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European Radiology

, Volume 26, Issue 4, pp 951–958 | Cite as

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

  • Matthias Renker
  • Akos Varga-Szemes
  • U. Joseph SchoepfEmail author
  • Stefan Baumann
  • Davide Piccini
  • Michael O. Zenge
  • Wolfgang G. Rehwald
  • Edgar Müller
  • Jeremy D. Rier
  • Helge Möllmann
  • Christian W. Hamm
  • Daniel H. Steinberg
  • Carlo N. De Cecco
Magnetic Resonance

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.

Keywords

Aortic valve stenosis Transcatheter aortic valve replacement Magnetic resonance imaging Contrast media Renal insufficiency 

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

Notes

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.

References

  1. 1.
    Bloomfield GS, Gillam LD, Hahn RT et al (2012) A practical guide to multimodality imaging of transcatheter aortic valve replacement. J Am Coll Cardiol Img 5:441–455CrossRefGoogle Scholar
  2. 2.
    Tsang W, Bateman MG, Weinert L et al (2012) Accuracy of aortic annular measurements obtained from three-dimensional echocardiography, CT and MRI: human in vitro and in vivo studies. Heart 98:1146–1152CrossRefPubMedGoogle Scholar
  3. 3.
    Blanke P, Schoepf UJ, Leipsic JA (2013) CT in transcatheter aortic valve replacement. Radiology 269:650–669CrossRefPubMedGoogle Scholar
  4. 4.
    Achenbach S, Delgado V, Hausleiter J, Schoenhagen P, Min JK, Leipsic JA (2012) SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr 6:366–380CrossRefPubMedGoogle Scholar
  5. 5.
    Nguyen G, Leipsic J (2013) Cardiac computed tomography and computed tomography angiography in the evaluation of patients prior to transcatheter aortic valve implantation. Curr Opin Cardiology 28:497–504CrossRefGoogle Scholar
  6. 6.
    Leipsic J, Wood D, Manders D et al (2009) The evolving role of MDCT in transcatheter aortic valve replacement: a radiologists' perspective. Am J Roentgenol 193:W214–W219CrossRefGoogle Scholar
  7. 7.
    Lung B, Cachier A, Baron G et al (2005) Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J 26:2714–2720CrossRefGoogle Scholar
  8. 8.
    Vahanian A, Otto CM (2010) Risk stratification of patients with aortic stenosis. Eur Heart J 31:416–423CrossRefPubMedGoogle Scholar
  9. 9.
    Abbara S, Arbab-Zadeh A, Callister TQ, Desai MY et al (2009) SCCT guidelines for performance of coronary computed tomography angiography: A report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 3:190–204CrossRefPubMedGoogle Scholar
  10. 10.
    Jabbour A, Ismail TF, Moat N et al (2011) Multimodality imaging in transcatheter aortic valve implantation and post-procedural aortic regurgitation: comparison among cardiovascular magnetic resonance, cardiac computed tomography, and echocardiography. J Am Coll Cardiol 58:2165–2173CrossRefPubMedGoogle Scholar
  11. 11.
    Barone-Rochette G, Pierard S, Seldrum S et al (2013) Aortic valve area, stroke volume, left ventricular hypertrophy, remodeling, and fibrosis in aortic stenosis assessed by cardiac magnetic resonance imaging: comparison between high and low gradient and normal and low flow aortic stenosis. Circ Cardiovasc Imaging 6:1009–1017CrossRefPubMedGoogle Scholar
  12. 12.
    Debl K, Djavidani B, Seitz J et al (2005) Planimetry of aortic valve area in aortic stenosis by magnetic resonance imaging. Invest Radiol 40:631–636CrossRefPubMedGoogle Scholar
  13. 13.
    Friedrich MG, Schulz-Menger J, Poetsch T, Pilz B, Uhlich F, Dietz R (2002) Quantification of valvular aortic stenosis by magnetic resonance imaging. Am Heart J 144:329–334CrossRefPubMedGoogle Scholar
  14. 14.
    Agarwal R, Brunelli SM, Williams K, Mitchell MD, Feldman HI, Umscheid CA (2009) Gadolinium-based contrast agents and nephrogenic systemic fibrosis: a systematic review and meta-analysis. Nephrol Dial Transplant 24:856–863CrossRefPubMedGoogle Scholar
  15. 15.
    Wang Y, Alkasab TK, Narin O et al (2011) Incidence of nephrogenic systemic fibrosis after adoption of restrictive gadolinium-based contrast agent guidelines. Radiology 260:105–111CrossRefPubMedGoogle Scholar
  16. 16.
    von Knobelsdorff-Brenkenhoff F, Gruettner H, Trauzeddel RF, Greiser A, Schulz-Menger J (2014) Comparison of native high-resolution 3D and contrast-enhanced MR angiography for assessing the thoracic aorta. Eur Heart J Cardiovasc Imaging 15:651–658CrossRefGoogle Scholar
  17. 17.
    Piccini D, Monney P, Sierro C et al (2014) Respiratory Self-navigated Postcontrast Whole-Heart Coronary MR Angiography: Initial Experience in Patients. Radiology 270:378–386CrossRefPubMedGoogle Scholar
