Real-time Assessment of Right and Left Ventricular Volumes and Function in Children Using High Spatiotemporal Resolution Spiral bSSFP with Compressed Sensing

Background: Real-time (RT) assessment of ventricular volumes and function enables data acquisition during free-breathing. However, in children the requirement for high spatiotemporal resolution requires accelerated imaging techniques. In this study, we implemented a novel RT bSSFP spiral sequence reconstructed using Compressed Sensing (CS) and validated it against the breath-hold (BH) reference standard for assessment of ventricular volumes in children with heart disease. Methods: Data was acquired in 60 children. Qualitative image scoring and evaluation of ventricular volumes was performed by 3 clinical cardiac MR specialists. 30 cases were reassessed for intra-observer variability, and the other 30 cases for inter-observer variability. Results: Spiral RT images were of good quality, however qualitative scores reflected more residual artefact than standard BH images and slightly lower edge definition. Quantification of Left Ventricular (LV) and Right Ventricular (RV) metrics showed excellent correlation between the techniques with narrow limits of agreement. However, we observed small but statistically significant overestimation of LV end-diastolic volume, underestimation of LV end-systolic volume, as well as a small overestimation of RV stroke volume and ejection fraction using the RT imaging technique. No difference in inter-observer or intra-observer variability were observed between the BH and RT sequences. Conclusions: Real-time bSSFP imaging using spiral trajectories combined with a compressed sensing reconstruction is feasible. The main benefit is that it can be acquired during free breathing. However, another important secondary benefit is that a whole ventricular stack can be acquired in ~20 seconds, as opposed to ~6 minutes for standard BH imaging. Thus, this technique holds the potential to significantly shorten MR scan times in children

Applications of the golden angle in cardiovascular MRI

The use of radial trajectories has been seen as a potential solution to highly efficient cardiovascular magnetic resonance imaging (MRI). By acquiring a broad range of spatial frequencies per repetition time, the acquisition is time-efficient and robust against motion. Of particular interest is the golden angle profile order, which promises a near-uniform k-space coverage for an arbitrary number of readouts, enabling flexible data resorting, which is critical for efficient cardiovascular MRI. In Study I the use of 2D golden angle profile ordering is explored for imaging pulmonary embolisms. The insensitivity to motion and flow is used to reduce the artifacts that otherwise degrade images of the pulmonary vasculature when imaging with thin slices. It was found that the proposed technique could improve the image quality. Another source of artifacts arises when gradients are rapidly switched, and local induction of eddy currents may perturb spin equilibrium. In Study II, we propose a generalized golden angle profile orderings in 3D which reduces eddy-current artifacts. We demonstrate the efficacy of our generalization through numerical simulations, phantom imaging and imaging of a healthy volunteer. In Study III an improved 2D golden angle profile ordering was explored which resulted in a higher degree of k-space uniformity after physiological binning. This novel profile ordering was used in combination with a phase-contrast readout to enable quantification of myocardial tissue velocity and transmitral blood flow velocity, which are essential parameters for diastolic function assessment. When compared to echocardiography, it was found that MRI could accurately quantify myocardial tissue velocity, whereas transmitral blood flow velocity was underestimated. Study IV explored a further development of Study III by proposing a 3D version of the improved profile ordering. This novel ordering was used to acquire whole-heart functional images during free-breathing in less than one minute. Together, these results indicate that golden-angle-based imaging has the potential to improve cardiovascular MRI in several areas

Doctor of Philosophy

dissertationThe gold standard for evaluation of arterial disease using MR continues to be contrast-enhanced MR angiography (MRA) with gadolinium-based contrast agents (Gd-MRA). There has been a recent resurgence in interest in methods that do not rely on gadolinium for enhancement of blood vessels due to associations Gd-MRA has with nephrogenic systemic fibrosis (NSF) in patients with impaired renal function. The risk due to NSF has been shown to be minimized when selecting the appropriate contrast type and dose. Even though the risk of NSF has been shown to be minimized, demand for noncontrast MRA has continued to rise to reduce examination cost, and improve patient comfort and ability to repeat scans. Several methods have been proposed and used to perform angiography of the aorta and peripheral arteries without the use of gadolinium. These techniques have had limitations in transmit radiofrequency field (B1+) inhomogeneities, acquisition time, and specific hardware requirements, which have stunted the utility of noncontrast enhanced MRA. In this work feasibility of noncontrast (NC) MRA at 3T of the femoral arteries using dielectric padding, and using 3D radial stack of stars and compressed sensing to accelerate acquisitions in the abdomen and thorax were tested. Imaging was performed on 13 subjects in the pelvis and thighs using high permittivity padding, and 11 in the abdomen and 19 in the thorax using 3D radial stack of stars with tiny golden angle using gold standards or previously published techniques. Qualitative scores for each study were determined by radiologists who were blinded to acquisition type. Vessel conspicuity in the thigh and pelvis showed significant increase when high permittivity padding was used in the acquisition. No significant difference in image quality was observed in the abdomen and thorax when using undersampling, except for the descending aorta in thoracic imaging. All image quality scores were determined to be of diagnostic quality. In this work it is shown that NC-MRA can be improved through the use of high permittivity dielectric padding and acquisition time can be decreased through the use of 3D radial stack of stars acquisitions

