Search

Aims: A relationship between left atrial strain and pressure has been demonstrated in many studies, but not in an atrial fibrillation (AF) cohort. In this work, we hypothesized that elevated left atrial (LA) tissue fibrosis might mediate and confound the LA strain vs. pressure relationship, resulting instead in a relationship between LA fibrosis and stiffness index (mean pressure/ LA reservoir strain). Methods and Results: Sixty-seven patients with AF underwent a standard cardiac MR exam including long-axis cine views (2 and 4-ch) and a free-breathing high resolution three-dimensional late gadolinium enhancement (LGE) of the atrium (N=41), within 30 days prior to AF ablation, at which procedure invasive mean left atrial pressure (LAP) was measured. LV and LA Volumes, EF, and comprehensive analysis of LA strains (strain and strain rates and strain timings during the atrial reservoir, conduit and active phases) were measured and LA fibrosis content (LGE (ml)) was assessed from 3D LGE volumes. LA LGE was well correlated to atrial stiffness index (LA mean pressure/ LA reservoir strain) overall (R=0.59, pConclusion: In our AF cohort, pressure is correlated to maximum LA volume and time to peak reservoir strain. LA LGE is a strong marker of stiffness.

Left atrial (LA) imaging is still not routinely used for diagnosis and risk stratification, although recent studies have emphasized its importance as an imaging biomarker. Cardiovascular magnetic resonance is able to evaluate LA structure and function, metrics that serve as early indicators of disease, and provide prognostic information, e.g. regarding diastolic dysfunction, and atrial fibrillation (AF). MR angiography defines atrial anatomy, useful for planning ablation procedures, and also for characterizing atrial shapes and sizes that might predict cardiovascular events, e.g. stroke. Long-axis cine images can be evaluated to define minimum, maximum, and pre-atrial contraction LA volumes, and ejection fractions (EFs). More modern feature tracking of these cine images provides longitudinal LA strain through the cardiac cycle, and strain rates. Strain may be a more sensitive marker than EF and can predict post-operative AF, AF recurrence after ablation, outcomes in hypertrophic cardiomyopathy, stratification of diastolic dysfunction, and strain correlates with atrial fibrosis. Using high-resolution late gadolinium enhancement (LGE), the extent of fibrosis in the LA can be estimated and post-ablation scar can be evaluated. The LA LGE method is widely available, its reproducibility is good, and validations with voltage-mapping exist, although further scan–rescan studies are needed, and consensus regarding atrial segmentation is lacking. Using LGE, scar patterns after ablation in AF subjects can be reproducibly defined. Evaluation of ‘pre-existent’ atrial fibrosis may have roles in predicting AF recurrence after ablation, predicting new-onset AF and diastolic dysfunction in patients without AF. LA imaging biomarkers are ready to enter into diagnostic clinical practice.

Purpose Conventional cardiac T2 mapping suffers from the partial-voluming effect in the endocardium and epicardium due to the co-presence of intra-cavity blood and epicardial fat. The aim of the study is to develop a novel single-breath-hold Fat-Saturated Dark-Blood (FSDB) cardiac T2-mapping technique to mitigate the partial-voluming and improve T2 accuracy. Methods The proposed FSDB T2-mapping technique combines T2-prepared bSSFP, a novel use of double inversion-recovery with heart-rate-adaptive TI, and spectrally-selective fat saturation to mitigate partial-voluming from both the blood and fat. FSDB T2 mapping was compared to conventional T2 mapping via simulations, phantom imaging, healthy-subject imaging (n = 8), and patient imaging (n = 7). In the healthy subjects, a high-resolution coplanar anatomical imaging was performed to provide a gold standard for segmentation of endocardium and epicardium. T2 maps were registered to the gold standard image to evaluate any inter-layer T2 difference, which is a surrogate for partial-voluming. Results Simulations and phantom imaging showed that FSDB T2 mapping was accurate in a range of heartrates, off-resonance, and T2 values, and blood/fat reasonably nulled in a range of heartrates. In healthy subjects, FSDB T2 mapping showed similar T2 values over different myocardial layers in all 3 short-axis slices (e.g. basal epicardial/mid-wall/endocardial T2 = 42 ± 2 ms/41 ± 1 ms/42 ± 1 ms), whereas conventional T2 mapping showed considerably increased T2 in the endocardium and epicardium (e.g. basal epicardial/mid-wall/endocardial T2 = 48 ± 3 ms/43 ± 1 ms/49 ± 3 ms). The homogeneous T2 in the FSDB T2 mapping increased the apparent LV-wall thickness by 25–41% compared with the conventional method. Conclusions The proposed technique improves accuracy of myocardial T2 mapping against partial-voluming associated with both fat and blood, facilitating a multi-layer T2 evaluation of the myocardium. This technique may improve utility of cardiac T2 mapping in diseases affecting the endocardium and epicardium, and in patients with a small heart.

Balanced steady-state free precession (bSSFP) is important in cardiac MRI but suffers from off-resonance artifacts. The interpretation-limiting artifacts in patients with cardiac implants remain an unsolved issue.To develop an interleaved radial linear combination bSSFP (lcSSFP) method with partial dephasing (PD) for improved cardiac cine imaging when implanted cardiovascular devices are present.Prospective.Flow phantom adjacent to a pacemaker and 10 healthy volunteers (mean age ± standard deviation: 31.9 ± 2.9 years, 4 females) with a cardioverter-defibrillator (ICD) positioned extracorporeally at the left chest in the prepectoral region.A 3-T, 1) Cartesian bSSFP, 2) Cartesian gradient echo (GRE), 3) Cartesian lcSSFP, and 4) radial lcSSFP cine sequences.Flow artifacts mitigation using PD was validated with phantom experiments. Undersampled radial lcSSFP with interleaving across phase-cyclings and cardiac phases (RLC-SSFP), combined with PD, was then employed for achieving improved quality of cine images from left ventricular short-axis view. The image quality in the presence of cardiac devices was qualitatively assessed by three independent raters (1 = worst, 5 = best), regarding five criteria (banding artifacts, streak artifacts, flow artifacts, cavity visibility, and overall image quality).Wilcoxon rank-sum test for the five criteria between Cartesian bSSFP cine and RLC-SSFP with PD. Fleiss kappa test for inter-reader agreement. A P value 0.05 was considered statistically significant.Based on simulations and phantom experiments, 60 projections per phase cycling and 1/6 PD were chosen. The in vivo experiments demonstrated significantly reduced banding artifacts (4.8 ± 0.4 vs. 2.7 ± 0.7), fewer streak artifacts (3.7 ± 0.6 vs. 2.6 ± 0.7) and flow artifacts (4.4 ± 0.4 vs. 3.7 ± 0.6), therefore improved cavity visibility (4.1 ± 0.4 vs. 2.9 ± 0.9) and overall quality (4.0 ± 0.4 vs. 2.7 ± 0.7).RLC-SSFP method with PD may improve cine image quality in subjects with cardiac devices.2.Stage 1.

