Cardiac balanced steady-state free precession MRI at 0.35 T: a comparison study with 1.5 T

Bringing MRI to low- and middle-income countries: Directions, challenges and potential solutions

The global disparity of magnetic resonance imaging (MRI) is a major challenge, with many low- and middle-income countries (LMICs) experiencing limited access to MRI. The reasons for limited access are technological, economic and social. With the advancement of MRI technology, we explore why these challenges still prevail, highlighting the importance of MRI as the epidemiology of disease changes in LMICs. In this paper, we establish a framework to develop MRI with these challenges in mind and discuss the different aspects of MRI development, including maximising image quality using cost-effective components, integrating local technology and infrastructure and implementing sustainable practices. We also highlight the current solutions-including teleradiology, artificial intelligence and doctor and patient education strategies-and how these might be further improved to achieve greater access to MRI.

Cardiac MRI at Low Field Strengths

Cardiac MR imaging is well established for assessment of cardiovascular structure and function, myocardial scar, quantitative flow, parametric mapping, and myocardial perfusion. Despite the clear evidence supporting the use of cardiac MRI for a wide range of indications, it is underutilized clinically. Recent developments in low-field MRI technology, including modern data acquisition and image reconstruction methods, are enabling high-quality low-field imaging that may improve the cost-benefit ratio for cardiac MRI. Studies to-date confirm that low-field MRI offers high measurement concordance and consistent interpretation with clinical imaging for several routine sequences. Moreover, low-field MRI may enable specific new clinical opportunities for cardiac imaging such as imaging near metal implants, MRI-guided interventions, combined cardiopulmonary assessment, and imaging of patients with severe obesity. In this review, we discuss the recent progress in low-field cardiac MRI with a focus on technical developments and early clinical validation studies. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 1.

New clinical opportunities of low-field MRI: heart, lung, body, and musculoskeletal

Contemporary whole-body low-field MRI scanners (< 1 T) present new and exciting opportunities for improved body imaging. The fundamental reason is that the reduced off-resonance and reduced SAR provide substantially increased flexibility in the design of MRI pulse sequences. Promising body applications include lung parenchyma imaging, imaging adjacent to metallic implants, cardiac imaging, and dynamic imaging in general. The lower cost of such systems may make MRI favorable for screening high-risk populations and population health research, and the more open configurations allowed may prove favorable for obese subjects and for pregnant women. This article summarizes promising body applications for contemporary whole-body low-field MRI systems, with a focus on new platforms developed within the past 5 years. This is an active area of research, and one can expect many improvements as MRI physicists fully explore the landscape of pulse sequences that are feasible, and as clinicians apply these to patient populations.

Ramping down a clinical 3 T scanner: a journey into MRI and MRS at 0.75 T

OBJECT

Lower-field MR is reemerging as a viable, potentially cost-effective alternative to high-field MR, thanks to advances in hardware, sequence design, and reconstruction over the past decades. Evaluation of lower field strengths, however, is limited by the availability of lower-field systems on the market and their considerable procurement costs. In this work, we demonstrate a low-cost, temporary alternative to purchasing a dedicated lower-field MR system.

MATERIALS AND METHODS

By ramping down an existing clinical 3 T MRI system to 0.75 T, proton signals can be acquired using repurposed ¹³C transmit/receive hardware and the multi-nuclei spectrometer interface. We describe the ramp-down procedure and necessary software and hardware changes to the system.

RESULTS

Apart from presenting system characterization results, we show in vivo examples of cardiac cine imaging, abdominal two- and three-point Dixon-type water/fat separation, water/fat-separated MR Fingerprinting, and point-resolved spectroscopy. In addition, the ramp-down approach allows unique comparisons of, e.g., gradient fidelity of the same MR system operated at different field strengths using the same receive chain, gradient coils, and amplifiers.

DISCUSSION

Ramping down an existing MR system may be seen as a viable alternative for lower-field MR research in groups that already own multi-nuclei hardware and can also serve as a testing platform for custom-made multi-nuclei transmit/receive coils.

