Goran Abdula, Joao G Ramos, David Marlevi, Alexander Fyrdahl, Henrik Engblom, Peder Sörensson, Daniel Giese, Ning Jin, Andreas Sigfridsson, Martin Ugander
Abstract Aims Non-invasive estimation of mean pulmonary artery pressure (mPAP) by cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow analysis has shown excellent agreement with invasive right heart catheterization. However, clinical application is limited by relatively long scan times. Therefore, the aim of this study was to evaluate the accuracy and time reduction of compressed sensing (CS) accelerated acquisition for mPAP estimation. Methods and results Patients (n = 51) referred for clinical CMR at 1.5 T or 3 T underwent imaging with both a prototype CS-accelerated and a non-CS-accelerated flow sequence acquiring time-resolved multiple 2D slice phase-contrast three-directional velocity-encoded images covering the pulmonary artery. Prototype software was used for the blinded analysis of pulmonary artery (PA) vortex duration to estimate mPAP as previously validated. CS-accelerated and non-CS-accelerated acquisition showed increased mPAP in 22/51 (43%) and 24/51 (47%) patients, respectively. The mean bias for estimating mPAP between the two methods was 0.1 ± 1.9 mmHg and the intraclass correlation coefficient was 0.97 (95% confidence interval 0.94–0.98). Effective scan time was lower for the CS-accelerated acquisition (1 min 55 s ± 27 s vs. 9 min 6 s ± 2 min 20 s, P < 0.001, 79% reduction). Conclusions CS-accelerated CMR acquisition enables preserved accuracy for estimating mPAP compared to a non-CS-accelerated sequence, allowing for an average scan time of less than 2 min. CS-acceleration thereby increases the clinical utility of CMR 4D flow analysis to estimate mPAP.
【摘要】目的利用心血管磁共振(CMR)四维血流分析无创估计平均肺动脉压(mPAP)与有创右心导管术具有良好的一致性。然而，临床应用受到相对较长的扫描时间的限制。因此，本研究的目的是评估压缩感知(CS)加速采集用于mPAP估计的准确性和减少时间。方法和结果51例在1.5 T或3t行临床CMR的患者接受了原型cs加速和非cs加速血流序列的成像，获得了覆盖肺动脉的时间分辨率多重二维切片相对比三方向速度编码图像。原型软件用于肺动脉(PA)漩涡持续时间的盲法分析，以估计先前验证的mPAP。cs加速和非cs加速获得分别显示22/51(43%)和24/51(47%)患者的mPAP增加。两种方法估计mPAP的平均偏倚为0.1±1.9 mmHg，类内相关系数为0.97(95%可信区间0.94 ~ 0.98)。cs加速采集的有效扫描时间较低(1 min 55 s±27 s vs. 9 min 6 s±2 min 20 s)， P <0.001，减少79%)。与非cs加速序列相比，cs加速CMR采集能够保持估计mPAP的准确性，允许平均扫描时间小于2分钟。因此cs加速增加了CMR 4D血流分析估计mPAP的临床实用性。
{"title":"Non-invasive estimation of mean pulmonary artery pressure by cardiovascular magnetic resonance in under 2 min scan time","authors":"Goran Abdula, Joao G Ramos, David Marlevi, Alexander Fyrdahl, Henrik Engblom, Peder Sörensson, Daniel Giese, Ning Jin, Andreas Sigfridsson, Martin Ugander","doi":"10.1093/ehjimp/qyad014","DOIUrl":"https://doi.org/10.1093/ehjimp/qyad014","url":null,"abstract":"Abstract Aims Non-invasive estimation of mean pulmonary artery pressure (mPAP) by cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow analysis has shown excellent agreement with invasive right heart catheterization. However, clinical application is limited by relatively long scan times. Therefore, the aim of this study was to evaluate the accuracy and time reduction of compressed sensing (CS) accelerated acquisition for mPAP estimation. Methods and results Patients (n = 51) referred for clinical CMR at 1.5 T or 3 T underwent imaging with both a prototype CS-accelerated and a non-CS-accelerated flow sequence acquiring time-resolved multiple 2D slice phase-contrast three-directional velocity-encoded images covering the pulmonary artery. Prototype software was used for the blinded analysis of pulmonary artery (PA) vortex duration to estimate mPAP as previously validated. CS-accelerated and non-CS-accelerated acquisition showed increased mPAP in 22/51 (43%) and 24/51 (47%) patients, respectively. The mean bias for estimating mPAP between the two methods was 0.1 ± 1.9 mmHg and the intraclass correlation coefficient was 0.97 (95% confidence interval 0.94–0.98). Effective scan time was lower for the CS-accelerated acquisition (1 min 55 s ± 27 s vs. 9 min 6 s ± 2 min 20 s, P &lt; 0.001, 79% reduction). Conclusions CS-accelerated CMR acquisition enables preserved accuracy for estimating mPAP compared to a non-CS-accelerated sequence, allowing for an average scan time of less than 2 min. CS-acceleration thereby increases the clinical utility of CMR 4D flow analysis to estimate mPAP.","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135703369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aims Transient ischaemic dilation (TID) is a marker of underlying extensive coronary artery disease (CAD) during myocardial perfusion imaging (MPI). The