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Magn Reson Imaging. 2018 Jun;49:47-54. doi: 10.1016/j.mri.2017.12.023. Epub 2018 Jan 12.

Improved coronary magnetic resonance angiography using gadobenate dimeglumine in pediatric congenital heart disease.

Author information

1
Division of Imaging Sciences & Biomedical Engineering, King's College London, London, UK. Electronic address: miguel.silvavieira@kcl.ac.uk.
2
Division of Imaging Sciences & Biomedical Engineering, King's College London, London, UK. Electronic address: markus.henningsson@kcl.ac.uk.
3
Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. Electronic address: nathalie.dedieu@gosh.nhs.uk.
4
CMR Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK. Electronic address: v.vassiliou@rbht.nhs.uk.
5
Evelina Children's Hospital London, Guy's and St. Thomas' NHS Foundation Trust, London, UK. Electronic address: aaron.bell@gstt.nhs.uk.
6
Evelina Children's Hospital London, Guy's and St. Thomas' NHS Foundation Trust, London, UK. Electronic address: sujeev.mathur@gstt.nhs.uk.
7
Evelina Children's Hospital London, Guy's and St. Thomas' NHS Foundation Trust, London, UK. Electronic address: kuberan.pushparajah@gstt.nhs.uk.
8
Division of Imaging Sciences & Biomedical Engineering, King's College London, London, UK; Departments of Surgery and Biomedical Engineering, University of Michigan, MI, USA. Electronic address: figueroc@med.umich.edu.
9
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, USA. Electronic address: mohammad.hussain@utsouthwestern.edu.
10
Division of Imaging Sciences & Biomedical Engineering, King's College London, London, UK; Pontificia Universidad Católica de Chile, Escuela de Ingeniería, Santiago, Chile. Electronic address: rene.botnar@kcl.ac.uk.
11
Division of Imaging Sciences & Biomedical Engineering, King's College London, London, UK; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, USA. Electronic address: gerald.greil@utsouthwestern.edu.

Abstract

BACKGROUND:

CMRA in pediatrics remains challenging due to the smaller vessel size, high heart rates (HR), potential image degradation caused by limited patient cooperation and long acquisition times. High-relaxivity contrast agents have been shown to improve coronary imaging in adults, but limited data is available in children. We sought to investigate whether gadobenate dimeglumine (Gd-BOPTA) together with self-navigated inversion-prepared coronary magnetic resonance angiography (CMRA) sequence design improves coronary image quality in pediatric patients.

METHODS:

Forty consecutive patients (mean age 6±2.8years; 73% males) were prospectively recruited for a 1.5-T MRI study under general anesthesia. Two electrocardiographic-triggered free breathing steady-state free precession (SSFP) angiography sequences (A and B) with isotropic spatial resolution (1.3mm3) were acquired using a recently developed image-based self-navigation technique. Sequence A was acquired prior to contrast administration using T2 magnetization preparation (T2prep). Sequence B was acquired 5-8min after a bolus of Gd-BOPTA with the T2prep replaced by an inversion recovery (IR) pulse to null the signal from the myocardium. Scan time, signal-to noise and contrast-to-noise ratios (SNR and CNR), vessel wall sharpness (VWS) and qualitative visual score for each sequence were compared.

RESULTS:

Scan time was similar for both sequences (5.3±1.8 vs 5.2±1.5min, p=.532) and average heart rate (78±14.7 vs 78±14.5bpm, p=.443) remained constant throughout both acquisitions. Sequence B resulted in higher SNR (12.6±4.4 vs 31.1±7.4, p<.001) and CNR (9.0±1.8 vs 13.5±3.7, p<.001) and provided improved coronary visualization in all coronary territories (VWS A=0.53±0.07 vs B=0.56±0.07, p=.001; and visual scoring A=3.8±0.59 vs B=4.1±0.53, p<.001). The number of non-diagnostic coronary segments was lower for sequence B [A=42 (13.1%) segments vs B=33 (10.3%) segments; p=.002], and contrary to the pre-contrast sequence, never involved a proximal segment. These results were independent of the patients' age, body surface area and HR.

CONCLUSIONS:

The use of Gd-BOPTA with a 3D IR SSFP CMRA sequence results in improved coronary visualization in small infants and young children with high HR within a clinically acceptable scan time.

KEYWORDS:

Coronary magnetic resonance angiography; Gadobenate dimeglumine; Pediatric congenital heart disease; Respiratory image-based navigation

PMID:
29339139
DOI:
10.1016/j.mri.2017.12.023
[Indexed for MEDLINE]

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