Free-breathing 3D cardiac MRI using iterative image-based respiratory motion correction.

Respiratory motion compensation using diaphragmatic navigator gating with a 5 mm gating window is conventionally used for free-breathing cardiac MRI. Because of the narrow gating window, scan efficiency is low resulting in long scan times, especially for patients with irregular breathing patterns. In this work, a new retrospective motion compensation algorithm is presented to reduce the scan time for free-breathing cardiac MRI that increasing the gating window to 15 mm without compromising image quality. The proposed algorithm iteratively corrects for respiratory-induced cardiac motion by optimizing the sharpness of the heart. To evaluate this technique, two coronary MRI datasets with 1.3 mm(3) resolution were acquired from 11 healthy subjects (seven females, 25 ± 9 years); one using a navigator with a 5 mm gating window acquired in 12.0 ± 2.0 min and one with a 15 mm gating window acquired in 7.1 ± 1.0 min. The images acquired with a 15 mm gating window were corrected using the proposed algorithm and compared to the uncorrected images acquired with the 5 and 15 mm gating windows. The image quality score, sharpness, and length of the three major coronary arteries were equivalent between the corrected images and the images acquired with a 5 mm gating window (P-value > 0.05), while the scan time was reduced by a factor of 1.7.

Contrast-enhanced specific absorption rate-efficient 3D cardiac cine with respiratory-triggered radiofrequency gating.

PURPOSE: To investigate the use of radiofrequency (RF) gating in conjunction with a paramagnetic contrast agent to reduce the specific absorption rate (SAR) and increase the blood-myocardium contrast in balanced steady-state free precession (bSSFP) 3D cardiac cine. MATERIALS AND METHODS: RF gating was implemented by synchronizing the RF-excitation with an external respiratory sensor (bellows), which could additionally be used for respiratory gating. For reference, respiratory-gated 3D cine images were acquired without RF gating. Free-breathing 3D cine images were acquired in eight healthy subjects before and after contrast injection (Gd-BOPTA) and compared to breath-hold 2D cine. RESULTS: RF-gated 3D cine reduced the SAR by nearly 40% without introducing significant artifacts while providing left ventricle (LV) measurements similar to those obtained with 2D cine. The contrast-to-noise ratio (CNR) was significantly higher for 3D cine compared to 2D cine, both before and after contrast injection; however, no statistically significant CNR increase was observed for the postcontrast 3D cine compared to the precontrast acquisitions. CONCLUSION: Respiratory-triggered RF gating significantly reduces SAR in 3D cine acquisitions, which may enable a more widespread clinical use of 3D cine. Furthermore, CNR of 3D bSSFP cine is higher than of 2D and administration of Gd-BOPTA does not improve the CNR of 3D cine.

Free-breathing 3D whole-heart black-blood imaging with motion sensitized driven equilibrium.

PURPOSE: To assess the efficacy and robustness of motion sensitized driven equilibrium (MSDE) for blood suppression in volumetric 3D whole-heart cardiac MR. MATERIALS AND METHODS: To investigate the efficacy of MSDE on blood suppression and myocardial signal-to-noise ratio (SNR) loss on different imaging sequences, seven healthy adult subjects were imaged using 3D electrocardiogram (ECG)-triggered MSDE-prep T(1) -weighted turbo spin echo (TSE), and spoiled gradient echo (GRE), after optimization of MSDE parameters in a pilot study of five subjects. Imaging artifacts, myocardial and blood SNR were assessed. Subsequently, the feasibility of isotropic spatial resolution MSDE-prep black-blood was assessed in six subjects. Finally, 15 patients with known or suspected cardiovascular disease were recruited to be imaged using a conventional multislice 2D double inversion recovery (DIR) TSE imaging sequence and a 3D MSDE-prep spoiled GRE. RESULTS: The MSDE-prep yielded significant blood suppression (75%-92%), enabling a volumetric 3D black-blood assessment of the whole heart with significantly improved visualization of the chamber walls. The MSDE-prep also allowed successful acquisition of black-blood images with isotropic spatial resolution. In the patient study, 3D black-blood MSDE-prep and DIR resulted in similar blood suppression in left ventricle and right ventricle walls but the MSDE-prep had superior myocardial signal and wall sharpness. CONCLUSION: MSDE-prep allows volumetric black-blood imaging of the heart.

