Cardiovascular Magnetic Resonance (CMR) has established as a unique method in combining acquisition of morphological, functional and tissue characterization information in a single non-invasive examination.
Thanks to the possibility of combining multiparametric data acquisition and a
highly sophisticated, quantitative image analysis, CMR has now became the method of choice for the investigation of a large number of myocardial diseases.
However, the rapid development of more elaborate sequences determined an increasing complex mass of data that requires the implementation and a further development of more advanced image analysis software.
Current research trends in cardiovascular imaging are aimed to improve and refine techniques both on the quantitative analysis of tissue relaxivity, on the geometric mechanic distortions of the cardiac chambers over the cycle and the three-dimensional evaluation of the blood flows.
This requires today to move towards to an analysis in 4D environment and to combine the different parametric tissue characteristics in fusion maps.
The proposed software enables to perform tissue mapping, advanced analysis of myocardial contraction through feature tracking algorithm and evaluation of 4D flow dataset. Moreover, the recent development of artificial intelligence systems promises to provided new valuable diagnostic tools in post-processing and finding interpretation.
To maintain cutting – edge researches in the CMR field there is absolute need of these state-of-the-art features, which are currently lacking or only partially available on our MRI systems.
Tissue mapping pulse sequences are currently only available in one of our 1.5T scanner, while 4D flow sequences only as prototype on a 3T scanner with limited application.
Feature tracking technique is a analysis algorithm exploiting the information already present on the traditional ECG-gated cineMR images, widely available in all of our scanner.
Having these software tools available would allow us to collaborate on equal terms with the most modern research centers, with the possibility of being leaders in international studies with centralized data analysis.
The rise of artificial intelligence has yet to come, as extensive validation of algorithms in several different populations is needed before clinical application. In this context there are several ongoing multicentric studies that we could participate in, if we had advanced enough hardware and software.
With time, the absence of these techniques will become heavier and heavier, and will inevitably reflect on the attractiveness of our institution.
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CMR42
The cmr42 software produced by the Circle Cardiovascular is the best tool currently available on the market that enables to transform the CMR examination from simple morphological-functional acquisition to a real source of a large variety of qualitative and quantitative data. It allows in a few minutes to evaluate:
1) Functional analysis of left and right ventricles
° Easily detect wall motion abnormality. Autodisplay - powered by Deep Learning - of stroke volume, ejection fraction and end-diastolic and end-systolic volumes and masses.
° Short axis 3D (Full ventricular and atrial assessment; Fully automated Deep Learning based contour detection; Circle’s thresholding tool);
° Multiple Long Axis (Quick and highly reproducible LV assessment Semiautomatic contour detection Dynamic assessment of atrioventricular junction);
° Bi-Triplanar (LV and LA/RA assessment, Fully automated Deep Learning based contour detection, Semi-automatic LV contouring)
° Customizable segmentation, including the AHA
° Polar maps for wall thickness and wall movement analysis
° Tissue Tracking Module (2D and 3D global and regional LV/RV strain analysis, Calculation of radial, circumferential and longitudinal strain including strain rate, displacement, velocity and torsion and torsion rate)
2) Perfusion Analysis
° Qualitative and semi-quantitative analysis
° Contour identification and automatic registration
° Graphic visualization of the SI (AHA and other models)
° View rest and stress images next to scar and wall motion
° Semi-quantitative analysis
° Polar map display of perfusion parameters including MPRI
3) Tissue Characterization
Assessment of myocardial perfusion, scar, edema, MVO, ECV and Iron concentration.
° Early and late enhancement and T2 weighted imaging
Semi-automatic, regional and global scar, edema and MVO analysis
° Global and regional T1 & T2 maping analysis
Motion correction and registration
T1, T2 and ECV map generation with customizable color tables
Contour identification
° T2* MAPPING
Global and regional T2* analysis
T2* color overlay Reporting of iron content
4) Flow Analysis
° Quantify flow, automatically calculate QP:QS and correct for aliasing,
° 2D Flow: Full flow analysis including volumes, regurgitation fraction, velocities, gradients, etc; Semi-automatic contour detection; Offset correction and antialiasing; Flow comparisons and Qp/Qs calculation
° 4D Flow:
- Pre-Processing
Ability to crop large data sets to a region of interest for faster processing
Customizable offset correction and phase unwrapping
Comprehensive 4D viewer to preview flow dynamics
- Segmentation
Fully automated PC-MRA calculation
Advanced vessel segmentation based on signal intensity thresholds
Semi-automatic centerline extraction for multiple structures
Export volume as STL file
- Analysis
Diverse flow visualization options (velocity, vectors, pathlines and streamlines)
Multiple and flexible planes of analysis
Centerline based and free-plane navigation
Automated vessel lumen detection and planar flow measurement including net flow, peak velocities and regurgitation
- Advanced Clinical Tools
Energy loss calculation and visualization
Visualization and calculation of direct, residual, delayed and retained ventricular flow components
- Advanced Research Tools
Advanced research tools are for research purposes only.
Calculation of Pulse Wave Velocity
Relative Pressure Mapping
Circumferential and axial Wall Shear Stress in 2D and global Wall Shear Sress in 3D
5) Module for 3D / 4D Anatomical Visualization
° Visualization of 4D cine animation of multi-phase 3D data
° Customizable tables for color coding
The cmr42 software also allows the import of DICOM images from all sources.