PURPOSE Deuterium metabolic imaging (DMI) maps the uptake of deuterated precursors and their conversion into lactate and other markers of tumor metabolism. Even after leveraging 2 H's short T1 s, DMI's signal-to-noise ratio (SNR) is limited. We hypothesize that a multi-echo balanced steady-state free precession (ME-bSSFP) approach would increase SNR compared to chemical shift imaging (CSI), while achieving spectral isolation of the metabolic precursors and products. METHODS Suitably tuned 2 H ME-bSSFP (five echo times [TEs], ΔTE = 2.2 ms, repetition time [TR]/flip-angle = 12 ms/60°) was implemented at 15.2T and compared to CSI (TR/flip-angle = 95 ms/90°) regarding SNR and spectral isolation, in simulations, in deuterated phantoms and for the in vivo diagnosis of a mouse tumor model of pancreatic adenocarcinoma (N = 10). RESULTS Simulations predicted an SNR increase vs. CSI of 3-5, and that the peaks of 2 H-water, 2 H6,6' -glucose, and 2 H3,3' -lactate can be well isolated by ME-bSSFP; phantoms confirmed this. In vivo, at equal spatial resolution (1.25 × 1.25 mm2 ) and scan time (10 min), 2 H6,6' -glucose's and 2 H3,3' -lactate's SNR were indeed higher for bSSFP than for CSI, three-fold for glucose (57 ± 30 vs. 19 ± 11, P < .001), doubled for water (13 ± 5 vs. 7 ± 3, P = .005). The time courses and overall localization of all metabolites agreed well, comparing CSI against ME-bSSFP. However, a clearer localization of glucose in kidneys and bladder, the detection of glucose-avid rims in certain tumors, and a heterogeneous pattern of intra-tumor lactate production could only be observed using ME-bSSFP's higher resolution. CONCLUSIONS ME-bSSFP provides greater SNR per unit time than CSI, providing for higher spatial resolution mapping of glucose uptake and lactate production in tumors.

BackgroundSegmentation of the left atrium (LA) is required to evaluate atrial size and function, which are important imaging biomarkers for a wide range of cardiovascular conditions, such as atrial fibrillation, stroke, and diastolic dysfunction. LA segmentations are currently being performed manually, which is time-consuming and observer-dependent.MethodsThis study presents an automated image processing algorithm for time-resolved LA segmentation in cardiac magnetic resonance imaging (MRI) long-axis cine images of the 2-chamber (2ch) and 4-chamber (4ch) views using active contours. The proposed algorithm combines mitral valve tracking, automated threshold calculation, edge detection on a radially resampled image, edge tracking based on Dijkstra’s algorithm, and post-processing involving smoothing and interpolation. The algorithm was evaluated in 37 patients diagnosed mainly with paroxysmal atrial fibrillation. Segmentation accuracy was assessed using the Dice similarity coefficient (DSC) and Hausdorff distance (HD), with manual segmentations in all time frames as the reference standard. For inter-observer variability analysis, a second observer performed manual segmentations at end-diastole and end-systole on all subjects.ResultsThe proposed automated method achieved high performance in segmenting the LA in long-axis cine sequences, with a DSC of 0.96 for 2ch and 0.95 for 4ch, and an HD of 5.5 mm for 2ch and 6.4 mm for 4ch. The manual inter-observer variability analysis had an average DSC of 0.95 and an average HD of 4.9 mm.ConclusionThe proposed automated method achieved performance on par with human experts analyzing MRI images for evaluation of atrial size and function.

Background In mitral valve dysfunction, noninvasive measurement of transmitral blood flow is an important clinical examination. Flow imaging of the mitral valve, however, is challenging, since it moves in and out of the image plane during the cardiac cycle. Purpose To more accurately measure mitral flow, a slice‐following MRI phase contrast sequence is proposed. This study aimed to implement such a sequence, validate its slice‐following functionality in a phantom and healthy subjects, and test its feasibility in patients with mitral valve dysfunction. Study Type Prospective. Phantom and Subjects The slice‐following functionality was validated in a cone‐shaped phantom by measuring the depicted slice radius. Sixteen healthy subjects and 10 mitral valve dysfunction patients were enrolled at two sites. Field Strength/Sequence 1.5T and 3T gradient echo cine phase contrast. Assessment A single breath‐hold retrospectively gated sequence using offline feature‐tracking of the mitral valve was developed. Valve displacements were measured and imported to the scanner, allowing the slice position to change dynamically based on the cardiac phase. Mitral valve imaging was performed with slice‐following and static imaging planes. Validation was performed by comparing mitral stroke volume with planimetric and aortic stroke volume. Statistical Tests Measurements were compared using linear regression, Pearson's R, parametric paired t‐tests, Bland–Altman analysis, and intraclass correlation coefficient (ICC). Results Phantom experiments confirmed accurate slice displacements. Slice‐following was feasible in all subjects, yielding physiologically accurate mitral flow patterns. In healthy subjects, mitral and aortic stroke volumes agreed, with ICC = 0.72 and 0.90 for static and slice‐following planes; with bias ±1 SDs 23.2 ± 13.2 mls and 8.4 ± 10.8 mls, respectively. Agreement with planimetry was stronger, with ICC = 0.84 and 0.96; bias ±1 SDs 13.7 ± 13.7 mls and –2.0 ± 8.8 mls for static and slice‐following planes, respectively. Data Conclusion Slice‐following outperformed the conventional sequence and improved the accuracy of transmitral flow, which is important for assessment of diastolic function and mitral regurgitation. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1412–1421.

