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  • 1.
    Ahlander, Britt-Marie
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Magnetic Resonance Imaging of the Heart: Image quality, measurement accuracy and patient experience2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Non-invasive diagnostic imaging of atherosclerotic coronary artery disease (CAD) is frequently carried out with cardiovascular magnetic resonance imaging (CMR) or myocardial perfusion single photon emission computed tomography (MPS). CMR is the gold standard for the evaluation of scar after myocardial infarction and MPS the clinical gold standard for ischemia. Magnetic Resonance Imaging (MRI) is at times difficult for patients and may induce anxiety while patient experience of MPS is largely unknown.

    Aims: To evaluate image quality in CMR with respect to the sequences employed, the influence of atrial fibrillation, myocardial perfusion and the impact of patient information. Further, to study patient experience in relation to MRI with the goal of improving the care of these patients.

    Method: Four study designs have been used. In paper I, experimental cross-over, paper (II) experimental controlled clinical trial, paper (III) psychometric crosssectional study and paper (IV) prospective intervention study. A total of 475 patients ≥ 18 years with primarily cardiac problems (I-IV) except for those referred for MRI of the spine (III) were included in the four studies.

    Result: In patients (n=20) with atrial fibrillation, a single shot steady state free precession (SS-SSFP) sequence showed significantly better image quality than the standard segmented inversion recovery fast gradient echo (IR-FGRE) sequence (I). In first-pass perfusion imaging the gradient echo-echo planar imaging sequence (GREEPI) (n=30) had lower signal-to-noise and contrast–to-noise ratios than the steady state free precession sequence (SSFP) (n=30) but displayed a higher correlation with the MPS results, evaluated both qualitatively and quantitatively (II). The MRIAnxiety Questionnaire (MRI-AQ) was validated on patients, referred for MRI of either the spine (n=193) or the heart (n=54). The final instrument had 15 items divided in two factors regarding Anxiety and Relaxation. The instrument was found to have satisfactory psychometric properties (III). Patients who prior CMR viewed an information video scored significantly (lower) better in the factor Relaxation, than those who received standard information. Patients who underwent MPS scored lower on both factors, Anxiety and Relaxation. The extra video information had no effect on CMR image quality (IV).

    Conclusion: Single shot imaging in atrial fibrillation produced images with less artefact than a segmented sequence. In first-pass perfusion imaging, the sequence GRE-EPI was superior to SSFP. A questionnaire depicting anxiety during MRI showed that video information prior to imaging helped patients relax but did not result in an improvement in image quality.

  • 2.
    Ahlander, Britt-Marie
    Örebro universitet, Hälsoakademin.
    Promising use of Contrast Enhanced Magnetic Resonance Imaging for the detection of ischemia and viability- a comparison with Myocardial Perfusion Scintigraphy2009Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 3.
    Ahlander, Britt-Marie
    et al.
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Radiology, Ryhov County Hospital, Jönköping, Sweden.
    Arestedt, Kristofer
    Center for Collaborative Palliative Care, Linnaeus University, Kalmar, Sweden.
    Maret, Eva
    Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden; Department of Radiology, Ryhov County Hospital, Jönköping, Sweden.
    Engvall, Jan E.
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Center of Image Science and Visualization, Linköping University, Linköping, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Development and validation of a questionnaire evaluating patient anxiety during Magnetic Resonance Imaging: the Magnetic Resonance Imaging-Anxiety Questionnaire (MRI-AQ)2016Ingår i: 19th Annual SCMR Scientific Sessio: Meeting abstracts, BioMed Central, 2016, Vol. 18 S1, artikel-id P312Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: MR examinations of the heart are sometimes negatively affected by anxiety that could have been detected by the pre-scan administration of a suitable questionnaire and psychological support given. To better understand patient experience during the examination and to evaluate psychological intervention, use of general anxiety scales is unsuitable and an MR-specific questionnaire was developed.

