Bob Hu

All Publications

• Initial Invasive or Conservative Strategy for Stable Coronary Disease. The New England journal of medicine Maron, D. J., Hochman, J. S., Reynolds, H. R., Bangalore, S. n., O'Brien, S. M., Boden, W. E., Chaitman, B. R., Senior, R. n., López-Sendón, J. n., Alexander, K. P., Lopes, R. D., Shaw, L. J., Berger, J. S., Newman, J. D., Sidhu, M. S., Goodman, S. G., Ruzyllo, W. n., Gosselin, G. n., Maggioni, A. P., White, H. D., Bhargava, B. n., Min, J. K., Mancini, G. B., Berman, D. S., Picard, M. H., Kwong, R. Y., Ali, Z. A., Mark, D. B., Spertus, J. A., Krishnan, M. N., Elghamaz, A. n., Moorthy, N. n., Hueb, W. A., Demkow, M. n., Mavromatis, K. n., Bockeria, O. n., Peteiro, J. n., Miller, T. D., Szwed, H. n., Doerr, R. n., Keltai, M. n., Selvanayagam, J. B., Steg, P. G., Held, C. n., Kohsaka, S. n., Mavromichalis, S. n., Kirby, R. n., Jeffries, N. O., Harrell, F. E., Rockhold, F. W., Broderick, S. n., Ferguson, T. B., Williams, D. O., Harrington, R. A., Stone, G. W., Rosenberg, Y. n. 2020

  Abstract

  Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain.We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction.Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32).Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).

  View details for DOI 10.1056/NEJMoa1915922

  View details for PubMedID 32227755

• Health-Status Outcomes with Invasive or Conservative Care in Coronary Disease. The New England journal of medicine Spertus, J. A., Jones, P. G., Maron, D. J., O'Brien, S. M., Reynolds, H. R., Rosenberg, Y. n., Stone, G. W., Harrell, F. E., Boden, W. E., Weintraub, W. S., Baloch, K. n., Mavromatis, K. n., Diaz, A. n., Gosselin, G. n., Newman, J. D., Mavromichalis, S. n., Alexander, K. P., Cohen, D. J., Bangalore, S. n., Hochman, J. S., Mark, D. B. 2020

  Abstract

  In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients.We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency.At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina).In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).

  View details for DOI 10.1056/NEJMoa1916370

  View details for PubMedID 32227753

• Combined T2 -preparation and multidimensional outer volume suppression for coronary artery imaging with 3D cones trajectories. Magnetic resonance in medicine Zeng, D. Y., Baron, C. A., Malave, M. O., Kerr, A. B., Yang, P. C., Hu, B. S., Nishimura, D. G. 2019

  Abstract

  PURPOSE: To develop a modular magnetization preparation sequence for combined T2 -preparation and multidimensional outer volume suppression (OVS) for coronary artery imaging.METHODS: A combined T2 -prepared 1D OVS sequence with fat saturation was defined to contain a 90°-60 180°60 composite nonselective tip-down pulse, two 180°Y hard pulses for refocusing, and a -90° spectral-spatial sinc tip-up pulse. For 2D OVS, 2 modules were concatenated, selective in X and then Y. Bloch simulations predicted robustness of the sequence to B0 and B1 inhomogeneities. The proposed sequence was compared with a T2 -prepared 2D OVS sequence proposed by Luo et al, which uses a spatially selective 2D spiral tip-up. The 2 sequences were compared in phantom studies and in vivo coronary artery imaging studies with a 3D cones trajectory.RESULTS: Phantom results demonstrated superior OVS for the proposed sequence compared with the Luo sequence. In studies on 15 healthy volunteers, the proposed sequence had superior image edge profile acutance values compared with the Luo sequence for the right (P < .05) and left (P < .05) coronary arteries, suggesting superior vessel sharpness. The proposed sequence also had superior signal-to-noise ratio (P < .05) and passband-to-stopband ratio (P < .05). Reader scores and reader preference indicated superior coronary image quality of the proposed sequence for both the right (P < .05) and left (P < .05) coronary arteries.CONCLUSION: The proposed sequence with concatenated 1D spatially selective tip-ups and integrated fat saturation has superior image quality and suppression compared with the Luo sequence with 2D spatially selective tip-up.

  View details for DOI 10.1002/mrm.28057

  View details for PubMedID 31691350

• Baseline Characteristics and Risk Profiles of Participants in the ISCHEMIA Randomized Clinical Trial. JAMA cardiology Hochman, J. S., Reynolds, H. R., Bangalore, S., O'Brien, S. M., Alexander, K. P., Senior, R., Boden, W. E., Stone, G. W., Goodman, S. G., Lopes, R. D., Lopez-Sendon, J., White, H. D., Maggioni, A. P., Shaw, L. J., Min, J. K., Picard, M. H., Berman, D. S., Chaitman, B. R., Mark, D. B., Spertus, J. A., Cyr, D. D., Bhargava, B., Ruzyllo, W., Wander, G. S., Chernyavskiy, A. M., Rosenberg, Y. D., Maron, D. J., ISCHEMIA Research Group 2019

  Abstract

  Importance: It is unknown whether coronary revascularization, when added to optimal medical therapy, improves prognosis in patients with stable ischemic heart disease (SIHD) at increased risk of cardiovascular events owing to moderate or severe ischemia.Objective: To describe baseline characteristics of participants enrolled and randomized in the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial and to evaluate whether qualification by stress imaging or nonimaging exercise tolerance test (ETT) influenced risk profiles.Design, Setting, and Participants: The ISCHEMIA trial recruited patients with SIHD with moderate or severe ischemia on stress testing. Blinded coronary computed tomography angiography was performed in most participants and reviewed by a core laboratory to exclude left main stenosis of at least 50% or no obstructive coronary artery disease (CAD) (<50% for imaging stress test and <70% for ETT). The study included 341 enrolling sites (320 randomizing) in 38 countries and patients with SIHD and moderate or severe ischemia on stress testing. Data presented were extracted on December 17, 2018.Main Outcomes and Measures: Enrolled, excluded, and randomized participants' baseline characteristics. No clinical outcomes are reported.Results: A total of 8518 patients were enrolled, and 5179 were randomized. Common reasons for exclusion were core laboratory determination of insufficient ischemia, unprotected left main stenosis of at least 50%, or no stenosis that met study obstructive CAD criteria on study coronary computed tomography angiography. Randomized participants had a median age of 64 years, with 1168 women (22.6%), 1726 nonwhite participants (33.7%), 748 Hispanic participants (15.5%), 2122 with diabetes (41.0%), and 4643 with a history of angina (89.7%). Among the 3909 participants randomized after stress imaging, core laboratory assessment of ischemia severity (in 3901 participants) was severe in 1748 (44.8%), moderate in 1600 (41.0%), mild in 317 (8.1%) and none or uninterpretable in 236 (6.0%), Among the 1270 participants who were randomized after nonimaging ETT, core laboratory determination of ischemia severity (in 1266 participants) was severe (an eligibility criterion) in 1051 (83.0%), moderate in 101 (8.0%), mild in 34 (2.7%) and none or uninterpretable in 80 (6.3%). Among the 3912 of 5179 randomized participants who underwent coronary computed tomography angiography, 79.0% had multivessel CAD (n=2679 of 3390) and 86.8% had left anterior descending (LAD) stenosis (n=3190 of 3677) (proximal in 46.8% [n=1749 of 3739]). Participants undergoing ETT had greater frequency of 3-vessel CAD, LAD, and proximal LAD stenosis than participants undergoing stress imaging.Conclusions and Relevance: The ISCHEMIA trial randomized an SIHD population with moderate or severe ischemia on stress testing, of whom most had multivessel CAD.Trial Registration: ClinicalTrials.gov Identifier: NCT01471522.

  View details for PubMedID 30810700

• Whole-heart coronary MR angiography using a 3D cones phyllotaxis trajectory MAGNETIC RESONANCE IN MEDICINE Malave, M. O., Baron, C. A., Addy, N., Cheng, J. Y., Yang, P. C., Hu, B. S., Nishimura, D. G. 2019; 81 (2): 1092–1103

  View details for DOI 10.1002/mrm.27475

  View details for Web of Science ID 000462086300030

• Whole-heart coronary MR angiography using a 3D cones phyllotaxis trajectory. Magnetic resonance in medicine Malave, M. O., Baron, C. A., Addy, N. O., Cheng, J. Y., Yang, P. C., Hu, B. S., Nishimura, D. G. 2018

  Abstract

  PURPOSE: To develop a 3D cones steady-state free precession sequence with improved robustness to respiratory motion while mitigating eddy current artifacts for free-breathing whole-heart coronary magnetic resonance angiography.METHOD: The proposed sequence collects cone interleaves using a phyllotaxis pattern, which allows for more distributed k-space sampling for each heartbeat compared to a typical sequential collection pattern. A Fibonacci number of segments is chosen to minimize eddy current effects with the trade-off of an increased number of acquisition heartbeats. For verification, phyllotaxis-cones is compared to sequential-cones through simulations, phantom studies, and in vivo coronary scans with 8 subjects using 2D image-based navigators for retrospective motion correction.RESULTS: Simulated point spread functions and moving phantom results show less coherent motion artifacts for phyllotaxis-cones compared to sequential-cones. Assessment of the right and left coronary arteries using reader scores and the image edge profile acutance vessel sharpness metric indicate superior image quality and sharpness for phyllotaxis-cones.CONCLUSION: Phyllotaxis 3D cones results in improved qualitative image scores and coronary vessel sharpness for free-breathing whole-heart coronary magnetic resonance angiography compared to standard sequential ordering when using a steady-state free precession sequence.

  View details for PubMedID 30370941

• 3D image-based navigators for coronary MR angiography MAGNETIC RESONANCE IN MEDICINE Addy, N. O., Ingle, R. R., Luo, J., Baron, C. A., Yang, P. C., Hu, B. S., Nishimura, D. G. 2017; 77 (5): 1874-1883

  Abstract

  To develop a method for acquiring whole-heart 3D image-based navigators (iNAVs) with isotropic resolution for tracking and correction of localized motion in coronary magnetic resonance angiography (CMRA).To monitor motion in all regions of the heart during a free-breathing scan, a variable-density cones trajectory was designed to collect a 3D iNAV every heartbeat in 176 ms with 4.4 mm isotropic spatial resolution. The undersampled 3D iNAV data were reconstructed with efficient self-consistent parallel imaging reconstruction (ESPIRiT). 3D translational and nonrigid motion-correction methods using 3D iNAVs were compared to previous translational and nonrigid methods using 2D iNAVs.Five subjects were scanned with a 3D cones CMRA sequence, accompanied by both 2D and 3D iNAVs. The quality of the right and left anterior descending coronary arteries was assessed on 2D and 3D iNAV-based motion-corrected images using a vessel sharpness metric and qualitative reader scoring. This assessment showed that nonrigid motion correction based on 3D iNAVs produced results that were noninferior to correction based on 2D iNAVs.The ability to acquire isotropic-resolution 3D iNAVs every heartbeat during a CMRA scan was demonstrated. Such iNAVs enabled direct measurement of localized motion for nonrigid motion correction in free-breathing whole-heart CMRA. Magn Reson Med, 2016. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.26269

  View details for Web of Science ID 000399666400014

• Nonrigid Motion Correction With 3D Image-Based Navigators for Coronary MR Angiography MAGNETIC RESONANCE IN MEDICINE Luo, J., Addy, N. O., Ingle, R. R., Baron, C. A., Cheng, J. Y., Hu, B. S., Nishimura, D. G. 2017; 77 (5): 1884-1893

  Abstract

  To develop a retrospective nonrigid motion-correction method based on 3D image-based navigators (iNAVs) for free-breathing whole-heart coronary magnetic resonance angiography (MRA).The proposed method detects global rigid-body motion and localized nonrigid motion from 3D iNAVs and compensates them with an autofocusing algorithm. To model the global motion, 3D rotation and translation are estimated from the 3D iNAVs. Two sets of localized nonrigid motions are obtained from deformation fields between 3D iNAVs and reconstructed binned images, respectively. A bank of motion-corrected images is generated and the final image is assembled pixel-by-pixel by selecting the best focused pixel from this bank. In vivo studies with six healthy volunteers were conducted to compare the performance of the proposed method with 3D translational motion correction and no correction.In vivo studies showed that compared to no correction, 3D translational motion correction and the proposed method increased the vessel sharpness by 13% ± 13% and 19% ± 16%, respectively. Out of 90 vessel segments, 75 segments showed improvement with the proposed method compared to 3D translational correction.We have developed a nonrigid motion-correction method based on 3D iNAVs and an autofocusing algorithm that improves the vessel sharpness of free-breathing whole-heart coronary MRA. Magn Reson Med, 2016. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.26273

  View details for Web of Science ID 000399666400015

  View details for PubMedCentralID PMC5107365

• 3D image-based navigators for coronary MR angiography. Magnetic resonance in medicine Addy, N. O., Ingle, R. R., Luo, J., Baron, C. A., Yang, P. C., Hu, B. S., Nishimura, D. G. 2016

  Abstract

  To develop a method for acquiring whole-heart 3D image-based navigators (iNAVs) with isotropic resolution for tracking and correction of localized motion in coronary magnetic resonance angiography (CMRA).To monitor motion in all regions of the heart during a free-breathing scan, a variable-density cones trajectory was designed to collect a 3D iNAV every heartbeat in 176 ms with 4.4 mm isotropic spatial resolution. The undersampled 3D iNAV data were reconstructed with efficient self-consistent parallel imaging reconstruction (ESPIRiT). 3D translational and nonrigid motion-correction methods using 3D iNAVs were compared to previous translational and nonrigid methods using 2D iNAVs.Five subjects were scanned with a 3D cones CMRA sequence, accompanied by both 2D and 3D iNAVs. The quality of the right and left anterior descending coronary arteries was assessed on 2D and 3D iNAV-based motion-corrected images using a vessel sharpness metric and qualitative reader scoring. This assessment showed that nonrigid motion correction based on 3D iNAVs produced results that were noninferior to correction based on 2D iNAVs.The ability to acquire isotropic-resolution 3D iNAVs every heartbeat during a CMRA scan was demonstrated. Such iNAVs enabled direct measurement of localized motion for nonrigid motion correction in free-breathing whole-heart CMRA. Magn Reson Med, 2016. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.26269

  View details for PubMedID 27174590

• Nonrigid motion correction with 3D image-based navigators for coronary MR angiography. Magnetic resonance in medicine Luo, J., Addy, N. O., Ingle, R. R., Baron, C. A., Cheng, J. Y., Hu, B. S., Nishimura, D. G. 2016

