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Janina Schellenberg¹, Paponrad Tontivuthikul², Joanna Chappell¹, Nada Mufti², Dimitra Flouri¹, Sebastien Ourselin¹, Anna David², Rosalind Aughwane², and Andrew Melbourne^1
1King's College London, London, United Kingdom, ²University College London, London, United Kingdom

Keywords: Data Analysis, Fetus

Fetal growth restriction (FGR) occurs when a fetus does not reach its full growth potential, predisposing the fetus to long-term impacts on lung function at birth and into childhood. We propose a novel model of fetal lung tissue based on combined diffusion and relaxation and apply this to a cohort of FGR and appropriately grown controls. We show differences in lung model parameters in FGR relative to controls and with gestational age. We also link these parameters to measurement of feto-placental oxygenation. This methodology could potentially provide a non-invasive method to assess fetal lung development.

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Maher Abadeer¹, Munes Fares¹, Jeanne Dillenbeck², Maddy Artunduaga², Sravani Avula¹, Sanja Dzelebdzic¹, Steven Philip¹, Tarique Hussain¹, and Gerald Greil^1
1Pediatric Cardiology, UT Southwestern, Dallas, TX, United States, ²Pediatric Radiology, UT Southwestern, Dallas, TX, United States

Keywords: Cardiovascular, Myocardium, Myocarditis, LGE, troponin

Pediatric myocarditis is associated with major morbidity and mortality. Biomarkers are needed to predict clinical outcomes. High-sensitivity troponin (hs-TnT) and late gadolinium enhancement (LGE) have been shown to correlate with poor outcomes in adult populations. We found that LGE and hs-TnT linearly correlated with each other in our pediatric population, and that children with myocarditis were more likely to be male, have a higher LGE score, higher hs-TnT values, and increased T2 signal intensity than those who did not. A cut-off of 1200 ms for native T1 global mean was significantly associated with the need for inotropic support.

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Fuchang Jiang¹, Kaylee Henry¹, Bhumi Bhusal², Pia Sanpitak², Gregory Webster³, Andrada Popescu⁴, Giorgio Bonmassar⁵, Christina Laternser⁶, Daniel Kim², and Laleh Golestanirad^1,2
1Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States, ²Department of Radiology, Northwestern University, Chicago, IL, United States, ³Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States, ⁴Division of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States, ⁵A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States, ⁶Center for Cardiovascular Innovation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Keywords: Heart, Safety, Implants

Children with congenital heart defects often have life-sustaining indications for an epicardial cardiac implantable electronic device (CIED). However few data exist on endocardial systems in children. Additionally, the FDA has never approved an epicardial system as MRI-Conditional due to limited data on potential heating risk. To provide evidence-based knowledge on RF-induced heating of CIEDs in children and adults with epicardial and endocardial leads of different lengths, we recorded the temperature increase of 120 clinically relevant trajectories positioned into adult and pediatric phantoms. Our results highlight the need for age and device-specific assessments of MRI safety in children with CIEDs. 

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Carla Avena-Zampieri¹, Paddy J Slator², Alena Uus¹, Mary Rutherford¹, Anne Greenough^3,4,5, Jana Hutter¹, and Lisa Story^1,6
1Perinatal imaging, King's College London, London, United Kingdom, ²Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom, ³Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, United Kingdom, ⁴Neonatal Unit, King’s College Hospital, London, United Kingdom, ⁵NIHR Biomedical Research Centre, Guy’s & St Thomas NHS Foundation Trusts and King’s College London, London, United Kingdom, ⁶Fetal Medicine Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom

Keywords: Data Analysis, Fetus, Prenatal lungs, non-invasive tool

We scanned the fetal lungs of healthy controls and fetuses that subsequently delivered preterm, to characterise typical and atypical lung development in-utero, with a combined T2*-diffusion protocol. We analysed our data with a joint T2*-ADC model, yielding voxelwise maps of T2* and ADC, plus calculated whole-lung T2*-ADC spectra. A reduction in both T2* and ADC values was demonstrated in the preterm cohort, potentially reflecting alterations in pulmonary development commencing in-utero. Our study demonstrates that voxelwise T2* and ADC maps, and whole-lung T2*-ADC spectra have the potential to provide additional information on fetal lung microstructure and improve detection of atypical development.

