PurposeTo validate three widely‐used acceleration methods in four‐dimensional (4D) flow cardiac MR; segmented 4D‐spoiled‐gradient‐echo (4D‐SPGR), 4D‐echo‐planar‐imaging (4D‐EPI), and 4D‐k‐t Broad‐use Linear Acquisition Speed‐up Technique (4D‐k‐t BLAST).Materials and MethodsAcceleration methods were investigated in static/pulsatile phantoms and 25 volunteers on 1.5 Tesla MR systems. In phantoms, flow was quantified by 2D phase‐contrast (PC), the three 4D flow methods and the time‐beaker flow measurements. The later was used as the reference method. Peak velocity and flow assessment was done by means of all sequences. For peak velocity assessment 2D PC was used as the reference method. For flow assessment, consistency between mitral inflow and aortic outflow was investigated for all pulse‐sequences. Visual grading of image quality/artifacts was performed on a four‐point‐scale (0 = no artifacts; 3 = nonevaluable).ResultsFor the pulsatile phantom experiments, the mean error for 2D PC = 1.0 ± 1.1%, 4D‐SPGR = 4.9 ± 1.3%, 4D‐EPI = 7.6 ± 1.3% and 4D‐k‐t BLAST = 4.4 ± 1.9%. In vivo, acquisition time was shortest for 4D‐EPI (4D‐EPI = 8 ± 2 min versus 4D‐SPGR = 9 ± 3 min, P < 0.05 and 4D‐k‐t BLAST = 9 ± 3 min, P = 0.29). 4D‐EPI and 4D‐k‐t BLAST had minimal artifacts, while for 4D‐SPGR, 40% of aortic valve/mitral valve (AV/MV) assessments scored 3 (nonevaluable). Peak velocity assessment using 4D‐EPI demonstrated best correlation to 2D PC (AV:r = 0.78, P < 0.001; MV:r = 0.71, P < 0.001). Coefficient of variability (CV) for net forward flow (NFF) volume was least for 4D‐EPI (7%) (2D PC:11%, 4D‐SPGR: 29%, 4D‐k‐t BLAST: 30%, respectively).ConclusionIn phantom, all 4D flow techniques demonstrated mean error of less than 8%. 4D‐EPI demonstrated the least susceptibility to artifacts, good image quality, modest agreement with the current reference standard for peak intra‐cardiac velocities and the highest consistency of intra‐cardiac flow quantifications. Level of Evidence: 1 Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2018;47:272–281.

AimsMyocardial perfusion imaging during hyperaemic stress is commonly used to detect coronary artery disease. The aim of this study was to investigate the relationship between left ventricular global longitudinal strain (GLS), strain rate (GLSR), myocardial early (E’) and late diastolic velocities (A’) with adenosine stress first-pass perfusion cardiovascular magnetic resonance (CMR) imaging.Methods and results44 patients met the inclusion criteria and underwent CMR imaging. The CMR imaging protocol included: rest/stress horizontal long-axis (HLA) cine, rest/stress first-pass adenosine perfusion and late gadolinium enhancement imaging. Rest and stress HLA cine CMR images were analysed using feature-tracking software for the assessment of myocardial deformation. The presence of perfusion defects was scored on a binomial scale. In patients with hyperaemia-induced perfusion defects, rest global longitudinal strain GLS (−16.9 ± 3.7 vs. −19.6 ± 3.4; p-value = 0.02), E’ (−86 ± 22 vs. −109 ± 38; p-value = 0.02), GLSR (69 ± 31 vs. 93 ± 38; p-value = 0.01) and stress GLS (−16.5 ± 4 vs. −21 ± 3.1; p < 0.001) were significantly reduced when compared with patients with no perfusion defects. Stress GLS was the strongest independent predictor of perfusion defects (odds ratio 1.43 95% confidence interval 1.14–1.78, p-value <0.001). A threshold of −19.8% for stress GLS demonstrated 78% sensitivity and 73% specificity for the presence of hyperaemia-induced perfusion defects.ConclusionsAt peak myocardial hyperaemic stress, GLS is reduced in the presence of a perfusion defect in patients with suspected coronary artery disease. This reduction is most likely caused by reduced endocardial blood flow at maximal hyperaemia because of transmural redistribution of blood flow in the presence of significant coronary stenosis.Electronic supplementary materialThe online version of this article (10.1007/s12471-017-1071-3) contains supplementary material, which is available to authorized users.

