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Myocardial Late Enhancement
 
(LE) Myocardial late enhancement in contrast enhanced cardiac MRI has the ability to precisely delineate myocardial scar associated with coronary artery disease. Viability imaging implies evaluating infarcted myocardium to see whether there is enough viable tissue available for revascularization. The reversal of myocardial dysfunction is particularly relevant in patients with depressed ventricular function because revascularization improves long-term survival. In comparison to SPECT and PET imaging, myocardial late enhancement MRI demonstrates areas of delayed enhancement exactly in correlation with the infarcted region.
Viability on cardiac MRI (CMR) is based on the fact that all infarcts enhance vividly 10-15 minutes after the administration of intravenous paramagnetic contrast agents. This enhancement represents the accumulation of gadolinium in the extracellular space, due to the loss of membrane integrity in the infarcted tissue. This phenomenon of delayed hyperenhancement has been proven to correlate with the actual extent of the infarct.
MRI myocardial late enhancement can quantify the size, location and transmural extent of the infarct. If the transmural extent of the infarct (region of enhancement on MRI) is less than 50% of the wall thickness, there will be improved contractility in that segment following revascularization. In areas of hypokinesia, if there is a rim of "black" or non-infarcted myocardium that is not contracting well, it indicates the presence of hibernating myocardium, which is likely to improve after revascularization of the artery supplying that particular territory.
The total duration of a myocardial late enhancement MR imaging protocol for viability is approximately 30 minutes, including scout images, first-pass images, cine images in two planes, and delayed myocardial enhancement images. In order to assess viable myocardium, the gadolinium contrast agent is injected at a dose of 0.15 to 0.2 mmol/kg. After about 10 minutes, short axis and long axis views (see cardiac axes) of the heart are obtained using an inversion prepared ECG gated gradient echo sequence. The inversion pulse is adjusted to suppress normal myocardium. Areas of nonviable myocardium retain extremely high signal intensity, black areas show normal tissue.

For Ultrasound Imaging (USI) see Myocardial Contrast Echocardiography at Medical-Ultrasound-Imaging.com.
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• Related Searches:
    • Displacement Encoding with Stimulated Echoes
    • Inversion Time
    • Perfusion Imaging
    • Cardiac MRI
    • Cardiovascular Imaging
 
Further Reading:
  Basics:
A Guide To Cardiac Imaging
   by www.simplyphysics.com    
  News & More:
Prediction of Myocardial Viability by MRI
1999   by circ.ahajournals.org    
Geron Demonstrates hESC-derived cardiomyocytes improve heart function after myocardial infarction
Monday, 27 August 2007   by www.brightsurf.com    
MRI Resources 
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Perfusion ImagingForum -
related threadsInfoSheet: - Sequences - 
Intro, 
Overview, 
Types of, 
etc.
 
(PWI - Perfusion Weighted Imaging) Perfusion MRI techniques (e.g. PRESTO - Principles of Echo Shifting using a Train of Observations) are sensitive to microscopic levels of blood flow. Contrast enhanced relative cerebral blood volume (rCBV) is the most used perfusion imaging. Both, the ready availability and the T2* susceptibility effects of gadolinium, rather than the T1 shortening effects make gadolinium a suitable agent for use in perfusion imaging. Susceptibility here refers to the loss of MR signal, most marked on T2* (gradient echo)-weighted and T2 (spin echo)-weighted sequences, caused by the magnetic field-distorting effects of paramagnetic substances.
T2* perfusion uses dynamic sequences based on multi or single shot techniques. The T2* (T2) MRI signal drop within or across a brain region is caused by spin dephasing during the rapid passage of contrast agent through the capillary bed. The signal decrease is used to compute the relative perfusion to that region. The bolus through the tissue is only a few seconds, high temporal resolution imaging is required to obtain sequential images during the wash in and wash out of the contrast material and therefore, resolve the first pass of the tracer. Due to the high temporal resolution, processing and calculation of hemodynamic maps are available (including mean transit time (MTT), time to peak (TTP), time of arrival (T0), negative integral (N1) and index.
An important neuroradiological indication for MRI is the evaluation of incipient or acute stroke via perfusion and diffusion imaging. Diffusion imaging can demonstrate the central effect of a stroke on the brain, whereas perfusion imaging visualizes the larger 'second ring' delineating blood flow and blood volume. Qualitative and in some instances quantitative (e.g. quantitative imaging of perfusion using a single subtraction) maps of regional organ perfusion can thus be obtained.
Echo planar and potentially echo volume techniques together with appropriate computing power offer real time images of dynamic variations in water characteristics reflecting perfusion, diffusion, oxygenation (see also Oxygen Mapping) and flow.
Another type of perfusion MR imaging allows the evaluation of myocardial ischemia during pharmacologic stress. After e.g., adenosine infusion, multiple short axis views (see cardiac axes) of the heart are obtained during the administration of gadolinium contrast. Ischemic areas show up as areas of delayed and diminished enhancement. The MRI stress perfusion has been shown to be more accurate than nuclear SPECT exams. Myocardial late enhancement and stress perfusion imaging can also be performed during the same cardiac MRI examination.
 
