Rapid evaluation of left ventricular volume and mass without breath-holding using real-time interactive cardiac magnetic resonance imaging system.

OBJECTIVES: The purpose of this study was to validate cardiac measurements derived from real-time cardiac magnetic resonance imaging (MRI) as compared with well-validated conventional cine MRI. BACKGROUND: Although cardiac MRI provides accurate assessment of left ventricular (LV) volume and mass, most techniques have been relatively slow and required electrocardiogram (ECG) gating over many heart beats. A newly developed real-time MRI system allows continuous real-time dynamic acquisition and display without cardiac gating or breath-holding. METHODS: Fourteen healthy volunteers and nine patients with heart failure underwent real-time and cine MRI in the standard short-axis orientation with a 1.5T MRI scanner. Nonbreath-holding cine MRI was performed with ECG gating and respiratory compensation. Left ventricular end-diastolic volume (LVEDV), left ventricular endsystolic volume (LVESV), ejection fraction (EF) and LV mass calculated from the images obtained by real-time MRI were compared to those obtained by cine MRI. RESULTS: The total study time including localization for real-time MRI was significantly shorter than cine MRI (8.6 +/- 2.3 vs. 24.7 +/- 3.5 min, p < 0.001). Both imaging techniques yielded good quality images allowing cardiac measurements. The measurements of LVEDV, LVESV, EF and LV mass obtained with real-time MRI showed close correlation with those obtained with cine MRI (LVEDV: r = 0.985, p < 0.001; LVESV: r = 0.994, p < 0.001; EF: r = 0.975, p < 0.001; LV mass: r = 0.977, p < 0.001). CONCLUSIONS: Real-time MRI provides accurate measurements of LV volume and mass in a time-efficient manner with respect to image acquisition.

Real-time black-blood MRI using spatial presaturation.

A real-time interactive black-blood imaging system is described. Rapid blood suppression is achieved by exciting and dephasing slabs outside the imaging slice before each imaging excitation. Sharp-profiled radio frequency saturation pulses placed close to the imaging slice provide good blood suppression, even in views containing slow through-plane flow. In vivo results indicate that this technique improves endocardial border definition during systole in real-time cardiac wall-motion studies. Phantom and animal results indicate that this technique nearly eliminates flow artifacts in real-time intravascular studies. J. Magn. Reson. Imaging 2001;13:807-812.

Partial-FOV reconstruction in dynamic spiral imaging.

In many applications of dynamic MR imaging, only a portion of the field-of-view (FOV) exhibits considerable variations in time. In such cases, a prior knowledge of the static part of the image allows a partial-FOV reconstruction of the dynamic section using only a fraction of the raw data. This method of reconstruction generally results in higher temporal resolution, because the scan time for partial-FOV data is shorter. The fidelity of this reconstruction technique depends, among other factors, on the accuracy of the prior information of the static section. This information is usually derived from the reconstructed images at previous time frames. This data, however, is normally corrupted by the motion artifact Because the temporal frequency contents of the motion artifact is very similar to that of the dynamic section, a temporal low-pass filter can efficiently remove this artifact from the static data. The bandwidth of the filter can be obtained from the rate of variations inside and outside the dynamic area. In general, when the temporal bandwidth is not spatially uniform, a bank of low-pass filters can provide a proper suppression of the motion artifact outside the dynamic section. This reconstruction technique is adapted for spiral acquisition and is successfully applied to cardiac fluoroscopy, doubling the temporal resolution.

Real-time color flow MRI.

A real-time interactive color flow MRI system capable of rapidly visualizing cardiac and vascular flow is described. Interleaved spiral phase contrast datasets are acquired continuously, while real-time gridding and phase differencing is used to compute density and velocity maps. These maps are then displayed using a color overlay similar to what is used by ultrasound. For cardiac applications, 6 independent images/sec are acquired with in-plane resolution of 2.4 mm over a 20 cm field of view (FOV). Sliding window reconstruction achieves display rates up to 18 images/sec. Appropriate tradeoffs are made for other applications. Flow phantom studies indicate this technique accurately measures velocities up to 2 m/sec, and accurately captures real-time velocity waveforms (comparable to continuous wave ultrasound). In vivo studies indicate this technique is useful for imaging cardiac and vascular flow, particularly valvular regurgitation. Arbitrary scan planes can be quickly localized, and flow measured in any direction.

