Ferumoxytol-Enhanced Cardiac Cine MRI Reconstruction Using a Variable-Splitting Spatiotemporal Network

Background: Balanced steady-state free precession (bSSFP) imaging is commonly used in cardiac cine MRI but prone to image artifacts. Ferumoxytol-enhanced (FE) gradient echo (GRE) has been proposed as an alternative. Utilizing the abundance of bSSFP images to develop a computationally efficient network that is applicable to FE GRE cine would benefit future network development. Purpose: To develop a variable-splitting spatiotemporal network (VSNet) for image reconstruction, trained on bSSFP cine images and applicable to FE GRE cine images. Study Type: Retrospective and prospective. Subjects: 41 patients (26 female, 53 +/- 19 y/o) for network training, 31 patients (19 female, 49 +/- 17 y/o) and 5 healthy subjects (5 female, 30 +/- 7 y/o) for testing. Field Strength/Sequence: 1.5T and 3T, bSSFP and GRE. Assessment: VSNet was compared to VSNet with total variation loss, compressed sensing and low rank methods for 14x accelerated data. The GRAPPAx2/x3 images served as the reference. Peak signal-to-noise-ratio (PSNR), structural similarity index (SSIM), left ventricular (LV) and right ventricular (RV) end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) were measured. Qualitative image ranking and scoring were independently performed by three readers. Latent scores were calculated based on scores of each method relative to the reference. Statistics: Linear mixed-effects regression, Tukey method, Fleiss' Kappa, Bland-Altman analysis, and Bayesian categorical cumulative probit model. A P-value <0.05 was considered statistically significant. Results: VSNet achieved significantly higher PSNR (32.7 +/- 0.2), SSIM (0.880 +/- 0.004), rank (2.14 +/- 0.06), and latent scores (-1.72 +/- 0.22) compared to other methods (rank >2.90, latent score < -2.63). Fleiss' Kappa was 0.52 for scoring and 0.61 for ranking. VSNet showed no significantly different LV and RV ESV (P = 0.938) and EF (P = 0.143) measurements, but statistically significant different (2.62 mL) EDV measurements compared to the reference. Conclusion: VSNet produced the highest image quality and the most accurate functional measurements for FE GRE cine images among the tested 14x accelerated reconstruction methods. Level of Evidence: 3 Technical Efficacy: Stage 1