| 1. |
- Bissell, Malenka M., et al.
(författare)
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4D Flow cardiovascular magnetic resonance consensus statement : 2023 update
- 2023
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Ingår i: Journal of Cardiovascular Magnetic Resonance. - : BMC. - 1097-6647 .- 1532-429X. ; 25:1
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Forskningsöversikt (refereegranskat)abstract
- Hemodynamic assessment is an integral part of the diagnosis and management of cardiovascular disease. Four-dimensional cardiovascular magnetic resonance flow imaging (4D Flow CMR) allows comprehensive and accurate assessment of flow in a single acquisition. This consensus paper is an update from the 2015 ‘4D Flow CMR Consensus Statement’. We elaborate on 4D Flow CMR sequence options and imaging considerations. The document aims to assist centers starting out with 4D Flow CMR of the heart and great vessels with advice on acquisition parameters, post-processing workflows and integration into clinical practice. Furthermore, we define minimum quality assurance and validation standards for clinical centers. We also address the challenges faced in quality assurance and validation in the research setting. We also include a checklist for recommended publication standards, specifically for 4D Flow CMR. Finally, we discuss the current limitations and the future of 4D Flow CMR. This updated consensus paper will further facilitate widespread adoption of 4D Flow CMR in the clinical workflow across the globe and aid consistently high-quality publication standards.
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| 2. |
- Dewey, Marc, et al.
(författare)
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Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia
- 2020
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Ingår i: Nature Reviews Cardiology. - : Springer Nature. - 1759-5002 .- 1759-5010. ; 17:7, s. 427-450
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Tidskriftsartikel (refereegranskat)abstract
- Cardiac imaging has a pivotal role in the prevention, diagnosis and treatment of ischaemic heart disease. SPECT is most commonly used for clinical myocardial perfusion imaging, whereas PET is the clinical reference standard for the quantification of myocardial perfusion. MRI does not involve exposure to ionizing radiation, similar to echocardiography, which can be performed at the bedside. CT perfusion imaging is not frequently used but CT offers coronary angiography data, and invasive catheter-based methods can measure coronary flow and pressure. Technical improvements to the quantification of pathophysiological parameters of myocardial ischaemia can be achieved. Clinical consensus recommendations on the appropriateness of each technique were derived following a European quantitative cardiac imaging meeting and using a real-time Delphi process. SPECT using new detectors allows the quantification of myocardial blood flow and is now also suited to patients with a high BMI. PET is well suited to patients with multivessel disease to confirm or exclude balanced ischaemia. MRI allows the evaluation of patients with complex disease who would benefit from imaging of function and fibrosis in addition to perfusion. Echocardiography remains the preferred technique for assessing ischaemia in bedside situations, whereas CT has the greatest value for combined quantification of stenosis and characterization of atherosclerosis in relation to myocardial ischaemia. In patients with a high probability of needing invasive treatment, invasive coronary flow and pressure measurement is well suited to guide treatment decisions. In this Consensus Statement, we summarize the strengths and weaknesses as well as the future technological potential of each imaging modality.
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| 3. |
- Dyverfeldt, Petter, et al.
(författare)
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4D flow cardiovascular magnetic resonance consensus statement
- 2015
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Ingår i: Journal of Cardiovascular Magnetic Resonance. - : BioMed Central / Informa Healthcare. - 1097-6647 .- 1532-429X. ; 17:72
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Forskningsöversikt (refereegranskat)abstract
- Pulsatile blood flow through the cavities of the heart and great vessels is time-varying and multidirectional. Access to all regions, phases and directions of cardiovascular flows has formerly been limited. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has enabled more comprehensive access to such flows, with typical spatial resolution of 1.5x1.5x1.5 - 3x3x3 mm(3), typical temporal resolution of 30-40 ms, and acquisition times in the order of 5 to 25 min. This consensus paper is the work of physicists, physicians and biomedical engineers, active in the development and implementation of 4D Flow CMR, who have repeatedly met to share experience and ideas. The paper aims to assist understanding of acquisition and analysis methods, and their potential clinical applications with a focus on the heart and greater vessels. We describe that 4D Flow CMR can be clinically advantageous because placement of a single acquisition volume is straightforward and enables flow through any plane across it to be calculated retrospectively and with good accuracy. We also specify research and development goals that have yet to be satisfactorily achieved. Derived flow parameters, generally needing further development or validation for clinical use, include measurements of wall shear stress, pressure difference, turbulent kinetic energy, and intracardiac flow components. The dependence of measurement accuracy on acquisition parameters is considered, as are the uses of different visualization strategies for appropriate representation of time-varying multidirectional flow fields. Finally, we offer suggestions for more consistent, user-friendly implementation of 4D Flow CMR acquisition and data handling with a view to multicenter studies and more widespread adoption of the approach in routine clinical investigations.