A Feasibility Study of Geometric-Decomposition Coil Compression in MRI Radial Acquisitions

Receiver arrays with a large number of coil elements are becoming progressively available because of their increased signal-to-noise ratio (SNR) and enhanced parallel imaging performance. However, longer reconstruction time and intensive computational cost have become significant concerns as the number of channels increases, especially in some iterative reconstructions. Coil compression can effectively solve this problem by linearly combining the raw data from multiple coils into fewer virtual coils. In this work, geometric-decomposition coil compression (GCC) is applied to radial sampling (both linear-angle and golden-angle patterns are discussed) for better compression. GCC, which is different from directly compressing in k-space, is performed separately in each spatial location along the fully sampled directions, then followed by an additional alignment step to guarantee the smoothness of the virtual coil sensitivities. Both numerical simulation data and in vivo data were tested. Experimental results demonstrated that the GCC algorithm can achieve higher SNR and lower normalized root mean squared error values than the conventional principal component analysis approach in radial acquisitions

Real-Time Magnetic Resonance Imaging

Real‐time magnetic resonance imaging (RT‐MRI) allows for imaging dynamic processes as they occur, without relying on any repetition or synchronization. This is made possible by modern MRI technology such as fast‐switching gradients and parallel imaging. It is compatible with many (but not all) MRI sequences, including spoiled gradient echo, balanced steady‐state free precession, and single‐shot rapid acquisition with relaxation enhancement. RT‐MRI has earned an important role in both diagnostic imaging and image guidance of invasive procedures. Its unique diagnostic value is prominent in areas of the body that undergo substantial and often irregular motion, such as the heart, gastrointestinal system, upper airway vocal tract, and joints. Its value in interventional procedure guidance is prominent for procedures that require multiple forms of soft‐tissue contrast, as well as flow information. In this review, we discuss the history of RT‐MRI, fundamental tradeoffs, enabling technology, established applications, and current trends

Joint T1 and T2 Mapping with Tiny Dictionaries and Subspace-Constrained Reconstruction

Purpose: To develop a method that adaptively generates tiny dictionaries for joint T1-T2 mapping. Theory: This work breaks the bond between dictionary size and representation accuracy (i) by approximating the Bloch-response manifold by piece-wise linear functions and (ii) by adaptively refining the sampling grid depending on the locally-linear approximation error. Methods: Data acquisition was accomplished with use of an 2D radially sampled Inversion-Recovery Hybrid-State Free Precession sequence. Adaptive dictionaries are generated with different error tolerances and compared to a heuristically designed dictionary. Based on simulation results, tiny dictionaries were used for T1-T2 mapping in phantom and in vivo studies. Reconstruction and parameter mapping were performed entirely in subspace. Results: All experiments demonstrated excellent agreement between the proposed mapping technique and template matching using heuristic dictionaries. Conclusion: Adaptive dictionaries in combination with manifold projection allow to reduce the necessary dictionary sizes by one to two orders of magnitude

Cardiac magnetic resonance assessment of central and peripheral vascular function in patients undergoing renal sympathetic denervation as predictor for blood pressure response

Background: Most trials regarding catheter-based renal sympathetic denervation (RDN) describe a proportion of patients without blood pressure response. Recently, we were able to show arterial stiffness, measured by invasive pulse wave velocity (IPWV), seems to be an excellent predictor for blood pressure response. However, given the invasiveness, IPWV is less suitable as a selection criterion for patients undergoing RDN. Consequently, we aimed to investigate the value of cardiac magnetic resonance (CMR) based measures of arterial stiffness in predicting the outcome of RDN compared to IPWV as reference. Methods: Patients underwent CMR prior to RDN to assess ascending aortic distensibility (AAD), total arterial compliance (TAC), and systemic vascular resistance (SVR). In a second step, central aortic blood pressure was estimated from ascending aortic area change and flow sequences and used to re-calculate total arterial compliance (cTAC). Additionally, IPWV was acquired. Results: Thirty-two patients (24 responders and 8 non-responders) were available for analysis. AAD, TAC and cTAC were higher in responders, IPWV was higher in non-responders. SVR was not different between the groups. Patients with AAD, cTAC or TAC above median and IPWV below median had significantly better BP response. Receiver operating characteristic (ROC) curves predicting blood pressure response for IPWV, AAD, cTAC and TAC revealed areas under the curve of 0.849, 0.828, 0.776 and 0.753 (p = 0.004, 0.006, 0.021 and 0.035). Conclusions: Beyond IPWV, AAD, cTAC and TAC appear as useful outcome predictors for RDN in patients with hypertension. CMR-derived markers of arterial stiffness might serve as non-invasive selection criteria for RDN