Effect of Cangrelor on Infarct Size in ST-Segment-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention: A Randomized Controlled Trial (The PITRI Trial).

Background: The administration of intravenous cangrelor at reperfusion achieves faster onset of platelet P2Y12 inhibition than oral ticagrelor and has been shown to reduce myocardial infarction (MI) size in the preclinical setting. We hypothesized that the administration of cangrelor at reperfusion will reduce MI size and prevent microvascular obstruction in patients with ST-segment-elevation MI undergoing primary percutaneous coronary intervention.

Methods: This was a phase 2, multicenter, randomized, double-blind, placebo-controlled clinical trial conducted between November 2017 to November 2021 in 6 cardiac centers in Singapore.

Evaluation of trigeminal nerve tractography using two-fold-accelerated simultaneous multi-slice readout-segmented echo planar diffusion tensor imaging.

Objectives: Simultaneous multi-slice (SMS) imaging with short repetition time (TR) accelerates diffusion tensor imaging (DTI) acquisitions. However, its impact when combined with readout-segmented echo planar imaging (RESOLVE) on the cranial nerves given the challenging skull base/posterior fossa terrain is unexplored. We evaluated the reliability of trigeminal nerve DTI metrics using SMS with RESOLVE-DTI.

TSTIR preparation for single-shot cardiovascular magnetic resonance myocardial edema imaging.

Background: Myocardial edema in acute myocardial infarction (AMI) is commonly imaged using dark-blood short tau inversion recovery turbo spin echo (STIR-TSE) cardiovascular magnetic resonance (CMR). The technique is sensitive to cardiac motion and coil sensitivity variation, leading to myocardial signal nonuniformity and impeding reliable depiction of edematous tissues. T-prepared balanced steady state free precession (Tp-bSSFP) imaging has been proposed, but its contrast is low, and averaging is commonly needed.

Joint intracranial and carotid vessel wall imaging in 5 minutes using compressed sensing accelerated DANTE-SPACE.

Objectives: To compare visualization of joint intracranial and carotid vessel walls between 5× compressed sensing accelerated three-dimensional DANTE-SPACE sequence (CS VWI) acquired in 5 min and the same sequence accelerated by 2.7× parallel imaging (PI VWI) which takes 9-10 min currently.

Methods: Following institutional review board approval and informed consent, 28 subjects including 20 stroke patients underwent PI and CS VWI examinations with an acquired spatial resolution of isotropic 0.

Platelet inhibition to target reperfusion injury trial: Rationale and study design.

Background: In ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI), current oral P2Y12 platelet inhibitors do not provide maximal platelet inhibition at the time of reperfusion. Furthermore, administration of cangrelor prior to reperfusion has been shown in pre-clinical studies to reduce myocardial infarct (MI) size. Therefore, we hypothesize that cangrelor administered prior to reperfusion in STEMI patients will reduce the incidence of microvascular obstruction (MVO) and limit MI size in STEMI patients treated with PPCI.

Cardiovascular magnetic resonance evidence of myocardial fibrosis and its clinical significance in adolescent and adult patients with Ebstein's anomaly.

Background: Myocardial fibrosis is a common pathophysiological process that is related to ventricular remodeling in congenital heart disease. However, the presence, characteristics, and clinical significance of myocardial fibrosis in Ebstein's anomaly have not been fully investigated. This study aimed to evaluate myocardial fibrosis using cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) and T1 mapping techniques, and to explore the significance of myocardial fibrosis in adolescent and adult patients with Ebstein's anomaly.

Diffusion effect on T2 relaxometry in triple-echo steady state free precession sequence.

Purpose: The purpose of this study is to evaluate the effect of diffusion on SSFP (Steady-state Free Precession) signals in triple-echo steady state (TESS) sequence and ultimately on the accuracy of T2 relaxometry.

Methods: The extended phase graph (EPG) algorithm was used to study the effect of diffusion on SSFP signals and T2 relaxometry. The simulation results were verified by a commercial phantom and in vivo studies.

High resolution simultaneous imaging of intracranial and extracranial arterial wall with improved cerebrospinal fluid suppression.

Purpose: To develop a technique for three dimensional (3D) high resolution joint imaging of intracranial and extracranial arterial walls with improved cerebrospinal fluid (CSF) suppression and good blood suppression based on T1 weighted sampling perfection with application optimized contrast using different angle evolutions (T1w-SPACE) and to compare this technique (hereafter, iSPACE) with alternating with nutation for tailored excitation (DANTE) prepared SPACE sequence (DANTE-SPACE) for their CSF suppression performance around the mid cerebral arteries (MCA) and blood suppression at carotid arteries.

