Clinical Validation of a 3-Dimensional Ultrafast Cardiac Magnetic Resonance Protocol Including Single Breath-Hold 3-Dimensional Sequences

Abstract

Objectives This study sought to clinically validate a novel 3-dimensional (3D) ultrafast cardiac magnetic resonance (CMR) protocol including cine (anatomy and function) and late gadolinium enhancement (LGE), each in a single breath-hold. Background CMR is the reference tool for cardiac imaging but is time-consuming. Methods A protocol comprising isotropic 3D cine (Enhanced sensitivity encoding [SENSE] by Static Outer volume Subtraction [ESSOS]) and isotropic 3D LGE sequences was compared with a standard cine+LGE protocol in a prospective study of 107 patients (age 58 ± 11 years; 24% female). Left ventricular (LV) mass, volumes, and LV and right ventricular (RV) ejection fraction (LVEF, RVEF) were assessed by 3D ESSOS and 2D cine CMR. LGE (% LV) was assessed using 3D and 2D sequences. Results Three-dimensional and LGE acquisitions lasted 24 and 22 s, respectively. Three-dimensional and LGE images were of good quality and allowed quantification in all cases. Mean LVEF by 3D and 2D CMR were 51 ± 12% and 52 ± 12%, respectively, with excellent intermethod agreement (intraclass correlation coefficient [ICC]: 0.96; 95% confidence interval [CI]: 0.94 to 0.97) and insignificant bias. Mean RVEF 3D and 2D CMR were 60.4 ± 5.4% and 59.7 ± 5.2%, respectively, with acceptable intermethod agreement (ICC: 0.73; 95% CI: 0.63 to 0.81) and insignificant bias. Both 2D and 3D LGE showed excellent agreement, and intraobserver and interobserver agreement were excellent for 3D LGE. Conclusions ESSOS single breath-hold 3D CMR allows accurate assessment of heart anatomy and function. Combining ESSOS with 3D LGE allows complete cardiac examination in <1 min of acquisition time. This protocol expands the indication for CMR, reduces costs, and increases patient comfort.

Single breath‐hold CINE imaging with combined simultaneous multislice and region‐optimized virtual coils

“…Finally, it should be noted that our comparisons focused on very simple image reconstruction approaches, and our results did not leverage the benefits of advanced constrained image reconstruction methods that are achievable using approaches like sparsity-based reconstruction, [14][15][16] low-rank reconstruction, [17][18][19][20][21][22] structured low-rank reconstruction, [23][24][25][26][27] or machine-learning based reconstruction. [28][29][30] SMS and ROVir are expected to be complementary to such approaches, and the combination of the proposed approach with more advanced reconstruction methods (including previous methods that are also capable of single breath-hold CINE imaging [31][32][33] ) is another potentially-promising future direction.…”

A 72-channel receive array coil allows whole-heart cine MRI in two breath holds

“…We aimed at keeping the BHs relatively short (< 15 s) since long BHs are not well tolerated by a large group of patients, although we could have condensed the acquisition into one long BH as is done in some other approaches [30]. Higher accelerations have been achieved using prototype C-SENSE bSSFP sequences and other experimental accelerated two-and three-dimensional sequences that usually require dedicated offline non-vendor-supported reconstruction software [14,[16][17][18][30][31][32]. Often the number of BHs is reduced at the expense of very long BH times and decreased temporal resolution [30][31][32].…”

“…Higher accelerations have been achieved using prototype C-SENSE bSSFP sequences and other experimental accelerated two-and three-dimensional sequences that usually require dedicated offline non-vendor-supported reconstruction software [14,[16][17][18][30][31][32]. Often the number of BHs is reduced at the expense of very long BH times and decreased temporal resolution [30][31][32]. Note that the implementation of C-SENSE used in this study is a frame-by-frame reconstruction and does not exploit sparsity in the temporal domain.…”

Effect of remote ischaemic conditioning on infarct size and remodelling in ST-segment elevation myocardial infarction patients: the CONDI-2/ERIC-PPCI CMR substudy

“…These factors highlight the challenges of using CMR as a surrogate endpoint as only those able to tolerate a CMR scan and survive to 6 months would enter the substudy which creates an element of selection bias. The recent introduction of fast scanning CMR protocols for MI size and LVEF to under 15 min [19] may help to make CMR more tolerable to patients, keep costs down and improve accessibility, all of which may reduce dropout rates in future studies. We have presented data on the edema-based area-at-risk and edema-based myocardial salvage index in Tables 3 and 4 as this was a pre-planned secondary analysis in this substudy.…”