Real-time cardiac cine imaging with SPIDER: steady-state projection imaging with dynamic echo-train readout

A fast, noniterative approach for accelerated high-temporal resolution cine-CMR using dynamically interleaved streak removal in the power-spectral encoded domain with low-pass filtering (DISPEL) and modulo-prime spokes (MoPS)

PURPOSE

To introduce a pair of accelerated non-Cartesian acquisition principles that when combined, exploit the periodicity of k-space acquisition, and thereby enable acquisition of high-temporal cine Cardiac Magnetic Resonance (CMR).

METHODS

The mathematical formulation of a noniterative, undersampled non-Cartesian cine acquisition and reconstruction is presented. First, a low-pass filtering step that exploits streaking artifact redundancy is provided (i.e., Dynamically Interleaved Streak removal in the Power-spectrum Encoded domain with Low-pass filtering [DISPEL]). Next, an effective radial acquisition for the DISPEL approach that exploits the property of prime numbers is described (i.e., Modulo-Prime Spoke [MoPS]). Both DISPEL and MoPS are examined using numerical simulation of a digital heart phantom to show that high-temporal cine-CMR is feasible without removing physiologic motion vs aperiodic interleaving using Golden Angles. The combined high-temporal cine approach is next examined in 11 healthy subjects for a time-volume curve assessment of left ventricular systolic and diastolic performance vs conventional Cartesian cine-CMR reference.

RESULTS

The DISPEL method was first shown using simulation under different streak cycles to allow separation of undersampled radial streaking artifacts from physiologic motion with a sufficiently frequent streak-cycle interval. Radial interleaving with MoPS is next shown to allow interleaves with pseudo-Golden-Angle variants, and be more compatible with DISPEL against irrational and nonperiodic rotation angles, including the Golden-Angle-derived rotations. In the in vivo data, the proposed method showed no statistical difference in the systolic performance, while diastolic parameters sensitive to the cine's temporal resolution were statistically significant (P < 0.05 vs Cartesian cine).

CONCLUSIONS

We demonstrate a high-temporal resolution cine-CMR using DISPEL and MoPS, whose streaking artifact was separated from physiologic motion.

User-initialized active contour segmentation and golden-angle real-time cardiovascular magnetic resonance enable accurate assessment of LV function in patients with sinus rhythm and arrhythmias

BACKGROUND

Data obtained during arrhythmia is retained in real-time cardiovascular magnetic resonance (rt-CMR), but there is limited and inconsistent evidence to show that rt-CMR can accurately assess beat-to-beat variation in left ventricular (LV) function or during an arrhythmia.

METHODS

Multi-slice, short axis cine and real-time golden-angle radial CMR data was collected in 22 clinical patients (18 in sinus rhythm and 4 patients with arrhythmia). A user-initialized active contour segmentation (ACS) software was validated via comparison to manual segmentation on clinically accepted software. For each image in the 2D acquisitions, slice volume was calculated and global LV volumes were estimated via summation across the LV using multiple slices. Real-time imaging data was reconstructed using different image exposure times and frame rates to evaluate the effect of temporal resolution on measured function in each slice via ACS. Finally, global volumetric function of ectopic and non-ectopic beats was measured using ACS in patients with arrhythmias.

RESULTS

ACS provides global LV volume measurements that are not significantly different from manual quantification of retrospectively gated cine images in sinus rhythm patients. With an exposure time of 95.2 ms and a frame rate of > 89 frames per second, golden-angle real-time imaging accurately captures hemodynamic function over a range of patient heart rates. In four patients with frequent ectopic contractions, initial quantification of the impact of ectopic beats on hemodynamic function was demonstrated.

CONCLUSION

User-initialized active contours and golden-angle real-time radial CMR can be used to determine time-varying LV function in patients. These methods will be very useful for the assessment of LV function in patients with frequent arrhythmias.

Pediatric cardiovascular interventional devices: effect on CMR images at 1.5 and 3 Tesla

BACKGROUND

To predict the type and extent of CMR artifacts caused by commonly used pediatric trans-catheter devices at 1.5 T and 3 T as an aid to clinical planning and patient screening.

METHODS

Eleven commonly used interventional, catheter-based devices including stents, septal occluders, vascular plugs and embolization coils made from either stainless steel or nitinol were evaluated ex-vivo at both 1.5T and 3T. Pulse sequences and protocols commonly used for cardiovascular magnetic resonance (CMR) were evaluated, including 3D high-resolution MR angiography (MRA), time-resolved MRA, 2D balanced-SSFP cine and 2D phase-contrast gradient echo imaging (GRE). We defined the signal void amplification factor (F) as the ratio of signal void dimension to true device dimension. F1 and F2 were measured in the long axis and short axes respectively of the device. We defined F3 as the maximum extent of the off-resonance dark band artifact on SSFP measured in the B0direction. The effects of field strength, sequence type, orientation, flip angle and phase encode direction were tested. Clinical CMR images in 3 patients with various indwelling devices were reviewed for correlation with the in-vitro findings.

RESULTS

F1 and F2 were higher (p<0.05) at 3T than at 1.5T for all sequences except 3D-MRA. Stainless steel devices produced greater off-resonance artifact on SSFP compared to nitinol devices (p<0.05). Artifacts were most severe with the stainless steel Flipper detachable embolization coil (Cook Medical, Bloomington, IN), with F1 and F2 10 times greater than with stainless steel stents. The orientation of stents changed the size of off-resonance artifacts by up to two fold. Sequence type did influence the size of signal void or off-resonance artifact (p<0.05). Varying the flip angle and phase encode direction did not affect image artifact.

