scholarly journals Validation of thoracic aortic dimensions on ECG-triggered SSFP as alternative to contrast-enhanced MRA

2020 ◽  
Vol 30 (11) ◽  
pp. 5794-5804
Author(s):  
G. J. H. Snel ◽  
L. M. Hernandez ◽  
R. H. J. A. Slart ◽  
C. T. Nguyen ◽  
D. E. Sosnovik ◽  
...  
Keyword(s):  
Image Quality ◽  
Aortic Root ◽  
Sinus Of Valsalva ◽  
Motion Artefacts ◽  
Contrast Imaging ◽  
Sinotubular Junction ◽  
Contrast Enhanced ◽  
Key Points ◽  
Impaired Quality ◽  
Aortic Dimensions

Abstract Objectives Assessment of thoracic aortic dimensions with non-ECG-triggered contrast-enhanced magnetic resonance angiography (CE-MRA) is accompanied with motion artefacts and requires gadolinium. To avoid both motion artefacts and gadolinium administration, we evaluated the similarity and reproducibility of dimensions measured on ECG-triggered, balanced steady-state free precession (SSFP) MRA as alternative to CE-MRA. Methods All patients, with varying medical conditions, referred for thoracic aortic examination between September 2016 and March 2018, who underwent non-ECG-triggered CE-MRA and SSFP-MRA (1.5 T) were retrospectively included (n = 30). Aortic dimensions were measured after double-oblique multiplanar reconstruction by two observers at nine landmarks predefined by literature guidelines. Image quality was scored at the sinus of Valsalva, mid-ascending aorta and mid-descending aorta by semi-automatically assessing the vessel sharpness. Results Aortic dimensions showed high agreement between non-ECG-triggered CE-MRA and SSFP-MRA (r = 0.99, p < 0.05) without overestimation or underestimation of aortic dimensions in SSFP-MRA (mean difference, 0.1 mm; limits of agreement, − 1.9 mm and 1.9 mm). Intra- and inter-observer variabilities were significantly smaller with SSFP-MRA for the sinus of Valsalva and sinotubular junction. Image quality of the sinus of Valsalva was significantly better with SSFP-MRA, as fewer images were of impaired quality (3/30) than in CE-MRA (21/30). Reproducibility of dimensions was significantly better in images scored as good quality compared to impaired quality in both sequences. Conclusions Thoracic aortic dimensions measured on SSFP-MRA and non-ECG-triggered CE-MRA were similar. As expected, SSFP-MRA showed better reproducibility close to the aortic root because of lesser motion artefacts, making it a feasible non-contrast imaging alternative. Key Points • SSFP-MRA provides similar dimensions as non-ECG-triggered CE-MRA. • Intra- and inter-observer reproducibilities improve for the sinus of Valsalva and sinotubular junction with SSFP-MRA. • ECG-triggered SSFP-MRA shows better image quality for landmarks close to the aortic root in the absence of cardiac motion.

scholarly journals Radial self-navigated native magnetic resonance angiography in comparison to navigator-gated contrast-enhanced MRA of the entire thoracic aorta in an aortic patient collective

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Martina Correa Londono ◽  
Nino Trussardi ◽  
Verena C. Obmann ◽  
Davide Piccini ◽  
Michael Ith ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Image Quality ◽  
Magnetic Resonance Angiography ◽  
Thoracic Aorta ◽  
Aortic Root ◽  
Aortic Disease ◽  
Ascending Aorta ◽  
Scan Time ◽  
Contrast Enhanced

Abstract Background The native balanced steady state with free precession (bSSFP) magnetic resonance angiography (MRA) technique has been shown to provide high diagnostic image quality for thoracic aortic disease. This study compares a 3D radial respiratory self-navigated native MRA (native-SN-MRA) based on a bSSFP sequence with conventional Cartesian, 3D, contrast-enhanced MRA (CE-MRA) with navigator-gated respiration control for image quality of the entire thoracic aorta. Methods Thirty-one aortic native-SN-MRA were compared retrospectively (63.9 ± 10.3 years) to 61 CE-MRA (63.1 ± 11.7 years) serving as a reference standard. Image quality was evaluated at the aortic root/ascending aorta, aortic arch and descending aorta. Scan time was recorded. In 10 patients with both MRA sequences, aortic pathologies were evaluated and normal and pathologic aortic diameters were measured. The influence of artifacts on image quality was analyzed. Results Compared to the overall image quality of CE-MRA, the overall image quality of native-SN-MRA was superior for all segments analyzed (aortic root/ascending, p < 0.001; arch, p < 0.001, and descending, p = 0.005). Regarding artifacts, the image quality of native-SN-MRA remained superior at the aortic root/ascending aorta and aortic arch before and after correction for confounders of surgical material (i.e., susceptibility-related artifacts) (p = 0.008 both) suggesting a benefit in terms of motion artifacts. Native-SN-MRA showed a trend towards superior intraindividual image quality, but without statistical significance. Intraindividually, the sensitivity and specificity for the detection of aortic disease were 100% for native-SN-MRA. Aortic diameters did not show a significant difference (p = 0.899). The scan time of the native-SN-MRA was significantly reduced, with a mean of 05:56 ± 01:32 min vs. 08:51 ± 02:57 min in the CE-MRA (p < 0.001). Conclusions Superior image quality of the entire thoracic aorta, also regarding artifacts, can be achieved with native-SN-MRA, especially in motion prone segments, in addition to a shorter acquisition time.

