STEAM-SASHA: a novel approach for blood- and fat-suppressed native T1 measurement in the right ventricular myocardium.

OBJECTIVE: The excellent blood and fat suppression of stimulated echo acquisition mode (STEAM) can be combined with saturation recovery single-shot acquisition (SASHA) in a novel STEAM-SASHA sequence for right ventricular (RV) native T1 mapping. MATERIALS AND METHODS: STEAM-SASHA splits magnetization preparation over two cardiac cycles, nulling blood signal and allowing fat signal to decay. Breath-hold T1 mapping was performed in a T1 phantom and twice in 10 volunteers using STEAM-SASHA and a modified Look-Locker sequence at peak systole at 3T. T1 was measured in 3 RV regions, the septum and left ventricle (LV). RESULTS: In phantoms, MOLLI under-estimated while STEAM-SASHA over-estimated T1, on average by 3.0% and 7.0% respectively, although at typical 3T myocardial T1 (T1 > 1200 ms) STEAM-SASHA was more accurate. In volunteers, T1 was higher using STEAM-SASHA than MOLLI in the LV and septum (p = 0.03, p = 0.006, respectively), but lower in RV regions (p > 0.05). Inter-study, inter-observer and intra-observer coefficients of variation in all regions were < 15%. Blood suppression was excellent with STEAM-SASHA and noise floor effects were minimal. DISCUSSION: STEAM-SASHA provides accurate and reproducible T1 in the RV with excellent blood and fat suppression. STEAM-SASHA has potential to provide new insights into pathological changes in the RV in future studies.

Quantitative 3D myocardial perfusion with an efficient arterial input function.

PURPOSE: The purpose of this study was to further develop and combine several innovative sequence designs to achieve quantitative 3D myocardial perfusion. These developments include an optimized 3D stack-of-stars readout (150 ms per beat), efficient acquisition of a 2D arterial input function, tailored saturation pulse design, and potential whole heart coverage during quantitative stress perfusion. THEORY AND METHODS: All studies were performed free-breathing on a Prisma 3T MRI scanner. Phantom validation was used to verify sequence accuracy. A total of 21 subjects (3 patients with known disease) were scanned, 12 with a rest only protocol and 9 with both stress (regadenoson) and rest protocols. First pass quantitative perfusion was performed with gadoteridol (0.075 mmol/kg). RESULTS: Implementation and quantitative perfusion results are shown for healthy subjects and subjects with known coronary disease. Average rest perfusion for the 15 included healthy subjects was 0.79 ± 0.19 mL/g/min, the average stress perfusion for 6 healthy subject studies was 2.44 ± 0.61 mL/g/min, and the average global myocardial perfusion reserve ratio for 6 healthy subjects was 3.10 ± 0.24. Perfusion deficits for 3 patients with ischemia are shown. Average resting heart rate was 59 ± 7 bpm and the average stress heart rate was 81 ± 10 bpm. CONCLUSION: This work demonstrates that a quantitative 3D myocardial perfusion sequence with the acquisition of a 2D arterial input function is feasible at high stress heart rates such as during stress. T1 values and gadolinium concentrations of the sequence match the reference standard well in a phantom, and myocardial rest and stress perfusion and myocardial perfusion reserve values are consistent with those published in literature.

High resolution in-vivo DT-CMR using an interleaved variable density spiral STEAM sequence.

