Acoustic cardiac triggering: a practical solution for synchronization and gating of cardiovascular magnetic resonance at 7 Tesla

Two-center validation of Pilot Tone based cardiac triggering of a comprehensive cardiovascular magnetic resonance examination

The electrocardiogram (ECG) signal is prone to distortions from gradient and radiofrequency interference and the magnetohydrodynamic effect during cardiovascular magnetic resonance imaging (CMR). Although Pilot Tone Cardiac (PTC) triggering has the potential to overcome these limitations, effectiveness across various CMR techniques has yet to be established. To evaluate the performance of PTC triggering in a comprehensive CMR exam. Fifteen volunteers and 20 patients were recruited at two centers. ECG triggered images were collected for comparison in a subset of sequences. The PTC trigger accuracy was evaluated against ECG in cine acquisitions. Two experienced readers scored image quality in PTC-triggered cine, late gadolinium enhancement (LGE), and T1- and T2-weighted dark-blood turbo spin echo (DB-TSE) images. Quantitative cardiac function, flow, and parametric mapping values obtained using PTC and ECG triggered sequences were compared. Breath-held segmented cine used for trigger timing analysis was collected in 15 volunteers and 14 patients. PTC calibration failed in three volunteers and one patient; ECG trigger recording failed in one patient. Out of 1987 total heartbeats, three mismatched trigger PTC-ECG pairs were found. Image quality scores showed no significant difference between PTC and ECG triggering. There was no significant difference found in quantitative measurements in volunteers. In patients, the only significant difference was found in post-contrast T1 (p = 0.04). ICC showed moderate to excellent agreement in all measurements. PTC performance was equivalent to ECG in terms of triggering consistency, image quality, and quantitative image measurements across multiple CMR applications.

Two-center validation of Pilot Tone Based Cardiac Triggering of a Comprehensive Cardiovascular Magnetic Resonance Examination

Background

The electrocardiogram (ECG) signal is prone to distortions from gradient and radiofrequency interference and the magnetohydrodynamic effect during cardiovascular magnetic resonance imaging (CMR). Although Pilot Tone Cardiac (PTC) triggering has the potential to overcome these limitations, effectiveness across various CMR techniques has yet to be established.

Purpose

To evaluate the performance of PTC triggering in a comprehensive CMR exam.

Methods

Fifteen volunteers and twenty patients were recruited at two centers. ECG triggered images were collected for comparison in a subset of sequences. The PTC trigger accuracy was evaluated against ECG in cine acquisitions. Two experienced readers scored image quality in PTC-triggered cine, late gadolinium enhancement (LGE), and T1- and T2-weighted dark-blood turbo spin echo (DB-TSE) images. Quantitative cardiac function, flow, and parametric mapping values obtained using PTC and ECG triggered sequences were compared.

Results

Breath-held segmented cine used for trigger timing analysis was collected in 15 volunteers and 14 patients. PTC calibration failed in three volunteers and one patient; ECG trigger recording failed in one patient. Out of 1987 total heartbeats, three mismatched trigger PTC-ECG pairs were found. Image quality scores showed no significant difference between PTC and ECG triggering. There was no significant difference found in quantitative measurements in volunteers. In patients, the only significant difference was found in post-contrast T1 (p = 0.04). ICC showed moderate to excellent agreement in all measurements.

Conclusion

PTC performance was equivalent to ECG in terms of triggering consistency, image quality, and quantitative image measurements across multiple CMR applications.

Value of PET ECG gating in a cross-validation study of cardiac function assessment by PET/MR imaging

BACKGROUND

This work investigated the impact of different cardiac gating methods on the assessment of cardiac function by FDG-PET in a cross-validation PET/MR study.

METHODS AND RESULTS

MR- and PET-based left ventricular end-diastolic, end-systolic volumes, and ejection fraction (EDV, ESV, and EF) were delineated in 30 patients with a PET/MR examination. Cardiac PET imaging was performed using three ECG gating methods: fixed number of gates per beat (STD), STD with a beat acceptance window (STD-BR), and fixed gate duration (FW). High MR-PET correlations were found in all the values. ESVs correlated better than EDVs and EFs: Pearson's r coefficient [0.92, 0.92, 0.92] in ESV vs [0.75, 0.81, 0.80] in EDV and [0.79, 0.91, 0.87] in EF, for each method [STD, STD-BR, FW]. Biases with respect to MRI for all the evaluated PET methods were less than 13% in EDV, 5% in ESV, and 14% in EF, but with wide limits of agreements, in the range (59-68)% in EDV, (65-70)% in ESV, and (49-71)% in EF. STD showed the strongest disagreement, while there were no marked differences between STD-BR and FW.

CONCLUSION

Based on these findings, PET- and MR-based cardiac function parameters were highly correlated but in substantial disagreement with variabilities introduced by the selected PET ECG gating method. The most significant differences were associated with the ECG gating method susceptible to highly irregular beats, while similar performance was observed in the methods using uniform adjustment of gates width per beat with the beat acceptance window, and fixed gate width along all the beats. Thus, strict quality controls of R peak detection are needed to minimize its impact on the function assessment.

Ultra-high field cardiac MRI in large animals and humans for translational cardiovascular research

A key step in translational cardiovascular research is the use of large animal models to better understand normal and abnormal physiology, to test drugs or interventions, or to perform studies which would be considered unethical in human subjects. Ultrahigh field magnetic resonance imaging (UHF-MRI) at 7 T field strength is becoming increasingly available for imaging of the heart and, when compared to clinically established field strengths, promises better image quality and image information content, more precise functional analysis, potentially new image contrasts, and as all in-vivo imaging techniques, a reduction of the number of animals per study because of the possibility to scan every animal repeatedly. We present here a solution to the dual use problem of whole-body UHF-MRI systems, which are typically installed in clinical environments, to both UHF-MRI in large animals and humans. Moreover, we provide evidence that in such a research infrastructure UHF-MRI, and ideally combined with a standard small-bore UHF-MRI system, can contribute to a variety of spatial scales in translational cardiovascular research: from cardiac organoids, Zebra fish and rodent hearts to large animal models such as pigs and humans. We present pilot data from serial CINE, late gadolinium enhancement, and susceptibility weighted UHF-MRI in a myocardial infarction model over eight weeks. In 14 pigs which were delivered from a breeding facility in a national SARS-CoV-2 hotspot, we found no infection in the incoming pigs. Human scanning using CINE and phase contrast flow measurements provided good image quality of the left and right ventricle. Agreement of functional analysis between CINE and phase contrast MRI was excellent. MRI in arrested hearts or excised vascular tissue for MRI-based histologic imaging, structural imaging of myofiber and vascular smooth muscle cell architecture using high-resolution diffusion tensor imaging, and UHF-MRI for monitoring free radicals as a surrogate for MRI of reactive oxygen species in studies of oxidative stress are demonstrated. We conclude that UHF-MRI has the potential to become an important precision imaging modality in translational cardiovascular research.

External Hardware and Sensors, for Improved MRI

Complex engineered systems are often equipped with suites of sensors and ancillary devices that monitor their performance and maintenance needs. MRI scanners are no different in this regard. Some of the ancillary devices available to support MRI equipment, the ones of particular interest here, have the distinction of actually participating in the image acquisition process itself. Most commonly, such devices are used to monitor physiological motion or variations in the scanner's imaging fields, allowing the imaging and/or reconstruction process to adapt as imaging conditions change. "Classic" examples include electrocardiography (ECG) leads and respiratory bellows to monitor cardiac and respiratory motion, which have been standard equipment in scan rooms since the early days of MRI. Since then, many additional sensors and devices have been proposed to support MRI acquisitions. The main physical properties that they measure may be primarily "mechanical" (eg acceleration, speed, and torque), "acoustic" (sound and ultrasound), "optical" (light and infrared), or "electromagnetic" in nature. A review of these ancillary devices, as currently available in clinical and research settings, is presented here. In our opinion, these devices are not in competition with each other: as long as they provide useful and unique information, do not interfere with each other and are not prohibitively cumbersome to use, they might find their proper place in future suites of sensors. In time, MRI acquisitions will likely include a plurality of complementary signals. A little like the microbiome that provides genetic diversity to organisms, these devices can provide signal diversity to MRI acquisitions and enrich measurements. Machine-learning (ML) algorithms are well suited at combining diverse input signals toward coherent outputs, and they could make use of all such information toward improved MRI capabilities. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 1.