Images, Movies, Sliders:
 Normal Lung Gd Perfusion MRI  Open this link in a new window
      

Courtesy of  Robert R. Edelman

 Left Circumflex Ischemia First-pass Contrast Enhancement  Open this link in a new window
 
Radiology-tip.comradPerfusion Scintigraphy
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Medical-Ultrasound-Imaging.comBolus Injection
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• View the DATABASE results for 'Perfusion Imaging' (16).Open this link in a new window


• View the NEWS results for 'Perfusion Imaging' (3).Open this link in a new window.
 
Further Reading:
  Basics:
CHAPTER 55: Ischemia
2003
EVALUATION OF HUMAN STROKE BY MR IMAGING
2000
  News & More:
Non-invasive diagnostic procedures for suspected CHD: Search reveals informative evidence
Wednesday, 8 July 2020   by medicalxpress.co    
Implementation of Dual-Source RF Excitation in 3 T MR-Scanners Allows for Nearly Identical ADC Values Compared to 1.5 T MR Scanners in the Abdomen
Wednesday, 29 February 2012   by www.plosone.org    
Motion-compensation of Cardiac Perfusion MRI using a Statistical Texture Ensemble(.pdf)
June 2003   by www.imm.dtu.dk    
Turbo-FLASH Based Arterial Spin Labeled Perfusion MRI at 7 T
Thursday, 20 June 2013   by www.plosone.org    
Measuring Cerebral Blood Flow Using Magnetic Resonance Imaging Techniques
1999   by www.stanford.edu    
Vascular Filters of Functional MRI: Spatial Localization Using BOLD and CBV Contrast
MRI Resources 
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Bolus Injection
 
A bolus is a rapid infusion of high dose contrast agent. Dynamic and accumulation phase imaging can be performed after bolus injection. Since the transit time of the bolus through the tissue is only a few seconds, high temporal resolution imaging can be required to obtain sequential images during the wash in and wash out of the contrast material and, therefore, resolve the first pass of the tracer.
For the same injected dose of contrast agent the injection rate (and, consequently, the total injected volume) modifies the bolus peak profile. Increasing the injection rate produces a sharpening of the peak (Cmax increase, Tmax decrease, peak length decrease). At a low injection rate, the first pass presents a plateau form. Substantial changes in the gadolinium concentrations during signal acquisition induce artifacts. Furthermore, the haemodynamic parameters (cardiac output, blood pressure) influence the bolus profile. The characteristics of gadolinium agents are favorable in the early bolus phase, whereas the advantages of large complexes (e.g. blood pool agents) and ultrasmall superparamagnetic iron oxide (USPIO) are most evident in the distribution phase.
 
Images, Movies, Sliders:
 Left Circumflex Ischemia First-pass Contrast Enhancement  Open this link in a new window
      

Courtesy of  Robert R. Edelman

 Normal Lung Gd Perfusion MRI  Open this link in a new window
 
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• View the DATABASE results for 'Bolus Injection' (9).Open this link in a new window

 
Further Reading:
  News & More:
Contrast Bolus Timing and Scan Delay
2003   by www.med.nyu.edu    
MRI Resources 
Devices - Quality Advice - Pediatric and Fetal MRI - IR - Mobile MRI Rental - Knee MRI
 
Ventilation AgentsInfoSheet: - Contrast Agents - 
Intro, Overview, 
Characteristics, 
Types of, 
etc.MRI Resource Directory:
 - Contrast Agents -
 
Inert hyperpolarized gases are under development for imaging air spaces, including those in the lungs. Because they mostly contain air and water, lungs are difficult organs to image.
These ventilation agents (gases) have potential in lung imaging and are currently used in studies of the pulmonary ventilation:
•
perfluorinated gases
•
aerosolized gadolinium-DTPA
•
hyperpolarized gases (xenon-129, helium-3)
•
molecular oxygen

