Magnetic Resonance Elastography For Estimating In Vivo Stiffness Of The Abdominal Aorta Using Cardiac-Gated Spin-Echo Echo-Planar Imaging: A Feasibility Study

Introduction Magnetic resonance elastography (MRE)-derived aortic stiffness is a potential biomarker for multiple cardiovascular diseases. Currently, gradient-recalled echo (GRE) MRE is a widely accepted technique to estimate aortic stiffness. However, multi-slice GRE MRE requires multiple breath-holds (BHs), which can be challenging for patients who cannot consistently hold their breath. The aim of this study was to investigate the feasibility of a multi-slice spin-echo echo-planar imaging (SE-EPI) MRE sequence for quantifying in vivo aortic stiffness using a free-breathing (FB) protocol and a single-BH protocol. Method On Scanner 1, 25 healthy subjects participated in the validation of FB SE-EPI against FB GRE. On Scanner 2, another 15 healthy subjects were recruited to compare FB SE-EPI with single-BH SE-EPI. Among all volunteers, five participants were studied on both scanners to investigate the inter-scanner reproducibility of FB SE-EPI aortic MRE. Bland-Altman analysis, Lin's concordance correlation coefficient (LCCC) and coefficient of variation (COV) were evaluated. The phase-difference signal-to-noise ratios (PD SNR) were compared. Results Aortic MRE using FB SE-EPI and FB GRE yielded similar stiffnesses (pairedt-test,P= 0.19), with LCCC = 0.97. The FB SE-EPI measurements were reproducible (intra-scanner LCCC = 0.96) and highly repeatable (LCCC = 0.99). The FB SE-EPI MRE was also reproducible across different scanners (inter-scanner LCCC = 0.96). Single-BH SE-EPI scans yielded similar stiffness to FB SE-EPI scans (LCCC = 0.99) and demonstrated a low COV of 2.67% across five repeated measurements. Conclusion Multi-slice SE-EPI aortic MRE using an FB protocol or a single-BH protocol is reproducible and repeatable with advantage over multi-slice FB GRE in reducing acquisition time. Additionally, FB SE-EPI MRE provides a potential alternative to BH scans for patients who have challenges in holding their breath.