Bi-ventricular assessment with cardiovascular magnetic resonance at 5 Tesla: A pilot study

Background

Cardiovascular magnetic resonance (CMR) imaging at ultra-high fields (UHF) such as 7T has encountered many challenges such as faster T2* relaxation, stronger B₀ and B₁₊ field inhomogeneities and additional safety concerns due to increased specific absorption rate (SAR) and peripheral nervous stimulation (PNS). Recently, a new line of 5T whole body MRI system has become available, and this study aims at evaluating the performance and benefits of this new UHF system for CMR imaging.

Methods

Gradient echo (GRE) CINE imaging was performed on healthy volunteers at both 5 and 3T, and was compared to balanced steady-state-free-procession (bSSFP) CINE imaging at 3T as reference. Higher spatial resolution GRE CINE scans were additionally performed at 5T. All scans at both fields were performed with ECG-gating and breath-holding. Image quality was blindly evaluated by two radiologists, and the cardiac functional parameters (e.g., EDV/ESV/mass/EF) of the left and right ventricles were measured for statistical analyses using the Wilcoxon signed-rank test and Bland-Altman analysis.

Results

Compared to 3T GRE CINE imaging, 5T GRE CINE imaging achieved comparable or improved image quality with significantly superior SNR and CNR, and it has also demonstrated excellent capability for high resolution (1.0 × 1.0 × 6.0 mm³) imaging. Functional assessments from 5T GRE CINE images were highly similar with the 3T bSSFP CINE reference.

Conclusions

This pilot study has presented the initial evaluation of CMR CINE imaging at 5T UHF, which yielded superior image quality and accurate functional quantification when compared to 3T counterparts. Along with reliable ECG gating, the new 5T UHF system has the potential to achieve well-balanced performance for CMR applications.

Sustainable low-field cardiovascular magnetic resonance in changing healthcare systems

Cardiovascular disease continues to be a major burden facing healthcare systems worldwide. In the developed world, cardiovascular magnetic resonance (CMR) is a well-established non-invasive imaging modality in the diagnosis of cardiovascular disease. However, there is significant global inequality in availability and access to CMR due to its high cost, technical demands as well as existing disparities in healthcare and technical infrastructures across high-income and low-income countries. Recent renewed interest in low-field CMR has been spurred by the clinical need to provide sustainable imaging technology capable of yielding diagnosticquality images whilst also being tailored to the local populations and healthcare ecosystems. This review aims to evaluate the technical, practical and cost considerations of low field CMR whilst also exploring the key barriers to implementing sustainable MRI in both the developing and developed world.

Fundamentals of Camera-PPG based Magnetic Resonance Imaging

In Magnetic Resonance Imaging (MRI), cardiac triggering that synchronizes data acquisition with cardiac contractions is an essential technique for acquiring high-quality images. Triggering is typically based on the Electrocardiogram (ECG) signal (e.g. R-peak). Since ECG acquisition involves extra workflow steps like electrode placement and ECG signals are usually disturbed by magnetic fields in high Magnetic Resonance (MR) systems, we explored camera-based photoplethysmography (PPG) as an alternative. We used the in-bore camera of a clinical MR system to investigate the feasibility and challenges of camera-based cardiac triggering. Data from ECG, finger oximeter and camera were synchronously collected. We found that that camera-PPG provides a higher availability of signal (and trigger) measurement, and the PPG signals measured from the forehead show considerably less delay w.r.t. the coupled ECG R-peak than the finger PPG signals in terms of trigger detection. The insights obtained in this study provide a basis for an envisioned system design phase.

Progress in Imaging the Human Torso at the Ultrahigh Fields of 7 and 10.5 T

Especially after the launch of 7 T, the ultrahigh magnetic field (UHF) imaging community achieved critically important strides in our understanding of the physics of radiofrequency interactions in the human body, which in turn has led to solutions for the challenges posed by such UHFs. As a result, the originally obtained poor image quality has progressed to the high-quality and high-resolution images obtained at 7 T and now at 10.5 T in the human torso. Despite these tremendous advances, work still remains to further improve the image quality and fully capitalize on the potential advantages UHF has to offer.

7-Tesla Functional Cardiovascular MR Using Vectorcardiographic Triggering-Overcoming the Magnetohydrodynamic Effect

Objective: Ultra-high-field B0 ≥ 7 tesla (7T) cardiovascular magnetic resonance (CMR) offers increased resolution. However, electrocardiogram (ECG) gating is impacted by the magneto-hydrodynamic effect distorting the ECG trace. We explored the technical feasibility of a 7T magnetic resonance scanner using an ECG trigger learning algorithm to quantitatively assess cardiac volumes and vascular flow. Methods: 7T scans were performed on 10 healthy volunteers on a whole-body research MRI MR scanner (Siemens Healthineers, Erlangen, Germany) with 8 channel Tx/32 channels Rx cardiac coils (MRI Tools GmbH, Berlin, Germany). Vectorcardiogram ECG was performed using a learning phase outside of the magnetic field, with a trigger algorithm overcoming severe ECG signal distortions. Vectorcardiograms were quantitatively analyzed for false negative and false positive events. Cine CMR was performed after 3rd-order B₀ shimming using a high-resolution breath-held ECG-retro-gated segmented spoiled gradient echo, and 2D phase contrast flow imaging. Artefacts were assessed using a semi-quantitative scale. Results: 7T CMR scans were acquired in all patients (100%) using the vectorcardiogram learning method. 3,142 R-waves were quantitatively analyzed, yielding sensitivity of 97.6% and specificity of 98.7%. Mean image quality score was 0.9, sufficient to quantitate both cardiac volumes, ejection fraction, and aortic and pulmonary blood flow. Mean left ventricular ejection fraction was 56.4%, right ventricular ejection fraction was 51.4%. Conclusion: Reliable cardiac ECG triggering is feasible in healthy volunteers at 7T utilizing a state-of-the-art three-lead trigger device despite signal distortion from the magnetohydrodynamic effect. This provides sufficient image quality for quantitative analysis. Other ultra-high-field imaging applications such as human brain functional MRI with physiologic noise correction may benefit from this method of ECG triggering.

Emerging Techniques in Cardiac Magnetic Resonance Imaging

Cardiovascular disease is the leading cause of death and a significant contributor of health care costs. Noninvasive imaging plays an essential role in the management of patients with cardiovascular disease. Cardiac magnetic resonance (MR) can noninvasively assess heart and vascular abnormalities, including biventricular structure/function, blood hemodynamics, myocardial tissue composition, microstructure, perfusion, metabolism, coronary microvascular function, and aortic distensibility/stiffness. Its ability to characterize myocardial tissue composition is unique among alternative imaging modalities in cardiovascular disease. Significant growth in cardiac MR utilization, particularly in Europe in the last decade, has laid the necessary clinical groundwork to position cardiac MR as an important imaging modality in the workup of patients with cardiovascular disease. Although lack of availability, limited training, physician hesitation, and reimbursement issues have hampered widespread clinical adoption of cardiac MR in the United States, growing clinical evidence will ultimately overcome these challenges. Advances in cardiac MR techniques, particularly faster image acquisition, quantitative myocardial tissue characterization, and image analysis have been critical to its growth. In this review article, we discuss recent advances in established and emerging cardiac MR techniques that are expected to strengthen its capability in managing patients with cardiovascular disease. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 1.

On the way to routine cardiac MRI at 7 Tesla - a pilot study on consecutive 84 examinations

Introduction

Cardiac magnetic resonance (CMR) at ultrahigh field (UHF) offers the potential of high resolution and fast image acquisition. Both technical and physiological challenges associated with CMR at 7T require specific hardware and pulse sequences. This study aimed to assess the current status and existing, publicly available technology regarding the potential of a clinical application of 7T CMR.

