Self-navigated versus navigator-gated 3D MRI sequence for non-enhanced aortic root measurement in transcatheter aortic valve implantation

Pamminger, Mathias; Kranewitter, Christof; Kremser, Christian; Reindl, Martin; Reinstadler, Sebastian Johannes; Henninger, Benjamin; Reiter, Gert; Piccini, Davide; Tiller, Christina; Holzknecht, Magdalena; Lechner, Ivan; Bauer, Axel; Klug, Gert; Metzler, Bernhard; Mayr, Agnes

doi:10.1016/j.ejrad.2021.109573

Cited by 9 publications

(10 citation statements)

References 30 publications

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“…Conventional 3D bSSFP CMRA techniques use diaphragmatic respiratory gating (dNAV) to minimize the effects of respiratory motion in the images, which results in unpredictable and excessively long acquisition times [ 22 ] and the risk of incomplete or aborted scans because of respiratory drift [ 23 , 24 ]. Alternatively, a variety of 1D (one-dimensional) self-navigated techniques have been proposed [ 18 , 25 – 27 ], which allow the extraction of a foot-head respiratory motion signal directly from the image data that can be used for translational respiratory motion correction during post-processing. However, 1D self-navigation also suffers from certain limitations that are related to the 1D translational motion model used for correction, which may not be accurate when a wide range of respiratory motion is present, such as the case among the different thoracic aortic components [ 28 – 30 ].…”

Section: Introductionmentioning

confidence: 99%

Efficient non-contrast enhanced 3D Cartesian cardiovascular magnetic resonance angiography of the thoracic aorta in 3Â min

Fotaki

Muñoz

Emanuel³

et al. 2022

Journal of Cardiovascular Magnetic Resonance

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Background The application of cardiovascular magnetic resonance angiography (CMRA) for the assessment of thoracic aortic disease is often associated with prolonged and unpredictable acquisition times and residual motion artefacts. To overcome these limitations, we have integrated undersampled acquisition with image-based navigators and inline non-rigid motion correction to enable a free-breathing, contrast-free Cartesian CMRA framework for the visualization of the thoracic aorta in a short and predictable scan of 3 min. Methods 35 patients with thoracic aortic disease (36 ± 13y, 14 female) were prospectively enrolled in this single-center study. The proposed 3D T2-prepared balanced steady state free precession (bSSFP) sequence with image-based navigator (iNAV) was compared to the clinical 3D T2-prepared bSSFP with diaphragmatic-navigator gating (dNAV), in terms of image acquisition time. Three cardiologists blinded to iNAV vs. dNAV acquisition, recorded image quality scores across four aortic segments and their overall diagnostic confidence. Contrast ratio (CR) and relative standard deviation (RSD) of signal intensity (SI) in the corresponding segments were estimated. Co-axial aortic dimensions in six landmarks were measured by two readers to evaluate the agreement between the two methods, along with inter-observer and intra-observer agreement. Kolmogorov–Smirnov test, Mann–Whitney U (MWU), Bland–Altman analysis (BAA), intraclass correlation coefficient (ICC) were used for statistical analysis. Results The scan time for the iNAV-based approach was significantly shorter (3.1 ± 0.5 min vs. 12.0 ± 3.0 min for dNAV, P = 0.005). Reconstruction was performed inline in 3.0 ± 0.3 min. Diagnostic confidence was similar for the proposed iNAV versus dNAV for all three reviewers (Reviewer 1: 3.9 ± 0.3 vs. 3.8 ± 0.4, P = 0.7; Reviewer 2: 4.0 ± 0.2 vs. 3.9 ± 0.3, P = 0.4; Reviewer 3: 3.8 ± 0.4 vs. 3.7 ± 0.6, P = 0.3). The proposed method yielded higher image quality scores in terms of artefacts from respiratory motion, and non-diagnostic images due to signal inhomogeneity were observed less frequently. While the dNAV approach outperformed the iNAV method in the CR assessment, the iNAV sequence showed improved signal homogeneity along the entire thoracic aorta [RSD SI 5.1 (4.4, 6.5) vs. 6.5 (4.6, 8.6), P = 0.002]. BAA showed a mean difference of < 0.05 cm across the 6 landmarks between the two datasets. ICC showed excellent inter- and intra-observer reproducibility. Conclusions Thoracic aortic iNAV-based CMRA with fast acquisition (~ 3 min) and inline reconstruction (3 min) is proposed, resulting in high diagnostic confidence and reproducible aortic measurements.

