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MRI anatomy visualization

MRI anatomy visualization

More precise Sustainable weight control of the supposed optimal target MRI anatomy visualization RMI interventions cannot balance ivsualization impact of other antaomy of error such as visualizatino resolution or MRI anatomy visualization mechanical accuracy of stereotactic systems. Romano, N. Toga, John K. Recommended if you're interested in Patient Care. Cortex 97—, Successively, vestibulocochlear nerve enters the brainstem and reaches the dorsal and ventral cochlear nucleus and the four vestibular nuclei that are located in the dorsolateral pons [ 6 ] Fig. CrossRef PubMed.


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MRI anatomy visualization -

A section of the lateral wall [panel] is enlarged in 3c showing that the vessels do not over lie the scar. The diameter of the coronary sinus was larger in the supero-inferior direction, than in the antero-posterior direction, in all groups as detailed in Table 2.

The mean maximum distance of demonstrable cardiac vein on the 3D image was There was large inter-individual variation in the lengths of visible vein, largely caused by overlying tissue obscuring the vein's path on the 3D images Figure 4.

In 4 cases, less than 10 mm of continuous vein could be demonstrated. However in 3 of these cases, distal tributaries of the venous system could be discerned on the axial images. Variations in venous anatomy. Three dimensional volume rendered images from different CMR data-sets showing the anatomy of the cardiac veins.

High signal from pericardial fluid can be seen over the lateral wall. We have shown that CMR imaging of the coronary venous system can be performed as part of a comprehensive CMR protocol which includes myocardial perfusion, LV function and viability assessment and using a standard extravascular contrast agent.

The techniques described in this study may be applicable to patients with heart failure undergoing CMR that are being considered for CRT.

CMR is already recognized as an important imaging modality for patients with heart failure, both in defining the aetiology and assessing the degree of LV dysfunction. In particular, patterns of scar tissue demonstrated by LGE imaging can be used to differentiate ischemic and non-ischemic origins, potentially avoiding invasive X-ray coronary angiography [ 11 ].

However CMR could also potentially provide information directly relevant to patients being considered for CRT. Firstly, a large scar burden, as detected by LGE imaging, is an important factor in predicting a lack of response to CRT, and has been proposed for inclusion in the selection process of CRT candidates [ 12 ].

Secondly, a recent study has indicated that CRT is less effective if the LV lead is placed in a vein overlying transmural scar in the postero-lateral LV wall [ 13 ]. Scar assessment with LGE is therefore an essential component of a CMR protocol in heart failure.

Relating scar distribution to venous anatomy, as shown in Figure 3 , potentially allows guidance of LV lead placement to areas of viable myocardium. The third application by which CMR could guide CRT is by providing prior knowledge of coronary venous anatomy. Location of the LV lead in a lateral vein, compared with lead placement in other locations, results in greater reverse LV remodelling and reduced diastolic dyssynchrony [ 14 ].

Hence patients with absence of lateral veins may not be ideal candidates for CRT. The main appeal of using CMR imaging in patients considered for CRT is that in a single examination CMR could accurately assess left ventricular function, define venous anatomy, and assess both the aetiology of the heart failure and likelihood of response to CRT using total scar burden and location of scar tissue.

Until recently, non invasive venous imaging was only possible using multi-detector CT MDCT. However widespread use of MDCT is restricted by the necessity for large doses of both ionising radiation and iodinated contrast media. Furthermore, MDCT is generally restricted to assessment of the coronary vessels.

The limited temporal resolution reduces the accuracy of MDCT for assessment of LV function when compared to modalities such as CMR or echocardiography [ 15 ], and, while MDCT has been proposed for viability assessment, this is not yet an established technique and leads to additional radiation exposure [ 16 , 17 ].

Several recent publications have demonstrated the ability of WHCA to delineate the course of the coronary veins in a three dimensional volume that can be reconstructed and volume rendered in a manner similar to MDCT [ 4 — 6 ]. The slow blood flow velocity and anatomic variability of coronary veins make them a challenging target for CMR imaging, so that intravascular contrast agents were used to enhance the coronary venous system in two of these three studies.

However, intravascular contrast agents are not currently licensed for cardiac use and do not allow an assessment of LGE, which relies on contrast leakage into the extravascular space. Our data therefore complement the existing evidence for coronary venous CMR by showing that the coronary veins can also be imaged using a standard gadolinium-based contrast agent and in combination with myocardial function and LGE imaging.

We expect that such combined assessment will be the most powerful clinical application for CMR in heart failure assessment and will distinguish it from MDCT. Importantly, measurements of the coronary venous system depicted in our study were similar to the results of previous studies using MDCT [ 10 ].

Our data also show that the delineation of the coronary venous system is dependent on the quality of the acquired data. For high resolution CMR whole heart imaging, data are acquired over many RR intervals mean nominal scan time in our study was 5.

The respiratory navigator can correct partially for bulk cardiac motion and arrhythmia rejection algorithms are available to limit the effects of heart rate changes, but in clinical practice around one third of WHCA studies are of impaired quality.

These general limitations of CMR WHCA were also reflected in our study. The CMR WHCA pulse sequence used in this study was designed to provide optimal visualization of the epicardial coronary arteries, and may therefore be suboptimal for demonstration of the coronary venous system.

Further studies will be required to define the best methodology to reliably demonstrate cardiac venous anatomy by CMR.

To our knowledge invasive venography, using retrograde contrast injection via the CS, has not yet been used to evaluate any non-invasive method of venous visualization. Without performing retrograde venography on all patients the true value of either CMR or MDCT to predict the anatomy of cardiac veins cannot be known.

