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Cardiac Function: MR Evaluation in One Breath Hold with Real-time True Fast Imaging with Steady-State Precession¹

¹ From the Department of Radiology–MRI, New York University Medical Center, 530 First Ave, HCC Basement, New York, NY 10016 (V.S.L., D.R., P.L., J.C.W.); and Siemens Medical Systems, Chicago, Ill (J.M.B., O.P.S.). Received July 5, 2001; revision requested August 22; revision received September 26; accepted October 22. Address correspondence to V.S.L. (e-mail: lee@mri.med.nyu.edu).

View larger version (181K): [in a new window]   Figure 1a. Horizontal long-axis MR images in a healthy volunteer. Cine FLASH images at (a) end diastole and (b) end systole. Single-section true FISP images at (c) end diastole and (d) end systole. (e, f) True FISP images in c and d, respectively, with short-axis section positions projected (oblique lines). These projections facilitated the selection of which sections to include in calculations of left ventricular volumes and masses. In e, the single line (arrow) perpendicular to the short-axis planes was used to define the vertical long-axis (two-chamber) view. Nine short-axis sections are used in e (end diastole). Seven short-axis sections are used in f (end systole) because the most basal and apical sections (lower and upper arrows, respectively) do not lie within the left ventricle. In-plane saturation contributes to the loss of signal intensity of the left ventricular blood pool in a and b. This is less apparent in c and d, especially at end systole (arrows in d) at blood-pool margins Midventricular short-axis MR images in the same volunteer. (g, h) Cine FLASH, (i, j) single-section true FISP, and (k, l) multisection true FISP MR images were obtained at end diastole (g, i, k) and end systole (h, j, l). In-plane saturation likely causes the relative loss of signal intensity in the blood pool (arrows in j and l) adjacent to the myocardium in g and h that is not as apparent in i-l despite their lower spatial resolution. This leads to decreased blood-pool volumes and higher ventricular masses with cine FLASH MR imaging, as was observed in all study subjects (Table 3).

View larger version (182K): [in a new window]   Figure 1b. Horizontal long-axis MR images in a healthy volunteer. Cine FLASH images at (a) end diastole and (b) end systole. Single-section true FISP images at (c) end diastole and (d) end systole. (e, f) True FISP images in c and d, respectively, with short-axis section positions projected (oblique lines). These projections facilitated the selection of which sections to include in calculations of left ventricular volumes and masses. In e, the single line (arrow) perpendicular to the short-axis planes was used to define the vertical long-axis (two-chamber) view. Nine short-axis sections are used in e (end diastole). Seven short-axis sections are used in f (end systole) because the most basal and apical sections (lower and upper arrows, respectively) do not lie within the left ventricle. In-plane saturation contributes to the loss of signal intensity of the left ventricular blood pool in a and b. This is less apparent in c and d, especially at end systole (arrows in d) at blood-pool margins Midventricular short-axis MR images in the same volunteer. (g, h) Cine FLASH, (i, j) single-section true FISP, and (k, l) multisection true FISP MR images were obtained at end diastole (g, i, k) and end systole (h, j, l). In-plane saturation likely causes the relative loss of signal intensity in the blood pool (arrows in j and l) adjacent to the myocardium in g and h that is not as apparent in i-l despite their lower spatial resolution. This leads to decreased blood-pool volumes and higher ventricular masses with cine FLASH MR imaging, as was observed in all study subjects (Table 3).

View larger version (179K): [in a new window]   Figure 1c. Horizontal long-axis MR images in a healthy volunteer. Cine FLASH images at (a) end diastole and (b) end systole. Single-section true FISP images at (c) end diastole and (d) end systole. (e, f) True FISP images in c and d, respectively, with short-axis section positions projected (oblique lines). These projections facilitated the selection of which sections to include in calculations of left ventricular volumes and masses. In e, the single line (arrow) perpendicular to the short-axis planes was used to define the vertical long-axis (two-chamber) view. Nine short-axis sections are used in e (end diastole). Seven short-axis sections are used in f (end systole) because the most basal and apical sections (lower and upper arrows, respectively) do not lie within the left ventricle. In-plane saturation contributes to the loss of signal intensity of the left ventricular blood pool in a and b. This is less apparent in c and d, especially at end systole (arrows in d) at blood-pool margins Midventricular short-axis MR images in the same volunteer. (g, h) Cine FLASH, (i, j) single-section true FISP, and (k, l) multisection true FISP MR images were obtained at end diastole (g, i, k) and end systole (h, j, l). In-plane saturation likely causes the relative loss of signal intensity in the blood pool (arrows in j and l) adjacent to the myocardium in g and h that is not as apparent in i-l despite their lower spatial resolution. This leads to decreased blood-pool volumes and higher ventricular masses with cine FLASH MR imaging, as was observed in all study subjects (Table 3).

