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The mechanisms of arterial signal intensity profile in non-contrast coronary MRA (NC-MRCA): a 3D printed phantom investigation and clinical translations

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Abstract

Signal intensity (SI) drop has been proposed as an indirect stenosis assessment in non-contrast coronary MRA (NC-MRCA) but it uses unproven assumptions. We aimed to clarify the mechanisms that govern the SI in vitro and develop a stenosis detection method in vivo. Flow phantom tubes with/without stenosis were scanned under two spatial resolutions (0.5/1.0 mm3) on a 3.0 T MRI. Thirty-two coronary arteries from 11 volunteers were prospectively scanned with an EKG- and respiratory-gated 3D NC-MRCA with a resolution of 1.0 mm3, with coronary computed tomography angiography (CTA) as reference. The normalized SI along the centerline of the tubes or the coronary arteries was assessed against the distance from the orifice using a linear regression model. Its coefficient (SI decay slope) and goodness-of-fit (R2) were extracted to assess the effect of flow velocity and stenosis on the SI profile curve. The R2 was utilized for the stenosis detection. Phantom study: A slow flow velocity caused a steep SI decay slope. The SI drop revealed only at the inlet and outlet of stenosis due to the flow turbulence/vortex and yielded low R2, in which shape changed by the resolution. Clinical study: The R2 cutoff to detect ≥ 50% stenosis for the left and right coronary arteries were 0.64 and 0.20 with a sensitivity/specificity of 71.5/71.5 and 66.7/100 (%), respectively. The SI drop did not reflect the actual stenosis position and not suitable for the stenosis localization. The R2 cutoff represents an alternative method to detect stenoses on NC-MRCA at vessel level.

Trial registration: ClinicalTrials.gov; NCT03768999, registered on December 7, 2018.

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Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank Jaclyn Sesso, our research nurse, for the participant recruitment and for providing care for the participants; Jennifer Wagner, our research collaborator from Canon Medical Systems, for supporting the MRI scans; Karan Kapoor, our cardiologist, for attending the clinical MRI scans; and Ryan Stewart, our collaborator from Johns Hopkins Biomedical Engineering, for 3D-printing the phantom. This study was supported by Canon Medical Systems Corporation, grant # 16–00632.

Funding

This study was supported by Canon Medical Systems Corporation, grant # 16–00632.

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Authors and Affiliations

  1. Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Yoko Kato, Chikara Noda, Jason M. Ortman & Joao A. C. Lima

  2. Division of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Bharath Ambale-Venkatesh

  3. Canon Medical Systems Corporation, 1385 Shimoishigami, Otawara-shi, Tochigi, 324-8550, Japan

    Yoshimori Kassai & Chia-Ying Liu

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Contributions

Each author’s contribution was as follows: YK: Conceptualization, methodology, formal analysis, investigation, data curation, writing- draft, writing-review and editing. CN: Investigation, writing- review and editing. BA-V: Conceptualization, writing-review and editing. JMO: Investigation, resources, writing-review and editing. YK: Software, resources, writing-review and editing. JACL: Supervision, writing-review and editing. C-YL: Conceptualization, methodology, investigation, supervision, writing-review and editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Chia-Ying Liu.

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Competing interests

Conflicts of interest/Competing interests: This work represents ongoing R&D between our group at Johns Hopkins Hospital and Canon Medical Systems. This study was supported by Canon Medical Systems Corporation, grant # 16–00632. Dr. Lima is the recipient of the grant. Drs Kassai and Liu are Canon Medical Systems employees in research and development roles, are members of the joint research group. We have been particularly careful at eliminating any perception of bias. Other co-authors have no conflict of interest. The authors have full control of all primary data and agree to allow the journal to review the data if requested.

Conflicts of interest

This work represents ongoing R&D between our group at Johns Hopkins Hospital and Canon Medical Systems. This study was supported by Canon Medical Systems Corporation, grant # 16–00632. Dr. Lima is the recipient of the grant. Drs Kassai and Liu are Canon Medical Systems employees in research and development roles, are members of the joint research group. We have been particularly careful at eliminating any perception of bias. Other co-authors have no conflict of interest. The authors have full control of all primary data and agree to allow the journal to review the data if requested.

Ethical approval

The study complied with the World Medical Association's Declaration of Helsinki. This study is registered with ClinicalTrials.gov, number NCT03768999. The Johns Hopkins School of Medicine institutional review board (IRB) approved the study protocol on Feb 17, 2020 with application number IRB00196000.

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Informed consent for publication was obtained from all individual participants included in the study.

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Kato, Y., Noda, C., Ambale-Venkatesh, B. et al. The mechanisms of arterial signal intensity profile in non-contrast coronary MRA (NC-MRCA): a 3D printed phantom investigation and clinical translations. Int J Cardiovasc Imaging 39, 209–220 (2023). https://doi.org/10.1007/s10554-022-02700-1

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