Pediatric Cardiology

, Volume 40, Issue 1, pp 79–88 | Cite as

Improved Workflow for Quantification of Right Ventricular Volumes Using Free-Breathing Motion Corrected Cine Imaging

  • Anthony MerloccoEmail author
  • Laura Olivieri
  • Peter Kellman
  • Hui Xue
  • Russell Cross
Original Article


Cardiac MR traditionally requires breath-holding for cine imaging. Younger or less stable patients benefit from free-breathing during cardiac MR but current free-breathing cine images can be spatially blurred. Motion corrected re-binning (MOC) is a novel approach that acquires and then reformats real-time images over multiple cardiac cycles with high spatial resolution. The technique was previously limited by reconstruction time but distributed computing has reduced these times. Using this technique, left ventricular volumetry has compared favorably to breath-held balanced steady-state free precession cine imaging (BH), the current gold-standard, however, right ventricular volumetry validation remains incomplete, limiting the applicability of MOC in clinical practice. Fifty subjects underwent cardiac MR for evaluation of right ventricular size and function by end-diastolic (EDV) and end-systolic (ESV) volumetry. Measurements using MOC were compared to those using BH. Pearson correlation coefficients and Bland–Altman plots tested agreement across techniques. Total scan plus reconstruction times were tested for significant differences using paired t-test. Volumes obtained by MOC compared favorably to BH (R = 0.9911 for EDV, 0.9690 for ESV). Combined acquisition and reconstruction time (previously reported) were reduced 37% for MOC, requiring a mean of 5.2 min compared to 8.2 min for BH (p < 0.0001). Right ventricular volumetry compares favorably to BH using MOC image reconstruction, but is obtained in a fraction of the time. Combined with previous validation of its use for the left ventricle, this novel method now offers an alternative imaging approach in appropriate clinical settings.


Retrospective reconstruction Cardiac volume Motion correction Cardiovascular MR Free-breathing Reconstruction time 



The authors wish to thank Michael Hansen PhD for his work through the National Institutes of Health/NHLBI. The combined contributions through development and implementation of the motion-corrected free-breathing re-binning technique made this work possible.


This study was funded by the Intramural Research Program of the National Institutes of Health (US), National Heart, Lung, and Blood Institute.

Compliance with Ethical Standards

Conflict of interest

Anthony Merlocco, Laura Olivieri, Peter Kellman, Hui Xue and Russell Cross declares that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board of Children’s National Health System and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Written informed consent, and assent when appropriate, was obtained from all study participants.


