Qian Xianling, Wu Yali, Speier Peter, Fu Caixia, Wu Yunzhu, Cheng Lude, Chen Yinyin, Wang Shiyu, Chen Caizhong, Liu Kai, Chen Ling, Jin Hang, Zeng Mengsu
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China.
Research & Clinical Translation, Magnetic Resonance, Siemens Healthineers AG, Erlangen, Germany.
J Cardiovasc Magn Reson. 2025 Jun 19;27(2):101925. doi: 10.1016/j.jocmr.2025.101925.
Electrocardiogram (ECG)-triggered cardiovascular magnetic resonance (CMR) can be challenging in patients with ECG unreliability. Pilot tone (PT)-triggered CMR may offer a reliable alternative.
To evaluate the feasibility of PT-triggered CMR and compare its performance with ECG-triggered imaging across various sequences in patients with common cardiovascular diseases.
This prospective study included 50 participants (26 males, 24 females; mean age 46.0±19.0y), including 15 with normal CMR findings and 35 with various cardiovascular diseases. All participants underwent both PT-triggered and ECG-triggered CMR on a 3T MRI system. Imaging included T2-weighted imaging (T2WI), T1-mapping, T2-mapping, cine, late gadolinium enhancement (LGE), and post-contrast T1-mapping sequences. Image quality and quantitative measurements were evaluated, including T2WI signal intensity, native T1-mapping, T2-mapping, and extracellular volume fraction (ECV) values, and comparative signal-to-noise ratio (compSNR) and comparative contrast-to-noise ratio (compCNR) of cine and LGE images, left/right ventricular function. Inter-reader agreement was evaluated using the intraclass correlation coefficient (ICC). Comparisons between the two methods were performed using paired t-test or the Wilcoxon signed-rank test.
No significant differences were observed in scanning times (p=.253-.864) or image quality (ICC: .589-1.000, p=.057-1.000) between PT- and ECG-triggered scans and images. Quantitative assessments showed good to excellent consistency (ICC=.843-.987). While PT-triggered LGE images showed higher compCNR (14.14±7.68 vs. 13.24±7.52, p=.016), other quantitative parameters showed no significant differences between PT- and ECG-triggered images. Six participants with hypertrophic cardiomyopathy or heart valve disease experienced false R-wave triggering during ECG gating, leading to motion artifacts, which were not visible in PT-triggered images.
PT-triggered cardiac MRI provides comparable image quality and quantitative assessments to ECG-triggered sequences and may offer advantages in minimizing motion artifacts, particularly in patients with conditions affecting ECG reliability, making it a promising alternative for cardiac MRI synchronization.
对于心电图（ECG）不可靠的患者，心电图触发的心血管磁共振成像（CMR）可能具有挑战性。试点音调（PT）触发的CMR可能提供一种可靠的替代方法。
评估PT触发的CMR的可行性，并在患有常见心血管疾病的患者的各种序列中，将其性能与ECG触发成像进行比较。
这项前瞻性研究纳入了50名参与者（26名男性，24名女性；平均年龄46.0±19.0岁），其中15名CMR检查结果正常，35名患有各种心血管疾病。所有参与者均在3T MRI系统上接受了PT触发和ECG触发的CMR检查。成像包括T2加权成像（T2WI）、T1映射、T2映射、电影成像、延迟钆增强（LGE）和对比剂后T1映射序列。评估图像质量和定量测量，包括T2WI信号强度、固有T1映射、T2映射和细胞外容积分数（ECV）值，以及电影成像和LGE图像的对比信噪比（compSNR）和对比对比噪声比（compCNR）、左/右心室功能。使用组内相关系数（ICC）评估阅片者间的一致性。两种方法之间的比较采用配对t检验或Wilcoxon符号秩检验。
PT触发和ECG触发的扫描及图像在扫描时间（p = 0.253 - 0.864）或图像质量（ICC：0.589 - 1.000，p = 0.057 - 1.000）方面未观察到显著差异。定量评估显示一致性良好至优秀（ICC = 0.843 - 0.987）。虽然PT触发的LGE图像显示出更高的compCNR（14.14±7.68 vs. 13.24±7.52，p = 0.016），但其他定量参数在PT触发和ECG触发的图像之间没有显著差异。6名患有肥厚型心肌病或心脏瓣膜病的参与者在ECG门控期间经历了假R波触发，导致运动伪影，而这些伪影在PT触发的图像中不可见。
PT触发的心脏MRI提供了与ECG触发序列相当的图像质量和定量评估，并且在最小化运动伪影方面可能具有优势，特别是在影响ECG可靠性的疾病患者中，使其成为心脏MRI同步的一种有前景的替代方法。
