Single‐breathhold, four‐dimensional, quantitative assessment of LV and RV function using triggered, real‐time, steady‐state free precession MRI in heart failure patients

Abstract

Purpose: To validate a novel, real-time, steady-state free precession (SSFP), single-breathhold technique for the assessment of left ventricular (LV) and right ventricular (RV) function in heart failure patients. Materials and Methods:A total of 20 heart failure patients (mean age 59 Ϯ 17 years) underwent scanning with our new, real-time, spiral SSFP sequence in which each cardiac phase was acquired in 118 msec at a resolution of 1.8 ϫ 1.8 mm. Each cardiac slice (1-cm thick) was automatically advanced based on a cardiac trigger, allowing complete coverage of the heart in a single breathhold. The patients also underwent LV and RV assessment with the gold standard: multiple breathhold, cardiac-gated, segmented k-space strategy. LV and RV end-systolic volume (ESV) and enddiastolic volume (EDV) and LV mass were compared between the two imaging techniques. Results:The new real-time strategy was highly concordant with the gold standard technique in the assessment of LVEDV (r ϭ 0.98), LVESV (r ϭ 0.98), RVESV (r ϭ 0.86), RVEDV (r ϭ 0.91), LVMASS (r ϭ 0.95), RVEF (r ϭ 0.70), and LVEF (r ϭ 0.94). The mean bias (95% confidence interval [CI]) for each parameter is LVEDV: 10.6 cc (cm 3 ) (3.8 -17.4 cc), LVESV: -0.8 cc (-5.3 to 3.7 cc), RVEDV: 3.7 cc (-5.6 to 13.2 cc), RVESV: -3.1 cc (-11.1 to 4.9 cc), LVMASS: 26 g (12.4 -39.8 g), RVEF: -2.9% (1.3 to -7.2 %), LVEF: 1.9% (5 to -1.1%). In addition, data acquisition was only nine Ϯ two seconds with the real-time strategy vs. 312 Ϯ 41 seconds for the standard technique. Conclusion:In patients with heart failure, real-time, spiral SSFP allows rapid and accurate assessment of RV and LV function in a single-breath hold. Using the same strategy, increased temporal resolution will allow real-time assessment of cardiac wall motion during stress studies.

Patient motion correction for multiplanar, multi‐breath‐hold cardiac cine MR imaging

“…To that end, several techniques have been developed for single-breath-hold, cine volumetric imaging of the heart by CMR (6,(37)(38)(39). These fast acquisition techniques could obviate the need for software correction as described in this work.…”

Exercise training improves cardiac performance in diabetes: in vivo demonstration with quantitative cine-MRI analyses

“…The use of MRI in our investigation was further motivated by the following advantages: 1) the confounding effects of thoracotomy and deep anesthesia that often accompany an invasive approach can be avoided (30); 2) MRI can capture the cardiac pump function in small animals despite their intrinsically high heart rates (40); and 3) being intrinsically three-dimensional, MRI computations overcome the limitations posed by geometric assumptions that facilitate volumetry in other commonly used noninvasive procedures, for example, echocardiography (13). In addition to these unique advantages, the versatility of use and accuracy of measurements made possible by MRI make it ideally suited for cardiac volumetric measurements in heart failure (29). MRI has also been proposed as the technique of choice for the assessment of treatment effects in clinical studies due to its accuracy, low interobserver variability, and the potential to reduce sample size substantially (3).…”

The future of real-time cardiac magnetic resonance imaging

“…Real-time CMR has already demonstrated its ability to rapidly acquire cardiac output without the need for cardiac gating [56]. Volumetric cardiac function could be obtained in a single breath-hold using real-time acquisition [45]. Rivas et al [24] demonstrated real-time color flow that can be used to rapidly survey the extent of valvular regurgitation and Nayak et al [57] demonstrated the feasibility of quantitation of the volume flow of that valvular leak once the jet has been identified.…”

“…Many recent s tud ies have in corp orat ed SSFP sequences, which provide higher and more stable bloodmyocardium contrast [45,46•] compared to GRE. A special advantage of SSFP is that it has sufficient contrast to enable automated segmentation with little operator guidance [47].…”