scholarly journals A Two-stage Cardiac PET and Late Gadolinium Enhancement MRI Co-registration Method for Improved Assessment of Non-ischemic Cardiomyopathies Using Integrated PET/MR

2021 ◽  
Author(s):  
Zheng Zhang ◽  
Xing Chen ◽  
Qing Wan ◽  
Haiyan Wang ◽  
Na Qi ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Diagnostic Accuracy ◽  
Single Stage ◽  
Whole Body ◽  
P Value ◽  
Cardiac Pet ◽  
Gadolinium Enhancement ◽  
Two Stage ◽  
Registration Method ◽  
The Mean

Abstract PurposeRespiratory motion causes mismatches between PET images of the myocardium and the corresponding cardiac MR images in cardiac integrated PET/MR. The mismatch may affect the attenuation correction and the diagnosis of non-ischemic cardiomyopathies. In this study, we present a two-stage cardiac PET and MR Late Gadolinium Enhancement (LGE) co-registration method, which seeks to improve diagnostic accuracy of non-ischemic cardiomyopathies via better image co-registration using an integrated whole-body PET/MR system.MethodsThe proposed PET and LGE two-stage co-registration method was evaluated through comparison with one-stage direct co-registration and no-registration. One hundred and ninety-one slices of LGE and forty lesions were studied. Two trained nuclear medicine physicians independently assessed the displacement between LGE and PET to qualitatively evaluate the co-registration quality. The changes of the mean SUV in the normal myocardium and the LGE-enhanced lesions before and after image co-registration were measured to quantitatively evaluate the accuracy and value of image co-registration.ResultsThe two-stage method had an improved image registration score (4.93±0.89) compared with the no-registration method (3.49±0.84, p value <0.001) and the single-stage method (4.23±0.81, p value <0.001). Furthermore, the two-stage method led to increased SUV value in the myocardium (3.87±2.56) compared with the no-registration method (3.14±1.92, p value <0.001) and the single-stage method (3.32±2.16, p value <0.001). The mean SUV in the LGE lesion significantly increased from 2.51±2.09 to 2.85±2.35 (p value<0.001) after the two-stage co-registration.ConclusionThe proposed two-stage registration method significantly improved the co-registration between PET and LGE in integrated PET/MR imaging. The technique may improve diagnostic accuracy of non-ischemic cardiomyopathies via better image co-registration.Registered No.DF-2020-085, 2020.04.30

scholarly journals T1-mapping and extracellular volume in patients with hypertrophic cardiomyopathy without focal myocardial injury in late gadolinium enhancement sequence

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
P Gac ◽  
B Kedzierski ◽  
K Truszkiewicz ◽  
R Poreba
Keyword(s):  
Late Gadolinium Enhancement ◽  
Hypertrophic Cardiomyopathy ◽  
Myocardial Injury ◽  
T1 Mapping ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Gadolinium Enhancement ◽  
Post Contrast ◽  
Mapping Sequence ◽  
The Mean

Abstract Funding Acknowledgements Type of funding sources: None. Background The LGE (late gadolinium enhancement) sequence is a recognized classic tool for imaging focal myocardial injury. The T1-mapping sequence to assess native T1 myocardial time, post-contrast T1 time, and myocardial extracellular volume (ECV) is a widely studied tool for imaging focal and diffused myocardial injury. Purpose The aim of the study was to evaluate the native T1 time, the post-contrast T1 time and the myocardial extracellular volume in the T1-mapping sequence in patients with hypertrophic cardiomyopathy without focal LGE myocardial injury. Methods The study group consisted of 28 consecutive patients who met the criteria for diagnosis of hypertrophic cardiomyopathy without focal LGE myocardial injury (HCM group; mean age 52.17 ± 6.35 years). 28 patients without cardiomyopathy (CON group; mean age 51.76 ± 6.49 years) with similar anthropometric parameters were selected by the case-to-case method as a control group. All patients underwent 1.5 T cardiac magnetic resonance, including cinematographic sequences (CINE), LGE sequence and T1-mapping sequences before (native) and 20-minutes after intravenous administration of a paramagnetic agent (post-contrast). In the T1-mapping sequences, the mean T1 time of the whole myocardium (T1 whole myocardium) was assessed, as well as the T1 time in the basal layers (T1 basal), middle layers (T1 middle) and apical layers (T1 apical) of the myocardium. Moreover, the mean T1 time was assessed in the 16-segment myocardial AHA model (T1 segment 1-16). The extracellular volume of the myocardium was estimated in an analogous way. Results In CINE sequences, in the HCM group compared to the CON group, the end-diastolic thickness of the anterior part of interventricular septum, the end-diastolic thickness of the left ventricular posterior wall and the left ventricular mass index were significantly higher. The studied groups did not differ in left ventricular ejection fraction. In both groups, no foci of myocardial injury in the LGE sequence were found. There were no statistically significant differences in T1 times between the study groups. In the HCM group as compared to the CON group, the ECV whole myocardium, ECV basal, ECV apical and ECV segments 1-3, 8, 13-16 were statistically significantly higher. Conclusion Patients with hypertrophic cardiomyopathy without myocardium focal injury in the LGE sequence are characterized by higher myocardial ECV values, assessed in the T1-mapping sequence.

