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Simultaneous correction of ghost and geometric distortion artifacts in EPI using a multiecho reference scan.

A computationally efficient technique is described for the simultaneous removal of ghosting and geometrical distortion artifacts in echo-planar imaging (EPI) utilizing a multiecho, gradient-echo reference scan. Nyquist ghosts occur in EPI reconstructions because odd and even lines of k-space are acquired with opposite polarity, and experimental imperfections such as gradient eddy currents, imperfect pulse sequence timing, B0 field inhomogeneity, susceptibility, and chemical shift result in the even and odd lines of k-space being offset by different amounts relative to the true center of the acquisition window. Geometrical distortion occurs due to the limited bandwidth of the EPI images in the phase-encode direction. This distortion can be problematic when attempting to overlay an activation map from a functional magnetic resonance imaging experiment generated from EPI data on a high-resolution anatomical image. The method described here corrects for geometrical distortion related to B0 inhomogeneity, gradient eddy currents, radio-frequency pulse frequency offset, and chemical shift effect. The algorithm for removing ghost artifacts utilizes phase information in two dimensions and is, thus, more robust than conventional one-dimensional methods. An additional reference scan is required which takes approximately 2 min for a matrix size of 64 X 64 and a repetition time of 2 s. Results from a water phantom and a human brain at 3 T demonstrate the effectiveness of the method for removing ghosts and geometric distortion artifacts.

Algorithms↗

Brain tumors: MR imaging with gadolinium-DTPA.

Magnetic resonance (MR) imaging was performed on 40 patients with intracranial tumors, before and after intravenous administration of gadolinium-DTPA (Gd-DTPA). Precontrast studies included a comprehensive protocol of spin-echo sequences. Tumors were visualized on precontrast images either directly or indirectly by anatomic distortion caused by the mass. However, differentiation of the tumor from adjacent tissues was possible in only 17 of 40 cases. Delineation of the tumor was best on precontrast, T2-weighted images. After administration of Gd-DTPA (0.1 mmol/kg), increased signal intensity from the tumor was observed in all patients. The localized increase in signal intensity in the tumor considerably improved the tumor delineation in 36 of 40 patients. Whereas most of the meningiomas, neuromas, and adenomas could be delineated prior to administration of contrast material if appropriate pulse sequences were applied, glioblastomas and intracranial metastases required Gd-DTPA administration for diagnostically sufficient tumor display.

Adenoma↗

Pulmonary magnetic resonance angiography.

In the past few years magnetic resonance angiography (MRA) of the pulmonary vasculature has advanced from a research tool to a clinically relevant imaging modality. Early 2D phase-contrast and time-of-flight (TOF) sequences without the use of contrast agents were time-consuming and limited by considerable imaging and motion artifacts. Since the introduction of MR scanners with stronger gradients (> 20 mT/m) and contrast-enhanced techniques, imaging of the pulmonary vasculature with adequate spatial resolution within a single breathhold is now possible. In the detection of pulmonary embolism in the lobar or segmental arteries, contrast-enhanced MRA is now on the verge of being considered an established modality, possibly competing with conventional pulmonary angiography and contrast-enhanced helical CT. In the future, utilization of phased-array torso coils, the application of navigator pulse sequences, and 3D time-resolved ultrafast MRA will overcome the final limitations of current techniques. Blood-pool MR contrast agents may provide a "one-stop-shopping" approach to the investigation of lower extremity veins and pulmonary arteries in venous thromboembolism.

Contrast Media↗

Cholecystitis: detection with MR imaging.

The role of magnetic resonance (MR) imaging in the detection of gallbladder disease was evaluated in 39 individuals (16 healthy, five with asymptomatic gallstones, and 18 with clinical symptoms of gallbladder disease). MR imaging was performed after they fasted for 12 hours. Imaging sequences included a combination of repetition times (TR) of 0.5 and 1.5 sec and echo times (TE) of 28 and 56 msec. On the images obtained at TR = 0.5 sec and TE = 56 msec, gallbladder bile was hyperintense compared with the liver in all healthy and asymptomatic subjects and was hypointense (n = 9), isointense (n = 4), or hyperintense (n = 5) in symptomatic patients, eight of whom had surgical confirmation of cholecystitis. Comparison of normal versus pathologically proved cases for the presence of gallbladder disease yielded a specificity of 100%, sensitivity of 75%, and a significant difference of P less than .01. Thus, with a pulse sequence of TR = 0.5 sec and TE = 56 msec, MR was sensitive in detecting gallbladder disease. However, the role of MR in the radiologic workup of gallbladder disease will be determined by more experience with this modality.

