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Updated: May 17, 2026
Cardiac Magnetic Resonance Imaging at 7 Tesla
Published on: January 6, 2019
High-resolution motion compensated MRA in patients with congenital heart disease using extracellular contrast agent
Darius Dabir1, Claas Philip Naehle, Ralf Clauberg
1Department of Radiology, University of Bonn, Bonn, Germany.
Background:
Using first-pass MRA (FP-MRA) spatial resolution is limited by breath-hold duration. In addition, image quality may be hampered by respiratory and cardiac motion artefacts. In order to overcome these limitations an ECG- and navigator-gated high-resolution-MRA sequence (HR-MRA) with slow infusion of extracellular contrast agent was implemented at 3 Tesla for the assessment of congenital heart disease and compared to standard first-pass-MRA (FP-MRA).
Methods:
34 patients (median age: 13 years) with congenital heart disease (CHD) were prospectively examined on a 3 Tesla system. The CMR-protocol comprised functional imaging, FP- and HR-MRA, and viability imaging. After the acquisition of the FP-MRA sequence using a single dose of extracellular contrast agent the motion compensated HR-MRA sequence with isotropic resolution was acquired while injecting the second single dose, utilizing the timeframe before viability imaging. Qualitative scores for image quality (two independent reviewers) as well as quantitative measurements of vessel sharpness and relative contrast were compared using the Wilcoxon signed-rank test. Quantitative measurements of vessel diameters were compared using the Bland-Altman test.
Results:
The mean image quality score revealed significantly better image quality of the HR-MRA sequence compared to the FP-MRA sequence in all vessels of interest (ascending aorta (AA), left pulmonary artery (LPA), left superior pulmonary vein (LSPV), coronary sinus (CS), and coronary ostia (CO); all p < 0.0001). In comparison to FP-MRA, HR-MRA revealed significantly better vessel sharpness for all considered vessels (AA, LSPV and LPA; all p < 0.0001). The relative contrast of the HR-MRA sequence was less compared to the FP-MRA sequence (AA: p <0.028, main pulmonary artery: p <0.004, LSPV: p <0.005). Both, the results of the intra- and interobserver measurements of the vessel diameters revealed closer correlation and closer 95 % limits of agreement for the HR-MRA. HR-MRA revealed one additional clinical finding, missed by FP-MRA.
Conclusions:
An ECG- and navigator-gated HR-MRA-protocol with infusion of extracellular contrast agent at 3 Tesla is feasible. HR-MRA delivers significantly better image quality and vessel sharpness compared to FP-MRA. It may be integrated into a standard CMR-protocol for patients with CHD without the need for additional contrast agent injection and without any additional examination time.
Insights
High-resolution MRA (HR-MRA) significantly improves image quality and vessel sharpness for congenital heart disease assessment compared to standard first-pass MRA (FP-MRA). This advanced technique offers better diagnostic accuracy without increasing contrast agent or scan time.
Area of Science:
- Cardiovascular Imaging
- Medical Physics
- Radiology
Background:
- First-pass MRA (FP-MRA) for congenital heart disease (CHD) is limited by breath-hold duration, leading to motion artifacts.
- A novel ECG- and navigator-gated high-resolution MRA (HR-MRA) sequence was developed at 3 Tesla to overcome FP-MRA limitations.
Purpose of the Study:
- To compare the diagnostic performance of the new HR-MRA sequence against standard FP-MRA in patients with CHD.
- To evaluate image quality, vessel sharpness, contrast, and diameter measurements between the two MRA techniques.
Main Methods:
- 34 patients with CHD underwent cardiac MRI (CMR) including FP-MRA and HR-MRA sequences at 3 Tesla.
- HR-MRA utilized slow contrast infusion during a second injection, synchronized with ECG and respiratory gating.
- Image quality, vessel sharpness, relative contrast, and vessel diameters were quantitatively and qualitatively assessed.
Main Results:
- HR-MRA demonstrated significantly superior image quality and vessel sharpness across all evaluated vessels compared to FP-MRA (p < 0.0001).
- While relative contrast was lower in HR-MRA, intra- and interobserver measurements showed closer agreement for vessel diameters.
- HR-MRA identified one additional clinical finding not detected by FP-MRA, improving diagnostic yield.
Conclusions:
- The developed ECG- and navigator-gated HR-MRA protocol is feasible and effective at 3 Tesla for CHD assessment.
- HR-MRA offers significant improvements in image quality and vessel sharpness over FP-MRA.
- HR-MRA can be integrated into standard CMR protocols for CHD patients without additional contrast or scan time.
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