PURPOSE: Diffusion tensor cardiovascular magnetic resonance (DT-CMR) has a limited spatial resolution. The purpose of this study was to demonstrate high-resolution DT-CMR using a segmented variable density spiral sequence with correction for motion, off-resonance, and T2*-related blurring. METHODS: A single-shot stimulated echo acquisition mode (STEAM) echo-planar-imaging (EPI) DT-CMR sequence at 2.8 × 2.8 × 8 mm3 and 1.8 × 1.8 × 8 mm3 was compared to a single-shot spiral at 2.8 × 2.8 × 8 mm3 and an interleaved spiral sequence at 1.8 × 1.8 × 8 mm3 resolution in 10 healthy volunteers at peak systole and diastasis. Motion-induced phase was corrected using the densely sampled central k-space data of the spirals. STEAM field maps and T2* measures were obtained using a pair of stimulated echoes each with a double spiral readout, the first used to correct the motion-induced phase of the second. RESULTS: The high-resolution spiral sequence produced similar DT-CMR results and quality measures to the standard-resolution sequence in both cardiac phases. Residual differences in fractional anisotropy and helix angle gradient between the resolutions could be attributed to spatial resolution and/or signal-to-noise ratio. Data quality increased after both motion-induced phase correction and off-resonance correction, and sharpness increased after T2* correction. The high-resolution EPI sequence failed to provide sufficient data quality for DT-CMR reconstruction. CONCLUSION: In this study, an in vivo DT-CMR acquisition at 1.8 × 1.8 mm2 in-plane resolution was demonstrated using a segmented spiral STEAM sequence. Motion-induced phase and off-resonance corrections are essential for high-resolution spiral DT-CMR. Segmented variable density spiral STEAM was found to be the optimal method for acquiring high-resolution DT-CMR data.

In-vivo validation of interpolation-based phase offset correction in cardiovascular magnetic resonance flow quantification: a multi-vendor, multi-center study.

BACKGROUND: A velocity offset error in phase contrast cardiovascular magnetic resonance (CMR) imaging is a known problem in clinical assessment of flow volumes in vessels around the heart. Earlier studies have shown that this offset error is clinically relevant over different systems, and cannot be removed by protocol optimization. Correction methods using phantom measurements are time consuming, and assume reproducibility of the offsets which is not the case for all systems. An alternative previously published solution is to correct the in-vivo data in post-processing, interpolating the velocity offset from stationary tissue within the field-of-view. This study aims to validate this interpolation-based offset correction in-vivo in a multi-vendor, multi-center setup. METHODS: Data from six 1.5 T CMR systems were evaluated, with two systems from each of the three main vendors. At each system aortic and main pulmonary artery 2D flow studies were acquired during routine clinical or research examinations, with an additional phantom measurement using identical acquisition parameters. To verify the phantom acquisition, a region-of-interest (ROI) at stationary tissue in the thorax wall was placed and compared between in-vivo and phantom measurements. Interpolation-based offset correction was performed on the in-vivo data, after manually excluding regions of spatial wraparound. Correction performance of different spatial orders of interpolation planes was evaluated. RESULTS: A total of 126 flow measurements in 82 subjects were included. At the thorax wall the agreement between in-vivo and phantom was - 0.2 ± 0.6 cm/s. Twenty-eight studies were excluded because of a difference at the thorax wall exceeding 0.6 cm/s from the phantom scan, leaving 98. Before correction, the offset at the vessel as assessed in the phantom was - 0.4 ± 1.5 cm/s, which resulted in a - 5 ± 16% error in cardiac output. The optimal order of the interpolation correction plane was 1st order, except for one system at which a 2nd order plane was required. Application of the interpolation-based correction revealed a remaining offset velocity of 0.1 ± 0.5 cm/s and 0 ± 5% error in cardiac output. CONCLUSIONS: This study shows that interpolation-based offset correction reduces the offset with comparable efficacy as phantom measurement phase offset correction, without the time penalty imposed by phantom scans. TRIAL REGISTRATION: The study was registered in The Netherlands National Trial Register (NTR) under TC 4865 . Registered 19 September 2014. Retrospectively registered.

An in-vivo comparison of stimulated-echo and motion compensated spin-echo sequences for 3 T diffusion tensor cardiovascular magnetic resonance at multiple cardiac phases.

