title: Robust free-breathing SASHA T1 mapping with high-contrast image registration.
abstract: Many widely used myocardial T1 mapping sequences use breath-hold acquisitions that limit the precision of calculated T1 maps. The SAturation-recovery single-SHot Acquisition (SASHA) sequence has high accuracy with robustness against systematic confounders, but has poorer precision compared to the commonly used MOdified Look-Locker Inversion recovery (MOLLI) sequence. We propose a novel method for generating high-contrast SASHA images to enable a robust image registration approach to free-breathing T1 mapping with high accuracy and precision.
  
  
  
  High-contrast (HC) images were acquired in addition to primary variable flip angle (VFA) SASHA images by collecting an additional 15 k-space lines and sharing k-space data with the primary image. The number of free-breathing images and their saturation recovery times were optimized through numerical simulations. Accuracy and precision of T1 maps using the proposed SASHA-HC sequence was compared in 10 volunteers at 1.5 T to MOLLI, a breath-hold SASHA-VFA sequence, and free-breathing SASHA-VFA data processed using conventional navigator gating and standard image registration. Free-breathing T1 maps from 15 patients and 10 volunteers were graded by blinded observers for sharpness and artifacts.
  
  
  
  Difference images calculated by subtracting HC and primary SASHA images had greater tissue-blood contrast than the primary images alone, with a 3× improvement for 700 ms TS saturation recovery images and a 6× increase in tissue-blood contrast for non-saturated images. Myocardial T1s calculated in volunteers with free-breathing SASHA-HC were similar to standard breath-hold SASHA-VFA (1156.1 ± 28.1 ms vs 1149.4 ± 26.5 ms, p >0.05). The standard deviation of myocardial T1 values using a 108 s free-breathing SASHA-HC (36.2 ± 3.1 ms) was 50 % lower (p <0.01) than breath-hold SASHA-VFA (72.7 ± 8.0 ms) and 34 % lower (p <0.01) than breath-hold MOLLI (54.7 ± 5.9 ms). T1 map quality scores in volunteers were higher with SASHA-HC (4.7 ± 0.3 out of 5) than navigator gating (3.6 ± 0.4, p <0.01) or normal registration (3.7 ± 0.4, p <0.01). SASHA-HC T1 maps had comparable precision to breath-hold MOLLI using a retrospectively down-sampled 30 s free-breathing acquisition and 30 % higher precision with a 60 s acquisition.
  
  
  
  High-contrast SASHA images enable a robust image registration approach to free-breathing T1 mapping. Free-breathing SASHA-HC provides accurate T1 maps with higher precision than MOLLI in acquisitions longer than 30 s.
authors.affiliation: Department of Medicine, University of Virginia Health System, PO Box 800158, 1215 Lee St, Charlottesville, 22908, VA, USA.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Chow
authors.affiliation: Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Medicine, University of Virginia Health System, PO Box 800158, 1215 Lee St, Charlottesville, 22908, VA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Shaw
authors.affiliation: Department of Medicine, University of Virginia Health System, PO Box 800158, 1215 Lee St, Charlottesville, 22908, VA, USA.|Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Kramer
authors.affiliation: Department of Medicine, University of Virginia Health System, PO Box 800158, 1215 Lee St, Charlottesville, 22908, VA, USA. msalerno@virginia.edu.|Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA, USA. msalerno@virginia.edu.|Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA. msalerno@virginia.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Salerno
mesh_terms: D016022:Case-Control Studies; D003287:Contrast Media / Q000008:administration & dosage*; D005355:Fibrosis; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D019047:Phantoms, Imaging; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012119:Respiration
chemical_list: D003287:Contrast Media
keywords: Extracellular volume; Fibrosis; Free-breathing; Image registration; SASHA; T1 mapping