The present disclosure relates to the magnetic resonance imaging (MRI) of the heart. Specifically, the present disclosure relates to the determination of timing of cardiac-cycle phases to guide cardiac MRI.
Currently, the slow data acquisition speed of cardiac magnetic resonance imaging (MRI) requires image acquisition to span multiple heartbeats in many applications involving the imaging of the heart. Under this circumstance, to prevent motion artifacts resulting from the heart beating during data acquisition, beat-to-beat data acquisitions need to be synchronized to the same stationary phase of the cardiac cycle. Typically, diastasis is the longest stationary period of the cardiac cycle; it occurs in between the periods of ventricular fast filling and atrial contraction during ventricular diastole (see
Typically, to perform prospective cardiac gating, the gating parameters need to be set prior to image acquisition. Ideal gating parameters, however, vary between subjects, and with heart rate. Therefore, calibration of gating parameters is desirable. For example, currently in MRI, a low spatial-resolution video of the 4-chamber view of the heart is acquired and used to determine the timing of the diastasis window, usually by a visual search for serial stationary frames. This approach, however, may produce gating errors on the order of tens of milliseconds due to limited temporal and/or spatial resolution of the calibration video. Since diastasis is preceded and succeeded by periods of significant ventricular motion, gating errors of tens of milliseconds may incur significant motion artifacts in high-resolution applications of cardiac imaging such as coronary angiography.
Liu et al. has demonstrated, using ultrasound and x-ray imaging, that long-axis motion and stasis of the basal ventricular septum accurately predict the motion and stasis of the coronary vasculature, respectively [1]. Septal motion-based cardiac gating is therefore more accurate than conventional ECG gating. It is desirable to have an MRI-based technique that measures septal motion to determine the cardiac gating parameters for cardiac MRI applications.
In embodiments disclosed herein, a method and system for determining the timing of diastasis using MRI cardiac imaging are disclosed. Tissue along the long-axis of a patient's ventricular septum is activated by the MRI and images are taken of a region of interest such that a time map of the MR images is produced. In a preferred embodiment, the region of interest is at the base of the septum and the images are generated by using a 1D steady-state free-precession pulse sequence or by 2D excitations. The images are then processed such that a velocity graph of points in the region of interest is generated over the course of at least a heartbeat.
The start and end times of the diastasis period is then determined. The start and end times are typically measured as a delay relative to the beginning of the heartbeat, typically chosen to be the onset of ventricular systole, which in turn is typically indicated by the R-peak of the ECG, a characteristic point determinable by someone skilled in the art of medical imaging. Therefore, in an embodiment, the ECG is used alongside the present disclosed method.
Upon locating the R-peak, the start and end times of the diastasis can typically be determined by finding, on the velocity graph, the period of low velocity in between the early and late ventricular filling peaks. Many methods are known to someone skilled in the art for determining this low velocity period. The method for selecting the diastasis period is non-specific to the present disclosure. In the preferred embodiment, the diastasis period is defined to be in between the first and last inflection points, respectively, enclosed by the early and late ventricular filling peaks of the velocity graph. The early and late ventricular filling peaks are determinable by someone skilled in the art. The inflection points are second derivative nulls representing the approach to and departure from the low velocity time period. In another embodiment, the diastasis period may be defined as the time period between the early and late ventricular filling peaks that fall below an arbitrary velocity threshold.
MR images may be generated using magnitude or phase data observed by the MRI detectors. In a preferred embodiment, diastasis is determined by intersecting findings over multiple heartbeats. In an embodiment, diastasis may be determined for a single heartbeat.
Embodiments will now be described, by way of example only, with reference to the drawings, in which:
A further understanding of the functional and advantageous aspects of the disclosure can be realized by reference to the following detailed description and drawings.
Various embodiments and aspects of the disclosure will be described with reference to details discussed below. The following description and drawings are illustrative of the disclosure and are not to be construed as limiting the disclosure. The drawings are not necessarily to scale. Numerous specific details are described to provide a thorough understanding of various embodiments of the present disclosure. However, in certain instances, well-known or conventional details are not described in order to provide a concise discussion of embodiments of the present disclosure.
As used herein, the terms, “comprises” and “comprising” are to be construed as being inclusive and open ended, and not exclusive. Specifically, when used in this specification including claims, the terms, “comprises” and “comprising” and variations thereof mean the specified features, steps or components are included. These terms are not to be interpreted to exclude the presence of other features, steps or components.
As used herein, the term “exemplary” means “serving as an example, instance, or illustration,” and should not be construed as preferred or advantageous over other configurations disclosed herein.
