Coronary Imaging

1351874 - Comparison of a new generation image-navigated 3D whole-heart CMRA against conventional diaphragmatic navigated CMRA in patients with suspected CAD

Thursday, January 26, 2023

4:30 PM – 5:10 PM

Location: Pacific Jewel

Presenting Author(s)

RH

Reza Hajhosseiny, MD, BSc

Clinical Research Fellow
King's College London
London, England, United Kingdom

Primary Author(s)

RH

Reza Hajhosseiny, MD, BSc

Clinical Research Fellow
King's College London
London, England, United Kingdom

Co-Author(s)

RH

Reza Hajhosseiny, MD, BSc

Clinical Research Fellow
King's College London
London, England, United Kingdom
Camila Munoz, PhD

Research Associate
King's College London
London, England, United Kingdom
Aurélien Bustin, PhD

Junior Professor
IHU LIRYC
Bordeaux, Aquitaine, France
IR

Imran Rashid, MD, PhD

Assistant Professor
King's College London, Ohio, United Kingdom
Gastao Cruz, PhD

Associate Professor
King's College London
London, United Kingdom
RN

Radhouene Neji, PhD

Siemens Research Scientist
King's College London, United Kingdom
KK

Karl P. Kunze, PhD

Senior Cardiac MR Scientist
Siemens Healthineers
London, England, United Kingdom
Pier-Giorgio Masci, MD, PhD

Consultant Cardiologist
|School of Biomedical Engineering & Imaging Sciences Faculty of Life Sciences & Medicine | King’s College London
London, United Kingdom
Claudia Prieto, PhD

Professor
King's College London
London, United Kingdom
René M. Botnar, PhD

Professor
King's College London
London, England, United Kingdom

Disclosure(s):

Aurélien Bustin, PhD: No financial relationships to disclose

Pier-Giorgio Masci, MD, PhD: No relevant disclosure to display

René M. Botnar, PhD: No financial relationships to disclose

Background: Clinical use of coronary magnetic resonance angiography (CMRA) remains limited due to prolonged and unpredictable acquisition times, low scan efficiency and residual respiratory motion artefacts associated with one-dimensional (1D) diaphragmatic navigator (dNAV) gating. We have integrated undersampled acquisitions with image-based navigators (iNAV) to enable two-dimensional (2D) translational motion estimation, three-dimensional (3D) non-rigid motion-correction and a 3D patch‐based low-rank reconstruction to achieve free-breathing, contrast-free 3D whole-heart CMRA with 100% respiratory scan efficiency in a clinically feasible scan time (< 10 minutes)^1-4. We aimed to investigate whether this iNAV CMRA framework could improve the visualisation of coronary arteries compared with the conventional dNAV CMRA in patients with suspected coronary artery disease (CAD) referred for a clinical computed tomography coronary angiogram (CTCA).

Methods: 31 patients with suspected CAD were recruited to undergo two CMRA scans acquired in a randomly allocated order on a 1.5T scanner (MAGNETOM Aera, Siemens Healthcare, Erlangen, Germany). The iNAV CMRA was acquired with 2-fold undersampling and reconstructed with the above framework. The dNAV CMRA was acquired with 2-fold undersampling with GRAPPA parallel imaging, 1D foot-head translational motion correction and a ±3.5mm respiratory gating window (gated and tracked). The acquired spatial resolution for both frameworks was 1.2mm³. Vessel length and vessel sharpness (proximal 4cm) of the right coronary artery (RCA), left anterior descending artery (LAD) and left circumflex artery (LCx) were measured and compared⁵. Image quality was compared using a 5-point image quality score performed by two independent CMR experts.

Results: Average scan time was 9.7 ± 2.3 mins (iNAV CMRA) and 20.9 ± 6.2 mins (dNAV CMRA) (P< 0.001), with 100% and 46% respiratory scan efficiency respectively (P< 0.001). Visible vessel length was significantly improved with the iNAV CMRA compared with the dNAV CMRA in all three coronary arteries, RCA 12.4 ± 3.7 cm vs. 8.7 ± 4.6 cm (P< 0.001); LAD 10.4 ± 3.0 cm vs. 7.1 ± 3.4 cm (P< 0.001) and LCx 6.8 ± 2.4 cm vs. 4.8 ± 2.6 cm (P< 0.001) (Figure 1A). There were no significant differences in the proximal 4cm vessel sharpness of all three vessels, RCA 49.1 ± 10.7 % vs. 48.1 ± 7.0 % (P=0.539); LAD 46.5 ± 10.2 % vs. 48.6 ± 7.1 % (P=0.185) and LCx 43.2 ± 8.4 % vs. 44.2 ± 5.2 % (P=0.243) (Figure 1B). Image quality score was significantly improved with the iNAV CMRA for the RCA, LAD, LCx and overall 3D whole-heart dataset (P=0.002, P=0.039, P< 0.001 and P=0.005) respectively (Figures 2 and 3).

Conclusion: We demonstrate the superior image quality, visible vessel length and non-inferiority of vessel sharpness of the new generation iNAV CMRA framework vs. dNAV CMRA in patients with suspected CAD, reducing the acquisiton time by 50% with 100% respiratory scan efficiency.