Building a comprehensive cardiovascular magnetic resonance exam on a commercial 0.55 T system: A pictorial essay on potential applications

Background

Contemporary advances in low-field magnetic resonance imaging systems can potentially widen access to cardiovascular magnetic resonance (CMR) imaging. We present our initial experience in building a comprehensive CMR protocol on a commercial 0.55 T system with a gradient performance of 26 mT/m amplitude and 45 T/m/s slew rate. To achieve sufficient image quality, we adapted standard imaging techniques when possible, and implemented compressed-sensing (CS) based techniques when needed in an effort to compensate for the inherently low signal-to-noise ratio at lower field strength.

Methods

A prototype CMR exam was built on an 80 cm, ultra-wide bore commercial 0.55 T MR system. Implementation of all components aimed to overcome the inherently lower signal of low-field and the relatively longer echo and repetition times owing to the slower gradients. CS-based breath-held and real-time cine imaging was built utilizing high acceleration rates to meet nominal spatial and temporal resolution recommendations. Similarly, CS 2D phase-contrast cine was implemented for flow. Dark-blood turbo spin echo sequences with deep learning based denoising were implemented for morphology assessment. Magnetization-prepared single-shot myocardial mapping techniques incorporated additional source images. CS-based dynamic contrast-enhanced imaging was implemented for myocardial perfusion and 3D MR angiography. Non-contrast 3D MR angiography was built with electrocardiogram-triggered, navigator-gated magnetization-prepared methods. Late gadolinium enhanced (LGE) tissue characterization methods included breath-held segmented and free-breathing single-shot imaging with motion correction and averaging using an increased number of source images. Proof-of-concept was demonstrated through porcine infarct model, healthy volunteer, and patient scans.

Results

Reasonable image quality was demonstrated for cardiovascular structure, function, flow, and LGE assessment. Low-field afforded utilization of higher flip angles for cine and MR angiography. CS-based techniques were able to overcome gradient speed limitations and meet spatial and temporal resolution recommendations with imaging times comparable to higher performance scanners. Tissue mapping and perfusion imaging require further development.

Conclusion

We implemented cardiac applications demonstrating the potential for comprehensive CMR on a novel commercial 0.55 T system. Further development and validation studies are needed before this technology can be applied clinically.

Pulmonary Dysfunction after Pediatric COVID-19

Background Long COVID occurs at a lower frequency in children and adolescents than in adults. Morphologic and free-breathing phase-resolved functional low-field-strength MRI may help identify persistent pulmonary manifestations after SARS-CoV-2 infection. Purpose To characterize both morphologic and functional changes of lung parenchyma at low-field-strength MRI in children and adolescents with post-COVID-19 condition compared with healthy controls. Materials and Methods Between August and December 2021, a cross-sectional clinical trial using low-field-strength MRI was performed in children and adolescents from a single academic medical center. The primary outcome was the frequency of morphologic changes at MRI. Secondary outcomes included MRI-derived functional proton ventilation and perfusion parameters. Clinical symptoms, the duration from positive reverse transcriptase-polymerase chain reaction test result, and serologic parameters were compared with imaging results. Nonparametric tests for pairwise and corrected tests for groupwise comparisons were applied to assess differences in healthy controls, recovered participants, and those with long COVID. Results A total of 54 participants after COVID-19 infection (mean age, 11 years ± 3 [SD]; 30 boys [56%]) and nine healthy controls (mean age, 10 years ± 3; seven boys [78%]) were included: 29 (54%) in the COVID-19 group had recovered from infection and 25 (46%) were classified as having long COVID on the day of enrollment. Morphologic abnormality was identified in one recovered participant. Both ventilated and perfused lung parenchyma (ventilation-perfusion [V/Q] match) was higher in healthy controls (81% ± 6.1) compared with the recovered group (62% ± 19; P = .006) and the group with long COVID (60% ± 20; P = .003). V/Q match was lower in patients with time from COVID-19 infection to study participation of less than 180 days (63% ± 20; P = .03), 180-360 days (63% ± 18; P = .03), and 360 days (41% ± 12; P < .001) as compared with the never-infected healthy controls (81% ± 6.1). Conclusion Low-field-strength MRI showed persistent pulmonary dysfunction in children and adolescents who recovered from COVID-19 and those with long COVID. Clinical trial registration no. NCT04990531 © RSNA, 2022 Supplemental material is available for this article. See also the editorial by Paltiel in this issue.

