Project description:ObjectivesTo define and compare growth rates of the distal aorta in Marfan patients with and without aortic root replacement using serial MR angiography (MRA).MethodsWe retrospectively included 136 Marfan patients with a total of 645 MRAs who underwent a median of five MRAs (range: 2-13) at 1.5 T and 3 T in annual intervals. Of these, 41 patients (34.8 ± 12 years) had undergone aortic root replacement. The remaining 95 patients (29.0 ± 17 years) still had a native aorta and served as the control group. Thoracic aortic diameters were independently measured at eleven predefined levels. Estimated growth rates were calculated using a mixed effects model adjusted for sex, age, BMI, and medication.ResultsMarfan patients with aortic root replacement revealed the highest mean estimated growth rate in the proximal descending aorta (0.77 mm/year, CI: 0.31-1.21). Mean growth rates at all levels of the distal thoracic aorta were significantly higher in patients with aortic root replacement (0.28-0.77 mm/year) when compared to patients without aortic root replacement (0.03-0.07 mm/year) (all p < 0.001). Antihypertensive medication, gender, and BMI had no significant impact on the distal aortic growth rates.ConclusionDistal thoracic aortic diameters increase at a significantly higher rate in Marfan patients with aortic root replacement compared to Marfan patients without aortic root replacement. Further studies are warranted to investigate if the increased growth rate of the distal thoracic aorta after aortic root replacement is caused by altered hemodynamics due to the rigid aortic root graft or due to the general genetic disposition of post-operative Marfan patients.Clinical relevance statementHigh growth rates of the distal aorta after aortic root replacement underline the need for careful life-long aortic imaging of Marfan patients after aortic root replacement.Key points• Aortic growth rates in Marfan patients with aortic root replacement are highest in the mid-aortic arch, the proximal- and mid-descending aorta. • Growth rates of the distal thoracic aorta are significantly higher in Marfan patients with aortic root replacement compared to Marfan patients without aortic root replacement. • Antihypertensive medication, gender, and BMI have no significant impact on distal aortic growth rates in Marfan patients.

Project description:BackgroundCardiovascular magnetic resonance (CMR) angiography (CMRA) is an important non-invasive imaging tool for congenital heart disease (CHD) and aortopathy patients. The conventional 3D balanced steady-state free precession (bSSFP) sequence is often confounded by imaging artifacts. We sought to compare the respiratory navigated and electrocardiogram (ECG) gated modified Dixon (mDixon) CMRA sequence to conventional non-gated dynamic multi-phase contrast enhanced CMRA (CE-CMRA) and bSSFP across a variety of diagnoses.MethodsWe included 24 patients with CHD or aortopathy with CMR performed between September 2017 to December 2017. Each patient had undergone CE-CMRA, followed by a bSSFP and mDixon angiogram. Patients with CMR-incompatible implants or contraindications to contrast were excluded. The studies were rated according to image quality at a scale from 1 (poor) to 4 (excellent) based on diagnostic adequacy, artifact burden, vascular border delineation, myocardium-blood pool contrast, and visualization of pulmonary and systemic veins and coronaries. Contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and quantitative vascular measurements were compared between the two gated sequences. Bland-Altman plots were generated to compare paired measures.ResultsAll scans were diagnostically adequate. Mean (SD) quality scores were 3.4 (0.7) for the mDixon, 3.2 (0.5) for the bSSFP and 3.4 (0.5) for the CE-CMRA. Qualitatively, the intracardiac anatomy and myocardium-blood pool definition were better in the bSSFP; however, mDixon images showed enhanced vessel wall sharpness with less blurring surrounding the anatomical borders distally. Coronary origins were identified in all cases. Pulmonary veins were visualized in 92% of mDixon sequences, 75% of bSSFP and 96% of CE-CMRA. Similarly, neck veins were identified in 92, 83 and 96% respectively. Artifacts prevented vascular measurement in 6/192 (3%) and 4/192 (2%) of total vascular measurements for the mDixon and bSSFP, respectively. However, the size of signal void and field distortion were significantly worse in the latter, particularly for flow and metal induced artifacts.ConclusionIn patients with congenital heart disease, ECG gated mDixon angiography yields high fidelity vascular images including better delineation of head and neck vasculature and pulmonary veins and fewer artifacts than the comparable bSSFP sequence. It should be considered as the preferred strategy for successful CHD imaging in patients with valve stenosis, vascular stents, or metallic implants.