As used herein, the term “diastasis window” refers to the time period spanning ventricular diastasis; “imaging window” refers to the time period spanning image data acquisition; and, “cardiac gating” refers to the method of synchronizing the imaging window to the diastasis window on a heartbeat-to-heartbeat basis for the purpose of avoiding cardiac motion artifacts.
As used herein, the expression “electrocardiogram” (ECG) is the graphical output of an electrical measurement obtained over a period of time from a pair of non-overlapping electrodes placed on a person's body surface. The electrodes detect the electrical activity of the person's heart. Typically, for MRI, more than two electrodes are placed on the person's chest, providing multiple ECG signals, known as “ECG leads.”
As used herein, the expression “R-peak” refers to the signal deflection on the ECG that is (1) associated in time with the onset of ventricular systole; and (2) caused by a bioelectrical depolarization wave propagating through the ventricular myocardium as observed by the electrodes on the body surface. The R-peak is often used to mark the beginning of a heartbeat.
As used herein, the expression “steady-state free-precession (SSFP) pulse sequence” refers to an MRI pulse sequence where (1) the readout gradient comprises of a zeroth- and first-moment nulled waveform; and (2) the transverse magnetization reaches a non-zero steady state prior to the application of each excitation pulse.
As used herein, the expression “1 D SSFP pulse sequence” refers to an SSFP pulse sequence used in conjunction with a slice excitation, and no phase encode gradients. The resultant reconstructed MR image is a 1D line image corresponding to the in-plane projection of the excited slice.
As used herein, the expression “k-space” refers to the data acquisition space in the MR image acquisition process.
As used herein, the expression “reconstructed image” refers to the image formed by processing the k-space data. Typically, this image reconstruction process involves the Fourier transform. The reconstructed image is comprised of pixel values of the complex mathematical type:
I=A+Bi (Eq. 1)
where I is the image matrix of pixel values, and A and B are the real and imaginary components, respectively, of I.
As used herein, the expression “magnitude image” means an image composed of the magnitude of the reconstructed image:
I
M
=|I|
I
M=√{square root over (A2+B2)} (Eq. 2)
where IM is the magnitude image.
As used herein, the expression “phase image” means an image composed of the phase of the reconstructed image:
where Iφ is the phase image.
As used herein, the expression “projection” as applied to an image means to reduce the typically two-dimensional image to a one-dimensional line image by summing the pixel intensities along one direction. For example, the magnitude projection of an image along the row-direction is the summation of all the magnitude pixel intensities by the columns of the image to form a single row of magnitude intensities.
In medical imaging today, cardiac gating is commonly performed by referencing the electrocardiogram (ECG), a depiction of the electrical activity of the heart produced by measuring the voltage across pairs of electrodes placed on the chest. With reference to
As used herein, the term “RR interval” refers to the time between two adjacent R-peaks on the ECG. It corresponds to the cardiac cycle duration, typically measured in milliseconds, and is inversely related to heart rate, typically measured in beats per minute.
As used herein, the term “trigger delay” refers to the time from the R-peak to the start of the imaging window.
As used herein, the term “gating parameters” refers to the trigger delay and imaging window duration.
As used herein, the term “gating error” refers to a misalignment between the imaging window and the diastasis window, causing a time difference between (a) the trigger delay and the beginning of the diastasis window, and/or (b) the imaging window duration and the diastasis window duration.
The present disclosure provides an MRI technique for determining the start and end of diastasis based on motion measurements of the ventricular septum. The technique provides line images, herein denoted “Septal Scouts,” that are magnitude projections of an image plane, herein denoted “Scout Plane,” which is oriented to be perpendicular to the 4-chamber long-axis plane and intersecting the approximate line formed by the septal wall, parallel to the long axis of the heart; the projection direction is through the 4-chamber long-axis plane (see
Referring now to
Referring now to
Referring now to
The velocity graph shows phases of ventricular dynamics and stases. It should be noted that the method for selecting the diastasis period is non-specific to the present disclosure. Many methods are known to someone skilled in the art. In the present embodiment, the start and end of diastasis is determined by the first and last inflection points (2nd derivative nulls), respectively, enclosed by the early and late ventricular filling peaks on the velocity graph. These characteristic time points represent the approach to and departure from the expected low velocity period enclosed in between early and late ventricular filling. In another embodiment, the start and end of diastasis may be determined by identifying a time period in between the early and late ventricular filling peaks during which the absolute value of the velocity function is below a selected threshold.
