Quantitative three-dimensional myocardial perfusion cardiovascular magnetic resonance with accurate two-dimensional arterial input function assessment

Abstract

BackgroundQuantification of myocardial perfusion from first-pass cardiovascular magnetic resonance (CMR) images at high contrast agent (CA) dose requires separate acquisition of blood pool and myocardial tissue enhancement. In this study, a dual-sequence approach interleaving 2D imaging of the arterial input function with high-resolution 3D imaging for myocardial perfusion assessment is presented and validated for low and high CA dose.MethodsA dual-sequence approach interleaving 2D imaging of the aortic root and 3D imaging of the whole left ventricle using highly accelerated k-t PCA was implemented. Rest perfusion imaging was performed in ten healthy volunteers after administration of a Gadolinium-based CA at low (0.025 mmol/kg b.w.) and high dose (0.1 mmol/kg b.w.). Arterial input functions extracted from the 2D and 3D images were analysed for both doses. Myocardial contrast-to-noise ratios (CNR) were compared across volunteers and doses. Variations of myocardial perfusion estimates between volunteers and across myocardial territories were studied.ResultsHigh CA dose imaging resulted in strong non-linearity of the arterial input function in the 3D images at peak CA concentration, which was avoided when the input function was derived from the 2D images. Myocardial CNR was significantly increased at high dose compared to low dose, with a 2.6-fold mean CNR gain. Most robust myocardial blood flow estimation was achieved using the arterial input function extracted from the 2D image at high CA dose. In this case, myocardial blood flow estimates varied by 24 % between volunteers and by 20 % between myocardial territories when analysed on a per-volunteer basis.ConclusionInterleaving 2D imaging for arterial input function assessment enables robust quantitative 3D myocardial perfusion imaging at high CA dose.

Quantitative 3D myocardial perfusion with an efficient arterial input function

“…Using linear rather than centric partition encoding would shorten the acquisition time but would also reduce contrast to noise . In a study by Wissmann et al, even with a linear encoding scheme, the preferred placement of the AIF acquisition was after the 3D acquisition …”

“…A hybrid approach of acquiring separate AIF and tissue data has been shown for 2D at stress . For 3D perfusion, the addition of a separately measured AIF would further restrict quantitative stress perfusion and has only been demonstrated in cardiac rest perfusion …”

“…19 Recent advances in pulse sequence design and image reconstruction [20][21][22][23] have begun to address this issue and a limited number of 3D cardiac perfusion studies have been reported. 4,[24][25][26][27][28][29][30][31][32] Despite these advances, none of the reported studies address all of the important clinical considerations discussed below.…”

“…52 For 3D perfusion, the addition of a separately measured AIF would further restrict quantitative stress perfusion and has only been demonstrated in cardiac rest perfusion. 29,53 The second objective of this work was to implement a novel method to more efficiently measure an AIF during quantitative stress perfusion imaging. An efficient dynamic 2D AIF acquired basal to the 3D volume was successfully implemented and validated.…”

Review of Journal of Cardiovascular Magnetic Resonance 2015

“…In this study, a dual-sequence approach interleaving 2D imaging of the arterial input function with high-resolution 3D imaging for myocardial perfusion assessment was presented and validated for low (0.025 mmol/kg) and high (0.1 mmol/kg) CA dose [102]. Most robust myocardial blood flow estimation was achieved using the arterial input function extracted from the 2D image at high CA dose.…”