An automated approach to fully self-gated free-running cardiac and respiratory motion-resolved 5D whole-heart MRI.

PURPOSE: To develop a previously reported, electrocardiogram (ECG)-gated, motion-resolved 5D compressed sensing whole-heart sparse MRI methodology into an automated, optimized, and fully self-gated free-running framework in which external gating or triggering devices are no longer needed. METHODS: Cardiac and respiratory self-gating signals were extracted from raw image data acquired in 12 healthy adult volunteers with a non-ECG-triggered 3D radial golden-angle 1.5 T balanced SSFP sequence. To extract cardiac self-gating signals, central k-space coefficient signal analysis (k0 modulation), as well as independent and principal component analyses were performed on selected k-space profiles. The procedure yielding triggers with the smallest deviation from those of the reference ECG was selected for the automated protocol. Thus, optimized cardiac and respiratory self-gating signals were used for binning in a compressed sensing reconstruction pipeline. Coronary vessel length and sharpness of the resultant 5D images were compared with image reconstructions obtained with ECG-gating. RESULTS: Principal component analysis-derived cardiac self-gating triggers yielded a smaller deviation ( 17.4±6.1ms ) from the reference ECG counterparts than k0 modulation ( 26±7.5ms ) or independent component analysis ( 19.8±5.2ms ). Cardiac and respiratory motion-resolved 5D images were successfully reconstructed with the automated and fully self-gated approach. No significant difference was found for coronary vessel length and sharpness between images reconstructed with the fully self-gated and the ECG-gated approach (all P≥.06 ). CONCLUSION: Motion-resolved 5D compressed sensing whole-heart sparse MRI has successfully been developed into an automated, optimized, and fully self-gated free-running framework in which external gating, triggering devices, or navigators are no longer mandatory. The resultant coronary MRA image quality was equivalent to that obtained with conventional ECG-gating.

Magnetic resonance fingerprinting: a technical review.

Multiparametric quantitative imaging is gaining increasing interest due to its widespread advantages in clinical applications. Magnetic resonance fingerprinting is a recently introduced approach of fast multiparametric quantitative imaging. In this article, magnetic resonance fingerprinting acquisition, dictionary generation, reconstruction, and validation are reviewed.

Magnetic resonance fingerprinting with quadratic RF phase for measurement of T2* simultaneously with δf , T1 , and T2.

PURPOSE: This study explores the possibility of using a gradient moment balanced sequence with a quadratically varied RF excitation phase in the magnetic resonance fingerprinting (MRF) framework to quantify T2* in addition to δf , T1 , and T2 tissue properties. METHODS: The proposed quadratic RF phase-based MRF method (qRF-MRF) combined a varied RF excitation phase with the existing balanced SSFP (bSSFP)-based MRF method to generate signals that were uniquely sensitive to δf , T1 , T2 , as well as the distribution width of intravoxel frequency dispersion, Γ . A dictionary, generated through Bloch simulation, containing possible signal evolutions within the physiological range of δf , T1 , T2 , and Γ , was used to perform parameter estimation. The estimated T2 and Γ were subsequently used to estimate T2* . The proposed method was evaluated in phantom experiments and healthy volunteers (N = 5). RESULTS: The T1 and T2 values from the phantom by qRF-MRF demonstrated good agreement with values obtained by traditional gold standard methods (r2 = 0.995 and 0.997, respectively; concordance correlation coefficient = 0.978 and 0.995, respectively). The T2* values from the phantom demonstrated good agreement with values obtained through the multi-echo gradient-echo method (r2 = 0.972, concordance correlation coefficient = 0.983). In vivo qRF-MRF-measured T1 , T2 , and T2* values were compared with measurements by existing methods and literature values. CONCLUSION: The proposed qRF-MRF method demonstrated the potential for simultaneous quantification of δf , T1 , T2 , and T2* tissue properties.

Image reconstruction algorithm for motion insensitive MR Fingerprinting (MRF): MORF.

