Investig Magn Reson Imaging.  2017 Sep;21(3):131-138. 10.13104/imri.2017.21.3.131.

Optimal Cardiac Magnetic Resonance Contrast-Enhanced Timing Robust Angiography (CMR-CENTRA) for the Three-Dimensional Reconstruction of the Bilateral Atria in the Electroanatomic Mapping (EAM) of Atrial Fibrillation

• Kim JS
• Oh YW
• Shim J
• Kim YH
• Hwang SH

• KMID: 2392683
• DOI: http://doi.org/10.13104/imri.2017.21.3.131

Abstract

PURPOSE
To optimize the timing of scans using cardiac magnetic resonance contrast-enhanced timing robust angiography (CMR-CENTRA) for electroanatomic mapping (EAM) of the right atrium (RA) and left atrium (LA) in patients with atrial fibrillation (AF).
MATERIALS AND METHODS
Fifty patients with AF (38 men; mean age, 59.6 ± 9.3 years) underwent CMR-CENTRA in preparation for EAM. The CMR-CENTRA data were acquired at five different scan times: 0 seconds, 5 seconds, 10 seconds, 15 seconds, and 20 seconds after an intravenous injection of contrast media. To evaluate the degree of contrast enhancement, right atrial relative contrast (RA-RC) and left atrial relative contrast (LA-RC) on the CMR-CENTRA scans were assessed at each time point. The three-dimensional (3D) reconstruction of the RA and LA for the EAM system was performed using the CMR-CENTRA data.
RESULTS
A CMR-CENTRA at a scan time of 10 seconds showed significantly greater LA-RC (P < 0.05) compared with all other scan times. A CMR-CENTRA at a scan time of 15 seconds showed significantly greater RA-RC (P < 0.05) compared with all other scan times. In the 3D reconstruction of the RA, the success rates of CMR-CENTRA at scan times of 10 seconds and 15 seconds were 18% and 100%, respectively. In the 3D reconstruction of the LA, the success rates of CMR-CENTRA at 10- and 15-second scan times were 100%.
CONCLUSION
The CMR-CENTRA data acquired at 15 seconds after the injection of contrast media is appropriate for the preparation of an EAM system that is focused on the RA and LA in patients with AF.

Keyword

Atrial fibrillation; Left atrium; Right atrium; Magnetic resonance imaging; Contrast media; Hemodynamics

MeSH Terms

Angiography*
Atrial Fibrillation*
Contrast Media
Heart Atria
Hemodynamics
Humans
Injections, Intravenous
Magnetic Resonance Imaging
Male
Contrast Media

Figure

• 

  Fig. 1 Sequential CMR-CENTRA images for the visualization of the contrast media passing through the heart. Coronal images (a) of CMR-CENTRA at 0s, 5s, 10s, 15s, and 20s show the dynamics of contrast media in the left atrium (white arrows). In addition, coronal images of CMR-CENTRA (b) at 0s, 5s, 10s, 15s, and 20s show the dynamics of contrast media in the right atrium. The CMR-CENTRA at 15s shows the weak but homogeneous contrast enhancement in the right atrium as well as the superior vena cava. CMR-CENTRA = cardiac magnetic resonance contrast-enhanced timing robust angiography; LA-RC = left atrial relative contrast; RA-RC = right atrial relative contrast

• 

  Fig. 2 3D-reconstruction of the right atrium (RA) and left atrium (LA) by using cardiac magnetic resonance contrast-enhanced timing robust angiography (CMR-CENTRA) data acquired at 15s. The 3D-recontstruction of RA and LA from CMR-CENTRA (a, b) provides the ideal RA and LA models (c). Ideal RA model (c) shows the superior vena cava (SVC), inferior vena cava (IVC), coronary sinus (CS), and RA clearly. Ideal LA model (c) shows the pulmonary vein (PV), left atrial appendage (LAA), and LA clearly.

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  Fig. 3 Comparison of the right atrial relative contrast (RA-RC) (a) and left atrial relative contrast (LA-RC) (b) among the five different scan times of cardiac magnetic resonance contrast-enhanced timing robust angiography (CMR-CENTRA).

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  Fig. 4 Comparison of the right atrial relative contrast (RA-RC) (a) and left atrial relative contrast (LA-RC) (b) between the ideal and imperfect models of the right atrium (RA) and left atrium (LA).

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  Fig. 5 The success rates for the 3D reconstruction of the right atrium (a) and left atrium (b) using cardiac magnetic resonance contrast-enhanced timing robust angiography (CMR-CENTRA).

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