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

• Published in: European journal of radiology 2021-04, Vol.137, p.109573-109573, Article 109573
• Main Authors: Pamminger, Mathias, Kranewitter, Christof, Kremser, Christian, Reindl, Martin, Reinstadler, Sebastian J., Henninger, Benjamin, Reiter, Gert, Piccini, Davide, Tiller, Christina, Holzknecht, Magdalena, Lechner, Ivan, Bauer, Axel, Klug, Gert, Metzler, Bernhard, Mayr, Agnes
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Computed Tomography Angiography; Computed tomography angiography (CTA); Female; Humans; Magnetic Resonance Angiography; Magnetic resonance angiography (MRA); Magnetic Resonance Imaging; Male; Reproducibility of Results; Transcatheter Aortic Valve Replacement; Transcatheter aortic valve replacement (TAVR)
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2021.109573

•3D whole-heart MRA provides TAVI relevant aortic root measurements without contrast media administration.•Self-navigated MRA enables TAVI measurements with shortened scan time and substantial larger volume coverage compared to navigator-gated MRA.•Valve prothesis sizing based on self-navigated MRA is equivalent to standardized computed tomography angiography. 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). 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. 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