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Improving congenital heart disease imaging using 3d whole-heart dual-phase MRI
Journal of Cardiovascular Magnetic Resonance volume 13, Article number: P1 (2011)
A single-phase 3d steady-state-free precession whole heart approach with respiratory navigator gating and ECG triggering (3d SSFP) is now frequently used for diagnostic imaging in children with congenital heart disease (CHD). However, certain cardiac structures may be better assessed during the systolic and others in the diastolic rest period. Therefore, a previously described dual phase 3d-SSFP whole heart sequence may offer clinical benefit in these patients. (Uribe et al 2008)
To determine whether 3d-dual phase imaging for CHD offers benefits in demonstrating or measuring cardiovascular structures.
50 consecutive children with CHD underwent 3D SSFP dual-phase imaging. All cardiac chambers and great vessels were analyzed for contrast-to-noise ratio (CNR) and image quality (IQ) (consensus reading by two independent observers; grade 0=non diagnostic; 1 to 4=diagnostic, McConnell et al 1997). Twelve patients were referred for RVOT assessment. Dimensions were measured at valvar, supravalvar and pre-bifurcation levels. CNR, image quality and RVOT measurements were compared between systole and diastole.
50 children (26 male, mean age 4yrs 10months, range 5days to 18yrs) underwent 3d dual-phase SFFP imaging. The mean HR was 90 bpm (56 to 139). Dual phase yielded diagnostic imaging for all chambers and great vessels in 48 cases. Systolic imaging alone was diagnostic in 45 cases and diastolic imaging in 47 cases. CNR (paired t-test) and IQ (Wilcoxon Signed Ranks test) were significantly (p<0.05) higher in systole for the pulmonary veins (figure 1), left atrium and both ventricles. Conversely, diastolic imaging had significantly higher CNR values for the aorta and superior cavo-pulmonary (Glenn) anastomosis. IQ was significantly higher in diastole for the branch pulmonary arteries and for arterial stenoses (e.g. coarctation, pulmonary artery stenosis; figure 2). Cross sectional measurements of the RVOT were significantly larger in systole at all 3 levels (valve 2.9 vs. 2.7cm2; supravalvar 3.2 vs. 2.7cm2 and bifurcation 3.3 vs. 2.5cm2: p<0.05 by paired t-test, max. difference to diastole 50%).
Dual phase 3D SSFP imaging improved the success rate of diagnostic quality imaging compared to single-phase imaging. Cardiac chambers and pulmonary veins are better imaged in systole possibly due to improved blood exchange. Less blood flow turbulence may have improved branch pulmonary arteries or arterial stenosis imaging in diastole. Our data confirms that under-sizing of RVOT stent-valve would have occurred if diastolic imaging were used to guide intervention.
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Hussain, T., Lossnitzer, D., Uribe, S. et al. Improving congenital heart disease imaging using 3d whole-heart dual-phase MRI. J Cardiovasc Magn Reson 13, P1 (2011). https://doi.org/10.1186/1532-429X-13-S1-P1
- Congenital Heart Disease
- Pulmonary Vein
- Dual Phase
- Branch Pulmonary Artery
- Pulmonary Artery Stenosis