Browsing by Author "Prieto Vásquez, Claudia Del Carmen"

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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-resolution automated free-breathing coronary magnetic resonance angiography in comparison with coronary computed tomography angiography
    (2025) Wood, Gregory; Uglebjerg Pedersen, Alexandra; Linde Nørgaard, Bjarne; Alcaraz Frederiksen, Christian; Møller Jensen, Jesper; Kunze, Karl-Philipp; Neji, Radhouene; Wetzl, Jens; Prieto Vásquez, Claudia Del Carmen; Botnar, Rene Michael; Yong Kim, Won
    Aims Clinical implementation of coronary magnetic resonance angiography (CMRA) is limited due to variability in image quality. A protocol utilizing an image navigator (iNAV) integrated with automated scan planning has been developed to facilitate consistent diagnostic image quality. The aim of this study was to evaluate the agreement of automated iNAV CMRA compared with coronary computed tomography angiography (CCTA) using Coronary Artery Disease-Reporting and Data System (CAD-RADS) to classify coronary artery disease (CAD). Methods and results Ninety-five individuals underwent automated iNAV CMRA at a resolution of 0.7 mm3 with a deep learning–assisted automated scan planning and trigger-delay detection protocol. CMRA and CCTA data sets were analysed using CAD-RADS to classify the per-patient severity of CAD. Additionally, the accuracy of both imaging modalities in predicting referral for invasive coronary angiography (ICA) and coronary revascularization was assessed. CMRA classification for CAD-RADS ≥ 1, ≥2, ≥3, and ≥4 agreed with CCTA for 80%, 73%, 63%, and 70% of cases, respectively. The area under the receiver operating characteristic curves with CAD-RADS ≥ 4 and ≥3 for CMRA and CCTA were comparable in predicting ICA referral (0.75 vs. 0.70, P = 0.687, and 0.70 vs. 0.70, P = 0.945) and revascularization (0.72 vs. 0.74, P = 0.811, and 0.68 vs. 0.76, P = 0.089). Conclusion A novel automated iNAV CMRA protocol was implemented, investigating individuals at risk of CAD. Using the CAD-RADS classification, there was moderate to good agreement between CMRA and CCTA. In patients with CAD-RADS ≥ 4 and ≥3, CMRA was as effective as CCTA in predicting ICA referral and revascularization.
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    Highlights of the Society for Magnetic Resonance Angiography 2024 Conference
    (2025) Prieto Vásquez, Claudia Del Carmen; Mossa-Basha, Mahmud; Christodoulou, Anthony; Sheagren, Calder D; Guo, Yin; Radjenovic, Aleksandra; Zhao, Xihai; Collins, Jeremy D.; Botnar, René Michael; Wieben, Oliver
    The 36th Annual International Meeting of the Society for Magnetic Resonance Angiography (SMRA), held from November 12-15, 2024, in Santiago de Chile, marked a milestone as the first SMRA conference in Latin America. Themed "The Ever-Changing Landscape of MRA", the event highlighted the rapid advancements in magnetic resonance angiography (MRA), including cutting-edge developments in contrast-enhanced MRA, contrast-free techniques, dynamic, multi-parametric, and multi-contrast MRA, 4D flow, low-field solutions and AI-driven technologies, among others. The program featured 174 attendees from 15 countries, including 43 early-career scientists and 30 industry representatives. The conference offered a rich scientific agenda, with 12 plenary talks, 24 educational talks, 98 abstract presentations, a joint SMRA-MICCAI challenge on intracranial artery lesion detection and segmentation and a joint session with the Society for Cardiovascular Magnetic Resonance (SCMR) emphasizing accessibility, low-field MRI, and AI's transformative role in cardiac imaging. The meeting's single-track format fostered engaging discussions on interdisciplinary research and highlighted innovations spanning various vascular beds. This paper summarizes the conference's key themes, emphasizing the collaborative efforts driving the future of MRA, while reflecting on SMRA's vision to advance research, education, and clinical practice globally.
