Biederman, Robert W

Doyle, Mark

Rayarao, Geetha

Shah, Moneal

Vido, Diane A

Williams, Ronald B

Yamrozik, June

English

PubMed

June Yamrozik

Mark Doyle

Ronald B Williams

Geetha Rayarao

Diane A Vido

Moneal Shah

Robert W Biederman

Springer - Publisher Connector

Can increasing the number of excitations (NEX) in late gadolinium enhancement (LGE) imaging prove beneficial in patients who can not hold their breath for the duration of the scan time?

TECHNOLOGIST PRESENTATION Open Access
Can increasing the number of excitations (NEX) in
late gadolinium enhancement (LGE) imaging
prove beneficial in patients who can not hold
their breath for the duration of the scan time?
June Yamrozik*, Mark Doyle, Ronald B Williams, Geetha Rayarao, Diane A Vido, Moneal Shah, Robert W Biederman
From 15th Annual SCMR Scientific Sessions
Orlando, FL, USA. 2-5 February 2012
Summary
Image quality greatly improves using a LGE sequence
with 4 NEX in patients that cannot hold their breath.
Background
It is imperative that patients hold their breath for Car-
diac MRI imaging.
Parallel imaging can be implemented on steady state
free precession (SSFP) imaging to reduce scan time.
However, for LGE imaging parallel imaging is not avail-
able. Manipulation of other parameters such as matrix,
views per segment can be utilized but scan times are
still too long for patients that cannot hold their breath.
Increasing the NEX will increase scan time but will
decrease respiratory motion. Perhaps, a free breathing
technique can be mastered instead of trying various
ways for a patient to hold their breath.
Hypothesis
We propose that by doubling the NEX on LGE imaging,
free breathing can be utilized and that image quality will
improve.
Methods
A total of 12 patients were imaged on a GE CV/i Excite
Version 12, 1.5 T system (GE, Milwaukee, WI). The
LGE sequence utilized was a 2D Gradient Echo IRP
(FGR with inversion recovery prep). The standard NEX
parameter which is 2 was utilized on all 12 patients for
breath hold imaging. The NEX parameter was increased
to 4 which doubled scan time and the 12 patients were
re-imaged without holding their breath. THree observers
rated the image quality, from a scale of 1 to 4. Four(4)
being the highest image quality and one(1) being the
lowest.
Results
Of the 12 patients imaged, 3 were unable to hold their
breath, 2 had difficulty holding their breath and 7 had
no difficulty suspending their breath. The CNR ratio
remained essentially unchanged between 2 and 4 NEX
(4.1 ± 1.4, 4.4± 1.6). Interobserver results showed that
the best image quality was obtained on those who could
hold their breath (3.4±.5) while those who could not
hold their breath had the lowest quality (2.1±.8). How-
ever, performing 4 NEX allowed the quality of those
who could not hold their breath to increase (3.6±.5,
p<0.01), while those comfortable holding their breath
trended to decrease in quality when 4 NEX were used
(3.0±.9, p=0.06). Those with partial ability to hold breath
had the best results with 4 NEX (2.8±.7 vs. 3.6±.5,
p=0.1). (Fig 1 &2).
Conclusions
Interestingly, increasing the NEX to 4 is advantageous
when imaging a patient that cannot hold their breath.
This information is useful, especially for those systems
that do not have a LGE sequence that can accommodate
patients that cannot hold their breath.
Funding
None.
Allegheny General Hospital, Pittsburgh, USA
Yamrozik et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):T10
http://www.jcmr-online.com/content/14/S1/T10
© 2012 Yamrozik et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Published: 1 February 2012
doi:10.1186/1532-429X-14-S1-T10
Cite this article as: Yamrozik et al.: Can increasing the number of
excitations (NEX) in late gadolinium enhancement (LGE) imaging prove
beneficial in patients who can not hold their breath for the duration of
the scan time? Journal of Cardiovascular Magnetic Resonance 2012 14
(Suppl 1):T10.
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Figure 1 The patient was unable to hold their breath using the
standard FGR sequence with 2 NEX.
Figure 2 Using 4 NEX and free breathing image quality is greatly
improved and an important diagnosis of myocarditis is made
Yamrozik et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):T10
http://www.jcmr-online.com/content/14/S1/T10
Page 2 of 2


Yamrozik June

Doyle Mark

Williams Ronald B

Rayarao Geetha

Vido Diane A

Shah Moneal

Biederman Robert W

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Can increasing the number of excitations (NEX) in late gadolinium enhancement (LGE) imaging prove beneficial in patients who can not hold their breath for the duration of the scan time?

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