Three-Dimensional Imaging of Pulmonary Veins by a Novel Steady-State Free-Precession Magnetic Resonance Angiography Technique Without the Use of Intravenous Contrast Agent

Krishnam, Mayil S.; Tomasian, Anderanik; Malik, Sachin B.; Singhal, Aparna; Sassani, Alex; Laub, Gerhard; Finn, J. Paul; Ruehm, Stefan G.

doi:10.1097/rli.0b013e3181a7c6cb

Cited by 37 publications

(24 citation statements)

References 28 publications

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“…Therefore, the SSFP sequence used in this study with a 60-80 mm axial imaging slab and a selective excitation RF pulse may be a promising alternative approach with shortened imaging time. The PV and LA signal voids described in this study has not been reported in previous investigations (10-12). We speculate the short TR (~2.5ms) enabled by non-selective RF pulses may be a reason for the absence of signal voids in these previous studies.…”

Section: Discussioncontrasting

confidence: 65%

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Noncontrast SSFP pulmonary vein magnetic resonance angiography: Impact of off‐resonance and flow

Stoeck

Smink

et al. 2010

Magnetic Resonance Imaging

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Purpose: To investigate pulmonary vein (PV) off-resonance and blood flow as causes of signal void artifacts in noncontrast steady-state-free-precession (SSFP) PV magnetic resonance angiography (MRA).Materials and Methods: PV blood off-resonance was measured on 11 healthy adult subjects and 10 atrial fibrillation (AF) patients. Noncontrast PV MRA was performed using a 3D slab-selective SSFP sequence at 1.5T on seven healthy subjects with signal profile shifts of 0-125 Hz. The time-resolved blood flow velocity of the PVs was measured on five healthy subjects. The impact of flow was studied on six healthy subjects, on whom SSFP PV MRA was acquired twice with the electrocardiogram (ECG) trigger delay corresponding to low and high flow, respectively. Results:The PV off-resonances were 97 6 27 Hz, 65 6 20 Hz, 74 6 25 Hz, and 52 6 17 Hz for right inferior, left inferior, right superior, and left superior PVs, respectively, on healthy subjects, and 74 6 20 Hz, 38 6 9 Hz, 51 6 20 Hz, and 28 6 11 Hz on AF patients (P<0.01 for all). The off-resonance caused severe signal voids in the PVs. Signal acquired during mid-diastole with high PV flow caused additional signal voids in the left atrium, which was reduced by setting the ECG trigger delay to latediastole.Conclusion: PV off-resonance and flow causes signal void artifacts in noncontrast 3D slab-selective SSFP PV MRA.

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Section: Discussioncontrasting

confidence: 65%

“…Recent reports on non-contrast SSFP PV MRA (10-12) used non-selective RF pulses, high receiver bandwidth, and partial echo to shorten TR and increase SSFP pass-band width. Consequently, imaging has to be performed in the coronal plane with an FOV in the slice-encoding direction of 150-250 mm to prevent aliasing.…”

Section: Discussionmentioning

confidence: 99%

Noncontrast SSFP pulmonary vein magnetic resonance angiography: Impact of off‐resonance and flow

Stoeck

Smink

et al. 2010

Magnetic Resonance Imaging

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“…Casella et al [43] have showed that collateral findings can be detected up to one-third of patients referred to CCT before RFCA allowing diagnosis and treatment of a potentially life-threatening condition in 1.7% of study population. On the other hand, CMR can be performed with time-resolved contrast-enhanced angiography sequence with low dose of gadolinium [25] or without any contrast by using 3D steady-state free procession angiography in case of severe renal impairment [44] and without radiation exposure with a better temporal resolution (ranging between 25 and 50 ms) as compared to CCT. Regarding to the latter, despite the accurate determination of LA size could be particularly challenging in AF patients resulting from electrocardiographic mis-triggering, the higher temporal resolution of CMR could better compensate these artifacts as compared to CCT.…”

Section: Discussionmentioning

confidence: 99%

Comparison of cardiac computed tomography versus cardiac magnetic resonance for characterization of left atrium anatomy before radiofrequency catheter ablation of atrial fibrillation

Andreini

Bertella

Petullà

et al. 2015

International Journal of Cardiology

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“…Image quality, as assessed by visibility and definition of pulmonary veins on the 3D volume acquisition dataset from each study, was graded on a four point scale (Figure 2), similar to scales used in other studies [17,27]: 1: not visualized; 2: poorly defined with blurring such that stenosis or diameter could not be confidently evaluated; 3: well defined with mild blurring only; 4: excellent image quality without blurring. These analyses were performed by two readers blinded to each other, and to HR and rhythm at time of imaging.…”

Section: Methodsmentioning

confidence: 99%

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

Groarke

Waller

Vita

et al. 2014

Journal of Cardiovascular Magnetic Resonance

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BackgroundWe aimed to assess the feasibility of 3 dimensional (3D) respiratory and ECG gated, gadolinium enhanced magnetic resonance angiography (MRA) on a 3 Tesla (3 T) scanner for imaging pulmonary veins (PV) and left atrium (LA). The impact of heart rate (HR) and rhythm irregularity associated with atrial fibrillation (AF) on image and segmentation qualities were also assessed.Methods101 consecutive patients underwent respiratory and ECG gated (ventricular end systolic window) MRA for pre AF ablation imaging. Image quality (assessed by PV delineation) was scored as 1 = not visualized, 2 = poor, 3 = good and 4 = excellent. Segmentation quality was scored on a similar 4 point scale. Signal to noise ratios (SNRs) were calculated for the LA, LA appendage (LAA), and PV. Contrast to noise ratios (CNRs) were calculated between myocardium and LA, LAA and PV, respectively. Associations between HR/rhythm and quality metrics were assessed.Results35 of 101 (34.7%) patients were in AF at time of MRA. 100 (99%) patients had diagnostic studies, and 91 (90.1%) were of good or excellent quality. Overall, mean ± standard deviation (SD) image quality score was 3.40 ± 0.69. Inter observer agreement for image quality scores was substantial, (kappa = 0.68; 95% confidence interval (CI): 0.46, 0.90). Neither HR adjusting for rhythm [odds ratio (OR) = 1.03, 95% CI = 0.98,1.09; p = 0.22] nor rhythm adjusting for HR [OR = 1.25, 95% CI = 0.20, 7.69; p = 0.81] demonstrated association with image quality. Similarly, SNRs and CNRs were largely independent of HR after adjusting for rhythm. Segmentation quality scores were good or excellent for 77.3% of patients: mean ± SD score = 2.91 ± 0.63, and scores did not significantly differ by baseline rhythm (p = 0.78).Conclusions3D respiratory and ECG gated, gadolinium enhanced MRA of the PVs and LA on a 3 T system is feasible during ventricular end systole, achieving high image quality and high quality image segmentation when imported into electroanatomic mapping systems. Quality is independent of HR and heart rhythm for this free breathing, radiation free, alternative strategy to current MRA or CT based approaches, for pre AF ablation imaging of PVs and LA.

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Three-Dimensional Imaging of Pulmonary Veins by a Novel Steady-State Free-Precession Magnetic Resonance Angiography Technique Without the Use of Intravenous Contrast Agent

Cited by 37 publications

References 28 publications

Noncontrast SSFP pulmonary vein magnetic resonance angiography: Impact of off‐resonance and flow

Noncontrast SSFP pulmonary vein magnetic resonance angiography: Impact of off‐resonance and flow

Comparison of cardiac computed tomography versus cardiac magnetic resonance for characterization of left atrium anatomy before radiofrequency catheter ablation of atrial fibrillation

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

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