Simultaneous multi-slice Cardiac Diffusion Tensor Imaging with variable CAIPIRINHA shifts and artefact-aware AI

Cardiac Diffusion Tensor Imaging (cDTI) provides unique insights into myocardial microstructure in-vivo but requires averaging multiple repetitions for adequate signal quality, leading to prohibitively long acquisition times. Standard acceleration strategies, such as reducing repetitions and employing simultaneous multi-slice (SMS) imaging, are limited by low signal-to-noise ratio (SNR) and inter-slice leakage artefacts, respectively. We introduce ORCAS, a unified framework that synergistically combines a novel variable CAIPIRINHA acquisition with an artefact-aware AI reconstruction to overcome these challenges. The variable CAIPIRINHA scheme decoheres SMS artefacts across repetitions, while our dual-domain deep learning model simultaneously suppresses these artefacts and combats the low SNR from fewer repetitions. The model is guided by patient-specific single-band auxiliary data to preserve anatomical fidelity. Validated on ex-vivo hearts with and without anomalies, ORCAS achieves an over 18-fold acceleration by combining these strategies, reducing a whole-heart scan from over two hours to under 7 min. This is accomplished while reducing errors in key biomarkers, such as Fractional Anisotropy, by up to 64%. The framework preserves essential microstructural properties and the delineation of abnormalities, representing a significant step towards the clinical translation of whole-heart cDTI.