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The primary objective of this research was to design, implement, and validate a programmable open-source pulsatile flow system to cost-effectively simulate vascular flows. We employed an Arduino-compatible microcontroller combined with a motor driver to control a centrifugal direct current (DC) motor pump. The system was programmed to produce pulsatile flows with an arterial pulse waveform. Validation with Doppler ultrasound and flow measurements confirmed that our Arduino-based system successfully replicated arterial vascular flow. The materials are easily accessible, with a total bill of materials as low as $99. This open-source programmable pulsatile pump platform offers superior cost-effectiveness and adaptability relative to commercial offerings.
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Congenital heart disease (CHD) encompasses a spectrum of cardiovascular structural abnormalities, often requiring customized treatment plans for individual patients. Computational modeling and analysis of these unique cardiac anatomies can improve diagnosis and treatment planning and may ultimately lead to improved outcomes. Deep learning (DL) methods have demonstrated the potential to enable efficient treatment planning by automating cardiac segmentation and mesh construction for patients with normal cardiac anatomies. However, CHDs are often rare, making it challenging to acquire sufficiently large patient cohorts for training such DL models. Generative modeling of cardiac anatomies has the potential to fill this gap via the generation of virtual cohorts; however, prior approaches were largely designed for normal anatomies and cannot readily capture the significant topological variations seen in CHD patients. Therefore, we propose a type- and shape-disentangled generative approach suitable to capture the wide spectrum of cardiac anatomies observed in different CHD types and synthesize differently shaped cardiac anatomies that preserve the unique topology for specific CHD types. Our DL approach represents generic whole heart anatomies with CHD type-specific abnormalities implicitly using signed distance fields (SDF) based on CHD type diagnosis. To capture the shape-specific variations, we then learn invertible deformations to morph the learned CHD type-specific anatomies and reconstruct patient-specific shapes. After training with a dataset containing the cardiac anatomies of 67 patients spanning 6 CHD types and 14 combinations of CHD types, our method successfully captures divergent anatomical variations across different types and the meaningful intermediate CHD states across the spectrum of related CHD diagnoses. Additionally, our method demonstrates superior performance in CHD anatomy generation in terms of CHD-type correctness and shape plausibility. It also exhibits comparable generalization performance when reconstructing unseen cardiac anatomies. Moreover, our approach shows potential in augmenting image-segmentation pairs for rarer CHD types to significantly enhance cardiac segmentation accuracy for CHDs. Furthermore, it enables the generation of CHD cardiac meshes for computational simulation, facilitating a systematic examination of the impact of CHDs on cardiac functions.
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Aprendizaje Profundo , Cardiopatías Congénitas , Humanos , Cardiopatías Congénitas/diagnóstico por imagen , Modelos CardiovascularesRESUMEN
