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Published on: June 3, 2018
[Clinical implication of parameter-optimized 3D-FISP MR angiography (MRA) in children with aortic coarctation:
1Radiologische Klinik, Abteilung Radiologische Diagnostik, Eberhard-Karls-Universität Tübingen. ulrich.kramer@med.uni-tuebingen.de
Insights
Optimized 3D-FISP MR angiography (MRA) accurately diagnoses aortic coarctation in children, offering excellent visualization of thoracic vasculature without contrast agents. This non-invasive technique is highly effective for pediatric cardiovascular assessment.
Area of Science:
- Cardiovascular Imaging
- Pediatric Radiology
- Medical Physics
Background:
- Aortic coarctation is a significant congenital heart defect requiring accurate diagnosis in children.
- Catheter angiography has been the gold standard but is invasive.
- Non-invasive imaging modalities are crucial for pediatric cardiovascular assessment.
Purpose of the Study:
- To implement and evaluate parameter-optimized 3D-FISP MR angiography (MRA) in children with suspected aortic coarctation.
- To compare the diagnostic performance of 3D-FISP MRA against conventional catheter angiography.
Main Methods:
- Eighteen pediatric patients (2-15 years) with aortic coarctation underwent 1.5T MR imaging.
- Parameter-optimized 3D-FISP MRA was performed in the sagittal plane.
- Image quality was assessed by reviewers, and results were compared with catheter angiography findings.
Main Results:
- 3D-FISP MRA identified aortic coarctation in 13 of 18 patients with high correlation (r=0.96) to catheter angiography.
- Excellent image quality (94%) and blood-tissue contrast were achieved with low sensitivity to motion.
- The technique provided excellent visualization of thoracic vasculature and improved diagnostic accuracy when combining source and MIP images.
Conclusions:
- 3D-FISP MRA is an excellent non-invasive tool for pediatric cardiovascular imaging.
- This technique allows for large 3D dataset acquisition without contrast agents, suitable for non-cooperative infants.
- It reliably assesses hemodynamic significance, collateral vessels, and other congenital heart diseases.
Purpose:
To implement parameter-optimized 3D-FISP MR angiography (MRA) with interleaved double-slab excitation and to compare the result with catheter angiography in children with aortic coarctation.
Materials And Methods:
Eighteen children aged 2 - 15 years (mean 9.1 years) underwent MR imaging on a 1.5T body scanner (Magnetom Vision, Siemens, Germany). All patients had undergone correlative catheter angiography. T1-weighted turbo spin echo (TSE) images (TR 600 ms, TE 17 ms, flip 160 degrees, slice thickness 2 - 4 mm) were obtained in axial and parasagittal orientation, followed by an optimized 3D-FISP MR angiography in a sagittal plane (TR 12.5 ms, TE 5.5 ms, flip 22 degrees, matrix 256 x 256, slice thickness 1.25 mm). All children were sedated but on spontaneous breathing. Image quality was graded by two experienced reviewers using a 4-point scoring system. Source images and reformatted maximum intensity projections (MIP) were analyzed for blood-tissue contrast as well as size and focal stenoses of the aortic arch.
Results:
Aortic coarctation was found in 13 of 18 patients, using the 3D-FISP MRA. A high correlation value (r = 0.96) was found compared to catheter angiography. Image quality was high in 94 % with well defined blood-tissue contrast in all cases. The sensitivity to flow and breathing motion was low. Examination time was about 15 minutes depending on volume of interest and heart rate. Diagnostic accuracy has shown improvement using a combined analysis of source and MIP images. The mentioned technique has provided an excellent display of thoracic vasculature.
Conclusion:
MR imaging represents an excellent tool for non-invasive examination of the cardiovascular system of children. The 3D-MRA allows the recording of a large 3D data set without the use of contrast agent and within an adequate measurement period, particularly in small infants unable to hold their breath. In addition, hemodynamic significance of aortic coarctation, the existence of collateral vessels and other congenital heart diseases can be described reliably by using this technique.
