Browsing by Author "Milotta, Giorgia"

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    3D whole-heart grey-blood late gadolinium enhancement cardiovascular magnetic resonance imaging
    (2021) Milotta, Giorgia; Munoz, Camila; Kunze, Karl P.; Neji, Radhouene; Figliozzi, Stefano; Chiribiri, Amedeo; Hajhosseiny, R.; Masci, Pier Giorgio; Prieto Vásquez, Claudia; Botnar, René Michael
    Abstract Purpose To develop a free-breathing whole-heart isotropic-resolution 3D late gadolinium enhancement (LGE) sequence with Dixon-encoding, which provides co-registered 3D grey-blood phase-sensitive inversion-recovery (PSIR) and complementary 3D fat volumes in a single scan of < 7 min. Methods A free-breathing 3D PSIR LGE sequence with dual-echo Dixon readout with a variable density Cartesian trajectory with acceleration factor of 3 is proposed. Image navigators are acquired to correct both inversion recovery (IR)-prepared and reference volumes for 2D translational respiratory motion, enabling motion compensated PSIR reconstruction with 100% respiratory scan efficiency. An intermediate PSIR reconstruction is performed between the in-phase echoes to estimate the signal polarity which is subsequently applied to the IR-prepared water volume to generate a water grey-blood PSIR image. The IR-prepared water volume is obtained using a water/fat separation algorithm from the corresponding dual-echo readout. The complementary fat-volume is obtained after water/fat separation of the reference volume. Ten patients (6 with myocardial scar) were scanned with the proposed water/fat grey-blood 3D PSIR LGE sequence at 1.5 T and compared to breath-held grey-blood 2D LGE sequence in terms of contrast ratio (CR), contrast-to-noise ratio (CNR), scar depiction, scar transmurality, scar mass and image quality. Results Comparable CRs (p = 0.98, 0.40 and 0.83) and CNRs (p = 0.29, 0.40 and 0.26) for blood-myocardium, scar-myocardium and scar-blood respectively were obtained with the proposed free-breathing 3D water/fat LGE and 2D clinical LGE scan. Excellent agreement for scar detection, scar transmurality, scar mass (bias = 0.29%) and image quality scores (from 1: non-diagnostic to 4: excellent) of 3.8 ± 0.42 and 3.6 ± 0.69 (p > 0.99) were obtained with the 2D and 3D PSIR LGE approaches with comparable total acquisition time (p = 0.29). Similar agreement in intra and inter-observer variability were obtained for the 2D and 3D acquisition respectively. Conclusion The proposed approach enabled the acquisition of free-breathing motion-compensated isotropic-resolution 3D grey-blood PSIR LGE and fat volumes. The proposed approach showed good agreement with conventional 2D LGE in terms of CR, scar depiction and scan time, while enabling free-breathing acquisition, whole-heart coverage, reformatting in arbitrary views and visualization of both water and fat information.
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    3D whole-heart isotropic-resolution motion-compensated joint T-1/T(2)mapping and water/fat imaging
    (2020) Milotta, Giorgia; Bustin, Aurelien; Jaubert, Olivier; Neji, Radhouene; Prieto Vásquez, Claudia; Botnar, René Michael
    Purpose To develop a free-breathing isotropic-resolution whole-heart joint T1 and T2 mapping sequence with Dixon-encoding that provides coregistered 3D T1 and T2 maps and complementary 3D anatomical water and fat images in a single ~9 min scan. Methods Four interleaved dual-echo Dixon gradient echo volumes are acquired with a variable density Cartesian trajectory and different preparation pulses: 1) inversion recovery-preparation, 2) and 3) no preparations, and 4) T2 preparation. Image navigators are acquired to correct each echo for 2D translational respiratory motion; the 8 echoes are jointly reconstructed with a low-rank patch-based reconstruction. A water/fat separation algorithm is used to obtain water and fat images for each acquired volume. T1 and T2 maps are generated by matching the signal evolution of the water images to a simulated dictionary. Complementary bright-blood and fat volumes for anatomical visualization are obtained from the T2-prepared dataset. The proposed sequence was tested in phantom experiments and 10 healthy subjects and compared to standard 2D MOLLI T1 mapping, 2D balance steady-state free precession T2 mapping, and 3D T2-prepared Dixon coronary MR angiography. Results High linear correlation was found between T1 and T2 quantification with the proposed approach and phantom spin echo measurements (y = 1.1 × −11.68, R2 = 0.98; and y = 0.85 × +5.7, R2 = 0.99). Mean myocardial values of T1/T2 = 1116 ± 30.5 ms/45.1 ± 2.38 ms were measured in vivo. Biases of T1/T2 = 101.8 ms/−0.77 ms were obtained compared to standard 2D techniques. Conclusion The proposed joint T1/T2 sequence permitted the acquisition of motion-compensated isotropic-resolution 3D T1 and T2 maps and complementary coronary MR angiography and fat volumes, showing promising results in terms of T1 and T2 quantification and visualization of cardiac anatomy and pericardial fat.