Accelerated contrast-enhanced whole-heart coronary MRI using low-dimensional-structure self-learning and thresholding.

We sought to evaluate the efficacy of prospective random undersampling and low-dimensional-structure self-learning and thresholding reconstruction for highly accelerated contrast-enhanced whole-heart coronary MRI. A prospective random undersampling scheme was implemented using phase ordering to minimize artifacts due to gradient switching and was compared to a randomly undersampled acquisition with no profile ordering. This profile-ordering technique was then used to acquire contrast-enhanced whole-heart coronary MRI in 10 healthy subjects with 4-fold acceleration. Reconstructed images and the acquired zero-filled images were compared for depicted vessel length, vessel sharpness, and subjective image quality on a scale of 1 (poor) to 4 (excellent). In a pilot study, contrast-enhanced whole-heart coronary MRI was also acquired in four patients with suspected coronary artery disease with 3-fold acceleration. The undersampled images were reconstructed using low-dimensional-structure self-learning and thresholding, which showed significant improvement over the zero-filled images in both objective and subjective measures, with an overall score of 3.6 ± 0.5. Reconstructed images in patients were all diagnostic. Low-dimensional-structure self-learning and thresholding reconstruction allows contrast-enhanced whole-heart coronary MRI with acceleration as high as 4-fold using clinically available five-channel phased-array coil.

Free-breathing cardiac MR with a fixed navigator efficiency using adaptive gating window size.

A respiratory navigator with a fixed acceptance gating window is commonly used to reduce respiratory motion artifacts in cardiac MR. This approach prolongs the scan time and occasionally yields an incomplete dataset due to respiratory drifts. To address this issue, we propose an adaptive gating window approach in which the size and position of the gating window are changed adaptively during the acquisition based on the individual's breathing pattern. The adaptive gating window tracks the breathing pattern of the subject throughout the scan and adapts the size and position of the gating window such that the gating efficiency is always fixed at a constant value. To investigate the image quality and acquisition time, free breathing cardiac MRI, including both targeted coronary MRI and late gadolinium enhancement imaging, was performed in 67 subjects using the proposed navigator technique. Targeted coronary MRI was acquired from eleven healthy adult subjects using both the conventional and proposed adaptive gating window techniques. Fifty-six patients referred for cardiac MRI were also imaged using late gadolinium enhancement with the proposed adaptive gating window technique. Subjective and objective image assessments were used to evaluate the proposed method. The results demonstrate that the proposed technique allows free-breathing cardiac MRI in a relatively fixed time without compromising imaging quality due to respiratory motion artifacts.

Subject-specific estimation of respiratory navigator tracking factor for free-breathing cardiovascular MR.

A mean respiratory navigator tracking factor of 0.6 is commonly used to estimate the respiratory motion of the heart from the displacement of the right hemi-diaphragm. A constant tracking factor can generate significant residual error in estimation of the respiratory motion of the heart for the cases where the actual tracking factor highly deviates from 0.6. In this study, we implemented and evaluated a robust method to calculate a subject-specific tracking factor for free-breathing high resolution cardiac MR. The subject-specific tracking factor was calculated from two consecutive navigator signals placed on the right hemi-diaphragm and the basal left ventricle in a training phase. To verify the accuracy of the estimated subject-specific tracking factor, nineteen subjects were recruited for comparing the estimated tracking factor in real-time with an image-based tracking factor, calculated off-line. Subsequently, in seven adult subjects, whole-heart or targeted coronary artery MR images were acquired using the estimated subject-specific tracking factor and visually compared with those acquired using a constant (0.6) tracking factor. It was shown that the proposed method can accurately estimate the subject-specific tracking factor and improve the quality of coronary images when the subject-specific tracking factor differs from 0.6.

Motion correction using coil arrays (MOCCA) for free-breathing cardiac cine MRI.

