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Unsupervised free-breathing 3D imaging of morphology, function and flow in congenital heart disease


To evaluate technical feasibility, image quality and quantitative integrity of a free-breathing protocol following administration of blood pool contrast agent, utilizing 3-dimensional (3D) imaging of morphology, function, and flow without physician supervision in a cohort of patients with CHD.


Five patients with CHD were included in this pilot study. The MR studies were performed on a Philips Acheiva 1.5T magnet using a multielement phased array coil with the following sequences in this order: 1. Free-breathing, respiratory synchronized [1], time-resolved MRA following injection of 0.03 mmol/kg of Gadofosveset, and injection rate 2-4cc/second using a power injector. Duration: < 1 minute 2. Free breathing equilibrium phase MRA, acquired voxel size 0.8 × 0.8 × 1.6 mm, 2 NEX. Duration: 2.5-4 minutes 3. Free breathing 3D cine SSFP with respiratory triggering (TR/TE/flip angle: 3/1.5/60; acquired voxel size: 1.5-1.9 × 1.5-2.1 × 7-8 mm3; SENSE acceleration factor: 1.5-2 × 1.5-2; temporal resolution: 30-45 ms). Duration: 4.5-7 minutes 4. Free breathing sagittal 4D phase contrast (PC) imaging with respiratory navigator (18-26 phases/cardiac cycle, Venc 150 cm/sec, spatial resolution 1.6-2.8 mm3.) Duration: 6-12 minutes 5. Free breathing 3D SSFP with respiratory navigator. (acquired voxel size 1 × 1 × 2 mm3) Duration: 5-7 minutes Comparative data was obtained using conventional 2D cine respiratory triggered SSFP sequences (2) in the VLA, 4 chamber and short axis planes, and 2D PC imaging. Data Analysis: Image quality assessment and quantitative volumetric and flow analysis was performed by a single blinded user. MRA images were graded using a semi-quantitative scale from 1-5 for relevant imaging targets in CHD [1], with 1: excellent, no limitations, and 5: non-diagnostic. The clinical scoring system for 2D and 3D cine SSFP was based on blood-myocardial contrast, endocardial edge definition and inter-slice alignment[2]. Paired t-test analysis was performed on LV and RV volumes.


All free-breathing 3D sequences were technically feasible in all 5 patients. Average time for performance of 5 free breathing 3D sequences was 29 minutes. Average score for first-pass MRA was 1.9/5. Average score for equilibrium MRA was 1.3/5. Clinical scores for 2D SSFP were consistently better than 3D-SSFP, but 3D SSFP images were adequate for recognition of pathology in all cases. Average percentage difference between 2D and 3D cine SSFP volumetric data were as follows: LVEDV (5.5%), LVSV (11.2%), LVEF (6%), RVEDV (-3.9%), RVSV (8%) and RVEF (9.1%). Comparative flow analysis between 2D PC and 4D PC data is pending.


It is feasible to perform an observer independent comprehensive CMR in CHD utilizing free-breathing 3D acquisitions for morphology, function and flow within 30 minutes.


  1. JCMR. 2010, 12 (Suppl 1): O31

  2. JCMR. 2013, 15 (Suppl 1): O98

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Krishnamurthy, R., Krishnamurthy, R., Malone, L. et al. Unsupervised free-breathing 3D imaging of morphology, function and flow in congenital heart disease. J Cardiovasc Magn Reson 16 (Suppl 1), P134 (2014).

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