ECG-gated multiecho Dixon fat-water separation in cardiac MRI: advantages over conventional fat-saturated imaging

Artifacts at Cardiac MRI: Imaging Appearances and Solutions

Cardiac MRI (CMR) is an important imaging modality in the evaluation of cardiovascular diseases. CMR image acquisition is technically challenging, which in some circumstances is associated with artifacts, both general as well as sequence specific. Recognizing imaging artifacts, understanding their causes, and applying effective approaches for artifact mitigation are critical for successful CMR. Balanced steady-state free precession (bSSFP), the most common CMR sequence, is associated with band and flow artifacts, which are amplified at 3-T imaging. This can be mitigated by targeted shimming, by short repetition time, or by using a frequency-scout sequence. In patients with cardiac arrhythmias or poor breath hold, the quality of cine imaging can be improved with a non-electrocardiographically gated free-breathing real-time sequence. Motion artifacts on late gadolinium enhancement (LGE) images can be mitigated by using single-shot technique with motion compensation and signal averaging. LGE images are also prone to partial-volume averaging and incomplete myocardial nulling. In phase-contrast imaging, aliasing artifact is seen when the velocity of blood is higher than the encoded velocity. Aliasing can be mitigated by increasing the encoded velocity or using postprocessing software. In first-pass perfusion imaging, a dark rim artifact due to Gibbs ringing can be distinguished from a true perfusion defect based on earlier appearance and fading after a few cardiac cycles. With implanted cardiac devices, artifactual high signal intensity mimicking scar is seen on LGE images, which can be mitigated using a wide-band sequence. With devices and metallic artifacts, traditional gradient-recalled echo sequence has fewer artifacts than bSSFP. CMR at 3 T requires adaptation of sequences to minimize artifacts. ©RSNA, 2025 Supplemental material is available for this article.

Cardiac MRI at Low Field Strengths

Cardiac MR imaging is well established for assessment of cardiovascular structure and function, myocardial scar, quantitative flow, parametric mapping, and myocardial perfusion. Despite the clear evidence supporting the use of cardiac MRI for a wide range of indications, it is underutilized clinically. Recent developments in low-field MRI technology, including modern data acquisition and image reconstruction methods, are enabling high-quality low-field imaging that may improve the cost-benefit ratio for cardiac MRI. Studies to-date confirm that low-field MRI offers high measurement concordance and consistent interpretation with clinical imaging for several routine sequences. Moreover, low-field MRI may enable specific new clinical opportunities for cardiac imaging such as imaging near metal implants, MRI-guided interventions, combined cardiopulmonary assessment, and imaging of patients with severe obesity. In this review, we discuss the recent progress in low-field cardiac MRI with a focus on technical developments and early clinical validation studies. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 1.

Radial and Circumferential CMR-Based RV Strain Predicts Low R Wave Amplitude after ICD Implantation in Patients with Arrhythmogenic Cardiomyopathy

Inadequate R wave amplitude (RWA) after implantable cardiac defibrillator (ICD) implantation in patients with arrhythmogenic cardiomyopathy (ACM) was suspected to relate to right ventricle impairment. However, little data-based evidence was provided to quantify the association. We retrospectively enrolled ACM patients receiving CMR examinations before transvenous ICD implantation from Fuwai Hospital. The RWA was obtained within 24 h and at 2-6-month follow-up after the operation. Structural, functional, as well as tissue characterization of the left ventricle (LV) and right ventricle (RV), were analyzed in relation to RWA. Among the 87 ACM patients (median RWA: 8.0 mV), 19 (21.8%) patients were found with low initial RWA (<5 mV) despite attempts in multiple positions. RV end diastolic diameter (RVEDD), (r = -0.44), RV ejection fraction (RVEF, r = 0.43), RV end diastolic volume index (RVEDVi, r = -0.49), RV end systolic volume index (RVESVi, r = -0.53), RV global circumferential (RVGCS, r = -0.64), and radial strain (RVGRS, r = 0.61, all p < 0.001) rather than LV metrics correlated strongly with initial RWA. RVGCS, RVESVi, and RVGRS were decent predictors of low RWA (areas under the curve AUC: 0.814, 0.769, 0.757, respectively) early after implantation and during 2-6-month follow-up. To summarize, low RWA of ICD lead in ACM patients was associated with RV abnormalities. The RVGCS, RVGRS, and RVESVi can be valuable predictors for identifying low RWA prior to ICD implantation.

