Name: cardiac magnetic resonance imaging at 7 tesla
Uploaded: 2019-01-06T13:00:00
Description: Watch this Scientific Journal Video about Cardiac Magnetic Resonance Imaging at 7 Tesla at JoVE.com

The authors acknowledge the facilities, and the scientific and technical assistance of the National Imaging Facility at the Centre for Advanced Imaging, University of Queensland. We would also like to thank Graham Galloway and Ian Brereton for their help to obtain a CAESIE grant for Thoralf Niendorf.

The study is approved by the ethics committee of the University of Queensland, Queensland, Australia and informed consent has been obtained from all subjects included in the study.
1. Subjects
<ol>
	<li>Recruit volunteer subjects over 18 years of age internally at the University of Queensland.</li>
	<li>Informed consent
	<ol>
		<li>Inform each subject about potential risks of undergoing the examination before entering the magnetic resonance imaging (MRI) safety zone. Specifically, discuss th...

<ol>
	<li>Kramer, C. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Standardized+cardiovascular+magnetic+resonance+(CMR)+protocols+2013+update.">Standardized cardiovascular magnetic resonance (CMR) protocols 2013 update.</a> Journal of Cardiovascular Magnetic Resonance. 15 (1), 1 (2013).</li><li>Earls, J. P., Ho, V. B., Foo, T. K., Castillo, E., Flamm, S. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiac+MRI:+Recent+progress+and+continued+challenges.">Cardiac MRI: Recent progress and continued challenges.</a> Journal of Magnetic Resonance Imaging. 16 (2), 111-127 (2002).</li><li>Wintersperger, B. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiac+CINE+MR+imaging+with+a+32-channel+cardiac+coil+and+parallel+imaging:+Impact+of+acceleration+factors+on+image+quality+and+volumetric+accuracy.">Cardiac CINE MR imaging with a 32-channel cardiac coil and parallel imaging: Impact of acceleration factors on image quality and volumetric accuracy.</a> Journal of Magnetic Resonance Imaging. 23 (2), 222-227 (2006).</li><li>Schmitt, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+128-channel+receive-only+cardiac+coil+for+highly+accelerated+cardiac+MRI+at+3+Tesla.">A 128-channel receive-only cardiac coil for highly accelerated cardiac MRI at 3 Tesla.</a> Magnetic Resonance in Medicine. 59 (6), 1431-1439 (2008).</li><li>Wech, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High-resolution+functional+cardiac+MR+imaging+using+density-weighted+real-time+acquisition+and+a+combination+of+compressed+sensing+and+parallel+imaging+for+image+reconstruction.">High-resolution functional cardiac MR imaging using density-weighted real-time acquisition and a combination of compressed sensing and parallel imaging for image reconstruction.</a> R&#246;Fo: Fortschritte Auf Dem Gebiete Der R&#246;ntgenstrahlen Und Der Nuklearmedizin. 182 (8), 676-681 (2010).</li><li>St&#228;b, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=CAIPIRINHA+accelerated+SSFP+imaging.">CAIPIRINHA accelerated SSFP imaging.</a> Magnetic Resonance in Medicine. 65 (1), 157-164 (2011).</li><li>Gutberlet, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Influence+of+high+magnetic+field+strengths+and+parallel+acquisition+strategies+on+image+quality+in+cardiac+2D+CINE+magnetic+resonance+imaging:+comparison+of+1.5+T+vs.+3.0+T.">Influence of high magnetic field strengths and parallel acquisition strategies on image quality in cardiac 2D CINE magnetic resonance imaging: comparison of 1.5 T vs. 3.0 T.</a> European Radiology. 15 (8), 1586-1597 (2005).</li><li>Gutberlet, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comprehensive+cardiac+magnetic+resonance+imaging+at+3.0+Tesla:+feasibility+and+implications+for+clinical+applications.">Comprehensive cardiac magnetic resonance imaging at 3.0 Tesla: feasibility and implications for clinical applications.</a> Investigative radiology. 41 (2), 154-167 (2006).</li><li>Kraff, O., Fischer, A., Nagel, A. M., M&#246;nninghoff, C., Ladd, M. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=MRI+at+7+tesla+and+above:+Demonstrated+and+potential+capabilities:+Capabilities+of+MRI+at+7T+and+Above.">MRI at 7 tesla and above: Demonstrated and potential capabilities: Capabilities of MRI at 7T and Above.</a> Journal of Magnetic Resonance Imaging. 41 (1), 13-33 (2015).</li><li>Moser, E., Stahlberg, F., Ladd, M. E., Trattnig, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=7-T+MR-from+research+to+clinical+applications?.">7-T MR-from research to clinical applications?.</a> NMR in Biomedicine. 25 (5), 695-716 (2012).</li><li>Hecht, E. M., Lee, R. F., Taouli, B., Sodickson, D. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Perspectives+on+Body+MR+Imaging+at+Ultrahigh+Field.">Perspectives on Body MR Imaging at Ultrahigh Field.</a> Magnetic Resonance Imaging Clinics of North America. 15 (3), 449-465 (2007).</li><li>Niendorf, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=W(h)ither+human+cardiac+and+body+magnetic+resonance+at+ultrahigh+fields?+technical+advances,+practical+considerations,+applications,+and+clinical+opportunities:+Advances+in+ultrahigh+field+Cardiac+and+Body+Magnetic+Resonance.">W(h)ither human cardiac and body magnetic resonance at ultrahigh fields? technical advances, practical considerations, applications, and clinical opportunities: Advances in ultrahigh field Cardiac and Body Magnetic Resonance.</a> NMR in Biomedicine. 29 (9), 1173-1179 (2016).</li><li>Niendorf, T., Sodickson, D. K., Krombach, G. A., Schulz-Menger, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Toward+cardiovascular+MRI+at+7+T:+clinical+needs,+technical+solutions+and+research+promises.">Toward cardiovascular MRI at 7 T: clinical needs, technical solutions and research promises.</a> European Radiology. 20 (12), 2806-2816 (2010).</li><li>Niendorf, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Progress+and+promises+of+human+cardiac+magnetic+resonance+at+ultrahigh+fields:+A+physics+perspective.">Progress and promises of human cardiac magnetic resonance at ultrahigh fields: A physics perspective.</a> Journal of Magnetic Resonance. 229, 208-222 (2013).</li><li>Hinton, D. P., Wald, L. L., Pitts, J., Schmitt, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+Cardiac+MRI+on+1.5+and+3.0+Tesla+Clinical+Whole+Body+Systems.">Comparison of Cardiac MRI on 1.5 and 3.0 Tesla Clinical Whole Body Systems.</a> Investigative Radiology. 38 (7), 436-442 (2003).</li><li>Ohliger, M. A., Grant, A. K., Sodickson, D. