Imaging - Cardiovascular MRI Core

Background

Non-invasive cardiovascular imaging includes echocardiography, nuclear cardiac imaging (myocardial perfusion and positron emission tomography), computed tomography and cardiovascular magnetic resonance (CMR). In the assessment of cardiac volumes, function and mass, CMR is widely accepted as the gold standard. Moreover, it is unique in its ability to characterize the myocardium using conventional and novel imaging sequences. CMR does not involve radiation and the use of gadolinium contrast for tissue characterization is very safe. These are strengths that have expanded the clinical and research applications of CMR.

The Imaging Core at NHRIS has a specialized and dedicated team of CMR physicist, post-doctorate radiographer, engineers, research fellows and clinician scientists. NHRIS houses two CMR (3T Philips Ingenia and 1.5T Siemens Aera) to meet the increasing research and clinical demands.

Expertise

The Imaging Core laboratory is well-suited in the analysis of the cardiovascular system:

1. Cardiac ventricular volumes, function, wall thickness, myocardial perfusion and tissue characterization (late gadolinium enhancement and T1/T2/T2* mapping techniques)
2. Assessment of arterial stiffness (pulse wave velocity)
3. Complex 3D atlas modeling
4. Myocardial strain assessment using feature tracking

Methodology

Image analysis in the Corelab is performed by experienced and trained analysts according to standardized protocols. Analysis methodologies are validated and tested for variability. The Corelab uses a standardized commercially available image analysis package (CMR42, Circle Cardiovascular Imaging).

Research Area

The current studies supported by the Imaging Core:

1. NHRIS Biobank Project (healthy volunteers and inherited cardiomyopathies)

   Healthy volunteers are carefully phenotyped using state-of-the-art CMR; and blood samples (serum and DNA) are stored and analyzed for normal genetic variants in the local/Asian population. Individuals with inherited cardiomyopathies (hypertrophic cardiomyopathy and dilated cardiomyopathy) are scanned using a standardized protocol as part of a larger multi-center collaboration with prominent international CMR centers.

2. REMODEL Hypertension study

   The REMODEL (Response of the myocardium to hypertrophic conditions in the adult population) is a prospective observational study that aims to investigate the determinants of myocardial fibrosis in patients with hypertensive heart disease.

3. Exercise CMR study

   We have recently developed and optimized an exercise CMR protocol using an in-scanner supine ergometer. Using this protocol, we could assess exercise capacities, wall motion abnormalities and perfusion defects.

Achievements

Publications

1. Chin CW, Semple S, Malley T, White AC, Mirsadraee S, Weale PJ, Prasad S, Newby DE, Dweck MR. Optimization and comparison of myocardial T1 techniques at 3T in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging. 2014;15(5):556-65.
2. Chin CW, Chin CY, Ng M, Le TT, Huang FQ, Fong KY, Thumboo J, Tan RS. Endothelial function is associated with myocardial diastolic function in women with systemic lupus erythematosus. Rheumatol Int. 2014;34(9):1281-1285.
3. Chin CW, Khaw HJ, Luo E, Tan SW, White AC, Newby DE, Dweck MR. Echocardiography underestimates stroke volume and aortic valve area: implications for the classification of patients with small-area low-gradient aortic stenosis. Can J Cardiol. 2014;30(9):1064-1072.
4. Chin CW, Messika-Zeitoun D, Shah ASV, Lefevre G, Bailleul S, Yeung ENW, Koo M, Mathieu T, Semple SI, Mills NL, Vahanian A, Newby DE, Dweck MR. A clinical risk score of myocardial fibrosis predicts adverse outcomes in aortic stenosis. Eur Heart J. 2016;37:713-723.
5. Le TT, Tan RS, De Deyn M, Goh E, Han Y, Leong B, Cook SA, Chin CW. Cardiovascular magnetic resonance assessment of the heart and aorta in Chinese at 3T. J Cardiovasc Magn Reson. 2016;18(1):21.
6. Chin CY, Chin CW, Chiam P, Tan RS. Chest pain with a blue hand – simultaneous coronary and left subclavian artery thrombosis. AsiaIntervention. 2016.