Abstract
Background and objective: Cardiac magnetic resonance (CMR) is a key tool for cardiac work-up. However, arrhythmia can be responsible for arrhythmia-related artifacts (ARA) and increased scan time using segmented sequences. The aim of this study is to evaluate the effect of cardiac arrhythmia on image quality in a comparison of a compressed sensing real-time (CSrt) cine sequence with the reference prospectively gated segmented balanced steady-state free precession (Cineref) technique regarding ARA. Methods: A total of 71 consecutive adult patients (41 males; mean age = 59.5 ± 20.1 years (95% CI: 54.7–64.2 years)) referred for CMR examination with concomitant irregular heart rate (defined by an RR interval coefficient of variation >10%) during scanning were prospectively enrolled. For each patient, two cine sequences were systematically acquired: first, the reference prospectively triggered multi-breath-hold Cineref sequence including a short-axis stack, one four-chamber slice, and a couple of two-chamber slices; second, an additional single breath-hold CSrt sequence providing the same slices as the reference technique. Two radiologists independently assessed ARA and image quality (overall, acquisition, and edge sharpness) for both techniques. Results: The mean heart rate was 71.8 ± 19.0 (SD) beat per minute (bpm) (95% CI: 67.4–76.3 bpm) and its coefficient of variation was 25.0 ± 9.4 (SD) % (95% CI: 22.8–27.2%). Acquisition was significantly faster with CSrt than with Cineref (Cineref: 556.7 ± 145.4 (SD) s (95% CI: 496.7–616.7 s); CSrt: 23.9 ± 7.9 (SD) s (95% CI: 20.6–27.1 s); p < 0.0001). A total of 599 pairs of cine slices were evaluated (median: 8 (range: 6–14) slices per patient). The mean proportion of ARA-impaired slices per patient was 85.9 ± 22.7 (SD) % using Cineref, but this was figure was zero using CSrt (p < 0.0001). The European CMR registry artifact score was lower with CSrt (median: 1 (range: 0–5)) than with Cineref (median: 3 (range: 0–3); p < 0.0001). Subjective image quality was higher in CSrt than in Cineref (median: 3 (range: 1–3) versus 2 (range: 1–4), respectively; p < 0.0001). In line, edge sharpness was higher on CSrt cine than on Cineref images (0.054 ± 0.016 pixel−1 (95% CI: 0.050–0.057 pixel−1) versus 0.042 ± 0.022 pixel−1 (95% CI: 0.037–0.047 pixel−1), respectively; p = 0.0001). Conclusion: Compressed sensing real-time cine drastically reduces arrhythmia-related artifacts and thus improves cine image quality in patients with arrhythmia.
Highlights
Cardiac magnetic resonance (CMR) is a major imaging modality for the assessment of left and right ventricular volumes and mass [1,2,3]
Retrospective electrocardiogram (ECG) gating requires the heart rate (HR) to be a regular periodic phenomenon as pieces of data are continuously acquired on multiple cardiac cycles, time-labelled and merged for the reconstruction of a whole cine slice, which is a weighted representation of successive heartbeats
Patients were referred for initial work-up or follow-up of coronary artery disease (n = 17; 23.9%), heart rhythm disorder (n = 14; 19.7%), dilated cardiomyopathy (n = 11; 15.5%), infiltrative cardiomyopathy (n = 8; 11.3%), heart valve disease (n = 7; 9.9%), myocarditis (n = 6; 8.5%), hypertrophic cardiomyopathy (n = 5; 7.0%), and heart failure (n = 3; 4.2%)
Summary
Cardiac magnetic resonance (CMR) is a major imaging modality for the assessment of left and right ventricular volumes and mass [1,2,3]. Retrospective electrocardiogram (ECG) gating requires the heart rate (HR) to be a regular periodic phenomenon as pieces of data are continuously acquired on multiple cardiac cycles, time-labelled and merged for the reconstruction of a whole cine slice, which is a weighted representation of successive heartbeats It allows adapting the length of the acquisition window to the duration of the heartbeat during the continuous acquisition. Arrhythmia rejection algorithms can be applied with retrospective gating but may end in exceedingly long breath-holds These arrhythmia-related artifacts (ARA) may be limited using prospectively triggered sequences by setting the acquisition window shorter than the briefest measured RR interval (time laps between two consecutive R peaks) [8]. As a result of these adjustments, longer breath-holds and scan time are observed while the last phases of the cardiac cycle are not sampled
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