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Jiali Wang¹, Kai Xu¹, Chunfeng Hu¹, Yankai Meng¹, Shuguang Han¹, Yuan Lu¹, Peng Wu², Lu Han², and Yongzhou Xu^3
1The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China, ²Philips Healthcare, Shanghai, China, ³Philips Healthcare, Guangzhou, China

Keywords: Myocardium, Ischemia, T1 mapping

ST-segment elevation myocardial infarction (STEMI) remains a major cause of morbidity and mortality worldwide, effective risk stratification is crucial for the management of STEMI. This study sought to investigate the predictive value of total ischemic time (symptom onset to balloon, S2B), native T1 and extracellular volume (ECV) in STEMI patients undergoing primary percutaneous coronary intervention (PCI). We found regardless of microvascular obstruction (MVO) or not, ECV in myocardial infarction (ECV_MI) was significantly correlated with S2B time, while native T1 was not. In the 4-month follow-up, ECV_MI was independently associated with final larger infarct size in multivariable regression analysis.

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Tom Dresselaers^1,2, Baptiste Vande Berg¹, Sofie Tilborghs^3,4, Alexandru Cernicanu⁵, and Jan Bogaert^1,2
1Radiology, UZ Leuven, Leuven, Belgium, ²Dept. of Imaging and Pathology, KU Leuven, Leuven, Belgium, ³Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium, ⁴Medical Imaging Research Center, UZ Leuven, Leuven, Belgium, ⁵Philips Benelux, Eindhoven, Netherlands

Keywords: Heart, Radiomics

Several studies suggest that radiomics of non-contrast cine balanced steady-state free precession (bSSFP) images allows to detect myocardial infarct patients. Relevant radiomic features vary however without clear knowledge of the underlying causes. Most studies rely on time consuming manual contouring on use end-diastolic images while it was shown that features vary through the heart cycle. In this study we show that radiomics of end-systolic images result in a higher classification accuracy than for end-diastolic images and produce the same result when relying on commercial automated contouring.

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Sonia Borodzicz-Jazdzyk^1,2, Roel Hoek¹, Caitlin Vink¹, Luuk Hopman¹, Mark Hofman³, Yvemarie Somsen¹, Ruben de Winter¹, Paul Knaapen¹, Mitchel Benovoy⁴, and Marco Gotte^1
1Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands, ²1st Chair and Department of Cardiology,, Medical University of Warsaw, Warsaw, Poland, ³Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Amsterdam, Netherlands, ⁴Area19 Medical Inc, Montreal, QC, Canada

Keywords: Atherosclerosis, Perfusion

Recently, a fully automated QP CMR workflow has been established, which provides measures of stress MBF according to a 32-segmentation model with subdivision into endo- and epicardial subsegments. We compared the diagnostic accuracy of QP CMR according to the standard AHA 16-segment model (16M-QP) and the newly developed automated 32-segment model (32M-QP) with conventional visual assessment in patients who underwent adenosine stress perfusion CMR imaging followed by invasive coronary angiography and/or coronary computed tomography angiography. Our preliminary data have not shown superiority of diagnostic accuracy of 16M-QP or 32M-QP in comparison to visual assessment of adenosine stress first-pass perfusion imaging.

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Jiali Wang¹, Kai Xu¹, Chunfeng Hu¹, Yankai Meng¹, Shuguang Han¹, Yuan Lu¹, Peng Wu², Lu Han², and Yongzhou Xu^3
1The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China, ²Philips Healthcare, Shanghai, China, ³Philips Healthcare, Guangzhou, China

Keywords: Myocardium, Ischemia

Early reperfusion and early evaluation of cardiac adverse left ventricular remodeling (ALVR) have become important aspects of treatment for ST-segment elevation myocardial infarction (STEMI) post-percutaneous coronary intervention (PCI). The aim of this study was to investigate the predictive value of emergency medical service (EMS) delays on the severity of myocardial injury in STEMI patients after PCI. Cardiac magnetic resonance (CMR) cine, myocardial strain, and scar characteristics were analyzed. The first medical contact to balloon (FMC2B) time was recorded. FMC2B time > 90 min led to poor recovery of cardiac function and was an independent predictor of ALVR.

