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Purpose: To develop a fully automatic method for extraction anddirectionality determination of respiratory signal in free-breathing, real-time(RT) cardiac MRI.  Methods: The respiratory signal is extracted by a principal componentanalysis method from RT cine images. Then, a two-step procedure is used todetermine the directionality (sign) of the respiratory signal. First, thesignal polarity of all slices is made consistent with a reference slice.Second, a global sign correction is performed by maximizing the correlation ofthe respiratory signal with the zeroth-moment center curve. The proposed methodis evaluated in multi-slice RT cine from eleven volunteers and two patients.The motion in a manually selected region-of-interest is used as reference.  Results: The extracted respiratory signal using the proposed method exhibitshigh, positive correlation with the reference in all cases and is more robustcompared to a recently proposed method. To demonstrate its clinical utility,the method is used to identify heartbeats from inspiratory and expiratoryphases and, in turn, to account for respiration-induced changes in the cardiacoutput.  Conclusions: The proposed method enables fully automatic extraction anddirectionality determinations of respiratory signal from RT cardiac cineimages, allowing accurate cardiac function quantification.

Automatic image-based respiratory signal extraction in real-time CMR