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Khan S, Fakhouri F, Majeed W, Kolipaka A. Cardiovascular magnetic resonance elastography: A review. NMR IN BIOMEDICINE 2018; 31:e3853. [PMID: 29193358 PMCID: PMC5975119 DOI: 10.1002/nbm.3853] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/25/2017] [Accepted: 09/29/2017] [Indexed: 05/19/2023]
Abstract
Cardiovascular diseases are the leading cause of death worldwide. These cardiovascular diseases are associated with mechanical changes in the myocardium and aorta. It is known that stiffness is altered in many diseases, including the spectrum of ischemia, diastolic dysfunction, hypertension and hypertrophic cardiomyopathy. In addition, the stiffness of the aortic wall is altered in multiple diseases, including hypertension, coronary artery disease and aortic aneurysm formation. For example, in diastolic dysfunction in which the ejection fraction is preserved, stiffness can potentially be an important biomarker. Similarly, in aortic aneurysms, stiffness can provide valuable information with regard to rupture potential. A number of studies have addressed invasive and non-invasive approaches to test and measure the mechanical properties of the myocardium and aorta. One of the non-invasive approaches is magnetic resonance elastography (MRE). MRE is a phase-contrast magnetic resonance imaging technique that measures tissue stiffness non-invasively. This review article highlights the technical details and application of MRE in the quantification of myocardial and aortic stiffness in different disease states.
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Affiliation(s)
- Saad Khan
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Faisal Fakhouri
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210, USA
| | - Waqas Majeed
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Arunark Kolipaka
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210, USA
- Department of Internal Medicine-Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
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Miller R, Kolipaka A, Nash MP, Young AA. Relative identifiability of anisotropic properties from magnetic resonance elastography. NMR IN BIOMEDICINE 2018; 31:e3848. [PMID: 29106765 PMCID: PMC5936684 DOI: 10.1002/nbm.3848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/31/2017] [Accepted: 09/20/2017] [Indexed: 05/24/2023]
Abstract
Although magnetic resonance elastography (MRE) has been used to estimate isotropic stiffness in the heart, myocardium is known to have anisotropic properties. This study investigated the determinability of global transversely isotropic material parameters using MRE and finite-element modeling (FEM). A FEM-based material parameter identification method, using a displacement-matching objective function, was evaluated in a gel phantom and simulations of a left ventricular (LV) geometry with a histology-derived fiber field. Material parameter estimation was performed in the presence of Gaussian noise. Parameter sweeps were analyzed and characteristics of the Hessian matrix at the optimal solution were used to evaluate the determinability of each constitutive parameter. Four out of five material stiffness parameters (Young's modulii E1 and E3 , shear modulus G13 and damping coefficient s), which describe a transversely isotropic linear elastic material, were well determined from the MRE displacement field using an iterative FEM inversion method. However, the remaining parameter, Poisson's ratio, was less identifiable. In conclusion, Young's modulii, shear modulii and damping can theoretically be well determined from MRE data, but Poisson's ratio is not as well determined and could be set to a reasonable value for biological tissue (close to 0.5).
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Affiliation(s)
- Renee Miller
- Department of Anatomy and Medical Imaging, University of Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - Arunark Kolipaka
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Martyn P Nash
- Auckland Bioengineering Institute, University of Auckland, New Zealand
- Department of Engineering Science, University of Auckland, New Zealand
| | - Alistair A Young
- Department of Anatomy and Medical Imaging, University of Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, New Zealand
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Miller R, Kolipaka A, Nash MP, Young AA. Estimation of transversely isotropic material properties from magnetic resonance elastography using the optimised virtual fields method. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34. [PMID: 29528568 PMCID: PMC5993646 DOI: 10.1002/cnm.2979] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Magnetic resonance elastography (MRE) has been used to estimate isotropic myocardial stiffness. However, anisotropic stiffness estimates may give insight into structural changes that occur in the myocardium as a result of pathologies such as diastolic heart failure. The virtual fields method (VFM) has been proposed for estimating material stiffness from image data. This study applied the optimised VFM to identify transversely isotropic material properties from both simulated harmonic displacements in a left ventricular (LV) model with a fibre field measured from histology as well as isotropic phantom MRE data. Two material model formulations were implemented, estimating either 3 or 5 material properties. The 3-parameter formulation writes the transversely isotropic constitutive relation in a way that dissociates the bulk modulus from other parameters. Accurate identification of transversely isotropic material properties in the LV model was shown to be dependent on the loading condition applied, amount of Gaussian noise in the signal, and frequency of excitation. Parameter sensitivity values showed that shear moduli are less sensitive to noise than the other parameters. This preliminary investigation showed the feasibility and limitations of using the VFM to identify transversely isotropic material properties from MRE images of a phantom as well as simulated harmonic displacements in an LV geometry.
