Double Inversion Recovery in myocardial Arterial Spin Labeling (ASL) for reduced physiological noise

Motivation: Myocardial Arterial Spin Labeling (myoASL) presents a promising contrast-agent-free approach for assessing myocardial blood flow (MBF), but its clinical translation is hampered by high levels of physiological noise (PN). Goal(s): We introduce double inversion recovery (DIR) preparations for FAIR-myoASL to mitigate sensitivity to heart rate variations and reduce PN. Approach: A flip-back inversion pulse was added immediately after the FAIR-labeling, to allow for near-complete recovery and, thus, for more effective cancellation of the myocardial background signal in the presence of heart rate variations. Results: Using DIR preparations in vivo, led to a PN reduction of up to 66 % compared to conventional myoASL. Impact: FAIR-myoASL with double inversion recovery (DIR) labeling can compensate for fluctuating myocardial background signals due to heart rate variability. In vivo, experiments suggest that DIR-preparations substantially reduce PN, thus, improving overall robustness and potentially facilitating broader clinical translation of myoASL.