PURPOSE: The purpose of this study is to increase the robustness of MR fingerprinting (MRF) toward subject motion. METHODS: A novel reconstruction algorithm, MOtion insensitive MRF (MORF), was developed, which uses an iterative reconstruction based retrospective motion correction approach. Each iteration loops through the following steps: pattern recognition, metric based identification of motion corrupted frames, registration based motion estimation, and motion compensated data consistency verification. The proposed algorithm was validated using in vivo 2D brain MRF data with retrospective in-plane motion introduced at different stages of the acquisition. The validation was performed using qualitative and quantitative comparisons between results from MORF, the iterative multi-scale (IMS) algorithm, and with the IMS results using data without motion for a ground truth comparison. Additionally, the MORF algorithm was evaluated in prospectively motion corrupted in vivo 2D brain MRF datasets. RESULTS: For datasets corrupted by in-plane motion both prospectively and retrospectively, MORF noticeably reduced motion artifacts compared with iterative multi-scale and closely resembled the results from data without motion, even when ∼54% of data was motion corrupted during different parts of the acquisition. CONCLUSIONS: MORF improves the insensitivity of MRF toward rigid-body motion occurring during any part of the MRF acquisition.

Improved respiratory self-navigation for 3D radial acquisitions through the use of a pencil-beam 2D-T2 -prep for free-breathing, whole-heart coronary MRA.

PURPOSE: In respiratory self-navigation (SN), signal from static structures, such as the chest wall, may complicate motion detection or introduce post-correction artefacts. Suppressing signal from superfluous tissues may therefore improve image quality. We thus test the hypothesis that SN whole-heart coronary magnetic resonance angiography (MRA) will benefit from an outer-volume suppressing 2D-T2 -Prep and present both phantom and in vivo results. METHODS: A 2D-T2 -Prep and a conventional T2 -Prep were used prior to a free-breathing 3D-radial SN sequence. Both techniques were compared by imaging a home-built moving cardiac phantom and by performing coronary MRA in nine healthy volunteers. Reconstructions were performed using both a reference-based and a reference-independent approach to motion tracking, along with several coil combinations. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were compared, along with vessel sharpness (VS). RESULTS: In phantoms, using the 2D-T2 -Prep increased SNR by 16% to 53% and mean VS by 8%; improved motion tracking precision was also achieved. In volunteers, SNR increased by an average of 29% to 33% in the blood pool and by 15% to 25% in the myocardium, depending on the choice of reconstruction coils and algorithm, and VS increased by 34%. CONCLUSION: A 2D-T2 -Prep significantly improves image quality in both phantoms and volunteers when performing SN coronary MRA. Magn Reson Med 79:1293-1303, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

5D whole-heart sparse MRI.

PURPOSE: A 5D whole-heart sparse imaging framework is proposed for simultaneous assessment of myocardial function and high-resolution cardiac and respiratory motion-resolved whole-heart anatomy in a single continuous noncontrast MR scan. METHODS: A non-electrocardiograph (ECG)-triggered 3D golden-angle radial balanced steady-state free precession sequence was used for data acquisition. The acquired 3D k-space data were sorted into a 5D dataset containing separated cardiac and respiratory dimensions using a self-extracted respiratory motion signal and a recorded ECG signal. Images were then reconstructed using XD-GRASP, a multidimensional compressed sensing technique exploiting correlations/sparsity along cardiac and respiratory dimensions. 5D whole-heart imaging was compared with respiratory motion-corrected 3D and 4D whole-heart imaging in nine volunteers for evaluation of the myocardium, great vessels, and coronary arteries. It was also compared with breath-held, ECG-gated 2D cardiac cine imaging for validation of cardiac function quantification. RESULTS: 5D whole-heart images received systematic higher quality scores in the myocardium, great vessels and coronary arteries. Quantitative coronary sharpness and length were always better for the 5D images. Good agreement was obtained for quantification of cardiac function compared with 2D cine imaging. CONCLUSION: 5D whole-heart sparse imaging represents a robust and promising framework for simplified comprehensive cardiac MRI without the need for breath-hold and motion correction. Magn Reson Med 79:826-838, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Chest-MRI under pulsatile flow ventilation: A new promising technique.