Purpose Balanced steady-state free precession (bSSFP) left atrial (LA) cine suffers from off-resonance artifacts, particularly in the pulmonary veins (PVs). Linear combination or multiple-acquisition SSFP (MA-SSFP) effectively removes banding but greatly increases scan time. We hypothesized that MA-SSFP with interleaved radial undersampling, where each phase-cycling is acquired with an interleaved set of radial projections, would improve image quality of LA cine with a small increase of scan time and streak artefacts. Methods Undersampled radial MA-SSFP with and without interleaving was compared with fully sampled radial bSSFP by means of simulations, phantoms, and in vivo imaging. Ten healthy subjects were imaged on a 3T scanner, with bSSFP and MA-SSFP cine of the left atrium, and B0-mapping. Images were assessed (1 = worst, 5 = best) by 2 independent readers, with respect to 5 qualitative criteria and apparent signal-to-noise ratio. Results In healthy subjects, off-resonance differed from the right inferior PVs to the LA cavity by 163 Hz ± 73 Hz at 3T. Compared with fully sampled radial bSSFP, interleaved radial MA-SSFP significantly improved image quality with respect to off-resonance artifacts (3.8 ± 0.6 versus 2.3 ± 1.0; P = 0.005), PV conspicuity (2.8 ± 1.0 versus 4.3 ± 0.5; P = 0.005), and the number of visualized PVs (1.7 ± 0.4 versus 0.9 ± 0.7; P = 0.008), although with greater streak artifacts (3.4 ± 0.4 versus 4.9 ± 0.2; P = 0.004) and lower measured apparent signal-to-noise ratio (24 ± 9 versus 69 ± 36; P = 0.002). Flow artifacts were similar. Interleaved radial MA-SSFP reduced streaking artifacts and increased apparent signal-to-noise ratio versus noninterleaved radial. Conclusions Interleaved radial MA-SSFP cine reduces banding artifacts with an acceptable increase of scan time and streak artifacts. The proposed technique improves the LA and PV visualization in bSSFP cine imaging.

The prevalence of cardiovascular diseases (CVD) is increased in subjects with post-traumatic stress disorder (PTSD). Vascular inflammation mediates CVD and may be assessed by(18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging. In this pilot study, we investigated whether subjects with PTSD have enhanced vascular and systemic inflammation compared to healthy controls, as assessed by FDG PET imaging. METHODS: A prospective group of 16 subjects (9 PTSD and 7 controls, age 34±7) without prior history of CVD underwent FDG PET/CT imaging. The presence of PTSD symptoms at the time of the study was confirmed using PTSD checklist for DSM-5 (PCL5) questionnaire. Blood samples were collected to determine blood glucose, lipid and inflammatory biomarkers (tumor necrosis factor α, interleukin-1β, and interleukin-6) levels. FDG signal in the ascending aorta, amygdala, spleen and bone marrow was quantified. RESULTS: The two groups matched closely with regards to cardiovascular risk factors. The inflammatory biomarkers were all within the normal range. There was no significant difference in FDG signal in the aorta (target to background ratio: 2.40±0.29 and 2.34±0.29 for control and PTSD subjects, difference −0.6, 95% confidence interval of difference −0.38 – 0.26), spleen, bone marrow, or amygdala between control and PTSD subjects. There was no significant correlation between aortic and amygdala FDG signal. However, a significant positive correlation existed between amygdala, splenic, and bone marrow FDG signal. CONCLUSION: This pilot, small study did not reveal any difference in vascular or systemic inflammation as assessed by FDG PET imaging between PTSD and healthy control subjects. Because of the small number of subjects, a modest increase in vascular inflammation, which requires larger scale studies to establish, cannot be excluded. The correlation between FDG signal in amygdala, spleen and bone marrow may reflect a link between amygdala activity and systemic inflammation.

Background Left atrial late gadolinium enhancement (LA LGE) measured with cardiac magnetic resonance (CMR) imaging is emerging as a marker of atrial fibrosis and has been associated with worse outcomes in AF ablation procedures. However, the prognostic value of LA LGE for incident AF remains unknown. Methods CMR including measurement of left ventricular (LV) and LA volumes and function, as well as LV extracellular volume fraction and LA LGE, was acquired in 68 patients aged at least 70 years with risk factors for stroke. All included patients received and implantable loop recorder and were continuously monitored for previously unknown AF. Incident AF was adjudicated by senior cardiologists. Results Patients were monitored for AF with implantable loop recorder during a median of 41 [36; 43] months. AF episodes lasting ≥6 minutes were detected in 32 patients (47%) and 16 patients (24%) experienced AF episodes lasting ≥5.5-hour. In Cox regression analyses adjusted for sex, age and comorbidities, we found that LA volumes and function and LA LGE were independently associated with incident AF. For LA LGE, the hazard ratio for time to AF episodes lasting ≥6 minutes and ≥5.5 hours were 1.40 (1.03, 1.89) per 10 cm2 increase (p=0.03) and 1.63 (1.11, 2.40) per 10 cm2 increase (p=0.01), respectively. LA LGE was significantly associated with high burden of AF. The addition of LA LGE to a multivariable risk prediction model for incident AF significantly increased the predictive value. Conclusions Extent of LA fibrosis measured by LA LGE was significantly associated with incident AF detected by implantable loop recorder. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Innovation Fund Denmark, The Research Foundation for the Capital Region of Denmark [no grant number]

Hypertrophic cardiomyopathy (HCM) is associated with increased left ventricular (LV) mass, decreased myocardial strain, and the presence of LV fibrosis and scar. The relationship between LV scar and fibrosis with left atrial (LA) fibrosis in the setting of HCM has not been examined. The purpose of this study is to demonstrate a correlation between the degree of LA fibrosis and LV parameters in subjects with HCM. Twenty-eight subjects with HCM were imaged on a 1.5T MRI scanner with cine, LV and LA late gadolinium enhancement (LGE) sequences. LA LGE and LA measurements were correlated with LV measurements of volumes, mass, strain, and LGE. Other clinical conditions and medication usage were also examined and evaluated for correlation with LA and LV parameters. LV LGE was identified in 24 (86%) of the cases and LA LGE was identified in all of the cases. Extent of LA fibrosis significantly correlated with percent LV LGE (r = 0.64, p = 0.001), but not with indexed LV mass or maximum wall thickness. Extent of LA fibrosis also moderately correlated with decreased LV global strain (radial, r = - 0.50, p = 0.013; circumferential, r = 0.47, p = 0.02; longitudinal, r = 0.52, p = 0.013). Increased LA systolic volume correlated moderately with LV end diastolic volume (r = 0.50, p = 0.006). Patients on therapy with Renin-Angiotensin-Aldosterone System (RAAS) Inhibition had significantly less LA LGE compared to those without (18.6% vs 10.8%, p = 0.023). LA fibrosis, as measured by LGE, is prevalent in HCM and is correlated with LV LGE. The correlation between LA and LV LGE might suggest either that LA fibrosis is a consequence of LV remodeling, or that LA and LV fibrosis are both manifestations of the same cardiomyopathic process. Further study is warranted to determine the causality of LA scar in this population.