Project description:BackgroundA significant portion of cryptogenic stroke is hypothesized to be secondary to cardiac embolism. However, transthoracic echocardiogram is usually delayed after stroke, and more detailed cardiac imaging is not routinely done.AimsThis study aimed to determine whether non-ECG-gated cardiac CT angiography (cCTA) during hyperacute stroke would provide diagnostic quality images and act as an adjunct modality of cardiac imaging to detect sources of emboli.MethodsIn this single-center prospective cohort study, modified Code Stroke imaging was implemented with a 64-slice CT scanner, where the longitudinal axis of CT angiography was extended from the carina to the diaphragm. The primary outcomes of image quality, recruitment feasibility, impact on hyperacute time metrics, and additional radiation dose were assessed. Secondary outcomes consisted of detection of high-risk cardiac sources of embolism, mediastinal or lung pathology, and impact on etiologic classification.ResultsOne hundred and twenty eligible patients were enrolled, of which 105 (87.5%) had good/moderate quality images for motion artifact and 119 (99.2%) for contrast opacification. Total CT time, door-to-needle time, and door-to-groin puncture time were unchanged with the addition of cCTA. Eighty-nine patients received a final diagnosis of ischemic stroke, of which 12/89 (13.5%) had high-risk cardioembolic findings on cCTA. Incidental findings, such as pulmonary embolism (PE) (7/89, 7.9%) and malignancy (6/89, 6.7%), were observed. cCTA led to changes in management for 19/120 (15.8%) of all patients, and reclassification of stroke etiology for 8/89 (9%) of patients.ConclusionsNon-ECG-gated cCTA can be feasibly incorporated into Code Stroke and provide diagnostic quality images without delays in hyperacute time metrics. It can detect high-risk cardiac sources, and other findings impacting patient care. This may help reclassify a subset of cryptogenic stroke cases and improve secondary prevention.

Project description:PurposeTo implement an integrated reconstruction pipeline including a graphics processing unit (GPU)-based convolutional neural network (CNN) architecture and test whether it reconstructs four-dimensional non-Cartesian, non-contrast material-enhanced MR angiographic k-space data faster than a central processing unit (CPU)-based compressed sensing (CS) reconstruction pipeline, without significant losses in data fidelity, summed visual score (SVS), or arterial vessel-diameter measurements.Materials and methodsRaw k-space data of 24 patients (18 men and six women; mean age, 56.8 years ± 11.8 [standard deviation]) suspected of having thoracic aortic disease were used to evaluate the proposed reconstruction pipeline derived from an open-source three-dimensional CNN. For training, 4800 zero-filled images and the corresponding CS-reconstructed images from 10 patients were used as input-output pairs. For testing, 6720 zero-filled images from 14 different patients were used as inputs to a trained CNN. Metrics for evaluating the agreement between the CNN and CS images included reconstruction times, structural similarity index (SSIM) and normalized root-mean-square error (NRMSE), SVS (3 = nondiagnostic, 9 = clinically acceptable, 15 = excellent), and vessel diameters.ResultsThe mean reconstruction time was 65 times and 69 times shorter for the CPU-based and GPU-based CNN pipelines (216.6 seconds ± 40.5 and 204.9 seconds ± 40.5), respectively, than for CS (14 152.3 seconds ± 1708.6) (P < .001). Compared with CS as practical ground truth, CNNs produced high data fidelity (SSIM = 0.94 ± 0.02, NRMSE = 2.8% ± 0.4) and not significantly different (P = .25) SVS and aortic diameters, except at one out of seven locations, where the percentage difference was only 3% (ie, clinically irrelevant).ConclusionThe proposed integrated reconstruction pipeline including a CNN architecture is capable of rapidly reconstructing time-resolved volumetric cardiovascular MRI k-space data, without a significant loss in data quality, thereby supporting clinical translation of said non-contrast-enhanced MR angiograms. Supplemental material is available for this article. © RSNA, 2020.

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ECG-gated MR angiography at 3T for follow-up after surgery involving the ascending aorta.

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ECG-gated MR angiography at 3T for follow-up after surgery involving the ascending aorta.

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