Free‐breathing cardiac MR with a fixed navigator efficiency using adaptive gating window size

A respiratory navigator with a fixed acceptance gating window is commonly used to reduce respiratory motion artifacts in cardiac MR. This approach prolongs the scan time and occasionally yields an incomplete dataset due to respiratory drifts. To address this issue, we propose an adaptive gating window approach in which the size and position of the gating window are changed adaptively during the acquisition based on the individual's breathing pattern. The adaptive gating window tracks the breathing pattern of the subject throughout the scan and adapts the size and position of the gating window such that the gating efficiency is always fixed at a constant value. To investigate the image quality and acquisition time, free breathing cardiac MRI, including both targeted coronary MRI and late gadolinium enhancement imaging, was performed in 67 subjects using the proposed navigator technique. Targeted coronary MRI was acquired from eleven healthy adult subjects using both the conventional and proposed adaptive gating window techniques. Fifty‐six patients referred for cardiac MRI were also imaged using late gadolinium enhancement with the proposed adaptive gating window technique. Subjective and objective image assessments were used to evaluate the proposed method. The results demonstrate that the proposed technique allows free‐breathing cardiac MRI in a relatively fixed time without compromising imaging quality due to respiratory motion artifacts. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.     

Technique for producing cardiac radionuclide motion images.

Sequential frames of different portions of the cardiac cycle are gated into a minicomputer by using an EKG signal recorded onto digital tape simultaneously with imaging information. Serial display of these frames on the computer oscilloscope or projection of 35-mm half frames of these images provides a cardiac motion image with information content adequate for qualitatively assessing cardiac motion.     

Free‐Breathing 3D Cardiac MRI Using Iterative Image‐Based Respiratory Motion Correction

Respiratory motion compensation using diaphragmatic navigator gating with a 5 mm gating window is conventionally used for free‐breathing cardiac MRI. Because of the narrow gating window, scan efficiency is low resulting in long scan times, especially for patients with irregular breathing patterns. In this work, a new retrospective motion compensation algorithm is presented to reduce the scan time for free‐breathing cardiac MRI that increasing the gating window to 15 mm without compromising image quality. The proposed algorithm iteratively corrects for respiratory‐induced cardiac motion by optimizing the sharpness of the heart. To evaluate this technique, two coronary MRI datasets with 1.3 mm³ resolution were acquired from 11 healthy subjects (seven females, 25 ± 9 years); one using a navigator with a 5 mm gating window acquired in 12.0 ± 2.0 min and one with a 15 mm gating window acquired in 7.1 ± 1.0 min. The images acquired with a 15 mm gating window were corrected using the proposed algorithm and compared to the uncorrected images acquired with the 5 and 15 mm gating windows. The image quality score, sharpness, and length of the three major coronary arteries were equivalent between the corrected images and the images acquired with a 5 mm gating window (P‐value > 0.05), while the scan time was reduced by a factor of 1.7. Magn Reson Med, 70:1005–1015, 2013. © 2012 Wiley Periodicals, Inc.     

Respiratory self-gated four-dimensional coronary MR angiography: a feasibility study.

The four-dimensional (4D) coronary MR angiography (MRA) approach has been developed to eliminate the need for accurate determination of the acquisition window and trigger delay time. Diaphragm navigator (NAV) has been the conventional respiratory gating method for free-breathing coronary MRA. However, NAV echo acquisition interrupts the continuous radiofrequency pulse application required for 4D steady-state free precession coronary MRA. The objective of this work was to investigate the feasibility of a respiratory self-gating (RSG) technique for 4D coronary MRA and its effectiveness by comparing with retrospective NAV gating. Data were acquired continuously throughout the cardiac cycle and retrospectively remapped to cardiac phases based on the electrocardiogram signal simultaneously recorded. An RSG signal extracted from a direct measurement of the heart position was used for retrospective respiratory gating and motion correction. In seven healthy volunteers, 4D MRA images were reconstructed, allowing retrospective assessment of the cardiac motion of the coronary artery and selection of the images with the best vessel delineation. Statistical analysis shows that 4D RSG provides coronary artery delineation comparable to mid-diastole images acquired using NAV. Respiratory self-gating is an effective method for eliminating respiratory motion artifacts and allows 4D coronary MRA during free breathing.     

