A non-contrast self-navigated 3-dimensional MR technique for aortic root and vascular access route assessment in the context of transcatheter aortic valve replacement: proof of concept

Renker, Matthias; Varga-Szemes, Ákos; Schoepf, U. Joseph; Baumann, Stefan; Piccini, Davide; Zenge, Michael O.; Rehwald, Wolfgang G; Rier, Jeremy; Möllmann, Helge; Hamm, Christian W.; Steinberg, Daniel; Cecco, Carlo N. De

doi:10.1007/s00330-015-3906-x

Cited by 30 publications

(22 citation statements)

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“…Whole-heart magnetic resonance angiography (MRA) has been extensively used as a clinical tool to visualize three-dimensional (3D) cardiac anatomy [1]. While 3D whole-heart MRA can be obtained using contrast-enhanced techniques [2], the most common application remains the unenhanced steady-state free-precession (SSFP) acquisition [3–6]. As the heart is relatively still only for a short mid-diastolic or late systolic period of the cardiac cycle, collection of such MRA data requires hundreds of cardiac cycles and a protocol designed for free-breathing imaging.…”

Section: Introductionmentioning

confidence: 99%

Correcting versus resolving respiratory motion in free-breathing whole-heart MRA: a comparison in patients with thoracic aortic disease

et al. 2019

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Background Whole-heart magnetic resonance angiography (MRA) requires sophisticated methods accounting for respiratory motion. Our purpose was to evaluate the image quality of compressed sensing-based respiratory motion-resolved three-dimensional (3D) whole-heart MRA compared with self-navigated motion-corrected whole-heart MRA in patients with known thoracic aorta dilation. Methods Twenty-five patients were prospectively enrolled in this ethically approved study. Whole-heart 1.5-T MRA was acquired using a prototype 3D radial steady-state free-precession free-breathing sequence. The same data were reconstructed with a one-dimensional motion-correction algorithm (1D-MCA) and an extradimensional golden-angle radial sparse parallel reconstruction (XD-GRASP). Subjective image quality was scored and objective image quality was quantified (signal intensity ratio, SIR; vessel sharpness). Wilcoxon, McNemar, and paired t tests were used. Results Subjective image quality was significantly higher using XD-GRASP compared to 1D-MCA (median 4.5, interquartile range 4.5–5.0 versus 4.0 [2.25–4.75]; p < 0.001), as well as signal homogeneity (3.0 [3.0–3.0] versus 2.0 [2.0–3.0]; p = 0.003), and image sharpness (3.0 [2.0–3.0] vs 2.0 [1.25–3.0]; p < 0.001). SIR with the 1D-MCA and XD-GRASP was 6.1 ± 3.9 versus 7.4 ± 2.5, respectively ( p < 0.001); while signal homogeneity was 274.2 ± 265.0 versus 199.8 ± 67.2 ( p = 0.129). XD-GRASP provided a higher vessel sharpness (45.3 ± 10.7 versus 40.6 ± 101, p = 0.025). Conclusions XD-GRASP-based motion-resolved reconstruction of free-breathing 3D whole-heart MRA datasets provides improved image contrast, sharpness, and signal homogeneity and seems to be a promising technique that overcomes some of the limitations of motion correction or respiratory navigator gating.

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Section: Introductionmentioning

confidence: 99%

Correcting versus resolving respiratory motion in free-breathing whole-heart MRA: a comparison in patients with thoracic aortic disease

et al. 2019

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“…Conversely, self-navigated techniques (9)(10)(11)(12)(13)(14) that directly extract a respiratory motion signal from the imaging data to perform respiratory motion correction, operate with 100% scan efficiency, have highly predictable scan duration, and improved ease-of-use. Such techniques have been extensively tested in both volunteer (10,15,16) and patient (14,17) cohorts in single-center studies. However, self-navigation still suffers from limitations related to the motion model employed for correction (e.g., one-dimensional [1D], three-dimensional [3D], affine, etc.)…”