Diagnostic Accuracy of Single-shot 2-Dimensional Multisegment Late Gadolinium Enhancement in Ischemic and Nonischemic Cardiomyopathy

2020 ◽  
Vol 35 (1) ◽  
pp. 56-63 ◽  
Author(s):  
Giuseppe Muscogiuri ◽  
Marco Gatti ◽  
Serena Dell’Aversana ◽  
Daniele Andreini ◽  
Andrea I. Guaricci ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Diagnostic Accuracy ◽  
Single Shot ◽  
Nonischemic Cardiomyopathy ◽  
Gadolinium Enhancement

scholarly journals Longitudinal changes in extent of late gadolinium enhancement in repaired Tetralogy of Fallot: a retrospective analysis of serial CMRs

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Kwannapas Saengsin ◽  
Minmin Lu ◽  
Lynn Sleeper ◽  
Tal Geva ◽  
Ashwin Prakash
Keyword(s):  
Late Gadolinium Enhancement ◽  
Tetralogy Of Fallot ◽  
Gadolinium Enhancement ◽  
Rate Of Progression ◽  
The Mean ◽  
Linear Regression Modeling ◽  
Group 2 ◽  
Over Time ◽  
Group 1

Abstract Background Right ventricular (RV) late gadolinium enhancement (LGE) occurs due to surgical scarring and RV remodeling, and has been shown to be associated with clinical outcomes in Tetralogy of Fallot (TOF). However, it is not known if cardiovascular magnetic resonance (CMR) LGE extent progresses over time, and therefore, it is not known if serial reassessment of LGE is necessary. We determined the rate of progression in the extent of RV LGE on serial CMR examinations in repaired TOF. Methods Retrospective review of 127 patients after TOF repair (49% male, median age at first CMR 18.9 years (Interquartile range (IQR) 13.3,27.0) who had at least two CMRs (median follow-up duration of 4.0 years (IQR 2.1,5.9)) was performed. 84/127 patients had no interventions between serial CMRs (Group 1) while 43/127 patients had transcatheter or surgical intervention between CMRs (Group 2). The extent of RV LGE was assessed using 2 methods: a semiquantitative RV LGE score and a quantitative RV LGE extent expressed as % of RV mass. Mixed effects linear regression modeling to estimate changes in LGE over time. Results RV LGE was present in all patients on the first CMR. % RV LGE extent and LGE score did not increase over time in either patient group. The mean 5 year rates of change were small and negative for both % RV LGE extent [− 2.3 (95% CI − 2.9, − 1.8, p < 0.001) in Group 1, and − 1.9 (95% CI − 3.2, − 0.7, p = 0.004) in Group 2], and RV LGE score [− 0.9 (95% CI − 1.1, − 0.6, p < 0.001) in Group 1, and − 0.5 (95% CI − 1.1, − 0.0, p = 0.047) in Group 2]. Conclusions In this serial CMR evaluation of children and adults with repaired TOF, no significant progression in the extent of RV LGE was seen on intermediate term follow-up. Given recent concerns regarding the safety of gadolinium-based contrast agents, frequent assessment of LGE may not be necessary in follow-up.

scholarly journals The first-phase ejection fraction - association with outcome in aortic valve stenosis

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
R Carter-Storch ◽  
NSB Mortensen ◽  
NL Christensen ◽  
M Ali ◽  
K Laursen ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Late Gadolinium Enhancement ◽  
Aortic Valve ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Primary Outcome ◽  
Wall Stress ◽  
Left Ventricular ◽  
P Value ◽  
Gadolinium Enhancement

