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Single centre experience of the application of self navigated 3D whole heart cardiovascular magnetic resonance for the assessment of cardiac anatomy in congenital heart disease.

Monney P, Piccini D, Rutz T, Vincenti G, Coppo S, Koestner SC, Sekarski N, Di Bernardo S, Bouchardy J, Stuber M, Schwitter J - J Cardiovasc Magn Reson (2015)

Bottom Line: Factors associated with insufficient image quality were identified using multivariate logistic regression.Younger age, higher heart rate, lower ejection fraction, and lack of contrast medium were independently associated with reduced image quality.However, a similar rate of diagnostic image quality was obtained in children and adults.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology and Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland. pierre.monney@chuv.ch.

ABSTRACT

Background: For free-breathing cardiovascular magnetic resonance (CMR), the self-navigation technique recently emerged, which is expected to deliver high-quality data with a high success rate. The purpose of this study was to test the hypothesis that self-navigated 3D-CMR enables the reliable assessment of cardiovascular anatomy in patients with congenital heart disease (CHD) and to define factors that affect image quality.

Methods: CHD patients ≥2 years-old and referred for CMR for initial assessment or for a follow-up study were included to undergo a free-breathing self-navigated 3D CMR at 1.5T. Performance criteria were: correct description of cardiac segmental anatomy, overall image quality, coronary artery visibility, and reproducibility of great vessels diameter measurements. Factors associated with insufficient image quality were identified using multivariate logistic regression.

Results: Self-navigated CMR was performed in 105 patients (55% male, 23 ± 12y). Correct segmental description was achieved in 93% and 96% for observer 1 and 2, respectively. Diagnostic quality was obtained in 90% of examinations, and it increased to 94% if contrast-enhanced. Left anterior descending, circumflex, and right coronary arteries were visualized in 93%, 87% and 98%, respectively. Younger age, higher heart rate, lower ejection fraction, and lack of contrast medium were independently associated with reduced image quality. However, a similar rate of diagnostic image quality was obtained in children and adults.

Conclusion: In patients with CHD, self-navigated free-breathing CMR provides high-resolution 3D visualization of the heart and great vessels with excellent robustness.

No MeSH data available.


Related in: MedlinePlus

Representative 2D images reconstructed from the 3D self-navigated datasets in the 10 children presented on Table 6. a. Coarctation of the aorta. b. Operated type 1 truncus arteriosus; * indicates the aortic root (originally : common arterial trunk) overriding the interventricular septum. c. Coarctation of the aorta. d. Unoperated pulmonary atresia with open septum. E. Unoperated sinus venosus atrial septum defect; # indicates the defect – the right superior pulmonary vein drains into the proximal part of the superior vena cava. F. Hypoplastic left heart syndrome (after Norwood operation). G. Unoperated pulmonary atresia with open septum. H. Coarctation of the aorta. I. Aberrant right subclavian artery. J. Marfan syndrome with aortic root dilatation.CoA - aortic coarctation ; HLV - hypoplastic LV ; LA - left atrium ; LPA - left pulmonary artery ; PDA - patent ductus arteriosus ; MAPCA - major aorto-pulmonary collateral artery ; RSPV - right superior pulmonary vein ; RPA - right pulmonary artery ; RVOT - right ventricular outflow tract. Other abbreviations as in Fig. 2
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Fig4: Representative 2D images reconstructed from the 3D self-navigated datasets in the 10 children presented on Table 6. a. Coarctation of the aorta. b. Operated type 1 truncus arteriosus; * indicates the aortic root (originally : common arterial trunk) overriding the interventricular septum. c. Coarctation of the aorta. d. Unoperated pulmonary atresia with open septum. E. Unoperated sinus venosus atrial septum defect; # indicates the defect – the right superior pulmonary vein drains into the proximal part of the superior vena cava. F. Hypoplastic left heart syndrome (after Norwood operation). G. Unoperated pulmonary atresia with open septum. H. Coarctation of the aorta. I. Aberrant right subclavian artery. J. Marfan syndrome with aortic root dilatation.CoA - aortic coarctation ; HLV - hypoplastic LV ; LA - left atrium ; LPA - left pulmonary artery ; PDA - patent ductus arteriosus ; MAPCA - major aorto-pulmonary collateral artery ; RSPV - right superior pulmonary vein ; RPA - right pulmonary artery ; RVOT - right ventricular outflow tract. Other abbreviations as in Fig. 2

Mentions: To further characterize the performance of the self-navigated 3D sequence in the pediatric population, we compared the baseline characteristics and the obtained image quality according to quintiles of age (Table 5). The children (2 – 14 years, 1st quintile) had a significantly lower height and weight and a higher HR. The acquisition window was significantly shorter as it was individually adapted to the faster HR. The rate of diagnostic quality obtained with the self-navigated 3D sequence was not significantly different in children and in adults, although good to excellent quality datasets (quality grade 4 and 5) were more frequently obtained in adult patients. The rate of coronary artery detection was high in all age groups. To illustrate the performance of the sequence in the small children population, the baseline characteristics as well as representative images of the 10 youngest patients (2–8 years) are presented in Table 6 and Fig. 4.Table 5


Single centre experience of the application of self navigated 3D whole heart cardiovascular magnetic resonance for the assessment of cardiac anatomy in congenital heart disease.