Cardiac MRF using rosette trajectories for simultaneous myocardial T1, T2, and proton density fat fraction mapping

The goal of this work is to extend prior work on cardiac MR Fingerprinting (cMRF) using rosette k-space trajectories to enable simultaneous T₁, T₂, and proton density fat fraction (PDFF) mapping in the heart. A rosette trajectory designed for water-fat separation at 1.5T was used in a 2D ECG-triggered 15-heartbeat cMRF sequence. Water and fat specific T₁ and T₂ maps were generated from the cMRF data. A PDFF map was also retrieved using Hierarchical IDEAL by segmenting the rosette cMRF data into multiple echoes. The accuracy of rosette cMRF in T₁, T₂, and PDFF quantification was validated in the ISMRM/NIST phantom and an in-house built fat fraction phantom, respectively. The proposed method was also applied for myocardial tissue mapping of healthy subjects and cardiac patients at 1.5T. T₁, T₂, and PDFF values measured using rosette cMRF in the ISMRM/NIST phantom and the fat fraction phantom agreed well with the reference values. In 16 healthy subjects, rosette cMRF yielded T₁ values which were 80~90 ms higher than spiral cMRF and MOLLI. T₂ values obtained using rosette cMRF were ~3 ms higher than spiral cMRF and ~5 ms lower than conventional T₂-prep bSSFP method. Rosette cMRF was also able to detect abnormal T₁ and T₂ values in cardiomyopathy patients and may provide more accurate maps due to effective fat suppression. In conclusion, this study shows that rosette cMRF has the potential for efficient cardiac tissue characterization through simultaneous quantification of myocardial T₁, T₂, and PDFF.

Diagnostic Accuracy of Standalone T2 Dixon Sequence Compared with Conventional MRI in Sacroiliitis

Aim  The aim of this article was to assess the profile of T2-weighted (T2W) multipoint Dixon sequence and conventional sequences in magnetic resonance imaging (MRI) of sacroiliac joints for the diagnosis of active and chronic sacroiliitis.

Settings and Design  Prospective observational study.

Materials and Methods  Thirty-seven patients with sacroiliitis underwent MRI with conventional coronal oblique short tau inversion recovery, T1W sequences, and T2W multipoint Dixon sequences. T1 fat-saturated postcontrast sequences were added in active cases. Comparisons were made between conventional and T2 Dixon sequences both quantitatively and qualitatively.

Statistical Analysis  Paired t -test was used to study the difference in contrast–noise ratio (CNR) between two groups. Chi-squared analysis with p -value of ≤ 0.05 was used to test the significant association of different sequences.

Results  Water only images had highest mean CNR (296.35 ± 208.28) for the detection of bone marrow edema/osteitis. T1W (186.09 ± 96.96) and opposed-phase (OP) images (279.22 ± 188.40) had highest mean CNR for the detection of subchondral sclerosis and periarticular fat deposition, respectively. OP images ( p -value <0.001) followed by fat-only (FO) images ( p -value = 0.001) were superior to T1W sequences in detecting periarticular fat deposition. In-phase (IP) images in detecting subchondral sclerosis and IP and FO images in detecting cortical erosions were comparable to conventional T1W sequences ( p -value < 0.001).

Conclusions  T2 Dixon sequences are superior or comparable to conventional MR sequences in detection of sacroiliitis, except ankylosis. Hence, Dixon can be used as a single sequence to replace the multiple sequences used in conventional imaging protocol of acute sacroiliac joints due to higher image quality. It can be used as an additional sequence in case of chronic sacroiliitis to increase the confidence and accuracy of diagnosis.

COVID-19 vs. Classical Myocarditis Associated Myocardial Injury Evaluated by Cardiac Magnetic Resonance and Endomyocardial Biopsy

Background: Despite the ongoing global pandemic, the impact of COVID-19 on cardiac structure and function is still not completely understood. Myocarditis is a rare but potentially serious complication of other viral infections with variable recovery, and is, in some cases, associated with long-term cardiac remodeling and functional impairment.

Aim: To assess myocardial injury in patients who recently recovered from an acute SARS-CoV-2 infection with advanced cardiac magnetic resonance imaging (CMR) and endomyocardial biopsy (EMB).

Methods: In total, 32 patients with persistent cardiac symptoms after a COVID-19 infection, 22 patients with acute classic myocarditis not related to COVID-19, and 16 healthy volunteers were included in this study and underwent a comprehensive baseline CMR scan. Of these, 10 patients post COVID-19 and 13 with non-COVID-19 myocarditis underwent a follow-up scan. In 10 of the post-COVID-19 and 15 of the non-COVID-19 patients with myocarditis endomyocardial biopsy (EMB) with histological, immunohistological, and molecular analysis was performed.

