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Dual-Phase 3D Modified Dixon Steady-State MR Angiography in Pediatric Complex Congenital Heart Disease
Lucia D Beissel1,2, Christopher Hart1,3, Alexander Isaak1,2
1Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
Insights
Dual-phase modified Dixon MR angiography improves image quality and vessel assessment in pediatric congenital heart disease (CHD). Systolic imaging enhances diagnostic adequacy for specific structures, aiding in single-acquisition evaluations.
Area of Science:
- Radiology
- Medical Imaging
- Cardiovascular Imaging
Background:
- Congenital heart disease (CHD) necessitates advanced imaging techniques for accurate diagnosis and monitoring.
- Phase-dependent variations in cardiovascular structures impact image quality and measurements in pediatric patients.
- Steady-state MR angiography (MRA) is crucial for visualizing complex vascular anatomy in CHD.
Purpose of the Study:
- To evaluate the impact of dual-phase 3D modified Dixon (mDixon) steady-state MRA on phase-dependent image quality.
- To assess the accuracy of vessel measurements obtained with dual-phase 3D mDixon steady-state MRA in pediatric CHD.
- To determine the diagnostic utility of acquiring both systolic and diastolic images within a single MRA examination.
Main Methods:
- Retrospective single-center study involving pediatric patients with CHD undergoing cardiac MRI at 3 T.
- Free-breathing dual-phase 3D mDixon steady-state MRA with respiratory navigator gating and interleaved systolic/diastolic acquisition.
- Independent measurement of vessel diameters by two readers and Likert scale evaluation of image quality, including artifacts.
Main Results:
- Arterial vessel diameters were significantly larger during systole compared to diastole (e.g., main pulmonary artery: 23.2 mm vs 19.1 mm, P < .01).
- Systolic imaging demonstrated higher quality for coronary arteries and pulmonary veins (median score 5.00 vs 4.00, P < .01).
- Diastolic imaging yielded higher quality for most other vessels (e.g., main pulmonary artery: median score 5.00 vs 3.00, P < .01), with systolic imaging providing diagnostic quality in cases of non-diagnostic diastolic images due to arrhythmias.
Conclusions:
- Dual-phase 3D mDixon steady-state MRA effectively enables phase-dependent assessment of vessel dimensions and image quality in pediatric CHD.
- The addition of systolic imaging improves diagnostic adequacy and visualization of selected cardiovascular structures within a single MRA acquisition.
- This technique offers enhanced diagnostic capabilities for evaluating complex congenital heart disease in pediatric populations.
Abstract:
Purpose To evaluate the impact of dual-phase three-dimensional (3D) modified Dixon (mDixon) steady-state MR angiography (MRA) on phase-dependent image quality and vessel measurements in pediatric patients with congenital heart disease (CHD). Materials and Methods In this retrospective single-center study, pediatric patients with CHD underwent cardiac MRI at 3 T, including free-breathing dual-phase 3D mDixon steady-state MRA with respiratory navigator gating and interleaved acquisition of diastolic and systolic images. Vessel diameters were measured independently by two readers. Overall image quality, including vessel border delineation and breathing-, motion-, flow-, and susceptibility-related artifacts, was evaluated using a five-point Likert scale (1 = nondiagnostic; 5 = excellent). Paired t tests or Wilcoxon signed rank tests were used for phase comparisons. Results A total of 47 patients (mean age, 6.4 years ± 3.5 [SD]) were included. Arterial vessel diameters were larger in systole than in diastole (eg, main pulmonary artery: mean, 23.2 mm ± 5.3 [SD] vs 19.1 mm ± 3.9; P < .01). Systolic image quality was higher for coronary arteries and pulmonary veins (eg, pulmonary veins: median, 5.00 [IQR, 4.00-5.00] vs 4.00 [IQR, 3.00-4.00]; P < .01), whereas diastolic image quality was higher for most other vessels (eg, main pulmonary artery: median, 5.00 [IQR, 4.00-5.00] vs 3.00 [IQR, 2.00-4.00]; P < .01). In two (4%) of 47 patients with nondiagnostic diastolic image quality due to arrhythmia or high heart rate variability, systolic imaging yielded diagnostic image quality. Conclusion Dual-phase 3D mDixon steady-state MRA enabled phase-dependent assessment of vessel dimensions and image quality in pediatric CHD. Additional systolic imaging improved diagnostic adequacy and visualization of selected structures within a single acquisition. Keywords: Pediatric Congenital Heart Disease, Modified Dixon MR Angiography Supplemental material is available for this article. © RSNA, 2026.
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