This article describes an MR-safe treadmill that enables cardiovascular exercise stress testing adjacent to the MRI system, facilitating cardiac MR imaging immediately following exercise stress. The treadmill was constructed of non-ferromagnetic components utilizing a hydraulic power system. Computer control ensured precise execution of the standard Bruce treadmill protocol commonly used for cardiovascular exercise stress testing. The treadmill demonstrated no evidence of ferromagnetic attraction and did not affect image quality. Treadmill performance met design specifications both inside and outside the MRI environment. Ten healthy volunteers performed the Bruce protocol with the treadmill positioned adjacent to the MRI table. Upon reaching peak stress (98% ± 8% of age-predicted maximum heart rate (APMHR)), the subjects lay down directly on the MRI table, a cardiac array coil was placed, an intravenous line connected, and stress cine and perfusion imaging performed. Cine imaging commenced on average within 24 ± 4 s and was completed within 40 ± 7 s of the end of exercise. Subject heart rates were 86% ± 9% of APMHR at the start of imaging and 81% ± 9% of APMHR upon completion of cine imaging. The MRI compatible treadmill was shown to operate safely and effectively in the MRI environment.

Phase contrast magnetic resonance imaging (PC-MRI) is used routinely to measure fluid and tissue velocity with a variety of clinical applications. PC-MRI methods require acquisition of additional data to enable phase difference reconstruction, making real-time imaging problematic. Shared Velocity Encoding (SVE), a method devised to improve the effective temporal resolution of PC-MRI, was implemented in a real-time pulse sequence with segmented echo planar readout. The effect of SVE on peak velocity measurement was investigated in computer simulation, and peak velocities and total flow were measured in a flow phantom and in volunteers and compared with a conventional ECG-triggered, segmented k-space phase-contrast sequence as a reference standard. Computer simulation showed a 36% reduction in peak velocity error from 8.8% to 5.6% with SVE. A similar reduction of 40% in peak velocity error was shown in a pulsatile flow phantom. In the phantom and volunteers, volume flow did not differ significantly when measured with or without SVE. Peak velocity measurements made in the volunteers using SVE showed a higher concordance correlation (0.96) with the reference standard than non-SVE (0.87). The improvement in effective temporal resolution with SVE reconstruction has a positive impact on the precision and accuracy of real-time PC-MRI peak velocity measurements.

OBJECTIVES The purpose of this study was to evaluate the ability of a novel cardiac magnetic resonance (CMR) real-time phase contrast (RT-PC) flow measurement technique to reveal the discordant respirophasic changes in mitral and tricuspid valve in flow indicative of the abnormal hemodynamics seen in constrictive pericarditis (CP). BACKGROUND Definitive diagnosis of CP requires identification of constrictive hemodynamics with or without pericardial thickening. CMR to date has primarily provided morphological assessment of the pericardium. METHODS Sixteen patients (age 57 ± 13 years) undergoing CMR to assess known or suspected CP and 10 controls underwent RT-PC that acquired simultaneous mitral valve and tricuspid valve inflow velocities over 10 s of unrestricted breathing. The diagnosis of CP was confirmed via clinical history, diagnostic imaging, cardiac catheterization, intraoperative findings, and histopathology. RESULTS Ten patients had CP, all with increased pericardial thickness (6.2 ± 1.0 mm). RT-PC imaging demonstrated discordant respirophasic changes in atrioventricular valve inflow velocities in all CP patients, with mean ± SD mitral valve and tricuspid valve inflow velocity variation of 46 ± 20% and 60 ± 15%, respectively, compared with 16 ± 8% and 24 ± 11% in patients without CP (p < 0.004 vs. patients with CP for both) and 17 ± 5% and 31 ± 13% in controls (p < 0.001 vs. patients with CP for both). There was no difference in atrioventricular valve inflow velocity variation between patients without CP compared with controls (p > 0.3 for both). Respiratory variation exceeding 25% across the mitral valve yielded a sensitivity of 100%, a specificity of 100%, and an area under the receiver-operating characteristic curve of 1.0 to detect CP physiology. Using a cutoff of 45%, variation of transtricuspid valve velocity had a sensitivity of 90%, a specificity of 88%, and an area under the receiver-operating characteristic curve of 0.98. CONCLUSIONS Accentuated and discordant respirophasic changes in mitral valve and tricuspid valve inflow velocities characteristic of CP can be identified noninvasively with RT-PC CMR. When incorporated into existing CMR protocols for imaging pericardial morphology, RT-PC CMR provides important hemodynamic evidence with which to make a definite diagnosis of CP.

Segmented interleaved echo planar imaging (EPI) is a highly efficient data acquisition technique; however, EPI is sensitive to artifacts from off-resonance spins. The choice of k-space trajectories is important in determining how off-resonance spins contribute to image artifacts. Top-down and center-out trajectories are theoretically analyzed, simulated, implemented, and tested in phantom and volunteer experiments. Theoretical results show off-resonance artifact manifests as a simple positional shift for the top-down trajectory, while for the center-out trajectory off-resonance artifact manifests as a splitting of the object, which entails both shift and blurring. These results were validated using simulation and phantom scan data where a frequency-offset was introduced ranging from –300 Hz to +300 Hz. As predicted by the theoretical results, inferior image quality was observed for the center-out trajectory in a single volunteer. Off-resonance produces more severe and complex artifacts with the center-out trajectory than the top-down trajectory.

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