Results: In total, 10 (31%) patients with COVID-19 showed evidence of myocardial injury, eight (25%) presented with myocardial oedema, eight (25%) exhibited global or regional systolic left ventricular (LV) dysfunction, and nine (28%) exhibited impaired right ventricular (RV) function. However, only three (9%) of COVID-19 patients fulfilled updated CMR–Lake Louise criteria (LLC) for acute myocarditis. Regarding EMB, none of the COVID-19 patients but 87% of the non-COVID-19 patients with myocarditis presented histological findings in keeping with acute or chronic inflammation. COVID-19 patients with severe disease on the WHO scale presented with reduced biventricular longitudinal function, increased RV mass, and longer native T1 times compared with those with only mild or moderate disease.

Conclusions: In our cohort, CMR and EMB findings revealed that SARS-CoV-2 infection was associated with relatively mild but variable cardiac involvement. More symptomatic COVID-19 patients and those with higher clinical care demands were more likely to exhibit chronic inflammation and impaired cardiac function compared to patients with milder forms of the disease.

Free-breathing high resolution modified Dixon steady-state angiography with compressed sensing for the assessment of the thoracic vasculature in pediatric patients with congenital heart disease

BACKGROUND

Cardiovascular magnetic resonance angiography (CMRA) is a non-invasive imaging modality of choice in pediatric patients with congenital heart disease (CHD). This study was aimed to evaluate the diagnostic utility of a respiratory- and electrocardiogram-gated steady-state CMRA with modified Dixon (mDixon) fat suppression technique and compressed sensing in comparison to standard first-pass CMRA in pediatric patients with CHD at 3 T.

METHODS

In this retrospective single center study, pediatric CHD patients who underwent CMR with first-pass CMRA followed by mDixon steady-state CMRA at 3 T were analyzed. Image quality using a Likert scale from 5 (excellent) to 1 (non-diagnostic) and quality of fat suppression were assessed in consensus by two readers. Blood-to-tissue contrast and quantitative measurements of the thoracic vasculature were assessed separately by two readers. CMRA images were reevaluated by two readers for additional findings, which could be identified only on either one of the CMRA types. Paired Student t test, Wilcoxon test, and intraclass correlation coefficients (ICCs) were used for statistical analysis.

RESULTS

32 patients with CHD (3.3 ± 1.7 years, 13 female) were included. Overall image quality of steady-state mDixon CMRA was higher compared to first-pass CMRA (4.5 ± 0.5 vs. 3.3 ± 0.5; P < 0.001). Blood-to-tissue contrast ratio of steady-state mDixon CMRA was comparable to first-pass CMRA (7.85 ± 4.75 vs. 6.35 ± 2.23; P = 0.133). Fat suppression of steady-state mDixon CMRA was perfect in 30/32 (94%) cases. Vessel diameters were greater in first-pass CMRA compared to steady-state mDixon CMRA with the greatest differences at the level of pulmonary arteries and veins (e.g., right pulmonary artery for reader 1: 10.4 ± 2.4 vs. 9.9 ± 2.3 mm, P < 0.001). Interobserver agreement was higher for steady-state mDixon CMRA for all measurements compared to first-pass CMRA (ICCs > 0.92). In 9/32 (28%) patients, 10 additional findings were identified on mDixon steady-state CMRA (e.g., partial anomalous venous return, abnormalities of coronary arteries, subclavian artery stenosis), which were not depicted using first-pass CMRA.

CONCLUSIONS

Steady-state mDixon CMRA offers a robust fat suppression, a high image quality, and diagnostic utility for the assessment of the thoracic vasculature in pediatric CHD patients.

Myocardial T1 and T2 quantification and water-fat separation using cardiac MR fingerprinting with rosette trajectories at 3T and 1.5T

PURPOSE

This work aims to develop an approach for simultaneous water-fat separation and myocardial T₁ and T₂ quantification based on the cardiac MR fingerprinting (cMRF) framework with rosette trajectories at 3T and 1.5T.

METHODS

Two 15-heartbeat cMRF sequences with different rosette trajectories designed for water-fat separation at 3T and 1.5T were implemented. Water T₁ and T₂ maps, water image, and fat image were generated with B₀ inhomogeneity correction using a B₀ map derived from the cMRF data themselves. The proposed water-fat separation rosette cMRF approach was validated in the International Society for Magnetic Resonance in Medicine/National Institute of Standards and Technology MRI system phantom and water/oil phantoms. It was also applied for myocardial tissue mapping of healthy subjects at both 3T and 1.5T.