    Methods: A new questionnaire, MRI-AQ, was designed from patient expressions of anxiety in MRI-scanners. The patient sample was recruited between October 2012 and October 2014. Factor structure was evaluated with exploratory factor analysis and internal consistency with Cronbach’s alpha. Criterion-related validity, known-group validity and test-retest was evaluated. The new instrument was compared with the Spielberg State Anxiety Index (STAI), the Hospital Anxiety and Depression Scale (HAD), and with nine statements from the Fear Survey Schedule developed by Lukins et al.

    Results: In total, 247 participants (54.7 ± 14.3 years), referred for MRI examinations of either the spine or the heart, accepted to participate in the study. The development and validation of MRI-AQ resulted in 15 items which could be used as an overall global score or as two sub scale scores. Cronbach’s alpha was found to be high (a = 0.90). MRI-AQ correlated higher with instruments measuring anxiety than with depression scales. Known-group validity demonstrated a higher level of anxiety for patients undergoing MRI scan of the heart than for those examining the spine (p < 0.01). Test-retest reliability demonstrated acceptable level for the scale (ICC = 0.90; CCC = 0.90). Conclusions: MRI-AQ bridges a gap among existing questionnaires, making it a simple and useful tool for measuring patient anxiety during MRI examinations.

  • 4.
    Ahlander, Britt-Marie
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Engvall, Jan
    Linköping University, Linköping, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Anxiety during Magnetic Resonance Imaging of the spine in relation to scanner design and size.2019Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background

    Magnetic resonance imaging in closed-bore scanners is at times anxiety-ridden. Open scanners are easier to tolerate. Manufacturers are working towards making the bores wider and shorter.

    Aim

    To compare patient anxiety in closed-bore scanners with bore diameters of 62cm and 70 cm compared to that of open design scanners.

    Method

    Consecutive patients referred for examination of the spine in 62 cm and 70 cm scanners and one open design were asked to participate. Most of those who were scheduled for examination in the open scanner, was it due to problems with closed bores. For anxiety evaluation, four questionnaires were used:

     Before the examination: Spielberger State and Trait anxiety – state (STAI-S) [1]. Hospital Anxiety and Depression scale, Anxiety (HAD-A) and depression (HAD-D) [2], The Magnetic Resonance Imaging- Fear survey schedule (MRI-FSS) [3].  

    Directly after the examination: The Magnetic Resonance Imaging- Anxiety Questionnaire (MRI-AQ) consisting of two factors anxiety and relaxation [4], STAI-S, patients also ranged their level of worry and experience.

    One week after the examination: MRI-AQ, HAD, MRI-FSS

    Result

    155 patients responded to the questionnaires before and immediately after the examination. 109 responded also one week after. Patients in the open scanner rated higher levels of anxiety (<0.001) before, directly after and one week after the examination, compared to closed bore scanners. No difference was found in the patient scores between the 62 cm and the 70 cm scanners on the examination day. At follow-up, patients in the 62 cm bore rated their examination experience lower (<0.05), compared to patients in the 70 cm bore.

    Conclusion

    In conclusion patient experience of the examination was similar in the 62 cm and 70 cm bores immediately after the examination. However, patient recall of the examination was more pleasant for those examined in the 70 cm bore scanner.

    MRI in an open scanner may be the only way for patients with anxiety problems to endure an examination. If open scanners are unavailable, different interventions are needed to enable these patients to undergo an examination. Patient anxiety in connection with MRI is a challenge for the radiographers necessitating constant improvements in technology and interventions.

     

    1.         Spielberger CD, Goursch, R.L., Lushene, R.E.: Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologist Press 1970.

    2.         Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983, 67(6):361-370.

    3.         Lukins R, Davan IGP, Drummond PD: A cognitive behavioural approach to preventing anxiety during magnetic resonance imaging. Journal of behavior therapy and experimental psychiatry 1997, 28(2):97-104.

    4.         Ahlander BM, Arestedt K, Engvall J, Maret E, Ericsson E: Development and validation of a questionnaire evaluating patient anxiety during Magnetic Resonance Imaging: the Magnetic Resonance Imaging-Anxiety Questionnaire (MRI-AQ). J Adv Nurs 2016, 72(6):1368-1380.

