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

Mari Nieves Velasco Forte, Israel Valverde, Nanda Prabhu, Teresa Correia, Srinivas Ananth Narayan, Aaron Bell, Sujeev Mathur, Reza Razavi, Mohammad T Hussain, Kuberan Pushparajah, Markus Henningsson

Research output: Contribution to journalArticle

Abstract

Aims: 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. Methods: 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. Results: 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). Conclusion: 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.

Original languageEnglish (US)
Article number13
JournalJournal of Cardiovascular Magnetic Resonance
Volume21
Issue number1
DOIs
StatePublished - Feb 25 2019

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Magnetic Resonance Angiography
Coronary Angiography
Coronary Vessels
Pediatrics
Patient Navigation
General Anesthesia
Contrast Media
Heart Diseases
Weights and Measures

Keywords

  • Coronary artery disease
  • Coronary magnetic resonance angiography
  • Image-based navigation
  • Respiratory motion compensation

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

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. / Velasco Forte, Mari Nieves; Valverde, Israel; Prabhu, Nanda; Correia, Teresa; Narayan, Srinivas Ananth; Bell, Aaron; Mathur, Sujeev; Razavi, Reza; Hussain, Mohammad T; Pushparajah, Kuberan; Henningsson, Markus.

In: Journal of Cardiovascular Magnetic Resonance, Vol. 21, No. 1, 13, 25.02.2019.

Research output: Contribution to journalArticle

Velasco Forte, Mari Nieves ; Valverde, Israel ; Prabhu, Nanda ; Correia, Teresa ; Narayan, Srinivas Ananth ; Bell, Aaron ; Mathur, Sujeev ; Razavi, Reza ; Hussain, Mohammad T ; Pushparajah, Kuberan ; Henningsson, Markus. / 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. In: Journal of Cardiovascular Magnetic Resonance. 2019 ; Vol. 21, No. 1.
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abstract = "Aims: 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. Methods: 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. Results: 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). Conclusion: 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.",
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T2 - comparison of image-navigation and the standard approach for respiratory motion compensation

AU - Velasco Forte, Mari Nieves

AU - Valverde, Israel

AU - Prabhu, Nanda

AU - Correia, Teresa

AU - Narayan, Srinivas Ananth

AU - Bell, Aaron

AU - Mathur, Sujeev

AU - Razavi, Reza

AU - Hussain, Mohammad T

AU - Pushparajah, Kuberan

AU - Henningsson, Markus

PY - 2019/2/25

Y1 - 2019/2/25

N2 - Aims: 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. Methods: 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. Results: 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). Conclusion: 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.

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KW - Coronary artery disease

KW - Coronary magnetic resonance angiography

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KW - Respiratory motion compensation

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