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Single-Shot Coronary Quiescent-Interval Slice-Selective Magnetic Resonance Angiography Using Compressed Sensing: A Feasibility Study in Patients With Congenital Heart Disease.

ABSTRACT: OBJECTIVE:The aim of this study was to determine whether it is feasible to visualize the coronary origins in patients with congenital heart disease (CHD) using single-shot coronary quiescent-interval slice-selective (QISS) magnetic resonance angiography (MRA) with compressed sensing (CS). METHODS:This retrospective study leveraged a parent study, which aimed to compare breath-hold, 2.1-fold accelerated, 2-shot coronary QISS MRA and clinical standard contrast-enhanced (CE) MRA in 14 patients with CHD (mean age, 17.0 ± 8.6 years, 6 females and 8 males). We evaluated the feasibility of single-shot coronary QISS MRA by retrospectively undersampling the 2-shot data set by an additional factor of 2, performing CS reconstruction, and comparing the retrospectively derived single-shot QISS MRA to 2-shot coronary QISS MRA and clinical standard CE MRA. For quantitative analysis, structural similarity index and normalized root mean square error were calculated. For qualitative analysis, 2 experienced readers scored the conspicuity of coronary origins on a 5-point Likert scale (1 = nondiagnostic, 2 = poor, 3 = clinically acceptable, 4 = good, 5 = excellent). RESULTS:Compared with 2-shot QISS, single-shot QISS produced normalized root mean square error of 5.8% ± 0.8% and structural similarity index of 95.4% ± 1.6%, suggesting high data fidelity by CS reconstruction. Compared with the mean conspicuity scores for clinical CE MRA (4.2 ± 0.5 and 4.1 ± 0.6 for right and left coronary origins, respectively), the mean conspicuity scores were not significantly different (P > 0.3) for 2-shot QISS (4.4 ± 0.9 and 4.2 ± 1.1, respectively) and single-shot QISS with CS (4.3 ± 1.1 and 3.8 ± 1.3, respectively) and deemed clinically acceptable to good (scores ?3.0). CONCLUSIONS:This study shows that it is feasible to visualize the coronary origins in patients with CHD with clinically acceptable to good image quality using single-shot coronary QISS MRA with CS.

SUBMITTER: Shen D

PROVIDER: S-EPMC6138547 | biostudies-literature | 2018 Sep/Oct

REPOSITORIES: biostudies-literature

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Single-Shot Coronary Quiescent-Interval Slice-Selective Magnetic Resonance Angiography Using Compressed Sensing: A Feasibility Study in Patients With Congenital Heart Disease.

Shen Daming D Edelman Robert R RR Robinson Joshua D JD Haji-Valizadeh Hassan H Messina Marci M Giri Shivraman S Koktzoglou Ioannis I Rigsby Cynthia K CK Kim Daniel D

Journal of computer assisted tomography 20180901 5

<h4>Objective</h4>The aim of this study was to determine whether it is feasible to visualize the coronary origins in patients with congenital heart disease (CHD) using single-shot coronary quiescent-interval slice-selective (QISS) magnetic resonance angiography (MRA) with compressed sensing (CS).<h4>Methods</h4>This retrospective study leveraged a parent study, which aimed to compare breath-hold, 2.1-fold accelerated, 2-shot coronary QISS MRA and clinical standard contrast-enhanced (CE) MRA in 1 ...[more]

PMID: 29958198

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Project description:BackgroundStandard-of-care time-of-flight (TOF) techniques for nonenhanced magnetic resonance angiography (NEMRA) of the carotid bifurcation and other cervical arteries often provide nondiagnostic image quality due to motion and flow artifacts.PurposeTo perform an initial evaluation of an ungated radial quiescent-interval slice-selective (QISS) technique for NEMRA of the neck, in comparison with 2D TOF and contrast-enhanced magnetic resonance angiography (CEMRA).Study typeRetrospective.PopulationSixty patients referred for neck MR angiography.Field strength/sequenceUngated radial QISS at 3T.AssessmentThree radiologists scored image quality of 18 arterial segments using a 4-point scale (1, nondiagnostic; 2, fair; 3, good; 4, excellent), and two radiologists graded proximal internal carotid stenosis using five categories (<50%, 50-69%, 70-99%, occlusion, nondiagnostic).Statistical testsFriedman tests with post-hoc Wilcoxon signed-rank tests; unweighted Gwet's AC1 statistic; tests for equality of proportions.ResultsUngated radial QISS provided image quality that significantly exceeded 2D TOF (mean scores of 2.7 vs. 2.0, 2.7 vs. 2.2, and 2.9 vs. 2.3; P < 0.001, all comparisons), while CEMRA provided the best image quality (mean scores of 3.6, 3.7, and 3.5 for the three reviewers). Interrater agreement of image quality scores was substantial for CEMRA (AC1 = 0.70, P < 0.001), and moderate for QISS (AC1 = 0.43, P < 0.001) and TOF (AC1 = 0.41, P < 0.001). Compared with TOF, QISS NEMRA provided a significantly higher percentage of diagnostic segments for all three reviewers (91.0% vs. 71.7%, 93.5% vs. 72.9%, 95.5% vs. 85.2%; P < 0.0001) and demonstrated better agreement with CEMRA for grading of proximal internal carotid stenosis (AC1 = 0.94 vs. 0.73 for reviewer 1, P < 0.05; AC1 = 0.89 vs. 0.68 for reviewer 2, P < 0.05).Data conclusionIn this initial study, ungated radial QISS significantly outperformed 2D TOF for the evaluation of the neck arteries, with overall better image quality and more diagnostic arterial segments, and improved agreement with CEMRA for grading stenosis of the proximal internal carotid artery.Level of evidence3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1798-1807.

Project description:To assess the diagnostic performance of quiescent-interval single-shot (QISS) magnetic resonance (MR) angiography, a nonenhanced two-dimensional electrocardiographically gated single-shot balanced steady-state free precession examination for the evaluation of symptomatic chronic lower limb ischemia.For this prospective institutional review board-approved, HIPAA-compliant study, the institutional review board waived the requirement for informed patient consent. The QISS nonenhanced MR angiography technique was evaluated in a two-center trial involving 53 patients referred for lower extremity MR angiography for suspected or known chronic peripheral arterial disease (PAD), with contrast material-enhanced MR angiography serving as the noninvasive reference standard. The accuracy of stenosis assessments performed with the nonenhanced MR angiography sequence was evaluated relative to the reference standard. Per-segment, per-region, and per-limb sensitivities and specificities were calculated, and assessments were considered correct only if they were in exact agreement with the reference standard-derived assessments. Generalized estimating equation (GEE) modeling with use of an unstructured binomial logit analysis was used to account for clustering of multiple measurements per case. The sensitivity and specificity of QISS MR angiography for the determination of nonsignificant (<50%) versus significant (50%-100%) stenosis were compared with the sensitivity and specificity of the reference standard.The diagnostic performance of nonenhanced MR angiography was found to be nearly equivalent to the diagnostic performances of contrast-enhanced MR angiography and digital subtraction angiography. Non-GEE segment-based analysis revealed that for the two reviewers, nonenhanced MR angiography had sensitivities of 89.7% (436 of 486 segments) and 87.0% (423 of 486 segments) and specificities of 96.5% (994 of 1030 segments) and 94.6% (973 of 1028 segments).QISS nonenhanced MR angiography offers an alternative to currently used imaging tests for symptomatic chronic lower limb ischemia, for which the administration of iodinated or gadolinium-based contrast agents is contraindicated.

Project description:The high incidence of renal insufficiency in patients with Peripheral Arterial Disease raises the concern for nephrogenic systemic fibrosis (NSF) with respect to contrast enhanced MRA. The risk of NSF is eliminated with non-contrast enhanced magnetic resonance angiography. The purpose of the current study is to compare image quality and diagnostic performance of non-contrast enhanced Quiescent Interval Single Shot (QISS) magnetic resonance angiography at 3 T versus CT angiography for evaluation of lower extremity Peripheral Arterial Disease (PAD).32 consecutive patients (23 male, 9 female, age range 40-81 years, average age 61.97 years) with clinically suspected lower extremity PAD underwent QISS MRA and CTA. 19 of 32 patients underwent Digital Subtraction Angiography (DSA). Image quality of MRA was compared with CTA by two radiologists with 10 and 8 years' experience according to a 4-point scale. The Kappa test was used to determine the intermodality agreement between MRA and CTA in stenosis assessment, and interobserver agreement with each method. Sensitivity and specificity of CTA and MRA in detecting hemodynamically significant stenosis (≥50 %) were compared, with DSA serving as reference standard when available.Image quality of QISS MRA was rated 3.70 ± 0.49 by reader 1, and 3.72 ± 0.47 by reader 2, significantly lower than that of CTA (3.80 ± 0.44 and 3.82 ± 0.42, P < 0.001 for both readers). Intermodality agreement between MRA and CTA was excellent for assessment of stenosis (Kappa = 0.923 ± 0.013 for reader 1, 0.930 ± 0.012 for reader 2). Interobserver agreement was 0.936 ± 0.012 for CTA and 0.935 ± 0.011 for MRA. For readers 1 and 2 respectively, the sensitivity of QISS was 94.25 and 93.26 % (versus 90.11 and 89.13 % for CTA, P > 0.05), and specificity of QISS was 96.70 and 97.75 % (versus 96.55 and 96.51 % for CTA, P > 0.05). For heavily calcified segments, sensitivity of QISS (95.83 and 95.83 %) was significantly higher than that of CTA (74.19 and 76.67 %, P < 0.05).QISS is a reliable alternative to CTA for evaluation of lower extremity PAD, and may be suitable as a first-line screening examination in patients with contraindications to intravenous contrast administration.

Project description:BackgroundFree-breathing noncontrast-enhanced (non-CE) magnetic resonance angiography (MRA) techniques are of considerable interest for the diagnosis of acute pulmonary embolism (APE), due to the possibility for repeated examinations, avoidance of side effects from iodine-based contrast agents, and the absence of ionizing radiation exposure as compared to CE-computed tomographic angiography (CTA).PurposeTo analyze the clinical performance of free-breathing and electrocardiogram (ECG)-gated radial quiescent-interval slice-selective (QISS)-MRA compared to CE-CTA and to Cartesian balanced steady-state free precession (bSSFP)-MRA.Study typeProspective.SubjectsThirty patients with confirmed APE and 30 healthy volunteers (HVs).Field strength/sequenceRadial QISS- and bSSFP-MRA at 1.5T.AssessmentSignal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were computed to compare the pulmonary imaging quality between MRA methods. The pulmonary arterial tree was divided into 25 branches and an ordinal scoring system was used to assess the image quality of each pulmonary branch. The clinical performance of the two MRA techniques in accurately assessing APE was evaluated with respect to CE-CTA as the clinical reference standard.Statistical testsWilcoxon signed-rank and Spearman's correlation tests were performed. Sensitivity and specificity of the MRA techniques were determined using CE-CTA as the clinical reference standard.ResultsThrombus-mimicking artifacts appeared more frequently in lobar and peripheral arteries of patients with Cartesian bSSFP than with radial QISS-MRA (pulmonary trunk: 12.2% vs. 14.0%, P = 0.64; lobar arteries: 35.6% vs. 22.0%, P = 0.005, peripheral arteries: 74.4% vs. 49.0%, P < 0.001). The relative increases in SNR and of CNR provided by radial QISS-MRA with respect to Cartesian bSSFP-MRA were 30-35% (P-values of SNR/CNR, HVs: 0.09/0.09, patients: 0.03/0.02). The image quality of pulmonary arterial branches was considered good to excellent in 77.2% of patients with radial QISS-MRA and in 43.2% with Cartesian bSSFP-MRA (P < 0.0001). The clinical performance of radial QISS-MRA was higher than Cartesian bSSFP-MRA for grading embolism, with a total sensitivity of 86.0% vs. 80.6% and a specificity of 93.3% vs. 84.0%, respectively.Data conclusionRadial QISS-MRA is a reliable and safe non-CE angiographic technique with promising clinical potential compared to Cartesian bSSFP-MRA and as an alternative technique to CE-CTA for the diagnosis of APE.Level of evidence1 TECHNICAL EFFICACY STAGE: 3.

Dataset Information

Single-Shot Coronary Quiescent-Interval Slice-Selective Magnetic Resonance Angiography Using Compressed Sensing: A Feasibility Study in Patients With Congenital Heart Disease.

Publications

Single-Shot Coronary Quiescent-Interval Slice-Selective Magnetic Resonance Angiography Using Compressed Sensing: A Feasibility Study in Patients With Congenital Heart Disease.

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