Exact monitoring of aortic diameters in Marfan patients without gadolinium contrast: intraindividual comparison of 2D SSFP imaging with 3D CE-MRA and echocardiography

Purpose 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). Conclusion 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. Key Points • ECG-gated 2D SSFP imaging provides better image quality than non-ECG-gated contrast-enhanced 3D MRA • ECG-gated 2D SSFP imaging provides higher reproducibility than non-ECG-gated contrast-enhanced 3D MRA • 2D SSFP imaging provides higher validity than 3D MRA using echocardiography as reference • ECG-gated non-contrast 2D SFFP imaging allows for riskless monitoring of Marfan patients