Improved coronary magnetic resonance angiography using gadobenate dimeglumine in pediatric congenital heart disease

Miguel Silva Vieira, Markus Henningsson, Nathalie Dedieu, Vassilios S. Vassiliou, Aaron Bell, Sujeev Mathur, Kuberan Pushparajah, Carlos Alberto Figueroa, Tarique Hussain, René Botnar, Gerald F. Greil

Research output: Contribution to journalArticle

Abstract

Background: CMRA in pediatrics remains challenging due to the smaller vessel size, high heart rates (HR), potential image degradation caused by limited patient cooperation and long acquisition times. High-relaxivity contrast agents have been shown to improve coronary imaging in adults, but limited data is available in children. We sought to investigate whether gadobenate dimeglumine (Gd-BOPTA) together with self-navigated inversion-prepared coronary magnetic resonance angiography (CMRA) sequence design improves coronary image quality in pediatric patients. Methods: Forty consecutive patients (mean age 6 ± 2.8 years; 73% males) were prospectively recruited for a 1.5-T MRI study under general anesthesia. Two electrocardiographic-triggered free breathing steady-state free precession (SSFP) angiography sequences (A and B) with isotropic spatial resolution (1.3 mm3) were acquired using a recently developed image-based self-navigation technique. Sequence A was acquired prior to contrast administration using T2 magnetization preparation (T2prep). Sequence B was acquired 5–8 min after a bolus of Gd-BOPTA with the T2prep replaced by an inversion recovery (IR) pulse to null the signal from the myocardium. Scan time, signal-to noise and contrast-to-noise ratios (SNR and CNR), vessel wall sharpness (VWS) and qualitative visual score for each sequence were compared. Results: Scan time was similar for both sequences (5.3 ± 1.8 vs 5.2 ± 1.5 min, p =.532) and average heart rate (78 ± 14.7 vs 78 ± 14.5 bpm, p =.443) remained constant throughout both acquisitions. Sequence B resulted in higher SNR (12.6 ± 4.4 vs 31.1 ± 7.4, p <.001) and CNR (9.0 ± 1.8 vs 13.5 ± 3.7, p <.001) and provided improved coronary visualization in all coronary territories (VWS A = 0.53 ± 0.07 vs B = 0.56 ± 0.07, p =.001; and visual scoring A = 3.8 ± 0.59 vs B = 4.1 ± 0.53, p <.001). The number of non-diagnostic coronary segments was lower for sequence B [A = 42 (13.1%) segments vs B = 33 (10.3%) segments; p =.002], and contrary to the pre-contrast sequence, never involved a proximal segment. These results were independent of the patients’ age, body surface area and HR. Conclusions: The use of Gd-BOPTA with a 3D IR SSFP CMRA sequence results in improved coronary visualization in small infants and young children with high HR within a clinically acceptable scan time.

Original languageEnglish (US)
Pages (from-to)47-54
Number of pages8
JournalMagnetic Resonance Imaging
Volume49
DOIs
StatePublished - Jun 1 2018

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Pediatrics
Angiography
Magnetic Resonance Angiography
Magnetic resonance
Coronary Angiography
Heart Diseases
Heart Rate
Noise
Magnetization
Visualization
Recovery
Body Surface Area
Patient Compliance
Magnetic resonance imaging
General Anesthesia
Image quality
Contrast Media
Pulse
Coronary Vessels
Myocardium

Keywords

  • Coronary magnetic resonance angiography
  • Gadobenate dimeglumine
  • Pediatric congenital heart disease
  • Respiratory image-based navigation

ASJC Scopus subject areas

  • Biophysics
  • Biomedical Engineering
  • Radiology Nuclear Medicine and imaging

Cite this

Improved coronary magnetic resonance angiography using gadobenate dimeglumine in pediatric congenital heart disease. / Silva Vieira, Miguel; Henningsson, Markus; Dedieu, Nathalie; Vassiliou, Vassilios S.; Bell, Aaron; Mathur, Sujeev; Pushparajah, Kuberan; Figueroa, Carlos Alberto; Hussain, Tarique; Botnar, René; Greil, Gerald F.

In: Magnetic Resonance Imaging, Vol. 49, 01.06.2018, p. 47-54.

