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Eur J Cardiothorac Surg 2006;29:S158-S164
© 2006 Elsevier Science NL
Department of Diagnostic Radiology, Medical Physics, Hugstetterstr. 55, D-79106 Freiburg, University of Freiburg, Germany
Received 22 February 2006; accepted 27 February 2006.
* Corresponding author. Tel.: +49 761 270 7393; fax: +49 761 270 3831. (Email: bernd.jung{at}uniklinik-freiburg.de).
| Abstract |
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Key Words: Spatial myocardial fiber orientation Magnetic resonance imaging Tissue phase mapping Sequential heart motion Helical ventricular myocardial band Acceleration fiber tracking
| 1. Introduction |
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The heart primarily consists of muscle cells, which are bundled together in fibers. These muscle fibers are arranged anisotropically in the heart wall, shown with histologic cross-sections that demonstrate that fibers in subendocardial and subepicardial regions are oriented in opposed directions [5,6]. Subepicardial regions shorten along the direction of the fibers themselves, whereas subendocardial regions exhibit a significant component of shortening perpendicular to the fiber direction (cross-fiber shortening) [7,8]. The impact of the arrangement of the muscle fibers on these different fiber-shortening properties is not fully understood. Based on the helical ventricular myocardial band it is postulated that the arrangement of the muscle fibers are of a great importance for the function of the heart [9,10].
A non-invasive method to determine information on the structure of the muscle fibers in the human heart would therefore be of a great interest for the investigation of the relation between the heart wall motion and the geometry of the fibers. Information on the interaction of structure and function during the cardiac cycle in the normal heart may become a fundamental concept that underlies medical and surgical interventions aimed at correction of dysfunction produced by diseases, where abnormal cardiac mechanical contraction and electrical propagation is adversely changed.
Previously reported approaches for the extraction of information about the myocardial fiber structure in vivo consist of diffusion magnetic resonance imaging (MRI) using stimulated echoes [1113]. An intrinsic drawback of these techniques is the use of echo planar imaging for data acquisition. Susceptibility and motion artifacts often provide image quality not sufficient for the clinical routine. Furthermore, diffusion measurements are inherently motion sensitive, and may become adversely affected by breathing- and cardiac motion which is difficult to control due to the extremely high motion sensitivity of such techniques.
Nevertheless, MR imaging provides useful and reliable non-invasive tools for the investigation of myocardial function. Beside a subjective observation of the wall motion with cine imaging techniques, methods for the assessment of regional and global heart wall motion were introduced [14,15]. Established methods to quantify myocardial wall motion include tagging [16], phase contrast velocity mapping (tissue phase mapping, TPM) [17], and displacement encoding with stimulated echoes (DENSE) [18]. Of these, TPM provides high spatial resolution of the functional information (i.e. myocardial motion), which is limited in tagging by the number and density of the grid points. Furthermore, TPM provides time-resolved information compared to DENSE and a higher spatial resolution compared to the recently presented 2D-Cine-DENSE method [19].
To date, no attempts have been reported to derive information about the fiber structures of the ventricles from functional TPM datasets. Since muscle force acts along the fibers, the observed spatiotemporal myocardial velocity over the cardiac cycle is inherently related to the fiber structure. Exact reconstruction of the fiber orientation from functional measurements requires suitable mechanical modeling and knowing how intraventricular blood data influence force vectors in order to solve the inverse problem of extracting the orientation of force vectors (and thus the fibers) from the velocities as a result of these forces. This is beyond the scope of this paper, which describes a first approach using a direct application of tracking algorithms to acceleration vector fields derived from the time-resolved velocity fields of the whole left ventricle (LV) as measured by TPM with velocity encoding in all three dimensions.
| 2. Theoretical considerations |
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The observed ventricular wall motion velocities in each pixel will depend on separate forces: the actual force F loc of the muscle fiber within the pixel, the external force F ext, and the momentum M tot acquired as the result of the preceding motion (see Fig. 1a). F ext contains components from locations along the same fiber, which act in the same direction as F loc, but also resultant forces from all other fibers linked by the elasticity of the myocardial tissue. Additionally, resistive forces from the blood in the heart chamber have to be included. Based on the assumption that accelerations are more related to the development of force than the velocities, a tracking was performed using derived acceleration fields.
