Biomedical subjects

Graham A Wright

Publications and source records attributed to Graham A Wright.

At least 19 recordsLinked to original sources

PubMed2007

Ex vivo imaging of chronic total occlusions using forward-looking optical coherence tomography.

BACKGROUND AND OBJECTIVES: Percutaneous coronary interventions (PCI) of chronic total occlusions (CTOs) of arteries are more challenging lesions to treat with angioplasty and stenting than stenotic vessels due primarily to the difficulty in guiding the wire across the lesion. Angiography alone is unable to differentiate between the occluded lumen and the vessel wall and to characterize the content of the occlusion. New technologies to aid in interventional guidance are therefore highly desirable. We sought to evaluate tissue characterization in arterial (CTOs) by imaging ex vivo peripheral arterial samples with optical coherence tomography (OCT). STUDY DESIGN/MATERIALS AND METHODS: Ex vivo arterial samples were obtained from patients undergoing peripheral limb amputation. Samples were imaged in an enface orientation using an OCT system, enabling sequential acquisition of longitudinal images and volumetric reconstruction of cross-sectional views of the occluded arteries. Histology was performed for comparison. RESULTS: OCT imaging reliably differentiated between the occluded lumen and the underlying arterial wall in peripheral CTOs. OCT correctly identified tissue composition within the CTO, such as the presence of collagen and calcium and was also able to identify intraluminal microchannels. CONCLUSIONS: OCT imaging of CTO anatomy and tissue characteristics may potentially lead to substantial improvements in PCI interventions by providing novel guiding capabilities.

Angiography↗

PubMed2006

Evaluating contrast kinetics by acquiring 2D images during 3D contrast-enhanced MR angiography.

PURPOSE: To monitor contrast kinetics by acquiring multiple 2D images during 3D contrast-enhanced magnetic resonance angiography (CE MRA). MATERIALS AND METHODS: A 2D real-time autotriggering tool was integrated into a 3D sequence, enabling it to run multiple times during 3D acquisition. Several dummy scans were applied after each transition to maintain the steady state condition of both sequences. The number of the acquired 2D images and their distribution can be adjusted. Each 2D image was saved along with its associated timing. Contrast signal variations over time were plotted, reflecting selective signal measurement over an artery and vein from the saved 2D images. RESULTS: Different contrast kinetics timings were calculated from the resulting plot. Contrast arrival time to the internal cerebral artery was 13.2 +/- 1.2 seconds and the peak arterial to peak venous (at the confluence of sinuses) enhancement was 6.7 +/- 0.6 seconds. The observed timing could be used for 3D sequence optimization; the saved 2D images are useful in detecting and characterizing vascular abnormalities. CONCLUSION: Integrating 2D and 3D sequences into one sequence to monitor contrast kinetics through the neurovasculature is feasible without the need for extra injections or reduced spatial resolution. The technique can also be used in different parts of the body to extract useful clinical information.

Artifacts↗

PubMed2006

High-resolution imaging of the intracranial arterial and venous systems following a single contrast injection.

PURPOSE: To generate two separate three-dimensional (3D) high spatial resolution images of the intracranial arterial and venous systems using a single contrast injection. MATERIALS AND METHODS: A 3D contrast-enhanced (CE) magnetic resonance angiography (MRA) acquisition was modified to create two separate k-space data sets to encode the arterial and venous enhancement signals individually after contrast agent injection. Following an automated detection of contrast arrival, the central k-space views corresponding to the arterial phase were acquired for the first eight seconds. A full elliptical-centric acquisition was then acquired for the venous phase and the missing views in the periphery of the first k-space data set were copied from the venous phase. A total of 18 patients underwent this study. Image quality, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were determined in both intracranial systems. RESULTS: Two 3D image sets were generated for the arterial and venous intracranial systems. Both sets have high quality images that are clinically diagnostic. SNR and CNR were high in both sets, so that all the major vessels were visible. CONCLUSION: This technique provides images with high spatial resolution for both arterial and venous intracranial systems using a single contrast injection.

Arteriovenous Malformations↗

PubMed2006

Characterizing coronary motion and its effect on MR coronary angiography--initial experience.