PURPOSE To investigate Shift Undersampling improves Parametric mapping Efficiency and Resolution (SUPER), a novel blockwise curve-fitting method for accelerating parametric mapping with very fast reconstruction. METHODS SUPER uses interleaved k-space undersampling, which enables a blockwise decomposition of the otherwise large-scale cost function to improve the reconstruction efficiency. SUPER can be readily combined with SENSE to achieve at least 4-fold acceleration. D-factor, a parametric-mapping counterpart of g-factor, was proposed and formulated to compare spatially heterogeneous noise amplification because of different acceleration methods. As a proof-of-concept, SUPER/SUPER-SENSE was validated using T1 mapping, by comparing them to alternative model-based methods, including MARTINI and GRAPPATINI, via simulations, phantom imaging, and in vivo brain imaging (N = 5), over criteria of normalized root-mean-squares error (NRMSE), average d-factor, and computational time per voxel (TPV). A novel SUPER-SENSE MOLLI cardiac T1 -mapping sequence with improved resolution (1.4 mm × 1.4 mm) was compared to standard MOLLI (1.9 mm × 2.5 mm) in 8 healthy subjects. RESULTS In brain imaging, 2-fold SUPER achieved lower NRMSE (0.04 ± 0.02 vs. 0.11 ± 0.02, P < 0.01), lower average d-factor (1.01 ± 0.002 vs. 1.12 ± 0.004, P < 0.001), and lower TPV (4.6 ms ± 0.2 ms vs. 79 ms ± 3 ms, P < 0.001) than 2-fold MARTINI. Similarly, 4-fold SUPER-SENSE achieved lower NRMSE (0.07 ± 0.01 vs. 0.13 ± 0.03, P = 0.02), lower average d-factor (1.15 ± 0.01 vs. 1.20 ± 0.01, P < 0.001), and lower TPV (4.0 ms ± 0.1 ms vs. 72 ms ± 3 ms, P < 0.001) than 4-fold GRAPPATINI. In cardiac T1 mapping, SUPER-SENSE MOLLI yielded similar myocardial T1 (1151 ms ± 63 ms vs. 1159 ms ± 32 ms, P = 0.6), slightly lower blood T1 (1643 ms ± 86 ms vs. 1680 ms ± 79 ms, P = 0.004), but improved spatial resolution compared with standard MOLLI in the same imaging time. CONCLUSION SUPER and SUPER-SENSE provide fast model-based reconstruction methods for accelerating parametric mapping and improving its clinical appeal.

Background Cardiac 3D navigator-gated late gadolinium enhancement (LGE) imaging is important for assessment of left atrial fibrosis, but the image quality is often degraded due to arrhythmia. Purpose To investigate a novel 3D LGE sequence with improved myocardial nulling and reduced ghosting artifacts during arrhythmia. Study type Prospective. Population Arrhythmia patients (n = 14). Sequence The proposed technique, REPAIRit (Regrowth Equalization Pulse for Arrhythmias in Inversion Recovery with automatic inversion time calculation), inserts a saturation pulse with a dynamic flip angle into the 3D LGE sequence to minimize arrhythmia-induced signal fluctuations. Using ShMOLLI (shortened modified Look-Locker imaging) to estimate myocardial T1 , REPAIRit automatically calculates the optimal inversion time (TI) based on Bloch equations. Assessment REPAIRit LGE and the standard LGE were compared with simulations, phantom imaging, and patient studies. Patient images were assessed quantitatively, based on ghost-to-noise ratio (GNR), blood signal-to-noise ratio (SNRb), myocardial signal-to-noise ratio (SNRm), and blood-to-myocardium contrast-to-noise ratio (CNR), and qualitatively on a 4-point scale. Patients were subgrouped based on the presence of arrhythmia to assess the image quality difference. Statistical tests The two LGE sequences were compared by Student's t-test and Wilcoxon signed-rank test. The two patient-subgroups were compared using Welch's t-test and Wilcoxon rank-sum test. Results In 14 analyzed patients, REPAIRit LGE significantly lowered GNR (1.25 ± 0.41 vs. 1.42 ± 0.42, P = 0.04), reduced SNRm (1.90 ± 0.60 vs. 3.16 ± 1.66, P = 0.01), improved ghosting artifact scores (2.5 ± 0.6 vs. 2.2 ± 0.9, P = 0.03), myocardial nulling scores (2.7 ± 0.5 vs. 2.3 ± 0.7, P = 0.02), and atrial quality scores (2.8 ± 0.3 vs. 2.4 ± 0.8, P = 0.03) compared with the standard LGE. Comparing patients with arrhythmia (n = 6) to those without (n = 8) during the scan, the former had lower left ventricular (LV) myocardial T1 s (430 ± 26 msec vs. 469 ± 39 msec, P = 0.06) but similar blood T1 s (318 ± 55 msec vs. 316 ± 27 msec, P = 0.96), and significantly lower blood SNR (5.2 ± 1.8 vs. 9.2 ± 3.0, P = 0.01) and significantly worse image quality (P = 0.01 for REPAIRit and P = 0.03 for standard). Data conclusion REPAIRit improves myocardial nulling and reduces ghosting artifacts of 3D LGE under arrhythmia. Level of evidence 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:688-699.

