Fully automatic, retrospective enhancement of real-time acquired cardiac cine MR images using image-based navigators and respiratory motion-corrected averaging

Real-time imaging may be clinically important in patients with congestive heart failure, arrhythmias, or in pediatric cases. However, real-time imaging typically has compromised spatial and temporal resolution compared with gated, segmented studies. To combine the best features of both types of imaging, a new method is proposed that uses parallel imaging to improve temporal resolution of real-time acquired images at the expense of signal-to-noise ratio (SNR), but then produces an SNR-enhanced cine by means of respiratory motion-corrected averaging of images acquired in real-time over multiple heartbeats while free-breathing. The retrospective processing based on image-based navigators and nonrigid image registration is fully automated. The proposed method was compared with conventional cine images in 21 subjects. The resultant image quality for the proposed method (3.9 +/- 0.44) was comparable to the conventional cine (4.2 +/- 0.99) on a 5-point scale (P = not significant [n.s.]). The conventional method exhibited degraded image quality in cases of arrhythmias whereas the proposed method had uniformly good quality. Motion-corrected averaging of real-time acquired cardiac images provides a means of attaining high-quality cine images with many of the benefits of real-time imaging, such as free-breathing acquisition and tolerance to arrhythmias.