FReSCO: Flow Reconstruction and Segmentation for low‐latency Cardiac Output monitoring using deep artifact suppression and segmentation

PURPOSE: Real‐time monitoring of cardiac output (CO) requires low‐latency reconstruction and segmentation of real‐time phase‐contrast MR, which has previously been difficult to perform. Here we propose a deep learning framework for “FReSCO” (Flow Reconstruction and Segmentation for low latency Cardiac Output monitoring). METHODS: Deep artifact suppression and segmentation U‐Nets were independently trained. Breath‐hold spiral phase‐contrast MR data (N = 516) were synthetically undersampled using a variable‐density spiral sampling pattern and gridded to create aliased data for training of the artifact suppression U‐net. A subset of the data (N = 96) was segmented and used to train the segmentation U‐net. Real‐time spiral phase‐contrast MR was prospectively acquired and then reconstructed and segmented using the trained models (FReSCO) at low latency at the scanner in 10 healthy subjects during rest, exercise, and recovery periods. Cardiac output obtained via FReSCO was compared with a reference rest CO and rest and exercise compressed‐sensing CO. RESULTS: The FReSCO framework was demonstrated prospectively at the scanner. Beat‐to‐beat heartrate, stroke volume, and CO could be visualized with a mean latency of 622 ms. No significant differences were noted when compared with reference at rest (bias = −0.21 ± 0.50 L/min, p = 0.246) or compressed sensing at peak exercise (bias = 0.12 ± 0.48 L/min, p = 0.458). CONCLUSIONS: The FReSCO framework was successfully demonstrated for real‐time monitoring of CO during exercise and could provide a convenient tool for assessment of the hemodynamic response to a range of stressors.