Monney P, Piccini D, Rutz T, Vincenti G, Coppo S, Koestner SC, Sekarski N, Di Bernardo S, Bouchardy J, Stuber M, Schwitter J - J Cardiovasc Magn Reson (2015)

Representative 2D images reconstructed from the 3D self-navigated datasets in the 10 children presented on Table 6. a. Coarctation of the aorta. b. Operated type 1 truncus arteriosus; * indicates the aortic root (originally : common arterial trunk) overriding the interventricular septum. c. Coarctation of the aorta. d. Unoperated pulmonary atresia with open septum. E. Unoperated sinus venosus atrial septum defect; # indicates the defect – the right superior pulmonary vein drains into the proximal part of the superior vena cava. F. Hypoplastic left heart syndrome (after Norwood operation). G. Unoperated pulmonary atresia with open septum. H. Coarctation of the aorta. I. Aberrant right subclavian artery. J. Marfan syndrome with aortic root dilatation.CoA - aortic coarctation ; HLV - hypoplastic LV ; LA - left atrium ; LPA - left pulmonary artery ; PDA - patent ductus arteriosus ; MAPCA - major aorto-pulmonary collateral artery ; RSPV - right superior pulmonary vein ; RPA - right pulmonary artery ; RVOT - right ventricular outflow tract. Other abbreviations as in Fig. 2
© Copyright Policy - open-access
Related In: Results  -  Collection

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Fig4: Representative 2D images reconstructed from the 3D self-navigated datasets in the 10 children presented on Table 6. a. Coarctation of the aorta. b. Operated type 1 truncus arteriosus; * indicates the aortic root (originally : common arterial trunk) overriding the interventricular septum. c. Coarctation of the aorta. d. Unoperated pulmonary atresia with open septum. E. Unoperated sinus venosus atrial septum defect; # indicates the defect – the right superior pulmonary vein drains into the proximal part of the superior vena cava. F. Hypoplastic left heart syndrome (after Norwood operation). G. Unoperated pulmonary atresia with open septum. H. Coarctation of the aorta. I. Aberrant right subclavian artery. J. Marfan syndrome with aortic root dilatation.CoA - aortic coarctation ; HLV - hypoplastic LV ; LA - left atrium ; LPA - left pulmonary artery ; PDA - patent ductus arteriosus ; MAPCA - major aorto-pulmonary collateral artery ; RSPV - right superior pulmonary vein ; RPA - right pulmonary artery ; RVOT - right ventricular outflow tract. Other abbreviations as in Fig. 2
Mentions: To further characterize the performance of the self-navigated 3D sequence in the pediatric population, we compared the baseline characteristics and the obtained image quality according to quintiles of age (Table 5). The children (2 – 14 years, 1st quintile) had a significantly lower height and weight and a higher HR. The acquisition window was significantly shorter as it was individually adapted to the faster HR. The rate of diagnostic quality obtained with the self-navigated 3D sequence was not significantly different in children and in adults, although good to excellent quality datasets (quality grade 4 and 5) were more frequently obtained in adult patients. The rate of coronary artery detection was high in all age groups. To illustrate the performance of the sequence in the small children population, the baseline characteristics as well as representative images of the 10 youngest patients (2–8 years) are presented in Table 6 and Fig. 4.Table 5

Bottom Line: Factors associated with insufficient image quality were identified using multivariate logistic regression.Younger age, higher heart rate, lower ejection fraction, and lack of contrast medium were independently associated with reduced image quality.However, a similar rate of diagnostic image quality was obtained in children and adults.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology and Cardiac MR Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland. pierre.monney@chuv.ch.

ABSTRACT

Background: For free-breathing cardiovascular magnetic resonance (CMR), the self-navigation technique recently emerged, which is expected to deliver high-quality data with a high success rate. The purpose of this study was to test the hypothesis that self-navigated 3D-CMR enables the reliable assessment of cardiovascular anatomy in patients with congenital heart disease (CHD) and to define factors that affect image quality.

Methods: CHD patients ≥2 years-old and referred for CMR for initial assessment or for a follow-up study were included to undergo a free-breathing self-navigated 3D CMR at 1.5T. Performance criteria were: correct description of cardiac segmental anatomy, overall image quality, coronary artery visibility, and reproducibility of great vessels diameter measurements. Factors associated with insufficient image quality were identified using multivariate logistic regression.

Results: Self-navigated CMR was performed in 105 patients (55% male, 23 ± 12y). Correct segmental description was achieved in 93% and 96% for observer 1 and 2, respectively. Diagnostic quality was obtained in 90% of examinations, and it increased to 94% if contrast-enhanced. Left anterior descending, circumflex, and right coronary arteries were visualized in 93%, 87% and 98%, respectively. Younger age, higher heart rate, lower ejection fraction, and lack of contrast medium were independently associated with reduced image quality. However, a similar rate of diagnostic image quality was obtained in children and adults.

Conclusion: In patients with CHD, self-navigated free-breathing CMR provides high-resolution 3D visualization of the heart and great vessels with excellent robustness.

No MeSH data available.


Related in: MedlinePlus