Technical assessment of whole body angiography and cardiac function within a single MRI examination

S.J Gandy,M Lambert,J.J.F Belch,I.D Cavin,E Crowe,R Littleford,J.A Macfarlane,S.Z Matthew,P Martin,R.S Nicholas,A.D Struthers,F Sullivan,S.A Waugh,R.D White,J.R Weir-Mccall,J.G Houston

doi:10.1016/j.crad.2015.02.003

Abstract

AimTo evaluate a combined protocol for simultaneous cardiac MRI (CMR) and contrast-enhanced (CE) whole-body MR angiography (WB-MRA) techniques within a single examination.Materials and methodsAsymptomatic volunteers (n = 48) with low-moderate risk of cardiovascular disease (CVD) were recruited. The protocol was divided into four sections: (1) CMR of left ventricle (LV) structure and function; (2) CE-MRA of the head, neck, and thorax followed by the distal lower limbs; (3) CMR LV “late gadolinium enhancement” assessment; and (4) CE-MRA of the abdomen and pelvis followed by the proximal lower limbs. Multiple observers undertook the image analysis.ResultsFor CMR, the mean ejection fraction (EF) was 67.3 ± 4.8% and mean left ventricular mass (LVM) was 100.3 ± 22.8 g. The intra-observer repeatability for EF ranged from 2.1–4.7% and from 9–12 g for LVM. Interobserver repeatability was 8.1% for EF and 19.1 g for LVM. No LV delayed myocardial enhancement was observed. For WB-MRA, some degree of luminal narrowing or stenosis was seen at 3.6% of the vessel segments (involving n = 29 of 48 volunteers) and interobserver radiological opinion was consistent in 96.7% of 1488 vessel segments assessed.ConclusionCombined assessment of WB-MRA and CMR can be undertaken within a single examination on a clinical MRI system. The associated analysis techniques are repeatable and may be suitable for larger-scale cardiovascular MRI studies.

Highlights

Cardiovascular disease (CVD) accounts for a significant burden of mortality and morbidity in developed societies
The protocol was divided into four sections: (1) cardiac MRI (CMR) of left ventricle (LV) structure and function; (2) CE-MRA of the head, neck, and thorax followed by the distal lower limbs; (3) CMR LV “late gadolinium enhancement” assessment; and (4) CE-MRA of the abdomen and pelvis followed by the proximal lower limbs
The intra-observer repeatability for ejection fraction (EF) ranged from 2.1e4.7% and from 9e12 g for left ventricular mass (LVM)

Summary

Introduction

Cardiovascular disease (CVD) accounts for a significant burden of mortality and morbidity in developed societies. The majority of CVD deaths are from coronary heart disease (CHD) or stroke, the disease is often spread across all vascular territories and may present elsewhere first, e.g., in the arteries of the legs. Disease in more than one vascular bed (especially when involving the peripheral arteries) is known to have a cumulative effect on worsening prognosis, so early detection and stratification of the wholebody burden of CVD (e.g., identifying those at highest risk of sudden death through CHD or stroke) is desirable. Primary prevention of CVD events is effective, but targeting suitable treatment, such as protective drug therapy and/or procedural interventions, to those most likely to benefit remains a challenge. A method to screen for “pre-clinical” cardiovascular disease may help to improve how primary prevention is targeted

Objectives

Methods

Results

Discussion

Conclusion