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32-channel coil boosts cardiac studies at SLEH

Best Practice
Cheong, Benjamin, M.D. Houston, St. Luke's Episcopal Hospital USA

St. Luke's Episcopal Hospital, home of the Texas Heart® Institute is a tertiary referral center performing about 80 to 100 cardiovascular MR exams in an average month. Benjamin Cheong, MD, cardiologist at St. Luke's, routinely uses the SENSE Torso/Cardiac coil for cardiovascular MR.
 Benjamin Cheong, MD
Benjamin Cheong, MD

 

"All of our cardiovascular studies, ranging from functional assessment to aortic studies, benefit from the 32-channel coil," he says. "With the increase in imaging speed, the staff can complete an image sequence and finish the examination much more quickly than before. That helps our throughput, and our patients obviously appreciate a faster examination and less time in the scanner."

 

Multiple breath holds are often unnecessary with the 32-channel coil, explains Dr. Cheong. "Cardiac MR has already established itself as the gold standard for functional and morphological assessment of the left and right ventricles with the traditional multislice cine imaging that covers both ventricles in 10 to 12 slices. But with the new 32-channel cardiac coil, knowing that we can increase the imaging speed or the spatial resolution, we can actually acquire multislice images of the left ventricle in a single breath hold without the risk of slice misregistration."

Coil enables improved speed and resolution

With the traditional 5-channel cardiac coil, typically a SENSE factor of 2-3 is used. Higher acceleration factors may result in decreased signal-to-noise ratio or image artifacts. The high number of coil elements in the 32-channel coil enables use of higher SENSE acceleration factors and multidimensional parallel imaging accelerations.

 

Dr. Cheong says in the past, using the 5-channel cardiac coil with parallel imaging, a coronary whole-heart MRA typically required an imaging time of 8 to 12 minutes, even with reasonable respiratory gating efficiency. "However, I was the first to try out the 32-channel coil," says Dr. Cheong. "The whole-heart coronary MRA of myself was acquired in only four minutes, with a gating efficiency close to 70% and an isotropic resolution of 1 x 1 x 1 mm. I had never seen such quality images coming from a 1.5T scanner. All major epicardial coronary arteries were well visualized."

 

"The higher spatial and temporal resolution of the images is impressive. One of the applications where MR really shines is in the assessment of the arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C)," says Dr. Cheong. "The right ventricle (RV) is a thin wall structure of about 3-4 mm in thickness. The 32-channel coil allows us to achieve a higher spatial resolution in order to image the RV free wall, without a prolonged breath hold. That is of paramount importance in the assessment of fatty infiltration and fibrous replacement of the right ventricle in patients suspected to have ARVD/C. Our image quality, and therefore our diagnostic capability, is much higher."

 

St. Luke's senior physicist, Raja Muthupillai, PhD, recently completed a study using the 32-channel coil to achieve very high temporal resolution (3-6 ms) in a cine sequence for evaluation of the left ventricular diastolic function. As certain diastolic indices, such as isovolumic relaxation time, are about 70-80 ms in normal individuals, this high temporal resolution is essential to help distinguish between normal and abnormal heart function.

 

"For cardiac imaging, MR is a modality that is accurate, well established, non-invasive, and does not expose the patient to radiation," says Dr. Cheong. "And using the 32-channel coil gives us a huge advantage."

Clinical cases:

 Left ventricular outflow tract Mid short axis
Left ventricular outflow tract
Mid short axis

 

68-year-old male with prior myocardial infarction and congestive cardiac failure presented for pre-operative surgical planning. Echocardiography demonstrated left ventricular aneurysm. Cardiac MR was performed with 32-channel SENSE Torso/Cardiac coil, SENSE factor 2, voxels 1.8 x 1.8 x 8 mm, breath hold 6 sec. Cine SSFP of the left ventricular outflow tract and mid short-axis demonstrate left ventricular aneurysmal dilation present in the proximal half of the inferolateral wall (left, arrowhead) extending into the inferior wall (right, arrowhead). LV = left ventricle; RA = right atrium; Ao = aorta; RV = right ventricle.

 

 Two-chamber view
Two-chamber view

 

58-year-old male with congestive cardiac failure of unknown etiology. CMR with SENSE Torso/Cardiac coil, SENSE factor 2, voxels 1.8 x 1.8 x 8 mm, breath hold 6 sec. Cine SSFP of the two-chamber view shows increased trabeculation confined to the left ventricular apex (arrowhead) consistent with left ventricular non-compaction.

 

 Five-chamber” cine at mid-systole Short-axis cine near base of left ventricle
Five-chamber” cine at mid-systole
Short-axis cine near base of left ventricle

 

38-year-old male with prior Ross procedure and repaired co-arctation of aorta presented with pulmonic stenosis. In addition, surface echocardiography demonstrated a small left-to-right shunt. Cardiac MR was performed with 32-channel SENSE Torso/ Cardiac coil, SENSE factor 2, voxels 1.8 x 1.8 x 8 mm, breath hold 6 sec. The midsystolic "five-chamber" SSFP cine image shows a jet arising from the basal septum of the left ventricle into the right atrium, indicating a left ventricular-to-right atrial communication (arrowhead). The short-axis SSFP cine image (right) also demonstrates the left ventricular-to-right atrial communication (arrowhead). LV = left ventricle; RV = right ventricle; LA = left atrium; RA = right atrium.

References:

R Krishnamurthy, A Pednekar, B Cheong, R Muthupillai

High-Temporal Resolution SSFP Cine MRI for Estimation of Left Ventricular Diastolic Parameters. Submitted

Related information:



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Best Practice
Achieva 1.5T
Release 2.5, Release 2.6
Nova, Nova Dual, Pulsar
32ch SENSE Torso/Cardiac coil, aneurysm, Aorta, Cardiac, Cardiac Morphology, cmr, Coronary arteries, Function Cine, Function Non-Cine
 

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