Real time cardiac MRI and its clinical usefulness in arrhythmias and wall motion abnormalities

  • Christina Unterberg-Buchwald
  • Martin Fasshauer
  • Jan M Sohns
  • Wieland Staab
  • Andreas Schuster
  • Dirk Voit
  • Johannes T Kowallick
  • Michael Steinmetz
  • Jens Frahm
  • Joachim Lotz
Open Access
Poster presentation
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Keywords

Atrial Fibrillation Image Quality Sinus Rhythm Diagnostic Quality Wall Motion Abnormality 

Background

Analysis of cardiac function in patients with arrhythmias is very limited or nearly impossible in ECG synchronized cine acquisitions with balanced SSFP. A real-time method at 1.5 T with SSFP contrast was used to show that this method is superior for image quality and analysis of ventricular function in a subset of patients with atrial fibrillation and AV-Block.

Methods

Radial gradient-echo sequences with fully balanced SSFP gradients and at least 15-fold undersampling (real-time SSFP, RT) and conventional ECG-synchronized cine SSFP CMR (Cine) was used on a 1.5 T scanner system. Patients who had permanent arrhythmias (most often atrial fibrillation, AA; n = 8) or wall motion abnormalities (WMA; n = 3) were scanned in the standard views and compared to patients in sinus rhythm (SR;n = 21) without wall motion abnormalities. Image reconstruction of RT was performed offline by regularized nonlinear inversion. Quality (IQ) of scan was detected using an image quality score (ranging from 0 = no diagnostic quality to 1 = reduced diagnostic quality, 2 = many artifacts, 3 = some artifacts, and 4 = optimal diagnostic quality). Cardiac function was analyzed using a semiautomatic contour detection (Q mass, Medis, NL) applied to 5 consecutive baets in RT and Cine avering data of 10-12 beats. All analysis was done by two blinded observers (3 and 8 years experience of CMR evaluation).

Results

IQ was comparable for Cine and RT SSFP in patients with WMA or patients in sinus rhythm without WMA given in Table 1. However, IQ was significantly better for RT compared to Cine in all three short axis in patients with arryhthmias. Functional parameters showed no significant differences, however there was a trend to lower values for enddiastolic, endsystolic and beat volumes for Cine (10-12 beats) compated to RT (5 consecutive beats) in RT.

Table 1

Views for IQ and quantitative parameters

Patient groups

Number of views

RT

Cine

Short axis base (IQ)

AA

WMA

SR

16

6

42

3.94 ± 0.25 *

4.00 ± 0.00

3.62 ± 0.54

2.75 ± 0.68

4.00 ± 0.00

3.95 ± 0.22

Short axis mid (IQ)

AA

WMA

SR

16

6

42

3.81 ± 0.40 *

3.67 ± 0.5

3.48 ± 0.67

2.69 ± 0.60

4.00 ± 0.00

3.93 ± 0.26

Short axis apex (IQ)

AA

WMA

SR

16

6

42

3.81 ± 0.40 *

3.00 ± 1.26

3.07 ± 0.97

2.19 ± 0.91

3.50 ± 0.55

3.70 ± 0.55

Enddiastolic volume [ml]

AA

WMA

SR

16

3

16

55.15 ± 10.17

52.39 ± 3.91

47.50 ± 12.70

36.80 ± 20.13

43.10 ± 6.73

51.32 ± 18.4

Endsystolic volume [ml]

AA

WMA

SR

16

3

16

32.30 ± 13.11

30.50 ± 9.80

25.10 ± 13.0

21.60 ± 16.50

24.10 ± 6.86

22.40 ± 10.70

Beat volume [ml]

AA

WMA

SR

16

3

16

22.83 ± 6.30

21.90 ± 8.50

22.37 ± 5.30

15.20 ± 6.20

19.00 ± 1.27

29.84 ± 16.7

Ejection fraction [%]

AA

WMA

SR

16

3

16

43.50 ± 15.10

41.70 ± 16.70

50.00 ± 12.20

46.30 ± 16.10

45.00 ± 6.90

57.90 ± 12.50

* p < 0.001 RT vs Cine

Conclusions

RT cardiac MRI is a robust method with high image quality that has the potential to allow functional analysis of sequences in patients with arrhythmias that are often difficult or impossible to analyze by cine SSFP.

Funding

No funding.

Copyright information

© Unterberg-Buchwald et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Christina Unterberg-Buchwald
    • 1
    • 2
  • Martin Fasshauer
    • 2
  • Jan M Sohns
    • 2
  • Wieland Staab
    • 2
  • Andreas Schuster
    • 1
  • Dirk Voit
    • 3
  • Johannes T Kowallick
    • 1
  • Michael Steinmetz
    • 4
  • Jens Frahm
    • 3
  • Joachim Lotz
    • 2
  1. 1.CardiologyUniversity Clinic GoettingenGoettingenGermany
  2. 2.Institute of Diagnostic and Interventional RadiologyUniversity Clinic GoettingenGoettingenGermany
  3. 3.Biomedizinische NMR ForschungsGmbHMax-Planck-Institut für biophysikalische ChemieGoettingenGermany
  4. 4.Pediatric Cardiology and Intensive CareUniversity Clinic GoettingenGoettingenGermany

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