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The ID Qube NIR Free-Running brings a major breakthrough for single-photon detection in free-running operation at telecom wavelengths.It provides a cost-effective solution for applications in which asynchronous photon detection is essential, such as photon correlation or time of flight measurements. Moreover, it is especially suited for applications such as LiDAR, where compactness is a key requirement.

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Coronary cardiovascular magnetic resonance angiography (CCMRA) of congenital heart disease (CHD) in pediatric patients requires accurate planning, adequate sequence parameter adjustments, lengthy scanning sessions, and significant involvement from highly trained personnel. Anesthesia and intubation are commonplace to minimize movements and control respiration in younger subjects. To address the above concerns and provide a single-click imaging solution, we applied our free-running framework for fully self-gated (SG) free-breathing 5D whole-heart CCMRA to CHD patients after ferumoxytol injection. We tested the hypothesis that spatial and motion resolution suffice to visualize coronary artery ostia in a cohort of CHD subjects, both for intubated and free-breathing acquisitions.

In 18 pediatric CHD patients, non-electrocardiogram (ECG) triggered 5D free-running gradient echo CCMRA with whole-heart 1 mm3 isotropic spatial resolution was performed in seven minutes on a 1.5T CMR scanner. Eleven patients were anesthetized and intubated, while seven were breathing freely without anesthesia. All patients were slowly injected with ferumoxytol (4 mg/kg) over 15 minutes. Cardiac and respiratory motion-resolved 5D images were reconstructed with a fully SG approach. To evaluate the performance of motion resolution, visibility of coronary artery origins was assessed. Intubated and free-breathing patient sub-groups were compared for image quality using coronary artery length and conspicuity as well as lung-liver interface sharpness.

Data collection using the free-running framework was successful in all patients in less than 8 min; scan planning was very simple without the need for parameter adjustments, while no ECG lead placement and triggering was required. From the resulting SG 5D motion-resolved reconstructed images, coronary artery origins could be retrospectively extracted in 90% of the cases. These general findings applied to both intubated and free-breathing pediatric patients (no difference in terms of lung-liver interface sharpness), while image quality and coronary conspicuity between both cohorts was very similar.

A simple-to-use push-button framework for 5D whole-heart CCMRA was successfully employed in pediatric CHD patients with ferumoxytol injection. This approach, working without any external gating and for a wide range of heart rates and body sizes provided excellent definition of cardiac anatomy for both intubated and free-breathing patients.

Respiratory motion resolution. a Four different respiratory states from a 5D motion-resolved reconstructed dataset are displayed in a coronal view, from end-expiration (R1) to end-inspiration (R4). b Average sharpness (over the 18 subjects) of the lung-liver interface for the 4 respiratory states. The difference between R1 and R2 did not reach the statistical significance threshold, and neither did the one between R3 and R4. c The interface sharpness values from the plot in b are displayed separately for intubated and free-breathing patients. No statistically significant difference was found between the two groups at any respiratory state

Anomalous coronary anatomy. Coronary reformats for 4 different subjects for simultaneous visualization of RCA ostium (yellow arrow) and LM artery ostium (light blue arrow). The arrows with red outline highlight anomalous coronary vessel anatomy. In particular, subjects 4 and 13 show anomalous LM coronaries originating from the right sinus, while subjects 6 and 14 present anomalous RCA coming out of the left coronary sinus. Overall, the anomalous vessel anatomy is well demonstrated in both intubated and free-breathing patients

The use of ferumoxytol as a CMR contrast agent provides a significant T1-shortening effect in the blood pool that may particularly benefit GRE sequences, which enables imaging with high spatial and high temporal resolution as demonstrated by the current study. Still, a number of limitations must also be considered. Slow infusion of ferumoxytol is necessary to avoid potential anaphylactic reactions which in turn prolongs patient preparation. Additionally, unlike gadolinium, ferumoxytol remains primarily intravascular and may therefore not be easily used for perfusion and delayed enhancement imaging. Considering these limitations, the free-running framework may offer additional advantages in that it provides a comprehensive evaluation of the structure and anatomy of the heart in a predictable scan time creating a potential trade-off between preparation time and actual time in the scanner. Furthermore, while the current study used ferumoxytol, previous studies have demonstrated free-running CCMRA with native contrast and therefore, the current results with ferumoxytol motivate further study of free-running CCMRA in a pediatric population without the use of contrast agents. Conversely, in the current study, strong flow dephasing artifacts were present as demonstrated by Additional file 1. To reduce these artifacts, an ultrashort echo time GRE approach may be useful, but would likely require the continued use of contrast agents due to the poor blood to myocardium contrast obtained with native GRE. On the other hand, and with the flexible a posteriori selection of the time point in the cardiac cycle, images with little or no flow artifacts may freely be selected. 59ce067264

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