Imaging the adult with simple shunt lesions: position paper from the EACVI and the ESC WG on ACHD. Endorsed by AEPC (Association for European Paediatric and Congenital Cardiology).

In 2018, the position paper 'Imaging the adult with congenital heart disease: a multimodality imaging approach' was published. The paper highlights, in the first part, the different imaging modalities applied in adult congenital heart disease patients. In the second part, these modalities are discussed more detailed for moderate to complex anatomical defects. Because of the length of the paper, simple lesions were not touched on. However, imaging modalities to use for simple shunt lesions are still poorly known. One is looking for structured recommendations on which they can rely when dealing with an (undiscovered) shunt lesion. This information is lacking for the initial diagnostic process, during repair and at follow-up. Therefore, this paper will focus on atrial septal defect, ventricular septal defect, and persistent arterial duct. Pre-, intra-, and post-procedural imaging techniques will be systematically discussed. This position paper will offer algorithms that might help at a glance. The document is prepared for general cardiologists, trainees, medical students, imagers/technicians to select the most appropriate imaging modality and to detect the requested information for each specific lesion. It might serve as reference to which researchers could refer when setting up a (imaging) study.

Imaging the adult with congenital heart disease: a multimodality imaging approach-position paper from the EACVI.

Advances in the diagnosis and management of congenital heart disease have led to a marked improvement in the survival of adult with congenital heart disease (ACHD) patients. However, ACHD patients are a heterogeneous population, with a large spectrum of anatomic substrates even within specific lesions. In addition, the nature of previous surgery and other intervention is highly variable rendering each patient unique and residual anatomic and haemodynamic abnormalities are very common. As the ACHD population continues to age, acquired heart disease will also require cardiac imaging assessment. It is increasingly recognized in ACHD community that the diagnostic utility of a multimodality cardiovascular approach is greater than the sum of individual tests. In ACHD patients, diagnostic information can be obtained using a variety of diagnostic tools. The aims of this document are to describe the role of each diagnostic modality in the care of ACHD patients and to provide guidelines for a multimodality approach. The goal should be to provide the most appropriate and cost-effective diagnostic pathway for each individual ACHD patient.

Cardiac transplantation in a 20-year-old woman with scleroderma.

Purpose: To describe cardiac transplantation in a young woman with juvenile onset diffuse scleroderma and cardiac involvement. Methods: Case report. Results: A young White girl developed anti-topoisomerase-1 positive diffuse scleroderma aged 14 years with myositis. Pulmonary function tests were normal. Skin disease was treated with mycophenolate mofetil 1 g twice daily, methotrexate 7.5 mg weekly and periodic intravenous prostacyclin. When aged 17 years, she developed raised troponin T of 0.207 mcg/L (normal range <0.03) and NTproBNP (155 pmol/L); 6-min walking distance was 341 m, and she had episodes of presyncope with effort. The next year she developed symptomatic ventricular tachycardias and dual-chamber implantable cardioverter-defibrillator was inserted, with further episodes of ventricular tachycardia and one shock delivered. By age 19 years, 6-min walking distance was 125 m. Echocardiography showed ejection fraction of 15%-20% with dilated left ventricle and pericardial effusion. She was treated with intravenous Rituximab. She became breathless while dressing and managed only 118 m in 6 min. She experienced increasing orthopnoea and peripheral oedema and was found to be in a low cardiac output state, requiring treatment with intravenous milrinone to maintain renal function. She underwent orthotopic cardiac transplantation, making an excellent post-operative recovery, and was discharged 16 days later with tacrolimus, mycophenolate mofetil and prednisolone. After 1 year, she was in New York Heart Association functional class I and with normal cardiac function on echocardiography. Conclusion: This case illustrates the severe cardiac involvement that can occur in juvenile onset diffuse cutaneous systemic sclerosis, in which cardiac involvement is the leading cause of death.

Novel System for Real-Time Integration of 3-D Echocardiography and Fluoroscopy for Image-Guided Cardiac Interventions: Preclinical Validation and Clinical Feasibility Evaluation.

