Cardiac cine with compressed sensing real-time imaging and retrospective motion correction for free-breathing assessment of left ventricular function and strain in clinical practice

Background: Free-breathing cardiac cine magnetic resonance imaging (MRI) comparable to the traditional breath-hold 2D segmented cine imaging (SegBH) is clinically required for cardiac function and strain analysis. This study is to assess the feasibility and accuracy of a free-breathing cardiac cine technique (RTCSCineMoCo) combined with highly accelerated real-time acquisition, compressed sensing, and fully automated non-rigid motion correction for left ventricular (LV) function and strain analysis, using SegBH as the reference and comparing with free-breathing single-shot real-time compressed sensing cine imaging (RTCSCine) without motion correction. Methods: A total of 67 patients scheduled for clinical cardiac MRI were included. Cine images were acquired using three techniques (SegBH, RTCSCineMoCo, RTCSCine) consecutively at 3.0 T. LV functional parameters, including ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volumes (SV), and LV mass (LVM) were measured and compared. Strain parameters including global radial (GRS), circumferential (GCS), and longitudinal (GLS) strain as well as corresponding time to peak strain (TPS) were computed by magnetic resonance (MR) feature tracking and compared. Subgroup analyses were performed according to heart rate (HR), left ventricular ejection fraction (LVEF), and etiology. Results: All quantitative parameters of LV function and strain measured by RTCSCineMoCo (r>_0.766) and RTCSCine (r>_0.712) showed strong correlations with SegBH (all P<0.001). LV functional parameters were not statistically different between RTCSCineMoCo and SegBH (all P>0.05), but an overestimation of LV end-systolic volume (LVESV) and underestimation of LVEF and LVM were observed using RTCSCine (all P<0.001). GRS, GCS, and GLS by RTCSCineMoCo and RTCSCine were significantly different than those by SegBH (all P<0.05). All TPS values by RTCSCineMoCo showed no significant differences (all P>0.05) compared with SegBH, but TPS in longitudinal directions (TPSL) by RTCSCine was significantly different (P=0.011). There were no significant differences for GRS or GCS between RTCSCineMoCo and SegBH in patients with HR <70 bpm or LVEF <50%. GRS by RTCSCineMoCo showed similar results compared to SegBH in patients with pulmonary hypertension. Conclusions: RTCSCineMoCo is a promising method for robust free-breathing cardiac cine imaging, yielding more precise quantitative analytic results for LV function compared with RTCSCine. RTCSCineMoCo mildly underestimated GRS, GCS, and GLS, but showed smaller bias compared to RTCSCine in LV strain analysis.