Heart Failure: Evaluation of Cardiopulmonary Transit Times with Time-resolved MR Angiography

Shors, Stephanie M.; Cotts, William; Pavlovic-Surjancev, Biljana; François, Christopher J.; Gheorghiade, Mihai; Finn, J. Paul

doi:10.1148/radiol.2293021363

Cited by 78 publications

(94 citation statements)

References 28 publications

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“…Our assumption of a clinical significance of these density measurements is supported by the correlation with BNP and with proBNP, cardiac biomarkers that strongly correlate with heart failure. [10][11][12][13][14] The finding of a delayed pulmonary passage of contrast material, indicating a prolonged pulmonary circulation time, which is reflected in increased PA density and reduced LA density, is in accordance with previous studies including a study of Shors et al 15 from 2003. Using MR angiography, this group found significantly prolonged cardiopulmonary transit times in patients with heart failure and left ventricular dysfunction in comparison with a healthy control group.…”

Section: Discussionsupporting

confidence: 91%

Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion

Thieme¹,

Meinel²,

Graef³

et al. 2014

BJR

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CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion. Br J Radiol 2014;87:20140079. FULL PAPER Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion S F THIEME, F G MEINEL, A GRAEF, A D HELCK, M F REISER and T RC JOHNSON Results: No significant difference of PBV but significant differences of mean PA and LA enhancement and individual enhancement differences (PA 2 LA) were found between the populations. PA 2 LA was higher in patients with elevated BNP and proBNP and was positively correlated with these values. Receiver operating characteristic analysis revealed a moderate discriminatory power of the PA 2 LA difference for the presence of cardiac biomarker elevations. Conclusion: PBV in DE-CTPA is not altered in patients with signs of congestive heart failure. However, differences in enhancement values in the pre-and postpulmonary vessels were found in comparison with the control population. Advances in knowledge: Altered pulmonary vascular haemodynamics in pulmonary venous congestion are not reflected in dual-energy-derived PBV maps. In the diagnosis of left heart failure in patients with chest pain and dyspnoea, density measurements in the pulmonary artery and in the left atrium in CTPA images may be a helpful diagnostic tool.In the diagnostic algorithms for patients with acute dyspnoea, CT pulmonary angiography (CTPA) plays a major role, specifically in cases when pulmonary embolism (PE) is suspected. Whenever no PE can be detected, radiologists face the challenge to detect alternative pathological thoracic findings. An undiagnosed acute or chronic left heart failure with pulmonary congestion can be an alternative cause of acute dyspnoea. Although there are some direct and indirect CT criteria that suggest the diagnosis of congestive heart failure with pulmonary venous hypertension (e.g. dilated pulmonary veins with a blurry appearance of the vessel walls, thickening of the interlobular septal lines, ground-glass opacities/alveolar oedema, pleural effusions and an enlargement of the left atrium and/or ventricle), the diagnosis of left heart failure on the basis of CT findings is often equivocal and rather rater dependent. For suspected left heart failure, chest radiography represents the primary diagnostic tool rather than CT. Still, if CTPA is performed in chest pain workup, an improved, more objective diagnosis of congestive heart failure would be desirable. Dual-energy CTPA (DE-CTPA) can quantify the iodinerelated pulmonary beam absorption and thus allow an automated, reader-independent, software-based quantification of the pulmonary content of iodinated contrast material [termed "perfused blood volume" (PBV)].1 Based on the assumption that an impaired left heart function leads to variances in the pulmonary blood content and in the dynamics of the pulmonary passage of the contrast bolus, we tried to find out if ...

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Section: Discussionsupporting

confidence: 91%

Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion

Thieme¹,

Meinel²,

Graef³

et al. 2014

BJR

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“…Also, our findings are limited to patients without significant cardiac output abnormalities, and the number of patients with significantly decreased ejection fraction was limited. In a prior study evaluating cardiopulmonary transit time with MR angiography [14], the transit time was increased with decreased LVEF; however, poor temporal resolution with timing bolus by CT may prevent the verification of such a finding.…”

Section: Limitationsmentioning

confidence: 93%

Validation of a Novel Method for Cardiac Output Estimation by CT Coronary Angiography

Mehta¹,

Choi²,

Sanai³

et al. 2012

ACT

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Background: Cardiac output can be estimated during retrospectively gated CT coronary angiography by anatomically determining left ventricular volumes; prospective triggering to minimize radiation precludes this methodology. We propose an alternative method for cardiac output estimation based on preclinical models suggesting that cardiac output may be inversely related to contrast washout from the aortic root during timing bolus scanning, as measured by peak aortic root contrast attenuation. Methods: 34 patients had CT coronary angiography timing bolus performed with 20 ml iodixanol at 5.5 ml/s followed by 20 ml normal saline at 5.5 ml/s through an 18-Ga antecubital catheter. Peak aortic root contrast attenuation was correlated to cardiac output calculated by echocardiography using heart rate stroke volume from biplane Simpson's method. Results: Mean age was 58 ± 13 years; body surface area, 2.0 ± 0.5 m 2 . 53% were women. Stroke volume, cardiac output and cardiac index were 67 ± 19 ml, 4.5 ± 1.6 L/min, and 2.2 ± 0.7 L/min/m 2 , respectively. Peak aortic root contrast attenuation was 207 ± 46 HU and correlated to cardiac output and cardiac index with r = -0.64, p < 0.0001 and r = -0.55, p < 0.001, respectively. Regression analysis estimates cardiac output = -0.02 peak aortic root contrast attenuation +9.1. Conclusion: This novel method for cardiac output estimation by CTCA appears feasible. The CT physiologic parameters using the timing test-bolus data moderately correlated with echocardiographic assessment of cardiac output. The calculation of cardiac output adds important hemodynamic data to anatomic information provided by CTCA, and further development of this method may preserve assessment of left ventricular performance in prospective triggering.

