Recently, a free-breathing T2-prepared BOOST sequence was introduced for post-contrast 3D whole-heart bright-blood coronary angiography and black-blood late gadolinium enhancement (LGE) imaging, for simultaneous visualization of the coronary lumen and myocardial scar. However, high-resolution fully-sampled BOOST requires long acquisition times of ~20min. In this work, we propose to accelerate the T2-prepared BOOST sequence and achieve high spatial resolution 3D whole-heart black-blood LGE and coronary MR angiography. This is accomplished by extending a modified version of XD-ORCCA, a highly efficient respiratory-resolved motion-corrected framework, to BOOST imaging. The proposed framework enables simultaneous black-blood LGE and bright-blood coronary angiography within clinically feasible acquisition times.
Phase sensitive inversion recovery (PSIR) reconstruction applied to late gadolinium enhancement (LGE) imaging is widely used for detecting myocardial infarction. Conventional PSIR sequences require an IR-prepared image (or “magnitude image”) and a proton density weighted image (or “reference image”) to provide a reference for background phase. These images are used to reconstruct the PSIR image. Thus, these sequences require the acquisition of an extra (reference) image, which does not provide additional diagnostic information. Moreover, conventional PSIR sequences provide suboptimal contrast between the scar tissue and the blood pool, meaning that sub-endocardial infarctions could be difficult to detect or delineate. Moreover, conventional 2D PSIR LGE provides limited coverage of the heart and acquisitions are performed under breath-hold. Recently, free-breathing 3D whole-heart PSIR acquisitions have been proposed, but they have low scan efficiency and lead to long and unpredictable scan times.
High?resolution 3D whole-heart PSIR images obtained in a clinically feasible and predictable scan time would be ideal. These acquisitions should be performed in free-breathing, with 100% scan efficiency, ensure whole-heart coverage and have (nearly) isotropic spatial resolution. The two 3D volumes acquired for the PSIR reconstruction should be co-registered and the reference image should ideally also provide complementary diagnostic information. In addition, the contrast between the blood pool and the scar tissue should be optimized for an improved detection of sub-endocardial infarctions.
This activity covers recently developed sequences based on the concepts of black-blood PSIR. It also covers novel image reconstruction strategies that allow scan acceleration and respiratory motion compensation. By combining these acquisition and reconstruction techniques it is possible to obtain high-resolution 3D whole-heart images for simultaneous visualization of cardiac anatomy, coronary arteries and myocardial infarction.
- Learners need to know about (knowledge): Coronary CMR angiography, Lage gadolinium enhancement (LGE), Phase-sensitive inversion Recovery (PSIR), dark-blood PSIR, compressed sensing and respiratory motion correction techniques.
- Learners need to know how to apply (intention to put into practice): LGE and PSIR sequences.
- Learners need to do (perform): Read relevant literature.
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Credit Designation Statement
The Society for Cardiovascular Magnetic Resonance (SCMR) designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit (s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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The planners and faculty for this activity did not have any relationships to disclose.
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Bibliography1. SCMR Physics MRI Webinar - Physics Just the Basics Series #07 - LGE Methods and Principles 2. Kellman, P., Arai, A.E., McVeigh, E.R. and Aletras, A.H. (2002), Phase?sensitive inversion recovery for detecting myocardial infarction using gadolinium?delayed hyperenhancement†. Magn. Reson. Med., 47: 372-383. https://doi.org/10.1002/mrm.10051 3. Kellman, P., Xue, H., Olivieri, L.J. et al. Dark blood late enhancement imaging. J Cardiovasc Magn Reson 18, 77 (2017). https://doi.org/10.1186/s12968-016-0297-3 4. Kellman, P. and Arai, A.E. (2012), Cardiac imaging techniques for physicians: Late enhancement . J. Magn. Reson. Imaging, 36: 529-542. https://doi.org/10.1002/jmri.23605 5. Ginami, G., Neji, R., Phinikaridou, A., Whitaker, J., Botnar, R.M. and Prieto, C. (2018), Simultaneous bright? and black?blood whole?heart MRI for noncontrast enhanced coronary lumen and thrombus visualization. Magn. Reson. Med, 79: 1460-1472. https://doi.org/10.1002/mrm.26815 6. Ginami, G., Neji, R., Rashid, I. et al. 3D whole-heart phase sensitive inversion recovery CMR for simultaneous black-blood late gadolinium enhancement and bright-blood coronary CMR angiography. J Cardiovasc Magn Reson 19, 94 (2017). https://doi.org/10.1186/s12968-017-0405-z 7. Correia, T, Ginami, G, Cruz, G, et al. Optimized respiratory?resolved motion?compensated 3D Cartesian coronary MR angiography. Magn Reson Med. 2018; 80: 2618– 2629. https://doi.org/10.1002/mrm.27208