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Alkassar M, Engelhardt S, Abu-Tair T, Ojeda E, Treffer PC, Weyand M, Rompel O. Comparative Study of 2D-Cine and 3D-wh Volumetry: Revealing Systemic Error of 2D-Cine Volumetry. Diagnostics (Basel) 2023; 13:3162. [PMID: 37891983 PMCID: PMC10605840 DOI: 10.3390/diagnostics13203162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/28/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
This study investigates the crucial factors influencing the end-systolic and end-diastolic volumes in MRI volumetry and their direct effects on the derived functional parameters. Through the simultaneous acquisition of 2D-cine and 3D whole-heart slices in end-diastole and end-systole, we present a novel direct comparison of the volumetric measurements from both methods. A prospective study was conducted with 18 healthy participants. Both 2D-cine and 3D whole-heart sequences were obtained. Despite the differences in the creation of 3D volumes and trigger points, the impact on the LV volume was minimal (134.9 mL ± 16.9 mL vs. 136.6 mL ± 16.6 mL, p < 0.01 for end-diastole; 50.6 mL ± 11.0 mL vs. 51.6 mL ± 11.2 mL, p = 0.03 for end-systole). In our healthy patient cohort, a systematic underestimation of the end-systolic volume resulted in a significant overestimation of the SV (5.6 mL ± 2.6 mL, p < 0.01). The functional calculations from the 3D whole-heart method proved to be highly accurate and correlated well with function measurements from the phase-contrast sequences. Our study is the first to demonstrate the superiority of 3D whole-heart volumetry over 2D-cine volumetry and sheds light on the systematic error inherent in 2D-cine measurements.
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Affiliation(s)
- Muhnnad Alkassar
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
- Department of Pediatrics, Paracelsus Medical School, General Hospital of Nuremberg, 90419 Nuremberg, Germany
| | - Sophia Engelhardt
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
| | - Tariq Abu-Tair
- Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany;
| | - Efren Ojeda
- Siemens Healtineers, 91052 Erlangen, Germany; (E.O.); (P.C.T.)
| | | | - Michael Weyand
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
| | - Oliver Rompel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany;
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Isaak A, Mesropyan N, Hart C, Zhang S, Kravchenko D, Endler C, Katemann C, Weber O, Pieper CC, Kuetting D, Attenberger U, Dabir D, Luetkens JA. Non-contrast free-breathing 3D cardiovascular magnetic resonance angiography using REACT (relaxation-enhanced angiography without contrast) compared to contrast-enhanced steady-state magnetic resonance angiography in complex pediatric congenital heart disease at 3T. J Cardiovasc Magn Reson 2022; 24:55. [PMID: 36384752 PMCID: PMC9670549 DOI: 10.1186/s12968-022-00895-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To evaluate the great vessels in young children with complex congenital heart disease (CHD) using non-contrast cardiovascular magnetic resonance angiography (CMRA) based on three-dimensional relaxation-enhanced angiography without contrast (REACT) in comparison to contrast-enhanced steady-state CMRA. METHODS In this retrospective study from April to July 2021, respiratory- and electrocardiogram-gated native REACT CMRA was compared to contrast-enhanced single-phase steady-state CMRA in children with CHD who underwent CMRA at 3T under deep sedation. Vascular assessment included image quality (1 = non-diagnostic, 5 = excellent), vessel diameter, and diagnostic findings. For statistical analysis, paired t-test, Pearson correlation, Bland-Altman analysis, Wilcoxon test, and intraclass correlation coefficients (ICC) were applied. RESULTS Thirty-six young children with complex CHD (median 4 years, interquartile range, 2-5; 20 males) were included. Native REACT CMRA was obtained successfully in all patients (mean scan time: 4:22 ± 1:44 min). For all vessels assessed, diameters correlated strongly between both methods (Pearson r = 0.99; bias = 0.04 ± 0.61 mm) with high interobserver reproducibility (ICC: 0.99 for both CMRAs). Native REACT CMRA demonstrated comparable overall image quality to contrast-enhanced CMRA (3.9 ± 1.0 vs. 3.8 ± 0.9, P = 0.018). With REACT CMRA, better image quality was obtained at the ascending aorta (4.8 ± 0.5 vs. 4.3 ± 0.8, P < 0.001), coronary roots (e.g., left: 4.1 ± 1.0 vs. 3.3 ± 1.1, P = 0.001), and inferior vena cava (4.6 ± 0.5 vs. 3.2 ± 0.8, P < 0.001). In all patients, additional vascular findings were assessed equally with native REACT CMRA and the contrast-enhanced reference standard (n = 6). CONCLUSION In young children with complex CHD, REACT CMRA can provide gadolinium-free high image quality, accurate vascular measurements, and equivalent diagnostic quality compared to standard contrast-enhanced CMRA.
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Affiliation(s)
- Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany.
