Reduction in flow artifacts by using interleaved data acquisition in segmented balanced steady-state free precession cardiac MRI.

Balanced steady-state free precession (SSFP) magnetic resonance (MR) imaging is feasible for cine cardiac images because of the high contrast between myocardium and blood pool and robustness to rapid blood flow. Nonetheless, the flow artifacts are often observed because of off-resonance effects and to in-flow effects of the blood flow. Although reshimming the gradients or readjusting the center frequency reduces the artifacts, the technique can be susceptible for respiratory and cardiac motion and operator-dependent. The purpose of this study is to use another MR imaging technique for the reduction in the flow artifacts in the heart: odd-even interleaved data acquisition in segmented balanced SSFP imaging. The flow artifacts in the ventricle, ghost outside the heart, and visualization of the myocardial border were visually compared between sequential and odd-even interleaved k-space data acquisitions in cine balanced SSFP cardiac MR imaging. The odd-even interleaved k-space data acquisition significantly reduced dark flow artifacts in the left ventricle, improved the visualization of the myocardial border, and was easily installed. This imaging technique should be applied to cine segmented balanced SSFP cardiac MR imaging.     

Wideband SSFP: alternating repetition time balanced steady state free precession with increased band spacing.

Balanced steady-state free precession (SSFP) imaging is limited by off-resonance banding artifacts, which occur with periodicity 1/TR in the frequency spectrum. A novel balanced SSFP technique for widening the band spacing in the frequency response is described. This method, called wideband SSFP, utilizes two alternating repetition times with alternating RF phase, and maintains high SNR and T(2)/T(1) contrast. For a fixed band spacing, this method can enable improvements in spatial resolution compared to conventional SSFP. Alternatively, for a fixed readout duration this method can widen the band spacing, and potentially avoid the banding artifacts in conventional SSFP. The method is analyzed using simulations and phantom experiments, and is applied to the reduction of banding artifacts in cine cardiac imaging and high-resolution knee imaging at 3T.     

Neonatal cardiac MRI using prolonged balanced SSFP imaging at 3T with active frequency stabilization

Cardiac MRI in neonates holds promise as a tool that can provide detailed functional information in this vulnerable group. However, their small size, rapid heart rate, and inability to breath‐hold, pose particular challenges that require prolonged high‐contrast and high‐SNR methods. Balanced‐steady state free precession (SSFP) offers high SNR efficiency and excellent contrast, but is vulnerable to off‐resonance effects that cause banding artifacts. This is particularly problematic in the blood‐pool, where off‐resonance flow artifacts severely degrade image quality. Methods: In this article, we explore active frequency stabilization, combined with image‐based shimming, to achieve prolonged SSFP imaging free of banding artifacts. The method was tested using 2D multislice SSFP cine acquisitions on 18 preterm infants, and the functional measures derived were validated against phase‐contrast flow assessment. Results: Significant drifts in the resonant frequency (165 ± 23Hz) were observed during 10‐min SSFP examinations. However, full short‐axis stacks free of banding artifacts were achieved in 16 subjects with stabilization; the cardiac output obtained revealed a mean difference of 9.0 ± 8.5% compared to phase‐contrast flow measurements. Conclusion: Active frequency stabilization has enabled the use of prolonged SSFP acquisitions for neonatal cardiac imaging at 3T. The findings presented could have broader implications for other applications using prolong SSFP acquisitions. Magn Reson Med 70:776–784, 2013. © 2012 Wiley Periodicals, Inc.     