OBJECTIVES: Magnetic resonance imaging (MRI) of the chest has long suffered from its sensitivity to respiratory and cardiac motion with an intrinsically low signal to noise ratio and a limited spatial resolution. The purpose of this study was to perform chest MRI under an adapted non invasive pulsatile flow ventilation system (high frequency percussive ventilation, HFPV®) allowing breath hold durations 10 to 15 times longer than other existing systems. METHODS: One volunteer and one patient known for a thymic lesion underwent a chest MRI under ventilation percussion technique (VP-MR). Routinely used sequences were performed with and without the device during three sets of apnoea on inspiration. RESULTS: VP-MR was well tolerated in both cases. The mean duration of the thoracic stabilization was 10.5 min (range 8.5-12) and 5.8 min (range 5-6.2) for Volunteer 1 and Patient 1, respectively. An overall increased image quality was seen under VP-MR with a better delineation of the mediastinal lesion for Patient 1. Nodules discovered in Volunteer 1 were confirmed with low dose CT. CONCLUSION: VP-MR was feasible and increased spatial resolution of chest MRI by allowing acquisition at full inspiration during thoracic stabilization approaching prolonged apnoea. This new technique could be of benefit to numerous thoracic disorders.

Slice profile and B1 corrections in 2D magnetic resonance fingerprinting.

PURPOSE: The goal of this study is to characterize and improve the accuracy of 2D magnetic resonance fingerprinting (MRF) scans in the presence of slice profile (SP) and B1 imperfections, which are two main factors that affect quantitative results in MRF. METHODS: The SP and B1 imperfections are characterized and corrected separately. The SP effect is corrected by simulating the radiofrequency pulse in the dictionary, and the B1 is corrected by acquiring a B1 map using the Bloch-Siegert method before each scan. The accuracy, precision, and repeatability of the proposed method are evaluated in phantom studies. The effects of both SP and B1 imperfections are also illustrated and corrected in the in vivo studies. RESULTS: The SP and B1 corrections improve the accuracy of the T1 and T2 values, independent of the shape of the radiofrequency pulse. The T1 and T2 values obtained from different excitation patterns become more consistent after corrections, which leads to an improvement of the robustness of the MRF design. CONCLUSION: This study demonstrates that MRF is sensitive to both SP and B1 effects, and that corrections can be made to improve the accuracy of MRF with only a 2-s increase in acquisition time. Magn Reson Med 78:1781-1789, 2017. © 2017 International Society for Magnetic Resonance in Medicine.

Magnetic Resonance Fingerprinting-An Overview.

Magnetic Resonance Fingerprinting (MRF) is a new approach to quantitative magnetic resonance imaging that allows simultaneous measurement of multiple tissue properties in a single, time-efficient acquisition. The ability to reproducibly and quantitatively measure tissue properties could enable more objective tissue diagnosis, comparisons of scans acquired at different locations and time points, longitudinal follow-up of individual patients and development of imaging biomarkers. This review provides a general overview of MRF technology, current preclinical and clinical applications and potential future directions. MRF has been initially evaluated in brain, prostate, liver, cardiac, musculoskeletal imaging, and measurement of perfusion and microvascular properties through MR vascular fingerprinting.

Four-dimensional respiratory motion-resolved whole heart coronary MR angiography.

