Deep Learning-Based Breath-Hold and Free-Breathing Cine MRI for Comprehensive Cardiac Evaluation

Figures

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  Fig. 1. Illustration of ES quantification using SI profiles in cine MRI. A-C: BHDL (A), FBDL (B), and standard cine (C) mid-ventricular short-axis images at end-systole in a healthy 27-year-old male. Profile lines are drawn from the septal myocardium to the LV blood pool. D-F: Corresponding SI curves (D: BHDL, E: FBDL, F: standard cine). ES is defined as the reciprocal of the distance between the points corresponding to 80% and 20% of the intensity range (Imax - Imin) along the curve. ES = edge sharpness, SI = signal intensity, BH = breath-hold, DL = deep learning, FB = free-breathing, LV = left ventricle, Imax = maximal signal intensity, Imin = minimal signal intensity

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  Fig. 2. Bland–Altman analysis of LV parameters comparing DL cine with standard cine. Bland–Altman plots were used to assess agreements for LV functional parameters, including LVEF, LVEDV, LVESV, and LVSV. A-H: Panels (A, C, E, G) show mean differences between BHDL and standard cine, while panels (B, D, F, H) show mean differences between FBDL and standard cine. The central dashed line indicates the mean difference between the two sequences, and the upper and lower dashed lines indicate the 95% limits of agreement. LV = left ventricle, DL = deep learning, EF = ejection fraction, EDV = end-diastolic volume, ESV = end-systolic volume, SV = stroke volume, BH = breath-hold, FB = free-breathing, SD = standard deviation

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  Fig. 3. Bland–Altman analysis of RV parameters comparing DL cine and standard cine. Bland–Altman plots were used to assess agreements for RV functional parameters, including RVEF, RVEDV, RVESV, and RVSV. A-H: Panels (A, C, E, G) show mean differences between BHDL and standard cine, whereas panels (B, D, F, H) show mean differences between FBDL and standard cine. The central dashed line indicates the mean difference between the two sequences, and the upper and lower dashed lines indicate the 95% limits of agreement. RV = right ventricle, DL = deep learning, EF = ejection fraction, EDV = end-diastolic volume, ESV = end-systolic volume, SV = stroke volume, BH = breath-hold, FB = free-breathing, SD = standard deviation

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  Fig. 4. Representative cine cardiac MRI images from participants with normal sinus rhythm and eupnea. A-I: Panels (A-C) show standard cine acquisitions; (D-F) depict BHDL cine cardiac MRI acquisitions; and (G-I) display FBDL cine cardiac MRI acquisitions. Subtle contrast differences are observed across the three acquisition types. Images in (A, D, G) are from a 48-year-old healthy female; (B, E, H) from a 42-year-old male with HCM; and (C, F, I) from a 56-year-old female post-surgery, showing metallic artifacts on the chest wall. BH = breath-hold, DL = deep learning, FB = free-breathing, HCM = hypertrophic cardiomyopathy

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  Fig. 5. Representative cine cardiac MRI images from patients in the arrhythmia subgroup. A-I: Standard cine cardiac MRI acquisitions (A-C), BHDL cine cardiac MRI acquisitions (D-F), and FBDL cine cardiac MRI acquisitions (G-I). Images (A, D, G) from a 78-year-old female with AF, basal short-axis slice. The BHDL image demonstrated the best quality, whereas the standard cine image showed pronounced artifacts owing to arrhythmia. Images (B, E, H) from a 35-year-old male with AF. The standard cine image exhibited a prominent artifact, with blurring most evident at the LV lateral wall (arrow in B). In contrast, both BHDL and FBDL provided sharper and clearer images. Images (C, F, I) from an 89-year-old female with PVCs. The standard cine image was significantly affected by artifacts. BH = breath-hold, DL = deep learning, FB = free-breathing, AF = atrial fibrillation, LV = left ventricle, PVC = premature ventricular contraction

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  Fig. 6. Representative cine cardiac MRI images from a 54-year-old male in the dyspnea subgroup. A: Standard cine cardiac MRI acquisitions. B: BHDL cine cardiac MRI acquisitions. C: FBDL cine cardiac MRI acquisitions. BH = breath-hold, DL = deep learning, FB = free-breathing