Oxygenation-sensitive cardiovascular magnetic resonance

Matthias G Friedrich, Theodoros D Karamitsos, Matthias G Friedrich, Theodoros D Karamitsos

Abstract

Oxygenation-sensitive cardiovascular magnetic resonance (CMR) is a non-contrast technique that allows the non-invasive assessment of myocardial oxygenation. It capitalizes on the fact that deoxygenated hemoglobin in blood can act as an intrinsic contrast agent, changing proton signals in a fashion that can be imaged to reflect the level of blood oxygenation. Increases in O(2) saturation increase the BOLD imaging signal (T2 or T2*), whereas decreases diminish it. This review presents the basic concepts and limitations of the BOLD technique, and summarizes the preclinical and clinical studies in the assessment of myocardial oxygenation with a focus on recent advances. Finally, it provides future directions and a brief look at emerging techniques of this evolving CMR field.

Figures

Figure 1
Figure 1
Relationship between oxygenation and T2* (from [[18]]).
Figure 2
Figure 2
Correlation of changes of myocardial oxygenation during Adenosine infusion with blood flow and coronary sinus oxygenation. Note the exponential relationship between flow and signal intensity as opposed to the linear relationship with changes of coronary sinus blood oxygenation, showing that signal intensity changes reflect changes of oxygen and not blood flow (modified from [19].
Figure 3
Figure 3
Parametric maps obtained with a quantitative BOLD approach by using a multiecho gradient-echo and spin-echo echo-planar imaging method in a healthy subject (A) and a patient with stroke (B). High oxygen-extraction fraction (OEF) can be observed in the affected region of the patient with stroke (white arrow). This method holds promise to evaluate the brain oxygenation status in a rapid fashion, which is critical in the acute stroke work-up (from [27]).
Figure 4
Figure 4
Oxygenation-sensitive imaging in coronary artery disease: Note the regional abnormality reflecting a lack of signal intensity change in a coronary territory subtended by a stenotic artery (from [[32]]).
Figure 5
Figure 5
Rest and Stress BOLD Images With Corresponding Subtraction Images. (A) The BOLD CMR images at rest and during adenosine stress together with the corresponding subtraction image and its parametric color map. A stress-induced signal loss in the anterior myocardial segment can be seen (white arrows). (B) Bull’s eye plot of the complete 3-dimensional data set of subtracted BOLD images showing a stress-inducible signal loss in the anterior segments. The color scale indicates the transmurality of the stress-induced signal loss (0 = no signal loss, 1 = 1% to 25%, 2 = 26% to 50%, 3 = 51% to 75%, 4 = 76% to 100% transmurality). BOLD = blood oxygen level–dependent; CMR = cardiovascular magnetic resonance; ΔSI = relative signal intensity changes of blood oxygen level–dependent cardiovascular magnetic resonance (from [36]).
Figure 6
Figure 6
Single-session CMR examination that allows a comprehensive evaluation of oxygenation and contrast-enhanced first pass perfusion imaging at rest and during adenosine stress. Standard parts of the protocol are cine imaging and late gadolinium enhancement CMR. Thrombus and flow imaging are optional components of the protocol. The total duration of the protocol is <60min. BOLD, blood-oxygen level-dependent; CMR, cardiovascular magnetic resonance; SA, short-axis.
Figure 7
Figure 7
An example of the effect of shimming (correction of inhomogeneities in the magnetic field) in BOLD images. The image on the left is acquired before shimming and shows significant artifacts in the septum, the anterior wall, and the blood pool. After shimming adjustments (right image), image quality is significantly improved. From [32].
Figure 8
Figure 8
Oxygenation changes throughout the cardiac cycle as assessed by CMR during apnea in the blood (left) and the myocardium (right). While the signal intensity in the blood drops in the blood (de-oxygenation), it increases in the myocardium due to increased myocardial blood flow. Measurements were performed in the same images (modified from [23].

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