Hence the frequency with which CMR demonstrated venous branches in this study may be related both to the patient group or to the imaging modality and the relative contribution of each of these factors cannot be assessed.

Finally the efficacy of CMR for coronary venous assessment specifically in patients with severe heart failure and broad QRS duration has not yet been assessed and may prove more challenging. Coronary venous anatomy can be demonstrated as part of a comprehensive CMR protocol that also includes late gadolinium enhanced imaging with a standard extracellular contrast agent.

This may prove a useful addition to standard CMR in the assessment of patients with LV dysfunction who are being considered for CRT. Bleasdale RA, Frenneaux MP: Cardiac resynchronisation therapy: when the drugs don't work.

PubMed Central PubMed Google Scholar. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al: Cardiac resynchronization in chronic heart failure.

N Engl J Med. Article PubMed Google Scholar. J Am Coll Cardiol. Nezafat R, Han Y, Yeon S, Peters DC, Wylie J, Zimetbaum J, et al: MR Coronary Vein Imaging in Cardiac Resynchronization Therapy: Initial Experience.

J Cardiovasc Magn Reson. Google Scholar. Rasche V, Binner L, Cavagna F, Hombach V, Kunze M, Spiess J, et al: Whole-heart coronary vein imaging: a comparison between non-contrast-agent- and contrast-agent-enhanced visualization of the coronary venous system.

Magn Reson Med. Chiribiri A, Kelle S, Götze S, et al: Visualization of the Cardiac Venous System Using Cardiac Magnetic Resonance. The American Journal of Cardiology. Plein S, Jones TR, Ridgway JP, Sivananthan MU: Three-dimensional coronary MR angiography performed with subject-specific cardiac acquisition windows and motion-adapted respiratory gating.

AJR Am J Roentgenol. Kim WY, Danias PG, Stuber M, Flamm SD, Plein S, Nagel E, et al: Coronary magnetic resonance angiography for the detection of coronary stenoses. Article CAS PubMed Google Scholar. Jahnke C, Paetsch I, Nehrke K, Schnackenburg B, Gebker R, Fleck E, et al: Rapid and complete coronary arterial tree visualization with magnetic resonance imaging: feasibility and diagnostic performance.

European Heart Journal. Jongbloed MR, Lamb HJ, Bax JJ, Schuijf JD, de Roos A, van der Wall EE, et al: Noninvasive visualization of the cardiac venous system using multislice computed tomography. McCrohon JA, Moon JCC, Prasad SK, McKenna WJ, Lorenz CH, Coats AJS, et al: Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance.

Ypenburg C, Roes SD, Bleeker GB, Kaandorp TA, de Roos A, Schalij MJ, et al: Effect of total scar burden on contrast-enhanced magnetic resonance imaging on response to cardiac resynchronization therapy. Am J Cardiol. Bleeker GB, Kaandorp TA, Lamb HJ, Boersma E, Steendijk P, de Roos A, et al: Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy.

Rovner A, de Las FL, Faddis MN, Gleva MJ, Davila-Roman VG, Waggoner AD: Relation of left ventricular lead placement in cardiac resynchronization therapy to left ventricular reverse remodeling and to diastolic dyssynchrony. Chan J, Jenkins C, Khafagi F, Du L, Marwick TH: What is the optimal clinical technique for measurement of left ventricular volume after myocardial infarction?

A comparative study of 3-dimensional echocardiography, single photon emission computed tomography, and cardiac magnetic resonance imaging. J Am Soc Echocardiogr. Mahnken AH, Koos R, Katoh M, Wildberger JE, Spuentrup E, Buecker A, et al: Assessment of myocardial viability in reperfused acute myocardial infarction using slice computed tomography in comparison to magnetic resonance imaging.

Lardo AC, Cordeiro MA, Silva C, Amado LC, George RT, Saliaris AP, et al: Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar.

Article PubMed Central PubMed Google Scholar. Download references. This work was undertaken on the British Heart Foundation research CMR imaging system. Data from this study were presented at the Society of Cardiovascular Magnetic Resonance Scientific Sessions, Rome, Feb Younger et al.

Visualisation of the coronary venous system with a three dimensional single volume cardiac magnetic resonance protocol. JCMR ;9 2 Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia. Academic Unit of Cardiovascular Medicine, University of Leeds, Leeds, UK.

Cardiac Magnetic Resonance Unit, Leeds General Infirmary, Leeds, UK. Peter Munk Cardiac Center, Toronto General Hospital, Ontario, Canada. You can also search for this author in PubMed Google Scholar.

Correspondence to John P Greenwood. All authors were responsible for study design, conduct and analysis, and all read and approved the final manuscript. Open Access This article is published under license to BioMed Central Ltd. Reprints and permissions. Younger, J. et al.

Visualization of coronary venous anatomy by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 11 , 26 Download citation. Received : 11 March Accepted : 11 August Published : 11 August Anyone you share the following link with will be able to read this content:.

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Search all BMC articles Search. Download PDF. Download ePub. Abstract Background Coronary venous imaging with whole-heart cardiovascular magnetic resonance CMR angiography has recently been described using developmental pulse sequences and intravascular contrast agents.

Methods and Results Thirty-one 3D whole heart CMR studies, performed after intravenous administration of 0. Conclusion Coronary venous anatomy can be reliably demonstrated using a comprehensive CMR protocol and a standard extracellular contrast agent.

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