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- Title
Non-contrast MRI protocol for TAVI guidance: quiescent-interval single-shot angiography in comparison with contrast-enhanced CT.
- Authors
Pamminger, Mathias; Klug, Gert; Kranewitter, Christof; Reindl, Martin; Reinstadler, Sebastian J.; Henninger, Benjamin; Tiller, Christina; Holzknecht, Magdalena; Kremser, Christian; Bauer, Axel; Jaschke, Werner; Metzler, Bernhard; Mayr, Agnes
- Abstract
<bold>Objectives: </bold>To prospectively compare unenhanced quiescent-interval single-shot MR angiography (QISS-MRA) with contrast-enhanced computed tomography angiography (CTA) for contrast-free guidance in transcatheter aortic valve intervention (TAVI).<bold>Methods: </bold>Twenty-six patients (mean age 83 ± 5 years, 15 female [58%]) referred for TAVI evaluation underwent QISS-MRA for aortoiliofemoral access guidance and non-contrast three-dimensional (3D) "whole heart" MRI for prosthesis sizing on a 1.5-T system. Contrast-enhanced CTA was performed as imaging gold standard for TAVI planning. Image quality was assessed by a 4-point Likert scale; continuous MRA and CTA measurements were compared with regression and Bland-Altman analyses.<bold>Results: </bold>QISS-MRA and CTA-based measurements of aortoiliofemoral vessel diameters correlated moderately to very strong (r = 0.572 to 0.851, all p ≤ 0.002) with good to excellent inter-observer reliability (intra-class correlation coefficient (ICC) = 0.862 to 0.999, all p < 0.0001) regarding QISS assessment. Mean diameters of the infrarenal aorta and iliofemoral vessels differed significantly (bias 0.37 to 0.98 mm, p = 0.041 to < 0.0001) between the two modalities. However, inter-method decision for transfemoral access route was comparable (κ = 0.866, p < 0.0001). Aortic root parameters assessed by 3D whole heart MRI strongly correlated (r = 0.679 to 0.887, all p ≤ 0.0001) to CTA measurements.<bold>Conclusion: </bold>QISS-MRA provides contrast-free access route evaluation in TAVI patients with moderate to strong correlations compared with CTA and substantial inter-observer agreement. Despite some significant differences in minimal vessel diameters, inter-method agreement for transfemoral accessibility is strong. Combination with 3D whole heart MRI facilitates unenhanced TAVI guidance.<bold>Key Points: </bold>• QISS-MRA and CTA inter-method agreement for transfemoral approach is strong. • QISS-MRA is a very good alternative to CTA and MRA especially in patients with Kidney Disease Outcomes Quality Initiativestages 4 and 5. • Combination of QISS-MRA and 3D "whole heart" MRI facilitates fully unenhanced TAVI guidance.
- Subjects
ANGIOGRAPHY; HEART valve prosthesis implantation; AORTIC valve; INTER-observer reliability; LIKERT scale; AORTIC valve surgery; MAGNETIC resonance angiography; HEART valve diseases; RESEARCH; FERRANS &; Powers Quality of Life Index; COMPUTER-assisted surgery; RESEARCH evaluation; RESEARCH methodology; CONTRAST media; EVALUATION research; MEDICAL cooperation; COMPARATIVE studies; PROSTHETIC heart valves
- Publication
European Radiology, 2020, Vol 30, Issue 9, p4847
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-020-06832-7