cut-off for a normal TID ratio (TIDr) value is often derived from a cohort of individuals with no apparent CAD. Varying criteria have been used to define the absence of CAD. We aim to derive TIDr cut-offs using patients with normal MPI and coronary artery calcium (CAC) score of zero, and compare the TIDr obtained from different software packages. Methods and results We studied 232 patients with zero CAC and normal MPI undergoing exercise or dipyridamole stress using either a 1- or 2-day protocol. All patients were scanned in the supine position with a cadmium-zinc-telluride camera. TIDr was automatically generated using quantitative perfusion SPECT (QPS) software initially, and subsequently using Myometrix for comparison. The TIDr cut-offs calculated using the mean + 2 standard deviation were 1.29 and 1.24 for the 1- and 2-day protocol groups, respectively. In patients undergoing a 2-day protocol, dipyridamole stress resulted in significantly higher mean TIDr when compared to exercise stress (1.07 ± 0.13 vs. 1.01 ± 0.12, P = 0.035). Myometrix-derived TIDr were also significantly lower compared to QPS-derived values for most protocols except for 2-day exercise stress. Conclusion This study is the first to derive TIDr threshold values using a normal population defined by zero CAC and normal MPI. TIDr was found to vary depending on stress modality, protocol as well as the software used.
目的在心肌灌注成像(MPI)中，短暂性缺血扩张(TID)是潜在的广泛冠状动脉疾病(CAD)的标志。正常TID比值(TIDr)值的临界值通常来源于无明显CAD的个体队列。不同的标准被用来定义CAD的缺失。我们的目标是使用MPI正常且冠状动脉钙(CAC)评分为零的患者获得TIDr截止值，并比较不同软件包获得的TIDr。方法和结果我们研究了232例CAC为零、MPI正常的患者，采用1天或2天的方案进行运动或双嘧达莫应激。所有患者均采用仰卧位镉锌碲化照相机进行扫描。最初使用定量灌注SPECT (QPS)软件自动生成TIDr，随后使用Myometrix进行比较。使用平均值+ 2标准差计算的1天和2天方案组的TIDr截止值分别为1.29和1.24。在接受2天方案的患者中，与运动应激相比，双嘧达莫应激导致的平均TIDr显著更高(1.07±0.13 vs 1.01±0.12,P = 0.035)。除2天运动应激外，大多数方案中肌内膜衍生的TIDr也显著低于qps衍生的值。本研究首次使用由零CAC和正常MPI定义的正常人群推导出TIDr阈值。发现TIDr根据应力模式，协议以及使用的软件而变化。
{"title":"Transient ischemic dilation ratio thresholds in patients with zero coronary calcium score undergoing exercise or dipyridamole stress SPECT myocardial perfusion imaging using a cadmium-zinc-telluride camera","authors":"Eran Wen Jun Sim, Min Sen Yew","doi":"10.1093/ehjimp/qyad013","DOIUrl":"https://doi.org/10.1093/ehjimp/qyad013","url":null,"abstract":"Abstract Aims Transient ischaemic dilation (TID) is a marker of underlying extensive coronary artery disease (CAD) during myocardial perfusion imaging (MPI). The cut-off for a normal TID ratio (TIDr) value is often derived from a cohort of individuals with no apparent CAD. Varying criteria have been used to define the absence of CAD. We aim to derive TIDr cut-offs using patients with normal MPI and coronary artery calcium (CAC) score of zero, and compare the TIDr obtained from different software packages. Methods and results We studied 232 patients with zero CAC and normal MPI undergoing exercise or dipyridamole stress using either a 1- or 2-day protocol. All patients were scanned in the supine position with a cadmium-zinc-telluride camera. TIDr was automatically generated using quantitative perfusion SPECT (QPS) software initially, and subsequently using Myometrix for comparison. The TIDr cut-offs calculated using the mean + 2 standard deviation were 1.29 and 1.24 for the 1- and 2-day protocol groups, respectively. In patients undergoing a 2-day protocol, dipyridamole stress resulted in significantly higher mean TIDr when compared to exercise stress (1.07 ± 0.13 vs. 1.01 ± 0.12, P = 0.035). Myometrix-derived TIDr were also significantly lower compared to QPS-derived values for most protocols except for 2-day exercise stress. Conclusion This study is the first to derive TIDr threshold values using a normal population defined by zero CAC and normal MPI. TIDr was found to vary depending on stress modality, protocol as well as the software used.","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135466131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Djawid Hashemi, Patrick Doeblin, Karl Jakob Weiss, Matthias Schneider-Reigbert, Rebecca Elisabeth Beyer, Corinna Else, Alessandro Faragli, Christian Stehning, Philipp Stawowy, Steffen Petersen, Chiara Bucciarelli-Ducci, Allison G Hays, Norbert Frey, Holger Thiele, Andreas Portmann, Eckart Fleck, Sebastian Kelle