Contrast Enhanced Ultrasound: Visualization of Far Field and Classification of Plaque in the Extracranial Carotid Arteries

2018 ◽  
Vol 42 (3) ◽  
pp. 109-115 ◽  
Author(s):  
Paige L. Rowland ◽  
Michelle Colpitts ◽  
Angela Malone ◽  
Munis Raza ◽  
Lenora L. Eberhart ◽  
...  
Keyword(s):  
Image Quality ◽  
Carotid Artery ◽  
Carotid Arteries ◽  
Carotid Artery Disease ◽  
Plaque Morphology ◽  
Far Field ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Imaging ◽  
Contrast Enhanced ◽  
Artery Disease

Ultrasound stratification for the degree of carotid artery disease based solely on lumen reduction has poorly predicted patient outcomes. This pilot study focused on patients with moderate carotid artery stenosis. Our purpose was to use contrast imaging with ultrasound to improve carotid field. A total of 10 patients diagnosed with moderate carotid artery stenosis were rescanned with an administration of a contrast imaging agent. Two-dimensional (2D) imaging, color, and Doppler were utilized to scan the patients. The 20 carotid arteries were blindly read by 2 experienced physicians. Visualization of far field, quality of Doppler envelope, plaque morphology, and overall image quality were semi-quantifiably assessed. With the use of a contrast imaging agent, there was a reduction in interphysician interpretation variability. The Kappa coefficient yielded an increase in agreement for postcontrast imaging in the majority of variables. The Doppler envelope showed improvement from precontrast (0.06) to postcontrast (0.63). The visualization of the far fields demonstrated a significant increase in agreement (0.77, 0.71, and 0.67) postcontrast. Plaque morphology demonstrated enhancement in characterization with contrast (–0.09 to 0.66). In this study, contrast-enhanced ultrasound (CEUS) was found to increase overall image quality. Improved interpretation can enhance risk stratification and with further exploration could be used to guide treatment plans for patients with asymptomatic moderate carotid artery disease.

scholarly journals Aortic root dimensions as a correlate for aortic regurgitation’s severity

2021 ◽  
Author(s):  
Jan-Per Wenzel ◽  
Elina Petersen ◽  
Julius Nikorowitsch ◽  
Jessica Müller ◽  
Tilo Kölbel ◽  
...  
Keyword(s):  
Aortic Root ◽  
Severe Aortic Stenosis ◽  
Binary Logistic Regression ◽  
Population Based ◽  
Health Study ◽  
Binary Logistic Regression Analysis ◽  
Sinus Of Valsalva ◽  
Sinotubular Junction ◽  
Artery Disease ◽  
The Individual

AbstractTo evaluate the prevalence of aortic regurgitation (AR) and associations between the individual aortic root components and AR severity in the general population. The study included the first 10,000 participants of the population-based Hamburg City Health Study (HCHS) of whom 8259 subjects, aged 62.23 ± 8.46 years (51.3% females), enrolled 2016–2018, provided echocardiographic data. 69 subjects with bicuspid valves and 23 subjects with moderate/severe aortic stenosis were excluded. Aortic root dimensions were measured using state-of-the-art cardiac ultrasound, including the aortic annulus, sinus of Valsalva, sinotubular junction (STJ), and ascending aorta, in diastole and systole. The distribution of AR was: 932 (11.4%) mild, 208 (2.5%) moderate, and 20 (0.24%) severe. Patients with moderate or severe AR were predominantly male at advanced age who had hypertension, coronary artery disease, atrial fibrillation, and renal dysfunction. Increasing AR severity correlated with higher absolute and indexed aortic root diameters (e.g., end-diastolic sinus of Valsalva for no-mild-moderate-severe AR in mm ± standard deviation: 34.06 ± 3.81; 35.65 ± 4.13; 36.13 ± 4.74; 39.67 ± 4.61; p < 0.001). In binary logistic regression analysis, all aortic root components showed significant associations with moderate/severe AR. Mid-systolic STJ showed the strongest association with moderate/severe AR (OR 1.33, 95% confidence interval 1.25–1.43, p < 0.001). AR was prevalent in 14.2%, of whom 2.8% showed moderate/severe AR. All assessed aortic root diameters correlated with the prevalence and severity of AR. STJ diameter had the strongest association with moderate/severe AR possibly reflecting the pathophysiological impact of an increasingly dilated STJ in the context of an ageing aorta.

