Synopsis

Early efforts towards the correction for cardiac motion have focused on addressing respiratory motion of the heart, and particularly for imaging of the coronary arteries. After over two decades of key developments that include navigator gating, self-navigation, and more elaborate 2D and 3D variants of these navigator approaches, numerous motion correction methods have proliferated to almost every aspects of cardiac MRI, including LGE, cine, relaxometry mapping approaches, tagging, perfusion, and new inherently 3D methods such as Quantitative Susceptibility Mapping. This presentation will additionally cover the current state-of-the-art methods that include highly advanced approaches in cardiovascular MRI research today.

Highlights

1) Navigator approaches as either separate echo acquisitions or self-gated acquisitions can provide key physiologic information to overcome respiratory motion that leads to notable displacement of the heart.

2) New cardiac motion correction approaches that are tailored to specific Cardiac MR assessments may offer improved evaluation of clinical evaluations of the heart, and add diagnostic value in MR-based assessment of cardiovascular diseases and conditions.

Target Audience

Introduction

This lecture on correcting cardiac motion is divided into two parts.

In part 1, we will summarize the technical development and clinical translation process of numerous clinical and advanced research cardiac motion correction methods available today.

In part 2, we will provide examples of novel cardiac motion correction methods and techniques, and thereby provide a big-picture overview of where Cardiac MR (CMR) may lead to in the near future.

Part 1: The Navigator Approach and Respiratory Motion Correction – from initial efforts towards 3D Coronary Imaging to the Comprehensive CMR protocol.

In this first part, we discuss prior works with cardiac motion correction that go hand-in-hand with the technical development of MRI-based methods to obtain high-resolution, motion-free images of the heart. Among these, imaging of the coronary arteries was considered among the most critical challenges over the past several decades, and notably while alternative modality approaches such as X-ray and CT often required significantly higher ionizing radiation dosages than what they require today.

Over this two-decade period, key research and developments were made towards achieving superior images of the coronary arteries in the heart through innovations in: a) image acquisition, b) real-time and post-processing, and c) systems instrumentation. Key features of these techniques are now widely available in the clinical MRI system settings, and these have helped establish the technical foundation of cardiac motion correction that are applicable to techniques beyond the originally intended high-resolution and motion-resolved coronary artery imaging.

Examples of how motion correction is embedded during non-conventional magnetization preparation phases of CMR pulse sequence designs for techniques including LGE, T1 mapping, 3D-Cine, and novel (and inherently 3D) approaches such as cardiac Quantitative Susceptibility Mapping, will be described.

Part 2: Emerging correction methods beyond overcoming motion artifacts for cardiac MRI.

In this second part, we discuss how the accumulated knowledge pool from prior efforts over several decades have evolved into today’s state-of-the-art cardiac imaging using MRI – both in clinical and pre-clinical research space. Select contribution slides by key innovators in this field will be provided to offer a broad picture of how uniquely tailored motion correction techniques may address specific cardiac MRI challenges. There will be specific focus as the cardiac MRI field transitions from qualitative assessment to more quantitative assessment methods that report direct measurements in absolute terms. Key topics for this section include:

- Motion correction within the cardiac phase, and expanding to free-breathing methods for increased scan utilization within the cardiac cycle (non-Cartesian methods and 4D/5D methods).

- Combined acquisition, motion correction and reconstruction strategies, notably for dynamic cardiac sequences (simultaneous acquisitions; perfusion, navigator-gated T1 mapping, etc.).

- Inter-related reconstruction/post-processing strategies to overcome either: imperfect breath-held or free-breathing motion in new CMR pulse sequences.

Acknowledgements

We thank all investigators who contributed research slides for this education presentation.

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