Improved 3‐Tesla cardiac cine imaging using wideband

Cine balanced steady‐state free precession (SSFP) is the most widely used sequence for assessing cardiac ventricular function at 1.5 T because it provides high signal‐to‐noise ratio efficiency and strong contrast between myocardium and blood. At 3 T, the use of SSFP is limited by susceptibility‐induced off‐resonance, resulting in either banding artifacts or the need to use a short‐sequence pulse repetition time that limits the readout duration and hence the achievable spatial resolution. In this work, we apply wideband SSFP, a variant of SSFP that uses two alternating pulse repetition times to establish a steady state with wider band spacing in its frequency response and overcome the key limitations of SSFP. Prospectively gated cine two‐dimensional imaging with wideband SSFP is evaluated in healthy volunteers and compared to conventional balanced SSFP, using quantitative metrics and qualitative interpretation by experienced clinicians. We demonstrate that by trading off temporal resolution and signal‐to‐noise ratio efficiency, wideband SSFP mitigates banding artifacts and enables imaging with approximately 30% higher spatial resolution compared to conventional SSFP with the same effective band spacing. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

Dynamic visualization of arachnoid adhesions in a patient with idiopathic syringomyelia using high‐resolution cine magnetic resonance imaging at 3T

A 39‐year‐old female patient with thoracic syringomyelia underwent routine magnetic resonance imaging (MRI) and 3 T MRI to investigate the value of retrospectively cardiac‐gated cine steady‐state free precession (SSFP) MRI in the preoperative and postoperative diagnosis of arachnoid membranes in the spinal subarachnoid space. Therefore, 3T MRI included sagittal and transverse retrospectively cardiac‐gated cine balanced fast‐field echo (balanced‐FFE) sequences both preoperatively and after microsurgical lysis of arachnoid adhesions and expansive duraplasty. Arachnoid membranes were detected and this result was correlated with intraoperative findings and the results of routine cardiac‐gated phase‐contrast cerebrospinal fluid (CSF) flow MRI. Retrospectively cardiac‐gated cine SSFP MRI enabled imaging of arachnoid membranes with high spatial resolution and sufficient contrast to delineate them from hyperintense CSF preoperatively and postoperatively. The images were largely unaffected by artifacts. Surgery confirmed the presence of arachnoid adhesions in the upper thoracic spine. Not all arachnoid membranes that were seen on cine balanced‐FFE sequences caused significant spinal CSF flow blockages in cardiac‐gated phase‐contrast CSF flow studies. In conclusion, retrospectively cardiac‐gated cine SSFP MRI may become a valuable tool for the preoperative detection of arachnoid adhesions and the postoperative evaluation of microsurgical adhesiolysis in patients with idiopathic syringomyelia. J. Magn. Reson. Imaging 2010. © 2010 Wiley‐Liss, Inc.     

Principles and applications of balanced SSFP techniques

During the past 5 years balanced steady-state free precession (SSFP) has become increasingly important for diagnostic and functional imaging. Balanced SSFP is characterized by two unique features: it offers a very high signal-to noise ratio and a T2/T1-weighted image contrast. This article focuses on the physical principles, on the signal formation, and on the resulting properties of balanced SSFP. Mechanisms for contrast modification, recent clinical application, and potential extensions of this technique are discussed.     

Fundamentals of balanced steady state free precession MRI

Balanced steady state free precession (balanced SSFP) has become increasingly popular for research and clinical applications, offering a very high signal‐to‐noise ratio and a T₂/T₁‐weighted image contrast. This review article gives an overview on the basic principles of this fast imaging technique as well as possibilities for contrast modification. The first part focuses on the fundamental principles of balanced SSFP signal formation in the transient phase and in the steady state. In the second part, balanced SSFP imaging, contrast, and basic mechanisms for contrast modification are revisited and contemporary clinical applications are discussed. J. Magn. Reson. Imaging 2013;38:2–11. © 2013 Wiley Periodicals, Inc.     

Double average parallel steady-state free precession imaging: optimized eddy current and transient oscillation compensation.