Adipose Tissue↗

[Ultrafast MRI of lung ventilation using hyperpolarized helium-3].

OBJECTIVE: Assessment of the temporal and spatial dynamics of hyperpolarized Helium-3 (3He) distribution in the lung with ultrafast gradient-echo magnetic-resonance imaging. MATERIAL AND METHODS: Coronal images of the lung were acquired using ultrafast gradient-echo pulse sequences with TR/TE = 3.3 ms/1.3 ms (slice thickness, 40 mm) and TR/TE = 2.0 ms/0.7 ms (without slice selection). A series of 80 or 160 projection images was obtained with 210 ms or 130 ms temporal resolution, respectively. Imaging was performed during several respiratory cycles after application of a single bolus of 300 mL hyperpolarized 3He. Measurements were performed in six healthy volunteers (spontaneous breathing). RESULTS: Different phases of in- and expiration could be visualized. During the course of consecutive respiratory cycles the 3He signal decreased due to dilution of 3He in residual alveolar gas and by inspired air, relaxation due to oxygen and the RF pulses, and due to Helium-3 washout. The signal of a single bolus of 3He was detected in the lung for up to four respiratory cycles. Anatomical structures were better visualized on slice selective images than on images without slice selection. CONCLUSION: Distribution of inspired 3He within the tracheobronchial tree and alveolar space and its washout can be visualized by ultrafast imaging of a single bolus of hyperpolarized 3He gas. This method may allow for regional analysis of lung function with temporal and spatial resolution superior to conventional methods.

Helium↗

Direct comparison of an intravascular and an extracellular contrast agent for quantification of myocardial perfusion. Cardiac MRI Group.

A direct comparison of extracellular and intravascular contrast agents for the assessment of myocardial perfusion was carried out in a porcine model (N = 5) with a flow-limiting occluder on the left anterior descending coronary artery. Rapid imaging during the first pass of an extracellular or intravascular contrast agent with a saturation-recovery-prepared TurboFLASH sequence showed comparable peak contrast-to-noise enhancements in myocardial tissue regions with flows averaging 1.1 +/- 0.2 at baseline to 4.8 +/- 0.6 ml/min/g during hyperemia. The coefficient of variation between the MR estimates of blood flow with Gadomer-17 and the microsphere blood flow measurements was 11 +/- 11%, while the corresponding co-efficient of variation for blood flow estimates with the extracellular CA was 23 +/- 11%. Blood volume differences between rest and hyperemia observed with the intravascular tracer were significant (Vvasc(rest) = 0.078 +/- 0.013 ml/g, versus Vvasc(hyperemia) = 0.102 +/- 0.019 ml/g; p < 0.05). The effects of water exchange were minimized through the choice of pulse sequence parameters to provide blood volume estimates consistent with the changes expected between rest and hyperemia. This study represents the first application of multiple indicators in first pass imaging studies for the assessment of myocardial perfusion. The use of an intravascular instead of an extracellular contrast agent allows a reduction of the degrees of freedom for modeling tissue residue curves and results in improved accuracy of blood flow estimates.

Animals↗

Simultaneous acquisition of multislice PET and MR images: initial results with a MR-compatible PET scanner.

UNLABELLED: PET and MRI are powerful imaging techniques that are largely complementary in the information they provide. We have designed and built a MR-compatible PET scanner based on avalanche photodiode technology that allows simultaneous acquisition of PET and MR images in small animals. METHODS: The PET scanner insert uses magnetic field-insensitive, position-sensitive avalanche photodiode (PSAPD) detectors coupled, via short lengths of optical fibers, to arrays of lutetium oxyorthosilicate (LSO) scintillator crystals. The optical fibers are used to minimize electromagnetic interference between the radiofrequency and gradient coils and the PET detector system. The PET detector module components and the complete PET insert assembly are described. PET data were acquired with and without MR sequences running, and detector flood histograms were compared with the ones generated from the data acquired outside the magnet. A uniform MR phantom was also imaged to assess the effect of the PET detector on the MR data acquisition. Simultaneous PET and MRI studies of a mouse were performed ex vivo. RESULTS: PSAPDs can be successfully used to read out large numbers of scintillator crystals coupled through optical fibers with acceptable performance in terms of energy and timing resolution and crystal identification. The PSAPD-LSO detector performs well in the 7-T magnet, and no visible artifacts are detected in the MR images using standard pulse sequences. CONCLUSION: The first images from the complete system have been successfully acquired and reconstructed, demonstrating that simultaneous PET and MRI studies are feasible and opening up interesting possibilities for dual-modality molecular imaging studies.