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Affiliation(s)
- Renee Miller
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Arunark Kolipaka
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Martyn P. Nash
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Alistair A. Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Mazumder R, Schroeder S, Mo X, Litsky AS, Clymer BD, White RD, Kolipaka A. In vivo magnetic resonance elastography to estimate left ventricular stiffness in a myocardial infarction induced porcine model. J Magn Reson Imaging 2016; 45:1024-1033. [PMID: 27533317 DOI: 10.1002/jmri.25432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/04/2016] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To estimate change in left ventricular (LV) end-systolic and end-diastolic myocardial stiffness (MS) in pigs induced with myocardial infarction (MI) with disease progression using cardiac magnetic resonance elastography (MRE) and to compare it against ex vivo mechanical testing, LV circumferential strain, and magnetic resonance imaging (MRI) relaxometry parameters (T1 , T2 , and extracellular volume fraction [ECV]). MATERIALS AND METHODS MRI (1.5T) was performed on seven pigs, before surgery (Bx), and 10 (D10), and 21 (D21) days after creating MI. Cardiac MRE-derived MS was measured in infarcted region (MIR) and remote region (RR), and validated against mechanical testing-derived MS obtained postsacrifice on D21. Circumferential strain and MRI relaxometry parameters (T2 , T1 , and ECV) were also obtained. Multiparametric analysis was performed to determine correlation between cardiac MRE-derived MS and 1) strain, 2) relaxometry parameters, and 3) mechanical testing. RESULTS Mean diastolic (D10: 5.09 ± 0.6 kPa; D21: 5.45 ± 0.7 kPa) and systolic (D10: 5.72 ± 0.8 kPa; D21: 6.34 ± 1.0 kPa) MS in MIR were significantly higher (P < 0.01) compared to mean diastolic (D10: 3.97 ± 0.4 kPa; D21: 4.12 ± 0.2 kPa) and systolic (D10: 5.08 ± 0.6 kPa; and D21: 5.16 ± 0.6 kPa) MS in RR. The increase in cardiac MRE-derived MS at D21 (MIR) was consistent and correlated strongly with mechanical testing-derived MS (r(diastolic) = 0.86; r(systolic) = 0.89). Diastolic MS in MIR demonstrated a negative correlation with strain (r = 0.58). Additionally, cardiac MRE-derived MS demonstrated good correlations with post-contrast T1 (r(diastolic) = -0.549; r(systolic) = -0.741) and ECV (r(diastolic) = 0.548; r(systolic) = 0.703), and no correlation with T2 . CONCLUSION As MI progressed, cardiac MRE-derived MS increased in MIR compared to RR, which significantly correlated with mechanical testing-derived MS, T1 and ECV. LEVEL OF EVIDENCE 1 J. Magn. Reson. Imaging 2017;45:1024-1033.
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Affiliation(s)
- Ria Mazumder
- Department of Electrical and Computer Engineering, 205 Dreese Laboratories, Ohio State University, Columbus, Ohio, USA.,Department of Radiology, Ohio State University, Columbus, Ohio, USA
| | - Samuel Schroeder
- Department of Radiology, Ohio State University, Columbus, Ohio, USA.,Department of Mechanical Engineering, Ohio State University, Columbus, Ohio, USA
| | - Xiaokui Mo
- Center for Biostatistics, Department of Biomedical Informatics, Columbus, Ohio, USA
| | - Alan S Litsky
- Department of Biomedical Engineering, Ohio State University, Columbus, Ohio, USA.,Department of Orthopaedics, Columbus, Ohio, USA
| | - Bradley D Clymer
- Department of Electrical and Computer Engineering, 205 Dreese Laboratories, Ohio State University, Columbus, Ohio, USA
| | - Richard D White
- Department of Radiology, Ohio State University, Columbus, Ohio, USA.,Department of Internal Medicine-Division of Cardiovascular Medicine, 244 Davis Heart & Lung Research Institute, Ohio State University, Columbus, Ohio, USA
| | - Arunark Kolipaka
- Department of Radiology, Ohio State University, Columbus, Ohio, USA.,Department of Internal Medicine-Division of Cardiovascular Medicine, 244 Davis Heart & Lung Research Institute, Ohio State University, Columbus, Ohio, USA
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Urban MW, Qiang B, Song P, Nenadic IZ, Chen S, Greenleaf JF. Investigation of the effects of myocardial anisotropy for shear wave elastography using impulsive force and harmonic vibration. Phys Med Biol 2016; 61:365-82. [PMID: 26674613 PMCID: PMC4816222 DOI: 10.1088/0031-9155/61/1/365] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The myocardium is known to be an anisotropic medium where the muscle fiber orientation changes through the thickness of the wall. Shear wave elastography methods use propagating waves which are measured by ultrasound or magnetic resonance imaging (MRI) techniques to characterize the mechanical properties of various tissues. Ultrasound- or MR-based methods have been used and the excitation frequency ranges for these various methods cover a large range from 24-500 Hz. Some of the ultrasound-based methods have been shown to be able to estimate the fiber direction. We constructed a model with layers of elastic, transversely isotropic materials that were oriented at different angles to simulate the heart wall in systole and diastole. We investigated the effect of frequency on the wave propagation and the estimation of fiber direction and wave speeds in the different layers of the assembled models. We found that waves propagating at low frequencies such as 30 or 50 Hz showed low sensitivity to the fiber direction but also had substantial bias in estimating the wave speeds in the layers. Using waves with higher frequency content (>200 Hz) allowed for more accurate fiber direction and wave speed estimation. These results have particular relevance for MR- and ultrasound-based elastography applications in the heart.
