutoff due to microscopic system size effects. The main parameter controlling the range of the individual regimes is the volume fraction of the magnetized objects. In addition to our numerical analysis, which is based on eigenfunction expansions, we provide analytical results and approximations based on the generalized moment expansion.

[Safety of cardiac pacemakers and implantable cardioverter-defibrillators in magnetic resonance imaging. Assessment of the aggregate function at 1.5 tesla]. / Sicherheit von Herzschrittmachern und implantierbaren Kardioverter-Defibrillatoren im Magnetresonanztomographen. Beurteilung der Aggregatfunktion bei 1,5 Tesla.

BACKGROUND AND OBJECTIVE: Magnetic resonance imaging (MRI) is increasingly used in patients, but it is contraindicated in those with cardiac pacemakers (CP) or implantable cardioverter defibrillators (ICD). This study examined circumstances in which potentially life-threatening arrhythmias may be triggered in patients with CP undergoing MRI and whether these problems can be avoided by reprogramming of these devices. METHODS: Eight CP and seven ICDs were investigated in a phantom at 1.5 tesla (experimental and imaging sequences). RESULTS: A decrease in battery voltage was found in four CP after MRI (indication for elective replacement). Additionally, three showed changes in programming (resets). Analogous changes did not appear in the tested ICDs, but periods of tachycardia were recorded in all types of devices during MRI depending on the pulse sequence employed. CONCLUSION: MRI-related electromagnetic fields as used in routine MRI can induce severe pacemaker device malfunctions. Device programming approaches are unreliable for prevention of patient hazards, as programming changes or resets are one of the primary malfunctions during MRI.

Local frequency density of states around field inhomogeneities in magnetic resonance imaging: effects of diffusion.

A method describing NMR-signal formation in inhomogeneous tissue is presented which covers all diffusion regimes. For this purpose, the frequency distribution inside the voxel is described. Generalizing the results of the well-known static dephasing regime, we derive a formalism to describe the frequency distribution that is valid over the whole dynamic range. The expressions obtained are in agreement with the results obtained from Kubos line-shape theory. To examine the diffusion effects, we utilize a strong collision approximation, which replaces the original diffusion process by a simpler stochastic dynamics. We provide a generally valid relation between the frequency distribution and the local Larmor frequency inside the voxel. To demonstrate the formalism we give analytical expressions for the frequency distribution and the free induction decay in the case of cylindrical and spherical magnetic inhomogeneities. For experimental verification, we performed measurements using a single-voxel spectroscopy method. The data obtained for the frequency distribution, as well as the magnetization decay, are in good agreement with the analytic results, although experiments were limited by magnetic field gradients caused by an imperfect shim and low signal-to-noise ratio.

Scaling laws for transverse relaxation times.

Simple scaling laws are useful tools in understanding the effect of changing parameters in MRI experiments. In this paper the general scaling behavior of the transverse relaxation times is discussed. We consider the dephasing of spins diffusing around a field inhomogeneity inside a voxel. The strong collision approximation is used to describe the diffusion process. The obtained scaling laws are valid over the whole dynamic range from motional narrowing to static dephasing. The dependence of the relaxation times on the external magnetic field, diffusion coefficients of the surrounding medium, and the characteristic scale of the field inhomogeneity is analyzed. For illustration the generally valid scaling laws are applied to the special case of a capillary, usually used as a model of the myocardial BOLD effect.

Frequency distribution and signal formation around a vessel.

We describe the NMR signal formation properties of a single vessel. Instead of assuming the frequency distribution to be a simple Lorentzian or Gaussian one, we take into account that the frequency distribution around the vessel is a complex function. Considering the static dephasing regime we find a relationship between signal formation and frequency distribution. Analytical expressions for the frequency distribution in a voxel and the magnetization decay are obtained. In the case of small volume fractions of blood and week magnetic fields the results can be used for describing signal formation processes in a vascular network. A relationship between the frequency distribution and the properties of the vascular network is derived. The magnetization decay in different time regimes is discussed. The result is relevant for describing signal formation processes around a vessel for arbitrary pulse sequences.

Transverse relaxation of cells labeled with magnetic nanoparticles.

We describe the NMR relaxation properties of magnetically labeled cells. The cells are labeled with magnetic nanoparticles (SPIO, USPIO), which generate susceptibility contrast. The geometry of the labeled cells and the surrounding tissue is considered. We assume that the magnetic nanoparticles accumulate to form a magnetic core of radius RC inside the cell. The correlation time tau, which describes the motion of spins around this core, is analyzed. Using the strong collision approach, explicit expressions are derived for the transverse relaxation rate R2* for tissue containing labeled cells as a function of the core radius, the diffusion coefficient, and the concentration of the nanoparticles. The predictions of this model agree well with numerical simulations and experimental data.

