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A non-contrast self-navigated 3-dimensional MR technique for aortic root and vascular access route assessment in the context of transcatheter aortic valve replacement: proof of concept

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Due to the high prevalence of renal failure in transcatheter aortic valve replacement (TAVR) candidates, a non-contrast MR technique is desirable for pre-procedural planning. We sought to evaluate the feasibility of a novel, non-contrast, free-breathing, self-navigated three-dimensional (SN3D) MR sequence for imaging the aorta from its root to the iliofemoral run-off in comparison to non-contrast two-dimensional-balanced steady-state free-precession (2D-bSSFP) imaging.

Methods

SN3D [field of view (FOV), 220-370 mm3; slice thickness, 1.15 mm; repetition/echo time (TR/TE), 3.1/1.5 ms; and flip angle, 115°] and 2D-bSSFP acquisitions (FOV, 340 mm; slice thickness, 6 mm; TR/TE, 2.3/1.1 ms; flip angle, 77°) were performed in 10 healthy subjects (all male; mean age, 30.3 ± 4.3 yrs) using a 1.5-T MRI system. Aortic root measurements and qualitative image ratings (four-point Likert-scale) were compared.

Results

The mean effective aortic annulus diameter was similar for 2D-bSSFP and SN3D (26.7 ± 0.7 vs. 26.1 ± 0.9 mm, p = 0.23). The mean image quality of 2D-bSSFP (4; IQR 3-4) was rated slightly higher (p = 0.03) than SN3D (3; IQR 2-4). The mean total acquisition time for SN3D imaging was 12.8 ± 2.4 min.

Conclusions

Our results suggest that a novel SN3D sequence allows rapid, free-breathing assessment of the aortic root and the aortoiliofemoral system without administration of contrast medium.

Key Points

• The prevalence of renal failure is high among TAVR candidates.

• Non-contrast 3D MR angiography allows for TAVR procedure planning.

• The self-navigated sequence provides a significantly reduced scanning time.

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Abbreviations

2D-bSSFP:

two-dimensional balanced steady-state free-precession

3D:

three-dimensional

CNR:

contrast-to-noise ratio

CT:

computed tomography

Deff :

effective diameter

FOV:

field of view

MR:

magnetic resonance

ROI:

region of interest

SI:

signal intensity

SN3D:

self-navigated 3-dimenasional

TAVR:

transcatheter aortic valve replacement

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Acknowledgments

The scientific guarantor of this publication is UJS. The authors of this manuscript declare relationships with the following companies: UJS is a consultant for and/or receives research support from Bayer, Bracco, GE Healthcare, Medrad, and Siemens Healthcare. DHS is a consultant for St. Jude Medical. HM receives lecture fees from St. Jude Medical. DP and EM are employees of Siemens Healthcare Germany. WGR and MOZ are employees of Siemens Healthcare USA. The other authors declare that they have no competing interests. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects in this study. None of the study subjects or cohorts have been previously reported. Methodology: prospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA

    Matthias Renker, Akos Varga-Szemes, U. Joseph Schoepf, Stefan Baumann, Jeremy D. Rier, Daniel H. Steinberg & Carlo N. De Cecco

  2. Department of Medicine I, University Hospital Giessen and Marburg, Giessen, Germany

    Matthias Renker & Christian W. Hamm

  3. 1st Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany

    Stefan Baumann

  4. Advanced Clinical Imaging Technology, Siemens Healthcare IM BM PI, Lausanne, Switzerland

    Davide Piccini

  5. Department of Radiology, University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland

    Davide Piccini

  6. Siemens AG, Healthcare Sector, Erlangen, Germany

    Michael O. Zenge & Edgar Müller

  7. Cardiovascular MR Center, Duke University Medical Center, Durham, NC, USA

    Wolfgang G. Rehwald

  8. Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    Helge Möllmann

  9. Department of Radiological Sciences, Oncology and Pathology, University of Rome “Sapienza”-Polo Pontino, Latina, Italy

    Carlo N. De Cecco

  10. Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Ashley River Tower, Charleston, SC, 29425-2260, USA

    U. Joseph Schoepf

Authors
  1. Matthias Renker
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  2. Akos Varga-Szemes
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  3. U. Joseph Schoepf
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  4. Stefan Baumann
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  5. Davide Piccini
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  7. Wolfgang G. Rehwald
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  8. Edgar Müller
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  9. Jeremy D. Rier
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  10. Helge Möllmann
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  11. Christian W. Hamm
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  13. Carlo N. De Cecco
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Corresponding author

Correspondence to U. Joseph Schoepf.

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Renker, M., Varga-Szemes, A., Schoepf, U.J. et al. A non-contrast self-navigated 3-dimensional MR technique for aortic root and vascular access route assessment in the context of transcatheter aortic valve replacement: proof of concept. Eur Radiol 26, 951–958 (2016). https://doi.org/10.1007/s00330-015-3906-x

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  • DOI: https://doi.org/10.1007/s00330-015-3906-x

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