  • 5.
    Ahlander, Britt-Marie
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Ryhov County Hospital, Jönköping, Sweden.
    Engvall, Jan
    Department of Clinical Physiology, Linköping University, Linköping, Sweden; Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Anxiety during magnetic resonance imaging of the spine in relation to scanner design and size2019Ingår i: Radiography, ISSN 1078-8174, E-ISSN 1532-2831Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Magnetic resonance imaging in closed-bore scanners sometimes provokes anxiety but closed-bore designs have gradually become wider and shorter. Open scanners may be easier to tolerate. The aim was to compare patient anxiety during MRI between bore diameters of 60 cm and 70 cm, and to determine the current level of patient anxiety and experience in open scanners in a clinical setrting.

    Methods: Consecutive patients referred for examination of the spine in 60 cm and 70 cm bores and one open scanner participated. Four established/validated questionnaires, answered before, directly after (N = 155) and one week after (N = 109) the MRI-examination were used, measuring anxiety, fear and depression.

    Results: No difference was found in the patient scores of anxiety between the 60 cm and the 70 cm scanners on the examination day. At follow-up, patients in the 70 cm bore rated their examination experience better (p < 0.025), compared to patients in the 60 cm bore. Patients in the open scanner rated higher levels of anxiety (p < 0.001) before, directly after and one week after the examination, compared to the closed bore scanners.

    Conclusion: Scanners with a 70 cm diameter bore seem more tolerable than those with a 60 cm bore. Patients referred to the open scanner had on average a higher tendency to express anxiety. Still, patient anxiety in MRI is challenging and further research required.

    Implications for practice: Patients prefer to be examined in 70 cm bore scanners compared with 60 cm. If open scanners aren't available extended support may be necessary for the most anxious patients.

  • 6.
    Ahlander, Britt-Marie
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Engvall, Jan
    Department of Clinical Physiology, Linköping University, Linköping, Sweden; Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
    Maret, Eva
    Department of Clinical Physiology, Karolinska Institute, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Positive effect on patient experience of video information given prior to cardiovascular magnetic resonance imaging: A clinical trial2018Konferensbidrag (Refereegranskat)
  • 7.
    Ahlander, Britt-Marie
    et al.
    Department of Radiology, Ryhov County Hosptial, Jönköping, Sweden.
    Engvall, Jan
    Department of Clinical Physiology, Linköping University, Linköping, Sweden; Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
    Maret, Eva
    Department of Clinical Physiology, Karolinska Institutet, stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Positive effect on patient experience of video-information given prior to cardiovascular magnetic resonance imaging, a clinical trial2018Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, nr 5-6, s. 1250-1261Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectives: To evaluate the effect of video information given before cardiovascular magnetic resonance imaging on patient anxiety and to compare patient experiences of cardiovascular magnetic resonance imaging versus myocardial perfusion scintigraphy. To evaluate whether additional information has an impact on motion artefacts.

    Background: Cardiovascular magnetic resonance imaging and myocardial perfusion scintigraphy are technically advanced methods for the evaluation of heart diseases. Although cardiovascular magnetic resonance imaging is considered to be painless, patients may experience anxiety due to the closed environment.

    Design: A prospective randomised intervention study, not registered.

    Methods: The sample (n = 148) consisted of 97 patients referred for cardiovascular magnetic resonance imaging, randomised to receive either video information in addition to standard text-information (CMR-video/n = 49) or standard text-information alone (CMR-standard/n = 48). A third group undergoing myocardial perfusion scintigraphy (n = 51) was compared with the cardiovascular magnetic resonance imaging-standard group. Anxiety was evaluated before, immediately after the procedure and 1 week later. Five questionnaires were used: Cardiac Anxiety Questionnaire, State-Trait Anxiety Inventory, Hospital Anxiety and Depression scale, MRI Fear Survey Schedule and the MRI-Anxiety Questionnaire. Motion artefacts were evaluated by three observers, blinded to the information given. Data were collected between April 2015–April 2016. The study followed the CONSORT guidelines.

