No description available.

Throughout the development of computed tomographic (CT) imaging the challenges of capturing the heart, with its perpetual, vigorous motion, and in particular the tiny detail within the coronary arteries, has driven technological progress. Today, CT is a widely used and rapidly growing modality for the investigation of coronary artery disease, as well as other cardiac pathology. However, limitations remain and particular patient groups present a significant challenge to the CT operator. This thesis adds new knowledge to the assessment of these difficult-to-image patients. It considers patients with artefact from coronary artery calcification or stents, examining the remarkable diagnostic performance of high definition scanning, as well as material subtraction techniques using dual energy CT, alongside ways in which current technology might be revisited and refined with the use of alternative image reconstruction methods. Patients with challenging heart rate or rhythm abnormalities are considered in three studies; how to achieve diagnostic image quality in atrial fibrillation, the safety of an aggressive approach to intravenous beta-blocker use prior to coronary imaging, and the development of patient information to address anxiety as a source of tachycardia and motion artefact. Finally, the novel application of a single source, dual energy CT scanner to additional cardiac information is considered, with studies of myocardial perfusion CT and delayed iodine enhancement imaging, to identify ways in which non-coronary imaging might be exploited to more thoroughly evaluate a patient’s coronary artery status. These findings are presented in the context of developing technology and together offer a range of potential options for operators of cardiac CT when faced with a difficult-to-image patient.

Respiratory motion causes artifacts and blurring of cardiac structures in reconstructed images of SPECT and PET cardiac studies. Hysteresis in respiratory motion causes the organs to move in distinct paths during inspiration and expiration. Current respiratory motion correction methods use a signal generated by tracking the motion of the abdomen during respiration to bin list- mode data as a function of the magnitude of this respiratory signal. They thereby fail to account for hysteretic motion. The goal of this research was to demonstrate the effects of hysteretic respiratory motion and the importance of its correction for different medical imaging techniques particularly SPECT and PET. This study describes a novel approach for detecting and correcting hysteresis in clinical SPECT and PET studies. From the combined use of MRI and a synchronized Visual Tracking System (VTS) in volunteers we developed hysteretic modeling using the Bouc-Wen model with inputs from measurements of both chest and abdomen respiratory motion. With the MRI determined heart motion as the truth in the volunteer studies we determined the Bouc Wen model could match the behavior over a range of hysteretic cycles. The proposed approach was validated through phantom simulations and applied to clinical SPECT studies.

<p>Cardiovascular disease is the leading cause of death for developed countries, including the United States. In order to diagnose and detect certain cardiac diseases, it is necessary to assess myocardial performance and function. One mechanical property that has been shown to reflect myocardial performance is myocardial stiffness. Acoustic radiation force impulse (ARFI) imaging has been demonstrated to be capable of visualizing variations in local stiffness within soft tissue. </p><p>In this thesis, the initial investigations into the visualization of myocardial performance with ARFI imaging are presented. <italic>In vivo</italic> ARFI images were acquired with a linear array placed on exposed <italic>canine</italic> hearts. When co-registered with the electrocardiogram (ECG), ARFI images of the heart reflected the expected changes in myocardial stiffness through the cardiac cycle. With the implementation of a quadratic motion filter, motion artifacts within the ARFI images were reduced to below 1.5 &mu m at all points of the cardiac cycle. The inclusion of pre-excitation displacement estimates in the quadratic motion filter further reduced physiological motion artifacts at all points of the cardiac cycle to below 0.5 &mu m. </p><p>In order for cardiac ARFI imaging to more quantitatively assess myocardial performance, novel ARFI imaging sequences and methods were developed to address challenges specifically related to cardiac imaging. These improvements provided finer sampling and improved spatial and temporal resolution within the ARFI images. <italic>In vivo</italic> epicardial ARFI images of an <italic>ovine</italic> heart were formed using these sequences, and the quality and utility of the resultant ARFI-induced displacement curves were examined.</p><p><italic>In vivo</italic> cardiac ARFI images were formed of <italic>canine</italic> left ventricular free walls while the hearts were externally paced by one of two electrodes positioned epicardially on either side of the imaging plane. Directions and speeds of myocardial stiffness propagation were measured within the ARFI imaging field of view. In all images, the myocardial stiffness waves were seen to be traveling away from the stimulating electrode. The stiffness propagation velocities were also shown to be consistent with propagation velocities measured from elastography and tissue velocity imaging as well as the local epicardial ECG.</p><p>ARFI-induced displacement curves of an <italic>ovine</italic> heart were formed and temporally registered with left ventricular pressure and volume measurements. From these plots, the synchronization of myocardial stiffening and relaxation with the four phases (isovolumic contraction, ejection, isovolumic relaxation, and filling) of the cardiac cycle was determined. These ARFI imaging sequences were also used to correlate changes in left ventricular performance with changes in myocardial stiffness. These preliminary results indicated that changes in the ARFI imaging-derived stiffnesses were consistent with those predicted by current, clinically accepted theories of myocardial performance and function.</p><p>These results demonstrate the ability of ARFI imaging to visualize changes in myocardial stiffness through the cardiac cycle and its feasibility to provide clinically useful insight into myocardial performance.</p> / Dissertation

