High-resolution MRI of cardiac function with projection reconstruction and steady-state free precession.

The purpose of this study was to investigate the trabecular structure of the endocardial wall of the living human heart, and the effect of that structure on the measurement of myocardial function using MRI. High-resolution MR images (0.8 x 0.8 x 8 mm voxels) of cardiac function were obtained in five volunteers using a combination of undersampled projection reconstruction (PR) and steady-state free precession (SSFP) contrast in ECG-gated breath-held scans. These images provide movies of cardiac function with new levels of endocardial detail. The trabecular-papillary muscle complex, consisting of a mixture of blood and endocardial structures, is measured to constitute as much as 50% of the myocardial wall in some sectors. Myocardial wall strain measurements derived from tagged MR images show correlation between regions of trabeculae and papillary muscles and regions of high strain, leading to an overestimation of function in the lateral wall.     

2D free-breathing dual navigator-gated cardiac function validated against the 2D breath-hold acquisition

PURPOSE: To develop and validate a free-breathing cardiac cine acquisition, with potential to simplify cardiac MR studies, provide registered slices, and increase spatial resolution. MATERIALS AND METHODS: A 2D free-breathing (FB) navigator-gated cine radial acquisition for cardiac function was developed that used two navigators (one placed prior to the QRS, and another 500 msec after the QRS complex, after systole) to provide complete motion-compensated assessment of systole, without loss of end-diastole. Eleven subjects were studied. RESULTS: The 2D FB method provided results visually and quantitatively similar to the 2D breath-hold (BH) methods. Comparison of volumes measured with FB to those measured by standard 2D BH cine resulted in mean bias+/-2 standard deviations of 1.0 mL+/-13.7 mL, 1.1 mL+/-7.6 mL, 3.0 g+/-18.8 g, and 0.3%+/-2.5%, for end-diastolic volume, end-systolic volume, left ventricular (LV) mass, and ejection fraction, respectively. Slice misregistration was identified in four (36%) of the BH studies, but none (0%) of the FB studies. In subjects with slice misregistration, there was greater discordance in LV volume measurements (P<0.05 for end-diastolic mass). CONCLUSION: The FB cine acquisition provided results qualitatively and quantitatively similar to 2D BH methods with improved slice registration.     

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).     

Three-dimensional cine imaging using variable-density spiral trajectories and SSFP with application to coronary artery angiography.

A single breath-hold 3D cardiac phase resolved steady-state free precession (SSFP) sequence was developed, allowing 3D visualization of the moving coronary arteries. A 3D stack of spirals was acquired continuously throughout the cardiac cycle, and a sliding window reconstruction was used to achieve high temporal resolution. A coil specific field of view reconstruction technique was combined with Parallel Imaging with Localized Sensitivities (PILS) to allow acquisition of a reduced field of view. A view ordering incorporating fat suppression was employed to allow use of sliding window reconstruction. The technique was evaluated on healthy volunteers (n=8), yielding images with 102 ms temporal resolution and 1.35 mm in-plane resolution, and reasonable visualization of the left and right coronary arteries was achieved.     

Improved coronary MR angiography using wideband steady state free precession at 3 tesla with sub‐millimeter resolution

Purpose:

To suppress off‐resonance artifacts in coronary artery imaging at 3 Tesla (T), and therefore improve spatial resolution.

Materials and Methods:

Wideband steady state free precession (SSFP) sequences use an oscillating steady state to reduce banding artifacts. Coronary artery images were obtained at 3T using three‐dimensional navigated gradient echo, balanced SSFP, and wideband SSFP sequences.

Results:

The highest in‐plane resolution of left coronary artery images was 0.68 mm in the frequency‐encoding direction. Wideband SSFP produced an average SNR efficiency of 70% relative to conventional balanced SSFP and suppressed off‐resonance artifacts.

Conclusion:

Wideband SSFP was found to be a promising approach for obtaining noncontrast, high‐resolution coronary artery images at 3 Tesla with reliable image quality. J. Magn. Reson. Imaging 2010;31:1224–1229. © 2010 Wiley‐Liss, Inc.     