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultimate+intrinsic+signal-to-noise+ratio+for+parallel+MRI:+Electromagnetic+field+considerations.">Ultimate intrinsic signal-to-noise ratio for parallel MRI: Electromagnetic field considerations.</a> Magnetic resonance in medicine. 50 (5), 1018-1030 (2003).</li><li>Vaughan, J. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Whole-body+imaging+at+7T:+Preliminary+results.">Whole-body imaging at 7T: Preliminary results.</a> Magnetic Resonance in Medicine. 61 (1), 244-248 (2009).</li><li>Hezel, F., Thalhammer, C., Waiczies, S., Schulz-Menger, J., Niendorf, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High+Spatial+Resolution+and+Temporally+Resolved+T2*+Mapping+of+Normal+Human+Myocardium+at+7.0+Tesla:+An+Ultrahigh+Field+Magnetic+Resonance+Feasibility+Study.">High Spatial Resolution and Temporally Resolved T2* Mapping of Normal Human Myocardium at 7.0 Tesla: An Ultrahigh Field Magnetic Resonance Feasibility Study.</a> PLOS ONE. 7 (12), e52324 (2012).</li><li>Suttie, J. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=7+Tesla+(T)+human+cardiovascular+magnetic+resonance+imaging+using+FLASH+and+SSFP+to+assess+cardiac+function:+validation+against+1.5+T+and+3+T.">7 Tesla (T) human cardiovascular magnetic resonance imaging using FLASH and SSFP to assess cardiac function: validation against 1.5 T and 3 T.</a> NMR in biomedicine. 25 (1), 27-34 (2012).</li><li>von Knobelsdorff-Brenkenhoff, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiac+chamber+quantification+using+magnetic+resonance+imaging+at+7+Tesla-a+pilot+study.">Cardiac chamber quantification using magnetic resonance imaging at 7 Tesla-a pilot study.</a> European Radiology. 20 (12), 2844-2852 (2010).</li><li>Winter, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+three+multichannel+transmit/receive+radiofrequency+coil+configurations+for+anatomic+and+functional+cardiac+MRI+at+7.0T:+implications+for+clinical+imaging.">Comparison of three multichannel transmit/receive radiofrequency coil configurations for anatomic and functional cardiac MRI at 7.0T: implications for clinical imaging.</a> European Radiology. 22 (10), 2211-2220 (2012).</li><li>Schmitter, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiac+imaging+at+7+tesla:+Single-+and+two-spoke+radiofrequency+pulse+design+with+16-channel+parallel+excitation:+Cardiac+Imaging+at+7T.">Cardiac imaging at 7 tesla: Single- and two-spoke radiofrequency pulse design with 16-channel parallel excitation: Cardiac Imaging at 7T.</a> Magnetic Resonance in Medicine. 70 (5), 1210-1219 (2013).</li><li>Krug, J., Rose, G., Stucht, D., Clifford, G., Oster, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Limitations+of+VCG+based+gating+methods+in+ultra+high+field+cardiac+MRI.">Limitations of VCG based gating methods in ultra high field cardiac MRI.</a> Journal of Cardiovascular Magnetic Resonance. 15 (Suppl 1), W19 (2013).</li><li>St&#228;b, D., Roessler, J., O'Brien, K., Hamilton-Craig, C., Barth, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ECG+Triggering+in+Ultra-High+Field+Cardiovascular+MRI.">ECG Triggering in Ultra-High Field Cardiovascular MRI.</a> Tomography. 2 (3), 167-174 (2016).</li><li>Gr&#228;&#223;l, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Design,+evaluation+and+application+of+an+eight+channel+transmit/receive+coil+array+for+cardiac+MRI+at+7.0T.">Design, evaluation and application of an eight channel transmit/receive coil array for cardiac MRI at 7.0T.</a> European Journal of Radiology. 82 (5), 752-759 (2013).</li><li>Graessl, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modular+32-channel+transceiver+coil+array+for+cardiac+MRI+at+7.0T.">Modular 32-channel transceiver coil array for cardiac MRI at 7.0T.</a> Magnetic Resonance in Medicine. 72 (1), 276-290 (2014).</li><li>Snyder, C. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Initial+results+of+cardiac+imaging+at+7+tesla.">Initial results of cardiac imaging at 7 tesla.</a> Magnetic Resonance in Medicine. 61 (3), 517-524 (2009).</li><li>Meloni, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detailing+magnetic+field+strength+dependence+and+segmental+artifact+distribution+of+myocardial+effective+transverse+relaxation+rate+at+1.5,+3.0,+and+7.0+T:+Magnetic+Field+Dependence+of+Myocardial+R+2+*.">Detailing magnetic field strength dependence and segmental artifact distribution of myocardial effective transverse relaxation rate at 1.5, 3.0, and 7.0 T: Magnetic Field Dependence of Myocardial R 2 *.</a> Magnetic Resonance in Medicine. 71 (6), 2224-2230 (2014).</li><li>von Knobelsdorff-Brenkenhoff, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+the+right+ventricle+with+cardiovascular+magnetic+resonance+at+7+Tesla.">Assessment of the right ventricle with cardiovascular magnetic resonance at 7 Tesla.</a> Journal of Cardiovascular Magnetic Resonance. 15, 23 (2013).</li><li>Petersen, S. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reference+ranges+for+cardiac+structure+and+function+using+cardiovascular+magnetic+resonance+(CMR)+in+Caucasians+from+the+UK+Biobank+population+cohort.">Reference ranges for cardiac structure and function using cardiovascular magnetic resonance (CMR) in Caucasians from the UK Biobank population cohort.</a> Journal of Cardiovascular Magnetic Resonance. 19 (1), (2017).</li><li>Frauenrath, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Feasibility+of+cardiac+gating+free+of+interference+with+electro-magnetic+fields+at+1.5+Tesla,+3.0+Tesla+and+7.0+Tesla+using+an+MR-stethoscope.">Feasibility of cardiac gating free of interference with electro-magnetic fields at 1.5 Tesla, 3.0 Tesla and 7.0 Tesla using an MR-stethoscope.</a> Investigative radiology. 44 (9), 539-547 (2009).</li><li>Frauenrath, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acoustic+cardiac+triggering:+a+practical+solution+for+synchronization+and+gating+of+cardiovascular+magnetic+resonance+at+7+Tesla.">Acoustic cardiac triggering: a practical solution for synchronization and gating of cardiovascular magnetic resonance at 7 Tesla.</a> Journal of Cardiovascular Magnetic Resonance. 12 (1), 67 (2010).</li><li>Schroeder, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Novel+Method+for+Contact-Free+Cardiac+Synchronization+Using+the+Pilot+Tone+Navigator.">A Novel Method for Contact-Free Cardiac Synchronization Using the Pilot Tone Navigator.</a> Proceedings of the International Society for Magnetic Resonance in Medicine. 24, 3103 (2016).</li></ol>

