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Improved functional cardiac MR imaging using the intravascular contrast agent CLARISCAN™

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Abstract

Purpose: Using segmented k-space turbo gradient echo MR techniques (TGE) contrast between blood and myocardium is often reduced in long axis views due to reduced in plane spin-refreshment, particularly in patients with low ejection fraction. The application of an intravascular contrast agent (CA) may improve endocardial border delineation. Materials and methods: In 15 patients cardiac cine loops in two long axis and two short axis views were acquired during breath hold using a TGE sequence without and with increasing doses of CA (0.75, 2.0, 5.0 mg Fe/kg). Two independent observers evaluated left ventricular function (LVEF, modified Simpson's rule) and assigned a visual score (range: 0 = ‘not visualized’ to 6 = ‘excellent visualization’) for endocardial border delineation. Signal- and contrast-to-noise ratios (SNR; CNR) were determined. Results: Endocardial border delineation score for TGE was 1.7 ± 0.6 and 3.9 ± 0.6**, 4.4 ± 0.5**, 4.6 ± 0.4** for 0.75, 2.0, 5.0 mg Fe/kg of CA, respectively ( ** p < 0.01 vs. TGE). SNR of blood increased significantly with any dose of CA with a mild drop of myocardial SNR resulting in a significant increase of CNR blood/myocardium. The maximum effect with 2.0 mg Fe/kg was a >2-fold CNR increase. Inter- and intraobserver variability assessed according to the method of Bland–Altmann was reduced at 2.0 mg Fe/kg for determination of LVEF and reached statistical significance for LVEF <50%. Conclusion: Intravascular CA increased CNR between blood and myocardium by a factor >2 and significantly improved the determination of cardiac volumes. The benefit in accuracy was most for patients with left ventricular ejection fraction <50%.

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Authors and Affiliations

  1. Clinic of Internal Medicine/Cardiology, German Heart Institute, Berlin, Germany

    I. Paetsch, H. Thiele, A. Bornstedt, E. Fleck & E. Nagel

  2. Philips Clincal Science, Best, The Netherlands

    B. Schnackenburg

  3. Nycomed Amersham Imaging, Munich, Germany

    A. Müller-York

  4. Department of Cardiology, Clinic of Nürnberg, Germany

    J. Schwab

Authors
  1. I. Paetsch
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  2. H. Thiele
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  3. B. Schnackenburg
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  4. A. Bornstedt
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  5. A. Müller-York
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  6. J. Schwab
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  7. E. Fleck
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  8. E. Nagel
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Paetsch, I., Thiele, H., Schnackenburg, B. et al. Improved functional cardiac MR imaging using the intravascular contrast agent CLARISCAN™ . Int J Cardiovasc Imaging 19, 337–343 (2003). https://doi.org/10.1023/A:1025432415983

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  • DOI: https://doi.org/10.1023/A:1025432415983

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