Second-Order Motion-Compensated Echo-Planar Cardiac Diffusion-Weighted MRI: Usefulness of Compressed Sensitivity Encoding

Background: Cardiac diffusion-weighted imaging (DWI) using second-order motion-compensated spin echo (M2C) can provide noninvasive in-vivo microstructural assessment, but limited by relatively low signal-to-noise ratio (SNR). Echo-planar imaging (EPI) with compressed sensitivity encoding (EPICS) could address these issues. Purpose: To combine M2C DWI and EPCIS (M2C EPICS DWI), and compare image quality for M2C DWI. Study Type: Prospective. Population: Ten ex-vivo hearts, 10 healthy volunteers (females, 5 [50%]; mean +/- SD of age, 25 +/- 4 years), and 12 patients with diseased hearts (female, 1 [8.3%]; mean +/- SD of age, 44 +/- 16 years; including coronary artery heart disease, congenital heart disease, dilated cardiomyopathy, amyloidosis, and myocarditis). Field Strength/Sequence: 3-T, M2C EPICS DWI, and M2C DWI. Assessment: The apparent SNR (aSNR) and the rating scores were used to evaluate and compared image quality of all three groups. The aSNR was calculated using aSNR=Mean intensitymyocardium/Standard deviationmyocardium, and the myocardium was segmented manually. Three observers independently rated subjective image quality using a 5-point Likert scale. Statistical Tests: Bland-Altman analysis and paired t-tests. The threshold for statistical significance was set at P < 0.05. Results: In healthy volunteers, the aSNR with a b-value of 450 s/mm(2) acquired by M2C EPICS DWI was significantly higher than M2C DWI at in-plane resolutions of 3.0 x 3.0, 2.5 x 2.5, and 2.0 x 2.0 mm(2). In patients with diseased hearts, the aSNR ofM2C EPICS DWI was also significantly higher than that for M2C DWI (bias of M2C EPICS-M2C = 1.999, 95% limits of agreement, 0.362 to 3.636; mean +/- SD, 7.80 +/- 1.37 vs. 5.80 +/- 0.81). The ADC values of M2C EPICS was significantly higher than M2C DWI in in-vivo hearts. Over 80% of the images with rating scores for M2C EPICS DWI were higher than M2C DWI in in-vivo hearts. Data Conclusion: Cardiac imaging by M2C EPICS DWI may demonstrate better overall image quality and higher aSNR than M2C DWI. Evidence Level: 2 Technical Efficacy: Stage 1