Whole-heart coronary MR angiography using image-based navigation for the detection of coronary anomalies in adult patients with congenital heart disease

Background The purpose of this study was to evaluate a recently developed two-dimensional (2D) image-based navigation approach (iNAV_G+C) combined with respiratory bellows gating for CMRA in patients with congenital heart disease. Methods Nine healthy volunteers (mean age 32 ± 6 years [standard deviation]) and 29 patients (28 ± 9 years) were scanned on a 1.5 Tesla clinical scanner using iNAV_G+C motion compensated T2prepared CMRA, and the conventional 1D NAV approach. Scan time was recorded for each CMRA scan. An image quality score was given to each coronary artery from (0, uninterpretable; to 4, excellent image quality). Additionally, vessel sharpness of each coronary artery was measured. Results Average scan time was significantly shorter (P < 0.01) using the proposed iNAVC+G approach (7:57 ± 1:34) compared with 1D NAV (9:15 ± 3:02). Improved visual scores of the right coronary artery (iNAV_G+C: 4,3,4 (median, 25th percentile, 75th percentile) versus 1D NAV: 3,3,4; P < 0.001) and left anterior descending artery (iNAV_G+C: 3,3,4 versus 1D NAV: 3,2,3; P < 0.001) were obtained using iNAV_G+C compared with 1D NAV as well as an increased vessel sharpness of the right coronary artery (iNAV_G+C: 65.3% ± 6.6% (mean ± standard deviation) versus 1D NAV: 60.2% ± 11.4%; P < 0.05) and left anterior descending artery (iNAV_G+C: 63.2% ± 6.7% versus 1D NAV: 58.3% ± 9.5%; P < 0.05). Conclusion Image-based navigation in combination with respiratory bellows gating allows for more robust suppression of respiratory motion artifacts for whole-heart CMRA compared with conventional 1D NAV as images can be acquired in a shorter time and with improved image quality.