Cardiovascular magnetic resonance physics for clinicians: part I
© Ridgway; licensee BioMed Central Ltd. 2010
- Received: 3 June 2010
- Accepted: 30 November 2010
- Published: 30 November 2010
There are many excellent specialised texts and articles that describe the physical principles of cardiovascular magnetic resonance (CMR) techniques. There are also many texts written with the clinician in mind that provide an understandable, more general introduction to the basic physical principles of magnetic resonance (MR) techniques and applications. There are however very few texts or articles that attempt to provide a basic MR physics introduction that is tailored for clinicians using CMR in their daily practice. This is the first of two reviews that are intended to cover the essential aspects of CMR physics in a way that is understandable and relevant to this group. It begins by explaining the basic physical principles of MR, including a description of the main components of an MR imaging system and the three types of magnetic field that they generate. The origin and method of production of the MR signal in biological systems are explained, focusing in particular on the two tissue magnetisation relaxation properties (T1 and T2) that give rise to signal differences from tissues, showing how they can be exploited to generate image contrast for tissue characterisation. The method most commonly used to localise and encode MR signal echoes to form a cross sectional image is described, introducing the concept of k-space and showing how the MR signal data stored within it relates to properties within the reconstructed image. Before describing the CMR acquisition methods in detail, the basic spin echo and gradient pulse sequences are introduced, identifying the key parameters that influence image contrast, including appearances in the presence of flowing blood, resolution and image acquisition time. The main derivatives of these two pulse sequences used for cardiac imaging are then described in more detail. Two of the key requirements for CMR are the need for data acquisition first to be to be synchronised with the subject's ECG and to be fast enough for the subject to be able to hold their breath. Methods of ECG synchronisation using both triggering and retrospective gating approaches, and accelerated data acquisition using turbo or fast spin echo and gradient echo pulse sequences are therefore outlined in some detail. It is shown how double inversion black blood preparation combined with turbo or fast spin echo pulse sequences acquisition is used to achieve high quality anatomical imaging. For functional cardiac imaging using cine gradient echo pulse sequences two derivatives of the gradient echo pulse sequence; spoiled gradient echo and balanced steady state free precession (bSSFP) are compared. In each case key relevant imaging parameters and vendor-specific terms are defined and explained.
- Cardiovascular Magnetic Resonance
- Transverse Magnetisation
- Magnetic Field Gradient
- Larmor Frequency
- Magnetic Resonance Signal
This review is the first of two that aim to cover the basic physical principles underlying the most commonly used cardiovascular magnetic resonance (CMR) techniques. There are numerous texts and journal articles that provide excellent, in-depth explanations of MR physics and in particular CMR physics [1–5]. This review does not intend in any way to supplant these but rather to provide an overview of the key physical principles that underlie the most commonly used CMR techniques. This review begins with the basic principles of MR signal generation and image formation, outlines the principles of cardiac synchronisation and fast, breath-hold imaging. Finally, the principles behind the two most common CMR techniques; anatomical imaging using a double inversion, black-blood spin echo pulse sequence and bright blood functional cine imaging using two gradient echo-based pulse sequences are described in some detail.
A gradient magnetic field that can be rapidly switched on and off is generated by each of the three gradient coils mounted inside the main magnet (Figure 1a). Each of these gradient coils generates a magnetic field in the same direction as Bo but with a strength that changes with position along the x, y or z directions, according to which gradient coil is used. This gradient field is superimposed onto the Bo magnetic field so that its strength increases (or decreases) along the direction of the applied gradient field. The strength of the gradient magnetic field reflects the 'steepness' of its slope and is measured in units of millitesla per metre (mT/m).
A radiofrequency (rf) magnetic field is generated by the rf transmitter coil mounted inside the gradient coil, closest to the patient (Figure 1a). It has a much smaller amplitude than the other magnetic fields, but oscillates at a characteristic frequency in the megahertz range (hence, radiofrequency), the value of which is determined by the nominal field strength of the main magnet. The rf field is often referred to as the B1 field. The static magnetic field and radiofrequency field combine to generate magnetic resonance signals that are spatially localised and encoded by the gradient magnetic fields to create an MR image. For cardiac imaging, a separate rf receiver coil that is tailored to maximise signal from the heart is normally used to detect the emitted MR signals (Figure 1a).