Digital angiography

The many available methods of digital subtraction angiography (DSA) are briefly reviewed. At present the most commonly used are temporal filtration techniques, which include conventional subtraction, integrated remasking , and various types of filtering. Their present use in intravenous, as well as intra-arterial, DSA is shown. The "moving mask" subtraction technique for cardiac and coronary studies is of particular interest. The current status of second-order subtraction techniques such as tomographic DSA and parametric digital imaging is presented. The latter method is particularly useful for demonstration of shunts. Finally, several examples of non-angiographic and future applications of digital radiography are presented.     

Effects of breathing and cardiac motion on spatial resolution in the microscopic imaging of rodents.

One can acquire high-resolution pulmonary and cardiac images in live rodents with MR microscopy by synchronizing the image acquisition to the breathing cycle across multiple breaths, and gating to the cardiac cycle. The precision with which one can synchronize image acquisition to the motion defines the ultimate resolution limit that can be attained in such studies. The present work was performed to evaluate how reliably the pulmonary and cardiac structures return to the same position from breath to breath and beat to beat across the prolonged period required for MR microscopy. Radiopaque beads were surgically glued to the abdominal surface of the diaphragm and on the cardiac ventricles of anesthetized, mechanically ventilated rats. We evaluated the range of motion for the beads (relative to a reference vertebral bead) using digital microradiography with two specific biological gating methods: 1) ventilation synchronous acquisition, and 2) both ventilation synchronous and cardiac-gated acquisitions. The standard deviation (SD) of the displacement was < or =100 microm, which is comparable to the resolution limit for in vivo MRI imposed by signal-to-noise ratio (SNR) constraints. With careful control of motion, its impact on resolution can be limited. This work provides the first quantitative measure of the motion-imposed resolution limits for in vivo imaging.     

Assessment of motion gating strategies for mouse magnetic resonance at high magnetic fields

PURPOSE: To assess the performance of motion gating strategies for mouse cardiac magnetic resonance (MR) at high magnetic fields by quantifying the levels of motion artifact observed in images and spectra in vivo. MATERIALS AND METHODS: MR imaging (MRI) of the heart, diaphragm, and liver; MR angiography of the aortic arch; and slice-selective 1H-spectroscopy of the heart were performed on anesthetized C57Bl/6 mice at 11.75 T. Gating signals were derived using a custom-built physiological motion gating device, and the gating strategies considered were no gating, cardiac gating, conventional gating (i.e., blanking during respiration), automatic gating, and user-defined gating. Both automatic and user-defined modes used cardiac and respiratory gating with steady-state maintenance during respiration. Gating performance was assessed by quantifying the levels of motion artifact observed in images and the degree of amplitude and phase stability in spectra. RESULTS: User-defined gating with steady-state maintenance during respiration gave the best performance for mouse cardiac imaging, angiography, and spectroscopy, with a threefold increase in signal intensity and a sixfold reduction in noise intensity compared to cardiac gating only. CONCLUSION: Physiological gating with steady-state maintenance during respiration is essential for mouse cardiac MR at high magnetic fields.     

CINE turbo spin echo imaging

High‐resolution turbo spin echo (TSE) images have demonstrated important details of carotid artery morphology; however, it is evident that pulsatile blood and wall motion related to the cardiac cycle are still significant sources of image degradation. Although ECG gating can reduce artifacts due to cardiac‐induced pulsations, gating is rarely used because it lengthens the acquisition time and can cause image degradation due to nonconstant repetition time. This work introduces a relatively simple method of converting a conventional TSE acquisition into a retrospectively ECG‐correlated cineTSE sequence. The cineTSE sequence generates a full sequence of ECG‐correlated images at each slice location throughout the cardiac cycle in the same scan time that is conventionally used by standard TSE sequences to produce a single image at each slice location. The cineTSE images exhibit reduced pulsatile artifacts associated with a gated sequence but without the increased scan time or associated nonconstant repetition time effects. Magn Reson Med, 2011. © 2011 Wiley Periodicals, Inc.     