Contrast-optimal simultaneous multi-slice bSSFP cine cardiac imaging at 0.55 T

PURPOSE

To determine if contemporary 0.55 T MRI supports the use of contrast-optimal flip angles (FA) for simultaneous multi-slice (SMS) balanced SSFP (bSSFP) cardiac function assessment, which is impractical at conventional field strengths because of excessive SAR and/or banding artifacts.

METHODS

Blipped-CAIPI bSSFP was combined with spiral sampling for ventricular function assessment at 0.55 T. Cine movies with single band and SMS factors of 2 and 3 (SMS 2 and 3), and FA ranging from 60° to 160°, were acquired in seven healthy volunteers. Left ventricular blood and myocardial signal intensity (SI) normalized by background noise and blood-myocardium contrast were measured and compared across acquisition settings.

RESULTS

Myocardial SI was slightly higher in single band than in SMS and decreased with an increasing FA. Blood SI increased as the FA increased for single band, and increment was small for FA ≥120°. Blood SI for SMS 2 and 3 increased with an increasing FA up to ∼100°. Blood-myocardium contrast increased with an increasing FA for single band, peaked at FA = 160° (systole: 28.43, diastole: 29.15), attributed mainly to reduced myocardial SI when FA ≥120°. For SMS 2, contrast peaked at 120° (systole: 21.43, diastole: 19.85). For SMS 3, contrast peaked at 120° in systole (16.62) and 100° in diastole (19.04).

CONCLUSIONS

Contemporary 0.55 T MR scanners equipped with high-performance gradient systems allow the use of contrast-optimal FA for SMS accelerated bSSFP cine examinations without compromising image quality. The contrast-optimal FA was found to be 140° to 160° for single band and 100° to 120° for SMS 2 and 3.

Denoising Using Noise2Void for Low-Field Magnetic Resonance Imaging: A Phantom Study

To reduce noise for low-field magnetic resonance imaging (MRI) using Noise2Void (N2V) and to demonstrate the N2V validity. N2V is one of the denoising convolutional neural network methods that allows the training of a model without a noiseless clean image. In this study, a kiwi fruit was scanned using a 0.35 Tesla MRI system, and the image qualities at pre- and postdenoising were evaluated. Structural similarity (SSIM), signal-to-noise ratio (SNR), and contrast ratio (CR) were measured, and visual assessment of noise and sharpness was observed. Both SSIM and SNR were significantly improved using N2V (P < 0.05). CR was unchanged between pre- and postdenoising images. The results of visual assessment for noise revealed higher scores in postdenoising images than that in predenoising images. The sharpness scores of postdenoising images were high when SNR was low. N2V provides effective noise reduction and is a useful denoising technique in low-field MRI.

Sustainable low-field cardiovascular magnetic resonance in changing healthcare systems

Cardiovascular disease continues to be a major burden facing healthcare systems worldwide. In the developed world, cardiovascular magnetic resonance (CMR) is a well-established non-invasive imaging modality in the diagnosis of cardiovascular disease. However, there is significant global inequality in availability and access to CMR due to its high cost, technical demands as well as existing disparities in healthcare and technical infrastructures across high-income and low-income countries. Recent renewed interest in low-field CMR has been spurred by the clinical need to provide sustainable imaging technology capable of yielding diagnosticquality images whilst also being tailored to the local populations and healthcare ecosystems. This review aims to evaluate the technical, practical and cost considerations of low field CMR whilst also exploring the key barriers to implementing sustainable MRI in both the developing and developed world.