Abstract Aims This study aims to evaluate the success of the cardiovascular magnetic resonance (CMR) imaging Academy Berlin’s transition from in-person to online CMR imaging training during the global pandemic 2020 and to gather recommendations for future courses. Methods and results We conducted an online survey targeting CMR course participants from both the pre-pandemic, in-person era and the pandemic, online era of the CMR Academy Berlin. The survey primarily used Likert-type questions to assess participants’ experiences and preferences. A total of 61 out of 158 invited participants (38.61%) completed the survey, with 31 (50.82%) being in-person alumni and 30 (49.18%) being online alumni. Both in-person [83.87% (26/31)] and online [83.33% (25/30)] participants rated the course as either ‘very good’ or ‘excellent’, and both groups found the course either ‘extremely helpful’ or ‘very helpful’. However, a higher percentage of in-person participants [96.77% (30/31)] felt comfortable asking questions compared to online participants [83.33% (25/30); P = 0.025]. The majority in both groups preferred a written exam [total: 75.41% (46/61); in-person alumni: 77.42% (24/31); online alumni 73.33% (22/30)]. In terms of course format preferences, in-person courses were preferred by both in-person alumni [38.71% (12/31)] and online alumni [60% (18/30)], almost as much as a hybrid format combining in-person and online elements [in-person alumni: 41.94% (13/31), online alumni: 30% (9/30)]. Conclusion The transition from in-person to online CMR training at the CMR Academy Berlin was successful in maintaining overall satisfaction. However, there is room for improvement in terms of increased interaction, particularly for online participants. Future CMR- and potentially also cardiac computer tomography-courses should consider adopting a hybrid format to accommodate participants’ preferences and enhance their learning experience, especially to gain level II competency, whereas level I virtual only might be sufficient.
{"title":"Virtual CMR training proves feasible and effective: Survey data from international participants of the CMR Academy Berlin, Germany","authors":"Djawid Hashemi, Patrick Doeblin, Karl Jakob Weiss, Matthias Schneider-Reigbert, Rebecca Elisabeth Beyer, Corinna Else, Alessandro Faragli, Christian Stehning, Philipp Stawowy, Steffen Petersen, Chiara Bucciarelli-Ducci, Allison G Hays, Norbert Frey, Holger Thiele, Andreas Portmann, Eckart Fleck, Sebastian Kelle","doi":"10.1093/ehjimp/qyad015","DOIUrl":"https://doi.org/10.1093/ehjimp/qyad015","url":null,"abstract":"Abstract Aims This study aims to evaluate the success of the cardiovascular magnetic resonance (CMR) imaging Academy Berlin’s transition from in-person to online CMR imaging training during the global pandemic 2020 and to gather recommendations for future courses. Methods and results We conducted an online survey targeting CMR course participants from both the pre-pandemic, in-person era and the pandemic, online era of the CMR Academy Berlin. The survey primarily used Likert-type questions to assess participants’ experiences and preferences. A total of 61 out of 158 invited participants (38.61%) completed the survey, with 31 (50.82%) being in-person alumni and 30 (49.18%) being online alumni. Both in-person [83.87% (26/31)] and online [83.33% (25/30)] participants rated the course as either ‘very good’ or ‘excellent’, and both groups found the course either ‘extremely helpful’ or ‘very helpful’. However, a higher percentage of in-person participants [96.77% (30/31)] felt comfortable asking questions compared to online participants [83.33% (25/30); P = 0.025]. The majority in both groups preferred a written exam [total: 75.41% (46/61); in-person alumni: 77.42% (24/31); online alumni 73.33% (22/30)]. In terms of course format preferences, in-person courses were preferred by both in-person alumni [38.71% (12/31)] and online alumni [60% (18/30)], almost as much as a hybrid format combining in-person and online elements [in-person alumni: 41.94% (13/31), online alumni: 30% (9/30)]. Conclusion The transition from in-person to online CMR training at the CMR Academy Berlin was successful in maintaining overall satisfaction. However, there is room for improvement in terms of increased interaction, particularly for online participants. Future CMR- and potentially also cardiac computer tomography-courses should consider adopting a hybrid format to accommodate participants’ preferences and enhance their learning experience, especially to gain level II competency, whereas level I virtual only might be sufficient.","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135466110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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