Three-dimensional dual-phase whole-heart MR imaging: clinical implications for congenital heart disease

Area of Science:

• Cardiovascular Imaging
• Pediatric Cardiology
• Medical Imaging Physics

Background:

• Three-dimensional (3D) whole-heart imaging is crucial for evaluating complex cardiac anatomy in congenital heart disease (CHD).
• Optimizing image acquisition timing during the cardiac cycle is essential for accurate structural assessment and measurement.
• Previous studies have not definitively established the optimal cardiac phase for imaging specific structures in CHD using 3D whole-heart techniques.

Purpose of the Study:

• To determine whether systole or diastole provides superior imaging for assessing cardiac structures in pediatric congenital heart disease using 3D whole-heart imaging.
• To compare image quality and contrast-to-noise ratio (CNR) between systolic and diastolic phases for various cardiac components.

Main Methods:

• Fifty children with CHD underwent 3D dual-phase whole-heart magnetic resonance imaging (MRI).
• Image quality and CNR were quantitatively assessed for multiple cardiac structures, including atria, ventricles, great vessels, and pulmonary veins.
• Cross-sectional measurements of the aortic arch and right ventricular outflow tract (RVOT) were performed.

Main Results:

• Systolic imaging yielded significantly higher CNR and image quality for the right atrium, left atrium, right ventricle, left ventricle, and pulmonary veins (P < .05).
• Diastolic imaging demonstrated significantly higher CNR in the aorta (P = .013) and superior image quality for the pulmonary arteries and post-stenotic areas (P < .001).
• Systolic measurements were significantly larger for the aortic arch and RVOT, indicating optimal assessment of these structures during this phase.

Conclusions:

• Neither systolic nor diastolic phase is universally optimal; specific cardiac structures are better visualized in distinct phases.
• A dual-phase imaging approach, capturing both systole and diastole, enhances overall success rates and provides comprehensive anatomical data.
• This dual-phase strategy is advantageous over single-phase imaging for planning interventional procedures in CHD due to its ability to depict dynamic diameter changes.