Rong Xu¹, Wei Huang², Lini Liu¹, Xiaoyong zhang³, and Yingkun Guo^1
1West China Second University Hospital, Chengdu, China, ²West China Second Universityy Hospital, Chengdu, China, ³Clinical Science, Philips Healthcare, Chengdu, China

Keywords: Cardiomyopathy, Cancer

The stage of chemotherapy in children with ALL is a long process, and the myocardial damage caused by chemotherapy is still unknown. The different chemotherapy stages may have different degrees of myocardial damage. In this study, cardiac magnetic resonance was used to evaluate myocardial strain in ALL patients at different stages of treatment, and it was found that myocardial strain reduction was more pronounced in the early stages of treatment, and that global strain was a risk factor for adverse clinical outcomes.

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Margaret M Samyn¹, Adam M Gordon², Ke Yan³, Jian Zhang⁴, Aspen M Duffin⁵, Jonathan H Soslow⁶, Bruce Damon⁷, Jennifer M Gerardin¹, Benjamin M Goot⁸, Joseph R Cava¹, and Steven J Kindel^1
1Pediatrics, Medical College of Wisconsin/ Herma Heart Institute at Children's Wisconsin, Milwaukee, WI, United States, ²Medical College of Wisconsin, Milwaukee, WI, United States, ³Pediatrics, Medical College of Wisconsin/ Quantitative Health Sciences, Milwaukee, WI, United States, ⁴Quantitative Health Sciences, Medical College of Wisconsin/ Quantitative Health Sciences, Milwaukee, WI, United States, ⁵Herma Heart Institute, Children's Wisconsin, Milwaukee, WI, United States, ⁶Pediatrics, Vanderbilt Univesity Medical Center, Nashville, TN, United States, ⁷Bioengineering, Carle Foundation Hospital/University of Illinois, Urbana, IL, United States, ⁸Pediatrics (Cardiology), Medical College of Wisconsin/ Herma Heart Institute at Children's Wisconsin, Milwaukee, WI, United States

Keywords: Cardiovascular, Tissue Characterization, Cardiac transplant; 3Tesla; Parametric Imaging

Pediatric heart transplant recipients undergo frequent invasive cardiac catheterization with endomyocardial biopsy for routine allograft surveillance. Risks associated with catheterization and sampling error call into question this accepted “gold standard.” Cardiac magnetic resonance imaging (CMR), with parametric imaging, may advance myocardial surveillance in this population. Fifty-two pediatric patients (transplanted at ≤18 years old) underwent CMR (September 2016 to June 2019) at 3T to evaluate myocardial health using MOLLI sequence. Healthy transplant recipients had normal global biventricular function, native T1 higher than published values for healthy children at 3T with similar extracellular volume (ECV) despite history of treated rejection.

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Lajja Desai¹, Elizabeth Weiss², Juliet Varghese³, Rizwan Ahmad³, Orlando Simonetti³, Cynthia Rigsby¹, and Michael Markl^2
1Lurie Children's Hospital/Northwestern University Feinberg School of Medicine, Chicago, IL, United States, ²Northwestern University, Chicago, IL, United States, ³Ohio State University, Columbus, OH, United States

Keywords: Cardiovascular, Translational Studies, 4D Flow

Cardiac magnetic resonance imaging can provide novel non-invasive estimation of blood oxygen saturation and quantification of blood flow streaming in pediatric and adult patients with complex single ventricle physiology. Non-uniform distribution of inferior and superior caval blood flow and oxygenation to the left and right lungs may cause complications in patients with Fontan circulation. An individualized, comprehensive approach may identify patients at risk.

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Takashi Fujiwara¹, LaDonna Malone¹, Kelly Jarvis², Kathryn C Chatfield³, Lorna P Browne¹, and Alex J Barker^1,4
1Department of Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, United States, ²Department of Radiology, Northwestern University, Chicago, IL, United States, ³Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, United States, ⁴Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States

Keywords: Flow, Velocity & Flow, 4D flow MRI

Bicuspid aortic valve is associated with progressive aortic dilatation, which is seen both in pediatric and adult populations. Although several studies have found a connection between aortic hemodynamics, vessel wall architectural abnormalities, and progressive dilation, the role of hemodynamics in pediatric aortopathy remains unclear. We used 4D flow MRI data in pediatric bicuspid aortic valve patients to identify potential hemodynamic biomarkers associated with aortic diameter. Despite no clear association with aortic diameter, different flow features between BAV patients with/without coarctation were found.

