Respiratory motion correction
Markus Henningsson1

1School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom


Respiratory motion remains a significant hurdle for widespread clinical adoption of CMR. This lecture will cover key concepts in respiratory motion correction, including respiratory navigators, gating, slice tracking, prospective/retrospective correction and the state-of-the-art in the field. The main focus will be on high-resolution volumetric coronary angiography, which has been an active area of research for 25 years, and the challenges of clinical translation. However, we will also discuss the unique challenges of motion correction for other applications such as quantitative CMR (T1 and T2 mapping) and late gadolinium enhancement.


Respiratory motion has plagued the field of cardiovascular magnetic resonance (CMR) since its origins, causing blurring and ghosting artifacts, and reduced diagnostic yield1. Although breath-holding is the technically most simple and therefore clinically practical solution to avoid motion artifacts in CMR, in many applications the scan time extends beyond that which can be acquired within a 10-15 second breath-hold duration. These include (but are not limited to) high-resolution volumetric imaging such as coronary magnetic resonance angiography2, dynamic contrast-enhanced first-pass perfusion3 and time-resolved cine imaging4. Furthermore, it is desirable to minimize the need for patient compliance as many patients struggle to consistently hold their breath5. For many of these CMR applications respiratory motion correction strategies can be employed to enable data acquisition during free-breathing with minimal motion artifacts. In this session we will be exploring different respiratory motion correction techniques and important concepts such as prospective and retrospective correction, navigators, respiratory gating and slice tracking with different degrees of freedom. It is important to note that, due to the highly variable nature of CMR pulse sequences, there is not one correction technique which can be applied and expected to work robustly for all applications. Rather, each CMR application will have a highly tailored motion correction solution, often combining different compensation strategies, which work within the constraints of the specific pulse sequence6. Here, we will primarily focus on coronary magnetic resonance angiography which historically has been the subject of most research into respiratory motion correction7.

Respiratory navigators, gating and correction

Respiratory navigators are real-time images interleaved with the diagnostic CMR acquisitions8. Navigator images can be used to estimate (using image registration) and correct for the respiratory motion during the scan. The most commonly used respiratory navigator in CMR is the 1D diaphragmatic navigator, which was originally proposed for abdominal imaging in the 1980's9. We will look at why the diaphragmatic 1D navigator has become the dominant method for respiratory motion correction in CMR, its advantages and disadvantages and why it has remained the conventional technique for over 20 years10,11. The navigator motion information can be used for both respiratory gating and correction of the CMR acquisition. Respiratory gating involve adapting which k-space of the CMR scan to sample based on the respiratory motion state or to disable/enable data acquisition12-14, while correcting uses the motion information to modify the k-space data itself to undo the motion assuming some motion model (translation, rotation, affine or non-linear)15,16. In this lecture we will discuss different respiratory gating and correction techniques, including the merits of prospective and retrospective correction.

Recent motion correction techniques and remaining challenges

In the last decade, there has been a move away from diaphragmatic 1D navigator techniques towards measuring and correcting for the motion directly on the heart17-20. The aim of this has been improve motion correction accuracy and to reduce the need for time consuming respiratory gating. To a large extent, this has been achieved by innovations in navigator acquisition techniques, including the use of self-navigation17,18 and image-based navigation19-23, but also more sophisticated gating strategies, often in combination with inherently motion tolerant k-space trajectories24-27. In this lecture, we will survey the current state-of-the-art motion correction techniques, primarily in the field of high-resolution volumetric coronary angiography. However, we will also consider the obstacles towards clinical translation28-30 and the unique challenges of extending these respiratory motion correction techniques to other CMR applications31.


We would like to thank colleagues who supported this lecture by sharing their slides


1. Scott AD, Keegan J, Firmin DN.Radiology. Motion in cardiovascular MR imaging. 2009 Feb;250(2):331-51.

2. Henningsson M, Botnar RM. Advanced respiratory motion compensation for coronary MR angiography. Sensors (Basel). 2013 May 24;13(6):6882-99.