Balanced steady-state free precession (SSFP) imaging is sensitive to off-resonance effects, which can lead to considerable artifacts during a transient phase following magnetization preparation or steady-state interruption. In addition, nonlinear k-space encoding is required if contrast-relevant k-space regions need to be acquired at specific delays following magnetization preparation or for transient artifact reduction in cardiac-gated k-space segmented CINE imaging. Such trajectories are problematic for balanced SSFP imaging due to nonconstant eddy current effects and resulting disruption of the steady state.In this work, a novel acquisition strategy for balanced SSFP imaging is presented that utilizes scan time reduction by parallel imaging for optimized "double average" eddy current compensation and artifact reduction during the transient phase following steady-state storage and magnetization preparation. Double average parallel SSFP imaging was applied to k-space segmented CINE SSFP tagging as well as nongated centrically encoded SSFP imaging. Phantom and human studies exhibit substantial reduction in steady-state storage and eddy current artifacts while maintaining spatial resolution, signal-to-noise ratio, and similar total scan time of a standard SSFP acquisition. The proposed technique can easily be extended to other acquisition schemes that would benefit from nonlinear reordering schemes and/or rely on interruption of the balanced SSFP steady state.     

Projection reconstruction balanced fast field echo for interactive real-time cardiac imaging.

A balanced fast field echo (FFE) sequence (also referred to as true fast imaging with steady precession (true FISP)), based on projection reconstruction (PR) is evaluated in combination with real-time reconstruction and interactive scanning capabilities for cardiac function studies. Cardiac image sequences obtained with the balanced PR-FFE method are compared with images obtained with a spin-warp (2D Fourier transform (2DFT)) technique. In particular, the representation of motion artifacts in both techniques is investigated. Balanced PR-FFE provides a similar contrast to spin-warp-related techniques, but is less sensitive to motion artifacts. The use of angular undersampling within balanced PR-FFE is examined as a means to increase temporal resolution while causing only minor artifacts. Furthermore, a modification of the profile order allows the reconstruction of PR images at different spatial and temporal resolution levels from the same data. This study shows that balanced PR-FFE is a robust tool for cardiac function studies.     

Cardiac SSFP imaging at 3 Tesla.

Balanced steady-state free precession (SSFP) techniques provide excellent contrast between myocardium and blood at a high signal-to-noise ratio (SNR). Hence, SSFP imaging has become the method of choice for assessing cardiac function at 1.5T. The expected improvement in SNR at higher field strength prompted us to implement SSFP at 3.0T. In this work, an optimized sequence protocol for cardiac SSFP imaging at 3.0T is derived, taking into account several partly adverse effects at higher field, such as increased field inhomogeneities, longer T(1), and power deposition limitations. SSFP contrast is established by optimizing the maximum amplitude of the radiofrequency (RF) field strength for shortest TR, as well as by localized linear or second-order shimming and local optimization of the resonance frequency. Given the increased SNR, sensitivity encoding (SENSE) can be employed to shorten breath-hold times. Short-axis, long-axis, and four-chamber cine views obtained in healthy adult subjects are presented, and three different types of artifacts are discussed along with potential methods for reducing them.     

MR ventriculocisternography by using 3D balanced steady-state free precession imaging: technical note

This study investigated the effects of flip angle setting in 3D balanced steady-state free precession (SSFP) imaging on CSF-parenchyma contrast and section aliasing artifacts. Theoretical derivations indicated that the extent of section aliasing artifacts decreased as the flip angle was lowered, at the expense of a sacrifice in CSF-parenchyma contrast. Experimental data agreed closely with theoretical predictions. A flip angle of about 40 degrees is therefore recommended for 3D balanced SSFP MR ventriculocisternography.     

Balanced phase-contrast steady-state free precession (PC-SSFP): a novel technique for velocity encoding by gradient inversion.

A technique for measuring velocity is presented that combines cine phase contrast (PC) MRI and balanced steady-state free precession (SSFP) imaging, and is thus termed PC-SSFP. Flow encoding was performed without the introduction of additional velocity encoding gradients in order to keep the repetition time (TR) as short as in typical SSFP imaging sequences. Sensitivity to through-plane velocities was instead established by inverting (i.e., negating) all gradients along the slice-select direction. Velocity sensitivity (VENC) could be adjusted by altering the first moments of the slice-select gradients. Disturbances of the SSFP steady state were avoided by acquiring different flow echoes in consecutively (i.e., sequentially) executed scans, each over several cardiac cycles, using separate steady-state preparation periods. A comparison of phantom measurements with those from established 2D-cine-PC MRI demonstrated excellent correlation between both modalities. In examinations of volunteers, PC-SSFP exhibited a higher intrinsic signal-to-noise ratio (SNR) and consequently low phase noise in measured velocities compared to conventional PC scans. An additional benefit of PC-SSFP is that it relies less on in-flow-dependent signal enhancement, and thus yields more uniform SNRs and better depictions of vessel geometry throughout the whole cardiac cycle in structures with slow and/or pulsatile flow.     