PURPOSE: Free-breathing whole-heart coronary MR angiography (MRA) commonly uses navigators to gate respiratory motion, resulting in lengthy and unpredictable acquisition times. Conversely, self-navigation has 100% scan efficiency, but requires motion correction over a broad range of respiratory displacements, which may introduce image artifacts. We propose replacing navigators and self-navigation with a respiratory motion-resolved reconstruction approach. METHODS: Using a respiratory signal extracted directly from the imaging data, individual signal-readouts are binned according to their respiratory states. The resultant series of undersampled images are reconstructed using an extradimensional golden-angle radial sparse parallel imaging (XD-GRASP) algorithm, which exploits sparsity along the respiratory dimension. Whole-heart coronary MRA was performed in 11 volunteers and four patients with the proposed methodology. Image quality was compared with that obtained with one-dimensional respiratory self-navigation. RESULTS: Respiratory-resolved reconstruction effectively suppressed respiratory motion artifacts. The quality score for XD-GRASP reconstructions was greater than or equal to self-navigation in 80/88 coronary segments, reaching diagnostic quality in 61/88 segments versus 41/88. Coronary sharpness and length were always superior for the respiratory-resolved datasets, reaching statistical significance (P < 0.05) in most cases. CONCLUSION: XD-GRASP represents an attractive alternative for handling respiratory motion in free-breathing whole heart MRI and provides an effective alternative to self-navigation. Magn Reson Med 77:1473-1484, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Respiratory optimized data selection for more resilient self-navigated whole-heart coronary MR angiography.

OBJECTIVES: Our objective was to test a data-exclusion strategy for respiratory motion suppression by retrospectively eliminating data acquired at extreme respiratory positions for improved coronary vessel sharpness (VS) of 1-D self-navigated 3-D radial whole-heart coronary angiography acquisitions. MATERIALS AND METHODS: 3-D radial self-navigated acquisitions were performed on a 1.5T scanner in volunteers during free-breathing (n = 8), in coached volunteers (n = 13) who were asked to breathe in a controlled manner to mimic cardiovascular patients presenting with Cheyne-Stokes breathing, and in free-breathing patients (n = 20). Data collected during large respiratory excursions were gradually excluded retrospectively from the reconstruction yielding 14 data sets per subject on average. The impact on VS, blood and myocardium signal-to-noise and contrast-to-noise was measured. From these results, two retrospective gating strategies were defined for the k-line elimination procedure and tested in all groups. RESULTS: Maximum right coronary artery VS improvement was +7.4 and +2.7% in coached volunteers and patients (P < 0.0001 for both), respectively, and 1.6% for the free-breathing volunteers (P = 0.13). The first gating strategy was defined as a fixed undersampling factor of 5 compared to a fully sampled 3-D radial acquisition, yielding significant VS improvement in coached volunteers and patients while myocardial signal-to-noise decreased in these. The second strategy was defined as a fixed gating window of 5.7 mm, leading to similar improvements. CONCLUSION: The presented strategies improve image quality of self-navigated acquisitions by retrospectively excluding data collected during end-inspiration.

Improved border sharpness of post-infarct scar by a novel self-navigated free-breathing high-resolution 3D whole-heart inversion recovery magnetic resonance approach.

The border zone of post-infarction myocardial scar as identified by late gadolinium enhancement (LGE) has been identified as a substrate for arrhythmias and consequently, high-resolution 3D scar information is potentially useful for planning of electrophysiological interventions. This study evaluates the performance of a novel high-resolution 3D self-navigated free-breathing inversion recovery magnetic resonance pulse sequence (3D-SN-LGE) vs. conventional 2D breath-hold LGE (2D-LGE) with regard to sharpness of borders (SBorder) of post-infarction scar. Patients with post-infarction scar underwent two magnetic resonance examinations for conventional 2D-LGE and high-resolution 3D-SN-LGE acquisitions (both 15 min after 0.2 mmol/kg Gadobutrol IV) at 1.5T. In the prototype 3D-SN-LGE sequence, each ECG-triggered radial steady-state-free-precession read-out segment is preceded by a non-slice-selective inversion pulse. Scar volume and SBorder were assessed on 2D-LGE and matching reconstructed high-resolution 3D-SN-LGE short-axis slices. In 16 patients (four females, 58 ± 10y) all scars visualized by 2D-LGE could be identified on 3D-SN-LGE (time between 2D-LGE and 3D-SN-LGE 48 ± 53 days). A good agreement of scar volume by 3D-SN-LGE vs. 2D-LGE was found (Bland-Altman: -3.7 ± 3.4 ml, correlation: r = 0.987, p < 0.001) with a small difference in scar volume (20.5 (15.8, 35.2) ml vs. 24.5 (20.0, 41.9)) ml, respectively, p = 0.002] and a good intra- and interobserver variability (1.1 ± 4.1 and -1.1 ± 11.9 ml, respectively). SBorder of border "scar to non-infarcted myocardium" was superior on 3D-SN-LGE vs. 2D-LGE: 0.180 ± 0.044 vs. 0.083 ± 0.038, p < 0.001. Detection and quantification of myocardial scar by 3D-SN-LGE is feasible and accurate in comparison to 2D-LGE. The high spatial resolution of the 3D sequence improves delineation of scar borders.

