Development of whole-heart myocardial perfusion magnetic resonance imaging

Abstract

Myocardial perfusion imaging is of huge importance for the detection of coronary artery disease (CAD), one of the leading causes of morbidity and mortality worldwide, as it can provide non-invasive detection at the early stages of the disease. Magnetic resonance imaging (MRI) can assess myocardial perfusion by capturing the rst-pass perfusion (FPP) of a gadolinium-based contrast agent (GBCA), which is now a well-established technique and compares well with other modalities. However, current MRI methods are restricted by their limited coverage of the left ventricle. Interest has therefore grown in 3D volumetric \whole-heart" FPP by MRI, although many challenges currently limit this. For this thesis, myocardial perfusion assessment in general, and 3D whole-heart FPP in particular, were reviewed in depth, alongside MRI techniques important for achieving 3D FPP. From this, a 3D `stack-of-stars' (SOS) FPP sequence was developed with the aim of addressing some current limitations. These included the breath-hold requirement during GBCA rst-pass, long 3D shot durations corrupted by cardiac motion, and a propensity for artefacts in FPP. Parallel imaging and compressed sensing were investigated for accelerating whole-heart FPP, with modi cations presented to potentially improve robustness to free-breathing. Novel sequences were developed that were capable of individually improving some current sequence limits, including spatial resolution and signal-to-noise ratio, although with some sacri ces. A nal 3D SOS FPP technique was developed and tested at stress during free-breathing examinations of CAD patients and healthy volunteers. This enabled the rst known detection of an inducible perfusion defect with a free-breathing, compressed sensing, 3D FPP sequence; however, further investigation into the diagnostic performance is required. Simulations were performed to analyse potential artefacts in 3D FPP, as well as to examine ways towards further optimisation of 3D SOS FPP. The nal chapter discusses some limitations of the work and proposes opportunities for further investigation.