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Yanan Zhao¹, Jianing Cui¹, Xiuzheng Yue², Sicong Huang², Yun Kang², and Tao Li^1
1Department of Radiology, The First Medical Center of PLA General Hospital, Beijing, China, ²Philips Healthcare(Beijing), Beijing, China

Keywords: Heart, Heart, right ventricular dysfunction; machine learning techniques; ST-Segment-Elevation myocardial infarction

In clinical work, right ventricular (RV) dysfunction has been ignored in acute ST-Segment-Elevation myocardial infarction (STEMI) patients. And previous studies have shown the interaction between left ventricular (LV) and RV. The aim of this study was to assess RV function by cardiovascular magnetic resonance feature tracking (CMR-FT) and to explore what factors affect RV dysfunction by machine learning techniques. The results showed that the incidence of RV dysfunction was 32.28% in STEMI patients and the occurrence of RV dysfunction was associated with RV end-systolic volume index, LV ejection fraction (EF), and interventricular septum radial strain by machine learning technique.

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Xin Liu¹, Lu Liang¹, Jing An², Chen Zhang³, Karl-Philipp Kunze⁴, Radhouene Neji⁴, René M Botnar⁵, Claudia Prieto⁵, and Qi Yang^1
1Radiology, Beijing Chaoyang Hospital, Beijing, China, ²Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China, ³China MR Scientific Marketing, Siemens Healthineers, Beijing, China, ⁴MR Research Collaborations, Siemens Healthcare Limited, Camberley, United Kingdom, ⁵School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom

Keywords: Myocardium, Myocardium

Bright- and black-blood MRI sequences provide multi-contrast information for myocardial assessment in patients with acute ST-segment-elevation myocardial infarction (STEMI). A free-breathing 3D whole-heart bright-blood and black-blood phase sensitive (BOOST) inversion recovery sequence has been recently proposed for a simultaneous multi-contrast high-quality depiction of cardiac and vascular structures without contrast agent injection. In this study, we applied this sequence to visualize reperfusion injury in 10 patients with STEMI. Good agreement in microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) visualization was observed between the proposed approach and traditional 2D imaging methods in patients, promising potential integration into clinical treatment workflow.

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Bin Li^1,2, Guohai Su^1,2, Qiang Wang¹, Jian Wang³, Xiuzheng Yue⁴, Yingjie Ma¹, Peng Wang¹, Yang Li¹, and Jing Tian^1
1Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China, ²Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China, ³Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China, ⁴Philips Healthcare, Beijing, Beijing, China

Keywords: Myocardium, Cardiovascular, Acute ST-segment elevation myocardial infarction

With the development of the emergency system, we can see more and more acute ST-segment elevation myocardial infarction patients with preserved left ventricular ejection fraction.the predictive value of myocardial strain as determined by cardiac magnetic resonance (CMR) for myocardial infarct size could not been clarified by previous investigations in STEMI patients with preserved LVEF. The present study reveals incremental value of global circumferential strain (GCS), determined by CMR, for the prediction of infarction size after STEMI, above and beyond LVEF as well as global longitudinal strains. The findings of this study suggest that GCS may represents a potential marker of infarct size and may be used to better guide drug therapy. It may be beneficial to use GCS to determine the infarct size and prognosis of post-MI patients who do not qualify for contrast imaging.

