Abstract
BackgroundThe use of gadolinium contrast agents in cardiovascular magnetic resonance is well-established and serves to improve both vascular imaging as well as enable late gadolinium enhancement (LGE) imaging for tissue characterization. Currently, gadofosveset trisodium, an intravascular contrast agent, combined with a three-dimensional inversion recovery balanced steady state free precession (3D IR bSSFP) sequence, is commonly used in pediatric cardiac imaging and yields excellent vascular imaging, but cannot be used for late gadolinium enhancement. Gadofosveset use remains limited in clinical practice, and manufacture was recently halted, thus an alternative is needed to allow 3D IR bSSFP and LGE in the same study.MethodsHere we propose a protocol to give a bolus of 0.1 mL/kg = 0.1 mmol/kg gadobutrol (GADAVIST/GADOVIST) for time-resolved magnetic resonance angiography (MRA). Subsequently, 0.1 mmol/kg is diluted up to 5 or 7.5 mL with saline and then loaded into intravenous tubing connected to the patient. A 0.5 mL short bolus is infused, then a slow infusion is given at 0.02 or 0.03 mL/s. Image navigated (iNAV) 3D IR bSSFP imaging is initiated 45–60 s after the initiation of the infusion, with a total image acquisition time of ~5 min. If necessary, LGE imaging using phase sensitive inversion recovery reconstruction (PSIR) is performed at 10 min after the infusion is initiated.ResultsWe have successfully performed the above protocol with good image quality on 10 patients with both time-resolved MRA and 3D IR bSSFP iNAV imaging. Our initial attempts to use pencil beam respiratory navigation failed due to signal labeling in the liver by the navigator. We have also performed 2D PSIR LGE successfully, with both LGE positive and LGE negative results.ConclusionA bolus of gadobutrol, followed later by a slow infusion, allows time-resolved MRA, 3D IR bSSFP using the iNAV navigation technique, and LGE imaging, all in a single study with a single contrast agent.
Highlights
The use of gadolinium contrast agents in cardiovascular magnetic resonance is well-established and serves to improve both vascular imaging as well as enable late gadolinium enhancement (LGE) imaging for tissue characterization
Due to gadofosveset trisodium’s albumin binding, the kinetics are such that they preclude late gadolinium enhancement (LGE) imaging in the same study
At 10 to 15 min after the start of the infusion, 2D phase-sensitive inversion recovery (PSIR) LGE imaging can be performed, if necessary; representative sequence parameters include repetition time/echo time (TR/TE) = 5.5/6 ms, flip angle = 25°, echo train length = 22, in-plane resolution = 1.9 × 1.9 mm, slice thickness = 8 mm. We successfully completed both time-resolved magnetic resonance angiography (MRA) and 3D IR bSSFP image navigation (iNAV) imaging with the above technique for 10 patients (Fig. 4) with a variety of diagnoses including: pulmonary stenosis and sinus venosus atrial septal
Summary
The use of gadolinium contrast agents in cardiovascular magnetic resonance is well-established and serves to improve both vascular imaging as well as enable late gadolinium enhancement (LGE) imaging for tissue characterization. Current techniques for vascular imaging in CHD are in three major groups: Non-contrast three-dimensional (3D), ECG and respiratory navigated, T2-prepared, fat saturated imaging with a balanced steady-state free precession readout (3D T2-prep bSSFP). Intravascular contrast-enhanced, 3D, ECG and respiratory navigated, fat saturated imaging with an inversion recovery pulse and balanced steady-state free precession readout (3D IR bSSFP) [1, 2]. This latter technique has been shown to be superior to non-contrast 3D T2-prep bSSFP with both intravascular and extravascular contrast agents [2], and to IR gradient recovery echo sequences [3]. Due to gadofosveset trisodium’s albumin binding, the kinetics are such that they preclude late gadolinium enhancement (LGE) imaging in the same study
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