PURPOSE: Diffusion encoding gradient waveforms can impart intra-voxel and inter-voxel dephasing owing to bulk motion, limiting achievable signal-to-noise and complicating multishot acquisitions. In this study, we characterize improvements in phase consistency via gradient moment nulling of diffusion encoding waveforms. METHODS: Healthy volunteers received neuro ( N = 10 $$ N=10 $$ ) and cardiac ( N = 10 $$ N=10 $$ ) MRI. Three gradient moment nulling levels were evaluated: compensation for position ( M 0 $$ {M}_0 $$ ), position + velocity ( M 1 $$ {M}_1 $$ ), and position + velocity + acceleration ( M 1 + M 2 $$ {M}_1+{M}_2 $$ ). Three experiments were completed: (Exp-1) Fixed Trigger Delay Neuro DWI; (Exp-2) Mixed Trigger Delay Neuro DWI; and (Exp-3) Fixed Trigger Delay Cardiac DWI. Significant differences ( p < 0 . 05 $$ p<0.05 $$ ) of the temporal phase SD between repeated acquisitions and the spatial phase gradient across a given image were assessed. RESULTS: M 0 $$ {M}_0 $$ moment nulling was a reference for all measures. In Exp-1, temporal phase SD for G z $$ {G}_z $$ diffusion encoding was significantly reduced with M 1 $$ {M}_1 $$ (35% of t-tests) and M 1 + M 2 $$ {M}_1+{M}_2 $$ (68% of t-tests). The spatial phase gradient was reduced in 23% of t-tests for M 1 $$ {M}_1 $$ and 2% of cases for M 1 + M 2 $$ {M}_1+{M}_2 $$ . In Exp-2, temporal phase SD significantly decreased with M 1 + M 2 $$ {M}_1+{M}_2 $$ gradient moment nulling only for G z $$ {G}_z $$ (83% of t-tests), but spatial phase gradient significantly decreased with only M 1 $$ {M}_1 $$ (50% of t-tests). In Exp-3, M 1 + M 2 $$ {M}_1+{M}_2 $$ gradient moment nulling significantly reduced temporal phase SD and spatial phase gradients (100% of t-tests), resulting in less signal attenuation and more accurate ADCs. CONCLUSION: We characterized gradient moment nulling phase consistency for DWI. Using M1 for neuroimaging and M1 + M2 for cardiac imaging minimized temporal phase SDs and spatial phase gradients.
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Background: A reduced left atrial (LA) strain correlates with the presence of atrial fibrillation (AF). Conventional atrial strain analysis uses two-dimensional (2D) imaging, which is, however, limited by atrial foreshortening and an underestimation of through-plane motion. Retrospective gated computed tomography (RGCT) produces high-fidelity three-dimensional (3D) images of the cardiac anatomy throughout the cardiac cycle that can be used for estimating 3D mechanics. Its feasibility for LA strain measurement, however, is understudied. Aim: The aim of this study is to develop and apply a novel workflow to estimate 3D LA motion and calculate the strain from RGCT imaging. The utility of global and regional strains to separate heart failure in patients with reduced ejection fraction (HFrEF) with and without AF is investigated. Methods: A cohort of 30 HFrEF patients with (n = 9) and without (n = 21) AF underwent RGCT prior to cardiac resynchronisation therapy. The temporal sparse free form deformation image registration method was optimised for LA feature tracking in RGCT images and used to estimate 3D LA endocardial motion. The area and fibre reservoir strains were calculated over the LA body. Universal atrial coordinates and a human atrial fibre atlas enabled the regional strain calculation and the fibre strain calculation along the local myofibre orientation, respectively. Results: It was found that global reservoir strains were significantly reduced in the HFrEF + AF group patients compared with the HFrEF-only group patients (area strain: 11.2 ± 4.8% vs. 25.3 ± 12.6%, P = 0.001; fibre strain: 4.5 ± 2.0% vs. 15.2 ± 8.8%, P = 0.001), with HFrEF + AF patients having a greater regional reservoir strain dyssynchrony. All regional reservoir strains were reduced in the HFrEF + AF patient group, in whom the inferior wall strains exhibited the most significant differences. The global reservoir fibre strain and LA volume + posterior wall reservoir fibre strain exceeded LA volume alone and 2D global longitudinal strain (GLS) for AF classification (area-under-the-curve: global reservoir fibre strain: 0.94 ± 0.02, LA volume + posterior wall reservoir fibre strain: 0.95 ± 0.02, LA volume: 0.89 ± 0.03, 2D GLS: 0.90 ± 0.03). Conclusion: RGCT enables 3D LA motion estimation and strain calculation that outperforms 2D strain metrics and LA enlargement for AF classification. Differences in regional LA strain could reflect regional myocardial properties such as atrial fibrosis burden.