Specific isotopes of inert gases can be hyperpolarized. Hyperpolarized is a state in which almost all of the atoms nuclei are spinning in the same direction. Once the nuclei in the isotope 3He have been hyperpolarized using a laser, they remain in this state for several days. The inert, hyperpolarized gas can then be used in a lung imaging study, where the high concentration of polarized nuclei provides a sharp contrast in MRI. The technique is already being developed with a view to commercialization by Magnetic Imaging Technologies in Durham, North Carolina. According to the company, existing MRI equipment can be used with a few minor modifications, along with a gas polarizer. The technique could provide early detection and monitoring of pulmonary disease.
Hyperpolarized 129Xe can also be used as a magnetic resonance tracer because of its MR-enhanced sensitivity combined with its high solubility. This isotope differs from 3He in that it can dissolve in the blood. Strong enhancement of the nuclear spin polarization of xenon in the gas phase can be achieved by optical pumping of rubidium and subsequent spin-exchange with the xenon nuclei. This technique can increase the magnetic resonance signal of xenon by five orders of magnitude, thus allowing NMR detection of xenon in very low concentration. MR spectroscopy and imaging of optically polarized xenon shows considerable potential for medical applications (see also back projection imaging).
Nycomed Amersham anticipated the market for inert gases in pulmonary imaging. The company obtained an exclusive license for the use of helium (He) and xenon (Xe) as MRI contrast agents. Currently, the US FDA has not yet approved the commercial distribution of inert gas imaging equipment, because the technique is still undergoing trials.
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• View the DATABASE results for 'Ventilation Agents' (3).Open this link in a new window

 
Further Reading:
  Basics:
New oxygen-enhanced MRI scan 'helps identify most dangerous tumours'
Thursday, 10 December 2015   by www.dailymail.co.uk    
Low-Field MRI of Laser Polarized Noble Gas
   by xenon.unh.edu    
  News & More:
Hyperpolarized Gas MRI for Pulmonary Disease Assessment: Interview with Richard Hullihen, CEO of Polarean Imaging
Wednesday, 9 September 2020   by www.medgadget.com    
Pumpkin-shaped molecule enables 100-fold improved MRI contrast: new agent for detecting pathological cells
Tuesday, 13 October 2015   by phys.org    
MRI Mapping of Cerebrovascular Reactivity via Gas Inhalation Challenges
Wednesday, 17 December 2014   by www.jove.com    
Using MRI to study gas reactions
Thursday, 31 January 2008   by www.theengineer.co.uk    
New Technique Reveals Insights Into Lung Disease
Thursday, 13 December 2007   by www.sciencedaily.com    
MRI Resources 
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Liver ImagingForum -
related threadsMRI Resource Directory:
 - Liver Imaging -
 
Liver imaging can be performed with sonography, computed tomography (CT) and magnetic resonance imaging (MRI). Ultrasound is, caused by the easy access, still the first-line imaging method of choice; CT and MRI are applied whenever ultrasound imaging yields vague results. Indications are the characterization of metastases and primary liver tumors e.g., benign lesions such as focal nodular hyperplasia (FNH), adenoma, hemangioma and malignant lesions (cancer) such as hepatocellular carcinomas (HCC). The decision, which medical imaging modality is more suitable, MRI or CT, is dependent on the different factors. CT is less costly and more widely available; modern multislice scanners provide high spatial resolution and short scan times but has the disadvantage of radiation exposure.
With the introduction of high performance MR systems and advanced sequences the image quality of MRI for the liver has gained substantially. Fast spin echo or single shot techniques, often combined with fat suppression, are the most common T2 weighted sequences used in liver MRI procedures. Spoiled gradient echo sequences are used as ideal T1 weighted sequences for evaluating of the liver. The repetition time (TR) can be sufficiently long to acquire enough sections covering the entire liver in one pass, and to provide good signal to noise. The TE should be the shortest in phase echo time (TE), which provides strong T1 weighting, minimizes magnetic susceptibility effects, and permits acquisition within one breath hold to cover the whole liver. A flip angle of 80° provides good T1 weighting and less of power deposition and tissue saturation than a larger flip angle that would provide comparable T1 weighting.
Liver MRI is very dependent on the administration of contrast agents, especially when detection and characterization of focal lesions are the issues. Liver MRI combined with MRCP is useful to evaluate patients with hepatic and biliary disease.
Gadolinium chelates are typical non-specific extracellular agents diffusing rapidly to the extravascular space of tissues being cleared by glomerular filtration at the kidney. These characteristics are somewhat problematic when a large organ with a huge interstitial space like the liver is imaged. These agents provide a small temporal imaging window (seconds), after which they begin to diffuse to the interstitial space not only of healthy liver cells but also of lesions, reducing the contrast gradient necessary for easy lesion detection. Dynamic MRI with multiple phases after i.v. contrast media (Gd chelates), with arterial, portal and late phase images (similar to CT) provides additional information.
An additional advantage of MRI is the availability of liver-specific contrast agents (see also Hepatobiliary Contrast Agents). Gd-EOB-DTPA (gadoxetate disodium, Gadolinium ethoxybenzyl dimeglumine, EOVIST Injection, brand name in other countries is Primovist) is a gadolinium-based MRI contrast agent approved by the FDA for the detection and characterization of known or suspected focal liver lesions.
Gd-EOB-DTPA provides dynamic phases after intravenous injection, similarly to non-specific gadolinium chelates, and distributes into the hepatocytes and bile ducts during the hepatobiliary phase. It has up to 50% hepatobiliary excretion in the normal liver.
Since ferumoxides are not eliminated by the kidney, they possess long plasmatic half-lives, allowing circulation for several minutes in the vascular space. The uptake process is dependent on the total size of the particle being quicker for larger particles with a size of the range of 150 nm (called superparamagnetic iron oxide). The smaller ones, possessing a total particle size in the order of 30 nm, are called ultrasmall superparamagnetic iron oxide particles and they suffer a slower uptake by RES cells. Intracellular contrast agents used in liver MRI are primarily targeted to the normal liver parenchyma and not to pathological cells. Currently, iron oxide based MRI contrast agents are not marketed.
Beyond contrast enhanced MRI, the detection of fatty liver disease and iron overload has clinical significance due to the potential for evolution into cirrhosis and hepatocellular carcinoma. Imaging-based liver fat quantification (see also Dixon) provides noninvasively information about fat metabolism; chemical shift imaging or T2*-weighted imaging allow the quantification of hepatic iron concentration.

