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Aortic diameter assessment by cardiovascular magnetic resonance: do we really need contrast enhanced images?
Irene Ferrari1, Nerejda Shehu1, Naira Mkrtchyan1
1Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany.
Insights
Cardiovascular magnetic resonance (CMR) using systolic-gated 3D imaging provides larger aortic diameters than diastolic-gated 3D or contrast-enhanced angiography. Diastolic-gated 3D measurements closely match angiography, supporting its use for aortic assessment.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Radiology
Background:
- Consensus on optimal Cardiovascular Magnetic Resonance (CMR) sequences and cardiac phases for aortic diameter assessment is lacking.
- Contrast-enhanced-magnetic-resonance-angiography (angiography) is common but alternatives like navigated 3D-whole-heart-steady-state-free-precession sequences offer contrast-free imaging.
- These 3D sequences, typically ECG-gated in diastole, provide sharp anatomical rendering but are not yet routine.
Purpose of the Study:
- To evaluate aortic diameters using a systolic-gated 3D sequence.
- To validate the use of a diastolic-gated 3D sequence as an alternative to angiography.
- To compare measurements from systolic-gated 3D, diastolic-gated 3D, and conventional angiography.
Main Methods:
- Retrospective analysis of 30 patients undergoing routine angiography.
- Aorta measurements taken at 9 standard positions using three sequences: angiography, 3D-diastole, and 3D-systole.
- Comparison of diameters using paired t-test analysis to determine significant differences.
Main Results:
- Systolic-gated 3D measurements yielded significantly larger aortic diameters compared to both diastolic-gated 3D and angiography (P<0.01).
- Maximal differences in the ascending aorta were observed between systole and diastole (1.7±1.02 mm) and between systole and angiography (1.5±1.07 mm).
- No significant difference was found between diastolic-gated 3D and angiography measurements (mean difference 0.2±0.16 mm, P not significant).
Conclusions:
- Navigated 3D-whole-heart CMR is supported for evaluating aortic diameters.
- Systolic-gated 3D imaging results in larger aortic diameters, particularly in the ascending aorta.
- Diastolic-gated 3D imaging serves as a reliable alternative to angiography for aortic diameter assessment.
Background:
Cardiovascular magnetic resonance (CMR) is widely used for aortic diameter assessment but there is no consensus on the sequence or cardiac cycle phase in which the measures should be taken. The most used sequence is contrast-enhanced-magnetic-resonance-angiography (angiography), usually non-ECG-triggered. An alternative is a navigated 3D-whole-heart-steady-state-free-precession sequence which is contrast-free and breath- and ECG-gated (mostly diastolic gating), producing very sharp anatomical rendering. Nonetheless, its routine use has not yet spread. Our aim was evaluating aortic diameters by a systolic-gated 3D and put additional effort in the validation of diastolic-gated 3D as alternative to angiography.
Methods:
We retrospectively analysed 30 patients scheduled for routine Angiography. We measured the aorta at 9 standard positions by three different sequences (angiography, 3D-diastole and 3D-systole) and compared the diameters obtained by calculating the differences and by paired t-test analysis.
Results:
Diameters by 3D-systole were larger than by 3D-diastole and angiography (P<0.01). In the ascending aorta we found the maximal differences between systole and diastole and between systole and angiography which were 1.7± SD 1.02 mm and 1.5± SD 1.07 mm respectively. There was no significant difference between diastolic and angiography measurements (mean difference 0.2± SD 0.16 mm, P not significant).
Conclusions:
Our results support the use of navigated 3D-whole-heart CMR to evaluate aortic diameters. Systolic-gated 3D produces larger diameter, especially in the ascending aorta.
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