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| 4. |
- Ibanez, Borja, et al.
(författare)
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Cardiac MRI Endpoints in Myocardial Infarction Experimental and Clinical Trials : JACC Scientific Expert Panel
- 2019
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097. ; 74:2, s. 238-256
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Forskningsöversikt (refereegranskat)abstract
- After a reperfused myocardial infarction (MI), dynamic tissue changes occur (edema, inflammation, microvascular obstruction, hemorrhage, cardiomyocyte necrosis, and ultimately replacement by fibrosis). The extension and magnitude of these changes contribute to long-term prognosis after MI. Cardiac magnetic resonance (CMR) is the gold-standard technique for noninvasive myocardial tissue characterization. CMR is also the preferred methodology for the identification of potential benefits associated with new cardioprotective strategies both in experimental and clinical trials. However, there is a wide heterogeneity in CMR methodologies used in experimental and clinical trials, including time of post-MI scan, acquisition protocols, and, more importantly, selection of endpoints. There is a need for standardization of these methodologies to improve the translation into a real clinical benefit. The main objective of this scientific expert panel consensus document is to provide recommendations for CMR endpoint selection in experimental and clinical trials based on pathophysiology and its association with hard outcomes.
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| 5. |
- Sigfridsson, Andreas, 1978-
(författare)
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Multidimensional MRI of Myocardial Dynamics : Acquisition, Reconstruction and Visualization
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Methods for measuring deformation and motion of the human heart in-vivo are crucial in the assessment of cardiac function. Applications ranging from basic physiological research, through early detection of disease to follow-up studies, all rely on the quality of the measurements of heart dynamics. This thesis presents new improved magnetic resonance imaging methods for acquisition, image reconstruction and visualization of cardiac motion and deformation.As the heart moves and changes shape during the acquisition, synchronization to the heart dynamics is necessary. Here, a method to resolve not only the cardiac cycle but also the respiratory cycle is presented. Combined with volumetric imaging, this produces a five-dimensional data set with two cyclic temporal dimensions. This type of data reveals unique physiological information, such as interventricular coupling in the heart in different phases of the respiratory cycle.The acquisition can also be sensitized to motion, measuring not only the magnitude of the magnetization but also a signal proportional to local velocity or displacement. This allows for quantification of the motion which is especially suitable for functional study of the cardiac deformation. In this work, an evaluation of the influence of several factors on the signal-to-noise ratio is presented for in-vivo displacement encoded imaging. Additionally, an extension of the method to acquire multiple displacement encoded slices in a single breath hold is also presented.Magnetic resonance imaging is usually associated with long scan times, and many methods exist to shorten the acquisition time while maintaining acceptable image quality. One class of such methods involves acquiring only a sparse subset of k-space. A special reconstruction is then necessary in order to obtain an artifact-free image. One family of these reconstruction techniques tailored for dynamic imaging is the k-t BLAST approach, which incorporates data-driven prior knowledge to suppress aliasing artifacts that otherwise occur with the sparse sampling. In this work, an extension of the original k-t BLAST method to two temporal dimensions is presented and applied to data acquired with full coverage of the cardio-respiratory cycles. Using this technique, termed k-t2 BLAST, simultaneous reduction of scan time and improved spatial resolution is demonstrated. Further, the loss of temporal fidelity when using the k-t BLAST approach is investigated, and an improved reconstruction is proposed for the application of cardiac function analysis.Visualization is a crucial part of the imaging chain. Scalar data, such as regular anatomical images, are straightforward to display. Myocardial strain and strain-rate, however, are tensor quantities which do not lend themselves to direct visualization. The problem of visualizing the tensor field is approached in this work by combining a local visualization that displays all degrees of freedom for a single tensor with an overview visualization using a scalar field representation of the complete tensor field. The scalar field is obtained by iterated adaptive filtering of a noise field, creating a continuous geometrical representation of the myocardial strain-rate tensor field.The results of the work presented in this thesis provide opportunities for improved imaging of myocardial function, in all areas of the imaging chain; acquisition, reconstruction and visualization.
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