Origin of the MR signal
The size of this net magnetisation is one of the key determinants of the maximum signal intensity that can be generated and used to form images. The greater the applied magnetic field strength, Bo, the greater the excess of protons aligned with the magnetic field and the greater the size of the net magnetisation.
This equation is known as the Larmor equation. The constant γ is called the gyromagnetic ratio and has a value of 42.6 MHz/Tesla for the proton. The Larmor frequency is therefore proportional to the strength of the magnetic field and for 1.5 Tesla, the Larmor frequency is approximately 64 MHz. This is also known as the resonant frequency, as the protons only absorb energy (or resonate) at this characteristic frequency. The rf field is normally applied as a short pulse, known as an rf pulse.
Radiofrequency pulses and flip angle
Before the rf pulse is switched on the net magnetisation, Mo, is at equilibrium, aligned along the z-axis in the same direction as Bo (Figure 2a). When the rf pulse is switched on, the net magnetisation begins to move away from its alignment with the Bo field and rotate around it. The speed of this rotational motion, known as precession, is also at the Larmor frequency. The Larmor frequency is therefore also sometimes referred to as the frequency of precession. The movement of the net magnetisation away from alignment with Bo is caused by a much slower rotation about the much smaller applied rf field, B1. This oscillating field, B1 is applied as a rotating field at right angles to Bo in the plane of the x and y axes. As it rotates at the same frequency as the Larmor frequency, it appears as an additional static field to the rotating net magnetisation vector. The net magnetisation therefore rotates about both the Bo and the B1 fields. As a result of these two rotations, the net magnetisation follows a spiral path from its alignment with the Bo field (z-axis) towards a rotational motion in the plane of the x and y axes.
Remember that the net magnetisation is the result of the sum of many individual magnetic moments. So long as they rotate together (a condition known as coherence) they will produce a net magnetisation that is rotating. The greater the amount of energy applied by the rf pulse, the greater the angle that the net magnetisation makes with the Bo field (the z axis). This depends upon both the amplitude and duration of the pulse. The rf pulse is switched off once the angle of precession has reached a prescribed value. This is known as the flip angle of the rf pulse (Figure 2b).
Once the rf pulse has caused the net magnetisation to make an angle with the z-axis, it can be split into two components (Figure 2b). One component is parallel to the z-axis. This is known as the z-component of the magnetisation, Mz, also know as the longitudinal component. The other component lies at right angles to the z axis within the plane of the x and y axes and is known as the x-y component of the net magnetisation, Mxy, or the transverse component. The transverse component rotates at the Larmor frequency within the xy plane and as it rotates, it generates its own small, oscillating magnetic field which is detected as an MR signal by the rf receiver coil. Radiofrequency pulses are commonly classified by both their flip angle and by their effect.
Radiofrequency pulses that generate an MR signal by delivering energy to the hydrogen spin population, causing the magnetisation to move away from its equilibrium position are known as excitation pulses. The 90° rf excitation pulse delivers just enough energy to rotate the net magnetisation through 90° (Figure 2c). This transfers all of the net magnetisation from the z-axis into the xy (transverse) plane, leaving no component of magnetisation along the z-axis immediately after the pulse. The system of protons is then said to be 'saturated' and the 90° rf pulse is therefore sometimes referred to as a saturation pulse. When applied once, a 90° rf pulse produces the largest possible transverse magnetisation and MR signal. This pulse is used to initially generate the signal for spin echo-based pulse sequences.
Low flip angle rf excitation pulses rotate the net magnetisation through a pre-defined angle of less than 90° (Figure 2b). A low flip is represented by the symbol α or can be assigned a specific value, e.g. 30°. Only a proportion of the net magnetisation is transferred from the z axis into the xy plane, with some remaining along the z axis. While a low flip angle rf pulse produces an intrinsically lower signal than the 90° excitation pulse described above, it can be repeated more rapidly as some of the magnetisation remains along the z-axis immediately after the pulse. This excitation pulse is used to generate the signal in gradient echo pulse sequences to control the amount of magnetisation that is transferred between the z-axis and the xy plane for fast imaging applications.
