title: Feasibility of cardiac gating free of interference with electro-magnetic fields at 1.5 Tesla, 3.0 Tesla and 7.0 Tesla using an MR-stethoscope.
abstract: OBJECTIVE
  To circumvent the challenges of conventional electrocardiographic (ECG)-gating by examining the efficacy of an MR stethoscope, which offers (i) no risk of high voltage induction or patient burns, (ii) immunity to electromagnetic interference, (iii) suitability for all magnetic field strengths, and (iv) patient comfort together with ease of use for the pursuit of reliable and safe (ultra)high field cardiac gated magnetic resonance imaging (MRI).
  
  
  METHODS
  The acoustic gating device consists of 3 main components: an acoustic sensor, a signal processing unit, and a coupler unit to the MRI system. Signal conditioning and conversion are conducted outside the 0.5 mT line using dedicated electronic circuits. The final waveform is delivered to the internal physiological signal controller circuitry of a clinical MR scanner. Cardiovascular MRI was performed of normal volunteers (n = 17) on 1.5 T, 3.0 T and 7.0 T whole body MR systems. Black blood imaging, 2D CINE imaging, 3D phase contrast MR angiography, and myocardial T2* mapping were carried out.
  
  
  RESULTS
  The MR-stethoscope provided cardiograms at 1.5 T, 3.0 T and 7.0 T free of interference from electromagnetic fields and magneto-hydrodynamic effects. In comparison, ECG waveforms were susceptible to T-wave elevation and other distortions, which were more pronounced at higher fields. Acoustically gated black blood imaging at 1.5 T and 3.0 T provided image quality comparable with or even superior to that obtained from the ECG-gated approach. In the case of correct R-wave recognition, ECG-gated 2D CINE SSFP imaging was found to be immune to cardiac motion effects -even at 3.0 T. However, ECG-gated 2D SSFP CINE imaging was prone to cardiac motion artifacts if R-wave mis-registration occurred because of T-wave elevation. Acoustically gated 3D PCMRA at 1.5 T, 3.0 T and 7.0 T resulted in images free of blood pulsation artifacts because the acoustic gating approach provided cardiac signal traces free of interference with electromagnetic fields or magneto-hydrodynamic effects even at 7.0 Tesla. Severe ECG-trace distortions and T-wave elevations occurred at 3.0 T and 7.0 T. Acoustically cardiac gated T2* mapping at 3.0 T yielded a T2* value of 22.3 +/- 4.8 ms for the inferoseptal myocardium.
  
  
  CONCLUSIONS
  The proposed MR-stethoscope presents a promising alternative to currently available techniques for cardiac gating of (ultra)high field MRI. Its intrinsic insensitivity to interference from electromagnetic fields renders it suitable for clinical imaging because of its excellent trigger reliability, even at 7.0 Tesla.
authors: Department of Radiology, Division of Experimental MR Imaging, University Hospital, RWTH Aachen, Aachen, Germany. tobias.frauenrath@gmail.com
authors: Tobias
authors: T
authors: Frauenrath
authors: Fabian
authors: F
authors: Hezel
authors: Uwe
authors: U
authors: Heinrichs
authors: Sebastian
authors: S
authors: Kozerke
authors: Jane F
authors: JF
authors: Utting
authors: Malte
authors: M
authors: Kob
authors: Christoph
authors: C
authors: Butenweg
authors: Peter
authors: P
authors: Boesiger
authors: Thoralf
authors: T
authors: Niendorf
mesh_terms: D000328:Adult; D016477:Artifacts; D055424:Cardiac-Gated Imaging Techniques / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation*; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D010701:Phonocardiography / Q000295:instrumentation*; D019023:Stethoscopes