Error assessment due to coronary stents in flow-encoded phase contrast MR angiography: a phantom study

Lethimonnier, Franck; Bouligand, B.; Thouveny, F.; Furber, Alain; Jallet, P.; Caron-Poitreau, C; Jeune, J. J. Le

doi:10.1002/(sici)1522-2586(199911)10:5<899::aid-jmri40>3.0.co;2-1

Cited by 16 publications

(3 citation statements)

References 15 publications

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“…19 In this study, a significant decrease in flow velocity measurements was noted when measured near the stent. In stents with material properties yielding high magnetic susceptibility, phase offset phenomena apparently reduce flow measurements significantly.…”

Section: Discussionmentioning

confidence: 55%

Sequential Magnetic Resonance Monitoring of Pulmonary Flow With Endovascular Stents Placed Across the Pulmonary Valve in Growing Swine

et al. 2001

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Background-Patients with endovascular stent implantation for the treatment of right ventricular outflow tract obstruction are often left with incomplete relief of the obstruction and significant pulmonary regurgitation. A noninvasive and reproducible method for monitoring such patients is desirable. MRI in the presence of a stent, however, has to overcome the problem of potential metallic artifacts. Methods and Results-Under x-ray fluoroscopic guidance, endovascular nitinol stents were placed across the pulmonary valve in 6 young pigs to induce pulmonary regurgitation. Five additional pigs served as controls. Initial MRI was performed after 2 days (13.5Ϯ1.8 kg) and follow-up after 3 months (32Ϯ2.9 kg). Pulmonary flow volumes and regurgitant fraction were quantified by velocity-encoded cine (VEC) MRI through (VEC-TS) and distal to (VEC-DS) the stent. VEC-TS was compared with VEC-DS and volumetric measurements of left and right ventricular stroke volumes provided by cine MRI ("gold standard"). Antegrade and retrograde pulmonary flow volumes by VEC-TS were slightly but significantly less than those with VEC-DS and cine MRI. Excellent correlations (rϾ0.97) for phasic pulmonary flow volumes as measured by VEC-TS and VEC-DS were shown. Pulmonary regurgitant fraction increased from 32.8Ϯ15% to 49.6Ϯ17% (PϽ0.05) over the course of 3 months with VEC-TS. Conclusions-MRI demonstrates the progression of pulmonary regurgitation in growing swine. VEC MRI has the ability to quantify pulmonary blood flow inside the lumen of nitinol stents. MRI appears to be ideally suited for monitoring patients with endovascular nitinol stents in the pulmonary artery or pulmonary valve position.

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Section: Discussionmentioning

confidence: 55%

Sequential Magnetic Resonance Monitoring of Pulmonary Flow With Endovascular Stents Placed Across the Pulmonary Valve in Growing Swine

et al. 2001

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“…3–5 Similarly, phase contrast CMR imaging is well validated for assessment of native valvular regurgitation, 10, 11 but can be compromised by localized field disturbances as can be produced by prosthetic materials. 19, 20 Of course, prosthetic materials within both bio- and mechanical mitral valves can produce susceptibility artifacts due to localized changes in magnetic field homogeneity, 21, 22 prohibiting direct cine-CMR evaluation of valve morphology and obscuring small amounts of regurgitant flow. However, our results demonstrate that such localized disturbances do not typically interfere with assessment of substantial (i.e.…”

Section: Discussionmentioning

confidence: 99%

Routine Cine-CMR for Prosthesis Associated Mitral Regurgitation: A Multicenter Comparison to Echocardiography

