Two-center clinical validation and quantitative assessment of respiratory triggered retrospectively cardiac gated balanced-SSFP cine cardiovascular magnetic resonance imaging in adults

Abstract

BackgroundBreath-hold (BH) requirement remains the limiting factor on the spatio-temporal resolution and coverage of the cine balanced steady-state free precession (bSSFP) cardiovascular magnetic resonance (CMR) imaging. In this prospective two-center clinical trial, we validated the performance of a respiratory triggered (RT) bSSFP cine sequence for evaluation of biventricular function.MethodsOur study included 23 asymptomatic healthy subjects and 60 consecutive patients from Institute A (n = 39) and Institute B (n = 21) referred for a clinically indicated CMR study. We implemented a RT sequence with a respiratory synchronized drive to steady state (SS) of bSSFP signal, before the commencement of image data acquisition with prospective cardiac arrhythmia rejection and retrospectively cardiac gated reconstruction in real-time. Left (LV) and right (RV) ventricular function and LV mass were evaluated by using RT-bSSFP and conventional BH-bSSFP sequences with one cardiac cycle for SS preparation keeping all the imaging parameters identical. The performance of the sequences was evaluated by using quantitative and semi-quantitative metrics.ResultsGlobal LV and RV functional parameters and LV mass obtained from the RT-bSSFP and BH-bSSFP sequences were in good agreement. Quantitative metrics designed to capture fluctuation in SS signal intensity showed no significant difference between sequences. In addition, blood-to-myocardial contrast was nearly identical between sequences. The combined clinical score for image quality was excellent or good for 100% of cases with the BH-bSSFP and 83% of cases with the RT-bSSFP sequence. The de facto image acquisition time for RT-bSSFP was statistically significantly longer than that for conventional BH-bSSFP (7.9 ± 3.4 min vs. 5.1 ± 2.6 min).ConclusionsCine RT-bSSFP is an alternative for evaluating global biventricular function with contrast and spatio-temporal resolutions that are similar to those attained by using the BH-bSSFP sequence, albeit with a modest time penalty and a small reduction in image quality.

High frame rate cardiac cine MRI for the evaluation of diastolic function and its direct correlation with echocardiography

“…Third, although the single slice‐based estimation of diastolic function indices (basal slice for V EFP /V LFP , and mid LV slice for R EFP /R LFP ) correlated well with indices extracted from the entire LV volume, it remains to be determined whether such correlations are valid in patients with regional wall motion abnormalities. Furthermore, a recent study has shown that the free‐breathing cine MRI method used in this study takes longer (about 3 min) and that the image quality—although diagnostic—is slightly inferior to that of conventional breath‐hold cine imaging . Further studies are necessary to evaluate whether recent advances in spatiotemporal undersampling methods such as compressed sensing may be used to partly or fully address the issue of longer scan times.…”

“…Furthermore, a recent study has shown that the free-breathing cine MRI method used in this study takes longer (about 3 min) and that the image quality-although diagnostic-is slightly inferior to that of conventional breath-hold cine imaging. 22 Further studies are necessary to evaluate whether recent advances in spatiotemporal undersampling methods such as compressed sensing may be used to partly or fully address the issue of longer scan times. High frame rate cine imaging requires additional time for the cardiovascular imager to segment the LV cavity, which may be partly reduced with semiautomatic or automatic LV contour analysis tools.…”

“…A custom‐built respiratory‐triggered, free‐breathing, high frame rate SSFP imaging technique was used to acquire a stack of contiguous slices that covered the entire left ventricle in the short‐axis orientation . The sequence, previously described in detail, included the following specific acquisition parameters: repetition time / echo time (TR/TE) / flip angle, 3.2/1.5 msec/55°; acquired temporal resolution, 14.2 ± 2.1 msec/phase; acquired in‐plane spatial resolution, 2.25 × 2.25 mm 2 ; parallel imaging factor, 2; typical field of view (FOV), 350 × 350 mm 2 ; and slice thickness, 10 mm, with no gap between slices.…”

“…Recently, Pednekar et al 22 described the use of a respiratory-triggered cine SSFP sequence that obviates the need for breath-holding to obtain cine SSFP MR images at conventional frame rates. 22,23 We hypothesized that this technique could be used to attain the high frame rates necessary to evaluate both systolic and diastolic function without the constraint of the breath-holding ability of patients. In this study, we examined the feasibility of extracting indices from the temporal changes in LV cavity volume during the filling phase of the cardiac cycle to characterize diastolic function and compared these indices with traditional indices of diastolic function measured by using echocardiography or PC-MRI.…”

Breath-hold and free-breathing quantitative assessment of biventricular volume and function using compressed SENSE: a clinical validation in children and young adults

“…Accelerated cine CMR techniques (such as k-t BLAST, TPAT, TSENSE, and compressed sensing) have reported bias in left ventricular (LV) volumes, function, and LV mass due to spatiotemporal blurring and temporal filtering [20][21][22][23][24][25][26]. Free-breathing (FB) respiratory triggered retrospectively cardiac gated cine bSSFP sequences have been reported to provide biventricular volumes, function, and LV mass comparable to BH acquisitions with a SENSE acceleration factor of 2 in adults and children [27,28]. With the goal of accelerating SENSE, a compressed sensitivity encoding (C-SENSE) algorithm was developed that employs a pseudorandom undersampling of k-space in the spatial domain.…”