Functional CMR examinations could be conducted successfully at 7 Tesla. Based on the field strength driven SNR gain, CINE images of the human heart could be acquired with significantly higher spatial resolution compared to 1.5 or 3 T. While a slice thickness of 6 to 8 mm and in-plane voxel edge lengths of 1.2 to 2.0 mm are commonly used at lower clinical field strengths1,30, the measurements at 7 Tesla could be conducted with a slice thickness of 4 mm and an isot...

Cardiovascular magnetic resonance (CMR) is of proven clinical value with a growing range of clinical indications1,2. In particular, the evaluation of cardiac morphology and function is of major relevance and typically realized by tracking and visualizing the heart motion throughout the entire cardiac cycle using segmented breath-held two-dimensional (2D) cinematograpic (CINE) imaging techniques. While a high spatio-temporal resolution, high blood-myocardium contrast and high signal-to-noise ratio (SNR) are required, the data acquisition is highly constrained by the cardiac and respiratory motion and the use of multiple breath-holds as well as the need for whole heart or left-ventricular coverage often leads to extensive scan times. Parallel imaging, simultaneous multi-slice imaging or other acceleration techniques help to address the motion related constraints3,4,5,6.
Moreover, to benefit from the inherent SNR gain at higher magnetic fields, high field systems with B0 = 3 Tesla are increasingly employed in clinical routine7,8. The development has also encouraged investigations into ultra-high field (B0&#8805;7 Tesla, f&#8805;298 MHz) CMR9,10,11,12,13,14. The gain in SNR and blood-myocardium contrast inherent to the higher field strength holds the promise to be transferrable into enhanced functional CMR using a spatial resolution that exceeds today&#39;s limits15,16,17. In turn, new possibilities for magnetic resonance (MR) based myocardial tissue characterization, metabolic imaging and microstructure imaging are expected13. So far, several groups have demonstrated the feasibility of CMR at 7 Tesla and specifically tailored ultra-high field technology has been introduced17,18,19,20,21,22. Regarding these promising developments, the potential of ultra-high field CMR can be considered to be yet untapped13. At the same time, physical phenomena and practical obstacles such as magnetic field inhomogeneities, radio frequency (RF) excitation field non-uniformities, off-resonance artifacts, dielectric effects, localized tissue heating and field strength independent RF power deposition constraints make imaging at ultra-high field challenging10,17. The latter are employed to control RF induced tissue heating and to ensure safe operation. Moreover, electrocardiogram (ECG) based triggering can be significantly impacted by the magneto-hydrodynamic (MHD) effect19,23,24. To address the challenges induced by the short wavelength in tissue, many-element transceiver RF coil arrays tailored for CMR at 7 Tesla were proposed21,25,26,27. Parallel RF transmission provides means for transmission field shaping, also known as B1+ shimming, which allows to reduce the magnetic field inhomogeneities and susceptibility artefacts18,28. While at the current stage, some of these measures might increase the experimental complexity, the concepts have proven helpful and may be translated to the clinical field strengths of CMR 1.5 T or 3 T.
Currently, 2D balanced steady state free precession (bSSFP) CINE imaging is the standard of reference for clinical functional CMR at 1.5 T and 3 T1. Recently, the sequence was successfully employed at 7 Tesla, but a large number of challenges remain19. Patient specific B1+ shimming and extra RF coil adjustments were applied to manage RF power deposition constraints and careful B0 shimming was performed to control the sequence typical banding artifacts. With an average scan time of 93 minutes for left-ventricular (LV) function assessment, the efforts prolonged the examination times beyond clinically acceptable limits. Here, spoiled gradient echo sequences provide a viable alternative. At 7 Tesla, total examination times of (29 &#177; 5) min for LV function assessment were reported, which corresponds well to clinical imaging protocols at lower field strengths21. Thereby, spoiled gradient echo based CMR benefits from the prolonged T1 relaxation times at ultra-high field that result in an enhanced blood-myocardium contrast superior to gradient echo imaging at 1.5 T. This renders subtle anatomic structures such as the pericardium, the mitral and tricuspid valves as well as the papillary muscles well identifiable. Congruously, spoiled gradient echo based cardiac chamber quantification at 7 Tesla agrees closely with LV parameters derived from 2D bSSFP CINE imaging at 1.5 T20. Apart from that, accurate right-ventricular (RV) chamber quantification was recently demonstrated feasible using a high resolution spoiled gradient echo sequence at 7 Tesla29.
Recognizing the challenges and opportunities of CMR at ultra-high field, this work presents a setup and protocol customized for functional CMR acquisitions on an investigational 7 Tesla research scanner. The protocol outlines the technical underpinnings, shows how impediments can be overcome, and provides practical considerations that help to keep the extra experimental overhead at a minimum. The proposed imaging protocol constitutes a four-fold improvement in the spatial resolution versus today&#39;s clinical practice. It is meant to provide a guideline for clinical adaptors, physician scientists, translational researchers, application experts, MR radiographers, technologists and new entrants into the field.