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Sophia Swago¹, Elizabeth W. Thompson¹, Annefleur Loth², Abhijit Bhattaru³, Brianna F. Moon¹, Giovanni Ferrari⁴, Estibaliz Castillero⁴, Victor A. Ferrari⁵, Robert Gorman⁶, Cory Tschabrunn⁷, Robert Mach³, Joel Karp³, Walter R. Witschey³, and Paco Bravo^3
1Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States, ²Amsterdam Medical Centre, University of Amsterdam (AMC-UvA), Amsterdam, Netherlands, ³Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States, ⁴Department of Surgery, Columbia University, New York City, NY, United States, ⁵Department of Medicine and Penn Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA, United States, ⁶Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States, ⁷Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States

Keywords: Myocardium, Ischemia

Additional myocardial injury can occur after reestablishing blood flow post ischemia. We use a multimodal protocol of sequential quantitative susceptibility mapping and positron emission tomography to directly image reactive oxygen species (ROS) and tissue iron in vivo in pig hearts after ischemic injury. We found that ROS was increased in infarct compared to remote regions of the myocardium in all animals. In an animal with microvascular obstruction, we observed an increase in susceptibility measured by QSM in the infarct region, indicating increased tissue iron, but no increased susceptibility was seen in the animals without microvascular obstruction.

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Sadi Loai^1,2, Beiping Qiang³, Michael A. Laflamme^3,4,5, and Hai-Ling Margaret Cheng^1,2,6
1Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada, ²Translational Biology & Engineering Program, Ted Rogers Centre for Heart Research, Toronto, ON, Canada, ³McEwen Stem Cell Institute, University Health Network, Toronto, ON, Canada, ⁴Laboratory of Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada, ⁵Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada, ⁶The Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada

Keywords: Vessels, Perfusion

Coronary microvascular dysfunction is driven by vascular inflammation and can go undetected for years. Current imaging diagnostics lack the ability to quantify microvascular vasomodulation, a potential biomarker for cardiac diseases dominated by microvascular disease. We propose a novel MRI approach that utilizes elevated carbon dioxide and a blood-pool contrast agent to quantify changes in microvascular blood volume. Our results confirmed hypercapnia caused strong vasodilation within female myocardium but no response in males. Transitioning from hypercapnia to room air elicited strong vasoconstriction in both sexes.  This technology will be valuable for early detection of microvascular dysfunction in various diseases.  

 

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Tom Dresselaers^1,2, Baptiste Vande Berg¹, Sofie Tilborghs^3,4, Alexandru Cernicanu⁵, and Jan Bogaert^1,2
1Radiology, UZ Leuven, Leuven, Belgium, ²Dept. of Imaging and Pathology, KU Leuven, Leuven, Belgium, ³Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium, ⁴Medical Imaging Research Center, UZ Leuven, Leuven, Belgium, ⁵Philips Benelux, Eindhoven, Netherlands

Keywords: Myocardium, Cardiomyopathy, infarction

Pre-contrast balanced steady-state free precession (bssfp) cine images seem to contain sufficient information to identify patients with an acute or chronic myocardial infarction using radiomics or deep learning methods. The reason remains however to be elucidated. It is also unclear if the cardiac phase should be considered although radiomics features vary through the heart cycle. In this study we show that the known global myocardial bssfp signal intensity variations observed in healthy subject are in fact segment dependent and have a reproducible three peak profile. In patients with acute myocardial infarct these profiles shows segment dependent alterations vs. controls.

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Alena Kollmann¹, David Lohr¹, Maya Bille¹, Maxim Terekhov¹, Michael Hock¹, Ibrahim Elabyad¹, Florian Schnitter², Wolfgang Bauer^1,2, Ulrich Hofmann², and Laura Maria Schreiber^1
1Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany, ²Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany

Keywords: Myocardium, Ischemia

Late gadolinium enhancement (LGE) is considered the gold standard for the quantification of scar size. We tested in a large animal model of acute and chronic infarction if clinically used methods for the assessment of infarct size (manual planimetry and several semi-automatic approaches) in LGE images are applicable to preclinical 7T LGE imaging of porcine hearts. We found excellent intra-observer reproducibility for all methods. The tested semi-automatic methods performed differently on magnitude (MAG) and phase-sensitive inversion recovery (PSIR) images. Overall, infarct sizes measured in in vivo scans showed good correlation to ex vivo LGE measurements.