Real-time imaging is required to guide minimally invasive catheter-based cardiac interventions. While transesophageal echocardiography allows for high-quality visualization of cardiac anatomy, X-ray fluoroscopy provides excellent visualization of devices. We have developed a novel image fusion system that allows real-time integration of 3-D echocardiography and the X-ray fluoroscopy. The system was validated in the following two stages: 1) preclinical to determine function and validate accuracy; and 2) in the clinical setting to assess clinical workflow feasibility and determine overall system accuracy. In the preclinical phase, the system was assessed using both phantom and porcine experimental studies. Median 2-D projection errors of 4.5 and 3.3 mm were found for the phantom and porcine studies, respectively. The clinical phase focused on extending the use of the system to interventions in patients undergoing either atrial fibrillation catheter ablation (CA) or transcatheter aortic valve implantation (TAVI). Eleven patients were studied with nine in the CA group and two in the TAVI group. Successful real-time view synchronization was achieved in all cases with a calculated median distance error of 2.2 mm in the CA group and 3.4 mm in the TAVI group. A standard clinical workflow was established using the image fusion system. These pilot data confirm the technical feasibility of accurate real-time echo-fluoroscopic image overlay in clinical practice, which may be a useful adjunct for real-time guidance during interventional cardiac procedures.

Higher dose dobutamine stress MR imaging in repaired Tetralogy of Fallot: observer variance of volumetric assessment compared with normal volunteers.

PURPOSE: To investigate changes in image quality and observer variance between rest and higher-dose dobutamine stress MR imaging (DS-MR) in tetralogy of Fallot (TOF) patients and in a group of normal healthy volunteers using both axial and short axis orientation for cardiac volumetric assessment. MATERIALS AND METHODS: Eighteen adult patients (age 34 ± 13) with TOF and severe pulmonary regurgitation and 10 healthy volunteers underwent ventricular MR volumetry at baseline and during dobutamine infusion of 10 µg/kg/min and 20 µg/kg/min. Inter-observer and intra-observer agreement was calculated by coefficient of variance (COV). RESULTS: Inter-observer comparison showed good agreement for left ventricle (LV) and right ventricle (RV) end-diastolic volumes at rest and both stress levels in TOF patients (axial geometry) and in normal volunteers (short axis). During dobutamine stress, the COV in TOF patients increased for LV end-systolic volume (LV-ESV) with each level, suggesting less agreement between observers. In contrast, RV-ESV was much more comparable with a COV < 10 at each condition. All volumetric measurements in normal volunteers showed good inter-observer agreement. Excellent intra-observer agreement could be seen for all volumetric parameters with COV levels below 7. CONCLUSION: Volumetric assessment during DS-MR shows excellent inter-observer agreement, except for LV-ESV in the TOF patients at higher doses of dobutamine. The axial geometry appears to be reproducible for assessment of RV parameters, and could be considered superior to short axis imaging in patients with repaired TOF.

Extended-field-of-view three-dimensional transesophageal echocardiography using image-based X-ray probe tracking.

The use of ultrasound imaging for guidance of cardiac interventional procedures is limited by the small field of view of the ultrasound volume. A larger view can be created by image-based registration of several partially overlapping volumes, but automatic registration is likely to fail unless the registration is initialized close to the volumes' correct alignment. In this article, we use X-ray images to track a transesophageal ultrasound probe and thereby provide initial position information for the registration of the ultrasound volumes. The tracking is possible using multiple X-rays or just a single X-ray for each probe position. We test the method in a phantom experiment and find that with at least 50% overlap, 88% of volume pairs are correctly registered when tracked using three X-rays and 86% when using single X-rays. Excluding failed registrations with errors greater than 10 mm, the average registration accuracy is 2.92 mm between ultrasound volumes and 4.75 mm for locating an ultrasound volume in X-ray space. We conclude that the accuracy and robustness of the registrations are sufficient to provide useful images for interventional guidance.

Dobutamine stress MRI in repaired tetralogy of Fallot with chronic pulmonary regurgitation: a comparison with healthy volunteers.