Section: Introductionmentioning

confidence: 99%

Four-dimensional respiratory motion-resolved whole heart coronary MR angiography

et al. 2016

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Purpose Free-breathing whole-heart coronary MR angiography (MRA) commonly uses navigators to gate respiratory motion, resulting in lengthy and unpredictable acquisition times. Conversely, self-navigation has 100% scan efficiency, but requires motion correction over a broad range of respiratory displacements, which may introduce image artifacts. We propose replacing navigators and self-navigation with a respiratory motion-resolved reconstruction approach. Methods Using a respiratory signal extracted directly from the imaging data, individual signal-readouts are binned according to their respiratory states. The resultant series of undersampled images are reconstructed using an extradimensional golden-angle radial sparse parallel imaging (XD-GRASP) algorithm, which exploits sparsity along the respiratory dimension. Whole-heart coronary MRA was performed in 11 volunteers and four patients with the proposed methodology. Image quality was compared with that obtained with one-dimensional respiratory self-navigation. Results Respiratory-resolved reconstruction effectively suppressed respiratory motion artifacts. The quality score for XD-GRASP reconstructions was greater than or equal to self-navigation in 80/88 coronary segments, reaching diagnostic quality in 61/88 segments versus 41/88. Coronary sharpness and length were always superior for the respiratory-resolved datasets, reaching statistical significance (P < 0.05) in most cases. Conclusion XD-GRASP represents an attractive alternative for handling respiratory motion in free-breathing whole heart MRI and provides an effective alternative to self-navigation.

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“…Regarding contrast-free imaging in the context of TAVI, Renker and colleagues presented a rapid, non-contrast, free-breathing, self-navigated three-dimensional MR sequence to study aortic root and vascular access route [ 15 ]. However, this feasibility study was conducted in 10 healthy volunteers only.…”

Section: Discussionmentioning

confidence: 99%

Non-contrast MRI protocol for TAVI guidance: quiescent-interval single-shot angiography in comparison with contrast-enhanced CT

et al. 2020

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Objectives To prospectively compare unenhanced quiescent-interval single-shot MR angiography (QISS-MRA) with contrastenhanced computed tomography angiography (CTA) for contrast-free guidance in transcatheter aortic valve intervention (TAVI). Methods Twenty-six patients (mean age 83 ± 5 years, 15 female [58%]) referred for TAVI evaluation underwent QISS-MRA for aortoiliofemoral access guidance and non-contrast three-dimensional (3D) "whole heart" MRI for prosthesis sizing on a 1.5-T system. Contrast-enhanced CTA was performed as imaging gold standard for TAVI planning. Image quality was assessed by a 4point Likert scale; continuous MRA and CTA measurements were compared with regression and Bland-Altman analyses.Results QISS-MRA and CTA-based measurements of aortoiliofemoral vessel diameters correlated moderately to very strong (r = 0.572 to 0.851, all p ≤ 0.002) with good to excellent inter-observer reliability (intra-class correlation coefficient (ICC) = 0.862 to 0.999, all p < 0.0001) regarding QISS assessment. Mean diameters of the infrarenal aorta and iliofemoral vessels differed significantly (bias 0.37 to 0.98 mm, p = 0.041 to < 0.0001) between the two modalities. However, inter-method decision for transfemoral access route was comparable (κ = 0.866, p < 0.0001). Aortic root parameters assessed by 3D whole heart MRI strongly correlated (r = 0.679 to 0.887, all p ≤ 0.0001) to CTA measurements. Conclusion QISS-MRA provides contrast-free access route evaluation in TAVI patients with moderate to strong correlations compared with CTA and substantial inter-observer agreement. Despite some significant differences in minimal vessel diameters, inter-method agreement for transfemoral accessibility is strong. Combination with 3D whole heart MRI facilitates unenhanced TAVI guidance. Key Points • QISS-MRA and CTA inter-method agreement for transfemoral approach is strong. • QISS-MRA is a very good alternative to CTA and MRA especially in patients with Kidney Disease Outcomes Quality Initiative stages 4 and 5. • Combination of QISS-MRA and 3D "whole heart" MRI facilitates fully unenhanced TAVI guidance.

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A non-contrast self-navigated 3-dimensional MR technique for aortic root and vascular access route assessment in the context of transcatheter aortic valve replacement: proof of concept

Abstract: • The prevalence of renal failure is high among TAVR candidates. • Non-contrast 3D MR angiography allows for TAVR procedure planning. • The self-navigated sequence provides a significantly reduced scanning time.

Cited by 30 publications

References 30 publications

Correcting versus resolving respiratory motion in free-breathing whole-heart MRA: a comparison in patients with thoracic aortic disease

Correcting versus resolving respiratory motion in free-breathing whole-heart MRA: a comparison in patients with thoracic aortic disease

Four-dimensional respiratory motion-resolved whole heart coronary MR angiography

Non-contrast MRI protocol for TAVI guidance: quiescent-interval single-shot angiography in comparison with contrast-enhanced CT

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