Renal perfusion imaging using arterial spin labeling (ASL) is challenged by respiratory motion and physiologic noise, often dealt with by breathing instructions requiring patient cooperation. We investigated if background suppression (BGS) combined with image registration, guided by the ASL-images themselves or additionally acquired fat-images, would enable free-breathing renal ASL. To this end, free-breathing ASL was compared with paced-breathing ASL, both including BGS and image registration. BGS and registration improved the quality of free-breathing renal pCASL, showing increased temporal SNR similar to paced-breathing ASL, without reducing perfusion-weighted signal. In conclusion, free-breathing renal pCASL is possible when employing BGS and image registration.
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