The 180° refocusing pulse is used in spin echo pulse sequences after the 90° excitation pulse, where the net magnetisation has already been transferred into the x-y plane. It flips the direction of the magnetisation in the x-y plane through 180° as it rotates at the Larmor frequency (Figure 2d). This pulse is used in spin echo-based techniques to reverse the loss of coherence caused by magnetic field inhomogeneities (described in the next section).
The 180° pulses are also used to prepare the net magnetisation before the application of an excitation pulse. These are known as inversion pulses and are used in inversion recovery or dark-blood pulse sequences. They are applied when the net magnetisation is at or close to equilibrium and invert the excess population of proton magnetic moments from being aligned to anti-aligned with the Bo field (Figure 2e). Because the resultant magnetisation lies only along the z axis this pulse does not result in a detectable signal. It is used to prepare the z-magnetisation in inversion recovery pulse sequences and in black blood preparation schemes. This type of pulse is therefore also often referred to as a magnetisation preparation pulse.
MR signal characteristics - T1, T2 and T2* relaxation
Immediately after the rf pulse the spin system starts to return back to its original state, at equilibrium. This process is known as relaxation. There are two distinct relaxation processes that relate to the two components of the Net Magnetisation, the longitudinal (z) and transverse (xy) components. The first relaxation process, longitudinal relaxation, commonly referred to as T1 relaxation is responsible for the recovery of the z component along the longitudinal (z) axis to its original value at equilibrium. The second relaxation process, transverse relaxation, is responsible for the decay of the xy component as it rotates about the z axis, causing a corresponding decay of the observed MR signal. Longitudinal and transverse relaxation both occur at the same time, however, transverse relaxation is typically a much faster process for human tissue. The signal decays away long before the spin system returns to its equilibrium state.
This arises from the fact that the rate of precession for an individual proton depends on the magnetic field it experiences at a particular instant. While the applied magnetic field Bo is constant, it is however possible for the magnetic moment of one proton to slightly modify the magnetic field experienced by a neighbouring proton. As the protons are constituents of atoms within molecules, they are moving rapidly and randomly and so such effects are transient and random. The net effect is for the Larmor frequency of the individual protons to fluctuate in a random fashion, leading to a loss of coherence across the population of protons. i.e. the spins gradually acquire different phase angles, pointing in different directions to one another and are said to move out of phase with one another (this is often referred to as de-phasing). The resultant decay of the transverse component of the magnetisation (Mxy) has an exponential form with a time constant, T2, hence this contribution to transverse relaxation is known as T2 relaxation (Figure 4). As it is caused by interactions between neighbouring proton spins it is also sometimes known as spin-spin relaxation. Due to the random nature of the spin-spin interactions, the signal decay caused by T2 relaxation is irreversible.
The second cause for the loss of coherence (de-phasing) relates to local static variations (inhomogeneities) in the applied magnetic field, Bo which are constant in time. If this field varies between different locations, then so does the Larmor frequency. Protons at different spatial locations will therefore rotate at different rates, causing further de-phasing so that the signal decays more rapidly. In this case, as the cause of the variation in Larmor frequency is fixed, the resultant de-phasing is potentially reversible. The combined effect of T2 relaxation and the effect of magnetic field non-uniformities is referred to as T2* relaxation and this determines the actual rate of decay observed when measuring an FID signal (Figure 4). T2* relaxation is also an exponential process with a time constant T2*.