View larger version (183K): [in a new window]   Figure 1d. Horizontal long-axis MR images in a healthy volunteer. Cine FLASH images at (a) end diastole and (b) end systole. Single-section true FISP images at (c) end diastole and (d) end systole. (e, f) True FISP images in c and d, respectively, with short-axis section positions projected (oblique lines). These projections facilitated the selection of which sections to include in calculations of left ventricular volumes and masses. In e, the single line (arrow) perpendicular to the short-axis planes was used to define the vertical long-axis (two-chamber) view. Nine short-axis sections are used in e (end diastole). Seven short-axis sections are used in f (end systole) because the most basal and apical sections (lower and upper arrows, respectively) do not lie within the left ventricle. In-plane saturation contributes to the loss of signal intensity of the left ventricular blood pool in a and b. This is less apparent in c and d, especially at end systole (arrows in d) at blood-pool margins Midventricular short-axis MR images in the same volunteer. (g, h) Cine FLASH, (i, j) single-section true FISP, and (k, l) multisection true FISP MR images were obtained at end diastole (g, i, k) and end systole (h, j, l). In-plane saturation likely causes the relative loss of signal intensity in the blood pool (arrows in j and l) adjacent to the myocardium in g and h that is not as apparent in i-l despite their lower spatial resolution. This leads to decreased blood-pool volumes and higher ventricular masses with cine FLASH MR imaging, as was observed in all study subjects (Table 3).

View larger version (186K): [in a new window]   Figure 1e. Horizontal long-axis MR images in a healthy volunteer. Cine FLASH images at (a) end diastole and (b) end systole. Single-section true FISP images at (c) end diastole and (d) end systole. (e, f) True FISP images in c and d, respectively, with short-axis section positions projected (oblique lines). These projections facilitated the selection of which sections to include in calculations of left ventricular volumes and masses. In e, the single line (arrow) perpendicular to the short-axis planes was used to define the vertical long-axis (two-chamber) view. Nine short-axis sections are used in e (end diastole). Seven short-axis sections are used in f (end systole) because the most basal and apical sections (lower and upper arrows, respectively) do not lie within the left ventricle. In-plane saturation contributes to the loss of signal intensity of the left ventricular blood pool in a and b. This is less apparent in c and d, especially at end systole (arrows in d) at blood-pool margins Midventricular short-axis MR images in the same volunteer. (g, h) Cine FLASH, (i, j) single-section true FISP, and (k, l) multisection true FISP MR images were obtained at end diastole (g, i, k) and end systole (h, j, l). In-plane saturation likely causes the relative loss of signal intensity in the blood pool (arrows in j and l) adjacent to the myocardium in g and h that is not as apparent in i-l despite their lower spatial resolution. This leads to decreased blood-pool volumes and higher ventricular masses with cine FLASH MR imaging, as was observed in all study subjects (Table 3).

View larger version (185K): [in a new window]   Figure 1f. Horizontal long-axis MR images in a healthy volunteer. Cine FLASH images at (a) end diastole and (b) end systole. Single-section true FISP images at (c) end diastole and (d) end systole. (e, f) True FISP images in c and d, respectively, with short-axis section positions projected (oblique lines). These projections facilitated the selection of which sections to include in calculations of left ventricular volumes and masses. In e, the single line (arrow) perpendicular to the short-axis planes was used to define the vertical long-axis (two-chamber) view. Nine short-axis sections are used in e (end diastole). Seven short-axis sections are used in f (end systole) because the most basal and apical sections (lower and upper arrows, respectively) do not lie within the left ventricle. In-plane saturation contributes to the loss of signal intensity of the left ventricular blood pool in a and b. This is less apparent in c and d, especially at end systole (arrows in d) at blood-pool margins Midventricular short-axis MR images in the same volunteer. (g, h) Cine FLASH, (i, j) single-section true FISP, and (k, l) multisection true FISP MR images were obtained at end diastole (g, i, k) and end systole (h, j, l). In-plane saturation likely causes the relative loss of signal intensity in the blood pool (arrows in j and l) adjacent to the myocardium in g and h that is not as apparent in i-l despite their lower spatial resolution. This leads to decreased blood-pool volumes and higher ventricular masses with cine FLASH MR imaging, as was observed in all study subjects (Table 3).