Xuefang Lu¹, Weiyin Vivian Liu², Guangnan Quan³, Changsheng Liu¹, Yuchen Yan¹, Wei Gong¹, Yilin Zhao¹, Zhoufeng Peng¹, and Yunfei Zha^1
1Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China, ²GE Healthcare, MR Research China, Beijing, China, ³GE Healthcare, Beijing, China

Keywords: Myocardium, Ischemia, strain

Preclinical disease is primarily assessed through the coronary artery calcium score (CACS) and used for risk assessment. Our study demonstrated that the moderate correlation of the CACS and strain, suggesting atrial or ventricular myocardium and vascular changes influence each other. In addition, there were statistically different strain values between CAD and non-CAD patients. Strain analysis for cine CMR can add functional information such as chamber wall movement on early prediction of myocardium abnormities like myocadiac ischemia and be beneficial to patients who receive one-stop check-ups for less imaging time, no contrast, and radiation-free screening.

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Anna V Naumova¹ and William S Kerwin^1
1Radiology, University of Washington, Seattle, WA, United States

Keywords: Myocardium, Heart, myocardial infarction

A new tagging method has been proved as a sensitive approach for assessment of regional deformation in the infarcted pig’s heart. The linear tags were placed in 60-degree pattern offsets and aligned with the AHA segments. The tagging analysis algorithm uses local Fourier transformation of the isolated spectral peaks. We have shown the temporal changes in circumferential strain of the infarcted segments of myocardium and faster recovery of myocardial strain followed by 60-min ischemia-reperfusion injury in comparison with 90-min. Circumferential strain was a more sensitive parameter for earlier detection of regional contractile dysfunction in comparison with ejection fraction.

Zi-Yi Gu¹, Wei-Bo Chen², Yong-Yi Wang¹, and Lian-Ming Wu^3
1Department of Cardiovascular Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China, ²Philips Healthcare, Shanghai, China, ³Department of Radiology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Keywords: Heart, Heart, HFpEF

HFpEF patients with multivessel CAD have changes in myocardial trabecular complexity. The left ventricular FD obtained with fractal analysis can reflect the complexity of myocardial trabecular and has an independent predictive value for the diagnosis of HFpEF in patients with multivessel CAD. Including FD into the diagnostic model can help improve the diagnosis.

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Blake Benyard¹, Sophia Swago ¹, Neil E. Wilson¹, Paul S. Jacobs¹, Walter Witschey¹, Mohammed Harris¹, and Ravinder Reddy^1
1Center for Advanced Metabolic Imaging in Precision Medicine (CAMIPM), Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States

Keywords: Myocardium, Heart, CEST & MT

Two ex-vivo animal hearts were scanned at 7T to track lipid and macromolecular changes using NOE_MTR and rNOE. Data was acquired on a fresh lamb heart and a healthy Yorkshire swine with an anteroseptal infarct by occlusion of the left anterior descending (LAD) coronary artery. After performing a multi-pool analysis, it is demonstrated that the NOE_MTR and rNOE signal decreases in the infarcted region of the swine heart compared to the normal tissue and lamb heart. 

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Jing Xu¹, Zhao Shihua¹, and Minjie Lu^1
1Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Beijing, China

Keywords: Myocardium, Heart

ATP can cause a pronounced positive inotropic effect on human heart. CMR-FT even at rest provides an excellent negative predictive value for myocardial ischemia and infarction in patients with CAD. CMR-FT is easy to perform without the need for dedicated acquisition and complex post-processing which can be applied to standard CMR cine sequences. Rest myocardial strain might be a noninvasive option serving as an additional gatekeeper for CAD patients with a needle-free test. Human studies are needed to validate these findings in a multicenter setting and to test whether CMR-FT can be incorporated into clinical guidelines.

