BackgroundIntravoxel incoherent motion (IVIM) imaging of diffusion and perfusion in the heart suffers from high parameter estimation error. The purpose of this work is to improve cardiac IVIM parameter mapping using Bayesian inference.MethodsA second-order motion-compensated diffusion weighted spin-echo sequence with navigator-based slice tracking was implemented to collect cardiac IVIM data in early systole in eight healthy subjects on a clinical 1.5 T CMR system. IVIM data were encoded along six gradient optimized directions with b-values of 0–300 s/mm2. Subjects were scanned twice in two scan sessions one week apart to assess intra-subject reproducibility. Bayesian shrinkage prior (BSP) inference was implemented to determine IVIM parameters (diffusion D, perfusion fraction F and pseudo-diffusion D*). Results were compared to least-squares (LSQ) parameter estimation. Signal-to-noise ratio (SNR) requirements for a given fitting error were assessed for the two methods using simulated data. Reproducibility analysis of parameter estimation in-vivo using BSP and LSQ was performed.ResultsBSP resulted in reduced SNR requirements when compared to LSQ in simulations. In-vivo, BSP analysis yielded IVIM parameter maps with smaller intra-myocardial variability and higher estimation certainty relative to LSQ. Mean IVIM parameter estimates in eight healthy subjects were (LSQ/BSP): 1.63 ± 0.28/1.51 ± 0.14·10−3 mm2/s for D, 13.13 ± 19.81/13.11 ± 5.95% for F and 201.45 ± 313.23/13.11 ± 14.53·10−3 mm2/s for D ∗. Parameter variation across all volunteers and measurements was lower with BSP compared to LSQ (coefficient of variation BSP vs. LSQ: 9% vs. 17% for D, 45% vs. 151% for F and 111% vs. 155% for D ∗). In addition, reproducibility of the IVIM parameter estimates was higher with BSP compared to LSQ (Bland-Altman coefficients of repeatability BSP vs. LSQ: 0.21 vs. 0.26·10−3 mm2/s for D, 5.55 vs. 6.91% for F and 15.06 vs. 422.80·10−3 mm2/s for D*).ConclusionRobust free-breathing cardiac IVIM data acquisition in early systole is possible with the proposed method. BSP analysis yields improved IVIM parameter maps relative to conventional LSQ fitting with fewer outliers, improved estimation certainty and higher reproducibility. IVIM parameter mapping holds promise for myocardial perfusion measurements without the need for contrast agents.

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Purpose: Mapping intravoxel incoherent motion (IVIM) in the heart remains challenging despite advances in cardiac DWI and DTI. In the present work, simulations and experimental imaging are used to compare the IVIM encoding efficiency of spinecho-and stimulated-echo-based DWI/DTI for assessing myocardial perfusion. Methods: Using normalized phase distributions and statistical models of capillary networks derived from histological studies, along with typical diffusion gradient waveforms for in vivo cardiac DWI/DTI, Monte Carlo simulations were performed. The simulation results were compared to IVIM measurements of perfused porcine hearts regarding both magnitude and phase modulation. An IVIM tensor model was used to account for anisotropy of the capillary network, and potential bias of parameter estimation was reported based on simulations. Results: Both computer simulations and experimental data demonstrate a low sensitivity of spin-echo DWI/DTI sequences for IVIM parameters, whereas stimulatedecho-based DWI/DTI with typical mixing times can differentiate between no-flow baseline and perfused myocardium (+129% IVIM-derived flow). In addition, ischemic territories induced by coronary occlusion could be successfully detected. With increasing order of motion compensation (M0/M1/M2) of the diffusion encoding gradients, as required for cardiac in vivo spin-echo DWI/DTI, the low IVIM sensitivity of spin-echo DWI/DTI decreased further in simulations: maximum attenuations of perfusion compartment 52/13/5% (b = 500 s/mm 2 ). Conclusion: Given the short encoding time of spin-echo-based DWI/DTI sequences, a limited perfusion sensitivity results, in particular in combination with motioncompensated diffusion gradients. In contrast, stimulated-echo based DWI/DTI has the potential to identify perfusion changes in cardiac IVIM in vivo. K E Y W O R D S DWI, intravoxel incoherent motion, motion-compensated spin-echo, myocardial perfusion, perfused heart, STEAM F I G U R E 2 Gradient shapes, 0th moments, and integrals of the 0th moment. Normalized effective gradient shapes of Stejskal-Tanner SE-DWI (M0, red), first-order motion-compensated SE-DWI (M1, green), second-order motion-compensated SE-DWI (M2, blue), and STEAM-DWI (orange). The normalized time on the x-axis corresponds to the timing used in the simulations and ex vivo studies. The bottom row shows the integral of the 0th gradient moment (multiplied by the normalized b-value), which is used for generation of phase distributions M0,