PURPOSE: To characterize coronary artery motion as a prescan procedure to select the optimum scan setting that will produce high-resolution images. MATERIALS AND METHODS: A 2D real-time scan was used to image the major coronary arteries during breath-holding and free-breathing conditions. With the use of the 2D images, motion displacement of each artery was measured along three axes. Motion data obtained from a computer simulation were used to estimate point-spread functions (PSFs) associated with different high-resolution spiral acquisition strategies, including real-time, cardiac-gated, and respiratory-gated acquisitions. The simulation output determined the optimum acquisition and scan parameters that would produce the highest-spatial-resolution images of the coronary arteries. The effects of heart rate (HR), extended breath-holding, and number of slices per heart cycle were also investigated. RESULTS: Substantial variations in coronary motion occur among individuals, which directly influences the optimum parameters for a high-resolution scan. Lower HRs and longer breath-holds yield substantially increased spatial resolution. The maximum number of slices per heart cycle can also be determined to minimize slice-to-slice distortion. CONCLUSION: The results suggest that to obtain high-resolution coronary images, one should perform a prescan coronary-motion characterization for each individual so that the scan parameters can be optimized before data acquisition.

Computer Simulation↗

PubMed2006

Three-dimensional reconstruction of limited-view projections for contrast-enhanced magnetic resonance angiography at high temporal and spatial resolution.

The feasibility of reconstructing three-dimensional (3D) MRI data sets from limited-view projections is investigated in phantom and in vivo animal studies to improve the temporal resolution of magnetic resonance angiography without sacrificing spatial resolution. Thirty-two pairs of orthogonal biplane projections are acquired in an interleaved manner during the first pass of a contrast agent. The full data set is reconstructed as a priori 3D information. Each pair of projections is then reconstructed into an individual 3D data set based on a correlation analysis with the a priori data set. In this way, time-resolved 3D data sets at 1- to 2-s time intervals are reconstructed with submillimeter spatial resolution. Artifacts are limited if the image is simply structured or sparse and if SNR is sufficient in the projection images. With this technique, both high temporal and spatial resolution can be achieved simultaneously.

Animals↗

PubMed2006

Rapid high-resolution T(1) mapping by variable flip angles: accurate and precise measurements in the presence of radiofrequency field inhomogeneity.

Rapid 3D mapping of T(1) relaxation times is valuable in diverse clinical applications. Recently, the variable flip angle (VFA) spoiled gradient recalled echo approach was shown to be a practical alternative to conventional methods, providing better precision and speed. However, the method is known to be sensitive to transmit field (B(1) (+)) inhomogeneity and can result in significant systematic errors in T(1) estimates, especially at high field strengths. The main challenge is to improve the accuracy of the VFA approach without sacrificing speed. In this article, the VFA method was optimized for both accuracy and precision by considering the influence of imperfect transmit fields, noise bias, and selection of flip angles. An analytic solution was developed for systematic B(1) (+)-induced T(1) errors and allows simple correction of T(1) measurements acquired with any imaging parameters. A noise threshold was also identified and provided a guideline for avoiding T(1) biases. Finally, it was shown that three flip angles were the most efficient for maintaining accuracy and high precision over large ranges of T(1). A rapid B(1) (+) mapping sequence was employed in all phantom experiments and high-field in vivo brain scans. Experimental results confirmed the theory and validated the accuracy of the proposed method.

Brain↗

PubMed2006

Detecting microcirculatory changes in blood oxygen state with steady-state free precession imaging.

Recently, it has been demonstrated that oxygen-weighted images of whole blood can be obtained with steady-state methods. In this article, based on computational and experimental models, we investigate the potential for employing this technique to monitor oxygen changes in microcirculation. Results show that oxygen-sensitive images of rabbit kidney and muscle may be obtained at high signal-to-noise ratio within a few seconds. The results also show that in steady-state free precession imaging, in addition to the exchange mechanism that generates oxygen contrast in blood, there are additional mechanisms that provide oxygen-sensitive contrast in microcirculation.

Algorithms↗

PubMed2006

The effect of altering heart rate on ventricular function in patients with heart failure treated with beta-blockers.

BACKGROUND: Beta-blockers are effective for the treatment of heart failure, but their mechanism of action is unresolved. Heart rate reduction may be a central mechanism or a troublesome side effect. METHODS: A randomized, double-blind, parallel group study comparing chronic higher-rate (80 pulses per minute) with lower-rate (60 pulses per minute) pacing in pacemaker-dependent patients with symptomatic left ventricular (LV) systolic dysfunction, receiving beta-blockers. Gated radionuclide ventriculography (RNVG) was performed at baseline and after at least 9 months. The primary outcome was change in LV volumes, as a marker of beneficial reverse remodeling, from baseline to follow-up. RESULTS: Forty-nine patients were randomized. Mean age was 74 +/- 6 years and with LV ejection fraction of 26% +/- 9% at baseline. During 14 +/- 13 months of follow-up, 21 patients (43%) died and 25 (51%) completed the study protocol: 12 in the higher-rate and 13 in the lower-rate group. Mean LV end-diastolic (higher rate +20 +/- 104 mL vs lower rate -65 +/- 92 mL, P = .03) and systolic (higher rate +29 +/- 83 mL vs lower rate -60 +/- 74 mL, P = .006) volumes increased with higher-rate versus lower-rate pacing, whereas LV ejection fraction declined (higher rate -4.2% +/- 4.4% vs lower rate +2.2% +/- 5.4%, P = .002). CONCLUSION: Reversal of beta-blocker-induced bradycardia has deleterious effects on ventricular function, suggesting heart rate reduction is an important mediator of their effects. The prognosis of patients with pacemakers and heart failure is poor.

