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Final Program


Program-At-A-Glance

Rapid Fire Session

Session: Rapid Fire Session 4: Peds/Congenital - Protocols (Monitor 12)

Image-based navigated CMRA late after gadobutrol reliably delineates the coronaries in children and adults

Friday, February 6, 2026
3:59 PM - 4:06 PM  
Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)

    Presenting Author(s)

  • Kevin K. Whitehead, MD, PhD

    Associate Professor of Pediatrics
    Children's Hospital of Philadelphia
    Sewell, New Jersey, United States

    • Primary Author(s)

  • Kevin K. Whitehead, MD, PhD

    Associate Professor of Pediatrics
    Children's Hospital of Philadelphia
    Sewell, New Jersey, United States

    • Co-Author(s)

  • Mark A. Fogel, MD

    Professor
    University of Pennsylvania
    PHILADELPHIA , Pennsylvania, United States

  • DV

    Danish Vaiyani, MD

    Cardiologist
    Children's Hospital of Philadelphia
    Philadelphia, Pennsylvania, United States

  • DB

    David Biko, MD

    Assistant Professor of Pediatrics
    The Children's Hospital of Philadelphia, Pennsylvania, United States

  • SP

    Sara Partington, MD

    Associate Professor of Pediatrics
    Children's Hospital of Philadelphia
    Philadelphia, Pennsylvania, United States

  • RS

    Robert Sellers, RT

    Applications Specialist
    Siemens Medical Solutions USA
    Malvern, Pennsylvania, United States

  • RG

    Robert Gagnon, BSc, RT

    CV MRI Technician
    Children's Hospital of Philadelphia
    Philadelphia, Pennsylvania, United States

  • Karl P. Kunze, PhD

    Senior Cardiac MR Scientist
    Siemens Healthineers
    Camberley, England, United Kingdom

  • Rene M. Botnar

    Professor of Cardiovascular Imaging
    Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile
    Santiago de Chile, Region Metropolitana, Chile

  • Claudia Prieto, PhD

    Professor
    Pontificia Universidad Católica de Chile / King's College London
    Santiago, Region Metropolitana, Chile

  • MH

    Matthew A. Harris, MD

    Associate Director, Cardiac MRI
    Children's Hospital of Philadelphia
    Merion Station, Pennsylvania, United States

Background: 3D whole-heart cardiac magnetic resonance angiography (MRA), particularly coronary evaluation, remains challenging using conventional respiratory navigation. Motion correction strategies have shown promise in improving efficiency and quality. We previously reported excellent results with a non-contrast 3D whole-heart sequence with bright-blood (BB) and dark-blood (DB) phase sensitive inversion recovery (IR) using an interleaved T2prep-IR and no prep sequence with image-based navigation (iNAV) and a variable-density Cartesian spiral-like profile order trajectory (VD-CASPR). However, resolution and contrast limitations still make resolving very small structures like anomalous coronaries structures challenging. We reported using the above BB-BOOST strategy after ferumoxytol infusion with improved results. However, this precludes scar analysis or prolongs scan time for dual contrast. To this end we evaluated a previously introduced single-interleave CMRA iNAV sequence for BB imaging after gadolinium infusion using stead state free precession (SSFP) with T2-preparation with 8 refocusing pulses (8-MLEV). We hypothesized that iNAV-CMRA with 8-MLEV acquisitions improved reliability of the MRA in comparison to BB-BOOST, particularly in delineating coronary anomalies.

Methods: Patients undergoing clinically indicated CMRs from April to August 2025 were prospectively enrolled and scanned at 1.5T (AVANTO FIT, Siemens) using an iNAV T2-prepared SSFP research CMRA sequence employing 8-MLEV. A subset of patients had an iNAV or conventional diaphragmatic respiratory navigated IR-FLASH either just after gadolinium infusion or after ferumoxytol. Both imaging methods were rated on a 1-4 scale: 1=non-diagnostic, 2= significant image degradation, 3=mild image degradation, and 4=sharp delineation of the coronaries delineating coronary dominance. Group comparisons used a paired t-test (two-tailed, p< 0.05).

Results: 75 pts, mean age 9.8 years (range=1 month- 69 years) underwent T2-prep iNAV imaging late after gadavist infusion. 22 had an iNav BB-BOOST during slow gadavist infusion for comparison and 10 after ferumoxytol infusion. 12 pts had coronary anomalies (5 with right coronary either high or from the left sinus, 2 with left coronaries from the right sinus). Coronary anomalies were delineated on all late CMRA iNAV exams with a mean score of 3.6, compared to a score of 2.8 for BB-BOOST during gadavist infusion (p< 0.01) and 3.8 after ferumoxytol (p=NS)

Conclusion: In our series spanning a large age range from infants to adults, T2-prep SSFP iNAV imaging consistently delineated the coronary anatomy including in a range of coronary anomalies and was equivalent to ferumoxytol BB-BOOST iNAV in delineating the coronaries, with the latter requiring a longer scan duration.

Anomalous RCA from above the left sinus imaged with T2-prep SSFP iNAV after gadavist in sedated 4 year old.
Anomalous RCA from above the left sinus imaged with IR-FLASH iNAV after ferumoxytol in same sedated 4 year old.
Anomalous RCA from the left sinus imaged with T2-prep SSFP iNAV after gadavist in a non-sedated 13 year old.