In this study, we present a motion correction technique using coil arrays (MOCCA) and evaluate its application in free-breathing respiratory self-gated cine MRI. Motion correction technique using coil arrays takes advantages of the fact that motion-induced changes in k-space signal are modulated by individual coil sensitivity profiles. In the proposed implementation of motion correction technique using coil arrays self-gating for free-breathing cine MRI, the k-space center line is acquired at the beginning of each k-space segment for each cardiac cycle with 4 repetitions. For each k-space segment, the k-space center line acquired immediately before was used to select one of the 4 acquired repetitions to be included in the final self-gated cine image by calculating the cross correlation between the k-space center line with a reference line. The proposed method was tested on a cohort of healthy adult subjects for subjective image quality and objective blood-myocardium border sharpness. The method was also tested on a cohort of patients to compare the left and right ventricular volumes and ejection fraction measurements with that of standard breath-hold cine MRI. Our data indicate that the proposed motion correction technique using coil arrays method provides significantly improved image quality and sharpness compared with free-breathing cine without respiratory self-gating and provides similar volume measurements compared with breath-hold cine MRI.

Compressed-sensing motion compensation (CosMo): a joint prospective-retrospective respiratory navigator for coronary MRI.

Prospective right hemidiaphragm navigator (NAV) is commonly used in free-breathing coronary MRI. The NAV results in an increase in acquisition time to allow for resampling of the motion-corrupted k-space data. In this study, we are presenting a joint prospective-retrospective NAV motion compensation algorithm called compressed-sensing motion compensation (CosMo). The inner k-space region is acquired using a prospective NAV; for the outer k-space, a NAV is only used to reject the motion-corrupted data without reacquiring them. Subsequently, those unfilled k-space lines are retrospectively estimated using compressed sensing reconstruction. We imaged right coronary artery in nine healthy adult subjects. An undersampling probability map and sidelobe-to-peak ratio were calculated to study the pattern of undersampling, generated by NAV. Right coronary artery images were then retrospectively reconstructed using compressed-sensing motion compensation for gating windows between 3 and 10 mm and compared with the ones fully acquired within the gating windows. Qualitative imaging score and quantitative vessel sharpness were calculated for each reconstruction. The probability map and sidelobe-to-peak ratio show that the NAV generates a random undersampling k-space pattern. There were no statistically significant differences between the vessel sharpness and subjective score of the two reconstructions. Compressed-sensing motion compensation could be an alternative motion compensation technique for free-breathing coronary MRI that can be used to reduce scan time.

Low-dimensional-structure self-learning and thresholding: regularization beyond compressed sensing for MRI reconstruction.

An improved image reconstruction method from undersampled k-space data, low-dimensional-structure self-learning and thresholding (LOST), which utilizes the structure from the underlying image is presented. A low-resolution image from the fully sampled k-space center is reconstructed to learn image patches of similar anatomical characteristics. These patches are arranged into "similarity clusters," which are subsequently processed for dealiasing and artifact removal, using underlying low-dimensional properties. The efficacy of the proposed method in scan time reduction was assessed in a pilot coronary MRI study. Initially, in a retrospective study on 10 healthy adult subjects, we evaluated retrospective undersampling and reconstruction using LOST, wavelet-based l(1)-norm minimization, and total variation compressed sensing. Quantitative measures of vessel sharpness and mean square error, and qualitative image scores were used to compare reconstruction for rates of 2, 3, and 4. Subsequently, in a prospective study, coronary MRI data were acquired using these rates, and LOST-reconstructed images were compared with an accelerated data acquisition using uniform undersampling and sensitivity encoding reconstruction. Subjective image quality and sharpness data indicate that LOST outperforms the alternative techniques for all rates. The prospective LOST yields images with superior quality compared with sensitivity encoding or l(1)-minimization compressed sensing. The proposed LOST technique greatly improves image reconstruction for accelerated coronary MRI acquisitions.

Pulmonary vein inflow artifact reduction for free-breathing left atrium late gadolinium enhancement.

Two-dimensional "pencil-beam" navigator, placed on the right hemidiaphragm, is used for free-breathing late gadolinium enhancement of the left atrium in patients with atrial fibrillation. The pencil-beam navigator creates an inflow artifact in the right pulmonary veins and atrial wall that may obscure local pulmonary vein and left atrium scars. To reduce this artifact, we propose a large slab right hemidiaphragm projection navigator that measures the respiratory motion while reducing the associated inflow artifact. Eighteen subjects underwent pulmonary vein late gadolinium enhancement using the pencil-beam and projection navigator. Subjective inflow and respiratory motion artifact scores (1 = severe, 2 = moderate, 3 = mild, and 4 = none) from two blinded readers were compared. The artifact scores were 3.8 ± 0.4 and 2.1 ± 0.7 for the projection and pencil-beam navigators, respectively (P < 0.001). Respiratory motion artifact scores were similar between the two techniques (3.0 ± 0.5 vs. 3.1 ± 0.5 for projection vs. pencil-beam navigator). The proposed method greatly reduces the inflow artifact in free-breathing pulmonary vein late gadolinium enhancement while allowing adequate respiratory motion compensation.

