Multidimensional and Multiparametric Quantitative Cardiac MRI from Continuous Free-Breathing Acquisition

Lead Research Organisation: King's College London
Department Name: Imaging & Biomedical Engineering

Abstract

Cardiovascular disease (CVD) is the leading single cause of morbidity and mortality in the Western world, causing over 65.000 deaths every year in England. Improving the treatment and outcome of cardiovascular disease is one of the main priorities of the National Health Service (NHS) and a reduction of 25% in mortality associated to cardiovascular disease by the year 2025 is one of the major challenges proposed by the United Nations. Magnetic Resonance Imaging (MRI) is a very promising non-invasive tool for early risk assessment, guidance of therapy and treatment monitoring of CVD. MRI has been shown to provide exquisite depiction of cardiac anatomy and is considered the gold standard to assess ventricular volumes and function. More recently, quantitative mapping of magnetic relaxation properties (known as e.g. T1 and T2 relaxation times) have been developed to standardise the quantitative measurement of myocardial tissue properties, enabling non-invasive characterisation and differentiation of diseased and healthy tissue. Clinical research studies have shown the potential of parametric mapping techniques for quantification of diffuse myocardial fibrosis (T1 map) and the assessment of myocardial oedema and inflammation (T2 map). Thus, MR parameter mapping offer the promise of early disease detection and monitoring over time or in response to therapy, changing the MR paradigm from visualisation to quantification.

The limitation of the current MRI scheme is that all these images (e.g. cardiac anatomy, function, T1 map and T2 map) are acquired sequentially, usually with different resolution, different geometric orientations and at different breath-hold positions. This scheme requires patient cooperation as acquisitions are usually performed under multiple breath holds, requires experienced radiographers to plan and perform the different acquisitions, and results in long scan times. Moreover patients are usually unable to hold their breath at the same respiratory position. Thus images acquired at different breath-holds cannot be directly fused thereby affecting diagnosis, accuracy and reproducibility of cardiac MRI.

The method proposed in this project will overcome these problems by allowing the simultaneous acquisition of MR images with multiple parameters (e.g. cardiac anatomy, function, T1 map and T2 map), throughout the whole cardiac and respiratory cycles, from a single free-breathing acquisition. Thus providing anatomic and functional information simultaneously with quantitative information of multiple tissue parameters for an efficient (single scan, shorter and predictable scan time), accurate, simplified (less planning required and more comfortable for the patients) and comprehensive assessment of cardiovascular disease.

Planned Impact

The beneficiaries of this research will be patients with cardiovascular disease (CVD), who will benefit from an efficient, accurate and more comfortable non-invasive diagnostic test. Secondary beneficiaries will be clinicians involved in the diagnosis and treatment of CVD. Complementary and co-registered information provided by both qualitative and quantitative cardiac MR images will enable more reliable diagnosis. In the long term this project will also help reducing NHS healthcare costs by a) reducing planning and scan times, therefore decreasing the exam cost per patient; and b) improving hospital discharge rates by providing more accurate diagnosis. Moreover the technology developed in this project may also have an impact on other applications such as abdominal and liver imaging where accurate quantification and respiratory motion are known major challenges. Through commercialisation, the research will be of benefit to the imaging manufacturers and subsequently to the healthcare system by improving patient management through improved treatment outcome and reduced healthcare costs on a national and international level.

Our goal is to maximise the impact of our work through dissemination of our ideas and results to the academic and clinical communities and potential industrial partners. The scientific methodology results from this research will be output as research publications in high-impact journals in the field of medical imaging. Results of the proposed research will be also presented to the Cardiovascular Patient and Public Involvement group at St Thomas' Hospital as well as to the general public in engagement activities such as Pint of Science and Healthcare Science Week. Throughout the project we will also post blogs about our latest results on the Division's blog (https://kingsimaging.wordpress.com/) to reach a larger community and to make our research results more accessible to a larger community. A large amount of phantom and in-vivo data will be generated during the lifetime of the grant. After the studies are published in scientific journals, and after they are patented if patenting is a viable option, this data will be made publicly available for research use. Moreover the data and reconstruction codes generated during the lifetime of the grant will be used in different teaching, and networking activities. At the completion of this project we plan to work closely together with industrial partners to transfer the developed methodology into their product software to allow wide spread clinical use of this research.

