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Cardiovascular Magnetic Resonance Techniques for Myocardial Tissue Characterization in Coronary Artery Disease

Giri, Shivraman
http://rave.ohiolink.edu/etdc/view?acc_num=osu1325233054

Abstract Details

2012, Doctor of Philosophy, Ohio State University, Biomedical Engineering.
Accurate diagnosis of coronary artery disease (CAD), a life-threatening condition when in acute stage, is a clinical challenge, especially in an emergency setting. Current strategies for the initial triage of chest-pain patients fall short of providing enough diagnostic accuracy, resulting in unnecessary hospitalization of low-risk patients or early discharge of high-risk patients; the former increases societal health-care burden and exposes patients to the risk of invasive procedures and ionizing radiations, whereas the latter leads avoidable mortalities. This research was undertaken with the objective of equipping health-care providers with magnetic resonance imaging (MRI) diagnostic techniques for improved assessment of CAD patients. MRI has many advantages over other techniques: it is non-invasive, involves no ionizing radiations, provides high spatial resolution, is capable of probing multiple biomarkers, can provide information at all levels – molecular, cellular, tissue and organ. Of these, tissue characterization is a unique forte of MRI, and has been exploited in this work. To address the clinical need of finding improved MRI techniques, the pathophysiology of CAD was first investigated to identify the early biomarkers of this disease, with an emphasis on those that signify reversible injury to the heart. Two such biomarkers – myocardial edema and perfusion – were studied in greater detail. MR physics was then reviewed with a view to designing an optimal strategy for characterizing these tissue changes. Finally, engineering solutions, in the form of pulse sequences and post processing strategies, were provided to enable the translation of these techniques from “bench to bedside”. The solution provided for edema characterization is a robust quantitative T2 mapping pulse sequence. Multiple T2-quantification approaches were evaluated to propose an optimal strategy that was shown to address many of the problems that have precluded the use of qualitative T2-weighted approaches for myocardial edema imaging in routine clinical scans. The optimal T2 mapping strategy was then implemented on Siemens 1.5T systems, incorporating novel automatic motion compensation technique into the work-flow. Subsequently, the diagnostic performance of this technique was evaluated in single-center clinical trials for two cardiovascular pathologies: acute myocardial infarction and acute inflammatory diseases. Myocardial perfusion assessment using MRI has been around since 1991; despite advancements in scanner hardware, novel pulse sequences, and reconstruction strategies, several limitations continue to exist. Using the same basic pulse sequence – saturation recovery preparation followed by a fast readout module, most of the contemporary research has focused on advanced acceleration and reconstruction strategies. The solution proposed in this work uses an alternative approach of imaging in steady-state, which circumvents many of the suspected sources of limitations in the current techniques. This pulse sequence can be combined with any of the advanced acceleration technique and could potentially accomplish whole-heart perfusion imaging. Initial experience with this technique is presented and suggestions for its further improvement are provided.
Orlando P. Simonetti, PhD (Advisor)
Subha V. Raman, MD (Committee Member)
Richard D. White, MD (Committee Member)
Arunark Kolipaka, PhD (Committee Member)
Biomedical Engineering; Biomedical Research
mri; cardiovascular; coronary artery disease;

Recommended Citations

Citations

  • Giri, S. (2012). Cardiovascular Magnetic Resonance Techniques for Myocardial Tissue Characterization in Coronary Artery Disease [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1325233054

    APA Style (7th edition)

  • Giri, Shivraman. Cardiovascular Magnetic Resonance Techniques for Myocardial Tissue Characterization in Coronary Artery Disease. 2012. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1325233054.

    MLA Style (8th edition)

  • Giri, Shivraman. "Cardiovascular Magnetic Resonance Techniques for Myocardial Tissue Characterization in Coronary Artery Disease." Doctoral dissertation, Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1325233054

    Chicago Manual of Style (17th edition)

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