Compartmentalized MR Spectroscopy for improved accuracy of cardiac energy metabolism assessment

Investigators: Ladislav Valkovič, Iveta Pajanová

Cardiac energy metabolism is still rather dependent on the experience of the operator, both at the acquisition and analysis stages. Mainly because any shift in the acquisition matrix or wrong voxel selection increase inaccuracy, which is one of the reasons why this promising technique is not yet used in clinical practice. Therefore, we have implemented reconstruction technique SLAM, which uses image segmentation to improve measurement accuracy. We have demonstrated that SLAM reconstruction is fully independent on the matrix position and if the segmentation is correct also on the analyst. Segmentation could also be automated, which is something we will investigate in the future. In addition, SLAM have increased signal-to-noise ratio and fitting confidence, which makes it a very appealing for future implementation of energy metabolism measurement in the clinic.

The importance of energetics assessment was demonstrated in a separate clinical study involving 41 patients with type II diabetes, where liraglutide treatment led to improved energetics, myocardial perfusion and general well being of the patients.

Fig. 1: Each panel shows how the reconstructed PCr/ATP ratios for each method varies as the data are shifted in the y-direction. The mean PCr/ATP of each shifted dataset is shown above the corresponding box, and the points corresponding to a single scan are joined by gray lines. The SLAM reconstruction not matching the shifted cardiac data (B) already shows markedly less change in the PCr/ATP ratio than the FT-MRS reconstruction (A). The SLAM compensated method (C), i.e. when the segmentation is correct as shown bottom left, demonstrates that the SLAM method is insensitive to the acquisition matrix position.

Projects: APVV-21-0299, VEGA 2/0004/23

Foreign partner: Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Headington, Oxford, UK

Publications 2024:   

  • TYLER, A. – HUNDERTMARK, M.J. – MILLER, J.J. – RIDER, O. – TYLER, D.J. – VALKOVIČ, Ladislav. Compartment-based reconstruction of acquisition-weighted 31P cardiac MRSI reduces sensitivity to cardiac motion and scan planning. In Frontiers in Physiology, 2024, vol. 14, art. no. 1325458. ISSN 1664-042X. (3.2 – IF2023) Q2
  • AXFORD, A. – PAJANOVÁ, Iveta – WATSON, W.D. – TYLER, A. – XAVIER, R. – MÓZES, F.E. – RIDER, O.J. – TYLER, D.J. – VALKOVIČ, Ladislav. Measurement of creatine-kinase (CK) reaction rates in the human heart using compartmentalized 31P MRS at 3 T. In Magnetic Resonance Materials in Physics, Biology and Medicine: Book of Abstracts ESMRMB 2024 Online 40th Annual Scientific Meeting, 2024, vol. 37, p. S352. ISSN 0968-5243
  • CHOWDHARY, A. – THIRUNAVUKARASU, S. – JOSEPH, T. – JEX, N. – KOTHA, S. – GIANNOUDI, M. – PROCTER, H. – CASH, L. – AKKAYA, S. – BROADBENT, D. – XUE, H. – SWOBODA, P. – VALKOVIČ, Ladislav – KELLMAN, P. – PLEIN, S. – RIDER, O.J. – NEUBAUER, S. – GREENWOOD, J.P. – LEVELT, E. Liraglutide improves myocardial perfusion and energetics and exercise tolerance in patients with type 2 diabetes. In Journal of the American College of Cardiology, 2024, vol. 84, no. 6, p. 540-557. ISSN 0735-1097. (21.7 – IF2023) Q1
  • SMISETH, O.A. – RIDER, O.- CVIJIC, M. – VALKOVIČ, Ladislav – REMME, E.W. – VOIGT, J.-U. Myocardial strain imaging: : Theory, Current Practice, and the Future In JACC : Cardiovascular Imaging, 2024. ISSN 1936-878X. (12.8 – IF2023) Q1