Development of a universal dual-bolus injection scheme for the quantitative assessment of myocardial perfusion cardiovascular magnetic resonance

<p>Abstract</p> <p>Background</p> <p>The dual-bolus protocol enables accurate quantification of myocardial blood flow (MBF) by first-pass perfusion cardiovascular magnetic resonance (CMR). However, despite the advantages and increasing demand for the dual-bolus method f...

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Main Authors: Alfakih Khaled, Schnackenburg Bernhard, Lossnitzer Dirk, Merkle Nico, Steen Henning, Paul Matthias, Hussain Shazia, Chiribiri Amedeo, Morton Geraint, Schuster Andreas, Ishida Masaki, Plein Sven, Nagel Eike
Format: Article
Language:English
Published: Elsevier 2011-05-01
Series:Journal of Cardiovascular Magnetic Resonance
Online Access:http://www.jcmr-online.com/content/13/1/28
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author Alfakih Khaled
Schnackenburg Bernhard
Lossnitzer Dirk
Merkle Nico
Steen Henning
Paul Matthias
Hussain Shazia
Chiribiri Amedeo
Morton Geraint
Schuster Andreas
Ishida Masaki
Plein Sven
Nagel Eike
author_facet Alfakih Khaled
Schnackenburg Bernhard
Lossnitzer Dirk
Merkle Nico
Steen Henning
Paul Matthias
Hussain Shazia
Chiribiri Amedeo
Morton Geraint
Schuster Andreas
Ishida Masaki
Plein Sven
Nagel Eike
author_sort Alfakih Khaled
collection DOAJ
description <p>Abstract</p> <p>Background</p> <p>The dual-bolus protocol enables accurate quantification of myocardial blood flow (MBF) by first-pass perfusion cardiovascular magnetic resonance (CMR). However, despite the advantages and increasing demand for the dual-bolus method for accurate quantification of MBF, thus far, it has not been widely used in the field of quantitative perfusion CMR. The main reasons for this are that the setup for the dual-bolus method is complex and requires a state-of-the-art injector and there is also a lack of post processing software. As a solution to one of these problems, we have devised a universal dual-bolus injection scheme for use in a clinical setting. The purpose of this study is to show the setup and feasibility of the universal dual-bolus injection scheme.</p> <p>Methods</p> <p>The universal dual-bolus injection scheme was tested using multiple combinations of different contrast agents, contrast agent dose, power injectors, perfusion sequences, and CMR scanners. This included 3 different contrast agents (Gd-DO3A-butrol, Gd-DTPA and Gd-DOTA), 4 different doses (0.025 mmol/kg, 0.05 mmol/kg, 0.075 mmol/kg and 0.1 mmol/kg), 2 different types of injectors (with and without "pause" function), 5 different sequences (turbo field echo (TFE), balanced TFE, k-space and time (k-t) accelerated TFE, k-t accelerated balanced TFE, turbo fast low-angle shot) and 3 different CMR scanners from 2 different manufacturers. The relation between the time width of dilute contrast agent bolus curve and cardiac output was obtained to determine the optimal predefined pause duration between dilute and neat contrast agent injection.</p> <p>Results</p> <p>161 dual-bolus perfusion scans were performed. Three non-injector-related technical errors were observed (1.9%). No injector-related errors were observed. The dual-bolus scheme worked well in all the combinations of parameters if the optimal predefined pause was used. Linear regression analysis showed that the optimal duration for the predefined pause is 25s to separate the dilute and neat contrast agent bolus curves if 0.1 mmol/kg dose of Gd-DO3A-butrol is used.</p> <p>Conclusion</p> <p>The universal dual-bolus injection scheme does not require sophisticated double-head power injector function and is a feasible technique to obtain reasonable arterial input function curves for absolute MBF quantification.</p>
