Tridimensional late gadolinium enhancement at 3 T cardiac magnetic resonance for the evaluation of coronary venous anatomy: feasibility and findings
DOI:
https://doi.org/10.53903/01212095.156Keywords:
Coronary vessels, Cicatrix, Magnetic resonance imaging, Cardiac imaging techniquesAbstract
Objective: Knowledge of coronary venous anatomy (CVA) has critical importance for planning and performing electrophysiological procedures such as cardiac resynchronization therapy (CRT), left ventricle and right atrium ablation therapy and catheter arrhythmia mapping. Our aim is to evaluate the feasibility and applications of cardiac magnetic resonance imaging (RMC) performed at 3T for non-invasive depiction of CVA employing a three-dimensional late gadolinium enhancement sequence (3D RTG). Methods: 138 consecutive patients who underwent 3T RMC were evaluated using a 3D RTG sequence over a period of one year between 2016 and 2017. Identification of
different coronary venous structures as well as its relationship with myocardial fibrosis and other relevant clinical variables were recorded. Quality assessment was performed creating 3 groups (optimal, good, poor) according to visual assessment of each individual study. Association tests(Chi-square and Kruskall-Wallis) were performed. Results: The study included 62 women and
76 men with a median age of 48 (29-61) years. 3D RTG sequence yielded a diagnostic quality (optimal-good) for CVA evaluation in 76% of patients (p < 0.001). The following structures were identified (patients, %): anterior interventricular vein: 110 (79.7%), great cardiac vein: 109 (79%), posterior interventricular vein: 106 (76.8%), marginal vein: 53 patients (38.4%) and posterolateral vein: 74 (53.6%). Myocardial fibrosis was identified in 42 patients and epicardic fibrotic involvement of at least one coronary
vein path was recorded on 12% of patients on this subset. Shorter acquisition periods (p < 0.02) and performing the study under general anesthesia (p < 0.03) resulted in significantly better study quality. Conclusions: Non-invasive CVA evaluation is feasible with 3D RTG sequence obtained at 3T RMC. This approach may offer a valuable clinical tool for electrophysiological procedural planning.
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