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Danish Heart Association. Background First-phase ejection fraction (EF1), the ejection fraction (EF) until the time of peak systolic flow may be a sensitive marker of subclinical left ventricular (LV) dysfunction. This study investigated the prognostic value of EF1 in asymptomatic and symptomatic severe aortic stenosis (AS). Methods This study included 94 asymptomatic and 108 symptomatic patients with severe AS. The prognostic value of EF1 was compared with other echocardiographic markers and magnetic resonance imaging (MRI) measured end-systolic wall stress and late gadolinium enhancement fibrosis (LGE). Asymptomatic patients were followed up for 3.0 years (primary outcome death or aortic valve replacement). Symptomatic patients were followed up for 4.3 years (primary outcome death). Results In multivariate regression analysis wall stress (p &lt; 0.001) and LGE (p = 0.03) were associated with EF1. In the asymptomatic cohort EF1 was significantly associated with the end-point, especially among the subgroup of patients with a mean gradient &lt; 40 mmHg (HR 0.91, p = 0.005), while global longitudinal strain was not. In the surgical cohort, EF1 was borderline associated with death (p = 0.08) which was significant after correction for LGE (HR 0.90, p = 0.02). Conclusion EF1 is a predictor of death or AVR in asymptomatic AS, especially among discordantly graded patients with low area and low gradient. Univariate β (95% CI) p-value Multivariate β (95% CI) p-value Age (years) .03 (-.09 to .16) 0.58 .03 (-.12 to .18) 0.69 Sex (male) -.12 (-2.26 to 2.03) 0.91 .24 (-2.31 to 2.80) 0.85 Hypertension -.08 (-2.22 to 2.07) 0.95 Aortic valve area (0.01 cm2) .09 (.04 to .14) 0.001 Aortic mean gradient (mmHg) -.02 (-.08 to .04) 0.56 LV end-diastolic volume (ml) -.07 (-.11 to -.03) &lt;0.001 LV end-systolic volume (ml) -.17 (-.22 to -.12) &lt;0.001 -.07 (-.15 to .02) 0.11 LV ejection fraction (%) .28 (.19 to .38) &lt;0.001 LV peak ejection time (ms) -.07 (-.16 to .02) 0.13 LGE fibrosis -3.04 (-5.67 to -.42) 0.02 -2.64 (-4.99 to -.30) 0.03 Wall stress (kdynes/m3) -.10 (-.13 to -.08) &lt;0.001 -.08 (-.12 to -.04) &lt;0.001 Multivariate linear regression analysis for associations with first phase ejection fraction. LV is left ventricular, LGE late gadolinium enhancement Abstract Figure. AVR-free survival according to EF1

scholarly journals Septal late gadolinium enhancement on Cardiac MRI predicts failure to achieve left bundle pacing

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
NADINE Ali ◽  
AD Arnold ◽  
AA Miyazawa ◽  
D Keene ◽  
NS Peters ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Cardiac Mri ◽  
Left Ventricular ◽  
Cardiac Conduction ◽  
Ventricular Septum ◽  
Cardiac Resynchronization ◽  
Rank Test ◽  
P Value ◽  
Gadolinium Enhancement ◽  
Pacing Lead

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Background; Left bundle area pacing is a novel technique that provides direct stimulation of cardiac conduction tissue in order to deliver physiological ventricular activation. The approach for left bundle area pacing is transseptal lead implantation, where the lead is advanced from the right ventricular side of the septum to the left ventricular side to capture the proximal left bundle. Observational data suggests that whilst this is a safe and feasible method, implant success rate is not 100%, and appears to be lower in patients with a cardiac resynchronization therapy (CRT) indication rather than a bradycardia indication for pacing. The mechanisms for failure to advance the lead through the ventricular septum are not well understood. Purpose; We used pre-procedural CMR to determine whether there are features which can help identify patients where lead implantation may be challenging.  We assessed whether the extent and location of septal late gadolinium enhancement identified patients in whom left bundle area pacing will be challenging.  We hypothesized that the presence of extensive scar in the septum impedes advancing the lead to the left ventricular septum and prevents capture of the left bundle. Methods; Patients underwent cardiac MRI including motion corrected free-breathing late gadolinium enhancement imaging1 before implantation.  Scar was quantified using the full height half maximum method and expressed as the overall proportion of myocardial mass in the basal anteroseptal and basal inferoseptal segments, as shown in Figure 1.  Left bundle area pacing was then attempted in patients with a CRT indication for pacing.  We compared the extent of septal scar between patients in whom left bundle area pacing was achieved and those where there was failure to advance the lead deep into the septum. Results; 12 patients (11 male, 1 female), with average age 72 (IQR 63 to 78) and LVEF 30% (IQR 26 to 33) were studied.  There was failure to advance the lead deep into the septum in 4 patients.  There was a significantly higher basal septal scar burden in those patients where there was failure to advance the left bundle lead compared to those in which left bundle capture was achieved as shown in Figure 2 (median 55% and 5% respectively, p-value 0.02 by Wilcoxon signed rank test). Conclusion; The presence and extent of late gadolinium enhancement in the basal septum appears to be an important determinant of successful implantation of left bundle pacing lead using current implant technology. This may be because extensive septal scar prevents advancement of the pacing lead through the septum. Cardiac MRI before left bundle area pacing is likely to be useful in procedural planning.