A revisit of the k-space filtering effects of magnetization-prepared 3D FLASH and balanced SSFP acquisitions: Analytical characterization of the point spread functions

PURPOSE

3D FLASH and balanced SSFP (bSSFP) are increasingly used in quantitative MRI after contrast preparation. The acquired k-space data are modulated by T₁ relaxation (or additional T₂ for bSSFP). Three separate sequence parameters including the number of phase-encoding steps per shot (N), flip angle (FA), and TR have made the transient state of rapid gradient echo (GRE) imaging difficult for analysis and optimization. Here we aim to analytically characterize the k-space filtering effect of magnetization-prepared FLASH and bSSFP with the point spread functions (PSF).

METHODS

The amplitude effect is characterized with the peak magnitude of the PSF, i.e. PSF(0), which, due to their approaching from transient state to steady-state for the GRE acquisitions, obeys a linear (with a slope and an intercept, not proportional) relationship with the prepared longitudinal magnetization (M_prep). The blurring effect is characterized by the FWHM of the PSF. The magnetization-prepared acquisition-dependent image contrast efficiency is characterized with the relative contrast-to-noise ratio (CNR) per unit time (ruCNR).

RESULTS

The slope of PSF(0) characterizes the relative contrast between different M_prep levels. The intercept of PSF(0) could lead to quantification bias for magnetization-prepared imaging. FLASH and bSSFP experience very little blurring effect, which is to the contrary of conventional fast spin echo (FSE). Analytical selections of N, FA, and TR are provided to optimize ruCNR for different scenarios.

CONCLUSIONS

PSFs of the FLASH and bSSFP acquisitions are analytically derived and numerically validated, and compared with the FSE acquisition, thus providing a useful tool for optimizing magnetization-prepared GRE acquisitions.

Feasibility of MR fingerprinting using a high-performance 0.55 T MRI system

BACKGROUND

MR fingerprinting (MRF) is a versatile method for rapid multi-parametric quantification. The application of MRF for lower MRI field could enable multi-contrast imaging and improve exam efficiency on these systems. The purpose of this work is to demonstrate the feasibility of 3D whole-brain T1 and T2 mapping using MR fingerprinting on a contemporary 0.55 T MRI system.

MATERIALS AND METHODS

A 3D whole brain stack-of-spirals FISP MRF sequence was implemented for 0.55 T. Quantification was validated using the NIST/ISMRM Quantitative MRI phantom, and T1 and T2 values of white matter, gray matter, and cerebrospinal fluid were measured in 19 healthy subjects. To assess MRF performance in the lower SNR regime of 0.55 T, measurement precision was calculated from 100 simulated pseudo-replicas of in vivo data and within-session measurement repeatability was evaluated.

RESULTS

T1 and T2 values calculated by MRF were strongly correlated to standard measurements in the ISMRM/NIST MRI system phantom (R² > 0.99), with a small constant bias of approximately 5 ms in T2 values. 3D stack-of-spirals MRF was successfully applied for whole brain quantitative T1 and T2 at 0.55 T, with spatial resolution of 1.2 mm × 1.2 mm × 5 mm, and acquisition time of 8.5 min. Moreover, the T1 and T2 quantifications had precision <5%, despite the lower SNR of 0.55 T.

CONCLUSION

A 3D whole-brain stack-of-spirals FISP MRF sequence is feasible for T1 and T2 mapping at 0.55 T.

Current landscape and future perspectives in preclinical MR and PET imaging of brain metastasis

Brain metastasis (BM) is a major cause of cancer patient morbidity. Clinical magnetic resonance imaging (MRI) and positron emission tomography (PET) represent important resources to assess tumor progression and treatment responses. In preclinical research, anatomical MRI and to some extent functional MRI have frequently been used to assess tumor progression. In contrast, PET has only to a limited extent been used in animal BM research. A considerable culprit is that results from most preclinical studies have shown little impact on the implementation of new treatment strategies in the clinic. This emphasizes the need for the development of robust, high-quality preclinical imaging strategies with potential for clinical translation. This review focuses on advanced preclinical MRI and PET imaging methods for BM, describing their applications in the context of what has been done in the clinic. The strengths and shortcomings of each technology are presented, and recommendations for future directions in the development of the individual imaging modalities are suggested. Finally, we highlight recent developments in quantitative MRI and PET, the use of radiomics and multimodal imaging, and the need for a standardization of imaging technologies and protocols between preclinical centers.