Contrast-enhanced whole-heart coronary MRI with bolus infusion of gadobenate dimeglumine at 1.5 T.

We sought to investigate the T(1) kinetics of blood and myocardium after three infusion schemes of gadobenate dimeglumine (Gd-BOPTA) and subsequently compared contrast-enhanced whole-heart coronary MRI after a bolus Gd-BOPTA infusion with nonenhanced coronary MRI at 1.5 T. Blood and myocardium T(1) was measured in seven healthy adults, after each underwent three Gd-BOPTA infusion schemes (bolus: 0.2 mmol/kg at 2 mL/sec, hybrid: 0.1 mmol/kg at 2 mL/sec followed by 0.1 mmol/kg at 0.1 mL/sec, and slow: 0.2 mmol/kg at 0.3 mL/sec). Fourteen additional subjects underwent contrast-enhanced coronary MRI with an inversion-recovery steady-state free precession sequence after bolus Gd-BOPTA infusion. Images were compared with nonenhanced T(2) -prepared steady-state free precision whole-heart coronary MRI in signal-to-noise ratio, contrast-to-noise ratio, depicted vessel length, vessel sharpness, and subjective image quality. Bolus and slow infusion schemes resulted in similar T(1) during coronary MRI, whereas the hybrid infusion method yielded higher T(1) values. A bolus infusion of Gd-BOPTA significantly improved signal-to-noise ratio, contrast-to-noise ratio, depicted coronary artery length, and subjective image quality, when all segments were collectively compared but not when compared segment by segment. In conclusion, whole-heart steady-state free precision coronary MRI at 1.5 T can benefit from a bolus infusion of 0.2 mmol/kg Gd-BOPTA.

Noncontrast SSFP pulmonary vein magnetic resonance angiography: impact of off-resonance and flow.

PURPOSE: To investigate pulmonary vein (PV) off-resonance and blood flow as causes of signal void artifacts in noncontrast steady-state-free-precession (SSFP) PV magnetic resonance angiography (MRA). MATERIALS AND METHODS: PV blood off-resonance was measured on 11 healthy adult subjects and 10 atrial fibrillation (AF) patients. Noncontrast PV MRA was performed using a 3D slab-selective SSFP sequence at 1.5T on seven healthy subjects with signal profile shifts of 0-125 Hz. The time-resolved blood flow velocity of the PVs was measured on five healthy subjects. The impact of flow was studied on six healthy subjects, on whom SSFP PV MRA was acquired twice with the electrocardiogram (ECG) trigger delay corresponding to low and high flow, respectively. RESULTS: The PV off-resonances were 97 ± 27 Hz, 65 ± 20 Hz, 74 ± 25 Hz, and 52 ± 17 Hz for right inferior, left inferior, right superior, and left superior PVs, respectively, on healthy subjects, and 74 ± 20 Hz, 38 ± 9 Hz, 51 ± 20 Hz, and 28 ± 11 Hz on AF patients (P<0.01 for all). The off-resonance caused severe signal voids in the PVs. Signal acquired during mid-diastole with high PV flow caused additional signal voids in the left atrium, which was reduced by setting the ECG trigger delay to late-diastole. CONCLUSION: PV off-resonance and flow causes signal void artifacts in noncontrast 3D slab-selective SSFP PV MRA.

Optimization of on-resonant magnetization transfer contrast in coronary vein MRI.