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Christopher Hart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Shuo Zhang
- Philips GmbH Market DACH, Hamburg, Germany
| | - Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | | | | | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Darius Dabir
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
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3
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Well L, Weinrich JM, Meyer M, Kehl T, Salamon J, Rüffer A, Adam G, Herrmann J, Groth M. Sensitivity of High-Pitch Dual-Source Computed Tomography for the Detection of Anomalous Pulmonary Venous Connection in Infants. ROFO-FORTSCHR RONTG 2020; 193:551-558. [PMID: 33302310 DOI: 10.1055/a-1290-6843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the sensitivity, specificity, and interobserver reliability of high-pitch dual-source computed tomography angiography (CTA) in the detection of anomalous pulmonary venous connection (APVC) in infants with congenital heart defects and to assess the associated radiation exposure. MATERIALS AND METHODS 78 pulmonary veins in 17 consecutively enrolled patients with congenital heart defects (6 females; 11 males; median age: 6 days; range: 1-299 days) were retrospectively included in this study. All patients underwent high-pitch dual-source CTA of the chest at low tube voltages (70 kV). APVC was evaluated independently by two radiologists. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and interobserver agreement were determined. For standard of reference, one additional observer reviewed CT scans, echocardiography reports, clinical reports as well as surgical reports. In cases of disagreement the additional observer made the final decision based on all available information. RESULTS Detection of APVC with high-pitch dual-source CTA revealed a good sensitivity (91 %) and specificity (99 %), with PPV and NPV of 98 % and 97 %. Interobserver agreement was almost perfect (Kappa = 0.84). The median DLP was 3.8 mGy*cm (IQR 3.3-4.7 mGy*cm) and the median radiation dose was 0.33 mSv (IQR 0.26-0.39 mSv). CONCLUSION High-pitch dual-source CTA in infants with congenital heart defects allows for accurate and reliable assessment of APVC at a low radiation dose. KEY POINTS · High-pitch dual-source CTA enables detection of anomalous pulmonary vein connection with high sensitivity in infants.. · Interrater reliability in the detection of anomalous pulmonary vein connection with high-pitch dual-source CTA is almost perfect.. · Radiation dose of high-pitch dual-source CTA in the cardiac examination of infants is low.. CITATION FORMAT · Well L, Weinrich JM, Meyer M et al. Sensitivity of High-Pitch Dual-Source Computed Tomography for the Detection of Anomalous Pulmonary Venous Connection in Infants. Fortschr Röntgenstr 2021; 193: 551 - 558.
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Affiliation(s)
- Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mathias Meyer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Torben Kehl
- Department of Pediatric Cardiology, University Heart & Vascular Center Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Rüffer
- Department of Pediatric Cardiology, University Heart & Vascular Center Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Department of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Groth
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Department of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
Lung pathologies in the pediatric population can usually be detected using chest radiography. Multidetector computed tomography (MDCT) imaging is often used as a supplementary method in the evaluation of lung diseases. Recently, magnetic resonance imaging (MRI) techniques were found to be reliable in the evaluation of pulmonary diseases in the pediatric population. This review study describes the routine application of MRI examinations and the use of thoracic MRI with a particular focus in pediatric patients.
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Affiliation(s)
- Adem Karaman
- Department of Radiology, Ataturk University School of Medicine, Erzurum, Turkey
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Zitzelsberger T, Krumm P, Hornung A, Kramer U, Nikolaou K, Schäfer JF, Schick F, Sieverding L, Martirosian P. Multi-phase coronary magnetic resonance angiography improves delineation of coronary arteries. Acta Radiol 2019; 60:1422-1429. [PMID: 30799635 DOI: 10.1177/0284185119830289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tanja Zitzelsberger
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany
| | - Patrick Krumm
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany
| | - Andreas Hornung
- Department of Pediatric Cardiology, University of Tuebingen, Germany
| | - Ulrich Kramer
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany
| | - Jürgen F Schäfer
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Germany
| | - Fritz Schick
- Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University of Tuebingen, Germany
| | - Ludger Sieverding
- Department of Pediatric Cardiology, University of Tuebingen, Germany
| | - Petros Martirosian
- Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University of Tuebingen, Germany
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6
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Moghari MH, Uecker M, Roujol S, Sabbagh M, Geva T, Powell AJ. Accelerated whole-heart MR angiography using a variable-density poisson-disc undersampling pattern and compressed sensing reconstruction. Magn Reson Med 2017; 79:761-769. [PMID: 28497620 DOI: 10.1002/mrm.26730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 03/09/2017] [Accepted: 04/02/2017] [Indexed: 11/07/2022]
Abstract
PURPOSE To accelerate whole-heart three-dimension MR angiography (MRA) by using a variable-density Poisson-disc undersampling pattern and a compressed sensing (CS) reconstruction algorithm, and compare the results with sensitivity encoding (SENSE). METHODS For whole-heart MRA, a prospective variable-density Poisson-disc k-space undersampling pattern was developed in which 1-2% of central part of k-space was fully sampled, and sampling in the remainder decreased exponentially toward the periphery. The undersampled data were then estimated using CS reconstruction. In patients, images using this sequence with an undersampling rate of ≈6 were compared with those using a SENSE rate of 2 (n = 15) and a SENSE rate of 6 (n = 13). RESULTS Compared with SENSE rate 2, CS rate 6 images had similar objective border sharpness, significantly lower subjective image quality scores at all four locations (all P < 0.01), and shorter scan times (P < 0.05). Compared with SENSE rate 6, CS rate 6 had similar objective border sharpness at all four locations, significantly better subjective image quality scores at three of four locations (all P < 0.01), and similar scan times (P = 0.24). CONCLUSION Compared with SENSE with a comparable acceleration rate, a variable-density Poisson-disc undersampling pattern and CS reconstruction achieved better subjective image quality and similar border sharpness. Magn Reson Med 79:761-769, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Mehdi H Moghari
- Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Martin Uecker
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany, and Department of Diagnostic and Interventional Radiology, University Medical Center, Göttingen, Germany
| | - Sébastien Roujol
- Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Majid Sabbagh
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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7
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Nguyen KL, Han F, Zhou Z, Brunengraber DZ, Ayad I, Levi DS, Satou GM, Reemtsen BL, Hu P, Finn JP. 4D MUSIC CMR: value-based imaging of neonates and infants with congenital heart disease. J Cardiovasc Magn Reson 2017; 19:40. [PMID: 28366171 PMCID: PMC5376692 DOI: 10.1186/s12968-017-0352-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/03/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND 4D Multiphase Steady State Imaging with Contrast (MUSIC) acquires high-resolution volumetric images of the beating heart during uninterrupted ventilation. We aim to evaluate the diagnostic performance and clinical impact of 4D MUSIC in a cohort of neonates and infants with congenital heart disease (CHD). METHODS Forty consecutive neonates and infants with CHD (age range 2 days to 2 years, weight 1 to 13 kg) underwent 3.0 T CMR with ferumoxytol enhancement (FE) at a single institution. Independently, two readers graded the diagnostic image quality of intra-cardiac structures and related vascular segments on FE-MUSIC and breath held FE-CMRA images using a four-point scale. Correlation of the CMR findings with surgery and other imaging modalities was performed in all patients. Clinical impact was evaluated in consensus with referring surgeons and cardiologists. One point was given for each of five key outcome measures: 1) change in overall management, 2) change in surgical approach, 3) reduction in the need for diagnostic catheterization, 4) improved assessment of risk-to-benefit for planned intervention and discussion with parents, 5) accurate pre-procedural roadmap. RESULTS All FE-CMR studies were completed successfully, safely and without adverse events. On a four-point scale, the average FE-MUSIC image quality scores were >3.5 for intra-cardiac structures and >3.0 for coronary arteries. Intra-cardiac morphology and vascular anatomy were well visualized with good interobserver agreement (r = 0.46). Correspondence between the findings on MUSIC, surgery, correlative imaging and autopsy was excellent. The average clinical impact score was 4.2 ± 0.9. In five patients with discordant findings on echo/MUSIC (n = 5) and catheter angiography/MUSIC (n = 1), findings on FE-MUSIC were shown to be accurate at autopsy (n = 1) and surgery (n = 4). The decision to undertake biventricular vs univentricular repair was amended in 2 patients based on FE-MUSIC findings. Plans for surgical approaches which would have involved circulatory arrest were amended in two of 28 surgical cases. In all 28 cases requiring procedural intervention, FE-MUSIC provided accurate dynamic 3D roadmaps and more confident risk-to-benefit assessments for proposed interventions. CONCLUSIONS FE-MUSIC CMR has high clinical impact by providing accurate, high quality, simple and safe dynamic 3D imaging of cardiac and vascular anatomy in neonates and infants with CHD. The findings influenced patient management in a positive manner.
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Affiliation(s)
- Kim-Lien Nguyen
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
- Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Fei Han
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
- Department of Biomedical Physics, University of California, Los Angeles, CA USA
- Department of Radiological Sciences, University of California at Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave., Los Angeles, CA 90095-7206 USA
| | - Ziwu Zhou
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
- Department of Biomedical Physics, University of California, Los Angeles, CA USA
- Department of Radiological Sciences, University of California at Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave., Los Angeles, CA 90095-7206 USA
| | - Daniel Z. Brunengraber
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
- Department of Radiological Sciences, University of California at Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave., Los Angeles, CA 90095-7206 USA
| | - Ihab Ayad
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Daniel S. Levi
- Division of Pediatric Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Gary M. Satou
- Division of Pediatric Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Brian L. Reemtsen
- Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Peng Hu
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
- Department of Biomedical Physics, University of California, Los Angeles, CA USA
- Department of Radiological Sciences, University of California at Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave., Los Angeles, CA 90095-7206 USA
| | - J. Paul Finn
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
- Department of Biomedical Physics, University of California, Los Angeles, CA USA
- Department of Radiological Sciences, University of California at Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave., Los Angeles, CA 90095-7206 USA
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Finn JP, Nguyen KL, Han F, Zhou Z, Salusky I, Ayad I, Hu P. Cardiovascular MRI with ferumoxytol. Clin Radiol 2016; 71:796-806. [PMID: 27221526 DOI: 10.1016/j.crad.2016.03.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 11/28/2022]
Abstract
The practice of contrast-enhanced magnetic resonance angiography (CEMRA) has changed significantly in the span of a decade. Concerns regarding gadolinium (Gd)-associated nephrogenic systemic fibrosis in those with severely impaired renal function spurred developments in low-dose CEMRA and non-contrast MRA as well as efforts to seek alternative MR contrast agents. Originally developed for MR imaging use, ferumoxytol (an ultra-small superparamagnetic iron oxide nanoparticle), is currently approved by the US Food and Drug Administration for the treatment of iron deficiency anaemia in adults with renal disease. Since its clinical availability in 2009, there has been rising interest in the scientific and clinical use of ferumoxytol as an MR contrast agent. The unique physicochemical and pharmacokinetic properties of ferumoxytol, including its long intravascular half-life and high r1 relaxivity, support a spectrum of MRI applications beyond the scope of Gd-based contrast agents. Moreover, whereas Gd is not found in biological systems, iron is essential for normal metabolism, and nutritional iron deficiency poses major public health challenges worldwide. Once the carbohydrate shell of ferumoxytol is degraded, the elemental iron at its core is incorporated into the reticuloendothelial system. These considerations position ferumoxytol as a potential game changer in the field of CEMRA and MRI. In this paper, we aim to summarise our experience with the cardiovascular applications of ferumoxytol and provide a brief synopsis of ongoing investigations on ferumoxytol-enhanced MR applications.