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This work presents a deep learning approach for rapid and accurate muscle water T2 with subject-specific fat T2 calibration using multi-spin-echo acquisitions. This method addresses the computational limitations of conventional bi-component Extended Phase Graph fitting methods (nonlinear-least-squares and dictionary-based) by leveraging fully connected neural networks for fast processing with minimal computational resources. We validated the approach through in vivo experiments using two different MRI vendors. The results showed strong agreement of our deep learning approach with reference methods, summarized by Lin's concordance correlation coefficients ranging from 0.89 to 0.97. Further, the deep learning method achieved a significant computational time improvement, processing data 116 and 33 times faster than the nonlinear least squares and dictionary methods, respectively. In conclusion, the proposed approach demonstrated significant time and resource efficiency improvements over conventional methods while maintaining similar accuracy. This methodology makes the processing of water T2 data faster and easier for the user and will facilitate the utilization of the use of a quantitative water T2 map of muscle in clinical and research studies.
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Algoritmos , Aprendizaje Profundo , Agua , Calibración , Imagen por Resonancia Magnética/métodos , Músculos/diagnóstico por imagen , Fantasmas de Imagen , Procesamiento de Imagen Asistido por Computador/métodos , EncéfaloRESUMEN
PURPOSE: To evaluate the use of pre-excitation gradients for eddy current-nulled convex optimized diffusion encoding (Pre-ENCODE) to mitigate eddy current-induced image distortions in diffusion-weighted MRI (DWI). METHODS: DWI sequences using monopolar (MONO), ENCODE, and Pre-ENCODE were evaluated in terms of the minimum achievable echo time (TE min $$ {}_{\mathrm{min}} $$ ) and eddy current-induced image distortions using simulations, phantom experiments, and in vivo DWI in volunteers ( N = 6 $$ N=6 $$ ). RESULTS: Pre-ENCODE provided a shorter TE min $$ {}_{\mathrm{min}} $$ than MONO (71.0 ± $$ \pm $$ 17.7ms vs. 77.6 ± $$ \pm $$ 22.9ms) and ENCODE (71.0 ± $$ \pm $$ 17.7ms vs. 86.2 ± $$ \pm $$ 14.2ms) in 100 % $$ \% $$ of the simulated cases for a commercial 3T MRI system with b-values ranging from 500 to 3000 s/mm 2 $$ {}^2 $$ and in-plane spatial resolutions ranging from 1.0 to 3.0mm 2 $$ {}^2 $$ . Image distortion was estimated by intravoxel signal variance between diffusion encoding directions near the phantom edges and was significantly lower with Pre-ENCODE than with MONO (10.1 % $$ \% $$ vs. 22.7 % $$ \% $$ , p = 6 - 5 $$ p={6}^{-5} $$ ) and comparable to ENCODE (10.1 % $$ \% $$ vs. 10.4 % $$ \% $$ , p = 0 . 12 $$ p=0.12 $$ ). In vivo measurements of apparent diffusion coefficients were similar in global brain pixels (0.37 [0.28,1.45] × 1 0 - 3 $$ \times 1{0}^{-3} $$ mm 2 $$ {}^2 $$ /s vs. 0.38 [0.28,1.45] × 1 0 - 3 $$ \times 1{0}^{-3} $$ mm 2 $$ {}^2 $$ /s, p = 0 . 25 $$ p=0.25 $$ ) and increased in edge brain pixels (0.80 [0.17,1.49] × 1 0 - 3 $$ \times 1{0}^{-3} $$ mm 2 $$ {}^2 $$ /s vs. 0.70 [0.18,1.48] × 1 0 - 3 $$ \times 1{0}^{-3} $$ mm 2 $$ {}^2 $$ /s, p = 0 . 02 $$ p=0.02 $$ ) for MONO compared to Pre-ENCODE. CONCLUSION: Pre-ENCODE mitigated eddy current-induced image distortions for diffusion imaging with a shorter TE min $$ {}_{\mathrm{min}} $$ than MONO and ENCODE.
