Visualization of coronary arteries in paediatric patients using whole-heart coronary magnetic resonance angiography: comparison of image-navigation and the standard approach for respiratory motion compensation

• Published in: Journal of cardiovascular magnetic resonance Vol. 21; no. 1; pp. 13 - 9
• Main Authors: Velasco Forte, Mari Nieves, Valverde, Israel, Prabhu, Nanda, Correia, Teresa, Narayan, Srinivas Ananth, Bell, Aaron, Mathur, Sujeev, Razavi, Reza, Hussain, Tarique, Pushparajah, Kuberan, Henningsson, Markus
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 25.02.2019; BioMed Central; Elsevier
• Subjects: Adolescent; Anesthesia; Angiography; Arteries; Cardiovascular disease; Care and treatment; Child; Child, Preschool; Congenital diseases; Contrast agents; Contrast media; Contrast Media - administration & dosage; Coronary artery; Coronary artery disease; Coronary magnetic resonance angiography; Coronary vessels; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Diagnostic imaging; Echoes; Efficiency; Female; Gadobutrol; Gadoterate meglumine; Gating; Genetic disorders; Heart; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - physiopathology; Heart diseases; Humans; Image acquisition; Image quality; Image-based navigation; Infant; Magnetic resonance; Magnetic Resonance Angiography; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine; Male; Medical imaging; Medical research; Meglumine - administration & dosage; Morphology; Motion compensation; NMR; Nuclear magnetic resonance; Organometallic Compounds - administration & dosage; Patients; Pediatric research; Pediatrics; Predictive Value of Tests; Quality; Reproducibility of Results; Respiration; Respiratory motion compensation; Sharpness; Time Factors; Visualization; Weight; Workflow; Respiratory motion compensation; Image-based navigation; Coronary artery disease; Coronary magnetic resonance angiography
• ISSN: 1097-6647; 1532-429X; 1532-429X
• DOI: 10.1186/s12968-019-0525-8

To investigate the use of respiratory motion compensation using image-based navigation (iNAV) with constant respiratory efficiency using single end-expiratory thresholding (CRUISE) for coronary magnetic resonance angiography (CMRA), and compare it to the conventional diaphragmatic navigator (dNAV) in paediatric patients with congenital or suspected heart disease. iNAV allowed direct tracking of the respiratory heart motion and was generated using balanced steady state free precession startup echoes. Respiratory gating was achieved using CRUISE with a fixed 50% efficiency. Whole-heart CMRA was acquired with 1.3 mm isotropic resolution. For comparison, CMRA with identical imaging parameters were acquired using dNAV. Scan time, visualization of coronary artery origins and mid-course, imaging quality and sharpness was compared between the two sequences. Forty patients (13 females; median weight: 44 kg; median age: 12.6, range: 3 months-17 years) were enrolled. 25 scans were performed in awake patients. A contrast agent was used in 22 patients. The scan time was significantly reduced using iNAV for awake patients (iNAV 7:48 ± 1:26 vs dNAV 9:48 ± 3:11, P = 0.01) but not for patients under general anaesthesia (iNAV = 6:55 ± 1:50 versus dNAV = 6:32 ± 2:16; P = 0.32). In 98% of the cases, iNAV image quality had an equal or higher score than dNAV. The visual score analysis showed a clear difference, favouring iNAV (P = 0.002). The right coronary artery and the left anterior descending vessel sharpness was significantly improved (iNAV: 56.8% ± 10.1% vs dNAV: 53.7% ± 9.9%, P < 0.002 and iNAV: 55.8% ± 8.6% vs dNAV: 53% ± 9.2%, P = 0.001, respectively). iNAV allows for a higher success-rate and clearer depiction of the mid-course of coronary arteries in paediatric patients. Its acquisition time is shorter in awake patients and image quality score is equal or superior to the conventional method in most cases.