Abstract
AimsTo investigate the use of respiratory motion compensation using image-based navigation (iNAV) with constant respiratory efficiency using single end-expiratory thresholding (CRUISE) for coronary magnetic resonance angiography (CMRA), and compare it to the conventional diaphragmatic navigator (dNAV) in paediatric patients with congenital or suspected heart disease.MethodsiNAV allowed direct tracking of the respiratory heart motion and was generated using balanced steady state free precession startup echoes. Respiratory gating was achieved using CRUISE with a fixed 50% efficiency. Whole-heart CMRA was acquired with 1.3 mm isotropic resolution. For comparison, CMRA with identical imaging parameters were acquired using dNAV. Scan time, visualization of coronary artery origins and mid-course, imaging quality and sharpness was compared between the two sequences.ResultsForty patients (13 females; median weight: 44 kg; median age: 12.6, range: 3 months–17 years) were enrolled. 25 scans were performed in awake patients. A contrast agent was used in 22 patients. The scan time was significantly reduced using iNAV for awake patients (iNAV 7:48 ± 1:26 vs dNAV 9:48 ± 3:11, P = 0.01) but not for patients under general anaesthesia (iNAV = 6:55 ± 1:50 versus dNAV = 6:32 ± 2:16; P = 0.32). In 98% of the cases, iNAV image quality had an equal or higher score than dNAV. The visual score analysis showed a clear difference, favouring iNAV (P = 0.002). The right coronary artery and the left anterior descending vessel sharpness was significantly improved (iNAV: 56.8% ± 10.1% vs dNAV: 53.7% ± 9.9%, P < 0.002 and iNAV: 55.8% ± 8.6% vs dNAV: 53% ± 9.2%, P = 0.001, respectively).ConclusioniNAV allows for a higher success-rate and clearer depiction of the mid-course of coronary arteries in paediatric patients. Its acquisition time is shorter in awake patients and image quality score is equal or superior to the conventional method in most cases.
Highlights
Whole-heart coronary magnetic resonance angiography (CMRA) is commonly used in paediatric patients, especially in those with congenital heart disease (CHD) to assess cardiac morphology and structural disease [1]
Conclusion: image-based navigation (iNAV) allows for a higher success-rate and clearer depiction of the mid-course of coronary arteries in paediatric patients
Its acquisition time is shorter in awake patients and image quality score is equal or superior to the conventional method in most cases
Summary
Whole-heart coronary magnetic resonance angiography (CMRA) is commonly used in paediatric patients, especially in those with congenital heart disease (CHD) to assess cardiac morphology and structural disease [1]. This technique allows for volumetric data acquisition with adequate signal-to-noise ratio and spatial resolution that provides crucial diagnostic information for clinical assessment in these patients [2]. The extensive scan time of CMRA requires acquisition during free-breathing and respiratory motion compensation techniques to mitigate motion artifacts [3, 4]. The dNAV can be used to correct for the respiratory motion by employing a linear tracking factor between the respiratory motion of the diaphragm and that of the heart, often assumed to be 0.6 [6]
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