A non-contrast self-navigated 3-dimensional MR technique for aortic root and vascular access route assessment in the context of transcatheter aortic valve replacement: proof of concept

ObjectivesDue to the high prevalence of renal failure in transcatheter aortic valve replacement (TAVR) candidates, a non-contrast MR technique is desirable for pre-procedural planning. We sought to evaluate the feasibility of a novel, non-contrast, free-breathing, self-navigated three-dimensional (SN3D) MR sequence for imaging the aorta from its root to the iliofemoral run-off in comparison to non-contrast two-dimensional-balanced steady-state free-precession (2D-bSSFP) imaging.MethodsSN3D [field of view (FOV), 220-370 mm3; slice thickness, 1.15 mm; repetition/echo time (TR/TE), 3.1/1.5 ms; and flip angle, 115°] and 2D-bSSFP acquisitions (FOV, 340 mm; slice thickness, 6 mm; TR/TE, 2.3/1.1 ms; flip angle, 77°) were performed in 10 healthy subjects (all male; mean age, 30.3 ± 4.3 yrs) using a 1.5-T MRI system. Aortic root measurements and qualitative image ratings (four-point Likert-scale) were compared.ResultsThe mean effective aortic annulus diameter was similar for 2D-bSSFP and SN3D (26.7 ± 0.7 vs. 26.1 ± 0.9 mm, p = 0.23). The mean image quality of 2D-bSSFP (4; IQR 3-4) was rated slightly higher (p = 0.03) than SN3D (3; IQR 2-4). The mean total acquisition time for SN3D imaging was 12.8 ± 2.4 min.ConclusionsOur results suggest that a novel SN3D sequence allows rapid, free-breathing assessment of the aortic root and the aortoiliofemoral system without administration of contrast medium.Key Points• The prevalence of renal failure is high among TAVR candidates.• Non-contrast 3D MR angiography allows for TAVR procedure planning.• The self-navigated sequence provides a significantly reduced scanning time.

[1]  A. Colombo,et al.  Acute kidney injury after transcatheter aortic valve implantation with self-expanding CoreValve prosthesis: results from a large multicentre Italian research project. , 2014, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[2]  Tarik K Alkasab,et al.  Incidence of nephrogenic systemic fibrosis after adoption of restrictive gadolinium-based contrast agent guidelines. , 2011, Radiology.

[3]  Harold I Feldman,et al.  Gadolinium-based contrast agents and nephrogenic systemic fibrosis: a systematic review and meta-analysis. , 2008, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[4]  S. Achenbach,et al.  SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). , 2012, Journal of cardiovascular computed tomography.

[5]  T. Callister,et al.  SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. , 2009, Journal of cardiovascular computed tomography.

[6]  J. Leipsic,et al.  CT in transcatheter aortic valve replacement. , 2013, Radiology.

[7]  P. Börnert,et al.  Free‐breathing whole‐heart coronary MRA with 3D radial SSFP and self‐navigated image reconstruction , 2005, Magnetic resonance in medicine.

[8]  Philippe Ravaud,et al.  Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? , 2005, European heart journal.

[9]  J. Leipsic,et al.  Cardiac computed tomography and computed tomography angiography in the evaluation of patients prior to transcatheter aortic valve implantation , 2013, Current opinion in cardiology.

[10]  Davide Piccini,et al.  Spiral phyllotaxis: The natural way to construct a 3D radial trajectory in MRI , 2011, Magnetic resonance in medicine.

[11]  B. Gerber,et al.  Aortic Valve Area, Stroke Volume, Left Ventricular Hypertrophy, Remodeling, and Fibrosis in Aortic Stenosis Assessed by Cardiac Magnetic Resonance Imaging: Comparison Between High and Low Gradient and Normal and Low Flow Aortic Stenosis , 2013, Circulation. Cardiovascular imaging.