Anatomy, Cross-Sectional↗

High-resolution black-blood MRI of the carotid vessel wall using phased-array coils at 1.5 and 3 Tesla.

RATIONALE AND OBJECTIVES: The aim of this report is to investigate the magnetic field dependence of the signal-to-noise ratio (SNR) for carotid vessel wall magnetic resonance imaging using phased-array (PA) surface coils by comparing images obtained at 1.5 and 3 Tesla (T) and determine the extent to which the improved SNR at the higher field can be traded for improved spatial resolution. MATERIALS AND METHODS: Two pairs of dual-element PA coils were constructed for operation at the two field strengths. The individual elements of each PA were matched to 50 Omega impedance on the neck and tuned at the respective frequencies. The coils were evaluated on a cylindrical phantom positioned with its axis parallel to the main field and the coils placed on either side of the phantom parallel to the sagittal plane. In vivo magnetic resonance images of the carotid arteries were obtained in five subjects at both field strengths with a fast spin-echo double-inversion black-blood pulse sequence with fat saturation. SNR was measured at both field strengths by using standard techniques. RESULTS: At a depth corresponding to the average location of the carotid arteries in the study subjects, mean phantom SNR for the two coils was higher at 3 T by a factor of 2.5. The greater than linear increase is caused by only partial coil loading of these relatively small coils. The practically achievable average SNR gain in vivo was 2.1. The lower in vivo SNR gain is attributed to a reduction in T2 and prolongation of T1 at the higher field strength and, to a lesser extent, the requirement for a decreased refocusing pulse flip angle to operate within specific absorption rate limits. The superior SNR at 3 T appears to provide considerably improved vessel-wall delineation. CONCLUSIONS: Carotid artery vessel-wall magnetic resonance imaging using PA surface coils provides a considerable increase in SNR when field strength is increased from 1.5 to 3 T. This increase can be traded for enhanced in-plane resolution.

Adult↗

Three-dimensional time-of-flight MR angiography using selective inversion recovery RAGE with fat saturation and ECG-triggering: application to renal arteries.

A three-dimensional (3D), ECG-triggered, selective inversion recovery (SIR) rapid gradient-echo (RAGE) technique is proposed to obtain MR angiograms of the main renal arteries. By using the selective inversion recovery and fat saturation, the background is significantly suppressed while blood maintains a high signal intensity as compared with conventional 3D time-of-flight (TOF) MR angiography. The sequence is ECG-triggered so that blood in-flow is maximized during systole, and intravoxel dephasing and pulsatile flow artifacts are minimized by collecting data during diastole. As a result, vessel boundary blurring and ghosting artifacts due to background motion are dramatically reduced, and the conspicuity and lumen definition of the arteries are significantly improved. High-quality MR angiograms of the main renal arteries with excellent blood/tissue contrast and suppression of motion artifacts have been consistently obtained for normal volunteers, with the length of visualization being 51 +/- 07 mm for the left, and 57 +/- 06 mm for the right renal arteries, significantly greater than using conventional 3D TOF pulse sequences. Statistical analysis was performed by using a one-sided Student's t test.

Angiography↗

Abnormal lipid profile of dystrophic cardiac tissue as demonstrated by one- and two-dimensional magic-angle spinning (1)H NMR spectroscopy.

Dystrophin, a protein associated with sarcolemma and cell membranes, is not expressed in sufferers of Duchenne muscular dystrophy (DMD), or in the mdx mouse. DMD is a fatal disorder, with a significant proportion of fatalities associated with cardiac failure ( approximately 40% having dilated cardiomyopathy and >90% clinically significant cardiac defects at death). In this study, the metabolic composition of intact dystrophic cardiac tissue was investigated using high-resolution magic-angle spinning (HRMAS) (1)H NMR spectroscopy with both 1- and 2D pulse sequences coupled with pattern recognition (PR). While conventional solvent presaturation spectra indicated increases in CH(2) chain length in lipids, PR analysis of correlation spectroscopy (COSY) spectra demonstrated that this was also accompanied by an increase in concentration of lactate or threonine along with a relative decrease in CH = CHCH(2)CO groups in these lipids. To investigate the physical environment of these lipids, T(2)- and diffusion-weighted (1)H MAS NMR spectra were acquired on whole-tissue samples. The relatively increased lipid signal intensity in dystrophic tissue was due to an increase in molecules with long T(2) and short diffusion rates. The use of a range of pulse programs allowed the direct probing of the biochemical environment in which the lipid infiltration occurred, and by coupling the experiments to PR the significance of lipid infiltration and accumulation was also assessed.