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Affiliation(s)
- Matthew W. Urban
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - Bo Qiang
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - Pengfei Song
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - Ivan Z. Nenadic
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - Shigao Chen
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - James F. Greenleaf
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN 55905
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Time-Resolved Analysis of Left Ventricular Shear Wave Amplitudes in Cardiac Elastography for the Diagnosis of Diastolic Dysfunction. Invest Radiol 2016; 51:1-6. [DOI: 10.1097/rli.0000000000000198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wassenaar PA, Eleswarpu CN, Schroeder SA, Mo X, Raterman BD, White RD, Kolipaka A. Measuring age-dependent myocardial stiffness across the cardiac cycle using MR elastography: A reproducibility study. Magn Reson Med 2015; 75:1586-93. [PMID: 26010456 DOI: 10.1002/mrm.25760] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 04/08/2015] [Accepted: 04/11/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess reproducibility in measuring left ventricular (LV) myocardial stiffness in volunteers throughout the cardiac cycle using MR elastography (MRE) and to determine its correlation with age. METHODS Cardiac MRE (CMRE) was performed on 29 normal volunteers, with ages ranging from 21 to 73 years. For assessing reproducibility of CMRE-derived stiffness measurements, scans were repeated per volunteer. Wave images were acquired throughout the LV myocardium, and were analyzed to obtain mean stiffness during the cardiac cycle. CMRE-derived stiffness values were correlated to age. RESULTS Concordance correlation coefficient revealed good interscan agreement with rc of 0.77, with P-value < 0.0001. Significantly higher myocardial stiffness was observed during end-systole (ES) compared with end-diastole (ED) across all subjects. Additionally, increased deviation between ES and ED stiffness was observed with increased age. CONCLUSION CMRE-derived stiffness is reproducible, with myocardial stiffness changing cyclically across the cardiac cycle. Stiffness is significantly higher during ES compared with ED. With age, ES myocardial stiffness increases more than ED, giving rise to an increased deviation between the two.
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Affiliation(s)
- Peter A Wassenaar
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Chethanya N Eleswarpu
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Samuel A Schroeder
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Mechanical Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Xiaokui Mo
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Brian D Raterman
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Richard D White
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Internal Medicine-Division of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Arunark Kolipaka
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA.,Department of Internal Medicine-Division of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Elgeti T, Knebel F, Hättasch R, Hamm B, Braun J, Sack I. Shear-wave amplitudes measured with cardiac MR elastography for diagnosis of diastolic dysfunction. Radiology 2014; 271:681-7. [PMID: 24475861 DOI: 10.1148/radiol.13131605] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE To test whether shear-wave amplitudes (SWAs) in the myocardium measured with cardiac magnetic resonance (MR) elastography enable diagnosis of myocardial relaxation abnormalities in patients with diastolic dysfunction. MATERIALS AND METHODS Each subject gave written informed consent to participate in this institutional review board-approved prospective study. Electrocardiographically triggered SWA-based cardiac MR elastography with 24.13-Hz external vibration frequency was performed in 50 subjects grouped into asymptomatic young (n = 10, 18-39 years) and asymptomatic old (n = 10, 40-68 years) subjects and patients with echocardiographically proved mild, moderate, or severe diastolic dysfunction (n = 30, 44-73 years). SWA images were analyzed in the left ventricular (LV) region and were normalized against reference SWA of the thoracic wall. Analysis of variance with Bonferroni-corrected pairwise comparison and Pearson correlation were used for statistical evaluation. RESULTS Young and old control subjects had normalized mean LV SWA of 0.67 ± 0.04 (standard error of the mean) and 0.56 ± 0.04 (P = .18, F test), respectively. Compared with the control groups, patients with mild, moderate, and severe diastolic dysfunction displayed significantly reduced normalized mean LV SWA of 0.37 ± 0.04, 0.34 ± 0.04, and 0.29 ± 0.04 (P < .001, F test), respectively, which was inversely correlated to the severity of diastolic dysfunction (R = -0.61, P < .001). The best cutoff value to differentiate between asymptomatic volunteers and patients was 0.43, yielding an area under the receiver operating characteristic curve of 0.92, with 90% sensitivity and 89.7% specificity. CONCLUSION LV SWA measured with cardiac MR elastography provides image contrast sensitive to myocardial relaxation abnormalities and shows significantly lower values in patients with diastolic dysfunction.