BACKGROUND Cardiac dark-blood turbo spin-echo (TSE) imaging is sensitive to through-plane motion, resulting in myocardial signal reduction. PURPOSE To propose and validate reverse double inversion-recovery (RDIR)-a dark-blood preparation with improved motion robustness for the cardiac dark-blood TSE sequence. STUDY TYPE Prospective. POPULATION Healthy volunteers (n = 10) and patients (n = 20). FIELD STRENGTH 1.5T (healthy volunteers) and 3T (patients). ASSESSMENT Compared to double inversion recovery (DIR), RDIR swaps the two inversion pulses in time and places the slice-selective 180° in late-diastole of the previous cardiac cycle to minimize slice misregistration. RDIR and DIR were performed in the same left-ventricular basal short-axis slice. Healthy subjects were imaged with two preparation slice thicknesses, 110% and 200%, while patients were imaged using a 200% slice thickness only. Images were assessed quantitatively, by measuring the myocardial signal heterogeneity and the extent of dropout, and also qualitatively on a 5-point scale. STATISTICAL TESTS Quantitative and qualitative data were assessed with Student's t-test and Wilcoxon signed-rank test, respectively. RESULTS In healthy subjects, RDIR with 110% slice thickness significantly reduced signal heterogeneity in both the left ventricle (LV) and right ventricle (RV) (LV: P = 0.006, RV: P < 0.0001) and the extent of RV dropout (P < 0.0001), while RDIR with 200% slice thickness significantly reduced RV signal heterogeneity (P = 0.001) and the extent of RV dropout (P = 0.0002). In patients, RDIR significantly reduced RV myocardial signal heterogeneity (0.31 vs. 0.43; P = 0.003) and the extent of RV dropout (24% vs. 46%; P = 0.0005). LV signal heterogeneity exhibited a trend towards improvement with RDIR (0.12 vs. 0.16; P = 0.06). Qualitative evaluation showed a significant improvement of LV and RV visualization in RDIR compared to DIR (LV: P = 0.04, RV: P = 0.0007) and a significantly improved overall image quality (P = 0.03). DATA CONCLUSION RDIR TSE is less sensitive to through-plane motion, potentiating increased clinical utility for black-blood TSE. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:1498-1508.

${R}_{ {2}}^{*}$ mapping is a useful tool in blood-oxygen-level dependent fMRI due to its quantitative nature. However, like ${T}_{ {2}}^{*}$ -weighted imaging, standard ${R}_{{2}}^{*}$ mapping based on multi-echo EPI suffers from geometric distortion, due to strong off-resonance near the air–tissue interface. Joint mapping of ${R}_{{2}}^{*}$ and off-resonance can correct the geometric distortion and is less susceptible to motion artifacts. Single-shot joint mapping of ${R}_{{2}}^{*}$ and off-resonance is possible with a rosette trajectory due to its frequent sampling of the $k$ -space center. However, the corresponding reconstruction is nonlinear, ill-conditioned, large-scale, and computationally inefficient with current algorithms. In this paper, we propose a novel algorithm for joint mapping of ${R}_{{2}}^{*}$ and off-resonance, using rosette $k$ -space trajectories. The new algorithm, based on the alternating direction method of multipliers, improves the reconstruction efficiency by simplifying the original complicated cost function into a composition of simpler optimization steps. Compared with a recently developed trust region algorithm, the new algorithm achieves the same accuracy and an acceleration of threefold to sixfold in reconstruction time. Based on the new algorithm, we present simulation and in vivo data from single-shot, double-shot, and quadruple-shot rosettes and demonstrate the improved image quality and reduction of distortions in the reconstructed ${R}_{{2}}^{*}$ map.

Purpose While O-Space imaging is well known to accelerate image acquisition beyond traditional Cartesian sampling, its advantages compared to undersampled radial imaging, the linear trajectory most akin to O-Space imaging, have not been detailed. In addition, previous studies have focused on ultrafast imaging with very high acceleration factors and relatively low resolution. The purpose of this work is to directly compare O-Space and radial imaging in their potential to deliver highly undersampled images of high resolution and minimal artifacts, as needed for diagnostic applications. We report that the greatest advantages to O-Space imaging are observed with extended data acquisition readouts. Theory and methods A sampling strategy that uses high resolution readouts is presented and applied to compare the potential of radial and O-Space sequences to generate high resolution images at high undersampling factors. Simulations and phantom studies were performed to investigate whether use of extended readout windows in O-Space imaging would increase k-space sampling and improve image quality, compared to radial imaging. Results Experimental O-Space images acquired with high resolution readouts show fewer artifacts and greater sharpness than radial imaging with equivalent scan parameters. Radial images taken with longer readouts show stronger undersampling artifacts, which can cause small or subtle image features to disappear. These features are preserved in a comparable O-Space image. Conclusions High resolution O-Space imaging yields highly undersampled images of high resolution and minimal artifacts. The additional nonlinear gradient field improves image quality beyond conventional radial imaging. Keywords O-space imaging; Nonlinear spatial encoding; High-resolution; Parallel imaging 1. Introduction Nonlinear magnetic field methods [1]; [2]; [3] ; [4] may provide a wide range of advantages, such as lower peripheral nerve stimulation, enhanced resolution at the edge of the FOV, and localized imaging both in-plane and through-plane. More recently, spatial encoding with multi-order nonlinear magnetic fields has been pursued to enhance parallel imaging [5]. O-Space imaging [6] ; [7] was the first sequence explicitly designed to improve highly undersampled parallel imaging with nonlinear gradients, though many other methods have since been studied. These include Patloc Imaging [1], Null Space imaging [5], O-Space TSE imaging [8]; [9] ; [10], Single Echo MRI [11], FRONSAC imaging [12]; [13]; [14] ; [15], 4D–RIO [16], EPI-PatLoc [17], CS O-Space [18], Multi-Dimensional Encoding [19] and others [20]; [21]; [22] ; [23]. O-Space imaging encodes spatial information with a single radially varying magnetic gradient field: Bi = GZ2(z2 − 1/2((x − xi)2 + (y − yi)2)), which is created from a combination of linear gradients as well as the nonlinear “Z2” gradient whose coefficient is in units of Hz/cm2 (Fig. 1). Each projection is acquired under this radially varying field centered at different in-plane locations, (xi, yi), which are also called center placements. The projections are acquired such that the center placements form a ring about the FOV center, typically with radius FOV/2. The circular isocontours of the frequency encoding field were chosen to maximize the complementarity between the gradient geometry and RF coil geometry. Previous reconstruction results [6] ; [7] have shown this approach outperforms Cartesian SENSE [24]; [25] ; [26], when the effective acceleration factor approaches, equals, or exceeds the number of radiofrequency (RF) coils. Compared to radial imaging, simulations predict that O-Space imaging should provide sharper resolution and more diffuse undersampling artifacts [6] ; [7]. However, previous experiments have not rigorously detailed and analyzed the benefits of O-Space compared to radial imaging.