Simprini

Afroz

Klem

et al. 2013

Journal of the American College of Cardiology

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Background/Aim MR is an important complication after PMV. Transthoracic echocardiography is widely used to screen for native MR, but can be limited with PMV. Cine-CMR holds potential to non-invasively assess regurgitant severity based on MR-induced inter-voxel dephasing. This study evaluated routine cine-CMR for visual assessment of prosthetic mitral valve (PMV) associated mitral regurgitation (MR). Methods Routine cine-CMR was performed at 9 sites. A uniform protocol was used to grade MR based on jet size in relation to the left atrium (mild <1/3, moderate 1/3–2/3, severe >2/3): MR was graded in each long axis orientation, with overall severity based on cumulative grade. Cine-CMR was also scored for MR density and pulmonary vein systolic flow reversal (PSFR). Visual interpretation was compared to quantitative analysis in a single center (derivation) cohort, and to transesophageal echocardiography (TEE) in a multicenter (validation) cohort. Results The population comprised 85 PMV patients (59% mechanical, 41% bioprosthetic). Among the derivation cohort (n=25), quantitative indices paralleled visual scores, with stepwise increases in jet size and density in relation to visually graded MR severity (both p=0.001): Patients with severe MR had nearly a 3-fold increase in quantitative jet area (p=0.002), and 2-fold increase in density (p=0.04) than did others. Among the multicenter cohort, cine-CMR and TEE (Δ=2±3 days) demonstrated moderate agreement (κ=0.44); 64% of discordances differed by ≤ 1 grade (Δ=1.2±0.5). Using a TEE reference, cine-CMR yielded excellent diagnostic performance for severe MR (sensitivity, negative predictive value=100%). Patients with visually graded severe MR also had more frequent PVSFR (p<0.001), denser jets (p<0.001), and larger left atria (p=0.01) on cine-CMR. Conclusions Cine-CMR is useful for assessment of PMV-associated MR, which manifests concordant quantitative and qualitative changes in size and density of inter-voxel dephasing. Visual MR assessment based on jet size provides an accurate non-invasive means of screening for TEE-evidenced severe MR.

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“…7,8,13,14 One study, however, detected a notable error in flow measurements in the presence of stents. 15 Furthermore, detection, direct visualization, and classification of in-stent restenosis are important. Although nitinol stents cause smaller artifacts when compared with stainless steel stents, 6,16 even the former are still not artifact-free on MR images 6 and do not allow for visualization of in-stent restenosis.…”

mentioning

confidence: 99%

Artifact-Free Coronary Magnetic Resonance Angiography and Coronary Vessel Wall Imaging in the Presence of a New, Metallic, Coronary Magnetic Resonance Imaging Stent

et al. 2005

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Background-Coronary in-stent restenosis cannot be directly assessed by magnetic resonance angiography (MRA) because of the local signal void of currently used stainless steel stents. The aim of this study was to investigate the potential of a new, dedicated, coronary MR imaging (MRI) stent for artifact-free, coronary MRA and in-stent lumen and vessel wall visualization. Methods and Results-Fifteen prototype stents were deployed in coronary arteries of 15 healthy swine and investigated with a double-oblique, navigator-gated, free-breathing, T2-prepared, 3D cartesian gradient-echo sequence; a T2-prepared, 3D spiral gradient-echo sequence; and a T2-prepared, 3D steady-state, free-precession coronary MRA sequence. Furthermore, black-blood vessel wall imaging by a dual-inversion-recovery, turbo spin-echo sequence was performed. Artifacts of the stented vessel segment and signal intensities of the coronary vessel lumen inside and outside the stent were assessed. With all investigated sequences, the vessel lumen and wall could be visualized without artifacts, including the stented vessel segment. No signal intensity alterations inside the stent when compared with the vessel lumen outside the stent were found. Conclusions-The new, coronary MRI stent allows for completely artifact-free coronary MRA and vessel wall imaging.

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Error assessment due to coronary stents in flow-encoded phase contrast MR angiography: a phantom study

Cited by 16 publications

References 15 publications

Sequential Magnetic Resonance Monitoring of Pulmonary Flow With Endovascular Stents Placed Across the Pulmonary Valve in Growing Swine

Sequential Magnetic Resonance Monitoring of Pulmonary Flow With Endovascular Stents Placed Across the Pulmonary Valve in Growing Swine

Routine Cine-CMR for Prosthesis Associated Mitral Regurgitation: A Multicenter Comparison to Echocardiography

Artifact-Free Coronary Magnetic Resonance Angiography and Coronary Vessel Wall Imaging in the Presence of a New, Metallic, Coronary Magnetic Resonance Imaging Stent

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