Methods

Using a 7T MRI scanner and a commercially available radiofrequency coil, a total of 84 CMR examinations on 72 healthy volunteers (32 males, age 19–70 years, weight 50–103 kg) were obtained. Both electrocardiographic and acoustic triggering were employed. The data were analyzed regarding the diagnostic image quality and the influence of patient and hardware dependent factors. 50 complete short axis stacks and 35 four chamber CINE views were used for left ventricular (LV) and right ventricular (RV), mono-planar LV function, and RV fractional area change (FAC). Twenty-seven data sets included aortic flow measurements that were used to calculate stroke volumes. Subjective acceptance was obtained from all volunteers with a standardized questionnaire.

Results

Functional analysis showed good functions of LV (mean EF 56%), RV (mean EF 59%) and RV FAC (mean FAC 52%). Flow measurements showed congruent results with both ECG and ACT triggering. No significant influence of experimental parameters on the image quality of the LV was detected. Small fractions of 5.4% of LV and 2.5% of RV segments showed a non-diagnostic image quality. The nominal flip angle significantly influenced the RV image quality.

Conclusion

The results demonstrate that already now a commercially available 7T MRI system, without major methods developments, allows for a solid morphological and functional analysis similar to the clinically established CMR routine approach. This opens the door towards combing routine CMR in patients with development of advanced 7T technology.

Investigating the effect of trigger delay on cardiac 31P MRS signals

The heart’s geometry and its metabolic activity vary over the cardiac cycle. The effect of these fluctuations on phosphorus (³¹P) magnetic resonance spectroscopy (MRS) data quality and metabolite ratios was investigated. 12 healthy volunteers were measured using a 7 T MR scanner and a cardiac ³¹P-¹H loop coil. ³¹P chemical shift imaging data were acquired untriggered and at four different times during the cardiac cycle using acoustic triggering. Signals of adenosine-triphosphate (ATP), phosphocreatine (PCr), inorganic phosphate (Pi) and 2,3-diphosphoglycerate (2,3-DPG) and their fit quality as Cramér-Rao lower bounds (CRLB) were quantified including corrections for contamination by ³¹P signals from blood, flip angle, saturation and total acquisition time. The myocardial filling factor was estimated from cine short axis views. The corrected signals of PCr and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\gamma$$\end{document}γ-ATP were higher during end-systole and lower during diastasis than in untriggered acquisitions (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$P<0.05$$\end{document}P<0.05). Signal intensities of untriggered scans were between those with triggering to end-systole and diastasis. Fit quality of PCr and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\gamma$$\end{document}γ-ATP peaks was best during end-systole when blood contamination of ATP and Pi signals was lowest. While metabolite ratios and pH remained stable over the cardiac cycle, signal amplitudes correlated strongly with myocardial voxel filling. Triggering of cardiac ³¹P MRS acquisitions improves signal amplitudes and fit quality if the trigger delay is set to end-systole. We conclude that triggering to end-systole is superior to triggering to diastasis.

Cardiac self-gating using blind source separation for 2D cine cardiovascular magnetic resonance imaging

PURPOSE

To develop and validate a new cardiac self-gating algorithm using blind source separation for 2D cine steady-state free precession (SSFP) imaging.

METHODS

A standard cine SSFP sequence was modified so that the center point of k-space was sampled with each excitation. The center points of k-space were processed by 4 blind source separation methods, and used to detect heartbeats and assign k-space data to appropriate time points in the cardiac cycle. The proposed self-gating technique was prospectively validated in 8 patients against the standard electrocardiogram (ECG)-gating method by comparing the cardiac cycle lengths, image quality metrics, and ventricular volume measurements.

RESULTS

There was close agreement between the cardiac cycle length using the ECG- and self-gating methods (bias 0.0 bpm, 95% limits of agreement ±2.1 bpm). The image quality metrics were not significantly different between the ECG- and self-gated images. The ventricular volumes, stroke volumes, and mass measured from self-gated images were all comparable with those from ECG-gated images (all biases <5%).

CONCLUSION

The self-gating method yielded comparable cardiac cycle length, image quality, and ventricular measurements compared with standard ECG-gated cine imaging. It may simplify patient preparation, be more robust when there is arrhythmia, and allow cardiac gating at higher field strengths.

Emerging methods for the characterization of ischemic heart disease: ultrafast Doppler angiography, micro-CT, photon-counting CT, novel MRI and PET techniques, and artificial intelligence

After an ischemic event, disruptive changes in the healthy myocardium may gradually develop and may ultimately turn into fibrotic scar. While these structural changes have been described by conventional imaging modalities mostly on a macroscopic scale-i.e., late gadolinium enhancement at magnetic resonance imaging (MRI)-in recent years, novel imaging methods have shown the potential to unveil an even more detailed picture of the postischemic myocardial phenomena. These new methods may bring advances in the understanding of ischemic heart disease with potential major changes in the current clinical practice. In this review article, we provide an overview of the emerging methods for the non-invasive characterization of ischemic heart disease, including coronary ultrafast Doppler angiography, photon-counting computed tomography (CT), micro-CT (for preclinical studies), low-field and ultrahigh-field MRI, and ¹¹C-methionine positron emission tomography. In addition, we discuss new opportunities brought by artificial intelligence, while addressing promising future scenarios and the challenges for the application of artificial intelligence in the field of cardiac imaging.

Monitoring and Synchronization of Cardiac and Respiratory Traces in Magnetic Resonance Imaging: A Review

Synchronization of human vital signs, namely the cardiac cycle and respiratory excursions, is necessary during magnetic resonance imaging of the cardiovascular system and the abdominal cavity to achieve optimal image quality with minimized artifacts. This review summarizes techniques currently available in clinical practice, as well as methods under development, outlines the benefits and disadvantages of each approach, and offers some unique solutions for consideration.

Doppler ultrasound cardiac gating of intracranial flow at 7T

BACKGROUND

Ultra-high field magnetic resonance imaging (MR) may be used to improve intracranial blood flow measurements. However, standard cardiac synchronization methods tend to fail at ultra-high field MR. Therefore, this study aims to investigate an alternative synchronization technique using Doppler ultrasound.

METHODS

Healthy subjects (n = 9) were examined with 7T MR. Flow was measured in the M1-branch of the middle cerebral artery (MCA) and in the cerebral aqueduct (CA) using through-plane phase contrast (2D flow). Flow in the circle of Willis was measured with three-dimensional, three-directional phase contrast (4D flow). Scans were gated with Doppler ultrasound (DUS) and electrocardiogram (ECG), and pulse oximetry data (POX) was collected simultaneously. False negative and false positive trigger events were counted for ECG, DUS and POX, and quantitative flow measures were compared.

RESULTS

There were fewer false positive triggers for DUS compared to ECG (5.3 ± 11 vs. 25 ± 31, p = 0.031), while no other measured parameters differed significantly. Net blood flow in M1 was similar between DUS and ECG for 2D flow (1.5 ± 0.39 vs. 1.6 ± 0.41, bias ± 1.96SD: - 0.021 ± 0.36) and 4D flow (1.8 ± 0.48 vs. 9 ± 0.59, bias ± 1.96SD: - 0.086 ± 0.57 ml). Net CSF flow per heart beat in the CA was also similar for DUS and ECG (3.6 ± 2.1 vs. 3.0 ± 5.8, bias ± 1.96SD: 0.61 ± 13.6 μl).

CONCLUSION

Gating with DUS produced fewer false trigger events than using ECG, with similar quantitative flow values. DUS gating is a promising technique for cardiac synchronization at 7T.

Pilot tone-based motion correction for prospective respiratory compensated cardiac cine MRI

PURPOSE

To evaluate prospective motion correction using the pilot tone (PT) as a quantitative respiratory motion signal with high temporal resolution for cardiac cine images during free breathing.