scholarly journals Scaling to produce size-independent indices of echocardiographic derived aortic root dimensions in elite Rugby Football League players

Ultrasound ◽  
2019 ◽  
Vol 27 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Simon A Oates ◽  
Lynsey Forsythe ◽  
John D Somauroo ◽  
Keith P George ◽  
Michael Papadakis ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Aortic Root ◽  
Allometric Scaling ◽  
Ascending Aorta ◽  
Aortic Annulus ◽  
Linear Scaling ◽  
Sinus Of Valsalva ◽  
Sinotubular Junction

The assessment of aortic root dimensions is important in cardiac pre-participation screening. Scaling of cardiac dimensions removes the impact of body size allowing meaningful inter/intra group comparisons. Developing appropriate scaling approaches, scaling variables and extending the application to major vessels is warranted so underlying pathology can be detected and managed appropriately. The study aims to define relationships between aortic root dimensions and body surface area/height. Two hundred and twenty elite Rugby Football League athletes were recruited. All participants completed anthropometric assessments, a 12-lead ECG and echocardiogram. Aortic root was measured at the aortic annulus, sinus of valsalva, sinotubular junction and the proximal ascending aorta. Linear and allometric scaling were performed on the relationship between aortic measurements and body surface area/height. Absolute aortic root measurements fell within normal population data (mean ± standard deviation (range): aortic annulus: 22 ± 2 (17–28) mm, sinus of valsalva: 28 ± 3 (20–38) mm, sinotubular junction: 22 ± 3 (14–33) mm, proximal ascending aorta: 22 ± 3 (15–31) mm). Linear scaling to height produced size-independent indices at all aortic measurement sites (P < 0.05). Conversely, linear scaling using body surface area did not produce size-independent indices at any site (P > 0.05). Allometric scaling, using both body surface area and height, produced size-independent indices at all sites (P < 0.05). We recommend linearly scaling aortic root dimensions to height in elite Rugby Football League athletes and discourage the use of body surface area as a linear scaling quantity. Allometric scaling is also effective when using both body surface area and height.

Acute liver failure in ruptured sinus of Valsalva aneurysm

2021 ◽  
pp. e20210012
Author(s):  
Yaqeen Abduallah ◽  
Safaa Azzouz ◽  
Kelita Singh ◽  
Marc Deschenes ◽  
Giada Sebastiani
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Aortic Root ◽  
Hepatic Veins ◽  
Sinus Of Valsalva ◽  
Sinus Of Valsalva Aneurysm ◽  
Sinotubular Junction ◽  
Root Area ◽  
Liver Transaminases ◽  
The Right

A sinus of Valsalva aneurysm (SOVA) is a rare cardiac defect in which the aortic root area between the aortic annulus and the sinotubular junction is dilated. We present a case of acute liver failure (ALF) in a 21-year-old man secondary to ruptured SOVA inducing severe ischemic hepatitis. The patient presented clinically with classical ALF. The liver ultrasound reported hepatomegaly with pulsatile portal flow and dilated hepatic veins. A transthoracic echocardiogram revealed focal aneurysmal dilatation of the aortic root with flow across the aneurysm toward the right atrium and elevated right chambers pressures. The surgical repair of the non-coronary SOVA was successful, and post-operatively, liver transaminases improved, and ALF resolved. Given that ruptured SOVA can be surgically repaired, hepatologists should be aware of this diagnosis in a young patient with ALF.

scholarly journals Progression of aortic root dilatation and aortic valve regurgitation after the arterial switch operation

