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Assessment of Myocardial Function with Interactive Non–Breath-hold Real-time MR Imaging: Comparison with Echocardiography and Breath-hold Cine MR Imaging¹

¹ From Medical Clinic I (H.P.K., A.W., A.F., J.S., P.H.) and the Departments of Diagnostic Radiology (E.S., R.W.G., A.B.) and Medical Statistics (N.H.), University Hospital Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany. Received September 29, 2002; revision requested December 10; final revision received September 20, 2003; accepted September 29. Address correspondence to H.P.K. (e-mail: hkuehl@ukaachen.de).

View larger version (21K): [in a new window]   Figure 1. Drawing illustrates the segmentation model of the American Society of Echocardiography. CV = chamber view, SAX = short-axis view. Numbers 1-16 refer to the different myocardial segments. Note that segments 2, 4, 7, 10, 12, and 15 are represented twice—on the short- and long-axis views.

View larger version (24K): [in a new window]   Figure 2. Flow diagram of patient recruitment. CMRI = cardiac MR imaging, pat. = patient.

View larger version (16K): [in a new window]   Figure 3. Bar graph illustrates the percentages of segments for which there was good (white bars), moderate (gray), or poor (black bars) image quality with the different imaging techniques. With the BH-SSFP and radial sequences, there was good depiction of the majority of segments, while image quality was impaired with the spiral sequence and ECHO.

View larger version (37K): [in a new window]   Figure 4. Bar graph illustrates mean visibility scores for the short-axis (SAX) view and the long-axis two-, three-, and four-chamber views (CV) acquired by using ECHO (black bars) and radial (striped bars), spiral (white bars), and BH-SSFP (gray bars) sequences. The short-axis views had high visibility scores with all three MR imaging modalities but lower visibility scores with ECHO. The long-axis views had high visibility scores with the BH-SSFP and radial sequences but lower visibility scores with the spiral sequence and ECHO. * = P < .0001 for difference in scores between BH-SSFP MR imaging and either ECHO or spiral MR imaging. = P < .05 for difference in scores between the BH-SSFP and spiral sequences.

View larger version (43K): [in a new window]   Figure 5. Bar graphs illustrate mean visibility scores for each of the 16 segments depicted with the different imaging modalities. Black bars indicate no significant differences in visibility scores between the given modality and BH-SSFP MR imaging. White bars indicate significant (P < .0001) differences in visibility scores between the given modality and BH-SSFP MR imaging.

View larger version (164K): [in a new window]   Figure 6a. (a) Diastolic and (b) systolic stop-frame images of the heart acquired with the four imaging techniques in a patient with an old anterior myocardial infarction. Shown from left to right are two-, three, and four-chamber long-axis views and the short-axis view acquired with BH-SSFP MR imaging (top row), radial MR imaging (second row), spiral MR imaging (third row), and ECHO (bottom row). Note the poor image quality of the long-axis spiral views.

View larger version (167K): [in a new window]   Figure 6b. (a) Diastolic and (b) systolic stop-frame images of the heart acquired with the four imaging techniques in a patient with an old anterior myocardial infarction. Shown from left to right are two-, three, and four-chamber long-axis views and the short-axis view acquired with BH-SSFP MR imaging (top row), radial MR imaging (second row), spiral MR imaging (third row), and ECHO (bottom row). Note the poor image quality of the long-axis spiral views.

View larger version (154K): [in a new window]   Figure 7. Corresponding diastolic (images in left column on left and right sides) and systolic (images in right column on left and right sides) stop-frame images of long-axis two-chamber views (left group of images) and short-axis views (right group of images) obtained in a patient with normal myocardial wall motion. BH-SSFP (top row), radial (second row), spiral (third row), and ECHO (bottom row) images are shown. Note the poor image quality of the long- and short-axis ECHO views.