METHODS

Before cine data acquisition, a short prescan was performed, calibrating the PT to the respiratory-induced heart motion using respiratory-resolved real-time images. The calibrated PT was then applied for nearly real-time prospective motion correction of cine MRI through slice tracking (ie, updating the slice position before every readout). Additionally, in-plane motion correction was performed retrospectively also based on the calibrated PT data. The proposed method was evaluated in a moving phantom and 10 healthy volunteers.

RESULTS

The PT showed very good correlation to the phantom motion. In volunteer studies using a long-term scan over 7.96 ± 1.40 min, the mean absolute error between registered and predicted motion from the PT was 1.44 ± 0.46 mm in head-feet and 0.46 ± 0.07 mm in anterior-posterior direction. Irregular breathing could also be corrected well with the PT. The PT motion correction leads to a significant improvement of contrast-to-noise ratio by 68% (P ≤ .01) between blood pool and myocardium and sharpness of endocardium by 24% (P = .04) in comparison to uncorrected data. The image score, which refers to the cine image quality, has improved with the utilization of the proposed PT motion correction.

CONCLUSION

The proposed approach provides respiratory motion-corrected cine images of the heart with improved image quality and a high scan efficiency using the PT. The PT is independent of the MR acquisition, making this a very flexible motion-correction approach.

Impact of sequence type and field strength (1.5, 3, and 7T) on 4D flow MRI hemodynamic aortic parameters in healthy volunteers

PURPOSE

4D flow magnetic resonance imaging (4D-MRI) allows time-resolved visualization of blood flow patterns, quantification of volumes, velocities, and advanced parameters, such as wall shear stress (WSS). As 4D-MRI enters the clinical arena, standardization and awareness of confounders are important. Our aim was to evaluate the equivalence of 4D flow-derived aortic hemodynamics in healthy volunteers using different sequences and field strengths.

METHODS

4D-MRI was acquired in 10 healthy volunteers at 1.5T using three different prototype sequences, at 3T and at 7T (Siemens Healthineers). After evaluation of diagnostic quality in three segments (ascending-, descending aorta, aortic arch), peak velocity, flow volumes, and WSS were investigated. Equivalence limits for comparison of field strengths/sequences were based on the limits of Bland-Altman analyses of the intraobserver variability.

RESULTS

Non-diagnostic quality was found in 10/144 segments, 9/10 were obtained at 7T. Apart for the comparison of forward flow between sequence 1 and 3, the differences in measurements between field strengths/sequences exceeded the range of agreement. Significant differences were found between field strengths/sequences for forward flow (1.5T vs. 3T, 3T vs. 7T, sequence 1 vs. 3, 2 vs. 3 [P < .001]), WSS (1.5T vs. 3T [P < .05], sequence 1 vs. 2, 1 vs. 3, 2 vs. 3 [P < .001]), and peak velocity (1.5T vs. 7T, sequence 1 vs. 3 [P > .001]). All parameters at all field strengths/with all sequences correlated moderately to strongly (r ≥ 0.5).

CONCLUSION

Data from all sequences could be acquired and resulting images showed sufficient quality for further analysis. However, the variability of the measurements of peak velocity, flow volumes, and WSS was higher when comparing field strengths/sequences as the equivalence limits defined by the intraobserver assessments.

B0 shimming of the human heart at 7T

PURPOSE

Inhomogeneities of the static magnetic B₀ field are a major limiting factor in cardiac MRI at ultrahigh field (≥ 7T), as they result in signal loss and image distortions. Different magnetic susceptibilities of the myocardium and surrounding tissue in combination with cardiac motion lead to strong spatio-temporal B₀ -field inhomogeneities, and their homogenization (B₀ shimming) is a prerequisite. Limitations of state-of-the-art shimming are described, regional B₀ variations are measured, and a methodology for spherical harmonics shimming of the B₀ field within the human myocardium is proposed.

METHODS

The spatial B₀ -field distribution in the heart was analyzed as well as temporal B₀ -field variations in the myocardium over the cardiac cycle. Different shim region-of-interest selections were compared, and hardware limitations of spherical harmonics B₀ shimming were evaluated by calibration-based B₀ -field modeling. The role of third-order spherical harmonics terms was analyzed as well as potential benefits from cardiac phase-specific shimming.

RESULTS

The strongest B₀ -field inhomogeneities were observed in localized spots within the left-ventricular and right-ventricular myocardium and varied between systolic and diastolic cardiac phases. An anatomy-driven shim region-of-interest selection allowed for improved B₀ -field homogeneity compared with a standard shim region-of-interest cuboid. Third-order spherical harmonics terms were demonstrated to be beneficial for shimming of these myocardial B₀ -field inhomogeneities. Initial results from the in vivo implementation of a potential shim strategy were obtained. Simulated cardiac phase-specific shimming was performed, and a shim term-by-term analysis revealed periodic variations of required currents.

CONCLUSION

Challenges in state-of-the-art B₀ shimming of the human heart at 7 T were described. Cardiac phase-specific shimming strategies were found to be superior to vendor-supplied shimming.

Cardiovascular magnetic resonance imaging for structural heart disease

Cardiovascular magnetic resonance (CMR) has increasingly become a powerful imaging technique over the past few decades due to increasing knowledge about clinical applications, operator experience and technological advances, including the introduction of high field strength magnets, leading to improved signal-to-noise ratio. Its success is attributed to the free choice of imaging planes, the wide variety of imaging techniques, and the lack of harmful radiation. Developments in CMR have led to the accurate evaluation of cardiac structure, function and tissues characterisation, so this non-invasive technique has become a powerful tool for a broad range of cardiac pathologies. This review will provide an introduction of magnetic resonance imaging (MRI) physics, an overview of the current techniques and clinical application of CMR in structural heart disease, and illustrated examples of its use in clinical practice.

First in-vivo human imaging at 10.5T: Imaging the body at 447 MHz

PURPOSE

To investigate the feasibility of imaging the human torso and to evaluate the performance of several radiofrequency (RF) management strategies at 10.5T.

METHODS

Healthy volunteers were imaged on a 10.5T whole-body scanner in multiple target anatomies, including the prostate, hip, kidney, liver, and heart. Phase-only shimming and spoke pulses were used to demonstrate their performance in managing the B 1 + inhomogeneity present at 447 MHz. Imaging protocols included both qualitative and quantitative acquisitions to show the feasibility of imaging with different contrasts.

RESULTS

High-quality images were acquired and demonstrated excellent overall contrast and signal-to-noise ratio. The experimental results matched well with predictions and suggested good translational capabilities of the RF management strategies previously developed at 7T. Phase-only shimming provided increased efficiency, but showed pronounced limitations in homogeneity, demonstrating the need for the increased degrees of freedom made possible through single- and multispoke RF pulse design.

CONCLUSION

The first in-vivo human imaging was successfully performed at 10.5T using previously developed RF management strategies. Further improvement in RF coils, transmit chain, and full integration of parallel transmit functionality are needed to fully realize the benefits of 10.5T.

Scattering matrix imaging pulse design for real-time respiration and cardiac motion monitoring

Purpose

The scattering matrix (S‐matrix) of a parallel transmit (pTx) coil is sensitive to physiological motion but requires additional monitoring RF pulses to be measured. In this work, we present and evaluate pTx RF pulse designs that simultaneously excite for imaging and measure the S‐matrix to generate real‐time motion signals without prolonging the image sequence.

Theory and Methods

Three pTx waveforms for measuring the S‐matrix were identified and superimposed onto the imaging excitation RF pulses: (1) time division multiplexing, (2) frequency division multiplexing, and (3) code division multiplexing. These 3 methods were evaluated in healthy volunteers for scattering sensitivity and image artefacts. The S‐matrix and real‐time motion signals were calculated on the image calculation environment of the MR scanner. Prospective cardiac triggers were identified in early systole as a high rate of change of the cardiac motion signal. Monitoring accuracy was compared against electrocardiogram or the imaged diaphragm position.

Results

All 3 monitoring approaches measure the S‐matrix during image excitation with quality correlated to input power. No image artefacts were observed for frequency multiplexing, and low energy artefacts were observed in the other methods. The accuracy of the achieved prospective cardiac gating was 15 ± 16 ms for breath hold and 24 ± 17 ms during free breathing. The diaphragm position prediction accuracy was 1.3 ± 0.9 mm. In all volunteers, good quality cine images were acquired for breath hold scans and dual gated CINEs were demonstrated.