Adrenergic beta-Antagonists↗

PubMed2005

A novel microbubble construct for intracardiac or intravascular MR manometry: a theoretical study.

It has been demonstrated that gas-filled microbubble contrast agents, based on their volume changes, can serve as pressure probes in an MR field. It was recently reported that such an MR-based pressure measurement with microbubbles at 1.5 T must make use of microbubbles that have a volumetric magnetic susceptibility difference with the blood of at least 34 ppm in SI units. In this work, we show through analytical approximations and numerical simulations that such a microbubble formulation can be achieved by coating typical lipid-shelled microbubbles with particles of high dipole moment. Through finite-element simulations we demonstrate that the effective volumetric magnetic susceptibility of a coated microbubble is dependent on the radius, the shell volume fraction and the magnetic susceptibility of the particulates on the shell. Our calculations suggest that a suitable microbubble formulation which will be MR-sensitive to small pressure changes at 1.5 T must be 2-3 microm in radius and be uniformly coated with single-domain magnetic nanoparticles, such as magnetite, at shell volume fractions below 5%.

Arteries↗

PubMed2005

The effect of ventricular pacing on measurements of left ventricular function: a comparison between echocardiographic methods and with radionuclide ventriculography.

AIMS: Different methods exist for measuring left ventricular function echocardiographically; each may be error prone due to the abnormal pattern of ventricular activation during pacing. METHODS AND RESULTS: Echocardiography was undertaken on 307 patients with permanent pacemakers; a subset of 57 underwent radionuclide ventriculography. Intrinsic and paced beats were analysed for left ventricular function by: Simpson's bi-plane, Teicholz M-mode, wall-motion scoring and 'eyeball' assessment. Agreement between techniques and with radionuclide ventriculography were compared according to intrinsic or paced beats. Echocardiographic measures of ejection fraction give mean values 5% higher than radionuclide ventriculography (Simpson's 30+/-9%, vs. Teicholz 30+/-13% vs. radionuclide ventriculography 25+/-9%, p=0.03). Agreement between Simpson's, Teicholz and radionuclide ventriculography by Bland-Altman analysis showed poor agreement (Simpson's vs. Teicholz range (4xSD)=57%, Simpson's vs. radionuclide ventriculography=36%, Teicholz vs. radionuclide ventriculography=46%, p=0.02), the level of agreement deteriorates with ventricular pacing (Simpson's vs. Teicholz range=61%, Simpson's vs. radionuclide ventriculography=34%, Teicholz vs. radionuclide ventriculography=47%, p=0.02). The correlation between wall motion analysis and radionuclide ventriculography is moderately poor (all subjects r=0.58, ventricular pacing r=0.52, not pacing r=0.66). CONCLUSION: Echocardiography and radionuclide ventriculography are the only non-invasive techniques to assess left ventricular function in the paced population. Results are poorly interchangeable and the accuracy of any comparison dependent on the underlying rhythm.

Echocardiography↗

PubMed2005

Quantitative apparent diffusion coefficients and T2 relaxation times in characterizing contrast enhancing brain tumors and regions of peritumoral edema.

