Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende Patientenratgeber
Erweiterte Suche
Anmelden
nach oben
European Radiology
Erschienen in:

07.05.2018 | Cardiac

Is MRI equivalent to CT in the guidance of TAVR? A pilot study

verfasst von: Agnes Mayr, Gert Klug, Sebastian J. Reinstadler, Hans-Josef Feistritzer, Martin Reindl, Christian Kremser, Christof Kranewitter, Nikolaos Bonaros, Guy Friedrich, Gudrun Feuchtner, Bernhard Metzler

Erschienen in: European Radiology | Ausgabe 11/2018

Einloggen, um Zugang zu erhalten

Abstract

Objectives

To compare a comprehensive cardiovascular magnetic resonance imaging (MRI) protocol with contrast-enhanced computed tomography angiography (CTA) for guidance in transcatheter aortic valve replacement (TAVR) evaluation.

Methods and results

Non-contrast three-dimensional (3D) ‘whole heart’ MRI imaging for aortic annulus sizing and measurements of coronary ostia heights, contrast-enhanced MRI angiography (MRA) for evaluation of transfemoral routes as well as aortoiliofemoral-CTA were performed in 16 patients referred for evaluation of TAVR. Aortic annulus measurements by MRI and CTA showed a very strong correlation (r=0.956, p<0.0001; effective annulus area for MRI 430±74 vs. 428±78 mm2 for CTA, p=0.629). Regarding decision for valve size there was complete consistency between MRI and CTA. Moreover, vessel luminal diameters and angulations of aortoiliofemoral access as measured by MRA and CTA showed overall very strong correlations (r= 0.819 to 0.996, all p<0.001), the agreement of minimal vessel diameter between the two modalities revealed a bias of 0.02 mm (upper and lower limit of agreement: 1.02 mm and -0.98 mm).

Conclusions

In patients referred for TAVR, MRI measurements of aortic annulus and minimal aortoiliofemoral diameters showed good to excellent agreement. Decisions based on MRI measurements regrading prosthesis sizing and transfemoral access would not have modified TAVR-strategy as compared to a CTA-based choice.