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Algoritmos , Encéfalo , Imagen de Difusión por Resonancia Magnética , Procesamiento de Imagen Asistido por Computador , Fantasmas de Imagen , Humanos , Encéfalo/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Simulación por Computador , Artefactos , Adulto , Voluntarios SanosRESUMEN
Blood pressure gradient ( Δ P ) across an aortic coarctation (CoA) is an important measurement to diagnose CoA severity and gauge treatment efficacy. Invasive cardiac catheterization is currently the gold-standard method for measuring blood pressure. The objective of this study was to evaluate the accuracy of Δ P estimates derived non-invasively using patient-specific 0D and 3D deformable wall simulations. Medical imaging and routine clinical measurements were used to create patient-specific models of patients with CoA (N = 17). 0D simulations were performed first and used to tune boundary conditions and initialize 3D simulations. Δ P across the CoA estimated using both 0D and 3D simulations were compared to invasive catheter-based pressure measurements for validation. The 0D simulations were extremely efficient ( â¼ 15 s computation time) compared to 3D simulations ( â¼ 30 h computation time on a cluster). However, the 0D Δ P estimates, unsurprisingly, had larger mean errors when compared to catheterization than 3D estimates (12.1 ± 9.9 mmHg vs 5.3 ± 5.4 mmHg). In particular, the 0D model performance degraded in cases where the CoA was adjacent to a bifurcation. The 0D model classified patients with severe CoA requiring intervention (defined as Δ P ≥ 20 mmHg) with 76% accuracy and 3D simulations improved this to 88%. Overall, a combined approach, using 0D models to efficiently tune and launch 3D models, offers the best combination of speed and accuracy for non-invasive classification of CoA severity.
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Coartación Aórtica , Humanos , Coartación Aórtica/diagnóstico por imagen , Presión Sanguínea , Angiografía por Resonancia Magnética/métodos , Velocidad del Flujo Sanguíneo , Simulación por ComputadorRESUMEN
Cardiovascular magnetic resonance (CMR) is a proven imaging modality for informing diagnosis and prognosis, guiding therapeutic decisions, and risk stratifying surgical intervention. Patients with a cardiac implantable electronic device (CIED) would be expected to derive particular benefit from CMR given high prevalence of cardiomyopathy and arrhythmia. While several guidelines have been published over the last 16 years, it is important to recognize that both the CIED and CMR technologies, as well as our knowledge in MR safety, have evolved rapidly during that period. Given increasing utilization of CIED over the past decades, there is an unmet need to establish a consensus statement that integrates latest evidence concerning MR safety and CIED and CMR technologies. While experienced centers currently perform CMR in CIED patients, broad availability of CMR in this population is lacking, partially due to limited availability of resources for programming devices and appropriate monitoring, but also related to knowledge gaps regarding the risk-benefit ratio of CMR in this growing population. To address the knowledge gaps, this SCMR Expert Consensus Statement integrates consensus guidelines, primary data, and opinions from experts across disparate fields towards the shared goal of informing evidenced-based decision-making regarding the risk-benefit ratio of CMR for patients with CIEDs.