BACKGROUND: To compare the ventricular response to dobutamine stress between adult patients with chronic pulmonary regurgitation (PR) after repair of tetralogy of Fallot (r-TOF) and healthy volunteers using a staged dobutamine stress MR (DS-MR) protocol. METHODS: Eighteen r-TOF patients (median age 31.9 years, range 16.2-60.1) with severe PR and 10 healthy controls (median age 40.6 years, range 23.9-51.8) completed staged DS-MR (baseline, 10 and 20 µg/kg/min) with ventricular volumetry and pulmonary flow quantification. Comparative analysis involved 3-way ANOVA, t-test, regression analysis, and coefficient of variance. RESULTS: All controls had significant increase of ejection fraction (EF) at each stress level for both ventricles (normal contractile reserve, all p<0.05). In r-TOF patients (RV-EDV 126 ± 27 ml/m(2), RV-EF 55 ± 7%, LV-EF 58 ± 6%, PR-fraction 43 ± 15%), low-dose DS-MR at 10 µg/kg/min demonstrated normal biventricular contractile reserve as seen in volunteers. On increase from 10 to 20 µg/kg/min a subgroup showed worsening ejection fraction (n=8, p<0.05), mainly due to lack of reduction or even increase of RV-ESV, while the remainder responded with further reduction of RV-ESV and RV-EDV (n=10, p<0.05) and a non-significant trend to increased EF. This different response could not be predicted at baseline. CONCLUSIONS: In r-TOF patients with chronic PR, DS-MR at 10 µg/kg/min showed normal biventricular systolic response compared with controls. Increase to 20 µg/kg/min provoked abnormal RV-ESV response in some r-TOF patients, suggesting presence of ventricular systolic dysfunction not evident at rest.

Single breath-hold assessment of cardiac function using an accelerated 3D single breath-hold acquisition technique--comparison of an intravascular and extravascular contrast agent.

BACKGROUND: Cardiovascular magnetic resonance (CMR) is the current gold standard for the assessment of left ventricular (LV) function. Repeated breath-holds are needed for standard multi-slice 2D cine steady-state free precession sequences (M2D-SSFP). Accelerated single breath-hold techniques suffer from low contrast between blood pool and myocardium. In this study an intravascular contrast agent was prospectively compared to an extravascular contrast agent for the assessment of LV function using a single-breath-hold 3D-whole-heart cine SSFP sequence (3D-SSFP). METHODS: LV function was assessed in fourteen patients on a 1.5 T MR-scanner (Philips Healthcare) using 32-channel coil technology. Patients were investigated twice using a 3D-SSFP sequence (acquisition time 18-25 s) after Gadopentetate dimeglumine (GdD, day 1) and Gadofosveset trisodium (GdT, day 2) administration. Image acquisition was accelerated using sensitivity encoding in both phase encoding directions (4xSENSE). CNR and BMC were both measured between blood and myocardium. The CNR incorporated noise measurements, while the BMC represented the coeffiancy between the signal from blood and myocardium [1]. Contrast to noise ratio (CNR), blood to myocardium contrast (BMC), image quality, LV functional parameters and intra-/interobserver variability were compared. A M2D-SSFP sequence was used as a reference standard on both days. RESULTS: All 3D-SSFP sequences were successfully acquired within one breath-hold after GdD and GdT administration. CNR and BMC were significantly (p < 0.05) higher using GdT compared to GdD, resulting in an improved endocardial definition. Using 3D-SSFP with GdT, Bland-Altman plots showed a smaller bias (95% confidence interval LVEF: 9.0 vs. 23.7) and regression analysis showed a stronger correlation to the reference standard (R2 = 0.92 vs. R2 = 0.71), compared to 3D-SSFP with GdD. CONCLUSIONS: A single-breath-hold 3D-whole-heart cine SSFP sequence in combination with 32-channel technology and an intravascular contrast agent allows for the accurate and fast assessment of LV function.

Cardiovascular magnetic resonance myocardial feature tracking detects quantitative wall motion during dobutamine stress.

BACKGROUND: Dobutamine stress cardiovascular magnetic resonance (DS-CMR) is an established tool to assess hibernating myocardium and ischemia. Analysis is typically based on visual assessment with considerable operator dependency. CMR myocardial feature tracking (CMR-FT) is a recently introduced technique for tissue voxel motion tracking on standard steady-state free precession (SSFP) images to derive circumferential and radial myocardial mechanics.We sought to determine the feasibility and reproducibility of CMR-FT for quantitative wall motion assessment during intermediate dose DS-CMR. METHODS: 10 healthy subjects were studied at 1.5 Tesla. Myocardial strain parameters were derived from SSFP cine images using dedicated CMR-FT software (Diogenes MRI prototype; Tomtec; Germany). Right ventricular (RV) and left ventricular (LV) longitudinal strain (EllRV and EllLV) and LV long-axis radial strain (ErrLAX) were derived from a 4-chamber view at rest. LV short-axis circumferential strain (EccSAX) and ErrSAX; LV ejection fraction (EF) and volumes were analyzed at rest and during dobutamine stress (10 and 20 µg · kg⁻¹· min⁻¹). RESULTS: In all volunteers strain parameters could be derived from the SSFP images at rest and stress. EccSAX values showed significantly increased contraction with DSMR (rest: -24.1 ± 6.7; 10 µg: -32.7 ± 11.4; 20 µg: -39.2 ± 15.2; p < 0.05). ErrSAX increased significantly with dobutamine (rest: 19.6 ± 14.6; 10 µg: 31.8 ± 20.9; 20 µg: 42.4 ± 25.5; p < 0.05). In parallel with these changes; EF increased significantly with dobutamine (rest: 56.9 ± 4.4%; 10 µg: 70.7 ± 8.1; 20 µg: 76.8 ± 4.6; p < 0.05). Observer variability was best for LV circumferential strain (EccSAX ) and worst for RV longitudinal strain (EllRV) as determined by 95% confidence intervals of the difference. CONCLUSIONS: CMR-FT reliably detects quantitative wall motion and strain derived from SSFP cine imaging that corresponds to inotropic stimulation. The current implementation may need improvement to reduce observer-induced variance. Within a given CMR lab; this novel technique holds promise of easy and fast quantification of wall mechanics and strain.