Animals↗

Magnetic resonance imaging of the presumed normal canine adrenal glands.

Forty-three dogs without evidence of endocrine disease that underwent spinal or abdominal magnetic resonance imaging (MRI) for clinical reasons were studied. Because the procedures were not optimized for inclusion of the adrenal glands, they were not always visible in all planes. Eighty-five of the 86 adrenal glands were seen and only the left gland in a 6-month-old Irish wolfhound could not be found. The right adrenal gland lay cranial to the left in all of the animals in which both glands were seen. The best landmarks for localization of the glands were vascular; both adrenal glands were always cranial to the ipsilateral renal vessels and in the region of the celiac and cranial mesenteric arteries. Various measurements were made on all the available scan planes. In some dogs the whole adrenal gland was difficult to visualize clearly, and this hindered the measuring process, especially when the right adrenal gland was in close contact with the caudal vena cava. The adrenal glands were mainly linear in shape but also had a variable degree of modification of their poles, especially the cranial pole of the right adrenal gland, which tended to be consistently wider and to present different shapes (rounded, arrowhead, inverted P, hook-shaped, triangular, or dome-shaped). Two main patterns of signal intensity were seen on fast spin echo (FSE) sequences (T2-weighted, T1-weighted, and T1-weighted after administration of a paramagnetic contrast medium): homogeneous and hypointense to surroundings or a corticomedullary type pattern with a hyperintense central area surrounded by a hypointense rim of tissue. The outline of the left adrenal gland was always very clear. The clarity of outline of the right adrenal gland was more variable, especially if it was in contact with the liver or the caudal vena cava. It was felt that the amount of retroperitoneal fat was not as important as stated in the human literature for visualization of the adrenal glands and that with an appropriate selection of scan planes and pulse sequences good assessment of the adrenal glands can be performed with MRI in canine patients.

Adrenal Glands↗

Water suppression in 1H magnetic resonance images by the generation of multiple-quantum coherence.

Pulse sequences which generate multiple- and zero-quantum coherence and suppress the detection of single-quantum coherence have ben used to greatly reduce the intensity of the water signal in NMR images. In the experiment, image signals having multiple-quantum behavior add constructively while single-quantum signals, such as the signal arising from water, are canceled. Since the generation of multiple-quantum coherence is only a function of spin-spin coupling, water suppression by this technique is independent of chemical shift. Consequently, suppression of the water resonance in a 1H NMR image can be accomplished in an inhomogeneous magnetic field provided that the excitation profile of the rf pulses is equal for all spins. Furthermore, variations in the T1 and T2 of coupled and uncoupled spins do not affect the efficiency of the multiple-quantum filter.

Humans↗

[MR mammography at 0.5 tesla. I. Comparison of image quality and sensitivity of MR mammography at 0.5 and 1.5 T].

PURPOSE: To determine whether dynamic MR mammography is possible on midfield systems without loss of diagnostic sensitivity when compared to the standard highfield technique. MATERIALS AND METHODS: 42 consecutive patients were examined twice: Once using the standard dynamic 2D gradient echo technique at 1.5 T; a second examination was performed on a 0.5 T system. For the midfield examinations a 3D sequence with optimized T1 contrast was used to compensate for the shorter T1 relaxation times at 0.5 T. Subtraction images were calculated to improve detectability of enhancing lesions. RESULTS: Image quality was comparable on both systems. Mean enhancement of lesions was higher at 0.5 T/3D as compared to 1.5 T/2D (161% versus 112%). In malignant lesions, enhancement at 0.5 T/3D surpassed that at 1.5 T/2D in 88% of cases; average maximum signal intensity increase of cancers was significantly higher at 0.5 T/3D as compared to 1.5 T/2D (183% versus 108% relative to baseline). One satellite lesion of a recurrent carcinoma was detected on the 0.5 T/3D images only. CONCLUSION: A 3D gradient echo pulse sequence can be used to compensate for the T1 shortening effect of the lower field strength. With a 3D sequence, sensitivity of MRM at 0.5 T is even superior to that of the standard 2D highfield technique.