Significance of the T1 value
T1 relaxation involves the release of energy from the proton spin population as it returns to its equilibrium state. The rate of relaxation is related to the rate at which energy is released to the surrounding molecular structure. This in turn is related to the size of the molecule that contains the hydrogen nuclei and in particular the rate of molecular motion, known as the tumbling rate of the particular molecule. As molecules tumble or rotate they give rise to a fluctuating magnetic field which is experienced by protons in adjacent molecules. When this fluctuating magnetic field is close to the Larmor frequency, energy exchange is more favourable. For example, lipid molecules are of a size that gives rise to a tumbling rate which is close to the Larmor frequency and therefore extremely favourable for energy exchange. Fat therefore has one of the fastest relaxation rates of all body tissues and therefore the shortest T1 relaxation time. Larger molecules have much slower tumbling rates that are unfavourable for energy exchange, giving rise to long relaxation times. For free water, its smaller molecular size has a much faster molecular tumbling rate which is also unfavourable for energy exchange and therefore it has a long T1 relaxation time. The tumbling rates of water molecules that are adjacent to large macromolecules can however be slowed down towards the Larmor frequency shortening the T1 value. Water- based tissues with a high macromolecular content (e.g. muscle) therefore tend to have shorter T1 values. Conversely, when the water content is increased, for example by an inflammatory process, the T1 value also increases.
Significance of the T2 value
T2 relaxation is related to the amount of spin-spin interaction that takes place. Free water contains small molecules that are relatively far apart and moving rapidly and therefore spin-spin interactions are less frequent and T2 relaxation is slow (leading to long T2 relaxation times). Water molecules bound to large molecules are slowed down and more likely in interact, leading to faster T2 relaxation and shorter T2 relaxation times. Water- based tissues with a high macromolecular content (e.g. muscle) tend to have shorter T2 values. Conversely, when the water content is increased, for example by an inflammatory process, the T2 value also increases. Lipid molecules are of an intermediate size and there are interactions between the hydrogen nuclei on the long carbon chains (an effect known as J-coupling) that cause a reduction of the T2 relaxation time constant to an intermediate value. Rapidly repeated rf pulses, such as those used in turbo or fast spin echo techniques, can have the effect of reducing J-coupling, resulting in an increased T2 relaxation time and higher signal intensity from fat .
Whilst the FID can be detected as a MR signal, for MR imaging it is more common to generate and measure the MR signal in the form of an echo. This is because the magnetic field gradients that are used to localise and encode the MR signals in space cause additional de-phasing which disrupts the FID. The two most common types of echo used for MR imaging are gradient echoes and spin echoes. The following sections describe how these echoes are generated.
Spin echo versus gradient echo
In general, because of the 180° refocusing pulse removes the de-phasing caused by magnetic field inhomogeneities, the amplitude of the spin echo signal is greater than the gradient echo signal. Imaging based on spin echo is also less affected by the presence of field inhomogeneities caused by metallic artefacts (e.g. sternal wires or metallic heart). Gradient echo imaging is however more affected by the presence of magnetic field inhomogeneities caused by iron and so is useful, for example, in the assessment of patients with increased iron deposition within the heart and liver.
The MR echo signals produced above can be localised and encoded by applying magnetic field gradients as they are generated to produce an image. This is because the application of a magnetic field gradient causes the strength of the magnetic field and hence, the Larmor frequency to depend on position along that direction. The sections that follow describe the most commonly used method to build up a cross-sectional 2-dimensional image (or image slice) using a combination of rf pulses and gradient magnetic fields.
Step 1 - Selection of an image slice
Step 2 - Phase encoding
Step 3 - Frequency encoding
Following the phase encoding gradient, the frequency encoding gradient, GF, is applied in a direction at right angles to it and in a similar way causes the protons to rotate at different frequencies according to their relative position along that direction gradient (Figure 8). This gradient is applied for longer, and at the same time the signal is measured or digitally sampled. The signal is comprised of a range of frequencies (or bandwidth), corresponding to the Larmor frequencies of the proton magnetic moments at their different locations along the gradient. This process is known as frequency encoding, the direction of the frequency encoding gradient defines the frequency encoding direction. The phase encoding and frequency encoding processes in steps 2 and 3 are further illustrated in an animation provided in Additional File 1.
Note that in Figure 9 additional gradient pulses are shown both after the slice selection gradient and before the frequency encoding gradient. These extra gradient pulses are required to counteract de-phasing that is caused by these two imaging gradients, to ensure the maximum possible signal at the centre of the MR signal echo. The additional gradient pulses are applied along the same direction as the imaging gradients, but with opposite slope, so that the transverse magnetisation is brought back into phase. For the slice selection gradient, de-phasing only occurs during the second half of the slice selection gradient since the transverse magnetisation is only generated halfway through the applied rf pulse. It is therefore followed by a re-phasing gradient that is only half the length of the slice selection gradient. This ensures that de-phasing that occurs along the slice selection gradient is reversed. The frequency encoding gradient is normally preceded by a de-phasing gradient so that when the frequency encoding gradient is applied, the de-phasing is reversed by the first half of the frequency encoding gradient and the signal echo reaches its maximum amplitude at the centre of the sampling period.