<table border="0" cellpadding="0" cellspacing="0" style="width:572px;" width="573">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">7 Tesla MRI system</td>
			<td style="width:71px;">Siemens</td>
			<td style="width:119px;"></td>
			<td style="width:167px;">Investigational Device</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">32-Channel -1H-Cardiac Coil</td>
			<td style="width:71px;">MRI.Tools GmbH</td>
			<td style="width:119px;"></td>
			<td>Transmit/Receive RF Coil for MR Imaging and Spectroscopy at 7.0 Tesla</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">ECG Trigger Device</td>
			<td style="width:71px;">Siemens</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Pulse Trigger Device</td>
			<td style="width:71px;">Siemens</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
	</tbody>
</table>

cardiac magnetic resonance imaging at 7 tesla

CMR at an ultra-high field (magnetic field strength B0&#160;&#8805; 7 Tesla) benefits from the signal-to-noise ratio (SNR) advantage inherent at higher magnetic field strengths and potentially provides improved signal contrast and spatial resolution. While promising results have been achieved, ultra-high field CMR is challenging due to energy deposition constraints and physical phenomena such as transmission field non-uniformities and magnetic field inhomogeneities. In addition, the magneto-hydrodynamic effect renders the synchronization of the data acquisition with the cardiac motion difficult. The challenges are currently addressed by explorations into novel magnetic resonance technology. If all impediments can be overcome, ultra-high field CMR may generate new opportunities for functional CMR, myocardial tissue characterization, microstructure imaging or metabolic imaging. Recognizing this potential, we show that multi-channel radio frequency (RF) coil technology tailored for CMR at 7 Tesla together with higher order B0 shimming and a backup signal for cardiac triggering facilitates high fidelity functional CMR. With the proposed setup, cardiac chamber quantification can be accomplished in examination times similar to those achieved at lower field strengths. To share this experience and to support the dissemination of this expertise, this work describes our setup and protocol tailored for functional CMR at 7 Tesla.

Representative results of cardiac CINE examinations derived from volunteers are depicted in Figure 4. Shown are diastolic and systolic time-frames of short axis and a four-chamber long axis views of the human heart. The significantly higher spatial resolution for the short axis views (Figure&#160;4a, 4b, 4e, 4f) compared to the long axis views (Figure&#160;4c...

Watch this Scientific Journal Video about Cardiac Magnetic Resonance Imaging at 7 Tesla at JoVE.com

Cardiac Magnetic Resonance Imaging at 7 Tesla

The sensitivity gain inherent to ultrahigh field magnetic resonance holds promise for high spatial resolution imaging of the heart. Here, we describe a protocol customized for functional cardiovascular magnetic resonance (CMR) at 7 Tesla using an advanced multi-channel radio-frequency coil, magnetic field shimming and a triggering concept.

CMR at an ultra-high field (magnetic field strength B0&#160;&#8805; 7 Tesla) benefits from the signal-to-noise ratio (SNR) advantage inherent at higher ...