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Affiliation(s)
- J P Finn
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - K-L Nguyen
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - F Han
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Z Zhou
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - I Salusky
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - I Ayad
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - P Hu
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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9
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Zuluaga MA, Burgos N, Mendelson AF, Taylor AM, Ourselin S. Voxelwise atlas rating for computer assisted diagnosis: Application to congenital heart diseases of the great arteries. Med Image Anal 2015; 26:185-94. [PMID: 26433929 PMCID: PMC4686005 DOI: 10.1016/j.media.2015.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/01/2015] [Accepted: 09/03/2015] [Indexed: 11/26/2022]
Abstract
Atlas-based analysis methods rely on the morphological similarity between the atlas and target images, and on the availability of labelled images. Problems can arise when the deformations introduced by pathologies affect the similarity between the atlas and a patient's image. The aim of this work is to exploit the morphological dissimilarities between atlas databases and pathological images to diagnose the underlying clinical condition, while avoiding the dependence on labelled images. We propose a voxelwise atlas rating approach (VoxAR) relying on multiple atlas databases, each representing a particular condition. Using a local image similarity measure to assess the morphological similarity between the atlas and target images, a rating map displaying for each voxel the condition of the atlases most similar to the target is defined. The final diagnosis is established by assigning the condition of the database the most represented in the rating map. We applied the method to diagnose three different conditions associated with dextro-transposition of the great arteries, a congenital heart disease. The proposed approach outperforms other state-of-the-art methods using annotated images, with an accuracy of 97.3% when evaluated on a set of 60 whole heart MR images containing healthy and pathological subjects using cross validation.
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Affiliation(s)
- Maria A Zuluaga
- Translational Imaging Group, Centre for Medical Image Computing, University College London, UK.
| | - Ninon Burgos
- Translational Imaging Group, Centre for Medical Image Computing, University College London, UK
| | - Alex F Mendelson
- Translational Imaging Group, Centre for Medical Image Computing, University College London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK; Cardiorespiratory Division, Great Ormond Street Hospital for Children, London, UK
| | - Sébastien Ourselin
- Translational Imaging Group, Centre for Medical Image Computing, University College London, UK
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10
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Han F, Rapacchi S, Khan S, Ayad I, Salusky I, Gabriel S, Plotnik A, Finn JP, Hu P. Four-dimensional, multiphase, steady-state imaging with contrast enhancement (MUSIC) in the heart: a feasibility study in children. Magn Reson Med 2015; 74:1042-9. [PMID: 25302932 DOI: 10.1002/mrm.25491] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/09/2014] [Accepted: 09/21/2014] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop a technique for high resolution, four-dimensional (4D), multiphase, steady-state imaging with contrast enhancement (MUSIC) in children with complex congenital heart disease. METHODS Eight pediatric patients underwent cardiovascular MRI with controlled mechanical ventilation after ferumoxytol administration. Breath-held contrast-enhanced MRA (CE-MRA) was performed during the first-pass and delayed phases of ferumoxytol, followed by a respiratory gated, 4D MUSIC acquisition during the steady state distribution phase of ferumoxytol. The subjective image quality and image sharpness were evaluated. Assessment of ventricular volumes based on 4D MUSIC was compared with those based on multislice 2D cardiac cine MRI. RESULTS The 4D MUSIC technique provided cardiac-phase-resolved (65-95 ms temporal resolution) and higher spatial resolution (0.6-0.9 mm isotropic) images than previously achievable using first-pass CE-MRA or 2D cardiac cine. When compared with Ferumoxytol-based first-pass CE-MRA, the 4D MUSIC provided sharper images and better definition of the coronary arteries, aortic root, myocardium, and pulmonary trunk (P < 0.05 for all). The ventricular volume measurements were in good agreement between 4D MUSIC and 2D cine (concordance correlation coefficient >0.95). CONCLUSION The 4D MUSIC technique may represent a new paradigm in MR evaluation of cardiovascular anatomy and function in children with complex congenital heart disease.
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Affiliation(s)
- Fei Han
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Stanislas Rapacchi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Sarah Khan
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ihab Ayad
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Isidro Salusky
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Simon Gabriel
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Adam Plotnik
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - J Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Biomedical Physics Inter-Departmental Graduate Program, University of California, Los Angeles, California, USA
| | - Peng Hu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Biomedical Physics Inter-Departmental Graduate Program, University of California, Los Angeles, California, USA
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Seeger A, Krumm P, Hornung A, Schäfer JF, Kramer U, Sieverding L. 3-D cardiac MRI in free-breathing newborns and infants: when is respiratory gating necessary? Pediatr Radiol 2015; 45:1448-54. [PMID: 25903840 DOI: 10.1007/s00247-015-3346-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/31/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Newborns and small infants have shallow breathing. OBJECTIVE To suggest criteria for when respiratory gating is necessary during cardiac MRI in newborns and infants. MATERIALS AND METHODS One-hundred ten data sets of newborns and infants with (n = 92, mean age: 1.9 ± 1.7 [SD] years) and without (n = 18, mean age: 1.6 ± 1.8 [SD] years) navigator gating were analysed retrospectively. The respiratory motion of the right hemidiaphragm was recorded and correlated to age, weight, body surface area and qualitative image quality on a 4-point score. Quantitative image quality assessment was performed (sharpness of the delineation of the ventricular septal wall) as well as a matched-pair comparison between navigator-gated and non-gated data sets. RESULTS No significant differences were found in overall image quality or in the sharpness of the ventricular septal wall between gated and non-gated scans. A navigator acceptance of >80% was frequently found in patients ages <12 months, body surface area <0.40 m(2), body weight <10 kg and a size of <80 cm. CONCLUSION Sequences without respiratory gating may be used in newborns and small infants, in particular if age <12 months, body surface area <0.40 m(2), body weight <10 kg and height <80 cm.