Conclusion

The S‐matrix can be measured during image excitation to generate real‐time cardiac and respiratory motion signals for prospective gating. No artefacts are introduced when frequency division multiplexing is used.

Evolution of UHF Body Imaging in the Human Torso at 7T: Technology, Applications, and Future Directions

The potential value of ultrahigh field (UHF) magnetic resonance imaging (MRI) and spectroscopy to biomedical research and in clinical applications drives the development of technologies to overcome its many challenges. The increased difficulties of imaging the human torso compared with the head include its overall size, the dimensions and location of its anatomic targets, the increased prevalence and magnitude of physiologic effects, the limited availability of tailored RF coils, and the necessary transmit chain hardware. Tackling these issues involves addressing notoriously inhomogeneous transmit B1 (B1) fields, limitations in peak B1, larger spatial variations of the static magnetic field B0, and patient safety issues related to implants and local RF power deposition. However, as research institutions and vendors continue to innovate, the potential gains are beginning to be realized. Solutions overcoming the unique challenges associated with imaging the human torso are reviewed as are current studies capitalizing on the benefits of UHF in several anatomies and applications. As the field progresses, strategies associated with the RF system architecture, calibration methods, RF pulse optimization, and power monitoring need to be further integrated into the MRI systems making what are currently complex processes more streamlined. Meanwhile, the UHF MRI community must seize the opportunity to build upon what have been so far proof of principle and feasibility studies and begin to further explore the true impact in both research and the clinic.

Vital Sign Monitoring and Cardiac Triggering at 1.5 Tesla: A Practical Solution by an MR-Ballistocardiography Fiber-Optic Sensor

This article presents a solution for continuous monitoring of both respiratory rate (RR) and heart rate (HR) inside Magnetic Resonance Imaging (MRI) environments by a novel ballistocardiography (BCG) fiber-optic sensor. We designed and created a sensor based on the Fiber Bragg Grating (FBG) probe encapsulated inside fiberglass (fiberglass is a composite material made up of glass fiber, fabric, and cured synthetic resin). Due to this, the encapsulation sensor is characterized by very small dimensions (30 × 10 × 0.8 mm) and low weight (2 g). We present original results of real MRI measurements (conventionally most used 1.5 T MR scanner) involving ten volunteers (six men and four women) by performing conventional electrocardiography (ECG) to measure the HR and using a Pneumatic Respiratory Transducer (PRT) for RR monitoring. The acquired sensor data were compared against real measurements using the objective Bland–Altman method, and the functionality of the sensor was validated (95.36% of the sensed values were within the ±1.96 SD range for the RR determination and 95.13% of the values were within the ±1.96 SD range for the HR determination) by this means. The accuracy of this sensor was further characterized by a relative error below 5% (4.64% for RR and 4.87% for HR measurements). The tests carried out in an MRI environment demonstrated that the presence of the FBG sensor in the MRI scanner does not affect the quality of this imaging modality. The results also confirmed the possibility of using the sensor for cardiac triggering at 1.5 T (for synchronization and gating of cardiovascular magnetic resonance) and for cardiac triggering when a Diffusion Weighted Imaging (DWI) is used.

Pros and cons of ultra-high-field MRI/MRS for human application

Magnetic resonance imaging and spectroscopic techniques are widely used in humans both for clinical diagnostic applications and in basic research areas such as cognitive neuroimaging. In recent years, new human MR systems have become available operating at static magnetic fields of 7 T or higher (≥300 MHz proton frequency). Imaging human-sized objects at such high frequencies presents several challenges including non-uniform radiofrequency fields, enhanced susceptibility artifacts, and higher radiofrequency energy deposition in the tissue. On the other side of the scale are gains in signal-to-noise or contrast-to-noise ratio that allow finer structures to be visualized and smaller physiological effects to be detected. This review presents an overview of some of the latest methodological developments in human ultra-high field MRI/MRS as well as associated clinical and scientific applications. Emphasis is given to techniques that particularly benefit from the changing physical characteristics at high magnetic fields, including susceptibility-weighted imaging and phase-contrast techniques, imaging with X-nuclei, MR spectroscopy, CEST imaging, as well as functional MRI. In addition, more general methodological developments such as parallel transmission and motion correction will be discussed that are required to leverage the full potential of higher magnetic fields, and an overview of relevant physiological considerations of human high magnetic field exposure is provided.

Feasibility of aortic valve planimetry at 7 T ultrahigh field MRI: Comparison to aortic valve MRI at 3 T and 1.5 T

Introduction

This study examined the feasibility of aortic valve planimetry at 7 T ultrahigh field MRI in intraindividual comparison to 3 T and 1.5 T MRI.

Material and methods

Aortic valves of eleven healthy volunteers (mean age, 26.4 years) were examined on a 7 T, 3 T, and 1.5 T MR system using FLASH and TrueFISP sequences. Two experienced radiologists evaluated overall image quality, the presence of artefacts, tissue contrast ratios, identifiability, and image details of the aortic valve opening area (AVOA). Furthermore, AVOA was quantified twice by reader 1 and once by reader 2. Correlation analysis between artefact severity and employed magnetic field strength was performed by modified Fisher’s exact-test. Paired t-test was used to analyse for AVOA differences, and Bland-Altman plots were used to analyse AVOA intra-rater and inter-rater variability.

Results

Aortic valve imaging at 7 T, 3 T, and 1.5 T with using FLASH was less hampered by artefacts than TrueFISP imaging at 3 T and 1.5 T. Tissue contrast and image details were rated best at 7 T. AVOA was measured slightly smaller at 7 T compared to 3 T (TrueFISP, p-value = 0.057; FLASH, p-value = 0.016) and 1.5 T (TrueFISP, p-value = 0.029; FLASH, p-value = 0.018). Intra-rater and inter-rater variability of AVOA tended to be slightly smaller at 7 T than at 3 T and 1.5 T.

Conclusion

Aortic valve planimetry at 7 T ultrahigh field MRI is technically feasible and in healthy volunteers offers an improved tissue contrast and a slightly better reproducibility than MR planimetry at 1.5 T and 3 T.

Model checking for trigger loss detection during Doppler ultrasound-guided fetal cardiovascular MRI

PURPOSE

Ultrasound (US) is the state of the art in prenatal diagnosis to depict fetal heart diseases. Cardiovascular magnetic resonance imaging (CMRI) has been proposed as a complementary diagnostic tool. Currently, only trigger-based methods allow the temporal and spatial resolutions necessary to depict the heart over time. Of these methods, only Doppler US (DUS)-based triggering is usable with higher field strengths. DUS is sensitive to motion. This may lead to signal and, ultimately, trigger loss. If too many triggers are lost, the image acquisition is stopped, resulting in a failed imaging sequence. Moreover, losing triggers may prolong image acquisition. Hence, if no actual trigger can be found, injected triggers are added to the signal based on the trigger history.

METHOD

We use model checking, a technique originating from the computer science domain that formally checks if a model satisfies given requirements, to simultaneously model heart and respiratory motion and to decide whether respiration has a prominent effect on the signal. Using bounds on the physiological parameters and their variability, the method detects when changes in the signal are due to respiration. We use this to decide when to inject a trigger.

RESULTS

In a real-world scenario, we can reduce the number of falsely injected triggers by 94% from more than 87% to less than 5%. On a subset of motion that would allow CMRI, the number can be further reduced to below 0.2%. In a study using simulations with a robot, we show that our method works for different types of motions, motion ranges, starting positions and heartbeat traces.

CONCLUSION

While DUS is a promising approach for fetal CMRI, correct trigger injection is critical. Our model checking method can reduce the number of wrongly injected triggers substantially, providing a key prerequisite for fast and artifact free CMRI.