CONCLUSION

Stainless steel embolization coils render large zones of anatomy uninterpretable, consistent with predictions based on ex-vivo testing. Most other commonly used devices produce only mild artifact ex-vivo and are compatible with diagnostic quality in-vivo studies. Knowledge of ex-vivo device behavior can help predict the technical success or failure of CMR scans and may preempt the performance of costly, futile studies.

Cardiovascular magnetic resonance artefacts

The multitude of applications offered by CMR make it an increasing popular modality to study the heart and the surrounding vessels. Nevertheless the anatomical complexity of the chest, together with cardiac and respiratory motion, and the fast flowing blood, present many challenges which can possibly translate into imaging artefacts. The literature is wide in terms of papers describing specific MR artefacts in great technical detail. In this review we attempt to summarise, in a language accessible to a clinical readership, some of the most common artefacts found in CMR applications. It begins with an introduction of the most common pulse sequences, and imaging techniques, followed by a brief section on typical cardiovascular applications. This leads to the main section on common CMR artefacts with examples, a short description of the mechanisms behind them, and possible solutions.

High-resolution 3D radial bSSFP with IDEAL

Radial trajectories facilitate high-resolution balanced steady state free precession (bSSFP) because the efficient gradients provide more time to extend the trajectory in k-space. A number of radial bSSFP methods that support fat-water separation have been developed; however, most of these methods require an environment with limited B0 inhomogeneity. In this work, high-resolution bSSFP with fat-water separation is achieved in more challenging B0 environments by combining a 3D radial trajectory with the IDEAL chemical species separation method. A method to maintain very high resolution within the timing constraints of bSSFP and IDEAL is described using a dual-pass pulse sequence. The sampling of a unique set of radial lines at each echo time is investigated as a means to circumvent the longer scan time that IDEAL incurs as a multiecho acquisition. The manifestation of undersampling artifacts in this trajectory and their effect on chemical species separation are investigated in comparison to the case in which each echo samples the same set of radial lines. This new bSSFP method achieves 0.63 mm isotropic resolution in a 5-min scan and is demonstrated in difficult in vivo imaging environments, including the breast and a knee with ACL reconstruction hardware at 1.5 T.

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.

Rapid time-resolved magnetic resonance angiography via a multiecho radial trajectory and GraDeS reconstruction

Contrast-enhanced magnetic resonance angiography is challenging due to the need for both high spatial and temporal resolution. A multishot trajectory composed of pseudo-random rotations of a single multiecho radial readout was developed. The trajectory is designed to give incoherent aliasing artifacts and a relatively uniform distribution of projections over all time scales. A field map (computed from the same data set) is used to avoid signal dropout in regions of substantial field inhomogeneity. A compressed sensing reconstruction using the GraDeS algorithm was used. Whole brain angiograms were reconstructed at 1-mm isotropic resolution and a 1.1-s frame rate (corresponding to an acceleration factor > 100). The only parameter which must be chosen is the number of iterations of the GraDeS algorithm. A larger number of iterations improves the temporal behavior at cost of decreased image signal-to-noise ratio. The resulting images provide a good depiction of the cerebral vasculature and have excellent arterial/venous separation.

Self-calibrated multiple-echo acquisition with radial trajectories using the conjugate gradient method (SMART-CG)

PURPOSE

To remove phase inconsistencies between multiple echoes, an algorithm using a radial acquisition to provide inherent phase and magnitude information for self correction was developed. The information also allows simultaneous support for parallel imaging for multiple coil acquisitions.

MATERIALS AND METHODS

Without a separate field map acquisition, a phase estimate from each echo in multiple echo train was generated. When using a multiple channel coil, magnitude and phase estimates from each echo provide in vivo coil sensitivities. An algorithm based on the conjugate gradient method uses these estimates to simultaneously remove phase inconsistencies between echoes, and in the case of multiple coil acquisition, simultaneously provides parallel imaging benefits. The algorithm is demonstrated on single channel, multiple channel, and undersampled data.

RESULTS

Substantial image quality improvements were demonstrated. Signal dropouts were completely removed and undersampling artifacts were well suppressed.

CONCLUSION

The suggested algorithm is able to remove phase cancellation and undersampling artifacts simultaneously and to improve image quality of multiecho radial imaging, the important technique for fast three-dimensional MRI data acquisition.

Contrast-enhanced whole-heart coronary magnetic resonance angiography at 3 T with radial EPI

Whole-heart coronary magnetic resonance angiography is a promising method for detecting coronary artery disease. However, the imaging time is relatively long (typically 10-15 min). The goal of this study was to implement a radial echo planar imaging sequence for contrast-enhanced whole-heart coronary magnetic resonance angiography, with the aim of combining the scan efficiency of echo planar imaging with the motion insensitivity of radial k-space sampling. A self-calibrating phase correction technique was used to correct for off-resonance effects, trajectory measurement was used to correct for k-space trajectory errors, and variable density sampling was used in the partition direction to reduce streaking artifacts. Seven healthy volunteers and two patients were scanned with the proposed radial echo planar imaging sequence, and the images were compared with a traditional gradient echo and X-ray angiography techniques, respectively. Whole-heart images with the radial EPI technique were acquired with a resolution of 1.0 × 1.0 × 2.0 mm(3) in a scan time of 5 min. In healthy volunteers, the average image quality scores and visualized vessel lengths of the RCA and LAD were similar for the radial EPI and gradient echo techniques (P value > 0.05 for all). Anecdotal patient studies showed excellent agreement of the radial EPI technique with X-ray angiography.