Improved spectral selectivity and reduced susceptibility in SSFP using a near zero TE undersampled three-dimensional PR sequence

PURPOSE: To improve the performance of fat/water separation and reduce the sensitivity to susceptibility variation in balanced SSFP sequences. MATERIALS AND METHODS: Decreasing the repetition time (TR) reduces susceptibility artifacts in SSFP imaging. A shorter TR may also improve the spectral selectivity obtained when linearly combining data acquired using different radiofrequency phase cycling schedules. The desired short TR is achieved by using an angularly undersampled three-dimensional radial acquisition sequence that achieves a near zero echo time (TE) and also a short TR. RESULTS: Images from human volunteers demonstrate broad coverage of the cervical spine and knee with isotropic resolution. Excellent fat/water separation is achieved in these studies. CONCLUSION: The short TR capability of the proposed sequence greatly improves the fat suppression in SSFP imaging. High-resolution volumetric T2-like contrast imaged with reduced susceptibility artifacts can be obtained from a single acquisition using this technique.     

Analysis of cardiac function--comparison between 1.5 Tesla and 3.0 Tesla cardiac cine magnetic resonance imaging: preliminary experience

PURPOSE: We sought to assess the feasibility of magnetic resonance imaging to evaluate cardiac function at 3.0 T compared with 1.5 T. MATERIAL AND METHODS: In a prospective intraindividual comparative study, 12 volunteers (range, 18-54 years), and 2 patients (range, 43-53 years) underwent cardiac cine magnetic resonance at both 3.0 T and 1.5 T. Data were acquired both with a steady-state free precession sequence (SSFP) and a spoiled gradient echo (SGE) sequence. If necessary, a frequency scout was used to correct for off-resonance artifacts. For both SSFP and SGE imaging, 6-mm thick retrospectively EKG-gated short axis views were acquired with equal matrix size (192 x 163) and comparable repetition time (TR). Cardiac function parameters were determined manually by a single investigator. Cardiac function parameters, signal to noise ratio (SNR), contrast to noise ratio (CNR), and the presence of artifacts were compared between the 2 magnetic field strengths. For statistical analysis, a Pearson's correlation coefficient was calculated, and a paired Student t test was used to test statistical significance. RESULTS: Very good correlations between cardiac function parameters at 1.5 T and 3.0 T (r > 0.84, P < 0.0011) were obtained. Compared with SGE, SSFP more frequently was prone to artifacts. With SSFP/SGE at 3.0 T, a SNR gain of 9.4/16% was achieved compared with 1.5 T. CONCLUSION: Functional cardiac cine magnetic resonance imaging can be regarded as equally accurate at 3.0 T compared with 1.5 T. Compared with SSFP imaging, the SGE sequence benefits more from higher field strengths and is less affected by artifacts.     

Navigator-gated coronary magnetic resonance angiography using steady-state-free-precession: comparison to standard T2-prepared gradient-echo and spiral imaging

RATIONALE AND OBJECTIVES: Recent developments of magnetic resonance imaging enabled free-breathing coronary MRA (cMRA) using steady-state-free-precession (SSFP) for endogenous contrast. The purpose of this study was a systematic comparison of SSFP cMRA with standard T2-prepared gradient-echo and spiral cMRA. METHODS: Navigator-gated free-breathing T2-prepared SSFP-, T2-prepared gradient-echo- and T2-prepared spiral cMRA was performed in 18 healthy swine (45-68 kg body-weight). Image quality was investigated subjectively and signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and vessel sharpness were compared. RESULTS: SSFP cMRA allowed for high quality cMRA during free breathing with substantial improvements in SNR, CNR and vessel sharpness when compared with standard T2-prepared gradient-echo imaging. Spiral imaging demonstrated the highest SNR while image quality score and vessel definition was best for SSFP imaging. CONCLUSION: Navigator-gated free-breathing T2-prepared SSFP cMRA is a promising new imaging approach for high signal and high contrast imaging of the coronary arteries with improved vessel border definition.     