An embodiment of the present disclosure provides the use of two-dimensional (2D) excitation schemes. More specifically, the Septal Scout is no longer obtained by a one-dimensional projection of an excited Scout Plane. Rather, a 2D excitation pulse is used to excite a line or column of tissue at the intersection of the Scout Plane and the 4-chamber long-axis plane. The Septal Scout is then directly detected from the excited tissue. The cross-sectional shape of the column excitation is selectable, but is typically a circle. In addition, another 2D excitation scheme may be used. The Scout Plane and the 4-chamber long-axis plane may both be excited at half power, one immediately after the other; the two excited planes will produce a full power excitation at their intersection. The resultant Septal Scout will have a dominant signal source from the intersection of the two excited planes. The combination of excitation powers in this scheme is selectable.
An embodiment of the present disclosure provides the use of phase images in the Septal Scouts in addition to the conventional magnitude images. For example, the phase images of the Septal Scout are suitable for detecting accelerating blood or tissue where high intensities on the phase images represent high acceleration. This is described in more detail below in another embodiment of the present disclosure.
An embodiment of the present disclosure provides the determination of other cardiac phases, such as the end-systole period as an alternative cardiac gating window at high heart rates. End-systole is a low-cardiac-motion period that exists in between ventricular ejection and fast filling during the phase of isovolumic relaxation. It is typically shorter than diastasis, lasting less than 100 ms. In this embodiment, the Septal Scout velocity graph is used to identify a period of low velocity before the early ventricular filling peak. Specifically, the start and end of the end-systole period may be determined by identifying a time period before the early ventricular filling peak during which the absolute value of the velocity graph is below a selected threshold.
An embodiment of the present disclosure combines the Septal Scout technique with existing free-breathing MRI using respiratory navigators. To perform MRI during free-breathing, image data acquisitions are typically gated to the end-expiration phase of tidal breathing. Respiratory navigators are short MRI acquisitions that monitor the caudo-cranial position of the diaphragm, where end-expiration corresponds to the diaphragm being situated at the most caudal monitored position. In this embodiment, an MRA acquisition is performed during free-breathing. The Septal Scout is used to guide cardiac gating. At the same time, a respiratory navigator is used to identify the cardiac gating periods that occur during end-expiration. The data acquired during these coincident periods of cardiac and respiratory stasis are deemed free from motion artifacts and retained for reconstruction.
An embodiment of the present disclosure provides real-time acquisition of Septal Scouts such that the cardiac-gated imaging is triggered and terminated upon the real-time detection of the onset and end of diastasis, respectively. In this way, this implementation of the Septal Scout technique mimics a navigator approach. Furthermore, this embodiment precludes the use of the ECG for determining the imaging windows; rather, the R-peak of the ECG may be used to indicate the beginning of a pre-acquisition period during which contrast preparation such as fat-suppression may be performed.
An embodiment of the present disclosure provides an MRI-based cardiac gating system (MRI-CGS) based on the use of the Septal Scout. This system provides the benefit of not having to maintain an ECG signal to perform cardiac-gated MR imaging. Currently, the ECG signal may arbitrarily deteriorate due to loosened connections at the chest electrodes; also, R-peak detection may fail due to significant T-wave amplification. This system embodiment comprises of five functions:
Function 1: Calibration Scan
Function 2: Calibration Check
Function 3: Ventricular Systole Detection
Function 4: Cardiac Gating
Function 5: Heart Rate Variability Tracking
Referring now to
An embodiment of the present disclosure provides the detection of the onset of ventricular systole by monitoring the Septal Scout at depths that do not necessarily include the basal septum. Referring now to
An embodiment of the present disclosure provides imaging of a coronary artery stenosis using the Septal Scout. Referring now to
The present Septal Scout technique can be clearly distinguished from MRI navigator techniques. In the past, MR projection imaging has been used to characterize one-dimensional motion of the diaphragm in respiratory navigator techniques [2], and lateral walls of the heart for cardiac navigator techniques [3]. The present disclosure can be distinguished from these previous navigator techniques by having a different target region of interest (ROI) for motion monitoring. The present disclosure focuses on the basal ventricular septum as a surrogate for motion of the coronary vasculature, as demonstrated by Liu et. al. [1]. The present disclosure is a novel use of MRI to track septal motion for the purpose of determining cardiac gating windows that is not obvious to one skilled in the art.
The foregoing description of the preferred embodiments of the invention has been presented to illustrate the principles of the invention and not to limit the invention to the particular embodiment illustrated. It is intended that the scope of the invention be defined by all of the embodiments encompassed within the following claims and their equivalents.
Number | Date | Country | |
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61867513 | Aug 2013 | US |
Number | Date | Country | |
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Parent | 14910775 | Feb 2016 | US |
Child | 16423513 | US |