Magnetization transfer contrast has been used commonly for endogenous tissue contrast improvements in angiography, brain, body, and cardiac imaging. Both off-resonant and on-resonant RF pulses can be used to generate magnetization transfer based contrast. In this study, on-resonant magnetization transfer preparation using binomial pulses were optimized and compared with off-resonant magnetization transfer for imaging of coronary veins. Three parameters were studied with simulations and in vivo measurements: flip angle, pulse repetitions, and binomial pulse order. Subsequently, first or second order binomial on-resonant magnetization transfer pulses with eight repetitions of 720° and 240° flip angle were used for coronary vein MRI. Flip angles of 720° yielded contrast enhancement of 115% (P < 0.0006) for first order on-resonant and 95% (P < 0.0006) for off-resonant magnetization transfer. There was no statistically significance difference between off-resonant and on-resonant first order binomial Magnetization transfer at 720°. However, for off-resonance pulses, much more preparation time is needed when compared with the binomials but with considerably reduced specific absorption rate.

Predictors of preserved left ventricular systolic function after surgery for chronic organic mitral regurgitation: a prospective study.

BACKGROUND AND AIM OF THE STUDY: For patients with chronic severe mitral regurgitation (MR), one consideration for the timing of mitral valve surgery is the desire to have a preserved postoperative left ventricular ejection fraction (LVEF). It was hypothesized that the preoperative left ventricular (LV) volume and effective forward LVEF (defined as the ratio of forward aortic stroke volume and LV end-diastolic volume (LVEDV)) would accurately predict the intermediate (three-month) LVEF following surgery. It was also hypothesized that at years after successful surgical correction, there would be ongoing positive ventricular remodeling with improvements in systolic function. A quantitative volumetric cardiovascular magnetic resonance (CMR) system was used prospectively to study these relationships, and to define predictors of postoperative LV systolic function after surgery for chronic severe MR. METHODS: Twenty patients (eight females, 12 males; mean age 52 +/-12 years) with chronic severe MR, who had been referred for elective mitral valve repair or replacement with chordal preservation, were prospectively enrolled. All patients underwent quantitative CMR with assessment of LV volume, LVEF, and effective forward LVEF prior to, and at three months after, surgery. Fourteen of the patients returned at a median of 27 months after valve surgery for repeat CMR. RESULTS: The preoperative LVEF was normal in 90% of patients (0.62 +/- 0.09), but the effective forward LVEF was depressed in all subjects (0.36 +/- 0.09). Compared to preoperative values, at three months after surgery the LVEF had declined by 0.16 +/- 0.08 (p < 0.001), whereas the effective forward LVEF was increased by 0.09 +/- 0.10 (p < 0.001) and the LV end-diastolic volume index (LVEDVI) had declined by 32% (p < 0.001). Multivariate analysis demonstrated a significant correlation between postoperative LVEF and both preoperative LV end-systolic volume index (LVESVI) (p = 0.003) and the preoperative effective forward LVEF (p = 0.05). A depressed postoperative LVEF (< 0.50) during the early period was best predicted by a preoperative effective forward LVEF < 0.40 (sensitivity 100%, specificity 75%). At the 27-month follow up, 12 of the 14 patients (86%) had a normal LVEF, and there was a continuing normalization of other LV parameters, including the LVEDVI and LV mass index. CONCLUSION: Among patients with chronic severe MR, the preoperative LVESVI best correlated with the three-month postoperative LVEF. A preoperative effective forward LVEF < 0.40 accurately predicted a depressed postoperative LVEE. Over the succeeding two years, there will be ongoing positive LV remodeling. If confirmed in a larger series, the effective forward LVEF may serve as a useful clinical guide for the timing of corrective surgery in this population.

Coronary MR imaging: effect of timing and dose of isosorbide dinitrate administration.

