A new compressed sensing cine cardiac MRI sequence with free-breathing real-time acquisition and fully automated motion-correction: A comprehensive evaluation

•Motion-corrected compressed sensing cine cardiac MRI acquired during free-breathing is robust to arrhythmia and preserves image quality by averaging multiple real-time acquisitions.•Regardless of the patient's heart rhythm or ability to maintain apnea, motion-corrected compressed sensing cine cardiac MRI improves edge sharpness compared to the reference cine MRI sequence at the same spatial resolution.•With reliable assessment of left and right ventricular functional parameters and preserved image quality, this new sequence overcomes recurring cine cardiac MRI image quality issues, namely arrhythmia and shortness of breath. The purpose of this study was to compare a new free-breathing compressed sensing cine (FB-CS) cardiac magnetic resonance imaging (CMR) to the standard reference multi-breath-hold segmented cine (BH-SEG) CMR in an unselected population. From January to April 2021, 52 consecutive adult patients who underwent both conventional BH-SEG CMR and new FB-CS CMR with fully automated respiratory motion correction were retrospectively enrolled. There were 29 men and 23 women with a mean age of 57.7 ± 18.9 (standard deviation [SD]) years (age range: 19.0–90.0 years) and a mean cardiac rate of 74.6 ± 17.9 (SD) bpm. For each patient, short-axis stacks were acquired with similar parameters providing a spatial resolution of 1.8 × 1.8 × 8.0 mm3 and 25 cardiac frames. Acquisition and reconstruction times, image quality (Likert scale from 1 to 4), left and right ventricular volumes and ejection fractions, left ventricular mass, and global circumferential strain were assessed for each sequence. FB-CS CMR acquisition time was significantly shorter (123.8 ± 28.4 [SD] s vs. 267.2 ± 39.3 [SD] s for BH-SEG CMR; P < 0.0001) at the penalty of a longer reconstruction time (271.4 ± 68.7 [SD] s vs. 9.9 ± 2.1 [SD] s for BH-SEG CMR; P < 0.0001). In patients without arrhythmia or dyspnea, FB-CS CMR provided subjective image quality that was not different from that of BH-SEG CMR (P = 0.13). FB-CS CMR improved image quality in patients with arrhythmia (n = 18; P = 0.002) or dyspnea (n = 7; P = 0.02), and the edge sharpness was improved at end-systole and end-diastole (P = 0.0001). No differences were observed between the two techniques in ventricular volumes and ejection fractions, left ventricular mass or global circumferential strain in patients in sinus rhythm or with cardiac arrhythmia. This new FB-CS CMR addresses respiratory motion and arrhythmia-related artifacts