Cardiac Magnetic Resonance Elastography
Abstract
Magnetic resonance elastography (MRE) is a novel, innovative noninvasive imaging technique used to estimate the stiffness of soft tissues. It has been shown that MRE can be used as a research tool to diagnose different disease states in the heart, liver, brain, pancreas, breast, aorta etc. Currently, liver MRE is a clinical tool to stage liver fibrosis. This chapter describes the principle of MRE, the motivation for use of MRE for cardiac applications, and the current state-of-the-art in the development of cardiac MRE, which includes the requirement of hardware, pulse sequences and analysis. Finally, cardiac MRE applications and future directions are also discussed/presented.
Abbreviations
- DI
Direct inversion
- DTI
Diffusion tensor imaging
- ECV
Extra-cellular volume
- ED
End-diastole
- ES
End-systole
- FDA
Food and Drug Administration
- GRE
Gradient-recalled echo
- HCM
Hypertrophic cardiomyopathy
- HF
Heart failure
- HFpEF
Heart failure with preserved ejection fraction
- HFrEF
Heart failure with reduced ejection fraction
- LFE
Local frequency estimation
- LV
Left ventricular
- MEG
Motion encoding gradient
- MI
Myocardial infarction
- MRE
Magnetic resonance elastography
- MRI
Magnetic resonance imaging
- PG
Phase gradient
- P-V
Pressure-volume
- TE
Echo time
- TR
Repetition time
- UE
Ultrasound elastography
References
- 1.Zile MR, Baicu CF, Gaasch WH. Diastolic heart failure – abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med. 2004;350(19):1953–9.CrossRefPubMedGoogle Scholar
- 2.Pislaru C, Bruce CJ, Anagnostopoulos PC, Allen JL, Seward JB, Pellikka PA, Ritman EL, Greenleaf JF. Ultrasound strain imaging of altered myocardial stiffness: stunned versus infarcted reperfused myocardium. Circulation. 2004;109(23):2905–10.CrossRefPubMedGoogle Scholar
- 3.Cingolani HE, Rebolledo OR, Portiansky EL, Perez NG, Camilion de Hurtado MC. Regression of hypertensive myocardial fibrosis by Na(+)/H(+) exchange inhibition. Hypertension. 2003;41(2):373–7.CrossRefPubMedGoogle Scholar
- 4.Hoskins AC, Jacques A, Bardswell SC, McKenna W, Tsang V, Dos Remedios CG, Ehler E, Adams K, Jalilzadeh S, Avkiran M, et al. Normal passive viscoelasticity but abnormal myofibrillar force generation in human hypertrophic cardiomyopathy. J Mol Cell Cardiol. 2010;49(5):737–45.CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Al-Mohammad A, Mant J, Laramee P, Swain S. Diagnosis and management of adults with chronic heart failure: summary of updated NICE guidance. BMJ. 2010;341:c4130.CrossRefPubMedGoogle Scholar
- 6.Lam CS, Lyass A, Kraigher-Krainer E, Massaro JM, Lee DS, Ho JE, Levy D, Redfield MM, Pieske BM, Benjamin EJ, et al. Cardiac dysfunction and noncardiac dysfunction as precursors of heart failure with reduced and preserved ejection fraction in the community. Circulation. 2011;124(1):24–30.CrossRefPubMedPubMedCentralGoogle Scholar
- 7.De Keulenaer GW, Brutsaert DL. The heart failure spectrum: time for a phenotype-oriented approach. Circulation. 2009;119(24):3044–6.CrossRefPubMedGoogle Scholar
- 8.Zile MR, Baicu CF, Ikonomidis JS, Stroud RE, Nietert PJ, Bradshaw AD, Slater R, Palmer BM, Van Buren P, Meyer M, et al. Myocardial stiffness in patients with heart failure and a preserved ejection fraction contributions of collagen and titin. Circulation. 2015;131(14):1247–59.CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Holmes JW, Borg TK, Covell JW. Structure and mechanics of healing myocardial infarcts. Annu Rev Biomed Eng. 2005;7:223–53.CrossRefPubMedGoogle Scholar
- 10.Frank O. Zur Dynamik des Herzmuskels. Z Biol. 1895;32:370–437.Google Scholar
