Coronary artery assessment using self-navigated free-breathing radial whole-heart magnetic resonance angiography in patients with congenital heart disease

Albrecht, Moritz H.; Varga-Szemes, Ákos; Schoepf, U. Joseph; Apfaltrer, Georg; Xu, Jiaqian; Jin, Kwang Nam; Hlavacek, Anthony M.; Chowdhury, Shahryar M; Surányi, Pál; Tesche, Christian; Cecco, Carlo N. De; Piccini, Davide; Stuber, Matthias; Ginami, Giulia; Vogl, Thomas J.; Nutting, Arni

doi:10.1007/s00330-017-5035-1

Cited by 17 publications

(16 citation statements)

References 38 publications

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“…1). For this purpose, a 3D radial imaging sequence as described above was used for coronary artery imaging by enabling respiratory-self-navigation and electrocardiograph (ECG) triggering [4, 6, 20, 21]. Whole-heart volumes were acquired during free-breathing.…”

Section: Methodsmentioning

confidence: 99%

Noncontrast free-breathing respiratory self-navigated coronary artery cardiovascular magnetic resonance angiography at 3 T using lipid insensitive binomial off-resonant excitation (LIBRE)

Bastiaansen

Heeswijk

Stuber

et al. 2019

Journal of Cardiovascular Magnetic Resonance

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Background Robust and homogeneous lipid suppression is mandatory for coronary artery cardiovascular magnetic resonance (CMR) imaging since the coronary arteries are commonly embedded in epicardial fat. However, effective large volume lipid suppression becomes more challenging when performing radial whole-heart coronary artery CMR for respiratory self-navigation and the problem may even be exacerbated at increasing magnetic field strengths. Incomplete fat suppression not only hinders a correct visualization of the coronary vessels and generates image artifacts, but may also affect advanced motion correction methods. The aim of this study was to evaluate a recently reported lipid insensitive CMR method when applied to a noncontrast self-navigated coronary artery CMR acquisitions at 3 T, and to compare it to more conventional fat suppression techniques. Methods Lipid insensitive binomial off resonant excitation (LIBRE) radiofrequency excitation pulses were included into a self-navigated 3D radial GRE coronary artery CMR sequence at 3 T. LIBRE was compared against a conventional CHESS fat saturation (FS) and a binomial 1–180°-1 water excitation (WE) pulse. First, fat suppression of all techniques was numerically characterized using Matlab and experimentally validated in phantoms and in legs of human volunteers. Subsequently, free-breathing self-navigated coronary artery CMR was performed using the LIBRE pulse as well as FS and WE in ten healthy subjects. Myocardial, arterial and chest fat signal-to-noise ratios (SNR), as well as coronary vessel conspicuity were quantitatively compared among those scans. Results The results obtained in the simulations were confirmed by the experimental validations as LIBRE enabled near complete fat suppression for 3D radial imaging in vitro and in vivo. For self-navigated whole-heart coronary artery CMR at 3 T, fat SNR was significantly attenuated using LIBRE compared with conventional FS. LIBRE increased the right coronary artery (RCA) vessel sharpness significantly (37 ± 9% (LIBRE) vs. 29 ± 8% (FS) and 30 ± 8% (WE), both p < 0.05) and led to a significant increase in the measured RCA vessel length to (83 ± 31 mm (LIBRE) vs. 56 ± 12 mm (FS) and 59 ± 27 (WE) p < 0.05). Conclusions Applied to a respiratory self-navigated noncontrast 3D radial whole-heart sequence, LIBRE enables robust large volume fat suppression and significantly improves coronary artery image quality at 3 T compared to the use of conventional FS and WE.

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Section: Methodsmentioning

confidence: 99%

Noncontrast free-breathing respiratory self-navigated coronary artery cardiovascular magnetic resonance angiography at 3 T using lipid insensitive binomial off-resonant excitation (LIBRE)

Bastiaansen

Heeswijk

Stuber

et al. 2019

Journal of Cardiovascular Magnetic Resonance

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“…17 Experience in patients already exists for self-navigated techniques. A sequence similar to Stehning et al 12 but with more sophisticated motion detection 18 and a different 3D radial trajectory 19 has been used in some of the largest patient studies with self-navigated respiratory motion-correction to date, [20][21][22] reaching a total of ~300 subjects. More recently, image-based self-navigation has also been clinically evaluated with promising results.…”

Section: Introductionmentioning

confidence: 99%

“…For the self‐navigated reference, we selected the previously mentioned prototype 3D radial protocol that has been used in some of the largest patient studies with self‐navigated techniques. [] Preliminary results from this work were in part presented in abstract form at the Joint EuroCMR/SCMR Conference 2018 …”

Section: Introductionmentioning

confidence: 99%

A quantitative comparison between a navigated Cartesian and a self‐navigated radial protocol from clinical studies for free‐breathing 3D whole‐heart bSSFP coronary MRA

