Single-shot EPI for ASL-CMR

Update on state-of-the-art for arterial spin labeling (ASL) human perfusion imaging outside of the brain

This review article provides an overview of developments for arterial spin labeling (ASL) perfusion imaging in the body (i.e., outside of the brain). It is part of a series of review/recommendation papers from the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group. In this review, we focus on specific challenges and developments tailored for ASL in a variety of body locations. After presenting common challenges, organ-specific reviews of challenges and developments are presented, including kidneys, lungs, heart (myocardium), placenta, eye (retina), liver, pancreas, and muscle, which are regions that have seen the most developments outside of the brain. Summaries and recommendations of acquisition parameters (when appropriate) are provided for each organ. We then explore the possibilities for wider adoption of body ASL based on large standardization efforts, as well as the potential opportunities based on recent advances in high/low-field systems and machine-learning. This review seeks to provide an overview of the current state-of-the-art of ASL for applications in the body, highlighting ongoing challenges and solutions that aim to enable more widespread use of the technique in clinical practice.

Non-contrast myocardial perfusion in rest and exercise stress using systolic flow-sensitive alternating inversion recovery

OBJECTIVE

To evaluate systolic flow-sensitive alternating inversion recovery (FAIR) during rest and exercise stress using 2RR (two cardiac cycles) or 1RR intervals between inversion pulse and imaging.

MATERIALS AND METHODS

1RR and 2RR FAIR was implemented on a 3T scanner. Ten healthy subjects were scanned during rest and stress. Stress was performed using an in-bore ergometer. Heart rate, mean myocardial blood flow (MBF) and temporal signal-to-noise ratio (TSNR) were compared using paired t tests.

RESULTS

Mean heart rate during stress was higher than rest for 1RR FAIR (85.8 ± 13.7 bpm vs 63.3 ± 11.1 bpm; p < 0.01) and 2RR FAIR (83.8 ± 14.2 bpm vs 63.1 ± 10.6 bpm; p < 0.01). Mean stress MBF was higher than rest for 1RR FAIR (2.97 ± 0.76 ml/g/min vs 1.43 ± 0.6 ml/g/min; p < 0.01) and 2RR FAIR (2.8 ± 0.96 ml/g/min vs 1.22 ± 0.59 ml/g/min; p < 0.01). Resting mean MBF was higher for 1RR FAIR than 2RR FAIR (p < 0.05), but not during stress. TSNR was lower for stress compared to rest for 1RR FAIR (4.52 ± 2.54 vs 10.12 ± 3.69; p < 0.01) and 2RR FAIR (7.36 ± 3.78 vs 12.41 ± 5.12; p < 0.01). 2RR FAIR TSNR was higher than 1RR FAIR for rest (p < 0.05) and stress (p < 0.001).

DISCUSSION

We have demonstrated feasibility of systolic FAIR in rest and exercise stress. 2RR delay systolic FAIR enables non-contrast perfusion assessment during stress with relatively high TSNR.

CMR for myocardial characterization in ischemic heart disease: state-of-the-art and future developments

Ischemic heart disease and its sequelae are one of the major contributors to morbidity and mortality worldwide. Over the last decades, technological developments have strengthened the role of noninvasive imaging for detection, risk stratification, and management of patients with ischemic heart disease. Cardiac magnetic resonance (CMR) imaging incorporates both functional and morphological characterization of the heart to determine presence, acuteness, and severity of ischemic heart disease by evaluating myocardial wall motion and function, the presence and extent of myocardial edema, ischemia, and scarring. Currently established clinical protocols have already demonstrated their diagnostic and prognostic value. Nevertheless, there are emerging imaging technologies that provide additional information based on advanced quantification of imaging biomarkers and improved diagnostic accuracy, therefore potentially allowing reduction or avoidance of contrast and/or stressor agents. The aim of this review is to summarize the current state of the art of CMR imaging for ischemic heart disease and to provide insights into promising future developments.

Myocardial arterial spin labeling in systole and diastole using flow-sensitive alternating inversion recovery with parallel imaging and compressed sensing

Quantitative myocardial perfusion can be achieved without contrast agents using flow-sensitive alternating inversion recovery (FAIR) arterial spin labeling. However, FAIR has an intrinsically low sensitivity, which may be improved by mitigating the effects of physiological noise or by increasing the area of artifact-free myocardium. The aim of this study was to investigate if systolic FAIR may increase the amount of analyzable myocardium compared with diastolic FAIR and its effect on physiological noise. Furthermore, we compare parallel imaging acceleration with a factor of 2 with compressed sensing acceleration with a factor of 3 for systolic FAIR. Twelve healthy subjects were scanned during rest on a 3 T scanner using diastolic FAIR with parallel imaging factor 2 (FAIR-PI2_D ), systolic FAIR with the same acceleration (FAIR-PI2_S ) and systolic FAIR with compressed sensing factor 3 (FAIR-CS3_S ). The number of analyzable pixels in the myocardium, temporal signal-to-noise ratio (TSNR) and mean myocardial blood flow (MBF) were calculated for all methods. The number of analyzable pixels using FAIR-CS3_S (663 ± 55) and FAIR-PI2_S (671 ± 58) was significantly higher than for FAIR-PI2_D (507 ± 82; P = .001 for both), while there was no significant difference between FAIR-PI2_S and FAIR-CS3_S . The mean TSNR of the midventricular slice for FAIR-PI2_D was 11.4 ± 3.9, similar to that of FAIR-CS3_S, which was 11.0 ± 3.3, both considerably higher than for FAIR-PI2_S, which was 8.4 ± 3.1 (P < .05 for both). Mean MBF was similar for all three methods. The use of compressed sensing accelerated systolic FAIR benefits from an increased number of analyzable myocardial pixels compared with diastolic FAIR without suffering from a TSNR penalty, unlike systolic FAIR with parallel imaging acceleration.

Robust autocalibrated structured low-rank EPI ghost correction

PURPOSE

We propose and evaluate a new structured low-rank method for echo-planar imaging (EPI) ghost correction called Robust Autocalibrated LORAKS (RAC-LORAKS). The method can be used to suppress EPI ghosts arising from the differences between different readout gradient polarities and/or the differences between different shots. It does not require conventional EPI navigator signals, and is robust to imperfect autocalibration data.

METHODS

Autocalibrated LORAKS is a previous structured low-rank method for EPI ghost correction that uses GRAPPA-type autocalibration data to enable high-quality ghost correction. This method works well when the autocalibration data are pristine, but performance degrades substantially when the autocalibration information is imperfect. RAC-LORAKS generalizes Autocalibrated LORAKS in two ways. First, it does not completely trust the information from autocalibration data, and instead considers the autocalibration and EPI data simultaneously when estimating low-rank matrix structure. Second, it uses complementary information from the autocalibration data to improve EPI reconstruction in a multi-contrast joint reconstruction framework. RAC-LORAKS is evaluated using simulations and in vivo data, including comparisons to state-of-the-art methods.

RESULTS

RAC-LORAKS is demonstrated to have good ghost elimination performance compared to state-of-the-art methods in several complicated EPI acquisition scenarios (including gradient-echo brain imaging, diffusion-encoded brain imaging, and cardiac imaging).

CONCLUSIONS

RAC-LORAKS provides effective suppression of EPI ghosts and is robust to imperfect autocalibration data.