New real-time interactive cardiac magnetic resonance imaging system complements echocardiography.

OBJECTIVES: We conducted an initial clinical trial of a newly developed cardiac magnetic resonance imaging (CMRI) system. We evaluated left ventricular (LV) function in 85 patients to compare the clinical utility of the CMRI system with echocardiography, the current noninvasive gold standard. BACKGROUND: Conventional CMRI systems require cardiac-gating and respiratory compensation to synthesize a single image from data acquired over multiple cardiac cycles. In contrast, the new CMRI system allows continuous real-time dynamic acquisition and display of any scan plane at 16 images/s without the need for cardiac gating or breath-holding. METHODS: A conventional 1.5T Signa MRI Scanner (GE, Milwaukee, Wisconsin) was modified by the addition of an interactive workstation and a bus adapter. The new CMRI system underwent clinical trial by testing its ability to evaluate global and regional LV function. The first group (A) consisted of 31 patients with acceptable echocardiography image quality. The second group (B) consisted of 31 patients with suboptimal echocardiography image quality. The third group (C) consisted of 29 patients with severe lung disease or congenital cardiac malformation who frequently have suboptimal echo study. Two independent observers scored wall motion and image quality using the standard 16-segment model and rank-order analysis. RESULTS: CMRI evaluation was complete in less than 15 min. In group A, no significant difference was found between ECHO and CMRI studies (p = NS). In group B, adequate visualization of wall segments was obtained 38% of the time using ECHO and 97% of the time using CMRI (p < 0.0001). When grouped into coronary segments, adequate visualization of at least one segment occurred in 18 of 30 patients (60%) with ECHO and in all 30 patients (100%) with CMRI (p < 0.0001). In group C, adequate visualization of the wall segments was obtained in 58% (CI 0.53-0.62) of the time using echocardiography and 99.7% (CI 0.99-1.0) of the time using CMRI (p < 0.0001). CONCLUSIONS: The new CMRI system provides clinically reliable evaluation of LV function and complements suboptimal echocardiography. In comparison with the conventional CMRI, the new CMRI system significantly reduces scan time, patient discomfort and associated cost.

Interactive coronary MRI.

The acquisition of complete three-dimensional (3D), segmented gradient-echo data sets to visualize the coronary arteries can be both time consuming and sensitive to motion, even with use of multiple breath-holding or respiratory gating. An alternate hybrid approach is demonstrated here, in which real-time interactive imaging is first used to locate an optimal oblique coronary scan plane. Then, a limited number of contiguous slices are acquired around that plane within a breath-hold with use of two-dimensional (2D) segmented gradient-echo imaging. Dual inversion nulling is used to suppress fat and myocardium. Finally, if needed, a limited reformat of the data is performed to produce images from relatively long sections of the coronaries. This approach yields relatively rapid visualization of portions of the coronary tree. Several different methods are compared for interactively moving the scan plane.

Real-time interactive MRI on a conventional scanner.

A real-time interactive MRI system capable of localizing coronary arteries and imaging arrhythmic hearts in real-time is described. Non-2DFT acquisition strategies such as spiral-interleaf, spiral-ring, and circular echo-planar imaging provide short scan times on a conventional scanner. Real-time gridding reconstruction at 8-20 images/s is achieved by distributing the reconstruction on general-purpose UNIX workstations. An X-windows application provides interactive control. A six-interleaf spiral sequence is used for cardiac imaging and can acquire six images/s. A sliding window reconstruction achieves display rates of 16-20 images/s. This allows cardiac images to be acquired in real-time, with minimal motion and flow artifacts, and without breath holding or cardiac gating. Abdominal images are acquired at over 2.5 images/s with spiral-ring or circular echo-planar sequences. Reconstruction rates are 8-10 images/s. Rapid localization in the abdomen is demonstrated with the spiral-ring acquisition, whereas peristaltic motion in the small bowel is well visualized using the circular echo-planar sequence.