The overall goal of the following experiment is to perform high-fidelity functional cardiac MRI of the heart at ultra high field strength of 7 Tesla. This is achieved by A.utilizing multi-channel RF coil technology specifically tailored to the ultra high field strength. B.careful subject positioning.C.employing high order BO shimming and D.making use of the available ECG trigger devices. Cardiovascular magnetic resonance imaging is of proven clinical value with a growing range of indications. This imaging in particular is of profound relevance for the assessment of myocardial function.Ultra feeds, such as 7 Tesla, provides of a large signal noise advantage which can be transferred into spay-shous-lou-shus that exceed today's limits. In turn, we expect new possibilities for myocardial tissue characterization and micro structure imaging. The advantages of 7 Tesla is sometimes offset by a number of practical obstacles and physics raley phenomenon, such as Moreover, ECG triggering can be significantly impacted by the magneto-hydrodynamic effect.Recognizing these challenges, we propose a setup and protocol for functional at 7 Tesla. The proposed imaging protocol consists of a four-fold improvement in spatial resolution with today's clinical practice. Unlike clinical scanners, operating at 1 point 5 or 3 Tesla, the ultra-high field scanner is not equipped with a body coil, and the use of a local transceiver array is essential to signal excitation.Thus, the patient table has to be prepared to accommodate the additional hardware required to operate the dedicated 32-channel transceiver RF coil. The coil used in this experiment consists of several power-splitter, phase-shifter, and transmit receive interface boxes, in addition to the two RF coil sections that will be placed below and on top of the subject. First, place the additional RF coil hardware at the top end of the patient table.Link the individual boxes with the appropriate BNC cables. Connect the interface boxes to the four coil plugs on the patient table. Make sure that there is sufficient space on the table to guarantee the positioning of the subject within the isocenter of the magnet.As shown here, this can be achieved by pre-defining a spot for the coil on the patient table, in the preliminary test with volunteers of different body height. Place the posterior coil array into the pre-defined spot on the patient table. Connect the coil with the appropriate interface box.Next, connect the four modules of the anterior coil array with its interface, and place them aside to allow for the subject positioning. Inform the subject about the imaging procedure, as well as the potential risks of undergoing the examination, and obtain consent in writing. Before entering the MRI safety zone, perform the MRI safety and metal screening.Since imaging is performed during breath-hold at the end of expiration, consistent breath-holding is integral to image quality. Coach the subject on breathing technique prior to scanning. Position the subject's heart central to the posterior coil array.The head will usually be placed on top of the coil interface box connectors. Careful placement of the cables and appropriate use of cushioning is important, and ensures the subject's comfort and compliance. Attach the ECG electrodes and trigger device to the body.Attach the pulse trigger device to the subject's index finger. The second trigger device allows for switching in the event of severe ECG signal distortions. Hand the safety squeeze ball to the subject.Place the anterior coil on the subject's chest. Use headphones and ear buds to reduce the noise exposure and allow communication with the subject. Drive the subject into the scanner bore.Check the communication systems and the well-being of the subject before proceeding. Hi, can you hear me? Are you okay?We're gonna start the scanner shortly now. Use basic localizer scans to verify the correct positioning of the participant's heart in the isocenter. Reposition the subject as necessary.Next, prescribe the shim volume so that it covers the heart entirely. Use a non-triggered flow compensated, 2D multi-echo flash shim sequence to calculate the third-order shim currents. After setting the currents, make sure that the shim volume and the shim currents remain fixed throughout the remainder of the examination.For double-oblique slice planning employ a breath-held and ECG triggered 2D flash sequence. The breath is always held in expiration. First, plan the two-chamber localizer slice perpendicular on the axial scout, and parallel to the septal wall.To optimize the image contrast employ high-flip angles or use a segmented cine acquisition. Second, plan the four-chamber localizer slice perpendicular to the two-chamber localizer through the mitrial valve and the apex of the left ventricle. Finally, acquire seven short access localizer slices perpendicular to the four-chamber localizer slice, parallel to the mitrial valve and perpendicular to the septal wall.Adapt the field of view as needed. Perform the cine acquisitions using a high-resolution, breath-held, ECG-triggered, segmented, 2D flash sequence. Start with the left ventricular four-chamber view, also known as the horizontal long axis.Plan the central slice through the center of the mitral and tri-cuspid valves, and the apex of the left ventricle. Cover the entire heart. Scan each slice during an individual breath-hold expiration.Proceed with the left ventricular short axis slices. Plan them perpendicular to the horizontal long axis and parallel to the mitral valve. Cover the whole left ventricle from the base to the apex.Make sure that the first slice is accurately positioned at the mitral valve in leaflet insertions. Again, acquire each slice with an individual breath-hold and expiration. This figure shows a typical ECG trace obtained from a volunteer outside of the magnet bore on the left, and in the isocenter of the magnet on the right.The ECG is corrupted by interference with electromagnetic fields and by the magneto-hydrodynamic effect, or MHD Effect, for short. The MHD effect is pronounced during the cardiac phases of systolic aortic flow and is visible as a severe distortion of the ST segment in the ECG trace. This compromises R-wave recognition and synchronization of the data acquisition within the cardiac cycle.This figure shows representative diastolic and systolic images of the long axis views obtained using the proposed protocol. Due to severe distortions of the ECG trigger signal, pulse triggering was utilized for this acquisition. The jitter in the trigger signal induced minor motion artifacts which are pronounced during sistol.Here, representative short axis views are shown. The very high spatial resolution of one by one millimeter in plane is clearly visible. Even when employing a slice thickness as thin as four millimeters, the images provide ample signal to noise and contrast to delineate the myocardial walls.In some cases, signal voids due to destructive interferences in the transmission field can be seen as well. The 7 tesla allows us to perform the Cneg rescisions with very high special resolution. Compared to 1.5 or 3 Tesla, we were able to improve the spatial resolution by a factor of three to four.Our results show that fungshotic MRI examinations can be successfully conducted at 7 Tesla and we can demonstrate the potential of ultra-field cardiovascular imaging.

cardiac-magnetic-resonance-imaging-at-7-tesla

Research

Education

JoVE Core

JoVE Journal

Physics

Medicine

Unit 1

Magnetic Forces and Fields

SCIENTISTS IN ACTION

Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking

Purpose: An accurate and practical method to measure parameters like strain in myocardial tissue is of great clinical value, since it has been shown, that strain is a more sensitive and earlier marker for contractile dysfunction than the frequently used parameter EF. Current technologies for CMR are time consuming and difficult to implement in clinical practice. Feature tracking is a technology that can lead to more automization and robustness of quantitative analysis of medical images with less time consumption than comparable methods.
Methods: An automatic or manual input in a single phase serves as an initialization from which the system starts to track the displacement of individual patterns representing anatomical structures over time. The specialty of this method is that the images do not need to be manipulated in any way beforehand like e.g. tagging of CMR images.
Results: The method is very well suited for tracking muscular tissue and with this allowing quantitative elaboration of myocardium and also blood flow.
Conclusions: This new method offers a robust and time saving procedure to quantify myocardial tissue and blood with displacement, velocity and deformation parameters on regular sequences of CMR imaging. It therefore can be implemented in clinical practice.

