CMR Artifact

Artifacts at Cardiac MRI: causes and how to avoid them
Poster No.: 415

Congress: ESCR 2013
Type: Poster Presentation
Authors: A. Gyftopoulos, N. Kiriakopoulos, G. Delimpasis, S. KOROPOULI;
ATHENS/GR
Keywords: MR physics, Cardiac, MR, Diagnostic procedure, Quality
assurance, Artifacts
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Purpose
• To review the artifacts of certain pulse sequences used at Cardiac MRI

• To explain the physics underlying the propagation of each artifact type
• To describe useful tips to avoid them
• To demonstrate the imaging chalenges at CMR and the apropriate solutions
• How to avoid potential diagnostic pitfalls
Methods and Materials
Examinations were performed on a 1.5-T MR unit (Siemens Sonata Maestro).
Images for this section:
Fig. 5
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Results
There are numerous kinds of artifacts that can occur in Cardiac MRI (motion-related
Fig. 31 on page 42 or ghosting artefacts , aliasing , turbulent flow, suspectibility
artefacts ,dark band artifacts (SSFP) Fig. 23 on page 41 ,dark rim and DHE artifacts
etch). Most of them are related to specific pulse sequences. Some effect the quality of
the MRI exam while others do not effect the diagnostic quality but may be confused with
pathology.
Nonetheless cardiac MRI is now entirely feasible thanks to the implemented techniques
such as ECG triggering, respiration gating, ultrafast or even real-time imaging methods
that have efficiently minimized or overcome cardiac and breathing motion artifacts
• In the heart the EPI technique is prone to artifacts.
Balanced SSFP sequences provide high-speed T2*/T1 contrast images. the high speed
allows rapid assessment of acute abdominal conditions in patients who are unstable or
unable to stay in the magnet a long time.
Good blood/myocardium contrast and high speed make balanced SSFP sequences
suitable for cardiac imaging applications.
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Fig. 6
References: RADIOLOGY, 251 HELLENIC AIR FORCE HOSPITAL - ATHENS/GR
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Fig. 7
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Fig. 8
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Fig. 9
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Fig. 10
Real time imaging is very helpfull in patient who can't hold their breath for a long time
Fig. 22 on page 40 .
Darkband artefact is not apparent in areas of low signal intensity.
Is is caused by dephasing of the spins with loss of steady -state (field inhomogeneity,off
-resonanse frequency) Fig. 2 on page 22 .
It is contributed by increased TR (inversely related to TR) ,low TE (increased chemical

shift artifact) and is worse at 3Tesla.
T2 IMAGING Fig. 29 on page 44 Fig. 30 on page 43
T2w-imaging is prone to several problems :
• variability in signal intensity caused by phased array coils,
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• improper timing causing signal loss in the posterior wall,
• high signal from slow flowing blood adjacent to the jeopardized myocardium
( can mimic and mask adjacent myocardial edema ),
• motion artifacts, and
• subjective nature of image interpretation of T2w sequences
Saturation bands are extremely usefull. We use three bands for SA images and one at
4CH.
A slight increase (10-20msec) in TI may help when there is signal loss in the lateral or
posterior wall.
T2-values for normal myocardium typically range between 50 and 55 ms on a 1.5T

scanner.
Fig. 11
Phase contrast
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Two opposites gradients are used , the first induces phase shift in flowing blood and
stationary tissue and the second reverses the phase shift of the latter.
Three images are obtained:
• Magnitude (used for anatoming contouring) Fig. 3 on page 23

• Re-phased magnitude (reconstructed image -flowing blood appears bright)
• Phase which is a substracted velocity image (grayscale value: White:
positive direction ,Black: negative direction , gray : Stationary spins) Fig. 1
on page 21
Fig. 12
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Fig. 13
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Fig. 14
Perfusion imaging
Higher doses of contrast yield greater myocardial enhancement but do not increase
diagnostic accuracy. At higher doses susceptibility artifacts become more prominent, and
may be mistaken for real perfusion defects (false-positives).
Respiration artifacts are often annoying, especially for (semi)quantitative analysis. It is

advisable to suspend breathing at least for the relatively short period that covers the
wash-in of contrast agents
Caution must be taken because thrombi or calcification may be misinterpreted as a

perfusion defect.
Another cause of false negative results is globally decreased perfusion usually due to
3-vessel disease (balanced perfusion defect).
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Fig. 15
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Fig. 16
TI scout- Look Locker sequence
TI values typically vary between 200 and 250 ms for early images, to 250-300 ms for
late images.
If there is no contrast between blood, myocardium and infarcted tissue (if present) and
all structures appear to be too dark, this indicates either that the contrast has already
washed out or an insufficient amount of contrast agent was injected.
The PSIR sequence Fig. 25 on page 48 acquires a background phase map during
the same acquisition of the image.
Although PSIR is considered to be be indebendent of time to inversion we usually adjust