    Result: The CMR-video group scored lower (better) than the cardiovascular magnetic resonance imaging-standard group in the factor Relaxation (p =.039) but not in the factor Anxiety. Anxiety levels were lower during scintigraphic examinations compared to the CMR-standard group (p <.001). No difference was found regarding motion artefacts between CMR-video and CMR-standard.

    Conclusion: Patient ability to relax during cardiovascular magnetic resonance imaging increased by adding video information prior the exam, which is important in relation to perceived quality in nursing. No effect was seen on motion artefacts.

    Relevance to clinical practice: Video information prior to examinations can be an easy and time effective method to help patients cooperate in imaging procedures.

  • 8.
    Ahlander, Britt-Marie
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Maret, Eva
    Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Engvall, Jan
    Department of Clinical Physiology, Linköping University, Linköping, Sweden; Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
    Magnetkameraundersökning av hjärtat2014Konferensbidrag (Övrigt vetenskapligt)
  • 9.
    Ahlander, Britt-Marie
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Röntgenavdelningen, Ryhov, Jönköping.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Maret, Eva
    Department of Clinical Physiology, Karolinska Institute, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Engvall, Jan
    Department of Clinical Physiology, Linköping University Hospital, Linköping, Sweden; Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
    Magnetkameraundersökning av hjärtat: bildkvalitet, mätnoggrannhet och patientupplevelse2017Konferensbidrag (Refereegranskat)
    Abstract [sv]

    Syfte:

    Att utvärdera bildkvaliteten vid magnetkamera undersökning av hjärtat (hjärt-MR) genom val av sekvens vid undersökning av infarktutbredning hos patienter med förmaksflimmer och vid studie av hjärtmuskelns genomblödning, samt eventuell inverkan av given information.

    Att studera patientens upplevelse vid hjärt-MR med målet att kunna förbättre patientupplevelsenoch bildkvaliteten.

    Material och metoder:

    På 20 patienter med förmaksflimmer och genomgången hjärtinfarkt har två viabilitetssekvenser jämförts, en segmenterad (bilden samlas in under flera hjärtslag) och en single shot (bilden samlas in under ett hjärtslag).

    På 60 patienter remitterade för hjärtscintigrafi gjordes även hjärt-MR. Perfusionssekvenser utfördes under Adenosine-stress. Två olika sekvenser användes, SSFP och GRE-EPI. Undersökningarna har utvärderats både visuellt och semi-kvantitativt med hjärtscintigrafi som referensmetod.

    Med resultatet från en studie av Erna Törnqvist et al (2006), har ett skattningsinstrument konstruerats, Magnetic Resonance Imaging - Anxiety Questionnaire (MRI-QA). För validering har 247 patienter remitterade för MR-undersökning av rygg (n=193) och hjärta (n=54) besvarat frågorna.

    På två grupper av patienter remitterade för hjärt-MR har informationens betydelse utvärderats. En grupp erhöll video information (n=49) och en standard information (n=48). Likaså utvärderades informationens betydelse för bildkvaliteten.

    Resultat:

    Single shot sekvensen hade bättre bildkvalitet än den segmenterade. Hjärtinfarktens utbredning överensstämde mellan de båda sekvenserna.

    Trots att SSFP sekvensen hade bättre signal brus och kontrast brus förhållande överensstämde GREEPI sekvensen bäst med myokardscintigrafin både vid visuell och vid semi-kvantitativ bedömning.

    MRI-AQ resulterade i 15 påståenden. Det består av två faktorer, en som mäter ångest (12 påståenden) och en som mäter avslappning (tre påståenden). Det har psykometriska förutsättningar att kunna värdera patienters upplevelse av MR-undersökning.

    Patienter som fick utökad information i form av en film var signifikant mer avslappnade under undersökningen än patienter som fick standardinformation. Däremot påverkade inte den utökade informationen bildkvaliteten.