Single breathhold cardiac CINE imaging with multi-echo three-dimensional hybrid radial SSFP acquisition

PURPOSE

To achieve single breathhold whole heart cardiac CINE imaging with improved spatial resolution and temporal resolution by using a multi-echo three-dimensional (3D) hybrid radial SSFP acquisition.

MATERIALS AND METHODS

Multi-echo 3D hybrid radial SSFP acquisitions were used to acquire cardiac CINE imaging within a single breathhold. An optimized interleaving scheme was developed for view ordering throughout the cardiac cycle.

RESULTS

Whole heart short axis views were acquired with a spatial resolution of 1.3 x 1.3 x 8.0 mm(3) and temporal resolution of 45 ms, within a single 17 s breathhold. The technique was validated on eight healthy volunteers by measuring the left ventricular volume throughout the cardiac cycle and comparing with the conventional 2D multiple breathhold technique. The left ventricle functional measurement bias of our proposed 3D technique from the conventional 2D technique: end diastolic volume -3.3 mL +/- 13.7 mL, end systolic volume 1.4 mL +/- 6.1 mL, and ejection fraction -1.7% +/- 4.3%, with high correlations 0.94, 0.97, and 0.91, accordingly.

CONCLUSION

A multi-echo 3D hybrid radial SSFP acquisition was developed to allow for a whole heart cardiac CINE exam in a single breathhold. Cardiac function measurements in volunteers compared favorably with the standard multiple breathhold exams.

Characterizing and correcting gradient errors in non-cartesian imaging: Are gradient errors linear time-invariant (LTI)?

Non-Cartesian and rapid imaging sequences are more sensitive to scanner imperfections such as gradient delays and eddy currents. These imperfections vary between scanners and over time and can be a significant impediment to successful implementation and eventual adoption of non-Cartesian techniques by scanner manufacturers. Differences between the k-space trajectory desired and the trajectory actually acquired lead to misregistration and reduction in image quality. While early calibration methods required considerable scan time, more recent methods can work more quickly by making certain approximations. We examine a rapid gradient calibration procedure applied to multiecho three-dimensional projection reconstruction (3DPR) acquisitions in which the calibration runs as part of every scan. After measuring the trajectories traversed for excitations on each of the orthogonal gradient axes, trajectories for the oblique projections actually acquired during the scan are synthesized as linear combinations of these measurements. The ability to do rapid calibration depends on the assumption that gradient errors are linear and time-invariant (LTI). This work examines the validity of these assumptions and shows that the assumption of linearity is reasonable, but that gradient errors can vary over short time periods (due to changes in gradient coil temperature) and thus it is important to use calibration data matched to the scan data.

Cardiac magnetic resonance imaging using radial k-space sampling and self-calibrated partial parallel reconstruction

Radial sampling has been demonstrated to be potentially useful in cardiac magnetic resonance imaging because it is less susceptible to motion than Cartesian sampling. Nevertheless, its capability of imaging acceleration remains limited by undersampling-induced streaking artifacts. In this study, a self-calibrated reconstruction method was developed to suppress streaking artifacts for highly accelerated parallel radial acquisitions in cardiac magnetic resonance imaging. Two- (2D) and three-dimensional (3D) radial k-space data were collected from a phantom and healthy volunteers. Images reconstructed using the proposed method and the conventional regridding method were compared based on statistical analysis on a four-point scale imaging scoring. It was demonstrated that the proposed method can effectively remove undersampling streaking artifacts and significantly improve image quality (P<.05). With the use of the proposed method, image score (1-4, 1=poor, 2=good, 3=very good, 4=excellent) was improved from 2.14 to 3.34 with the use of an undersampling factor of 4 and from 1.09 to 2.5 with the use of an undersampling factor of 8. Our study demonstrates that the proposed reconstruction method is effective for highly accelerated cardiac imaging applications using parallel radial acquisitions without calibration data.

Steady-state MR imaging sequences: physics, classification, and clinical applications

Steady-state sequences are a class of rapid magnetic resonance (MR) imaging techniques based on fast gradient-echo acquisitions in which both longitudinal magnetization (LM) and transverse magnetization (TM) are kept constant. Both LM and TM reach a nonzero steady state through the use of a repetition time that is shorter than the T2 relaxation time of tissue. When TM is maintained as multiple radiofrequency excitation pulses are applied, two types of signal are formed once steady state is reached: preexcitation signal (S-) from echo reformation; and postexcitation signal (S+), which consists of free induction decay. Depending on the signal sampled and used to form an image, steady-state sequences can be classified as (a) postexcitation refocused (only S+ is sampled), (b) preexcitation refocused (only S- is sampled), and (c) fully refocused (both S+ and S- are sampled) sequences. All tissues with a reasonably long T2 relaxation time will show additional signals due to various refocused echo paths. Steady-state sequences have revolutionized cardiac imaging and have become the standard for anatomic functional cardiac imaging and for the assessment of myocardial viability because of their good signal-to-noise ratio and contrast-to-noise ratio and increased speed of acquisition. They are also useful in abdominal and fetal imaging and hold promise for interventional MR imaging. Because steady-state sequences are now commonly used in MR imaging, radiologists will benefit from understanding the underlying physics, classification, and clinical applications of these sequences.

