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Inversion recovery and saturation recovery pulmonary vein MR angiography using an image based navigator fluoro trigger and variable-density 3D cartesian sampling with spiral-like order

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Abstract

Contrast enhanced pulmonary vein magnetic resonance angiography (PV CE-MRA) has value in atrial ablation pre-procedural planning. We aimed to provide high fidelity, ECG gated PV CE-MRA accelerated by variable density Cartesian sampling (VD-CASPR) with image navigator (iNAV) respiratory motion correction acquired in under 4 min. We describe its use in part during the global iodinated contrast shortage. VD-CASPR/iNAV framework was applied to ECG-gated inversion and saturation recovery gradient recalled echo PV CE-MRA in 65 patients (66 exams) using .15 mmol/kg Gadobutrol. Image quality was assessed by three physicians, and anatomical segmentation quality by two technologists. Left atrial SNR and left atrial/myocardial CNR were measured. 12 patients had CTA within 6 months of MRA. Two readers assessed PV ostial measurements versus CTA for intermodality/interobserver agreement. Inter-rater/intermodality reliability, reproducibility of ostial measurements, SNR/CNR, image, and anatomical segmentation quality was compared. The mean acquisition time was 3.58 ± 0.60 min. Of 35 PV pre-ablation datasets (34 patients), mean anatomical segmentation quality score was 3.66 ± 0.54 and 3.63 ± 0.55 as rated by technologists 1 and 2, respectively (p = 0.7113). Good/excellent anatomical segmentation quality (grade 3/4) was seen in 97% of exams. Each rated one exam as moderate quality (grade 2). 95% received a majority image quality score of good/excellent by three physicians. Ostial PV measurements correlated moderate to excellently with CTA (ICCs range 0.52–0.86). No difference in SNR was observed between IR and SR. High quality PV CE-MRA is possible in under 4 min using iNAV bolus timing/motion correction and VD-CASPR.

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Abbreviations

bSSFP:

Balanced steady-state free precession

CE-MRA:

Contrast enhanced magnetic resonance angiography

CNR:

Contrast to noise

CTA:

Computed tomography angiography

dNAV:

Diaphragmatic navigator

GBCA:

Gadolinium based contrast agent

iNAV:

Image based navigator

IPAT:

Integrated parallel acquisition techniques

IR GRE:

Inversion recovery gradient recalled echo

Dixon GRE:

Inversion recovery Dixon gradient recalled echo

PV MRA:

Pulmonary vein magnetic resonance angiography

MRA:

Magnetic resonance angiography

MRI:

Magnetic resonance imaging

LA:

Left atrial

LGE:

Late gadolinium enhancement

SNR:

Signal to noise

SR GRE:

Saturation recovery gradient recalled echo

VD-CASPR:

Variable-density 3D Cartesian sampling with spiral-like order

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Acknowledgements

Drs Eddy Barasch, Haoyi Zheng, Lu Chen, Lin Wang, Praveena Paruchuri, Dennis Mihalatos, Kathleen Stergiopoulos, Jane Cao, and Kana Fujikura for providing clinical support. Dr Orlando Simonetti for his feedback on submission quality.

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Author notes

  1. Claudia Prieto and Rene M. Botnar Senior both serve as senior authors.

Authors and Affiliations

  1. Division of Cardiovascular Imaging, DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, 101 Northern Blvd, Greenvale, NY, 11548, USA

    Jason Craft, Jonathan Weber, Yulee Li, Joshua Y. Cheng, Nancy Diaz, Marie Grgas, Suzanne Weber, John Tang, Roosha Parikh, Afiachukwu Onuegbu, Ann-Marie Yamashita, Elizabeth Haag, Cristian B. Espada, Leana Figueroa, Jonathan A. Rothbaum & Omar K. Khalique

  2. MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK

    Karl P. Kunze

  3. Siemens Healthineers, Erlangen, Germany

    Michaela Schmidt

  4. Biosense Webster Incorporated, Irvine, CA, USA

    Daniel Fuentes & Michael Czipo

  5. School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK

    Radhouene Neji, Claudia Prieto & Rene M. Botnar

  6. Division of Cardiology, NYU Grossman School of Medicine, New York, NY, USA

    Kana Fujikura

  7. Department of Nephrology and Hypertension, Stony Brook University Hospital, New York, NY, 11794, USA

    Ruqiyya Bano

  8. School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile

    Claudia Prieto

  9. Institute of Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile

    Rene M. Botnar

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  1. Jason Craft
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Contributions

JC- manuscript lead/main author, study design (MR parameters, MR protocol, injection protocol, post-processing), supervising physician. JW/JAR/LF/CBE-statistical analysis, preparations of chart/tables. YL-preparation of figures. SW- project management, patient recruitment, nursing supervisor. MG- project management, project coordination, patient recruitment, data management. CP/RMB/KPK/RN/MS- sequence concept and design, physicist level support of project. RMB and CP substantially contributed to the revision of the manuscript. JT- data management, project management, database design. EH-protocol preparation, project management, project coordination. RP-expert opinion on image quality. AO- expert opinion on image quality, ostial measurements. OKK- expert opinion on image quality. KF-expert opinion on image quality, ostial measurements. MC-expert opinion on segmentation quality. DF- expert opinion on segmentation quality. JYC- patient management, chief MR operator, MR protocol design and implementation, MR supervision. ND/AY- patient management, MR operator, protocol training and MR supervision. All authors participated in manuscript revision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jason Craft.

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Funding

This manuscript was funded by an endowment from the St. Francis Hospital Foundation.

Competing interests

MG/EH/ND/JYC/SW/JW/AO/RP/JT/AY/OKK/CP/RMB/JAR/CBE/LF/KF have no competing interest.

Financial interests

OKK has no disclosures relevant to contents of this manuscript. General disclosures: consultant, Edwards Lifesciences, Croivalve, Philips Healthcare, Cardiac Implants, Restore Medical. Equity, Cardiac Implants, Triflo. JTC has no disclosures relevant to the contents of this manuscript. General disclosures: honorarium from Philips Healthcare. MS, KPK and RN are employees of Siemens Healthcare MC and DF are employees of Biosense Webster Incorporated.

Ethics approval

The study protocol was approved by the Saint Francis Hospital IRB, Roslyn NY as reference # 19–27.

Consent to participate

Informed consent, or waiver of informed consent was provided for each MRA exam.

Consent to publish

The authors affirm that human research participants provided informed consent for publication of the images in Figs. 3 , 4, 5, 6 and 7.

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Craft, J., Weber, J., Li, Y. et al. Inversion recovery and saturation recovery pulmonary vein MR angiography using an image based navigator fluoro trigger and variable-density 3D cartesian sampling with spiral-like order. Int J Cardiovasc Imaging (2024). https://doi.org/10.1007/s10554-024-03111-0

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