Balanced steady-state free precession phase contrast at 0.55T applied to aortic flow

There is a growing interest in the development and application of mid-field (0.55T) for cardiovascular magnetic resonance (CMR), including flow imaging. However, aortic flow imaging at 0.55T has limited signal-to-noise ratio (SNR), especially in diastolic phases where there is reduced inflow-driven contrast for spoiled gradient recalled echo (GRE) sequences. The low SNR can limit the accuracy of flow and regurgitant fraction measurements.

In this work, we developed a two-dimensional phase contrast (PC) acquisition with balanced steady-state free precession (bSSFP), termed PC-SSFP, for flow imaging and quantification at 0.55T. This PC-SSFP approach precisely nulls the zeroth and first gradient moments at both the echo time (TE) and repetition time, except for the flow-encoded acquisition, for which the first gradient moment at the TE is determined by the velocity encoding. Our proposed sequence was tested in both phantoms and in healthy volunteers (n = 11), to measure aortic flow. In volunteers, both a breath-hold (bh) and a free-breathing (fb) protocol, with averaging to increase SNR, were obtained. Total flow, peak flow, cardiac output, and SNR were compared for PC-SSFP and PC-GRE. Stroke volumes were also measured and compared to planimetry method.

In a phantom, SNR was significantly higher using PC-SSFP compared to PC-GRE (25.5 ± 9.6 vs 8.2 ± 2.9), and the velocity measurements agreed well (R = 1.00). In healthy subjects, for both bh and fb protocols, PC-SSFP measured accurate peak flow (fb: R = 0.99, bh: R = 0.96) and cardiac output (fb: R = 0.98, bh: R = 0.88), compared to PC-GRE, accurate stroke volume (fb: R = 0.94, bh: R = 0.97), compared to planimetry measurement, and offered constant high SNR (fb: 28 ± 9 vs 18 ± 6, bh: 24 ± 7 vs 11 ± 3) over the cardiac cycle in 11 subjects.

PC-SSFP is a more reliable evaluation tool for aortic flow quantification, when compared to the conventional PC-GRE method at 0.55T, providing higher SNR, and thus potentially more accurate flows.