Publications

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Bustin A (2020) From Compressed-Sensing to Artificial Intelligence-Based Cardiac MRI Reconstruction. in Frontiers in cardiovascular medicine

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Bustin A (2020) 3D whole-heart isotropic sub-millimeter resolution coronary magnetic resonance angiography with non-rigid motion-compensated PROST. in Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance

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Coronado R (2021) A Spatial Off-Resonance Correction in Spirals for Magnetic Resonance Fingerprinting in IEEE Transactions on Medical Imaging

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Correia T (2020) Accelerated high-resolution free-breathing 3D whole-heart T2-prepared black-blood and bright-blood cardiovascular magnetic resonance. in Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance

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Cruz G (2019) Rigid motion-corrected magnetic resonance fingerprinting. in Magnetic resonance in medicine

 
Description Myocardial T1 and T2 mapping have been recognised as one of the most valuable quantitative mapping techniques to support diagnostic, therapeutic and prognostic decision making in ischemic and non-ischemic cardiomyopathies. However current acquisitions cannot cover the whole heart (since scans need to be performed under a breath hold) and may missed regions with disease. We have developed a free-running 3D myocardial T1 mapping technique with whole heart coverage and high isotropic spatial resolution. We have developed a free-running 3D myocardial joint T1 and T2 mapping technique with whole heart coverage and high isotropic spatial resolution that can quantify both parameters from a single scan while providing functional cardiac information. Currently we are investigating the clinical value of the proposed technique in about 40 patients with cardiovascular disease. In addition, we have developed a 3D Magnetic Resonance Fingerprinting approach to simultaneously quantify myocardial T1 and T2 values. Comparison of both approaches and evaluation in patients with cardiovascular disease is warranted.
Exploitation Route This technique could be used by clinicians to improve diagnosis of several cardiovascular diseases and is currently being evaluated in a small cohort of patients.
Sectors Healthcare

 
Description We have developed a free-running 3D myocardial joint T1 and T2 mapping technique with whole heart coverage and high isotropic spatial resolution that can quantify both parameters from a single scan while providing functional cardiac information. Currently we are investigating the clinical value of the proposed technique in a small cohort of patients with cardiovascular disease. In addition, we have recently developed a 3D Magnetic Resonance Fingerprinting approach to simultaneously quantify myocardial T1 and T2 values and a free-running approach to quantify T1 and T2 mapping and CINE imaging in a single 3-min scan. Further developments in terms of speeding up reconstruction of images are needed before clinical evaluation of the later.
First Year Of Impact 2020
Sector Healthcare
Impact Types Societal

 
Description BHF Clinical Research Training Fellowship
Amount £255,962 (GBP)
Funding ID FS/20/13/34857 
Organisation British Heart Foundation (BHF) 
Sector Charity/Non Profit
Country United Kingdom
Start 09/2020 
End 09/2023
 
Description EPSRC-KCL IAA Advancing Impact Award Scheme
Amount £60,701 (GBP)
Organisation King's College London 
Sector Academic/University
Country United Kingdom
Start 03/2019 
End 11/2019
 
Description International Society for Magnetic Resonance in Medicine (ISMRM): - ISMRM Educational Stipend 2018 ($ 1815; 2018 - 2018)
Amount $400 (USD)
Organisation International Society for Magnetic Resonance in Medicine (ISMRM) 
Sector Charity/Non Profit
Country United States
Start 03/2020 
End 04/2020
 
Description NIHR Pump-Prime
Amount £66,757 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 03/2020 
End 11/2020
 
Description SCMR 2019 Travel Award (3 people)
Amount € 1,500 (EUR)
Organisation Society for Cardiovascular Magnetic Resonance (SCMR) 
Sector Charity/Non Profit
Country United States
Start 02/2019 
End 02/2019
 
Description SMRA 2018
Amount $550 (USD)
Organisation Society for Magnetic Resonance Angiography (SMRA) 
Sector Learned Society
Country Canada
Start 07/2018 
End 08/2018
 
Title Low-rank Motion Corrected Reconstruction 
Description Reconstruction framework for low rank motion corrected MRI reconstructions (i.e., combination of motion compensation, global low rank and additional regularizers (e.g. PROST)) using ADMM-based solvers. 
Type Of Material Improvements to research infrastructure 
Year Produced 2019 
Provided To Others? Yes  
Impact This method has enabled acceleration of several cardiac MRI methods and is being used by several members of the group and collaborators within and outside KCL 
 
Description Imperial College London CMRA 
Organisation Imperial College London
Country United Kingdom 
Sector Academic/University 
PI Contribution Established a collaborative project with Imperial College London to clinically validate a new coronary cardiac MR sequence that includes our under sampled and motion compensated reconstruction developments with intravascular optical coherence tomography in patients with acute coronary syndrome for the simultaneous non-contrast free breathing 3D high resolution magnetic resonance coronary artery angiography and high-risk plaque imaging. Ethical approval for the project has been obtained, an NIHR Pump-Prime award worth (£66,757.50) has been competitively secured and a British Heart Foundation Clinical Research Fellowship grant application has been submitted (currently under assessment).
Collaborator Contribution Access to facilities and patients.
Impact NIHR Pump-Prime award worth (£66,757.50) has been competitively secured and a British Heart Foundation Clinical Research Fellowship grant application has been submitted (currently under assessment).
Start Year 2019
 