Repetition time and image acquisition time
If a greater spatial resolution is required in the phase encoding direction (for a fixed field of view), the number of pixels in that direction (sometimes referred to as the acquired image matrix size) must be increased. This requires a greater number of repetitions, and therefore a longer image acquisition time.
The way that the MR signals are generated and encoded by the use of magnetic field gradients gives rise to a particular relationship between the data points in the signal and those in the image. A single data point in an MR signal contributes a particular attribute to the whole image. Conversely, a single pixel in the image may have contributions from all of the MR signals collected. Just as each pixel occupies a unique location in image space, each point of an MR signal echo belongs to a particular location in a related space known as k-space . There is an inverse relationship between the image space and k-space (Figure 12). Whereas the coordinates of the image represent spatial position (x and y), the coordinates of k-space represent 1/x and 1/y, sometimes referred to as spatial frequencies, kx and ky. The value of each point in k-space represents how much of a particular spatial frequency is contained within the corresponding image.
Image contrast and weighting
One of the most important advantages of MR imaging over other imaging modalities is the ability to generate contrast between different soft tissue types. This is because different types of soft tissue have different characteristic T1 and T2 relaxation times. The dependence of the MR signal for a particular tissue on its relaxation properties is controlled by the choice of the pulse sequence parameters. For spin echo pulse sequences the excitation flip angle is fixed at 90° and the choice of TR and TE only control the influence of a tissue's T1 and T2 relaxation times on the signal. For gradient echo pulse sequences, the TR, TE and flip angle control the influence of a tissue's T1 and T2* relaxation times on the signal.
Spin echo contrast and weighting
For spin echo pulse sequences the addition of a 180° refocusing pulse removes the effect of T2* relaxation and determines that the amplitude of the spin echo is influenced by T2 relaxation only. The TR and TE are chosen to weight the image contrast so that it is either primarily dependent upon the differences in T1 relaxation times (T1-weighted), or primarily dependent on the differences in T2 relaxation times (T2 weighted). If the parameters are chosen so that the image contrast is influenced by neither the T1 or T2 differences, the tissue signal is said to be primarily 'proton density' weighted. The TR controls the T1 weighting, while the TE controls the T2 weighting.
T1-weighted spin echo
T2-weighted spin echo
Proton density-weighted spin echo
Black blood contrast of spin echo pulse sequences
Gradient echo contrast and weighting
There are a number of types of gradient echo pulse sequence, each having quite different contrast behaviour . The two main types of gradient echo pulse sequence used for cardiac cine imaging have the generic names, spoiled gradient echo and balanced steady state free precession (bSSFP). MR manufacturers also have their own names for these pulse sequences and these are also given in the following sections:
Spoiled gradient echo
Siemens: FLASH Fast Low Angle Shot
Philips: T1 FFE T1-weighted Fast Field Echo
GE: SPGR Spoiled GRASS (Gradient Recalled
Acquisition in the Steady State)
Gradient echo pulse sequences in cardiac imaging typically use very short TR values (<10 milliseconds) which gives rise to a more complex contrast behaviour. The TR values used are much shorter than the T2 relaxation times of blood and myocardium. This means that unless the transverse magnetisation generated by each rf pulse is destroyed after it has been sampled, it would still exist when the next rf pulse is applied. This can potentially contribute to, or interfere with, the signal during the following TR. In spoiled gradient echo, this signal is de-phased (or spoiled) either using a spoiler gradient at the end of each TR period, or by using a technique known as rf spoiling  so that its contribution to subsequent TR periods is suppressed.
T1-weighted spoiled gradient echo
For spoiled gradient echo, T1-contrast is controlled by both the TR and the flip angle.
