Marc Kouwenhoven

Functional cardiac MR imaging with steady-state free precession (SSFP) significantly improves endocardial border delineation without contrast agents

Contrast between blood and myocardium in standard turbo gradient echo MR techniques (TFE) used routinely in clinical practice is mainly caused by unsaturated inflowing blood. Steady‐state free precession (SSFP) has excellent contrast even in the absence of inflow effects. In 45 subjects cardiac cine loops in two long axis projections were acquired using TFE and compared with SSFP. A visual score (range 0 worst – 3 best) was assigned for endocardial border delineation for six myocardial segments in two long axis views. Endocardial border delineation score for TFE was 1.3 ± 0.3 per segment and 2.4 ± 0.3 for SSFP (P < 0.0001). Signal intensity blood/signal intensity myocardium was 1.5 ± 0.4 at enddiastole and 1.4 ± 0.3 at systole for TFE and 3.5 ± 1.1 and 3.2 ± 1.3 for SSFP, respectively (P < 0.0001). SSFP increases contrast between blood and myocardium more than twofold, resulting in an improved endocardial border definition. This may reduce variability for the determination of cardiac volumes and ejection fraction. J. Magn. Reson. Imaging 2001;14:362–367. ©2001 Wiley‐Liss, Inc.

Accuracy and precision of time-averaged flow as measured by nontriggered 2D phase-contrast MR angiography, a phantom evaluation

The purpose of this study was to assess the accuracy and precision of time-averaged flow as measured by nontriggered 2D PC. Mono-, bi-, and triphasic flow patterns, modelling waveforms encountered in the human vascular system, were generated by a computer-controlled flow system. Time-averaged flow velocity was measured by conventional 2D cardiac-triggered cine PC and by nontriggered 2D PC for different settings of the excitation flip angle and the velocity sensitivity. Accuracy and precision were determined by repeating the measurements (N = 6) and comparing the results against precisely known calibration values. Measurements revealed waveform-specific deviations between triggered and nontriggered acquisitions that depended on the velocity sensitivity and, more strongly, on the flip angle of the nontriggered experiment. This confirmed the theoretically predicted predominance of amplitude over phase effects. Systematic errors could be reduced by decreasing the flip angle and the velocity sensitivity, although at the expense of signal-to-noise, so that additional signal averaging was required to maintain a specified precision. The attainable accuracy appeared to be acceptable only for waveforms with a relatively low pulsatility index. The study demonstrates the feasibility of accurate and precise nontriggered velocity measurements for weakly pulsatile flow and indicates a route towards improving the reliability for highly pulsatile flow.

Dual-Source Radiofrequency Transmission with Patient-Adaptive Local Radiofrequency Shimming for 3.0-T Cardiac MR Imaging: Initial Experience

PURPOSE To evaluate the effect of dual-source parallel radiofrequency (RF) transmission with patient-adaptive local RF shimming on image quality, image contrast, and diagnostic confidence at routine clinical cardiac magnetic resonance (MR) imaging with use of a 3.0-T dual-channel transmit whole-body MR system. MATERIALS AND METHODS Written informed consent was obtained from all patients, and the study protocol was approved by the local institutional review board. Cardiac MR imaging was performed in 28 patients by using a 3.0-T MR unit equipped with a dual-source RF transmission system. The effect of conventional versus dual-source RF transmission on steady-state free precession (SSFP) cine sequences and turbo spin-echo (TSE) black-blood (BB) sequences was evaluated. The homogeneity of the B1 field and contrast-to-noise ratios (CNRs) were measured and tested for statistical significance with the paired t test. Images were analyzed qualitatively for homogeneity, the presence of off-resonance artifacts, and diagnostic confidence independently by two readers. Statistical significance was assessed with the Wilcoxon signed rank test. Inter- and intraobserver agreement was assessed with κ statistics. RESULTS Quantitative image analysis revealed that B1 homogeneity and CNR were significantly improved for images acquired with dual-source RF transmission compared with conventional RF transmission (P = .005). The quality of SSFP and TSE BB images of the left and the right ventricles showed a significant improvement with respect to image homogeneity and diagnostic confidence as evaluated by the readers (P = .0001, κ > 0.74). As a side effect, off-resonance artifacts were significantly reduced on SSFP images (P = .0001, κ > 0.76). CONCLUSION Dual-source parallel RF transmission significantly improves image homogeneity, image contrast, and diagnostic confidence compared with conventional RF transmission of cardiac SSFP and TSE BB sequences.

Renal artery blood flow: quantification with breath-hold or respiratory triggered phase-contrast MR imaging

Abstract. The aim of this study was to evaluate the validity and reproducibility of breath-hold and respiratory triggered phase-contrast (PC) MR imaging techniques in the measurement of renal artery blood flow. In 12 healthy subjects cardiac-gated PC flow measurements were obtained in the renal arteries using a breath-hold and a respiratory-triggered technique. The flow measurements were repeated in each renal artery separately. Comparison between the sum of flow measurements in the renal arteries and the difference in aortic flow measurements above and below the renal arteries served as an internal control. The flow measurements showed a good reproducibility both with the breath-hold (r = 0.92, p < 0.0001) and with the respiratory-triggered (r = 0.91, p < 0.0001) technique. The validity of both methods was good and there was no statistically significant difference. Reproducible quantitative measurements of renal artery blood flow are possible with respiratory controlled, cardiac-gated, PC MR imaging.

Evaluation of a subject specific dual-transmit approach for improving B1 field homogeneity in cardiovascular magnetic resonance at 3T.