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    Highly efficient free-breathing 3D whole-heart imaging in 3-min: single center study in adults with congenital heart disease
    (2024) Fotaki, Anastasia; Pushparajah, Kuberan; Rush, Christopher; Muñoz, Camila; Velasco, Carlos; Neji, Radhouene; Kunze, Karl P.; Botnar, René Michael; Prieto Vásquez, Claudia Del Carmen
    Background: Three dimensional, whole-heart (3DWH) MRI is an established non-invasive imaging modality in patients with congenital heart disease (CHD) for the diagnosis of cardiovascular morphology and for clinical decision making. Current techniques utilise diaphragmatic navigation (dNAV) for respiratory motion correction and gating and are frequently limited by long acquisition times. This study proposes and evaluates the diagnostic performance of a respiratory gating-free framework, which considers respiratory image-based navigation (iNAV), and highly accelerated variable density Cartesian sampling in concert with non-rigid motion correction and low-rank patch-based denoising (iNAV-3DWH-PROST). The method is compared to the clinical dNAV-3DWH sequence in adult patients with CHD. Methods: In this prospective single center study, adult patients with CHD who underwent the clinical dNAV-3DWH MRI were also scanned with the iNAV-3DWH-PROST. Diagnostic confidence (4-point Likert scale) and diagnostic accuracy for common cardiovascular lesions was assessed by three readers. Scan times and diagnostic confidence were compared using the Wilcoxon-signed rank test. Co-axial vascular dimensions at three anatomic landmarks were measured, and agreement between the research and the corresponding clinical sequence was assessed with Bland-Altman analysis. Results: The study included 60 participants (mean age ± [SD]: 33 ± 14 years; 36 men). The mean acquisition time of iNAV-3DWH-PROST was significantly lower compared with the conventional clinical sequence (3.1 ± 0.9 min vs 13.9 ± 3.9 min, p < 0.0001). Diagnostic confidence was higher for the iNAV-3DWH-PROST sequence compared with the clinical sequence (3.9 ± 0.2 vs 3.4 ± 0.8, p < 0.001), however there was no significant difference in diagnostic accuracy. Narrow limits of agreement and mean bias less than 0.08 cm were found between the research and the clinical vascular measurements. Conclusions: The iNAV-3DWH-PROST framework provides efficient, high quality and robust 3D whole-heart imaging in significantly shorter scan time compared to the standard clinical sequence.
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    Isotropic, high-resolution, whole-chest inversion recovery contrast-enhanced magnetic resonance angiography in under 4.5 min using image-based navigator fluoro trigger
    (2025) Craft, Jason; Parikh, Roosha; Cheng, Josh Y.; Diaz, Nancy; Kunze, Karl P.; Schmidt, Michaela; Neji, Radhouene; Leung, Amanda; Weber, Suzanne; Weber, Jonathan; Carter, Timothy; Biso, Sylvia; Yamashita, Ann-Marie; Wolff, Eric H.; Prieto Vásquez, Claudia Del Carmen; Botnar, Rene Michael
    BACKGROUND: Serial assessment of the thoracic aorta with magnetic resonance angiography (MRA) is desirable due to 3D volumetric dataset, high spatial resolution, and lack of ionizing radiation. Electrocardiogram (ECG) gated, contrast-enhanced (CE), inversion recovery gradient echo MRA is efficient and historically provides low artifact burden, but the window for imaging with weak albumin binding extracellular gadolinium based contrast agents is small. Our purpose was to acquire whole-chest gated CE-MRA with 1.2 mm 3 resolution using image-based navigator (iNAV) for motion correction/contrast monitoring, and variable density sampling in 4-5 min. Image quality and vessel diameter reproducibility are assessed against time resolved MRA (TR-MRA). METHODS: iNAV CE-MRA and TR-MRA were obtained prospectively in 40 patients and reviewed by 3 blinded cardiologists for vessel diameter and image quality rated on a four point scale: (1) non-diagnostic; (2) poor-significant blurring; (3) good-mild blurring; and (4) excellent. Reproducibility and image quality were evaluated using the concordance correlation statistic and Cohen's kappa with mean differences evaluated using paired t-tests and repeat-measures ANOVA. RESULTS: iNAV CE-MRA scan time was 4.2 ± 0.7 min. iNAV CE-MRA quality score was higher ( p  
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    The future of MRI in thoracic aortopathy: blueprint for the paradigm shift to improve management
    (2025) Nadel, James; Rodríguez Palomares, José; Phinikaridou, Alkystis; Prieto Vásquez, Claudia Del Carmen; Masci, Pier Giorgio; Botnar, René Michael
    Thoracic aortopathies result in aneurysmal expansion of the aorta that can lead to rapidly fatal aortic dissection or rupture. Despite the availability of abundant non-invasive imaging tools, the greatest contemporary challenge in the management of thoracic aortic aneurysm (TAA) is the lack of reliable metrics for risk stratification, with absolute aortic diameter, growth rate and syndromic factors remaining the primary determinants by which prophylactic surgical intervention is adjudged. Advanced MRI techniques present as a potential key to unlocking insights into TAA that could guide disease surveillance and surgical intervention. MRI has the capacity to encapsulate the aorta as a complex biomechanical structure, permitting the determination of aortic volume, morphology, composition, distensibility and fluid dynamics in a time-efficient manner. Nevertheless, current standard-of-care imaging protocols do not harness its full capacity. This state-of-the-art review explores the emerging role of MRI in the assessment of TAA and presents a blueprint for the required paradigm shift away from aortic size as the sole metric for risk stratifying TAA.