title: Exact monitoring of aortic diameters in Marfan patients without gadolinium contrast: intraindividual comparison of 2D SSFP imaging with 3D CE-MRA and echocardiography.
abstract: OBJECTIVE
  To assess whether ECG-gated non-contrast 2D steady-state free precession (SSFP) imaging allows for exact monitoring of aortic diameters in Marfan syndrome (MFS) patients using non-ECG-gated contrast-enhanced 3D magnetic resonance angiography (CE-MRA) and echocardiography for intraindividual comparison.
  
  
  METHODS
  Non-ECG-gated CE-MRA and ECG-gated non-contrast SSFP at 1.5 T were prospectively performed in 50 patients. Two readers measured aortic diameters on para-sagittal images identically aligned with the aortic arch at the sinuses of Valsalva, sinotubular junction, ascending/descending aorta and aortic arch. Image quality was assessed on a three-point scale. Aortic root diameters acquired by echocardiography were used as reference.
  
  
  RESULTS
  Intra- and interobserver variances were smaller for SSFP at the sinuses of Valsalva (p = 0.002; p = 0.002) and sinotubular junction (p = 0.014; p = 0.043). Image quality was better in SSFP than in CE-MRA at the sinuses of Valsalva (p < 0.0001), sinotubular junction (p < 0.0001) and ascending aorta (p = 0.02). CE-MRA yielded higher diameters than SSFP at the sinuses of Valsalva (mean bias, 2.5 mm; p < 0.0001), and comparison with echocardiography confirmed a higher bias for CE-MRA (7.2 ± 3.4 mm vs. SSFP, 4.7 ± 2.6 mm).
  
  
  CONCLUSIONS
  ECG-gated non-contrast 2D SSFP imaging provides superior image quality with higher validity compared to non-ECG-gated contrast-enhanced 3D imaging. Since CE-MRA requires contrast agents with potential adverse effects, non-contrast SSFP imaging is an appropriate alternative for exact and riskless aortic monitoring of MFS patients.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Würzburg, Bavaria, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Veldhoen
authors.forename: Cyrus
authors.initials: C
authors.lastname: Behzadi
authors.forename: Thorsten
authors.initials: T
authors.lastname: Derlin
authors.forename: Meike
authors.initials: M
authors.lastname: Rybczinsky
authors.forename: Yskert
authors.initials: Y
authors.lastname: von Kodolitsch
authors.forename: Sara
authors.initials: S
authors.lastname: Sheikhzadeh
authors.forename: Frank Oliver
authors.initials: FO
authors.lastname: Henes
authors.forename: Thorsten Alexander
authors.initials: TA
authors.lastname: Bley
authors.forename: Gerhard
authors.initials: G
authors.lastname: Adam
authors.forename: Peter
authors.initials: P
authors.lastname: Bannas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology*; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008382:Marfan Syndrome / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D015588:Observer Variation; D055815:Young Adult