  Abstract

  To develop a retrospective nonrigid motion-correction method based on 3D image-based navigators (iNAVs) for free-breathing whole-heart coronary magnetic resonance angiography (MRA).The proposed method detects global rigid-body motion and localized nonrigid motion from 3D iNAVs and compensates them with an autofocusing algorithm. To model the global motion, 3D rotation and translation are estimated from the 3D iNAVs. Two sets of localized nonrigid motions are obtained from deformation fields between 3D iNAVs and reconstructed binned images, respectively. A bank of motion-corrected images is generated and the final image is assembled pixel-by-pixel by selecting the best focused pixel from this bank. In vivo studies with six healthy volunteers were conducted to compare the performance of the proposed method with 3D translational motion correction and no correction.In vivo studies showed that compared to no correction, 3D translational motion correction and the proposed method increased the vessel sharpness by 13% ± 13% and 19% ± 16%, respectively. Out of 90 vessel segments, 75 segments showed improvement with the proposed method compared to 3D translational correction.We have developed a nonrigid motion-correction method based on 3D iNAVs and an autofocusing algorithm that improves the vessel sharpness of free-breathing whole-heart coronary MRA. Magn Reson Med, 2016. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.26273

  View details for PubMedID 27174673

  View details for PubMedCentralID PMC5107365

• Combined Outer Volume Suppression and T-2 Preparation Sequence for Coronary Angiography MAGNETIC RESONANCE IN MEDICINE Luo, J., Addy, N. O., Ingle, R. R., Hargreaves, B. A., Hu, B. S., Nishimura, D. G., Shin, T. 2015; 74 (6): 1632-1639

  Abstract

  To develop a magnetization preparation sequence for simultaneous outer volume suppression (OVS) and T2 weighting in whole-heart coronary magnetic resonance angiography.A combined OVS and T2 preparation sequence (OVS-T2 Prep) was designed with a nonselective adiabatic 90° tipdown pulse, two adiabatic 180° refocusing pulses, and a 2D spiral -90° tipup pulse. The OVS-T2 Prep preserves the magnetization inside an elliptic cylinder with T2 weighting, while saturating the magnetization outside the cylinder. Its performance was tested on phantoms and on 13 normal subjects with coronary magnetic resonance angiography using 3D cones trajectories.Phantom studies showed expected T2 -dependent signal amplitude in the spatial passband and suppressed signal in the spatial stopband. In vivo studies with full-field-of-view cones yielded a passband-to-stopband signal ratio of 3.18 ± 0.77 and blood-myocardium contrast-to-noise ratio enhancement by a factor of 1.43 ± 0.20 (P < 0.001). In vivo studies with reduced-field-of-view cones showed that OVS-T2 Prep well suppressed the aliasing artifacts, as supported by significantly reduced signal in the regions with no tissues compared to the images acquired without preparation (P < 0.0001).OVS-T2 Prep is a compact sequence that can accelerate coronary magnetic resonance angiography by suppressing signals from tissues surrounding the heart while simultaneously enhancing the blood-myocardium contrast.

  View details for DOI 10.1002/mrm.25575

  View details for Web of Science ID 000367737300014

  View details for PubMedCentralID PMC4470881

• Combined outer volume suppression and T2 preparation sequence for coronary angiography. Magnetic resonance in medicine Luo, J., Addy, N. O., Ingle, R. R., Hargreaves, B. A., Hu, B. S., Nishimura, D. G., Shin, T. 2015; 74 (6): 1632-9

  Abstract

  To develop a magnetization preparation sequence for simultaneous outer volume suppression (OVS) and T2 weighting in whole-heart coronary magnetic resonance angiography.A combined OVS and T2 preparation sequence (OVS-T2 Prep) was designed with a nonselective adiabatic 90° tipdown pulse, two adiabatic 180° refocusing pulses, and a 2D spiral -90° tipup pulse. The OVS-T2 Prep preserves the magnetization inside an elliptic cylinder with T2 weighting, while saturating the magnetization outside the cylinder. Its performance was tested on phantoms and on 13 normal subjects with coronary magnetic resonance angiography using 3D cones trajectories.Phantom studies showed expected T2 -dependent signal amplitude in the spatial passband and suppressed signal in the spatial stopband. In vivo studies with full-field-of-view cones yielded a passband-to-stopband signal ratio of 3.18 ± 0.77 and blood-myocardium contrast-to-noise ratio enhancement by a factor of 1.43 ± 0.20 (P < 0.001). In vivo studies with reduced-field-of-view cones showed that OVS-T2 Prep well suppressed the aliasing artifacts, as supported by significantly reduced signal in the regions with no tissues compared to the images acquired without preparation (P < 0.0001).OVS-T2 Prep is a compact sequence that can accelerate coronary magnetic resonance angiography by suppressing signals from tissues surrounding the heart while simultaneously enhancing the blood-myocardium contrast.

  View details for DOI 10.1002/mrm.25575

  View details for PubMedID 25521477

  View details for PubMedCentralID PMC4470881

• Non-contrast-enhanced peripheral angiography using a sliding interleaved cylinder acquisition. Magnetic resonance in medicine Kwon, K. T., Kerr, A. B., Wu, H. H., Hu, B. S., Brittain, J. H., Nishimura, D. G. 2015; 74 (3): 727-738

  Abstract

  To develop a new sequence for non-contrast-enhanced peripheral angiography using a sliding interleaved cylinder (SLINCYL) acquisition.A venous saturation pulse was incorporated into a three-dimensional magnetization-prepared balanced steady-state free precession sequence for non-contrast-enhanced peripheral angiography to improve artery-vein contrast. The SLINCYL acquisition, which consists of a series of overlapped thin slabs for volumetric coverage similar to the original sliding interleaved ky (SLINKY) acquisition, was used to evenly distribute the venous-suppression effects over the field of view. In addition, the thin-slab-scan nature of SLINCYL and the centric-ordered sampling geometry of its readout trajectory were exploited to implement efficient fluid-suppression and parallel imaging schemes. The sequence was tested in healthy subjects and a patient.Compared to a multiple overlapped thin slab acquisition, both SLINKY and SLINCYL suppressed the venetian blind artifacts and provided similar artery-vein contrast. However, SLINCYL achieved this with shorter scan times and less noticeable artifacts from k-space amplitude modulation than SLINKY. The fluid-suppression and parallel imaging schemes were also validated. A patient study using the SLINCYL-based sequence well identified stenoses at the superficial femoral arteries, which were also confirmed with digital subtraction angiography.Non-contrast-enhanced angiography using SLINCYL can provide angiograms with improved artery-vein contrast in the lower extremities. Magn Reson Med 74:727-738, 2015. © 2014 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.25452

  View details for PubMedID 25203505

• High-resolution variable-density 3D cones coronary MRA MAGNETIC RESONANCE IN MEDICINE Addy, N. O., Ingle, R. R., Wu, H. H., Hu, B. S., Nishimura, D. G. 2015; 74 (3): 614-621

  Abstract

  To improve the spatial/temporal resolution of whole-heart coronary MR angiography by developing a variable-density (VD) 3D cones acquisition suitable for image reconstruction with parallel imaging and compressed sensing techniques.A VD 3D cones trajectory design incorporates both radial and spiral trajectory undersampling techniques to achieve higher resolution. This design is used to generate a VD 3D cones trajectory with 0.8 mm/66 ms isotropic spatial/temporal resolution, using a similar number of readouts as our previous fully sampled cones trajectory (1.2 mm/100 ms). Scans of volunteers and patients are performed to evaluate the performance of the VD trajectory, using non-Cartesian L1 -ESPIRiT for high-resolution image reconstruction.With gridding reconstruction, the high-resolution scans experience an expected drop in signal-to-noise and contrast-to-noise ratios, but with L1 -ESPIRiT, the apparent noise is substantially reduced. Compared with 1.2 mm images, in each volunteer, the L1 -ESPIRiT 0.8 mm images exhibit higher vessel sharpness values in the right and left anterior descending arteries.Coronary MR angiography with isotropic submillimeter spatial resolution and high temporal resolution can be performed with VD 3D cones to improve the depiction of coronary arteries. Magn Reson Med 74:614-621, 2015. © 2015 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.25803

  View details for Web of Science ID 000360222900004

  View details for PubMedCentralID PMC4545694

• Non-contrast-enhanced peripheral angiography using a sliding interleaved cylinder acquisition MAGNETIC RESONANCE IN MEDICINE Kwon, K. T., Kerr, A. B., Wu, H. H., Hu, B. S., Brittain, J. H., Nishimura, D. G. 2015; 74 (3): 727-738

  Abstract

  To develop a new sequence for non-contrast-enhanced peripheral angiography using a sliding interleaved cylinder (SLINCYL) acquisition.A venous saturation pulse was incorporated into a three-dimensional magnetization-prepared balanced steady-state free precession sequence for non-contrast-enhanced peripheral angiography to improve artery-vein contrast. The SLINCYL acquisition, which consists of a series of overlapped thin slabs for volumetric coverage similar to the original sliding interleaved ky (SLINKY) acquisition, was used to evenly distribute the venous-suppression effects over the field of view. In addition, the thin-slab-scan nature of SLINCYL and the centric-ordered sampling geometry of its readout trajectory were exploited to implement efficient fluid-suppression and parallel imaging schemes. The sequence was tested in healthy subjects and a patient.Compared to a multiple overlapped thin slab acquisition, both SLINKY and SLINCYL suppressed the venetian blind artifacts and provided similar artery-vein contrast. However, SLINCYL achieved this with shorter scan times and less noticeable artifacts from k-space amplitude modulation than SLINKY. The fluid-suppression and parallel imaging schemes were also validated. A patient study using the SLINCYL-based sequence well identified stenoses at the superficial femoral arteries, which were also confirmed with digital subtraction angiography.Non-contrast-enhanced angiography using SLINCYL can provide angiograms with improved artery-vein contrast in the lower extremities. Magn Reson Med 74:727-738, 2015. © 2014 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.25452

  View details for Web of Science ID 000360222900014

  View details for PubMedCentralID PMC4362915

• High-resolution variable-density 3D cones coronary MRA. Magnetic resonance in medicine Addy, N. O., Ingle, R. R., Wu, H. H., Hu, B. S., Nishimura, D. G. 2015; 74 (3): 614-621

  Abstract

  To improve the spatial/temporal resolution of whole-heart coronary MR angiography by developing a variable-density (VD) 3D cones acquisition suitable for image reconstruction with parallel imaging and compressed sensing techniques.A VD 3D cones trajectory design incorporates both radial and spiral trajectory undersampling techniques to achieve higher resolution. This design is used to generate a VD 3D cones trajectory with 0.8 mm/66 ms isotropic spatial/temporal resolution, using a similar number of readouts as our previous fully sampled cones trajectory (1.2 mm/100 ms). Scans of volunteers and patients are performed to evaluate the performance of the VD trajectory, using non-Cartesian L1 -ESPIRiT for high-resolution image reconstruction.With gridding reconstruction, the high-resolution scans experience an expected drop in signal-to-noise and contrast-to-noise ratios, but with L1 -ESPIRiT, the apparent noise is substantially reduced. Compared with 1.2 mm images, in each volunteer, the L1 -ESPIRiT 0.8 mm images exhibit higher vessel sharpness values in the right and left anterior descending arteries.Coronary MR angiography with isotropic submillimeter spatial resolution and high temporal resolution can be performed with VD 3D cones to improve the depiction of coronary arteries. Magn Reson Med 74:614-621, 2015. © 2015 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.25803

  View details for PubMedID 26172829

  View details for PubMedCentralID PMC4545694

• Cardiovascular magnetic resonance phase contrast imaging JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE Nayak, K. S., Nielsen, J., Bernstein, M. A., Markl, M., Gatehouse, P. D., Botnar, R. M., Saloner, D., Lorenz, C., Wen, H., Hu, B. S., Epstein, F. H., Oshinski, J. N., Raman, S. V. 2015; 17

  View details for DOI 10.1186/s12968-015-0172-7

  View details for Web of Science ID 000359155700001

• Self-Gated Fat-Suppressed Cardiac Cine MRI MAGNETIC RESONANCE IN MEDICINE Ingle, R. R., Santos, J. M., Overall, W. R., McConnell, M. V., Hu, B. S., Nishimura, D. G. 2015; 73 (5): 1764-1774

  Abstract

  To develop a self-gated alternating repetition time balanced steady-state free precession (ATR-SSFP) pulse sequence for fat-suppressed cardiac cine imaging.Cardiac gating is computed retrospectively using acquired magnetic resonance self-gating data, enabling cine imaging without the need for electrocardiogram (ECG) gating. Modification of the slice-select rephasing gradients of an ATR-SSFP sequence enables the acquisition of a one-dimensional self-gating readout during the unused short repetition time (TR). Self-gating readouts are acquired during every TR of segmented, breath-held cardiac scans. A template-matching algorithm is designed to compute cardiac trigger points from the self-gating signals, and these trigger points are used for retrospective cine reconstruction. The proposed approach is compared with ECG-gated ATR-SSFP and balanced steady-state free precession in 10 volunteers and five patients.The difference of ECG and self-gating trigger times has a variability of 13 ± 11 ms (mean ± SD). Qualitative reviewer scoring and ranking indicate no statistically significant differences (P > 0.05) between self-gated and ECG-gated ATR-SSFP images. Quantitative blood-myocardial border sharpness is not significantly different among self-gated ATR-SSFP ( 0.61±0.15 mm -1), ECG-gated ATR-SSFP ( 0.61±0.15 mm -1), or conventional ECG-gated balanced steady-state free precession cine MRI ( 0.59±0.15 mm -1).The proposed self-gated ATR-SSFP sequence enables fat-suppressed cardiac cine imaging at 1.5 T without the need for ECG gating and without decreasing the imaging efficiency of ATR-SSFP. Magn Reson Med, 2014. © 2014 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.25291

  View details for PubMedID 24806049

• Rapid Single-Breath-Hold 3D Late Gadolinium Enhancement Cardiac MRI Using a Stack-of-Spirals Acquisition JOURNAL OF MAGNETIC RESONANCE IMAGING Shin, T., Lustig, M., Nishimura, D. G., Hu, B. S. 2014; 40 (6): 1496-1502

  Abstract

  To develop a rapid single-breath-hold 3D late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) method, and demonstrate its feasibility in cardiac patients.An inversion recovery dual-density 3D stack-of-spirals imaging sequence was developed. The spiral acquisition was 2-fold accelerated by self-consistent parallel imaging reconstruction (SPIRiT), which resulted in a total scan time of 12 heartbeats. Field map-based linear off-resonance correction was incorporated to the SPIRiT reconstruction. The 3D spiral LGE scans were performed in 15 patients who were referred for clinically ordered cardiac MR examinations that included the standard 2D multislice LGE imaging. Image sharpness and overall quality were qualitatively assessed based on 5-point scales.Scar-induced hyper-LGE was identified in 4 out of the 15 patients by both 3D spiral and 2D multislice LGE tests. On average over all datasets (n = 15), the image sharpness scores were 3.9 (3D spiral) and 4.0 (2D multislice), and the image quality scores were 4.1 (3D spiral) and 4.0 (2D multislice) with no significant difference in both metrics (paired t-test; P > 0.1). The average scar contrast enhancement ratios were 0.72 and 0.75 in 3D and 2D images, respectively (n = 4). The average difference of fractional scar volumes measured in 3D and 2D images was 4.3% (n = 3).Stack-of-spiral acquisition combined with non-Cartesian SPIRiT parallel imaging enables rapid 3D LGE MRI in a 12 heartbeat-long breath-hold.J.

