1129 Image-guided placement of ECG leads to improve ECG gating in cardiac MRI
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BioMed Central
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Meeting abstract
1129 Image-guided placement of ECG leads to improve ECG gating in cardiac MRI James D Barnwell*1, Brian Hyslop2, Larry Klein2, Clif Stallings2 and Amanda Sturm2 Address: 1UNC, Durham, NC, USA and 2UNC, Chapel-Hill, NC, USA * Corresponding author
from 11th Annual SCMR Scientific Sessions Los Angeles, CA, USA. 1–3 February 2008 Published: 22 October 2008 Journal of Cardiovascular Magnetic Resonance 2008, 10(Suppl 1):A254
doi:10.1186/1532-429X-10-S1-A254
Abstracts of the 11th Annual SCMR Scientific Sessions - 2008
Meeting abstracts – A single PDF containing all abstracts in this Supplement is available here. http://www.biomedcentral.com/content/pdf/1532-429X-10-S1-info.pdfThis abstract is available from: http://jcmr-online.com/content/10/S1/A254 © 2008 Barnwell et al; licensee BioMed Central Ltd.
Introduction CMR is a noninvasive means of studying the heart without exposing the patient to ionizing radiation. A prerequisite to high-resolution CMR is effective cardiac gating. Although alternative techniques such as air-filled plethysmograph gating, laser-Doppler capillary gating, and selfgated imaging have been employed, the most common commercially available technique relies on ECG gating. In a subset of patients, the standard technique for ECG lead placement may be suboptimal secondary to patient factors such as abnormal cardiothoracic anatomy, obesity, or eventration of the hemidiaphragm. For such patients, a systematic time-efficient approach to optimizing ECG lead placement may improve image quality.
patient's heart. Measurements were performed to move the leads as follows: left leg lead (LL) to the apex of the left ventricle and right arm lead (RA) to the superior aspect of the right atrium. To place the right leg lead (RL), a straight line was measured from the RA lead to the LL lead. These two leads were moved and the distance between them measured. This distance was bisected and a perpendicular line projected inferiorly at a 90 degree angle. The RL lead was placed on this perpendicular line at a distance equal to half the original line's measurement (between RA and LL). The pre- and post-correction ECG tracings were qualitatively assessed by two blinded CMR physicians (one cardiologist and one radiologist). They ranked the two tracings in qualitative order as better, worse, or unchanged.
Purpose To develop a time-efficient image-based technique with commercially available pulse sequences to guide lead placement and maximize R wave registration for CMR gating.
Methods We prospectively studied 29 consecutive adult patients undergoing CMR. Imaging was performed on a 1.5 T Avanto magnet (Siemens, Erlangen, Germany). The ECG leads were initially positioned according to vendor guidelines. A vitamin E marker was placed on each lead to allow visualization on a T1-weighted breathhold 3D gradient echo pulse sequence. Multiplanar 3D reconstruction was performed to visualize lead placement relative to the
Results Using the technique described, the ECG tracin
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