Self-gated cardiac cine MRI.

The need for ECG gating presents many difficulties in cardiac magnetic resonance imaging (CMRI). Real-time imaging techniques eliminate the need for ECG gating in cine CMRI, but they cannot offer the spatial and temporal resolution provided by segmented acquisition techniques. Previous MR signal-based techniques have demonstrated an ability to provide cardiac gating information; however, these techniques result in decreased imaging efficiency. The purpose of this work was to develop a new "self-gated" (SG) acquisition technique that eliminates these efficiency deficits by extracting the motion synchronization signal directly from the same MR signals used for image reconstruction. Three separate strategies are proposed for deriving the SG signal from data acquired using radial k-space sampling: echo peak magnitude, kymogram, and 2D correlation. The SG techniques were performed on seven normal volunteers. A comparison of the results showed that they provided cine image series with no significant differences in image quality compared to that obtained with conventional ECG gating techniques. SG techniques represent an important practical advance in clinical MRI because they enable the acquisition of high temporal and spatial resolution cardiac cine images without the need for ECG gating and with no loss in imaging efficiency.     

Tomographic digital subtraction angiography: initial clinical studies using tomosynthesis. Work in progress

We have developed a method for acquiring multiple tomographic subtraction images using a rapid, repetitive, circular tomographic motion. The method combines the principles of digital subtraction angiography (DSA) and electronic tomosynthesis. Fifteen patients were examined with the technique using single intravenous bolus injections of contrast material. The image sequence obtained during each injection was first processed with a nontomographic mask subtraction, and the result was then compared with the tomographic DSA scans synthesized from the same sequence. The effective section thickness was approximately 0.5 cm, with each section being 0.5-1.0 cm apart. Twelve of the intravenous DSA scans provided the necessary diagnostic or clinically useful information. Two of the three nondiagnostic scans were caused by avoidable technical reasons. In eight cases, the tomographic DSA scans were superior in quality to the nontomographic scans, exhibited significantly less artifact from patient motion and overlying bowel gas, and were effective in separating overlapping vessels. Tomosynthesis permits multiple electronic imaging of the area of interest without reinjection of contrast material and appears to be more informative than nontomographic intravenous DSA imaging.     

The beneficial effects of short pulse width acquisition and ECG-gating in digital angiocardiography

Experimental intravenous left ventriculography and coronary angiography after aortic root injection were performed in 13 animals. Various image acquisition and digital image processing techniques were employed. These included single mask mode subtraction, integrated mask mode subtraction, ECG-gated image acquisition, TV camera read-out in interlaced mode, and pulse progressive read-out with 1- to 5-ms pulse width. High quality images were obtained consistently only after ECG-gating and use of 1- to 5-ms pulse width with pulse progressive read-out of the TV camera. Integration of four to eight background as well as contrast images all from the same phase of the cardiac cycle further improved image quality.     

Cardiac imaging with digital subtraction angiography

Central cardiovascular anatomy and function have been evaluated with intravenous digital subtraction angiography (DSA). The subtraction techniques used for studying the left ventricle (LV) were mask mode, time interval difference and functional subtraction. Aside from contrast enhancement, a major use of digital fluoroscopy for cardiac applications has been computer-assisted quantitative analysis of LV dimensions and function. Left ventricular volumes and wall thickness determined from DSA studies have correlated closely with direct left ventriculograms and sonocardiometry measurements in patients and animals, respectively. Measurements of segmental LV contraction with DSA correlated closely with direct left ventriculography in normal patients and patients with coronary artery disease. The sensitivity of intravenous DSA for detecting significant coronary artery disease was increased by performing DSA immediately after increasing the myocardial oxygen demands by atrial pacing. The advantages and disadvantages of DSA in relation to other semi-or non-invasive imaging modalities are discussed.     

Motion compensation in digital subtraction angiography using graphics hardware.