Background Surgeons of today are faced with unprecedented challenges; necessitating a novel approach to preoperative preparation which takes into account the specific tests each case poses. In this study, we examine patientspecific mental rehearsal for pre-surgical practice and assess whether this method has an additional effect when compared to generic mental rehearsal. Methods Sixteen medical students were trained how to perform a simulated laparoscopic cholecystectomy (SLC). After baseline assessments, they were randomised to two equal groups and asked to complete three SLCs involving different anatomical variants. Prior to each procedure, Group A practiced mental rehearsal with the use of a preprepared checklist and Group B mental rehearsal with the checklist combined with virtual models matching the anatomical variations of the SLCs. The performance of the two groups was compared using simulator provided metrics and competency assessment tool (CAT) scoring by two blinded assessors.Results The participants performed equally well when presented with a ''straight-forward'' anatomy [Group A vs. Conclusion These results suggest that patient-specific preparation with the combination of anatomical models and mental rehearsal may increase operative quality of complex procedures.

Objectives We used CMR with extracellular volume fraction (ECV) measurement to characterise cardiac involvement in relation to outcome in ATTR amyloidosis. Methods Subjects comprised 263 patients with cardiac ATTR amyloidosis corroborated by grade 2-3 99m Tc-DPD cardiac uptake, 17 with suspected cardiac ATTR amyloidosis (grade 1 99m Tc-DPD) and 12 asymptomatic individuals with amyloidogenic transthyretin (TTR) mutations. Fifty patients with cardiac AL amyloidosis acted as disease controls. Results In contrast to AL amyloidosis, asymmetric septal hypertrophy was present in 79% of ATTR patients (70% sigmoid septum and 30% reverse septal curvature), whilst symmetric left ventricular hypertrophy (LVH) was present in only 18%; 3% of patients has no LVH. In patients with cardiac amyloidosis, the pattern of LGE was always typical for amyloidosis (29% subendocardial, 71% transmural) including right ventricular LGE (96%). 65 patients died during follow-up (19 ±14 months). ECV independently correlated with mortality and remained independent after adjustment for age, N-terminal pro-brain natriuretic peptide, ejection fraction, E/E' and left ventricular mass index (hazard ratio, 1.164; 95% confidence interval, 1.066-1.271; p<0.01). Conclusions Asymmetric hypertrophy, traditionally associated with hypertrophic cardiomyopathy, is the commonest pattern of ventricular remodelling in ATTR amyloidosis.LGE imaging is typical in all patients with cardiac ATTR amyloidosis. ECV correlates with amyloid burden and provides incremental information on outcome even after adjustment for known prognostic factors. Introduction Pulmonary hypertension is a common complication of chronic obstructive pulmonary disease(COPD). Pulmonary arterial stiffening has been described in COPD both in those with pulmonary hypertension at rest and at exercise. Pulmonary pulse wave velocity (PWV) allows the non-invasive measurement of pulmonary arterial stiffening providing the potential for detection of early pulmonovascular changes before overt pulmonary hypertension sets in, but has not previously been assessed in COPD. The aim of the current study is thus to assess PWV in COPD and its effects on right ventricular(RV) remodelling. Methods 58 participants with COPD underwent pulmonary function tests, six minute walk test, and cardiac MRI, while 21 age and sex matched healthy volunteers underwent cardiac MRI. 32 of the COPD patients underwent a follow-up MRI at 1 year to assess for longitudinal changes. Phase contrast imaging of the main pulmonary artery was performed in order to calculate pulmonary PWV using the flow-area technique. Results Those with COPD demonstrated pulmonary arterial stiffening and pulmonary vascular remodelling with higher pulmonary artery area at end diastole (COPD: 2.36±0.56 cm 025 DETERMINANTS OF PULMONARY ARTERIAL REMODELLING IN COPD AND IMPLICATIONS FOR RIGHT VENTRICULAR REMODELLING