Congenital heart disease: cardiovascular MR imaging by using an intravascular blood pool contrast agent.

PURPOSE: To compare the image quality and diagnostic performance of a contrast agent-specific inversion-recovery (IR) steady-state free precession (SSFP) magnetic resonance (MR) imaging sequence performed by using an intravascular contrast agent (gadofosveset trisodium) with those of a commonly used T2-prepared SSFP sequence performed by using an extravascular (gadopentetate dimeglumine) and an intravascular (gadofosveset trisodium) contrast agent in patients with congenital heart disease (CHD). MATERIALS AND METHODS: The local ethics committee and the United Kingdom Medicines and Healthcare products Regulatory Agency approved this study. Patient informed consent was obtained. Twenty-three patients with CHD were examined by using a 1.5-T MR imaging unit and a 32-channel coil. Gadopentetate dimeglumine and gadofosveset trisodium were used in the same patient on consecutive days. Vessel wall sharpness, contrast-to-noise ratios (CNRs), image quality, and diagnostic performance achieved by using the IR SSFP sequence with gadofosveset trisodium were compared with those achieved by using the T2-prepared SSFP sequence with gadopentetate dimeglumine and gadofosveset trisodium and with those achieved at respective contrast material-enhanced MR angiographic examinations. The Wilcoxon rank sum test was used to compare categoric variables; t tests were used to compare continuous variables. RESULTS: Use of the IR SSFP sequence with gadofosveset trisodium significantly improved vessel wall sharpness, CNRs, and image quality (P < .05 for all) for all investigated intra- and extracardiac structures compared with the T2-prepared SSFP sequence with gadopentetate dimeglumine and gadofosveset trisodium and the respective contrast-enhanced MR angiographic examinations. With use of the IR SSFP sequence with gadofosveset trisodium, new, unsuspected diseases (five [22%] of 23) were diagnosed, while other diseases could be excluded (15 [65%] of 23). Information available from echocardiography (n = 23), conventional angiography (n = 4), and/or surgery (n = 1) confirmed all diagnoses. CONCLUSION: IR SSFP with gadofosveset trisodium improved image quality and diagnostic performance, allowing a more accurate and complete assessment of cardiovascular anatomy in patients with CHD compared with T2-prepared SSFP with gadopentetate dimeglumine and gadofosveset trisodium and respective contrast-enhanced MR angiographic examinations.

Cardiovascular MR dobutamine stress in adult tetralogy of Fallot: disparity between CMR volumetry and flow for cardiovascular function.

PURPOSE: To evaluate the MR agreement of cardiac function parameters between volumetric (cine SSFP) and phase contrast flow (PC-flow) assessment in patients with repaired tetralogy of Fallot (r-TOF) and chronic pulmonary regurgitation (PR) at rest and under dobutamine stress (DS-MR). MATERIALS AND METHODS: We studied 18 patients with r-TOF and severe chronic PR (34 ± 12.7 years, PR fraction([flow]) 44 ± 15%) by cardiac MR at rest, 10 and 20 µg/kg/min of dobutamine. We compared analogous functional parameters by volumetry and PC-flow: (i) Systemic output [left ventricle stroke volume (LV(SV)) versus aortic forward flow (AO(FF))], (ii) Pulmonary output [right ventricle stroke volume (RV(SV)) versus pulmonary forward flow (PA(FF))], (iii) PR volume [(RV(SV)-LV(SV)) versus pulmonary backward flow (PA(BF))], (iv) PR fraction [(RV(SV)-LV(SV)/RV(SV)) versus (PA(BF)/PA(FF))]. RESULTS: We found excellent Bland-Altman agreement (mean difference ± limits of agreement, mL/beat/m(2)) at rest for both the systemic (-0.8 ± 5.7) and pulmonary strokes volumes (-0.1 ± 7.6), which slightly deteriorates during DS-MR. The PR volume showed acceptable agreement at rest (-3.6 ± 15.1), but also further deteriorated during stress (5.4 ± 24). In contrast, the PR fraction showed poor agreement equally at rest (-5.6 ± 22.8) and DS-MR (3.2 ± 19.2). CONCLUSION: In r-TOF with chronic PR, analogous functional parameters should not be used interchangeably between volumetric and PC-flow assessment during DS-MR evaluation.

