Off-frequency tuning error artifact in steady-state free precession cine imaging due to adjacent air-filled bowel

Identification of common cardiovascular magnetic resonance (CMR) artifacts is important to optimal image acquisition quality and the avoidance of mistaken clinical diagnosis. We describe an off-frequency tuning error artifact observed during rapid steady-state free precession acquisitions in three patients and resulting in a dramatic appearance within the right and left ventricles. These artifacts were associated with large, adjacent air pockets within a loop of bowel or stomach and were eradicated by retuning of the magnetic resonance scanner's frequency. Awareness of this artifact, its cause and correction, should improve diagnostic image quality and avoid clinical diagnostic confusion. This report also heightens the need for a more robust shimming sequence for cardiac studies.