Balanced Steady-State Free Precession Cine MR Imaging in the Presence of Cardiac Devices: Value of Interleaved Radial Linear Combination Acquisition With Partial Dephasing

Background Balanced steady-state free precession (bSSFP) is important in cardiac MRI but suffers from off-resonance artifacts. The interpretation-limiting artifacts in patients with cardiac implants remain an unsolved issue. Purpose To develop an interleaved radial linear combination bSSFP (lcSSFP) method with partial dephasing (PD) for improved cardiac cine imaging when implanted cardiovascular devices are present. Study Type Prospective. Phantom and Subjects Flow phantom adjacent to a pacemaker and 10 healthy volunteers (mean age +/- standard deviation: 31.9 +/- 2.9 years, 4 females) with a cardioverter-defibrillator (ICD) positioned extracorporeally at the left chest in the prepectoral region. Field Strength/Sequence A 3-T, 1) Cartesian bSSFP, 2) Cartesian gradient echo (GRE), 3) Cartesian lcSSFP, and 4) radial lcSSFP cine sequences. Assessment Flow artifacts mitigation using PD was validated with phantom experiments. Undersampled radial lcSSFP with interleaving across phase-cyclings and cardiac phases (RLC-SSFP), combined with PD, was then employed for achieving improved quality of cine images from left ventricular short-axis view. The image quality in the presence of cardiac devices was qualitatively assessed by three independent raters (1 = worst, 5 = best), regarding five criteria (banding artifacts, streak artifacts, flow artifacts, cavity visibility, and overall image quality). Statistical Tests Wilcoxon rank-sum test for the five criteria between Cartesian bSSFP cine and RLC-SSFP with PD. Fleiss kappa test for inter-reader agreement. A P value < 0.05 was considered statistically significant. Results Based on simulations and phantom experiments, 60 projections per phase cycling and 1/6 PD were chosen. The in vivo experiments demonstrated significantly reduced banding artifacts (4.8 +/- 0.4 vs. 2.7 +/- 0.7), fewer streak artifacts (3.7 +/- 0.6 vs. 2.6 +/- 0.7) and flow artifacts (4.4 +/- 0.4 vs. 3.7 +/- 0.6), therefore improved cavity visibility (4.1 +/- 0.4 vs. 2.9 +/- 0.9) and overall quality (4.0 +/- 0.4 vs. 2.7 +/- 0.7). Data Conclusion RLC-SSFP method with PD may improve cine image quality in subjects with cardiac devices. Evidence Level 2. Technical Efficacy Stage 1.