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
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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.
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.
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.
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.
• 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.
KeywordsAortic valve stenosis Transcatheter aortic valve replacement Magnetic resonance imaging Contrast media Renal insufficiency
two-dimensional balanced steady-state free-precession
field of view
region of interest
transcatheter aortic valve replacement
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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