Prospective evaluation of acute cerebral injury by DW-MRI following transcarotid artery revascularization using a double-layer micromesh stent.

BACKGROUND: Transcervical carotid artery revascularization (TCAR) has demonstrated a low overall stroke rate in carotid artery stenting (CAS). Furthermore, the use of a double-layer micromesh stent is expected to reduce embolization and plaque prolapse. The combination of TCAR and the double layer stent may lead to improved results compared to previously reported outcomes. The objective of this study is to present the findings of a prospective study including patients treated with the Roadsaver stent and TCAR. METHODS: Between January 2017 and May 2022, 85 patients were enrolled. Every patient underwent TCAR with the Roadsaver stent. As per our protocol, a neurological examination and an ultrasound were performed within 24 hours before and after the procedure, and again 30 days after. A diffusion-weighted magnetic resonance imaging (DW-MRI) was conducted 24 hours before the procedure and 48-72 hours after the procedure. The primary endpoint was the detection of new ischemic lesions on postoperative DW-MRI. The secondary endpoint was a composite of all strokes, death, and myocardial infarction within 30 days. RESULTS: Sixty-four patients (75.29%) were symptomatic, out of which 25 were treated within 14 days of the onset of the symptoms. Pre and postprocedural DW-MRI were performed in 83 patients. Postprocedural lesions were found in nine patients (10.84%). There were no strokes or death within 30 days, but two patients experienced a myocardial infarction. CONCLUSIONS: Our study suggests that the use of TCAR and the Roadsaver stent could be a safe alternative to carotid endarterectomy because it entails a low incidence of cerebral embolization, even in recently symptomatic and elderly patients.

Time-efficient three-dimensional transmural scar assessment provides relevant substrate characterization for ventricular tachycardia features and long-term recurrences in ischemic cardiomyopathy.

Delayed gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) imaging requires novel and time-efficient approaches to characterize the myocardial substrate associated with ventricular arrhythmia in patients with ischemic cardiomyopathy. Using a translational approach in pigs and patients with established myocardial infarction, we tested and validated a novel 3D methodology to assess ventricular scar using custom transmural criteria and a semiautomatic approach to obtain transmural scar maps in ventricular models reconstructed from both 3D-acquired and 3D-upsampled-2D-acquired LGE-CMR images. The results showed that 3D-upsampled models from 2D LGE-CMR images provided a time-efficient alternative to 3D-acquired sequences to assess the myocardial substrate associated with ischemic cardiomyopathy. Scar assessment from 2D-LGE-CMR sequences using 3D-upsampled models was superior to conventional 2D assessment to identify scar sizes associated with the cycle length of spontaneous ventricular tachycardia episodes and long-term ventricular tachycardia recurrences after catheter ablation. This novel methodology may represent an efficient approach in clinical practice after manual or automatic segmentation of myocardial borders in a small number of conventional 2D LGE-CMR slices and automatic scar detection.

Robust estimation of the apparent diffusion coefficient invariant to acquisition noise and physiological motion.

PURPOSE: In this work, we have proposed a methodology for the estimation of the apparent diffusion coefficient in the body from multiple breath hold diffusion weighted images, which is robust to two preeminent confounding factors: noise and motion during acquisition. METHODS: We have extended a method for the joint groupwise multimodal registration and apparent diffusion coefficient estimation, previously proposed by the authors, in order to correct the bias that arises from the non-Gaussianity of the data and the registration procedure. RESULTS: Results show that the proposed methodology provides a statistically significant improvement both in robustness for displacement fields calculation and in terms of accuracy for the apparent diffusion coefficient estimation as compared with traditional sequential approaches. Reproducibility has also been measured on real data in terms of the distribution of apparent diffusion coefficient differences obtained from different b-values subsets. CONCLUSIONS: Our proposal has shown to be able to effectively correct the estimation bias by introducing additional computationally light procedures to the original method, thus providing robust apparent diffusion coefficient maps in the liver and allowing an accurate and reproducible analysis of the tissue.

Vortical features for myocardial rotation assessment in hypertrophic cardiomyopathy using cardiac tagged magnetic resonance.

Left ventricular rotational motion is a feature of normal and diseased cardiac function. However, classical torsion and twist measures rely on the definition of a rotational axis which may not exist. This paper reviews global and local rotation descriptors of myocardial motion and introduces new curl-based (vortical) features built from tensorial magnitudes, intended to provide better comprehension about fibrotic tissue characteristics mechanical properties. Fifty-six cardiomyopathy patients and twenty-two healthy volunteers have been studied using tagged magnetic resonance by means of harmonic phase analysis. Rotation descriptors are built, with no assumption about a regular geometrical model, from different approaches. The extracted vortical features have been tested by means of a sequential cardiomyopathy classification procedure; they have proven useful for the regional characterization of the left ventricular function by showing great separability not only between pathologic and healthy patients but also, and specifically, between heterogeneous phenotypes within cardiomyopathies.

Joint groupwise registration and ADC estimation in the liver using a B-value weighted metric.

PURPOSE: The purpose of this work is to develop a groupwise elastic multimodal registration algorithm for robust ADC estimation in the liver on multiple breath hold diffusion weighted images. METHODS: We introduce a joint formulation to simultaneously solve both the registration and the estimation problems. In order to avoid non-reliable transformations and undesirable noise amplification, we have included appropriate smoothness constraints for both problems. Our metric incorporates the ADC estimation residuals, which are inversely weighted according to the signal content in each diffusion weighted image. RESULTS: Results show that the joint formulation provides a statistically significant improvement in the accuracy of the ADC estimates. Reproducibility has also been measured on real data in terms of the distribution of ADC differences obtained from different b-values subsets. CONCLUSIONS: The proposed algorithm is able to effectively deal with both the presence of motion and the geometric distortions, increasing accuracy and reproducibility in diffusion parameters estimation.

Multi-oriented windowed harmonic phase reconstruction for robust cardiac strain imaging.

The purpose of this paper is to develop a method for direct estimation of the cardiac strain tensor by extending the harmonic phase reconstruction on tagged magnetic resonance images to obtain more precise and robust measurements. The extension relies on the reconstruction of the local phase of the image by means of the windowed Fourier transform and the acquisition of an overdetermined set of stripe orientations in order to avoid the phase interferences from structures outside the myocardium and the instabilities arising from the application of a gradient operator. Results have shown that increasing the number of acquired orientations provides a significant improvement in the reproducibility of the strain measurements and that the acquisition of an extended set of orientations also improves the reproducibility when compared with acquiring repeated samples from a smaller set of orientations. Additionally, biases in local phase estimation when using the original harmonic phase formulation are greatly diminished by the one here proposed. The ideas here presented allow the design of new methods for motion sensitive magnetic resonance imaging, which could simultaneously improve the resolution, robustness and accuracy of motion estimates.