Cardiac cine imaging requires very short repetition times to be used and so resultant spoiled gradient echo sequence, with both a short TR(<10 ms) and TE (<5 ms), combined with a flip angle of around 30° essentially behaves as a T1-weighted pulse sequence. As a very short TR is used, myocardial tissue or blood that remains in the slice becomes saturated. This sequence thus relies on the flow of blood to generate contrast.
T2*-weighted spoiled gradient echo
T2* weighting with spoiled gradient echo pulse sequences is achieved by increasing the TR and TE to relatively long values. As the T2* values for tissues are shorter than the T2 values, the echo times chosen to achieve T2* weighting with gradient echo are also much shorter than the echo times required to achieve T2 weighting with spin echo sequences. For T2*-weighted gradient echo, the image contrast is strongly influenced by the presence of magnetic susceptibility effects and can be used to detect the presence of iron, for example where there is haemorrhage or iron loading of tissue .
Balanced steady state free precession (bSSFP)
GE: FIESTA Fast Imaging Employing Steady sTate Acquisition
Philips: bFFE balanced Fast Field Echo
Siemens: True FISP True Fast Imaging with Steady Precession
Balanced SSFP gradient echo sequences are designed to ensure that the transverse magnetisation is not spoiled but brought back into phase at the end of each TR period when the next rf pulse is applied. This then carries over into the next repetition and is superimposed onto the to the transverse magnetisation generated by that rf pulse. After a number of repetitions this gives rise to a steady state condition where the transverse magnetisation from two or three successive repetition periods combine to give a much greater signal [15, 16].
The contrast behaviour of bSSFP sequences is very different to that of the spoiled gradient echo sequences. SSFP contrast is related to the tissue's T2/T1 ratio, with fluid and fat in particular appearing as brighter than other tissues. Because the transverse magnetisation originating from several TR's are combined, the MR signal amplitude for bSSFP is much greater compared to spoiled gradient echo. The increased signal allows a higher receiver bandwidths to be used, resulting in a shorter TE and TR compared to spoiled gradient echo pulse sequences and therefore improved imaging efficiency. However, if the magnetic field is not uniform, the transverse magnetisation from different TRs can destructively cancel rather than add together in areas of magnetic field inhomogeneity, making the SSFP technique prone to dark banding artefacts across the image . It is therefore very important to ensure that the magnetic field is as uniform as possible over the region of interest to achieve images that are free of banding artefacts. This is achieved by a patient-specific process called dynamic shimming which uses the magnetic field gradients to correct for patient induced field inhomogeneities. Keeping the TR as short as possible also helps to minimise the banding artefacts observed in bSSFP imaging.
Bright blood contrast of gradient echo pulse sequences
In contrast to the spin echo sequence, the gradient echo sequence only uses one rf pulse to generate the signal and so the spin washout effect does not apply and the signal from flowing blood is usually visible. Indeed, rather than suffering from a reduction in signal, flowing blood often appears with an apparently increased signal, compared to the surrounding tissues . The gradient echo pulse sequence is therefore commonly referred to as a bright blood imaging technique.
Spin echo vs. gradient echo
Summary of key differences between gradient echo and spin echo sequences
Gradient echo (bSSFP)
Flip angle (excitation pulse)
180° refocusing pulse
T1, T2, 'proton density'
Short Repetition time (T1- weighting)
3-400 ms (depends on flip angle)
Short echo time (minimise T2 or T2* weighting)
Long echo time (for T2 or T2* weighting)
Long Repetition time (minimises T1 weighting)
100 ms - (depends on flip angle)
Shortest practical TR
Intra-voxel signal loss (susceptibility, iron)
Signal from blood flowing through the slice
Dark (spin washout)
Bright (inflow enhancement)
Bright (intrinsic T2/T1 contrast)
T1, T2 and 'proton density'-weighted anatomical imaging and tissue characterisation
Fast cine imaging, Contrast-enhanced MR angiography,
T2*-weighted imaging for iron loading.
