Free-breathing cardiac cine MRI with compressed sensing real-time imaging and retrospective motion correction: clinical feasibility and validation

Objectives To prospectively evaluate the feasibility and biventricular assessment accuracy of a free-breathing cardiac cine imaging technique (RTCSCineMoCo) combined with highly accelerated real-time (RT) acquisition, compressed sensing (CS) reconstruction, and fully automated non-rigid respiratory motion correction. Methods We evaluated 80 patients scheduled for clinical cardiac MRI. Cardiac cine images of the same long-axis and short-axis stacks were acquired using three techniques: (1) SegBH: standard segmented cine with breath-hold; (2) RTCSCineMoCo; (3) RTCSCine: single-shot RT CS cine at 3.0 T. Image quality (IQ) was evaluated using a qualitative 5-point Likert scale and the European CMR registry standardized criteria. Quantitative parameters including left (LV) and right ventricular (RV) ejection fractions (EF), end-diastolic volumes (EDV), end-systolic volumes (ESV), stroke volumes (SV), and LV mass (LVM) were measured and compared. Results RTCSCineMoCo and SegBH had equivalent IQ scores (4.4 ± 0.7 vs. 4.2 ± 0.8, p = 0.066), while RTCSCine had a significantly lower IQ score than SegBH (4.0 ± 0.8 vs. 4.2 ± 0.8, p = 0.031). In a quantitative analysis, RTCSCineMoCo and SegBH yielded similar measurements for all parameters, while the majority of RTCSCine parameters were significantly different compared with SegBH, except for LVEDV. Conclusion RTCSCineMoCo is a promising method for robust free-breathing cardiac cine imaging, achieving better IQ and more precise quantitative analysis results for both ventricles compared with RTCSCine. Key Points • RTCSCineMoCo is a promising method for free-breathing cardiac MR cine imaging in daily practice. • RTCSCineMoCo provided better IQ and more precise quantitative measurements compared with RTCSCine, by extending RT data acquisition to multiple heartbeats, performing non-rigid respiratory motion correction, and signal averaging. • RTCSCineMoCo may be suitable for routine clinical use for vulnerable patients who may otherwise pose a challenge to image successfully with the conventional segmented cine technique.