Materials And Methods: Eight volunteers and twelve patients were prospectively recruited in this institutional review board approved study. A custom designed 32-channel coil set covering the intracranial and extracranial arteries was used for signal reception.

Reference value of left and right atrial size and phasic function by SSFP CMR at 3.0 T in healthy Chinese adults.

The size and function of the left atrium (LA) and right atrium (RA) are related closely with the prognosis of cardiovascular diseases. However, their normal reference values, as measured by cardiac magnetic resonance (CMR), are not well established in Chinese populations. Healthy Chinese subjects (n = 135, 66 males, age 23-83 years) without cardiovascular risk factors were recruited.

Improved workflow for quantifying left ventricular function via cardiorespiratory-resolved analysis of free-breathing MR real-time cines.

Purpose: To evaluate the feasibility of a proposed cardiorespiratory-resolved analysis in left ventricular (LV) function quantification from real-time cines in a cohort of cardiac patients.

Materials And Methods: Electrocardiograph (ECG)-free free-breathing real-time cine imaging based on the balanced steady-state free precession technique was performed on short-axis slices of 20 cardiac patients at 3T. K-means cluster segmentation was used to delineate the endocardial contours, from which the LV centroid and cavity area were determined.

Assessing exercise cardiac reserve using real-time cardiovascular magnetic resonance.

Background: Exercise cardiovascular magnetic resonance (ExCMR) has great potential for clinical use but its development has been limited by a lack of compatible equipment and robust real-time imaging techniques. We developed an exCMR protocol using an in-scanner cycle ergometer and assessed its performance in differentiating athletes from non-athletes.

Methods: Free-breathing real-time CMR (1.

A fast screening protocol for carotid plaques imaging using 3D multi-contrast MRI without contrast agent.

Purpose: To implement a fast (~15min) MRI protocol for carotid plaque screening using 3D multi-contrast MRI sequences without contrast agent on a 3Tesla MRI scanner.

Materials And Methods: 7 healthy volunteers and 25 patients with clinically confirmed transient ischemic attack or suspected cerebrovascular ischemia were included in this study. The proposed protocol, including 3D T1-weighted and T2-weighted SPACE (variable-flip-angle 3D turbo spin echo), and T1-weighted magnetization prepared rapid acquisition gradient echo (MPRAGE) was performed first and was followed by 2D T1-weighted and T2-weighted turbo spin echo, and post-contrast T1-weighted SPACE sequences.

A 32-channel coil system for MR vessel wall imaging of intracranial and extracranial arteries at 3T.

Purpose: To develop a RF coil system for joint imaging of intracranial and extracranial arterial vessel wall at 3T.

Materials And Method: The coil system consists of a 24-channel head coil combined with an 8-channel carotid coil. It is compared with a standard coil configuration (12-channel head coil+4-channel neck coil+8-channel carotid coil) for SNR and g-factors in phantoms and healthy volunteers.

Fast T1 mapping of the brain at high field using Look-Locker and fast imaging.

This study aims to develop and evaluate a new method for fast high resolution T1 mapping of the brain based on the Look-Locker technique. Single-shot turboflash sequence with high temporal acceleration is used to sample the recovery of inverted magnetization. Multi-slice interleaved acquisition within one inversion slab is used to reduce the number of inversion pulses and hence SAR.

Referenceless MR thermometry-a comparison of five methods.

Proton resonance frequency shift (PRFS) MR thermometry is commonly used to measure temperature in thermotherapy. The method requires a baseline temperature map and is therefore motion sensitive. Several referenceless MR thermometry methods were proposed to address this problem but their performances have never been compared.

An 8-channel RF coil array for carotid artery MR imaging in humans at 3 T.

Purpose: Carotid artery diseases due to plaque buildup at the carotid bifurcation are a leading cause of stroke. Accurate plaque quantification and characterization of plaque composition and morphology by magnetic resonance imaging (MRI) is essential to identifying high-risk patients. Difficulties in detecting plaque, which is physically small, and the unique physiological structure of the carotid artery make use of a radio frequency (RF) coil array with high resolution, large longitudinal coverage, and deep penetration ideal for clinical examinations.

Middle Cerebral Artery Atherosclerotic Plaques in Recent Small Subcortical Infarction: A Three-Dimensional High-resolution MR Study.

