X-ray magnetic resonance fusion modality may reduce radiation exposure and contrast dose in diagnostic cardiac catheterization of congenital heart disease

Abstract

Background: Radiation exposure in the pediatric population may increase the risk of future malignancy. Children with congenital heart disease who often undergo repeated catheterizations are at risk. One possible strategy to reduce radiation is to use X-ray Magnetic Resonance Fusion (XMRF) to facilitate cardiac catheterization.

Methods: Catheterization data of patients who underwent diagnostic XMRF procedures between January 1, 2009 and February 1, 2012 were reviewed. Cases were matched 1:1 to contemporary controls who did not undergo XMRF based on weight and diagnosis and were compared in radiation exposure, contrast dose, and procedural and anesthesia times.

Results: Forty-four matched pairs were included. Baseline demographics were similar in both groups. Patients in the XMRF group had lower indices of radiation exposure measured by fluoroscopy time (14 vs. 16.4 vs. P = 0.047), dose-area product from fluoroscopy (513.2 vs. 589.1 µGy·m(2) , P = 0.042), total dose-area product (625.8 vs. 995.2 µGy·m(2) , P = 0.027), and total air kerma dose (94.5 vs. 153.8 mGy, P = 0.017). There was also a significant reduction in contrast dose (2 vs. 3.3 cc/kg, P <0.001). Procedural time tended to be shorter in the XMRF group but anesthesia time was significantly longer.

Conclusion: Select diagnostic cardiac catheterization cases that utilized XMRF used less radiation and contrast than similar cases where XMRF was not used. Future work is needed to determine whether similar benefits can be extended to other types of diagnostic and complex interventional procedures.

Keywords: cardiac MRI; pediatric interventions.