Cardiac MR. Dr John Ridgway. Leeds Teaching Hospitals NHS Trust, UK

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1 Cardiac MR Dr John Ridgway Leeds Teaching Hospitals NHS Trust, UK

2 Cardiac MR Physics for clinicians: Part I Journal of Cardiovascular Magnetic Resonance 2010, 12:71

3 Where does the MR signal come from?

4 @ H 2 O + lipid H 1 p+ e - B o

5 Resonance

6 @ What causes the resonance in MR? RF Pulse RF coil Transmitting f pulse = B o MHz Range B o

7 @ MR Signal MR Signal Echo RF coil Receiving TE Echo Time B o f signal = B o

8 Advantages & Limitations (1) Advantages No ionising radiation Repeat studies / Follow up Healthy Volunteers Limitations Expensive (limited availability) Not portable

9 How do we make an image?

10 @ Magnetic Field Gradient Gradient Off Gradient coil B o uniform B o

11 @ Magnetic Field Gradient Gradient Pulse On B o weaker Gradient coil B o stronger B o

12 @ Slice Selection Apply RF Pulse & gradient together Resonance in slice only B o

13 @ Slice Selection Gradient switched off Signal emitted B o

14 Frequency Encoding Frequency Encoding? Apply gradient across patient during measurement of signal. Frequency of signal depends on position B o

15 Phase Encoding Phase Encoding Gradient momentary Phase change applied frequency dependent between change slice on position dependent selection & on measurement position B o

16 Need to repeat many times.. Repetition time, TR 90 o rf pulse rf G S G P MR Signals G F Signal 7

17 Phase Encoding Direction No of phase encoding steps, N P k space (raw data matrix) Phase encoding gradient determines which line of k- space is filled 2D Fourier Transform Scan time = TR. N P No of pixels in phase encoding direction, N P Frequency Encoding Direction Image (image matrix)

18 Need Synchronisation for Cardiac Imaging.. without with Circa 1986!

19 N P pixels Cardiac Synchronisation (conventional pulse sequences) Scan Time N P N P = number of lines ECG TR Repetition Time = R-R interval Pulse Sequence Time averaged image data

20 Accelerating the Acquisition turbo/fast Spin Echo ECG ECG TR Repetition Time TR Repetition Time RF pulses RF pulses Readout Gradient Readout Gradient Signal TE Signal ES Conventional SE TSE / FSE

21 Advantages & Limitations (2) Advantages Cross-sectional imaging Unlimited imaging window Free choice of image orientation (oblique/double oblique) Acceleration techniques enable breath-hold imaging Limitations Image acquisition relatively slow Cardiac and respiratory motion a problem Need reliable synchronisation with cardiac cycle (ECG) Time-averaged data no imaging of beat-to-beat variation Turbo/Fast acceleration techniques increase acquisition window within cardiac cycle (poorer temporal resolution)

22 What determines Image contrast? Amount of tissue proton density Properties of Tissue Relaxation Times Motion Blood flow, diffusion Type of Pulse sequence Spin Echo, Gradient Echo,Phase contrast, Diffusion sensitive Pulse sequence parameters TR,TE Contast agent

23 Two Basic Techniques for cardiac imaging Spin Echo Black Blood Cine Gradient Echo Bright Blood

24 Still imaging for anatomy (Black-Blood turbo Spin echo) TI blood Black Blood Preparation Pulses 180 o 180 o selective TSE 90 o 180 o 180 o 180 o 180 o Effective TE Single Slice acquired in one breathhold period

25 odema imaging for tissue characterisation (triple IR / Black Blood STIR) TI blood 180 o 180 o selective TI fat 180 o TSE TE = 100 ms TR = 2 RR intervals TI fat = 160 ms Black Blood Preparation Pulses turbostir 90 o 180 o 180 o 180 o 180 o Effective TE Simonetti, O. P., Finn, J. P., White, R. D., Laub, G. and Henry, D. A. (1996), Black blood T2-weighted inversion-recovery MR imaging of the heart., Radiology 199(1), 49-57

26 Cine Gradient Echo for functional imaging Cardiac Phase Number: 1,2...

27 Accelerating the Cine Acquisition turbo/fast Gradient Echo ECG ECG Heart Phase interval Heart Phase interval RF pulses RF pulses Readout Gradient Readout Gradient Signal TE Signal TE Conventional GE Fast / turbo GE

28 Ventricular volume, mass and wall motion 1-2 slices per breath-hold

29 Intra-myocardial motion with cine tagging R-R interval Tagging Pulses applied immediately after R- peak Cine acquisition follows motion/distortion of lines over the cardiac cycle Composite Binomial rf pulse Cine Gradient Echo acquisition o o o o Heart Phase Interval or TR Modulating Gradients Tagging Preparation Scheme Actual TR Fast/turbo Spoiled Gradient Echo Figure 16.11

30 Add contrast agent Spoiled Gradient echo (FLASH, SPGR, T1-FFE) Dynamic series after contrast T1-weighted applications Short TR, Short TE Contrastenhanced MRA

31 Myocardial Perfusion Imaging ECG Time n Bolus Contrast Administration Rapid Dynamic Imaging - First Pass Technique Single Shot - Complete image acquisition in each heart beat (x3-4 slices) Must be performed at Stress (and Rest?)

32 Inversion Recovery Gradient Echo Delayed imaging after contrast administration TI myocardium 180 o Fast / turbo Gradient Echo o o o o 180 o pulse TI Hyper-enhancing Scar Tissue Short TR Data Acquisition performed when normal myocardium reaches null point Time after 180 pulse

33 Flow Velocity Mapping Velocity related phase change Phase change which is related to motion Bipolar gradient pulses (equal area, opposite sign) Blood moving along gradient direction RF Pulse Bipolar Gradient Pulses Bipolar gradient pulses cause a relative change in phase which is proportional to velocity TE

34 Velocity Mapping Raw image data Magnitude image Phase image additional acquisition for each component of velocity measured Gradient Echo signal amplitude Velocity Map Thro plane velocity component Phase is proportional to Velocity

35 Trade-offs SNR Image contrast Spatial resolution & coverage Scan time

36 Trade off s 2D Slice Imaging Voxel volume Image acquisition matrix FOV P N P FOV R N R Frequency encoding (readout) SNR Voxel volume. N R.N P Total scan time = (TR. N P ) x no. of slices

37 Why don t we do 3D imaging? T 2D = TR x N p x NSA T 3D = T 2D x N s Acquisition times

38 Advantages & Limitations (3) Advantages Anatomical imaging in multiple planes Soft tissue contrast for tissue characterisation Functional imaging, ventricular wall motion Intra-myocardial motion (tagging) (strain etc) Blood flow velocity mapping (outflow, ventricular, coronary) (diffusion tensor imaging potential for mapping fibre orientation) (MR spectrosopy metabolism) 3D imaging possible no mis-registration issues Limitations Some of above only available in leading research institutes Trade off between spatial and temporal resolution, acquisition time and image quality 3D imaging pushes boundaries of acceleration techniques

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