Abstract
Background and objective: To evaluate the reliability of compressed-sensing (CS) real-time single-breath-hold cine imaging for quantification of right ventricular (RV) function and volumes in congenital heart disease (CHD) patients in comparison with the standard multi-breath-hold technique. Methods: Sixty-one consecutive CHD patients (mean age = 22.2 ± 9.0 (SD) years) were prospectively evaluated during either the initial work-up or after repair. For each patient, two series of cine images were acquired: first, the reference segmented multi-breath-hold steady-state free-precession sequence (SSFPref), including a short-axis stack, one four-chamber slice, and one long-axis slice; then, an additional real-time compressed-sensing single-breath-hold sequence (CSrt) providing the same slices. Two radiologists independently assessed the image quality and RV volumes for both techniques, which were compared using the Wilcoxon test and paired Student’s t test, Bland–Altman, and linear regression analyses. The visualization of wall-motion disorders and tricuspid-regurgitation-related signal voids were also analyzed. Results: The mean acquisition time for CSrt was 22.4 ± 6.2 (SD) s (95% CI: 20.8–23.9 s) versus 442.2 ± 89.9 (SD) s (95% CI: 419.2–465.2 s) for SSFPref (p < 0.001). The image quality of CSrt was diagnostic in all examinations and was mostly rated as good (n = 49/61; 80.3%). There was a high correlation between SSFPref and CSrt images regarding RV ejection fraction (49.8 ± 7.8 (SD)% (95% CI: 47.8–51.8%) versus 48.7 ± 8.6 (SD)% (95% CI: 46.5–50.9%), respectively; r = 0.94) and RV end-diastolic volume (192.9 ± 60.1 (SD) mL (95% CI: 177.5–208.3 mL) versus 194.9 ± 62.1 (SD) mL (95% CI: 179.0–210.8 mL), respectively; r = 0.98). In CSrt images, tricuspid-regurgitation and wall-motion disorder visualization was good (area under receiver operating characteristic curve (AUC) = 0.87) and excellent (AUC = 1), respectively. Conclusions: Compressed-sensing real-time cine imaging enables, in one breath hold, an accurate assessment of RV function and volumes in CHD patients in comparison with standard SSFPref, allowing a substantial improvement in time efficiency.
Highlights
The advent of heart surgery and percutaneous cardiac procedures has considerably improved outcomes in patients born with congenital heart disease [1]
cardiac magnetic resonance (CMR) is considered superior to echocardiography for the evaluation of right ventricular (RV) and should be regularly used when the information is essential for patient management, i.e., for quantification of RV volume and ejection fraction, quantification of pulmonary regurgitation, evaluation of RV outflow-tract and pulmonary arteries, detection of myocardial fibrosis or scar, and tissue characterization [2]
The 61 patients (29 men, 32 women; mean age: 22.2 ± 9.0 (SD) years; 95% confidence interval (CI): 19.9–24.5 years) underwent CMR for: tetralogy of Fallot (n = 33/61; 54.1%), pulmonary atresia with a ventricular septal defect (n = 7/61; 11.5%), cardiac shunt (n = 7/61; 11.5%), transposition of great arteries (n = 3/61; 4.9%), aortic coarctation (n = 2/61; 3.3%), congenital pulmonary stenosis (n = 2/61; 3.3%), cor triatriatum sinister (n = 2/61; 3.3%), congenitally corrected transposition of the great arteries (n = 2/61; 3.3%), pulmonary atresia with intact ventricular septum after biventricular repair (n = 2/61; 3.3%), and congenital aortic stenosis (n = 1/61; 1.6%)
Summary
The advent of heart surgery and percutaneous cardiac procedures has considerably improved outcomes in patients born with congenital heart disease [1]. One major limitation of such extensive CMR examinations is currently the acquisition time, which can be difficult to tolerate in this population, as well as the iterative breath holds, which can be difficult to maintain, leading to poor-quality examinations because of breathing artifacts. To reduce this limitation, the development of acceleration techniques in MR imaging is crucial, and compressed sensing (CS) represents a promising technique in this category. To evaluate the reliability of compressed-sensing (CS) real-time single-breath-hold cine imaging for quantification of right ventricular (RV) function and volumes in congenital heart disease (CHD) patients in comparison with the standard multi-breath-hold technique. There was a high correlation between SSFPref and CSrt images regarding RV ejection fraction (49.8 ± 7.8 (SD)% (95% CI: 47.8–51.8%) versus 48.7 ± 8.6 (SD)%
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