Key Points

• ‘Whole heart’ MRI and CTA measurements of aortic annulus correlate very strongly.
• MRI- and CTA-based prostheses sizing are in excellent agreement.
• MRA and CTA equally guide TAVR access strategy.
Literatur
1.
Baumgartner H, Falk V, Bax JJ et al (2017) 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 38:2739–2791CrossRef
2.
Rosenhek R, Binder T, Porenta G et al (2000) Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med 343:611–617CrossRef
3.
Nishimura RA, Otto CM, Bonow RO et al (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63:2438–2488CrossRef
4.
Leon MB, Smith CR, Mack MJ et al (2016) Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med 374:1609–1620CrossRef
5.
Zamorano JL, Goncalves A, Lang R (2014) Imaging to select and guide transcatheter aortic valve implantation. Eur Heart J 35:1578–1587CrossRef
6.
Barbash IM, Ben-Dor I, Dvir D et al (2012) Incidence and predictors of acute kidney injury after transcatheter aortic valve replacement. Am Heart J 163:1031–1036CrossRef
7.
Bagur R, Webb JG, Nietlispach F et al (2010) Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J 31:865–874CrossRef
8.
Najjar M, Salna M, George I (2015) Acute kidney injury after aortic valve replacement: incidence, risk factors and outcomes. Expert Rev Cardiovasc Ther 13:301–316CrossRef
9.
Chieffo A, Giustino G, Spagnolo P et al (2015) Routine Screening of Coronary Artery Disease With Computed Tomographic Coronary Angiography in Place of Invasive Coronary Angiography in Patients Undergoing Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 8:e002025CrossRef
10.
Spagnolo P, Giglio M, Di Marco D et al (2016) Feasibility of ultra-low contrast 64-slice computed tomography angiography before transcatheter aortic valve implantation: a real-world experience. Eur Heart J Cardiovasc Imaging 17:24–33CrossRef
11.
Mayr A, Klug G, Schocke M et al (2012) Late microvascular obstruction after acute myocardial infarction: relation with cardiac and inflammatory markers. Int J Cardiol 157:391–396CrossRef
12.
Klug G, Reinstadler SJ, Feistritzer HJ et al (2016) Cardiac index after acute ST-segment elevation myocardial infarction measured with phase-contrast cardiac magnetic resonance imaging. Eur Radiol 26:1999–2008CrossRef
13.
Feistritzer HJ, Klug G, Reinstadler SJ et al (2016) Oscillometric analysis compared with cardiac magnetic resonance for the assessment of aortic pulse wave velocity in patients with myocardial infarction. J Hypertens 34:1746–1751CrossRef
14.
Koos R, Altiok E, Mahnken AH et al (2012) Evaluation of aortic root for definition of prosthesis size by magnetic resonance imaging and cardiac computed tomography: implications for transcatheter aortic valve implantation. Int J Cardiol 158:353–358CrossRef
15.
Ruile P, Blanke P, Krauss T et al (2016) Pre-procedural assessment of aortic annulus dimensions for transcatheter aortic valve replacement: comparison of a non-contrast 3D MRA protocol with contrast-enhanced cardiac dual-source CT angiography. Eur Heart J Cardiovasc Imaging 17:458–466CrossRef
16.
Renker M, Varga-Szemes A, Schoepf UJ et al (2016) A non-contrast self-navigated 3-dimensional MR technique for aortic root and vascular access route assessment in the context of transcatheter aortic valve replacement: proof of concept. Eur Radiol 26:951–958CrossRef
17.
Bernhardt P, Rodewald C, Seeger J et al (2016) Non-contrast-enhanced magnetic resonance angiography is equal to contrast-enhanced multislice computed tomography for correct aortic sizing before transcatheter aortic valve implantation. Clin Res Cardiol 105:273–278CrossRef
18.
Prince MR, Narasimham DL, Jacoby WT et al (1996) Three-dimensional gadolinium-enhanced MR angiography of the thoracic aorta. AJR Am J Roentgenol 166:1387–1397CrossRef
19.
Menke J, Larsen J (2010) Meta-analysis: Accuracy of contrast-enhanced magnetic resonance angiography for assessing steno-occlusions in peripheral arterial disease. Ann Intern Med 153:325–334CrossRef
20.
Thurnher SA, Dorffner R, Thurnher MM et al (1997) Evaluation of abdominal aortic aneurysm for stent-graft placement: comparison of gadolinium-enhanced MR angiography versus helical CT angiography and digital subtraction angiography. Radiology 205:341–352CrossRef
21.
Plank F, Friedrich G, Bartel T et al (2012) Benefits of high-pitch 128-slice dual-source computed tomography for planning of transcatheter aortic valve implantation. Ann Thorac Surg 94:1961–1966CrossRef
22.
Binder RK, Webb JG, Willson AB et al (2013) The impact of integration of a multidetector computed tomography annulus area sizing algorithm on outcomes of transcatheter aortic valve replacement: a prospective, multicenter, controlled trial. J Am Coll Cardiol 62:431–438CrossRef
23.
Blanke P, Willson AB, Webb JG et al (2014) Oversizing in transcatheter aortic valve replacement, a commonly used term but a poorly understood one: dependency on definition and geometrical measurements. J Cardiovasc Comput Tomogr 8:67–76CrossRef
24.
Suchá D, Tuncay V, Prakken NH et al (2015) Does the aortic annulus undergo conformational change throughout the cardiac cycle? A systematic review. Eur Heart J Cardiovasc Imaging 16(12):1307–1317PubMed
25.
Paelinck BP, Van Herck PL, Rodrigus I et al (2011) Comparison of magnetic resonance imaging of aortic valve stenosis and aortic root to multimodality imaging for selection of transcatheter aortic valve implantation candidates. Am J Cardiol 108:92–98CrossRef
26.
Pontone G, Andreini D, Bartorelli AL et al (2013) Comparison of accuracy of aortic root annulus assessment with cardiac magnetic resonance versus echocardiography and multidetector computed tomography in patients referred for transcatheter aortic valve implantation. Am J Cardiol 112:1790–1799CrossRef
27.
Borisch I, Horn M, Butz B et al (2003) Preoperative evaluation of carotid artery stenosis: comparison of contrast-enhanced MR angiography and duplex sonography with digital subtraction angiography. AJNR Am J Neuroradiol 24:1117–1122PubMed
28.
De Cobelli F, Venturini M, Vanzulli A et al (2000) Renal arterial stenosis: prospective comparison of color Doppler US and breath-hold, three-dimensional, dynamic, gadolinium-enhanced MR angiography. Radiology 214:373–380CrossRef
29.
Randoux B, Marro B, Koskas F, Chiras J, Dormont D, Marsault C (2003) Proximal great vessels of aortic arch: comparison of three-dimensional gadolinium-enhanced MR angiography and digital subtraction angiography. Radiology 229:697–702CrossRef
30.
Sherrah AG, Grieve SM, Jeremy RW, Bannon PG, Vallely MP, Puranik R (2015) MRI in Chronic Aortic Dissection: A Systematic Review and Future Directions. Front Cardiovasc Med 2:5CrossRef
31.
Di Cesare E, Giordano AV, Cerone G, De Remigis F, Deusanio G, Masciocchi C (2000) Comparative evaluation of TEE, conventional MRI and contrast-enhanced 3D breath-hold MRA in the post-operative follow-up of dissecting aneurysms. Int J Card Imaging 16:135–147CrossRef
32.
Owen AR, Roditi GH (2011) Peripheral arterial disease: the evolving role of non-invasive imaging. Postgrad Med J 87:189–198CrossRef
33.
Heijenbrok-Kal MH, Kock MC, Hunink MG (2007) Lower extremity arterial disease: multidetector CT angiography meta-analysis. Radiology 245:433–439CrossRef
34.
Laurent S, Elst LV, Muller RN (2006) Comparative study of the physicochemical properties of six clinical low molecular weight gadolinium contrast agents. Contrast Media Mol Imaging 1:128–137CrossRef
35.
Hao D, Ai T, Goerner F, Hu X, Runge VM, Tweedle M (2012) MRI contrast agents: basic chemistry and safety. J Magn Reson Imaging 36:1060–1071CrossRef
36.
Perazella MA (2009) Advanced kidney disease, gadolinium and nephrogenic systemic fibrosis: the perfect storm. Curr Opin Nephrol Hypertens 18:519–525CrossRef
37.
Sadowski EA, Bennett LK, Chan MR et al (2007) Nephrogenic systemic fibrosis: risk factors and incidence estimation. Radiology 243:148–157CrossRef
38.
Thomsen HS, European Society of Urogenital R (2007) ESUR guideline: gadolinium-based contrast media and nephrogenic systemic fibrosis. Eur Radiol 17:2692–2696CrossRef
39.
Thomsen HS, Morcos SK, Almen T et al (2013) Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 23:307–318CrossRef
40.
Lind Ramskov K, Thomsen HS (2009) Nephrogenic systemic fibrosis and contrast medium-induced nephropathy: a choice between the devil and the deep blue sea for patients with reduced renal function? Acta Radiol 50:965–967CrossRef
41.
Martin DR, Semelka RC, Chapman A et al (2009) Nephrogenic systemic fibrosis versus contrast-induced nephropathy: risks and benefits of contrast-enhanced MR and CT in renally impaired patients. J Magn Reson Imaging 30:1350–1356CrossRef
42.
Barbanti M, Yang TH, Rodes Cabau J et al (2013) Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement. Circulation 128:244–253CrossRef
43.
Barrett JF, Keat N (2004) Artifacts in CT: recognition and avoidance. Radiographics 24:1679–1691CrossRef
Metadaten
Titel
Is MRI equivalent to CT in the guidance of TAVR? A pilot study
verfasst von
Agnes Mayr
Gert Klug
Sebastian J. Reinstadler
Hans-Josef Feistritzer
Martin Reindl
Christian Kremser
Christof Kranewitter
Nikolaos Bonaros
Guy Friedrich
Gudrun Feuchtner
Bernhard Metzler
Publikationsdatum
07.05.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 11/2018
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5386-2

