O. Vardoulis, P. Monney, A. Bermano, A. Vaxman, C. Gotsman, J. Schwitter, M. Stuber, N. Stergiopulos, J. Schwitter:
"Single breath-hold 3D measurement of left atrial volume using compressed sensing CMR and a non-model-based reconstruction approach";
Journal of Cardiovascular Magnetic Resonance,
BACKGROUND:Left atrial (LA) dilatation is associated with a large variety of cardiac diseases. Current cardiovascular magnetic resonance (CMR) strategies to measure LA volumes are based on multi-breath-hold multi-slice acquisitions, which are time-consuming and susceptible to misregistration.AIM:To develop a time-efficient single breath-hold 3D CMR acquisition and reconstruction method to precisely measure LA volumes and function.METHODS:A highly accelerated compressed-sensing multi-slice cine sequence (CS-cineCMR) was combined with a non-model-based 3D reconstruction method to measure LA volumes with high temporal and spatial resolution during a single breath-hold. This approach was validated in LA phantoms of different shapes and applied in 3 patients. In addition, the influence of slice orientations on accuracy was evaluated in the LA phantoms for the new approach in comparison with a conventional model-based biplane area-length reconstruction. As a reference in patients, a self-navigated high-resolution whole-heart 3D dataset (3D-HR-CMR) was acquired during mid-diastole to yield accurate LA volumes.RESULTS:Phantom studies. LA volumes were accurately measured by CS-cineCMR with a mean difference of 4.73+/-1.75ml (8.67+/-3.54%, r2=0.94). For the new method the calculated volumes were not significantly different when different orientations of the CS-cineCMR slices were applied to cover the LA phantoms. Long-axis "aligned" vs "not aligned" with the phantom long-axis yielded similar differences vs the reference volume (4.87+/-1.73ml vs 4.45+/-1.97ml, p=0.67) and short-axis "perpendicular" vs "not-perpendicular" with the LA long-axis (4.72+/-1.66ml vs 4.75+/-2.13ml; p=0.98). The conventional bi-plane area-length method was susceptible for slice orientations (p=0.0085 for the interaction of "slice orientation" and "reconstruction technique", 2-way ANOVA for repeated measures). To use the 3D-HR-CMR as the reference for LA volumes in patients, it was validated in the LA phantoms (mean difference: 1.37+/-1.35ml, 2.38+/-2.44%, r2=0.97). Patient study: The CS-cineCMR LA volumes of the mid-diastolic frame matched closely with the reference LA volume (measured by 3D-HR-CMR) with a difference of 2.66+/-6.5ml (3.0% underestimation; true LA volumes: 63ml, 62ml, and 395ml). Finally, a high intra- and inter-observer agreement for maximal and minimal LA volume measurement is also shown.CONCLUSIONS:The proposed method combines a highly accelerated single-breathhold compressed-sensing multi-slice CMR technique with a non-model-based 3D reconstruction to accurately and reproducibly measure LA volumes and function.
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