BACKGROUND: Stimulated-echo (STEAM) and, more recently, motion-compensated spin-echo (M2-SE) techniques have been used for in-vivo diffusion tensor cardiovascular magnetic resonance (DT-CMR) assessment of cardiac microstructure. The two techniques differ in the length scales of diffusion interrogated, their signal-to-noise ratio efficiency and sensitivity to both motion and strain. Previous comparisons of the techniques have used high performance gradients at 1.5 T in a single cardiac phase. However, recent work using STEAM has demonstrated novel findings of microscopic dysfunction in cardiomyopathy patients, when DT-CMR was performed at multiple cardiac phases. We compare STEAM and M2-SE using a clinical 3 T scanner in three potentially clinically interesting cardiac phases. METHODS: Breath hold mid-ventricular short-axis DT-CMR was performed in 15 subjects using M2-SE and STEAM at end-systole, systolic sweet-spot and diastasis. Success was defined by ≥50% of the myocardium demonstrating normal helix angles. From successful acquisitions DT-CMR results relating to tensor orientation, size and shape were compared between sequences and cardiac phases using non-parametric statistics. Strain information was obtained using cine spiral displacement encoding with stimulated echoes for comparison with DT-CMR results. RESULTS: Acquisitions were successful in 98% of STEAM and 76% of M2-SE cases and visual helix angle (HA) map scores were higher for STEAM at the sweet-spot and diastasis. There were significant differences between sequences (p < 0.05) in mean diffusivity (MD), fractional anisotropy (FA), tensor mode, transmural HA gradient and absolute second eigenvector angle (E2A). Differences in E2A between systole and diastole correlated with peak radial strain for both sequences (p ≤ 0.01). CONCLUSION: M2-SE and STEAM can be performed equally well at peak systole at 3 T using standard gradients, but at the sweet-spot and diastole STEAM is more reliable and image quality scores are higher. Differences in DT-CMR results are potentially due to differences in motion sensitivity and the longer diffusion time of STEAM, although the latter appears to be the dominant factor. The benefits of both sequences should be considered when planning future studies and sequence and cardiac phase specific normal ranges should be used for comparison.

Towards accurate and precise T 1 and extracellular volume mapping in the myocardium: a guide to current pitfalls and their solutions.

Mapping of the longitudinal relaxation time (T 1) and extracellular volume (ECV) offers a means of identifying pathological changes in myocardial tissue, including diffuse changes that may be invisible to existing T 1-weighted methods. This technique has recently shown strong clinical utility for pathologies such as Anderson-Fabry disease and amyloidosis and has generated clinical interest as a possible means of detecting small changes in diffuse fibrosis; however, scatter in T 1 and ECV estimates offers challenges for detecting these changes, and bias limits comparisons between sites and vendors. There are several technical and physiological pitfalls that influence the accuracy (bias) and precision (repeatability) of T 1 and ECV mapping methods. The goal of this review is to describe the most significant of these, and detail current solutions, in order to aid scientists and clinicians to maximise the utility of T 1 mapping in their clinical or research setting. A detailed summary of technical and physiological factors, issues relating to contrast agents, and specific disease-related issues is provided, along with some considerations on the future directions of the field.

Apheresis as novel treatment for refractory angina with raised lipoprotein(a): a randomized controlled cross-over trial.

AIMS: To determine the clinical impact of lipoprotein apheresis in patients with refractory angina and raised lipoprotein(a) > 500 mg/L on the primary end point of quantitative myocardial perfusion, as well as secondary end points including atheroma burden, exercise capacity, symptoms, and quality of life. METHODS: We conducted a single-blinded randomized controlled trial in 20 patients with refractory angina and raised lipoprotein(a) > 500 mg/L, with 3 months of blinded weekly lipoprotein apheresis or sham, followed by crossover. The primary endpoint was change in quantitative myocardial perfusion reserve (MPR) assessed by cardiovascular magnetic resonance. Secondary endpoints included measures of atheroma burden, exercise capacity, symptoms and quality of life. RESULTS: The primary endpoint, namely MPR, increased following apheresis (0.47; 95% CI 0.31-0.63) compared with sham (-0.16; 95% CI - 0.33-0.02) yielding a net treatment increase of 0.63 (95% CI 0.37-0.89; P < 0.001 between groups). Improvements with apheresis compared with sham also occurred in atherosclerotic burden as assessed by total carotid wall volume (P < 0.001), exercise capacity by the 6 min walk test (P = 0.001), 4 of 5 domains of the Seattle angina questionnaire (all P < 0.02) and quality of life physical component summary by the short form 36 survey (P = 0.001). CONCLUSION: Lipoprotein apheresis may represent an effective novel treatment for patients with refractory angina and raised lipoprotein(a) improving myocardial perfusion, atheroma burden, exercise capacity and symptoms.