Planning of catheter interventions for pulmonary artery stenosis: improved measurement agreement with magnetic resonance angiography using identical angulations.

OBJECTIVES: To evaluate the current disagreement between the gold standard X-ray angiography (XRA) and magnetic resonance angiography (MRA) for the measurement of peripheral pulmonary artery stenosis (PPAS). BACKGROUND: MRA may help planning of catheter interventions for PPAS. However, there are sources of disagreement between XRA and MRA as measures are performed differently. We hypothesized that agreement may improve if identical angulation views are used. METHODS: In this retrospective study, 17 patients were included. Four independent observers analyzed the pictures in three technique modalities: (1) XRA, (2) cross-sectional-MRA: reformatted to obtain the perpendicular cut-off view of the vessel, and (3) angulated-MRA: reformatted using the same angulations used in XRA. We measured: (a) minimal diameter at stenosis, (b) vessel diameter 1 cm proximal, and (c) 1 cm distal to the stenosis. RESULTS: While in elliptical vessels cross-sectional-MRA provided both the larger and smaller diameter, XRA and angulated-MRA typically provided only the larger diameter due to projections. We found poor agreement between the smaller diameter in cross-sectional-MRA and XRA. XRA underestimate the diameter at the three locations (<15-22%). However, there was a good agreement between the larger cross-sectional-MRA diameter and XRA. This further improved if MRA images were reformatted with the identical angulations used in XRA (angulated-MRA). CONCLUSIONS: Conventional cross-sectional-MRA measurements of PPAS only moderately agree with XRA. However, using identical angulations in MRA reduces the bias. Hence, MRA is a valuable tool for planning angulations and measurements of PPAS prior to catheter interventions.

Cardiovascular MR imaging of conotruncal anomalies.

Conotruncal anomalies are congenital heart defects that result from abnormal formation and septation of the outflow tracts of the heart and great vessels. The major conotruncal anomalies include tetralogy of Fallot, transposition of the great arteries, double-outlet right ventricle, truncus arteriosus, and interrupted aortic arch. Cardiovascular magnetic resonance (MR) imaging is an important modality for the evaluation of patients with these defects. Major advances in cardiovascular MR imaging equipment and techniques allow precise delineation of the cardiovascular anatomy and accurate quantitative assessment of ventricular function and blood flow. The data provided by cardiovascular MR imaging are useful for treatment planning and posttreatment monitoring, supplement information obtained with echocardiography, and in many cases obviate cardiac catheterization.

Single breath-hold assessment of ventricular volumes using 32-channel coil technology and an extracellular contrast agent.

PURPOSE: To evaluate the feasibility of a single breath-hold 3D cine balanced steady-state free precession (b-SSFP) sequence after gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA) injection for volumetric cardiac assessment. MATERIALS AND METHODS: Fifteen adult patients routinely referred for cardiac magnetic resonance imaging (MRI) underwent quantitative ventricular volumetry on a clinical 1.5T MR-scanner using a 32-channel cardiac coil. A stack of 2D cine b-SSFP slices covering the ventricles was used as reference, followed by a single breath-hold 3D cine balanced SSFP protocol acquired before and after administration of Gd-DTPA. The acquisition was accelerated using SENSE in both phase encoding directions. Volumetric and contrast-to-noise data for each technique were assessed and compared. RESULTS: The 3D cine protocol was accomplished within one breath-hold (mean acquisition time 20 sec; spatial resolution 2.1 x 2.1 x 10 mm; temporal resolution 51 msec). The contrast-to-noise ratio between blood and myocardium was 234 determined for the multiple 2D cine data, and could be increased for the 3D acquisition from 136 (3D precontrast) to 203 (3D postcontrast) after injecting Gd-DTPA. In addition the endocardial definition was significantly improved in postcontrast 3D cine b-SSFP. There was no significant difference for left and right ventricular volumes between standard 2D and 3D postcontrast cine b-SSFP. However, Bland-Altman plots showed greater bias and scatter when comparing 2D with 3D cine b-SSFP without contrast. CONCLUSION: 3D cine b-SSFP imaging of the heart using 32 channel coil technology and spatial undersampling allows reliable volumetric assessment within a single breath-hold after application of Gd-DTPA.

