title: Improved workflow for quantification of left ventricular volumes and mass using free-breathing motion corrected cine imaging.
abstract: BACKGROUND
  Traditional cine imaging for cardiac functional assessment requires breath-holding, which can be problematic in some situations. Free-breathing techniques have relied on multiple averages or real-time imaging, producing images that can be spatially and/or temporally blurred. To overcome this, methods have been developed to acquire real-time images over multiple cardiac cycles, which are subsequently motion corrected and reformatted to yield a single image series displaying one cardiac cycle with high temporal and spatial resolution. Application of these algorithms has required significant additional reconstruction time. The use of distributed computing was recently proposed as a way to improve clinical workflow with such algorithms. In this study, we have deployed a distributed computing version of motion corrected re-binning reconstruction for free-breathing evaluation of cardiac function.
  
  
  METHODS
  Twenty five patients and 25 volunteers underwent cardiovascular magnetic resonance (CMR) for evaluation of left ventricular end-systolic volume (ESV), end-diastolic volume (EDV), and end-diastolic mass. Measurements using motion corrected re-binning were compared to those using breath-held SSFP and to free-breathing SSFP with multiple averages, and were performed by two independent observers. Pearson correlation coefficients and Bland-Altman plots tested agreement across techniques. Concordance correlation coefficient and Bland-Altman analysis tested inter-observer variability. Total scan plus reconstruction times were tested for significant differences using paired t-test.
  
  
  RESULTS
  Measured volumes and mass obtained by motion corrected re-binning and by averaged free-breathing SSFP compared favorably to those obtained by breath-held SSFP (r = 0.9863/0.9813 for EDV, 0.9550/0.9685 for ESV, 0.9952/0.9771 for mass). Inter-observer variability was good with concordance correlation coefficients between observers across all acquisition types suggesting substantial agreement. Both motion corrected re-binning and averaged free-breathing SSFP acquisition and reconstruction times were shorter than breath-held SSFP techniques (p < 0.0001). On average, motion corrected re-binning required 3 min less than breath-held SSFP imaging, a 37% reduction in acquisition and reconstruction time.
  
  
  CONCLUSIONS
  The motion corrected re-binning image reconstruction technique provides robust cardiac imaging that can be used for quantification that compares favorably to breath-held SSFP as well as multiple average free-breathing SSFP, but can be obtained in a fraction of the time when using cloud-based distributed computing reconstruction.
authors.affiliation: Division of Cardiology, Children's National Health System, 111 Michigan Avenue, NW, Washington, DC, 20010, USA. rcross@childrensnational.org.
authors.forename: Russell
authors.initials: R
authors.lastname: Cross
authors.affiliation: Division of Cardiology, Children's National Health System, 111 Michigan Avenue, NW, Washington, DC, 20010, USA. lolivier@childrensnational.org.
authors.forename: Laura
authors.initials: L
authors.lastname: Olivieri
authors.affiliation: Division of Cardiology, Children's National Health System, 111 Michigan Avenue, NW, Washington, DC, 20010, USA. keobrien@childrensnational.org.
authors.forename: Kendall
authors.initials: K
authors.lastname: O'Brien
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA. kellmanp@nhlbi.nih.gov.
authors.forename: Peter
authors.initials: P
authors.lastname: Kellman
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA. hui.xue@nih.gov.
authors.forename: Hui
authors.initials: H
authors.lastname: Xue
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA. michael.hansen@nih.gov.
authors.forename: Michael
authors.initials: M
authors.lastname: Hansen
mesh_terms: D000328:Adult; D000465:Algorithms; D000067917:Cloud Computing; D005240:Feasibility Studies; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012119:Respiration; D013318:Stroke Volume; D016277:Ventricular Function, Left; D057188:Workflow; D055815:Young Adult