An accurate and practical method to measure parameters like strain in myocardial tissue is of great clinical value, since it has been shown, that strain is a more sensitive and earlier marker for contractile dysfunction than the frequently used parameter EF.

Purpose: An accurate and practical method to measure parameters like strain in myocardial tissue is of great clinical value, since it has been shown, that ...

Magnetic Resonance Imaging Quantification of Pulmonary Perfusion using Calibrated Arterial Spin Labeling

This demonstrates a MR imaging method to measure the spatial distribution of pulmonary blood flow in healthy subjects 
during normoxia (inspired O2, fraction (FIO2) = 0.21) hypoxia (FIO2 = 0.125), and hyperoxia 
(FIO2 = 1.00). In addition, the physiological responses of the subject are monitored in the MR scan environment. MR images 
were obtained on a 1.5 T GE MRI scanner during a breath hold from a sagittal slice in the right lung at functional residual capacity. An arterial 
spin labeling sequence (ASL-FAIRER) was used to measure the spatial distribution of pulmonary blood flow 1,2 and a multi-echo fast 
gradient echo (mGRE) sequence 3 was used to quantify the regional proton (i.e. H2O) density, allowing the quantification 
of density-normalized perfusion for each voxel (milliliters blood per minute per gram lung tissue). 
With a pneumatic switching valve and facemask equipped with a 2-way non-rebreathing valve, different oxygen concentrations 
were introduced to the subject in the MR scanner through the inspired gas tubing. A metabolic cart collected expiratory gas via expiratory tubing. Mixed expiratory O2 and CO2 concentrations, oxygen consumption, carbon dioxide production, respiratory exchange ratio, 
respiratory frequency and tidal volume were measured. Heart rate and oxygen saturation were monitored using pulse-oximetry. 
Data obtained from a normal subject showed that, as expected, heart rate was higher in hypoxia (60 bpm) than during normoxia (51) or hyperoxia (50) and the arterial oxygen saturation (SpO2) was reduced during hypoxia to 86%. Mean ventilation was 8.31 L/min BTPS during hypoxia, 7.04 L/min during normoxia, and 6.64 L/min during hyperoxia. Tidal volume was 0.76 L during hypoxia, 0.69 L during normoxia, and 0.67 L during hyperoxia. 
Representative quantified ASL data showed that the mean density normalized perfusion was 8.86 ml/min/g during hypoxia, 8.26 ml/min/g during normoxia and 8.46 ml/min/g during hyperoxia, respectively. In this subject, the relative dispersion4, an index of global heterogeneity, was increased in hypoxia (1.07 during hypoxia, 0.85 during normoxia, and 0.87 during hyperoxia) while the fractal dimension (Ds), another index of heterogeneity reflecting vascular branching structure, was unchanged (1.24 during hypoxia, 1.26 during normoxia, and 1.26 during hyperoxia). 
Overview. This protocol will demonstrate the acquisition of data to measure the distribution of pulmonary perfusion noninvasively under conditions of normoxia, hypoxia, and hyperoxia using a magnetic resonance imaging technique known as arterial spin labeling (ASL). 
Rationale: Measurement of pulmonary blood flow and lung proton density using MR technique offers high spatial resolution images which can be quantified and the ability to perform repeated measurements under several different physiological conditions. In human studies, PET, SPECT, and CT are commonly used as the alternative techniques. However, these techniques involve exposure to ionizing radiation, and thus are not suitable for repeated measurements in human subjects.

A MR imaging method to study the distribution of pulmonary blood flow under a variety of physiological conditions, in this case exposure to three different inspired oxygen concentrations: hypoxia, normoxia, and hyperoxia, is described. This technique utilizes human pulmonary physiology research techniques in an MR scanning environment.

This demonstrates a MR imaging method to measure the spatial distribution of pulmonary blood flow in healthy subjects 
during normoxia (inspired O2, ...

Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases

Diffusion tensor imaging (DTI) techniques provide information on the microstructural processes of the cerebral white matter (WM) in vivo. The present applications are designed to investigate differences of WM involvement patterns in different brain diseases, especially neurodegenerative disorders, by use of different DTI analyses in comparison with matched controls. 	
DTI data analysis is performed in a variate fashion, i.e. voxelwise comparison of regional diffusion direction-based metrics such as fractional anisotropy (FA), together with fiber tracking (FT) accompanied by tractwise fractional anisotropy statistics (TFAS) at the group level in order to identify differences in FA along WM structures, aiming at the definition of regional patterns of WM alterations at the group level. Transformation into a stereotaxic standard space is a prerequisite for group studies and requires thorough data processing to preserve directional inter-dependencies. The present applications show optimized technical approaches for this preservation of quantitative and directional information during spatial normalization in data analyses at the group level. On this basis, FT techniques can be applied to group averaged data in order to quantify metrics information as defined by FT. Additionally, application of DTI methods, i.e. differences in FA-maps after stereotaxic alignment, in a longitudinal analysis at an individual subject basis reveal information about the progression of neurological disorders. Further quality improvement of DTI based results can be obtained during preprocessing by application of a controlled elimination of gradient directions with high noise levels.	
In summary, DTI is used to define a distinct WM pathoanatomy of different brain diseases by the combination of whole brain-based and tract-based DTI analysis.