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Consenso , Desfibriladores Implantables , Imagen por Resonancia Magnética , Marcapaso Artificial , Valor Predictivo de las Pruebas , Humanos , Factores de Riesgo , Medición de Riesgo , Imagen por Resonancia Magnética/normas , Imagen por Resonancia Magnética/efectos adversos , Toma de Decisiones Clínicas , Arritmias Cardíacas/terapia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/diagnóstico por imagen , Arritmias Cardíacas/fisiopatología , Cardioversión Eléctrica/instrumentación , Cardioversión Eléctrica/efectos adversos , Cardiopatías/diagnóstico por imagen , Cardiopatías/terapiaRESUMEN
PURPOSE: Poor acoustic windows make interval assessment of systolic function in patients with (Duchenne Muscular Dystrophy) DMD by echocardiography (echo) difficult. Cardiac magnetic resonance imaging (CMR) can be challenging in DMD patients due to study duration and patient discomfort. We developed an abbreviated CMR (aCMR) protocol and hypothesized that aCMR would compare favorably to echo in image quality and clinical utility without significant differences in exam duration, patient satisfaction, and functional measurements. METHODS: DMD patients were recruited prospectively to undergo echo and aCMR. Modalities were compared with a global quality assessment score (GQAS), clinical utility score (CUS), and patient satisfaction score (PSS). Results were compared using Wilcoxon signed-rank tests, Spearman correlations, intraclass correlations, and Bland-Altman analyses. RESULTS: Nineteen DMD patients were included. PSS scores and exam duration were equivalent between modalities, while CUS and GQAS scores favored aCMR. ACMR scored markedly higher than echo in RV visualization and assessment of atrial size. Older age was negatively correlated with echo GQAS and CUS scores, as well as aCMR PSS scores. Higher BMI was positively correlated with aCMR GQAS scores. Nighttime PPV requirement and non-ambulatory status were correlated with worse echo CUS scores. Poor image quality precluding quantification existed in five (26%) echo and zero (0%) aCMR studies. There was moderate correlation between aCMR and echo for global circumferential strain and left ventricular four chamber global longitudinal strain. CONCLUSION: The aCMR protocol resulted in improved clinical relevance and quality scores relative to echo, without significant detriment to patient satisfaction or exam duration.
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Distrofia Muscular de Duchenne , Disfunción Ventricular Izquierda , Humanos , Distrofia Muscular de Duchenne/complicaciones , Distrofia Muscular de Duchenne/diagnóstico por imagen , Ecocardiografía/métodos , Satisfacción del Paciente , Valor Predictivo de las Pruebas , Imagen por Resonancia Magnética , Atrios Cardíacos , Imagen por Resonancia Cinemagnética/métodosRESUMEN
Understanding the complex interplay between morphologic and hemodynamic features in aortic dissection is critical for risk stratification and for the development of individualized therapy. This work evaluates the effects of entry and exit tear size on the hemodynamics in type B aortic dissection by comparing fluid-structure interaction (FSI) simulations with in vitro 4D-flow magnetic resonance imaging (MRI). A baseline patient-specific 3D-printed model and two variants with modified tear size (smaller entry tear, smaller exit tear) were embedded into a flow- and pressure-controlled setup to perform MRI as well as 12-point catheter-based pressure measurements. The same models defined the wall and fluid domains for FSI simulations, for which boundary conditions were matched with measured data. Results showed exceptionally well matched complex flow patterns between 4D-flow MRI and FSI simulations. Compared to the baseline model, false lumen flow volume decreased with either a smaller entry tear (- 17.8 and - 18.5%, for FSI simulation and 4D-flow MRI, respectively) or smaller exit tear (- 16.0 and - 17.3%). True to false lumen pressure difference (initially 11.0 and 7.9 mmHg, for FSI simulation and catheter-based pressure measurements, respectively) increased with a smaller entry tear (28.9 and 14.6 mmHg), and became negative with a smaller exit tear (- 20.6 and - 13.2 mmHg). This work establishes quantitative and qualitative effects of entry or exit tear size on hemodynamics in aortic dissection, with particularly notable impact observed on FL pressurization. FSI simulations demonstrate acceptable qualitative and quantitative agreement with flow imaging, supporting its deployment in clinical studies.