Objectives: The authors hypothesized that left atrial (LA) fibrosis was associated with incident atrial fibrillation (AF) as detected by continuous long-term monitoring in an at-risk population. Background: LA late gadolinium enhancement (LGE) measured with cardiac magnetic resonance is emerging as a marker of atrial fibrosis and has been associated with worse outcomes in AF ablation procedures; however, the prognostic value of LA LGE for incident AF remains unknown. Methods: Cardiac magnetic resonance, including measurement of left ventricular and LA volumes and function, as well as left ventricular extracellular volume fraction and LA LGE, was acquired in 68 patients aged at least 70 years with risk factors for stroke. All included patients received an implantable loop recorder and were continuously monitored for previously unknown AF. Incident AF was adjudicated by senior cardiologists. Results: Patients were monitored for AF with an implantable loop recorder during a median of 41 (interquartile range: 7) months. AF episodes lasting ≥6 min were detected in 32 patients (47%), and 16 patients (24%) experienced AF episodes lasting ≥5.5 h. In Cox regression analyses adjusted for sex, age, and comorbidities, we found that LA volumes and function and LA LGE were independently associated with incident AF. For LA LGE, the hazard ratios for time to AF episodes lasting ≥6 min and ≥5.5 h were 1.40 (95% CI: 1.03 to 1.89) per 10 cm 2 increase (p = 0.03) and 1.63 (95% CI: 1.11 to 2.40) per 10 cm 2 increase (p = 0.01), respectively. LA LGE was significantly associated with high burden of AF. The addition of LA LGE to a multivariable risk prediction model for incident AF significantly increased the predictive value. Conclusions: Extent of LA fibrosis measured by LA LGE was significantly associated with incident AF detected by implantable loop recorder. (Atrial Fibrillation Detected by Continuous ECG Monitoring [LOOP]; NCT02036450)

Purpose To investigate toxicity, efficacy, and microenvironmental effects of idarubicin-loaded 40-μm and 100-μm drug-eluting embolic (DEE) transarterial chemoembolization in a rabbit liver tumor model. Materials and Methods Twelve male New Zealand White rabbits with orthotopically implanted VX2 liver tumors were assigned to DEE chemoembolization with 40-μm (n = 5) or 100-μm (n = 4) ONCOZENE microspheres or no treatment (control; n = 3). At 24–72 hours postprocedurally, multiparametric magnetic resonance (MR) imaging including dynamic contrast-enhanced (DCE), diffusion-weighted imaging (DWI), and biosensor imaging of redundant deviation in shifts (BIRDS) was performed to assess extracellular pH (pHe), followed by immediate euthanasia. Laboratory parameters and histopathologic ex vivo analysis included fluorescence confocal microscopy and immunohistochemistry. Results DCE MR imaging demonstrated a similar degree of devascularization of embolized tumors for both microsphere sizes (mean arterial enhancement, 8% ± 12 vs 36% ± 51 in controls; P = .07). Similarly, DWI showed postprocedural increases in diffusion across the entire lesion (apparent diffusion coefficient, 1.89 × 10−3 mm2/s ± 0.18 vs 2.34 × 10−3 mm2/s ± 0.18 in liver; P = .002). BIRDS demonstrated profound tumor acidosis at baseline (mean pHe, 6.79 ± 0.08 in tumor vs 7.13 ± 0.08 in liver; P = .02) and after chemoembolization (6.8 ± 0.06 in tumor vs 7.1 ± 0.04 in liver; P = .007). Laboratory and ex vivo analyses showed central tumor core penetration and greater increase in liver enzymes for 40-μm vs 100-μm microspheres. Inhibition of cell proliferation, intratumoral hypoxia, and limited idarubicin elution were equally observed with both sphere sizes. Conclusions Noninvasive multiparametric MR imaging visualized chemoembolic effects in tumor and tumor microenvironment following DEE chemoembolization. Devascularization, increased hypoxia, coagulative necrosis, tumor acidosis, and limited idarubicin elution suggest ischemia as the predominant therapeutic mechanism. Substantial size-dependent differences indicate greater toxicity with the smaller microsphere diameter.

PURPOSE: To demonstrate feasibility of developing a noninvasive extracellular pH (pH(e)) mapping method on a clinical MRI scanner for molecular imaging of liver cancer. METHODS: In vivo pH(e) mapping has been demonstrated on preclinical scanners (e.g., 9.4T, 11.7T) with Biosensor Imaging of Redundant Deviation in Shifts (BIRDS), where the pH(e) readout by 3D chemical shift imaging (CSI) depends on hyperfine shifts emanating from paramagnetic macrocyclic chelates like TmDOTP(5−) which upon extravasation from blood resides in the extracellular space. We implemented BIRDS-based pH(e) mapping on a clinical 3T Siemens scanner, where typically diamagnetic (1)H signals are detected using millisecond-long radiofrequency (RF) pulses, and (1)H shifts span over ±10 ppm with long transverse (T(2), 10(2) ms) and longitudinal (T(1), 10(3) ms) relaxation times. We modified this 3D-CSI method for ultra-fast acquisition with microsecond-long RF pulses, because even at 3T the paramagnetic (1)H shifts of TmDOTP(5−) have millisecond-long T(2) and T(1) and ultra-wide chemical shifts (±200 ppm) as previously observed in ultra-high magnetic fields. RESULTS: We validated BIRDS-based pH in vitro with a pH electrode. We measured pH(e) in a rabbit model for liver cancer using VX2 tumors, which are highly vascularized and hyperglycolytic. Compared to intratumoral pH(e) (6.8 ± 0.1; P < 10(−9)) and tumor’s edge pH(e) (6.9 ± 0.1; P < 10(−7)), liver parenchyma pH(e) was significantly higher (7.2 ± 0.1). Tumor localization was confirmed with histopathological markers of necrosis (hematoxylin and eosin), glucose uptake (glucose transporter 1), and tissue acidosis (lysosome-associated membrane protein 2). CONCLUSION: This work demonstrates feasibility and potential clinical translatability of high-resolution pH(e) mapping to monitor tumor aggressiveness and therapeutic outcome, all to improve personalized cancer treatment planning.