Diffusion tensor imaging (DTI) basically serves as an MRI-based tool to identify in vivo the microstructure of the brain and pathological processes due to neurological disorders within the cerebral white matter. DTI-based analyses allow for application to brain diseases both at the group level and in single subject data.

Diffusion tensor imaging (DTI) techniques provide information on the microstructural processes of the cerebral white matter (WM) in vivo. The present ...

Noninvasive Assessment of Cardiac Abnormalities in Experimental Autoimmune Myocarditis by Magnetic Resonance Microscopy Imaging in the Mouse

Myocarditis is an inflammation of the myocardium, but only ~10% of those affected show clinical manifestations of the disease. To study the immune events of myocardial injuries, various mouse models of myocarditis have been widely used. This study involved experimental autoimmune myocarditis (EAM) induced with cardiac myosin heavy chain (Myhc)-&#945; 334-352 in A/J mice; the affected animals develop lymphocytic myocarditis but with no apparent clinical signs. In this model, the utility of magnetic resonance microscopy (MRM) as a non-invasive modality to determine the cardiac structural and functional changes in animals immunized with Myhc-&#945; 334-352 is shown. EAM and healthy mice were imaged using a 9.4 T (400 MHz) 89 mm vertical core bore scanner equipped with a 4 cm millipede radio-frequency imaging probe and 100 G/cm triple axis gradients. Cardiac images were acquired from anesthetized animals using a gradient-echo-based cine pulse sequence, and the animals were monitored by respiration and pulse oximetry. The analysis revealed an increase in the thickness of the ventricular wall in EAM mice, with a corresponding decrease in the interior diameter of ventricles, when compared with healthy mice. The data suggest that morphological and functional changes in the inflamed hearts can be non-invasively monitored by MRM in live animals. In conclusion, MRM offers an advantage of assessing the progression and regression of myocardial injuries in diseases caused by infectious agents, as well as response to therapies.

This study demonstrates the successful establishment of magnetic resonance microscopy imaging as a non-invasive tool to assess the cardiac abnormalities in mice affected with autoimmune myocarditis. The data indicate that the technique can be used to monitor the disease-progression in live animals.

Myocarditis is an inflammation of the myocardium, but only ~10% of those affected show clinical manifestations of the disease. To study the immune events ...

Tracking the Mammary Architectural Features and Detecting Breast Cancer with Magnetic Resonance Diffusion Tensor Imaging

Breast cancer is the most common cause of cancer among women worldwide. Early detection of breast cancer has a critical role in improving the quality of life and survival of breast cancer patients. In this paper a new approach for the detection of breast cancer is described, based on tracking the mammary architectural elements using diffusion tensor imaging (DTI). 
The paper focuses on the scanning protocols and image processing algorithms and software that were designed to fit the diffusion properties of the mammary fibroglandular tissue and its changes during malignant transformation. The final output yields pixel by pixel vector maps that track the architecture of the entire mammary ductal glandular trees and parametric maps of the diffusion tensor coefficients and anisotropy indices. 
The efficiency of the method to detect breast cancer was tested by scanning women volunteers including 68 patients with breast cancer confirmed by histopathology findings. Regions with cancer cells exhibited a marked reduction in the diffusion coefficients and in the maximal anisotropy index as compared to the normal breast tissue, providing an intrinsic contrast for delineating the boundaries of malignant growth. Overall, the sensitivity of the DTI parameters to detect breast cancer was found to be high, particularly in dense breasts, and comparable to the current standard breast MRI method that requires injection of a contrast agent. Thus, this method offers a completely non-invasive, safe and sensitive tool for breast cancer detection.

We describe how to obtain parametric and vector maps of the diffusion tensor of the breast using magnetic resonance imaging. The protocol and final output following imaging processing are tailored for tracking breast architectural features and detecting breast malignancy.

Breast cancer is the most common cause of cancer among women worldwide. Early detection of breast cancer has a critical role in improving the quality of ...

Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease

Quantitative magnetic resonance imaging (qMRI) describes the development and use of MRI to quantify physical, chemical, and/or biological properties of living systems. Neuromuscular diseases often exhibit a temporally varying, spatially heterogeneous, and multi-faceted pathology. The goal of this protocol is to characterize this pathology using qMRI methods. The MRI acquisition protocol begins with localizer images (used to locate the position of the body and tissue of interest within the MRI system), quality control measurements of relevant magnetic field distributions, and structural imaging for general anatomical characterization. The qMRI portion of the protocol includes measurements of the longitudinal and transverse relaxation time constants (T1 and T2, respectively). Also acquired are diffusion-tensor MRI data, in which water diffusivity is measured and used to infer pathological processes such as edema. Quantitative magnetization transfer imaging is used to characterize the relative tissue content of macromolecular and free water protons. Lastly, fat-water MRI methods are used to characterize fibro-adipose tissue replacement of muscle. In addition to describing the data acquisition and analysis procedures, this paper also discusses the potential problems associated with these methods, the analysis and interpretation of the data, MRI safety, and strategies for artifact reduction and protocol optimization.

Neuromuscular diseases often exhibit a temporally varying, spatially heterogeneous, and multi-faceted pathology. The goal of this protocol is to characterize this pathology using non-invasive magnetic resonance imaging methods.