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Disección Aórtica , Humanos , Disección Aórtica/diagnóstico por imagen , Hemodinámica , Imagen por Resonancia Magnética/métodos , Simulación por Computador , Presión , Modelos CardiovascularesRESUMEN
Congenital heart disease (CHD) encompasses a spectrum of cardiovascular structural abnormalities, often requiring customized treatment plans for individual patients. Computational modeling and analysis of these unique cardiac anatomies can improve diagnosis and treatment planning and may ultimately lead to improved outcomes. Deep learning (DL) methods have demonstrated the potential to enable efficient treatment planning by automating cardiac segmentation and mesh construction for patients with normal cardiac anatomies. However, CHDs are often rare, making it challenging to acquire sufficiently large patient cohorts for training such DL models. Generative modeling of cardiac anatomies has the potential to fill this gap via the generation of virtual cohorts; however, prior approaches were largely designed for normal anatomies and cannot readily capture the significant topological variations seen in CHD patients. Therefore, we propose a type- and shape-disentangled generative approach suitable to capture the wide spectrum of cardiac anatomies observed in different CHD types and synthesize differently shaped cardiac anatomies that preserve the unique topology for specific CHD types. Our DL approach represents generic whole heart anatomies with CHD type-specific abnormalities implicitly using signed distance fields (SDF) based on CHD type diagnosis, which conveniently captures divergent anatomical variations across different types and represents meaningful intermediate CHD states. To capture the shape-specific variations, we then learn invertible deformations to morph the learned CHD type-specific anatomies and reconstruct patient-specific shapes. Our approach has the potential to augment the image-segmentation pairs for rarer CHD types for cardiac segmentation and generate cohorts of CHD cardiac meshes for computational simulation.
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Purpose: Blood pressure gradient (ΔP) across an aortic coarctation (CoA) is an important measurement to diagnose CoA severity and gauge treatment efficacy. Invasive cardiac catheterization is currently the gold-standard method for measuring blood pressure. The objective of this study was to evaluate the accuracy of ΔP estimates derived non-invasively using patient-specific 0D and 3D deformable wall simulations. Methods: Medical imaging and routine clinical measurements were used to create patient-specific models of patients with CoA (N=17). 0D simulations were performed first and used to tune boundary conditions and initialize 3D simulations. ΔP across the CoA estimated using both 0D and 3D simulations were compared to invasive catheter-based pressure measurements for validation. Results: The 0D simulations were extremely efficient (~15 secs computation time) compared to 3D simulations (~30 hrs computation time on a cluster). However, the 0D ΔP estimates, unsurprisingly, had larger mean errors when compared to catheterization than 3D estimates (12.1 ± 9.9 mmHg vs 5.3 ± 5.4 mmHg). In particular, the 0D model performance degraded in cases where the CoA was adjacent to a bifurcation. The 0D model classified patients with severe CoA requiring intervention (defined as ΔP≥20 mmHg) with 76% accuracy and 3D simulations improved this to 88%. Conclusion: Overall, a combined approach, using 0D models to efficiently tune and launch 3D models, offers the best combination of speed and accuracy for non-invasive classification of CoA severity.
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BACKGROUND: Left ventricular (LV) global longitudinal strain (GLS) has been proposed as an early imaging biomarker of cardiac mechanical dysfunction. OBJECTIVE: To assess the impact of angiotensin-converting enzyme (ACE) inhibitor treatment of hypertensive heart disease on LV GLS and mechanical function. METHODS: The spontaneously hypertensive rat (SHR) model of hypertensive heart disease ( n â=â38) was studied. A subset of SHRs received quinapril (TSHR, n â=â16) from 3âmonths (mo). Wistar Kyoto rats (WKY, n â=â13) were used as controls. Tagged cardiac MRI was performed using a 4.7 T Varian preclinical scanner. RESULTS: The SHRs had significantly lower LV ejection fraction (EF) than the WKYs at 3 mo (53.0â±â1.7% vs. 69.6â±â2.1%, P â<â0.05), 14 mo (57.0â±â2.5% vs. 74.4â±â2.9%, P â<â0.05) and 24 mo (50.1â±â2.4% vs. 67.0â±â2.0%, P â<â0.01). At 24 mo, ACE inhibitor treatment was associated with significantly greater LV EF in TSHRs compared to untreated SHRs (64.2â±â3.4% vs. 50.1â±â2.4%, P â<â0.01). Peak GLS magnitude was significantly lower in SHRs compared with WKYs at 14âmonths (7.5%â±â0.4% vs. 9.9â±â0.8%, P â<â0.05). At 24âmonths, Peak GLS magnitude was significantly lower in SHRs compared with both WKYs (6.5â±â0.4% vs. 9.7â±â1.0%, P â<â0.01) and TSHRs (6.5â±â0.4% vs. 9.6â±â0.6%, P â<â0.05). CONCLUSIONS: ACE inhibitor treatment curtails the decline in global longitudinal strain in hypertensive rats, with the treatment group exhibiting significantly greater LV EF and GLS magnitude at 24 mo compared with untreated SHRs.