PURPOSE: To investigate the potential value and relationship of in vivo quantification of apparent diffusion coefficients (ADCs) and T2 relaxation times for characterizing brain tumor cellularity and tumor-related edema. MATERIALS AND METHODS: A total of 26 patients with newly diagnosed gliomas, meningiomas, or metastases underwent diffusion-weighted and six-echo multisection T2-preparation imaging. Regions of interest (ROIs) were drawn on conventional MR images to include tumor (as defined by contrast agent enhancement) and immediate and peripheral edema. Areas of necrosis were excluded. Median values of ADCs and T2 in the ROIs were calculated. RESULTS: ADCs for gliomas were similar to those for meningiomas or metastases in all regions. Tumor T2 values for gliomas (159.5+/-30.6 msec) were significantly higher than those for meningiomas or metastases (125.0+/-31.1 msec; P=0.005). Immediate-edema T2 values for meningiomas or metastases (226.0+/-44.1 msec) were significantly higher than those for gliomas (203.5+/-32.8 msec; P=0.033). Peripheral-edema T2 values for gliomas (219.5+/-41.9 msec) were similar to those for meningiomas or metastases (202.5+/-26.5 msec; P=0.377). Both immediate- and peritumoral-edema ADCs and T2 values were significantly higher than those in tumor for both tumor types. ADCs and T2 values from all regions correlated significantly for gliomas (r=0.95; P<0.0001) and for meningiomas or metastases (r=0.81; P<0.0001). CONCLUSION: The higher immediate-edema T2 values for nonglial tumors than for gliomas suggest tumor-related edema (vasogenic vs. infiltrated) can be further characterized by using T2 values. There were significant correlations between ADC and T2 values.

Adult↗

PubMed2005

Oxygen-sensitive contrast in blood for steady-state free precession imaging.

Steady-state free precession (SSFP) methods have gained widespread recognition for their ability to provide fast scans at high signal-to-noise ratio. This paper demonstrates that such methods are also capable of reflecting functional information, particularly blood oxygenation state. It is well known that SSFP signals show substantial sensitivity to small off-resonance frequency variations. However, that mechanism cannot explain the oxygen-sensitive contrast in blood that was observed with steady-state methods using phase-cycled radiofrequency pulses. From theoretical and experimental models it is demonstrated that the mechanism responsible for such contrast originates from the motion of spins through local field inhomogeneities in and around deoxygenated red blood cells. In addition, this work shows that it is critical to choose the scan parameters carefully for robust oxygen-sensitive contrast. Finally, it is demonstrated that it is possible to build a quantitative model that incorporates the Luz-Meiboom model, which had been used in the past to estimate quantitative measures of vascular blood oxygen levels. It is envisioned that this method could be instrumental in real-time imaging focused on detecting diseases where the oxygen state of blood is impaired.

Chi-Square Distribution↗

PubMed2005

Real-time magnetic resonance with physiologic monitoring for improved scan localization.

Imaging of the coronary arteries at diagnostic resolutions is made difficult due to cardiac and respiratory motion during data acquisition. Cardiac gating and respiratory gating or breath holding are effective ways to reduce the effects of motion. The optimal cardiac and respiratory timings vary widely across individuals. This work presents a real-time magnetic resonance imaging approach with physiologic monitoring that can be used to predict the optimal timings on a subject-by-subject basis during a brief real-time prescan. The feasibility of this approach at determining the optimal cardiac trigger delay and respiratory phase is demonstrated.

Adult↗

PubMed2005

Optimization of 3D contrast-enhanced pulmonary magnetic resonance angiography in pediatric patients with congenital heart disease.

Contrast kinetics were studied in the main pulmonary artery (MPA) and ascending aorta (AAo) of 12 children with congenital heart disease. This information was used to optimize the timing of data acquisition for contrast-enhanced MR angiography in these vessels. To reduce contrast-agent dosage in these fragile patients, contrast enhancement was measured during routine diagnostic 3D magnetic resonance (MR) angiography instead of using test-bolus methods. This was possible by acquiring 2D cross-sectional images of the MPA and AAo during the 3D scan. Time-to-peak in the MPA and AAo was 4.9 +/- 2.2 and 6.1 +/- 2.2 s, respectively, while the transit time between the two vessels was 4.5 +/- 0.6 s. A point-spread-function analysis showed that intravascular signal strength was maximized if data acquisition began 4.7 +/- 2.3 s after the first arrival of contrast in the MPA and 5.6 +/- 2.3 s in the AAo. Little signal loss and artifact resulted when longer acquisition delays were used because contrast-agent clearance was slow. Based on these results, MR angiography of both the MPA and the AAo in children with congenital heart disease can be performed using elliptic-centric k-space sampling and a trigger delay of 7.9 s after contrast arrival in the AAo (i.e., time-to-peak signal strength in the AAo plus one SD to account for intersubject variability).

Adolescent↗

PubMed2005

Microvessels in chronic total occlusions: pathways for successful guidewire crossing?