Based on the acquisition trajectory, PROPELLER MRI repeatedly sampled the center k-space in every blade, which was used to provide most of the energy of an image. The purpose of view sharing PROPELLER is to improve the spatio-temporal resolution of dynamic imaging by reducing the acquisition time of single frame to that of single blade. With the center k-space provided by only one blade, which is called the target blade, the high spatial-frequency components were appropriately contributed by a set of neighboring blades with different rotation angles, leading to the high spatial resolution after reconstruction. In this study, a flow phantom experiment with the injection of T1-shortening Gd-DTPA solution was performed to exam the feasibility and accuracy of view-sharing PROPELLER. Furthermore, cardiac imaging of healthy volunteer obtained by the proposed technique was also done with ECG gating to test the image quality without any injection of contrast agent. The in-vivo experiment was done with and without breath holding. In addition to slight aliasing artifact due to insufficient FOV, no other artifact was observed.

The aim of this work is to propose an algorithm to segment and track the myocardium using the level-set formalism. The myocardium is first approximated by a geometric model (hyperquadrics) which allows to handle asymetric shapes such as the myocardium while avoiding a learning step. This representation is then embedded into the level-set formalism as a shape prior for the joint segmentation of the endocardial and epicardial borders. This shape prior term is coupled with a local data attachment term and a thickness term that prevents both contours from merging. The algorithm is validated on a dataset of 80 images at end diastolic and end systolic phase with manual references from 3 cardiologists. In a second step, we propose to segment whole sequences using motion information. To this end, we apply a level conservation constraint on the implicit function associated to the level-set and express this contraint as an energy term in a variational framework. This energy is then added to the previously described algorithm in order to constrain the temporal evolution of the contour. Finally the algorithm is validated on 20 echocardiographic sequences with manual references of 2 experts (corresponding to approximately 1200 images).

This thesis belongs to the research line of Biomedical Imaging Tecnologies and proposes as main objective to develop and research spatio-temporal non-rigid registration methods to estimate and compesate motion in cardiac magnetic resonance sequences and to validate and verify the suitability of those techniques in the clinical environment. / -

BACKGROUND Aortic stenosis is a common and potentially fatal condition in which fibro-calcific changes within the valve leaflets lead to the obstruction of blood flow. Severe symptomatic stenosis is an indication for aortic valve replacement and timely referral is essential to prevent adverse clinical events. Calcification is believed to represent the central process driving disease progression. 18F-Fluoride positron emission tomography computed tomography (PET-CT) and CT aortic valve calcium scoring (CT-AVC) quantify calcification activity and burden respectively. The overarching aim of this thesis was to evaluate the applications of these techniques to the study and management of aortic stenosis. METHODS AND RESULTS REPRODUCIBILITY The scan-rescan reproducibility of 18F-fluoride PET-CT and CT-AVC were investigated in 15 patients with mild, moderate and severe aortic stenosis who underwent repeated 18F-fluoride PET-CT scans 3.9±3.3 weeks apart. Modified techniques enhanced image quality and facilitated clear localization of calcification activity. Percentage error was reduced from ±63% to ±10% (tissue-to-background ratio most-diseased segment (MDS) mean of 1.55, bias -0.05, limits of agreement - 0·20 to +0·11). Excellent scan-rescan reproducibility was also observed for CT-AVC scoring (mean of differences 2% [limits of agreement, 16 to -12%]). AORTIC VALVE CALCIUM SCORE: SINGLE CENTRE STUDY Sex-specific CT-AVC thresholds (2065 in men and 1271 in women) have been proposed as a flow-independent technique for diagnosing severe aortic stenosis. In a prospective cohort study, the impact of CT-AVC scores upon echocardiographic measures of severity, disease progression and aortic valve replacement (AVR)/death were examined. Volunteers (20 controls, 20 with aortic sclerosis, 25 with mild, 33 with moderate and 23 with severe aortic stenosis) underwent CT-AVC and echocardiography at baseline and again at either 1 or 2-year time-points. Women required less calcification than men for the same degree of stenosis (p < 0.001). Baseline CT-AVC measurements appeared to provide the best prediction of subsequent disease progression. After adjustment for age, sex, peak aortic jet velocity (Vmax) ≥ 4m/s and aortic valve area (AVA) < 1 cm2, the published CT-AVC thresholds were the only independent predictor of AVR/death (hazard ratio = 6.39, 95% confidence intervals, 2.90-14.05, p < 0.001). AORTIC VALVE CALCIUM SCORE: MULTICENTRE STUDY CT-AVC thresholds were next examined in an international multicenter registry incorporating a wide range of patient populations, scanner vendors and analysis platforms. Eight centres contributed data from 918 patients (age 77±10, 60% male, Vmax 3.88±0.90 m/s) who had undergone ECG-gated CT within 3 months of echocardiography. Of these 708 (77%) had concordant echocardiographic assessments, in whom our own optimum sex-specific CT-AVC thresholds (women 1377, men 2062 AU) were nearly identical to those previously published. These thresholds provided excellent discrimination for severe stenosis (c-statistic: women 0.92, men 0.88) and independently predicted AVR and death after adjustment for age, sex, Vmax ≥4 m/s and AVA < 1 cm2 (hazards ratio, 3.02 [95% confidence intervals, 1.83-4.99], p < 0.001). In patients with discordant echocardiographic assessments (n=210), CT-AVC thresholds predicted an adverse prognosis. BICUSPID AORTIC VALVES Within the multicentre study, higher continuity-derived estimates of aortic valve area were observed in patients with bicuspid valves (n=68, 1.07±0.35 cm) compared to those with tri-leaflet valves (0.89±0.36 cm p < 0.001,). This was despite no differences in measurements of Vmax (p=0.152), or CT-AVC scores (p=0.313). The accuracy of AVA measurments in bicuspid valves was therefore tested against alternative markers of disease severity. AVA measurements in bicuspid valves demonstrated extremely weak associations with CT-AVC scores (r2=0.08, p=0.02) and failed to correlate with downstream markers of disease severity in the valve and myocardium and against clinical outcomes. AVA measurements in bicuspid patients also failed to independently predict AVR/death after adjustment for Vmax ≥4 m/s, age and gender. In this population CT-AVC thresholds (women 1377, men 2062 AU) again provided excellent discrimination for severe stenosis. CONCLUSIONS Optimised 18F-fluoride PET-CT scans quantify and localise calcification activity, consolidating its potential as a biomarker or end-point in clinical trials of novel therapies. CT calcium scoring of aortic valves is a reproducible technique, which provides diagnostic clarity in addition to powerful prediction of disease progression and adverse clinical events.

