Four‐dimensional, multiphase, steady‐state imaging with contrast enhancement (MUSIC) in the heart: A feasibility study in children

Han, Fei; Rapacchi, Stanislas; Khan, Sarah; Ayad, Ihab; Salusky, Isidro B.; Габриэль, С. А.; Plotnik, Adam N.; Finn, J. Paul; Hu, Peng

doi:10.1002/mrm.25491

Cited by 50 publications

(59 citation statements)

References 26 publications

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“…FE-MUSIC leverages reliable cardio-respiratory gating and ferumoxytol enhancement at 3.0 T to generate 4D images of the beating heart with true isotropic voxel dimensions of 0.6–0.9 mm [1]. This was accomplished by exploiting the high relaxivity and stable blood-pool concentration of ferumoxytol for steady state imaging, combined with regular airway pressure and ECG signals for optimal cardio-respiratory gating.…”

Section: Discussionmentioning

confidence: 99%

“…Imaging parameters for breath-held FE-CMRA were: repetition time/echo time (TR/TE) 2.9/0.9 ms; flip angle 15-17°; in-plane resolution 0.9–1.2 mm; slice thickness 0.9–1.1 mm; GRAPPA acceleration 3×–4×; 75% partial Fourier acquisition in both phase encoding directions. FE-MUSIC was acquired during continuous ventilation using the airway pressure signal for respiratory gating [1]. No adjustments were made to the ventilatory frequency, amplitude or waveform to maximize gating efficiency and the default settings were employed.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, a 4D Multiphase Steady-state Imaging with Contrast (MUSIC) CMR technique was introduced, which generates sub-millimeter, isotropic 3D voxels over multiple phases of the cardiac cycle [1]. MUSIC data are acquired without breath holding during continuous positive pressure ventilation, and the airway pressure signal is used for respiratory gating.…”

Section: Introductionmentioning

confidence: 99%

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4D MUSIC CMR: value-based imaging of neonates and infants with congenital heart disease

Nguyen

Han

Zhou

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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Background4D 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).MethodsForty 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.ResultsAll 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.ConclusionsFE-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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-017-0352-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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4D MUSIC CMR: value-based imaging of neonates and infants with congenital heart disease

Nguyen

Han

Zhou

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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“…The total time for the l1-ESPIRiT reconstruction was less than one hour on a server with two 10-core CPUs. Scans were performed after injection of 0.1 mL/kg ferumoxytol (Feraheme; AMAG Pharmaceuticals, Waltham, Massachusetts, USA) for blood pool enhancement (23–25). General anesthesia was used in the majority of cases (n=17, 77.3%).…”

Section: Methodsmentioning

confidence: 99%

Assessment of the precision and reproducibility of ventricular volume, function, and mass measurements with ferumoxytol‐enhanced 4D flow MRI

Hanneman

Kino

Cheng

et al. 2016

Magnetic Resonance Imaging

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Purpose To compare the precision and inter-observer agreement of ventricular volume, function and mass quantification by three-dimensional time-resolved (4D) flow MRI relative to cine steady state free precession (SSFP). Materials and Methods With research board approval, informed consent, and HIPAA compliance, 22 consecutive patients with congenital heart disease (CHD) (10 males, 6.4±4.8 years) referred for 3T ferumoxytol-enhanced cardiac MRI were prospectively recruited. Complete ventricular coverage with standard 2D short-axis cine SSFP and whole chest coverage with axial 4D flow were obtained. Two blinded radiologists independently segmented images for left ventricular (LV) and right ventricular (RV) myocardium at end systole (ES) and end diastole (ED). Statistical analysis included linear regression, ANOVA, Bland-Altman (BA) analysis, and intra-class correlation (ICC). Results Significant positive correlations were found between 4D flow and SSFP for ventricular volumes (r = 0.808–0.972, p<0.001), ejection fraction (EF) (r = 0.900–928, p<0.001), and mass (r = 0.884–0.934, p<0.001). BA relative limits of agreement for both ventricles were between −52% to 34% for volumes, −29% to 27% for EF, and −41% to 48% for mass, with wider limits of agreement for the RV compared to the LV. There was no significant difference between techniques with respect to mean square difference of ED-ES mass for either LV (F=2.05, p=0.159) or RV (F=0.625, p=0.434). Inter-observer agreement was moderate to good with both 4D flow (ICC 0.523–0.993) and SSFP (ICC 0.619–0.982), with overlapping confidence intervals. Conclusion Quantification of ventricular volume, function and mass can be accomplished with 4D flow MRI with precision and inter-observer agreement comparable to that of cine SSFP.

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“…Han et al also aimed to improve the image quality and exam efficiency in pediatric patients without requiring breath-holding, by developing a cardiac and respiratorygated high-resolution 3-dimensional (3D) magnetic resonance angiography technique [4]. Electrocardiogram-gating was used to generate multiple 3D angiography data sets across the cardiac cycle with a temporal resolution of 65-95 ms, isotropic spatial resolution of 0.6-0.9 mm, and scan time of 3.5-8 min.…”

Section: Cmr Techniquesmentioning

confidence: 98%

Cardiovascular Magnetic Resonance in Pediatric and Congenital Heart Disease: An Update on Recent Developments

Beroukhim

Powell

2015

Curr Pediatr Rep

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Cardiovascular magnetic resonance (CMR) plays an important role in the evaluation of children and adults with congenital heart disease. It provides complementary information to echocardiography and cardiac catheterization, and has unique diagnostic capabilities. Accordingly, data from CMR are increasingly being incorporated into disease management algorithms. This article critically reviews recently published reports related to pediatric and congenital CMR with sections on new techniques, congenital heart disease lesions, and cardiomyopathy.

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Four‐dimensional, multiphase, steady‐state imaging with contrast enhancement (MUSIC) in the heart: A feasibility study in children

Abstract: The 4D MUSIC technique may represent a new paradigm in MR evaluation of cardiovascular anatomy and function in children with complex congenital heart disease.

Cited by 50 publications

References 26 publications

4D MUSIC CMR: value-based imaging of neonates and infants with congenital heart disease

4D MUSIC CMR: value-based imaging of neonates and infants with congenital heart disease

Assessment of the precision and reproducibility of ventricular volume, function, and mass measurements with ferumoxytol‐enhanced 4D flow MRI

Cardiovascular Magnetic Resonance in Pediatric and Congenital Heart Disease: An Update on Recent Developments

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