Quantitative magnetic resonance imaging (qMRI) describes the development and use of MRI to quantify physical, chemical, and/or biological properties of ...

Dynamic Contrast Enhanced Magnetic Resonance Imaging of an Orthotopic Pancreatic Cancer Mouse Model

Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) has been limitedly used for orthotopic pancreatic tumor xenografts due to severe respiratory motion artifact in the abdominal area. Orthotopic tumor models offer advantages over subcutaneous ones, because those can reflect the primary tumor microenvironment affecting blood supply, neovascularization, and tumor cell invasion. We have recently established a protocol of DCE-MRI of orthotopic pancreatic tumor xenografts in mouse models by securing tumors with an orthogonally bent plastic board to prevent motion transfer from the chest region during imaging. The pressure by this board was localized on the abdominal area, and has not resulted in respiratory difficulty of the animals. This article demonstrates the detailed procedure of orthotopic pancreatic tumor modeling using small animals and DCE-MRI of the tumor xenografts. Quantification method of pharmacokinetic parameters in DCE-MRI is also introduced. The procedure described in this article will assist investigators to apply DCE-MRI for orthotopic gastrointestinal cancer mouse models.

The goal of this protocol is to apply dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) for orthotopic pancreatic tumor xenografts in mice. DCE-MRI is a non-invasive method to analyze microvasculature in a target tissue, and useful to assess vascular response in a tumor following a novel therapy.

Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) has been limitedly used for orthotopic pancreatic tumor xenografts due to severe ...

Simultaneous PET/MRI Imaging During Mouse Cerebral Hypoxia-ischemia

Dynamic changes in tissue water diffusion and glucose metabolism occur during and after hypoxia in cerebral hypoxia-ischemia reflecting a bioenergetics disturbance in affected cells. Diffusion weighted magnetic resonance imaging (MRI) identifies regions that are damaged, potentially irreversibly, by hypoxia-ischemia. Alterations in glucose utilization in the affected tissue may be detectable by positron emission tomography (PET) imaging of 2-deoxy-2-(18F)fluoro-&#7429;-glucose ([18F]FDG) uptake. Due to the rapid and variable nature of injury in this animal model, acquisition of both modes of data must be performed simultaneously in order to meaningfully correlate PET and MRI data. In addition, inter-animal variability in the hypoxic-ischemic injury due to vascular differences limits the ability to analyze multi-modal data and observe changes to a group-wise approach if data is not acquired simultaneously in individual subjects. The method presented here allows one to acquire both diffusion-weighted MRI and [18F]FDG uptake data in the same animal before, during, and after the hypoxic challenge in order to interrogate immediate physiological changes.

The method presented here uses simultaneous positron emission tomography and magnetic resonance imaging. In the cerebral hypoxia-ischemia model, dynamic changes in diffusion and glucose metabolism occur during and after injury. The evolving and irreproducible damage in this model necessitates simultaneous acquisition if meaningful multi-modal imaging data are to be acquired.

Dynamic changes in tissue water diffusion and glucose metabolism occur during and after hypoxia in cerebral hypoxia-ischemia reflecting a bioenergetics ...

Phase Contrast Magnetic Resonance Imaging in the Rat Common Carotid Artery

Phase contrast magnetic resonance imaging (PC-MRI) is a noninvasive approach that can quantify flow-related parameters such as blood flow. Previous studies have shown that abnormal blood flow may be associated with systemic vascular risk. Thus, PC-MRI can facilitate the translation of data obtained from animal models of cardiovascular diseases to pertinent clinical investigations. In this report, we describe the procedure for measuring blood flow in the common carotid artery (CCA) of rats using cine-gated PC-MRI and discuss relevant analysis methods. This procedure can be performed in a live, anesthetized animal and does not require euthanasia after the procedure. The proposed scanning parameters yield repeatable measurements for blood flow, indicating excellent reproducibility of the results. The PC-MRI procedure described in this article can be used for pharmacological testing, pathophysiological assessment, and cerebral hemodynamics evaluation.

The overall goal of this procedure is to measure the blood flow in the rat common carotid artery by using noninvasive phase contrast magnetic resonance imaging.

Phase contrast magnetic resonance imaging (PC-MRI) is a noninvasive approach that can quantify flow-related parameters such as blood flow. Previous ...

Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse

Here we present a protocol to examine the levator ani hiatus in males and females with pelvic organ prolapse, during the Valsalva maneuver and while evacuating acoustic gel, using a horizontally oriented 1.5 T magnetic resonance (MR) scanner. On midsagittal images, the vertical distance of pelvic organs is measured in millimeters relative to the hymen plane (female) and to the lower border of the symphysis pubis (male), preceded by - (above) or + ( below) signs. On axial images, the levator ani area is calculated in square centimeters with a free-hand tracing method from three key images, passing through the midsymphysis (level I), tangential to the lower border of the symphysis (level II), and at the maximal anterior rectal wall bulging (level III). Areas at rest and strained are compared to find evidence of a percentage of increase. The purpose is to provide objective evidence of the maximal extent of pelvic organs descent and hiatus enlargement without the interference of foreign objects or the examiner&#39;s proximity, so as to overcome the limitations of pelvic examination and transperineal sonography (i.e., subjectivity and sex-related limitations [female only]).

Here we present a protocol to standardize the measurement of the levator ani hiatus size&#160;by magnetic resonance imaging. The purpose is to extract biomechanical inferences from image analysis by comparing resting and straining values in patients of both sexes with pelvic prolapse, using consistent anatomical bony landmarks.

Here we present a protocol to examine the levator ani hiatus in males and females with pelvic organ prolapse, during the Valsalva maneuver and while ...