Purpose: To establish magnetic resonance (MR)–based molecular imaging paradigms for the noninvasive monitoring of extracellular pH (pHe) as a functional surrogate biomarker for metabolic changes induced by locoregional therapy of liver cancer. Experimental Design: Thirty-two VX2 tumor-bearing New Zealand white rabbits underwent longitudinal imaging on clinical 3T-MRI and CT scanners before and up to 2 weeks after complete conventional transarterial chemoembolization (cTACE) using ethiodized oil (lipiodol) and doxorubicin. MR-spectroscopic imaging (MRSI) was employed for pHe mapping. Multiparametric MRI and CT were performed to quantify tumor enhancement, diffusion, and lipiodol coverage of the tumor posttherapy. In addition, incomplete cTACE with reduced chemoembolic doses was applied to mimic undertreatment and exploit pHe mapping to detect viable tumor residuals. Imaging findings were correlated with histopathologic markers indicative of metabolic state (HIF-1α, GLUT-1, and LAMP-2) and viability (proliferating cell nuclear antigen and terminal deoxynucleotidyl-transferase dUTP nick-end labeling). Results: Untreated VX2 tumors demonstrated a significantly lower pHe (6.80 ± 0.09) than liver parenchyma (7.19 ± 0.03, P < 0.001). Upregulation of HIF-1α, GLUT-1, and LAMP-2 confirmed a hyperglycolytic tumor phenotype and acidosis. A gradual tumor pHe increase toward normalization similar to parenchyma was revealed within 2 weeks after complete cTACE, which correlated with decreasing detectability of metabolic markers. In contrast, pHe mapping after incomplete cTACE indicated both acidic viable residuals and increased tumor pHe of treated regions. Multimodal imaging revealed durable tumor devascularization immediately after complete cTACE, gradually increasing necrosis, and sustained lipiodol coverage of the tumor. Conclusions: MRSI-based pHe mapping can serve as a longitudinal monitoring tool for viable tumors. As most liver tumors are hyperglycolytic creating microenvironmental acidosis, therapy-induced normalization of tumor pHe may be used as a functional biomarker for positive therapeutic outcome.

PURPOSE The conventional two-point (2pt) Dixon technique explicitly estimates B0 map by performing phase unwrapping. When signal loss, phase singularity, artifacts, or spatially isolated regions corrupt the measured phase images, this unwrapping-based technique will face difficulty. This work aims to improve the reliability of B0 mapping by performing unwrapping error correction. METHOD To detect the unwrapping-caused phase errors, we determined a magnitude-based fat/water mask and used it as reference to identify pixels being mismatched by the phase-based mask, which was derived from the B0-corrected phase term of the Hermitian product between echoes. Then, we corrected the afore-determined phase error on a region-by-region basis. We tested the developed method with nine patients' data, and the results were compared with a well-established region-growing technique. RESULTS By adding the step to correct unwrapping-caused error, we improved the robustness of B0 mapping, resulting in better fat-water separation when compared with the conventional 2pt and the phasor-based region-growing techniques. CONCLUSION We showed the feasibility of B0 mapping with bipolar 2pt human cardiac data. The software is freely available to the scientific community. Magn Reson Med 78:1862-1869, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

BackgroundImmune checkpoint inhibitors (ICIs) are highly effective in treating cancer; however, cardiotoxicity can occur, including myocarditis. Cardiac magnetic resonance (CMR) imaging is useful for evaluation of myocarditis, although it has not been well studied in ICI cardiotoxicity.MethodsWe identified patients referred for CMR evaluation of ICI cardiotoxicity from September 2015 through September 2019. We assessed structural and functional parameters, feature tracking (FT) left ventricular and atrial strain, T2- weighted ratios and quantitative late gadolinium enhancement (LGE). We also applied the Updated Lake Louise Criteria for diagnosis of myocarditis.ResultsOf the 20 patients referred, the median left ventricular ejection fraction (LVEF) was 52.5% ± 19.1 and 50% had a normal LVEF (≥53%). FT strain analysis revealed an average abnormal global longitudinal strain (GLS) of −9.8%± 4.2%. In patients with a normal LVEF, the average GLS remained depressed at −12.3%± 2.4%. In all patients, GLS demonstrated a significant negative correlation with LVEF (rs= −0.64, p 0.002). Sixteen patients (80%) had presence of LGE (14 non-ischemic pattern and 2 ischemic). Percent LGE did not correlate with any CMR parameters and notably did not correlate with LVEF (rs= −0.29, p = 0.22) or GLS (rs= 0.10, p = 0.67), highlighting the value of tissue characterization beyond functional assessment. Nine patients (45%) met full Updated Lake Louise Criteria and 85% met at least one criterion, suggestive of myocarditis in the correct clinical context. Thirteen patients (65%) were treated for ICI-associated myocarditis and, of these, 54% (n = 7) had recovery of LVEF to normal. There was no correlation between LVEF (p = 0.47), GLS (0.89), or % LGE (0.15) and recovery of LVEF with treatment.ConclusionIn patients with suspected ICI cardiotoxicity, CMR is an important diagnostic tool, even in the absence of overt left ventricular dysfunction, as abnormalities in left ventricular strain, T2 signal and LGE can identifying disease.

The development of radiofrequency ablation for the treatment of atrial fibrillation has led to an increased interest in the accurate determination of pulmonary vein anatomy and left atrial fibrosis assessment to help plan the procedure and to monitor for postablation stenosis. Contrast-enhanced magnetic resonance angiography readily demonstrates the pulmonary veins and is the method of choice for these imaging studies. In this chapter, we review the methods used to image the pulmonary veins, normal and anomalous pulmonary venous anatomy. We describe how late gadolinium enhancement imaging is used to identify fibrosis and scar. The utility of cardiovascular magnetic resonance before and after atrial fibrillation ablation is described.

This chapter introduces to those with little or no experience the basic principles of cardiovascular magnetic resonance (CMR). The chapter describes how CMR images are created, using high static magnetic fields and magnetic gradients. The concepts of spin and precession at the Larmor frequency are explained. Radiofrequency (RF) excitation and subsequent T1 and T2 relaxation are illustrated. The basic foundations of CMR, including slice selection, frequency encoding, and phase encoding, are described, along with the pulse sequences most commonly used (i.e., gradient echo, spin echo, fast spin echo, and balanced steady-state free precession [SSFP]). The concepts of repetition time (TR) and echo time (TE) are defined and their importance is demonstrated. Some common methods for generating T1 or T2 contrast are introduced.