Coronary endothelial function assessment using self-gated cardiac cine MRI and k-t sparse SENSE.

PURPOSE: Electrocardiogram (ECG)-gated cine MRI, paired with isometric handgrip exercise, can be used to accurately, reproducibly, and noninvasively measure coronary endothelial function (CEF). Obtaining a reliable ECG signal at higher field strengths, however, can be challenging due to rapid gradient switching and an increased heart rate under stress. To address these limitations, we present a self-gated cardiac cine MRI framework for CEF measurements that operates without ECG signal. METHODS: Cross-sectional slices of the right coronary artery (RCA) were acquired using a two-dimensional golden angle radial trajectory. This sampling approach, combined with the k-t sparse SENSE algorithm, allows for the reconstruction of both real-time images for self-gating signal calculations and retrospectively reordered self-gated cine images. CEF measurements were quantitatively compared using both the self-gated and the standard ECG-gated approach. RESULTS: Self-gated cine images with high-quality, temporal, and spatial resolution were reconstructed for 18 healthy volunteers. CEF as measured in self-gated images was in good agreement (R2 = 0.60) with that measured by its standard ECG-gated counterpart. CONCLUSION: High spatial and temporal resolution cross-sectional cine images of the RCA can be obtained without ECG signal. The coronary vasomotor response to handgrip exercise compares favorably with that obtained with the standard ECG-gated method. Magn Reson Med 76:1443-1454, 2015. © 2015 International Society for Magnetic Resonance in Medicine.

Ultra-high-resolution 3D imaging of atherosclerosis in mice with synchrotron differential phase contrast: a proof of concept study.

The goal of this study was to investigate the performance of 3D synchrotron differential phase contrast (DPC) imaging for the visualization of both macroscopic and microscopic aspects of atherosclerosis in the mouse vasculature ex vivo. The hearts and aortas of 2 atherosclerotic and 2 wild-type control mice were scanned with DPC imaging with an isotropic resolution of 15 µm. The coronary artery vessel walls were segmented in the DPC datasets to assess their thickness, and histological staining was performed at the level of atherosclerotic plaques. The DPC imaging allowed for the visualization of complex structures such as the coronary arteries and their branches, the thin fibrous cap of atherosclerotic plaques as well as the chordae tendineae. The coronary vessel wall thickness ranged from 37.4 ± 5.6 µm in proximal coronary arteries to 13.6 ± 3.3 µm in distal branches. No consistent differences in coronary vessel wall thickness were detected between the wild-type and atherosclerotic hearts in this proof-of-concept study, although the standard deviation in the atherosclerotic mice was higher in most segments, consistent with the observation of occasional focal vessel wall thickening. Overall, DPC imaging of the cardiovascular system of the mice allowed for a simultaneous detailed 3D morphological assessment of both large structures and microscopic details.

Single centre experience of the application of self navigated 3D whole heart cardiovascular magnetic resonance for the assessment of cardiac anatomy in congenital heart disease.