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Affiliation(s)
- Achim Seeger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
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Febbo JA, Galizia MS, Murphy IG, Popescu A, Bi X, Turin A, Collins J, Markl M, Edelman RR, Carr JC. Congenital heart disease in adults: Quantitative and qualitative evaluation of IR FLASH and IR SSFP MRA techniques using a blood pool contrast agent in the steady state and comparison to first pass MRA. Eur J Radiol 2015; 84:1921-9. [PMID: 26253499 DOI: 10.1016/j.ejrad.2015.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/16/2015] [Accepted: 06/29/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate magnetic resonance angiography sequences during the contrast steady-state (SS-MRA) using inversion recovery (IR) with fast low-angle shot (IR-FLASH) or steady-state free precession (IR-SSFP) read-outs, following the injection of a blood-pool contrast agent, and compare them to first-pass MR angiography (FP-MRA) in adults with congenital heart disease (CHD). MATERIALS AND METHODS Twenty-three adult patients with CHD who underwent both SS-MRA and FP-MRA using a 1.5-T scanner were retrospectively identified. Signal-to-noise and contrast-to-noise ratios were obtained at eight locations within the aorta and pulmonary vessels.. Image quality and the presence of artifacts were subjectively assessed by two radiologists. The presence of pathology was noted and given a confidence score. RESULTS There was no difference in vessel dimensions among the sequences. IR-SSFP showed better image quality and fewer artifacts than IR-FLASH and FP-MRA. Confidence scores were significantly higher for SS-MRA compared to FP-MRA. Seven cases (30.4%) had findings detected at SS-MRA that were not detected at FP-MRA, and 2 cases (8.7%) had findings detected by IR-SSFP only. CONCLUSION SS-MRA of the thoracic vasculature using a blood pool contrast agent offers superior image quality and reveals more abnormalities compared to standard FP-MRA in adults with CHD, and it is best achieved with an IR-SSFP sequence. These sequences could lead to increased detection rates of abnormalities and provide a simpler protocol image acquisition.
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Affiliation(s)
- Jennifer A Febbo
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA.
| | - Mauricio S Galizia
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA; Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ian G Murphy
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Andrada Popescu
- Department of Medical Imaging, Children's Memorial Hospital, Chicago, IL, USA
| | - Xiaoming Bi
- Cardiovascular MR R&D, Siemens Healthcare, Chicago, IL, USA
| | - Alexander Turin
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Jeremy Collins
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA; Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Robert R Edelman
- Department of Radiology, North Shore University Health System, Evanston, IL, USA
| | - James C Carr
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
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Moghari MH, Annese D, Geva T, Powell AJ. Three-dimensional heart locator and compressed sensing for whole-heart MR angiography. Magn Reson Med 2015; 75:2086-93. [PMID: 26069182 DOI: 10.1002/mrm.25800] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE We sought to develop a whole-heart magnetic resonance angiography technique with three-dimensional (3D) respiratory motion compensation and reduced scan time. METHODS A novel respiratory motion compensation method was implemented that acquires a 1D navigator (NAV) and a low-resolution 3D-image of the heart (3D-LOC) just before the angiography data. The central 10% of SSFP k-space was fully acquired using NAV-gating, and then 10% of peripheral k-space was randomly undersampled to complete the scan. Spatial registration of the 3D-LOC information was used to correct the central and peripheral k-space lines for the bulk respiratory motion in three dimensions, and then the remaining k-space data was estimated using compressed sensing (CS). Ten volunteers each underwent two angiography acquisitions with 1 mm(3) resolution: (i) conventional NAV with CS, and (ii) the new 3D-LOC with CS. RESULTS Compared with conventional NAV, the new 3D-LOC with CS technique had a shorter scan time (4.8 ± 1.1 versus 6.3 ± 1.7 min; P < 0.001), better objective vessel sharpness for all three coronary arteries (P < 0.05), and no difference in subjective vessel sharpness for all three coronary arteries. CONCLUSION Compared with conventional NAV with CS, acceleration and respiratory motion correction using 3D-LOC with CS reduces scan time and improves objective vessel sharpness.
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Affiliation(s)
- Mehdi H Moghari
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - David Annese
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI. Cardiol Young 2015; 25:819-38. [PMID: 25739865 DOI: 10.1017/s1047951115000025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.
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15
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Valsangiacomo Buechel ER, Grosse-Wortmann L, Fratz S, Eichhorn J, Sarikouch S, Greil GF, Beerbaum P, Bucciarelli-Ducci C, Bonello B, Sieverding L, Schwitter J, Helbing WA, Galderisi M, Miller O, Sicari R, Rosa J, Thaulow E, Edvardsen T, Brockmeier K, Qureshi S, Stein J. Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI. Eur Heart J Cardiovasc Imaging 2015; 16:281-97. [PMID: 25712078 DOI: 10.1093/ehjci/jeu129] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.
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16
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Yasukochi S. Assessment of Intracardiac Anatomy by Magnetic Resonance Imaging. CONGENIT HEART DIS 2015. [DOI: 10.1007/978-4-431-54355-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Unenhanced steady state free precession versus traditional MR imaging for congenital heart disease. Eur J Radiol 2013; 82:1743-8. [DOI: 10.1016/j.ejrad.2013.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 02/01/2013] [Accepted: 03/25/2013] [Indexed: 11/20/2022]
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18
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Fratz S, Chung T, Greil GF, Samyn MM, Taylor AM, Valsangiacomo Buechel ER, Yoo SJ, Powell AJ. Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease. J Cardiovasc Magn Reson 2013; 15:51. [PMID: 23763839 PMCID: PMC3686659 DOI: 10.1186/1532-429x-15-51] [Citation(s) in RCA: 309] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/08/2013] [Indexed: 01/12/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) has taken on an increasingly important role in the diagnostic evaluation and pre-procedural planning for patients with congenital heart disease. This article provides guidelines for the performance of CMR in children and adults with congenital heart disease. The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols. Variations in practice are highlighted and expert consensus recommendations are provided. Indications and appropriate use criteria for CMR examination are not specifically addressed.