  View details for DOI 10.1002/jmri.24494

  View details for Web of Science ID 000344786200028

• Rapid single-breath-hold 3D late gadolinium enhancement cardiac MRI using a stack-of-spirals acquisition. Journal of magnetic resonance imaging Shin, T., Lustig, M., Nishimura, D. G., Hu, B. S. 2014; 40 (6): 1496-1502

  Abstract

  To develop a rapid single-breath-hold 3D late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) method, and demonstrate its feasibility in cardiac patients.An inversion recovery dual-density 3D stack-of-spirals imaging sequence was developed. The spiral acquisition was 2-fold accelerated by self-consistent parallel imaging reconstruction (SPIRiT), which resulted in a total scan time of 12 heartbeats. Field map-based linear off-resonance correction was incorporated to the SPIRiT reconstruction. The 3D spiral LGE scans were performed in 15 patients who were referred for clinically ordered cardiac MR examinations that included the standard 2D multislice LGE imaging. Image sharpness and overall quality were qualitatively assessed based on 5-point scales.Scar-induced hyper-LGE was identified in 4 out of the 15 patients by both 3D spiral and 2D multislice LGE tests. On average over all datasets (n = 15), the image sharpness scores were 3.9 (3D spiral) and 4.0 (2D multislice), and the image quality scores were 4.1 (3D spiral) and 4.0 (2D multislice) with no significant difference in both metrics (paired t-test; P > 0.1). The average scar contrast enhancement ratios were 0.72 and 0.75 in 3D and 2D images, respectively (n = 4). The average difference of fractional scar volumes measured in 3D and 2D images was 4.3% (n = 3).Stack-of-spiral acquisition combined with non-Cartesian SPIRiT parallel imaging enables rapid 3D LGE MRI in a 12 heartbeat-long breath-hold.J.

  View details for DOI 10.1002/jmri.24494

  View details for PubMedID 24243575

• Nonrigid autofocus motion correction for coronary MR angiography with a 3D cones trajectory. Magnetic resonance in medicine Ingle, R. R., Wu, H. H., Addy, N. O., Cheng, J. Y., Yang, P. C., Hu, B. S., Nishimura, D. G. 2014; 72 (2): 347-361

  Abstract

  To implement a nonrigid autofocus motion correction technique to improve respiratory motion correction of free-breathing whole-heart coronary magnetic resonance angiography acquisitions using an image-navigated 3D cones sequence.2D image navigators acquired every heartbeat are used to measure superior-inferior, anterior-posterior, and right-left translation of the heart during a free-breathing coronary magnetic resonance angiography scan using a 3D cones readout trajectory. Various tidal respiratory motion patterns are modeled by independently scaling the three measured displacement trajectories. These scaled motion trajectories are used for 3D translational compensation of the acquired data, and a bank of motion-compensated images is reconstructed. From this bank, a gradient entropy focusing metric is used to generate a nonrigid motion-corrected image on a pixel-by-pixel basis. The performance of the autofocus motion correction technique is compared with rigid-body translational correction and no correction in phantom, volunteer, and patient studies.Nonrigid autofocus motion correction yields improved image quality compared to rigid-body-corrected images and uncorrected images. Quantitative vessel sharpness measurements indicate superiority of the proposed technique in 14 out of 15 coronary segments from three patient and two volunteer studies.The proposed technique corrects nonrigid motion artifacts in free-breathing 3D cones acquisitions, improving image quality compared to rigid-body motion correction. Magn Reson Med, 2013. © 2013 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.24924

  View details for PubMedID 24006292

• Off-resonance-robust velocity-selective magnetization preparation for non-contrast-enhanced peripheral MR angiography. Magnetic resonance in medicine Shin, T., Hu, B. S., Nishimura, D. G. 2013; 70 (5): 1229-1240

  Abstract

  PURPOSE: To develop a new velocity-selective (VS) excitation pulse sequence which is robust to field inhomogeneity, and demonstrate its application to non-contrast-enhanced peripheral MR angiography (MRA). METHODS: The off-resonance-robust VS saturation pulse is designed by incorporating 180° refocusing pulses into the k-space-based reference design and tailoring sequence parameters in a velocity region of interest. The VS saturation pulse is used as magnetization preparation for non-contrast-enhanced peripheral MRA to suppress background tissues but not arterial blood based on their velocities. Non-contrast-enhanced peripheral MRA using the proposed VS preparation was tested in healthy volunteers and a patient with arterial stenosis. RESULTS: Calf angiograms obtained using the new VS preparation show more uniform background suppression than the reference VS preparation, as demonstrated by larger mean values and smaller standard deviations of artery-to-vein and artery-to-muscle contrast-to-noise ratios (71.0 ± 11.4 and 75.3 ± 12.1 versus 61.7 ± 22.7 and 58.5 ± 27.8). Two-station peripheral MRA using the new VS preparation identifies stenosis of the femoral and popliteal arteries in the patient, as validated by digital subtraction angiography. CONCLUSION: Non-contrast-enhanced MRA using the new VS magnetization preparation can reliably provide high angiographic contrast in the lower extremities with significantly improved immunity to field inhomogeneity. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.

  View details for DOI 10.1002/mrm.24561

  View details for PubMedID 23192893

  View details for PubMedCentralID PMC3594489

• Off-resonance-robust velocity-selective magnetization preparation for non-contrast-enhanced peripheral MR angiography. Magnetic resonance in medicine Shin, T., Hu, B. S., Nishimura, D. G. 2013; 70 (5): spcone-?

  View details for DOI 10.1002/mrm.25042

  View details for PubMedID 24167102

• Non-contrast-enhanced renal and abdominal MR angiography using velocity-selective inversion preparation. Magnetic resonance in medicine Shin, T., Worters, P. W., Hu, B. S., Nishimura, D. G. 2013; 69 (5): 1268-1275

  Abstract

  Non-contrast-enhanced MR angiography is a promising alternative to the established contrast-enhanced approach as it reduces patient discomfort and examination costs and avoids the risk of nephrogenic systemic fibrosis. Inflow-sensitive slab-selective inversion recovery imaging has been used with great promise, particularly for abdominal applications, but has limited craniocaudal coverage due to inflow time constraints. In this work, a new non-contrast-enhanced MR angiography method using velocity-selective inversion preparation is developed and applied to renal and abdominal angiography. Based on the excitation k-space formalism and Shinnar-Le-Roux transform, a velocity-selective excitation pulse is designed that inverts stationary tissues and venous blood while preserving inferiorly flowing arterial blood. As the magnetization of the arterial blood in the abdominal aorta and iliac arteries is well preserved during the magnetization preparation, artery visualization over a large abdominal field of view is achievable with an inversion delay time that is chosen for optimal background suppression. Healthy volunteer tests demonstrate that the proposed method significantly increases the extent of visible arteries compared with the slab-selective approach, covering renal arteries through iliac arteries over a craniocaudal field of view of 340 mm.

  View details for DOI 10.1002/mrm.24356

  View details for PubMedID 22711643

  View details for PubMedCentralID PMC3449049

• Reproducibility study for free-breathing measurements of pyruvate metabolism using hyperpolarized 13C in the heart MAGNETIC RESONANCE IN MEDICINE Wu, H. H., Gurney, P. T., Hu, B. S., Nishimura, D. G., McConnell, M. V. 2013; 69 (4): 1083-1093

  Abstract

  Noninvasive visualization of the coronary arteries in vivo is one of the most important goals in cardiovascular imaging. Compared to other paradigms for coronary MR angiography, a free-breathing three-dimensional whole-heart iso-resolution approach simplifies prescription effort, requires less patient cooperation, reduces overall exam time, and supports retrospective reformats at arbitrary planes. However, this approach requires a long continuous acquisition and must account for respiratory and cardiac motion throughout the scan. In this work, a new free-breathing coronary MR angiography technique that reduces scan time and improves robustness to motion is developed. Data acquisition is accomplished using a three-dimensional cones non-Cartesian trajectory, which can reduce the number of readouts 3-fold or more compared to conventional three-dimensional Cartesian encoding and provides greater robustness to motion/flow effects. To further enhance robustness to motion, two-dimensional navigator images are acquired to directly track respiration-induced displacement of the heart and enable retrospective compensation of all acquired data (none discarded) for image reconstruction. In addition, multiple cardiac phases are imaged to support retrospective selection of the best phase(s) for visualizing each coronary segment. Experimental results demonstrate that whole-heart coronary angiograms can be obtained rapidly and robustly with this proposed technique.

  View details for DOI 10.1002/mrm.24342

  View details for Web of Science ID 000316629300020

• Free-breathing multiphase whole-heart coronary MR angiography using image-based navigators and three-dimensional cones imaging. Magnetic resonance in medicine : official journal of the Society of Magnetic Resonance in Medicine / Society of Magnetic Resonance in Medicine Wu, H. H., Gurney, P. T., Hu, B. S., Nishimura, D. G., McConnell, M. V. 2013; 69 (4): 1083-93

  Abstract

  Noninvasive visualization of the coronary arteries in vivo is one of the most important goals in cardiovascular imaging. Compared to other paradigms for coronary MR angiography, a free-breathing three-dimensional whole-heart iso-resolution approach simplifies prescription effort, requires less patient cooperation, reduces overall exam time, and supports retrospective reformats at arbitrary planes. However, this approach requires a long continuous acquisition and must account for respiratory and cardiac motion throughout the scan. In this work, a new free-breathing coronary MR angiography technique that reduces scan time and improves robustness to motion is developed. Data acquisition is accomplished using a three-dimensional cones non-Cartesian trajectory, which can reduce the number of readouts 3-fold or more compared to conventional three-dimensional Cartesian encoding and provides greater robustness to motion/flow effects. To further enhance robustness to motion, two-dimensional navigator images are acquired to directly track respiration-induced displacement of the heart and enable retrospective compensation of all acquired data (none discarded) for image reconstruction. In addition, multiple cardiac phases are imaged to support retrospective selection of the best phase(s) for visualizing each coronary segment. Experimental results demonstrate that whole-heart coronary angiograms can be obtained rapidly and robustly with this proposed technique.

  View details for DOI 10.1002/mrm.24346

  View details for PubMedID 22648856

• Three-dimensional first-pass myocardial perfusion MRI using a stack-of-spirals acquisition MAGNETIC RESONANCE IN MEDICINE Shin, T., Nayak, K. S., Santos, J. M., Nishimura, D. G., Hu, B. S., McConnell, M. V. 2013; 69 (3): 839-844

  Abstract

  Three-dimensional cardiac magnetic resonance perfusion imaging is promising for the precise sizing of defects and for providing high perfusion contrast, but remains an experimental approach primarily due to the need for large-dimensional encoding, which, for traditional 3DFT imaging, requires either impractical acceleration factors or sacrifices in spatial resolution. We demonstrated the feasibility of rapid three-dimensional cardiac magnetic resonance perfusion imaging using a stack-of-spirals acquisition accelerated by non-Cartesian k-t SENSE, which enables entire myocardial coverage with an in-plane resolution of 2.4 mm. The optimal undersampling pattern was used to achieve the largest separation between true and aliased signals, which is a prerequisite for k-t SENSE reconstruction. Flip angle and saturation recovery time were chosen to ensure negligible magnetization variation during the transient data acquisition. We compared the proposed three-dimensional perfusion method with the standard 2DFT approach by consecutively acquiring both data during each R-R interval in cardiac patients. The mean and standard deviation of the correlation coefficients between time intensity curves of three-dimensional versus 2DFT were 0.94 and 0.06 across seven subjects. The linear correlation between the two sets of upslope values was significant (r = 0.78, P < 0.05).

  View details for DOI 10.1002/mrm.24303

  View details for PubMedID 22556062

• Reducing artifacts in one-dimensional Fourier velocity encoding for fast and pulsatile flow MAGNETIC RESONANCE IN MEDICINE Lee, D., Santos, J. M., Hu, B. S., Pauly, J. M., Kerr, A. B. 2012; 68 (6): 1876-1885

  Abstract

  When evaluating the severity of valvular stenosis, the peak velocity of the blood flow is routinely used to estimate the transvalvular pressure gradient. One-dimensional Fourier velocity encoding effectively detects the peak velocity with an ungated time series of spatially resolved velocity spectra in real time. However, measurement accuracy can be degraded by the pulsatile and turbulent nature of stenotic flow and the existence of spatially varying off-resonance. In this work, we investigate the feasibility of improving the peak velocity detection capability of one-dimensional Fourier velocity encoding for stenotic flow using a novel echo-shifted interleaved readout combined with a variable-density circular k-space trajectory. The shorter echo and readout times of the echo-shifted interleaved acquisitions are designed to reduce sensitivity to off-resonance. Preliminary results from limited phantom and in vivo results also indicate that some artifacts from pulsatile flow appear to be suppressed when using this trajectory compared to conventional single-shot readouts, suggesting that peak velocity detection may be improved. The efficiency of the new trajectory improves the temporal and spatial resolutions. To realize the proposed readout, a novel multipoint-traversing algorithm is introduced for flexible and automated gradient-waveform design.

  View details for DOI 10.1002/mrm.24212

  View details for Web of Science ID 000311398600021

  View details for PubMedID 22457248

  View details for PubMedCentralID PMC3499673

• Methods for registration of magnetic resonance images of ex vivo prostate specimens with histology JOURNAL OF MAGNETIC RESONANCE IMAGING Kimm, S. Y., Tarin, T. V., Lee, J. H., Hu, B., Jensen, K., Nishimura, D., Brooks, J. D. 2012; 36 (1): 206-212

  Abstract

  To evaluate two methods of scanning and tissue processing to achieve accurate magnetic resonance (MR)-histologic correlation in human prostate specimens.Two prostates had acrylic paint markers injected to define the plane of imaging and serve as internal fiducials. Each was placed on a polycarbonate plane-finder device (PFD), which was adjusted to align the imaging and cutting planes. Three prostates were aligned by use of a plane finder key (PFK), a polycarbonate plate that locks the specimen in a cylindrical carrier. Markers were injected for registration analysis. Prostates were imaged, then sectioned. Imaging software was used to create registration maps of the MR and histology images. Measurements between control points were made and compared.Accurate correlation was achieved between MR and histologic images. The mean displacement (MD) between the corresponding registration points using the PFD technique ranged from 1.11-1.38 mm for each section. The MD for all sections was 1.24 mm. The MD using the PFK technique ranged from 0.79-1.01 mm for each section, and the MD across all sections for the PFK was 0.92 mm.We describe two methods that can achieve accurate, reproducible correlation between MR imaging and histologic sections in human prostatectomy specimens.