An inherent disadvantage of digital subtraction angiography (DSA) is its sensitivity to patient motion which causes artifacts in the subtraction images. These artifacts could often reduce the diagnostic value of this technique. Automated, fast and accurate motion compensation is therefore required. To cope with this requirement, we first examine a method explicitly designed to detect local motions in DSA. Then, we implement a motion compensation algorithm by means of block matching on modern graphics hardware. Both methods search for maximal local similarity by evaluating a histogram-based measure. In this context, we are the first who have mapped an optimizing search strategy on graphics hardware while paralleling block matching. Moreover, we provide an innovative method for creating histograms on graphics hardware with vertex texturing and frame buffer blending. It turns out that both methods can effectively correct the artifacts in most case, as the hardware implementation of block matching performs much faster: the displacements of two 1024 x 1024 images can be calculated at 3 frames/s with integer precision or 2 frames/s with sub-pixel precision. Preliminary clinical evaluation indicates that the computation with integer precision could already be sufficient.     

Assessment of flow in the right human coronary artery by magnetic resonance phase contrast velocity measurement: Effects of cardiac and respiratory motion

Flow in the human right coronary artery was determined using magnetic resonance phase contrast velocity quantification. Two methods were applied to reduce respiratory motion: imaging during breath holding, which is fast, and retrospective respiratory gating, which has a high temporal resolution (32 ms) in the cardiac cycle. Vessel cross-sectional area, through-plane velocity, and volume flow were determined in six healthy subjects. In-plane vessel displacement during the cardiac cycle, caused by cardiac contraction, was about 2–4 mm within a time frame of 32 ms in systole and early diastole. The motion resulted in blurring of images obtained during breath holding caused by the large acquisition time window (126 ms) within the cardiac cycle. Therefore, only with a high temporal resolution correct velocity images over the entire cardiac cycle could be obtained. The time- and cross-sectionally averaged velocity was 7 ± 2 cm/s, and the volume flow was 30 ± 10 ml/min.     

Cardiac-respiratory gating method for magnetic resonance imaging of the heart.

In studies of transmural myocardial function, acquisitions of high spatial and temporal resolution tagged cardiac images often exceed the practical time limit for breath-hold fast imaging techniques. Therefore, a dual cardiac-respiratory gating device has been constructed to acquire SPAMM-tagged cardiac MR images at or near end-expiration during spontaneous breathing, by providing an external trigger to a conventional MRI system. Combined cardiac and respiratory gating essentially eliminates the respiratory motion artifacts in tagged cardiac MR images. Compared to cardiac-gated images obtained during intermittent breath-holds, cardiac-respiratory gated images show improved tag-myocardium contrast due to magnetization recovery during inspiration.     

A retrospectively ECG-gated multislice spiral CT scan and reconstruction technique with suppression of heart pulsation artifacts for cardio-thoracic imaging with extended volume coverage

A method for cardio-thoracic multislice spiral CT imaging with ECG gating for suppression of heart pulsation artifacts is introduced. The proposed technique offers extended volume coverage compared with standard ECG-gated spiral scan and reconstruction approaches for cardiac applications: Thin-slice data of the entire thorax can be acquired within one breath-hold period using a four-slice CT system. The extended volume coverage is enabled by a modified approach for ECG-gated image reconstruction. For a CT system with 0.5-s gantry rotation time, images are reconstructed with 250-ms image temporal resolution. Instead of selecting scan data acquired in exactly the same phase of the cardiac cycle for each image as in standard ECG-gated reconstruction techniques, the patient's ECG signal is used to omit scan data acquired during the systolic phase of highest cardiac motion. With this approach cardiac pulsation artifacts in CT studies of the aorta, of paracardiac lung segments, and of coronary bypass grafts can be effectively reduced.     

Nonlinear Geometric Warping of the Mask Image: A New Method for Reducing Misregistration Artifacts in Digital Subtraction Angiography

Purpose: Misregistration artifact is the major cause of image degradation in digital subtraction angiography (DSA). The purpose of this study was to evaluate the efficacy of a newly developed nonlinear geometric warping method to reduce misregistration artifact in DSA. Methods: The processing of the images was carried out on a workstation with a fully automatic computerized program. After making differential images with a lapracian filter, 49 regions of interest (ROIs) were set in the image to be processed. Each ROI of the live image scanned the corresponding ROI of the mask image searching for the best position to match itself. Each pixel of the mask image was shifted individually following the data calculated from the shifts of the ROIs. Five radiologists compared the images produced by the conventional parallel shift technique and those processed with this new method in 16 series of cerebral DSA. Results: In 14 of 16 series (88%), more radiologists judged the images processed with the new method to be better in quality. Small arteries near the skull base and veins of low density were clearly visualized in the images processed by the new method. Conclusion: This newly proposed method could be a simple and practical way to automatically reduce misregistration artifacts in DSA.     