Generalized k-space decomposition with chemical shift correction for non-Cartesian water-fat imaging

Chemical-shift artifacts associated with non-Cartesian imaging are more complex to model and less clinically acceptable than the bulk fat shift that occurs with conventional spin-warp Cartesian imaging. A novel k-space based iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) approach is introduced that decomposes multiple species while simultaneously correcting distortion of off-resonant species. The new signal model accounts for the additional phase accumulated by off-resonant spins at each point in the k-space acquisition trajectory. This phase can then be corrected by adjusting the decomposition matrix for each k-space point during the final IDEAL processing step with little increase in reconstruction time. The technique is demonstrated with water-fat decomposition using projection reconstruction (PR)/radial, spiral, and Cartesian spin-warp imaging of phantoms and human subjects, in each case achieving substantial correction of chemical-shift artifacts. Simulations of the point-spread-function (PSF) for off-resonant spins are examined to show the nature of the chemical-shift distortion for each acquisition. Also introduced is an approach to improve the signal model for species which have multiple resonant peaks. Many chemical species, including fat, have multiple resonant peaks, although such species are often approximated as a single peak. The improved multipeak decomposition is demonstrated with water-fat imaging, showing a substantial improvement in water-fat separation.

Model-based image reconstruction for dynamic cardiac perfusion MRI from sparse data

The paper presents a novel approach for dynamic magnetic resonance imaging (MRI) cardiac perfusion image reconstruction from sparse k-space data. It formulates the reconstruction problem in an inverse-methods setting. Relevant prior information is incorporated via a parametric model for the perfusion process. This wealth of prior information empowers the proposed method to give high-quality reconstructions from very sparse k-space data. The paper presents reconstruction results using both Cartesian and radial sampling strategies using data simulated from a real acquisition. The proposed method produces high-quality reconstructions using 14% of the k-space data. The model-based approach can potentially greatly benefit cardiac myocardial perfusion studies as well as other dynamic contrast-enhanced MRI applications including tumor imaging.

Automatic correction of in-plane bulk motion artifacts in self-navigated radial MRI

Radial MRI is typically used for scans that are sensitive to unavoidable motion. While the translational motion artifact can be easily removed from the radial trajectory data by phase correction, correction of rotational motion still remains a challenge in radial MRI. We present a novel method to refocus the image corrupted by view-to-view motion in the view-interleaved radial MRI data. In this method, the error in rotational view angles was modeled as a polynomial function of the view order and the model parameters were estimated by minimizing the self-navigator image metrics such as image entropy, gradient entropy, normalized gradient squared and mean square difference. Translational motion correction was conducted by aligning the projection profiles. Simulation studies were conducted to demonstrate the robustness of both translational and rotational motion correction methods in different noise levels. The proposed method was successfully applied to correct for motion of healthy subjects. Substantial motion correction with relative error of less than 5% was achieved by using either first- or second-order model with the image metrics. This study demonstrates the potential of the method for motion-sensitive applications.

Cardiac MR imaging: state of the technology

Recent developments in magnetic resonance (MR) imaging of the heart have refocused attention on the potential of MR and continue to attract intense interest within the radiology and cardiology communities. Improvements in speed, image quality, reliability, and range of applications have evolved to the point where cardiac MR imaging is increasingly seen as a practical clinical tool. As is often the case with MR imaging, not all of the most powerful techniques are necessarily easy to master or understand, and many-nonspecialists and specialists alike-are challenged to stay abreast. This review covers some of the major milestones that have led to the current state of cardiac MR and attempts to put into context some concepts that, although technical, have a real impact on the diagnostic power of cardiac MR imaging. Topics discussed include functional imaging, myocardial viability and perfusion imaging, flow quantification, and coronary artery imaging. A review such as this can only scratch the surface of what is a dynamic interdisciplinary field, but the hope is that sufficient information and insight are provided to stimulate the motivated reader to take his or her interest to the next level.

Inversion recovery radial MRI with interleaved projection sets

The radial trajectory has found applications in cardiac imaging because of its resilience to undersampling and motion artifacts. Recent work has shown that interleaved and weighted radial imaging can produce images with multiple contrasts from a single data set. This feature was investigated for inversion recovery imaging of scar using a radial technique. The 2D radial imaging method was modified to acquire quadruply interleaved projection sets within each acquisition window of the cardiac cycle. These data were reconstructed using k-space weightings that used a smaller segment of the acquisition window for the central k-space data, the determinant of image contrast. This method generates four images with different T1 weightings. The novel approach was compared with noninterleaved radial imaging, interleaved radial without weightings, and Cartesian imaging in simulations, phantoms, and seven subjects with clinical myocardial infarction. The results show that during a typical acquisition window after an inversion pulse, magnetization changes rapidly. The interleaved acquisition provided better image quality than the noninterleaved radial acquisition. Interleaving with weighting provided better quality when the inversion time (TI) was shorter than optimal; otherwise, interleaving without weighting was superior. These methods enable a radial trajectory to be employed in conjunction with preparation pulses for viability imaging.