P89 Role of inflammation as a risk factor for atrial fibrillation in rheumatic mitral stenosis and its correlation with atrial late gadolinium enhancement (LGE) on cardiac MRI

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
M A Malik ◽  
G Sharma ◽  
K P Ganga ◽  
S Sharma
Keyword(s):  
Atrial Fibrillation ◽  
Late Gadolinium Enhancement ◽  
Sinus Rhythm ◽  
Cardiac Mri ◽  
Mitral Stenosis ◽  
Inflammatory Markers ◽  
P Value ◽  
Gadolinium Enhancement ◽  
Rheumatic Mitral Stenosis ◽  
Show Evidence

Abstract Funding Acknowledgements ICMR Aims Association of atrial fibrillation (AF) is a common cause of morbidity and mortality in patients with rheumatic heart disease (RHD). Association of Atrial Fibrillation with inflammation is well delineated in nonvalvular AF as compared to Rheumatic AF. This study evaluated the presence of atrial inflammation, in patients with AF and rheumatic mitral stenosis (MS), using cardiac MRI and its correlation with inflammatory markers. Methods and Results Twenty RHD patients with predominant mitral stenosis were recruited for the study. Ten patients had persistent AF, three had paroxysmal AF and seven were in sinus rhythm. Patients with AF had lower mitral valve areas. Cardiac MRI showed evidence of late gadolinium enhancement (LGE) in the atrial wall in 61.54% (8/13) of patients with AF as compared with only 20% (1/5; p &lt; 0.05) of patients in sinus rhythm. Mean levels of IL-6 were also significantly higher in patients with AF (10.62 ± 5.92 pg/mL versus 4.37 ± 2.68 pg/mL; P= 0.017). IL6 with a cutoff of ≥ 6.5 pg/mL was associated with a sensitivity of 76.92 % and specificity of 71.43 % for prediction of AF. There was also significant association between high IL-6 levels and LGE on MRI (13.13 ± 5.75 pg/mL vs 5.29 ± 3.23pg/mL; P &lt; 0.05) Conclusion Patients with MS who developed AF show evidence of atrial inflammatory sequelae in the form of fibrosis as suggested by LGE on cardiac MRI. Systemic inflammation in the form of elevated IL-6 levels correlated significantly with atrial fibrosis and AF. Table 1: MS patients with or without AF Clinical Features Rhythm P-Value NSR (n = 7) AF (n = 13) Mean Valve Area (cm2) 1.28 ± 0.35 0.83 ± 0.26 &lt; 0.01 Mean Diastolic Gradient (mmHg) 6.29 ± 2.2 11.92 ± 5.65 &lt;0.01 Wilkin Score 7 ± 0.816 8.46 ± 1.66 0.04 LVEF % (non indexed) 59.57 ± 1.13 58.77 ± 2.89 0.49 LA Volume with MRI (ml) 127.50 ± 51.32 284.33 ± 133.12 &lt;0.01 Inflammatory Markers hs-CRP (mg/L) 5.59 ± 3.89 3.94 ± 3.47 0.34 IL6 (pg/mL) 4.37 ± 2.68 10.62 ± 5.92 0.017 sCD-40L (ng/mL) 3.72 ± 3.73 4.77 ± 2.80 0.48 Atrial LGE 0 (0%) 8 (61.5%) 0.04 Abstract P89 Figure. Image 1: Cardiac MRI showing LGE

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