Assessment of magnetization transfer effects in myocardial tissue using balanced steady‐state free precession (bSSFP) cine MRI

Magnetization transfer imaging (MTI) by means of MRI exploits the mobility of water molecules in tissue and offers an alternative contrast mechanism beyond the more commonly used mechanisms based on relaxation times. A cardiac MTI method was implemented on a commercially available 1.5 T MR imager. It is based on the acquisition of two sets of cardiac‐triggered cine balanced steady‐state free precession (bSSFP) images with different levels of RF power deposition. Reduction of RF power was achieved by lengthening the RF excitation pulses of a cine bSSFP sequence from 0.24 ms to 1.7 ms, while keeping the flip angle constant. Normal volunteers and patients with acute myocardial infarcts were imaged in short and long axis views. Normal myocardium showed an MT ratio (MTR) of 33.0 ± 3.3%. In acute myocardial infarct, MTR was reduced to 24.5 ± 9.2% (P < 0.04), most likely caused by an increase in water content due to edema. The method thus allows detection of acute myocardial infarct without the administration of contrast agents. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.     

Assessment of left ventricular function by breath-hold cine MR imaging: Comparison of different steady-state free precession sequences

PURPOSE: To compare steady-state free precession (SSFP) sequence protocols with different acquisition times (TA) and temporal resolutions (tRes) due to the implementation of a view sharing technique called shared phases for the assessment of left ventricular (LV) function by breath-hold cine magnetic resonance (MR) imaging. MATERIALS AND METHODS: End-diastolic and end-systolic volumes (EDV, ESV) were measured in contiguous short-axis slices with a thickness of 8 mm acquired in 10 healthy male volunteers. The following true fast imaging with steady-state precession (TrueFISP) sequence protocols were compared: protocol A) internal standard of reference, segmented: tRes 34.5 msec, TA 18 beats per slice; protocol B) segmented, shared phases: tRes 34.1 msec, TA 10 beats per slice; and protocol C) real-time, shared phases, parallel acquisition technique: tRes 47.3 msec, TA 24 beats for 12 slices covering the entire left ventricle. RESULTS: Phase sharing leads to a significant decrease in EDV, stroke volume (SV), and ejection fraction (EF) (median difference -7.0 mL [*], -9.6 mL, and -3.4%, respectively, for protocol B; -15.3 mL, -13.3 mL, and -2.4% for protocol C; P = 0.002, *P = 0.021). The observed median difference of real-time EDV and SV estimates is of clinical relevance. Real-time cine MR imaging shows a greater variability of EDV and SV. No relevant differences in ESV were observed. CONCLUSION: The true cine frame duration of both shared phases sequence protocols exceeds the period of isovolumetric contraction (IVCT) of the left ventricle resulting in a systematic and significant underestimation of EDV and consequently SV and EF. SSFP sequence protocol parameters, particularly tRes and use of view sharing techniques, should therefore be known at follow-up examinations in order to be able to assess LV remodeling in patients with heart failure.     

Coronary MRA with 3D undersampled projection reconstruction TrueFISP.

Undersampled projection reconstruction (PR) offers improved imaging efficiency allowing a relative tradeoff between signal-to-noise ratio (SNR) or streak artifact and the number of acquired k-space views rather than the tradeoff between resolution or aliasing artifact and the number of acquired k-space lines inherent to Fourier imaging techniques. TrueFISP (true fast imaging with steady state precession) is ideally suited for undersampled PR imaging because of its inherently high SNR. The purpose of this work was to investigate the feasibility of using undersampled three-dimensional (3D) PR TrueFISP for breathhold coronary artery imaging. Phantom studies and a preliminary in vivo comparison demonstrated the improved spatial resolution of PR over Fourier TrueFISP with the same imaging time. In a 24-heartbeat coronary imaging scheme, segmented 3D PR TrueFISP provided a 1.0 x 1.0 mm(2) isotropic in-plane voxel size while acquiring between 93 and 153 views per partition. Streak artifacts were present in some images but were not found to impede coronary artery delineation. In conclusion, 3D undersampled PR TrueFISP provides isotropic in-plane voxel size within a single breathhold and is a promising technique for coronary artery imaging.     

Cine MRI using steady state free precession in the radial long axis orientation is a fast accurate method for obtaining volumetric data of the left ventricle.

In this study we assessed the use of a steady state free precession (SSFP) cine sequence in a series of radially orientated long axis slices for the measurement of left ventricular volumes and mass. We validated the radial long axis approach in phantoms and ex vivo porcine hearts and applied it to normal volunteers and patients using the SSFP and turbo gradient-echo (TGE) sequences. High quality images were obtained for analysis, and the measured volumes with radial long axis SSFP sequence correlated well with short axis TGE and SSFP volumes (r > 0.98). The best interobserver agreement for left ventricular volumes was obtained using SSFP in the long axis radial orientation (variability < 2.3%). We conclude that this combination of sequence and scan orientation has intrinsic advantages for image analysis due to the improved contrast and the avoidance of errors associated with the basal slice in the short axis orientation.     

