Whole-heart spiral simultaneous multi-slice first-pass myocardial perfusion imaging

Purpose: To develop and evaluate a simultaneous multislice (SMS) spiral perfusion pulse sequence with whole-heart coverage. Methods: An orthogonal set of phase cycling angles following a Hadamard pattern was incorporated into a golden-angle (GA) variable density spiral perfusion sequence to perform SMS imaging at different multiband (MB) factors. Images were reconstructed using an SMS extension of L1-SPIRiT that we have termed SMS-L1-SPIRiT. The proposed sequence was evaluated in 40 subjects (10 each for MB factors of 1, 2, 3, and 4). Images were blindly graded by 2 cardiologists on a 5-point scale (5, excellent). To quantitatively evaluate the reconstruction performance against images acquired without SMS, the MB = 1 data were used to retrospectively simulate data acquired at MB factors of 2 to 4. Results: Analysis of the SMS point-spread function for the desired slice showed that the proposed sampling strategy significantly canceled the main-lobe energy of the other slices and has low side-lobe energy resulting in an incoherent temporal aliasing pattern when rotated by the GA. Retrospective experiments demonstrated the SMS-L1-SPIRiT method removed aliasing from the interfering slices and showed excellent agreement with the ground-truth MB = 1 images. Clinical evaluation demonstrated high-quality perfusion images with average image-quality scores of 4.3 +/- 0.5 (MB = 2), 4.2 +/- 0.5 (MB = 3), and 4.4 +/- 0.4 (MB = 4) with no significant quality difference in image quality between MB factors (P = 0.38). Conclusion: SMS spiral perfusion at MB factors 2, 3, and 4 produces high-quality perfusion images with whole-heart coverage in a clinical setting with high sampling efficiency.