Fast four-dimensional coronary MR angiography with k-t GRAPPA

Technical Background for 4D Flow MR Imaging

Recently, the hemodynamic assessments with 3D cine phase-contrast (PC) MRI (4D flow MRI) have attracted considerable attention from clinicians. Unlike 2D cine PC MRI, the technique allows for cardiac phase-resolved data acquisitions of flow velocity vectors within the entire FOV during a clinically viable period. Thus, the method has enabled retrospective flowmetry in the spatial and temporal axes, which are essential to derive hemodynamic parameters related to vascular homeostasis and those to the progression of the pathologies. Accelerations in imaging are critical for this technology to be clinically viable; however, a high SNR or velocity-to-noise ratio (VNR) is also vital for accurate flow measurements. In this chapter, the technologies enabling this difficult balance are discussed.

5D whole-heart sparse MRI

PURPOSE

A 5D whole-heart sparse imaging framework is proposed for simultaneous assessment of myocardial function and high-resolution cardiac and respiratory motion-resolved whole-heart anatomy in a single continuous noncontrast MR scan.

METHODS

A non-electrocardiograph (ECG)-triggered 3D golden-angle radial balanced steady-state free precession sequence was used for data acquisition. The acquired 3D k-space data were sorted into a 5D dataset containing separated cardiac and respiratory dimensions using a self-extracted respiratory motion signal and a recorded ECG signal. Images were then reconstructed using XD-GRASP, a multidimensional compressed sensing technique exploiting correlations/sparsity along cardiac and respiratory dimensions. 5D whole-heart imaging was compared with respiratory motion-corrected 3D and 4D whole-heart imaging in nine volunteers for evaluation of the myocardium, great vessels, and coronary arteries. It was also compared with breath-held, ECG-gated 2D cardiac cine imaging for validation of cardiac function quantification.

RESULTS

5D whole-heart images received systematic higher quality scores in the myocardium, great vessels and coronary arteries. Quantitative coronary sharpness and length were always better for the 5D images. Good agreement was obtained for quantification of cardiac function compared with 2D cine imaging.

CONCLUSION

5D whole-heart sparse imaging represents a robust and promising framework for simplified comprehensive cardiac MRI without the need for breath-hold and motion correction. Magn Reson Med 79:826-838, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Free-running 4D whole-heart self-navigated golden angle MRI: Initial results

PURPOSE

To test the hypothesis that both coronary anatomy and ventricular function can be assessed simultaneously using a single four-dimensional (4D) acquisition.

METHODS

A free-running 4D whole-heart self-navigated acquisition incorporating a golden angle radial trajectory was implemented and tested in vivo in nine healthy adult human subjects. Coronary magnetic resonance angiography (MRA) datasets with retrospective selection of acquisition window width and position were extracted and quantitatively compared with baseline self-navigated electrocardiography (ECG) -triggered coronary MRA. From the 4D datasets, the left-ventricular end-systolic, end-diastolic volumes (ESV & EDV) and ejection fraction (EF) were computed and compared with values obtained from conventional 2D cine images.

RESULTS

The 4D datasets enabled dynamic assessment of the whole heart with isotropic spatial resolution of 1.15 mm(3). Coronary artery image quality was very similar to that of the ECG-triggered baseline scan despite some SNR penalty. A good agreement between 4D and 2D cine imaging was found for EDV, ESV, and EF.

CONCLUSION

The hypothesis that both coronary anatomy and ventricular function can be assessed simultaneously in vivo has been tested positive. Retrospective and flexible acquisition window selection allows to best visualize each coronary segment at its individual time point of quiescence.

ECG and navigator-free four-dimensional whole-heart coronary MRA for simultaneous visualization of cardiac anatomy and function

PURPOSE

To develop a cardiac and respiratory self-gated four-dimensional (4D) coronary MRA technique for simultaneous cardiac anatomy and function visualization.

