ECG-gated MR angiography provides better reproducibility for standard aortic measurements

Objective Cardiac motion and aortic pulsatility can affect the image quality of 3D contrast-enhanced MR angiography (CE-MRA). The addition of ECG gating improves image quality; however, no studies have directly linked image quality improvements to clinically used measures. In this study, we directly...

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Bibliographic Details
Published in:	European radiology Vol. 31; no. 7; pp. 5087 - 5095
Main Authors:	Smith, Logan R., Darty, Stephen N., Jenista, Elizabeth R., Gamoneda, George L., Wendell, David C., Azevedo, Clerio F., Parker, Michele A, Kim, Raymond J., Kim, Han W.
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2021 Springer Nature B.V
Subjects:	Angiography Aorta Aortic aneurysms Aortic arch Cardiac Coronary vessels Diagnostic Radiology Diameters EKG Gating Image contrast Image enhancement Image quality Imaging Internal Medicine Interventional Radiology Medical imaging Medicine Medicine & Public Health Neuroradiology Radiology Reproducibility Sharpness Thorax Ultrasound Variability Aortic aneurysm thoracic Magnetic resonance angiography Cardiac-gated imaging techniques
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Summary:	Objective Cardiac motion and aortic pulsatility can affect the image quality of 3D contrast-enhanced MR angiography (CE-MRA). The addition of ECG gating improves image quality; however, no studies have directly linked image quality improvements to clinically used measures. In this study, we directly compared diameter measurements in the same patient from ECG-gated to non-gated CE-MRA to evaluate the impact of ECG gating upon measurement reproducibility. Methods Fifty-three patients, referred for thoracic aortic angiography, were enrolled and underwent both non-gated and ECG-gated CE-MRA. Two readers independently measured vessel diameter, image quality, and vessel sharpness at the sinus of Valsalva (SOV), sinotubular junction (STJX), ascending aorta (AAO), distal aortic arch (DLSA), and descending aorta (DAO). Measurement reliability and reproducibility were compared between methods. Results Image quality with ECG gating was rated significantly higher at the SOV (3.2 ± 0.9 vs 1.2 ± 1.0, p < 0.0001), STJX (3.4 ± 0.7 vs 1.8 ± 1.0, p < 0.0001), AAO (3.5 ± 0.6 vs 1.7 ± 1.1 p < 0.0001), DLSA (4.0 ± 0.1 vs 3.6 ± 0.7, p = 0.006), and DAO (4.0 ± 0.1 vs 3.4 ± 0.9 p < 0.0001) than for non-gated studies. Bland-Altman analyses demonstrated that inter- and intra-observer variability was significantly smaller for ECG-gated MRA at the SOV and AAO. For the non-gated images at the SOV, the 95% limits of agreement for both inter- and intra-observer variability exceeded the growth-rate cutoff for surgical repair (0.5 cm). At the DAO, variability was similar between the two techniques. Conclusion ECG-gated CE-MRA resulted in improved reproducibility in aortic root and ascending aortic measurements. These data suggest that ECG-gated CE-MRA should be used for the serial assessment of the ascending thoracic aorta. Key Points • ECG-gated CE-MRA improves the reproducibility and repeatability of measurements of the ascending aorta. • With non-gated CE-MRA, pulsatile motion in the proximal aorta results in significant variability in measurement reproducibility.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0938-7994 1432-1084
DOI:	10.1007/s00330-020-07408-1