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J Thorac Cardiovasc Surg 2009;137:957-962
© 2009 The American Association for Thoracic Surgery

Evolving Technology

Tagged cine magnetic resonance imaging with a finite element model can predict the severity of retrosternal adhesions prior to redo cardiac surgery

Ichiro Yoshioka, MD, PhDa, Yoshikatsu Saiki, MD, PhDa,*, Azusa Ichinose, MD, PhDb, Kei Takase, MD, PhDb, Shoki Takahashi, MD, PhDb, Toshiro Ohashi, PhDc, Masaaki Sato, PhDc, Koichi Tabayashi, MD, PhDa

a Department of Cardiovascular Surgery, Graduate School of Engineering, Tohoku University, Sendai, Japan
b Department of Radiology, Graduate School of Engineering, Tohoku University, Sendai, Japan
c Department of Bioengineering and Robotics, Graduate School of Engineering, Tohoku University, Sendai, Japan

Received for publication May 9, 2008; revisions received September 15, 2008; accepted for publication October 27, 2008.

* Address for reprints: Yoshikatsu Saiki, MD, PhD, Department of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai 980-8574 Japan. (Email: ysaiki{at}mail.tains.tohoku.ac.jp).

Objective: Reoperative median sternotomy entails a risk of damaging the heart or great vessels. If the severity of retrosternal adhesion is accurately assessed before sternal re-entry, resternotomy-related complications can be prevented. The purpose of this investigation was to evaluate whether the severity of retrosternal adhesions can be accurately predicted by tagged cine magnetic resonance imaging.

Methods: Thirteen patients who were scheduled to undergo cardiac reoperation were investigated by electrocardiography-gated tagged cine magnetic resonance imaging before sternal re-entry. With the imaging data, the severity of retrosternal adhesion was scored visually on the basis of abnormality in regional myocardial motion and discordance in the tagged signals of the sternum and the myocardium. Also, with the aid of a finite element model, strain at the surface of the right ventricle was calculated on the basis of displacement of the tags on the heart over the cardiac cycle. For comparison, the adhesion severity was scored visually at the time of redo surgery by surgeons who were blinded to the preoperative assessment.

Results: The preoperative adhesion severity score, as determined visually by tagged cine magnetic resonance imaging, was correlated with the intraoperative severity score (correlation coefficient: r = 0.76, P < .01). Mean strain at the surface of the heart, as calculated preoperatively by finite element model analysis, was inversely correlated with the intraoperative adhesion severity score (r = –0.78, P < .01).

Conclusion: Tagged cine magnetic resonance imaging with a finite element model can provide an accurate quantitative assessment of retrosternal adhesions before redo cardiac surgery.

Abbreviations and Acronyms CT = computed tomography; FOV = field of view; MRI = magnetic resonance imaging; TR/TE = repetition time/echo time






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