Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue de Bugnon 46, BH-8-84, 1011, Lausanne, Switzerland.
Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
J Cardiovasc Magn Reson. 2022 Jun 27;24(1):39. doi: 10.1186/s12968-022-00871-3.
Coronary cardiovascular magnetic resonance angiography (CCMRA) of congenital heart disease (CHD) in pediatric patients requires accurate planning, adequate sequence parameter adjustments, lengthy scanning sessions, and significant involvement from highly trained personnel. Anesthesia and intubation are commonplace to minimize movements and control respiration in younger subjects. To address the above concerns and provide a single-click imaging solution, we applied our free-running framework for fully self-gated (SG) free-breathing 5D whole-heart CCMRA to CHD patients after ferumoxytol injection. We tested the hypothesis that spatial and motion resolution suffice to visualize coronary artery ostia in a cohort of CHD subjects, both for intubated and free-breathing acquisitions.
In 18 pediatric CHD patients, non-electrocardiogram (ECG) triggered 5D free-running gradient echo CCMRA with whole-heart 1 mm isotropic spatial resolution was performed in seven minutes on a 1.5T CMR scanner. Eleven patients were anesthetized and intubated, while seven were breathing freely without anesthesia. All patients were slowly injected with ferumoxytol (4 mg/kg) over 15 minutes. Cardiac and respiratory motion-resolved 5D images were reconstructed with a fully SG approach. To evaluate the performance of motion resolution, visibility of coronary artery origins was assessed. Intubated and free-breathing patient sub-groups were compared for image quality using coronary artery length and conspicuity as well as lung-liver interface sharpness.
Data collection using the free-running framework was successful in all patients in less than 8 min; scan planning was very simple without the need for parameter adjustments, while no ECG lead placement and triggering was required. From the resulting SG 5D motion-resolved reconstructed images, coronary artery origins could be retrospectively extracted in 90% of the cases. These general findings applied to both intubated and free-breathing pediatric patients (no difference in terms of lung-liver interface sharpness), while image quality and coronary conspicuity between both cohorts was very similar.
A simple-to-use push-button framework for 5D whole-heart CCMRA was successfully employed in pediatric CHD patients with ferumoxytol injection. This approach, working without any external gating and for a wide range of heart rates and body sizes provided excellent definition of cardiac anatomy for both intubated and free-breathing patients.
小儿先天性心脏病（CHD）的冠状动脉心血管磁共振血管造影（CCMRA）需要准确的规划、充分的序列参数调整、长时间的扫描和大量经过专业培训的人员的参与。为了减少运动并控制年轻患者的呼吸，麻醉和插管是常见的做法。为了解决上述问题并提供一键式成像解决方案，我们将我们的自由运行框架应用于注射 ferumoxytol 后的 CHD 患者的完全自主门控（SG）自由呼吸 5D 全心 CCMRA。我们假设，在 CHD 患者中，对于插管和自由呼吸采集，空间和运动分辨率足以可视化冠状动脉口，这一假设在一组 CHD 患者中得到了检验。
在 18 名小儿 CHD 患者中，在 1.5T CMR 扫描仪上进行了七分钟的非心电图（ECG）触发的 5D 自由运行梯度回波 CCMRA，具有 1mm 全心脏各向同性空间分辨率。11 名患者接受麻醉和插管，7 名患者在没有麻醉的情况下自由呼吸。所有患者均在 15 分钟内缓慢注射 ferumoxytol（4mg/kg）。使用完全 SG 方法重建具有心脏和呼吸运动分辨率的 5D 图像。为了评估运动分辨率的性能，评估了冠状动脉起源的可见性。使用冠状动脉长度和显影以及肺肝界面锐度比较了插管和自由呼吸患者亚组的图像质量。
使用自由运行框架成功地在不到 8 分钟的时间内收集了所有患者的数据；扫描计划非常简单，无需调整参数，也无需放置和触发 ECG 导联。从产生的 SG 5D 运动分辨率重建图像中，可以在 90%的情况下回溯提取冠状动脉起源。这些一般发现适用于插管和自由呼吸的小儿患者（肺肝界面锐度无差异），而两组之间的图像质量和冠状动脉显影非常相似。
在接受 ferumoxytol 注射的小儿 CHD 患者中，成功地使用了一种简单易用的 5D 全心 CCMRA 按钮式框架。这种方法无需任何外部门控，适用于广泛的心率和体型，为插管和自由呼吸患者提供了极好的心脏解剖定义。