  View details for DOI 10.1002/jmri.23614

  View details for PubMedID 22359365

• Three-dimensional fluid-suppressed T2-prep flow-independent peripheral angiography using balanced SSFP MAGNETIC RESONANCE IMAGING Bangerter, N. K., Cukur, T., Hargreaves, B. A., Hu, B. S., Brittain, J. H., Park, D., Gold, G. E., Nishimura, D. G. 2011; 29 (8): 1119-1124

  Abstract

  Accurate depiction of the vessels of the lower leg, foot or hand benefits from suppression of bright MR signal from lipid (such as bone marrow) and long-T1 fluid (such as synovial fluid and edema). Signal independence of blood flow velocities, good arterial/muscle contrast and arterial/venous separation are also desirable. The high SNR, short scan times and flow properties of balanced steady-state free precession (SSFP) make it an excellent candidate for flow-independent angiography. In this work, a new magnetization-prepared 3D SSFP sequence for flow-independent peripheral angiography is presented. The technique combines a number of component techniques (phase-sensitive fat detection, inversion recovery, T2-preparation and square-spiral phase-encode ordering) to achieve high-contrast peripheral angiograms at only a modest scan time penalty over simple 3D SSFP. The technique is described in detail, a parameter optimization performed and preliminary results presented achieving high contrast and 1-mm isotropic resolution in a normal foot.

  View details for DOI 10.1016/j.mri.2011.04.007

  View details for Web of Science ID 000295195900011

  View details for PubMedID 21705166

  View details for PubMedCentralID PMC3172338

• Magnetization-Prepared IDEAL bSSFP: A Flow-Independent Technique for Noncontrast-Enhanced Peripheral Angiography JOURNAL OF MAGNETIC RESONANCE IMAGING Cukur, T., Shimakawa, A., Yu, H., Hargreaves, B. A., Hu, B. S., Nishimura, D. G., Brittain, J. H. 2011; 33 (4): 931-939

  Abstract

  To propose a new noncontrast-enhanced flow-independent angiography sequence based on balanced steady-state free precession (bSSFP) that produces reliable vessel contrast despite the reduced blood flow in the extremities.The proposed technique addresses a variety of factors that can compromise the exam success including insufficient background suppression, field inhomogeneity, and large volumetric coverage requirements. A bSSFP sequence yields reduced signal from venous blood when long repetition times are used. Complex-sum bSSFP acquisitions decrease the sensitivity to field inhomogeneity but retain phase information, so that data can be processed with the Iterative Decomposition of Water and Fat with Echo Asymmetry and Least-Squares Estimation (IDEAL) method for robust fat suppression. Meanwhile, frequent magnetization preparation coupled with parallel imaging reduces the muscle and long-T(1) fluid signals without compromising scan efficiency.In vivo flow-independent peripheral angiograms with reliable background suppression and high spatial resolution are produced. Comparisons with phase-sensitive bSSFP angiograms (that yield out-of-phase fat and water signals, and exploit this phase difference to suppress fat) demonstrate enhanced vessel depiction with the proposed technique due to reduced partial-volume effects and improved venous suppression.Magnetization-prepared complex-sum bSSFP with IDEAL fat/water separation can create reliable flow-independent angiographic contrast in the lower extremities.

  View details for DOI 10.1002/jmri.22479

  View details for Web of Science ID 000288913200022

  View details for PubMedID 21448960

  View details for PubMedCentralID PMC3155993

• In Vivo High-Resolution Magnetic Resonance Skin Imaging at 1.5 T and 3 T MAGNETIC RESONANCE IN MEDICINE Barral, J. K., Bangerter, N. K., Hu, B. S., Nishimura, D. G. 2010; 63 (3): 790-796

  Abstract

  As a noninvasive modality, MR is attractive for in vivo skin imaging. Its unique soft tissue contrast makes it an ideal imaging modality to study the skin water content and to resolve the different skin layers. In this work, the challenges of in vivo high-resolution skin imaging are addressed. Three 3D Cartesian sequences are customized to achieve high-resolution imaging and their respective performance is evaluated. The balanced steady-state free precession (bSSFP) and gradient echo (GRE) sequences are fast but can be sensitive to off-resonance artifacts. The fast large-angle spin echo (FLASE) sequence provides a sharp depiction of the hypodermis structures but results in more specific absorption rate (SAR). The effect of increasing the field strength is assessed. As compared to 1.5 T, signal-to-noise ratio at 3 T slightly increases in the hypodermis and almost doubles in the dermis. The need for fat/water separation is acknowledged and a solution using an interleaved three-point Dixon method and an iterative reconstruction is shown to be effective. The effects of motion are analyzed and two techniques to prevent motion and correct for it are evaluated. Images with 117 x 117 x 500 microm(3) resolution are obtained in imaging times under 6 min.

  View details for DOI 10.1002/mrm.22271

  View details for Web of Science ID 000274938000029

  View details for PubMedID 20146351

  View details for PubMedCentralID PMC2832104

• Wideband SSFP: Alternating repetition time balanced steady state free precession with increased band spacing MAGNETIC RESONANCE IN MEDICINE Nayak, K. S., Lee, H., Hargreaves, B. A., Hu, B. S. 2007; 58 (5): 931-938

  Abstract

  Balanced steady-state free precession (SSFP) imaging is limited by off-resonance banding artifacts, which occur with periodicity 1/TR in the frequency spectrum. A novel balanced SSFP technique for widening the band spacing in the frequency response is described. This method, called wideband SSFP, utilizes two alternating repetition times with alternating RF phase, and maintains high SNR and T(2)/T(1) contrast. For a fixed band spacing, this method can enable improvements in spatial resolution compared to conventional SSFP. Alternatively, for a fixed readout duration this method can widen the band spacing, and potentially avoid the banding artifacts in conventional SSFP. The method is analyzed using simulations and phantom experiments, and is applied to the reduction of banding artifacts in cine cardiac imaging and high-resolution knee imaging at 3T.

  View details for DOI 10.1002/mrm.21296

  View details for Web of Science ID 000250560000010

  View details for PubMedID 17969129

• Rapid cardiac-output measurement with ungated spiral phase contrast MAGNETIC RESONANCE IN MEDICINE Park, J. B., Hu, B. S., Conolly, S. M., Nayak, K. S., Nishimura, D. G. 2006; 56 (2): 432-438

  Abstract

  An ungated spiral phase-contrast (USPC) method was used to measure cardiac output (CO) rapidly and conveniently. The USPC method, which was originally designed for small peripheral vessels, was modified to assess CO by measuring flow in the ascending aorta (AA). The modified USPC used a 12-interleaf spiral trajectory to acquire full-image data every 283 ms with 2-mm spatial resolution. The total scan time was 5 s. For comparison, a triggered real-time (TRT) method was used to indirectly calculate CO by measuring left-ventricular (LV) volume. The USPC and TRT measurements from all normal volunteers agreed. In a patient with patent ductus arteriosus (PDA), high CO was measured with USPC, which agreed well with the invasive cardiac-catheterized measurement. In normal volunteers, CO dropped about 20-30% with Valsalva maneuvering, and increased about 100% after exercise. Continuous 28-s cycling between Valsalva maneuvering and free-breathing showed that USPC can temporally resolve physiological CO changes.

  View details for DOI 10.1002/mrm.20970

  View details for Web of Science ID 000239465500023

  View details for PubMedID 16802317

• Single breath-hold whole-heart MRA using variable-density spirals at 3T MAGNETIC RESONANCE IN MEDICINE Santos, J. M., Cunningham, C. H., Lustig, M., Hargreaves, B. A., Hu, B. S., Nishimura, D. G., Pauly, J. M. 2006; 55 (2): 371-379

  Abstract

  Multislice breath-held coronary imaging techniques conventionally lack the coverage of free-breathing 3D acquisitions but use a considerably shorter acquisition window during the cardiac cycle. This produces images with significantly less motion artifact but a lower signal-to-noise ratio (SNR). By using the extra SNR available at 3 T and undersampling k-space without introducing significant aliasing artifacts, we were able to acquire high-resolution fat-suppressed images of the whole heart in 17 heartbeats (a single breath-hold). The basic pulse sequence consists of a spectral-spatial excitation followed by a variable-density spiral readout. This is combined with real-time localization and a real-time prospective shim correction. Images are reconstructed with the use of gridding, and advanced techniques are used to reduce aliasing artifacts.

  View details for DOI 10.1002/mrm.20765

  View details for Web of Science ID 000235326500019

  View details for PubMedID 16408262

• Real-time color-flow CMR in adults with congenital heart disease JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE de la Pena, E., Nguyen, P. K., Nayak, K. S., Yang, P. C., Rosenthal, D. N., Hu, B. S., Pauly, J. M., McConnell, M. V. 2006; 8 (6): 809-815

  Abstract

  CMR is valuable in the evaluation of congenital heart disease (CHD). Traditional flow imaging sequences involve cardiac and respiratory gating, increasing scan time and susceptibility to arrhythmias. We studied a real-time color-flow CMR system for the detection of flow abnormalities in 13 adults with CHD. All 16 congenital flow abnormalities previously detected by echocardiography were visualized using color-flow CMR, including atrial septal defects (n = 4), ventricular septal defects (n = 9), aortic coarctation (n = 1), Blalock-Taussig shunt (n = 1) and Fontan shunt (n = 1). Real-time color-flow CMR can identify intra- and extra-cardiac flow abnormalities in adults with congenital heart disease.

  View details for DOI 10.1080/10976640600777728

  View details for PubMedID 17060103

• High-resolution real-time spiral MRI for guiding vascular interventions in a rabbit model at 1.5 T. Journal of magnetic resonance imaging : JMRI Terashima, M., Hyon, M., de la Pena-Almaguer, E., Yang, P. C., Hu, B. S., Nayak, K. S., Pauly, J. M., McConnell, M. V. 2005; 22 (5): 687-690

  Abstract

  To study the feasibility of a combined high spatial and temporal resolution real-time spiral MRI sequence for guiding coronary-sized vascular interventions.Eight New Zealand White rabbits (four normal and four with a surgically-created stenosis in the abdominal aorta) were studied. A real-time interactive spiral MRI sequence combining 1.1 x 1.1 mm(2) in-plane resolution and 189-msec total image acquisition time was used to image all phases of an interventional procedure (i.e., guidewire placement, balloon angioplasty, and stenting) in the rabbit aorta using coronary-sized devices on a 1.5 T MRI system.Real-time spiral MRI identified all rabbit aortic stenoses and provided high-temporal-resolution visualization of guide-wires crossing the stenoses in all animals. Angioplasty balloon dilatation and deployment of coronary-sized copper stents in the rabbit aorta were also successfully imaged by real-time spiral MRI.Combining high spatial and temporal resolution with spiral MRI allows real-time MR-guided vascular intervention using coronary-sized devices in a rabbit model. This is a promising approach for guiding coronary interventions.

  View details for PubMedID 16217745

• High-resolution real-time spiral MRI for guiding vascular interventions in a rabbit model at 1L.5T JOURNAL OF MAGNETIC RESONANCE IMAGING Terashima, M., Hyon, M., De La Pena-Almaguer, E., Yang, P. C., Hu, B. S., Nayalk, K. S., Pauly, J. M., McConnell, M. V. 2005; 22 (5): 687-690

  Abstract

  To study the feasibility of a combined high spatial and temporal resolution real-time spiral MRI sequence for guiding coronary-sized vascular interventions.Eight New Zealand White rabbits (four normal and four with a surgically-created stenosis in the abdominal aorta) were studied. A real-time interactive spiral MRI sequence combining 1.1 x 1.1 mm(2) in-plane resolution and 189-msec total image acquisition time was used to image all phases of an interventional procedure (i.e., guidewire placement, balloon angioplasty, and stenting) in the rabbit aorta using coronary-sized devices on a 1.5 T MRI system.Real-time spiral MRI identified all rabbit aortic stenoses and provided high-temporal-resolution visualization of guide-wires crossing the stenoses in all animals. Angioplasty balloon dilatation and deployment of coronary-sized copper stents in the rabbit aorta were also successfully imaged by real-time spiral MRI.Combining high spatial and temporal resolution with spiral MRI allows real-time MR-guided vascular intervention using coronary-sized devices in a rabbit model. This is a promising approach for guiding coronary interventions.

  View details for DOI 10.1002/jmri.20409

  View details for Web of Science ID 000233096000015

• Variable-density one-shot Fourier velocity encoding MAGNETIC RESONANCE IN MEDICINE DiCarlo, J. C., Hargreaves, B. A., Nayak, K. S., Hu, B. S., Pauly, J. M., Nishimura, D. G. 2005; 54 (3): 645-655

  Abstract

  In areas of highly pulsatile and turbulent flow, real-time imaging with high temporal, spatial, and velocity resolution is essential. The use of 1D Fourier velocity encoding (FVE) was previously demonstrated for velocity measurement in real time, with fewer effects resulting from off-resonance. The application of variable-density sampling is proposed to improve velocity measurement without a significant increase in readout time or the addition of aliasing artifacts. Two sequence comparisons are presented to improve velocity resolution or increase the velocity field of view (FOV) to unambiguously measure velocities up to 5 m/s without aliasing. The results from a tube flow phantom, a stenosis phantom, and healthy volunteers are presented, along with a comparison of measurements using Doppler ultrasound (US). The studies confirm that variable-density acquisition of kz-kv space improves the velocity resolution and FOV of such data, with the greatest impact on the improvement of FOV to include velocities in stenotic ranges.

  View details for DOI 10.1002/mrm.20594

  View details for Web of Science ID 000231494000016

  View details for PubMedID 16088883

• Single-breathhold, four-dimensional, quantitative assessment of LV and RV function using triggered, real-time, steady-state free precession MRI in heart failure patients 12th Annual Meeting of the ISMRM Narayan, G., Nayak, K., Pauly, J., Hu, B. JOHN WILEY & SONS INC. 2005: 59–66

  Abstract

  To validate a novel, real-time, steady-state free precession (SSFP), single-breathhold technique for the assessment of left ventricular (LV) and right ventricular (RV) function in heart failure patients.A total of 20 heart failure patients (mean age 59 +/- 17 years) underwent scanning with our new, real-time, spiral SSFP sequence in which each cardiac phase was acquired in 118 msec at a resolution of 1.8 x 1.8 mm. Each cardiac slice (1-cm thick) was automatically advanced based on a cardiac trigger, allowing complete coverage of the heart in a single breathhold. The patients also underwent LV and RV assessment with the gold standard: multiple breathhold, cardiac-gated, segmented k-space strategy. LV and RV end-systolic volume (ESV) and end-diastolic volume (EDV) and LV mass were compared between the two imaging techniques.The new real-time strategy was highly concordant with the gold standard technique in the assessment of LVEDV (r = 0.98), LVESV (r = 0.98), RVESV (r = 0.86), RVEDV (r = 0.91), LVMASS (r = 0.95), RVEF (r = 0.70), and LVEF (r = 0.94). The mean bias (95% confidence interval [CI]) for each parameter is LVEDV: 10.6 cc (cm(3)) (3.8-17.4 cc), LVESV: -0.8 cc (-5.3 to 3.7 cc), RVEDV: 3.7 cc (-5.6 to 13.2 cc), RVESV: -3.1 cc (-11.1 to 4.9 cc), LVMASS: 26 g (12.4-39.8 g), RVEF: -2.9% (1.3 to -7.2 %), LVEF: 1.9% (5 to -1.1%). In addition, data acquisition was only nine +/- two seconds with the real-time strategy vs. 312 +/- 41 seconds for the standard technique.In patients with heart failure, real-time, spiral SSFP allows rapid and accurate assessment of RV and LV function in a single-breath hold. Using the same strategy, increased temporal resolution will allow real-time assessment of cardiac wall motion during stress studies.