3. Zakkaroff C, Biglands JD, Greenwood JP, Plein S, Boyle RD, Radjenovic A, Magee DR. Investigation into diagnostic accuracy of common strategies for automated perfusion motion correction. J Med Imaging (Bellingham). 2016 Apr;3(2):024002.

4. Usman M, Atkinson D, Odille F, Kolbitsch C, Vaillant G, Schaeffter T, Batchelor PG, Prieto C. Motion corrected compressed sensing for free-breathing dynamic cardiac MRI. Magn Reson Med. 2013 Aug;70(2):504-16.

5. Jahnke C, Paetsch I, Achenbach S, Schnackenburg B, Gebker R, Fleck E, Nagel E. Coronary MR imaging: breath-hold capability and patterns, coronary artery rest periods, and beta-blocker use. Radiology. 2006 Apr;239(1):71-8.

6. Zaitsev M, Maclaren J, Herbst M. Motion artifacts in MRI: A complex problem with many partial solutions. J Magn Reson Imaging. 2015 Oct;42(4):887-901.

7. van Heeswijk RB, Bonanno G, Coppo S, Coristine A, Kober T, Stuber M. Motion compensation strategies in magnetic resonance imaging. Crit Rev Biomed Eng. 2012;40(2):99-119.

8. Firmin D, Keegan J. Navigator echoes in cardiac magnetic resonance. J Cardiovasc Magn Reson. 2001;3(3):183-93.

9. Ehman RL, Felmlee JP. Adaptive technique for high-definition MR imaging of moving structures. Radiology 1989, 173, 255–263.

10. Wang Y, Riederer SJ, Ehman RL. Respiratory motion of the heart-kinematics and the implications for the spatial-resolution in coronary imaging. Magn. Reson. Med. 1995, 33, 713–719.

11. Stuber M, Botnar RM, Danias PG, Kissinger KV, Manning WJ. Submillimeter three-dimensional coronary MR angiography with real-time navigator correction: Comparison of navigator locations. Radiology 1999, 212, 579–587.

12. Oshinski JN, Hofland L, Mukundan S, Dixon WT, Parks WJ, Pettigrew RI. Two-dimensional coronary MR angiography without breath holding. Radiology 1996, 201, 737–743.

13. Jhooti P, Keegan J, Gatehouse PD, Collins S, Rowe A, Taylor AM, Firmin DN. 3D coronary artery imaging with phase reordering for improved scan efficiency. Magn Reson Med. 1999, 41, 555–562.

14. Henningsson M, Smink J, van Ensbergen G, Botnar R. Coronary MR angiography using image-based respiratory motion compensation with inline correction and fixed gating efficiency. Magn Reson Med. 2018 Jan;79(1):416-422.

15. Stuber M, Botnar RM, Danias PG, Sodickson DK, Kissinger KV, van Cauteren M. de Becker J, Manning WJ. Double-oblique free-breathing high resolution three-dimensional coronary magnetic resonance angiography. J. Am. Coll. Cardiol. 1999, 34, 524–531.

16. Schmidt JF, Buehrer M, Boesiger P, Kozerke S. Nonrigid retrospective respiratory motion correction in whole-heart coronary MRA. Magn Reson Med. 2011, 66, 1541–1549.

17. Stehning C, Bornert P, Nehrke K, Eggers H, Stuber M. Free-breathing whole-heart coronary MRA with 3D radial SSFP and self-navigated image reconstruction. Magn Reson Med. 2005, 54, 476–480.

18. Piccini D, Littmann A, Nielles-Vallespin S, Zenge MO. Respiratory self-navigation for whole-heart bright-blood coronary MRI: Methods for robust isolation and automatic segmentation of the blood pool. Magn Reson Med. 2012, 68, 571–579.

