Image-guided optimization of the ECG trace in cardiac MRI

Int J Cardiovasc Imaging (2012) 28:587593 DOI 10.1007/s10554-011-9865-7

ORIGINAL PAPER

Image-guided optimization of the ECG trace in cardiac MRI

James D. Barnwell J. Larry Klein

Cliff Stallings Amanda Sturm

Michael Gillespie Jason Fine W. Brian Hyslop

Received: 2 December 2010 / Accepted: 2 April 2011 / Published online: 16 April 2011 Springer Science+Business Media, B.V. 2011

Abstract Improper electrocardiogram (ECG) lead placement resulting in suboptimal gating may lead to reduced image quality in cardiac magnetic resonance imaging (CMR). A patientspecic systematic technique for rapid optimization of lead placement may improve CMR image quality. A rapid 3 dimensional image of the thorax was used to guide the realignment of ECG leads relative to the cardiac axis of the patient in forty consecutive adult patients. Using our novel approach and consensus reading of pre- and post-correction ECG traces, seventy-three percent of patients had a qualitative improvement in their ECG tracings, and no patient had a decrease in quality of their ECG tracing following the correction technique. Statistically signicant improvement was observed independent of gender,

body mass index, and cardiac rhythm. This technique provides an efcient option to improve the quality of the ECG tracing in patients who have a poor quality ECG with standard techniques.

Keywords Cardiac MR Magnetic resonance

ECG Quality improvement

Introduction

Cardiac Magnetic Resonance (CMR) relies on gating of the data acquisition relative to the cardiac cycle in order to obtain high-resolution images. Techniques for cardiac gating include air-lled plethysmography, peripheral gating using a pulse oximetry, self-gated

J. D. Barnwell (&)

UNC School of Medicine, 1001 Bondurant Hall, CB 9535, Attention Mail Box 404, Chapel Hill, NC 27599-9535, USAe-mail: [email protected]

J. L. Klein M. Gillespie

6040 Burnett-Womack Bldg., 6th Floor, 099 Manning Drive, CB 7075, Chapel Hill, NC 27599-7075, USA e-mail: [email protected]

M. Gillespiee-mail: [email protected]

C. Stallings A. Sturm

MRI Department UNC Health Care, 101 Manning Dr, Chapel Hill, NC 27514, USAe-mail: [email protected]

A. Sturme-mail: [email protected]

J. FineDepartment of Biostatistics, School of Public Health, UNC-Chapel Hill, Campus Box 7420, Chapel Hill, NC 27599-7420, USAe-mail: [email protected]

W. B. HyslopDepartment of Radiology, 2016 Old Clinic Building, CB# 7510, Chapel Hill, NC 27599-7010, USA e-mail: [email protected]

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techniques, and triggering from a multi-lead ECG signal. The rst two are less...