Respiratory Motion Management in Abdominal MRI: Revisiting the Gap Between Technical Advances and Clinical Translation.

The inherently slow acquisition speed of MRI makes abdominal imaging highly sensitive to respiratory motion artifacts. Since the early days of MRI, the development of respiratory motion compensation has been an active research topic, and this field has achieved substantial technical progress. Despite these advances, majority of these techniques are not clinically available, and motion management methods used in clinical abdominal MRI today have changed little over the past decades. This observation is striking and points to a significant gap between technical innovation and clinical translation in this area. This review is motivated by this question: why have so many motion management techniques not been adopted into routine clinical workflows? Unlike conventional survey-style reviews that focus on summarizing emerging methods, this article takes a different, and perhaps opposite, perspective to investigate why those technologically sophisticated innovations are misaligned with practical clinical needs. Specifically, we discuss the barriers behind the gap between research advances and clinical practice, clarify the clinical requirements for effective respiratory motion management in abdominal MRI, and highlight research directions with stronger relevance to routine workflows. The review begins with an overview of the clinical impact of respiratory motion in abdominal MRI, followed by a discussion of standard abdominal MRI sequences and their motion sensitivity. We then summarize current clinical strategies and advanced approaches, along with the barriers that hinder their clinical adoption. The article concludes with future directions and broader lessons learned from this translational gap, with the goal of guiding future developments towards improved clinical integration.