METHODS

A contrast-enhanced, ungated spoiled gradient echo sequence with self-gating (SG) and 3DPR trajectory was used for image acquisition. Data were retrospectively binned into different cardiac and respiratory phases based on information extracted from SG projections using principal component analysis. Each cardiac phase was reconstructed using a respiratory motion-corrected self-calibrating SENSE framework, and those belong to the quiescent period were retrospectively combined for coronary visualization. Healthy volunteer studies were conducted to evaluate the efficacy of the SG method, the accuracy of the left ventricle (LV) function parameters and the quality of coronary artery visualization.

RESULTS

SG performed reliably for all subjects including one with poor electrocardiogram (ECG). The LV function parameters showed excellent agreement with those from a conventional cine protocol. For coronary imaging, the proposed method yielded comparable apparent signal to noise ratio and coronary sharpness and lower apparent contrast to noise ratio on three subjects compared with an ECG and navigator-gated Cartesian protocol and an ECG-gated, respiratory motion-corrected 3DPR protocol.

CONCLUSION

A fully self-gated 4D whole-heart imaging technique was developed, potentially allowing cardiac anatomy and function assessment from a single measurement.

Pushing CT and MR imaging to the molecular level for studying the "omics": current challenges and advancements

During the past decade, medical imaging has made the transition from anatomical imaging to functional and even molecular imaging. Such transition provides a great opportunity to begin the integration of imaging data and various levels of biological data. In particular, the integration of imaging data and multiomics data such as genomics, metabolomics, proteomics, and pharmacogenomics may open new avenues for predictive, preventive, and personalized medicine. However, to promote imaging-omics integration, the practical challenge of imaging techniques should be addressed. In this paper, we describe key challenges in two imaging techniques: computed tomography (CT) and magnetic resonance imaging (MRI) and then review existing technological advancements. Despite the fact that CT and MRI have different principles of image formation, both imaging techniques can provide high-resolution anatomical images while playing a more and more important role in providing molecular information. Such imaging techniques that enable single modality to image both the detailed anatomy and function of tissues and organs of the body will be beneficial in the imaging-omics field.

MRI temporal acceleration techniques

In recent years, there has been an explosive growth of magnetic resonance imaging (MRI) techniques that allow faster scan speed by exploiting temporal or spatiotemporal redundancy of the images. These techniques improve the performance of dynamic imaging significantly across multiple clinical applications, including cardiac functional examinations, perfusion imaging, blood flow assessment, contrast-enhanced angiography, functional MRI, and interventional imaging, among others. The scan acceleration permits higher spatial resolution, increased temporal resolution, shorter scan duration, or a combination of these benefits. Along with the exciting developments is a dizzying proliferation of acronyms and variations of the techniques. The present review attempts to summarize this rapidly growing topic and presents conceptual frameworks to understand these techniques in terms of their underlying mechanics and connections. Techniques from view sharing, keyhole, k-t, to compressed sensing are covered.

Free-breathing multiphase whole-heart coronary MR angiography using image-based navigators and three-dimensional cones imaging

Noninvasive visualization of the coronary arteries in vivo is one of the most important goals in cardiovascular imaging. Compared to other paradigms for coronary MR angiography, a free-breathing three-dimensional whole-heart iso-resolution approach simplifies prescription effort, requires less patient cooperation, reduces overall exam time, and supports retrospective reformats at arbitrary planes. However, this approach requires a long continuous acquisition and must account for respiratory and cardiac motion throughout the scan. In this work, a new free-breathing coronary MR angiography technique that reduces scan time and improves robustness to motion is developed. Data acquisition is accomplished using a three-dimensional cones non-Cartesian trajectory, which can reduce the number of readouts 3-fold or more compared to conventional three-dimensional Cartesian encoding and provides greater robustness to motion/flow effects. To further enhance robustness to motion, two-dimensional navigator images are acquired to directly track respiration-induced displacement of the heart and enable retrospective compensation of all acquired data (none discarded) for image reconstruction. In addition, multiple cardiac phases are imaged to support retrospective selection of the best phase(s) for visualizing each coronary segment. Experimental results demonstrate that whole-heart coronary angiograms can be obtained rapidly and robustly with this proposed technique.