PURPOSE: To quantify the effect of sublingual isosorbide dinitrate (ISDN) administration on coronary magnetic resonance (MR) imaging. MATERIALS AND METHODS: Written informed consent was obtained from all participants, and the HIPAA-compliant protocol was approved by the Institutional Review Board. Coronary MR imaging was performed at 1.5 T before and after administration of ISDN (2.5 or 5 mg) in 25 healthy adult volunteers (mean age, 23 years +/- 4; nine men, 16 women) with three-dimensional targeted (n = 20, randomized into four groups) or whole-heart (n = 5) acquisitions with gradient-recalled echo (GRE) or balanced steady-state free precession (SSFP) sequences. Image quality was assessed by two cardiologists on a four-point scale. Signal-to-noise ratio (SNR), vessel diameter, and vessel sharpness were characterized. A linear mixed-effects model was used for data analysis. A P value of less than .05 was considered to indicate a significant difference. RESULTS: The maximum SNR enhancement with 5 mg of ISDN (GRE: 22.0% +/- 10.7%; SSFP: 20.1% +/- 6.0%) was similar (P > .05) to that with 2.5 mg (GRE: 21.9% +/- 5.4%; SSFP: 19.1% +/- 3.0%). However, the time to maximum SNR enhancement for the 5-mg dose (15.5 minutes +/- 6.0) was earlier (P < .01) than that for 2.5 mg (23.5 minutes +/- 6.7). The increase in vessel diameter with 5 mg of ISDN was greater than that with 2.5 mg (P < .05 for both GRE and SSFP sequences). The coronary images were sharper after ISDN administration (P < .03). Subjective image quality score significantly improved after ISDN administration for GRE images (P < .05 for both doses) but was similar for SSFP images (P = .24 for 2.5 mg; P = .27 for 5 mg). Whole-heart coronary SNR was improved about 10% after ISDN administration (P < .05). CONCLUSION: Sublingual ISDN improves coronary MR imaging SNR. Practitioners need to consider the dose and temporal effects of ISDN when performing coronary MR imaging.

Non-contrast-enhanced pulmonary vein MRI with a spatially selective slab inversion preparation sequence.

We propose a non-contrast-enhanced, three-dimensional, free-breathing, electrocardiogram-gated, gradient recalled echo sequence with a slab-selective inversion for pulmonary vein (PV) MRI. A sagittal inversion slab was applied prior to data acquisition to suppress structures adjacent to the left atrium (LA) and PVs, thereby improving the conspicuity of the PV and LA. Compared with other MR angiography methods using an inversion pulse, the proposed method does not require signal subtraction and the inversion slab is not parallel to the imaging slab. The feasibility of the proposed method was demonstrated in healthy subjects. The inversion slab thickness and inversion time were optimized to be 60 mm and 500 ms, respectively. Compared to conventional gradient recalled echo imaging without inversion, the proposed technique significantly increased the contrast-to-noise ratios between the LA and the right atrium by 20-fold (P < 0.01), increased the contrast-to-noise ratios between the PVs and right atrium by 10-fold (P < 0.03), and increased the contrast-to-noise ratios between the PVs, LA and pulmonary artery by 4-fold (P < 0.01 for both). The signal-to-noise ratios of the PVs and the LA were similar with and without the inversion slab (P > 0.3). The proposed technique greatly enhances the conspicuity of the PVs and LA without significant loss of signal-to-noise ratio.

Cardiac remodeling after substantial weight loss: a prospective cardiac magnetic resonance study after bariatric surgery.

BACKGROUND: Obesity is a risk factor for left ventricular (LV) hypertrophy and excess cardiovascular disease and mortality. Substantial weight loss is associated with a decrease in cardiovascular mortality. Using volumetric cardiovascular magnetic resonance (CMR) imaging, we studied changes in cardiac anatomy and systolic function in women undergoing substantial weight loss in a university hospital. METHODS: A total of 17 women (body mass index [BMI] 44.1 +/- 4.2 kg/m(2); age 44 +/- 11 yr) scheduled for bariatric surgery underwent volumetric CMR imaging before and 3 and 17 months after surgery. RESULTS: The body weight declined by 37.2 +/- 10.5 kg (32%) with a decrease in BMI to 29.9 +/- 4.7 kg/m(2) (32%, P < .004) during 17 months of observation. The LV mass decreased from 120 +/- 23 g to 82 +/- 11 g (32%, P < .004), with a linear relationship between the decrease in BMI and decrease in LV mass (P = .008) for the duration of the observation period. After adjustment for systolic and/or diastolic blood pressure, the relationship remained significant (P < .001). The right ventricular (RV) mass declined from 31.7 +/- 6.7 g preoperatively to 26.6 +/- 4.5 g at 3 months (16%, P < .001) but without additional changes at 17 months. No change was found in the LV or RV end-diastolic volume or ejection fraction. CONCLUSION: In morbidly obese women, substantial weight loss was associated with a reduction of LV and RV mass. The decrease in LV mass was linearly related to the reduction in BMI, independent of changes in blood pressure, and might partially explain the reduction in cardiovascular mortality associated with substantial weight loss. The BMI was a predictor of LV mass in this population.