View larger version (175K): [in a new window]   Figure 1g. Horizontal long-axis MR images in a healthy volunteer. Cine FLASH images at (a) end diastole and (b) end systole. Single-section true FISP images at (c) end diastole and (d) end systole. (e, f) True FISP images in c and d, respectively, with short-axis section positions projected (oblique lines). These projections facilitated the selection of which sections to include in calculations of left ventricular volumes and masses. In e, the single line (arrow) perpendicular to the short-axis planes was used to define the vertical long-axis (two-chamber) view. Nine short-axis sections are used in e (end diastole). Seven short-axis sections are used in f (end systole) because the most basal and apical sections (lower and upper arrows, respectively) do not lie within the left ventricle. In-plane saturation contributes to the loss of signal intensity of the left ventricular blood pool in a and b. This is less apparent in c and d, especially at end systole (arrows in d) at blood-pool margins Midventricular short-axis MR images in the same volunteer. (g, h) Cine FLASH, (i, j) single-section true FISP, and (k, l) multisection true FISP MR images were obtained at end diastole (g, i, k) and end systole (h, j, l). In-plane saturation likely causes the relative loss of signal intensity in the blood pool (arrows in j and l) adjacent to the myocardium in g and h that is not as apparent in i-l despite their lower spatial resolution. This leads to decreased blood-pool volumes and higher ventricular masses with cine FLASH MR imaging, as was observed in all study subjects (Table 3).

View larger version (168K): [in a new window]   Figure 1h. Horizontal long-axis MR images in a healthy volunteer. Cine FLASH images at (a) end diastole and (b) end systole. Single-section true FISP images at (c) end diastole and (d) end systole. (e, f) True FISP images in c and d, respectively, with short-axis section positions projected (oblique lines). These projections facilitated the selection of which sections to include in calculations of left ventricular volumes and masses. In e, the single line (arrow) perpendicular to the short-axis planes was used to define the vertical long-axis (two-chamber) view. Nine short-axis sections are used in e (end diastole). Seven short-axis sections are used in f (end systole) because the most basal and apical sections (lower and upper arrows, respectively) do not lie within the left ventricle. In-plane saturation contributes to the loss of signal intensity of the left ventricular blood pool in a and b. This is less apparent in c and d, especially at end systole (arrows in d) at blood-pool margins Midventricular short-axis MR images in the same volunteer. (g, h) Cine FLASH, (i, j) single-section true FISP, and (k, l) multisection true FISP MR images were obtained at end diastole (g, i, k) and end systole (h, j, l). In-plane saturation likely causes the relative loss of signal intensity in the blood pool (arrows in j and l) adjacent to the myocardium in g and h that is not as apparent in i-l despite their lower spatial resolution. This leads to decreased blood-pool volumes and higher ventricular masses with cine FLASH MR imaging, as was observed in all study subjects (Table 3).

View larger version (176K): [in a new window]   Figure 1i. Horizontal long-axis MR images in a healthy volunteer. Cine FLASH images at (a) end diastole and (b) end systole. Single-section true FISP images at (c) end diastole and (d) end systole. (e, f) True FISP images in c and d, respectively, with short-axis section positions projected (oblique lines). These projections facilitated the selection of which sections to include in calculations of left ventricular volumes and masses. In e, the single line (arrow) perpendicular to the short-axis planes was used to define the vertical long-axis (two-chamber) view. Nine short-axis sections are used in e (end diastole). Seven short-axis sections are used in f (end systole) because the most basal and apical sections (lower and upper arrows, respectively) do not lie within the left ventricle. In-plane saturation contributes to the loss of signal intensity of the left ventricular blood pool in a and b. This is less apparent in c and d, especially at end systole (arrows in d) at blood-pool margins Midventricular short-axis MR images in the same volunteer. (g, h) Cine FLASH, (i, j) single-section true FISP, and (k, l) multisection true FISP MR images were obtained at end diastole (g, i, k) and end systole (h, j, l). In-plane saturation likely causes the relative loss of signal intensity in the blood pool (arrows in j and l) adjacent to the myocardium in g and h that is not as apparent in i-l despite their lower spatial resolution. This leads to decreased blood-pool volumes and higher ventricular masses with cine FLASH MR imaging, as was observed in all study subjects (Table 3).

