Compressed Sensing Real-Time Cine Reduces CMR Arrhythmia-Related Artifacts

Benjamin Longère; Paul-Edouard Allard; Christos V Gkizas; Augustin Coisne; Justin Hennicaux; Arianna Simeone; Michaela Schmidt; Christoph Forman; Solenn Toupin; David Montaigne; François Pontana

doi:10.3390/jcm10153274

Compressed Sensing Real-Time Cine Reduces CMR Arrhythmia-Related Artifacts

J Clin Med. 2021 Jul 24;10(15):3274. doi: 10.3390/jcm10153274.

Affiliations

¹ University of Lille, Inserm, CHU Lille, Institut Pasteur Lille, U1011-European Genomic Institute for Diabetes (EGID), F-59000 Lille, France.
² CHU Lille, Department of Cardiovascular Radiology, F-59000 Lille, France.
³ MR Product Innovation and Definition, Magnetic Resonance, Siemens Healthcare GmbH, 91052 Erlangen, Germany.
⁴ Scientific Partnerships, Siemens Healthcare France, 93200 Saint-Denis, France.

Abstract

Background and objective: Cardiac magnetic resonance (CMR) is a key tool for cardiac work-up. However, arrhythmia can be responsible for arrhythmia-related artifacts (ARA) and increased scan time using segmented sequences. The aim of this study is to evaluate the effect of cardiac arrhythmia on image quality in a comparison of a compressed sensing real-time (CS_rt) cine sequence with the reference prospectively gated segmented balanced steady-state free precession (Cine_ref) technique regarding ARA.

Methods: A total of 71 consecutive adult patients (41 males; mean age = 59.5 ± 20.1 years (95% CI: 54.7-64.2 years)) referred for CMR examination with concomitant irregular heart rate (defined by an RR interval coefficient of variation >10%) during scanning were prospectively enrolled. For each patient, two cine sequences were systematically acquired: first, the reference prospectively triggered multi-breath-hold Cine_ref sequence including a short-axis stack, one four-chamber slice, and a couple of two-chamber slices; second, an additional single breath-hold CS_rt sequence providing the same slices as the reference technique. Two radiologists independently assessed ARA and image quality (overall, acquisition, and edge sharpness) for both techniques.

Results: The mean heart rate was 71.8 ± 19.0 (SD) beat per minute (bpm) (95% CI: 67.4-76.3 bpm) and its coefficient of variation was 25.0 ± 9.4 (SD) % (95% CI: 22.8-27.2%). Acquisition was significantly faster with CS_rt than with Cine_ref (Cine_ref: 556.7 ± 145.4 (SD) s (95% CI: 496.7-616.7 s); CS_rt: 23.9 ± 7.9 (SD) s (95% CI: 20.6-27.1 s); p < 0.0001). A total of 599 pairs of cine slices were evaluated (median: 8 (range: 6-14) slices per patient). The mean proportion of ARA-impaired slices per patient was 85.9 ± 22.7 (SD) % using Cine_ref, but this was figure was zero using CS_rt (p < 0.0001). The European CMR registry artifact score was lower with CS_rt (median: 1 (range: 0-5)) than with Cine_ref (median: 3 (range: 0-3); p < 0.0001). Subjective image quality was higher in CS_rt than in Cine_ref (median: 3 (range: 1-3) versus 2 (range: 1-4), respectively; p < 0.0001). In line, edge sharpness was higher on CS_rt cine than on Cine_ref images (0.054 ± 0.016 pixel^-1 (95% CI: 0.050-0.057 pixel^-1) versus 0.042 ± 0.022 pixel^-1 (95% CI: 0.037-0.047 pixel^-1), respectively; p = 0.0001).

Conclusion: Compressed sensing real-time cine drastically reduces arrhythmia-related artifacts and thus improves cine image quality in patients with arrhythmia.

Keywords: CMR; arrhythmia; artifact; cardiac; compressed sensing; fast imaging; heart; magnetic resonance; real-time.