Research output: Contribution to journalArticle

Silva Vieira, M, Henningsson, M, Dedieu, N, Vassiliou, VS, Bell, A, Mathur, S, Pushparajah, K, Figueroa, CA, Hussain, T, Botnar, R & Greil, GF 2018, 'Improved coronary magnetic resonance angiography using gadobenate dimeglumine in pediatric congenital heart disease', Magnetic Resonance Imaging, vol. 49, pp. 47-54. https://doi.org/10.1016/j.mri.2017.12.023
Silva Vieira, Miguel ; Henningsson, Markus ; Dedieu, Nathalie ; Vassiliou, Vassilios S. ; Bell, Aaron ; Mathur, Sujeev ; Pushparajah, Kuberan ; Figueroa, Carlos Alberto ; Hussain, Tarique ; Botnar, René ; Greil, Gerald F. / Improved coronary magnetic resonance angiography using gadobenate dimeglumine in pediatric congenital heart disease. In: Magnetic Resonance Imaging. 2018 ; Vol. 49. pp. 47-54.
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title = "Improved coronary magnetic resonance angiography using gadobenate dimeglumine in pediatric congenital heart disease",
abstract = "Background: CMRA in pediatrics remains challenging due to the smaller vessel size, high heart rates (HR), potential image degradation caused by limited patient cooperation and long acquisition times. High-relaxivity contrast agents have been shown to improve coronary imaging in adults, but limited data is available in children. We sought to investigate whether gadobenate dimeglumine (Gd-BOPTA) together with self-navigated inversion-prepared coronary magnetic resonance angiography (CMRA) sequence design improves coronary image quality in pediatric patients. Methods: Forty consecutive patients (mean age 6 ± 2.8 years; 73{\%} males) were prospectively recruited for a 1.5-T MRI study under general anesthesia. Two electrocardiographic-triggered free breathing steady-state free precession (SSFP) angiography sequences (A and B) with isotropic spatial resolution (1.3 mm3) were acquired using a recently developed image-based self-navigation technique. Sequence A was acquired prior to contrast administration using T2 magnetization preparation (T2prep). Sequence B was acquired 5–8 min after a bolus of Gd-BOPTA with the T2prep replaced by an inversion recovery (IR) pulse to null the signal from the myocardium. Scan time, signal-to noise and contrast-to-noise ratios (SNR and CNR), vessel wall sharpness (VWS) and qualitative visual score for each sequence were compared. Results: Scan time was similar for both sequences (5.3 ± 1.8 vs 5.2 ± 1.5 min, p =.532) and average heart rate (78 ± 14.7 vs 78 ± 14.5 bpm, p =.443) remained constant throughout both acquisitions. Sequence B resulted in higher SNR (12.6 ± 4.4 vs 31.1 ± 7.4, p <.001) and CNR (9.0 ± 1.8 vs 13.5 ± 3.7, p <.001) and provided improved coronary visualization in all coronary territories (VWS A = 0.53 ± 0.07 vs B = 0.56 ± 0.07, p =.001; and visual scoring A = 3.8 ± 0.59 vs B = 4.1 ± 0.53, p <.001). The number of non-diagnostic coronary segments was lower for sequence B [A = 42 (13.1{\%}) segments vs B = 33 (10.3{\%}) segments; p =.002], and contrary to the pre-contrast sequence, never involved a proximal segment. These results were independent of the patients’ age, body surface area and HR. Conclusions: The use of Gd-BOPTA with a 3D IR SSFP CMRA sequence results in improved coronary visualization in small infants and young children with high HR within a clinically acceptable scan time.",
keywords = "Coronary magnetic resonance angiography, Gadobenate dimeglumine, Pediatric congenital heart disease, Respiratory image-based navigation",
author = "{Silva Vieira}, Miguel and Markus Henningsson and Nathalie Dedieu and Vassiliou, {Vassilios S.} and Aaron Bell and Sujeev Mathur and Kuberan Pushparajah and Figueroa, {Carlos Alberto} and Tarique Hussain and Ren{\'e} Botnar and Greil, {Gerald F.}",
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TY - JOUR

T1 - Improved coronary magnetic resonance angiography using gadobenate dimeglumine in pediatric congenital heart disease

AU - Silva Vieira, Miguel

AU - Henningsson, Markus

AU - Dedieu, Nathalie

AU - Vassiliou, Vassilios S.