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Samal Munidasa^1,2, Brandon Zanette^1,2, Marie-Pier Dumas³, Wallace Wee³, Jacky Au³, Sharon Braganza¹, Daniel Li¹, Felix Ratjen³, and Giles Santyr^1,2
1Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada, ²Medical Biophysics, University of Toronto, Toronto, ON, Canada, ³Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada

Keywords: Data Processing, Lung

2D phase-resolved functional lung (PREFUL) MRI has been shown to correlate with hyperpolarized Xenon MRI (Xe-MRI) in pediatric Cystic Fibrosis (CF) lung disease but ventilation defects may be missed using the 2D approach. In this study we develop a 3D ultra-short echo time (UTE) PREFUL MRI method and compare to 2D PREFUL MRI and Xe-MRI in CF. 3D UTE PREFUL MRI showed a lower bias between Xe-MRI as compared to 2D PREFUL and was able to detect ventilation defects missed by the 2D approach, suggesting that the 3D approach may be a more comprehensive measure of ventilation in pediatric CF.

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Fraser Maurice Callaghan^1,2, Barbara Burkhardt^2,3, Emanuela Valsangiacomo Buechel^2,3, Christian Kellenberger^2,4, and Julia Geiger^2,4
1Center for MR Research, University Children's Hospital Zurich, Zurich, Switzerland, ²Children’s Research Center, University Children's Hospital Zurich, Zurich, Switzerland, ³Division of Pediatric Cardiology, University Children's Hospital Zurich, Zurich, Switzerland, ⁴Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland

Keywords: Cardiovascular, Cardiovascular, 4D flow, Congenital heart disease

4D flow MRI is used to assess flow dynamics in the pulmonary veins and left atrium of 10 patients (mean age 3.8 years) with partial anomalous pulmonary venous return and atrial septal defect compared with 13 age matched normal subjects. Anomalous veins do not have a higher proportion of total return flow compared to normal subjects. Flow across the atrial septal defect results in a higher proportion of flow during systole compared to normal subjects and results in lower atrial pressure and thus reduced left ventricle filling velocities. Atrial kick dynamics are not different compared with normal subjects.

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El-Sayed H. Ibrahim¹, John LaDisa¹, and Joy Lincoln^1
1Medical College of Wisconsin, Milwaukee, WI, United States

Keywords: Cardiovascular, Valves, congenital heart disease

Bicuspid Aortic Valve (BAV) is the most common congenital heart disease affecting 1-2% of all live births. Current clinical management includes periodic surveillance of aortic valve dysfunction, and only when the valve becomes stenotic is intervention recommended, which includes surgical procedures that come with insuperable long-term outcomes. We optimized a small-animal MRI protocol for comprehensive evaluation of the BAV structure, function, flow pattern, and tissue characterization. Children and adolescents with BAV would benefit from this comprehensive assessment of their risk profile during early stages of the disease to better predict outcomes and clinical management strategies.

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Paul Polak¹, Henrik von Kleist², Marcus Hott², Erin K Englund¹, Alex J Barker¹, Bettina Cuneo³, Richard M Friesen³, Lorna P Browne¹, and Mehdi Hedjazi Moghari^1
1Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States, ²Technische Universitat Munchen, Munich, Germany, ³Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States

Keywords: Fetal, Cardiovascular

Fetal cardiovascular magnetic resonance requires an accurate measure of the fetal heart rate for cine image acquisitions. In this work, we compared the use of Doppler ultrasound with a self-gating technique in 8 subjects. Images were acquired in the axial and short-axis orientations of the fetal heart, and the images were compared with qualitative scoring, heart rate analysis, and ventricular volumes. It was found that the techniques had only minor differences demonstrating the potential use of retrospective self-gating in the clinic, as it reduces workflow complexity and may lead to shorter exam times for pregnant women.