RESULTS

Water T₁ and T₂ values measured using rosette cMRF in the International Society for Magnetic Resonance in Medicine/National Institute of Standards and Technology phantom agreed well with the reference values. In the water/oil phantom, oil was well suppressed in the water images and vice versa. Rosette cMRF yielded comparable T₁ but 2~3 ms higher T₂ values in the myocardium of healthy subjects than the original spiral cMRF method. Epicardial fat deposition was also clearly shown in the fat images.

CONCLUSION

Rosette cMRF provides fat images along with myocardial T₁ and T₂ maps with significant fat suppression. This technique may improve visualization of the anatomical structure of the heart by separating water and fat and could provide value in diagnosing cardiac diseases associated with fibrofatty infiltration or epicardial fat accumulation. It also paves the way toward comprehensive myocardial tissue characterization in a single scan.

Comparing intramuscular adipose tissue on T1-weighted and two-point Dixon images

Purpose

The purpose of this study was to compare intramuscular adipose tissue content determined by two-point Dixon imaging and T1-weighted imaging, calculated using thresholding techniques.

Methods

In total, 19 nonobese younger adults (26.2 ± 4.9 years) and 13 older adults (72.2 ± 6.0 years) were recruited. Axial images of the mid-thigh were taken using T1-weighted and two-point Dixon sequences with a 3.0 T whole-body magnetic resonance device and used to measure intramuscular adipose tissue content of the vastus lateralis, adductor magnus, and long head of the biceps femoris.

Results

There was no significant difference in intramuscular adipose tissue content between T1-weighted and two-point Dixon imaging for the vastus lateralis (11.0 ± 4.4% and 12.2 ± 2.4%); however, intramuscular adipose tissue content determined by T1-weighted imaging was significantly higher than that of two-point Dixon imaging for the other muscles. Bland-Altman analysis showed a proportional bias for intramuscular adipose tissue calculations in all three muscles.

Conclusion

The validity of intramuscular adipose tissue content measurements between T1-weighted and two-point Dixon imaging is muscle-specific. This study showed discrepancies of intramuscular adipose tissue content between T1-weighted and two-point Dixon imaging.

Advances in knowledge

This study’s results suggest that care should be taken when selecting an imaging modality for intramuscular adipose tissue, especially for patients who would be suspected to have higher intramuscular adipose tissue values.

mDixon ECG-gated 3-dimensional cardiovascular magnetic resonance angiography in patients with congenital cardiovascular disease

BACKGROUND

Cardiovascular magnetic resonance (CMR) angiography (CMRA) is an important non-invasive imaging tool for congenital heart disease (CHD) and aortopathy patients. The conventional 3D balanced steady-state free precession (bSSFP) sequence is often confounded by imaging artifacts. We sought to compare the respiratory navigated and electrocardiogram (ECG) gated modified Dixon (mDixon) CMRA sequence to conventional non-gated dynamic multi-phase contrast enhanced CMRA (CE-CMRA) and bSSFP across a variety of diagnoses.

METHODS

We included 24 patients with CHD or aortopathy with CMR performed between September 2017 to December 2017. Each patient had undergone CE-CMRA, followed by a bSSFP and mDixon angiogram. Patients with CMR-incompatible implants or contraindications to contrast were excluded. The studies were rated according to image quality at a scale from 1 (poor) to 4 (excellent) based on diagnostic adequacy, artifact burden, vascular border delineation, myocardium-blood pool contrast, and visualization of pulmonary and systemic veins and coronaries. Contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and quantitative vascular measurements were compared between the two gated sequences. Bland-Altman plots were generated to compare paired measures.

RESULTS

All scans were diagnostically adequate. Mean (SD) quality scores were 3.4 (0.7) for the mDixon, 3.2 (0.5) for the bSSFP and 3.4 (0.5) for the CE-CMRA. Qualitatively, the intracardiac anatomy and myocardium-blood pool definition were better in the bSSFP; however, mDixon images showed enhanced vessel wall sharpness with less blurring surrounding the anatomical borders distally. Coronary origins were identified in all cases. Pulmonary veins were visualized in 92% of mDixon sequences, 75% of bSSFP and 96% of CE-CMRA. Similarly, neck veins were identified in 92, 83 and 96% respectively. Artifacts prevented vascular measurement in 6/192 (3%) and 4/192 (2%) of total vascular measurements for the mDixon and bSSFP, respectively. However, the size of signal void and field distortion were significantly worse in the latter, particularly for flow and metal induced artifacts.

