Validation of contrast-enhanced time-resolved magnetic resonance angiography in pre-ablation planning in patients with atrial fibrillation: comparison with traditional technique

Tarek Zghaib, Adeel Shahid, Chiara Pozzessere, Kristin K. Porter, Linda C. Chu, John Eng, Hugh Calkins, Ihab R. Kamel, Saman Nazarian, Stefan L. Zimmerman

Research output: Contribution to journalArticlepeer-review

Abstract

Bolus timing is critical to optimal magnetic resonance angiography (MRA) acquisitions but can be challenging in some patients. Our purpose was to evaluate whether contrast-enhanced time-resolved magnetic resonance angiography (TR-MRA), a dynamic multiphase sequence that does not rely on bolus timing, is a viable alternative method to conventional 3D fast-long angle shot contrast-enhanced magnetic resonance angiography (CE-MRA). Coronal subtracted conventional CE-MRA images in 50 consecutive patients presenting for pre-atrial fibrillation ablation pulmonary venous (PV) mapping were compared with 50 TR-MRA images performed in 50 subsequent patients. The TR-MRA protocol was modified to optimize spatial resolution with slightly reduced temporal resolution (6.1 s scan time). Three experienced readers evaluated each scan’s image quality and relative left atrial (LA) opacification based on a 4-point scale and diagnostic PV visualization in a binary fashion. Additionally, LA signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and PV dimensions were measured for both techniques. TR-MRA had significantly higher overall image quality (3.10 ± 0.69 vs. 2.42 ± 0.69, p < 0.0001), and LA opacification scores (3.33 ± 0.70 vs. 2.15 ± 1.13, p < 0.0001) compared to CE-MRA. The proportion of diagnostically visualized pulmonary veins was 137/150 (91%) in the CE-MRA group vs. 147/150 (98%) with TR-MRA (p = 0.010). Both SNR and CNR were higher with TR-MRA vs. CE-MRA (277.9 ± 48.9 vs. 106.8 ± 41, p = 0.002 and 100.3 ± 41.7 vs. 70.7 ± 48.0, p = 0.002, respectively). Inter-reader variance of individual PV measurements for each of the MR techniques ranged between 0.62 and 1.47 mm and the ICC for vein measurements was higher with TR-MRA (range: 0.62–0.81) compared to CE-MRA (range: 0.47–0.64). TR-MRA, modified to maximize spatial resolution, offers an alternative method for performing high quality MRA examinations in patients with AF. TR-MRA offers greater overall image quality, PV visualization, and similarly reproducible PV measurements compared to traditional CE-MRA, without the challenges of proper bolus timing.

Original languageEnglish (US)
Pages (from-to)1451-1458
Number of pages8
JournalInternational Journal of Cardiovascular Imaging
Volume34
Issue number9
DOIs
StatePublished - Sep 1 2018

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Contrast-enhanced magnetic resonance angiography
  • Time-resolved magnetic resonance angiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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