Abstract
ObjectivesCardiovascular magnetic resonance (CMR) cine imaging by compressed sensing (CS) is promising for patients unable to tolerate long breath-holding. However, the need for a steady-state free-precession (SSFP) preparation cardiac cycle for each slice extends the breath-hold duration (e.g. for 10 slices, 20 cardiac cycles) to an impractical length. We investigated a method reducing breath-hold duration by half and assessed its reliability for biventricular volume analysis in a pediatric population.MethodsFifty-five consecutive pediatric patients (median age 12 years, range 7–17) referred for assessment of congenital heart disease or cardiomyopathy were included. Conventional multiple breath-hold SSFP short-axis (SAX) stack cines served as the reference. Real-time CS SSFP cines were applied without the steady-state preparation cycle preceding each SAX cine slice, accepting the limitation of omitting late diastole. The total acquisition time was 1 RR interval/slice. Volumetric analysis was performed for conventional and “single-cycle-stack-advance” (SCSA) cine stacks.ResultsBland–Altman analyses [bias (limits of agreement)] showed good agreement in left ventricular (LV) end-diastolic volume (EDV) [3.6 mL (− 5.8, 12.9)], LV end-systolic volume (ESV) [1.3 mL (− 6.0, 8.6)], LV ejection fraction (EF) [0.1% (− 4.9, 5.1)], right ventricular (RV) EDV [3.5 mL (− 3.34, 10.0)], RV ESV [− 0.23 mL (− 7.4, 6.9)], and RV EF [1.70%, (− 3.7, 7.1)] with a trend toward underestimating LV and RV EDVs with the SCSA method. Image quality was comparable for both methods (p = 0.37).ConclusionsLV and RV volumetric parameters agreed well between the SCSA and the conventional sequences. The SCSA method halves the breath-hold duration of the commercially available CS sequence and is a reliable alternative for volumetric analysis in a pediatric population.Key Points• Compressed sensing is a promising accelerated cardiovascular magnetic resonance imaging technique.• We omitted the steady-state preparation cardiac cycle preceding each cine slice in compressed sensing and achieved an acquisition speed of 1 RR interval/slice.• This modification called “single-cycle-stack-advance” enabled the acquisition of an entire short-axis cine stack in a single short breath hold.• When tested in a pediatric patient group, the left and right ventricular volumetric parameters agreed well between the “single-cycle-stack-advance” and the conventional sequences.
Highlights
Left ventricular (LV) volumes and ejection fraction (EF) are the most widely used markers of cardiovascular outcome [1, 2]
We describe the clinical evaluation of a minor modification to the real-time (“single-shot”) compressed sensing (CS) steady-state free-precession (SSFP) multi-slice cine sequence (SCSA), which accelerates the SAX stack acquisition speed to one R–R interval for each required slice, halving the breath-hold time compared to the use of steady-state preparation cardiac cycles incorporated in most of the previous real-time CS cine methods
The SCSA modification was tested during clinical pediatric Cardiovascular magnetic resonance (CMR) scans and proved to be reliable in terms of right ventricles (RV)/LV volumetric analysis compared to the gold standard of multiple-breath holds (BHs) SSFP SAX cine stack
Summary
Left ventricular (LV) volumes and ejection fraction (EF) are the most widely used markers of cardiovascular outcome [1, 2]. They have been incorporated into clinical diagnosis and therapeutic decisionmaking pathways for various cardiac conditions [3, 4]. The standard volumetric assessment by CMR requires acquisition of 10–12 short-axis (SAX) steady-state free-precession (SSFP) cines with retrospective triggering and separate breath holds (BHs) [8]. 3D imaging, often employing compressed sensing (CS) or related acceleration techniques, for ventricular volumetry overcomes interslice misalignment caused by inconsistent expiratory BH positions [15, 16]; [15, 16]; the entire 3D data may be degraded by respiratory motion. Non-Cartesian highly accelerated real-time cine imaging for the SAX stack has been developed and applied clinically [22]
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