Improved dynamic parallel imaging coil calibration method robust to respiratory motion with application to first-pass contrast-enhanced myocardial perfusion imaging.

PURPOSE: To develop an accurate method of performing free-breathing coil calibration for application to parallel imaging reconstructions of dynamic single-shot datasets. METHODS: Coil calibration data are produced through acquisition of multiple prescans before the accelerated scan, applied during free-breathing. These multiple free-breathing prescans (MFPs) provide the necessary coil information for accurate parallel imaging reconstruction of each accelerated frame of a dynamic series, under guidance of an appropriate respiratory position based matching algorithm. This is investigated in myocardial first-pass perfusion with retrospectively undersampled datasets for analysis with standard calibration techniques to guide prospectively undersampled experiments for specific demonstration of performance against a range of "temporal" calibration techniques. RESULTS: Reconstruction of the retrospectively subsampled datasets with MFP-calibrated parallel imaging showed significant improvements in relative root-mean-square error comparative to all other techniques (all P < 0.05; n = 6) for acceleration factors R > 3. Accelerated acquisitions, reconstructed by means of various temporal calibration techniques and analyzed by visual observer artifact scoring, also demonstrated a large improvement with use of MFPs. Artifact levels were reduced from an average of 2.5 ± 0.6 for the best performing implementation of TGRAPPA to 0.8 ± 0.4 for MFP-GRAPPA (P < 0.001; n = 20) (0 = none to 4 = strong, nondiagnostic). CONCLUSION: MFP as parallel imaging coil calibration data can give improved performance in free-breathing dynamic MR while maintaining maximal acceleration. Magn Reson Med 75:2315-2323, 2016. © 2015 Wiley Periodicals, Inc.

Magnetic resonance imaging phantoms for quality-control of myocardial T1 and ECV mapping: specific formulation, long-term stability and variation with heart rate and temperature.

BACKGROUND: Magnetic resonance imaging (MRI) phantoms are routinely used for quality assurance in MRI centres; however their long term stability for verification of myocardial T1/ extracellular volume fraction (ECV) mapping has never been investigated. METHODS: Nickel-chloride agarose gel phantoms were formulated in a reproducible laboratory procedure to mimic blood and myocardial T1 and T2 values, native and late after Gadolinium administration as used in T1/ECV mapping. The phantoms were imaged weekly with an 11 heart beat MOLLI sequence for T1 and long TR spin-echo sequences for T2, in a carefully controlled reproducible manner for 12 months. RESULTS: There were only small relative changes seen in all the native and post gadolinium T1 values (up to 9.0 % maximal relative change in T1 values) or phantom ECV (up to 8.3 % maximal relative change of ECV, up to 2.2 % maximal absolute change in ECV) during this period. All native and post gadolinium T2 values remained stable over time with <2 % change. Temperature sensitivity testing showed MOLLI T1 values in the long T1 phantoms increasing by 23.9 ms per degree increase and short T1 phantoms increasing by 0.3 ms per degree increase. There was a small absolute increase in ECV of 0.069 % (~0.22 % relative increase in ECV) per degree increase. Variation in heart rate testing showed a 0.13 % absolute increase in ECV (~0.45 % relative increase in ECV) per 10 heart rate increase. CONCLUSIONS: These are the first phantoms reported in the literature modeling T1 and T2 values for blood and myocardium specifically for the T1mapping/ECV mapping application, with stability tested rigorously over a 12 month period. This work has significant implications for the utility of such phantoms in improving the accuracy of serial scans for myocardial tissue characterisation by T1 mapping methods and in multicentre work.