  1. 1.
    Hundley WG, Bluemke DA, Finn JP et al (2010) ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance. A report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 55(23):2614–2662. CrossRefGoogle Scholar
  2. 2.
    Fratz S, Chung T, Greil GF et al (2013) Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease. J Cardiovasc Magn Reson 15(1):51. CrossRefGoogle Scholar
  3. 3.
    Scheffler KLS (2003) Principles and applications of balanced SSFP techniques. Eur Radiol 13:2409–2418CrossRefGoogle Scholar
  4. 4.
    Ridgway JP (2010) Cardiovascular magnetic resonance physics for clinicians: part I. J Cardiovasc Magn Reson 12(1):71. CrossRefGoogle Scholar
  5. 5.
    Maceira A, Prasad S, Khan MPD (2006) Normalized left ventricular systolic and diastolic function by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson 8:417–426CrossRefGoogle Scholar
  6. 6.
    Kondo C, Caputo GR, Semelka R, Foster E, Shimakawa A, Higgins CB (1991) Right and left ventricular stroke volume measurements with velocity-encoded cine MR imaging: in vitro and in vivo validation. Am J Roentgenol 157(1):9–16. CrossRefGoogle Scholar
  7. 7.
    Suinesiaputra A, Bluemke DA, Cowan BR et al (2015) Quantification of LV function and mass by cardiovascular magnetic resonance: multi-center variability and consensus contours. J Cardiovasc Magn Reson 17(1):63. CrossRefGoogle Scholar
  8. 8.
    Pattynama PM, Lamb HJ, van der Velde EA, van der Wall EE, de Ross A (1993) Left ventricular measurements with cine and spin-echo MR imaging: a study of reproducibility with variance component analysis. Radiology 187:261–268CrossRefGoogle Scholar
  9. 9.
    Grothues F, Smith GC, Moon JC et al (2002) Comparison of interstudy reproducibility of cardiovascular magnetic resonance with two-dimensional echocardiography in normal subjects and in patients with heart failure or left ventricular hypertrophy. Am J Cardiol 90(1):29–34. CrossRefGoogle Scholar
  10. 10.
    Cross R, Olivieri L, O’Brien K, Kellman P, Xue H, Hansen M (2016) Improved workflow for quantification of left ventricular volumes and mass using free-breathing motion corrected cine imaging. J Cardiovasc Magn Reson 18(1):10. CrossRefGoogle Scholar
  11. 11.
    Kühl HP, Spuentrup E, Wall A, Franke A, Schröder J, Heussen N, Hanrath P, Gunther RBA (2004) Assessment of myocardial function with interactive non-breath-hold realtime MR imaging: comparison with echocardiography and breath-hold cine MR imaging. Radiology 231(1):198–207CrossRefGoogle Scholar
  12. 12.
    Lee VS, Resnick D, Bundy JM, Simonetti OP, Lee PWJ (2002) Cardiac function: MR evaluation in one breath hold with real-time true fast imaging with steady-state precession. Radiology 222:835–842CrossRefGoogle Scholar
  13. 13.
    Xue H, Kellman P, LaRocca G, Arai AE, Hansen MS (2013) High spatial and temporal resolution retrospective cine cardiovascular magnetic resonance from shortened free breathing real-time acquisitions. J Cardiovasc Magn Reson 15(1):102. CrossRefGoogle Scholar
  14. 14.
    Kellman P, Chefd’hotel C, Lorenz CH, Mancini C, Arai AE, McVeigh ER (2009) High spatial and temporal resolution cardiac cine MRI from retrospective reconstruction of data acquired in real time using motion correction and resorting. Magn Reson Med 62(6):1557–1564. CrossRefGoogle Scholar
  15. 15.
    Hansen MS, Sørensen TS, Arai AE, Kellman P (2012) Retrospective reconstruction of high temporal resolution cine images from real-time MRI using iterative motion correction. Magn Reson Med 68(3):741–750. CrossRefGoogle Scholar
  16. 16.
    Hansen M, Sørensen T (2013) Gadgetron: an open source framework for medical image reconstruction. Magn Reson Med 69:1768–1776CrossRefGoogle Scholar
  17. 17.
    Xue H, Inati S, Sørensen TS, Kellman PHM (2015) Distributed MRI reconstruction using Gadgetron-based cloud computing. Magn Reson Med 73:1015–1025CrossRefGoogle Scholar
  18. 18.
    Bland JMAD (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8:135–160CrossRefGoogle Scholar
  19. 19.
    McBride G (2005) A proposal for strength-of-agreement criteria for Lin’s concordance correlation coefficient. In: NIWA Client Report: HAM 2005-06. Report to Ministry of Health, p 6Google Scholar
  20. 20.
    Lin L (1989) A concordance correlation coefficient to evaluate reproducibility. Biometrics 45:255–268CrossRefGoogle Scholar
  21. 21.
    Mooij CF, de Wit CJ, Graham DA, Powell AJ, Geva T (2008) Reproducibility of MRI measurements of right ventricular size and function in patients with normal and dilated ventricles. J Magn Reson Imaging 28(1):67–73. CrossRefGoogle Scholar
  22. 22.
    Grothues F, Moon JC, Bellenger NG, Smith GS, Klein HU, Pennell DJ (2004) Interstudy reproducibility of right ventricular volumes, function, and mass with cardiovascular magnetic resonance. Am Heart J 147(2):218–223. CrossRefGoogle Scholar
  23. 23.
    Blalock SE, Banka P, Geva T, Powell AJ, Zhou J, Prakash A (2013) Interstudy variability in cardiac magnetic resonance imaging measurements of ventricular volume, mass, and ejection fraction in repaired tetralogy of Fallot: a prospective observational study. J Magn Reson Imaging 38(4):829–835. CrossRefGoogle Scholar
  24. 24.
    Caudron J, Fares J, Lefebvre V, Vivier P-H, Petitjean C, Dacher J-N (2012) Cardiac MRI assessment of right ventricular function in acquired heart disease: factors of variability. Acad Radiol 19(8):991–1002. CrossRefGoogle Scholar
  25. 25.
    Altmayer SPL, Teeuwen LA, Gorman RC, Han Y (2015) RV mass measurement at end-systole: improved accuracy, reproducibility, and reduced segmentation time. J Magn Reson Imaging 42(5):1291–1296. CrossRefGoogle Scholar
  26. 26.
    Sanders RD, Hassell J, Davidson AJ, Robertson NJ, Ma D (2013) Impact of anaesthetics and surgery on neurodevelopment: an update. Br J Anaesth 110:i53–i72. CrossRefGoogle Scholar
  27. 27.
    Pinyavat T, Warner DO, Flick RP et al (2016) Summary of the update session on clinical neurotoxicity studies. J Neurosurg Anesthesiol 28(4):356–360. CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Cardiology, Children’s National Health System, and the Department of PediatricsGeorge Washington Medical SchoolWashingtonUSA
  2. 2.National Institutes of Health/NHLBIBethesdaUSA
  3. 3.University of Tennessee Health Science CenterLe Bonheur Children’s HospitalMemphisUSA

Personalised recommendations