Arterial chronic total occlusions (CTO) are a common and clinically relevant problem in patients with coronary artery disease. Percutaneous coronary intervention (PCI) success rates in a wide range of CTO are low, primarily due to inability of guidewire crossing. The pathophysiology of CTO is poorly understood and limits our ability to introduce innovative therapies. Recent studies from our laboratory have suggested that microvessel formation within arterial CTO is a complex process with temporal and regional differences. Moreover, there is evidence from pilot studies that the presence of either microvessels or the particular extracellular matrix environment in the adjacent perivascular tissue can facilitate guidewire crossing and successful PCI. Currently, studies are underway in our experimental CTO model to delineate the pathophysiology of microvessel formation in CTO and its potential role in PCI.

Animals↗

PubMed2004

In vivo MRI measurement of blood oxygen saturation in children with congenital heart disease.

OBJECTIVE: The purpose of this prospective study was to measure in vivo blood oxygen saturation (%O2) by MRI in children with congenital heart disease (CHD) using population-based values for T2O (T2 signal decay of fully oxygenated blood) and K (a parameter representing the deoxyhemoglobin effect) and compare the %O2 with direct cardiac catheterization measurements. BACKGROUND: MRI can determine %O2 using in vivo measurement of signal decay (T2) and an in vitro calibration curve relating T2 and %O2, based on the equation: 1/T2 = 1/T2O + K(1-%O2/100)2. Recent studies have correlated the T2/%O2 in children with CHD with the adult calibration statistics. METHODS: A total of ten children (five male, five female) with single ventricle CHD (median age 4.8 months, range 2 months to 4.4 years) undergoing cardiac catheterization were included in the study. The blood T2 measurements for each patient were performed in a 1.5 T GE CV scanner. The %O2 was then calculated based on the equation using values of T2O determined from individual hematocrits, and a population average value of K derived for children. The %O2 values were compared with direct %O2 measurements from cardiac catheterization. RESULTS: The %O2 values by MRI were strongly correlated with direct cardiac catheterization measurements (R = 0.825; P < 0.001). CONCLUSION: The study indicates that the noninvasive measurement of %O2 by MRI can accurately measure oxygen saturation in children with complex CHD.

Aorta↗

PubMed2004

Comparison of matched-filtered two-dimensional projection and elliptical centric-ordered three-dimensional contrast-enhanced magnetic resonance angiography.

PURPOSE: To compare the image quality of matched-filtered two-dimensional projection magnetic resonance angiography (MRA) and elliptical centric-ordered (EC) three-dimensional MRA. MATERIALS AND METHODS: Signal-to-noise ratios (SNRs) of matched-filtered two-dimensional projection and EC three-dimensional MRA are developed theoretically and compared by clinical studies, in which 10-20 mL of gadolinium (Gd) was injected at 1.5 mL/second. The artery-vein contrast in two-dimensional projection MRA was managed by manually selecting specific templates for the matched filters. RESULTS: The SNR of matched-filtered two-dimensional projection MRA is superior to that of EC three-dimensional MRA for vessels wider than one pixel due to the integral effect. The artery-vein contrast can be managed flexibly in two-dimensional projection MRA by choosing different templates for the matched filter, while the artery-vein contrast in EC three-dimensional MRA is solely determined by the timing to start the acquisition. CONCLUSION: Matched-filtered two-dimensional projection MRA provides comparable image quality and is a flexible alternative to EC three-dimensional MRA in applications where contrast timing is difficult and temporal information is of interest.

Contrast Media↗

PubMed2004

Pulsatile motion effects on 3D magnetic resonance angiography: implications for evaluating carotid artery stenoses.

In-plane carotid artery motion during a 3D MR angiography (MRA) scan can significantly degrade the resulting image resolution. This study characterizes the effect of cardiac pulsatility on 3D contrast-enhanced (CE) MRA with elliptical centric acquisitions using a point-spread function (PSF) analysis. Internal carotid artery (ICA) motion was collected from volunteers and patients using both MR and ultrasound (US) scans. After measuring the carotid artery motion displacement, a simulation was performed which calculated the blurring effects for three different protocols: nongated and two different cardiac gating schemes. The motion sensitivity of each protocol was evaluated for different spatial resolutions. The selection of optimal imaging parameters for a given scan time was investigated. The final results showed that cardiac-gated acquisitions only over a limited region of k-space high spatial frequencies are more time-efficient than cardiac gating for the entire k-space, as it allows for higher resolutions to be achieved and for capturing the arterial phase with low spatial frequencies. Selecting the optimal gating parameters depends directly on the motion characteristics of each individual. Our initial clinical experience is presented, and the need for a real-time tool that characterizes motion behavior for each individual as a prescan protocol is discussed.

Carotid Arteries↗