Cardiac gating using scattering of an 8-channel parallel transmit coil at 7T

PURPOSE

To establish a cardiac signal from scattering matrix or scattering coefficient measurements made on a 7T 8-channel parallel transmit (pTx) system, and to evaluate its use for cardiac gating.

METHODS

Measurements of the scattering matrix and scattering coefficients were acquired using a monitoring pulse sequence and during a standard cine acquisition, respectively. Postprocessing used an independent component analysis and gating feature identification. The effect of the phase of the excitation radiofrequency (RF) field ( B1+ shim) on the cardiac signal was simulated for multiple B1+ shim configurations, and cine images were reconstructed from both the scattering coefficients and electrocardiogram (ECG).

RESULTS

The cardiac motion signal was successfully identified in all subjects with a mean signal-to-noise ratio of 33.1 and 5.7 using the scattering matrix and scattering coefficient measurements, respectively. The dominant gating feature in the cardiac signal was a peak aligned with end-systole that occurred on average at 311 and 391 ms after the ECG trigger, with a mean standard deviation of 13.4 and 18.1 ms relative to ECG when using the scattering matrix and scattering coefficients measurements, respectively. The scattering coefficients showed a dependence on B1+ shim with some shim configurations not showing any cardiac signal. Cine images were successfully reconstructed using the scattering coefficients with minimal differences compared to those using ECG.

CONCLUSION

We have shown that the scattering of a pTx RF coil can be used to estimate a cardiac signal, and that scattering matrix and coefficients can be used to cardiac gate MRI acquisitions with the scattering matrix providing a superior cardiac signal. Magn Reson Med 80:633-640, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Myocardial Effective Transverse Relaxation Time T 2* is Elevated in Hypertrophic Cardiomyopathy: A 7.0 T Magnetic Resonance Imaging Study

Hypertrophic cardiomyopathy (HCM) is the most common genetic disease of the myocardium and bares the risk of progression to heart failure or sudden cardiac death. Identifying patients at risk remains an unmet need. Recognizing the dependence of microscopic susceptibility on tissue microstructure and on cardiac macromorphology we hypothesized that myocardial T2* might be altered in HCM patients compared to healthy controls. To test this hypothesis, myocardial T2*-mapping was conducted at 7.0 Tesla to enhance T2*-contrast. 2D CINE T2*-mapping was performed in healthy controls and HCM patients. To ensure that T2* is not dominated by macroscopic magnetic field inhomogeneities, volume selective B0 shimming was applied. T2* changes in the interventricular septum across the cardiac cycle were analyzed together with left ventricular radius and ventricular septal wall thickness. The results show that myocardial T2* is elevated throughout the cardiac cycle in HCM patients compared to healthy controls. A mean septal T2* = 13.7 ± 1.1 ms (end-systole: T2*,systole = 15.0 ± 2.1, end-diastole: T2*,diastole = 13.4 ± 1.3 ms, T2*,systole/T2*,diastole ratio = 1.12) was observed in healthy controls. For HCM patients a mean septal T2* = 17.4 ± 1.4 ms (end-systole: T2*,systole = 17.7 ± 1.2 ms, end-diastole: T2*,diastole = 16.2 ± 2.5 ms, T2*,systole/T2*,diastole ratio = 1.09) was found. Our preliminary results provide encouragement that assessment of T2* and its changes across the cardiac cycle may benefit myocardial tissue characterization in HCM.

Evaluation of a Portable Doppler Ultrasound Gating Device for Fetal Cardiac MR Imaging: Initial Results at 1.5T and 3T

Purpose:

Fetal cardiac MRI has the potential to play an important role in the assessment of fetal cardiac pathologies, but it is up to now not feasible due to a missing gating method. The purpose of this work was the evaluation of Doppler ultrasound (DUS) for external fetal cardiac gating with regard to compatibility, functionality, and reliability. Preliminary results were assessed performing fetal cardiac MRI.

Methods:

An MRI conditional DUS device was developed to obtain a gating signal from the fetal heart. The MRI compatibility was evaluated at 1.5T and 3T using B₁ field maps and gradient echo images. The quality and sensitivity of the DUS device to detect the fetal heart motion for cardiac gating were evaluated outside the MRI room in 15 fetuses. A dynamic fetal cardiac phantom was employed to evaluate distortions of the DUS device and gating signal due to electromagnetic interferences at 1.5T and 3T. In the first in vivo experience, dynamic fetal cardiac images were acquired in four-chamber view at 1.5T and 3T in two fetuses.

Results:

The maximum change in the B₁ field and signal intensity with and without the DUS device was <6.5% for 1.5T and 3T. The sensitivity of the DUS device to detect the fetal heartbeat was 99.1%. Validation of the DUS device using the fetal cardiac phantom revealed no electromagnetic interferences at 1.5T or 3T and a high correlation to the simulated heart frequencies. Fetal cardiac cine images were successfully applied and showed good image quality.

Conclusion:

An MR conditional DUS gating device was developed and evaluated revealing safety, compatibility, and reliability for different field strengths. In a preliminary experience, the DUS device was successfully applied for in vivo fetal cardiac imaging at 1.5T and 3T.

Spatially Resolved MR-Compatible Doppler Ultrasound: Proof of Concept for Triggering of Diagnostic Quality Cardiovascular MRI for Function and Flow Quantification at 3T

OBJECTIVE

We demonstrate the use of a magnetic-resonance (MR)-compatible ultrasound (US) imaging probe using spatially resolved Doppler for diagnostic quality cardiovascular MR imaging (MRI) as an initial step toward hybrid US/MR fetal imaging.

METHODS

A newly developed technology for a dedicated MR-compatible phased array ultrasound-imaging probe acquired pulsed color Doppler carotid images, which were converted in near-real time to a trigger signal for cardiac cine and flow quantification MRI. Ultrasound and MR data acquired simultaneously were interference free. Conventional electrocardiogram (ECG) and the proposed spatially resolved Doppler triggering were compared in 10 healthy volunteers. A synthetic "false-triggered" image was retrospectively processed using metric optimized gating (MOG). Images were scored by expert readers, and sharpness, cardiac function and aortic flow were quantified. Four-dimensional (4-D) flow (two volunteers) showed feasibility of Doppler triggering over a long acquisition time.

RESULTS

Imaging modalities were compatible. US probe positioning was stable and comfortable. Image quality scores and quantified sharpness were statistically equal for Doppler- and ECG-triggering (p ). ECG-, Doppler-triggered, and MOG ejection fractions were equivalent (p ), with false-triggered values significantly lower (p < 0.0005). Aortic flow showed no difference between ECG- and Doppler-triggered and MOG (p > 0.05). 4-D flow quantification gave consistent results between ECG and Doppler triggering.

CONCLUSION

We report interference-free pulsed color Doppler ultrasound during MR data acquisition. Cardiovascular MRI of diagnostic quality was successfully obtained with pulsed color Doppler triggering.

SIGNIFICANCE

The hardware platform could further enable advanced free-breathing cardiac imaging. Doppler ultrasound triggering is applicable where ECG is compromised due to pathology or interference at higher magnetic fields, and where direct ECG is impossible, i.e., fetal imaging.

Adiabatic excitation for 31 P MR spectroscopy in the human heart at 7 T: A feasibility study

Purpose

Phosphorus magnetic resonance spectroscopy (³¹P‐MRS) provides a unique tool for assessing cardiac energy metabolism, often quantified using the phosphocreatine (PCr)/adenosine triphosphate (ATP) ratio. Surface coils are typically used for excitation for ³¹P‐MRS, but they create an inhomogeneous excitation field across the myocardium, producing undesirable, spatially varying partial saturation. Therefore, we implemented adiabatic excitation in a 3D chemical shift imaging (CSI) sequence for cardiac ³¹P‐MRS at 7 Tesla (T).

Methods

We optimized an adiabatic half passage pulse with bandwidth sufficient to excite PCr and γ‐ATP together. In addition, the CSI sequence was modified to allow interleaved excitation of PCr and γ‐ATP, then 2,3‐DPG, to enable PCr/ATP determination with blood correction. Nine volunteers were scanned at 2 transmit voltages to confirm that measured PCr/ATP was independent of B1+ (i.e. over the adiabatic threshold). Six septal voxels were evaluated for each volunteer.

