Comparison of cardiac volumetry using real-time MRI during free-breathing with standard cine MRI during breath-hold in children

Röwer, Lena Maria; Radke, Karl Ludger; Hußmann, Janina; Malik, Halima; Uelwer, Tobias; Voit, Dirk; Frahm, Jens; Wittsack, HJ; Harmeling, Stefan; Pillekamp, Frank; Klee, Dirk

doi:10.1007/s00247-022-05327-5

Cited by 11 publications

(13 citation statements)

References 34 publications

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“…The CO is one of the most important parameters to assess global cardiac function and is being calculated in several clinical conditions [ 4 , 22 , 12 ]. During exercise stress in particular, the CO provides additional use to identify severe conditions in a heart failure populations [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…This applies for example to patients with heart failure with preserved ejection fraction (HFpEF) [ 9 , 10 ]. Real-time CMR potentially allows reliable quantification of cardiac function during exercise stress in HFpEF but has not been validated against an invasive reference standard yet [ 11 , 12 ]. Therefore this methodological study aimed to introduce and validate a novel approach applying real-time phase-contrast imaging and directly compare it to RHC for the quantification of the CO at rest and during exercise stress in HFpEF patients.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of the cardiac output at rest and during exercise stress using real-time cardiovascular magnetic resonance imaging in HFpEF-patients

Schulz,

Mittelmeier,

Wagenhofer

et al. 2024

Int J Cardiovasc Imaging

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This methodological study aimed to validate the cardiac output (CO) measured by exercise-stress real-time phase-contrast cardiovascular magnetic resonance imaging (CMR) in patients with heart failure and preserved ejection fraction (HFpEF). 68 patients with dyspnea on exertion (NYHA ≥ II) and echocardiographic signs of diastolic dysfunction underwent rest and exercise stress right heart catheterization (RHC) and CMR within 24 h. Patients were diagnosed as overt HFpEF (pulmonary capillary wedge pressure (PCWP) ≥ 15mmHg at rest), masked HFpEF (PCWP ≥ 25mmHg during exercise stress but < 15mmHg at rest) and non-cardiac dyspnea. CO was calculated using RHC as the reference standard, and in CMR by the volumetric stroke volume, conventional phase-contrast and rest and stress real-time phase-contrast imaging. At rest, the CMR based CO showed good agreement with RHC with an ICC of 0.772 for conventional phase-contrast, and 0.872 for real-time phase-contrast measurements. During exercise stress, the agreement of real-time CMR and RHC was good with an ICC of 0.805. Real-time measurements underestimated the CO at rest (Bias:0.71 L/min) and during exercise stress (Bias:1.4 L/min). Patients with overt HFpEF had a significantly lower cardiac index compared to patients with masked HFpEF and with non-cardiac dyspnea during exercise stress, but not at rest. Real-time phase-contrast CO can be assessed with good agreement with the invasive reference standard at rest and during exercise stress. While moderate underestimation of the CO needs to be considered with non-invasive testing, the CO using real-time CMR provides useful clinical information and could help to avoid unnecessary invasive procedures in HFpEF patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of the cardiac output at rest and during exercise stress using real-time cardiovascular magnetic resonance imaging in HFpEF-patients

Schulz,

Mittelmeier,

Wagenhofer

et al. 2024

Int J Cardiovasc Imaging

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“…Therefore we would limit the complications associated with airway management, the need for monitoring equipment or ventilators, and the influence of the human factor. Several teams of radiologists have shown that apnea is not always essential to obtain images allowing a correct diagnosis in the follow-up of many congenital heart diseases in children [ 12 , 13 ]. Images can be obtained in real time while the patient remains breathing.…”

Section: Methodsmentioning

confidence: 99%

Major pneumothorax during pediatric cardiac MRI procedure under general anesthesia: step-by-step analysis and importance of a well-known environment and material

