Black blood myocardial T2 mapping
Chengyan Wang
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, People's Republic of China
Chengyan Wang and Jihye Jang contributed equally to this study.
Search for more papers by this authorJihye Jang
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Department of Computer Science, Technical University of Munich, Munich, Germany
Chengyan Wang and Jihye Jang contributed equally to this study.
Search for more papers by this authorUlf Neisius
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorMaryam Nezafat
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorAhmed Fahmy
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Biomedical Engineering Department, Cairo University, Giza, Egypt
Search for more papers by this authorJinkyu Kang
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorJennifer Rodriguez
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorBeth Goddu
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorPatrick Pierce
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorSophie Berg
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorJue Zhang
Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, People's Republic of China
Search for more papers by this authorXiaoying Wang
Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, People's Republic of China
Department of Radiology, Peking University First Hospital, Beijing, People's Republic of China
Search for more papers by this authorCorresponding Author
Reza Nezafat
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Correspondence
Reza Nezafat, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215.
Email: [email protected]
Search for more papers by this authorChengyan Wang
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, People's Republic of China
Chengyan Wang and Jihye Jang contributed equally to this study.
Search for more papers by this authorJihye Jang
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Department of Computer Science, Technical University of Munich, Munich, Germany
Chengyan Wang and Jihye Jang contributed equally to this study.
Search for more papers by this authorUlf Neisius
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorMaryam Nezafat
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorAhmed Fahmy
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Biomedical Engineering Department, Cairo University, Giza, Egypt
Search for more papers by this authorJinkyu Kang
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorJennifer Rodriguez
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorBeth Goddu
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorPatrick Pierce
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorSophie Berg
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorJue Zhang
Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, People's Republic of China
Search for more papers by this authorXiaoying Wang
Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, People's Republic of China
Department of Radiology, Peking University First Hospital, Beijing, People's Republic of China
Search for more papers by this authorCorresponding Author
Reza Nezafat
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Correspondence
Reza Nezafat, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215.
Email: [email protected]
Search for more papers by this authorFunding information: This study is supported in part by the National Institutes of Health (NIH) 1R01HL129185-01, 1R21HL127650, and 1R01HL129157; and the American Heart Association (AHA) 15EIA22710040. Chengyan Wang is funded by the National Science Foundation of China 81627901, and 81571666; and the China Postdoctoral Science Foundation 17Z102060138
Abstract
Purpose
To develop a black blood heart-rate adaptive T2-prepared balanced steady-state free-precession (BEATS) sequence for myocardial T2 mapping.
Methods
In BEATS, blood suppression is achieved by using a combination of preexcitation and double inversion recovery pulses. The timing and flip angles of the preexcitation pulse are auto-calculated in each patient based on heart rate. Numerical simulations, phantom studies, and in vivo studies were conducted to evaluate the performance of BEATS. BEATS T2 maps were acquired in 36 patients referred for clinical cardiac MRI and in 1 swine with recent myocardial infarction. Two readers assessed all images acquired in patients to identify the presence of artifacts associated with slow blood flow.
Results
Phantom experiments showed that the BEATS sequence provided accurate T2 values over a wide range of simulated heart rates. Black blood myocardial T2 maps were successfully obtained in all subjects. No significant difference was found between the average T2 measurements obtained from the BEATS and conventional bright-blood T2; however, there was a decrease in precision using the BEATS sequence. A suppression of the blood pool resulted in sharper definition of the blood–myocardium border and reduced partial voluming effect. The subjective assessment showed that 16% (18 out of 108) of short-axis slices have residual blood artifacts (12 in the apical slice, 4 in the midventricular slice, and 2 in the basal slice).
Conclusion
The BEATS sequence yields dark blood myocardial T2 maps with better definition of the blood–myocardium border. Further studies are warranted to evaluate diagnostic accuracy of black blood T2 mapping.
Supporting Information
| Filename | Description |
|---|---|
| mrm27360-sup-0001-SupInfo.docxWord document, 24.4 MB |
FIGURE S1 T2 measurements of phantoms using conventional bright-blood T2prep-bSSFP (simulated heart rates of 60 bpm) and BEATS sequences with different simulated heart rates ranging from 60 bpm to 110 bpm. T1 values of each vial are shown on the left-top, denoted as Reference T1. All measurements are displayed with average T2 (top number) and standard deviation (bottom number), except for the reference T1 and T2 values. FIGURE S2 Example slices from 4 different patients with different degrees of blood flow related artifacts (red arrows). The residual artifacts could occur on different locations; however, it often has a different signal level and recovery curve compared to the myocardium. Images at the apex show more artifacts at the mid-LV blood cavity (bottom right case). FIGURE S3 Example of T2-weighted images and BEATS T2 maps in apical, mid-ventricular, and basal slices from a patient with a heart rate of 96 bpm. Arrows show areas of blood-related artifact. FIGURE S4 Stunned myocardium after a non-ST segment elevation myocardial infarction (NSTEMI) affecting the left anterior descending artery territory. The patient was admitted with chest pain, a small troponin rise (Troponin I 0.12 ng/ml) and unspecific electrocardiographic changes (A). A coronary angiogram showed sequential severe stenosis in the left anterior descending artery (B, arrows). A cardiac MRI (C) on day 5 post NSTEMI showed improving left ventricular systolic function (LV ejection fraction of 59% vs. 35% on day 1 echocardiogram) with apical and mid-septal hypo- to dyskinesis. As the left ventricular function fully recovered 2 months later, the subendocardial to transmural late gadolinium enhancement (C, arrows) likely reflects cardiac edema secondary to stunned myocardium. In this context, septal subendocardial signal intensity appeared increased on short axis T2-weighted images by BEATS (TE = 0, 25, 55 ms; D-F) with the slice location and orientation depicted by green and orange lines (D). Comparison of T2 maps obtained from conventional bright blood T2prep-bSSFP (G) and BEATS (H) showed different results. This could potentially reflect on improved delineation of the subendocardial region on BEATS, blood flow, related artifacts, or both. FIGURE S5 Example of T2-weighted images and BEATS T2 maps acquired in short axis (SHAX), 4-chamber (4CH), horizontal long axis (HLA), and 2-chamber (2CH) views. In the imaging plane where the blood flows within the plane such as the 4CH, HLA, and 2CH views, DIR does not effectively null the blood signal. |
| mrm27360-sup-0002-VideoS1.movvideo/mov, 16.6 MB |
VIDEO S1 Examples of original T2-weighted images acquired with BEATS from one patient with heart rates of 60 bpm. |
| mrm27360-sup-0003-VideoS2.movvideo/mov, 17.6 MB |
VIDEO S2 Examples of original T2-weighted images acquired with BEATS from one patient with heart rates of 70 bpm. |
| mrm27360-sup-0004-VideoS3.movvideo/mov, 2.7 MB |
VIDEO S3 Example of original T2-weighted images in apical, mid-ventricular, and basal slices from a patient with a heart rate of 96 bpm. |
| mrm27360-sup-0005-VideoS4.movvideo/mov, 3.7 MB |
VIDEO S4 Example of original T2-weighted images in a patient with suspected large subendocardial enhancement in BEATS T2 maps. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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