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However, there are four classical phases within the cardiac cycle that include isovolumetric contraction (IVC, before the aortic valve opens), ventricular ejection during mid-systole, isovolumetric relaxation (IVR) after ejection during early diastole, after which rapid ventricular filling occurs, and finally the diastolic interval where passive ventricular filling. These four time intervals are associated with the four cardiac motions of narrowing, shortening, lengthening, and widening. Of great interest, a sequence of clockwise and counterclockwise motions exists with variances between the basal and apical segments with a reciprocal twist of the heart as it undergoes through these phases of isovolumetric contraction, ejection, rapid filling and passive filling during diastole.
The purpose of this report is to link these motions to changes in fiber orientation suggested by the foregoing analysis of acceleration vector fields derived from the time-resolved velocity fields. This intervention may provide an early insight into how suggested spatial anatomic fiber orientation pathways derived from the helical ventricular myocardial band interact with non-invasive functional measurements made by TPM.
| 3. Materials and methods |
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TPM images were acquired with a gradient echo sequence as described previously [20,21] with a spatial resolution of 1.3 mm x 1.3 mm. Data were acquired in two volunteers with a breath-hold sequence and a respiratory-gated free-breathing sequence both with a temporal resolution of 64 ms. The full velocity information of the beating heart was obtained in 25 heartbeats within a single breath-hold measurement. Furthermore, a dataset was acquired with a respiratory-gated free-breathing measurement [22] with the same spatial but a higher temporal resolution of 13.8 ms. The whole LV was covered with nine gapless short-axis slices of 8 mm thickness from base to apex.
3.2 Postprocessing
Data postprocessing was performed on a personal computer using customized software programmed in Matlab (The Mathworks). After contour segmentation and a correction for translational motion components of the LV [20], the resulting velocity vector was calculated from the measured x-, y-, and z-velocity components. Subsequently, pixelwise myocardial acceleration vectors were calculated from the time-resolved velocity data by calculating discrete temporal derivatives. Tracking of acceleration fields was performed based on fiber tracking algorithms for diffusion tensor imaging of the brain [23] as proposed by Mori et al. [24]. In this implementation, two criteria define the existence of tracks. A track was terminated if the maximum angle deviation of the acceleration vectors between adjacent voxels exceeded 30°. In addition, a minimum length of 10 voxels along the track was required. The exclusion of the motion component normal to the ventricular wall (i.e. radial motion component) was performed by a projection of the velocity vector of each voxel onto the corresponding tangential wall segment which was calculated from the three dimensional (3D) segmentation mask. For tracking, data was interpolated in the long-axis direction to a doubled number of slices in this direction due to the low spatial resolution (8 mm slice thickness). The global track angle with respect to the circumferential plane (see Fig. 4, left) for all identified tracks in each slice was calculated. The tracking algorithm was applied for four different time frames within the cardiac cycle: (a) IVC, (b) mid-systole, (c) IVR, and (d) mid-diastole.
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| 4. Results |
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In general, due to the complex rotational motion behavior of the LV (see also Fig. 2f) the tracks change their orientation dependent on the time point during the cardiac cycle. Track angles therefore permit the quantitative description of local and global track orientation. The definition for the track angle orientation is shown in the schematic diagram on the left side (see also Fig. 5
). The mean angle of all identified acceleration tracks is given in the corner for the depicted cardiac frames. For illustration purposes only about 25% (
2500) of all randomly chosen identified tracks are depicted.
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| 5. Discussion |
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The parameterized data were improved by the use of a respiratory-gated free-breathing acquisition strategy and by track calculation without the motion component perpendicular to the myocardial wall leading to better coverage by the identified tracks. Results for measurements with free breathing compared to sequential breath-hold acquisition demonstrate consistent high quality of the respiratory gating approach, whereas breath-hold images suffer from data inconsistency due to imperfect repositioning between breath-holds. In terms of image processing the algorithms used are commonly applied to generate streamlines in fluid studies. Since the term streamlines implies transportation processes, which is clearly not applicable to tissue velocity data, the more appropriate term tracks was used in this work.
As shown in Fig. 4, it can be qualitatively visualized that the inclination of the tracks with respect to the circumferential plane changes in different cardiac frame and inside a cardiac frame dependent from the location (e.g. Fig. 4c). Although the tracks show an identical helicity in, for example, (a) and (c), the acceleration vectors show in opposite directions since the longitudinal and the rotational motion components have both different signs in (a) and (c) (see time courses in Fig. 2).
