Manual Radiology of the Heart: Cardiac Imaging in Infants, Children, and Adults

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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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  8. 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.

    Radiology 3 — Eur Heart J Cardiovasc Imaging 16 3 — Coronary magnetic resonance angiography for the detection of coronary stenoses. N Engl J Med 26 —9. Coronary arteries: breath-hold MR angiography. Radiology 3 —3. Impact of bulk cardiac motion on right coronary MR angiography and vessel wall imaging. J Magn Reson Imaging 14 4 — Breathhold three-dimensional coronary magnetic resonance angiography using real-time navigator technology.

    J Cardiovasc Magn Reson 1 3 —8. Improved coronary artery definition with T2-weighted, free-breathing, three-dimensional coronary MRA. Circulation 99 24 — Optimal phase for coronary interpretations and correlation of ejection fraction using late-diastole and end-diastole imaging in cardiac computed tomography angiography: implications for prospective triggering. Int J Cardiovasc Imaging 25 7 — Detection of coronary artery anomalies in infants and young children with congenital heart disease by using MR imaging.

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    5. Congenital heart disease in children: coronary MR angiography during systole and diastole with dual cardiac phase whole-heart imaging. Radiology 1 — Three-dimensional dual-phase whole-heart MR imaging: clinical implications for congenital heart disease. Radiology 2 — Assessment of cardiac volumes using an isotropic whole-heart dual cardiac phase sequence in pediatric patients. J Magn Reson Imaging 39 3 — Volumetric cardiac quantification by using 3D dual-phase whole-heart MR imaging.

      Accelerating dual cardiac phase images using undersampled radial phase encoding trajectories. Magn Reson Imaging 34 7 — Automated identification of minimal myocardial motion for improved image quality on MR angiography at 3 T. Comparison of fat suppression strategies in 3D spiral coronary magnetic resonance angiography.

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      J Magn Reson Imaging 15 4 —6. Magn Reson Med 71 1 — Coronary MR angiography at 3T: fat suppression versus water-fat separation.

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      MAGMA 29 5 —8. Congenital heart disease: cardiovascular MR imaging by using an intravascular blood pool contrast agent. Radiology 3 —8. Eur J Radiol 84 10 —9. Improved high-resolution pediatric vascular cardiovascular magnetic resonance with gadofosveset-enhanced 3D respiratory navigated, inversion recovery prepared gradient echo readout imaging compared to 3D balanced steady-state free precession readout imaging. J Cardiovasc Magn Reson 18 1 Rofo 11 —5. A comparison between gadofosveset trisodium and gadobenate dimeglumine for steady state MRA of the thoracic vasculature.

      Biomed Res Int Linear gadolinium-based contrast agents are associated with brain gadolinium retention in healthy rats. Invest Radiol 51 2 — Minimizing risk of nephrogenic systemic fibrosis in cardiovascular magnetic resonance. J Cardiovasc Magn Reson A clinical combined gadobutrol bolus and slow infusion protocol enabling angiography, inversion recovery whole heart, and late gadolinium enhancement imaging in a single study.

      Henningsson M, Botnar RM. Advanced respiratory motion compensation for coronary MR angiography. Sensors 13 6 — Adaptive technique for high-definition MR imaging of moving structures. Nehrke K, Bornert P. Prospective correction of affine motion for arbitrary MR sequences on a clinical scanner. Magn Reson Med 54 5 —8.

      Respiratory self-navigation for whole-heart bright-blood coronary MRI: methods for robust isolation and automatic segmentation of the blood pool. Magn Reson Med 68 2 —9. A respiratory self-gating technique with 3D-translation compensation for free-breathing whole-heart coronary MRA.