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Castellanos DA, Jang J, Schidlow DN, Brassaw K, Agudelo S, Heuvelink-Marck A, Lipsitz SR, Powell AJ. The impact of audiovisual breathing guidance on respiratory-triggered cardiac magnetic resonance cine imaging. Magn Reson Imaging 2024; 111:15-20. [PMID: 38579974 DOI: 10.1016/j.mri.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/15/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND In patients who have difficulty holding their breath, a free breathing (FB) respiratory-triggered (RT) bSSFP cine technique may be used. However, this technique may have inferior image quality and a longer scan time than breath-hold (BH) bSSFP cine acquisitions. This study examined the effect of an audiovisual breathing guidance (BG) system on RT bSSFP cine image quality, scan time, and ventricular measurements. METHODS This study evaluated a BG system that provides audiovisual instructions and feedback on the timing of inspiration and expiration to the patient during image acquisition using input from the respiratory bellows to guide them toward a regular breathing pattern with extended end-expiration. In this single-center prospective study in patients undergoing a clinical cardiac magnetic resonance examination, a ventricular short-axis stack of bSSFP cine images was acquired using 3 techniques in each patient: 1) FB and RT (FBRT), 2) BG system and RT (BGRT), and 3) BH. The 3 acquisitions were compared for image quality metrics (endocardial edge definition, motion artifact, and blood-to-myocardial contrast) scored on a Likert scale, scan time, and ventricular volumes and mass. RESULTS Thirty-two patients (19 females; median age 21 years, IQR 18-32) completed the study protocol. For scan time, BGRT was faster than FBRT (163 s vs. 345 s, p < 0.001). Endocardial edge definition, motion artifact, and blood-to-myocardial contrast were all better for BGRT than FBRT (p < 0.001). Left ventricular (LV) end-systolic volume (ESV) was smaller (3%, p = 0.02) and LV ejection fraction (EF) was larger (0.5%, p = 0.003) with BGRT than with FBRT. There was no significant difference in LV end-diastolic volume (EDV), LV mass, right ventricular (RV) EDV, RV ESV, and RV EF. Scan times were shorter for BGRT compared to BH. Endocardial edge definition and blood-to-myocardial contrast were better for BH than BGRT. Compared to BH, the LV EDV, LV ESV, RV EDV, and RV ESV were mildly smaller (all differences <7%) for BGRT. CONCLUSIONS The addition of a BG system to RT bSSFP cine acquisitions decreased the scan time and improved image quality. Further exploration of this BG approach is warranted in more diverse populations and with other free breathing sequences.
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Affiliation(s)
- Daniel A Castellanos
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Jihye Jang
- Philips Healthcare, Gainesville, FL, USA
| | - David N Schidlow
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Kinsey Brassaw
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Stephanie Agudelo
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | | | - Stuart R Lipsitz
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Gallo-Bernal S, Bedoya MA, Gee MS, Jaimes C. Pediatric magnetic resonance imaging: faster is better. Pediatr Radiol 2022:10.1007/s00247-022-05529-x. [PMID: 36261512 DOI: 10.1007/s00247-022-05529-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/29/2022] [Accepted: 10/03/2022] [Indexed: 10/24/2022]
Abstract
Magnetic resonance imaging (MRI) has emerged as the preferred imaging modality for evaluating a wide range of pediatric medical conditions. Nevertheless, the long acquisition times associated with this technique can limit its widespread use in young children, resulting in motion-degraded or non-diagnostic studies. As a result, sedation or general anesthesia is often necessary to obtain diagnostic images, which has implications for the safety profile of MRI, the cost of the exam and the radiology department's clinical workflow. Over the last decade, several techniques have been developed to increase the speed of MRI, including parallel imaging, single-shot acquisition, controlled aliasing techniques, compressed sensing and artificial-intelligence-based reconstructions. These are advantageous because shorter examinations decrease the need for sedation and the severity of motion artifacts, increase scanner throughput, and improve system efficiency. In this review we discuss a framework for image acceleration in children that includes the synergistic use of state-of-the-art MRI hardware and optimized pulse sequences. The discussion is framed within the context of pediatric radiology and incorporates the authors' experience in deploying these techniques in routine clinical practice.
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Affiliation(s)
- Sebastian Gallo-Bernal
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - M Alejandra Bedoya
- Department of Radiology, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., 2nd floor, Main Building, Boston, MA, 02115, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Camilo Jaimes
- Department of Radiology, Harvard Medical School, Boston, MA, USA. .,Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., 2nd floor, Main Building, Boston, MA, 02115, USA.