Dosimetric impact from cardiac motion to heart substructures in thoracic cancer patients treated with a magnetic resonance guided radiotherapy system

Few studies have examined the cardiac volume and radiation dose differences among cardiac phases during radiation therapy (RT). Such information is crucial to dose reconstruction and understanding of RT related cardiac toxicity. In a cohort of nine patients, we studied the changes in the volume and doses of several cardiac substructures between the end-diastolic and end-systolic phases based on the clinical magnetic resonance-guided RT (MRgRT) treatment plans. Significant differences in the volume and dose between the two phases were observed. Onboard cardiac cine MRI holds promise for patient-specific cardiac sparing treatment designs.

Dosimetric feasibility of brain stereotactic radiosurgery with a 0.35 T MRI-guided linac and comparison vs a C-arm-mounted linac

PURPOSE

MRI is the gold-standard imaging modality for brain tumor diagnosis and delineation. The purpose of this work was to investigate the feasibility of performing brain stereotactic radiosurgery (SRS) with a 0.35 T MRI-guided linear accelerator (MRL) equipped with a double-focused multileaf collimator (MLC). Dosimetric comparisons were made vs a conventional C-arm-mounted linac with a high-definition MLC.

METHODS

The quality of MRL single-isocenter brain SRS treatment plans was evaluated as a function of target size for a series of spherical targets with diameters from 0.6 cm to 2.5 cm in an anthropomorphic head phantom and six brain metastases (max linear dimension = 0.7-1.9 cm) previously treated at our clinic on a conventional linac. Each target was prescribed 20 Gy to 99% of the target volume. Step-and-shoot IMRT plans were generated for the MRL using 11 static coplanar beams equally spaced over 360° about an isocenter placed at the center of the target. Couch and collimator angles are fixed for the MRL. Two MRL planning strategies (VR1 and VR2) were investigated. VR1 minimized the 12 Gy isodose volume while constraining the maximum point dose to be within ±1 Gy of 25 Gy which corresponded to normalization to an 80% isodose volume. VR2 minimized the 12 Gy isodose volume without the maximum dose constraint. For the conventional linac, the TB1 method followed the same strategy as VR1 while TB2 used five noncoplanar dynamic conformal arcs. Plan quality was evaluated in terms of conformity index (CI), conformity/gradient index (CGI), homogeneity index (HI), and volume of normal brain receiving ≥12 Gy (V_12Gy ). Quality assurance measurements were performed with Gafchromic EBT-XD film following an absolute dose calibration protocol.

RESULTS

For the phantom study, the CI of MRL plans was not significantly different compared to a conventional linac (P > 0.05). The use of dynamic conformal arcs and noncoplanar beams with a conventional linac spared significantly more normal brain (P = 0.027) and maximized the CGI, as expected. The mean CGI was 95.9 ± 4.5 for TB2 vs 86.6 ± 3.7 (VR1), 88.2 ± 4.8 (VR2), and 88.5 ± 5.9 (TB1). Each method satisfied a normal brain V_12Gy  ≤ 10.0 cm³ planning goal for targets with diameter ≤2.25 cm. The mean V_12Gy was 3.1 cm³ for TB2 vs 5.5 cm³ , 5.0 cm³ and 4.3 cm³ , for VR1, VR2, and TB1, respectively. For a 2.5-cm diameter target, only TB2 met the V_12Gy planning objective. The MRL clinical brain plans were deemed acceptable for patient treatment. The normal brain V_12Gy was ≤6.0 cm³ for all clinical targets (maximum target volume = 3.51 cm³ ). CI and CGI ranged from 1.12-1.65 and 81.2-88.3, respectively. Gamma analysis pass rates (3%/1mm criteria) exceeded 97.6% for six clinical targets planned and delivered on the MRL. The mean measured vs computed absolute dose difference was -0.1%.

