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In this work, accelerated non-Cartesian Magnetic Resonance Imaging (MRI) methods were established and applied to cardiovascular imaging (CMR) at different magnetic field strengths (3T and 7T).
To enable rapid data acquisition, highly efficient spiral k-space trajectories were created. In addition, hybrid sampling patterns such as the twisting radial lines (TWIRL) k-space trajectory were studied.
Imperfections of the dynamic gradient system of a MR scanner result in k-space sampling errors. Ultimately, these errors can lead to image artifacts in non-Cartesian acquisitions.
Among other reasons such as an increased reconstruction complexity, they cause the lack of spiral sequences in clinical routine compared to standard Cartesian imaging.
Therefore, the Gradient System Transfer Functions (GSTFs) of both scanners were determined and used for k-space trajectory correction in post-correction as well as in terms of a pre-emphasis.
The GSTF pre-emphasis was implemented as a fully automatic procedure, which enabled a precise correction of arbitrary gradient waveforms for double-oblique slice orientations.
Consequently, artifacts due to trajectory errors could be mitigated, which resulted in high image quality in non-Cartesian MRI.
Additionally, the GSTF correction was validated by measuring pre-emphasized spiral gradient outputs, which showed high agreement with the theoretical gradient waveforms.
Furthermore, it could be demonstrated that the performance of the GSTF correction is superior to a simple delay compensation approach.
The developed pulse sequences were applied to gated as well as real-time CMR. Special focus lied on the implementation of a spiral imaging protocol to resolve the beating heart of animals and humans in real time and free breathing.
In order to achieve real-time CMR with high spatiotemporal resolution, k-space undersampling was performed. For this reason, efficient sampling strategies were developed with the aim to facilitate compressed sensing (CS) during image reconstruction.
The applied CS approach successfully removed aliasing artifacts and yielded high-resolution cardiac image series. Image reconstruction was performed offline in all cases such that the images were not available immediately after acquisition at the scanner.
Spiral real-time CMR could be performed in free breathing, which led to an acquisition time of less than 1 minute for a whole short-axis stack.
At 3T, the results were compared to the gold standard of electrocardiogram-gated Cartesian CMR in breath hold, which revealed similar values for important cardiovascular functional and volumetric parameters.
This paves the way to an application of the developed framework in clinical routine of CMR.
In addition, the spiral real-time protocol was transferred to swallowing and speech imaging at 3T, and first images were presented.
The results were of high quality and confirm the straightforward utilization of the spiral sequence in other fields of MRI.
In general, the GSTF correction yielded high-quality images at both field strengths, 3T and 7T.
Off-resonance related blurring was mitigated by applying non-Cartesian readout gradients of short duration. At 7T, however, B1-inhomogeneity led to image artifacts in some cases.
All in all, this work demonstrated great advances in accelerating the MRI process by combining efficient, undersampled non-Cartesian k-space coverage with CS reconstruction.
Trajectory correction using the GSTF can be implemented at any scanner model and enables non-Cartesian imaging with high image quality.
Especially MRI of dynamic processes greatly benefits from the presented rapid imaging approaches.
Purpose
The AMADEUS (Area Measurement And DEpth and Underlying Structures) scoring and grading system has been proposed for the MRI based evaluation of untreated focal chondral defects around the knee. The clinical practicability, its correlation with arthroscopically assessed grading systems (ICRS – International Cartilage Repair Society) and thereby its clinical value in terms of decision making and guiding prognosis was yet to determine.
Methods
From 2008 to 2019 a total of 89 individuals were indicated for high tibial valgus osteotomy (HTO) due to tibial varus deformity and concomitant chondral defects of the medial compartment of the knee. All patients received a preoperative MRI (1.5 Tesla or 3.0 Tesla) and pre-osteotomy diagnostic arthroscopy. Chondral defects of the medial compartment were scored and graded with the MRI based AMADEUS by three independent raters and compared to arthroscopic defect grading by the ICRS system. Interrater and intrarater reliability as well as correlation analysis with the ICRS classification system were assessed.
Results
Intraclass correlation coefficients for the various subscores of the AMADEUS showed an overall good to excellent interrater agreement (min: 0.26, max: 0.80). Intrarater agreement turned out to be substantially inferior (min: 0.08, max: 0.53). Spearman correlation revealed an overall moderate correlative association of the AMADEUS subscores with the ICRS classification system, apart from the defect area subscore. Sensitivity of the AMADEUS to accurately identify defect severity according to the ICRS was 0.7 (0.69 for 3.0 Tesla MRI, 0.67 for 1.5 Tesla MRI). The mean AMADEUS grade was 2.60 ± 0.81 and the mean ICRS score 2.90 ± 0.63.
Conclusions
Overall, the AMADEUS with all its subscores shows moderate correlation with the arthroscopic chondral grading system according to ICRS. This suggests that chondral defect grading by means of the MRI based AMADEUS is well capable of influencing and guiding treatment decisions. Interrater reliability shows overall good agreement.
Acute ischemic cardiac injury predisposes one to cognitive impairment, dementia, and depression. Pathophysiologically, recent positron emission tomography data suggest astroglial activation after experimental myocardial infarction (MI). We analyzed peripheral surrogate markers of glial (and neuronal) damage serially within 12 months after the first ST-elevation MI (STEMI). Serum levels of glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) were quantified using ultra-sensitive molecular immunoassays. Sufficient biomaterial was available from 45 STEMI patients (aged 28 to 78 years, median 56 years, 11% female). The median (quartiles) of GFAP was 63.8 (47.0, 89.9) pg/mL and of NfL 10.6 (7.2, 14.8) pg/mL at study entry 0–4 days after STEMI. GFAP after STEMI increased in the first 3 months, with a median change of +7.8 (0.4, 19.4) pg/mL (p = 0.007). It remained elevated without further relevant increases after 6 months (+11.7 (0.6, 23.5) pg/mL; p = 0.015), and 12 months (+10.3 (1.5, 22.7) pg/mL; p = 0.010) compared to the baseline. Larger relative infarction size was associated with a higher increase in GFAP (ρ = 0.41; p = 0.009). In contrast, NfL remained unaltered in the course of one year. Our findings support the idea of central nervous system involvement after MI, with GFAP as a potential peripheral biomarker of chronic glial damage as one pathophysiologic pathway.