The desire to visualize noninvasively physiological processes at high temporal resolution has been a driving force for the development of MRI since its inception in 1973. In this article, we describe a unique method for real-time MRI that reduces image acquisition times to only 20 ms. Although approaching the ultimate limit of MRI technology, the method yields high image quality in terms of spatial resolution, signal-to-noise ratio and the absence of artifacts. As proposed previously, a fast low-angle shot (FLASH) gradient-echo MRI technique (which allows for rapid and continuous image acquisitions) is combined with a radial encoding scheme (which offers motion robustness and moderate tolerance to data undersampling) and, most importantly, an iterative image reconstruction by regularized nonlinear inversion (which exploits the advantages of parallel imaging with multiple receiver coils). In this article, the extension of regularization and filtering to the temporal domain exploits consistencies in successive data acquisitions and thereby enhances the degree of radial undersampling in a hitherto unexpected manner by one order of magnitude. The results obtained for turbulent flow, human speech production and human heart function demonstrate considerable potential for real-time MRI studies of dynamic processes in a wide range of scientific and clinical settings.

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The 16-channel bow tie antenna transceiver array supports accelerated and high spatial resolution cardiac MRI. The array is compatible with multichannel transmission and provides a technological basis for future clinical assessment of parallel transmission techniques at 7.0 Tesla. Magn Reson Med 75:2553-2565, 2016. © 2015 Wiley Periodicals, Inc.

BackgroundFunctional assessments of the heart by dynamic cardiovascular magnetic resonance (CMR) commonly rely on (i) electrocardiographic (ECG) gating yielding pseudo real-time cine representations, (ii) balanced gradient-echo sequences referred to as steady-state free precession (SSFP), and (iii) breath holding or respiratory gating. Problems may therefore be due to the need for a robust ECG signal, the occurrence of arrhythmia and beat to beat variations, technical instabilities (e.g., SSFP "banding" artefacts), and limited patient compliance and comfort. Here we describe a new approach providing true real-time CMR with image acquisition times as short as 20 to 30 ms or rates of 30 to 50 frames per second.MethodsThe approach relies on a previously developed real-time MR method, which combines a strongly undersampled radial FLASH CMR sequence with image reconstruction by regularized nonlinear inversion. While iterative reconstructions are currently performed offline due to limited computer speed, online monitoring during scanning is accomplished using gridding reconstructions with a sliding window at the same frame rate but with lower image quality.ResultsScans of healthy young subjects were performed at 3 T without ECG gating and during free breathing. The resulting images yield T1 contrast (depending on flip angle) with an opposed-phase or in-phase condition for water and fat signals (depending on echo time). They completely avoid (i) susceptibility-induced artefacts due to the very short echo times, (ii) radiofrequency power limitations due to excitations with flip angles of 10° or less, and (iii) the risk of peripheral nerve stimulation due to the use of normal gradient switching modes. For a section thickness of 8 mm, real-time images offer a spatial resolution and total acquisition time of 1.5 mm at 30 ms and 2.0 mm at 22 ms, respectively.ConclusionsThough awaiting thorough clinical evaluation, this work describes a robust and flexible acquisition and reconstruction technique for real-time CMR at the ultimate limit of this technology.