CONCLUSIONS

The MRL system can produce clinically acceptable brain SRS plans for spherical lesions with diameter ≤2.25 cm. Large lesions (>2.25 cm) should be treated with a linac capable of delivering noncoplanar beams.

Assessment of cardiac function, blood flow and myocardial tissue relaxation parameters at 0.35 T

A low field strength (B0) system could increase cardiac MRI availability for patients otherwise contraindicated at higher field. Lower equipment costs could also broaden cardiac MR accessibility. The current study investigated the feasibility of cardiac function with steady-state free precession and flow assessment with phase contrast (PC) cine images at 0.35 T, and evaluated differences in myocardial relaxation times using quantitative T1, T2 and T2* maps by comparison with 1.5 and 3 T results in a small cohort of six healthy volunteers. Signal-to-noise ratio (SNR) differences across systems were characterized with proton density-weighted spin echo phantom data. SNR at 0.35 T was lower by factors of 5.5 and 15.0 compared with the 1.5 and 3 T systems used in this study. All cine images at 0.35 T scored 3 or greater on a five-point image quality scale. Normalized blood-myocardium contrast in cine images, left ventricular volumes (end diastolic volume, end systolic volume) and function (ejection fraction and stroke volume) measures at 0.35 T matched 1.5 and 3 T results. Phase-to-noise ratio in 0.35 T PC images (11.7 ± 1.9) was lower than 1.5 T (18.7 ± 5.2) and 3 T (44.9 ± 16.5). Peak velocity and stroke volume determined from PC images were similar across systems. Myocardial T1 increased (564 ± 13 ms at 0.35 T, 955 ± 19 ms at 1.5 T and 1200 ± 35 ms at 3 T) while T2 (59 ± 4 ms at 0.35 T, 49 ± 3 ms at 1.5 T and 40 ± 2 ms at 3 T) and T2* (42 ± 8 ms at 0.35 T, 33 ± 6 ms at 1.5 T and 24 ± 3 ms at 3 T) decreased with increasing B0. Despite SNR deficits, cardiovascular function, flow assessment and myocardial relaxation parameter mapping is feasible at 0.35 T using standard cardiovascular imaging sequences.

A comparison of cine CMR imaging at 0.55 T and 1.5 T

BACKGROUND

There is a renewed interest in lower field magnetic resonance imaging (MRI) systems for cardiovascular magnetic resonance (CMR), due to their favorable physical properties, reduced costs, and increased accessibility to patients with implants. We sought to assess the diagnostic capabilities of high-performance low-field (0.55 T) CMR imaging for quantification of right and left ventricular volumes and systolic function in both healthy subjects and patients referred for clinical CMR.

METHODS

Sixty-five subjects underwent paired exams at 1.5 T using a clinical CMR scanner and using an identical CMR system modified to operate at 0.55 T. Volumetric coverage of the right ventricle (RV) and left ventricles (LV) was obtained using either a breath-held cine balanced steady-state free-precession acquisition or a motion-corrected free-breathing re-binned cine acquisition. Bland-Altman analysis was used to compare LV and RV end-systolic volume (ESV), end-diastolic volume (EDV), ejection fraction (EF), and LV mass. Diagnostic confidence was scored on a Likert-type ordinal scale by blinded readers.

RESULTS

There were no significant differences in LV and RV EDV between the two scanners (e.g., LVEDV: p = 0.77, bias = 0.40 mL, correlation coefficient = 0.99; RVEDV: p = 0.17, bias = - 1.6 mL, correlation coefficient = 0.98), and regional wall motion abnormality scoring was similar (kappa 0.99). Blood-myocardium contrast-to-noise ratio (CNR) at 0.55 T was 48 ± 7% of the 1.5 T CNR, and contrast was sufficient for endocardial segmentation in all cases. Diagnostic confidence of images was scored as "good" to "excellent" for the two field strengths in the majority of studies.

CONCLUSION

A high-performance 0.55 T system offers good bSSFP CMR image quality, and quantification of biventricular volumes and systolic function that is comparable to 1.5 T in patients.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03331380, NCT03581318.