Finite-element analysis of the displacement of closed DNA loops under torsional stress.

Closed DNA loops that contain intrinsic curvature occur in biologically important structures that are formed by bringing together proteins attached at distinct sites. Such loops constitute topological domains that are characterized by a linking number Delta Lk. We calculate, using finite-element analysis, the structural changes induced by small changes in this linking number, Delta Lk. Because of the intrinsic curvature, the slightest change in linking number induces writhe and the loop begins to fold in space. We previously studied the case in which the initial curvature is uniformly distributed along the DNA rod. We found that there are two different folding modes, depending on the amount of intrinsic curvature and the Poisson ratio, a quantity that measures the ratio of bending stiffness to torsional rigidity. For combinations of the Poisson ratio and curvature that lie below a critical curve, called the Fickel curve, the folding is monotonic in the sense that the writhe uniformly increases as Delta Lk increases, until self-contact occurs. For combinations below this curve, the folding is non-monotonic in the sense that as Delta Lk increases the writhe first increases, then decreases back to essentially zero, and then increases uniformly until self-contact occurs. The folding behaviour and the self-contact points in the two folding modes are completely different. In this paper we first review this previous work. We then extend those results to more-complex situations in which the curvature is initially distributed non-uniformly along the DNA rod. We show that the location of the Fickel curve depends upon both the extent of the initial curvature and upon its distribution along the rod. We also show that two DNAs with the same total intrinsic curvature will fold differently depending upon the distribution of that curvature along the DNA axis, and upon the point of the loop at which the applied rotation or change in Delta Lk is introduced.

Postcardiac injury syndrome following radiofrequeny ablation of atrial flutter.

We report the case of a 64-year-old woman who was admitted to our hospital for radiofrequency ablation of isthmus-dependent counterclockwise atrial flutter. Following an initially uncomplicated right atrial linear isthmus ablation that was associated with conversion of atrial flutter to sinus rhythm and evidence of complete isthmus block, the patient developed a small pericardial effusion, a marked and recurrent left-sided pleural effusion, and had significantly elevated inflammatory markers. After an extensive diagnostic work-up which excluded infectious, malignant and thromboembolic causes of the effusions, a diagnosis of postcardiac injury syndrome was made and the patient was treated with oral corticosteroids and nonsteroidal anti-inflammatory drugs. Over a treatment period of 2 months there was complete resolution of the pericardial and left-sided pleural effusions and normalization of inflammatory markers. Postcardiac injury syndrome is a rare complication of radiofrequency ablation that is characterized by signs of pericardial, pleural and pulmonary parenchymal inflammation.

Detection of myocardial viability in acute infarction using contrast-enhanced (1)H magnetic resonance imaging.

BACKGROUND: Reperfusion strategies salvage myocardium at risk in acute myocardial infarction (MI). This clinical study was performed to determine whether areas without evidence of delayed MRI contrast enhancement in MI correspond to viability by means of percent systolic wall thickening (%SWT) and enddiastolic wall thickness (EDWT) in chronic infarction. METHODS: Twenty MRI studies were performed in ten patients within 6 days of MI and 3 months post-MI. On a segmental basis the percentage of viable myocardium as defined by contrast-enhanced MRI (no delayed MRI contrast enhancement) in acute MI was measured and was compared with %SWT and EDWT in chronic MI. RESULTS: Of the 1718 segments in acute infarction in which the percentage of viable myocardium was measured 1333 were found to be completely viable by means of contrast-enhanced MRI (no delayed MRI contrast enhancement). All of these segments revealed %SWT on day 90 post-MI, and 97% of segments were viable by means of an EDWT of more than 5.5 mm. In 85 segments the proportion of viable myocardium was 50-99% (mean 56+/-8%), with 92% segments found to be viable by means of %SWT and 92% by EDWT, and of 156 segments with viable myocardium between 1-49% (36+/-8%) 79% were found to be viable by means of %SWT and 82% by EDWT. Corresponding proportions of 144 segments with transmural delayed MRI contrast enhancement in acute MI were 45% and 17%. CONCLUSIONS: In acute reperfused MI viable myocardium as delineated by contrast-enhanced MRI is correlated with clinical parameters of viability. Delayed MRI contrast enhancement resolves nontransmural MI and may become a valuable clinical tool when planning revascularization procedures.