Description Juntendo University Liver MRF 
Organisation Juntendo University Hospital
Country Japan 
Sector Hospitals 
PI Contribution We have developed a novel acquisition and reconstruction framework for simultaneous T1, T2, T2* and fat fraction quantification in liver imaging. This approach has been preliminary evaluated in healthy subjects.
Collaborator Contribution In collaboration with Juntendo University Hospital we aim to clinically validate the proposed liver MRF in a medium size cohort of patient with fatty liver disease and validate this against histopathology.
Impact An abstract has been accepted for publication at upcoming ISMRM international conference
Start Year 2020
 
Description UC Liver MRF 
Organisation Pontifical Catholic University of Chile
Country Chile 
Sector Academic/University 
PI Contribution We have developed a novel magnetic resonance fingerprinting for multiparametric liver tissue characterisation. We have developed a reconstruction method for this data.
Collaborator Contribution Our collaborators at UC have further developed the reconstruction method to improved quantification of T2* mapping. A postdoctoral researcher from UC spend 3 months in our lab at the start of this collaboration.
Impact Two abstracts have been accepted for presentation at the next international conference ISMRM 2020. A paper has been submitted to Magnetic Resonance in Medicine (under review) entitled "Multi-parametric liver tissue characterization using MR Fingerprinting: simultaneous T1, T2, T2* and fat fraction mapping"
Start Year 2019
 
Title METHOD AND APPARATUS FOR RECONSTRUCTING MAGNETIC RESONANCE IMAGE DATA 
Description In a method for reconstructing magnetic resonance (MR) image data from k-space data, k-space data of an image region of a subject are provided to a computer that is also provided with multiple navigator signals for the image region of the subject. The computer sorts the k-space data into multiple bins, the multiple bins representing different motion states of the subject. For each of the multiple bins, the computer executes a compressed sensing procedure to reconstruct the MR image data from the k-space data in the respective bin. Execution of the compressed sensing procedure includes solving an optimization problem comprising a data consistency component and a transform sparsity component. Motion information is incorporated by the computer into at least one of the data consistency component and the transform sparsity component of the optimization problem. 
IP Reference US2019317172 
Protection Patent application published
Year Protection Granted 2019
Licensed No
Impact Pre-product software for Siemens MRI scanners
 
Title METHOD OF PERFORMING MAGNETIC RESONANCE IMAGING AND A MAGNETIC RESONANCE APPARATUS 
Description In a method of performing magnetic resonance (MR) imaging, an MR apparatus, and a computer-readable medium during a first cardiac cycle of a subject, a first imaging sequence is generated for application to a subject. The first imaging sequence has a preparatory pulse and an inversion recovery pulse following the preparatory pulse. First signals emitted from the subject in response to the first imaging sequence are detected, and first image data are generated based on the first signals. During a second cardiac cycle following the first cardiac cycle, a second imaging sequence is generated for application to the subject. The second imaging sequence has a preparatory pulse. Second signals emitted from the subject in response to the second imaging sequence are detected, and second image data are generated based on the second signals. 
IP Reference US2019064299 
Protection Patent application published
Year Protection Granted 2019
Licensed No
Impact 20190064299
 
Title METHOD OF RECONSTRUCTING MAGNETIC RESONANCE IMAGE DATA 
Description A method of reconstructing magnetic resonance (MR) image data from k-space data. The method includes obtaining k-space data of an image region of a subject; and reconstructing, using a sparse image coding procedure, the MR image data from the k-space data by performing an iterative optimization method. The optimization method includes a data consistency iteration step and a denoising iteration step applied to MR image data generated by the data consistency iteration step. The denoising iteration step incorporates a sparsifying operation to provide a sparse representation of the MR image data for the imaged region as an input to the data consistency iteration step. 
IP Reference US2019346522 
Protection Patent application published
Year Protection Granted 2019
Licensed No
Impact Pre-product software for Siemens MRI scanners
 
Description Art x Science at the Science Museum 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Alina Schneider (PhD student) participated of the Art x Science at the Science Museum, London during the Great Exhibition Road Festival on Saturday 9th October 2022. Art x Science was an art exhibition exploring medical imaging and engineering research, with exhibits were developed in collaboration between PhD students from the School of Biomedical Engineering and Imaging Sciences and the Royal College of Arts. The exhibits covered some perinatal imaging, neurodevelopment, cardiology and cardiac imaging. As well as explaining the science behind the exhibit, Alina was also able to discuss her research with visitors.
Year(s) Of Engagement Activity 2021
URL https://www.greatexhibitionroadfestival.co.uk/event/art-x-science-2021/
 
Description Engagement activities for "I CAN BE" 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact The activity was carried out by PhD student Alina Psenicny. She participated in online engagement activities for an organisation called I CAN BE; a charity who aim to inspire young girls by introducing them to women with exciting careers. She created a short video explaining her work to children at schools. The video was then shared also with the other charity partner ECHO and they shared the videos on their 'happiness hub' for parents.
Year(s) Of Engagement Activity 2020
 
Description PSMR Training School 2018 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact This 2 day workshop focused on teaching concepts and methods for PET/MRI
Year(s) Of Engagement Activity 2019