AU - Bell, Aaron

AU - Mathur, Sujeev

AU - Pushparajah, Kuberan

AU - Figueroa, Carlos Alberto

AU - Hussain, Tarique

AU - Botnar, René

AU - Greil, Gerald F.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: CMRA in pediatrics remains challenging due to the smaller vessel size, high heart rates (HR), potential image degradation caused by limited patient cooperation and long acquisition times. High-relaxivity contrast agents have been shown to improve coronary imaging in adults, but limited data is available in children. We sought to investigate whether gadobenate dimeglumine (Gd-BOPTA) together with self-navigated inversion-prepared coronary magnetic resonance angiography (CMRA) sequence design improves coronary image quality in pediatric patients. Methods: Forty consecutive patients (mean age 6 ± 2.8 years; 73% males) were prospectively recruited for a 1.5-T MRI study under general anesthesia. Two electrocardiographic-triggered free breathing steady-state free precession (SSFP) angiography sequences (A and B) with isotropic spatial resolution (1.3 mm3) were acquired using a recently developed image-based self-navigation technique. Sequence A was acquired prior to contrast administration using T2 magnetization preparation (T2prep). Sequence B was acquired 5–8 min after a bolus of Gd-BOPTA with the T2prep replaced by an inversion recovery (IR) pulse to null the signal from the myocardium. Scan time, signal-to noise and contrast-to-noise ratios (SNR and CNR), vessel wall sharpness (VWS) and qualitative visual score for each sequence were compared. Results: Scan time was similar for both sequences (5.3 ± 1.8 vs 5.2 ± 1.5 min, p =.532) and average heart rate (78 ± 14.7 vs 78 ± 14.5 bpm, p =.443) remained constant throughout both acquisitions. Sequence B resulted in higher SNR (12.6 ± 4.4 vs 31.1 ± 7.4, p <.001) and CNR (9.0 ± 1.8 vs 13.5 ± 3.7, p <.001) and provided improved coronary visualization in all coronary territories (VWS A = 0.53 ± 0.07 vs B = 0.56 ± 0.07, p =.001; and visual scoring A = 3.8 ± 0.59 vs B = 4.1 ± 0.53, p <.001). The number of non-diagnostic coronary segments was lower for sequence B [A = 42 (13.1%) segments vs B = 33 (10.3%) segments; p =.002], and contrary to the pre-contrast sequence, never involved a proximal segment. These results were independent of the patients’ age, body surface area and HR. Conclusions: The use of Gd-BOPTA with a 3D IR SSFP CMRA sequence results in improved coronary visualization in small infants and young children with high HR within a clinically acceptable scan time.

AB - Background: CMRA in pediatrics remains challenging due to the smaller vessel size, high heart rates (HR), potential image degradation caused by limited patient cooperation and long acquisition times. High-relaxivity contrast agents have been shown to improve coronary imaging in adults, but limited data is available in children. We sought to investigate whether gadobenate dimeglumine (Gd-BOPTA) together with self-navigated inversion-prepared coronary magnetic resonance angiography (CMRA) sequence design improves coronary image quality in pediatric patients. Methods: Forty consecutive patients (mean age 6 ± 2.8 years; 73% males) were prospectively recruited for a 1.5-T MRI study under general anesthesia. Two electrocardiographic-triggered free breathing steady-state free precession (SSFP) angiography sequences (A and B) with isotropic spatial resolution (1.3 mm3) were acquired using a recently developed image-based self-navigation technique. Sequence A was acquired prior to contrast administration using T2 magnetization preparation (T2prep). Sequence B was acquired 5–8 min after a bolus of Gd-BOPTA with the T2prep replaced by an inversion recovery (IR) pulse to null the signal from the myocardium. Scan time, signal-to noise and contrast-to-noise ratios (SNR and CNR), vessel wall sharpness (VWS) and qualitative visual score for each sequence were compared. Results: Scan time was similar for both sequences (5.3 ± 1.8 vs 5.2 ± 1.5 min, p =.532) and average heart rate (78 ± 14.7 vs 78 ± 14.5 bpm, p =.443) remained constant throughout both acquisitions. Sequence B resulted in higher SNR (12.6 ± 4.4 vs 31.1 ± 7.4, p <.001) and CNR (9.0 ± 1.8 vs 13.5 ± 3.7, p <.001) and provided improved coronary visualization in all coronary territories (VWS A = 0.53 ± 0.07 vs B = 0.56 ± 0.07, p =.001; and visual scoring A = 3.8 ± 0.59 vs B = 4.1 ± 0.53, p <.001). The number of non-diagnostic coronary segments was lower for sequence B [A = 42 (13.1%) segments vs B = 33 (10.3%) segments; p =.002], and contrary to the pre-contrast sequence, never involved a proximal segment. These results were independent of the patients’ age, body surface area and HR. Conclusions: The use of Gd-BOPTA with a 3D IR SSFP CMRA sequence results in improved coronary visualization in small infants and young children with high HR within a clinically acceptable scan time.

KW - Coronary magnetic resonance angiography

KW - Gadobenate dimeglumine

KW - Pediatric congenital heart disease

KW - Respiratory image-based navigation

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