  View details for DOI 10.1002/jmri.20358

  View details for Web of Science ID 000230128900008

  View details for PubMedID 15971180

• Spiral balanced steady-state free precession cardiac imaging MAGNETIC RESONANCE IN MEDICINE Nayak, K. S., Hargreaves, B. A., Hu, B. S., Nishimura, D. G., Pauly, J. M., Meyer, C. H. 2005; 53 (6): 1468-1473

  Abstract

  Balanced steady-state free precession (SSFP) sequences are useful in cardiac imaging because they achieve high signal efficiency and excellent blood-myocardium contrast. Spiral imaging enables the efficient acquisition of cardiac images with reduced flow and motion artifacts. Balanced SSFP has been combined with spiral imaging for real-time interactive cardiac MRI. New features of this method to enable scanning in a clinical setting include short, first-moment nulled spiral trajectories and interactive control over the spatial location of banding artifacts (SSFP-specific signal variations). The feasibility of spiral balanced SSFP cardiac imaging at 1.5 T is demonstrated. In observations from over 40 volunteer and patient studies, spiral balanced SSFP imaging shows significantly improved contrast compared to spiral gradient-spoiled imaging, producing better visualization of cardiac function, improved localization, and reduced flow artifacts from blood.

  View details for DOI 10.1002/mrm.20489

  View details for Web of Science ID 000229468200031

  View details for PubMedID 15906302

• Rapid measurement of renal artery blood flow with ungated spiral phase-contrast MRI 10th Annual Meeting of the International-Society-for-Magnetic-Resonance-in-Medicine (ISMRM) Park, J. B., Santos, J. M., Hargreaves, B. A., Nayak, K. S., Sommer, G., Hu, B. S., Nishimura, D. G. JOHN WILEY & SONS INC. 2005: 590–95

  Abstract

  To verify the potential of ungated spiral phase-contrast (USPC), which has been shown to provide accurate and reproducible time-averaged measurements of pulsatile flow, for rapid measurement of renal artery blood flow (RABF) in vivo.The RABF rates of 11 normal human subjects and one patient with renal failure were measured with USPC within six seconds.Rapid USPC scans produced reproducible RABF measurements (SD < or = 9%) that agreed with the normal RABF rates known from the literature. The RABF rates of the patient with renal failure were substantially less (<50-65%) than the normal RABF rates.The results demonstrate that it is now possible to obtain rapid and consistent RABF measurements within six seconds with USPC.

  View details for DOI 10.1002/jmri.20325

  View details for Web of Science ID 000228653600012

  View details for PubMedID 15834919

• Noninvasive assessment of coronary vasodilation using magnetic resonance angiography JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Terashima, M., Meyer, C. H., Keeffe, B. G., Putz, E. J., De La Pena-Almaguer, E., Yang, P. C., Hu, B. S., Nishimura, D. G., McConnell, M. V. 2005; 45 (1): 104-110

  Abstract

  The purpose of this study was to investigate the use of coronary magnetic resonance angiography (MRA) for assessing human epicardial coronary artery vasodilation.Coronary vasodilation plays a vital role in the human coronary circulation. Previous studies of epicardial coronary vasodilation have used invasive coronary angiography. Coronary MRA may provide an alternative noninvasive method to directly assess changes in coronary size.Thirty-two subjects were studied: 12 patients (age 55 +/- 18 years) and 20 healthy subjects (age 34 +/- 4 years). High-resolution multi-slice spiral coronary MRA (in-plane resolution of 0.52 to 0.75 mm) was performed before and after sublingual nitroglycerin (NTG). Quantitative analysis of coronary vasodilation was performed on cross-sectional images of the right coronary artery (RCA). A time-course analysis of coronary vasodilation was performed in a subset of eight subjects for 30 min after NTG. Signal-to-noise ratio was also measured on the in-plane RCA images.Coronary MRA demonstrated a 23% increase in cross-sectional area after NTG (16.9 +/- 7.8 mm2 to 20.8 +/- 8.9 mm2, p <0.0001), with significant vasodilation between 3 and 15 min after NTG on time-course analysis. The MRA measurements had low interobserver variability (< or =5%) and good correlation with X-ray angiography (r=0.98). The magnitude of vasodilation correlated with baseline cross-sectional area (r=0.52, p=0.03) and age (r=0.40, p=0.019). Post-NTG images also demonstrated a 31% improvement in coronary signal-to-noise ratio (p = 0.002).Nitroglycerin-enhanced coronary MRA can noninvasively measure coronary artery vasodilation and is a promising noninvasive technique to study coronary vasomotor function.

  View details for DOI 10.1016/j.jacc.2004.09.057

  View details for PubMedID 15629383

• The future of real-time cardiac magnetic resonance imaging. Current cardiology reports Nayak, K. S., Hu, B. S. 2005; 7 (1): 45-51

  Abstract

  Dynamic changes in cardiac structure and function are usually examined by real-time imaging techniques such as angiography or echocardiography. MRI has many advantages compared with these established cardiac imaging modalities. However, system hardware and software limitations have limited cardiac MRI to gated acquisitions that are lengthy and often result in failed acquisitions and examinations. Recently, MRI has evolved into a technique capable of imaging dynamic processes in real time. Improvements in hardware, pulse sequences, and image reconstruction algorithms have enabled real-time cardiac MRI with high spatial resolution, high temporal resolution, and various types of image contrast without requiring cardiac gating or breath-holding. This article provides an overview of current capability and highlights key technical and clinical advances. The future prospects of real-time cardiac MRI will depend on 1) the development of techniques that further improve signal to noise ratio, contrast, spatial resolution, and temporal resolution, without introducing artifacts; 2) the development of software infrastructure that facilitates rapid interactive examination; and 3) the development and validation of several new clinical assessments.

  View details for PubMedID 15610648

• Developmental endothelial locus-1 (Del-1), a novel angiogenic protein - Its role in ischemia CIRCULATION Ho, H. K., Jang, J. J., Kaji, S., Spektor, G., Fong, A., Yang, P., Hu, B. S., Schatzman, R., Quertermous, T., Cooke, J. P. 2004; 109 (10): 1314-1319

  Abstract

  Developmentally regulated endothelial locus-1 (Del-1) is an extracellular matrix protein that is expressed by endothelial cells during embryological vascular development. We speculated that Del-1 may be reexpressed in ischemia and may be involved in endogenous angiogenesis.Del-1 protein was detected by immunohistochemistry in murine ischemic hindlimb after femoral artery excision. To determine whether exogenous Del-1 would augment angiogenesis in vivo, Del-1 or vehicle was administered for 3 weeks by intramuscular injection of murine ischemic hindlimbs. Angiogenesis was quantified by gadolinium-MRI perfusion and capillary densitometry. We used a disc angiogenesis system (DAS) to characterize the angiogenic response to vehicle (PBS), Del-1, Del-1 mutant (altered RGD domain), Del-1 minor (truncated discoidin-I-like domain), or basic fibroblast growth factor. After 14 days, the discs were extracted and sectioned to quantify vascular growth by morphometry. Endogenous Del-1 protein expression was increased in ischemic hindlimbs. Administration of Del-1 increased hindlimb vascular flow index and capillary density. In the DAS, Del-1 doubled fibrovascular growth, as did basic fibroblast growth factor. However, angiogenesis was not enhanced by the Del-1 mutant or Del-1 minor proteins.Del-1 is expressed in ischemic tissue. Del-1 stimulates angiogenesis, an effect that is dependent on the RGD motif and a second signaling sequence in the discoidin-I-like domain. Exogenous intramuscular administration of Del-1 significantly enhances angiogenesis in the murine ischemic hindlimb. Del-1 may prove to be a novel therapeutic agent for patients with ischemia.

  View details for DOI 10.1161/01.CIR.0000118465.36018.2D

  View details for PubMedID 14981004

• Spiral magnetic resonance coronary angiography - Direct comparison of 1.5 tesla vs. 3 tesla JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE Yang, P. C., Nguyen, P., Shimakawa, A., Brittain, J., Pauly, J., Nishimura, D., Hu, B., McConnell, M. 2004; 6 (4): 877-884

  Abstract

  MR coronary angiography (MRCA) has been demonstrated successfully at 3 Tesla (T). However, the advantages remain unclear. No systematic comparison of MRCA between 1.5 T and 3 T has been performed. Therefore, anatomic coverage, image quality, signal-to-noise ratio (SNR), contrast-to-noise ration (CNR), and susceptibility artifacts were compared in 23 subjects.Identical real-time (RT) and high-resolution (HR) sequences were implemented on the GE 1.5 T (Signa Twinspeed) and 3.0 T (Signa VH/i) whole body systems (GE, Milwaukee, WI). Both scanners were equipped with high-performance gradient systems capable of 40 mT/m peak amplitude and 150 mT/m/ms slew rate. Real-time localization of the coronary arteries was followed by a cardiac-gated, breath-hold HR sequence. Twenty-three subjects were recruited consecutively and underwent both 3 T and 1.5 T MRCA within one week. Coronary coverage based on the number of coronary segments visualized, image quality using a grading scale, SNR, CNR, and presence of susceptibility artifacts were analyzed. A significant improvement in SNR (47%), CNR (30%), and image quality were seen in 3 T. However, a significant increase in susceptibility artifacts was also noted.MRCA at 3 T significantly improves SNR, CNR, and image quality at the expense of susceptibility artifacts. Further optimization of the imaging parameters at 3 T may facilitate clinical implementation of MRCA.

  View details for DOI 10.1081/JCMR.20036180

  View details for PubMedID 15646891

• Dynamic real-time architecture in magnetic resonance coronary angiography-a prospective clinical trial JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE Yang, P. C., Santos, J. M., Nguyen, P. K., Scott, G. C., Engvall, J., McConnell, M. V., Wright, G. A., Nishimura, D. G., Pauly, J. M., Hu, B. S. 2004; 6 (4): 885-894

  Abstract

  A dynamic real-time (dRT) architecture has been developed to address limitations in magnetic resonance coronary angiography (MRCA). A prospective clinical trial of 45 patients suspected of coronary artery disease was conducted to determine clinical utility of this integrated real-time system.Clinical implementation of MRCA is not performed routinely today. However, improved anatomic coverage, image quality, and scan flexibility may enhance its clinical utility. A novel real-time architecture addresses these challenges through instantaneous reconfiguration between real-time (RT) and high-resolution (HR) imaging sequences with dynamic selection of the desired element on a custom-designed receiver coil.A total of 45 subjects were recruited consecutively to evaluate scan time, anatomic coverage, image quality, and detection of coronary lesions. Using a modern PC, the dRT switches from RT to gated HR imaging sequence in one repetition time (39 ms). Magnetic resonance imaging (MRI) scanning was performed using a custom-designed coronary coil consisting of two four-inch phase-array circular elements enabled with real-time selection of the desired coil element.All studies were completed in less than 45 minutes and required a mean of 12 breath holds (16 heartbeats). Of the total number of coronary segments, 91% (357/394) were visualized. Excellent or good image quality was achieved in 86% of the segments. Blinded analysis of the coronary arteries revealed sensitivity of 93% and specificity of 88% in the detection of coronary stenoses.The integrated environment of dRT provides a rapid and flexible scan protocol for MRCA while achieving wide anatomical coverage, high image quality, and reliable detection of coronary stenosis in short scan time.

  View details for DOI 10.1016/j.JCMR.20036192

  View details for PubMedID 15646892

• Fast 3D imaging using variable-density spiral trajectories with applications to limb perfusion MAGNETIC RESONANCE IN MEDICINE Lee, J. H., Hargreaves, B. A., Hu, B. S., Nishimura, D. G. 2003; 50 (6): 1276-1285

  Abstract

  Variable-density k-space sampling using a stack-of-spirals trajectory is proposed for ultra fast 3D imaging. Since most of the energy of an image is concentrated near the k-space origin, a variable-density k-space sampling method can be used to reduce the sampling density in the outer portion of k-space. This significantly reduces scan time while introducing only minor aliasing artifacts from the low-energy, high-spatial-frequency components. A stack-of-spirals trajectory allows control over the density variations in both the k(x)-k(y) plane and the k(z) direction while fast k-space coverage is provided by spiral trajectories in the k(x)-k(y) plane. A variable-density stack-of-spirals trajectory consists of variable-density spirals in each k(x)-k(y) plane that are located in varying density in the k(z) direction. Phantom experiments demonstrate that reasonable image quality is preserved with approximately half the scan time. This technique was then applied to first-pass perfusion imaging of the lower extremities which demands very rapid volume coverage. Using a variable-density stack-of-spirals trajectory, 3D images were acquired at a temporal resolution of 2.8 sec over a large volume with a 2.5 x 2.5 x 8 mm(3) spatial resolution. These images were used to resolve the time-course of muscle intensity following contrast injection.

  View details for DOI 10.1002/mrm.10644

  View details for PubMedID 14648576

• Steady-state sequence synthesis and its application to efficient fat-suppressed imaging MAGNETIC RESONANCE IN MEDICINE Overall, W. R., Nishimura, D. G., Hu, B. S. 2003; 50 (3): 550-559

  Abstract

  A new synthesis algorithm, based on the Shinnar-Le Roux (SLR) transform, can be used to generate fully refocused steady-state pulse sequences with arbitrary magnetization profiles as a function of off-resonant precession. This is accomplished by appropriate periodic oscillation of the RF excitation magnitude and phase from echo to echo. The technique is applied to the design of refocused steady-state free precession (SSFP) sequences with flat profiles, providing the opportunity for banding-artifact-free imaging with steady-state contrast. The algorithm is also used to generate refocused-SSFP sequences with an arbitrarily broad region of attenuated signal. These sequences are implemented and applied to the problem of steady-state fat suppression. Preliminary results show signal levels that agree well with theory, and a broad region of suppressed signal at each echo. Total imaging time is kept identical to that of a standard refocused-SSFP experiment through echo equalization and interleaving. 3D images from the leg of a normal volunteer acquired in 44 s demonstrate the applicability of the technique to fat-suppressed imaging.

