The online version of this article (doi:10.1186/s12968-017-0352-8) contains supplementary material, which is available to authorized users.
4D Multiphase Steady State Imaging with Contrast (MUSIC) acquires high-resolution volumetric images of the beating heart during uninterrupted ventilation. We aim to evaluate the diagnostic performance and clinical impact of 4D MUSIC in a cohort of neonates and infants with congenital heart disease (CHD).
Forty consecutive neonates and infants with CHD (age range 2 days to 2 years, weight 1 to 13 kg) underwent 3.0 T CMR with ferumoxytol enhancement (FE) at a single institution. Independently, two readers graded the diagnostic image quality of intra-cardiac structures and related vascular segments on FE-MUSIC and breath held FE-CMRA images using a four-point scale. Correlation of the CMR findings with surgery and other imaging modalities was performed in all patients. Clinical impact was evaluated in consensus with referring surgeons and cardiologists. One point was given for each of five key outcome measures: 1) change in overall management, 2) change in surgical approach, 3) reduction in the need for diagnostic catheterization, 4) improved assessment of risk-to-benefit for planned intervention and discussion with parents, 5) accurate pre-procedural roadmap.
All FE-CMR studies were completed successfully, safely and without adverse events. On a four-point scale, the average FE-MUSIC image quality scores were >3.5 for intra-cardiac structures and >3.0 for coronary arteries. Intra-cardiac morphology and vascular anatomy were well visualized with good interobserver agreement (r = 0.46). Correspondence between the findings on MUSIC, surgery, correlative imaging and autopsy was excellent. The average clinical impact score was 4.2 ± 0.9. In five patients with discordant findings on echo/MUSIC (n = 5) and catheter angiography/MUSIC (n = 1), findings on FE-MUSIC were shown to be accurate at autopsy (n = 1) and surgery (n = 4). The decision to undertake biventricular vs univentricular repair was amended in 2 patients based on FE-MUSIC findings. Plans for surgical approaches which would have involved circulatory arrest were amended in two of 28 surgical cases. In all 28 cases requiring procedural intervention, FE-MUSIC provided accurate dynamic 3D roadmaps and more confident risk-to-benefit assessments for proposed interventions.
FE-MUSIC CMR has high clinical impact by providing accurate, high quality, simple and safe dynamic 3D imaging of cardiac and vascular anatomy in neonates and infants with CHD. The findings influenced patient management in a positive manner.
Additional file 1: Table S1. Image quality scoring criteria. Table S2. Primary diagnoses of neonates and infants undergoing MUSIC CMR. Table S3. Hemodynamic Variation Before and After Injection of Ferumoxytol. (DOCX 47 kb)12968_2017_352_MOESM1_ESM.docx
Additional file 2: Figure S1. Multiplanar volume rendered MUSIC images from a 12-month old infant (11.4 kg) boy with a double aortic arch and complete vascular ring are shown in A-C. (DOCX 793 kb)12968_2017_352_MOESM2_ESM.docx
Additional file 3: Online videos. (ZIP 15120 kb)12968_2017_352_MOESM3_ESM.zip
US Food and Drug Administration. FDA Drug Safety Communication: FDA strengthens warnings and changes prescribing instructions to decrease the risk of serious allergic reactions with anemia drug Feraheme (ferumoxytol). 2015; Accessed 30 March 2015. http://www.fda.gov/Drugs/DrugSafety/ucm440138.htm.
Han F, Zhou Z, Han E, Gao Y, Nguyen KL, Finn JP, Hu P. Self-gated 4D multiphase, steady-state imaging with contrast enhancement (MUSIC) using rotating cartesian K-space (ROCK): Validation in children with congenital heart disease. Magn Reson Med. 2016. doi: 10.1002/mrm.26376 [Epub ahead of print].
Image Gently: The Alliance for Radiation Safety in Pediatric Imaging. Accessed 23 May 2016. http://www.imagegently.org/.
Febbo JA, Galizia MS, Murphy IG, Popescu A, Bi X, Turin A, Collins J, Markl M, Edelman RR, Carr JC. Congenital heart disease in adults: Quantitative and qualitative evaluation of IR FLASH and IR SSFP MRA techniques using a blood pool contrast agent in the steady state and comparison to first pass MRA. Eur J Radiol. 2015;84:1921–9. CrossRefPubMed
Lai LM, Cheng JY, Alley MT, Zhang T, Lustig M and Vasanawala SS. Feasibility of ferumoxytol-enhanced neonatal and young infant cardiac MRI without general anesthesia. J Magn Reson Imaging. 2016 Sep 28. doi: 10.1002/jmri.25482.
AMAG Pharmaceuticals. Feraheme Drug Label. 2014. (revised March 2015); April 2015.
Prince MR, Zhang HL, Chabra SG, Jacobs P, Wang Y. A pilot investigation of new superparamagnetic iron oxide (ferumoxytol) as a contrast agent for cardiovascular MRI. J Xray Sci Technol. 2003;11:231–40. PubMed
Neuwelt EA, Hamilton BE, Varallyay CG, Rooney WR, Edelman RD, Jacobs PM, Watnick SG. Ultrasmall superparamagnetic iron oxides (USPIOs): a future alternative magnetic resonance (MR) contrast agent for patients at risk for nephrogenic systemic fibrosis (NSF)? Kidney Int. 2009;75:465–74. CrossRefPubMed
Nguyen KL, Yoshida T, Han F, Ayad I, Reemtsen BL, Salusky IB, Satou GM, Hu P, Finn JP. MRI with Ferumoxytol: A Single Center Experience of Safety Across the Age Spectrum. J Magn Reson. 2017;45(3):804-812.
Elzouki AY HH, Nazer HM, Stapleton FB, Oh W, Whitley RJ. Textbook of Clinical Pediatrics. 2nd ed. New York: Springer; 2012. CrossRef
Gervassi AL, Horton H. Is Infant Immunity Actively Suppressed or Immature? Virol. 2014;2014:1–9.
- 4D MUSIC CMR: value-based imaging of neonates and infants with congenital heart disease
Daniel Z. Brunengraber
Daniel S. Levi
Gary M. Satou
Brian L. Reemtsen
J. Paul Finn
- BioMed Central
Neu im Fachgebiet Radiologie
Meistgelesene Bücher aus der Radiologie
Mail Icon II