TI with the data from TI-scout.
For balanced SSFP we usually add 20-30 msec for optimal result.
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Fig. 18
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Fig. 17
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Fig. 19
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Fig. 20
CEMRA
Maximum Intensity Projection (MIP) reconstructions are widely used and should be
interpreted with caution. This is because they may overestimate the degree of stenosis
and may obscure vascular pathology (2D image of a 3D object without depth information) .
We must always correlate the MIP image with the source images.
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Fig. 21
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Fig. 34
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Fig. 35
External Pacemaker Wires
These segments of the wires (the straight wire section) can cause significant susceptibility
artifacts on the anterior chest wall.
Images for this section:
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Fig. 1
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Fig. 2
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Fig. 3
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Fig. 6
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Fig. 15
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Fig. 16
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Fig. 17
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Fig. 18
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Fig. 19
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Fig. 20
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Fig. 14
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Fig. 13
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Fig. 12
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Fig. 11
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Fig. 10
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Fig. 9
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Fig. 7
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Fig. 21
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Fig. 8
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Fig. 22
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Fig. 23: SSFP cine : Dark band artefact at the lateral wall of the left ventricle ,as wee
as SENSE artefact.
Fig. 32
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Fig. 31
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Fig. 30: STIR Short Axis
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Fig. 29: STIR 4CH
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Fig. 28
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Fig. 27
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Fig. 26
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Fig. 25
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Fig. 24: Phase enconded artifact
Fig. 33
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Conclusion
With an improved awareness and understanding of the MR sequences used in Cardiac

MRI and the accompaning artefacts, radiologists will be better able to modify MR imaging
protocols and optimize clinical image quality.
References
1. Clinical Cardiac MRI - 2nd Edition, 2012, Bogaert , Dymarkowski ,

Taylor ,Muthurangu
2. Morelli et al ,An Image-based Approach to Understanding the Physics of MR
Artifacts-May 2011 RadioGraphics, 31,849-866
3. Farhood Saremi et al, Optimizing Cardiac MR Imaging: Practical Remedies
for Artifacts ,RadioGraphics 2008;28:1161-1187
Personal Information
251 Hellenic Air Force Hospital- MRI Department
Gyftopoulos Anastasios
Consultant Radiologist
mailto:tassosg@hotmail.com
telephone: +302107465904
Page 51 of 51

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Artifacts at Cardiac MRI: causes and how to avoid them

Poster No.: 415

• To review the artifacts of certain pulse sequences used at Cardiac MRI

Methods and Materials

Examinations were performed on a 1.5-T MR unit (Siemens Sonata Maestro).

Images for this section:

• In the heart the EPI technique is prone to artifacts.

Darkband artefact is not apparent in areas of low signal intensity.

It is contributed by increased TR (inversely related to TR) ,low TE (increased chemical

T2 IMAGING Fig. 29 on page 44 Fig. 30 on page 43

T2w-imaging is prone to several problems :

• variability in signal intensity caused by phased array coils,

T2-values for normal myocardium typically range between 50 and 55 ms on a 1.5T

Three images are obtained:

• Magnitude (used for anatoming contouring) Fig. 3 on page 23

Respiration artifacts are often annoying, especially for (semi)quantitative analysis. It is

Caution must be taken because thrombi or calcification may be misinterpreted as a

TI scout- Look Locker sequence

Although PSIR is considered to be be indebendent of time to inversion we usually adjust

External Pacemaker Wires

Images for this section:

With an improved awareness and understanding of the MR sequences used in Cardiac

1. Clinical Cardiac MRI - 2nd Edition, 2012, Bogaert , Dymarkowski ,

251 Hellenic Air Force Hospital- MRI Department

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