Balanced steady-state free precession vs. segmented fast low-angle shot for the evaluation of ventricular volumes, mass, and function at 3 Tesla

PURPOSE: To compare balanced steady-state free precession (SSFP) and segmented fast low angle shot (FLASH) for quantification of left and right ventricular volumes and function and for left ventricular mass at high field (3 Tesla). MATERIALS AND METHODS: A total of 33 patients (19 male, mean age 54 years) with various forms of heart disease underwent ventricular function studies using cine SSFP and FLASH sequences with identical slice orientations. RESULTS: Using SSFP, left ventricular end-diastolic (+10 mL [4.7%], P < 0.001) and end-systolic volumes (+9 mL [6.1%], P < 0.001) measured larger whereas mass was considerably smaller (-23 g [-12.9%], P < 0.001) and ejection fraction (-1% [-3.2%], P < 0.01) marginally smaller. Right ventricular end-diastolic (+4 mL [2.6%], P = 0.001) and end-systolic volumes (+4 mL [5.1%], P < 0.01) were also larger, but no significant difference for right ventricular ejection fraction (P = 0.05) was found. CONCLUSION: Similar to previous results at 1.5 Tesla, at high magnetic field the cine SSFP technique led to discrete but significantly higher ventricular volume measurements and to a significantly smaller measurement of left ventricular mass in patients. The effect on left and right ventricular ejection fraction was minor, although the difference remained significant for the left ventricle.     

Sodium MRI using a density‐adapted 3D radial acquisition technique

A density‐adapted three‐dimensional radial projection reconstruction pulse sequence is presented which provides a more efficient k‐space sampling than conventional three‐dimensional projection reconstruction sequences. The gradients of the density‐adapted three‐dimensional radial projection reconstruction pulse sequence are designed such that the averaged sampling density in each spherical shell of k‐space is constant. Due to hardware restrictions, an inner sphere of k‐space is sampled without density adaption. This approach benefits from both the straightforward handling of conventional three‐dimensional projection reconstruction sequence trajectories and an enhanced signal‐to‐noise ratio (SNR) efficiency akin to the commonly used three‐dimensional twisted projection imaging trajectories. Benefits for low SNR applications, when compared to conventional three‐dimensional projection reconstruction sequences, are demonstrated with the example of sodium imaging. In simulations of the point‐spread function, the SNR of small objects is increased by a factor 1.66 for the density‐adapted three‐dimensional radial projection reconstruction pulse sequence sequence. Using analytical and experimental phantoms, it is shown that the density‐adapted three‐dimensional radial projection reconstruction pulse sequence allows higher resolutions and is more robust in the presence of field inhomogeneities. High‐quality in vivo images of the healthy human leg muscle and the healthy human brain are acquired. For equivalent scan times, the SNR is up to a factor of 1.8 higher and anatomic details are better resolved using density‐adapted three‐dimensional radial projection reconstruction pulse sequence. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.     

Cardiac cine MRI: Quantification of the relationship between fast gradient echo and steady-state free precession for determination of myocardial mass and volumes

PURPOSE: To determine the correlation function between the steady-state free precession (SSFP) and fast gradient echo (FGRE) cine MRI pulse sequences for measuring the myocardial mass and volumes. MATERIALS AND METHODS: Cardiac cine MRI examinations were acquired in 50 individuals (female: 35, male: 15, mean age 64.1 +/- 9.1 years, range 48-83) using SSFP and FGRE cardiac pulse sequences. RESULTS: The mean (standard deviation [SD]) left ventricular end diastolic volume measured by SSFP was significantly larger (4.5%) than by FGRE (P < 0.001); this was also the case for end systolic volume (15.0%, P < 0.001). The relationship between SSFP and FGRE measures were linear and highly correlated (P < 0.001) for both left ventricular end diastolic and end systolic volumes (r(2) = 0.90 vs. 0.91, respectively). We determined linear regression models to estimate the SSFP values based on the FGRE measures. Slope (intercept) for ejection fraction, stroke volume, and cardiac output were 0.99 (-2.79), 0.77 (17.5), and 0.76 (1.29), respectively. CONCLUSION: Linear relationships exist for key LV function parameters when comparing SSFP and FGRE cine MRI. These results indicate that existing databases and normal values for FGRE LV function may be converted to corresponding LV function values for SSFP MRI.