Simultaneous non-contrast assessment of cardiac microstructure and perfusion in vivo in the human heart

Intravoxel incoherent motion (IVIM) imaging can provide information on cardiac microstructure and microvascular perfusion from a single examination. However, the spin echo-based approaches typically used for cardiac IVIM suffer from low sensitivity to changes in perfusion. The aim of this work was to develop a stimulated-echo (STEAM)-based method for IVIM and diffusion tensor cardiovascular magnetic resonance to simultaneously provide biomarkers of microstructure and perfusion in vivo in the human heart.

Here we introduce a novel STEAM-IVIM sequence incorporating phase cycling to obtain true non-diffusion weighted images (b = 0 s/mm²). STEAM-IVIM imaging was performed at 20 b-values (0 to 1000 s/mm²) to enable accurate estimation of the IVIM parameters, and with six diffusion encoding directions to enable reconstruction of the diffusion tensor. 20 healthy subjects (8 female, median age 31 years) were imaged on a clinical 3T system with STEAM-IVIM. A simulation study was performed to investigate the optimal fitting algorithms for the IVIM parameters, which was subsequently used to create pixel-wise IVIM parameter maps for the in vivo acquisitions.

Good image quality across the myocardium was obtained for all b-values. Mean(±SD) IVIM parameter estimates were: diffusivity D = 0.83 ± 0.07 × 10-3 mm²/s, perfusion coefficient D* = 19.08 ± 6.48 × 10-3 mm²/s, perfusion fraction f = 19.72 ± 4.11%, and mean diffusion tensor parameters were: mean diffusivity = 0.88 ± 0.06 × 10-3 mm²/s, fractional anisotropy = 0.45 ± 0.04, absolute E2 angle = 55.29 ± 6.38º, helix angle gradient = -0.68 ± 0.18º/%.

Phase-cycled STEAM-IVIM enables fitting of cardiac diffusion tensor and perfusion parameters in healthy subjects and shows promise for the simultaneous detection of microstructural aberration and perfusion abnormalities in the presence of cardiac disease without the need for exogenous contrast agents.