Dynamic inversion time for improved 3D late gadolinium enhancement imaging in patients with atrial fibrillation.

PURPOSE: High resolution three-dimensional (3D) late gadolinium enhancement (LGE) imaging is performed with single R-wave gating to minimize lengthy acquisition durations. In patients with atrial fibrillation (AF), heart rate variability results in variable magnetization recovery between sequence repeats, and image quality is often poor. In this study, we implemented and tested a dynamic inversion time (dynamic-TI) scheme designed to reduce sequence sensitivity to heart rate variations. METHODS: An inversion-prepared 3D segmented gradient echo sequence was modified so that the TI varied automatically from beat-to-beat (dynamic-TI) based on the time since the last sequence repeat. 3D LGE acquisitions were performed in 17 patients prior to radio frequency ablation of persistent AF both with and without dynamic-TI. Qualitative image quality scores, blood signal-to-ghosting ratios (SGRs). and blood-myocardium contrast-to-ghosting ratios (CGRs) were compared. RESULTS: Image quality scores were higher with dynamic-TI than without dynamic-TI (2.2 ± 0.9 vs. 1.8 ± 1.1, P = 0.008), as were blood-myocardium CGRs (13.8 ± 7.6 vs. 8.3 ± 6.1, P = 0.003) and blood SGRs (19.6 ± 8.5 vs. 13.1 ± 8.0, P = 0.003). CONCLUSION: The dynamic-TI algorithm improves image quality of 3D LGE imaging in this difficult patient population by reducing the sequence sensitivity to RR interval variations

Free-breathing 3D late gadolinium enhancement imaging of the left ventricle using a stack of spirals at 3T.

PURPOSE: To develop navigator-gated free-breathing 3D spiral late gadolinium enhancement (LGE) imaging of the left ventricle at 3T and compare it with conventional breath-hold 2D Cartesian imaging. MATERIALS AND METHODS: Equivalent slices from 3D spiral and multislice 2D Cartesian acquisitions were compared in 15 subjects in terms of image quality (1, nondiagnostic to 5, excellent), sharpness (1-3), and presence of artifacts (0-2). Blood signal-to-noise ratio (SNR), blood/myocardium contrast-to-noise ratio (CNR), and quantitative sharpness were also compared. RESULTS: All 3D spiral scans were completed faster than an equivalent 2D Cartesian short-axis stack (85 vs. 230 sec, P < 0.001). Image quality was significantly higher for 2D Cartesian images than 3D spiral images (3.7 ± 0.87 vs. 3.4 ± 1.05, P = 0.03) but not for mid or apical slices specifically. There were no significant differences in qualitative and quantitative sharpness (95% confidence interval [CI]: 1.91 ± 0.67 vs. 1.93 ± 0.69, P = 0.83 and 95% CI: 0.41 ± 0.07 vs. 0.40 ± 0.09, P = 0.25, respectively), artifact scores (95% CI: 0.16 ± 0.37 vs. 0.40 ± 0.58, P = 0.16), SNR (95% CI: 121.5 ± 55.3 vs. 136.4 ± 77.9, P = 0.13), and CNR (95% CI: 101.6 ± 48.4 vs. 102.7 ± 61.8, P = 0.98). Similar enhancement ratios (0.65 vs. 0.62) and volumes (13.8 vs. 14.1cm(3) ) were measured from scar regions of three patients. CONCLUSIO: Navigator-gated 3D spiral LGE imaging can be performed in significantly and substantially shorter acquisition durations, although with some reduced image quality, than multiple breath-hold 2D Cartesian imaging while providing higher resolution and contiguous coverage.

A review of 3D first-pass, whole-heart, myocardial perfusion cardiovascular magnetic resonance.

