Pulmonary vein morphology by free‐breathing whole heart magnetic resonance imaging at 3 tesla versus breathhold multi‐detector computed tomography

Abstract

Purpose This study compares pulmonary vein and left atrial anatomy using 3D free-breathing whole-heart magnetic resonance imaging (MR) at 3T and multi-detector computed tomography (MDCT). Materials and Methods Thirty three subjects (19 male, age 49±12 years) underwent free-breathing 3T MR and contrast-enhanced MDCT during inspiratory breath hold. Pulmonary vein parameters (ostial areas, diameters, angles) were measured. Results All pulmonary veins and anomalies were identified by 3T MR and by MDCT. The right-sided pulmonary veins were directed more posteriorly, the right superior pulmonary vein more inferiorly, and the right inferior pulmonary vein more superiorly by 3T MR when compared with MDCT. The cross-sectional area, perimeters and minimum diameters of right-sided pulmonary vein ostia were significantly larger by MR, as were the maximum diameters of right and left inferior pulmonary veins. There were no significant differences between techniques in distance to first pulmonary vein branch. Conclusion Pulmonary vein measurements demonstrated significant differences in angulations and dimensions when 3T MR is compared with MDCT. These differences likely represent hemodynamic and respiratory variation during free-breathing with MR versus breath-holding with MDCT. MR imaging at 3T during free-breathing offers an alternate method to define pulmonary vein and left atrial anatomy without exposure to radiation.

Feasibility study of electrocardiographic and respiratory gated, gadolinium enhanced magnetic resonance angiography of pulmonary veins and the impact of heart rate and rhythm on study quality

“…Although still practical, the overall mean acquisition time for this 3D respiratory and ECG gated MRA sequence of 7:51 ± 2:58 minutes is longer than acquisition times reported for commonly employed contrast enhanced MRA in expiratory breath hold, without ECG gating (5:45 ± 1:53 minutes) [ 13 ]. Furthermore, although the acquisition window is usually shorter for end-systolic compared to mid-diastolic imaging, mean acquisition time in this study was shorter than that reported in two smaller studies of 3D respiratory and ECG gated MRA of pulmonary veins where mid-diastolic ECG gating was used [ 13 , 16 ]. This increase in acquisition times compared to breath held, ungated MRAs may, in part, be offset by reductions in cardiac motion artifact associated through ECG gating and higher spatial resolution.…”

“…Furthermore, although the acquisition window is usually shorter for end-systolic compared to mid-diastolic imaging, mean acquisition time in this study was shorter than that reported in two smaller studies of 3D respiratory and ECG gated MRA of pulmonary veins where mid-diastolic ECG gating was used [13,16]. This increase in acquisition times compared to breath held, ungated MRAs may, in part, be offset by reductions in cardiac motion artifact associated through ECG gating and higher spatial resolution.…”

“…Free breathing, contrast enhanced MRA using a ECG triggered, respiratory gated, inversion recovery prepared, 3D volume whole heart acquisition segmented gradient echo sequence (echo time: 1.4 ms, echo spacing: 3.22 ms, number of k space lines per cardiac cycle: 35, flip angle: 20 degrees, inversion time = 200 ms, readout bandwidth = 698 Hz/pixel, slice thickness: 1.2 mm, acquired voxel size: 1.3 × 1.3 × 1.2 mm3, 88–120 slices) was obtained, starting 45 seconds after initiation of an intravenous infusion of 0.15 mmol/kg of gadobenate dimeglumine (MultiHance®; Bracco Imaging SpA, Milan, Italy) at a rate of 0.3 ml/sec using a power injector (MEDRAD Inc., Warrendale, PA, USA), followed by 20 ml saline at the same rate. Gadolinium dimeglumine with a higher T1 relaxivity relative to other gadolinium chelates [ 26 ], a dosing regimen similar to that used in a smaller study [ 16 ], and the infusion protocol were all selected in an effort to maintain maximum blood pool enhancement for the duration of MRA acquisition. The FOV was selected to include the entire LA, LA appendage (LAA) and proximal PVs.…”

“…Small studies have demonstrated the feasibility of free breathing, respiratory gated CMR for LA and PV imaging, with and without contrast enhancement [ 14 , 16 - 19 ]. The impact of heart rate (HR) and rhythm on image quality and registration accuracy, outside of data from very small studies, are uncertain [ 20 , 21 ].…”

Variations in human pulmonary vein ostia morphology: A systematic review with meta‐analysis

“…In general, the anatomical variations of PV ostia were examined in 73 studies including 13,811 subjects (Abadir et al, 2019; Akkaya et al, 2018; Aktan Ikiz et al, 2014; Allgayer et al, 2008; Altinkaynak & Koktener, 2019; Angulo Hervias et al, 2020; Anselme et al, 2006; Anselmino et al, 2011; Artuso et al, 2005; Baszko et al, 2012; Benini et al, 2008; Beukema et al, 2010; Bittner et al, 2011; Boersma et al, 2008; Bogot et al, 2009; Bourier et al, 2013; Brunelli et al, 2012; Carreras et al, 2005; Chen et al, 2017; Cirillo et al, 2004; Cronin et al, 2007; Dong et al, 2005, 2006; Fodi et al, 2013; Hamdan et al, 2009; Harbi et al, 2014; Hauser et al, 2006, 2015; Hof et al, 2009; Hoffmeister et al, 2007; Huang et al, 2018; Hunter et al, 2010; Ihara et al, 2011; Imanli et al, 2017; Istratoaie et al, 2019; Jongbloed et al, 2004; Jongbloed, Bax, et al, 2005; Jongbloed, Dirksen, et al, 2005; Kanaji et al, 2016; Kaseno et al, 2008; Klimek‐Piotrowska et al, 2016; Knecht et al, 2013; Koçyiğit et al, 2017; Krum et al, 2013; Kubala et al, 2011; Lickfett et al, 2004, 2005; Mansour et al, 2004; Martinez Urabayen et al, 2021; Merchant et al, 2016; Metzner et al, 2012; Micochova et al, 2005; Mulder et al, 2011; Niculescu et al, 2006; Patel et al, 2013; Pontone et al, 2015; Prasanna et a...…”