CONCLUSION

In patients with congenital heart disease, ECG gated mDixon angiography yields high fidelity vascular images including better delineation of head and neck vasculature and pulmonary veins and fewer artifacts than the comparable bSSFP sequence. It should be considered as the preferred strategy for successful CHD imaging in patients with valve stenosis, vascular stents, or metallic implants.

Fat fraction mapping using magnetic resonance imaging: insight into pathophysiology

Adipose cells have traditionally been viewed as a simple, passive energy storage depot for triglycerides. However, in recent years it has become clear that adipose cells are highly physiologically active and have a multitude of endocrine, metabolic, haematological and immune functions. Changes in the number or size of adipose cells may be directly implicated in disease (e.g. in the metabolic syndrome), but may also be linked to other pathological processes such as inflammation, malignant infiltration or infarction. MRI is ideally suited to the quantification of fat, since most of the acquired signal comes from water and fat protons. Fat fraction (FF, the proportion of the acquired signal derived from fat protons) has, therefore, emerged as an objective, image-based biomarker of disease. Methods for FF quantification are becoming increasingly available in both research and clinical settings, but these methods vary depending on the scanner, manufacturer, imaging sequence and reconstruction software being used. Careful selection of the imaging method-and correct interpretation-can improve the accuracy of FF measurements, minimize potential confounding factors and maximize clinical utility. Here, we review methods for fat quantification and their strengths and weaknesses, before considering how they can be tailored to specific applications, particularly in the gastrointestinal and musculoskeletal systems. FF quantification is becoming established as a clinical and research tool, and understanding the underlying principles will be helpful to both imaging scientists and clinicians.

Left Atrial Epicardial Fat Volume Is Associated With Atrial Fibrillation: A Prospective Cardiovascular Magnetic Resonance 3D Dixon Study

BACKGROUND

Recent studies demonstrated a strong association between atrial fibrillation (AF) and epicardial fat around the left atrium (LA). We sought to assess whether epicardial fat volume around the LA is associated with AF, and to determine the additive value of LA-epicardial fat measurements to LA structural remodeling for identifying patients with AF using 3-dimensional multi-echo Dixon fat-water separated cardiovascular magnetic resonance.

METHODS AND RESULTS

A total of 105 subjects were studied: 53 patients with a history of AF and 52 age-matched patients with other cardiovascular diseases but no history of AF. The 3-dimensional multi-echo Dixon fat-water separated sequence was performed for LA-epicardial fat measurements. AF patients had significantly greater LA-epicardial fat (28.9±12.3 and 14.2±7.3 mL for AF and non-AF, respectively; P<0.001) and LA volume (110.8±38.2 and 89.7±30.3 mL for AF and non-AF, respectively; P=0.002). LA-epicardial fat adjusted for LA volume was still higher in patients with AF compared with those without AF (P<0.001). LA-epicardial fat and hypertension were independently associated with the risk of AF (odds ratio, 1.17; 95% confidence interval, 1.10%-1.25%, P<0.001, and odds ratio, 3.29; 95% confidence interval, 1.17%-9.27%, P=0.03, respectively). In multivariable logistic regression analysis adjusted for body surface area, LA-epicardial fat remained significant and an increase per mL was associated with a 42% increase in the odds of AF presence (odds ratio, 1.42; 95% confidence interval, 1.23%-1.62%, P<0.001). Combined assessment of LA-epicardial fat and LA volume provided greater discriminatory performance for detecting AF than LA volume alone (c-statistic=0.88 and 0.74, respectively, DeLong test; P<0.001).

CONCLUSIONS

Cardiovascular magnetic resonance 3-dimensional Dixon-based LA-epicardial fat volume is significantly increased in AF patients. LA-epicardial fat measured by 3-dimensional Dixon provides greater performance for detecting AF beyond LA structural remodeling.

