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Two-center validation of Pilot Tone based cardiac triggering of a comprehensive cardiovascular magnetic resonance examination

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Abstract

The electrocardiogram (ECG) signal is prone to distortions from gradient and radiofrequency interference and the magnetohydrodynamic effect during cardiovascular magnetic resonance imaging (CMR). Although Pilot Tone Cardiac (PTC) triggering has the potential to overcome these limitations, effectiveness across various CMR techniques has yet to be established. To evaluate the performance of PTC triggering in a comprehensive CMR exam. Fifteen volunteers and 20 patients were recruited at two centers. ECG triggered images were collected for comparison in a subset of sequences. The PTC trigger accuracy was evaluated against ECG in cine acquisitions. Two experienced readers scored image quality in PTC-triggered cine, late gadolinium enhancement (LGE), and T1- and T2-weighted dark-blood turbo spin echo (DB-TSE) images. Quantitative cardiac function, flow, and parametric mapping values obtained using PTC and ECG triggered sequences were compared. Breath-held segmented cine used for trigger timing analysis was collected in 15 volunteers and 14 patients. PTC calibration failed in three volunteers and one patient; ECG trigger recording failed in one patient. Out of 1987 total heartbeats, three mismatched trigger PTC-ECG pairs were found. Image quality scores showed no significant difference between PTC and ECG triggering. There was no significant difference found in quantitative measurements in volunteers. In patients, the only significant difference was found in post-contrast T1 (p = 0.04). ICC showed moderate to excellent agreement in all measurements. PTC performance was equivalent to ECG in terms of triggering consistency, image quality, and quantitative image measurements across multiple CMR applications.

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Abbreviations

BMI:

Body mass index

bSSFP:

Balanced steady state free precession

CMR:

Cardiovascular magnetic resonance

CO:

Cardiac output

DB-TSE:

Dark-blood turbo spin echo

ECG:

Electrocardiogram

EF:

Ejection fraction

EGE:

Early gadolinium enhancement

EDV/ESV:

End diastolic/systolic volume

HR:

Heart rate

ICC:

Intra-class correlation coefficients

LGE:

Late gadolinium enhancement

MPA:

Main pulmonary artery

PCA:

Principal component analysis

PT:

Pilot Tone

PTC:

Pilot Tone Cardiac

RF:

Radiofrequency

SG:

Self-gating

SV:

Stroke volume

TR:

Repetition time

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Acknowledgements

The authors would like to acknowledge Debbie Scandling for assistance with subject scheduling, and research radiographer Raj Kumar Soundarajan for assistance with protocol setup.

Funding

This publication was supported by Award Number R01-HL161618 from the NIH National Heart Lung and Blood Institute. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Heart Lung and Blood Institute or the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA

    Yue Pan, Juliet Varghese & Orlando P. Simonetti

  2. Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Yue Pan, Juliet Varghese & Orlando P. Simonetti

  3. Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Matthew S. Tong & Orlando P. Simonetti

  4. Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA

    Vedat O. Yildiz

  5. Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK

    Alessia Azzu, Peter Gatehouse, Rick Wage, Sonia Nielles-Vallespin & Dudley J. Pennell

  6. Cardiovascular MR R&D, Siemens Medical Solutions USA, Malvern, PA, USA

    Ning Jin

  7. Siemens Healthineers AG, Erlangen, Germany

    Mario Bacher, Carmel Hayes & Peter Speier

  8. Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Orlando P. Simonetti

  9. Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Mario Bacher

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  1. Yue Pan
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Contributions

YP acquired a subset of volunteer and patient data at Site A, performed the analysis, and was the primary contributor in writing the manuscript. JV, NJ assisted in the scan protocol setup and data acquisition at Site A. MT assisted in the image quality and diagnostic assessment. VY provided assistance with statistical analysis. AA, PG, RW, SNV, and DP assisted in the scan protocol setup and data acquisition at Site B. MB, CH, and PS developed the technique used in this study. OPS assisted in the image quality assessment and was a major contributor in writing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Orlando P. Simonetti.

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Competing interests

Authors MB, CH, and PS are employees of Siemens Healthcare GmbH, Erlangen, Germany. Author NJ is an employee of Siemens Medical Solutions, USA, Malvern, PA. Author OPS receives institutional research support from Siemens Medical Solutions, USA.

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The study was approved by the local institutional review boards of both institutions, and informed written consent was obtained from all subjects.

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Pan, Y., Varghese, J., Tong, M.S. et al. Two-center validation of Pilot Tone based cardiac triggering of a comprehensive cardiovascular magnetic resonance examination. Int J Cardiovasc Imaging 40, 261–273 (2024). https://doi.org/10.1007/s10554-023-03002-w

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