MRIinCongenitalHeartDiseaseCanItDoItAll-FDA.pptVIP

Contrast Enhanced Pediatric Cardiac Magnetic Resonance ImagingFDA Advisory Committee Meeting ‘04 Personnel: Cardiologist/Radiologist, sedation nurse, MRI technician Monitoring equipment: Direct visualization via video link Direct audio feed from scanner ECG Pulse oximetry In addition, during sedation: ETCO2 BP monitor Gad Enhanced MRI in CHD - Anatomy Gad Enhanced MRI in CHD – Blood Flow Tissue Characterization – Delayed Enhancement time Normal Myocardium contrast injection Infarcted Myocardium Ischemic Myocardium First-Pass Delayed Enhancement 1 min 5 min * Mark A Fogel, MD, FACC, FAAP Associate Prof Cardiology/Radiology Director of Cardiac MRI The Children’s Hospital of Philadelphia Gad MRI in CHD MRI: differentiates tissue by magnetic properties Hydrogen/proton density T1 (longitudinal/vertical/spin-lattice) recovery rates T2(*) (horizontal/transverse/spin-spin) recovery rates Motion/flow properties (if any) Gadolinium: 7 unpaired electrons in outer shell Paramagnetic – large magnetic moment in magnetic field! Toxic - Must be bound to a chelator! Diethylenetriamine pentaaccetic acid (DPTA) Can be bound to large molecules (eg albumin) – doesn’t diffuse thru capillary membrane (“blood pool agent”) Not yet FDA approved Gad MRI in CHD T2 - rate of decay Benefit-Target T1 value similar to background but target takes up gad and background doesn’t Short TR, mod short TE, high flip angle studies Extracellular agent Rapid vascular equilibration extravasation into extravascular tissue relaxation rate of surrounding protons: Dose dependent T1 - constant which signal intensity T1 of blood 1200ms 100ms at 1.5T 1/T1 = 1/1200 ms + R1 [Gd] MAJOR Gad MRI in CHD Pharmacokinetics: Free gad – T? is several weeks Chelation is a tradeoff: efficiency of T1 relaxation rate toxicity by affecting pharmacokinetics When chelated, 500 X in the rate of renal excretion relative to pre-chelation T? is is 1.5 hours dissociation from ch