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Affiliation(s)
- Thomas Elgeti
- From the Department of Radiology (T.E., B.H., I.S.), Department of Cardiology, Angiology and Pulmonology (F.K., R.H.), and Institute of Medical Informatics (J.B.), Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Tzschätzsch H, Hättasch R, Knebel F, Klaua R, Schultz M, Jenderka KV, Braun J, Sack I. Isovolumetric elasticity alteration in the human heart detected by in vivo time-harmonic elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:2272-2278. [PMID: 24035628 DOI: 10.1016/j.ultrasmedbio.2013.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 07/01/2013] [Accepted: 07/11/2013] [Indexed: 06/02/2023]
Abstract
Time harmonic elastography (THE) has recently been introduced for measurement of the periodic alteration in myocardial shear modulus based on externally induced low-frequency acoustic vibrations produced by a loudspeaker. In this study, we propose further developments of cardiac THE toward a clinical modality including integration of the vibration source into the patient bed and automated parameter extraction from harmonic shear wave amplitudes, wall motion profiles and synchronized electrocardiographic records. This method has enabled us to evaluate the delay between wall motion and wave amplitude alteration for the measurement of isovolumetric times of elasticity alteration during contraction (τ(C)) and relaxation (τ(R)) in a group of 32 healthy volunteers. On average, the wave amplitudes changed between systole and diastole by a factor of 1.7 ± 0.3, with a τ(C) of 137 ± 61 ms and a τ(R) of 68 ± 73 ms, which agrees with results obtained with the more time-consuming and expensive cardiac magnetic resonance elastography. Furthermore, because of the high sampling rate, elasto-morphometric parameters such as transition times and the area of wave amplitude-cardiac motion cycles can be processed in an automated way for the future clinical detection of myocardial relaxation abnormalities.
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Affiliation(s)
- Heiko Tzschätzsch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Garteiser P, Sahebjavaher RS, Ter Beek LC, Salcudean S, Vilgrain V, Van Beers BE, Sinkus R. Rapid acquisition of multifrequency, multislice and multidirectional MR elastography data with a fractionally encoded gradient echo sequence. NMR IN BIOMEDICINE 2013; 26:1326-35. [PMID: 23712852 DOI: 10.1002/nbm.2958] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 05/16/2023]
Abstract
In MR elastography (MRE), periodic tissue motion is phase encoded using motion-encoding gradients synchronized to an externally applied periodic mechanical excitation. Conventional methods result in extended scan time for quality phase images, thus limiting the broad application of MRE in the clinic. For practical scan times, researchers have been relying on one-dimensional or two-dimensional motion-encoding, low-phase sampling and a limited number of slices, and artifact-prone, single-shot, echo planar imaging (EPI) readout. Here, we introduce a rapid multislice pulse sequence capable of three-dimensional motion encoding that is also suitable for simultaneously encoding motion with multiple frequency components. This sequence is based on a gradient-recalled echo (GRE) sequence and exploits the principles of fractional encoding. This GRE MRE pulse sequence was validated as capable of acquiring full three-dimensional motion encoding of isotropic voxels in a large volume within less than a minute. This sequence is suitable for monofrequency and multifrequency MRE experiments. In homogeneous paraffin phantoms, the eXpresso sequence yielded similar storage modulus values as those obtained with conventional methods, although with markedly reduced variances (7.11 ± 0.26 kPa for GRE MRE versus 7.16 ± 1.33 kPa for the conventional spin-echo EPI sequence). The GRE MRE sequence obtained better phase-to-noise ratios than the equivalent spin-echo EPI sequence (matched for identical acquisition time) in both paraffin phantoms and in vivo data in the liver (59.62 ± 11.89 versus 27.86 ± 3.81, 61.49 ± 14.16 versus 24.78 ± 2.48 and 58.23 ± 10.39 versus 23.48 ± 2.91 in the X, Y and Z components, respectively, in the case of liver experiments). Phase-to-noise ratios were similar between GRE MRE used in monofrequency or multifrequency experiments (75.39 ± 14.93 versus 86.13 ± 18.25 at 28 Hz, 71.52 ± 24.74 versus 86.96 ± 30.53 at 56 Hz and 95.60 ± 36.96 versus 61.35 ± 26.25 at 84Hz, respectively).
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