Fast cine imaging
Synchronising with the cardiac cycle
Dealing with respiratory motion
For conventional spin echo and gradient echo imaging techniques, the phase encoding gradient is incremented with each successive heart beat, acquiring a single line of k-space each heart beat and resulting in imaging times of several minutes. This means that images using these techniques are degraded by respiratory motion. Image degradation caused by respiratory motion can be reduced by using one of three possible approaches, namely respiratory compensation methods (respiratory gating), cardiac synchronised fast imaging techniques combined with patient breath-holding or ultra-fast (single-shot) imaging techniques (the so called real-time imaging techniques described later). In practice, most cardiac imaging is performed with patient breath-holding combined with fast imaging techniques and these are described in the following section.
Fast imaging techniques
Conventional imaging techniques acquire only one phase encoding step (one line of k-space) per heart beat. Thus the TR for those pulse sequences is defined by the patient's heart rate and is equal to the R-R interval. It therefore invariably takes several minutes to acquire an anatomical image dataset with conventional spin echo (SE) or a cine image dataset with conventional gradient echo sequences (spoiled gradient echo or bSSFP pulse sequences). In order to overcome this limitation to achieve shorter image acquisition times, fast imaging techniques acquire more than one line of k-space in each heart beat . This fills up k-space more rapidly, leading to shorter image acquisition times. Spin echo and gradient echo pulse sequences that use this principle are known as turbo or fast pulse sequences.
Still Imaging (Black blood anatomical imaging)
The ECG synchronisation technique used for still imaging is known as triggering. The synchronisation pulse is used as a trigger to initiate the pulse sequence at a particular time point after the R-wave in each cardiac cycle. This time point is known as the trigger delay and is selectable by the system operator to determine the point in the cardiac cycle at which the heart is to be imaged. This still imaging approach can be used for myocardial viability assessment or coronary angiography anatomical imaging, but the most routine application is to use it in combination with a fast or turbo spin echo pulse sequence to acquire black blood images for anatomical imaging.
Turbo (or fast) spin echo
Philips, Siemens TSE Turbo Spin Echo
GE FSE Fast Spin Echo
Black Blood Double Inversion preparation pulses
Anatomical imaging with black blood FSE/TSE pulse sequences
A common problem with this pulse sequence is loss of signal from the myocardium due to motion of the re-inverted myocardial tissue out of the image slice between the time of the black-blood preparation scheme and the time of the turbo or fast spin echo data acquisition. This effect can be reduced by increasing the thickness of the slice of tissue that is re-inverted by the second 180° pulse of the black-blood preparation scheme. While the image slice thickness may be typically 6-8 mm, a more appropriate value for the black blood inversion preparation pulse is 20 mm. The exact choice depends on how much displacement of the myocardium there is through the slice and it requires some adjustment depending on the trigger delay, slice orientation and location within the heart.
Triggering versus retrospective gating for cine imaging
For cine imaging, cardiac synchronisation can be performed in either of two ways: ECG triggering or ECG Gating (Figure 25). With ECG triggering the shortest possible trigger delay is used to commence data acquisition immediately after the QRS complex. Data is then acquired for multiple consecutive cardiac phases until nearly at the end of the cardiac cycle. Data acquisition is then stopped until the synchronisation pulse from the next 'R'-wave is received. This method requires the system to estimate an average R-R interval for the patient being imaged (This is either entered by the operator or captured from the ECG trace by the MR system). This is then used to determine the average length of the cardiac cycle over which data can be acquired and therefore how many cardiac phases can be acquired.
A consequence of this approach is that there is a 'blind spot' where no data is acquired at the end of the cardiac cycle while the system waits for the next trigger pulse. This is a disadvantage if imaging of diastolic function or mitral and tricuspid valve function is important. An alternative is to use retrospective ECG gating . Here the pulse sequence runs continuously with a short TR. The synchronisation pulse is used to record when a repetition of the pulse sequence is coincident with the 'R'-wave. The MR signal data from this and subsequent repetitions are then allocated to the corresponding time points in the cardiac cycle at the end of the entire k-space acquisition. With some refinement, retrospective gating can be used successfully when imaging patients with small beat-to-beat variations in RR interval. The method acquires data from the whole of each heart beat, so that heart beats of different lengths will have different numbers of data points recorded. At the end of the data acquisition, an average heart beat interval is calculated from the whole acquisition. The time intervals between data points acquired from shorter heart beats are stretched and data from longer heart beats are compressed to fit the average heart beat interval, ensuring that all points in the cardiac cycle are imaged. The use of retrospective gating is essential for applications such as imaging mitral or tricuspid valve function or atrial contraction.