- 11.Blix M. Die Lange und die Spannung des Muskels. Skand Arch Physiol. 1892;3:295–318.CrossRefGoogle Scholar
- 12.Abbott BC, Mommaerts WF. A study of inotropic mechanisms in the papillary muscle preparation. J Gen Physiol. 1959;42(3):533–51.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Abbott BC, Lowy J. Stress relaxation in muscle. Proc R Soc Lond B Biol Sci. 1956;146(923):281–8.CrossRefPubMedGoogle Scholar
- 14.Connelly CM, Vogel WM, Wiegner AW, Osmers EL, Bing OH, Kloner RA, Dunn-Lanchantin DM, Franzblau C, Apstein CS. Effects of reperfusion after coronary artery occlusion on post-infarction scar tissue. Circ Res. 1985;57(4):562–77.CrossRefPubMedGoogle Scholar
- 15.Gupta KB, Ratcliffe MB, Fallert MA, Edmunds Jr LH, Bogen DK. Changes in passive mechanical stiffness of myocardial tissue with aneurysm formation. Circulation. 1994;89(5):2315–26.CrossRefPubMedGoogle Scholar
- 16.Paulus WJ, van Ballegoij JJ. Treatment of heart failure with normal ejection fraction: an inconvenient truth! J Am Coll Cardiol. 2010;55(6):526–37.CrossRefPubMedGoogle Scholar
- 17.Perk G, Kronzon I. Non-Doppler two dimensional strain imaging for evaluation of coronary artery disease. Echocardiography. 2009;26(3):299–306.CrossRefPubMedGoogle Scholar
- 18.Hong Y, Liu X, Li Z, Zhang X, Chen M, Luo Z. Real-time ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules. J Ultrasound Med. 2009;28(7):861–7.CrossRefPubMedGoogle Scholar
- 19.Zhu QL, Jiang YX, Liu JB, Liu H, Sun Q, Dai Q, Chen X. Real-time ultrasound elastography: its potential role in the assessment of breast lesions. Ultrasound Med Biol. 2008;34(8):1232–8.CrossRefPubMedGoogle Scholar
- 20.Piscaglia F, Salvatore V, Di Donato R, D’Onofrio M, Gualandi S, Gallotti A, Peri E, Borghi A, Conti F, Fattovich G, et al. Accuracy of virtual touch Acoustic Radiation Force Impulse (ARFI) imaging for the diagnosis of cirrhosis during liver ultrasonography. Ultraschall Med. 2011;32(2):167–75.CrossRefPubMedGoogle Scholar
- 21.Stefanescu H, Grigorescu M, Lupsor M, Procopet B, Maniu A, Badea R. Spleen stiffness measurement using Fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients. J Gastroenterol Hepatol. 2011;26(1):164–70.CrossRefPubMedGoogle Scholar
- 22.Pislaru C, Urban MW, Nenadic I, Greenleaf JF. Shearwave dispersion ultrasound vibrometry applied to in vivo myocardium. Conf Proc IEEE Eng Med Biol Soc. 2009;2009:2891–4.PubMedGoogle Scholar
- 23.Manduca A, Oliphant TE, Dresner MA, Mahowald JL, Kruse SA, Amromin E, Felmlee JP, Greenleaf JF, Ehman RL. Magnetic resonance elastography: non-invasive mapping of tissue elasticity. Med Image Anal. 2001;5(4):237–54.CrossRefPubMedGoogle Scholar
- 24.Tse ZTH, Janssen H, Hamed A, Ristic M, Young I, Lamperth M. Magnetic resonance elastography hardware design: a survey. Proc Inst Mech Eng Part H J Eng Med. 2009;223(H4):497–514.CrossRefGoogle Scholar
- 25.Litwiller DV, Mariappan YK, Ehman RL. Magnetic resonance elastography. Curr Med Imaging Rev. 2012;8(1):46–55.CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Elgeti T, Rump J, Hamhaber U, Papazoglou S, Hamm B, Braun J, Sack I. Cardiac magnetic resonance elastography. Initial results. Investig Radiol. 2008;43(11):762–72.CrossRefGoogle Scholar
- 27.Wassenaar PA, Eleswarpu CN, Schroeder SA, Mo X, Raterman BD, White RD, Kolipaka A. Measuring age-dependent myocardial stiffness across the cardiac cycle using MR elastography: a reproducibility study. Magn Reson Med. 2016;75(4):1586–93.Google Scholar