Differences in null points between the left and right ventricles in contrast-enhanced inversion recovery MR imaging in patients with cardiac diseases

Delayed contrast-enhanced inversion recovery (IR) gradient-echo MR imaging has been applied to several cardiac diseases, including myocarditis, sarcoidosis, hypertrophic cardiomyopathy, and myocardial damages induced by medical procedures. Although a preliminary study has indicated the usefulness of this imaging for the detection of right ventricular (RV) myocardial damage associated with arrhythmogenic right ventricular cardiomyopathy, the null points of the RV myocardium have not been assessed on contrast-enhanced IR MR imaging. In this study, the null points of the RV and left ventricular (LV) myocardia were evaluated using an IR fast multi-shot echo-planar imaging (Look-Locker sequence) in 26 patients with various cardiac diseases. In nine of the 26 patients, the null points of the RV myocardium were shorter than those of the LV myocardium in the Look-Locker sequence. The RV myocardial signals were significantly higher than the LV myocardial signals in delayed contrast-enhanced MR images. Thus, more attention should be paid to evaluation of the late enhancement of the RV myocardium, and delayed contrast-enhanced MR imaging with a shorter inversion time may be required in some cases.

Characterizing radial undersampling artifacts for cardiac applications

The undersampled radial acquisition has been widely employed for accelerated (by a factor R = N(r)/N(p)) cardiac imaging, but the resulting reduction in image quality has not been well characterized. This investigation presents a method of measuring these artifacts through synthetic undersampling of high SNR images (SNR > or = 30). After validating the method in phantoms, the method was applied to a study of short-axis, long-axis, and coronary MRI imaging in healthy subjects. For 60 projections (60 N(p)), the total artifact is approximately 10% for short and long-axis imaging (R = 2.1) and approximately 15% for coronary MRI (R = 3.7). For 60 N(p), the SD of artifact in the region of the heart is 2% for short- and long-axis imaging (R = 2.1) and 3.5% for coronary MRI (R = 3.7). The artifact content is less in the region of the heart than in the periphery. The artifact is very reproducible among subjects for standard views. A study of coronary MRI at progressively fewer projections (at constant scan time) showed that right coronary MRI images were acceptable if total artifact was <6.5% of image content (N(p) > 120, R = 2.1).

Flow compensation in balanced SSFP sequences

In balanced steady-state free precession (b-SSFP) sequences, uncompensated first-order moments of encoding gradients induce a nonconstant phase evolution for moving spins within the excitation train, resulting in signal loss and image artifacts. To restore these flow-related phase perturbations, "pairing" of consecutive phase-encoding (PE) steps is compared with a fully flow-compensated sequence using compensating gradient waveforms along all three encoding directions. In volunteer studies, the quality of images acquired with the "pairing" technique was comparable to that of images obtained with the fully flow-compensated technique, regardless of the selected view-ordering scheme used for data acquisition. Nevertheless, the results of phantom experiments indicate that the pairing technique becomes ineffective at flow velocities exceeding roughly 0.5-1 m/s. Consequently, the additional scan time required to null the first gradient moments in a flow-compensated b-SSFP sequence makes the "pairing" technique preferable for applications in which slow to moderate flow velocities can be expected.

Fat/water separation in single acquisition steady-state free precession using multiple echo radial trajectories

Phase detection in fully refocused SSFP imaging has recently allowed fat/water separation without preparing the magnetization or using multiple acquisitions. Instead, it exploits the phase difference between fat and water at an echo time at the midpoint of the TR. To minimize the TR for improved robustness to B0 inhomogeneity, a 3D projection acquisition collecting two half echoes at the beginning and end of each excitation was previously implemented. Since echoes are not formed at the midpoint of the TR, this method still requires two passes of k-space for fat/water separation. A new method is presented to linearly combine the half echoes to separate fat and water in a single acquisition. Separation using phase detection provides superior contrast between fat and water voxels. Results from high resolution angiography and musculoskeletal studies with improved robustness to inhomogeneity and a 50% scan time reduction compared to the two pass method are presented.

Cardiovascular interventional MR imaging: a new road for therapy and repair in the heart

Over the last 5 years, interventional MR imaging has been fertile ground for research. Real-time MR imaging, combined with recent advances in other MR imaging modalities such as perfusion imaging and intravascular imaging, has opened up new paths for cardiac therapy. The recent reports on cardiac stem cell therapy guided and monitored by MR imaging suggest that we are already seeing the establishment of an important role for cardiac MR imaging in cardiac restoration. The collaborative effort from a multidisciplinary team of basic biologists, engineers, and clinicians will refine stem cell incubation and labeling for MR-guided transcatheter endomyocardial injections, and this in turn may facilitate new studies in humans. Several groups have demonstrated in animal studies the feasibility of MR-guided catheter interventions for the treatment of congenital heart disease and arrythmia therapy. Hence, applications in humans remain the challenge for the next years. Although there have been first reports of cardiac catheterizations in humans by combined use of x-ray fluoroscopy and MR imaging, there are no reports in the literature suggesting that active tracking methods by MR imaging have been applied to humans. Safety issues (namely, heating of catheters and wires) hamper clinical use, particularly in infants and children. Current reports are promising that these limitations will be overcome in the near future and will eventually reduce x-ray usage during catheterization. In its current state, cardiac MR imaging offers a unique opportunity to investigate new therapeutic strategies for the treatment of congenital and acquired heart disease.