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Gentle Touch: Noninvasive Approaches to Improve Patient Comfort and Cooperation for Pediatric Imaging. Top Magn Reson Imaging 2021; 29:187-195. [PMID: 32541256 DOI: 10.1097/rmr.0000000000000245] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pediatric imaging presents unique challenges related to patient anxiety, cooperation, and safety. Techniques to reduce anxiety and patient motion in adults must often be augmented in pediatrics, because it is always mentioned in the field of pediatrics, children are not miniature adults. This article will review methods that can be considered to improve patient experience and cooperation in imaging studies. Such techniques can range from modifications to the scanner suite, different ways of preparing and interacting with children, collaborating with parents for improved patient care, and technical advances such as accelerated acquisition and motion correction to reduce artifact. Special considerations for specific populations including transgender patients, neonates, and pregnant women undergoing fetal imaging will be described. The unique risks of sedation in children will also be briefly reviewed.
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Brunnquell CL, Hoff MN, Balu N, Nguyen XV, Oztek MA, Haynor DR. Making Magnets More Attractive: Physics and Engineering Contributions to Patient Comfort in MRI. Top Magn Reson Imaging 2020; 29:167-174. [PMID: 32541257 DOI: 10.1097/rmr.0000000000000246] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Patient comfort is an important factor of a successful magnetic resonance (MR) examination, and improvements in the patient's MR scanning experience can contribute to improved image quality, diagnostic accuracy, and efficiency in the radiology department, and therefore reduced cost. Magnet designs that are more open and accessible, reduced auditory noise of MR examinations, light and flexible radiofrequency (RF) coils, and faster motion-insensitive imaging techniques can all significantly improve the patient experience in MR imaging. In this work, we review the design, development, and implementation of these physics and engineering approaches to improve patient comfort.
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Affiliation(s)
- Christina L Brunnquell
- Department of Radiology, University of Washington, Seattle, WA Department of Radiology, The Ohio State University Wexler Medical Center, Columbus, OH
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Manning WJ. Journal of Cardiovascular Magnetic Resonance 2017. J Cardiovasc Magn Reson 2018; 20:89. [PMID: 30593280 PMCID: PMC6309095 DOI: 10.1186/s12968-018-0518-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023] Open
Abstract
There were 106 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2017, including 92 original research papers, 3 reviews, 9 technical notes, and 1 Position paper, 1 erratum and 1 correction. The volume was similar to 2016 despite an increase in manuscript submissions to 405 and thus reflects a slight decrease in the acceptance rate to 26.7%. The quality of the submissions continues to be high. The 2017 JCMR Impact Factor (which is published in June 2018) was minimally lower at 5.46 (vs. 5.71 for 2016; as published in June 2017), which is the second highest impact factor ever recorded for JCMR. The 2017 impact factor means that an average, each JCMR paper that were published in 2015 and 2016 was cited 5.46 times in 2017.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in continuus fashion and in the chronologic order of acceptance, with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or theme, so that readers can view areas of interest in a single article in relation to each other and other contemporary JCMR articles. In this publication, the manuscripts are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought within the journal. In addition, I have elected to use this format to convey information regarding the editorial process to the readership.I hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your very best, high quality manuscripts to JCMR for consideration. I thank our very dedicated Associate Editors, Guest Editors, and Reviewers for their efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the forefront journal of our field. And finally, I thank you for entrusting me with the editorship of the JCMR as I begin my 3rd year as your editor-in-chief. It has been a tremendous learning experience for me and the opportunity to review manuscripts that reflect the best in our field remains a great joy and highlight of my week!
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
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Manning WJ. Review of Journal of Cardiovascular Magnetic Resonance (JCMR) 2015-2016 and transition of the JCMR office to Boston. J Cardiovasc Magn Reson 2017; 19:108. [PMID: 29284487 PMCID: PMC5747150 DOI: 10.1186/s12968-017-0423-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023] Open
Abstract
The Journal of Cardiovascular Magnetic Resonance (JCMR) is the official publication of the Society for Cardiovascular Magnetic Resonance (SCMR). In 2016, the JCMR published 93 manuscripts, including 80 research papers, 6 reviews, 5 technical notes, 1 protocol, and 1 case report. The number of manuscripts published was similar to 2015 though with a 12% increase in manuscript submissions to an all-time high of 369. This reflects a decrease in the overall acceptance rate to <25% (excluding solicited reviews). The quality of submissions to JCMR continues to be high. The 2016 JCMR Impact Factor (which is published in June 2016 by Thomson Reuters) was steady at 5.601 (vs. 5.71 for 2015; as published in June 2016), which is the second highest impact factor ever recorded for JCMR. The 2016 impact factor means that the JCMR papers that were published in 2014 and 2015 were on-average cited 5.71 times in 2016.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in the order that they are accepted with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or themes, so that readers can view areas of interest in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes with previously published JCMR papers to guide continuity of thought in the journal. In addition, I have elected to open this publication with information for the readership regarding the transition of the JCMR editorial office to the Beth Israel Deaconess Medical Center, Boston and the editorial process.Though there is an author publication charge (APC) associated with open-access to cover the publisher's expenses, this format provides a much wider distribution/availability of the author's work and greater manuscript citation. For SCMR members, there is a substantial discount in the APC. I hope that you will continue to send your high quality manuscripts to JCMR for consideration. Importantly, I also ask that you consider referencing recent JCMR publications in your submissions to the JCMR and elsewhere as these contribute to our impact factor. I also thank our dedicated Associate Editors, Guest Editors, and reviewers for their many efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the leading publication in our field.