    Konklusion:

    Vid undersökning av infarktstorleken hos patienter med förmaksflimmer hade single shot sekvensen högre bildkvalitet än den segmenterade sekvensen.

    Vid bedömning av ischemi överensstämde hjärt-MR bättre med myokardscintigrafin om GRE-EPI sekvensen användes jämfört med SSFP sekvensen. Detta gällde både vid visuell och semi-kvantitativ bedömning.

    MRI-AQ bedöms som ett tillförlitligt instrument att använda för att utvärdera effekter av intervention vid MR-undersökning.

    Utökad information med video gör patienten mer avslappnad i undersökningssituationen men har ingen påverkan på bildkvaliteten.

  • 10.
    Ahlander, Britt-Marie
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Jönköping County Hospital, Jönköping, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Maret, Eva
    Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
    Engvall, Jan
    Linköping University, Linköping, Sweden.
    Video information prior to cardiovascular magnetic resonance imaging improves patient experience which still remains more challenging than in myocardial perfusion scintigraphy2017Ingår i: Abstract Proceedings from the 20th Annual SCMR Scientific Sessions, Society for Cardiovascular Magnetic Resonance (SCMR) , 2017Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: Cardiovascular magnetic resonance imaging (CMR) and myocardial perfusion scintigraphy (MPS) are two technically advanced methods for imaging cardiac diseases. Although CMR is considered to be painless, considerable patient cooperation is necessary during scanning. Some patients may experience anxiety because of the closed environment of the procedure.

    The aims of this paper were to evaluate the potential effect on patient anxiety and on motion artefacts by adding a 5 min video sequence to the standard written information given before CMR. Additionally, the patient experience of CMR was compared to that of MPS.

    Methods: The sample (n=146) consisted of 97 patients randomized to receive either video information in addition to standard written information (CMR-video/n=49) or standard written information alone (CMR-standard/n=48). A third group undergoing MPS (n=51) was used to compare CMR-standard and MPS. Anxiety was evaluated before, immediately after the procedure and one week later. Four questionnaires were used: State-Trait-Anxiety Inventory, Hospital-Anxiety and Depression-scale, MRI-Fear-Survey-Schedule and the MRI-Anxiety-Questionnaire (MRI-AQ). Motion artefacts were evaluated by three observers, blinded to the information given. Motion artefacts due to arrhythmia were not considered.

    Results: Measured with MRI-AQ, the CMR-video and the CMR-standard groups did not score significantly different on the factor Anxiety. However, CMR-video scored lower (=better) in the factor Relaxation (p=0.039). Younger patients and women scored a higher level of anxiety in most scales. Anxiety levels (MRI-AQ) were lower during MPS examinations compared to the CMRstandard group (p < 0.001 ). The presence of motion artefacts was similar in the CMR-video compared to the CMR-standard group.

    Conclusions: Patient ability to relax during CMR increased by adding video information prior to the exam. This positive effect on patient experience is important to enable technologists to obtain full patient cooperation. An apparent lack of effect on motion artefact could possibly be due to the addition of compensatory extra scans when a low image quality was recognized by the technologists.

  • 11.
    Ahlander, Britt-Marie
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Radiology, Ryhov County Hospital, Jönköping, Sweden.
    Maret, Eva
    Department of Radiology, Ryhov County Hospital, Jönköping, Sweden; Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
    Brudin, Lars
    Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden.
    Starck, Sven-Ake
    Department of Natural Science and Biomedicine, School of Health Sciences, Jönköping University, Jönköping, Sweden; Department of Oncology, Hospital Physics, Ryhov County Hospital, Jönköping, Sweden.
    Engvall, Jan
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Clinical Physiology, County Council of Östergötland, Linköping, Sweden; Center of Medical Image Science and Visualisation, Linköping University, Linköping, Sweden.
    An echo-planar imaging sequence is superior to a steady-state free precession sequence for visual as well as quantitative assessment of cardiac magnetic resonance stress perfusion2017Ingår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 37, nr 1, s. 52-61Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: To assess myocardial perfusion, steady-state free precession cardiac magnetic resonance (SSFP, CMR) was compared with gradient-echo-echo-planar imaging (GRE-EPI) using myocardial perfusion scintigraphy (MPS) as reference.

