Self-navigated versus navigator-gated 3D MRI sequence for non-enhanced aortic root measurement in transcatheter aortic valve implantation

Mathias Pamminger; Christof Kranewitter; Christian Kremser; Martin Reindl; Sebastian J Reinstadler; Benjamin Henninger; Gert Reiter; Davide Piccini; Christina Tiller; Magdalena Holzknecht; Ivan Lechner; Axel Bauer; Gert Klug; Bernhard Metzler; Agnes Mayr

doi:10.1016/j.ejrad.2021.109573

Self-navigated versus navigator-gated 3D MRI sequence for non-enhanced aortic root measurement in transcatheter aortic valve implantation

Eur J Radiol. 2021 Apr:137:109573. doi: 10.1016/j.ejrad.2021.109573. Epub 2021 Jan 31.

Authors

Affiliations

¹ University Hospital for Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
² University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
³ Research and Development, Siemens Healthcare Diagnostics GmbH, Straßgangerstraße 315, 8054 Graz, Austria.
⁴ Advanced Clinical Imaging Technology, Siemens Healthcare AG, EPFL QI-E, 1015, Lausanne, Switzerland.
⁵ University Hospital for Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria. Electronic address: a.mayr@i-med.ac.at.

PMID: 33578090
DOI: 10.1016/j.ejrad.2021.109573

Abstract

Objectives: To prospectively compare image-quality, reliability and graft sizing of a prototype self-navigated and a navigator-gated non-contrast three dimensional (3D) whole-heart magnetic-resonance-angiography (MRA) sequence with computed-tomography-angiography (CTA) for planning transcatheter-aortic-valve-implantation (TAVI).

Methods: Self- and navigator-gated 1.5 T MRA were performed in 27 patients (aged 83 ± 5 years, 41 % male) for aortic root sizing and coronary ostia height measurements; 15 (56 %) patients underwent additional CTA. Subjective-image quality was graded on a 4-point Likert scale, objective MRA image-quality was assessed by signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Continuous MRA and CTA measurements were analyzed with regression and Bland-Altman analysis, valve sizing by kappa statistics.

Results: Median image-quality as rated by two observers was 1.5 [interquartile range (IQR) 1-3] for self-navigated MRA and 1 [IQR 1-2] for navigator-gated MRA (p = 0.059). SNR and CNR were comparable between MRA sequences (p = 0.471 and 0.445, respectively). Acquisition time was shorter for self-navigated MRA compared to navigator-gated MRA (5.5 ± 1 min vs, 6.5 ± 2 min, p = 0.029). Inter-observer correlation of aortic root measurements was high to very high for both self- and navigator-gated MRA (r = 0.75 to 0.94 and r = 0.85 to 0.96, respectively, all p < 0.0001). Theoretical prosthetic valve sizing of self-navigated MRA and CTA was equivalent (κ = 1). However, in four patients (15 %) one coronary ostium each (right coronary artery 3, left main artery 1) was not clearly definable on self-navigated MRA.

Conclusion: Self-navigated MRA enables aortic annulus TAVI measurements without significant difference to navigator-gated MRA at shortened acquisition time. Prosthesis sizing by self-navigated MRA measurements is equivalent to navigator-gated MRA and CTA-based choice.

Keywords: Computed tomography angiography (CTA); Magnetic resonance angiography (MRA); Transcatheter aortic valve replacement (TAVR).

MeSH terms

Aged
Aged, 80 and over
Aortic Valve / diagnostic imaging
Aortic Valve / surgery
Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve Stenosis* / surgery
Computed Tomography Angiography
Female
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Male
Reproducibility of Results
Transcatheter Aortic Valve Replacement*