Motion robust respiratory-resolved 3D radial flow MRI and its application in neonatal congenital heart disease

Purpose: To test and implement a motion-robust and respiratory-resolved 3D Radial Flow framework that addresses the need for rapid, high resolution imaging in neonatal patients with congenital heart disease. Methods: A 4-point velocity encoding and 3D radial trajectory with double-golden angle ordering was combined with bulk motion correction (from projection center of mass) and respiration phase detection (from principal component analysis of heartbeat-averaged data) to create motion-robust 3D velocity cardiac time-averaged data. This framework was tested in a whole-chest digital phantom with simulated bulk and realistic physiological motion. In vivo imaging was performed in 20 congenital heart disease infants under feed-and-sleep with submillimeter isotropic resolution in ~3 min. Flows were validated against clinical 2D PCMRI and whole-heart visualizations of blood flow were performed. Results: The proposed framework resolved all simulated digital phantom motion states (mean ± standard error: rotation – azimuthal = 0.29 ± 0.02°; translation – Ty = 1.29 ± 0.12 mm, Tz = −0.27 ± 0.13 mm; rotation+translation – polar = 0.49 ± 0.16°, Tx = −2.47 ± 0.51 mm, Tz = 5.78 ± 1.33 mm). Measured timing errors of peak expiration across all signal-to-noise ratio values were 22% of the true respiratory period (range = [404-489 ± 298-334] ms). For in vivo imaging, motion correction improved 3D Radial Flow measurements (no correction: R2 = 0.62, root mean square error = 0.80 L/min/m2, Bland-Altman bias [limits of agreement] = −0.21 [−1.40, 0.94] L/min/m2; motion corrected, expiration: R2 = 0.90, root mean square error = 0.46 L/min/m2, bias [limits of agreement] = 0.06 [−0.49, 0.62] L/min/m2). Respiratory-resolved 3D velocity visualizations were achieved in various neonatal pathologies pre- and postsurgical correction. Conclusion: 3D cardiac flow may be visualized and accurately quantified in neonatal subjects using the proposed framework. This technique may enable more comprehensive hemodynamic studies in small infants.