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Cardiopatías , Hipertensión , Ratas , Animales , Quinapril , Ratas Endogámicas WKY , Tensión Longitudinal Global , Hipertensión/tratamiento farmacológico , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Ratas Endogámicas SHR , Presión SanguíneaRESUMEN
Purpose: To develop a three-dimensional (two dimensions + time) convolutional neural network trained with displacement encoding with stimulated echoes (DENSE) data for displacement and strain analysis of cine MRI. Materials and Methods: In this retrospective multicenter study, a deep learning model (StrainNet) was developed to predict intramyocardial displacement from contour motion. Patients with various heart diseases and healthy controls underwent cardiac MRI examinations with DENSE between August 2008 and January 2022. Network training inputs were a time series of myocardial contours from DENSE magnitude images, and ground truth data were DENSE displacement measurements. Model performance was evaluated using pixelwise end-point error (EPE). For testing, StrainNet was applied to contour motion from cine MRI. Global and segmental circumferential strain (Ecc) derived from commercial feature tracking (FT), StrainNet, and DENSE (reference) were compared using intraclass correlation coefficients (ICCs), Pearson correlations, Bland-Altman analyses, paired t tests, and linear mixed-effects models. Results: The study included 161 patients (110 men; mean age, 61 years ± 14 [SD]), 99 healthy adults (44 men; mean age, 35 years ± 15), and 45 healthy children and adolescents (21 males; mean age, 12 years ± 3). StrainNet showed good agreement with DENSE for intramyocardial displacement, with an average EPE of 0.75 mm ± 0.35. The ICCs between StrainNet and DENSE and FT and DENSE were 0.87 and 0.72, respectively, for global Ecc and 0.75 and 0.48, respectively, for segmental Ecc. Bland-Altman analysis showed that StrainNet had better agreement than FT with DENSE for global and segmental Ecc. Conclusion: StrainNet outperformed FT for global and segmental Ecc analysis of cine MRI.Keywords: Image Postprocessing, MR Imaging, Cardiac, Heart, Pediatrics, Technical Aspects, Technology Assessment, Strain, Deep Learning, DENSE Supplemental material is available for this article. © RSNA, 2023.
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Impaired cardiac filling in response to increased passive myocardial stiffness contributes to the pathophysiology of heart failure. By leveraging cardiac MRI data and ventricular pressure measurements, we can estimate in vivo passive myocardial stiffness using personalized inverse finite element models. While it is well-known that this approach is subject to uncertainties, only few studies quantify the accuracy of these stiffness estimates. This lack of validation is, at least in part, due to the absence of ground truth in vivo passive myocardial stiffness values. Here, using 3D printing, we created soft, homogenous, isotropic, hyperelastic heart phantoms of varying geometry and stiffness and simulate diastolic filling by incorporating the phantoms into an MRI-compatible left ventricular inflation system. We estimate phantom stiffness from MRI and pressure data using inverse finite element analyses based on a Neo-Hookean model. We demonstrate that our identified softest and stiffest values of 215.7 and 512.3 kPa agree well with the ground truth of 226.2 and 526.4 kPa. Overall, our estimated stiffnesses revealed a good agreement with the ground truth ([Formula: see text] error) across all models. Our results suggest that MRI-driven computational constitutive modeling can accurately estimate synthetic heart material stiffnesses in the range of 200-500 kPa.
