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01.12.2017 | Research | Ausgabe 1/2017 Open Access

Journal of Cardiovascular Magnetic Resonance 1/2017

4D MUSIC CMR: value-based imaging of neonates and infants with congenital heart disease

Journal of Cardiovascular Magnetic Resonance > Ausgabe 1/2017
Kim-Lien Nguyen, Fei Han, Ziwu Zhou, Daniel Z. Brunengraber, Ihab Ayad, Daniel S. Levi, Gary M. Satou, Brian L. Reemtsen, Peng Hu, J. Paul Finn
Wichtige Hinweise

Electronic supplementary material

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)
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)
Additional file 3: Online videos. (ZIP 15120 kb)
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