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“…Magn Reson Med 67:786-792, 2012. V C 2011 Wiley Periodicals, Inc. Key words: lung; pulmonary perfusion; k-t BLAST; contrastenhanced MRI; image acceleration; spatiotemporal dynamic Pulmonary perfusion is a fundamental diagnostic indicator of many cardiopulmonary disorders (1,2), as lung perfusion links closely to ventilation and hence functionality of gas exchange. Although assessments of pulmonary perfusion were conventionally performed by nuclear scintigraphic techniques incorporating radioactive isotopes (such as Tc99m-MAA) (3) at the cost of radiation and limited spatial resolution, dynamic contrastenhanced (DCE) pulmonary MR imaging with bolus administration of exogenous contrast agent gradually became an attractive alternative with simultaneous acquisition of high-resolution anatomical images without exposure of ionization radiation.…”

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confidence: 99%

Fast dynamic contrast‐enhanced lung MR imaging using k–t BLAST: A spatiotemporal perspective

Hsu

Tsai

et al. 2011

Magnetic Resonance in Med

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Dynamic contrast-enhanced MR imaging has long been an attractive alternative to measure pulmonary perfusion as it offers simultaneous acquisition of high-resolution anatomical images and various functional information without exposing to ionizing radiation. As higher temporal resolution in addition to simultaneous acquisition of more slices from different positions favors more precise diagnosis, rapid acquisition of multiple images during bolus contrast administration remains essential to pulmonary perfusion imaging. Nevertheless, the branching morphology together with asynchronization of contrast-enhanced pulmonary perfusion scattered among distinct blood vessels imposes difficulties to faster imaging. This work demonstrates that k-t broad-use linear acquisition speed-up technique (k-t BLAST), having substantial performance on accelerating cardiac cine imaging, can be applied to accelerate dynamic contrast-enhanced lung imaging up to a factor of 5 with errors less than 6% on five healthy subjects and less than 10% on 13 patients, respectively, in the overall signal intensity. Perfusion parameter estimates show somewhat less errors than those in overall signal intensity. Results from healthy subjects and two groups of patients with various diseases show high consistency between fully sampled datasets and their accelerated counterparts. These suggest feasibility of accelerated contrast-enhanced lung images in clinical examinations and potential of extending k-t BLAST into related applications. Magn Reson Med 67:786-792, 2012. V C 2011 Wiley Periodicals, Inc. Key words: lung; pulmonary perfusion; k-t BLAST; contrastenhanced MRI; image acceleration; spatiotemporal dynamic Pulmonary perfusion is a fundamental diagnostic indicator of many cardiopulmonary disorders (1,2), as lung perfusion links closely to ventilation and hence functionality of gas exchange. Although assessments of pulmonary perfusion were conventionally performed by nuclear scintigraphic techniques incorporating radioactive isotopes (such as Tc99m-MAA) (3) at the cost of radiation and limited spatial resolution, dynamic contrastenhanced (DCE) pulmonary MR imaging with bolus administration of exogenous contrast agent gradually became an attractive alternative with simultaneous acquisition of high-resolution anatomical images without exposure of ionization radiation. Patient studies have further shown the ability of DCE lung MR imaging to assist detection of pulmonary embolism (4,5), to evaluate postoperative lung function in lung cancer patients (6,7), and to assess complex pulmonary circulation in congenital heart diseases (8). The effectiveness DCE MR imaging, as demonstrated with comparable quality to the current gold standard (9,10) and with perfusion quantification validated by experimental animal model using invasive microsphere measurements (11), clearly reveals promising potential in the monitoring of pulmonary diseases (12).Acceleration using possible spatiotemporal redundancy, however, remains an important issue when adopting DCE MR imaging ...

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Heart Failure: Evaluation of Cardiopulmonary Transit Times with Time-resolved MR Angiography

Abstract: Time-resolved MR angiography allows determination of cardiopulmonary transit times that are significantly prolonged in heart failure and correlate directly with LV volumes and inversely with LV ejection fraction.

Cited by 78 publications

References 28 publications

Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion

Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion

Validation of a Novel Method for Cardiac Output Estimation by CT Coronary Angiography

Fast dynamic contrast‐enhanced lung MR imaging using k–t BLAST: A spatiotemporal perspective

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