Delhez,

Bairy,

Mitchell

et al. 2024

BMC Anesthesiol

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Background To perform step-by-step analysis of the different factors (material, anesthesia technique, human, and location) that led to major pneumothorax during an infrequent pediatric cardiac MRI and to prevent its occurrence in the future. Anesthesia equipment used in a remote location is often different than those in operating rooms. For magnetic resonance imaging (MRI), ventilation devices and monitors must be compatible with the magnetic fields. During cardiac MRI numerous apneas are required and, visual contact with the patient is limited for clinical evaluation. Anesthesia-related barotrauma and pneumothorax are rare in children and the first symptoms can be masked. Case Presentation A 3-year-old boy with atrial septal defect (ASD) and suspicious partial anomalous pulmonary venous return was anesthetized and intubated to perform a follow up with MRI. Sevoflurane maintenance and ventilation were performed using a circular CO2 absorber device, co-axial circuit, and 500 mL pediatric silicone balloon. Apneas were facilitated by Alfentanyl boluses and hyperventilation. A few moderated desaturations occurred during the imaging sequences without hemodynamic changes. At the end of the MRI, facial subcutaneous emphysema was observed by swollen eyelids and crackling snow neck palpation. A complete left pneumothorax was diagnosed by auscultation, sonography examination, and chest radiograph. Pneumo-mediastinum, -pericardium and -peritoneum were present. A chest drain was placed, and the child was extubated and transferred to the pediatric intensive care unit (PICU). Despite the anesthesiologist’s belief that PEEP was minimal, critical analysis revealed that PEEP was maintained at a high level throughout anesthesia. After the initial barotrauma, repeated exposure to high pressure led to the diffusion of air from the pleura to subcutaneous tissues and mediastinal and peritoneal cavities. Equipment check revealed a functional circular circuit; however, the plastic adjustable pressure-limiting valve (APL) closed within the last 30° rotation. The balloon was found to be more rigid and demonstrated significantly reduced compliance. Conclusions Anesthetists require proficiency is using equipment in non-OR locations and this equipment must be properly maintained and checked for malfunctions. Controlling the human factor risks by implementing checklists, formations, and alarms allows us to reduce errors. The number of pediatric anesthesia performed routinely appeared to be essential for limiting risks and reporting our mistakes will be a benefit for all who care about patients.

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“…9 When several phases are reconstructed, the resulting images can capture the underlying motion, typically the respiratory cycle and/or the beating motion of the heart. 11,12 Triggers may also be provided by the volunteer her/himself, in voluntary fashion, as sometimes done in functional MRI (fMRI) using handheld devices with button(s)/lever(s) 13 ; in this case, the temporal changes to be resolved are associated with brain function, as opposed to physiological motion.…”

Section: How Sensor Information Gets Usedmentioning

confidence: 99%

External Hardware and Sensors, for ImprovedMRI

Madore

Hess

Niekerk

et al. 2022

Magnetic Resonance Imaging

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Complex engineered systems are often equipped with suites of sensors and ancillary devices that monitor their performance and maintenance needs. MRI scanners are no different in this regard. Some of the ancillary devices available to support MRI equipment, the ones of particular interest here, have the distinction of actually participating in the image acquisition process itself. Most commonly, such devices are used to monitor physiological motion or variations in the scanner's imaging fields, allowing the imaging and/or reconstruction process to adapt as imaging conditions change. "Classic" examples include electrocardiography (ECG) leads and respiratory bellows to monitor cardiac and respiratory motion, which have been standard equipment in scan rooms since the early days of MRI. Since then, many additional sensors and devices have been proposed to support MRI acquisitions. The main physical properties that they measure may be primarily "mechanical" (eg acceleration, speed, and torque), "acoustic" (sound and ultrasound), "optical" (light and infrared), or "electromagnetic" in nature. A review of these ancillary devices, as currently available in clinical and research settings, is presented here. In our opinion, these devices are not in competition with each other: as long as they provide useful and unique information, do not interfere with each other and are not prohibitively cumbersome to use, they might find their proper place in future suites of sensors. In time, MRI acquisitions will likely include a plurality of complementary signals. A little like the microbiome that provides genetic diversity to organisms, these devices can provide signal diversity to MRI acquisitions and enrich measurements. Machine-learning (ML) algorithms are well suited at combining diverse input signals toward coherent outputs, and they could make use of all such information toward improved MRI capabilities.

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Comparison of cardiac volumetry using real-time MRI during free-breathing with standard cine MRI during breath-hold in children

Cited by 11 publications

References 34 publications

Assessment of the cardiac output at rest and during exercise stress using real-time cardiovascular magnetic resonance imaging in HFpEF-patients

Assessment of the cardiac output at rest and during exercise stress using real-time cardiovascular magnetic resonance imaging in HFpEF-patients

Major pneumothorax during pediatric cardiac MRI procedure under general anesthesia: step-by-step analysis and importance of a well-known environment and material

External Hardware and Sensors, for ImprovedMRI

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