Fat‐water separation with alternating repetition time balanced SSFP

Balanced SSFP achieves high SNR efficiency, but suffers from bright fat signal. In this work, a multiple‐acquisition fat‐water separation technique using alternating repetition time (ATR) balanced SSFP is proposed. The SSFP profile can be modified using alternating repetition times and appropriate phase cycling to yield two spectra where fat and water are in‐phase and out‐of‐phase, respectively. The signal homogeneity and the broad width of the created in‐phase and out‐of‐phase profiles lead to signal cancellation over a broad stop‐band. The stop‐band suppression is achieved for a wide range of flip angles and tissue parameters. This property, coupled with the inherent flexibility of ATR SSFP in repetition time selection, makes the method a good candidate for fat‐suppressed SSFP imaging. The proposed method can be tailored to achieve a smaller residual stop‐band signal or a decreased sensitivity to field inhomogeneity depending on application‐specific needs. Magn Reson Med 60:479–484, 2008. © 2008 Wiley‐Liss, Inc.     

Multishot EPI-SSFP in the heart.

Refocused steady-state free precession (SSFP), or fast imaging with steady precession (FISP or TrueFISP), has recently proven valuable for cardiac imaging because of its high signal-to-noise ratio (SNR) and excellent blood-myocardium contrast. In this study, various implementations of multiecho SSFP or EPI-SSFP for imaging in the heart are presented. EPI-SSFP has higher scan-time efficiency than single-echo SSFP, as two or more phase-encode lines are acquired per repetition time (TR) at the cost of a modest increase in TR. To minimize TR, a noninterleaved phase-encode order in conjunction with a phased-array ghost elimination (PAGE) technique was employed, removing the need for echo time shifting (ETS). The multishot implementation of EPI-SSFP was used to decrease the breath-hold duration for cine acquisitions or to increase the temporal or spatial resolution for a fixed breath-hold duration. The greatest gain in efficiency was obtained with the use of a three-echo acquisition. Image quality for cardiac cine applications using multishot EPI-SSFP was comparable to that of single-echo SSFP in terms of blood-myocardium contrast and contrast-to-noise ratio (CNR). The PAGE method considerably reduced flow artifacts due to both the inherent ghost suppression and the concomitant reduction in phase-encode blip size. The increased TR of multishot EPI-SSFP led to a reduced specific absorption rate (SAR) for a fixed RF flip angle, and allowed the use of a larger flip angle without increasing the SAR above the FDA-approved limits.     

Analysis and compensation of eddy currents in balanced SSFP.

Balanced steady-state free precession (SSFP) completely compensates for all gradients within each repetition time (TR), and is thus very sensitive to any magnetic field imperfection that disturbs the perfectly balanced acquisition scheme. It is demonstrated that balanced SSFP is especially sensitive to changing eddy currents that are induced by stepwise changing phase-encoding (PE) gradients. In contrast to the linear k-space trajectory, which has small variations between consecutive encoding steps, other encoding schemes (e.g., centric, random, or segmented orderings) exhibit significant jumps in k-space between adjacent PE steps, and consequently induce rapidly changing eddy currents. The resulting disturbances induce significant image artifacts, such that compensation strategies are essential when nonlinear PE schemes are applied. Although direct annihilation of the induced eddy currents by additional, opposing magnetic fields has been investigated, it is limited by uncertainty regarding the time evolution of induced eddy currents. A generic (and thus system-unrelated) compensation strategy is proposed that consists of "pairing" of consecutive PE steps. Another approach is based on partial dephasing along the slice direction that annihilates eddy-current-induced signal oscillations. Both pairing of the PE steps and "through-slice equilibration" are easy to implement and allow the use of arbitrary k-space trajectories for balanced SSFP.