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European Radiology

, Volume 28, Issue 11, pp 4625–4634 | Cite as

Is MRI equivalent to CT in the guidance of TAVR? A pilot study

  • Agnes Mayr
  • Gert Klug
  • Sebastian J. Reinstadler
  • Hans-Josef Feistritzer
  • Martin Reindl
  • Christian Kremser
  • Christof Kranewitter
  • Nikolaos Bonaros
  • Guy Friedrich
  • Gudrun Feuchtner
  • Bernhard Metzler
Cardiac

Abstract

Objectives

To compare a comprehensive cardiovascular magnetic resonance imaging (MRI) protocol with contrast-enhanced computed tomography angiography (CTA) for guidance in transcatheter aortic valve replacement (TAVR) evaluation.

Methods and results

Non-contrast three-dimensional (3D) ‘whole heart’ MRI imaging for aortic annulus sizing and measurements of coronary ostia heights, contrast-enhanced MRI angiography (MRA) for evaluation of transfemoral routes as well as aortoiliofemoral-CTA were performed in 16 patients referred for evaluation of TAVR. Aortic annulus measurements by MRI and CTA showed a very strong correlation (r=0.956, p<0.0001; effective annulus area for MRI 430±74 vs. 428±78 mm2 for CTA, p=0.629). Regarding decision for valve size there was complete consistency between MRI and CTA. Moreover, vessel luminal diameters and angulations of aortoiliofemoral access as measured by MRA and CTA showed overall very strong correlations (r= 0.819 to 0.996, all p<0.001), the agreement of minimal vessel diameter between the two modalities revealed a bias of 0.02 mm (upper and lower limit of agreement: 1.02 mm and -0.98 mm).

Conclusions

In patients referred for TAVR, MRI measurements of aortic annulus and minimal aortoiliofemoral diameters showed good to excellent agreement. Decisions based on MRI measurements regrading prosthesis sizing and transfemoral access would not have modified TAVR-strategy as compared to a CTA-based choice.

Key Points

• ‘Whole heart’ MRI and CTA measurements of aortic annulus correlate very strongly.

• MRI- and CTA-based prostheses sizing are in excellent agreement.

• MRA and CTA equally guide TAVR access strategy.

Keywords

Cardiac imaging techniques Magnetic resonance angiography Aortic valve Contrast media CT angiography 

Abbreviations

CTA

Computed tomography angiography

eGFR

Estimated Glomerular filtration rate

ICC

Intra-class correlation coefficients

IQR

Interquartile range

LM

Left main artery

MRA

Magnetic resonance angiography

MRI

Magnetic resonance imaging

ND

Normal distribution

NSF

Nephrogenic systemic fibrosis

RCA

Right coronary artery

SD

Standard deviation

SSFP

Steady-state free precession

TAVR

Transcatheter aortic valve replacement

TE

Echo time

TEE

Transesophageal echocardiography

TR

Repetition time

TTE

Transesophageal echocardiography

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Agnes Mayr, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Agnes Mayr
    • 1
  • Gert Klug
    • 2
  • Sebastian J. Reinstadler
    • 2
  • Hans-Josef Feistritzer
    • 2
  • Martin Reindl
    • 2
  • Christian Kremser
    • 1
  • Christof Kranewitter
    • 1
  • Nikolaos Bonaros
    • 3
  • Guy Friedrich
    • 2
  • Gudrun Feuchtner
    • 1
  • Bernhard Metzler
    • 2
  1. 1.University Clinic of Radiology, Medical University of InnsbruckInnsbruckAustria
  2. 2.University Clinic of Internal Medicine III, Cardiology and AngiologyMedical University of InnsbruckInnsbruckAustria
  3. 3.University Clinic of Cardiac Surgery, Medical University of InnsbruckInnsbruckAustria

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