Subtraction of time-resolved magnetic resonance angiography images improves visualization of the pulmonary veins and left atrium in adults with congenital heart disease: a novel post-processing technique

  • G. SugrueEmail author
  • A. Cradock
  • A. McGee
  • C. McEntee
  • S. K. Eustace
  • P. Fitzpatrick
  • L. P. Lawler
  • J. G. Murray
Original Paper


To describe a novel time-resolved magnetic resonance angiography (TR-MRA) postprocessing technique using the time-resolved angiography with interleaved stochastic trajectories (TWIST) method to evaluate the pulmonary veins and left atrium in adults with congenital heart disease undergoing cardiac MRI. Institutional ethics committee approved the study. 21 consecutive adult patients (14 female, 7 male patients, mean age 28 years) with known congenital heart disease who underwent a cardiac MRI were included. Post-processing of the TR-MRA sequences created novel “subtracted” datasets. Two independent observers reviewed the conventional TWIST and novel subtracted TWIST data sets in source and maximum intensity projection (MIP) coronal reformats to assess visualization of the pulmonary veins and left atrium based on a 5-point scale. Quantitative signal to noise (SNR) comparison was performed. TR-MRA yielded diagnostic image data in 20/21 patients (95.2%). The novel “subtracted” TR-MRA technique improved visualization of the pulmonary veins and left atrium compared to the source TR-MRA sequence in 16/20 patients (mean scores 3.34 ± 0.69 vs. 2.92 ± 0.69, p < 0.008). Further improved visualization of the pulmonary veins and left atrium was observed in the subtracted MIP TWIST sequences compared to the MIP TWIST images (mean scores 4.43 ± 0.80 vs. 3.02 ± 0.87 vs., p < 0.001). No significant SNR difference between the source and novel subtracted group was observed (85.4 vs. 70.4, p = 0.57). Compared to source TR-MRA images, subtraction of TR-MRA images is a novel postprocessing technique that improves visualization of the pulmonary veins and left atrium in a substantial number of patients.


Magnetic resonance angiography Heart defects Congenital Pulmonary veins Left atrium 



Magnetic resonance imaging


Congenital heart disease


Magnetic resonance angiography


Time-resolved angiography with interleaved stochastic trajectories


Right superior pulmonary vein


Left atrium


Region of interest


Pulmonary artery


Maximum intensity projection


Signal intensity




Time resolved magnetic resonance angiography


Contrast enhanced magnetic resonance angiography


Compliance with ethical standards

Conflict of interest

The authors declared that they have no conflict of interest.

Supplementary material

Supplementary material 1 (MP4 614 KB)

Supplementary material 2 (MP4 541 KB)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of RadiologyMater Misericordiae University HospitalDublinIreland
  2. 2.Radiography and Diagnostic Imaging, School of MedicineUniversity College DublinDublin 4Ireland
  3. 3.School of Public Health, Physiotherapy & Sports ScienceUniversity College DublinDublinIreland

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