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CLINICAL STUDIES

New real-time interactive cardiac magnetic resonance imaging system complements echocardiography

Phillip C. Yang, MD^a, Adam B. Kerr, PhD^*, Alex C. Liu, MD^a, David H. Liang, MD, PhD^a, Chris Hardy, PhD, Craig H. Meyer, MS^*, Albert Macovski, PhD^*, John M. Pauly, PhD^* and Bob S. Hu, MD, FACC^a

^a Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
^* Magnetic Resonance Systems Research Laboratory, Department of Electrical Engineering, Stanford University, Stanford, California, USA
General Electric Corporate Research and Development, Schenectady, New York, USA

Manuscript received February 9, 1998; revised manuscript received July 23, 1998, accepted August 20, 1998.

Address for correspondence: Dr. Phillip C. Yang, Stanford University, 300 Pasteur Drive, CVRC, Stanford, CA 94305
phillip{at}leland.stanford.edu

Objectives. We conducted an initial clinical trial of a newly developed cardiac magnetic resonance imaging (CMRI) system. We evaluated left ventricular (LV) function in 85 patients to compare the clinical utility of the CMRI system with echocardiography, the current noninvasive gold standard.

Background. Conventional CMRI systems require cardiac-gating and respiratory compensation to synthesize a single image from data acquired over multiple cardiac cycles. In contrast, the new CMRI system allows continuous real-time dynamic acquisition and display of any scan plane at 16 images/s without the need for cardiac gating or breath-holding.

Methods. A conventional 1.5T Signa MRI Scanner (GE, Milwaukee, Wisconsin) was modified by the addition of an interactive workstation and a bus adapter. The new CMRI system underwent clinical trial by testing its ability to evaluate global and regional LV function. The first group (A) consisted of 31 patients with acceptable echocardiography image quality. The second group (B) consisted of 31 patients with suboptimal echocardiography image quality. The third group (C) consisted of 29 patients with severe lung disease or congenital cardiac malformation who frequently have suboptimal echo study. Two independent observers scored wall motion and image quality using the standard 16-segment model and rank-order analysis.

Results. CMRI evaluation was complete in less than 15 min. In group A, no significant difference was found between ECHO and CMRI studies (p = NS). In group B, adequate visualization of wall segments was obtained 38% of the time using ECHO and 97% of the time using CMRI (p < 0.0001). When grouped into coronary segments, adequate visualization of at least one segment occurred in 18 of 30 patients (60%) with ECHO and in all 30 patients (100%) with CMRI (p < 0.0001). In group C, adequate visualization of the wall segments was obtained in 58% (CI 0.53–0.62) of the time using echocardiography and 99.7% (CI 0.99–1.0) of the time using CMRI (p < 0.0001).

Conclusions. The new CMRI system provides clinically reliable evaluation of LV function and complements suboptimal echocardiography. In comparison with the conventional CMRI, the new CMRI system significantly reduces scan time, patient discomfort and associated cost.

Abbreviations and Acronyms   CMRI = cardiac magnetic resonance imaging   ECHO = echocardiography   EPI = ECHO planar imaging   FOV = field of view   LV = left ventricular   TE = ECHO time   TPS = transceiver processor and storage   TR = repetition time

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