BACKGROUND: For free-breathing cardiovascular magnetic resonance (CMR), the self-navigation technique recently emerged, which is expected to deliver high-quality data with a high success rate. The purpose of this study was to test the hypothesis that self-navigated 3D-CMR enables the reliable assessment of cardiovascular anatomy in patients with congenital heart disease (CHD) and to define factors that affect image quality. METHODS: CHD patients ≥2 years-old and referred for CMR for initial assessment or for a follow-up study were included to undergo a free-breathing self-navigated 3D CMR at 1.5T. Performance criteria were: correct description of cardiac segmental anatomy, overall image quality, coronary artery visibility, and reproducibility of great vessels diameter measurements. Factors associated with insufficient image quality were identified using multivariate logistic regression. RESULTS: Self-navigated CMR was performed in 105 patients (55% male, 23 ± 12y). Correct segmental description was achieved in 93% and 96% for observer 1 and 2, respectively. Diagnostic quality was obtained in 90% of examinations, and it increased to 94% if contrast-enhanced. Left anterior descending, circumflex, and right coronary arteries were visualized in 93%, 87% and 98%, respectively. Younger age, higher heart rate, lower ejection fraction, and lack of contrast medium were independently associated with reduced image quality. However, a similar rate of diagnostic image quality was obtained in children and adults. CONCLUSION: In patients with CHD, self-navigated free-breathing CMR provides high-resolution 3D visualization of the heart and great vessels with excellent robustness.

Free-running 4D whole-heart self-navigated golden angle MRI: Initial results.

PURPOSE: To test the hypothesis that both coronary anatomy and ventricular function can be assessed simultaneously using a single four-dimensional (4D) acquisition. METHODS: A free-running 4D whole-heart self-navigated acquisition incorporating a golden angle radial trajectory was implemented and tested in vivo in nine healthy adult human subjects. Coronary magnetic resonance angiography (MRA) datasets with retrospective selection of acquisition window width and position were extracted and quantitatively compared with baseline self-navigated electrocardiography (ECG) -triggered coronary MRA. From the 4D datasets, the left-ventricular end-systolic, end-diastolic volumes (ESV & EDV) and ejection fraction (EF) were computed and compared with values obtained from conventional 2D cine images. RESULTS: The 4D datasets enabled dynamic assessment of the whole heart with isotropic spatial resolution of 1.15 mm(3). Coronary artery image quality was very similar to that of the ECG-triggered baseline scan despite some SNR penalty. A good agreement between 4D and 2D cine imaging was found for EDV, ESV, and EF. CONCLUSION: The hypothesis that both coronary anatomy and ventricular function can be assessed simultaneously in vivo has been tested positive. Retrospective and flexible acquisition window selection allows to best visualize each coronary segment at its individual time point of quiescence.

Repositioning precision of coronary arteries measured on X-ray angiography and its implications for coronary MR angiography.

BACKGROUND: To test the hypothesis that intervals with superior beat-to-beat coronary artery repositioning precision exist in the cardiac cycle, to design a coronary MR angiography (MRA) methodology in response, and to ascertain its performance. METHODS: Coronary repositioning precision in consecutive heartbeats was measured on x-ray coronary angiograms of 17 patients and periods with the highest repositioning precision were identified. In response, the temporal order of coronary MRA pulse sequence elements required modification and the T2 -prep now follows (T2 -post) rather than precedes the imaging part of the sequence. The performance of T2 -post was quantitatively compared (signal-to-noise [SNR], contrast-to-noise [CNR], vessel sharpness) to that of T2 -prep in vivo. RESULTS: Coronary repositioning precision is <1 mm at peak systole and in mid diastole. When comparing systolic T2 -post to diastolic T2 -prep, CNR and vessel sharpness remained unchanged (both P = NS) but SNR for muscle and blood increased by 104% and 36% (both P < 0.05), respectively. CONCLUSION: Windows with improved coronary repositioning precision exist in the cardiac cycle: one in peak systole and one in mid diastole. Peak-systolic imaging necessitates a re-design of conventional coronary MRA pulse sequences and leads to image quality very similar to that of conventional mid-diastolic data acquisition but improved SNR.

Compressed sensing single-breath-hold CMR for fast quantification of LV function, volumes, and mass.