  View details for DOI 10.1002/mrm.10542

  View details for Web of Science ID 000185174500014

  View details for PubMedID 12939763

• Rapid quantitation of high-speed flow jets 6th Annual Scientific Session of the Society-for-Cardiovascular-Magnetic-Resonance Nayak, K. S., Hu, B. S., Nishimura, D. G. JOHN WILEY & SONS INC. 2003: 366–72

  Abstract

  Flow jets containing velocities up to 5-7 m/s are common in patients with congenital defects and patients with valvular disease (stenosis and regurgitation). The quantitation of peak velocity and flow volume in these jets is clinically significant but requires specialized imaging sequences. Conventional 2DFT phase contrast sequences require lengthy acquisitions on the order of several minutes. Conventional spiral phase contrast sequences are faster, but are highly corrupted by flow artifacts at these high velocities due to phase dispersion and motion during the excitation and readout. A new prospectively gated method based on spiral phase contrast is presented, which has a sufficiently short measurement interval (<4 ms) to minimize flow artifacts, while achieving high spatial resolution (2 x 2 x 4 mm(3)) to minimize partial volume effects, all within a single breathhold. A complete single-slice phase contrast movie loop with 22 ms true temporal resolution is acquired in one 10-heartbeat breathhold. Simulations indicate that this technique is capable of imaging through-plane jets with velocities up to 10 m/s, and initial studies in aortic stenosis patients show accurate in vivo measurement of peak velocities up to 4.2 m/s (using echocardiography as a reference).

  View details for DOI 10.1002/mrm.10538

  View details for Web of Science ID 000184529300017

  View details for PubMedID 12876713

• Fat-suppressed steady-state free precession imaging using phase detection MAGNETIC RESONANCE IN MEDICINE Hargreaves, B. A., Vasanawala, S. S., Nayak, K. S., Hu, B. S., Nishimura, D. G. 2003; 50 (1): 210-213

  Abstract

  Fully refocused steady-state free precession (SSFP) is a rapid, efficient imaging sequence that can provide diagnostically useful image contrast. In SSFP, the signal is refocused midway between excitation pulses, much like in a spin-echo experiment. However, in SSFP, the phase of the refocused spins alternates for each resonant frequency interval equal to the reciprocal of the sequence repetition time (TR). Appropriate selection of the TR results in a 180 degrees phase difference between lipid and water signals. This phase difference can be used for fat-water separation in SSFP without any increase in scan time. The technique is shown to produce excellent non-contrast-enhanced, flow-independent angiograms of the peripheral vasculature.

  View details for DOI 10.1002/mrm.10488

  View details for Web of Science ID 000183961800028

  View details for PubMedID 12815698

• Spiral magnetic resonance coronary angiography with rapid real-time localization JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Yang, P. C., Meyer, C. H., Terashima, M., Kaji, S., McConnell, M. V., Macovski, A., Pauly, J. M., Nishimura, D. G., Hu, B. S. 2003; 41 (7): 1134-1141

  Abstract

  A spiral high-resolution coronary artery imaging sequence (SH) interfaced with real-time localization system (RT) has been developed. A clinical study of 40 patients suspected of coronary artery disease (CAD) was conducted. Segmented k-space acquisition techniques have dominated magnetic resonance coronary angiography (MRCA) over the last decade. Although a recent multicenter trial using this technique demonstrated encouraging results, the technique was hampered by low specificity. Spiral k-space acquisition had demonstrated several advantages for MRCA. Therefore, a first clinical trial implementing spiral high-resolution coronary imaging sequence with real-time localization (SH-RT) was performed.A clinical study of 40 patients suspected of CAD undergoing X-ray angiography was conducted to analyze the clinical reliability of this novel imaging system. The SH-RT had been designed to exploit the unique capability of two imaging sequences. The RT allowed a rapid localization of the coronary arteries. Then SH achieved multislice acquisition during a short breath-hold with submillimeter resolution. The MRCA data were analyzed for scan time, anatomic coverage, image quality, and accuracy in detecting CAD. In 40 subjects, SH achieved 0.7 to 0.9 mm resolution with 14-heartbeat breath-holds. Excellent or good image quality was achieved in 78% (263/337) of the coronary segments. Blinded consensus reading among three observers generated sensitivity of 76% and specificity of 91% in the detection of CAD compared with X-ray angiography. The MRCA imaging sequence implementing a novel spiral k-space acquisition technique enabled rapid and reliable imaging of the CAD in submillimeter resolution with short breath-holds.

  View details for DOI 10.1016/S0735-1097(03)00079-2

  View details for Web of Science ID 000181968900011

  View details for PubMedID 12679213

• Triggered real-time MRI and cardiac applications MAGNETIC RESONANCE IN MEDICINE Nayak, K. S., Hu, B. S. 2003; 49 (1): 188-192

  Abstract

  Real-time interactive MRI is becoming the method of choice for many cardiac applications. One current limitation of real-time techniques is inaccurate slice registration during free-breathing. A simple "triggered real-time" imaging approach is proposed which enables the acquisition of synchronized and accurately registered real-time movie loops during short breathholds. Initial in vivo results demonstrate application to complete 4D ventricular function assessment and fully resolved flow imaging.

  View details for DOI 10.1002/mrm.10341

  View details for Web of Science ID 000180148100025

  View details for PubMedID 12509837

• Magnetic resonance coronary angiography. Current cardiology reports Yang, P. C., McConnell, M. V., Nishimura, D. G., Hu, B. S. 2003; 5 (1): 55-62

  Abstract

  Magnetic resonance coronary angiography (MRCA) has witnessed tremendous technical advances over the past decade. Although high-quality images of the coronary arteries have been demonstrated, this imaging modality is not performed routinely today. The fundamental properties of the coronary arteries deterring noninvasive imaging are well known. This article provides an overview of the developmental efforts to overcome these challenges, and highlights key technical and clinical advances. The future prospect of MRCA depends on clinical implementation of the technique. In order to meet this challenge, the following issues must be addressed: contrast- and signal-to-noise ratio, temporal and spatial resolution, and scan protocol.

  View details for PubMedID 12493161

• Clinical use of cardiac ultrasound performed with a hand-carried device in patients admitted for acute cardiac care AMERICAN JOURNAL OF CARDIOLOGY Rugolotto, M., CHANG, C. P., Hu, B., Schnittger, I., Liang, D. H. 2002; 90 (9): 1040-?

  View details for Web of Science ID 000178991100033

  View details for PubMedID 12398985

• Fast phase-contrast velocity measurement in the steady state MAGNETIC RESONANCE IN MEDICINE Overall, W. R., Nishimura, D. G., Hu, B. S. 2002; 48 (5): 890-898

  Abstract

  A new method of encoding flow velocity as image phase in a refocused steady-state free precession (SSFP) sequence, called steady-state phase contrast (SSPC), can be used to generate velocity images rapidly while retaining high signal. Magnitude images with refocused-SSFP contrast are simultaneously acquired. This technique is compared with the standard method of RF-spoiled phase contrast (PC), and is found to have more than double the phase-signal to phase-noise ratio (PNR) when compared with standard PC at reasonable repetition intervals (TRs). As TR decreases, this advantage increases exponentially, facilitating rapid scans with high PNR efficiency. Rapid switching between the two necessary steady states can be accomplished by the insertion of a single TR interval with no flow-encoding gradient. The technique is implemented in a 2DFT sequence and validated in a phantom study. Preliminary results indicate that further TR reduction may be necessary for high-quality cardiac images; however, images in more stationary structures, such as the descending aorta and carotid bifurcation, exhibit good signal-to-noise ratio (SNR) and PNR. Comparisons with standard-PC images verify the PNR advantage predicted by theory.

  View details for DOI 10.1002/mrm.10285

  View details for Web of Science ID 000179055200018

  View details for PubMedID 12418005

• Oscillating dual-equilibrium steady-state angiography MAGNETIC RESONANCE IN MEDICINE Overall, W. R., Conolly, S. M., Nishimura, D. G., Hu, B. S. 2002; 47 (3): 513-522

  Abstract

  A novel technique of generating noncontrast angiograms is presented. This method, called oscillating dual-equilibrium steady-state angiography (ODESSA), utilizes a modified steady-state free precession (SSFP) pulse sequence. The SSFP sequence is modified such that flowing material reaches a steady state which oscillates between two equilibrium values, while stationary material attains a single, nonoscillatory steady state. Subtraction of adjacent echoes results in large, uniform signal from all flowing spins and zero signal from stationary spins. Venous signal can be suppressed based on its reduced T2. ODESSA arterial signal is more than three times larger than that of traditional phase-contrast angiography (PCA) in the same scan time, and also compares favorably with other techniques of MR angiography (MRA). Pulse sequences are implemented in 2D, 3D, and volumetric-projection modes. Angiograms of the lower leg, generated in as few as 5 s, show high arterial signal-to-noise ratio (SNR) and full suppression of other tissues.

  View details for DOI 10.1002/mrm.10070

  View details for Web of Science ID 000174127500012

  View details for PubMedID 11870838

• In vivo real-time intravascular MRI JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE Rivas, P. A., Nayak, K. S., Scott, G. C., McConnell, M. V., Kerr, A. B., Nishimura, D. G., Pauly, J. M., Hu, B. S. 2002; 4 (2): 223-232

  Abstract

  The Magnetic resonance imaging (MRI) is an emerging technology for catheter-based imaging and interventions. Real-time MRI is a promising methodfor overcoming catheter and physiologic motion for intravascular imaging.All imaging was performed on a 1.5 T Signa MRI scanner with high-speed gradients. Multiple catheter coils were designed and constructed, including low-profile, stub-matched coils. Coil sensitivity patterns and SNR measurements were compared. Real-time imaging was performed with an interleaved spiral sequence using a dedicated workstation, providing real-time data acquisition, image reconstruction and interactive control and display. Real-time "black-blood" imaging was achieved through incorporation of off-slice saturation pulses. The imaging sequence was tested in a continuous flow phantom and then in vivo in the rabbit aorta using a 2 mm catheter coil.The real-time intravascular imaging sequence achieved 120-440 micron resolution at up to 16 frames per second. Low-profile stub-tuned catheter coils achieved similar SNR to larger traditional coil designs. In the phantom experiments, addition of real-time black-blood saturation pulses effectively suppressed the flow signal and allowed visualization of the phantom wall. In vivo experiments clearly showed real-time intravascular imaging of the rabbit aortic wall with minimal motion artifacts and effective blood signal suppression.Real-time imaging with low-profile coil designs provides significant enhancements to intravascular MRI.

  View details for PubMedID 12074137

• Rapid assessment of cardiac anatomy and function with a new hand-carried ultrasound device (OptiGo): a comparison with standard echocardiography. European journal of echocardiography Rugolotto, M., Hu, B. S., Liang, D. H., Schnittger, I. 2001; 2 (4): 262-269

  Abstract

  The aim of this study was to evaluate image quality and accuracy of a new hand-carried ultrasound device, OptiGo (Agilent Technologies) when compared to standard echocardiography in the setting of a focused examination in the assessment of cardiac anatomy and function.One-hundred and twenty-one patients were prospectively enrolled. Image quality and accuracy in assessment of chamber sizes, left ventricular (LV) wall thickness and contractility, right ventricular (RV) function, mitral and aortic leaflet thickening, mitral annular calcification, pericardial effusion and valvular regurgitation were assessed. Two-dimensional (2D) findings were graded on a four-point scale, except for LV function (six-point) and valvular leaflet opening (two-point). Colour Doppler assessment of valvular regurgitation was graded on a seven-point scale. A one-point difference was considered minor; a two or more point difference was considered major. There was no statistically significant difference in image quality between the two devices. For 2D data, the number of total (minor and major) differences between the hand-carried and standard echocardiograph examinations was significantly greater than the inter-observer variability (14.3% vs 10.7%, P< 0.05), however, major differences alone were not statistically different. For the colour Doppler assessment of regurgitation there was a significant difference between the devices for total (minor and major) differences, (40.0% vs 31.8%,P < 0.007) however, the number of major differences is explained by inter-observer variability.Image quality and diagnostic accuracy of the hand-carried device, OptiGo, was adequate for the purpose of performing a focused assessment of a limited number of 2D and Doppler parameters for the evaluation of cardiac anatomy and function.

  View details for PubMedID 11888820

• Real-time interactive coronary MRA MAGNETIC RESONANCE IN MEDICINE Nayak, K. S., Pauly, J. M., Yang, P. C., Hu, B. S., Meyer, C. H., Nishimura, D. G. 2001; 46 (3): 430-435

  Abstract

  An interactive real-time imaging system capable of rapid coronary artery imaging is described. High-resolution spiral and circular echo planar trajectories were used to achieve 0.8 x 1.6 mm2 resolution in 135 ms (CEPI) or 1.13 x 1.13 mm2 resolution in 189 ms (spirals), over a 20-cm FOV. Using a sliding window reconstruction, display rates of up to 37 images/sec were achieved. Initial results indicate this technique can perform as a high-quality 2D coronary localizer and with SNR improvement may enable rapid screening of the coronary tree.

  View details for Web of Science ID 000170740300004

  View details for PubMedID 11550232

• Rapid evaluation of left ventricular volume and mass without breath-holding using real-time interactive cardiac magnetic resonance imaging system JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Kaji, S., Yang, P. C., Kerr, A. B., Tang, W. H., Meyer, C. H., Macovski, A., Pauly, J. M., Nishimura, D. G., Hu, B. S. 2001; 38 (2): 527-533

  Abstract

  The purpose of this study was to validate cardiac measurements derived from real-time cardiac magnetic resonance imaging (MRI) as compared with well-validated conventional cine MRI.Although cardiac MRI provides accurate assessment of left ventricular (LV) volume and mass, most techniques have been relatively slow and required electrocardiogram (ECG) gating over many heart beats. A newly developed real-time MRI system allows continuous real-time dynamic acquisition and display without cardiac gating or breath-holding.Fourteen healthy volunteers and nine patients with heart failure underwent real-time and cine MRI in the standard short-axis orientation with a 1.5T MRI scanner. Nonbreath-holding cine MRI was performed with ECG gating and respiratory compensation. Left ventricular end-diastolic volume (LVEDV), left ventricular endsystolic volume (LVESV), ejection fraction (EF) and LV mass calculated from the images obtained by real-time MRI were compared to those obtained by cine MRI.The total study time including localization for real-time MRI was significantly shorter than cine MRI (8.6 +/- 2.3 vs. 24.7 +/- 3.5 min, p < 0.001). Both imaging techniques yielded good quality images allowing cardiac measurements. The measurements of LVEDV, LVESV, EF and LV mass obtained with real-time MRI showed close correlation with those obtained with cine MRI (LVEDV: r = 0.985, p < 0.001; LVESV: r = 0.994, p < 0.001; EF: r = 0.975, p < 0.001; LV mass: r = 0.977, p < 0.001).Real-time MRI provides accurate measurements of LV volume and mass in a time-efficient manner with respect to image acquisition.

