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Feasibility of Single-Breath-Hold Compressed Sensing Real-Time Cine Imaging for Assessment of Ventricular Function and Left Ventricular Strain in Cardiac Magnetic Resonance
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摘要:目的 探讨磁共振单次屏气压缩感知实时电影成像（single-breath-hold compressed sensing real-time cine imaging, CS-cine）在心室功能及应变评估中的可行性。方法 前瞻性连续纳入70例受检者，所有患者均行心脏磁共振标准稳态自由进动电影成像（standard steady-state free precession cine imaging, sta-cine）和CS-cine。电影序列扫描方位：从心底到心尖的连续短轴位及左室两腔、三腔、四腔长轴位，同一受检者的两组电影图像扫描范围、层数、层厚、层间距等一致。对所有电影图像进行主观图像质量评价，并通过后处理软件分析得出左、右常规心室功能参数和左室应变参数。比较两组电影图像质量、常规心室功能参数及左室应变参数之间的差异。通过计算组内相关系数（ICC）验证CS-cine心室定量参数的重复性，采用Bland-Altman分析两组电影间心室定量参数的一致性。结果 sta-cine组、CS-cine组电影的中位采集时间分别为272 s和21 s。sta-cine组、CS-cine组电影图像质量评分中位数分别为4分和2分，差异有统计学意义（P<0.001）。两组电影间常规心室功能参数比较：CS-cine所获得的射血分数（ejection fraction, EF）、舒张末期容积（end-diastolic volume, EDV）、搏出量（stroke volume, SV）均显著降低（P<0.001），而左、右室收缩末期容积（end-systolic volume, ESV）及左室心肌质量（left ventricular mass, LVmass）差异无统计学意义（P>0.05）。两组电影间应变参数比较：左室中部径向应变峰值（peak radial strain, PRS）、周向应变峰值（peak circumferential strain, PCS）及纵向应变峰值（peak longitudinal strain, PLS）差异均有统计学意义（P<0.001）。CS-cine各功能定量参数都具有较好的重复性（ICC=0.88～0.99），Bland-Altman分析结果显示各参数测量中，右室容积功能及左室PCS、PLS测量有95%以上在一致性范围内，其余参数测量结果均有91%以上在一致性界值内，可认为两组电影测量结果一致性较好。结论 CS-cine能够快速获取图像进行心功能定量分析，其分析所得常规心室功能参数及左室整体应变参数有较好的重复性。Abstract:Objective To explore the feasibility of single-breath-hold compressed sensing real-time cine imaging (CS-cine) in the assessment of ventricular function and left ventricular (LV) strain.Methods A total of 70 subjects were enrolled prospectively, and all subjects underwent cardiac magnetic resonance imaging (cardiac MRI) using both the standard steady-state free procession cine (sta-cine) acquisition and a prototype CS-cine sequence. For both CS-cine and sta-cine imaging, continuous short-axis cine images were acquired from the base to the apex to cover the entire left ventricle, and long-axis cine images including two-, three-, and four-chamber views were also acquired. The scanning range, number of slices, slice thickness and intervals were kept identical for the two cine images of the same participant. Subjective evaluation of the image quality was performed on all cine images. For both sequences, the conventional function parameters of the left and the right ventricles and LV strain values were assessed with post-processing software analysis. The cine image quality, conventional ventricular function parameters, and LV strain values were compared between the two cine groups and the differences were examined. Inter- and intraobserver agreements for CS-cine images were measured using intraclass correlation coefficient (ICC). Bland-Altman analysis was performed to assess reproducibility between the two cine methods.Results The median scanning time of CS-cine was 21 s versus 272 s for sta-cine (P<0.001). The median image quality scores of two groups were significantly different, 4 points for sta-cine and 2 points for CS-cine (P<0.001). Bi-ventricular end-diastolic volumes (EDV), stroke volume (SV) and ejection fraction (EF) were significantly smaller in CS-cine (P<0.001). Nevertheless, no significant differences between the two groups in bi-ventricular ESV or LV mass were observed (P>0.05). LV strain parameters, including the peak radial strain, peak circumferential strain and peak longitudinal strain derived from LV mid-ventricular slice, were significantly different in the two sequences (P<0.001). Moreover, CS-cine-derived functional parameters and strain measurements have a good correlation with those of sta-cine (for RV function parameters, and left ventricular PLS, PCS values, more than 95% points fell within the limits of agreement [LoA]; meanwhile, more than 91% points fell within the LoA for other parameters) and inter- and intraobserver agreements were strong (ICC=0.88 to 0.99) for CS-cine.Conclusion CS-cine can well realize the rapid acquisition of cine images for quantitative analysis of cardiac function, and the conventional ventricular function parameters and LV globalized strain values obtained from CS-cine imaging have good reproducibility.
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图 1 sta-cine及CS-cine电影图像
Figure 1. Images acquired from sta-cine and CS-cine
A: sta-cine end-diastolic basal short-axis slice; B: sta-cine end-diastolic mid-ventricular short-axis slice; C: sta-cine end-diastolic 4-chamber long-axis slices; D: CS-cine end-diastolic basal short-axis slice; E: CS-cine end-diastolic mid-ventricular short-axis slice; F: CS-cine end-diastolic 4-chamber long-axis slices.