Purpose: Conventional two-dimensional vessel wall imaging has been used to depict the middle cerebral artery (MCA) wall in patients with recent small subcortical infarctions (RSSIs). However, its clinical use has been limited by restricted spatial coverage, low signal-to-noise ratio (SNR), and long scan time. We used a novel three-dimensional high-resolution MR imaging (3D HR-MRI) technique to investigate the presence, locations, and contrast-enhanced patterns of MCA plaques and their relationship with RSSI.

High resolution three dimensional intracranial arterial wall imaging at 3 T using T1 weighted SPACE.

Objective: To study the effect of imaging parameters on the contrast of T1 weighted SPACE (Sampling Perfection with Application optimized Contrast using different angle Evolutions, a 3D TSE variant) at 3 T for high resolution imaging of intracranial plaques before contrast and with post-gadolinium induced enhancement, and evaluate its relevance to patients with intracranial atherosclerosis.

Materials And Methods: Optimized parameters giving good T1 contrast between intracranial vessel wall and cerebrospinal fluid within a specific scan time and reasonable coverage were found by simulation and validated in a healthy volunteer study. Based on the results, a clinical protocol covering the three major intracranial arteries (middle cerebral arteries, basilar arteries, and petrous internal carotid arteries) was developed.

Efficient method for analyzing MR real-time cines: Toward accurate quantification of left ventricular function.

Background: To develop and assess an efficient method to identify end-expiratory end-diastolic (ED) and end-systolic (ES) images for accurate quantification of left ventricular (LV) function in real-time cine imaging.

Methods: ECG-free free-breathing real-time cine imaging was performed on short-axis slices of thirteen healthy volunteers at 3 Tesla. K-means cluster segmentation was applied to delineate the endocardial contour, from which the LV centroid and cavity area were determined in each cine image.

Noncontrast MRA of pedal arteries in type II diabetes: effect of disease load on vessel visibility.

Rationale And Objectives: Noncontrast magnetic resonance angiography (NC-MRA) of pedal artery remains challenging because of the global and regional disease load, tissue integrity, and altered microcirculation. This study aims to investigate the feasibility of the NC-MRA of pedal arteries with flow-sensitive dephasing-prepared steady-state free precession (FSD-SSFP) and to explore the effect of disease load of type II diabetes on the vessel depiction.

Materials And Methods: FSD-SSFP was performed on a 1.

Non-rigid registration and KLT filter to improve SNR and CNR in GRE-EPI myocardial perfusion imaging.

The purpose of the study was to evaluate the effect of motion compensation by non-rigid registration combined with the Karhunen-Loeve Transform (KLT) filter on the signal to noise (SNR) and contrast-to-noise ratio (CNR) of hybrid gradient-echo echoplanar (GRE-EPI) first-pass myocardial perfusion imaging. Twenty one consecutive first-pass adenosine stress perfusion MR data sets interpreted positive for ischemia or infarction were processed by non-rigid Registration followed by KLT filtering. SNR and CNR were measured in abnormal and normal myocardium in unfiltered and KLT filtered images following non-rigid registration to compensate for respiratory and other motions.

A fast referenceless PRFS-based MR thermometry by phase finite difference.

Proton resonance frequency shift-based MR thermometry is a promising temperature monitoring approach for thermotherapy but its accuracy is vulnerable to inter-scan motion. Model-based referenceless thermometry has been proposed to address this problem but phase unwrapping is usually needed before the model fitting process. In this paper, a referenceless MR thermometry method using phase finite difference that avoids the time consuming phase unwrapping procedure is proposed.

The Asymptotic Noise Distribution in Karhunen-Loeve Transform Eigenmodes.

Karhunen-Loeve Transform (KLT) is widely used in signal processing. Yet the well-accepted result is that, the noise is uniformly distributed in all eigenmodes is not accurate. We apply a result of the random matrix theory to understand the asymptotic noise distribution in KLT eigenmodes.

Myocardial T₂ mapping with respiratory navigator and automatic nonrigid motion correction.

Quantitative T₂ mapping was recently shown to be superior to T₂-weighted imaging in detecting T₂ changes across myocardium. Pixel-wise T₂ mapping is sensitive to misregistration between the images used to generate the parameter map. In this study, utility of two motion-compensation strategies-(i) navigator gating with prospective slice correction and (ii) nonrigid registration-was investigated for myocardial T₂ mapping in short axis and horizontal long axis views.