[12]  Debiao Li,et al.  A respiratory self‐gating technique with 3D‐translation compensation for free‐breathing whole‐heart coronary MRA , 2009, Magnetic resonance in medicine.

[13]  R. Guyton,et al.  Impact of preoperative renal dysfunction on long-term survival for patients undergoing aortic valve replacement. , 2011, The Annals of thoracic surgery.

[14]  J. Leipsic,et al.  A practical guide to multimodality imaging of transcatheter aortic valve replacement. , 2012, JACC. Cardiovascular imaging.

[15]  Jennifer Keegan,et al.  Aortic Root Measurement by Cardiovascular Magnetic Resonance: Specification of Planes and Lines of Measurement and Corresponding Normal Values , 2008, Circulation. Cardiovascular imaging.

[16]  F. von Knobelsdorff-Brenkenhoff,et al.  Comparison of native high-resolution 3D and contrast-enhanced MR angiography for assessing the thoracic aorta. , 2014, European heart journal cardiovascular Imaging.

[17]  Evaluation of aortic root for definition of prosthesis size by magnetic resonance imaging and cardiac computed tomography: implications for transcatheter aortic valve implantation , 2011, Journal of Cardiovascular Magnetic Resonance.

[18]  C. Otto,et al.  Risk stratification of patients with aortic stenosis. , 2010, European heart journal.

[19]  W. Nitz,et al.  Planimetry of Aortic Valve Area in Aortic Stenosis by Magnetic Resonance Imaging , 2005, Investigative radiology.

[20]  J. Dubois-Randé,et al.  Prognostic value of chronic kidney disease after transcatheter aortic valve implantation. , 2013, Journal of the American College of Cardiology.

[21]  J. Leipsic,et al.  The evolving role of MDCT in transcatheter aortic valve replacement: a radiologists' perspective. , 2009, AJR. American journal of roentgenology.

[22]  D. Andreini,et al.  Comparison of accuracy of aortic root annulus assessment with cardiac magnetic resonance versus echocardiography and multidetector computed tomography in patients referred for transcatheter aortic valve implantation. , 2013, The American journal of cardiology.

[23]  M. Stuber,et al.  Respiratory self-navigated postcontrast whole-heart coronary MR angiography: initial experience in patients. , 2014, Radiology.

[24]  A. Mahnken,et al.  Evaluation of aortic root for definition of prosthesis size by magnetic resonance imaging and cardiac computed tomography: implications for transcatheter aortic valve implantation , 2011, International journal of cardiology.

[25]  Tevfik F Ismail,et al.  Multimodality imaging in transcatheter aortic valve implantation and post-procedural aortic regurgitation: comparison among cardiovascular magnetic resonance, cardiac computed tomography, and echocardiography. , 2011, Journal of the American College of Cardiology.

[26]  Amit R. Patel,et al.  Accuracy of aortic annular measurements obtained from three-dimensional echocardiography, CT and MRI: human in vitro and in vivo studies , 2012, Heart.

[27]  R. Guyton,et al.  Impact of varying degrees of renal dysfunction on transcatheter and surgical aortic valve replacement. , 2013, The Journal of thoracic and cardiovascular surgery.

[28]  E. Kanal,et al.  ACR guidance document on MR safe practices: 2013 , 2013, Journal of magnetic resonance imaging : JMRI.

[29]  Mathias Langer,et al.  Conformational pulsatile changes of the aortic annulus: impact on prosthesis sizing by computed tomography for transcatheter aortic valve replacement. , 2012, JACC. Cardiovascular interventions.

[30]  S. Nielles-Vallespin,et al.  Respiratory self‐navigation for whole‐heart bright‐blood coronary MRI: Methods for robust isolation and automatic segmentation of the blood pool , 2012, Magnetic resonance in medicine.

[31]  J. Schulz-Menger,et al.  Quantification of valvular aortic stenosis by magnetic resonance imaging. , 2002, American heart journal.