L’imagerie cardiovasculaire du rongeur par RMN est un véritable défi en ce qui concerne la résolution spatiale et temporelle, le contraste et le temps d’expérience. S’il est aujourd’hui admis que l’acquisition 3D doit être privilégiée chez le petit animal, les temps d’acquisition en 3D sont parfois très longs. Ils doivent pourtant rester compatibles avec les temps d’expérience in vivo. L’objectif de cette thèse était donc de développer de nouvelles méthodes d’imagerie cardiovasculaire 3D rapides pour le petit animal à 4.7 et 9.4 T. Tout d’abord, nous avons développé deux méthodes d’IRM cardiaque 4D (3D résolue dans le temps) à contraste «sang noir». La première méthode est basée sur une séquence TrueFISP (Fast Imaging with Steady-state Precession). Elle a permis d’obtenir le contraste sang noir en une heure d’acquisition. La deuxième méthode est basée sur une séquence FLASH (Fast Low Angle Shot). Elle utilise un gradient bipolaire pour supprimer le signal sanguin et le contraste a été rehaussé en Manganèse. Trente minutes d’acquisition ont alors été suffisantes. Ensuite, une méthode d’angiographie temps-de-vol 3D du corps entier de la souris a été développée. Le contraste vasculaire a été amélioré grâce à l’adjonction de motifs de suppression du signal tissulaire. L’imagerie de l’arbre vasculaire entier a pu être réalisé en moins de 10 minutes. Enfin, une nouvelle méthode d’angiographie fonctionnelle ciné temps-de-vol 4D utilisant une acquisition écho-planar a été développée. Les résultats préliminaires montrent qu’il est possible de diviser par quatre les temps d’acquisition de l’angiographie fonctionnelle classique. Tous ces résultats montrent que l’imagerie cardiovasculaire 3D haute résolution est possible dans des temps d’acquisition raisonnables voire rapides / Cardiovascular MRI in rodents is a real challenge in terms of spatial and temporal resolution, contrast and experiment times. Though it is accepted that 3D acquisition should be preferred in small animals, 3D acquisition times can be very long. However, they must remain compatible with in vivo experiment times. The aim of this thesis was therefore to develop new fast 3D methods of cardiovascular imaging in small animals at 4.7 and 9.4 T. First, two 4D cardiac MRI methods (3D time resolved) were developed in «black-blood» contrast. The first method is based on a TrueFISP sequence (Fast Imaging with Steady-state Precession). It allowed to make black blood contrast in one hour acquisition time. The second method is based on a FLASH sequence (Fast Low Angle Shot). It uses a bipolar gradient to suppress the blood signal and the contrast was enhanced by using Manganese. Thirty minutes were then enough. Next, a time-of-flight angiography method for the whole body of mice was developed. The vascular contrast was improved by adding preparation modules to suppress the signal from tissues. The imaging of the whole arterial tree was realized within less than ten minutes. Finally, a new 4D time-of-flight method of functional cine angiography with echo-planar acquisition was developed. Preliminary results showed that acquisition times could be divided by four compared with those in classical functional angiography. All these results show that high resolution 3D cardiovascular imaging is possible in reasonable or even fast acquisition times.

No description available.