High Field Cardiac Magnetic Resonance Imaging – Current and Future Perspectives

Left Ventricular Function Evaluation on a 3T MR Scanner with Parallel RF Transmission Technique: Prospective Comparison of Cine Sequences Acquired before and after Gadolinium Injection

Objectives

To compare cine MR b-TFE sequences acquired before and after gadolinium injection, on a 3T scanner with a parallel RF transmission technique in order to potentially improve scanning time efficiency when evaluating LV function.

Methods

25 consecutive patients scheduled for a cardiac MRI were prospectively included and had their b-TFE cine sequences acquired before and right after gadobutrol injection. Images were assessed qualitatively (overall image quality, LV edge sharpness, artifacts and LV wall motion) and quantitatively with measurement of LVEF, LV mass, and telediastolic volume and contrast-to-noise ratio (CNR) between the myocardium and the cardiac chamber. Statistical analysis was conducted using a Bayesian paradigm.

Results

No difference was found before or after injection for the LVEF, LV mass and telediastolic volume evaluations. Overall image quality and CNR were significantly lower after injection (estimated coefficient cine after > cine before gadolinium: -1.75 CI = [-3.78;-0.0305], prob(coef>0) = 0% and -0.23 CI = [-0.49;0.04], prob(coef>0) = 4%) respectively), but this decrease did not affect the visual assessment of LV wall motion (cine after > cine before gadolinium: -1.46 CI = [-4.72;1.13], prob(coef>0) = 15%).

Conclusions

In 3T cardiac MRI acquired with parallel RF transmission technique, qualitative and quantitative assessment of LV function can reliably be performed with cine sequences acquired after gadolinium injection, despite a significant decrease in the CNR and the overall image quality.

Doppler Ultrasound Triggering for Cardiovascular MRI at 3T in a Healthy Volunteer Study

Purpose:

Electrocardiogram (ECG) triggering for cardiac magnetic resonance (CMR) may be influenced by electromagnetic interferences with increasing magnetic field strength. The aim of this study was to evaluate the performance of Doppler ultrasound (DUS) as an alternative trigger technique for CMR in comparison to ECG and pulse oximetry (POX) at 3T and using different sequence types.

Methods:

Balanced turbo field echo two-dimensional (2D) short axis cine CMR and 2D phase-contrast angiography of the ascending aorta was performed in 11 healthy volunteers at 3T using ECG, DUS, and POX for cardiac triggering. DUS and POX triggering were compared to the reference standard of ECG in terms of trigger quality (trigger detection and temporal variability), image quality [endocardial blurring (EB)], and functional measurements [left ventricular (LV) volumetry and aortic blood flow velocimetry].

Results:

Trigger signal detection and temporal variability did not differ significantly between ECG/DUS (I = 0.6) and ECG/POX (P = 0.4). Averaged EB was similar for ECG, DUS, and POX (p_ECG/DUS = 0.4, p_ECG/POX = 0.9). Diastolic EB was significantly decreased for DUS in comparison to ECG (P = 0.02) and POX (P = 0.04). The LV function assessment and aortic blood flow were not significantly different.

Conclusion:

This study demonstrated the feasibility of DUS for gating human CMR at 3T. The magnetohydrodynamic effect did not significantly disturb ECG triggering in this small healthy volunteer study. DUS showed a significant improvement in diastolic EB but could not be identified as a superior trigger method. The potential benefit of DUS has to be evaluated in a larger clinical patient population.

Late gadolinium enhancement cardiac imaging on a 3T scanner with parallel RF transmission technique: prospective comparison of 3D-PSIR and 3D-IR

OBJECTIVE

To qualitatively and quantitatively compare different late gadolinium enhancement (LGE) sequences acquired at 3T with a parallel RF transmission technique.

METHODS

One hundred and sixty participants prospectively enrolled underwent a 3T cardiac MRI with 3 different LGE sequences: 3D Phase-Sensitive Inversion-Recovery (3D-PSIR) acquired 5 minutes after injection, 3D Inversion-Recovery (3D-IR) at 9 minutes and 3D-PSIR at 13 minutes. All LGE-positive patients were qualitatively evaluated both independently and blindly by two radiologists using a 4-level scale, and quantitatively assessed with measurement of contrast-to-noise ratio and LGE maximal surface. Statistical analyses were calculated under a Bayesian paradigm using MCMC methods.

RESULTS

Fifty patients (70 % men, 56yo ± 19) exhibited LGE (62 % were post-ischemic, 30 % related to cardiomyopathy and 8 % post-myocarditis). Early and late 3D-PSIR were superior to 3D-IR sequences (global quality, estimated coefficient IR > early-PSIR : -2.37 CI = [-3.46 ; -1.38], prob(coef > 0) = 0 % and late-PSIR > IR : 3.12 CI = [0.62 ; 4.41], prob(coef > 0) = 100 %), LGE surface estimated coefficient IR > early-PSIR: -0.09 CI = [-1.11; -0.74], prob(coef > 0) = 0 % and late-PSIR > IR : 0.96 CI = [0.77; 1.15], prob(coef > 0) = 100 %). Probabilities for late PSIR being superior to early PSIR concerning global quality and CNR were over 90 %, regardless of the aetiological subgroup.

