Abstract
BackgroundThe application of cardiovascular magnetic resonance angiography (CMRA) for the assessment of thoracic aortic disease is often associated with prolonged and unpredictable acquisition times and residual motion artefacts. To overcome these limitations, we have integrated undersampled acquisition with image-based navigators and inline non-rigid motion correction to enable a free-breathing, contrast-free Cartesian CMRA framework for the visualization of the thoracic aorta in a short and predictable scan of 3 min.Methods35 patients with thoracic aortic disease (36 ± 13y, 14 female) were prospectively enrolled in this single-center study. The proposed 3D T2-prepared balanced steady state free precession (bSSFP) sequence with image-based navigator (iNAV) was compared to the clinical 3D T2-prepared bSSFP with diaphragmatic-navigator gating (dNAV), in terms of image acquisition time. Three cardiologists blinded to iNAV vs. dNAV acquisition, recorded image quality scores across four aortic segments and their overall diagnostic confidence. Contrast ratio (CR) and relative standard deviation (RSD) of signal intensity (SI) in the corresponding segments were estimated. Co-axial aortic dimensions in six landmarks were measured by two readers to evaluate the agreement between the two methods, along with inter-observer and intra-observer agreement. Kolmogorov–Smirnov test, Mann–Whitney U (MWU), Bland–Altman analysis (BAA), intraclass correlation coefficient (ICC) were used for statistical analysis.ResultsThe scan time for the iNAV-based approach was significantly shorter (3.1 ± 0.5 min vs. 12.0 ± 3.0 min for dNAV, P = 0.005). Reconstruction was performed inline in 3.0 ± 0.3 min. Diagnostic confidence was similar for the proposed iNAV versus dNAV for all three reviewers (Reviewer 1: 3.9 ± 0.3 vs. 3.8 ± 0.4, P = 0.7; Reviewer 2: 4.0 ± 0.2 vs. 3.9 ± 0.3, P = 0.4; Reviewer 3: 3.8 ± 0.4 vs. 3.7 ± 0.6, P = 0.3). The proposed method yielded higher image quality scores in terms of artefacts from respiratory motion, and non-diagnostic images due to signal inhomogeneity were observed less frequently. While the dNAV approach outperformed the iNAV method in the CR assessment, the iNAV sequence showed improved signal homogeneity along the entire thoracic aorta [RSD SI 5.1 (4.4, 6.5) vs. 6.5 (4.6, 8.6), P = 0.002]. BAA showed a mean difference of < 0.05 cm across the 6 landmarks between the two datasets. ICC showed excellent inter- and intra-observer reproducibility.ConclusionsThoracic aortic iNAV-based CMRA with fast acquisition (~ 3 min) and inline reconstruction (3 min) is proposed, resulting in high diagnostic confidence and reproducible aortic measurements.
Highlights
The application of cardiovascular magnetic resonance angiography (CMRA) for the assessment of thoracic aortic disease is often associated with prolonged and unpredictable acquisition times and residual motion artefacts
The thoracic aorta experiences a consequent displacement that follows the respiratory excursions of the thoracic wall, with significantly smaller displacement for the descending aorta than that of the ascending segment [29]. Three dimensional (3D)-rendered computed tomography angiography (CTA) images and lumen models for patients with aortic pathology have shown that significant multidirectional translation occurred secondary to respiration, shifting the thoracic aorta and arch vessels both posteriorly and superiorly [30]
Qualitative image quality analysis results Image quality scores with respect to blurring from respiratory motion and homogeneity of blood signal intensity for the proposed imagebased navigator (iNAV) in comparison to the clinical diaphragmatic-navigator gating (dNAV) sequence are shown in Figs. 4 and 5 and Table 1
Summary
The application of cardiovascular magnetic resonance angiography (CMRA) for the assessment of thoracic aortic disease is often associated with prolonged and unpredictable acquisition times and residual motion artefacts. To overcome these limitations, we have integrated undersampled acquisition with image-based navigators and inline non-rigid motion correction to enable a free-breathing, contrast-free Cartesian CMRA framework for the visualization of the thoracic aorta in a short and predictable scan of 3 min. Recent studies have shown that electrocardiogram (ECG)-triggered, free breathing diaphragmatic-navigator gated CE [14] or NC T2-prepared bSSFP sequences can be applied for aortic disease monitoring [10, 13, 15,16,17,18]. The thoracic aorta experiences a consequent displacement that follows the respiratory excursions of the thoracic wall, with significantly smaller displacement for the descending aorta than that of the ascending segment [29]. 3D-rendered computed tomography angiography (CTA) images and lumen models for patients with aortic pathology have shown that significant multidirectional translation occurred secondary to respiration, shifting the thoracic aorta and arch vessels both posteriorly and superiorly [30]
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