Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany.
Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt Lake City, UT, USA.
Br J Radiol. 2021 Jul 1;94(1123):20210048. doi: 10.1259/bjr.20210048. Epub 2021 Jun 11.
Magnetic resonance angiography (MRA) has been established as an important imaging method in cardiac ablation procedures. In pulmonary vein (PV) isolation procedures, MRA has the potential to minimize the risk of severe complications, such as atrio-esophageal fistula, by providing detailed information on esophageal position relatively to cardiac structures. However, traditional non-gated, first-pass (FP) MRA approaches have several limitations, such as long breath-holds, non-uniform signal intensity throughout the left atrium (LA), and poor esophageal visualization. The aim of this observational study was to validate a respiratory-navigated, ECG-gated (EC), saturation recovery-prepared MRA technique for simultaneous imaging of LA, LA appendage, PVs, esophagus, and adjacent anatomical structures.
Before PVI, 106 consecutive patients with a history of AF underwent either conventional FP-MRA ( = 53 patients) or our new EC-MRA ( = 53 patients). Five quality scores (QS) of LA and esophagus visibility were assessed by two experienced readers. The non-parametric Mann-Whitney U-test was used to compare QS between FP-MRA and EC-MRA groups, and linear regression was applied to assess clinical contributors to image quality.
EC-MRA demonstrated significantly better image quality than FP-MRA in every quality category. Esophageal visibility using the new MRA technique was markedly better than with the conventional FP-MRA technique (median 3.5 [IQR 1] median 1.0, < 0.001). In contrast to FP-MRA, overall image quality of EC-MRA was not influenced by heart rate.
Our ECG-gated, respiratory-navigated, saturation recovery-prepared MRA technique provides significantly better image quality and esophageal visibility than the established non-gated, breath-holding FP-MRA. Image quality of EC-MRA technique has the additional advantage of being unaffected by heart rate.
Detailed information of cardiac anatomy has the potential to minimize the risk of severe complications and improve success rates in invasive electrophysiological studies. Our novel ECG-gated, respiratory-navigated, saturation recovery-prepared MRA technique provides significantly better image quality of LA and esophageal structures than the traditional first-pass algorithm. This new MRA technique is robust to arrhythmia (tachycardic, irregular heart rates) frequently observed in AF patients.
磁共振血管造影（MRA）已成为心脏消融手术中的重要成像方法。在肺静脉（PV）隔离手术中，MRA 通过提供食管相对于心脏结构的详细位置信息，有可能降低严重并发症（如食管-心房瘘）的风险。然而，传统的非门控、单次通过（FP）MRA 方法存在多种局限性，例如需要长时间屏气、左心房（LA）内信号强度不均匀以及食管显示不佳。本观察性研究旨在验证一种用于同时成像 LA、LA 附件、PV、食管和相邻解剖结构的呼吸导航、心电图门控（EC）、饱和恢复准备的 MRA 技术。
在 PV 隔离术之前，106 例有房颤病史的连续患者接受了传统 FP-MRA（n = 53 例）或我们的新 EC-MRA（n = 53 例）。两位有经验的读者评估了 LA 和食管可视性的五个质量评分（QS）。使用非参数曼-惠特尼 U 检验比较 FP-MRA 和 EC-MRA 组之间的 QS，应用线性回归评估对图像质量有影响的临床因素。
EC-MRA 在每个质量类别中的图像质量均显著优于 FP-MRA。使用新 MRA 技术的食管可视性明显优于传统 FP-MRA 技术（中位数 3.5 [IQR 1]，中位数 1.0，<0.001）。与 FP-MRA 不同，EC-MRA 的整体图像质量不受心率影响。
与传统的非门控、屏气 FP-MRA 相比，我们的 ECG 门控、呼吸导航、饱和恢复准备的 MRA 技术提供了更好的图像质量和食管可视性。EC-MRA 技术的图像质量具有不受心率影响的额外优势。
详细的心脏解剖信息有可能降低严重并发症的风险并提高侵入性电生理研究的成功率。我们的新型 ECG 门控、呼吸导航、饱和恢复准备 MRA 技术提供了比传统单次通过算法更好的 LA 和食管结构的图像质量。这种新的 MRA 技术对房颤患者中经常观察到的心律失常（心动过速、不规则心率）具有鲁棒性。