See also Abdominal Imaging, Primovistâ„¢, Liver Acquisition with Volume Acquisition (LAVA), T1W High Resolution Isotropic Volume Examination (THRIVE) and Bolus Injection.

For Ultrasound Imaging (USI) see Liver Sonography at Medical-Ultrasound-Imaging.com.
 
Images, Movies, Sliders:
 Anatomic Imaging of the Liver  Open this link in a new window
      

 MRI Liver T2 TSE  Open this link in a new window
    
 
Radiology-tip.comradAbdomen CT,  Biliary Contrast Agents
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Medical-Ultrasound-Imaging.comLiver Sonography,  Vascular Ultrasound Contrast Agents
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• View the DATABASE results for 'Liver Imaging' (13).Open this link in a new window


• View the NEWS results for 'Liver Imaging' (10).Open this link in a new window.
 
Further Reading:
  Basics:
Comparison of liver scintigraphy and the liver-spleen contrast in Gd-EOB-DTPA-enhanced MRI on liver function tests
Thursday, 18 November 2021   by www.nature.com    
Liver Imaging Today
Friday, 1 February 2013   by www.healthcare.siemens.it    
Elastography: A Useful Method in Depicting Liver Hardness
Thursday, 15 April 2010   by www.sciencedaily.com    
Iron overload: accuracy of in-phase and out-of-phase MRI as a quick method to evaluate liver iron load in haematological malignancies and chronic liver disease
Friday, 1 June 2012   by www.ncbi.nlm.nih.gov    
  News & More:
Utility and impact of magnetic resonance elastography in the clinical course and management of chronic liver disease
Saturday, 20 January 2024   by www.nature.com    
Even early forms of liver disease affect heart health, Cedars-Sinai study finds
Thursday, 8 December 2022   by www.eurekalert.org    
For monitoring purposes, AI-aided MRI does what liver biopsy does with less risk, lower cost
Wednesday, 28 September 2022   by radiologybusiness.com    
Perspectum: High Liver Fat (Hepatic Steatosis) Linked to Increased Risk of Hospitalization in COVID-19 Patients With Obesity
Monday, 29 March 2021   by www.businesswire.com    
EMA's final opinion confirms restrictions on use of linear gadolinium agents in body scans
Friday, 21 July 2017   by www.ema.europa.eu    
T2-Weighted Liver MRI Using the MultiVane Technique at 3T: Comparison with Conventional T2-Weighted MRI
Friday, 16 October 2015   by www.ncbi.nlm.nih.gov    
EORTC study aims to qualify ADC as predictive imaging biomarker in preoperative regimens
Monday, 4 January 2016   by www.eurekalert.org    
MRI effectively measures hemochromatosis iron burden
Saturday, 3 October 2015   by medicalxpress.com    
Total body iron balance: Liver MRI better than biopsy
Sunday, 15 March 2015   by www.eurekalert.org    
MRI Resources 
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