Cardiac real‐time MRI using a pre‐emphasized spiral acquisition based on the gradient system transfer function

Purpose Segmented Cartesian acquisition in breath hold represents the current gold standard for cardiac functional MRI. However, it is also associated with long imaging times and severe restrictions in arrhythmic or dyspneic patients. Therefore, we introduce a real‐time imaging technique based on a spoiled gradient‐echo sequence with undersampled spiral k‐space trajectories corrected by a gradient pre‐emphasis. Methods A fully automatic gradient waveform pre‐emphasis based on the gradient system transfer function was implemented to compensate for gradient inaccuracies, to optimize fast double‐oblique spiral MRI. The framework was tested in a phantom study and subsequently transferred to compressed sensing–accelerated cardiac functional MRI in real time. Spiral acquisitions during breath hold and free breathing were compared with this reference method for healthy subjects (N = 7) as well as patients (N = 2) diagnosed with heart failure and arrhythmia. Left‐ventricular volumes and ejection fractions were determined and analyzed using a Wilcoxon signed‐rank test. Results The pre‐emphasis successfully reduced typical artifacts caused by k‐space misregistrations. Dynamic cardiac imaging was possible in real time (temporal resolution < 50 ms) with high spatial resolution (1.34 × 1.34 mm2), resulting in a total scan time of less than 50 seconds for whole heart coverage. Comparable image quality, as well as similar left‐ventricular volumes and ejection fractions, were observed for the accelerated and the reference method. Conclusion The proposed technique enables high‐resolution real‐time cardiac MRI with no need for breath holds and electrocardiogram gating, shortening the duration of an entire functional cardiac exam to less than 1 minute.