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spelling doaj.art-a165149313424c909712a9b9d51c34b02024-04-17T01:19:22ZengElsevierJournal of Cardiovascular Magnetic Resonance1097-66471532-429X2011-05-011312810.1186/1532-429X-13-28Development of a universal dual-bolus injection scheme for the quantitative assessment of myocardial perfusion cardiovascular magnetic resonanceAlfakih KhaledSchnackenburg BernhardLossnitzer DirkMerkle NicoSteen HenningPaul MatthiasHussain ShaziaChiribiri AmedeoMorton GeraintSchuster AndreasIshida MasakiPlein SvenNagel Eike<p>Abstract</p> <p>Background</p> <p>The dual-bolus protocol enables accurate quantification of myocardial blood flow (MBF) by first-pass perfusion cardiovascular magnetic resonance (CMR). However, despite the advantages and increasing demand for the dual-bolus method for accurate quantification of MBF, thus far, it has not been widely used in the field of quantitative perfusion CMR. The main reasons for this are that the setup for the dual-bolus method is complex and requires a state-of-the-art injector and there is also a lack of post processing software. As a solution to one of these problems, we have devised a universal dual-bolus injection scheme for use in a clinical setting. The purpose of this study is to show the setup and feasibility of the universal dual-bolus injection scheme.</p> <p>Methods</p> <p>The universal dual-bolus injection scheme was tested using multiple combinations of different contrast agents, contrast agent dose, power injectors, perfusion sequences, and CMR scanners. This included 3 different contrast agents (Gd-DO3A-butrol, Gd-DTPA and Gd-DOTA), 4 different doses (0.025 mmol/kg, 0.05 mmol/kg, 0.075 mmol/kg and 0.1 mmol/kg), 2 different types of injectors (with and without "pause" function), 5 different sequences (turbo field echo (TFE), balanced TFE, k-space and time (k-t) accelerated TFE, k-t accelerated balanced TFE, turbo fast low-angle shot) and 3 different CMR scanners from 2 different manufacturers. The relation between the time width of dilute contrast agent bolus curve and cardiac output was obtained to determine the optimal predefined pause duration between dilute and neat contrast agent injection.</p> <p>Results</p> <p>161 dual-bolus perfusion scans were performed. Three non-injector-related technical errors were observed (1.9%). No injector-related errors were observed. The dual-bolus scheme worked well in all the combinations of parameters if the optimal predefined pause was used. Linear regression analysis showed that the optimal duration for the predefined pause is 25s to separate the dilute and neat contrast agent bolus curves if 0.1 mmol/kg dose of Gd-DO3A-butrol is used.</p> <p>Conclusion</p> <p>The universal dual-bolus injection scheme does not require sophisticated double-head power injector function and is a feasible technique to obtain reasonable arterial input function curves for absolute MBF quantification.</p>http://www.jcmr-online.com/content/13/1/28
spellingShingle Alfakih Khaled
Schnackenburg Bernhard
Lossnitzer Dirk
Merkle Nico
Steen Henning
Paul Matthias
Hussain Shazia
Chiribiri Amedeo
Morton Geraint
Schuster Andreas
Ishida Masaki
Plein Sven
Nagel Eike
Development of a universal dual-bolus injection scheme for the quantitative assessment of myocardial perfusion cardiovascular magnetic resonance
Journal of Cardiovascular Magnetic Resonance
title Development of a universal dual-bolus injection scheme for the quantitative assessment of myocardial perfusion cardiovascular magnetic resonance
title_full Development of a universal dual-bolus injection scheme for the quantitative assessment of myocardial perfusion cardiovascular magnetic resonance
title_fullStr Development of a universal dual-bolus injection scheme for the quantitative assessment of myocardial perfusion cardiovascular magnetic resonance
title_full_unstemmed Development of a universal dual-bolus injection scheme for the quantitative assessment of myocardial perfusion cardiovascular magnetic resonance
title_short Development of a universal dual-bolus injection scheme for the quantitative assessment of myocardial perfusion cardiovascular magnetic resonance
title_sort development of a universal dual bolus injection scheme for the quantitative assessment of myocardial perfusion cardiovascular magnetic resonance
url http://www.jcmr-online.com/content/13/1/28
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