OBJECTIVES: The purpose of this study was to compare a novel compressed sensing (CS)-based single-breath-hold multislice magnetic resonance cine technique with the standard multi-breath-hold technique for the assessment of left ventricular (LV) volumes and function. BACKGROUND: Cardiac magnetic resonance is generally accepted as the gold standard for LV volume and function assessment. LV function is 1 of the most important cardiac parameters for diagnosis and the monitoring of treatment effects. Recently, CS techniques have emerged as a means to accelerate data acquisition. METHODS: The prototype CS cine sequence acquires 3 long-axis and 4 short-axis cine loops in 1 single breath-hold (temporal/spatial resolution: 30 ms/1.5 × 1.5 mm(2); acceleration factor 11.0) to measure left ventricular ejection fraction (LVEF(CS)) as well as LV volumes and LV mass using LV model-based 4D software. For comparison, a conventional stack of multi-breath-hold cine images was acquired (temporal/spatial resolution 40 ms/1.2 × 1.6 mm(2)). As a reference for the left ventricular stroke volume (LVSV), aortic flow was measured by phase-contrast acquisition. RESULTS: In 94% of the 33 participants (12 volunteers: mean age 33 ± 7 years; 21 patients: mean age 63 ± 13 years with different LV pathologies), the image quality of the CS acquisitions was excellent. LVEF(CS) and LVEF(standard) were similar (48.5 ± 15.9% vs. 49.8 ± 15.8%; p = 0.11; r = 0.96; slope 0.97; p < 0.00001). Agreement of LVSV(CS) with aortic flow was superior to that of LVSV(standard) (overestimation vs. aortic flow: 5.6 ± 6.5 ml vs. 16.2 ± 11.7 ml, respectively; p = 0.012) with less variability (r = 0.91; p < 0.00001 for the CS technique vs. r = 0.71; p < 0.01 for the standard technique). The intraobserver and interobserver agreement for all CS parameters was good (slopes 0.93 to 1.06; r = 0.90 to 0.99). CONCLUSIONS: The results demonstrated the feasibility of applying the CS strategy to evaluate LV function and volumes with high accuracy in patients. The single-breath-hold CS strategy has the potential to replace the multi-breath-hold standard cardiac magnetic resonance technique.

Respiratory self-navigated postcontrast whole-heart coronary MR angiography: initial experience in patients.

PURPOSE: To assess the diagnostic performance of respiratory self-navigation for whole-heart coronary magnetic resonance (MR) angiography in a patient cohort referred for diagnostic cardiac MR imaging. MATERIALS AND METHODS: Written informed consent was obtained from all participants for this institutional review board-approved study. Self-navigated coronary MR angiography was performed after administration of a contrast agent in 78 patients (mean age, 48.5 years ± 20.7 [standard deviation]; 53 male patients) referred for cardiac MR imaging because of coronary artery disease (n = 40), cardiomyopathy (n = 14), congenital anomaly (n = 17), or "other" (n = 7). Examination duration was recorded, and the image quality for each coronary segment was assessed with consensus reading. Vessel sharpness, length, and diameter were measured. Quantitative values in proximal, middle, and distal segments were compared by using analysis of variance and t tests. A double-blinded comparison with the results of x-ray angiography was performed when such results were available. RESULTS: When patients with different indications for cardiac MR imaging were examined with self-navigated postcontrast coronary MR angiography, whole-heart data sets with 1.15-mm isotropic spatial resolution were acquired in an average of 7.38 minutes ± 1.85. The main and proximal coronary segments could be visualized in 92.3% of cases, while the middle and distal segments could be visualized in 84.0% and 55.8% of cases, respectively. Subjective scores and vessel sharpness were significantly higher in the proximal segments than in the middle and distal segments (P < .05). Anomalies of the coronary arteries could be confirmed or excluded in all cases. Per-vessel sensitivity and specificity for stenosis detection were 64.7% and 85.0%, respectively, in the 31 patients for whom reference standard x-ray coronary angiography results were available. CONCLUSION: The self-navigated coronary MR angiography sequence shows promise for coronary imaging. However, technical improvements are needed to improve image quality, especially in the more distal coronary segments.