  View details for Web of Science ID 000170205800033

  View details for PubMedID 11499748

• Real-time black-blood MRI using spatial presaturation 7th Annual ISMRM Meeting Nayak, K. S., Rivas, P. A., Pauly, J. M., Scott, G. C., Kerr, A. B., Hu, B. S., Nishimura, D. G. JOHN WILEY & SONS INC. 2001: 807–12

  Abstract

  A real-time interactive black-blood imaging system is described. Rapid blood suppression is achieved by exciting and dephasing slabs outside the imaging slice before each imaging excitation. Sharp-profiled radio frequency saturation pulses placed close to the imaging slice provide good blood suppression, even in views containing slow through-plane flow. In vivo results indicate that this technique improves endocardial border definition during systole in real-time cardiac wall-motion studies. Phantom and animal results indicate that this technique nearly eliminates flow artifacts in real-time intravascular studies. J. Magn. Reson. Imaging 2001;13:807-812.

  View details for Web of Science ID 000171296300020

  View details for PubMedID 11329205

• Rapid ventricular assessment using real-time interactive multislice MRI MAGNETIC RESONANCE IN MEDICINE Nayak, K. S., Pauly, J. M., Nishimura, D. G., Hu, B. S. 2001; 45 (3): 371-375

  Abstract

  A multislice real-time imaging technique is described which can provide continuous visualization of the entire left ventricle under resting and stress conditions. Three dynamically adjustable slices containing apical, mid, and base short axis views are imaged 16 times/sec (48 images/sec), with each image providing 3.12 mm resolution over a 20 cm field of view. Initial studies indicate that this technique is useful for the assessment of LV function by providing simultaneous real-time visualization of all 16 wall segments. This technique may also be used for stress LV function and, when used in conjunction with contrast agents, myocardial perfusion imaging. Magn Reson Med 45:371-375, 2001.

  View details for Web of Science ID 000167163800004

  View details for PubMedID 11241692

• Real-time color flow MRI 2nd Annual Meeting of the Society-for-Cardiovascular-Magnetic-Resonance Nayak, K. S., Pauly, J. M., Kerr, A. B., Hu, B. S., Nishimura, D. G. JOHN WILEY & SONS INC. 2000: 251–58

  Abstract

  A real-time interactive color flow MRI system capable of rapidly visualizing cardiac and vascular flow is described. Interleaved spiral phase contrast datasets are acquired continuously, while real-time gridding and phase differencing is used to compute density and velocity maps. These maps are then displayed using a color overlay similar to what is used by ultrasound. For cardiac applications, 6 independent images/sec are acquired with in-plane resolution of 2.4 mm over a 20 cm field of view (FOV). Sliding window reconstruction achieves display rates up to 18 images/sec. Appropriate tradeoffs are made for other applications. Flow phantom studies indicate this technique accurately measures velocities up to 2 m/sec, and accurately captures real-time velocity waveforms (comparable to continuous wave ultrasound). In vivo studies indicate this technique is useful for imaging cardiac and vascular flow, particularly valvular regurgitation. Arbitrary scan planes can be quickly localized, and flow measured in any direction.

  View details for Web of Science ID 000084993500012

  View details for PubMedID 10680689

• The real-time interactive 3-D-DVA for robust coronary MRA IEEE TRANSACTIONS ON MEDICAL IMAGING Sachs, T. S., Meyer, C. H., Pauly, J. M., Hu, B. S., Nishimura, D. G., Macovski, A. 2000; 19 (2): 73-79

  Abstract

  A graphical user interface (GUI) has been developed which enables interactive feedback and control to the real-time diminishing variance algorithm (DVA). This interactivity allows the user to set scan parameters, view scan statistics, and view image updates during the course of the scan. In addition, the DVA has been extended to simultaneously reduce motion artifacts in three dimensions using three orthogonal navigators. Preliminary in vivo studies indicate that these improvements to the standard DVA allow for significantly improved consistency and robustness in eliminating respiratory motion artifacts from MR images, particularly when imaging the coronary arteries.

  View details for Web of Science ID 000086614000001

  View details for PubMedID 10784279

• High-resolution three-dimensional in vivo imaging of atherosclerotic plaque MAGNETIC RESONANCE IN MEDICINE Luk-Pat, G. T., Gold, G. E., Olcott, E. W., Hu, B. S., Nishimura, D. G. 1999; 42 (4): 762-771

  Abstract

  The internal structure of atherosclerotic-plaque lesions may be a useful predictor of which lesions will rupture and cause sudden events such as heart attack or stroke. With lipid and flow suppression, we obtained high-resolution, three-dimensional (3D) images of atherosclerotic plaque in vivo that show the cap thickness and core size of the lesions. 3D GRASE was used because it provides flexible T(2) contrast and good resistance to off-resonance artifacts. While 2D RARE has similar properties, its resolution in the slice-select direction, which is important because of the irregular geometry of atherosclerotic lesions, is limited by achievable slice-excitation profiles. Also, 2D imaging generally achieves lower SNR than 3D imaging because, for SNR purposes, 3D image data is averaged over all the slices of a corresponding multislice 2D dataset. Although 3D RARE has many of the advantages of 3D GRASE, it requires a longer scan time because it uses more refocusing pulses to acquire the same amount of data. Finally, cardiac gating is an important part of our imaging sequence, but can make the imaging time quite long. To obtain reasonable scan times, a 2D excitation pulse was used to restrict the field of view. Magn Reson Med 42:762-771, 1999.

  View details for Web of Science ID 000082944400019

  View details for PubMedID 10502766

• Real-time interactive MRI for cardiac applications International Symposium on Ultrafast Magnetic Resonance Imaging in Medicine (ISUM 99) Pauly, J., Kerr, A., Meyer, C., Nayak, K., Hu, B., Yang, P., Nishimura, D., Macovski, A. ELSEVIER SCIENCE BV. 1999: 119–123

  View details for Web of Science ID 000085322100017

• New real-time interactive cardiac magnetic resonance imaging system complements echocardiography JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Yang, P. C., Kerr, A. B., Liu, A. C., Liang, D. H., Hardy, C., Meyer, C. H., Macovski, A., Pauly, J. M., Hu, B. S. 1998; 32 (7): 2049-2056

  Abstract

  We conducted an initial clinical trial of a newly developed cardiac magnetic resonance imaging (CMRI) system. We evaluated left ventricular (LV) function in 85 patients to compare the clinical utility of the CMRI system with echocardiography, the current noninvasive gold standard.Conventional CMRI systems require cardiac-gating and respiratory compensation to synthesize a single image from data acquired over multiple cardiac cycles. In contrast, the new CMRI system allows continuous real-time dynamic acquisition and display of any scan plane at 16 images/s without the need for cardiac gating or breath-holding.A conventional 1.5T Signa MRI Scanner (GE, Milwaukee, Wisconsin) was modified by the addition of an interactive workstation and a bus adapter. The new CMRI system underwent clinical trial by testing its ability to evaluate global and regional LV function. The first group (A) consisted of 31 patients with acceptable echocardiography image quality. The second group (B) consisted of 31 patients with suboptimal echocardiography image quality. The third group (C) consisted of 29 patients with severe lung disease or congenital cardiac malformation who frequently have suboptimal echo study. Two independent observers scored wall motion and image quality using the standard 16-segment model and rank-order analysis.CMRI evaluation was complete in less than 15 min. In group A, no significant difference was found between ECHO and CMRI studies (p = NS). In group B, adequate visualization of wall segments was obtained 38% of the time using ECHO and 97% of the time using CMRI (p < 0.0001). When grouped into coronary segments, adequate visualization of at least one segment occurred in 18 of 30 patients (60%) with ECHO and in all 30 patients (100%) with CMRI (p < 0.0001). In group C, adequate visualization of the wall segments was obtained in 58% (CI 0.53-0.62) of the time using echocardiography and 99.7% (CI 0.99-1.0) of the time using CMRI (p < 0.0001).The new CMRI system provides clinically reliable evaluation of LV function and complements suboptimal echocardiography. In comparison with the conventional CMRI, the new CMRI system significantly reduces scan time, patient discomfort and associated cost.

  View details for Web of Science ID 000077396200039

  View details for PubMedID 9857892

• 3D MR coronary artery segmentation MAGNETIC RESONANCE IN MEDICINE Cline, H. E., Thedens, D. R., Irarrazaval, P., Meyer, C. H., Hu, B. S., Nishimura, D. G., Ludke, S. 1998; 40 (5): 697-702

  Abstract

  Coronary arteries are segmented from the blood pool using mathematical morphology operations from a 3D magnetic resonance spiral acquisition on a continuously breathing healthy volunteer. The segmented volume is maximal intensity projected at different views to yield coronary angiograms showing the left anterior descending artery (LAD), right coronary artery (RCA), and left circumflex artery (LCX). Magnetic resonance coronary angiography provides a retrospective rotating view of the coronary artery tree that complements oblique reformatted sections.

  View details for Web of Science ID 000076496700008

  View details for PubMedID 9797152

• One-shot spatially resolved velocity imaging MAGNETIC RESONANCE IN MEDICINE Pat, G. T., Pauly, J. M., Hu, B. S., Nishimura, D. G. 1998; 40 (4): 603-613

  Abstract

  For quantitative velocity measurement, we have developed a technique that acquires full velocity spectra without cardiac gating. After a cylindrical excitation restricts imaging to one spatial dimension, data are acquired while an oscillating gradient is played out. After each excitation, an image of velocity versus spatial location is obtained. For a given spatial location, a series of these images can be used to form an image of velocity versus time. Acquisition times are much shorter than for phase-contrast imaging or Fourier-encoded velocity imaging, obviating the need for cardiac gating. Although a two-shot version of this technique has been presented previously, we have developed a one-shot version that offers higher temporal resolution for a given velocity resolution and superior off-resonance properties.

  View details for Web of Science ID 000076080900012

  View details for PubMedID 9771577

• Interactive coronary MRI 5th Annual Meeting of the International-Society-of-Magnetic-Resonance-in-Medicine Hardy, C. J., Darrow, R. D., Pauly, J. M., Kerr, A. B., Dumoulin, C. L., Hu, B. S., Martin, K. M. JOHN WILEY & SONS INC. 1998: 105–11

  Abstract

  The acquisition of complete three-dimensional (3D), segmented gradient-echo data sets to visualize the coronary arteries can be both time consuming and sensitive to motion, even with use of multiple breath-holding or respiratory gating. An alternate hybrid approach is demonstrated here, in which real-time interactive imaging is first used to locate an optimal oblique coronary scan plane. Then, a limited number of contiguous slices are acquired around that plane within a breath-hold with use of two-dimensional (2D) segmented gradient-echo imaging. Dual inversion nulling is used to suppress fat and myocardium. Finally, if needed, a limited reformat of the data is performed to produce images from relatively long sections of the coronaries. This approach yields relatively rapid visualization of portions of the coronary tree. Several different methods are compared for interactively moving the scan plane.

  View details for Web of Science ID 000074302000014

  View details for PubMedID 9660560

• Real-time interactive MRI on a conventional scanner MAGNETIC RESONANCE IN MEDICINE Kerr, A. B., Pauly, J. M., Hu, B. S., Li, K. C., Hardy, C. J., Meyer, C. H., Macovski, A., Nishimura, D. G. 1997; 38 (3): 355-367

  Abstract

  A real-time interactive MRI system capable of localizing coronary arteries and imaging arrhythmic hearts in real-time is described. Non-2DFT acquisition strategies such as spiral-interleaf, spiral-ring, and circular echo-planar imaging provide short scan times on a conventional scanner. Real-time gridding reconstruction at 8-20 images/s is achieved by distributing the reconstruction on general-purpose UNIX workstations. An X-windows application provides interactive control. A six-interleaf spiral sequence is used for cardiac imaging and can acquire six images/s. A sliding window reconstruction achieves display rates of 16-20 images/s. This allows cardiac images to be acquired in real-time, with minimal motion and flow artifacts, and without breath holding or cardiac gating. Abdominal images are acquired at over 2.5 images/s with spiral-ring or circular echo-planar sequences. Reconstruction rates are 8-10 images/s. Rapid localization in the abdomen is demonstrated with the spiral-ring acquisition, whereas peristaltic motion in the small bowel is well visualized using the circular echo-planar sequence.

  View details for Web of Science ID A1997XW16200002

  View details for PubMedID 9339436

• Forward-looking catheters. Seminars in interventional cardiology : SIIC Liang, D. H., Hu, B. S. 1997; 2 (1): 75-81

  Abstract

  Current intravascular ultrasound catheters provide a cross-sectional view of the blood vessel that limits their ability to visualize severely stenosed or occluded vessels. Forward-looking ultrasound catheters can overcome these limitations. Development of a practical forward-looking ultrasound catheter requires solutions to address the need for improved lateral resolution and depth of penetration presented by the forward-looking format. Methods are also needed to generate the forward-looking scan within the space constraints of a catheter. New developments using mechanical scanning methods suggest that a practical device appears achievable. Two-dimensional, as well as three-dimensional imaging, may be possible. Early efforts towards a phased array scanner have also begun.

  View details for PubMedID 9546988

• A forward-viewing intravascular ultrasound catheter suitable for intracoronary use. Biomedical instrumentation & technology Liang, D. H., Hu, B. S. 1997; 31 (1): 45-53

  Abstract

  Current intravascular ultrasound (IVUS) catheters provide a transverse cross-sectional view of the blood vessel, thus limiting their ability to visualize severely stenosed or occluded vessels. Forward-viewing IVUS devices can overcome these limitations. Previously described forward-viewing IVUS catheters are mechanically complex, making them too bulky for use in coronary arteries. A new design for small-forward viewing IVUS catheters was developed. Using this design, flexible 5-Fr (1.6 mm diameter) and 8-Fr (2.6 mm diameter) prototype catheters up to 110 cm long, suitable for intravascular work, were constructed. Imaging of cadaver arterial segments was performed using these prototype catheters. Structures such as branches and plaque and features such as calcium were well seen with these catheters. Correlation of lumen dimensions measured with the IVUS catheters and by histology (HIST) was excellent: IVUS = 1.06 x HIST - 1.45 mm, r2 = 0.98. This new technology holds promise as a tool for guiding intravascular interventions.