BackgroundRadiofrequency (RF) shading artifacts degrade image quality while performing cardiovascular magnetic resonance (CMR) at higher field strengths. In this article, we sought to evaluate the effect of local RF (B1 field) shimming by using a dual-source–transmit RF system for cardiac cine imaging and to systematically evaluate the effect of subject body type on the B1 field with and without local RF shimming.MethodsWe obtained cardiac images from 37 subjects (including 11 patients) by using dual-transmit 3T CMR. B1 maps with and without subject-specific local RF shimming (exploiting the independent control of transmit amplitude and phase of the 2 RF transmitters) were obtained. Metrics quantifying B1 field homogeneity were calculated and compared with subject body habitus.ResultsLocal RF shimming across the region encompassed by the heart increased the mean flip angle (μ) in that area (88.5 ± 15.2% vs. 81.2 ± 13.3%; P = 0.0014), reduced the B1 field variation by 42.2 ± 13%, and significantly improved the percentage of voxels closer to μ (39% and 82% more voxels were closer to ± 10% and ± 5% of μ, respectively) when compared with no RF shimming. B1 homogeneity was independent of subject body type (body surface area [BSA], body mass index [BMI] or anterior-posterior/right-left patient width ratio [AP/RL]). Subject specific RF (B1) shimming with a dual-transmit system improved local RF homogeneity across all body types.ConclusionWith or without RF shimming, cardiac B1 field homogeneity does not depend on body type, as characterized by BMI, BSA, and AP/RL. For all body types studied, cardiac B1 field homogeneity was significantly improved by performing local RF shimming with 2 independent RF-transmit channels. This finding indicates the need for subject-specific RF shimming.

Three-dimensional balanced steady state free precession myocardial perfusion cardiovascular magnetic resonance at 3T using dual-source parallel RF transmission: initial experience.

BackgroundThe purpose of this study was to establish the feasibility of three-dimensional (3D) balanced steady-state-free-precession (bSSFP) myocardial perfusion cardiovascular magnetic resonance (CMR) at 3T using local RF shimming with dual-source RF transmission, and to compare it with spoiled gradient echo (TGRE) acquisition.MethodsDynamic contrast-enhanced 3D bSSFP perfusion imaging was performed on a 3T MRI scanner equipped with dual-source RF transmission technology. Images were reconstructed using k-space and time broad-use linear acquisition speed-up technique (k-t BLAST) and compartment based principle component analysis (k-t PCA).ResultsIn phantoms and volunteers, local RF shimming with dual source RF transmission significantly improved B1 field homogeneity compared with single source transmission (P = 0.01). 3D bSSFP showed improved signal-to-noise, contrast-to-noise and signal homogeneity compared with 3D TGRE (29.8 vs 26.9, P = 0.045; 23.2 vs 21.6, P = 0.049; 14.9% vs 12.4%, p = 0.002, respectively). Image quality was similar between bSSFP and TGRE but there were more dark rim artefacts with bSSFP. k-t PCA reconstruction reduced artefacts for both sequences compared with k-t BLAST. In a subset of five patients, both methods correctly identified those with coronary artery disease.ConclusionThree-dimensional bSSFP myocardial perfusion CMR using local RF shimming with dual source parallel RF transmission at 3T is feasible and improves signal characteristics compared with TGRE. Image artefact remains an important limitation of bSSFP imaging at 3T but can be reduced with k-t PCA.

Robust myocardial T2 and T2 * mapping at 3T using image-based shimming.

Intramyocardial hemorrhage and area at risk are both prognostic markers in acute myocardial infarction (AMI). Myocardial T2 and T2* mapping have been used to detect such tissue changes at 1.5T but these techniques are challenging at 3.0T due to additional susceptibility variation. We studied T2 and T2* myocardial mapping techniques at 3.0T on a system employing B1 shimming and compared two different methods of B0 shimming.

Feasibility of high-dose dobutamine stress SSFP cine MRI at 3 Tesla with patient adaptive local RF shimming using dual-source RF transmission: initial results

Cine SSFP sequences have become the gold standard for assessment of myocardial function at 1.5T. However, cine imaging at higher-field strengths is hampered by SAR limitations, the increased inhomogeneity of the B1 (RF) and B0 field and the high sensitivity of SSFP sequences to off-resonance artefacts. The effect is even more pronounced in HDDS studies, which are associated with a significant increase in heart rate and consequently more complex and faster blood flow. Previously, spoiled gradient-echo sequences have been proposed as an alternative for stress studies at 3T. Recently, the introduction of a dual-source RF transmission system with patient-adaptive local RF-shimming has lead to a significant improvement of image quality of SSFP imaging at 3T during resting conditions and may thus allow for reliable imaging of cardiac function even at high heart rates.

Clinical CMR at 3.0 Tesla using parallel RF transmission with patient-adaptive B1 shimming: initial experience

Introduction The clinical implementation of high-field CMR systems has introduced new challenges for cardiac imaging due to B0 and B1 field inhomogeneities. TSE Black-Blood sequences (BB) are compromised by dielectric artifacts, whereas SSFP cine-sequences are known to suffer from dark-band artifacts. The flip-angle non-uniformity across the field of view affects image homogeneity of both sequences. The use of a multi-source RF transmission system may help reduce dielectric effects, improve flip-angle uniformity and avoid local SAR peaks, thus allowing a shorter minimum TR/TE in SSFP-sequences.

High-dose dobutamine stress steady-state free precession (SSFP) cine MRI at 3T with patient adaptive local radiofrequency (RF) shimming using dual-source RF transmission

To prospectively assess the feasibility, image quality, and diagnostic accuracy of high‐dose dobutamine stress magnetic resonance imaging (DSMR) using steady‐state free precession (SSFP) cine imaging at 3T applying a dual‐source radiofrequency (RF) excitation magnetic resonance imaging (MRI) system with parallel transmission and patient adaptive local RF shimming.