Heart ◽  
2019 ◽  
Vol 105 (22) ◽  
pp. 1732-1740 ◽  
Author(s):  
Roel L F van der Palen ◽  
Teun van der Bom ◽  
Annika Dekker ◽  
Roula Tsonaka ◽  
Nan van Geloven ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Aortic Root ◽  
Arterial Switch Operation ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Sinotubular Junction ◽  
Switch Operation ◽  
Over Time ◽  
Aortic Dimensions

ObjectiveTo study neo-aortic growth and the evolution of neo-aortic valve regurgitation (AR) in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) from newborn to adulthood and to identify patients at risk.MethodsNeo-aortic dimensions (annulus/root/sinotubular junction) and neo-aortic valve regurgitation were assessed serially in 345 patients with TGA who underwent ASO between 1977 and 2015. Linear mixed-effect models were used to assess increase of neo-aortic dimensions over time and to identify risk factors for dilatation. Risk factor analysis for AR by using time-dependent Cox regression models.ResultsAfter a rapid increase in the first year after ASO and proportional growth in childhood, neo-aortic dimensions continue to increase in adulthood without stabilisation. Annual diameter increase in adulthood was 0.39±0.06, 0.63±0.09 and 0.54±0.11 mm for, respectively, neo-aortic annulus, root and sinotubular junction, all significantly exceeding normal growth. AR continues to develop over time: freedom from AR ≥moderate during the first 25 years post-ASO was 69%. Risk factors for root dilatation were complex TGA anatomy (TGA-ventricular septal defect (VSD), double outlet right ventricle with subpulmonary VSD) and male gender. Risk factors for AR ≥moderate were: complex TGA anatomy and neo-aortic growth. Per millimetre increase in aortic root dimension, there was a 9% increase in the hazard of AR ≥moderate. Bicuspid pulmonary valve did not relate to the presence of root dilatation or AR.ConclusionAfter ASO, neo-aortic dilatation proceeds beyond childhood and is associated with an increase in AR incidence over time. Careful follow-up of the neo-aortic valve and root function is mandatory, especially in males and in patients with complex TGA anatomy.

Image Quality Analysis of X-ray Grating Interferometer Using Integrating-bucket Method

2020 ◽  
Vol 64 (2) ◽  
pp. 20503-1-20503-5
Author(s):  
Faiz Wali ◽  
Shenghao Wang ◽  
Ji Li ◽  
Jianheng Huang ◽  
Yaohu Lei ◽  
...  
Keyword(s):  
Image Quality ◽  
Phase Contrast ◽  
Quality Analysis ◽  
Phase Contrast Imaging ◽  
Phase Image ◽  
Contrast Imaging ◽  
High Quality ◽  
Image Quality Analysis ◽  
X Ray ◽  
Grating Interferometer

Abstract Grating-based x-ray phase-contrast imaging has the potential to enhance image quality and provide inner structure details non-destructively. In this work, using grating-based x-ray phase-contrast imaging system and employing integrating-bucket method, the quantitative expressions of signal-to-noise ratios due to photon statistics and mechanical error are analyzed in detail. Photon statistical noise and mechanical error are the main sources affecting the image noise in x-ray grating interferometry. Integrating-bucket method is a new phase extraction method translated to x-ray grating interferometry; hence, its image quality analysis would be of great importance to get high-quality phase image. The authors’ conclusions provide an alternate method to get high-quality refraction signal using grating interferometer, and hence increases applicability of grating interferometry in preclinical and clinical usage.

Rotational Position of the Aortic Root is Associated with Increased Aortic Dimensions in Marfan and Loeys–Dietz Syndrome

2021 ◽  
Author(s):  
Shannon K. Powell ◽  
Hassan Almeneisi ◽  
Tarek Alsaied ◽  
Amy Shikany ◽  
Laura Riley ◽  
...  
Keyword(s):  
Aortic Root ◽  
Rotational Position ◽  
Aortic Dimensions

scholarly journals Self-navigated 3D whole-heart MRA for non-enhanced surveillance of thoracic aortic dilation: a comparison to CTA