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Corazón , Modelos Cardiovasculares , Corazón/diagnóstico por imagen , Miocardio , Ventrículos Cardíacos , Imagen por Resonancia Magnética/métodosRESUMEN
Cardiac magnetic resonance (CMR) is an essential clinical tool for the assessment of cardiovascular disease. Deep learning (DL) has recently revolutionized the field through image reconstruction techniques that allow unprecedented data undersampling rates. These fast acquisitions have the potential to considerably impact the diagnosis and treatment of cardiovascular disease. Herein, we provide a comprehensive review of DL-based reconstruction methods for CMR. We place special emphasis on state-of-the-art unrolled networks, which are heavily based on a conventional image reconstruction framework. We review the main DL-based methods and connect them to the relevant conventional reconstruction theory. Next, we review several methods developed to tackle specific challenges that arise from the characteristics of CMR data. Then, we focus on DL-based methods developed for specific CMR applications, including flow imaging, late gadolinium enhancement, and quantitative tissue characterization. Finally, we discuss the pitfalls and future outlook of DL-based reconstructions in CMR, focusing on the robustness, interpretability, clinical deployment, and potential for new methods.
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Understanding the complex interplay between morphologic and hemodynamic features in aortic dissection is critical for risk stratification and for the development of individualized therapy. This work evaluates the effects of entry and exit tear size on the hemodynamics in type B aortic dissection by comparing fluid-structure interaction (FSI) simulations with in vitro 4D-flow magnetic resonance imaging (MRI). A baseline patient-specific 3D-printed model and two variants with modified tear size (smaller entry tear, smaller exit tear) were embedded into a flow- and pressure-controlled setup to perform MRI as well as 12-point catheter-based pressure measurements. The same models defined the wall and fluid domains for FSI simulations, for which boundary conditions were matched with measured data. Results showed exceptionally well matched complex flow patterns between 4D-flow MRI and FSI simulations. Compared to the baseline model, false lumen flow volume decreased with either a smaller entry tear (-17.8 and -18.5 %, for FSI simulation and 4D-flow MRI, respectively) or smaller exit tear (-16.0 and -17.3 %). True to false lumen pressure difference (initially 11.0 and 7.9 mmHg, for FSI simulation and catheter-based pressure measurements, respectively) increased with a smaller entry tear (28.9 and 14.6 mmHg), and became negative with a smaller exit tear (-20.6 and -13.2 mmHg). This work establishes quantitative and qualitative effects of entry or exit tear size on hemodynamics in aortic dissection, with particularly notable impact observed on FL pressurization. FSI simulations demonstrate acceptable qualitative and quantitative agreement with flow imaging, supporting its deployment in clinical studies.
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The use of deep learning (DL) segmentation in cardiac MRI has the potential to streamline the radiology workflow, particularly for the measurement of myocardial strain. Recent efforts in DL motion tracking models have drastically reduced the time needed to measure the heart's displacement field and the subsequent myocardial strain estimation. However, the selection of initial myocardial reference points is not automated and still requires manual input from domain experts. Segmentation of the myocardium is a key step for initializing reference points. While high-performing myocardial segmentation models exist for cine images, this is not the case for tagged images. In this work, we developed and compared two novel DL models (nnU-net and Segmentation ResNet VAE) for the segmentation of myocardium from tagged CMR images. We implemented two methods to transform cardiac cine images into tagged images, allowing us to leverage large public annotated cine datasets. The cine-to-tagged methods included (i) a novel physics-driven transformation model, and (ii) a generative adversarial network (GAN) style transfer model. We show that pretrained models perform better (+2.8 Dice coefficient percentage points) and converge faster (6×) than models trained from scratch. The best-performing method relies on a pretraining with an unpaired, unlabeled, and structure-preserving generative model trained to transform cine images into their tagged-appearing equivalents. Our state-of-the-art myocardium segmentation network reached a Dice coefficient of 0.828 and 95th percentile Hausdorff distance of 4.745 mm on a held-out test set. This performance is comparable to existing state-of-the-art segmentation networks for cine images.