Whole heart magnetization-prepared steady-state free precession coronary vein MRI.

PURPOSE: To compare two coronary vein imaging techniques using whole-heart balanced steady-state free precession (SSFP) and a targeted double-oblique spoiled gradient-echo (GRE) sequences in combination with magnetization transfer (MT) preparation sequence for tissue contrast improvement. MATERIALS AND METHODS: Nine healthy subjects were imaged with the proposed technique. The results are compared with optimized targeted MT prepared GRE acquisitions. Both quantitative and qualitative analyses were performed to evaluate each imaging method. RESULTS: Whole-heart images were successfully acquired with no visible image artifact in the vicinity of the coronary veins. The anatomical features and visual grading of both techniques were comparable. However, the targeted small slab acquisition of the left ventricular lateral wall was superior to whole-heart acquisition for visualization of relevant information for cardiac resynchronization therapy (CRT) lead implantation. CONCLUSION: We demonstrated the feasibility of whole-heart coronary vein MRI using a 3D MT-SSFP imaging sequence. A targeted acquisition along the lateral left ventricular wall is preferred for visualization of branches commonly used in CRT lead implantation.

Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic resonance: optimizing correlation with Doppler echocardiography.

BACKGROUND: Cardiovascular magnetic resonance (CMR) is widely recognized as a non-invasive gold standard for quantification of ventricular volumes. In addition, it is an emerging diagnostic modality for clinical evaluation of mitral regurgitation (MR) and aortic regurgitation (AR). CMR facilitates accurate quantitation of regurgitation volumes and regurgitant fraction, but referring physicians are often more comfortable with qualitative measures, and few data exist for correlation of qualitative CMR regurgitation severity with that obtained by more conventional qualitative Doppler echocardiography. Because patients with AR and MR may commonly be assessed by both echocardiography and CMR modalities, consistency between qualitative gradient of regurgitation severity is important for follow-up. Therefore, we sought to define the CMR regurgitant fractions that best correlate with qualitative mild, moderate, and severe regurgitation by color Doppler echocardiography. METHODS AND RESULTS: Data from 141 consecutive patients (age 53 +/- 15 yr; 43% female) with contemporary (median, 31 days) CMR and echocardiographic data, including 107 regurgitant valves and 70 normal valves, were compared. Thresholds were developed on an initial cohort of patients with 55 regurgitant valves, and subsequently tested on a later cohort of patients with 52 regurgitant valves. Regurgitation fraction (RF) limits that optimized concordance of CMR and echo severity grades were similar for MR and AR and were: mild < or = 15%, moderate 16-25%, moderate-severe 26-48%, severe > 48%. CONCLUSIONS: The current study provides simple qualititative threshold grades for MR and AR severity that allows for standardized reporting of regurgitation severity by CMR and excellent correlation with clinical echocardiography.

Effect of raloxifene on aortic elasticity in healthy postmenopausal women.

BACKGROUND: The effect of raloxifene on aortic elasticity in healthy postmenopausal women is unknown. The purpose of the present study was to examine the effect of raloxifene on aortic elasticity and cardiovascular structure and function in healthy postmenopausal women. METHODS: A randomized, crossover, double-blind, placebo-controlled clinical trial was performed. Fourteen healthy postmenopausal women received treatment with raloxifene 60 mg daily and matching placebo for 8 weeks with an 8-week washout period in between the 2 treatment periods. Cardiovascular magnetic resonance imaging was used to assess ascending thoracic and abdominal aortic elasticity and cardiovascular structure and function (left ventricular volumes, ejection fraction, and mass and mitral annular displacement) before and at the end of each treatment period. RESULTS: Administration of raloxifene had no significant effect on either heart rate or systemic blood pressure. Raloxifene treatment was associated with a small decrease of the ascending aorta wall thickness (pretreatment 2.4 +/- 0.3 vs posttreatment 2.2 +/- 0.2 mm, P = .01). Consequently, there was an increase in the Young's elastic modulus after raloxifene treatment at the ascending thoracic aorta but not the abdominal aorta. There were no significant differences in aortic compliance or any cardiac indexes after raloxifene treatment. CONCLUSIONS: Raloxifene administration in healthy postmenopausal women over an 8-week period may decrease the aortic wall thickness but has no significant effects on aortic compliance or cardiac structure and function.