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Affiliation(s)
- Warren J Manning
- From the Journal of Cardiovascular Magnetic Resonance Editorial Office and the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Moghari MH, Barthur A, Amaral ME, Geva T, Powell AJ. Free-breathing whole-heart 3D cine magnetic resonance imaging with prospective respiratory motion compensation. Magn Reson Med 2017; 80:181-189. [PMID: 29222852 DOI: 10.1002/mrm.27021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/11/2017] [Accepted: 10/31/2017] [Indexed: 12/27/2022]
Abstract
PURPOSE To develop and validate a new prospective respiratory motion compensation algorithm for free-breathing whole-heart 3D cine steady-state free precession (SSFP) imaging. METHODS In a 3D cine SSFP sequence, 4 excitations per cardiac cycle are re-purposed to prospectively track heart position. Specifically, their 1D image is reconstructed and routed into the scanner's standard diaphragmatic navigator processing system. If all 4 signals are in end-expiration, cine image data from the entire cardiac cycle is accepted for image reconstruction. Prospective validation was carried out in patients (N = 17) by comparing in each a conventional breath-hold 2D cine ventricular short-axis stack and a free-breathing whole-heart 3D cine data set. RESULTS All 3D cine SSFP acquisitions were successful and the mean scan time was 5.9 ± 2.7 min. Left and right ventricular end-diastolic, end-systolic, and stroke volumes by 3D cine SSFP were all larger than those from 2D cine SSFP. This bias was < 6% except for right ventricular end-systolic volume that was 12%. The 3D cine images had a lower ventricular blood-to-myocardium contrast ratio, contrast-to-noise ratio, mass, and subjective quality score. CONCLUSION The novel prospective respiratory motion compensation method for 3D cine SSFP imaging was robust and efficient and yielded slightly larger ventricular volumes and lower mass compared to breath-hold 2D cine imaging. Magn Reson Med 80:181-189, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Mehdi H Moghari
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashita Barthur
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maria E Amaral
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Hamlet SM, Haggerty CM, Suever JD, Wehner GJ, Andres KN, Powell DK, Charnigo RJ, Fornwalt BK. Using a respiratory navigator significantly reduces variability when quantifying left ventricular torsion with cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:25. [PMID: 28245864 PMCID: PMC5331707 DOI: 10.1186/s12968-017-0338-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 02/08/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Left ventricular (LV) torsion is an important indicator of cardiac function that is limited by high inter-test variability (50% of the mean value). We hypothesized that this high inter-test variability is partly due to inconsistent breath-hold positions during serial image acquisitions, which could be significantly improved by using a respiratory navigator for cardiovascular magnetic resonance (CMR) based quantification of LV torsion. METHODS We assessed respiratory-related variability in measured LV torsion with two distinct experimental protocols. First, 17 volunteers were recruited for CMR with cine displacement encoding with stimulated echoes (DENSE) in which a respiratory navigator was used to measure and then enforce variability in end-expiratory position between all LV basal and apical acquisitions. From these data, we quantified the inter-test variability of torsion in the absence and presence of enforced end-expiratory position variability, which established an upper bound for the expected torsion variability. For the second experiment (in 20 new, healthy volunteers), 10 pairs of cine DENSE basal and apical images were each acquired from consecutive breath-holds and consecutive navigator-gated scans (with a single acceptance position). Inter-test variability of torsion was compared between the breath-hold and navigator-gated scans to quantify the variability due to natural breath-hold variation. To demonstrate the importance of these variability reductions, we quantified the reduction in sample size required to detect a clinically meaningful change in LV torsion with the use of a respiratory navigator. RESULTS The mean torsion was 3.4 ± 0.2°/cm. From the first experiment, enforced variability in end-expiratory position translated to considerable variability in measured torsion (0.56 ± 0.34°/cm), whereas inter-test variability with consistent end-expiratory position was 57% lower (0.24 ± 0.16°/cm, p < 0.001). From the second experiment, natural respiratory variability from consecutive breath-holds translated to a variability in torsion of 0.24 ± 0.10°/cm, which was significantly higher than the variability from navigator-gated scans (0.18 ± 0.06°/cm, p = 0.02). By using a respiratory navigator with DENSE, theoretical sample sizes were reduced from 66 to 16 and 26 to 15 as calculated from the two experiments. CONCLUSIONS A substantial portion (22-57%) of the inter-test variability of LV torsion can be reduced by using a respiratory navigator to ensure a consistent breath-hold position between image acquisitions.