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Affiliation(s)
- Sohrab Fratz
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (German Heart Center Munich) of the Technical University Munich, Munich, Germany
| | - Taylor Chung
- Department of Diagnostic Imaging, Children’s Hospital & Research Center Oakland, Oakland, California, USA
| | - Gerald F Greil
- Department of Pediatric Cardiology, Evelina Children’s Hospital/Guy’s and St. Thomas’ Hospital NHS Foundation Trust; Division of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
| | - Margaret M Samyn
- The Herma Heart Center, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, & Great Ormond Street Hospital for Children, London, UK
| | | | - Shi-Joon Yoo
- Department of Diagnostic Imaging and Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Powell
- Department of Cardiology, Boston Children’s Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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19
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Delgado JA, Abad P, Rascovsky S, Calvo V, Castrillon G, Greil G, Uribe S. Assessment of cardiac volumes using an isotropic whole-heart dual cardiac phase sequence in pediatric patients. J Magn Reson Imaging 2013; 39:708-16. [PMID: 23723135 DOI: 10.1002/jmri.24203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 04/12/2013] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To evaluate the accuracy of a three-dimensional dual phase (3D DP) whole-heart technique for cardiac volumetric assessment in pediatric patients with cardiac abnormalities. MATERIALS AND METHODS The institutional approved this study, and informed consent was obtained from patients or their guardians. This prospective study involved 31 pediatric patients (mean age, 7.9 years; range, 15 days to 15 years) for the assessment of cardiac abnormalities using cardiovascular MR. A standard protocol was performed for assessing cardiac anatomy and function. For evaluating the 3D DP technique, statistical comparison with a 2D cine multi-slice technique (2D steady-state free-precession [SSFP]) was performed using linear regression, intraclass correlation coefficient, and Bland Altman plots. RESULTS Left (LV) and right (RV) ventricular cardiac volumes obtained with the 3D DP technique were in strong agreement with those obtained with the 2D SSFP technique for small and large ventricular volumes. The intraclass correlation coefficients (ICC) between both techniques were 0.992 for the LV end-diastolic volume (EDV), 0.983 for the LV end-systolic volume (ESV), 0.952 for the LV-systolic volume (SV), 0.992 for the RV-EDV, 0.992 for the RV-ESV, 0.928 for the RV-SV. Interobserver analysis indicated good reproducibility for both the 2D SSFP and the 3D DP techniques. CONCLUSION The 3D DP technique provides as accurate cardiac volumes as the 2D SSFP technique in the pediatric population, but with the added benefits of easier data acquisition and detailed anatomical information of the whole heart and great vessels in a single free-breathing scan.
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Affiliation(s)
- Jorge A Delgado
- Fundación Instituto de Alta Tecnología Medica, Medellin, Colombia
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Bhatla P, Nielsen JC. Cardiovascular magnetic resonance as an alternate method for serial evaluation of proximal aorta: comparison with echocardiography. Echocardiography 2013; 30:713-8. [PMID: 23311530 DOI: 10.1111/echo.12105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Thoracic aortic disease is a known cause of aortic dilatation and poses significant risk of aortic dissection and rupture. Serial assessment of aortic root dimensions is traditionally performed using echocardiography, which is limited with older age and following surgery, due to poor acoustic windows. Although diastolic measurements are utilized as standard practice in decision making of adult aortopathy, systolic diameters are utilized in pediatric practice. Three-dimensional steady-state free precision (3D-SSFP) has shown promise as an alternate method for providing accurate and reproducible aortic measurements. The agreement between proximal aorta measurements by diastolic 3D-SSFP and echocardiography (both systole and diastole) was examined in 40 subjects. The maximum inner diameters at aortic annulus, root and sinotubular junction demonstrated excellent agreement between 3D-SSFP and echocardiography for all the 3 levels. The best agreement was observed for diastolic root dimensions with a mean difference of +0.01 cm, limits of agreement being -0.26 to +0.28 cm. Three D-SSFP can be used interchangeably with echocardiography in the serial assessment of the aortic root size. Careful attention to obtain an imaging plane utilizing 3D multiplanar reformatting is critical to maximize the agreement between the two imaging modalities.