Dynamic MR digital subtraction angiography using contrast enhancement,fast data acquisition,and complex subtraction

A dynamic MR angiography technique, MR digital subtraction angiography (MR DSA), is proposed using fast acquisition, contrast enhancement, and complex subtraction. When a bolus of contrast is injected into a patient, data acquisition begins, dynamically acquiring a thick slab using a fast gradient echo sequence for 10–100 s. Similar to x-ray DSA, a mask is selected from the images without contrast enhancement, and later images are subtracted from the mask to generate angiograms. Complex subtraction is used to overcome the partial volume effects related to the phase difference between the flowing and stationary magnetization in a voxel. Vessel signal is the enhancement of flow magnetization resulting from the contrast bolus. MR DSA was performed in 28 patients, including vessels in the lungs, brains, legs, abdomen, and pelvis. All targeted vessels were well depicted with MR DSA. Corresponding dynamic information (contrast arrival time t_a and duration of the arterial phase t_av) was measured: t_a/t_av = 3.4/4.7 s for the lung, 10.3/4.9 s for the brain, 12.8/19.3 for the aorta, 15.2/12.6 s for the leg. MR DSA can provide dynamic angiographic images using a very short acquisition time.     

Carotid bifurcation: MR imaging. Work in progress

To devise and implement an in-plane magnetic resonance angiography examination of the carotid bifurcation capable of producing high-resolution images, the authors examined 19 normal carotid arteries and 14 patients with angiographically documented disease with two flow-correction techniques: a three-gradient, velocity-refocused technique with spin-echo (SE) and gradient-echo sequences, and a four-gradient velocity- and acceleration-corrected SE technique. With use of three equal gradients in the read direction, velocity-related phase changes were minimized by placing the dephasing gradient after the 180 degree pulse and near the read gradient. Acceleration effects were minimized through the use of short echo times and cardiac gating. Both velocity- and acceleration-produced phase changes were corrected with the four-gradient scheme but at the expense of some limitations in spatial resolution. Both techniques consistently produced satisfactory images of the carotid bifurcation in healthy individuals. However, the results indicate that the present gradient-phase modulation techniques have several drawbacks, including susceptibility to patient motion, overlapping with the jugular vein, and inability to image carotid stenosis accurately due to turbulence.     

Error model for reduction of cardiac and respiratory motion effects in quantitative liver DW‐MRI

Diffusion‐weighted images of the liver exhibit signal dropout from cardiac and respiratory motion, particularly in the left lobe. These artifacts cause bias and variance in derived parameters that quantify intravoxel incoherent motion. Many models of diffusion have been proposed, but few separate attenuation from diffusion or perfusion from that of bulk motion. The error model proposed here (Beta*LogNormal) is intended to accomplish that separation by modeling stochastic attenuation from bulk motion as multiplication by a Beta‐distributed random variate. Maximum likelihood estimation with this error model can be used to derive intravoxel incoherent motion parameters separate from signal dropout, and does not require a priori specification of parameters to do so. Liver intravoxel incoherent motion parameters were derived for six healthy subjects under this error model and compared with least‐squares estimates. Least‐squares estimates exhibited bias due to cardiac and respiratory gating and due to location within the liver. Bias from these factors was significantly reduced under the Beta*LogNormal model, as was within‐organ parameter variance. Similar effects were appreciable in diffusivity maps in two patients with focal liver lesions. These results suggest that, relative to least‐squares estimation, the Beta*LogNormal model accomplishes the intended reduction of bias and variance from bulk motion in liver diffusion imaging. Magn Reson Med 70:1460–1469, 2013. © 2012 Wiley Periodicals, Inc.