View larger version (167K): [in a new window]   Figure 1j. Horizontal long-axis MR images in a healthy volunteer. Cine FLASH images at (a) end diastole and (b) end systole. Single-section true FISP images at (c) end diastole and (d) end systole. (e, f) True FISP images in c and d, respectively, with short-axis section positions projected (oblique lines). These projections facilitated the selection of which sections to include in calculations of left ventricular volumes and masses. In e, the single line (arrow) perpendicular to the short-axis planes was used to define the vertical long-axis (two-chamber) view. Nine short-axis sections are used in e (end diastole). Seven short-axis sections are used in f (end systole) because the most basal and apical sections (lower and upper arrows, respectively) do not lie within the left ventricle. In-plane saturation contributes to the loss of signal intensity of the left ventricular blood pool in a and b. This is less apparent in c and d, especially at end systole (arrows in d) at blood-pool margins Midventricular short-axis MR images in the same volunteer. (g, h) Cine FLASH, (i, j) single-section true FISP, and (k, l) multisection true FISP MR images were obtained at end diastole (g, i, k) and end systole (h, j, l). In-plane saturation likely causes the relative loss of signal intensity in the blood pool (arrows in j and l) adjacent to the myocardium in g and h that is not as apparent in i-l despite their lower spatial resolution. This leads to decreased blood-pool volumes and higher ventricular masses with cine FLASH MR imaging, as was observed in all study subjects (Table 3).

View larger version (162K): [in a new window]   Figure 1k. Horizontal long-axis MR images in a healthy volunteer. Cine FLASH images at (a) end diastole and (b) end systole. Single-section true FISP images at (c) end diastole and (d) end systole. (e, f) True FISP images in c and d, respectively, with short-axis section positions projected (oblique lines). These projections facilitated the selection of which sections to include in calculations of left ventricular volumes and masses. In e, the single line (arrow) perpendicular to the short-axis planes was used to define the vertical long-axis (two-chamber) view. Nine short-axis sections are used in e (end diastole). Seven short-axis sections are used in f (end systole) because the most basal and apical sections (lower and upper arrows, respectively) do not lie within the left ventricle. In-plane saturation contributes to the loss of signal intensity of the left ventricular blood pool in a and b. This is less apparent in c and d, especially at end systole (arrows in d) at blood-pool margins Midventricular short-axis MR images in the same volunteer. (g, h) Cine FLASH, (i, j) single-section true FISP, and (k, l) multisection true FISP MR images were obtained at end diastole (g, i, k) and end systole (h, j, l). In-plane saturation likely causes the relative loss of signal intensity in the blood pool (arrows in j and l) adjacent to the myocardium in g and h that is not as apparent in i-l despite their lower spatial resolution. This leads to decreased blood-pool volumes and higher ventricular masses with cine FLASH MR imaging, as was observed in all study subjects (Table 3).

View larger version (165K): [in a new window]   Figure 1l. Horizontal long-axis MR images in a healthy volunteer. Cine FLASH images at (a) end diastole and (b) end systole. Single-section true FISP images at (c) end diastole and (d) end systole. (e, f) True FISP images in c and d, respectively, with short-axis section positions projected (oblique lines). These projections facilitated the selection of which sections to include in calculations of left ventricular volumes and masses. In e, the single line (arrow) perpendicular to the short-axis planes was used to define the vertical long-axis (two-chamber) view. Nine short-axis sections are used in e (end diastole). Seven short-axis sections are used in f (end systole) because the most basal and apical sections (lower and upper arrows, respectively) do not lie within the left ventricle. In-plane saturation contributes to the loss of signal intensity of the left ventricular blood pool in a and b. This is less apparent in c and d, especially at end systole (arrows in d) at blood-pool margins Midventricular short-axis MR images in the same volunteer. (g, h) Cine FLASH, (i, j) single-section true FISP, and (k, l) multisection true FISP MR images were obtained at end diastole (g, i, k) and end systole (h, j, l). In-plane saturation likely causes the relative loss of signal intensity in the blood pool (arrows in j and l) adjacent to the myocardium in g and h that is not as apparent in i-l despite their lower spatial resolution. This leads to decreased blood-pool volumes and higher ventricular masses with cine FLASH MR imaging, as was observed in all study subjects (Table 3).

View larger version (30K): [in a new window]   Figure 2. Bland-Altman plot for ejection fraction measurements with multisection true FISP compared with single-section true FISP MR imaging. Differences are plotted against the average of the two ejection fraction measurements. Values for mean difference (1.6%) and mean ± 2 SDs (range, -11.2% to 14%) are also plotted. Despite the lower temporal and spatial resolutions with multisection true FISP compared with single-section true FISP imaging, measurements of ejection fraction with the two methods were remarkably similar. There was no appreciable underestimation of ejection fraction with the real-time sequence.