Results

Phantom experiments showed that adiabatic excitation can be reached at the depth of the heart using our pulse. The mean evaluated cardiac PCr/ATP ratio from all 9 volunteers corrected for blood signal was 2.14 ± 0.16. Comparing the two acquisitions with different voltages resulted in a minimal mean difference of −0.005.

Conclusion

Adiabatic excitation is possible in the human heart at 7 T, and gives consistent PCr/ATP ratios. Magn Reson Med 78:1667–1673, 2017. © 2016 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Initial evaluation of prospective cardiac triggering using photoplethysmography signals recorded with a video camera compared to pulse oximetry and electrocardiography at 7T MRI

BACKGROUND

Accurate synchronization between magnetic resonance imaging data acquisition and a subject's cardiac activity ("triggering") is essential for reducing image artifacts but conventional, contact-based methods for this task are limited by several factors, including preparation time, patient inconvenience, and susceptibility to signal degradation. The purpose of this work is to evaluate the performance of a new contact-free triggering method developed with the aim to eventually replace conventional methods in non-cardiac imaging applications. In this study, the method's performance is evaluated in the context of 7 Tesla non-enhanced angiography of the lower extremities.

METHODS

Our main contribution is a basic algorithm capable of estimating in real-time the phase of the cardiac cycle from reflection photoplethysmography signals obtained from skin color variations of the forehead recorded with a video camera. Instead of finding the algorithm's parameters heuristically, they were optimized using videos of the forehead as well as electrocardiography and pulse oximetry signals that were recorded from eight healthy volunteers in and outside the scanner, with and without active radio frequency and gradient coils. Based on the video characteristics, synthetic signals were generated and the "best available" values of an objective function were determined using mathematical optimization. The performance of the proposed method with optimized algorithm parameters was evaluated by applying it to the recorded videos and comparing the computed triggers to those of contact-based methods. Additionally, the method was evaluated by using its triggers for acquiring images from a healthy volunteer and comparing the result to images obtained using pulse oximetry triggering.

RESULTS

During evaluation of the videos recorded inside the bore with active radio frequency and gradient coils, the pulse oximeter triggers were labeled in 62.5% as "potentially usable" for cardiac triggering, the electrocardiography triggers in 12.5%, and the proposed method's triggers in 62.5%. Evaluation of the angiography images demonstrated that under appropriate conditions the method is feasible to produce an image quality comparable to pulse oximetry.

CONCLUSION

We conclude that cardiac triggering using the proposed method is technically feasible. However, for improved reliability the signal-to-noise ratio of the videos will have to be addressed by either replacing the camera sensor, improving the illumination, or by use of additional signal filtering techniques.

Dilated Cardiomyopathy: Phosphorus 31 MR Spectroscopy at 7 T

Purpose To test whether the increased signal-to-noise ratio of phosphorus 31 (³¹P) magnetic resonance (MR) spectroscopy at 7 T improves precision in cardiac metabolite quantification in patients with dilated cardiomyopathy (DCM) compared with that at 3 T. Materials and Methods Ethical approval was obtained, and participants provided written informe consent. In a prospective study, ³¹P MR spectroscopy was performed at 3 T and 7 T in 25 patients with DCM. Ten healthy matched control subjects underwent ³¹P MR spectroscopy at 7 T. Paired Student t tests were performed to compare results between the 3-T and 7-T studies. Results The phosphocreatine (PCr) signal-to-noise ratio increased 2.5 times at 7 T compared with that at 3 T. The PCr to adenosine triphosphate (ATP) concentration ratio (PCr/ATP) was similar at both field strengths (mean ± standard deviation, 1.48 ± 0.44 at 3 T vs 1.54 ± 0.39 at 7 T, P = .49), as expected. The Cramér-Rao lower bounds in PCr concentration (a measure of uncertainty in the measured ratio) were 45% lower at 7 T than at 3 T, reflecting the higher quality of 7-T ³¹P spectra. Patients with dilated cardioyopathy had a significantly lower PCr/ATP than did healthy control subjects at 7 T (1.54 ± 0.39 vs 1.95 ± 0.25, P = .005), which is consistent with previous findings. Conclusion 7-T cardiac ³¹P MR spectroscopy is feasible in patients with DCM and gives higher signal-to-noise ratios and more precise quantification of the PCr/ATP than that at 3 T. PCr/ATP was significantly lower in patients with DCM than in control subjects at 7 T, which is consistent with previous findings at lower field strengths.

Local Multi-Channel RF Surface Coil versus Body RF Coil Transmission for Cardiac Magnetic Resonance at 3 Tesla: Which Configuration Is Winning the Game?

INTRODUCTION

The purpose of this study was to demonstrate the feasibility and efficiency of cardiac MR at 3 Tesla using local four-channel RF coil transmission and benchmark it against large volume body RF coil excitation.

METHODS

Electromagnetic field simulations are conducted to detail RF power deposition, transmission field uniformity and efficiency for local and body RF coil transmission. For both excitation regimes transmission field maps are acquired in a human torso phantom. For each transmission regime flip angle distributions and blood-myocardium contrast are examined in a volunteer study of 12 subjects. The feasibility of the local transceiver RF coil array for cardiac chamber quantification at 3 Tesla is demonstrated.

RESULTS

Our simulations and experiments demonstrate that cardiac MR at 3 Tesla using four-channel surface RF coil transmission is competitive versus current clinical CMR practice of large volume body RF coil transmission. The efficiency advantage of the 4TX/4RX setup facilitates shorter repetition times governed by local SAR limits versus body RF coil transmission at whole-body SAR limit. No statistically significant difference was found for cardiac chamber quantification derived with body RF coil versus four-channel surface RF coil transmission. Our simulation also show that the body RF coil exceeds local SAR limits by a factor of ~2 when driven at maximum applicable input power to reach the whole-body SAR limit.

CONCLUSION

Pursuing local surface RF coil arrays for transmission in cardiac MR is a conceptually appealing alternative to body RF coil transmission, especially for patients with implants.

ECG Triggering in Ultra-High Field Cardiovascular MRI

Cardiac magnetic resonance imaging at ultra-high field (B₀ ≥ 7 T) potentially provides improved resolution and new opportunities for tissue characterization. Although an accurate synchronization of the acquisition to the cardiac cycle is essential, electrocardiogram (ECG) triggering at ultra-high field can be significantly impacted by the magnetohydrodynamic (MHD) effect. Blood flow within a static magnetic field induces a voltage, which superimposes the ECG and often affects the recognition of the R-wave. The MHD effect scales with B₀ and is particularly pronounced at ultra-high field creating triggering-related image artifacts. Here, we investigated the performance of a conventional 3-lead ECG trigger device and a state-of-the-art trigger algorithm for cardiac ECG synchronization at 7 T. We show that by appropriate subject preparation and by including a learning phase for the R-wave detection outside of the magnetic field, reliable ECG triggering is feasible in healthy subjects at 7 T without additional equipment. Ultra-high field cardiac imaging was performed with the ECG signal and the trigger events recorded in 8 healthy subjects. Despite severe ECG signal distortions, synchronized imaging was successfully performed. Recorded ECG signals, vectorcardiograms, and large consistency in trigger event spacing indicate high accuracy for R-wave detection.

W(h)ither human cardiac and body magnetic resonance at ultrahigh fields? technical advances, practical considerations, applications, and clinical opportunities

The objective of this study was to document and review advances and groundbreaking progress in cardiac and body MR at ultrahigh fields (UHF, B0 ≥ 7.0 T) with the goal to attract talent, clinical adopters, collaborations and resources to the biomedical and diagnostic imaging communities. This review surveys traits, advantages and challenges of cardiac and body MR at 7.0 T. The considerations run the gamut from technical advances to clinical opportunities. Key concepts, emerging technologies, practical considerations, frontier applications and future directions of UHF body and cardiac MR are provided. Examples of UHF cardiac and body imaging strategies are demonstrated. Their added value over the kindred counterparts at lower fields is explored along with an outline of research promises. The achievements of cardiac and body UHF-MR are powerful motivators and enablers, since extra speed, signal and imaging capabilities may be invested to overcome the fundamental constraints that continue to hamper traditional cardiac and body MR applications. If practical obstacles, concomitant physics effects and technical impediments can be overcome in equal measure, sophisticated cardiac and body UHF-MR will help to open the door to new MRI and MRS approaches for basic research and clinical science, with the lessons learned at 7.0 T being transferred into broad clinical use including diagnostics and therapy guiding at lower fields. Copyright © 2015 John Wiley & Sons, Ltd.