Heerfordt

Stuber

Maillot

et al. 2019

Magnetic Resonance in Med

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Purpose Navigator‐gated 3D bSSFP whole‐heart coronary MRA has been evaluated in several large studies including a multi‐center trial. Patient studies have also been performed with more recent self‐navigated techniques. In this study, these two approaches are compared side‐by‐side using a Cartesian navigator‐gated and corrected (CNG) and a 3D radial self‐navigated (RSN) protocol from published patient studies. Methods Sixteen healthy subjects were examined with both sequences on a 1.5T scanner. Assessment of the visibility of coronary ostia and quantitative comparisons of acquisition times, blood pool homogeneity, and visible length and sharpness of the right coronary artery (RCA) and the combined left main (LM)+left anterior descending (LAD) coronary arteries were performed. Paired sample t‐tests with P < .05 considered statistically significant were used for all comparisons. Results The acquisition time was 5:40 ± 0:28 min (mean ± SD) for RSN, being significantly shorter than the 16:59 ± 5:05 min of CNG (P < .001). RSN images showed higher blood pool homogeneity (P < .001). All coronary ostia were visible with both techniques. CNG provided significantly higher vessel sharpness in the RCA (CNG: 50.0 ± 8.6%, RSN: 34.2 ± 6.9%, P < .001) and the LM+LAD (CNG: 48.7 ± 6.7%, RSN: 32.3 ± 7.1%, P < .001). The visible vessel length was significantly longer in the LM+LAD using CNG (CNG: 9.8 ± 2.7 cm, RSN: 8.5 ± 2.6 cm, P < .05) but not in the RCA (CNG: 9.7 ± 2.3 cm, RSN: 9.3 ± 2.9 cm, P = .29). Conclusion CNG provided superior vessel sharpness and might hence be the better option for examining coronary lumina. However, its blood pool inhomogeneity and prolonged and unpredictable acquisition times compared to RSN may make clinical adoption more challenging.

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“…In cases in which the pathology of interest is known in one hemithorax, the diaphragm should be tracked on the contralateral side . Self‐navigated sequences, which infer the position of the diaphragm in real time from the acquired image data and allow for retrospective respiratory gating, can eliminate the pencil beam artifact and likely decrease scan duration …”

Section: Challenges In Thoracic Mrimentioning

confidence: 99%

“…[17][18][19][20] Self-navigated sequences, which infer the position of the diaphragm in real time from the acquired image data and allow for retrospective respiratory gating, can eliminate the pencil beam artifact and likely decrease scan duration. 21,22 The third important challenge for thoracic MRI is cardiac motion. Cardiac motion can lead to several deleterious effects on thoracic MR images.…”

Section: Challenges In Thoracic Mrimentioning

confidence: 99%

Building blocks for thoracic MRI: Challenges, sequences, and protocol design

Raptis

Ludwig

Hammer

et al. 2019

Magnetic Resonance Imaging

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Thoracic MRI presents important and unique challenges. Decreased proton density in the lung in combination with respiratory and cardiac motion can degrade image quality and render poorly executed sequences uninterpretable. Despite these challenges, thoracic MRI has an important clinical role, both as a problem‐solving tool and in an increasing array of clinical indications. Advances in scanner and sequence design have also helped to drive this development, presenting the radiologist with improved techniques for thoracic MRI. Given this evolving landscape, radiologists must be familiar with what thoracic MR has to offer. The first step in developing an effective thoracic MRI practice requires the creation of efficient and malleable protocols that can answer clinical questions. To do this, radiologists must have a working knowledge of the MR sequences that are used in the thorax, many of which have been adapted from use elsewhere in the body. These sequences can be broadly divided into three categories: traditional/anatomic, functional, and cine based. Traditional/anatomic sequences allow for the depiction of anatomy and pathologic processes with the ability for characterization of signal intensity and contrast enhancement. Functional sequences, including diffusion‐weighted imaging, and high temporal resolution dynamic contrast enhancement, allow for the noninvasive measurement of tissue‐specific parameters. Cine‐based sequences can depict the motion of structures in the thorax, either with retrospective ECG gating or in real time. The purpose of this article is to review these categories, the building block sequences that comprise them, and identify basic questions that should be considered in thoracic MRI protocol design. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:682–701.

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Coronary artery assessment using self-navigated free-breathing radial whole-heart magnetic resonance angiography in patients with congenital heart disease

Cited by 17 publications

References 38 publications

Noncontrast free-breathing respiratory self-navigated coronary artery cardiovascular magnetic resonance angiography at 3 T using lipid insensitive binomial off-resonant excitation (LIBRE)

Noncontrast free-breathing respiratory self-navigated coronary artery cardiovascular magnetic resonance angiography at 3 T using lipid insensitive binomial off-resonant excitation (LIBRE)

A quantitative comparison between a navigated Cartesian and a self‐navigated radial protocol from clinical studies for free‐breathing 3D whole‐heart bSSFP coronary MRA

Building blocks for thoracic MRI: Challenges, sequences, and protocol design

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