Magnetic resonance imaging-guided vascular interventions

Magnetic resonance imaging (MRI), which provides superior soft-tissue imaging and no known harmful effects, has the potential as an alternative modality to guide various medical interventions. This review will focus on MR-guided endovascular interventions and present its current state and future outlook. In the first technical part, enabling technologies such as developments in fast imaging, catheter devices, and visualization techniques are examined. This is followed by a clinical survey that includes proof-of-concept procedures in animals and initial experience in human subjects. In preclinical experiments, MRI has already proven to be valuable. For example, MRI has been used to guide and track targeted cell delivery into or around myocardial infarctions, to guide atrial septal puncture, and to guide the connection of portal and systemic venous circulations. Several investigational MR-guided procedures have already been reported in patients, such as MR-guided cardiac catheterization, invasive imaging of peripheral artery atheromata, selective intraarterial MR angiography, and preliminary angioplasty and stent placement. In addition, MR-assisted transjugular intrahepatic portosystemic shunt procedures in patients have been shown in a novel hybrid double-doughnut x-ray/MRI system. Numerous additional investigational human MR-guided endovascular procedures are now underway in several medical centers around the world. There are also significant hurdles: availability of clinical-grade devices, device-related safety issues, challenges to patient monitoring, and acoustic noise during imaging. The potential of endovascular interventional MRI is great because as a single modality, it combines 3-dimensional anatomic imaging, device localization, hemodynamics, tissue composition, and function.

Addressing efficiency and residual magnetization cross talk in multi-slice 2D steady-state free precession imaging of the heart

This work presents an efficient method for achieving steady state in multi-slice 2D balanced steady-state free precession (SSFP) imaging of cardiac function. With current techniques, data acquisition for each slice is preceded by one or two heartbeats of dummy excitations. Depending on the number of heartbeats required for data acquisition, these dummy heartbeats can represent a large fraction of the total imaging time. As described here, FIESTA-SP (FIESTA with steady-state preparation) increases the imaging efficiency to nearly 100% by eliminating dummy heartbeats. Steady state for each slice is achieved using a linear flip angle series of excitations during the first cardiac phase of the first heartbeat for each slice. Because imaging proceeds immediately from one slice to the next, a heretofore-unseen issue arises where residual magnetization from each slice contaminates subsequent acquisitions. Accelerating the approach to steady state for each slice and eliminating slice cross talk are important for both multi-slice and interactive real-time imaging.

Artifact-free coronary magnetic resonance angiography and coronary vessel wall imaging in the presence of a new, metallic, coronary magnetic resonance imaging stent

BACKGROUND

Coronary in-stent restenosis cannot be directly assessed by magnetic resonance angiography (MRA) because of the local signal void of currently used stainless steel stents. The aim of this study was to investigate the potential of a new, dedicated, coronary MR imaging (MRI) stent for artifact-free, coronary MRA and in-stent lumen and vessel wall visualization.

METHODS AND RESULTS

Fifteen prototype stents were deployed in coronary arteries of 15 healthy swine and investigated with a double-oblique, navigator-gated, free-breathing, T2-prepared, 3D cartesian gradient-echo sequence; a T2-prepared, 3D spiral gradient-echo sequence; and a T2-prepared, 3D steady-state, free-precession coronary MRA sequence. Furthermore, black-blood vessel wall imaging by a dual-inversion-recovery, turbo spin-echo sequence was performed. Artifacts of the stented vessel segment and signal intensities of the coronary vessel lumen inside and outside the stent were assessed. With all investigated sequences, the vessel lumen and wall could be visualized without artifacts, including the stented vessel segment. No signal intensity alterations inside the stent when compared with the vessel lumen outside the stent were found.

CONCLUSIONS

The new, coronary MRI stent allows for completely artifact-free coronary MRA and vessel wall imaging.

Optimal design of k-space trajectories using a multi-objective genetic algorithm

Spiral, radial, and other nonrectilinear k-space trajectories are an area of active research in MRI due largely to their typically rapid acquisition times and benign artifact patterns. Trajectory design has commonly proceeded from a description of a simple shape to an investigation of its properties, because there is no general theory for the derivation of new trajectories with specific properties. Here such a generalized methodology is described. Specifically, a multi-objective genetic algorithm (GA) is used to design trajectories with beneficial flow and off-resonance properties. The algorithm converges to a well-defined optimal set with standard spiral trajectories on the rapid but low-quality end, and a new class of trajectories on the slower but high-quality end. The new trajectories all begin with nonzero gradient amplitude at the k-space origin, and curve gently outward relative to standard spirals. Improvements predicted in simulated imaging experiments were found to correlate well with improvements in actual experimental measures of image quality. The impact of deviations from the desired k-space trajectory is described, as is the impact of using different phantoms.

SNR enhancement in radial SSFP imaging using partial k-space averaging

The steady-state free precessing (SSFP) sequences, widely used in MRI today, acquire data only during a short fraction of the repetition time (TR). Thus, they exhibit a poor scan efficiency. In this paper, a novel approach to extending the acquisition window for a given TR without considerably modifying the basic sequence is explored for radial SSFP sequences. The additional data are primarily employed to increase the signal-to-noise ratio, rather than to improve the temporal resolution of the imaging. The approach is analyzed regarding its effect on the image SNR (signal to noise ratio) and the reconstruction algorithm. Results are presented for phantom experiments and cardiac functions studies. The gain in SNR is most notable in rapid imaging, since SNR enhancement for a constant repetition time may be used to compensate for the increase in noise resulting from angular undersampling.