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    Evaluation of myocarditis with a free-breathing three-dimensional isotropic whole-heart joint T1 and T2 mapping sequence
    (ELSEVIER SCIENCE INC, 2024) Hua, Alina; Velasco, Carlos; Munoz, Camila; Milotta, Giorgia; Fotaki, Anastasia; Bosio, Filippo; Granlund, Inka; Sularz, Agata; Chiribiri, Amedeo; Kunze, Karl P.; Botnar Rene, Michael; Prieto Vásquez, Claudia Del Carmen; Ismail, Tevfik F.
    Background: The diagnosis of myocarditis by cardiovascular magnetic resonance (CMR) requires the use of T2 and T1 weighted imaging, ideally incorporating parametric mapping. Current two-dimensional (2D) mapping sequences are acquired sequentially and involve multiple breath-holds resulting in prolonged scan times and anisotropic image resolution. We developed an isotropic free-breathing three-dimensional (3D) whole-heart sequence that allows simultaneous T1 and T2 mapping and validated it in patients with suspected myocarditis. Methods: Eighteen healthy volunteers and 28 patients with suspected myocarditis underwent conventional 2D T1 and T2 mapping with whole-heart coverage and 3D joint T1/T2 mapping on a 1.5T scanner. Acquisition time, image quality, and diagnostic performance were compared. Qualitative analysis was performed using a 4-point Likert scale. Bland-Altman plots were used to assess the quantitative agreement between 2D and 3D sequences. Results: The 3D T1/T2 sequence was acquired in 8 min 26 s under free breathing, whereas 2D T1 and T2 sequences were acquired with breath-holds in 11 min 44 s (p = 0.0001). All 2D images were diagnostic. For 3D images, 89% (25/ 28) of T1 and 96% (27/28) of T2 images were diagnostic with no significant difference in the proportion of diagnostic images for the 3D and 2D T1 (p = 0.2482) and T2 maps (p = 1.0000). Systematic bias in T1 was noted with biases of 102, 115, and 152 ms for basal-apical segments, with a larger bias for higher T1 values. Good agreement between T2 values for 3D and 2D techniques was found (bias of 1.8, 3.9, and 3.6 ms for basal-apical segments). The sensitivity and specificity of the 3D sequence for diagnosing acute myocarditis were 74% (95% confidence interval [CI] 49%-91%) and 83% (36%-100%), respectively, with a c-statistic (95% CI) of 0.85 (0.79-0.91) and no statistically significant difference between the 2D and 3D sequences for the detection of acute myocarditis for T1 (p = 0.2207) or T2 (p = 1.0000). Conclusion: Free-breathing whole-heart 3D joint T1/T2 mapping was comparable to 2D mapping sequences with respect to diagnostic performance, but with the added advantages of free breathing and shorter scan times. Further work is required to address the bias noted at high T1 values, but this did not significantly impact diagnostic accuracy.
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    High-Spatial-Resolution 3D Whole-Heart MRI T2 Mapping for Assessment of Myocarditis
    (2021) Bustin, Aurélien; Hua, Alina; Milotta, Giorgia; Jaubert, Olivier; Hajhosseiny, Reza; Ismail, Tevfik F.; Botnar, René Michael; Prieto Vásquez, Claudia
    Background: Clinical guidelines recommend the use of established T2 mapping sequences to detect and quantify myocarditis and edema, but T2 mapping is performed in two dimensions with limited coverage and repetitive breath holds.Purpose:To assess the reproducibility of an accelerated free-breathing three-dimensional (3D) whole-heart T2 MRI mapping se-quence in phantoms and participants without a history of cardiac disease and to investigate its clinical performance in participants with suspected myocarditis.Materials and Methods: Eight participants (three women, mean age, 31 years 6 4 [standard deviation]; cohort 1) without a history of cardiac disease and 25 participants (nine women, mean age, 45 years 6 17; cohort 2) with clinically suspected myocarditis underwent accelerated free-breathing 3D whole-heart T2 mapping with 100% respiratory scanning efficiency at 1.5 T. The participants were enrolled from November 2018 to August 2020. Three repeated scans were performed on 2 separate days in cohort 1. Segmental variations in T2 relaxation times of the left ventricular myocardium were assessed, and intrasession and intersession reproducibility were measured. In cohort 2, segmental myocardial T2 values, detection of focal inflammation, and map quality were compared with those obtained from clinical breath-hold two-dimensional (2D) T2 mapping. Statistical differences were assessed using the nonparametric Mann-Whitney and Kruskal-Wallis tests, whereas the paired Wilcoxon signed-rank test was used to assess subjective scores.Results: Whole-heart T2 maps were acquired in a mean time of 6 minutes 53 seconds 6 1 minute 5 seconds at 1.5 mm3 resolution. Breath-hold 2D and free-breathing 3D T2 mapping had similar intrasession (mean T2 change of 3.2% and 2.3% for 2D and 3D, respectively) and intersession (4.8% and 4.9%, respectively) reproducibility. The two T2 mapping sequences showed similar map quality (P = .23, cohort 2). Abnormal myocardial segments were identified with confidence (score 3) in 14 of 25 participants (56%) with 3D T2 mapping and only in 10 of 25 participants (40%) with 2D T2 mapping.Conclusion: High-spatial-resolution three-dimensional (3D) whole-heart T2 mapping shows high intrasession and intersession repro-ducibility and helps provide T2 myocardial characterization in agreement with clinical two-dimensional reference, while enabling 3D assessment of focal disease with higher confidence.