Dynamics of intrapericardial and extrapericardial fat tissues during long-term, dietary-induced, moderate weight loss

Background: In view of evidence linking pericardial fat accumulation with increased cardiovascular disease risk, strategies to reduce its burden are needed. Data comparing the effects of specific long-term dietary interventions on pericardial fat tissue mobilization are sparse.Objective: We sought to evaluate intrapericardial-fat (IPF) and extrapericardial-fat (EPF) changes during weight-loss interventions by different dietary regimens.Design: During 18 mo of a randomized controlled trial, we compared a Mediterranean/low-carbohydrate (MED/LC) diet plus 28 g walnuts/d with a calorically equal low-fat (LF) diet among randomly assigned participants with moderate abdominal obesity. We performed whole-body MRI and volumetrically quantified IPF and EPF among 80 participants to follow the 18-mo changes.Results: The participants [mean age: 48.6 y; mean body mass index (BMI; in kg/m²); 31.7; 90% men] had baseline IPF and EPF (mean ± SD) volumes of 172.4 ± 53.3 mL and 194.9 ± 71.5 mL, respectively. The 18-mo moderate weight loss of 3.7 kg was similar in both groups, but the reduction in waist circumference was higher in the MED/LC group (-6.9 ± 6.6 cm) than in the LF diet group (-2.3 ± 6.5 cm; P = 0.01). After 18 mo, the IPF volume had reduced twice as much in the MED/LC group compared with the LF group [-37 ± 26.2 mL (-22% ± 15%) compared with -15.5 ± 26.2 mL (-8% ± 15%), respectively; P < 0.05, after adjustment for changes in weight or visceral adipose tissue]. The EPF volume had reduced similarly in both groups [-41.6 ± 30.2 mL (-23% ± 16%) in the MED/LC group compared with -37.9 ± 28.3 mL (-19% ± 14%) in the LF group; P > 0.1]. After controlling for weight loss, IPF and EPF volume reduction paralleled changes in lipid profile but not with improved glycemic profile variables: the IPF relative reduction was associated with a decrease in triglycerides (TGs) (β = 0.090; 95% CI: 0.026, 0.154; P = 0.007) and the ratio of TGs to high-density lipoprotein (HDL) cholesterol (β = 2.689; 95% CI: 0.373, 5.003; P = 0.024), and the EPF relative reduction was associated with an increase in HDL cholesterol (β = -0.452; 95% CI: -0.880, -0.023; P = 0.039) and a decrease in total cholesterol and HDL cholesterol (β = 3.766; 95% CI: 1.092, 6.440; P = 0.007).Conclusions: Moderate but persistent dietary-induced weight loss substantially decreased both IPF and EPF volumes. Reduction of pericardial adipose tissues is independently associated with an improved lipid profile. The Mediterranean diet, rich in unsaturated fats and restricted carbohydrates, is superior to an LF diet in terms of the IPF burden reduction. This trial was registered at clinicaltrials.gov as NCT01530724.

Fatty metaplasia quantification and impact on regional myocardial function as assessed by advanced cardiac MR imaging

Objective

This study aimed to investigate the advantages of recently developed cardiac imaging techniques of fat–water separation and feature tracking to characterize better individuals with chronic myocardial infarction (MI).

Materials and methods

Twenty patients who had a previous MI underwent CMR imaging. The study protocol included routine cine and late gadolinium enhancement (LGE) technique. In addition, mDixon LGE imaging was performed in every patient. Left ventricular (LV) circumferential (Ecc_LV) and radial (Err_LV) strain were calculated using dedicated software (CMR⁴², Circle, Calgary, Canada). The extent of global scar was measured in LGE and fat–water separated images to compare conventional and recent CMR imaging techniques.

Results

The infarct size derived from conventional LGE and fat–water separated images was similar. However, detection of lipomatous metaplasia was only possible with mDixon imaging. Subjects with fat deposition demonstrated a significantly smaller percentage of fibrosis than those without fat (10.68 ± 5.07% vs. 13.83 ± 6.30%; p = 0.005). There was no significant difference in Ecc_LV or Err_LV between myocardial segments containing fibrosis only and fibrosis with fat. However, Ecc_LV and Err_LV values were significantly higher in myocardial segments adjacent to fibrosis with fat deposition than in those adjacent to LGE only.

Conclusions

Advanced CMR imaging ensures more detailed tissue characterization in patients with chronic MI without a relevant increase in imaging and post-processing time. Fatty metaplasia may influence regional myocardial deformation especially in the myocardial segments adjacent to scar tissue. A simplified and shortened myocardial viability CMR protocol might be useful to better characterize and stratify patients with chronic MI.

Method of B0 mapping with magnitude-based correction for bipolar two-point Dixon cardiac MRI

PURPOSE

The conventional two-point (2pt) Dixon technique explicitly estimates B0 map by performing phase unwrapping. When signal loss, phase singularity, artifacts, or spatially isolated regions corrupt the measured phase images, this unwrapping-based technique will face difficulty. This work aims to improve the reliability of B0 mapping by performing unwrapping error correction.