A comprehensive review is undertaken of the methods available for 3D whole-heart first-pass perfusion (FPP) and their application to date, with particular focus on possible acceleration techniques. Following a summary of the parameters typically desired of 3D FPP methods, the review explains the mechanisms of key acceleration techniques and their potential use in FPP for attaining 3D acquisitions. The mechanisms include rapid sequences, non-Cartesian k-space trajectories, reduced k-space acquisitions, parallel imaging reconstructions and compressed sensing. An attempt is made to explain, rather than simply state, the varying methods with the hope that it will give an appreciation of the different components making up a 3D FPP protocol. Basic estimates demonstrating the required total acceleration factors in typical 3D FPP cases are included, providing context for the extent that each acceleration method can contribute to the required imaging speed, as well as potential limitations in present 3D FPP literature. Although many 3D FPP methods are too early in development for the type of clinical trials required to show any clear benefit over current 2D FPP methods, the review includes the small but growing quantity of clinical research work already using 3D FPP, alongside the more technical work. Broader challenges concerning FPP such as quantitative analysis are not covered, but challenges with particular impact on 3D FPP methods, particularly with regards to motion effects, are discussed along with anticipated future work in the field.

In vivo cardiovascular magnetic resonance diffusion tensor imaging shows evidence of abnormal myocardial laminar orientations and mobility in hypertrophic cardiomyopathy.

BACKGROUND: Cardiac diffusion tensor imaging (cDTI) measures the magnitudes and directions of intramyocardial water diffusion. Assuming the cross-myocyte components to be constrained by the laminar microstructures of myocardium, we hypothesized that cDTI at two cardiac phases might identify any abnormalities of laminar orientation and mobility in hypertrophic cardiomyopathy (HCM). METHODS: We performed cDTI in vivo at 3 Tesla at end-systole and late diastole in 11 healthy controls and 11 patients with HCM, as well as late gadolinium enhancement (LGE) for detection of regional fibrosis. RESULTS: Voxel-wise analysis of diffusion tensors relative to left ventricular coordinates showed expected transmural changes of myocardial helix-angle, with no significant differences between phases or between HCM and control groups. In controls, the angle of the second eigenvector of diffusion (E2A) relative to the local wall tangent plane was larger in systole than diastole, in accord with previously reported changes of laminar orientation. HCM hearts showed higher than normal global E2A in systole (63.9° vs 56.4° controls, p=0.026) and markedly raised E2A in diastole (46.8° vs 24.0° controls, p<0.001). In hypertrophic regions, E2A retained a high, systole-like angulation even in diastole, independent of LGE, while regions of normal wall thickness did not (LGE present 57.8°, p=0.0028, LGE absent 54.8°, p=0.0022 vs normal thickness 38.1°). CONCLUSIONS: In healthy controls, the angles of cross-myocyte components of diffusion were consistent with previously reported transmural orientations of laminar microstructures and their changes with contraction. In HCM, especially in hypertrophic regions, they were consistent with hypercontraction in systole and failure of relaxation in diastole. Further investigation of this finding is required as previously postulated effects of strain might be a confounding factor.

Magnetic resonance imaging of vein wall thickness in patients with Behçet's syndrome.

OBJECTIVES: Vascular disease is a serious complication of Behçet's syndrome (BS), occurring in up to 20% of subjects. Superficial thrombophlebitis, deep vein thrombosis, and arterial aneurysm formation are the most common manifestations. Venous thrombosis is thought to result from vessel wall inflammation. This work investigated the potential usefulness of high resolution magnetic resonance imaging (MRI) to identify inflammation in the venous walls in BS subjects. METHODS: Seven healthy control (HC) subjects and five BS subjects were scanned with 3T MRI (Siemens Skyra). A standard MRI sequence was adapted for use in the venous system. Metronome guided breathing generated a regular respiratory variation of venous blood velocity. The vein wall imaging was triggered at an appropriate delay after the metronome. The popliteal vein was imaged. Vein wall images were ranked based on wall thickness and signal enhancement by two blinded, experienced observers. RESULTS: Popliteal vein rank scores were found to be significantly increased in BS versus HC subjects by the first observer (p(Observer 1)=0.025, p(Observer2)=0.07) and also averaging both observers (p=0.05). The repeated images of each subject gave a degree of variability in results, potentially from drifting response to metronome guidance over the 10 minute scan. CONCLUSIONS: MR imaging can detect increased vein wall thickness in BS subjects compared to healthy controls. Variable response to the metronome-guided breathing requires further development.

