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mDixon ECG-gated 3-dimensional cardiovascular magnetic resonance angiography in patients with congenital cardiovascular disease.
Journal of Cardiovascular Magnetic Resonance ( IF 6.4 ) Pub Date : 2019-08-08 , DOI: 10.1186/s12968-019-0554-3
Soultana Kourtidou 1 , Marty R Jones 2 , Ryan A Moore 3 , Justin T Tretter 3 , Nicholas J Ollberding 4 , Eric J Crotty 5 , Mantosh S Rattan 5 , Robert J Fleck 5 , Michael D Taylor 3
Affiliation  

BACKGROUND Cardiovascular magnetic resonance (CMR) angiography (CMRA) is an important non-invasive imaging tool for congenital heart disease (CHD) and aortopathy patients. The conventional 3D balanced steady-state free precession (bSSFP) sequence is often confounded by imaging artifacts. We sought to compare the respiratory navigated and electrocardiogram (ECG) gated modified Dixon (mDixon) CMRA sequence to conventional non-gated dynamic multi-phase contrast enhanced CMRA (CE-CMRA) and bSSFP across a variety of diagnoses. METHODS We included 24 patients with CHD or aortopathy with CMR performed between September 2017 to December 2017. Each patient had undergone CE-CMRA, followed by a bSSFP and mDixon angiogram. Patients with CMR-incompatible implants or contraindications to contrast were excluded. The studies were rated according to image quality at a scale from 1 (poor) to 4 (excellent) based on diagnostic adequacy, artifact burden, vascular border delineation, myocardium-blood pool contrast, and visualization of pulmonary and systemic veins and coronaries. Contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and quantitative vascular measurements were compared between the two gated sequences. Bland-Altman plots were generated to compare paired measures. RESULTS All scans were diagnostically adequate. Mean (SD) quality scores were 3.4 (0.7) for the mDixon, 3.2 (0.5) for the bSSFP and 3.4 (0.5) for the CE-CMRA. Qualitatively, the intracardiac anatomy and myocardium-blood pool definition were better in the bSSFP; however, mDixon images showed enhanced vessel wall sharpness with less blurring surrounding the anatomical borders distally. Coronary origins were identified in all cases. Pulmonary veins were visualized in 92% of mDixon sequences, 75% of bSSFP and 96% of CE-CMRA. Similarly, neck veins were identified in 92, 83 and 96% respectively. Artifacts prevented vascular measurement in 6/192 (3%) and 4/192 (2%) of total vascular measurements for the mDixon and bSSFP, respectively. However, the size of signal void and field distortion were significantly worse in the latter, particularly for flow and metal induced artifacts. CONCLUSION In patients with congenital heart disease, ECG gated mDixon angiography yields high fidelity vascular images including better delineation of head and neck vasculature and pulmonary veins and fewer artifacts than the comparable bSSFP sequence. It should be considered as the preferred strategy for successful CHD imaging in patients with valve stenosis, vascular stents, or metallic implants.

中文翻译:

先天性心血管疾病患者的mDixon ECG门控3维心血管磁共振血管造影。

背景技术心血管磁共振(CMR)血管造影术(CMRA)是用于先天性心脏病(CHD)和主动脉病患者的重要的非侵入性成像工具。传统的3D平衡稳态自由进动(bSSFP)序列通常会与成像伪影混淆。我们试图在各种诊断中将呼吸导航和心电图(ECG)门控改良的Dixon(mDixon)CMRA序列与传统的非门控动态多相对比增强CMRA(CE-CMRA)和bSSFP进行比较。方法我们纳入了2017年9月至2017年12月进行的24例CHD或主动脉病CMR患者。每例患者均接受了CE-CMRA,然后进行了bSSFP和mDixon血管造影。排除了与CMR不兼容的植入物或对比禁忌症的患者。根据诊断的充分性,伪影负担,血管边界划定,心肌-血池对比以及肺和全身静脉和冠状动脉的可视化,根据图像质量在1(差)至4(优秀)的范围内对研究进行评级。比较了两个门控序列之间的对比噪声比(CNR),信噪比(SNR)和定量血管测量结果。生成了Bland-Altman图以比较成对的度量。结果所有扫描结果在诊断上都是足够的。mDixon的平均(SD)质量得分为3.4(0.7),bSSFP的平均(SD)质量得分为3.2(0.5),CE-CMRA的平均质量得分为3.4(0.5)。定性地,在bSSFP中,心内解剖和心肌血库的定义更好。然而,mDixon图像显示增强的血管壁清晰度,并且远端解剖边界周围的模糊较少。在所有情况下均确定了冠状动脉起源。在92%的mDixon序列,75%的bSSFP和96%的CE-CMRA中可以看到肺静脉。同样,分别在92%,83%和96%的人群中发现了颈静脉。伪影分别阻止了mDixon和bSSFP的总血管测量的6/192(3%)和4/192(2%)的血管测量。然而,在后者中,信号空隙的大小和场失真显着恶化,尤其是对于流动和金属引起的伪像。结论对于先天性心脏病患者,ECG门控mDixon血管造影可产生高保真度的血管图像,与可比较的bSSFP序列相比,可更好地描绘头颈部血管和肺静脉,并减少伪影。对于瓣膜狭窄,血管支架或金属植入物的患者,应将其视为成功进行CHD成像的首选策略。
更新日期:2019-08-08
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