Coronary imaging techniques with emphasis on CT and MRI

Coronary artery imaging in children is challenging, with high demands both on temporal and spatial resolution due to high heart rates and smaller anatomy. Although invasive conventional coronary angiography remains the benchmark technique, over the past 10 years, CT and MRI have emerged in the field of coronary imaging. The choice of hardware is important. For CT, the minimum requirement is a 64-channel scanner. The temporal resolution of the scanner is most important for optimising image quality and minimising radiation dose. Manufacturers have developed several modes of electrocardiographic (ECG) triggering to facilitate dose reduction. Recent technical advances have opened new possibilities in MRI coronary imaging. As a non-ionising radiation technique, MRI is of great interest in paediatric imaging. It is currently recommended in centres with appropriate expertise for the screening of patients with suspected congenital coronary anomalies. However, MRI is still not feasible in infants. This review describes and discusses the technical requirements and the pros and cons of all three techniques.

On the undersampling strategies to accelerate time-resolved 3D imaging using k-t-GRAPPA

The purpose of this study was to explore how to optimally undersample and reconstruct time-resolved 3D data using a k-t-space-based GRAPPA technique. The performance of different reconstruction strategies was evaluated using data sets with different ratios of phase (N(y)) and partition (N(z)) encoding lines (N(y) × N(z) = 64-128 × 40-64) acquired in a moving phantom. Image reconstruction was performed for different kernel configurations and different reduction factors (R = 5, 6, 8, and 10) and was evaluated using regional error quantification and SNR analysis. To analyze the temporal fidelity of the different kernel configurations in vivo, time-resolved 3D phase contrast data were acquired in the thoracic aorta of two healthy volunteers. Results demonstrated that kernel configurations with a small kernel extension yielded superior results especially for more asymmetric data matrices as typically used in clinical applications. The application of k-t-GRAPPA to in vivo data demonstrated the feasibility of undersampling of time-resolved 3D phase contrast data set with a nominal reduction factors of up to R(net) = 8, while maintaining the temporal fidelity of the measured velocity field. Extended GRAPPA-based parallel imaging with optimized multidimensional reconstruction kernels has the potential to substantially accelerate data acquisitions in time-resolved 3D MRI.

Fast MR image reconstruction for partially parallel imaging with arbitrary k-space trajectories

Both acquisition and reconstruction speed are crucial for magnetic resonance (MR) imaging in clinical applications. In this paper, we present a fast reconstruction algorithm for SENSE in partially parallel MR imaging with arbitrary k-space trajectories. The proposed method is a combination of variable splitting, the classical penalty technique and the optimal gradient method. Variable splitting and the penalty technique reformulate the SENSE model with sparsity regularization as an unconstrained minimization problem, which can be solved by alternating two simple minimizations: One is the total variation and wavelet based denoising that can be quickly solved by several recent numerical methods, whereas the other one involves a linear inversion which is solved by the optimal first order gradient method in our algorithm to significantly improve the performance. Comparisons with several recent parallel imaging algorithms indicate that the proposed method significantly improves the computation efficiency and achieves state-of-the-art reconstruction quality.

MR image-based geometric and hemodynamic investigation of the right coronary artery with dynamic vessel motion

The aim of this study was to develop a fully subject-specific model of the right coronary artery (RCA), including dynamic vessel motion, for computational analysis to assess the effects of cardiac-induced motion on hemodynamics and resulting wall shear stress (WSS). Vascular geometries were acquired in the right coronary artery (RCA) of a healthy volunteer using a navigator-gated interleaved spiral sequence at 14 time points during the cardiac cycle. A high temporal resolution velocity waveform was also acquired in the proximal region. Cardiac-induced dynamic vessel motion was calculated by interpolating the geometries with an active contour model and a computational fluid dynamic (CFD) simulation with fully subject-specific information was carried out using this model. The results showed the expected variation of vessel radius and curvature throughout the cardiac cycle, and also revealed that dynamic motion of the right coronary artery consequent to cardiac motion had significant effects on instantaneous WSS and oscillatory shear index. Subject-specific MRI-based CFD is feasible and, if scan duration could be shortened, this method may have potential as a non-invasive tool to investigate the physiological and pathological role of hemodynamics in human coronary arteries.