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Dabir D, Naehle CP, Clauberg R, Gieseke J, Schild HH, Thomas D. High-resolution motion compensated MRA in patients with congenital heart disease using extracellular contrast agent at 3 Tesla. J Cardiovasc Magn Reson 2012; 14:75. [PMID: 23107424 PMCID: PMC3552711 DOI: 10.1186/1532-429x-14-75] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 09/27/2012] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Using first-pass MRA (FP-MRA) spatial resolution is limited by breath-hold duration. In addition, image quality may be hampered by respiratory and cardiac motion artefacts. In order to overcome these limitations an ECG- and navigator-gated high-resolution-MRA sequence (HR-MRA) with slow infusion of extracellular contrast agent was implemented at 3 Tesla for the assessment of congenital heart disease and compared to standard first-pass-MRA (FP-MRA). METHODS 34 patients (median age: 13 years) with congenital heart disease (CHD) were prospectively examined on a 3 Tesla system. The CMR-protocol comprised functional imaging, FP- and HR-MRA, and viability imaging. After the acquisition of the FP-MRA sequence using a single dose of extracellular contrast agent the motion compensated HR-MRA sequence with isotropic resolution was acquired while injecting the second single dose, utilizing the timeframe before viability imaging. Qualitative scores for image quality (two independent reviewers) as well as quantitative measurements of vessel sharpness and relative contrast were compared using the Wilcoxon signed-rank test. Quantitative measurements of vessel diameters were compared using the Bland-Altman test. RESULTS The mean image quality score revealed significantly better image quality of the HR-MRA sequence compared to the FP-MRA sequence in all vessels of interest (ascending aorta (AA), left pulmonary artery (LPA), left superior pulmonary vein (LSPV), coronary sinus (CS), and coronary ostia (CO); all p < 0.0001). In comparison to FP-MRA, HR-MRA revealed significantly better vessel sharpness for all considered vessels (AA, LSPV and LPA; all p < 0.0001). The relative contrast of the HR-MRA sequence was less compared to the FP-MRA sequence (AA: p <0.028, main pulmonary artery: p <0.004, LSPV: p <0.005). Both, the results of the intra- and interobserver measurements of the vessel diameters revealed closer correlation and closer 95 % limits of agreement for the HR-MRA. HR-MRA revealed one additional clinical finding, missed by FP-MRA. CONCLUSIONS An ECG- and navigator-gated HR-MRA-protocol with infusion of extracellular contrast agent at 3 Tesla is feasible. HR-MRA delivers significantly better image quality and vessel sharpness compared to FP-MRA. It may be integrated into a standard CMR-protocol for patients with CHD without the need for additional contrast agent injection and without any additional examination time.
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Affiliation(s)
- Darius Dabir
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | - Ralf Clauberg
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | - Hans H Schild
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Daniel Thomas
- Department of Radiology, University of Bonn, Bonn, Germany
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Vyas HV, Greenberg SB, Krishnamurthy R. MR Imaging and CT Evaluation of Congenital Pulmonary Vein Abnormalities in Neonates and Infants. Radiographics 2012; 32:87-98. [DOI: 10.1148/rg.321105764] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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23
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Preoperative and postoperative MR evaluation of congenital heart disease in children. Radiol Clin North Am 2011; 49:1011-24. [PMID: 21889019 DOI: 10.1016/j.rcl.2011.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cardiovascular magnetic resonance imaging (CMR) plays an important role in the preoperative and postoperative evaluation of congenital heart disease with newer techniques enabling faster and more comprehensive evaluation of the pediatric patient. This article reviews the clinical applications of CMR before and after surgery in the most common congenital heart anomalies in pediatric patients.
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Transposition of the Great Vessels — The arterial switch operation, the atrial switch operation, the coronaries. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2009.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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25
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Three-dimensional cine MRI in free-breathing infants and children with congenital heart disease. Pediatr Radiol 2009; 39:1333-42. [PMID: 19798494 DOI: 10.1007/s00247-009-1390-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 07/09/2009] [Accepted: 07/19/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with congenital heart disease frequently have complex cardiac and vascular malformations requiring detailed non-invasive diagnostic evaluation including functional parameters. OBJECTIVE To evaluate the morphological and functional information provided by a novel 3-D cine steady-state free-precession (SSFP) sequence. MATERIALS AND METHODS Twenty consecutive children (mean age 2.2 years, nine boys) were examined using a 1.5-T MR system including 2-D cine gradient-recalled-echo sequences, static 3-D SSFP and 3-D cine SSFP sequences. RESULTS Measurement of ventricular structures and volumes showed close agreement between the 3-D cine SSFP sequence and the 2-D cine gradient-recalled-echo and static 3-D SSFP sequences (left ventricular volumes mean difference 1.0-1.9 ml and 8.8-11.4%, respectively; right ventricular volumes 1.7-2.1 ml and 9.9-16.9%, respectively). No systematic bias was observed. CONCLUSION 3-D cine MRI provides anatomic as well as functional information with sufficient spatial and temporal resolution in free-breathing infants with congenital heart disease.
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Virtual cardiotomy based on 3-D MRI for preoperative planning in congenital heart disease. Pediatr Radiol 2008; 38:1314-22. [PMID: 18953534 DOI: 10.1007/s00247-008-1032-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 07/30/2008] [Accepted: 08/28/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patient-specific preoperative planning in complex congenital heart disease may be greatly facilitated by virtual cardiotomy. Surgeons can perform an unlimited number of surgical incisions on a virtual 3-D reconstruction to evaluate the feasibility of different surgical strategies. OBJECTIVE To quantitatively evaluate the quality of the underlying imaging data and the accuracy of the corresponding segmentation, and to qualitatively evaluate the feasibility of virtual cardiotomy. MATERIALS AND METHODS A whole-heart MRI sequence was applied in 42 children with congenital heart disease (age 3 +/- 3 years, weight 13 +/- 9 kg, heart rate 96 +/- 21 bpm). Image quality was graded 1-4 (diagnostic image quality > or =2) by two independent blinded observers. In patients with diagnostic image quality the segmentation quality was also graded 1-4 (4 no discrepancies, 1 misleading error). RESULTS The average image quality score was 2.7 - sufficient for virtual reconstruction in 35 of 38 patients (92%) older than 1 month. Segmentation time was 59 +/- 10 min (average quality score 3.5). Virtual cardiotomy was performed in 19 patients. CONCLUSION Accurate virtual reconstructions of patient-specific cardiac anatomy can be produced in less than 1 h from 3-D MRI. The presented work thus introduces a new, clinically feasible noninvasive technique for improved preoperative planning in complex cases of congenital heart disease.