Myocardial effective transverse relaxation time T2* Correlates with left ventricular wall thickness: A 7.0 T MRI study

PURPOSE

Myocardial effective relaxation time T2* is commonly regarded as a surrogate for myocardial tissue oxygenation. However, it is legitimate to assume that there are multiple factors that influence T2*. To this end, this study investigates the relationship between T2* and cardiac macromorphology given by left ventricular (LV) wall thickness and left ventricular radius, and provides interpretation of the results in the physiological context.

METHODS

High spatio-temporally resolved myocardial CINE T2* mapping was performed in 10 healthy volunteers using a 7.0 Tesla (T) full-body MRI system. Ventricular septal wall thickness, left ventricular inner radius, and T2* were analyzed. Macroscopic magnetic field changes were elucidated using cardiac phase-resolved magnetic field maps.

RESULTS

Ventricular septal T2* changes periodically over the cardiac cycle, increasing in systole and decreasing in diastole. Ventricular septal wall thickness and T2* showed a significant positive correlation, whereas the inner LV radius and T2* were negatively correlated. The effect of macroscopic magnetic field gradients on T2* can be considered minor in the ventricular septum.

CONCLUSION

Our findings suggest that myocardial T2* is related to tissue blood volume fraction. Temporally resolved T2* mapping could be beneficial for myocardial tissue characterization and for understanding cardiac (patho)physiology in vivo. Magn Reson Med 77:2381-2389, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Dilated Cardiomyopathy: Phosphorus 31 MR Spectroscopy at 7 T

Cardiac phosphorus spectroscopy is demonstrated to be feasible in patients at 7 T, giving higher signal-to-noise ratios and more precise quantification of the phosphocreatine to adenosine triphosphate concentration ratio than at 3 T in a group of 25 patients with dilated cardiomyopathy.

Purpose

To test whether the increased signal-to-noise ratio of phosphorus 31 (³¹P) magnetic resonance (MR) spectroscopy at 7 T improves precision in cardiac metabolite quantification in patients with dilated cardiomyopathy (DCM) compared with that at 3 T.

Materials and Methods

Ethical approval was obtained, and participants provided written informe consent. In a prospective study, ³¹P MR spectroscopy was performed at 3 T and 7 T in 25 patients with DCM. Ten healthy matched control subjects underwent ³¹P MR spectroscopy at 7 T. Paired Student t tests were performed to compare results between the 3-T and 7-T studies.

Results

The phosphocreatine (PCr) signal-to-noise ratio increased 2.5 times at 7 T compared with that at 3 T. The PCr to adenosine triphosphate (ATP) concentration ratio (PCr/ATP) was similar at both field strengths (mean ± standard deviation, 1.48 ± 0.44 at 3 T vs 1.54 ± 0.39 at 7 T, P = .49), as expected. The Cramér-Rao lower bounds in PCr concentration (a measure of uncertainty in the measured ratio) were 45% lower at 7 T than at 3 T, reflecting the higher quality of 7-T ³¹P spectra. Patients with dilated cardioyopathy had a significantly lower PCr/ATP than did healthy control subjects at 7 T (1.54 ± 0.39 vs 1.95 ± 0.25, P = .005), which is consistent with previous findings.

Conclusion

7-T cardiac ³¹P MR spectroscopy is feasible in patients with DCM and gives higher signal-to-noise ratios and more precise quantification of the PCr/ATP than that at 3 T. PCr/ATP was significantly lower in patients with DCM than in control subjects at 7 T, which is consistent with previous findings at lower field strengths.

Doppler Ultrasound Triggering for Cardiovascular MRI at 3T in a Healthy Volunteer Study

Purpose:

Electrocardiogram (ECG) triggering for cardiac magnetic resonance (CMR) may be influenced by electromagnetic interferences with increasing magnetic field strength. The aim of this study was to evaluate the performance of Doppler ultrasound (DUS) as an alternative trigger technique for CMR in comparison to ECG and pulse oximetry (POX) at 3T and using different sequence types.

Methods:

Balanced turbo field echo two-dimensional (2D) short axis cine CMR and 2D phase-contrast angiography of the ascending aorta was performed in 11 healthy volunteers at 3T using ECG, DUS, and POX for cardiac triggering. DUS and POX triggering were compared to the reference standard of ECG in terms of trigger quality (trigger detection and temporal variability), image quality [endocardial blurring (EB)], and functional measurements [left ventricular (LV) volumetry and aortic blood flow velocimetry].

Results:

Trigger signal detection and temporal variability did not differ significantly between ECG/DUS (I = 0.6) and ECG/POX (P = 0.4). Averaged EB was similar for ECG, DUS, and POX (p_ECG/DUS = 0.4, p_ECG/POX = 0.9). Diastolic EB was significantly decreased for DUS in comparison to ECG (P = 0.02) and POX (P = 0.04). The LV function assessment and aortic blood flow were not significantly different.

Conclusion:

This study demonstrated the feasibility of DUS for gating human CMR at 3T. The magnetohydrodynamic effect did not significantly disturb ECG triggering in this small healthy volunteer study. DUS showed a significant improvement in diastolic EB but could not be identified as a superior trigger method. The potential benefit of DUS has to be evaluated in a larger clinical patient population.

High Spatial Resolution Cardiovascular Magnetic Resonance at 7.0 Tesla in Patients with Hypertrophic Cardiomyopathy - First Experiences: Lesson Learned from 7.0 Tesla

BACKGROUND

Cardiovascular Magnetic Resonance (CMR) provides valuable information in patients with hypertrophic cardiomyopathy (HCM) based on myocardial tissue differentiation and the detection of small morphological details. CMR at 7.0T improves spatial resolution versus today's clinical protocols. This capability is as yet untapped in HCM patients. We aimed to examine the feasibility of CMR at 7.0T in HCM patients and to demonstrate its capability for the visualization of subtle morphological details.

METHODS

We screened 131 patients with HCM. 13 patients (9 males, 56 ±31 years) and 13 healthy age- and gender-matched subjects (9 males, 55 ±31years) underwent CMR at 7.0T and 3.0T (Siemens, Erlangen, Germany). For the assessment of cardiac function and morphology, 2D CINE imaging was performed (voxel size at 7.0T: (1.4x1.4x2.5) mm3 and (1.4x1.4x4.0) mm3; at 3.0T: (1.8x1.8x6.0) mm3). Late gadolinium enhancement (LGE) was performed at 3.0T for detection of fibrosis.

RESULTS

All scans were successful and evaluable. At 3.0T, quantification of the left ventricle (LV) showed similar results in short axis view vs. the biplane approach (LVEDV, LVESV, LVMASS, LVEF) (p = 0.286; p = 0.534; p = 0.155; p = 0.131). The LV-parameters obtained at 7.0T where in accordance with the 3.0T data (pLVEDV = 0.110; pLVESV = 0.091; pLVMASS = 0.131; pLVEF = 0.182). LGE was detectable in 12/13 (92%) of the HCM patients. High spatial resolution CINE imaging at 7.0T revealed hyperintense regions, identifying myocardial crypts in 7/13 (54%) of the HCM patients. All crypts were located in the LGE-positive regions. The crypts were not detectable at 3.0T using a clinical protocol.

CONCLUSIONS

CMR at 7.0T is feasible in patients with HCM. High spatial resolution gradient echo 2D CINE imaging at 7.0T allowed the detection of subtle morphological details in regions of extended hypertrophy and LGE.