In vivo cardiac diffusion tensor imaging on an MR system featuring ultrahigh performance gradients with 200 mT/m maximum gradient strength

Abstract Purpose Our aim is to assess the potential of an MR system with ultrahigh performance gradients (200 mT/m maximum gradient strength) to address two interrelated challenges in cardiac DTI: low SNR and sensitivity to bulk motion. Methods Imaging was performed in 20 healthy volunteers, two patients, and one swine post‐myocardial infarction. The impact of maximum gradient strength was assessed with spin echo cardiac DTI featuring second‐order motion compensation and varying maximum system gradient strengths (40, 80, 200 mT/m). Motion compensation requirements at 200 mT/m were assessed with sequences featuring zeroth‐, first‐, and second‐order motion compensation. SNR, mean diffusivity, fractional anisotropy, helix angle transmurality, and secondary eigenvector angle in the left ventricle were compared. Results Increasing maximum system gradient strength from 40 and 80 mT/m to 200 mT/m increased SNR of b = 500 s/mm 2 images by 150% and 40% due to reductions in TE. Observed improvements in DTI metrics included reduction in variance in mean diffusivity and helix angle transmurality across healthy volunteers, improved visualization of myocardial borders and delineation of suspected scar. Whereas second‐order motion compensation acquisitions were robust to motion‐induced signal dropout, zeroth‐ and first‐order motion compensation acquisitions suffered from severe signal loss and localized signal voids, respectively. Conclusion Ultrahigh performance gradients (200 mT/m) enable high SNR DWIs of the heart and resultant improvements in diffusion tensor metrics. Despite reduced diffusion‐encoding duration, second‐order motion compensation is required to overcome sensitivity to cardiac motion.