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Affiliation(s)
- Sean M. Hamlet
- Department of Electrical and Computer Engineering, University of Kentucky, Lexington, KY USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
| | - Christopher M. Haggerty
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Imaging Science and Innovation, Geisinger Health System, Danville, PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Jonathan D. Suever
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Imaging Science and Innovation, Geisinger Health System, Danville, PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Gregory J. Wehner
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | | | - David K. Powell
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - Richard J. Charnigo
- Departments of Biostatistics and Statistics, University of Kentucky, Lexington, KY USA
| | - Brandon K. Fornwalt
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Imaging Science and Innovation, Geisinger Health System, Danville, PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
- Departments of Physiology and Medicine, University of Kentucky, Lexington, KY USA
- Department of Radiology, Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822-4400 USA
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Hamlet SM, Haggerty CM, Suever JD, Wehner GJ, Andres KN, Powell DK, Zhong X, Fornwalt BK. Optimal configuration of respiratory navigator gating for the quantification of left ventricular strain using spiral cine displacement encoding with stimulated echoes (DENSE) MRI. J Magn Reson Imaging 2016; 45:786-794. [PMID: 27458823 DOI: 10.1002/jmri.25389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/29/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To determine the optimal respiratory navigator gating configuration for the quantification of left ventricular strain using spiral cine displacement encoding with stimulated echoes (DENSE) MRI. MATERIALS AND METHODS Two-dimensional spiral cine DENSE was performed on a 3 Tesla MRI using two single-navigator configurations (retrospective, prospective) and a combined "dual-navigator" configuration in 10 healthy adults and 20 healthy children. The adults also underwent breathhold DENSE as a reference standard for comparisons. Peak left ventricular strains, signal-to-noise ratio (SNR), and navigator efficiency were compared. Subjects also underwent dual-navigator gating with and without visual feedback to determine the effect on navigator efficiency. RESULTS There were no differences in circumferential, radial, and longitudinal strains between navigator-gated and breathhold DENSE (P = 0.09-0.95) (as confidence intervals, retrospective: [-1.0%-1.1%], [-7.4%-2.0%], [-1.0%-1.2%]; prospective: [-0.6%-2.7%], [-2.8%-8.3%], [-0.3%-2.9%]; dual: [-1.6%-0.5%], [-8.3%-3.2%], [-0.8%-1.9%], respectively). The dual configuration maintained SNR compared with breathhold acquisitions (16 versus 18, P = 0.06). SNR for the prospective configuration was lower than for the dual navigator in adults (P = 0.004) and children (P < 0.001). Navigator efficiency was higher (P < 0.001) for both retrospective (54%) and prospective (56%) configurations compared with the dual configuration (35%). Visual feedback improved the dual configuration navigator efficiency to 55% (P < 0.001). CONCLUSION When quantifying left ventricular strains using spiral cine DENSE MRI, a dual navigator configuration results in the highest SNR in adults and children. In adults, a retrospective configuration has good navigator efficiency without a substantial drop in SNR. Prospective gating should be avoided because it has the lowest SNR. Visual feedback represents an effective option to maintain navigator efficiency while using a dual navigator configuration. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:786-794.
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Affiliation(s)
- Sean M Hamlet
- Department of Electrical and Computer Engineering, University of Kentucky, Lexington, Kentucky, USA.,Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | - Christopher M Haggerty
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.,Institute for Advanced Application, Geisinger Health System, Danville, Pennsylvania, USA
| | - Jonathan D Suever
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.,Institute for Advanced Application, Geisinger Health System, Danville, Pennsylvania, USA
| | - Gregory J Wehner
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.,Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky, USA
| | - Kristin N Andres
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | - David K Powell
- Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky, USA
| | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Atlanta, GA, USA
| | - Brandon K Fornwalt
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.,Institute for Advanced Application, Geisinger Health System, Danville, Pennsylvania, USA.,Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky, USA.,Department of Physiology, University of Kentucky, Lexington, Kentucky, USA.,Department of Medicine, University of Kentucky, Lexington, Kentucky, USA
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