Weitere Artikel der Ausgabe 11/2018

A radiopaque 3D printed, anthropomorphic phantom for simulation of CT-guided procedures

  • Interventional

The 3D reconstructions of female pelvic autonomic nerves and their related organs based on MRI: a first step towards neuronavigation during nerve-sparing radical hysterectomy

  • Computer Applications

Percutaneous intentional intra-luminal-assisted recanalization (PILAR technique) of challenging chronic total occlusions using a high-frequency vibration device

  • Vascular-Interventional

Meniscal pathologies on MRI correlate with increased bone tracer uptake in SPECT/CT

  • Musculoskeletal

LGE-CMR-derived texture features reflect poor prognosis in hypertrophic cardiomyopathy patients with systolic dysfunction: preliminary results

  • Cardiac

How many versus how much: comprehensive haemodynamic evaluation of partial anomalous pulmonary venous connection by cardiac MRI

  • Cardiac

Neu im Fachgebiet Radiologie

KI-gestütztes Mammografiescreening überzeugt im Praxistest

Mit dem Einsatz künstlicher Intelligenz lässt sich die Detektionsrate im Mammografiescreening offenbar deutlich steigern. Mehr unnötige Zusatzuntersuchungen sind laut der Studie aus Deutschland nicht zu befürchten.

Stumme Schlaganfälle − ein häufiger Nebenbefund im Kopf-CT?

In 4% der in der Notfallambulanz initiierten zerebralen Bildgebung sind „alte“ Schlaganfälle zu erkennen. Gar nicht so selten handelt es sich laut einer aktuellen Studie dabei um unbemerkte Insulte. Bietet sich hier womöglich die Chance auf ein effektives opportunistisches Screening?

Die elektronische Patientenakte kommt: Das sollten Sie jetzt wissen

Am 15. Januar geht die „ePA für alle“ zunächst in den Modellregionen an den Start. Doch schon bald soll sie in allen Praxen zum Einsatz kommen. Was ist jetzt zu tun? Was müssen Sie wissen? Wir geben in einem FAQ Antworten auf 21 Fragen.

Stören weiße Wände und viel Licht die Bildqualitätskontrolle?

Wenn es darum geht, die technische Qualität eines Mammogramms zu beurteilen, könnten graue Wandfarbe und reduzierte Beleuchtung im Bildgebungsraum von Vorteil sein. Darauf deuten zumindest Ergebnisse einer kleinen Studie hin. 

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise