Document Detail


Time-resolved MR venography of the pulmonary veins precatheter-based ablation for atrial fibrillation.
MedLine Citation:
PMID:  22996419     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: To evaluate time-resolved magnetic resonance angiography (TR-MRA) of the pulmonary venous circulation using the time-resolved angiography with interleaved stochastic trajectories (TWIST) method and compare it with the more commonly used conventional contrast-enhanced magnetic resonance angiography (CE-MRA) approach in atrial fibrillation patients referred for preablation pulmonary vein mapping. MATERIALS AND METHODS: This study was approved by the Institutional Review Board. Twenty-six patients (15 males; age 59.6 ± 12.7 years) referred for preablation pulmonary vein mapping underwent both conventional CE-MRA and TR-MRA with TWIST. Imaging was performed on a 1.5 T (Magnetom Avanto, Siemens Healthcare, Erlangen, Germany) MRI scanner. Source partition and maximum intensity projection (MIP) images were evaluated retrospectively. For quantitative analysis, pulmonary vein ostium orthogonal dimensions were measured using double oblique multiplanar reformatting. The results were analyzed using paired t-tests, Lin's concordance correlation coefficient, and Bland-Altman plots. For qualitative analysis, both source partition images and MIP images were assessed by two observers (A.P. and M.G.). The presence of common ostiums or accessory veins was recorded and analyzed using unweighted Cohen's kappa. Pulmonary vein conspicuity was scored on a scale of 1-4 (1 = poor, 2 = fair, 3 = good, 4 = excellent) and analyzed using paired t-tests, intraclass correlation coefficients, and quadratic weighted kappa statistics. RESULTS: Orthogonal venous diameters were comparable for both TR-MRA and conventional CE-MRA (1.34 ± 0.37 vs. 1.38 cm ± 0.36, respectively). Results of paired t-tests, Lin's concordance correlation coefficient, and Bland-Altman analysis revealed relatively close comparison between methods. The magnitude of the mean difference for any of the statistical comparisons did not exceed 0.10 cm. The visualization of variant pulmonary vein anatomy was very similar for both techniques. Agreement between techniques was determined to be "good" to "very good" (κ = 0.78-0.85). Conspicuity scores for each pulmonary vein were also very close. Paired t-tests, intraclass correlation coefficients, and quadratic weighted kappa statistics all revealed strong agreement between methods. CONCLUSION: TR-MRA using TWIST produces comparable anatomic images and pulmonary venous dimensions to the more widely used CE-MRA technique. Additionally, the TWIST technique improves arterio-venous separation, does not need exact bolus timing, requires less gadolinium, and gives additional information on vein perfusion. J. Magn. Reson. Imaging 2012;. © 2012 Wiley Periodicals, Inc.
Authors:
Michael Schonberger; Asad Usman; Maurizio Galizia; Andrada Popescu; Jeremy Collins; James C Carr
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-20
Journal Detail:
Title:  Journal of magnetic resonance imaging : JMRI     Volume:  -     ISSN:  1522-2586     ISO Abbreviation:  J Magn Reson Imaging     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9105850     Medline TA:  J Magn Reson Imaging     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Wiley Periodicals, Inc.
Affiliation:
Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. michael.schonberger@gmail.com.
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