Cardiac-synchronized gadolinium-enhanced MR angiography: preliminary experience for the evaluation of the thoracic aorta James W. Goldfarb a, 4 , Agnes E. Holland a , Frans M.J. Heijstraten a , Stefan Skotnicki b , Jelle O. Barentsz a a Department of Cardiothoracic Surgery, University Hospital Nijmegen, Nijmegen 6564BM, Netherlands b Department of Cardiothoracic Surgery, University Hospital Nijmegen, Nijmegen 6564BM, Netherlands Received 30 June 2005; accepted 11 December 2005 Abstract Gadolinium (Gd)-enhanced three-dimensional breath-hold magnetic resonance cardiac-synchronized angiography was performed in 13 patients suspected or known to have thoracic aortic disease. High-quality angiograms of the ascending/descending thoracic aorta and coronary arteries were obtained with this method. MR angiograms were compared with Gd-enhanced angiograms obtained without cardiac synchronization. Synchronized imaging showed significantly better aortic valve leaflet and proximal coronary artery depiction. Synchronization reduced motion artifacts, allowing better visualization of the aortic root and proximal coronary arteries. D 2006 Elsevier Inc. All rights reserved. Keywords: Magnetic resonance angiography; Gadolinium; Coronary artery 1. Introduction Malfunction of the aorta is the 13th most common cause of death [1]. Imaging tests include contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), transesophageal echocardiography and X-ray cath- eter angiography. Despite the advances in imaging technol- ogy, failure of diagnosis continues to be a major problem. A recent autopsy study (n =50) reported that 58% of the subjects dying from acute Stanford type A dissection did not undergo surgery, and, presumably, their disease was never diagnosed [2]. Gadolinium (Gd)-enhanced angiography without syn- chronization to the cardiac cycle, as described by Prince et al. [3], has become a routine protocol for the evaluation of both acquired and congenital disease of the thoracic aorta [4–9]. Many investigators have improved on the original technique, and current protocols differ mainly with respect to minor sequence parameters and optimization of contrast media usage. Important characteristics of the unsynchro- nized technique are the bolus injection of the Gd contrast agent, breath-holding, use of a short TR three-dimensional gradient-echo sequence and restriction of the acquisition time (~25 s) [10]. Several preliminary reports of cardiac-synchronized Gd-enhanced MRA have been published [11–15], but no comparison to unsynchronized imaging has, to date, been made. The current implementation of cardiac-synchronized Gd-enhanced MR angiography utilizes several additional techniques: ECG gating with optical conversion [16], echo- planar capable gradient hardware, multi-slab acquisition, steady-state radio frequency preparation, special phased array reconstruction [17] and a partial-Fourier reconstruction [18]. These techniques allow the collection of a three-dimensional angiogram in less than 3 s, and thus a 3D segmented k-space acquisition during a 24-heartbeat breath-hold can be realized [14]. A segmented k-space acquisition has been shown to improve the quality of MRI heart images, allowing the reliable visualization of the coronary arteries [19]. We present our initial experience using a cardiac- synchronized Gd-enhanced 3D breath-hold technique for routine imaging of thoracic aortic disease. We hypothe- sized that the use of a cardiac-synchronized technique should minimally provide the same diagnostic information and additionally allow the reliable visualization of the aortic valve leaflets and proximal coronary arteries. All 0730-725X/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.mri.2005.12.001 4 Corresponding author. Department of Research and Education, St. Francis Hospital, NY 11576, USA. Tel.: +1 516 622 4536. E-mail address: james.goldfarb@chsli.org (J.W. Goldfarb). Magnetic Resonance Imaging 24 (2006) 241 – 248