Efficient spiral in-out and EPI balanced steady-state free precession cine imaging using a high-performance 0.55T MRI

PURPOSE

Low-field MRI offers favorable physical properties for SNR-efficient long readout acquisitions such as spiral and EPI. We used a 0.55 tesla (T) MRI system equipped with high-performance hardware to increase the sampling duty cycle and extend the TR of balanced steady-state free precession (bSSFP) cardiac cine acquisitions, which typically are limited by banding artifacts.

METHODS

We developed a high-efficiency spiral in-out bSSFP acquisition, with zeroth- and first-gradient moment nulling, and an EPI bSSFP acquisition for cardiac cine imaging using a contemporary MRI system modified to operate at 0.55T. Spiral in-out and EPI bSSFP cine protocols, with TR = 8 ms, were designed to maintain both spatiotemporal resolution and breath-hold length. Simulations, phantom imaging, and healthy volunteer imaging studies (n = 12) were performed to assess SNR and image quality using these high sampling duty-cycle bSSFP sequences.

RESULTS

Spiral in-out bSSFP performed favorably at 0.55T and generated good image quality, whereas EPI bSSFP suffered motion and flow artifacts. There was no difference in ejection fraction comparing spiral in-out with standard Cartesian imaging. Moreover, human images demonstrated a 79% ± 21% increase in myocardial SNR using spiral in-out bSSFP and 50% ± 14% increase in SNR using EPI bSSFP as compared with the reference Cartesian acquisition. Spiral in-out acquisitions at 0.55T recovered 69% ± 14% of the myocardial SNR at 1.5T.

CONCLUSION

Efficient bSSFP spiral in-out provided high-quality cardiac cine imaging and SNR recovery on a high-performance 0.55T MRI system.

Opportunities in Interventional and Diagnostic Imaging by Using High-Performance Low-Field-Strength MRI

Background Commercial low-field-strength MRI systems are generally not equipped with state-of-the-art MRI hardware, and are not suitable for demanding imaging techniques. An MRI system was developed that combines low field strength (0.55 T) with high-performance imaging technology. Purpose To evaluate applications of a high-performance low-field-strength MRI system, specifically MRI-guided cardiovascular catheterizations with metallic devices, diagnostic imaging in high-susceptibility regions, and efficient image acquisition strategies. Materials and Methods A commercial 1.5-T MRI system was modified to operate at 0.55 T while maintaining high-performance hardware, shielded gradients (45 mT/m; 200 T/m/sec), and advanced imaging methods. MRI was performed between January 2018 and April 2019. T1, T2, and T2* were measured at 0.55 T; relaxivity of exogenous contrast agents was measured; and clinical applications advantageous at low field were evaluated. Results There were 83 0.55-T MRI examinations performed in study participants (45 women; mean age, 34 years ± 13). On average, T1 was 32% shorter, T2 was 26% longer, and T2* was 40% longer at 0.55 T compared with 1.5 T. Nine metallic interventional devices were found to be intrinsically safe at 0.55 T (<1°C heating) and MRI-guided right heart catheterization was performed in seven study participants with commercial metallic guidewires. Compared with 1.5 T, reduced image distortion was shown in lungs, upper airway, cranial sinuses, and intestines because of improved field homogeneity. Oxygen inhalation generated lung signal enhancement of 19% ± 11 (standard deviation) at 0.55 T compared with 7.6% ± 6.3 at 1.5 T (P = .02; five participants) because of the increased T1 relaxivity of oxygen (4.7e-4 mmHg-1sec-1). Efficient spiral image acquisitions were amenable to low field strength and generated increased signal-to-noise ratio compared with Cartesian acquisitions (P < .02). Representative imaging of the brain, spine, abdomen, and heart generated good image quality with this system. Conclusion This initial study suggests that high-performance low-field-strength MRI offers advantages for MRI-guided catheterizations with metal devices, MRI in high-susceptibility regions, and efficient imaging. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Grist in this issue.