Pharmacokinetic modeling of delayed gadolinium enhancement in the myocardium.

Delayed contrast-enhanced magnetic resonance imaging (DCE-MRI) provides prognostic information by delineating regions of myocardial scar. The mechanism of this delayed enhancement in myocardial infarctions (MIs) is hypothesized to result from altered kinetics and changes in the volumes of distribution in the myocardium. Pharmacokinetic models with two and three compartments were fitted to the concentration-time curves of dynamic contrast-enhanced MRI data obtained from five patients with known MI. Furthermore, the parameter stability was investigated in simulations for the two different models. The transfer constants and volumes of distribution showed a good correlation with imaging findings on early and delayed contrast-enhanced MRI. The two compartment model showed higher parameter stability. The three compartment model allows a more in-depth quantification of myocardial scarring. These models have the potential to improve the diagnosis of myocardial pathologies involving scar, with differing kinetics and volumes of distribution such as infarction or cardiomyopathy.

Atypical atrial septal defects in children: noninvasive evaluation by cardiac MRI.

BACKGROUND: Atypical left-to-right shunts at the level of the atrium in children such as sinus venosus atrial septal defects (ASDs) and partial anomalous pulmonary venous return (PAPVR) may be difficult to assess by transthoracic or transoesophageal echocardiography. Free-breathing cardiac MRI may be a powerful alternative. OBJECTIVE: To assess the value of free-breathing cardiac MRI in the delineation of atypical ASDs in children. MATERIALS AND METHODS: A total of 82 children (mean age 5.9 years, range 1.1-15.7 years) with suspected ASD and inconclusive transthoracic echocardiography underwent cardiac MRI under free-breathing, mostly sedated conditions. Phase-contrast MRI was used for defect visualization and shunt quantification, and multiphase inflow MR angiography for delineation of pulmonary/systemic venous connections. RESULTS: Of the 82 patients, 34 (41%) were diagnosed with atypical shunt lesions at the level of the atrium and 48 (59%) with simple secundum ASDs. No false-negative or false-positive findings were reported by MRI compared to cardiac catheterization and intraoperative findings. Superior sinus venosus ASD with partial anomalous PAPVR was present in 10 of the 82 children (12.2%), whereas 2 (2.4%) had a large posterior-inferior defect, 5 (6.1%) had isolated PAPVR, and 17 (20.7%) had multiple ASDs and/or associated vascular anomalies. Q(p)/Q(s) by phase-contrast MRI agreed well with oximetry values (mean difference 3%, limits of agreement +/-21-25%; Bland/Altman analysis). CONCLUSION: Free-breathing cardiac MRI under sedation allows reliable identification of atypical left-to-right shunt defects at the level of the atrium in children in whom transcatheter ASD closure is unsuitable, including delineation of pulmonary or systemic venous anomalies and shunt quantification.

Volumetric cardiac quantification by using 3D dual-phase whole-heart MR imaging.

This study was approved by the local institutional ethics committee, and informed consent was obtained from all volunteers and patients. The purpose of the study was to assess ventricular volumes by using three-dimensional (3D) whole-heart data sets acquired during end-systolic and end-diastolic phases during one free-breathing magnetic resonance imaging examination. In five healthy volunteers and 10 patients, 3D dual cardiac phase data sets, short-axis multisection breath-hold images, and through-plane flow images of the great vessels were acquired. Within these data sets, statistic analyses were performed to compare stroke, end-systolic, and end-diastolic volumes for the left ventricle (LV) and the right ventricle (RV). Results showed that the breath-hold multisection approach, the flow measurement approach, and the new dual-phase 3D approach delivered comparable results for quantification of cardiac volumes and function. High correlation values greater than 0.95 were found when these methods were compared, and no significant differences were recognized for stroke, end-systolic, or end-diastolic volumes in either the LV or the RV.