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图 2 CS-cine与sta-cine心室功能参数测量结果的一致性检验（n=62）
Figure 2. The consistency of volumetric measurement between CS-cine and sta-cine (n=62)
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图 3 CS-cine与sta-cine左室应变参数的一致性检验（n=62）
Figure 3. The consistency of LV strain values between CS-cine and sta-cine (n=62)
表 1 扫描参数
Table 1 Imaging parameters
Parameter sta-cine CS-cine ECG-gating Retrospective Adaptive-prospective TE/ms 1.43 1.23 Repetition time/ms 3.3 2.9 FOV 320 mm×340 mm 320 mm×340 mm Voxel size 1.6 mm×1.6 mm×
8.0 mm1.6 mm×1.6 mm×
8.0 mmTemporal resolution/ms 31.7-56.2 41.5-57.1 Slice thickness/mm 8-11 8-11 Flip angle degrees 50 50 Sequences defination Segments Single shot Band width/(Hz/Px) 962 962 Calculated phases 25 25 ECG: electrocardiography; TE: Echo time; FOV: Field of view. 
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表 2 两组电影常规心功能参数比较〔中位数（四分位间距）〕
Table 2 Comparison of the bi-ventricular conventional function parameters between two groups (median [P25, P75])
Parameters sta-cine group (n=62) CS-cine group (n=62) P LVEF/% 61.77 (47.33, 66.27) 58.68 (42.59, 63.99) <0.001 LVEDV/mL 148.22 (123.01, 182.81) 139.45 (112.29, 181.17) <0.001 LVESV/mL 56.22 (42.17, 97.85) 55.68 (42.45, 94.89) 0.702 LVSV/mL 80.97 (70.56, 95.83) 72.99 (66.01, 86.14) <0.001 LVmass/g 86.29 (66.26, 115.25) 85.37 (65.66, 119.30) 0.558 RVEF/% 55.68 (51.08, 61.10) 52.06 (48.04, 58.79) <0.001 RVEDV/mL 126.92 (103.90, 148.95) 119.55 (100.52, 145.77) <0.001 RVESV/mL 53.31 (46.58, 66.65) 55.29 (45.36, 68.35) 0.438 RVSV/mL 70.30 (56.11, 83.20) 63.50 (51.07, 77.78) <0.001 LVEF: Left ventricular ejection fraction; LVEDV: Left ventricular end-diastolic volume; LVESV: Left ventricular end-systolic volume; LVSV: Left ventricular stroke volume; LVmass: Left ventricular mass; RVEF: Right ventricular ejection fraction; RVEDV: Right ventricular end-diastolic volume; RVESV: Right ventricular end-systolic volume; RVSV: Right ventricular stroke volume.
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表 3 两组电影左室应变峰值比较〔中位数（四分位间距）〕
Table 3 Comparison of the LV peak strain values between two groups (median [P25, P75])
Parameters sta-cine group (n=62) CS-cine group (n=62) P PRS/% 38.54 (28.12, 45.33) 29.61 (19.98, 36.53) <0.001 PCS/% −16.42 (−18.57, −12.78) −12.98 (−14.58, −10.26) <0.001 PLS/% −13.76 (−15.67, −11.41) −9.19 (−10.48, −7.30) <0.001 PRS: Peak radial srain; PCS: Peak circumferential strain; PLS: Peak longitudinal strain.
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表 4 CS-cine常规心室功能参数组间及组内ICC（n=62）
Table 4 Intraobserver and interobserver variability of conventional ventricular function parameters for CS-cine (n=62)
Parameters ICC Interobserver Intraobserver LVEF/% 0.9735 0.9726 LVEDV/mL 0.9876 0.9868 LVESV/mL 0.9911 0.9949 LVSV/mL 0.9339 0.9014 LVmass/g 0.8921 0.8924 RVEF/% 0.9012 0.9005 RVEDV/mL 0.9815 0.9545 RVESV/mL 0.9683 0.9744 RVSV/mL 0.8809 0.8908 LVEF: Left ventricular ejection fraction; LVEDV: Left ventricular end-diastolic volume; LVESV: Left ventricular end-systolic volume; LVSV: Left ventricular stroke volume; LVmass: Left ventricular mass; RVEF: Right ventricular ejection fraction; RVEDV: Right ventricular end-diastolic volume; RVESV: Right ventricular end-systolic volume; RVSV: Right ventricular stroke volume.
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表 5 CS-cine左室应变参数组间及组内ICC（n=62）
Table 5 Intraobserver and interobserver variability of LV stain values for CS-cine (n=62)
Parameters ICC Interobserver Intraobserver PRS/% 0.9962 0.9912 PCS/% 0.9927 0.9777 PLS/% 0.9790 0.9789 PRS: Peak radial srain; PCS: Peak circumferential strain; PLS: Peak longitudinal strain.
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