METHOD

To detect the unwrapping-caused phase errors, we determined a magnitude-based fat/water mask and used it as reference to identify pixels being mismatched by the phase-based mask, which was derived from the B0-corrected phase term of the Hermitian product between echoes. Then, we corrected the afore-determined phase error on a region-by-region basis. We tested the developed method with nine patients' data, and the results were compared with a well-established region-growing technique.

RESULTS

By adding the step to correct unwrapping-caused error, we improved the robustness of B0 mapping, resulting in better fat-water separation when compared with the conventional 2pt and the phasor-based region-growing techniques.

CONCLUSION

We showed the feasibility of B0 mapping with bipolar 2pt human cardiac data. The software is freely available to the scientific community. Magn Reson Med 78:1862-1869, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Fast triple-spin-echo Dixon (FTSED) sequence for water and fat imaging

A number of 'Dixon' techniques based on fast spin echo (FSE) sequence have been proposed and successfully used in many branches of medicine. Some require only one scan, but most of them need multiple scans and long scan times. This article describes a new fast triple-spin-echo Dixon (FTSED) technique suitable for ultra-high field MRI, in which three specific time shifts are introduced in the echo train; thus, three images with defined water-fat phase-differences (0, π, 2π) are encoded in the phase of the acquired images without extreme restrictions upon the echo duration. The water and fat images are then calculated by iterative least-squares estimation method. The sequence was successfully implemented at a 9.4T ultra-high field MRI system and tested on a phantom and a rat.

Small animal cardiovascular MR imaging and spectroscopy

The use of MR imaging and spectroscopy for studying cardiovascular disease processes in small animals has increased tremendously over the past decade. This is the result of the remarkable advances in MR technologies and the increased availability of genetically modified mice. MR techniques provide a window on the entire timeline of cardiovascular disease development, ranging from subtle early changes in myocardial metabolism that often mark disease onset to severe myocardial dysfunction associated with end-stage heart failure. MR imaging and spectroscopy techniques play an important role in basic cardiovascular research and in cardiovascular disease diagnosis and therapy follow-up. This is due to the broad range of functional, structural and metabolic parameters that can be quantified by MR under in vivo conditions non-invasively. This review describes the spectrum of MR techniques that are employed in small animal cardiovascular disease research and how the technological challenges resulting from the small dimensions of heart and blood vessels as well as high heart and respiratory rates, particularly in mice, are tackled.

Imaging of carotid artery vessel wall edema using T2-weighted cardiovascular magnetic resonance

BACKGROUND

Atherothrombosis remains a major health problem in the western world, and carotid atherosclerosis is an important contributor to embolic ischemic strokes. It remains a clinical challenge to identify rupture-prone atherosclerotic plaques before clinical events occur. Inflammation, endothelial injury and angiogenesis are features of vulnerable plaques and may all be associated with plaque edema. Therefore, vessel wall edema, which can be detected by 2D T2-weighted cardiovascular magnetic resonance (CMR), may be used as a dynamic marker of disease activity in the atherosclerotic plaque. However, 2D imaging is limited by low spatial resolution in the slice-select direction compared to 3D imaging techniques. We sought to investigate the ability of novel 3D techniques to detect edema induced in porcine carotid arteries by acute balloon injury compared to conventional 2D T2-weighted black-blood CMR.

METHODS

Edema was induced unilaterally by balloon overstretch injury in the carotid artery of nine pigs. Between one to seven hours (average four hours) post injury, CMR was performed using 2D T2-weighted short-tau inversion recovery (T2-STIR), 3D volumetric isotropic turbo spin echo acquisition (VISTA) and 3D T2 prepared gradient-echo (T2prep-GE). The CMR images were compared in terms of signal-to-noise ratio (SNR) and contrast-to-noise (CNR) ratio. Furthermore, the presence of vessel wall injury was validated macroscopically by means of Evans Blue dye that only enters the injured vessel wall.

RESULTS

All three imaging sequences classified the carotid arteries correctly compared to Evans Blue and all sequences demonstrated a significant increase in SNR of the injured compared to the non-injured carotid vessel wall (T2-STIR, p = 0.002; VISTA, p = 0.004; and T2prep-GE, p = 0.003). There was no significant difference between sequences regarding SNR and CNR.