A modified projection reconstruction trajectory for reduction of undersampling artifacts

PURPOSE

To reduce undersampling artifacts for a given number of repetitions of the projection reconstruction (PR) sequence by modifying its k-space trajectory to sample more mid-frequencies while reducing the sampling coverage of the peripheral spatial frequencies.

MATERIALS AND METHODS

The single k-space spoke measured per repetition in the standard PR was modified so that one complete and two partial spokes were measured per repetition but with decreased k-space extent. The point spread functions (PSFs) and undersampling artifacts of the modified PR were compared with those of the standard PR for various numbers of projections. Phantom and in vivo images were used to assess the relative performance.

RESULTS

PSF analysis indicated that the modified PR method provided reduced undersampling artifacts with somewhat reduced spatial resolution. The phantom and in vivo images corroborated this.

CONCLUSION

The modified PR trajectory provides reduced undersampling artifact vs. the standard PR, particularly when the number of projections is limited and the artifact level is high.

Rapid fat-suppressed isotropic steady-state free precession imaging using true 3D multiple-half-echo projection reconstruction

Three-dimensional projection reconstruction (3D PR)-based techniques are advantageous for steady-state free precession (SSFP) imaging for several reasons, including the capability to achieve short repetition times (TRs). In this paper, a multi-half-echo technique is presented that dramatically improves the data-sampling efficiency of 3D PR sequences while it retains this short-TR capability. The k-space trajectory deviations are measured quickly and corrected on a per-sample point basis. A two-pass RF cycling technique is then applied to the dual-half-echo implementation to generate fat/water-separated images. The resultant improvement in the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) was demonstrated in volunteer studies. Volumetric images with excellent spatial resolution, coverage, and contrast were obtained with high speed. The non-contrast-enhanced SSFP studies show that this technique has promising potential for MR angiography (MRA).

Floating table isotropic projection (FLIPR) acquisition: A time-resolved 3D method for extended field-of-view MRI during continuous table motion

In this work, 3D vastly undersampled isotropic projection (VIPR) acquisition is used simultaneously with continuous table motion to extend the superior/inferior (S/I) FOV for MR angiograms. The new technique is termed floating table isotropic PR (FLIPR). The use of 3D PR in conjunction with table motion obviates the need to locate and prescribe imaging volumes containing the major blood vessels over the large superior-inferior (S/I) ranges encountered in whole-body imaging. In addition, the FLIPR technique provides extended anterior-posterior (A/P) abdominal coverage, isotropic spatial resolution, and temporal resolution. In volunteer studies, FLIPR MR angiograms with 1.6-mm isotropic spatial resolution that approached whole body in extent were acquired in less than 2 min.

View-ordering in radial fast spin-echo imaging

Radial MRI sequences are frequently used to obtain images with reduced sensitivity to motion. To decrease imaging time, multiple spin-echo acquisitions can be incorporated into radial sequences. In this case, different radial lines of Fourier data have different TE times and the resulting images can contain streaking artifacts due to T(2) decay. The streaking is not only dependent on the T(2) of the object and the timing of the data acquisition, but also on the order in which radial lines are collected (view order). The view ordering can easily be controlled to minimize artifacts due to T(2) decay as well as motion. Four view-ordering techniques are presented and evaluated for the radial FSE sequence.

Flow effects in balanced steady state free precession imaging

An analysis of the effect of flow on 2D fully balanced steady state free precession (SSFP) imaging is presented. Transient and steady-state SSFP signal intensities in the presence of steady and pulsatile flow were simulated using a matrix formalism based on the Bloch equations. Various through-plane flow waveforms and rates were modeled numerically considering factors such as the excitation slice profile and both in- and out-flow effects. Phantom measurements in an experimental setup that allowed the assessment of SSFP signal properties as a function of frequency offset and flow rate demonstrated that the computer simulations provided a suitable description of the effects of flow in SSFP imaging. A volunteer scan was performed to provide in vivo validations. For accurate modeling of SSFP signal intensities it is crucial to include effects such as imperfect slice profiles and, more importantly, "out-of-slice" contributions to the signal. Both simulations and experiments show that there can be considerably large-frequency offset dependent-signal contributions from flowing spins that have already left the imaging slice but still add to the SSFP signal. Although spins leaving the slice do not experience additional RF-excitation, gradient activity is not confined to the region of excitations and the balanced nature of the SSFP imaging gradients allows "out-of-slice" transverse magnetization to contribute to the total SSFP signal, effectively by broadening the slice thickness for flowing spins. This results in a frequency dependence of in-flow related signal enhancement and flow artifacts.

Radial alternating TE sequence for faster fat suppression

This study describes a steady-state sequence that uses a radial k-space trajectory and alternating echo times (TEs) between even and odd k-space views. The sequence generated a single data set that was used to reconstruct images with inherent fat suppression. This fat suppression results from the fat phase variation in alternate echoes giving rise to cancellation in the central portion of k-space. This new fat-suppression method provides inherent fat suppression in half the acquisition time relative to the radial two-point Dixon method. The improvement in k-space sampling efficiency is demonstrated in phantom and clinical images, and through measured point-spread functions (PSFs). As a result, the radial alternating TE sequence offers improved temporal resolution over a radial version of the two-point Dixon sequence by requiring fewer total projections to obtain the same effective resolution in water-based tissues.

