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Integration of cardiac and respiratory motion into MRI roadmaps fused with x-ray.

ABSTRACT: Volumetric roadmaps overlaid on live x-ray fluoroscopy may be used to enhance image guidance during interventional procedures. These roadmaps are often static and do not reflect cardiac or respiratory motion. In this work, the authors present a method for integrating cardiac and respiratory motion into magnetic resonance imaging (MRI)-derived roadmaps to fuse with live x-ray fluoroscopy images, and this method was tested in large animals.Real-time MR images were used to capture cardiac and respiratory motion. Nonrigid registration was used to calculate motion fields to deform a reference end-expiration, end-diastolic image to different cardiac and respiratory phases. These motion fields were fit to separate affine motion models for the aorta and proximal right coronary artery. Under x-ray fluoroscopy, an image-based navigator and ECG signal were used as inputs to deform the roadmap for live overlay. The in vivo accuracy of motion correction was measured in four swine as the ventilator tidal volume was varied.Motion correction reduced the root-mean-square error between the roadmaps and manually drawn centerlines, even under high tidal volume conditions. For the aorta, the error was reduced from 2.4 ± 1.5 mm to 2.2 ± 1.5 mm (p < 0.05). For the proximal right coronary artery, the error was reduced from 8.8 ± 16.2 mm to 4.3 ± 5.2 mm (p < 0.001). Using real-time MRI and an affine motion model it is feasible to incorporate physiological cardiac and respiratory motion into MRI-derived roadmaps to provide enhanced image guidance for interventional procedures.A method has been presented for creating dynamic 3D roadmaps that incorporate cardiac and respiratory motion. These roadmaps can be overlaid on live X-ray fluoroscopy to enhance image guidance for cardiac interventions.

SUBMITTER: Faranesh AZ

PROVIDER: S-EPMC3579864 | biostudies-other | 2013 Mar

REPOSITORIES: biostudies-other

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Project description:PurposeTo implement, validate, and apply a self-gated free-running whole-heart five-dimensional (5D) flow MRI framework to evaluate respiration-driven effects on three-dimensional (3D) hemodynamics in a clinical setting.Materials and methodsIn this prospective study, a free-running five-dimensional (5D) flow sequence was implemented with 3D radial sampling, self-gating, and a compressed-sensing reconstruction. The 5D flow was evaluated in a pulsatile phantom and adult participants with aortic and/or valvular disease who were enrolled between May and August 2019. Conventional twofold-accelerated four-dimensional (4D) flow of the thoracic aorta with navigator gating was performed as a reference comparison. Continuous parameters were evaluated for parameter normality and were compared between conventional 4D flow and 5D flow using a signed-rank or two-tailed paired t test. Differences between respiratory states were evaluated using a repeated-measure analysis of variance or a nonparametric Friedman test.ResultsA total of 20 adult participants (mean age, 49 years ± 17 [standard deviation]; 18 men and two women) were included. In vitro 5D flow results showed excellent agreement with conventional 4D flow-derived values (peak and net flow, <7% difference over all quantified planes). Whole-heart 5D flow data were collected in all participants in 7.65 minutes ± 0.35 (acceleration rate = 36.0-76.9) versus 9.88 minutes ± 3.17 for conventional aortic 4D flow. In vivo, 5D flow demonstrated moderate agreement with conventional 4D flow but demonstrated overestimation in net flow and peak velocity (up to 26% and 12%, respectively) in the ascending aorta and underestimation (<12%) in the arch and descending aorta. Respiratory-resolved analyses of caval veins showed significantly increased net and peak flow in the inferior vena cava in end inspiration compared with end expiration, and the opposite trend was shown in the superior vena cava.ConclusionA free-running 5D flow MRI framework consistently captured cardiac and respiratory motion-resolved 3D hemodynamics in less than 8 minutes. Supplemental material is available for this article. © RSNA, 2020.

Project description:Magnetic resonance imaging (MRI) can potentially be used for non-invasive screening of patients with stable angina pectoris to identify probable obstructive coronary artery disease. MRI-based coronary blood flow quantification has to date only been performed in a 2D fashion, limiting its clinical applicability. In this study, we propose a framework for coronary blood flow quantification using accelerated 4D flow MRI with respiratory motion correction and compressed sensing image reconstruction. We investigate its feasibility and repeatability in healthy subjects at rest. Fourteen healthy subjects received 8 times-accelerated 4D flow MRI covering the left coronary artery (LCA) with an isotropic spatial resolution of 1.0 mm3. Respiratory motion correction was performed based on 1) lung-liver navigator signal, 2) real-time monitoring of foot-head motion of the liver and LCA by a separate acquisition, and 3) rigid image registration to correct for anterior-posterior motion. Time-averaged diastolic LCA flow was determined, as well as time-averaged diastolic maximal velocity (VMAX) and diastolic peak velocity (VPEAK). 2D flow MRI scans of the LCA were acquired for reference. Scan-rescan repeatability and agreement between 4D flow MRI and 2D flow MRI were assessed in terms of concordance correlation coefficient (CCC) and coefficient of variation (CV). The protocol resulted in good visibility of the LCA in 11 out of 14 subjects (six female, five male, aged 28 ± 4 years). The other 3 subjects were excluded from analysis. Time-averaged diastolic LCA flow measured by 4D flow MRI was 1.30 ± 0.39 ml/s and demonstrated good scan-rescan repeatability (CCC/CV = 0.79/20.4%). Time-averaged diastolic VMAX (17.2 ± 3.0 cm/s) and diastolic VPEAK (24.4 ± 6.5 cm/s) demonstrated moderate repeatability (CCC/CV = 0.52/19.0% and 0.68/23.0%, respectively). 4D flow- and 2D flow-based diastolic LCA flow agreed well (CCC/CV = 0.75/20.1%). Agreement between 4D flow MRI and 2D flow MRI was moderate for both diastolic VMAX and VPEAK (CCC/CV = 0.68/20.3% and 0.53/27.0%, respectively). In conclusion, the proposed framework of accelerated 4D flow MRI equipped with respiratory motion correction and compressed sensing image reconstruction enables repeatable diastolic LCA flow quantification that agrees well with 2D flow MRI.

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Integration of cardiac and respiratory motion into MRI roadmaps fused with x-ray.

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