Purpose To investigate an ECG-gated dynamic-flip-angle BOLD sequence with improved robustness against cardiogenic noise in resting-state fMRI. Methods ECG-gating minimizes the cardiogenic noise but introduces T1 -dependent signal variation, which is minimized by combination of a dynamic-flip-angle technique and retrospective nuisance signal regression (NSR) using signals of white matter, CSF, and global average. The technique was studied with simulations in a wide range of T1 and B1 fields and phantom imaging with pre-programmed TR variations. Resting-state fMRI of 20 healthy subjects was acquired with non-gated BOLD (NG), ECG-gated constant-flip-angle BOLD (GCFA), ECG-gated BOLD with retrospective T1 -correction (GRC), and ECG-gated dynamic-flip-angle BOLD (GDFA), all processed by the same NSR method. GDFA was compared to alternative methods over temporal SNR (tSNR), seed-based connectivity, and whole-brain voxelwise connectivity based on intrinsic connectivity distribution (ICD). A previous large-cohort data set (N = 100) was used as a connectivity gold standard. Results Simulations and phantom imaging show substantial reduction of the T1 -dependent signal variation with GDFA alone, and further reduction with NSR. The resting-state study shows improved tSNR in the basal brain, comparing GDFA to NG, after both processed with NSR. Furthermore, GDFA significantly improved subcortical-subcortical and cortical-subcortical connectivity for several representative seeds and significantly improved ICD in the brainstem, thalamus, striatum, and prefrontal cortex, compared to the other 3 approaches. Conclusion GDFA with NSR improves mapping of the resting-state functional connectivity of the basal-brain regions by reducing cardiogenic noise.

The thin wall of the left atrium (LA) is difficult to visualize. The high spatial and temporal resolution of cardiac magnetic resonance (CMR) allows for the most accurate assessment of left atrial structure, function, and tissue characterization. This review will describe emerging methods used to image the LA with CMR, and will discuss associated clinical applications. LA function can now be described in a dynamic fashion with feature-tracking algorithms. Novel methods have been created to augment visualization of late gadolinium enhancement (LGE) in the LA, and left atrial fibrosis can be further quantified with T1 mapping algorithms. The advancement in how we image the LA with CMR has implications in atrial fibrillation (AF) and cardiomyopathic processes. A nuanced understanding of left atrial pathology is emerging with the rapid advancement of CMR technology, which has implications in the risk stratification and treatment of several cardiovascular disease states.

Atrial fibrosis can be estimated noninvasively by magnetic resonance imaging (MRI) using late gadolinium enhancement (LGE), but diastolic dysfunction is clinically assessed by transthoracic echocardiography (TTE), and rarely by MRI. This study aimed to evaluate well‐established diastolic parameters using MRI, and validate them with TTE and left ventricular (LV) filling pressures, and to study the relationship between left atrial (LA) remodeling and parameters of diastolic function. The study retrospectively included 105 patients (53 ± 16 years, 39 females) who underwent 3D LGE MRI between 2012 and 2016. Medical charts were reviewed for the echocardiographic diastolic parameters E, A, and e′ by TTE, and pressure catheterizations. E and A were measured from in‐plane phase‐contrast cardiac MRI images, and e′ by feature‐tracking, and validated with TTE. Interobserver and intraobserver variability was examined. Furthermore, LA volumes, function, and atrial LGE was correlated with diastolic parameters. Evaluation of e′ in MRI had strong agreement with TTE (r = 0.75, P

Corresponding Author

Cardiac 3D navigator-gated late gadolinium enhancement (LGE) imaging is important for assessment of left atrial fibrosis, but the image quality is often degraded due to arrhythmia.To investigate a novel 3D LGE sequence with improved myocardial nulling and reduced ghosting artifacts during arrhythmia.Prospective.Arrhythmia patients (n = 14).The proposed technique, REPAIRit (Regrowth Equalization Pulse for Arrhythmias in Inversion Recovery with automatic inversion time calculation), inserts a saturation pulse with a dynamic flip angle into the 3D LGE sequence to minimize arrhythmia-induced signal fluctuations. Using ShMOLLI (shortened modified Look-Locker imaging) to estimate myocardial TREPAIRit LGE and the standard LGE were compared with simulations, phantom imaging, and patient studies. Patient images were assessed quantitatively, based on ghost-to-noise ratio (GNR), blood signal-to-noise ratio (SNRb), myocardial signal-to-noise ratio (SNRm), and blood-to-myocardium contrast-to-noise ratio (CNR), and qualitatively on a 4-point scale. Patients were subgrouped based on the presence of arrhythmia to assess the image quality difference.The two LGE sequences were compared by Student's t-test and Wilcoxon signed-rank test. The two patient-subgroups were compared using Welch's t-test and Wilcoxon rank-sum test.In 14 analyzed patients, REPAIRit LGE significantly lowered GNR (1.25 ± 0.41 vs. 1.42 ± 0.42, P = 0.04), reduced SNRm (1.90 ± 0.60 vs. 3.16 ± 1.66, P = 0.01), improved ghosting artifact scores (2.5 ± 0.6 vs. 2.2 ± 0.9, P = 0.03), myocardial nulling scores (2.7 ± 0.5 vs. 2.3 ± 0.7, P = 0.02), and atrial quality scores (2.8 ± 0.3 vs. 2.4 ± 0.8, P = 0.03) compared with the standard LGE. Comparing patients with arrhythmia (n = 6) to those without (n = 8) during the scan, the former had lower left ventricular (LV) myocardial TREPAIRit improves myocardial nulling and reduces ghosting artifacts of 3D LGE under arrhythmia.2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:688-699.

Purpose Turbo spin echo (TSE) imaging reduces imaging time by acquiring multiple echoes per repetition (TR), requiring fewer TRs. O-space can also require fewer TRs by using a combination of nonlinear magnetic gradient fields and surface coil arrays. Although to date, O-space has only been demonstrated for gradient echo imaging, it is valuable to combine these two techniques. However, collecting multiple O-space echoes per TR is difficult because of the different local k-space trajectories and variable T2-weighting. Theory and Methods A practical scheme is demonstrated to combine the benefits of TSE and O-space for highly accelerated T2-weighted images. The scheme uses a modified acquisition order and filtered projection reconstruction to reduce artifacts caused by T2 decay, while retaining T2 contrast that corresponds to a specific echo time. Results The experiments revealed that the proposed method can produce highly accelerated T2-weighted images. Moreover, the method can generate multiple images with different T2 contrasts from a single dataset. Conclusions The proposed O-space TSE imaging method requires fewer echoes than conventional TSE and fewer repetitions than conventional O-space imaging. It retains resilience to undersampling, clearly outperforming Cartesian SENSE at high levels of undersampling, and can generate undistorted images with a range of T2 contrast from a single acquired dataset. Magn Reson Med 75:1654–1661, 2016. © 2015 Wiley Periodicals, Inc.