  18. 18.
    Lai P, Bi X, Jerecic R, Li D (2009) A respiratory self-gating technique with 3D-translation compensation for free-breathing whole-heart coronary MRA. Magn Reson Med 62:731–738CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Stehning C, Bornert P, Nehrke K, Eggers H, Stuber M (2005) Free-breathing whole-heart coronary MRA with 3D radial SSFP and self-navigated image reconstruction. Magn Reson Med 54:476–480CrossRefPubMedGoogle Scholar
  20. 20.
    Piccini D, Littmann A, Nielles-Vallespin S, Zenge MO (2012) Respiratory self-navigation for whole-heart bright-blood coronary MRI: methods for robust isolation and automatic segmentation of the blood pool. Magn Reson Med 68:571–579CrossRefPubMedGoogle Scholar
  21. 21.
    Expert Panel on MRS, Kanal E, Barkovich AJ et al (2013) ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging 37:501–530CrossRefGoogle Scholar
  22. 22.
    Piccini D, Littmann A, Nielles-Vallespin S, Zenge MO (2011) Spiral phyllotaxis: the natural way to construct a 3D radial trajectory in MRI. Magn Reson Med 66:1049–1056CrossRefPubMedGoogle Scholar
  23. 23.
    Pontone G, Andreini D, Bartorelli AL et al (2013) Comparison of accuracy of aortic root annulus assessment with cardiac magnetic resonance versus echocardiography and multidetector computed tomography in patients referred for transcatheter aortic valve implantation. Am J Cardiol 112:1790–1799CrossRefPubMedGoogle Scholar
  24. 24.
    Blanke P, Russe M, Leipsic J et al (2012) Conformational pulsatile changes of the aortic annulus: impact on prosthesis sizing by computed tomography for transcatheter aortic valve replacement. J Am Coll Cardiol Intv 5:984–994CrossRefGoogle Scholar
  25. 25.
    Thourani VH, Keeling WB, Sarin EL et al (2011) Impact of preoperative renal dysfunction on long-term survival for patients undergoing aortic valve replacement. Ann Thorac Surg 91:1798–1806CrossRefPubMedGoogle Scholar
  26. 26.
    Nguyen TC, Babaliaros VC, Razavi SA et al (2013) Impact of varying degrees of renal dysfunction on transcatheter and surgical aortic valve replacement. J Thorac Cardiovasc Surg 146:1399–1406CrossRefPubMedGoogle Scholar
  27. 27.
    Yamamoto M, Hayashida K, Mouillet G et al (2013) Prognostic value of chronic kidney disease after transcatheter aortic valve implantation. J Am Coll Cardiol 62:869–877CrossRefPubMedGoogle Scholar
  28. 28.
    Barbanti M, Latib A, Sgroi C et al (2013) Acute kidney injury after transcatheter aortic valve implantation with self-expanding CoreValve prosthesis: results from a large multicentre Italian research project. Euro Interv 10:133–140Google Scholar
  29. 29.
    Burman ED, Keegan J, Kilner PJ (2008) Aortic root measurement by cardiovascular magnetic resonance: specification of planes and lines of measurement and corresponding normal values. Circ Cardiovasc Imaging 1:104–113CrossRefPubMedGoogle Scholar
  30. 30.
    Koos R, Altiok E, Mahnken AH et al (2012) Evaluation of aortic root for definition of prosthesis size by magnetic resonance imaging and cardiac computed tomography: implications for transcatheter aortic valve implantation. Int J Cardiol 158:353–358CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Matthias Renker
    • 1
    • 2
  • Akos Varga-Szemes
    • 1
  • U. Joseph Schoepf
    • 1
    • 10
    Email author
  • Stefan Baumann
    • 1
    • 3
  • Davide Piccini
    • 4
    • 5
  • Michael O. Zenge
    • 6
  • Wolfgang G. Rehwald
    • 7
  • Edgar Müller
    • 6
  • Jeremy D. Rier
    • 1
  • Helge Möllmann
    • 8
  • Christian W. Hamm
    • 2
  • Daniel H. Steinberg
    • 1
  • Carlo N. De Cecco
    • 1
    • 9
  1. 1.Heart & Vascular CenterMedical University of South CarolinaCharlestonUSA
  2. 2.Department of Medicine IUniversity Hospital Giessen and MarburgGiessenGermany
  3. 3.1st Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM)University of HeidelbergMannheimGermany
  4. 4.Advanced Clinical Imaging TechnologySiemens Healthcare IM BM PILausanneSwitzerland
  5. 5.Department of RadiologyUniversity Hospital (CHUV) and University of Lausanne (UNIL)LausanneSwitzerland
  6. 6.Siemens AG, Healthcare SectorErlangenGermany
  7. 7.Cardiovascular MR CenterDuke University Medical CenterDurhamUSA
  8. 8.Kerckhoff Heart and Thorax CenterBad NauheimGermany
  9. 9.Department of Radiological Sciences, Oncology and PathologyUniversity of Rome “Sapienza”-Polo PontinoLatinaItaly
  10. 10.Department of Radiology and Radiological ScienceMedical University of South CarolinaCharlestonUSA

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