    METHODS: Cardiac magnetic resonance perfusion was recorded in 30 patients with SSFP and in another 30 patients with GRE-EPI. Timing and extent of inflow delay to the myocardium was visually assessed. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated. Myocardial scar was visualized with a phase-sensitive inversion recovery sequence (PSIR). All scar positive segments were considered pathologic. In MPS, stress and rest images were used as in clinical reporting. The CMR contrast wash-in slope was calculated and compared with the stress score from the MPS examination. CMR scar, CMR perfusion and MPS were assessed separately by one expert for each method who was blinded to other aspects of the study.

    RESULTS: Visual assessment of CMR had a sensitivity for the detection of an abnormal MPS at 78% (SSFP) versus 91% (GRE-EPI) and a specificity of 58% (SSFP) versus 84% (GRE-EPI). Kappa statistics for SSFP and MPS was 0·29, for GRE-EPI and MPS 0·72. The ANOVA of CMR perfusion slopes for all segments versus MPS score (four levels based on MPS) had correlation r = 0·64 (SSFP) and r = 0·96 (GRE-EPI). SNR was for normal segments 35·63 ± 11·80 (SSFP) and 17·98 ± 8·31 (GRE-EPI), while CNR was 28·79 ± 10·43 (SSFP) and 13·06 ± 7·61 (GRE-EPI).

    CONCLUSION: GRE-EPI displayed higher agreement with the MPS results than SSFP despite significantly lower signal intensity, SNR and CNR.

  • 12.
    Ahlander, Britt-Marie
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Radiology, Ryhov County Hospital, Jönköping, Sweden.
    Årestedt, Kristofer
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden; Center for Collaborative Palliative Care, Linnaeus University, Kalmar, Sweden.
    Engvall, Jan
    Department of Clinical Physiology, Linköping University, Linköping, Sweden; Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
    Maret, Eva
    Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Development and validation of a questionnaire evaluating patient anxiety during Magnetic Resonance Imaging: the Magnetic Resonance Imaging- Anxiety Questionnaire (MRI-AQ)2016Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, nr 6, s. 1368-1380Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To develop and validate a new instrument measuring patient anxiety during Magnetic Resonance Imaging examinations, Magnetic Resonance Imaging-Anxiety Questionnaire.

    Background: Questionnaires measuring patients’ anxiety during Magnetic Resonance Imaging examinations have been the same as used in a wide range of conditions. To learn about patients’ experience during examination and to evaluate interventions, a specific questionnaire measuring patient anxiety during Magnetic Resonance Imaging is needed.

    Design: Psychometric cross-sectional study with test-retest design.

    Methods: A new questionnaire, Magnetic Resonance Imaging-Anxiety Questionnaire, was designed from patient expressions of anxiety in Magnetic Resonance Imagingscanners. The sample was recruited between October 2012–October 2014. Factor structure was evaluated with exploratory factor analysis and internal consistency with Cronbach’s alpha. Criterion-related validity, known-group validity and test-retest was calculated.

    Results: Patients referred for Magnetic Resonance Imaging of either the spine or the heart, were invited to participate. The development and validation of Magnetic Resonance Imaging-Anxiety Questionnaire resulted in 15 items consisting of two factors. Cronbach’s alpha was found to be high. Magnetic Resonance Imaging-Anxiety Questionnaire correlated higher with instruments measuring anxiety than with depression scales. Known-group validity demonstrated a higher level of anxiety for patients undergoing Magnetic Resonance Imaging scan of the heart than for those examining the spine. Test-retest reliability demonstrated acceptable level for the scale.

