Cardiac MR Angiography is it Really Essential: Do We Have an Alternative?


Yishay Salem 1 Jeffrey Jacobson 2 Orly Goitein 2 Danny Roizen 2 Elio Di Segni 3 Bekker Elen 2 Brodov Yafim 3 Eli Konen 2
1Safra Center for Congenital Heart Disease, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Sheba Medical Center, Israel
2Diagnostic Imaging, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Sheba Medical Center, Israel
3Heart Institute, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Sheba medical center, Israel

On December 19, 2017, FDA announced that all gadolinium-based contrast agents (GBCAs) used intravenously in magnetic resonance imaging (MRI) leave traces of gadolinium that may remain in the body, including the brain, for months to years.

Gadolinium enhanced MR angiography (GEMRA) has been used for many years to demonstrate congenital heart defects. Due to potential risks, especially in the pediatric population, we explored an alternative method by using the sequence 3D SSFP with respiratory navigation (3D).

THE PURPOSE of this study was to compare traditional GEMRA and 3D and to determine if 3D can serve as an alternative for GEMRA.

MATERIALS AND METHODS: 20 patients above 6 months of age were included in the study, all of whom underwent both GEMRA (Time resolved MRA) and 3D. Scans of the heart and the great vessels were performed. Each study was started after the localizing sequences with 3D. We used 3D to create cardiac oriented localizers used in planning further sequences. All scans were evaluated by a pediatric cardiologist and pediatric radiologist.

RESULTS: Both sequences were satisfactory with good spatial and temporal resolution. The 3D had advantage over GEMRA in better demonstrating the great arteries, especially the blood vessel walls. The pulmonary veins were demonstrated better on GEMRA than on 3D. On 3D, we consistently demonstrate the coronary arteries, rarely seen on GEMRA.

GEMRA with time resolved MRA demonstrates dynamic enhancement by obtaining images at different times while in 3D only one phase is obtained.

CONCLUSIONS: 3D SSFP with respiratory navigator can serve as an adequate alternative for GEMRA, saving time and obtaining high spatial resolution without the necessity for gadolinium injection.

We believe that in the future, routine gadolinium injection will be avoided and reserved only for special indications.

Yishay Salem
ד"ר Yishay Salem
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