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The International Journal of Cardiovascular Imaging

, Volume 34, Issue 9, pp 1451–1458 | Cite as

Validation of contrast-enhanced time-resolved magnetic resonance angiography in pre-ablation planning in patients with atrial fibrillation: comparison with traditional technique

  • Tarek Zghaib
  • Adeel Shahid
  • Chiara Pozzessere
  • Kristin K. Porter
  • Linda C. Chu
  • John Eng
  • Hugh Calkins
  • Ihab R. Kamel
  • Saman Nazarian
  • Stefan L. Zimmerman
Original Paper
  • 70 Downloads

Abstract

Bolus timing is critical to optimal magnetic resonance angiography (MRA) acquisitions but can be challenging in some patients. Our purpose was to evaluate whether contrast-enhanced time-resolved magnetic resonance angiography (TR-MRA), a dynamic multiphase sequence that does not rely on bolus timing, is a viable alternative method to conventional 3D fast-long angle shot contrast-enhanced magnetic resonance angiography (CE-MRA). Coronal subtracted conventional CE-MRA images in 50 consecutive patients presenting for pre-atrial fibrillation ablation pulmonary venous (PV) mapping were compared with 50 TR-MRA images performed in 50 subsequent patients. The TR-MRA protocol was modified to optimize spatial resolution with slightly reduced temporal resolution (6.1 s scan time). Three experienced readers evaluated each scan’s image quality and relative left atrial (LA) opacification based on a 4-point scale and diagnostic PV visualization in a binary fashion. Additionally, LA signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and PV dimensions were measured for both techniques. TR-MRA had significantly higher overall image quality (3.10 ± 0.69 vs. 2.42 ± 0.69, p < 0.0001), and LA opacification scores (3.33 ± 0.70 vs. 2.15 ± 1.13, p < 0.0001) compared to CE-MRA. The proportion of diagnostically visualized pulmonary veins was 137/150 (91%) in the CE-MRA group vs. 147/150 (98%) with TR-MRA (p = 0.010). Both SNR and CNR were higher with TR-MRA vs. CE-MRA (277.9 ± 48.9 vs. 106.8 ± 41, p = 0.002 and 100.3 ± 41.7 vs. 70.7 ± 48.0, p = 0.002, respectively). Inter-reader variance of individual PV measurements for each of the MR techniques ranged between 0.62 and 1.47 mm and the ICC for vein measurements was higher with TR-MRA (range: 0.62–0.81) compared to CE-MRA (range: 0.47–0.64). TR-MRA, modified to maximize spatial resolution, offers an alternative method for performing high quality MRA examinations in patients with AF. TR-MRA offers greater overall image quality, PV visualization, and similarly reproducible PV measurements compared to traditional CE-MRA, without the challenges of proper bolus timing.

Keywords

Atrial fibrillation Catheter ablation Contrast-enhanced magnetic resonance angiography Time-resolved magnetic resonance angiography 

Abbreviations

PV

Pulmonary vein

MRA

Magnetic resonance angiography

CE-MRA

Contrast-enhanced magnetic resonance angiography

TR-MRA

Time-resolved magnetic resonance angiography

LA

Left atrium

SI

Signal intensity

AF

Atrial fibrillation

TR

Repetition time

TE

Echo time

CNR

Contrast to noise ratio

SNR

Signal to noise ratio

ROI

Regions of interest

ICC

Intra-class coefficient

RSPV

Right superior pulmonary vein

RIPV

Right inferior pulmonary vein

LSPV

Left superior pulmonary vein

LIPV

Left inferior pulmonary vein

Notes

Funding

The study was funded by the National Institutes of Health (Grant Nos. K23HL089333 and R01HL116280) as well as by a Biosense Webster grant to Dr Nazarian; the Roz and Marvin H. Weiner and Family Foundation; the Dr. Francis P. Chiaramonte Foundation; Marilyn and Christian Poindexter; and the Norbert and Louise Grunwald Cardiac Arrhythmia Research Fund. Funding bodies had no role in the design of the study; collection, analysis, or interpretation of data; or in writing the manuscript.