Adult↗

Manifestations of slow site exchange processes in solution NMR: a continuous Gaussian exchange model.

The effects of site exchange due to slow conformational changes in rapidly rotating molecules in solution are examined in detail. Significant gaps in the currently available theory are filled. The effects of site exchange on the lineshape, decay of a simple spin-echo, decay of the even echoes in a Carr-Purcell-Meiboom-Gill (CPMG) pulse-sequence, and decay of the transverse magnetization in a resonant spin-locking field are investigated. Both trajectory and stochastic operator approaches are formulated and shown to be completely equivalent whenever the dynamics of population transfers among the inequivalent sites is governed by either a stationary or a nonstationary Markov process. A nonstationary Markov process may result from Brownian dynamics (a stationary Markov process) in a larger conformational space that contains the subspace of inequivalent sites. A continuous Gaussian exchange model is formulated in which a nucleus undergoes continuous one-dimensional motion in a harmonic potential well that is located in a linear chemical shift gradient. The effects of this Gaussian exchange model on the lineshape, simple spin-echo decay, and decay of the even echoes of a CPMG pulse train are treated rigorously via the trajectory approach. Compact analytical expressions are obtained for the relevant correlation functions in each case. The relevant decays are found to be exponential in the very short time and long time limits, which are not necessarily experimentally significant in any given case. In the fast exchange limit the relevant decays are exponential at all times, and explicit formulas are given for their decay rates. In the long time limit, all discrete multisite models with the same intrinsic Ro2 at every site are shown to be completely equivalent to a continuous Gaussian model with appropriate relaxation time and variance of the Larmor frequency. The effects of this Gaussian exchange model on the decay of the transverse magnetization in a resonant spin-locking field are treated heuristically by a trajectory approach. The intrinsic contribution (Ro1rho) of rapid rotations and dipole-dipole interactions to relax the transverse magnetizations of two nuclei of the same kind in the presence of a (nearly) resonant spin-locking field is also derived and found to be practically the same as the intrinsic contribution, Ro2, of those same rotations to the simple and CPMG spin-echo decay rates and linewidth. Literature data for the linewidth, decay rate of the CPMG even spin-echoes, and R(1rho) decay rate for the A9-H2 protons of adenines at the central TpA step in the sequence, 5'-GCAGGTTTAAACCTCG-3', are analyzed using the Gaussian exchange model to assess the time-scale and variance of the site exchange process as well as the intrinsic Ro2 rate. Although a single Gaussian exchange process with appropriate parameters can fit these three A9-H2 data rather well, this particular "solution" cannot be reconciled with NMR relaxation data on other protons in the same DNA molecule. Rather good agreement with all of the observations is obtained by using a model of two concurrent Gaussian exchange processes, whose relaxation times, tau = 7 and 460 micros, differ in time-scale by a factor of 65. The insensitivity of R1rho in the presence of a fast site exchange process to much slower concurrent site exchange processes is explicitly demonstrated. Protocols for detecting and characterizing a second slow site exchange process are suggested.

Adenine↗

Improvement of spectral resolution in shift-reagent-aided 23Na NMR spectroscopy in the isolated perfused rat heart system.

The level of intracellular sodium (Nai) is maintained at approximately 14 mM in healthy myocytes. When myocytes are damaged, Nai increases and therefore the level of Nai may be a means of evaluating myocardial cell integrity. A particularly useful method to monitor Nai levels is 23Na NMR spectroscopy. However, because of the isochronous nature of the extracellular sodium (Nao) and Nai NMR signals, paramagnetic lanthanide shift reagents (LSR), such as dysprosium triphosphate, Dy(PPP)7-(2), have been used to shift the Nao signal. This reveals the unshifted Nai signal and allows the NMR monitoring of Nai in isolated perfused hearts and other systems. A major shortcoming of this method (the "shift-only" method) is in the need to minimize the Nao signal by not submerging the perfused hearts in Na(+)-containing buffer. An equally undesirable alternative is the utilization of relatively high concentrations of LSR to shift a large Nao signal sufficiently to enable reasonable resolution and quantitation of Nai. We present here a method, the "shift-relaxation" method, which is a combination of using a mixture of Dy(PPP)7-(2), a shift reagent, and gadolinium triphosphate, Gd(PPP)7-(2), a relaxation agent, with data acquisition using an inversion-recovery (IR) pulse sequence. This combination allows differentiation between Nao and Nai by the difference in their respective T1 values in addition to the shift between them. With this technique we can selectively minimize the extracellular signal and therefore minimize the need for a large Dy-induced shift, as well as allow data acquisition on a heart submerged in Na(+)-containing perfusate. The resulting improved discrimination between Nai and Nao at relatively low levels of LSR should be helpful for ultimate in vivo applications and potential clinical applications, where a lower dose of LSR also means a decreased possibility of physiologically deleterious effects. Also included in this paper is a method for the quick determination of an accurate 180 degrees pulse which is required for the optimization of the IR method.

