ArticleJournal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance2026
Monitoring myocardial oxygenation response to respiratory maneuvers using real-time magnetic resonance imaging.
Article in Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOxygenation-sensitive (OS) cardiovascular magnetic resonance (CMR), using breathing maneuver-induced stress and blood oxygen level-dependent contrast, is a well-tolerated, non-invasive approach for assessing myocardial oxygenation. This study evaluated two real-time CMR sequences and a semi-automated analysis workflow to enable continuous, motion-robust assessment of myocardial oxygenation dynamics, aiming to overcome limitations of electrocardiogram (ECG)-triggered acquisitions and reduce manual evaluation requirements.
methodsSignal intensity dynamics of ten young healthy female volunteers were analyzed from images acquired on a 3T scanner using an ECG-triggered balanced steady-state free precession (bSSFP) sequence, a real-time (RT) bSSFP sequence, and a RT fast low-angle short (FLASH) sequence. Images were obtained in a mid-ventricular slice while participants performed a breathing maneuver consisting of normal breathing, paced hyperventilation, and a prolonged breath hold. A semi-automated processing pipeline was implemented to generate motion-resolved oxygenation maps using retrospective cardiac phase binning, deformable image registration, and automated segmentation.
resultsThe RT sequences captured end-systolic global myocardial signal intensity change (ΔSI, relative to reference frames at breath-hold start) with dynamics comparable to those of the ECG-triggered bSSFP sequence. As expected in healthy volunteers, ΔSI decreased during hyperventilation and recovered during the prolonged breath-hold. At 20-30s, oxygenation responses at end-systole were 3.95%[3.36, 7.50] for ECG-triggered bSSFP, 5.47%[3.31, 9.08] for RT bSSFP, and 3.24%[1.99, 4.80] for RT FLASH. RT FLASH showed fewer artifacts but lower contrast and smaller ΔSI than the bSSFP sequences, with inter-sequence differences appearing modest in mixed-effects analysis.
conclusionsThis exploratory study demonstrates the feasibility of combining real-time MR sequences with a semi-automated processing pipeline for continuous assessment of T2∕T2*-related myocardial oxygenation dynamics. Potential confounders, including through-plane motion and physiological drift, warrant further investigation.
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