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- Coronary Artery Imaging in Children
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High quality 3D whole heart MRI datasets can display the entire lumen of the coronary arteries including their relation to neighboring structures.
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Accordingly, this technique has become an important and critical part of the MRI protocol for exclusion of abnormal coronary artery origins Figure 9 This is particularly important in the setting of aborted sudden cardiac death, in pediatric patients with chest pain, and in the setting of planning interventions in CHD.
As described above, the advance of technology allows successful imaging of the origin and proximal course of coronary arteries in the majority of infants and young children 9. Another relevant application of this technology is the assessment of the morphology of coronary arteries in patients post-Kawasaki disease, including the location, morphology, and maximal dimensions of coronary artery aneurysms Figure 10 39 — However, accurate coronary wall assessment requires specialized techniques, and unlike CT, cannot depict calcified lesions.
Furthermore, other MRI techniques have shown superiority over the 3D approach described here for the assessment of coronary artery stenoses Figure 9. Coronary in double outlet right ventricle. Three-dimensional balanced steady-state-free-precession sequence demonstrating left anterior descending LAD artery crossing the right ventricular outflow tract RVOT.
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This is an important finding to plan accurately the appropriate intervention. Figure Coronary aneurysm. Reformatted image of a 4-year-old patient with Kawasaki disease showing aneurysm in left anterior descending coronary artery arrow. Finally, isotropic 3D whole heart datasets are particularly useful in CHD for interventional planning. MR angiography has already been shown to be accurate for planning cardiac catheterization procedures, with the 3D nature of the dataset being critical More recently, clinicians have been fusing 3D whole heart datasets with conventional fluoroscopy angiography to augment procedural guidance.
This approach can be used to minimize radiation, preplan angulations for fluoroscopic imaging, and reduce the required dose of iodinated contrast agent Figure Augmented fluoroscopy. Three-dimensional whole heart MR images are fused with angiographic images to augment procedural guidance. In this case, the left pulmonary artery in a child with a Fontan circuit has been stented.
The optimal angulation for imaging is predetermined using the MR dataset. Blue ring markers on the MRI dataset are used to guide the positioning of the stent.
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The images show good registration on the angiogram after stenting has taken place. Improved rest period delineation, image contrast agent use, and motion compensation, along with sequence acceleration and appropriate use of magnetization pre-pulses, have resulted in iterative improvements in image quality. The detail offered allows accurate segmental morphological analysis and has opened new avenues in research, teaching, and clinical diagnostics.
A myriad of imaging applications, ranging from improved sequence planning during the course of the study, to volumetric analysis in complex ventricular geometries, and from 3D printing for surgical planning to computational modeling, have placed this sequence at the cornerstone of congenital cardiac MRI. The technique still requires diligence in planning, but current 3D whole heart images provide excellent quality overall and are often used to showcase image quality in clinical and commercial practice.
Coronary Artery Imaging in Children
All the authors GG, AT, MV, and TH made substantial contributions to this review, worked on drafting and revising the work; approved the final version; and agreed to be held responsible for all aspects of the work. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Video S1. A patient with functional single ventricle, who has undergone a Damus—Kaye—Stansel anastomosis and most recently a Fontan procedure. This image was acquired using 3D whole heart techniques with gadofosveset trisodium as described in the text. Video S2. A patient with Scimitar syndrome. This image was acquired using gadofosveset trisodium contrast and a 3D spoiled gradient echo 3D whole heart sequence. Coronary arteries: three-dimensional MR imaging with retrospective respiratory gating.
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