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Poskaite ◽  
M Pamminger ◽  
C Kranewitter ◽  
C Kremser ◽  
M Reindl ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Dilation ◽  
Subjective Image Quality ◽  
Contrast Enhanced ◽  
Whole Heart ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Abstract Funding Acknowledgements Type of funding sources: None. Background The natural history of thoracic aortic aneurysm (TAA) is one of progressive expansion. Asymptomatic patients who do not meet criteria for repair require conservative management including ongoing aneurysm surveillance, mostly carried out by contrast-enhanced computed tomography angiography (CTA). Purpose To prospectively compare image quality and reliability of a prototype non-contrast, self-navigated 3D whole-heart magnetic resonance angiography (MRA) with contrast-enhanced computed tomography angiography (CTA) for sizing of thoracic aortic aneurysm (TAA). Methods Self-navigated 3D whole-heart 1.5 T MRA was performed in 20 patients (aged 67 ± 8.6 years, 75% male) for sizing of TAA; a subgroup of 18 (90%) patients underwent additional contrast-enhanced CTA on the same day. Subjective image quality was scored according to a 4-point Likert scale and ratings between observers were compared by Cohen’s Kappa statistics. Continuous MRA and CTA measurements were analyzed with regression and Bland-Altman analysis. Results Overall subjective image quality as rated by two observers was 1 [interquartile range (IQR) 1-2] for self-navigated MRA and 1.5 [IQR 1-2] for CTA (p = 0.717). For MRA a perfect inter-observer agreement was found for presence of artefacts and subjective image sharpness (κ=1). Subjective signal inhomogeneity correlated highly with objectively quantified inhomogeneity of the blood pool signal (r = 0.78-0.824, all p &lt;0.0001). Maximum diameters of TAA as measured by self-navigated MRA and CTA showed excellent correlation (r = 0.997, p &lt; 0.0001) without significant inter-method bias (bias -0.0278, lower and upper limit of agreement -0.74 and 0.68, p = 0.749). Inter- and intraobserver correlation of aortic aneurysm as measured by MRA was excellent (r = 0.963 and 0.967, respectively) without significant bias (all p ≤ 0.05). Conclusion Self-navigated 3D whole-heart MRA enables reliable contrast- and radiation free aortic dilation surveillance without significant difference to standardized CTA while providing predictable acquisition time and by offering excellent image quality. Abstract Figure.

scholarly journals Value of bowel preparation techniques for prostate MRI: a preliminary study

2021 ◽  
Author(s):  
Cynthia Schmidt ◽  
Andreas M. Hötker ◽  
Urs J. Muehlematter ◽  
Irene A. Burger ◽  
Olivio F. Donati ◽  
...  
Keyword(s):  
Image Quality ◽  
Bowel Preparation ◽  
Statistical Tests ◽  
Intraclass Correlation ◽  
Geometric Distortion ◽  
Significant Independent Predictor ◽  
Contrast Enhanced ◽  
Treatment Naïve ◽  
Urogenital Imaging ◽  
Study Type

Abstract Background Bowel preparation before multiparametric MRI (mpMRI) of the prostate is performed widely, despite contradictory or no evidence for efficacy. Purpose To investigate the value of hyoscine N-butylbromide (HBB), microenema (ME) and ‘dietary restrictions’ (DR) for artifact reduction and image quality (IQ) in mpMRI of the prostate. Study type Retrospective. Population Between 10/2018 and 02/2020 treatment-naïve men (median age, 64.9; range 39.8–87.3) who underwent mpMRI of the prostate were included. The total patient sample comprised of n = 180 patients, who received either HBB, ME, were instructed to adhere to DR, or received a combination of those measures prior to the MR scan. Field strength/sequence T2-weighted imaging (T2w), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced MRI (DCE-MRI) scanned on two 3T systems. Assessment A radiologist specialized in urogenital imaging (R1) and a senior radiology resident (R2) visually assessed IQ parameters on transversal T2w, DWI and ADC maps on a 5-point Likert-like scale. Statistical tests Group comparison between IQ parameters was performed on reader level using Kruskal–Wallis and Mann–Whitney U tests. Binary univariate logistic regression analysis was used to assess independent predictors of IQ. Interrater agreement was assessed using Intraclass Correlation Coefficient (ICC). Results ‘DWI geometric distortion’ was significantly more pronounced in the HBB+/ME−/DR− (R1, 3.6 and R2, 4.0) as compared to the HBB−/ME+/DR− (R1, 4.2 and R2, 4.6) and HBB+/ME+/DR− (R1, 4.3 and R2, 4.7) cohort, respectively. Parameters ‘DWI IQ’ and ‘Whole MRI IQ’ were rated similarly by both readers. ME was a significant independent predictor of ‘good IQ’ for the whole MRI for R1 [b = 1.09, OR 2.98 (95% CI 1.29, 6.87)] and R2 [b = 1.01, OR 2.73 (95% CI 1.24, 6.04)], respectively. Data conclusion ME seems to significantly improve image quality of DWI and the whole mpMRI image set of the prostate. HBB and DR did not have any benefit.

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