Improved MRI R2 * relaxometry of iron-loaded liver with noise correction.

Accurate and reproducible MRI R2 * relaxometry for tissue iron quantification is important in managing transfusion-dependent patients. MRI data are often acquired using array coils and reconstructed by the root-sum-square algorithm, and as such, measured signals follow the noncentral chi distribution. In this study, two noise-corrected models were proposed for the liver R2 * quantification: fitting the signal to the first moment and fitting the squared signal to the second moment in the presence of the noncentral chi noise. These two models were compared with the widely implemented offset and truncation models on both simulation and in vivo data. The results demonstrated that the "slow decay component" of the liver R2 * was mainly caused by the noise. The offset model considerably overestimated R2 * values by incorrectly adding a constant to account for the slow decay component. The truncation model generally produced accurate R2 * measurements by only fitting the initial data well above the noise level to remove the major source of errors, but underestimated very high R2 * values due to the sequence limit of obtaining very short echo time images. Both the first and second-moment noise-corrected models constantly produced accurate and precise R2 * measurements by correctly addressing the noise problem.

In vivo comparison of myocardial T1 with T2 and T2* in thalassaemia major.

PURPOSE: To compare myocardial T1 against T2 and T2* in patients with thalassemia major (TM) for myocardial iron characterization. MATERIALS AND METHODS: A total of 106 TM patients (29 ± 10 years; 58 males) were studied on a 1.5 Tesla scanner using dedicated T1, T2*, and T2 relaxometry sequences. A single mid-ventricular short axis slice was acquired within a breath-hold. RESULTS: In patients with myocardial iron overload (T2* < 20 ms; n = 52), there were linear correlations between T2 and T2* (r = 0.82; P = 0.0), and between T1 and T2* (r = 0.83; P = 0.0). In patients with no myocardial iron (n = 54), T2* values were scattered with no significant correlation against T2 or T1. For all patients (n = 106) there was a strong linear correlation (r = 0.93; P = 0.0) between myocardial T1 and T2. CONCLUSION: In patients with iron overload, myocardial T2 and T1 are correlated with T2*. In patients with low or normal myocardial iron concentration, other factors become dominant in affecting T2* values as shown by scattered T2* data. Myocardial T1 correlates linearly with T2 measurements in all patients suggesting that these two relaxation parameters avoid extrinsic magnetic field inhomogeneity effects and may potentially provide improved myocardial tissue characterization.

Cardiovascular magnetic resonance artefacts.

The multitude of applications offered by CMR make it an increasing popular modality to study the heart and the surrounding vessels. Nevertheless the anatomical complexity of the chest, together with cardiac and respiratory motion, and the fast flowing blood, present many challenges which can possibly translate into imaging artefacts. The literature is wide in terms of papers describing specific MR artefacts in great technical detail. In this review we attempt to summarise, in a language accessible to a clinical readership, some of the most common artefacts found in CMR applications. It begins with an introduction of the most common pulse sequences, and imaging techniques, followed by a brief section on typical cardiovascular applications. This leads to the main section on common CMR artefacts with examples, a short description of the mechanisms behind them, and possible solutions.

Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement.