If the action exerted by the myocardial fibers themselves (F loc) is the dominant force, the measured velocity will be in good approximation point along the direction of the fibers and velocity vectors can be used to directly detect fiber orientation. However, this condition is never strictly met, but it is possible to use derived acceleration fields to improve the approximation to the local fiber force vector. Generally, tracking results may improve if fibers will have acted approximately coherently in the same overall direction before velocity changes as a result of altering forces occur (e.g. during mid-systole, see also Fig. 1). Although the measured velocity direction can be expected to somewhat deviate from the structural fiber orientation, it may be hypothesized that this is at least consistently related to structural fiber orientation. For interindividual comparison, it can thus be assumed that a more inclined acceleration vector with respect to the circumferential plane indicates a more diagonal arrangement of the fiber structure at equivalent time points in the ECG-cycle. Based on the hypothesis that a more diagonal arrangement of muscle fibers leads to a more efficient cardiac output, the track angle with respect to the circumferential plane could be an interesting parameter to investigate. Fig. 5 shows that the angle of the acceleration track can change dependent from the region in the LV (e.g. lower track angles near the apex and higher track angles towards the base for cardiac frame during IVR).
Note that the identified tracks do not necessarily correspond to the direction of existing anatomical muscle fibers. This is due to the complex motion of the heart wall which is characterized by an interaction between the local instant force and global forces such as the momentum of inertia. The aim of this heuristic parametrization is not primarily an exact biometric characterization of the structural fiber orientation, but rather the determination of surrogate parameters that are stable and reproducible. Such parameters might be useful for the characterization of the motion geometry during therapy treatment for the individual patient as well as for the diagnosis in the interindividual comparison.
An assessment of the extend to which the generated velocity fibers conform with the structural fiber orientation requires a comparison of our velocity-based evaluation with postmortem structural evaluation. For humans, such a comparison is clearly impossible, and hopefully large or small animal studies may be developed for demonstration of a biometric correspondence. The ratio of the pertinent forces F loc, F ext, and M tot can, however, not be expected to scale linearly with size and such a verification would thus have limited impact on human values. Verification by postmortem evaluation is possible but has to wait until such data can be acquired as a supplement to a study requiring the sacrifice of animals, which will be conducted in the future.
A fundamental limitation of deriving structural fiber information from dynamic velocity data is related to the fact that only net effects within each voxel are observed. For interwoven fiber pathways of different orientations, even sophisticated dynamic modeling can only detect the direction of the resultant force and will thus be unable to identify such criss-cross tissue types. The main purpose of our approach is not the exact assessment of the structural biomechanics, but to derive clinically useful surrogate parameters for further use in patient studies. In a first step, the biometric verification appears to be of secondary importance. For that, the primary aim will be to assess, whether derived surrogate parameters (fiber orientation, fiber length ...) provide useful parameters for clinical studies and/or improved understanding of ventricular performance. Further volunteer and patient investigations are necessary to perform a detailed analysis of the derived tracking data. In addition, a more detailed evaluation of different cardiac phases could provide more information on subregions of the ventricular wall and may resolve contributions of different muscle layers to the heart wall motion. This may help to elucidate and distinguish different models of cardiac structure such as the helical ventricular myocardial band.
This concept of a resultant force is implied by prior ultrasonic crystal measurements [25], whereby the crystals were placed into the angulation of the presumed functional units of the descending and ascending segments of the apical loop of the helical ventricular myocardial band. It would be of great interest for future studies to compare the direction of maximum shortening of ultrasonic crystal pairs with tracking results of velocity and acceleration fields obtained by TPM measurements.
For a better understanding of the function of the heart muscle, electro-mechanical heart models have been developed, which consider the electro-physiology of the cells, the electrical propagation in tissue and, the elasto-mechanical properties of the heart [26]. Different heart models have been presented including continuum-mechanical models [27], and discrete models that base on a spring-mass system [28]. These heart models simulate the cardiac wall motion considering the electrical propagation and the anisotropic mechanical properties of tissue, the viscosity of blood, and particularly the orientation of the myocardial fiber structure [29]. The application of such an electro-mechanical heart model to the motion describing TPM data could be used to verify the plausibility of the presented data-driven evaluation. Based on such a model, a calculation using simulated ideal fiber distribution could potentially determine if and how far the calculated motion pattern reflects the above hypothesis. In reverse, the model could be used to investigate if the motion describing vectors calculated with the velocity or acceleration tracks agree with the measured data.
| 6. Conclusion |
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| References |
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