- 28.Kolipaka A, Araoz PA, McGee KP, Manduca A, Ehman RL. Magnetic resonance elastography as a method for the assessment of effective myocardial stiffness throughout the cardiac cycle. Magn Reson Med. 2010;64(3):862–70.CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Kolipaka A, McGee KP, Araoz PA, Glaser KJ, Manduca A, Ehman RL. Evaluation of a rapid, multiphase MRE sequence in a heart-simulating phantom. Magn Reson Med. 2009;62(3):691–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Sack I, Rump J, Elgeti T, Samani A, Braun J. MR elastography of the human heart: noninvasive assessment of myocardial elasticity changes by shear wave amplitude variations. Magn Magn Reson Med. 2009;61(3):668–77.Google Scholar
- 31.Arani A, Glaser KL, Arunachalam SP, Rossman PJ, Lake DS, Trzasko JD, Manduca A, McGee KP, Ehman RL, Araoz PA. In vivo, high-frequency three-dimensional cardiac MR elastography: feasibility in normal volunteers. Magn Reson Med. 2017;77(1):351–60.Google Scholar
- 32.Kolipaka A, McGee KP, Manduca A, Romano AJ, Glaser KJ, Araoz PA, Ehman RL. Magnetic resonance elastography: inversions in bounded media. Magn Reson Med. 2009;62(6):1533–42.CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Romano A, Mazumdar R, Choi S, Clymer B, White RD, Kolipaka A. Waveguide magnetic resonance elastography of the heart. Proceedings in ISMRM. Salt Lake City. 2013.Google Scholar
- 34.Kolipaka A, McGee KP, Araoz PA, Glaser KJ, Manduca A, Romano AJ, Ehman RL. MR elastography as a method for the assessment of myocardial stiffness: comparison with an established pressure-volume model in a left ventricular model of the heart. Magn Reson Med. 2009;62(1):135–40.CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Elgeti T, Laule M, Kaufels N, Schnorr J, Hamm B, Samani A, Braun J, Sack I. Cardiac MR elastography: comparison with left ventricular pressure measurement. J Cardiovasc Magn Reson. 2009;11:44.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Kolipaka A, Aggarwal SR, McGee KP, Anavekar N, Manduca A, Ehman RL, Araoz PA. Magnetic resonance elastography as a method to estimate myocardial contractility. J Magn Reson Imaging. 2012;36(1):120–7.CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Kolipaka A, McGee KP, Manduca A, Anavekar N, Ehman RL, Araoz PA. In vivo assessment of MR elastography-derived effective end-diastolic myocardial stiffness under different loading conditions. J Magn Reson Imaging. 2011;33(5):1224–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 38.Mazumder R, Schroeder S, Mo X, Litsky AS, Clymer BD, White RD, Kolipaka A. In vivo magnetic resonance elastography to estimate left ventricular stiffness in a myocardial infarction induced porcine model. J Magn Reson Imaging. 2016. Epub ahead of print.Google Scholar
- 39.Mazumder R, Schroeder S, Mo X, Clymer BD, White RD, Kolipaka A. In vivo quantification of myocardial stiffness in hypertensive porcine hearts using MR elastography. J Magn Reson Imaging. 2017;45(3):813–20.Google Scholar
- 40.Elgeti T, Beling M, Hamm B, Braun J, Sack I. Cardiac magnetic resonance elastography: toward the diagnosis of abnormal myocardial relaxation. Investig Radiol. 2010;45(12):782–7.CrossRefGoogle Scholar
- 41.Elgeti T, Knebel F, Hattasch R, Hamm B, Braun J, Sack I. Shear-wave amplitudes measured with cardiac MR elastography for diagnosis of diastolic dysfunction. Radiology. 2014;271(3):681–7.CrossRefPubMedGoogle Scholar
- 42.Elgeti T, Steffen IG, Knebel F, Hattasch R, Hamm B, Braun J, Sack I. Time-resolved analysis of left ventricular shear wave amplitudes in cardiac elastography for the diagnosis of diastolic dysfunction. Investig Radiol. 2016;51(1):1–6.CrossRefGoogle Scholar
- 43.Mazumder A, Clymer BD, White RD, Romano A, Kolipaka A. In-vivo waveguide cardiac magnetic resonance elastography. J Cardiovasc Magn Reson. 2015;17(Suppl 1):35.CrossRefGoogle Scholar