Fat-suppressed steady-state free precession imaging using phase detection

Fully refocused steady-state free precession (SSFP) is a rapid, efficient imaging sequence that can provide diagnostically useful image contrast. In SSFP, the signal is refocused midway between excitation pulses, much like in a spin-echo experiment. However, in SSFP, the phase of the refocused spins alternates for each resonant frequency interval equal to the reciprocal of the sequence repetition time (TR). Appropriate selection of the TR results in a 180 degrees phase difference between lipid and water signals. This phase difference can be used for fat-water separation in SSFP without any increase in scan time. The technique is shown to produce excellent non-contrast-enhanced, flow-independent angiograms of the peripheral vasculature.

Quantitative assessment of left ventricular function with interactive real-time spiral and radial MR imaging

An interactive real-time spiral gradient-echo and an interactive real-time radial steady-state free precession sequence were investigated for the quantitative assessment of left ventricular function. Data were acquired in 18 patients without electrocardiographic triggering and breath holding. With the interactive real-time spiral gradient-echo sequence, significant underestimation of endocardial and epicardial volumes was demonstrated; with the interactive real-time radial steady-state free precession sequence, excellent agreement was shown with standard cardiac-triggered segmented k-space breath-hold steady-state free precession MR imaging. Interactive real-time radial steady-state free precession imaging allows accurate quantitative assessment of left ventricular volumes.

Metallic renal artery MR imaging stent: artifact-free lumen visualization with projection and standard renal MR angiography

A cardiac-triggered free-breathing three-dimensional (3D) balanced fast field-echo projection renal magnetic resonance (MR) angiographic sequence was investigated for in-stent lumen visualization of a dedicated metallic renal artery stent. Fourteen prototype stents were deployed in the renal arteries of six pigs (in two pigs, three stents were deployed). Projection renal MR angiography was compared with standard contrast material-enhanced 3D breath-hold MR angiography. Artifact-free in-stent lumen visualization was achieved with both projection MR angiography and contrast-enhanced MR angiography. These promising results warrant further studies for visualization of in-stent restenosis.

Fast interactive real-time magnetic resonance imaging of cardiac masses using spiral gradient echo and radial steady-state free precession sequences

RATIONALE AND OBJECTIVES

Cardiac and respiratory controlled MR-imaging is the gold standard for imaging of cardiac masses. However, this technique may be limited in patients with dyspnoe or arrhythmia. The aim of this study was the evaluation of an interactive MR-approach for the detection and localization of cardiac masses.

METHODS

Interactive real-time spiral gradient-echo (spiralGE) and radial steady-state-free-precession (radialSSFP) MR-imaging was performed during free-breathing and without cardiac triggering in 15 patients with 14 intracardiac or paracardiac masses. Standard cardiac triggered segmented k-space breath-hold steady-state-free-precession cine MR-imaging was used as the reference MR-imaging technique. Two groups of investigators blinded to clinical data were ask to rank image quality and to identify cardiac masses on real-time MR-images.

RESULTS

Image quality was superior using radialSSFP when compared with spiralGE. Using radialSSFP all masses were correctly detected while 6 of 14 masses were missed on spiralGE. Mean real-time MR-imaging time was less than 3 minutes for both techniques.

CONCLUSION

Interactive real-time radialSSFP MR-imaging allows for accurate and fast detection of cardiac masses without the need of cardiac or respiratory triggering.

Is TrueFISP a gradient-echo or a spin-echo sequence?

It is commonly accepted that TrueFISP (balanced FFE, FIESTA) belongs to the class of gradient-echo (GRE) sequences. GRE sequences are sensitive to dephasing effects of the transverse magnetization between the excitation pulse and echo acquisition, and phase coherence is only established directly after and before excitation pulses. However, an analysis of the phase evolution of transverse magnetization in a TrueFISP experiment shows very close similarities to the echo formation of a spin-echo (SE) experiment. If dephasing between excitation pulses is below +/-pi, TrueFISP exhibits a nearly complete refocusing of transverse magnetization at TE = TR/2. Only signals acquired before and after TR/2 show an additional T*2 sensitivity.

FIESTA-ET: high-resolution cardiac imaging using echo-planar steady-state free precession

This work describes a technique that combines multishot echo-planar imaging (EPI) with steady-state free precession (SSFP, also known as TrueFISP, FIESTA, and balanced FFE) for multislice, cine MR imaging of the heart. Unlike recently reported methods, the technique presented here (FIESTA-ET) is high-resolution and does not require offline reconstruction or postprocessing. It is therefore suitable for use on standard clinical scanners. FIESTA-ET was compared with conventional FIESTA imaging in 10 volunteers and quantitative analyses of myocardial signal-to-noise ratios (SNR) and ventricular volumes were performed. While providing comparable image quality, FIESTA-ET required half the acquisition time per slice of conventional FIESTA. Because multiple slices could be imaged in a single breathhold, the entire heart could be scanned in less than 2 min. Although the FIESTA-ET images exhibited an unexpected increase (P < 0.0005) in myocardial SNR of 16% over FIESTA, the volumetric measurements showed excellent correlation.

Cardiac MRI: recent progress and continued challenges

Cardiac MRI continues to develop and advance. MRI accurately depicts cardiac structure, function, perfusion, and myocardial viability with an overall capacity unmatched by any other single imaging modality. MRI is an accepted and widely utilized tool for cardiovascular research. Its clinical use has been limited, but is increasing because of its proven clinical efficacy, the proliferation of cardiac-capable MRI systems, and the development of improved pulse sequences. The following article reviews the landmark developments in this field, with an emphasis on recent progress in the evaluation of ischemic or acquired heart disease.