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Section: Introductionmentioning

confidence: 99%

Efficient non-contrast enhanced 3D Cartesian cardiovascular magnetic resonance angiography of the thoracic aorta in 3Â min

Fotaki

Muñoz

Emanuel³

et al. 2022

Journal of Cardiovascular Magnetic Resonance

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“…We have previously presented a fully CMR-guided approach to TAVR planning including aortic root sizing, determination of ostial and leaflet distances, and the evaluation of peripheral vascular access routes [32]. Moreover, we showed for the first time the feasibility of a completely non-contrast enhanced CMR protocol and presented a prototype, navigator-free "whole-heart" CMR angiography for TAVR planning [33,34]. According to the presented data, CMR is considered as a safe alternative to CT and TEE in the planning of TAVR procedures by leading experts in the field [12,35,36].…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Cardiac magnetic resonance imaging versus computed tomography to guide transcatheter aortic valve replacement: study protocol for a randomized trial (TAVR-CMR)

Klug

Reinstadler

Troger

et al. 2022

Trials

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Background The standard procedure for the planning of transcatheter aortic valve replacement (TAVR) is the combination of echocardiography, coronary angiography, and cardiovascular computed tomography (TAVR-CT) for the exact determination of the aortic valve dimensions, valve size, and implantation route. However, up to 80% of the patients undergoing TAVR suffer from chronic renal insufficiency. Alternatives to reduce the need for iodinated contrast agents are desirable. Cardiac magnetic resonance (CMR) imaging recently has emerged as such an alternative. Therefore, we aim to investigate, for the first time, the non-inferiority of TAVR-CMR to TAVR-CT regarding efficacy and safety end-points. Methods This is a prospective, randomized, open-label trial. It is planned to include 250 patients with symptomatic severe aortic stenosis scheduled for TAVR based on a local heart-team decision. Patients will be randomized in a 1:1 fashion to receive a predefined TAVR-CMR protocol or to receive a standard TAVR-CT protocol within 2 weeks after inclusion. Follow-up will be performed at hospital discharge after TAVR and after 1 and 2 years. The primary efficacy outcome is device implantation success at discharge. The secondary endpoints are a combined safety endpoint and a combined clinical efficacy endpoint at baseline and at 1 and 2 years, as well as a comparison of imaging procedure related variables. Endpoint definitions are based on the updated 2012 VARC-2 consensus document. Discussion TAVR-CMR might be an alternative to TAVR-CT for planning a TAVR procedure. If proven to be effective and safe, a broader application of TAVR-CMR might reduce the incidence of acute kidney injury after TAVR and thus improve outcomes. Trial registration The trial is registered at ClinicalTrials.gov (NCT03831087). The results will be disseminated at scientific meetings and publication in peer-reviewed journals.

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“…Moreover, we showed for the rst time the feasibility of a completely non-contrast enhanced CMR protocol and presented a prototype, navigator-free "whole-heart" CMR angiography for TAVR planning (33,34). According to the presented data, CMR is considered as a safe alternative to CT and TEE in the planning of TAVR procedures by leading experts in the eld (12,35,36).…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging versus Computed Tomography to Guide Transcatheter Aortic Valve Replacement: Study Protocol for a Randomized Trial (TAVR-CMR)

Klug

Reinstadler

Troger

et al. 2022

Preprint

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Background The standard procedure for the planning of transcatheter aortic valve replacement (TAVR) is the combination of echocardiography, coronary angiography and cardiovascular computed tomography (TAVR-CT) for the exact determination of the aortic valve dimensions, valve size and implantation route. However, up to 80% of the patients undergoing TAVR suffer from chronic renal insufficiency. Alternatives to reduce the need for iodinated contrast agents are desirable. Cardiac magnetic resonance (CMR) imaging recently has emerged as such an alternative. Therefore, we aim to investigate, for the first time, the non-inferiority of TAVR-CMR to TAVR-CT regarding efficacy and safety end-points Methods This is a prospective, randomized, open-label trial. It is planned to include 250 patients with symptomatic severe aortic stenosis scheduled for TAVR based on a local heart-team decision. Patients will be randomized in a 1:1 fashion to receive a predefined TAVR-CMR protocol or to receive a standard TAVR-CT protocol within two weeks after inclusion. Follow-up will be performed at hospital discharge after TAVR and after one and two years. The primary efficacy outcome is device implantation success at discharge. The secondary endpoints are a combined safety endpoint and a combined clinical efficacy endpoint at baseline and at one and two years, as well as a comparison of imaging procedure related variables. Endpoint definitions are based on the updated 2012 VARC-2 consensus document. Discussion TAVR-CMR might be an alternative to TAVR-CT for planning a TAVR procedure. If proven to be effective and safe, a broader application of TAVR-CMR might reduce the incidence of acute kidney injury after TAVR and thus improve outcomes. Trial registration: The trial is registered at ClinicalTrials.gov (NCT03831087). The results will be disseminated at scientific meetings and publication in peer-reviewed journals.

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Self-navigated versus navigator-gated 3D MRI sequence for non-enhanced aortic root measurement in transcatheter aortic valve implantation

Cited by 9 publications

References 30 publications

Efficient non-contrast enhanced 3D Cartesian cardiovascular magnetic resonance angiography of the thoracic aorta in 3Â min

Efficient non-contrast enhanced 3D Cartesian cardiovascular magnetic resonance angiography of the thoracic aorta in 3Â min

Cardiac magnetic resonance imaging versus computed tomography to guide transcatheter aortic valve replacement: study protocol for a randomized trial (TAVR-CMR)

Cardiac Magnetic Resonance Imaging versus Computed Tomography to Guide Transcatheter Aortic Valve Replacement: Study Protocol for a Randomized Trial (TAVR-CMR)

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