While retrospective gating works well for small beat-to-beat variations in the R-R interval, imaging of patients with large beat to beat variations is problematic. For occasional arrhythmias, there is usually an option for data points acquired from excessively long or short heart beats to be rejected and reacquired. This is known as arrhythmia rejection. In cases where there are many arrhythmias however, rejection of data is not practical and the only options are to revert to a triggered data acquisition if only systolic information is required, or to use a 'real-time' image data acquisition for which ECG synchronisation is not required [24–27]. The latter approach can only be taken at the expense of temporal and spatial resolution.
Turbo (or Fast) Gradient echo pulse sequences
The parameter that defines the number of lines of k-space acquired in each shot is dependent upon the manufacturer as follows:
Siemens no of segments*
GE views per segment
(*Note that on the Siemens interface, a single line of k-space is called a segment). This determines the acceleration factor for a particular pulse sequence. For functional imaging it also determines the length of the acquisition window corresponding to each phase of the cardiac cycle. Increasing the 'turbofactor' decreases the scan time (shortens the length of breath-hold) but increases the acquisition window for each cardiac phase, thus limiting the number of cardiac phases that can be imaged, resulting in a lower cine frame rate or poorer temporal resolution. In order to maximise the number of cardiac phases and minimise the breath-hold period, the ability of an MR system to achieve very short TR values is therefore an advantage.
For breath hold cine gradient echo imaging, this method of accelerated image acquisition can be applied to both spoiled gradient echo and bSSFP pulse sequences commonly used for cardiac imaging. The vendor-specific names for the 'turbo' or 'fast' versions of these sequences are given below:
Fast spoiled gradient echo.
Siemens TFL TurboFLASH
Philips T1-TFE T1-weighted Turbo Field Echo
GE FSPGR Fast SPoiled GRASS
Balanced Steady State Free Precession (bSSFP)
Siemens Segmented True FISP
Philips BTFE Balanced Turbo Field Echo
GE FIESTA Fast Imaging Employing Steady sTate Acquisition
Functional imaging with turbo or fast cine gradient echo pulse sequences
Spoiled gradient echo versus bSSFP cine imaging.
Cine imaging technique
Cine gradient echo
Spoiled gradient echo
Fast Spoiled GRASS (FSPGR)
Function, qualitative flow assessment, flow jets, regurgitation
Cine SSFP imaging
Segmented True FISP
Function, volumetric measurements
A key parameter for cine pulse sequences is the number of lines of k-space acquired within each heart phase (turbofactor, no of segments or number of views per segment). Increasing the value of this parameter shortens the acquisition time, but also increases the time between cardiac phases. This reduces the number of cardiac phases within the cardiac cycle and therefore the cine frame rate or 'temporal resolution' of the image acquisition (the ability to resolve faster motion). 'Real-Time' imaging is achieved by selecting a very high turbofactor [24–27], such that the whole image acquisition is completed in a single cardiac phase in a single heart beat (a single-shot acquisition). Since all the phase encoding steps are acquired in a single heart beat, cardiac synchronisation is not required for real time imaging. The drawback of the high turbofactor is a poor cine frame rate. An acceptable frame rate can only be achieved by reducing the total number of k-space lines acquired. Real time imaging therefore suffers from poor temporal and spatial resolution, although the use of parallel imaging [38–40] can help to preserve spatio-temporal resolution.
This review has outlined the key physical principles that underlie the most commonly used cardiac MR imaging techniques. The basic principles of MR signal generation and image production have been explained and key imaging parameters have been defined, explaining their influence on image contrast, resolution and acquisition time. It has been shown how fast spin echo and gradient echo imaging techniques can be combined with cardiac synchronisation methods to provide high quality anatomical and functional cine imaging of the heart within a single breath-hold period.
The author wishes to thank John Biglands for providing the additional animation file.
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