Compliance with ethical standards

Conflict of interest

Dr. Nazarian has received research grant funding from Biosense Webster during the conduct of the study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Ethics approval

The Johns Hopkins Institutional Review Board (JH-IRB) approved the study and retrospective study data was obtained under a HIPPA compliant waiver of consent.

References

  1. 1.
    Haïssaguerre M, Jaïs P, Shah DC, Takahashi A, Hocini M, Quiniou G et al (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666CrossRefPubMedGoogle Scholar
  2. 2.
    Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ et al (2014) Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 129:837–847CrossRefPubMedGoogle Scholar
  3. 3.
    Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen S-A et al (2012) 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 14:528–606CrossRefPubMedGoogle Scholar
  4. 4.
    Dewire J, Calkins H (2013) Update on atrial fibrillation catheter ablation technologies and techniques. Nat Rev Cardiol 10:599–612CrossRefPubMedGoogle Scholar
  5. 5.
    Maksimović R, Dill T, Ristić AD, Seferović PM (2006) Imaging in percutaneous ablation for atrial fibrillation. Eur Radiol 16:2491–2504CrossRefPubMedGoogle Scholar
  6. 6.
    Ghaye B, Szapiro D, Dacher J-N, Rodriguez L-M, Timmermans C, Devillers D et al. (2003) Percutaneous ablation for atrial fibrillation: the role of cross-sectional imaging. Radiographics 23(Spec No suppl_1):S19-33-50Google Scholar
  7. 7.
    Hauser TH, Peters DC, Wylie JV, Manning WJ (2008) Evaluating the left atrium by magnetic resonance imaging. Europace 10(Supplement 3):iii22–iii27CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Song T, Laine AF, Chen Q, Rusinek H, Bokacheva L, Lim RP et al (2009) Optimal k-space sampling for dynamic contrast-enhanced MRI with an application to MR renography. Magn Reson Med 61:1242–1248CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Vogt FM, Theysohn JM, Michna D, Hunold P, Neudorf U, Kinner S et al (2013) Contrast-enhanced time-resolved 4D MRA of congenital heart and vessel anomalies: image quality and diagnostic value compared with 3D MRA. Eur Radiol 23:2392–2404CrossRefPubMedGoogle Scholar
  10. 10.
    Schonberger M, Usman A, Galizia M, Popescu A, Collins J, Carr JC (2013) Time-resolved MR venography of the pulmonary veins precatheter-based ablation for atrial fibrillation. J Magn Reson Imaging 137:127–137CrossRefGoogle Scholar
  11. 11.
    Korosec FR, Frayne R, Grist TM, Mistretta CA (1996) Time-resolved contrast-enhanced 3D MR angiography. Magn Reson Med 36:345–351CrossRefPubMedGoogle Scholar
  12. 12.
    Pinto C, Hickey R, Carroll TJ, Sato K, Dill K, Omary RA et al (2006) Time-resolved MR angiography with generalized autocalibrating partially parallel acquisition and time-resolved echo-sharing angiographic technique for hemodialysis arteriovenous fistulas and grafts. J Vasc Interv Radiol 17:1003–1009CrossRefPubMedGoogle Scholar
  13. 13.
    Lim RP, Shapiro M, Wang EY, Law M, Babb JS, Rueff LE et al (2008) 3D time-resolved MR angiography (MRA) of the carotid arteries with time-resolved imaging with stochastic trajectories: comparison with 3D contrast-enhanced Bolus-Chase MRA and 3D time-of-flight MRA. Am J Neuroradiol 29:1847–1854CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Tarek Zghaib
    • 1
  • Adeel Shahid
    • 2
  • Chiara Pozzessere
    • 2
  • Kristin K. Porter
    • 3
  • Linda C. Chu
    • 2
  • John Eng
    • 2
  • Hugh Calkins
    • 1
  • Ihab R. Kamel
    • 2
  • Saman Nazarian
    • 4
  • Stefan L. Zimmerman
    • 2
  1. 1.Division of CardiologyJohns Hopkins MedicineBaltimoreUSA
  2. 2.§Russell A. Morgan Department of Radiology and Radiological SciencesJohns Hopkins MedicineBaltimoreUSA
  3. 3.Department of RadiologyUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.Division of CardiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaUSA

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