Animals↗

Visibility of epidermoid tumors on steady-state free precession images.

PURPOSE: To determine whether steady-state free precession sequences improve the MR visibility of epidermoid tumors in comparison with spin-echo images. METHODS: Patients were four women and three men with epidermoid tumors in the subarachnoid spaces. MR was performed with a 1.5-T superconductive unit. For steady-state free precession imaging, three-dimensional Fourier transform fast imaging with steady-state free precession (FISP) images were used (20-40/7 [repetition time/echo time], flip angle of 25 degrees). The visualization and contrast-to-noise ratio were compared in FISP images and spin-echo images. In one case, the images of FISP and fast low-angle shot were obtained with variable repetition times and flip angles to evaluate the best pulse sequences for the visualization of epidermoid tumors. RESULTS: The contrast-to-noise ratios between tumors and cerebrospinal fluid ranged from 7.9 to 17.5 (average was 12.9) on FISP images. The average of contrast-to-noise ratios on T1, T2, and proton density-weighted spin-echo images were 1.6, 2.0, and 4.2, respectively. Three-dimensional Fourier transform FISP images best showed central nervous system and demonstrated epidermoid tumors excellently. CONCLUSIONS: Epidermoid tumors in the subarachnoid spaces were better demonstrated on steady-state free precession (three-dimensional Fourier transform FISP) than on conventional spin-echo images.

Aged↗

T2-weighted MR imaging of the chest: comparison of electrocardiograph-triggered conventional and turbo spin-echo and nontriggered turbo spin-echo sequences.

In 22 patients with a diverse range of thoracic abnormalities, T2-weighted magnetic resonance (MR) images of the chest were obtained with electrocardiograph (ECG)-triggered turbo spin-echo (TSE), ECG-triggered conventional spin-echo (CSE), and nontriggered TSE sequences, and the images were compared. A 5-point rating scale was used by three radiologists experienced in MR imaging of the chest to independently evaluate the images for (a) freedom from ghosting, (b) clarity of heart wall and cardiac chambers, (c) clarity of mediastinal structures, (d) conspicuity of abnormalities, and (e) overall image quality. Evaluations were analyzed with statistical methods. For freedom from ghosting, clarity of heart wall and cardiac chambers, clarity of mediastinal structures, and overall image quality, the ECG-triggered TSE images were rated higher than the TSE images, which, in turn, were rated higher than the ECG-triggered CSE images at the P = .05 level of significance. No significant differences were seen between the pulse sequences in the conspicuity of abnormalities, although some differences were observed in individual cases. Our results suggest that ECG-triggered TSE imaging provides improved, time-efficient T2-weighted images of the chest.

Adolescent↗

Cardiac stress MR imaging with dobutamine.

Stress testing for detection of ischemia-induced wall-motion abnormalities has become a mainstay for noninvasive diagnosis and risk stratification of patients with suspected coronary artery disease (CAD). Recent technical developments in magnetic resonance imaging (MRI), including the adoption of balanced steady-state free precession (b-SSFP) sequences-preferentially in combination with parallel imaging techniques-have led to a significant reduction of imaging time and improved patient safety. The stress protocol includes application of high-dose dobutamine (up to 40 microg/kg/min) combined with fractionated atropine (up to a maximal dose of 1.0 mg). High-dose dobutamine stress MRI revealed good sensitivity (83-96%) and specificity (80-100%) for detection of significant CAD. Myocardial tagging methods have been shown to further increase sensitivity for CAD detection. Severe complications (sustained tachycardia, ventricular fibrillation, myocardial infarction, cardiogenic shock) are rare but may be expected in 0.1-0.3% of patients. Dobutamine stress MRI has emerged as a reliable and safe clinical alternative for noninvasive assessment of CAD. New pulse sequences, such as real-time imaging, might obviate the need for breath holding and electrocardiogram (ECG) triggering in patients with severe dyspnoea and cardiac arrhythmias, which may further improve the clinical impact and acceptance of stress MRI in the future.

Atropine↗