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Kelly Payette^1,2, Carla Avena Zampieri¹, Jordina Aviles Verdera^1,2, Lisa Story³, Raphael Tomi-Tricot⁴, Joseph V Hajnal^1,2, Mary Rutherford^1,2, and Jana Hutter^1,2
1Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences KCL, London, United Kingdom, ²Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, KCL, London, United Kingdom, ³Women’s Health, KCL, London, United Kingdom, ⁴MR Research Collaborations, Siemens Healthcare Limited, Frimley, United Kingdom

Keywords: Fetal, Low-Field MRI

Low field MRI for fetal imaging has the potential to be a powerful tool for prenatal diagnosis,  with a favourable combination of scope for a larger bore (adding comfort and reducing claustrophobia), and lower SAR, susceptibility effects and receiver coil properties. We performed functional scans of the fetal lung to demonstrate the high image quality that can be acquired. The quantitative values of the fetal lungs (IVIM parameters, T1, T2*) calculated from the low field images match the expected values from higher field strengths reported in the literature.

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Datta Singh Goolaub¹, Judd Storrs², John Kelly^3,4, Ramkumar Krishnamurthy², Karen Texter⁵, James Strainic⁶, Ellie Ragsdale⁷, Christopher Breuer³, Aimee Armstrong⁴, Rajesh Krishnamurthy², and Christopher K. Macgowan^1,8
1Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada, ²Radiology, Nationwide Children’s Hospital, Columbus, OH, United States, ³Center for Regenerative Medicine, Nationwide Children’s Hospital, Columbus, OH, United States, ⁴Cardiology, Nationwide Children’s Hospital, Columbus, OH, United States, ⁵The Heart Center, Nationwide Children’s Hospital, Columbus, OH, United States, ⁶Pediatrics, University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, OH, United States, ⁷OB/GYN-Maternal Fetal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States, ⁸Medical Biophysics, University of Toronto, Toronto, ON, Canada

Keywords: Fetal, Fetus

We compare flow distributions in fetal sheep obtained with Cartesian 4D flow MRI and slice-to-volume multidimensional blood flow imaging using accelerated multislice radial phase contrast MRI. In the latter, stacks of 2D slices are imaged. Real-time reconstructions allow for in-plane motion correction. CINEs are combined into a dynamic flow sensitive volume using slice-to-volume reconstruction with interslice motion correction. Comparison is performed in the presence and absence of contrast agent.

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Fatemeh Rastegar Jooybari^1,2, Christopher Huynh², Sharon Portnoy², Jonathan Voutsas³, Diana Balmer-Minnes², Ankavipar Saprungruang⁴, Shi-Joon Yoo⁵, Christopher Z Lam⁴, and Christopher K Macgowan^1,2
1Medical Biophysics, University of Toronto, Toronto, ON, Canada, ²Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada, ³Queen's University, Kingston, ON, Canada, ⁴Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada, ⁵Departments of Medical Imaging and Paediatrics, University of Toronto, Toronto, ON, Canada

Keywords: Cardiovascular, Quantitative Imaging, Flow, Heart, Cardiovascular, Congenital heart disease

The application of conventional 4D flow to evaluate the hemodynamics of the heart and vessels is limited by long scan time. Recent advances aim to reduce scan time while providing sufficient accuracy. Here we investigate a 4D flow pipeline based on an undersampled 3D golden angle radial trajectory that offers reconstruction flexibility. We evaluated this technique in a cross-section of 11 pediatric patients with congenital heart disease and compared flows against conventional 2D phase contrast in target vessels. 

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Margaret M Samyn¹, Ke Yan², Justin Godown³, Steven J Kindel¹, Bruce Damon⁴, Jonathan H Soslow⁵, and John Affleck-Graves^6
1Pediatrics, Medical College of Wisconsin/ Herma Heart Institute at Children's Wisconsin, Milwaukee, WI, United States, ²Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States, ³Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States, ⁴Grainger College of Engineering, Carle Foundation Hospital/University of Illinois, Urbana, IL, United States, ⁵Pediatrics, Vanderbilt Univesity Medical Center, Nashville, TN, United States, ⁶University of Notre Dame Mendoza College of Business, Notre Dame, IN, United States

Keywords: Cardiovascular, Health Care Economics, Heart Transplantation; Acute Rejection

Current transplant surveillance relies on frequent cardiac catheterization with endomyocardial biopsy (cath EMB) to detect life threatening acute rejection. Cardiac MRI has emerged as a diagnostic tool which can characterize the myocardium. The PEACE study (R01-HL164995-01) aims to evaluate the potential for using cardiac MRI parametric mapping as a pre-cath EMB screening tool to alleviate both patient and family burden and the financial burden of cath EMB. Consistent with the recent emphasis on "Value MRI," we therefore sought to understand the potential Medicare savings, if MRI is used for transplant surveillance for healthy heart transplant recipients rather than cath EMB.

