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Validation of contrast-enhanced time-resolved magnetic resonance angiography in pre-ablation planning in patients with atrial fibrillation: comparison with traditional technique

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Abstract

Bolus timing is critical to optimal magnetic resonance angiography (MRA) acquisitions but can be challenging in some patients. Our purpose was to evaluate whether contrast-enhanced time-resolved magnetic resonance angiography (TR-MRA), a dynamic multiphase sequence that does not rely on bolus timing, is a viable alternative method to conventional 3D fast-long angle shot contrast-enhanced magnetic resonance angiography (CE-MRA). Coronal subtracted conventional CE-MRA images in 50 consecutive patients presenting for pre-atrial fibrillation ablation pulmonary venous (PV) mapping were compared with 50 TR-MRA images performed in 50 subsequent patients. The TR-MRA protocol was modified to optimize spatial resolution with slightly reduced temporal resolution (6.1 s scan time). Three experienced readers evaluated each scan’s image quality and relative left atrial (LA) opacification based on a 4-point scale and diagnostic PV visualization in a binary fashion. Additionally, LA signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and PV dimensions were measured for both techniques. TR-MRA had significantly higher overall image quality (3.10 ± 0.69 vs. 2.42 ± 0.69, p < 0.0001), and LA opacification scores (3.33 ± 0.70 vs. 2.15 ± 1.13, p < 0.0001) compared to CE-MRA. The proportion of diagnostically visualized pulmonary veins was 137/150 (91%) in the CE-MRA group vs. 147/150 (98%) with TR-MRA (p = 0.010). Both SNR and CNR were higher with TR-MRA vs. CE-MRA (277.9 ± 48.9 vs. 106.8 ± 41, p = 0.002 and 100.3 ± 41.7 vs. 70.7 ± 48.0, p = 0.002, respectively). Inter-reader variance of individual PV measurements for each of the MR techniques ranged between 0.62 and 1.47 mm and the ICC for vein measurements was higher with TR-MRA (range: 0.62–0.81) compared to CE-MRA (range: 0.47–0.64). TR-MRA, modified to maximize spatial resolution, offers an alternative method for performing high quality MRA examinations in patients with AF. TR-MRA offers greater overall image quality, PV visualization, and similarly reproducible PV measurements compared to traditional CE-MRA, without the challenges of proper bolus timing.

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Abbreviations

PV:

Pulmonary vein

MRA:

Magnetic resonance angiography

CE-MRA:

Contrast-enhanced magnetic resonance angiography

TR-MRA:

Time-resolved magnetic resonance angiography

LA:

Left atrium

SI:

Signal intensity

AF:

Atrial fibrillation

TR:

Repetition time

TE:

Echo time

CNR:

Contrast to noise ratio

SNR:

Signal to noise ratio

ROI:

Regions of interest

ICC:

Intra-class coefficient

RSPV:

Right superior pulmonary vein

RIPV:

Right inferior pulmonary vein

LSPV:

Left superior pulmonary vein

LIPV:

Left inferior pulmonary vein

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Funding

The study was funded by the National Institutes of Health (Grant Nos. K23HL089333 and R01HL116280) as well as by a Biosense Webster grant to Dr Nazarian; the Roz and Marvin H. Weiner and Family Foundation; the Dr. Francis P. Chiaramonte Foundation; Marilyn and Christian Poindexter; and the Norbert and Louise Grunwald Cardiac Arrhythmia Research Fund. Funding bodies had no role in the design of the study; collection, analysis, or interpretation of data; or in writing the manuscript.

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Authors and Affiliations

  1. Division of Cardiology, Johns Hopkins Medicine, 600 N Wolfe St, Carnegie 592, Baltimore, MD, 21287, USA

    Tarek Zghaib & Hugh Calkins

  2. §Russell A. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD, USA

    Adeel Shahid, Chiara Pozzessere, Linda C. Chu, John Eng, Ihab R. Kamel & Stefan L. Zimmerman

  3. Department of Radiology, University of Alabama at Birmingham, Birmingham, USA

    Kristin K. Porter

  4. Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Saman Nazarian

Authors
  1. Tarek Zghaib
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  2. Adeel Shahid
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  3. Chiara Pozzessere
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  4. Kristin K. Porter
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  5. Linda C. Chu
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  6. John Eng
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  7. Hugh Calkins
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  8. Ihab R. Kamel
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  9. Saman Nazarian
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  10. Stefan L. Zimmerman
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Corresponding author

Correspondence to Tarek Zghaib.

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Conflict of interest

Dr. Nazarian has received research grant funding from Biosense Webster during the conduct of the study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Ethics approval

The Johns Hopkins Institutional Review Board (JH-IRB) approved the study and retrospective study data was obtained under a HIPPA compliant waiver of consent.

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Zghaib, T., Shahid, A., Pozzessere, C. et al. Validation of contrast-enhanced time-resolved magnetic resonance angiography in pre-ablation planning in patients with atrial fibrillation: comparison with traditional technique. Int J Cardiovasc Imaging 34, 1451–1458 (2018). https://doi.org/10.1007/s10554-018-1355-8

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  • DOI: https://doi.org/10.1007/s10554-018-1355-8

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