Efficient Non-contrast Enhanced 3D Cartesian MR Angiography of the Thoracic Aorta in 3 min

Anastasia Fotaki, Camila Munoz, Yaso Emmanuel, Alina Hua, Filippo Bosio, Karl Kunze, Radhouene Neji, Pier-Giorgio Masci, Rene Botnar, Claudia Prieto Vasquez

Research output: Contribution to journalArticlepeer-review


Background: The application of Magnetic Resonance Angiography (MRA) for the assessment of thoracic aortic disease is often associated with prolonged and unpredictable acquisition times and residual motion artefacts. To overcome these limitations, we have integrated undersampled acquisition with image-based navigators and inline non-rigid motion correction to enable a free-breathing, contrast-free Cartesian MRA framework for the visualization of the thoracic aorta in a short and predictable scan of 3 minutes.
Methods: 35 patients with thoracic aortic disease (36 ± 13y, 14 female) were prospectively enrolled in this single-center study. The proposed 3D T2-prepared balanced Steady State Free Precession (bSSFP) sequence with image-based navigator (iNAV) was compared to the clinical 3D T2-prepared bSSFP with diaphragmatic-navigator gating (dNAV), in terms of image acquisition time. Three blinded cardiologists, recorded image quality scores across four aortic segments and their overall diagnostic confidence. Contrast ratio (CR) and relative standard deviation (RSD) of signal intensity (SI) in the corresponding segments were estimated. Co-axial aortic dimensions in six landmarks were measured by two readers to evaluate the agreement between the two methods, along with inter-observer and intra-observer agreement. Kolmogorov‐Smirnov test, Mann-Whitney U (MWU), Bland-Altman analysis (BAA), intraclass correlation coefficient (ICC) were used for statistical analysis.
Results: The scan time for the iNAV-based approach was significantly shorter than for the clinical dNAV approach(3.10.5 min vs 12min3, P=0.005). Reconstruction was performed inline in 30.3min. Diagnostic confidence was similar for the proposed iNAV sequence versus the clinical sequence for all three reviewers (Reviewer 1: 3.91±0.32 vs 3.84±0.4,P=0.7; Reviewer 2: 3.97±0.17 vs 3.88±0.33,P=0.4; Reviewer 3: 3.83±0.38 vs 3.71±0.57,P=0.3). The proposed method yielded higher image quality scores in terms of artefacts from respiratory motion, and non-diagnostic images due to signal inhomogeneity were observed less frequently. While the dNAV approach outperformed the iNAV method in the CR assessment, the iNAV sequence showed improved signal homogeneity along the entire thoracic aorta [RSD SI 5.1 (4.4, 6.5) vs 6.5 (4.6, 8.6), P=0.002]. BAA showed a mean difference of <0.05 cm across the 6 landmarks between the two datasets. ICC showed excellent inter- and intra-observer reproducibility.
Conclusions: Thoracic aortic iNAV-based MRA with fast acquisition (about 3 min) and inline reconstruction (3min) is proposed, resulting in high diagnostic confidence and reproducible aortic measurements.
Original languageEnglish
Article numberJCMR-D-21-00231R1
Number of pages38
JournalJournal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
Publication statusAccepted/In press - 15 Dec 2021


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