Three-dimensional cine MRI in free-breathing infants and children with congenital heart disease

BACKGROUND

Patients with congenital heart disease frequently have complex cardiac and vascular malformations requiring detailed non-invasive diagnostic evaluation including functional parameters.

OBJECTIVE

To evaluate the morphological and functional information provided by a novel 3-D cine steady-state free-precession (SSFP) sequence.

MATERIALS AND METHODS

Twenty consecutive children (mean age 2.2 years, nine boys) were examined using a 1.5-T MR system including 2-D cine gradient-recalled-echo sequences, static 3-D SSFP and 3-D cine SSFP sequences.

RESULTS

Measurement of ventricular structures and volumes showed close agreement between the 3-D cine SSFP sequence and the 2-D cine gradient-recalled-echo and static 3-D SSFP sequences (left ventricular volumes mean difference 1.0-1.9 ml and 8.8-11.4%, respectively; right ventricular volumes 1.7-2.1 ml and 9.9-16.9%, respectively). No systematic bias was observed.

CONCLUSION

3-D cine MRI provides anatomic as well as functional information with sufficient spatial and temporal resolution in free-breathing infants with congenital heart disease.

k-TE generalized autocalibrating partially parallel acquisition (GRAPPA) for accelerated multiple gradient-recalled echo (MGRE) R2* mapping in the abdomen

Multiple gradient-recalled echo (MGRE) methods are commonly used for abdominal R(2)* mapping. Accelerated MGRE acquisitions would offer the potential to shorten requisite breathhold times and/or increase spatial resolution and coverage. In both phantom and normal volunteer studies, view-sharing (VS) methods, generalized autocalibrating partially parallel acquisition (GRAPPA) methods, and newly proposed k-echo time (k-TE) GRAPPA methods were compared for the purpose of accelerating MGRE acquisitions. Utilization of water-selective spatial spectral excitation pulses reduced artifact levels for both VS and k-TE GRAPPA approaches. VS approaches were found to be highly sensitive to off-resonance effects, particularly at increasing acceleration rates. k-TE GRAPPA significantly reduced residual artifact levels compared to GRAPPA approaches while improving the accuracy of accelerated abdominal R(2)* measurements. These initial feasibility studies demonstrate that k-TE GRAPPA is an effective method to reduce scan times during abdominal R(2)*-mapping procedures.

Accelerated CMR using zonal, parallel and prior knowledge driven imaging methods

Accelerated imaging is highly relevant for many CMR applications as competing constraints with respect to spatiotemporal resolution and tolerable scan times are frequently posed. Three approaches, all involving data undersampling to increase scan efficiencies, are discussed in this review. Zonal imaging can be considered a niche but nevertheless has found application in coronary imaging and CMR flow measurements. Current work on parallel-transmit systems is expected to revive the interest in zonal imaging techniques. The second and main approach to speeding up CMR sequences has been parallel imaging. A wide range of CMR applications has benefited from parallel imaging with reduction factors of two to three routinely applied for functional assessment, perfusion, viability and coronary imaging. Large coil arrays, as are becoming increasingly available, are expected to support reduction factors greater than three to four in particular in combination with 3D imaging protocols. Despite these prospects, theoretical work has indicated fundamental limits of coil encoding at clinically available magnetic field strengths. In that respect, alternative approaches exploiting prior knowledge about the object being imaged as such or jointly with parallel imaging have attracted considerable attention. Five to eight-fold scan accelerations in cine and dynamic CMR applications have been reported and image quality has been found to be favorable relative to using parallel imaging alone.With all acceleration techniques, careful consideration of the limits and the trade-off between acceleration and occurrence of artifacts that may arise if these limits are breached is required. In parallel imaging the spatially varying noise has to be considered when measuring contrast- and signal-to-noise ratios. Also, temporal fidelity in images reconstructed with prior knowledge driven methods has to be studied carefully.