19. Henningsson M, Smink J, Razavi R, Botnar RM. Prospective respiratory motion correction for coronary MR angiography using a 2D image navigator. Magn Reson Med. 2013, 69, 486–694.

20. Wu HH, Gurney PT, Hu BS, Nishimura DG, McConnell MV. Free-breathing multiphase whole-heart coronary MR angiography using image-based navigators and three-dimensional cones imaging. Magn Reson Med. 2013 Apr;69(4):1083-93.

21. Henningsson M, Koken P, Stehning C, Razavi R, Prieto C, Botnar RM. Whole-heart coronary MR angiography with 2D self-navigated image reconstruction. Magn Reson Med. 2012 Feb;67(2):437-45.

22. Kawaji K, Spincemaille P, Nguyen TD, Thimmappa N, Cooper MA, Prince MR, Wang Y. Direct coronary motion extraction from a 2D fat image navigator for prospectively gated coronary MR angiography. Magn Reson Med. 2014 Feb;71(2):599-607.

23. Moghari MH, Roujol S, Henningsson M, Kissinger KV, Annese D, Nezafat R, Manning WJ, Geva T, Powell AJ. Three-dimensional heart locator for whole-heart coronary magnetic resonance angiography. Magn Reson Med. 2014 Jun;71(6):2118-26.

24. Bhat H, Ge L, Nielles-Vallespin S, Zuehlsdorff S, Li D. 3D radial sampling and 3D affine transform-based respiratory motion correction technique for free-breathing whole-heart coronary MRA with 100% imaging efficiency. Magn Reson Med. 2011, 65, 1269–1277.

25. Prieto C, Doneva M, Usman M, Henningsson M, Greil G, Schaeffter T, Botnar RM. Highly efficient respiratory motion compensated free-breathing coronary MRA using golden-step Cartesian acquisition. J Magn Reson Imaging. 2015 Mar;41(3):738-46.

26. Ingle RR, Wu HH, Addy NO, Cheng JY, Yang PC, Hu BS, Nishimura DG. Nonrigid autofocus motion correction for coronary MR angiography with a 3D cones trajectory. Magn Reson Med. 2014 Aug;72(2):347-61.

27. Pang J, Bhat H, Sharif B, Fan Z, Thomson LE, LaBounty T, Friedman JD, Min J, Berman DS, Li D. Whole-heart coronary MRA with 100% respiratory gating efficiency: self-navigated three-dimensional retrospective image-based motion correction (TRIM). Magn Reson Med. 2014 Jan;71(1):67-74.

28. Piccini D, Monney P, Sierro C, Coppo S, Bonanno G, van Heeswijk RB, Chaptinel J, Vincenti G, de Blois J, Koestner SC, Rutz T, Littmann A, Zenge MO, Schwitter J, Stuber M. Respiratory self-navigated postcontrast whole-heart coronary MR angiography: initial experience in patients. Radiology. 2014 Feb;270(2):378-86.

29. He Y, Pang J, Dai Q, Fan Z, An J, Li D. Diagnostic Performance of Self-navigated Whole-Heart Contrast-enhanced Coronary 3-T MR Angiography. Radiology. 2016 Nov;281(2):401-408.

30. Henningsson M, Shome J, Bratis K, Vieira MS, Nagel E, Botnar RM. Diagnostic performance of image navigated coronary CMR angiography in patients with coronary artery disease. J Cardiovasc Magn Reson. 2017 Sep 11;19(1):68.

31. Bratis K, Henningsson M, Grigoratos C, Dell'Omodarme M, Chasapides K, Botnar R, Nagel E. Image-navigated 3-dimensional late gadolinium enhancement cardiovascular magnetic resonance imaging: feasibility and initial clinical results. J Cardiovasc Magn Reson. 2017 Dec 4;19(1):97.

Proc. Intl. Soc. Mag. Reson. Med. 26 (2018)