    Conclusion: Magnetic Resonance Imaging-Anxiety Questionnaire bridges a gap among existing questionnaires, making it a simple and useful tool for measuring patient anxiety during Magnetic Resonance Imaging examinations.

  • 13.
    Rosendahl, Lene
    et al.
    Department of Clinical Physiology, Ryhov County Hospital, Jönköping, Sweden; Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
    Ahlander, Britt-Marie
    Department of Radiology, Ryhov County Hospital, Jönköping, Sweden.
    Björklund, Per-Gunnar
    Department of Clinical Physiology, Ryhov County Hospital, Jönköping, Sweden.
    Blomstrand, Peter
    Department of Clinical Physiology, Ryhov County Hospital, Jönköping, Sweden.
    Brudin, Lars
    Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Engvall, Jan E.
    Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
    Image quality and myocardial scar size determined with magnetic resonance imaging in patients with permanent atrial fibrillation: a comparison of two imaging protocols2010Ingår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 30, nr 2, s. 122-129Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Magnetic resonance imaging (MRI) of the heart generally requires breath holding and a regular rhythm. Single shot 2D steady-state free precession (SS_SSFP) is a fast sequence insensitive to arrhythmia as well as breath holding. Our purpose was to determine image quality, signal-to-noise (SNR) and contrast-to-noise (CNR) ratios and infarct size with a fast single shot and a standard segmented MRI sequence in patients with permanent atrial fibrillation and chronic myocardial infarction.

    METHODS: Twenty patients with chronic myocardial infarction and ongoing atrial fibrillation were examined with inversion recovery SS_SSFP and segmented inversion recovery 2D fast gradient echo (IR_FGRE). Image quality was assessed in four categories: delineation of infarcted and non-infarcted myocardium, occurrence of artefacts and overall image quality. SNR and CNR were calculated. Myocardial volume (ml) and infarct size, expressed as volume (ml) and extent (%), were calculated, and the methodological error was assessed.

    RESULTS: SS_SSFP had significantly better quality scores in all categories (P = 0.037, P = 0.014, P = 0.021, P = 0.03). SNR(infarct) and SNR(blood) were significantly better for IR_FGRE than for SS_SSFP (P = 0.048, P = 0.018). No significant difference was found in SNR(myocardium) and CNR. The myocardial volume was significantly larger with SS_SSFP (170.7 versus 159.2 ml, P<0.001), but no significant difference was found in infarct volume and infarct extent.

    CONCLUSION: SS_SSFP displayed significantly better image quality than IR_FGRE. The infarct size and the error in its determination were equal for both sequences, and the examination time was shorter with SS_SSFP.

  • 14.
    Rosendahl, Lene
    et al.
    Department of Clinical Physiology, County Hospital Ryhov, Jönköping, Sweden; Center for Medical Image Science and Visualization, CMIV, Linköping, Sweden.
    Blomstrand, Peter
    Department of Clinical Physiology, County Hospital Ryhov, Jönköping, Sweden.
    Heiberg, Einar
    Department of Clinical Physiology, Lund University Hospital, Lund, Sweden.
    Ohlsson, Jan
    Department of Clinical Physiology, County Hospital Ryhov, Jönköping, Sweden.
    Björklund, Per-Gunnar
    Department of Clinical Physiology, County Hospital Ryhov, Jönköping, Sweden.
    Ahlander, Britt-Marie
    Department of Radiology, County Hospital Ryhov, Jönköping, Sweden.
    Engvall, Jan
    Center for Medical Image Science and Visualization, CMIV, Linköping, Sweden; Department of Clinical Physiology, Linköping University Hospital, Linköping, Sweden.
    Computer-assisted calculation of myocardial infarct size shortens the evaluation time of contrast-enhanced cardiac MRI2008Ingår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 28, nr 1, s. 1-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Delayed enhancement magnetic resonance imaging depicts scar in the left ventricle which can be quantitatively measured. Manual segmentation and scar determination is time consuming. The purpose of this study was to evaluate a software for infarct quantification, to compare with manual scar determination, and to measure the time saved.