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Uribe S, Tangchaoren T, Parish V, Wolf I, Razavi R, Greil G, Schaeffter T. Volumetric Cardiac Quantification by Using 3D Dual-Phase Whole-Heart MR Imaging. Radiology 2008; 248:606-14. [DOI: 10.1148/radiol.2482071568] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Assessment of thoracic aortic dimensions in an experimental setting: comparison of different unenhanced magnetic resonance angiography techniques with electrocardiogram-gated computed tomography angiography for possible application in the pediatric population. Invest Radiol 2008; 43:179-86. [PMID: 18301314 DOI: 10.1097/rli.0b013e31815f8870] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare different unenhanced magnetic resonance angiography (MRA) techniques for quantitative evaluation of vessel lumen in an experimental setting in young pigs whose dimensions allow for a comparison with a pediatric population. MATERIAL AND METHODS Magnetic resonance imaging was performed in 5 healthy ventilated pigs at 1.5 T. Three different electrocardiogram (ECG)-triggered sequences were applied for MRA: [TSE-Db] T2-weighted dark-blood TurboSpinEcho (2.0 x 1.1 x 4 mm3); [trueFISP] 2D-steady-state-free-precession (2.2 x 1.8 x 2 mm3); [NAV] respiratory-gated, T2-prepared 3D-trueFISP (1.3 x 1.3 x 1.3 mm3). ECG-gated-CT angiography (CTA) (16-row CT, 1 mm collimation) served as the standard of reference. The vessel lumen was measured at 7 positions perpendicularly angulated to the vessel wall on multiplanar reformations: ascending aorta (P1), the aortic arch before (P2) and after (P3) the origin of the first supraaortic branch, the aortic arch after the origin of the second supraaortic branch (P4), the descending aorta at the level of the diaphragm (P5), and the first and second supraaortic branches (P6, P7). RESULTS Percentage differences in the vessel area determined by MRA reformation compared with CTA-reformation were 10% +/- 20% and 35% +/- 27% (TSE-Db), -4% +/- 13% and 20% +/- 24% (trueFISP), and -3% +/- 13% and -10% +/- 19% (NAV), for positions P1 to P5 and P6 to P7, respectively. A significant difference from CTA was found for TSE-Db at all positions, and for trueFISP only at positions P6 and P7. CONCLUSIONS Unenhanced MRA techniques allow for a reliable assessment of the dimensions of the thoracic aorta compared with CTA as the standard of reference. Using ECG-gating and navigator techniques, the free-breathing approach showed the best agreement with CTA. This technique may therefore be the most useful in the pediatric age group allowing for true 3D data acquisition with its inherent postprocessing possibilities.
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Clinical Applications of Cardiovascular Magnetic Resonance in Congenital Heart Disease. Magn Reson Imaging Clin N Am 2007; 15:565-77, vi. [DOI: 10.1016/j.mric.2007.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Valente AM, Powell AJ. Clinical applications of cardiovascular magnetic resonance in congenital heart disease. Cardiol Clin 2007; 25:97-110, vi. [PMID: 17478242 DOI: 10.1016/j.ccl.2007.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cardiovascular malformations occur in approximately 1% of live births. Improved diagnostic techniques and therapeutic interventions have reduced early mortality substantially, and long-term survival has improved. Management issues, however, are challenging, and cardiovascular magnetic resonance (CMR) provides much diagnostic information to guide decisions. This article provides an approach to CMR evaluation of several common congenital heart lesions.
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Affiliation(s)
- Anne Marie Valente
- Boston Adult Congenital Heart Service, Department of Cardiology, Children's Hospital Boston, Brigham and Women's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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Greil GF, Wolf I, Kuettner A, Fenchel M, Miller S, Martirosian P, Schick F, Oppitz M, Meinzer HP, Sieverding L. Stereolithographic reproduction of complex cardiac morphology based on high spatial resolution imaging. Clin Res Cardiol 2007; 96:176-85. [PMID: 17225916 DOI: 10.1007/s00392-007-0482-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 11/16/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Precise knowledge of cardiac anatomy is mandatory for diagnosis and treatment of congenital heart disease. Modern imaging techniques allow high resolution three-dimensional (3D) imaging of the heart and great vessels. In this study stereolithography was evaluated for 3D reconstructions of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) data. METHODS A plastinated heart specimen was scanned with MDCT and after segmentation a stereolithographic (STL) model was produced with laser sinter technique. After scanning the STL model with MDCT these data were compared with those of the original specimen after rigid registration using the iterative closest points algorithm (ICP). The two surfaces of the original specimen and STL model were matched and the symmetric mean distance was calculated. Additionally, the heart and great vessels of patients (age range 41 days-21 years) with congenital heart anomalies were imaged with MDCT (n=2) or free breathing steady, state free-precession MRI (n=3). STL models were produced from these datasets and the cardiac segments were analyzed by two independent observers. RESULTS All cardiac structures of the heart specimen were reconstructed as a STL model within sub-millimeter resolution (mean surface distance 0.27+/-0.76 mm). Cardiac segments of the STL patient models were correctly analyzed by two independent observers compared to the original 3D datasets, echocardiography (n=5), x-ray angiography (n=5), and surgery (n=4). CONCLUSIONS High resolution MDCT or MRI 3D datasets can be accurately reconstructed using laser sinter technique. Teaching, research and preoperative planning may be facilitated in the future using this technique.
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Affiliation(s)
- G F Greil
- Department of Pediatric Cardiology, Children's Hospital, University of Tübingen, Hoppe-Seyler-Strasse 1, 72076, Tübingen, Germany.
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