Rapid innovations in cardiovascular magnetic resonance (CMR) now permit the routine acquisition of quantitative measures of myocardial and blood T1 which are key tissue characteristics. These capabilities introduce a new frontier in cardiology, enabling the practitioner/investigator to quantify biologically important myocardial properties that otherwise can be difficult to ascertain clinically. CMR may be able to track biologically important changes in the myocardium by: a) native T1 that reflects myocardial disease involving the myocyte and interstitium without use of gadolinium based contrast agents (GBCA), or b) the extracellular volume fraction (ECV)-a direct GBCA-based measurement of the size of the extracellular space, reflecting interstitial disease. The latter technique attempts to dichotomize the myocardium into its cellular and interstitial components with estimates expressed as volume fractions. This document provides recommendations for clinical and research T1 and ECV measurement, based on published evidence when available and expert consensus when not. We address site preparation, scan type, scan planning and acquisition, quality control, visualisation and analysis, technical development. We also address controversies in the field. While ECV and native T1 mapping appear destined to affect clinical decision making, they lack multi-centre application and face significant challenges, which demand a community-wide approach among stakeholders. At present, ECV and native T1 mapping appear sufficiently robust for many diseases; yet more research is required before a large-scale application for clinical decision-making can be recommended.

Myocardial first-pass perfusion imaging with hybrid-EPI: frequency-offsets and potential artefacts.

BACKGROUND: First-pass myocardial perfusion is often imaged with a tailored hybrid centric interleaved echo-planar-imaging sequence, providing rapid image acquisition with good contrast enhancement. The centric interleaved phase-encode order minimises the effective time-of-echo but it is sensitive to frequency-offsets. This short article aims to show possible artefacts that might originate with this sequence, in the context of first-pass perfusion imaging, when frequency-offsets are present. Non-uniform magnitude modulation effects were also analysed. METHODS: Numerical and phantom simulations were used to illustrate the effects of frequency-offsets and non-uniform magnitude modulation with this sequence in a typical perfusion protocol. In vivo data was post-processed to analyse the h-EPI's sensitivity to the frequency-offsets. RESULTS: The centric phase-order was shown to be highly sensitive to frequency-offsets due to its symmetrical phase slope. Resulting artefacts include blurring, and splitting of the image into two identical copies along the phase-encode direction. It was also shown that frequency-offsets can introduce signal loss and ghosting of the right ventricle signal into the myocardium. The in vivo results were confirmed by numerical and phantom simulations. Magnitude modulation effects were found to be small. CONCLUSIONS: Imaging first-pass myocardial perfusion with an hybrid centric echo-planar-imaging sequence can be corrupted with ghosting and splitting of the image due to frequency-offsets.

A multi-center inter-manufacturer study of the temporal stability of phase-contrast velocity mapping background offset errors.

BACKGROUND: Phase-contrast velocity images often contain a background or baseline offset error, which adds an unknown offset to the measured velocities. For accurate flow measurements, this offset must be shown negligible or corrected. Some correction techniques depend on replicating the clinical flow acquisition using a uniform stationary phantom, in order to measure the baseline offset at the region of interest and subtract it from the clinical study. Such techniques assume that the background offset is stable over the time of a patient scan, or even longer if the phantom scans are acquired later, or derived from pre-stored background correction images. There is no published evidence regarding temporal stability of the background offset. METHODS: This study assessed the temporal stability of the background offset on 3 different manufacturers' scanners over 8 weeks, using a retrospectively-gated phase-contrast cine acquisition with fixed parameters and at a fixed location, repeated 5 times in rapid succession each week. A significant offset was defined as 0.6 cm/s within 50 mm of isocenter, based upon an accuracy of 10% in a typical cardiac shunt measurement. RESULTS: Over the 5 repeated cine acquisitions, temporal drift in the baseline offset was insignificant on two machines (0.3 cm/s, 0.2 cm/s), and marginally insignificant on the third machine (0.5 cm/s) due to an apparent heating effect. Over a longer timescale of 8 weeks, insignificant drift (0.4 cm/s) occurred on one, with larger drifts (0.9 cm/s, 0.6 cm/s) on the other machines. CONCLUSIONS: During a typical patient study, background drift was insignificant. Extended high gradient power scanning with work requires care to avoid drift on some machines. Over the longer term of 8 weeks, significant drift is likely, preventing accurate correction by delayed phantom corrections or derivation from pre-stored background offset data.