Optimization of 3D contrast-enhanced pulmonary magnetic resonance angiography in pediatric patients with congenital heart disease

Contrast kinetics were studied in the main pulmonary artery (MPA) and ascending aorta (AAo) of 12 children with congenital heart disease. This information was used to optimize the timing of data acquisition for contrast-enhanced MR angiography in these vessels. To reduce contrast-agent dosage in these fragile patients, contrast enhancement was measured during routine diagnostic 3D magnetic resonance (MR) angiography instead of using test-bolus methods. This was possible by acquiring 2D cross-sectional images of the MPA and AAo during the 3D scan. Time-to-peak in the MPA and AAo was 4.9 ± 2.2 and 6.1 ± 2.2 s, respectively, while the transit time between the two vessels was 4.5 ± 0.6 s. A point-spread-function analysis showed that intravascular signal strength was maximized if data acquisition began 4.7 ± 2.3 s after the first arrival of contrast in the MPA and 5.6 ± 2.3 s in the AAo. Little signal loss and artifact resulted when longer acquisition delays were used because contrast-agent clearance was slow. Based on these results, MR angiography of both the MPA and the AAo in children with congenital heart disease can be performed using elliptic-centric k-space sampling and a trigger delay of 7.9 s after contrast arrival in the AAo (i.e., time-to-peak signal strength in the AAo plus one SD to account for intersubject variability).