CONCLUSION

The novel 3D imaging sequences VISTA and T2prep-GE perform comparably to conventional 2D T2-STIR in terms of detecting vessel wall edema. The improved spatial coverage of these 3D sequences may facilitate visualization of vessel wall edema to enable detection and monitoring of vulnerable carotid atherosclerotic plaques.

Clinical application of 3D VIBECAIPI-DIXON for non-enhanced imaging of the pancreas compared to a standard 2D fat-saturated FLASH

PURPOSE

To compare a fast 3D VIBE sequence with Dixon fat saturation and CAIPIRINHA acceleration techniques (3D VIBE(CAIPI-DIXON)) to a standard 2D FLASH sequence with spectral fat saturation and conventional GRAPPA acceleration technique (2D Flash(GRAPPA-fs)) for non-enhanced imaging of the pancreas.

METHODS AND MATERIALS

In this retrospective, institutional review board-approved intra-individual comparison study, 29 patients (7 female, 22 male; mean age 60.4 ± 20.9 years) examined on a 48-channel 3.0-T MR system (MAGNETOM Skyra VD 13, Siemens Healthcare Sector, Germany) were included. 3D VIBE(CAIPI-DIXON) (TR/TE-3.95/2.5+1.27 ms; spatial resolution-1.2 × 1.2 × 3.0 mm(3); CAIPIRINHA 2 × 2 [1], acquisition time-0:12 min) and 2D Flash(GRAPPA-fs) (TR/TE-195/3.69 ms; 1.2 × 1.2 × 3.0 mm(3); GRAPPA 2, 3 × 0:21 min) sequences were performed in each subject in random order prior to the administration of an intravenous contrast agent. Two radiologists evaluated the images with regard to diagnostic preference. Semi-quantitative signal ratios were calculated for the pancreas versus the liver, spleen, muscle, and visceral fat. Inter-reader agreement was calculated using unweighted Cohen's kappa. Signal ratio results were analyzed using a univariate analysis of variance. Additional signal-to-noise (SNR) measurements were performed in a phantom.

RESULTS

3D VIBE(CAIPI-DIXON) was preferred in 72.4% (both readers) and 2D Flash(GRAPPA-fs) in 3.4%/6.9% (reader 1/2) of cases with a kappa value of 0.756. The main reasons for this preference were homogenous fat saturation with 3D VIBE(CAIPI-DIXON) and reduced motion artifacts due to a faster acquisition, leading to improved delineation of the pancreas. Signal ratios of pancreatic to fat signal for 3D VIBE(CAIPI-DIXON) (10.08 ± 3.48) and 2D Flash(GRAPPA-fs) (6.53 ± 3.07) were statistically different (P<.001). However, no additional statistically significant differences in signal ratios were identified (range: 0.73 ± 0.18 to 1.37 ± 0.40; .514<P<.961). SNR did not statistically significantly differ between the sequences.

CONCLUSION

3D VIBE(CAIPI-DIXON) enables robust pancreatic imaging with a shorter time and improved fat suppression relative to conventional 2D Flash(GRAPPA-fs). At an acquisition time of 12 seconds, 3D VIBE(CAIPI-DIXON) can be obtained in considerably less time than standard fat-saturated VIBE sequences.

Whole-heart chemical shift encoded water-fat MRI

PURPOSE

To develop and evaluate a free-breathing chemical-shift-encoded (CSE) spoiled gradient-recalled echo (SPGR) technique for whole-heart water-fat imaging at 3 Tesla (T).

METHODS

We developed a three-dimensional (3D) multi-echo SPGR pulse sequence with electrocardiographic gating and navigator echoes and evaluated its performance at 3T in healthy volunteers (N = 6) and patients (N = 20). CSE-SPGR, 3D SPGR, and 3D balanced-SSFP with chemical fat saturation were compared in six healthy subjects with images evaluated for overall image quality, level of residual artifacts, and quality of fat suppression. A similar scoring system was used for the patient datasets.

RESULTS

Images of diagnostic quality were acquired in all but one subject. CSE-SPGR performed similarly to SPGR with fat saturation, although it provided a more uniform fat suppression over the whole field of view. Balanced-SSFP performed worse than SPGR-based methods. In patients, CSE-SPGR produced excellent fat suppression near metal. Overall image quality was either good (7/20) or excellent (12/20) in all but one patient. There were significant artifacts in 5/20 clinical cases.

CONCLUSION

CSE-SPGR is a promising technique for whole-heart water-fat imaging during free-breathing. The robust fat suppression in the water-only image could improve assessment of complex morphology at 3T and in the presence of off-resonance, with additional information contained in the fat-only image.