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Hooman Hamedani¹, Faraz Amzajerdian¹, Stephen Kadlecek¹, Kai Ruppert¹, Mostafa Ismail¹, Luis Loza¹, Ian Duncan¹, Madeline Boyes², Klaus Hopster², Rachel Hilliard², Thomas Schaer², Benjamin Sinder ³, Brian Snyder⁴, Axel Moore⁵, Dawn Elliott⁵, Kyle Meadows⁵, and Rahim Rizi^1
1University of Pennsylvania, Philadelphia, PA, United States, ²University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, United States, ³Children’s Hospital of Philadelphia, Philadelphia, PA, United States, ⁴Boston Children’s Hospital, Boston, MA, United States, ⁵University of Delaware, Newark, DE, United States

Keywords: Body, Skeletal

In a pilot study of thoracic insufficiency syndrome in a pig model, we demonstrated dynamic hyperpolarized xenon-129 (HXe) MRI’s ability to noninvasively measure respiratory dysfunction in terms of gas distribution and mixing in the lungs, and specifically showed ‘out of phase’ ventilation in constricted regions of the lung. This marker of ventilation—i.e., the temporal characteristic of signal build-up during inhalation and its wash-out during exhalation—is inaccessible without our dynamic imaging technique. This technique can be implemented clinically to enhance our understanding of TIS pathophysiology and evaluate treatment strategies aimed at fostering age appropriate alveolarization.

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Reina Oguchi¹, Kyoko Fujimoto², Kazuhiro Shiraga³, and Kagayaki Kuroda^1
1Tokai University, Kanagawa, Japan, ²GE Healthcare, Waukesha, WI, United States, ³Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan

Keywords: Safety, Safety

RF-induced SAR distributions around epicardial lead were compared with endocardial lead in the 29-month-old and 6-year-old pediatric anatomical models with cardiac pacemakers. Numerical simulations were performed with a 1.5-T birdcage coil and the pacemaker models segmented from the age-matching patient CT data. In both pediatric models, the simulation with the endocardial lead overall showed lower SAR values compared to that with the endocardial lead. The screw-like electrode attached to the endocardial lead may have resulted in much higher SAR values, compared to the tined-type electrode of the epicardial lead.

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Alena U. Uus¹, Lisa Story^2,3, Megan Hall^3,4,5, Vanessa Kyriakopoulou⁵, Alexia Egloff Collado⁵, Carla Avena Zampieri^1,5, Jacqueline Matthew^1,5, Irina Grigorescu¹, Ayse Ceren Tanritanir⁵, Joseph V. Hajnal^1,5, Jana Hutter^1,5, Mary Rutherford⁵, and Maria Deprez^1
1Department of Biomedical Engineering, King's College London, London, United Kingdom, ²Academic Women's Health Department, King's College London, London, United Kingdom, ³Fetal Medicine Department, GSTT, London, United Kingdom, ⁴Institute for Women’s and Children’s Health, King's College London, London, United Kingdom, ⁵Centre for the Developing Brain, King's College London, London, United Kingdom

Keywords: Prenatal, Segmentation

This work presents the first deep learning pipeline for segmentation of multiple body organs from motion corrected 3D  ssTSE fetal MRI. It is used to compare growth charts of the normal body organ development during 21-37 week GA range for 254 fetal datasets with different acquisition protocols (field strength and TE).

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Lexiaozi Fan^1,2, Kyungpyo D Hong², Joshua D. Robinson^2,3,4, Cynthia K. Rigsby^2,3,5, and Daniel Kim^1,2
1Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States, ²Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States, ³Department of Pediatric, Northwestern University Feinberg School of Medicine, Chicago, IL, United States, ⁴Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States, ⁵Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Keywords: Cardiovascular, Image Reconstruction

Highly-accelerated real-time cine MRI is a rapid technique that is particularly useful for patients with arrhythmia, dyspnea, and/or pediatric patients who may not be able to follow breath-hold instructions. Incorporating view-sharing (VS) and k-space weighted image contrast (KWIC) filtering into a compressed sensing (CS) reconstruction framework improves spatio-temporal resolution in our 32-fold accelerated real-time free-breathing cine MRI using radial k-space sampling. Resulting biventricular volumetric parameters are relatively accurate, which may eliminate the need for sedation/anesthesia in pediatric patients.