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. 2024 Jun;40(6):1363-1376.
doi: 10.1007/s10554-024-03111-0. Epub 2024 Apr 27.

Inversion recovery and saturation recovery pulmonary vein MR angiography using an image based navigator fluoro trigger and variable-density 3D cartesian sampling with spiral-like order

Jason Craft  1 , Jonathan Weber  2 , Yulee Li  2 , Joshua Y Cheng  2 , Nancy Diaz  2 , Karl P Kunze  3 , Michaela Schmidt  4 , Marie Grgas  2 , Suzanne Weber  2 , John Tang  2 , Roosha Parikh  2 , Afiachukwu Onuegbu  2 , Ann-Marie Yamashita  2 , Elizabeth Haag  2 , Daniel Fuentes  5 , Michael Czipo  5 , Radhouene Neji  6 , Cristian B Espada  2 , Leana Figueroa  2 , Jonathan A Rothbaum  2 , Kana Fujikura  7 , Ruqiyya Bano  8 , Omar K Khalique  2 , Claudia Prieto #  6   9 , Rene M Botnar #  6   10
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Inversion recovery and saturation recovery pulmonary vein MR angiography using an image based navigator fluoro trigger and variable-density 3D cartesian sampling with spiral-like order

Jason Craft et al. Int J Cardiovasc Imaging. 2024 Jun.

Abstract

Contrast enhanced pulmonary vein magnetic resonance angiography (PV CE-MRA) has value in atrial ablation pre-procedural planning. We aimed to provide high fidelity, ECG gated PV CE-MRA accelerated by variable density Cartesian sampling (VD-CASPR) with image navigator (iNAV) respiratory motion correction acquired in under 4 min. We describe its use in part during the global iodinated contrast shortage. VD-CASPR/iNAV framework was applied to ECG-gated inversion and saturation recovery gradient recalled echo PV CE-MRA in 65 patients (66 exams) using .15 mmol/kg Gadobutrol. Image quality was assessed by three physicians, and anatomical segmentation quality by two technologists. Left atrial SNR and left atrial/myocardial CNR were measured. 12 patients had CTA within 6 months of MRA. Two readers assessed PV ostial measurements versus CTA for intermodality/interobserver agreement. Inter-rater/intermodality reliability, reproducibility of ostial measurements, SNR/CNR, image, and anatomical segmentation quality was compared. The mean acquisition time was 3.58 ± 0.60 min. Of 35 PV pre-ablation datasets (34 patients), mean anatomical segmentation quality score was 3.66 ± 0.54 and 3.63 ± 0.55 as rated by technologists 1 and 2, respectively (p = 0.7113). Good/excellent anatomical segmentation quality (grade 3/4) was seen in 97% of exams. Each rated one exam as moderate quality (grade 2). 95% received a majority image quality score of good/excellent by three physicians. Ostial PV measurements correlated moderate to excellently with CTA (ICCs range 0.52-0.86). No difference in SNR was observed between IR and SR. High quality PV CE-MRA is possible in under 4 min using iNAV bolus timing/motion correction and VD-CASPR.

Keywords: Atrial fibrillation; Image based navigators; Left atrial delayed enhancement; Magnetic resonance angiography; Variable density cartesian sampling.

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References

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