Quantitative confounder analysis of electrocardiogram signals in cardiac magnetic resonance at 1.5, 3 and 7 T - assessing standardized electrode positions and sequence types - towards quality assurance
Autor(in); Institution
Hickstein, Richard; DZHK (German Centre for Cardiovascular Research), Berlin, GERMANY; Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité-Universitätsmedizin Berlin, Kardiologie-ECRC, Berlin, GERMANY
Wiesemann, Stephanie; Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology Charité—Universitätsmedizin Berlin, Kardiologie—ECRC Berlin GERMANY
Viezzer, Darian; DZHK (German Centre for Cardiovascular Research), Berlin, GERMANY; Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité-Universitätsmedizin Berlin, Kardiologie-ECRC, Berlin, GERMANY
Kleindienst, Denise; Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology Charité, Universitätsmedizin Berlin, Kardiologie, ECRC Berlin GERMANY
Hadler, Thomas; DZHK (German Centre for Cardiovascular Research), Berlin, GERMANY; Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité-Universitätsmedizin Berlin, Kardiologie-ECRC, Berlin, GERMANY
Schmitter, Sebastian; 8.1, Biomedizinische Magnetresonanz, PTB-Berlin; DZHK (German Centre for Cardiovascular Research), Berlin, GERMANY
Schulz‐Menger, Jeanette; DZHK (German Centre for Cardiovascular Research), Berlin, GERMANY; Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité-Universitätsmedizin Berlin, Kardiologie-ECRC, Berlin, GERMANY
Quelle/Jahr
Journal of Magnetic Resonance Imaging: 63
(2026), 4, 1140
- 1154
7 T ; cardiac gating ; cardiac gating confounders ; ultra‐high field
Zusammenfassung
Background: The electrocardiogram (ECG) used for gating in cardiac MRI may be compromised by multiple confounders inside the scanner bore.
Purpose: To quantify the influence of magnetic field strengths (1.5 T/3 T/7 T), standardized electrode positions, and imaging sequences on ECG signals used for gating.
Study type: Prospective.
Population: Sixteen healthy volunteers (eight male; mean age 26.25 ± 7.67 years).
Field strength/sequence: Balanced steady-state free precession cine (1.5 T/3 T), fast low-angle shot cine (7 T), and 4D flow (1.5 T/3 T/7 T) sequences.
Assessment: ECG-signals were recorded during breath-hold and non-breath-hold short axis cine (sax-bh and sax-nbh, respectively) and 4D flow scans at 1.5 T/3 T/7 T. All scans were repeated with 4 standardized electrode positionings (pos1-4) at each field strength. Pos1/2 were vendor-recommended positionings for 1.5 T/3 T/7 T scans, respectively, whereas pos3/4 were alternative positionings recommended in previous studies. Similarity between confounded ECG-signals and unconfounded baseline ECG-signals was assessed by QRS-feature correlation. Cine image quality (IQ) was assessed by 3 readers (with 6, 10, and 22 years experience) on a four-point Likert scale.
Statistical tests: Linear mixed models with type III tests of fixed effects (overall) and t tests with adjusted degrees of freedom (pairwise subgroup-comparisons) at significance level p < 0.05.
Results: Increasing field strength resulted in significantly decreasing similarity to baseline measurements, with r values (provided with 95% confidence interval) of 1.5 T: 97% (92.6-101.3); 3 T: 91.4% (87.1-95.8); 7 T: 50.4% (46-54.9) and lower IQ: 1.5 T: 2.33 (2.12-2.55); 3 T: 1.96 (1.75-2.17); 7 T: 0.91 (0.7-1.12). Vendor-specified electrode positions pos1: 91.8% (87.2-96.5), pos2: 88.3% (83.7-92.9) showed significantly higher correlation with baseline measurements than alternative positions pos3: 67.5% (62.9-72.1) and pos4: 70.8% (66.2-75.4). The evaluated standardized sequences showed similar amounts of electrocardiogram distortion, with r values of: sax-bh: 77.3% (73-81.7); 4D: 79.3% (75-83.7), p = 0.54; sax-nbh: 82.1% (77.8-86.5), p = 0.31, but the difference between sax-bh and sax-nbh: 4.8% (2.88-6.72) was significant.
Data conclusion: Increasing field strength leads to significant ECG signal distortions. Vendor-specified positions 1/2 resulted in less distorted ECG signals than alternative positions 3/4 recommended in previous publications.
Level of Evidance: 2.
Technical efficacy: Stage 5.
Plain Language Summary
The electrical signal of the heart plays an important role in synchronizing cardiac MR imaging with the heart's motion. This
study measured how much this signal is distorted by magnetic field strengths (1.5, 3, and 7 T), electrode positioning, and imaging
sequences. The results showed higher amounts of distortion with increasing field strengths but less distortion with standard
electrode positions. The tested imaging sequences showed little difference. These results highlight challenges for ultra-high-
field
MRI in clinical practice and provide practical guidance to optimize electrode placement. They may pave the way for more reliable
heart imaging at increasing magnetic field strengths.
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Rechteinformation
CC BY 4.0 ; Creative Commons Attribution 4.0 License
Förderinformationen (1)
Förderername: Deutsche Forschungsgemeinschaft (DFG)
Förderer ID: 0000 0001 2096 9829
Förderer ID Typ: ISNI
Förderprogramm: SCHM 2677/21, GRK 2260
Zitierung
Hickstein, R., Wiesemann, S., Viezzer, D., Kleindienst, D., Chitiboi, T., Gheorghita, B. A., Wetzl, J., Hadler, T., Dietrich, S., Schmitter, S., & Schulz‐Menger, J. (2026). Quantitative confounder analysis of electrocardiogram signals in cardiac magnetic resonance at 1.5, 3 and 7 T - assessing standardized electrode positions and sequence types - towards quality assurance. Journal of Magnetic Resonance Imaging, 63(4), 1140–1154. https://doi.org/10.1002/jmri.70130