    METHODS: Delayed enhancement magnetic resonance imaging was performed in 40 patients where myocardial perfusion single photon emission computed tomography imaging showed irreversible uptake reduction suggesting a myocardial scar. After segmentation, the semi-automatic software was applied. A scar area was displayed, which could be corrected and compared with manual delineation. The different time steps were recorded with both methods.

    RESULTS: The software shortened the average evaluation time by 12.4 min per cardiac exam, compared with manual delineation. There was good correlation of myocardial volume, infarct volume and infarct percentage (%) between the two methods, r = 0.95, r = 0.92 and r = 0.91 respectively.

    CONCLUSION: A computer software for myocardial volume and infarct size determination cut the evaluation time by more than 50% compared with manual assessment, with maintained clinical accuracy.

  • 15.
    Rosendahl, Lene
    et al.
    Department of Clinical Physiology, County Hospital Ryhov, Jönköping, Sweden; Center for Medical Image Science and Visualization, CMIV, Linköping University Hospital, Linköping, Sweden.
    Blomstrand, Peter
    Department of Clinical Physiology, County Hospital Ryhov, Jönköping, Sweden.
    Ohlsson, Jan L.
    Department of Clinical Physiology, County Hospital Ryhov, Jönköping, Sweden.
    Björklund, Per-Gunnar
    Department of Clinical Physiology, County Hospital Ryhov, Jönköping, Sweden.
    Ahlander, Britt-Marie
    Department of Radiology, County Hospital Ryhov, Jönköping, Sweden.
    Starck, Sven-Ake
    Hospital Physics Unit, Dept. Of Oncology, County Hospital Ryhov, Jönköping, Sweden.
    Engvall, Jan E.
    Center for Medical Image Science and Visualization, CMIV, Linköping, Sweden; Department of Clinical Physiology, Linköping University Hospital, Linköping, Sweden.
    Late gadolinium uptake demonstrated with magnetic resonance in patients where automated PERFIT analysis of myocardial SPECT suggests irreversible perfusion defect2008Ingår i: BMC Medical Imaging, ISSN 1471-2342, E-ISSN 1471-2342, Vol. 8, artikel-id 17Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Myocardial perfusion single photon emission computed tomography (MPS) is frequently used as the reference method for the determination of myocardial infarct size. PERFIT(R) is a software utilizing a three-dimensional gender specific, averaged heart model for the automatic evaluation of myocardial perfusion. The purpose of this study was to compare the perfusion defect size on MPS, assessed with PERFIT, with the hyperenhanced volume assessed by late gadolinium enhancement magnetic resonance imaging (LGE) and to relate their effect on the wall motion score index (WMSI) assessed with cine magnetic resonance imaging (cine-MRI) and echocardiography (echo).

    METHODS: LGE was performed in 40 patients where clinical MPS showed an irreversible uptake reduction suggesting a myocardial scar. Infarct volume, extent and major coronary supply were compared between MPS and LGE as well as the relationship between infarct size from both methods and WMSI.

    RESULTS: MPS showed a slightly larger infarct volume than LGE (MPS 29.6 +/- 23.2 ml, LGE 22.1 +/- 16.9 ml, p = 0.01), while no significant difference was found in infarct extent (MPS 11.7 +/- 9.4%, LGE 13.0 +/- 9.6%). The correlation coefficients between methods in respect to infarct size and infarct extent were 0.71 and 0.63 respectively. WMSI determined with cine-MRI correlated moderately with infarct volume and infarct extent (cine-MRI vs MPS volume r = 0.71, extent r = 0.71, cine-MRI vs LGE volume r = 0.62, extent r = 0.60). Similar results were achieved when wall motion was determined with echo. Both MPS and LGE showed the same major coronary supply to the infarct area in a majority of patients, Kappa = 0.84.

    CONCLUSION: MPS and LGE agree moderately in the determination of infarct size in both absolute and relative terms, although infarct volume is slightly larger with MPS. The correlation between WMSI and infarct size is moderate.

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