By developing suitable non-Cartesian encoding strategies as well as novel mathematical approaches for image reconstruction of highly undersampled datasets, Frahm’s team was able to reduce the measuring times of serial images to only about 10 to 40 milliseconds corresponding to MRI movies at 25 to 100 frames per second. The technology allows for the acquisition, reconstruction, and display of magnetic resonance images in real time, i.e. without detectable delay. Real-time imaging using FLASH 2 is expected to alter the future of MRI by offering many hitherto impossible applications in medicine and science. Selected examples include:

• Live cardiovascular imaging without the need for synchronization with the electro-cardiogram and during free breathing (see Fig. 1),
• Online assessments of quantitative blood flow,
• Real-time studies of cerebrospinal fluid (CSF) dynamics,
• Access to human articulatory processes, e.g. during speech production (stuttering) or brass playing (embouchure dystonia), or with the use of visual feedback,
• Dynamic assessment of joint movements, e.g. of the temporomandibular joint,
• Unique access to swallowing processes, e.g. in dysphagia, gastrointestinal reflux disorder, disturbances of stomach motility,
• Immediate visualization of physiological responses, e.g. of myocardial function and aortic blood flow to stress or physical exercise, or of tissue perfusion after admin-istration of an MRI contrast agent,
• Real-time monitoring of minimally invasive interventions.

Other variants of FLASH 2 enable high-speed volume coverage and simultaneous real-time MRI of multiple sections, while extensions of the basic technology lead to much improved solutions for quantitative MRI such as single-shot T1 mapping and phase-contrast flow MRI using model-based reconstructions.

FLASH 2 is already used for research purposes by a growing number of leading research institutes and clinics worldwide, for example:

• University Medical Center, University of Göttingen, Germany,
• Radcliffe Hospital, University of Oxford, UK,
• John Hopkins University, Baltimore, USA.

Currently, FLASH 2 is commercially available for MRI equipment produced by SIEMENS. Implementation and use require software for established measuring protocols as well as a bypass computer with multiple graphical processing units (GPU) and implementation of the FLASH 2 reconstruction software.

FLASH 2 can also be implemented on MRI systems of other vendors by adapting acquisition protocols as well as data and image transfer to the GPU computer.

Example videos of real-time MRI can be found at www.biomednmr.mpg.de/index.php?option=com_content&task=view&id=132&Itemid=39

• Unsurpassed temporal resolution
• High image quality
• Robust to motion
• Insensitive to susceptibility artifacts
• Flexible spatial and temporal resolution, variable contrasts
• Access to arbitrary physiological processes and body functions
• Ease of implementation

• EP 2550541 B1 filing date 23 Mar 2010;
• US 8384383 B2 filing date 23 Mar 2010;
• JP 5717839 B2 filing date 23 Mar 2010;
• CN 103038660 B filing date 23 Mar 2010.