Time-resolved mr venography pre catheter-based ablation for atrial fibrillation

Abstract

Objective The purpose of this study was to evaluate Time-resolved MR venography (TR-MRV) of the pulmonary venous circulation using the time-resolved angiography with interleaved stochastic trajectories (TWIST) method of time-resolved MRA (TR-MRA) and compare it with the more commonly used conventional Contrast enhanced magnetic resonance angiography (CE-MRA) approach in atrial fibrillation patients referred for pre-ablation pulmonary vein mapping. Background Catheter-based ablation of the pulmonary veins prevents recurrence of atrial fibrillation in 70-80% of patients during the first year of follow-up 1,2 . CE-MRA depicts the left atrium and pulmonary veins with high spatial resolution, enabling accurate measurement of pulmonary vein ostia to be made with depiction of their relationship to other structures. 1,3 Conventional CE-MRA however requires timing of contrast enhancement and produces images with overlap of venous and arterial structures, potentially obscuring pulmonary vein ostia. TR-MRA is an alternative to conventional CE-MRA and has been used successfully in other vascular territories. 4 Such an approach may be particularly advantageous in the pulmonary circulation with its rapid arteriovenous transit time, allowing acquisition of pure pulmonary venous phase images with a simpler imaging protocol. Material and methods 26 patients (15 males; age 60.0 ± 12.7y) referred for preablation pulmonary vein mapping underwent both conventional CE-MRA and TR-MRV with TWIST. Imaging was performed on a 1.5 Tesla (MAGNETOM Avanto, Siemens Healthcare) MRI scanner. Source partition and MIP images were evaluated. Quantitative Analysis: Pulmonary vein ostium orthogonal dimensions were measured using double oblique multiplanar reformatting. Qualitative Analysis: For qualitative analysis, both source partition images and MIP images were assessed by two observers. Pulmonary vein conspicuity was scored on a scale of 1-4 (1=poor, 2=fair, 3=good, 4=excellent). The number of pulmonary veins (3 veins= common ostium, 4 veins = normal, 5 veins=accessory vein) was recorded.