  View details for PubMedID 9051225

• Accuracy of biplane and multiplane transesophageal echocardiography in diagnosis of typical acute aortic dissection and intramural hematoma JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Keren, A., Kim, C. B., Hu, B. S., Eyngorina, I., Billingham, M. E., Mitchell, R. S., Miller, D. C., Popp, R. L., Schnittger, I. 1996; 28 (3): 627-636

  Abstract

  The purpose of this study was to evaluate the diagnostic accuracy of biplane and multiplane transesophageal echocardiography in patients with suspected aortic dissection, including intramural hematoma.Transesophageal echocardiography is a useful technique for rapid bedside evaluation of patients with suspected acute aortic dissection. The sensitivity of transesophageal echocardiography is high, but the diagnostic accuracy of biplane and multiplane transesophageal echocardiography for dissection and intramural hematoma is less well defined.We studied 112 consecutive patients at a major referral center who had undergone biplane or multiplane transesophageal echocardiography to identify aortic dissection. The presence, absence and type of aortic dissection (type A or B, typical dissection or intramural hematoma) were confirmed by operation or autopsy in 60 patients and by other imaging techniques in all. The accuracy of transesophageal echocardiography for ancillary findings of aortic dissection (intimal flap, fenestration and thrombosis) was assessed in the 60 patients with available surgical data.Of the 112 patients, aortic dissection was present in 49 (44%); 10 of these had intramural hematoma (5 with and 5 without involvement of the ascending aorta). Of the remaining 63 patients without dissection, 33 (29%) had aortic aneurysm and 30 (27%) had neither dissection nor aneurysm. The overall sensitivity and specificity of transesophageal echocardiography for the presence of dissection were 98% and 95%, respectively. The specificity for type A and type B dissection was 97% and 99%, respectively. The sensitivity and specificity for intramural hematoma was 90% and 99%, respectively. The accuracy of transesophageal echocardiography for diagnosis of acute significant aortic regurgitation and pericardial tamponade was 100%.Biplane and multiplane transesophageal echocardiography are highly accurate for prospective identification of the presence and site of aortic dissection, its ancillary findings and major complications in a large series of patients with varied aortic pathology. Intramural hematoma carries a high complication rate and should be treated identically with aortic dissection.

  View details for PubMedID 8772749

• Heart transplantation complicated by a patent foramen ovale of the recipient atrial septum ANNALS OF THORACIC SURGERY Yun, K. L., Reichenspurner, H., Schmoker, J., Hu, B., Stinson, E. B. 1996; 62 (3): 897-899

  Abstract

  A patent foramen ovale after heart transplantation is a relatively uncommon occurrence. We report a case of a 58-year-old man with profound hypoxemia after orthotopic cardiac transplantation for end-stage ischemic cardiomyopathy. Transesophageal echocardiography demonstrated the presence of a patent foramen ovale in the recipient atrial cuff. Primary closure was performed with correction of the right-to-left shunt.

  View details for Web of Science ID A1996VF66700067

  View details for PubMedID 8784035

• THE DIMINISHING VARIANCE ALGORITHM FOR REAL-TIME REDUCTION OF MOTION ARTIFACTS IN MRI MAGNETIC RESONANCE IN MEDICINE Sachs, T. S., Meyer, C. H., Irarrazabal, P., Hu, B. S., Nishimura, D. G., Macovski, A. 1995; 34 (3): 412-422

  Abstract

  A technique has been developed whereby motion can be detected in real time during the acquisition of data. This enables the implementation of several algorithms to reduce or eliminate motion effects from an image as it is being acquired. One such algorithm previously described is the acceptance/rejection method. This paper deals with another real-time algorithm called the diminishing variance algorithm (DVA). With this method, a complete set of preliminary data is acquired along with information about the relative motion position of each frame of data. After all the preliminary data are acquired, the position information is used to determine which data frames are most corrupted by motion. Frames of data are then reacquired, starting with the most corrupted one. The position information is continually updated in an iterative process; therefore, each subsequent reacquisition is always done on the worst frame of data. The algorithm has been implemented on several different types of sequences. Preliminary in vivo studies indicate that motion artifacts are dramatically reduced.

  View details for Web of Science ID A1995RR68700018

  View details for PubMedID 7500881

• CORONARY ANGIOGRAPHY WITH MAGNETIZATION-PREPARED T-2 CONTRAST MAGNETIC RESONANCE IN MEDICINE Brittain, J. H., Hu, B. S., Wright, G. A., Meyer, C. H., Macovski, A., Nishimura, D. G. 1995; 33 (5): 689-696

  Abstract

  A magnetization-prepared, T2-weighted sequence (T2 Prep) is used to suppress muscle and venous structures. When combined with lipid suppression, this technique improves the visualization of the coronary arteries. T2 Prep was designed to be rebust in the presence of flow as well as B0 and B1 inhomogeneities and may be combined with virtually any imaging technique. Here, it is implemented with both a single-slice spiral acquisition and a multi-slice spiral method that acquires up to 15 slices in a single breath-holding interval.

  View details for Web of Science ID A1995QV05800014

  View details for PubMedID 7596274

• REAL-TIME MOTION DETECTION IN SPIRAL MRI USING NAVIGATORS MAGNETIC RESONANCE IN MEDICINE Sachs, T. S., Meyer, C. H., Hu, B. S., Kohli, J., Nishimura, D. G., Macovski, A. 1994; 32 (5): 639-645

  Abstract

  A technique has been developed whereby motion can be detected in real time during the acquisition of data. This enables the implementation of an algorithm to accept or reject and reacquire data during a scan. Frames of data with motion are rejected and reacquired on the fly so that by the end of the scan, a complete motion-free data set has been acquired. The algorithm has been implemented on several different types of sequences. Preliminary in vivo studies indicate that motion artifacts are dramatically reduced.

  View details for Web of Science ID A1994PN57500012

  View details for PubMedID 7808265

• LOCALIZED REAL-TIME VELOCITY SPECTRA DETERMINATION MAGNETIC RESONANCE IN MEDICINE Hu, B. S., Pauly, J. M., Nishimura, D. G. 1993; 30 (3): 393-398

  Abstract

  The accurate measurement of flow velocity has long been a subject of NMR research. In the field of medical imaging, a variety of techniques primarily based on the principle of Fourier encoding have been described. Due to time constraints, necessary trade-offs exist between spatial versus velocity spectral resolution. In general, either the average velocity of individual pixels is displayed or velocity spectral determinations are made at the cost of spatial localization. The recent development of multidimensional excitation pulses makes spatial localization possible during the excitation phase of the pulse sequences. This approach, coupled with time varying gradient readout, can be used to obtain single-shot localized velocity spectra. Using these concepts, we have obtained in vivo real-time measurements of localized velocity spectra on our clinical imager.

  View details for Web of Science ID A1993LV99700018

  View details for PubMedID 8412614

• SPATIALLY-RESOLVED AND LOCALIZED REAL-TIME VELOCITY DISTRIBUTION MAGNETIC RESONANCE IN MEDICINE Irarrazabal, P., Hu, B. S., Pauly, J. M., Nishimura, D. G. 1993; 30 (2): 207-212

  Abstract

  A technique is presented for collecting the spin velocity distribution as a function of position and time. It uses a multidimensional excitation pulse to select a cylinder, giving localization in two dimensions. Resolution in the third spatial dimension is achieved in the readout. During readout, an oscillating gradient encodes the acquired data in both one spatial dimension (x) and one velocity dimension (v). Two acquisitions (42 ms each) are needed to get a complete coverage of kx--kv space, which makes this technique real-time. The data is interpolated from the nonuniformly sampled kx--kv space to a Cartesian frame with a gridding scheme to take advantage of the Fast Fourier Transform. The technique was successfully applied to phantoms and normal volunteers, giving reasonable real-time measurements of velocity.

  View details for Web of Science ID A1993LP88200008

  View details for PubMedID 8366802

• PULSED MAGNETIZATION TRANSFER SPIN-ECHO MR-IMAGING JOURNAL OF MAGNETIC RESONANCE IMAGING Pike, G. B., Glover, G. H., Hu, B. S., Enzmann, D. R. 1993; 3 (3): 531-539

  Abstract

  Cross relaxation between macromolecular protons and water protons is known to be important in biologic tissue. In magnetic resonance (MR) imaging sequences, selective saturation of the characteristically short T2 macromolecular proton pool can produce contrast called magnetization transfer contrast, based on the cross-relaxation process. Selective saturation can be achieved with continuous wave irradiation several kilohertz off resonance or short, intense 0 degree pulses on resonance. The authors analyze 0 degree binomial pulses for T2 selective saturation, present design guidelines, and demonstrate the use of these pulses in spin-echo imaging sequences in healthy volunteers and patients. Using the phenomenologic Bloch equations modified for two-site exchange, the authors derive the analytic expressions for water proton relaxation under periodic pulsed saturation of the macromolecular protons. This relaxation is shown to be monoexponential, with a rate constant dependent on the saturation pulse repetition rate and the individual and cross-relaxation rates.

  View details for Web of Science ID A1993LC10000013

  View details for PubMedID 8324313

• A 3-DIMENSIONAL SPIN-ECHO OR INVERSION PULSE MAGNETIC RESONANCE IN MEDICINE Pauly, J. M., Hu, B. S., Wang, S. J., Nishimura, D. G., Macovski, A. 1993; 29 (1): 2-6

  Abstract

  In theory, multidimensional pulses can be designed to be selective in any number of dimensions. In practice, available gradient power has enforced a limit to two dimensions. We show here that three-dimensional pi pulses are feasible on commercial imaging machines provided that the range of off-resonance frequencies are limited.

  View details for Web of Science ID A1993KJ34900001

  View details for PubMedID 8419739

• MAGNETIC-RESONANCE ANGIOGRAPHY WORKSHOP ON CARDIOVASCULAR IMAGING Macovski, A., Hu, B., Meyer, C., Pauly, J., Wright, G., Nishimura, D. G. RAVEN PRESS. 1993: 221–236

  View details for Web of Science ID A1993BY41M00015

• FAST SPIRAL CORONARY-ARTERY IMAGING MAGNETIC RESONANCE IN MEDICINE Meyer, C. H., Hu, B. S., Nishimura, D. G., Macovski, A. 1992; 28 (2): 202-213

  Abstract

  A flow-independent method for imaging the coronary arteries within a breath-hold on a standard whole-body MR imager was developed. The technique is based on interleaved spiral k-space scanning and forms a cardiac-gated image in 20 heartbeats. The spiral readouts have good flow properties and generate minimal flow artifacts. The oblique slices are positioned so that the arteries are in the plane and so that the chamber blood does not obscure the arteries. Fat suppression by a spectral-spatial pulse improves the visualization of the arteries.

  View details for Web of Science ID A1992KB92200003

  View details for PubMedID 1461123

• INITIAL PATIENT STUDIES WITH FAST SPIRAL MAGNETIC-RESONANCE CORONARY ANGIOGRAPHY Hu, B. S., Meyer, C. H., Macovski, A., Nishimura, D. G. LIPPINCOTT WILLIAMS & WILKINS. 1992: 503–

  View details for Web of Science ID A1992JT66002021

• PULSED SATURATION TRANSFER CONTRAST MAGNETIC RESONANCE IN MEDICINE Hu, B. S., Conolly, S. M., Wright, G. A., Nishimura, D. G., Macovski, A. 1992; 26 (2): 231-240

  Abstract

  In vivo 1H conventional NMR image contrast generation usually relies on the macroscopic T1 and T2 relaxation parameters of the tissues of interest. Recently cross-relaxation related image contrast has been reported by Wolff and Balaban in animal models. Due primarily to the broad lineshape of the intended saturation spin pool and the use of off-resonance irradiation, high specific absorption rate and an auxiliary RF amplifier have been necessary to produce these images. The relatively long spin-lattice relaxation property of this spin pool, however, suggests the use of pulse methods to achieve saturation. In this paper, we show that short-T2 spin pools can be selectively saturated with short intense RF pulses. Cross-relaxation time constants can be measured using the technique of saturation recovery. In vivo magnetization-transfer-weighted images can be produced using pulses on commercial whole-body imagers without additional hardware.

  View details for Web of Science ID A1992JH50500004

  View details for PubMedID 1325023

• MAGNETIZATION TRANSFER TIME-OF-FLIGHT MAGNETIC-RESONANCE ANGIOGRAPHY MAGNETIC RESONANCE IN MEDICINE Pike, G. B., Hu, B. S., Glover, G. H., Enzmann, D. R. 1992; 25 (2): 372-379

  Abstract

  Time-of-flight (TOF) angiography based on inflow enhancement is limited by the steady-state signal differences between blood and the surrounding stationary tissues. We present a new TOF sequence in which magnetization transfer contrast is used to supplement wash-in effects. Angiograms demonstrating the superior performance of this technique are presented.

  View details for Web of Science ID A1992HX35600016

  View details for PubMedID 1614322

• 1991 I.I. Rabi Award. Estimating oxygen saturation of blood in vivo with MR imaging at 1.5 T. Journal of magnetic resonance imaging : JMRI Wright, G. A., Hu, B. S., Macovski, A. 1991; 1 (3): 275-283

  Abstract

  The use of magnetic resonance (MR) imaging is investigated for noninvasively estimating the oxygen saturation of human blood (%HbO2) in vivo by means of relaxation characteristics identified in earlier MR spectrometry studies. To this end, a sequence is presented for determining the T2 of vascular blood in regions in which motions of the body and of the blood itself present a major challenge. With use of this sequence on a commercial 1.5-T whole-body imager, the relationship between the T2 and %HbO2 of blood is calibrated in vitro for the conditions expected in vivo. T2 varies predictably from about 30 to 250 msec as %HbO2 varies from 30% to 96%. T2 values measured in situ for vascular blood in the mediastinum of several healthy subjects qualitatively reflected the behavior observed in vitro. Estimates of %HbO2 for these vessels obtained with the in vitro calibration appear reasonable, particularly for venous blood, although difficulties arise in selecting the appropriate calibration factors. These encouraging initial results support a more systematic study of potential sources of error and an examination of the accuracy of in vivo measurements by comparison with direct measurements of %HbO2 in vessels.

  View details for PubMedID 1802140

• ESTIMATING OXYGEN-SATURATION OF BLOOD INVIVO WITH MR IMAGING AT 1.5T JMRI-JOURNAL OF MAGNETIC RESONANCE IMAGING Wright, G. A., Hu, B. S., Macovski, A. 1991; 1 (3): 275-283

  View details for Web of Science ID A1991HA76500002

• CORONARY ANGIOGRAPHY USING FAST SELECTIVE INVERSION RECOVERY MAGNETIC RESONANCE IN MEDICINE Wang, S. J., Hu, B. S., Macovski, A., Nishimura, D. G. 1991; 18 (2): 417-423

  Abstract

  Using a fast version of selective inversion recovery, we have obtained coronary angiograms of normal volunteers showing the proximal portions of the left coronary artery. Blood is tagged in the aortic root at end systole using a 2D inversion pulse. After a wash-in time of 300-600 ms, the coronary vessels are imaged with a 2- to 3-cm-thick slab in either axial or oblique projection. The scan is completed within a breathhold in 24 heartbeats.

  View details for Web of Science ID A1991FF36100015

  View details for PubMedID 2046523