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Sophia Swago¹, Jacob Smothers², Neil E. Wilson³, Mark A. Elliott³, Ravi Prakash Reddy Nanga³, Robert Gorman⁴, Cory Tschabrunn⁵, Arjun Sengupta⁶, Aalim Weljie⁶, Ravinder Reddy³, and Walter R. Witschey^3
1Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States, ²Department of Chemistry, West Virginia University, Morgantown, WV, United States, ³Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States, ⁴Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States, ⁵Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States, ⁶School of Medicine, University of Pennsylvania, Philadelphia, PA, United States

Keywords: Myocardium, Spectroscopy

Growing interest into in vivo 1H MRS of downfield metabolites (>4.7 ppm) has necessitated greater understanding of the metabolite contributions of peaks found in the downfield. 1H NMR provides high-SNR, high-spectral resolution data that can aid in the identification of metabolite resonances. We collected downfield NMR spectra at 700 MHz from infarct and remote myocardium extract of pig hearts after myocardial infarction. We were able to assign peaks to NAD+, NADH, ATP, and AMP in the downfield region and quantified these metabolites in infarct and remote myocardium.

Xuefang Lu¹, Yuchen Yan¹, Weiyin Vivian Liu², Changsheng Liu¹, Wei Gong¹, Yan Wang¹, Zhoufeng Peng¹, Guangnan Quan³, and Yunfei Zha^1
1Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China, ²GE Healthcare, MR Research China, Beijing, China, ³General Electric Medical (China) Co, Beijing, China

Keywords: Myocardium, Machine Learning/Artificial Intelligence, late gadolinum enhancement

Preclinical disease is primarily assessed through the coronary artery calcium score (CACS) and used for risk assessment, screening CACS is a reliable indicator for the assessment of coronary artery disease in our study, FWHM analysis of PSMDE_DL and PSMDE_O showed moderate correlation between the percentage of enhancement area and CACS, beneficial for check-up with less imaging time and low radiation screening. This finding should be further validated in a larger sample size. Moreover, threshold techniques such as 2SD to 5SD were sensitive to signal intensity and should be concerned for analysis on deep-learning reconstructed images, especially missing detection rate.

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Jianing Cui¹, Tao Li¹, Xiuzheng Yue², Sicong Huang², Yun Kang², and Fei Yan^1
1Radiology, the First Medical center, PLA General Hospital, Beijing, China, ²Philips Healthcare, Beijing, China

Keywords: Heart, Heart, reverse left ventricular remodeling

Radiomics is an emerging quantitative imaging method that could extract mineable high-dimensional data from medical images. We investigate the suitable models and significant radiomics features of LGE images in participants with STEMI and assess their value in predicting r-LVR. We chose 17 classification models to analyze all the adiomics features of LGE images in participants with STEMI. Our study found that the model of extra tree classifier was manifested relatively high AUC value in predicting r-LVR. The wavelet-HHH_gldm_SmallDependenceLowGrayLevelEmphasis was relatively strong predictor of r-LVR.

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Yanbing Yang¹, Xiuzheng YUE², Fang Wang³, and Yishi Wang^2
1People's Hospital of Ningxia Hui Autonomous Region, yinchuan, China, ²Philips Healthcare, beijing, China, ³People's Hospital of Ningxia Hui Autonomous Region, yinchaung, China

Keywords: Cardiomyopathy, Cardiomyopathy

The current reference standard for detection of myocardial scar tissue is late gadolinium enhancement(LGE). Cardiac magnetic resonance T 1 mapping is a technique that enables quantification of extracellular volume fraction (ECV). Calculating ECV mapping need to inject gadolinium contrast agent, which may be contraindicated in some patients. For those patients, T1rho contrast may help them find the changes in myocardial because T1rho MRI has been used to detect early myocardial infraction in swine model. In this study, we used T1rho to assess myocardial changes in patients with early CHD with a view to finding Grey zone of LGE positive patients.