CONCLUSIONS

In 3T cardiac MRI acquired with parallel RF transmission technique, 3D-PSIR is qualitatively and quantitatively superior to 3D-IR.

KEY POINTS

• Late gadolinium enhancement is an essential part of a cardiac MRI examination • PSIR and IR sequences are the two possible options for LGE imaging • At 3T with parallel RF transmission, PSIR sequences are significantly better • One LGE sequence is sufficient, allowing an optimization of the acquisition time.

Correlation imaging with arbitrary sampling trajectories

The presented work aims to develop a generalized linear approach to image reconstruction with arbitrary sampling trajectories for high-speed MRI. This approach is based on a previously developed image reconstruction framework, "correlation imaging". In the presented work, correlation imaging with arbitrary sampling trajectories is implemented in a multi-dimensional hybrid space that is formed from the physical sampling space and a virtually defined space. By introducing an undersampling trajectory with both uniformity and randomness in the hybrid space, correlation imaging may take advantage of multiple image reconstruction mechanisms including coil sensitivity encoding, data sparsity and information sharing. This hybrid-space implementation is demonstrated in multi-slice 2D imaging, multi-scan imaging, and radial dynamic imaging. Since more information is used in image reconstruction, it is found that hybrid-space correlation imaging outperforms several conventional techniques. The presented approach will benefit clinical MRI by enabling correlation imaging to be used to accelerate multi-scan clinical protocols that need different sampling trajectories in different scans.

Correlation imaging for multiscan MRI with parallel data acquisition

A new approach to high-speed magnetic resonance imaging (MRI) that uses all the data acquired in a multiscan imaging session is presented. This approach accelerates MRI data acquisition by statistically estimating correlation functions from images with different contrast and/or resolution. In multiscan MRI with parallel data acquisition, the estimation of correlation functions is dynamically improved as imaging proceeds. This allows imaging acceleration factors to be increased in subsequent scans, thereby reducing the total time of a multiscan MRI protocol. Furthermore, the correlation function estimates bring information about both coil sensitivity and anatomical structure into image reconstruction, thereby offering the ability to speed up MRI beyond the parallel imaging acceleration limit posed by a coil array alone. In this study, the feasibility of correlation imaging is demonstrated experimentally using brain and spine imaging protocols. The ability of correlation imaging to achieve an aggregate acceleration factor in excess of the number of coil elements in the phase encoding direction is also demonstrated.

Ischemic heart disease: comprehensive evaluation by cardiovascular magnetic resonance

Considerable technical advances over the past decade have increased the clinical application of cardiovascular magnetic resonance (CMR) imaging. A comprehensive CMR examination can accurately measure left and right ventricular size and function, identify the presence and extent of reversible versus irreversible myocardial injury, and detect inducible ischemia. Streamlined protocols allow such a CMR examination to be a time-efficient diagnostic tool in patients with coronary artery disease. Moreover, edema imaging with T2-weighted CMR allows the detection of acute coronary syndromes. In this review, we present the relevant CMR methods and discuss practical uses of CMR in acute and chronic ischemic heart disease.

Influence of the trigger technique on ventricular function measurements using 3-Tesla magnetic resonance imaging: comparison of ECG versus pulse wave triggering

BACKGROUND

Three Tesla cardiovascular magnetic resonance imaging (3T-CMR) is increasingly used in clinical practice. Despite many advantages one drawback is that ECG signal disturbances and artifacts increase with higher magnetic field strength resulting in trigger problems and false gating. This particularly affects cardiac imaging because most pulse sequences require ECG triggering. Pulse wave (PW) triggering is robust and might have advantages over ECG triggering.

PURPOSE

To evaluate differences in left ventricular (LV) function as an integral part of most CMR studies between ECG- and PW-triggered short-axis imaging using 3T-CMR.

MATERIAL AND METHODS

Forty-three patients underwent multiple short-axis cine imaging for LV-function assessment with ECG and PW triggering using standard multibreath hold steady-state free precession. LV-volumes (EDV, ESV), ejection fraction (EF), and mass were determined by slice summation. LV-wall motion was assessed by using a 4-point scoring scale. Bland Altman statistics for inter-observer variability were performed.

RESULTS

ECG triggering failed in 15 patients (34.8%). Thus, analysis was performed in 28 patients (13 with impaired LV function). Difference in volumes (EDV 0.13 ± 1.8 mL, ESV 0.59 ± 1.1 mL), EF (-0.32 ± 0.6%) and mass (0.01 ± 1.1 g) between ECG and PW triggering were very small and significant only for ESV and EF (p ≤ 0.011). In patients with impaired LV function (n = 19) differences were not significant (p ≥ 0.128). Wall motion scores did not differ between ECG and PW triggering (p ≥ 0.295). Inter-observer variability for function measurements was low.

CONCLUSION

Short-axis cine imaging for LV-function assessment can accurately be performed using PW triggering on 3T magnets, and may be used in clinical practice when ECG triggering is disturbed.